Physician Empowerment

Dr. Kevin Mailo welcomes Dr. Shawna Pandya - Physician, Aquanaut, Explorer, Director of IIAS Space Medicine Group, Space Medicine and Austere Environment Researcher - to the show to talk about her amazing career. But more than that, Shawna speaks about dreams and how to make them reality.

Shawna Pandya is an explorer, an aquanaut, she’s lived in a Mars simulation in the Utah desert, and she’s lived in an underwater habitat for five days. She works for a company focussed on immersive technologies and a company trying to put the world’s first rotating partial gravity artificial gravity space station into orbit. She’s also a martial artist, skydiver, and pilot-in-training. She has an amazing career. And she knows more than a little bit about having lofty dreams and not sacrificing them to reality but pursuing them with determination.

In this episode, Kevin Mailo and guest Dr. Shawna Pandya talk about the varied paths of Shawna’s career. And they dive deeply into how Shawna’s childhood dreams propelled her into the journey she’s on today. She addresses self acceptance, having a plan of action, positive visualization, preparing for setbacks, and the mentors who invested in her along the way. Her story and advice on dreams are deeply inspiring.

About Dr. Shawna Pandya:

Dr. Shawna Pandya is a scientist-astronaut candidate with Project PoSSUM, physician, aquanaut, speaker, martial artist, advanced diver, skydiver, pilot-in-training, VP Immersive Medicine with Luxsonic Technologies and Fellow of the Explorers' Club. She is also Director of the PosSUM Space Medicine Group and Chief Instructor of the PoSSUM Operational Space Medicine Group. 

She holds degrees in neuroscience (BSc Hons. Neuroscience, University of Alberta), space (MSc Space Studies, International Space University), entrepreneurship (Graduate Studies Program, Singularity University) and medicine (MD, University of Alberta), and is currently completing a fellowship in Wilderness Medicine (Academy of Wilderness Medicine).

Resources Discussed in this Episode:

• International Space University
• Nasa Johnson Space Center
• Chris Hadfield
• “An Astronaut’s Guide to Life on Earth” by Chris Hadfield

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Physician Empowerment: website | facebook | linkedin

Shawna Pandya, MD - Physician, Aquanaut, Explorer, Director - IIAS Space Medicine Group: linkedin | twitter | iias |  luxsonic | zenith canada pathways

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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.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 hosts of the Physician Empowerment Podcast. And today I'm very, very excited to be joined by Dr. Shawna Pandya. And before we get started in the interview, let me say a little bit about Shawna, and she is a primary care physician who practices mostly emergency medicine. And for years now, even before her career in medicine, Shawna has been pursuing space medicine with a focus as well in extreme medicine and hostile environments. And so I would love to hear from you, Shawna, and that probably isn't the full introduction. Why don't you tell us a little bit more about yourself?

Dr. Shawna Pandya: [00:01:15] Yeah, sure. So first of all, thanks so much for having me on the podcast. I think this will be really fun. So for those who don't know me, here's a little bit about my background. I'm an explorer, I'm an aquanaut, I've been on expeditions in what we call analog environments. So that is environments that are analogous in some way to the spaceflight environments. I've been to the Mars Desert, or I've been to the Utah desert on a Mars simulation. I've lived underwater for five days, yeah, in a water underwater habitat. There's lots to talk about. I work with a lot of space companies with applications for Earth. I work with Luxsonic Technologies, which focuses on immersive technologies. So virtual reality, augmented reality, 360 video for medical education, for health care workers, physicians, paramedics and more. And I also advise a company trying to put the world's first rotating partial gravity artificial gravity space station in orbit by the end of the decade, as well as a space food company. So that's Orbital Assembly Corporation and IIAS, respectively. There's a lot we could talk about. So I think this is going to be fun.

Dr. Kevin Mailo: [00:02:23] Yeah. So there is a lot we could talk about. And it's funny because at first I was tempted to interview you about space medicine specifically, right? Because I think that's extremely exciting. I myself am a big fan or I don't want to say fan, but I constantly follow space exploration and all the remarkable progress we've been making throughout the world in terms of space technologies. But I really want to hear about your dreams and the meaning of dreams in our lives, because what struck me, following you on social media, Shawna, is the fact that what appears to be your dreams are very much a part of your daily reality. And that your dreams have been integrated into your career. In fact, your career is your dream. You live and work your dream, and that is so incredibly rare. And in Physician Empowerment, actually, in December 2021, we were actually in Mexico talking about wellness practice transformation. But one of the topics that we covered is dreams and how dreams provide not only goals in our lives, it's bigger than that. Dreams provide focus and meaning in our lives. They give us a sense of the arc of our life, and it can be a source of immense personal comfort and wellness as we pursue them. So talk to us about what dreams mean in your life. Tell us about your dream journey. Like, how old were you when you decided you wanted to go on this path?

Dr. Shawna Pandya: [00:03:47] Yeah. So my childhood journey is actually, I think, where this all starts. And I think that's where this idea of, Hey, I want to go to space comes from. Before that, it came with actually even bigger ambitions. So this is me as a nine or ten year old settling down, quote/unquote, decide to pursue astronautics. And so I think this is really a good example of what it means to be limitless and not--

Dr. Kevin Mailo: [00:04:13] -- I love that--

Dr. Shawna Pandya: [00:04:14] -- bound by what is possible in reality. And so to make that more concrete, so when I was four, I was like, I want to save the world. I want to do good. And I'm going to do that by being a Transformer, like I was going to be Optimus Prime crime fighter. We do good. And then I matured a little bit. I became seven and I realized, Oh, you can't actually be a Transformer. That's just ridiculous. So I thought, okay, well, I will be a billionaire superhero like in this Batman, Bruce Wayne kind of context.

Dr. Kevin Mailo: [00:04:46] Also very reasonable.

Dr. Shawna Pandya: [00:04:48] Very reasonable. You know, I matured. I'd put on some years since the age four. And I thought, okay, well, clearly I need to do good in the world. I need to pursue this Batman persona, you know, get lots of money and also fight crime. And then I realized that's not something you go to school for. You don't get your degree in billionaire-ology. So then by the time I was nine, this is also during the nineties when Canada had sent its first ever female astronaut to space - and that was, of course, Dr. Roberta Bonder - and I looked at her and I said, okay, she's Canadian, I'm Canadian, she's female, I'm female. So now all I need to do is be a neuroscientist, physician, astronaut, boom, done. That's my path towards astronautics. And so if you look at all of my homework from junior high, it was all about astronautics and how to get to space and just everything obsessed with human spaceflight and exploration. And then in high school, again, focusing down more, I said, okay, I'm going to go be a neurosurgeon. I'm going to medical school. That's what I'm focusing on. So my first degree was neuroscience. And then somewhere along the way, that space dream kind of crept back in. And so by the time I was applying for medical school, I realized how insanely competitive it was. And I said, okay, I'm not guaranteed to even get an interview. I need to pick a backup plan, a contingency that even if I don't get into med school, will make me happy that I could spend the entire year, you know, saying, this is amazing, like not wishing I was somewhere else, like medical school. And I'd heard of someplace called the International Space University, which is in Strasbourg, France, offers a master's program, and in reality is like Starfleet Academy, where you meet amazing students from all across the world. It's very, they abide by this international, interdisciplinary, intercultural perspective. We had 50 students, 31 countries represented. We had lawyers, engineers, future physicians and myself. Everything we did was collaborative. And that's when I realized maybe I didn't have to choose between space or medicine. Maybe there was an intersection. That's where I really learned about what space medicine was. And so kind of tying back to your initial question, this is kind of where realizing that, hey, having these big dreams as a kid, you can actually forge a path towards them. And that's really kind of taking what seems pie in the sky limitless, but also maybe not necessarily attainable, becomes attainable.

Dr. Kevin Mailo: [00:07:14] So talk to us about self acceptance of dreams and living them boldly. Because I'll be honest, I'm a big dreamer. I have lots of my own dreams about what I want to do with my life, where I want to go, where I want to see Physician Empowerment go. And, you know, it took me years to live that boldly. It took me years to even speak about my dreams. And for those of you that come to our conferences, you'll hear all about it. But tell me about like learning to live that boldly, learning to speak it, share it, and overcome the people that might have something negative to say or who who aren't necessarily there to support you. Because that's hard when we work in highly collaborative environments or even just with friends and family. So talk to us about overcoming doubt.

Dr. Shawna Pandya: [00:08:05] Yeah. So I mean, I'm a big believer in having a plan of action, having multiple contingency plans, and also taking concrete steps to put yourself on the way. And I think Chris Hadfield actually captures this in his book perfectly when he says when he was a kid and decided to be an astronaut, he didn't just go into his kitchen and declare it to his family because he would have been laughed out of the kitchen. He said, okay, I'm just going to be the best student possible. I'm going to do this. I'm going to pursue a career as a fighter pilot. And so it comes down to creating an action plan of how is this going to move me forward towards my goals and my ambitions, and then also realizing that you can prepare yourself and that also just because you're not eligible for something today doesn't mean you shouldn't keep it on your radar. And so to give you a concrete example, I knew about the Canadian Space Agency sponsored Aerospace Medicine elective to go down to NASA for a month and perform research related to space medicine. I knew about that since I was in Grade 11 and I would, like, compulsively check the CSA website, but you weren't eligible to even apply for it until you were final year medical school or until you were a first year resident. So, I mean, that was at least a decade off. But the nice thing about keeping an eye for these opportunities is it gives you something to reach for. Then you start putting together that ladder that gets you there. You start making yourself a competitive candidate. And so that was always in the back of my mind. And by the time it came to apply, you know, I had publications under my name, I had a book chapter under my name. I was very involved in Canadian space activities. And so I became one of two Canadians sponsored for that term to go down to NASA. So part of it is being aware of the opportunities and then working towards them as a matter of attaining your goals. And then the other part of it is rehearsal and for the hard things. And so to give you an example of, like, how rehearsed I've been for what I've deemed the most important things in my life, I will practice it before the real thing ever comes. And so when I was writing my MCAT, my medical college admissions test, which I'm sure the entire audience is familiar with us, they've all we've all had to write it. My family was out of town. It was to a new part of the city I'd never been to. So as a dress rehearsal, I drove all the way to the test site, found my parking spot, figured out how long it would take me to get to the test hall, make sure I knew where it was. I did all of that the day before, just to make sure I knew that part of the the concrete part. I applied to medical school a year before I was qualified to even apply, just so I could go through the essays, know what they asked for, have them all written. So when it came time to actually apply, I had something to draw off of. Same thing for Canadian Space Agency astronaut selection. Even the years I wasn't eligible, I went through their 50 page, literally, 50 page submission process, so I knew what they were asking for, so I knew what they were looking for. So the qualifications I didn't have, I would just go out and get them. And so there's an element of preparation and planning and action that really comes along with realizing our dreams.

Dr. Kevin Mailo: [00:11:15] I love that. Tell us about positive visualization. Right? Because it's one thing to say, oh, I have this dream on the horizon, but like positive visualization goes further in that we start to have specific stepping stones imagined or seen or written down. Talk to us about the role of positive visualization in your mind, as well as negative visualization of setbacks.

Dr. Shawna Pandya: [00:11:43] Yeah. So I think we need to talk about, we can't talk about positive visualization without negative visualization. And I call it the what if game. Anyone who practices emergency medicine will be doing this at all times because we're constantly asking, What is the most likely diagnosis? What is the worst case scenario? Best case scenario? What else could this be? And in everything we do in life, we should be asking the same, like, what is most likely to happen? How would this work? What would this look like if this is was a best case scenario versus what could go wrong and the reason that we do this, so when we talk specifically about positive visualization and we go through, for example, the exact steps to do a procedure in medicine, we're building that muscle memory by activating our supplementary motor areas. So we're kind of priming our brains to say, I'm ready to perform. But the value of going through the worst case scenarios, playing that what if game is also saying, how am I going to react, I don't want to be caught unawares if something bad happens because I didn't plan for it. So I call it the What if game. Chris Hadfield calls it the power of negative thinking, but it's also preparing ourselves for the reality of what life is and saying that I have a plan for that as well.

Dr. Kevin Mailo: [00:12:56] I love that. I love that. Talk to us about failure or setbacks. Because I think that is inevitable. Any time we are pursuing a higher goal or a dream, trying to get somewhere, we encounter failure. And again, that's another thing it took me years to embrace was failure as a stepping stone to success. Talk to us about failure. You don't have to share any specific stories, but how you overcome failure, how you approach it, how you learn from it, and then how you move ahead and try again.

Dr. Shawna Pandya: [00:13:33] Yeah. One of my friends, she's amazing. She's Canada's seventh female fighter pilot and she said, If you've never failed, you're either lucky, lying, or Jesus himself. So I love that. And I, for me, I say, if you're always winning, you're probably in the wrong league. So you have to fail because you're not really pushing your own limits if you haven't failed. And the other part of it is to realize that success and failure are two sides of the same coin. And what I mean by that is even when we succeed, our successes aren't always pretty and perfect, that there's something that can always be improved upon. And when things, when we fail, it's not final. There's a quote that says Success is not final. Success, or failure is not final, failure's not fatal. It's the courage to go on that counts. And that's basically saying, well, if you fail, you've only failed if you refuse to do something about it. Why not take that situation, analyze what went wrong, figure out what went right so you can reinforce that part, and then come up with a plan to address the part that didn't go so well. And in the operational world, in aviation and space, we call that the art of the debrief. Any time we fly a zero gravity campaign, we are debriefing after every flight because we want to know what went well so we can reinforce that pattern of performance. What didn't go so well, so we can share those lessons learned with the rest of the team, and also so we can change our own actions and performance patterns in what didn't go so well. And so that's why I say success and failure are two sides of the same coin, because there's always actions to be optimized.

Dr. Kevin Mailo: [00:15:02] Absolutely love that. What else do you want to share with us about your journey or about what you've learned along the way in terms of pursuing your dreams?

Dr. Shawna Pandya: [00:15:11] Yeah, I definitely feel like I'm just getting started. I think there's so much else I want to do. So many other places I want to go.

Dr. Kevin Mailo: [00:15:20] I love that because you've been at it, like, dreaming for over 20 years, right?

Dr. Shawna Pandya: [00:15:24] Yeah I've been doing it my whole life.

Dr. Kevin Mailo: [00:15:25] But it still feels fresh. It still feels new. I really love that.

Dr. Shawna Pandya: [00:15:28] Absolutely. Every single day is like, Wow, I can't believe that someone would think of me for this. That's amazing. And part of it is you can't acknowledge success without acknowledging the imposter syndrome. We all feel it.

Dr. Kevin Mailo: [00:15:41] Right. Right.

Dr. Shawna Pandya: [00:15:42] And what I've learned is it's an opportunity. It's a growth opportunity. Right? Because someone even if I don't feel ready to be in, whatever, in medical school or to be in this position within a company or an organization, someone somewhere saw something in me that they believed I could do this. And so it's an opportunity to become better, smarter, more educated, and then also execute. So that's how I deal with the imposter syndrome. And then just realizing that you have to love every bit of the journey. And there's people who say, I want to be an astronaut, I'm going to study engineering, even though I hate it. I'm to go get my operational certifications in skydiving, whatever, even though I hate it. And when they're hating every step of it and then maybe ultimately they are medically disqualified forever from astronaut candidacy and they feel like they've wasted their life. And for me, it's the exact opposite. I love every aspect of what I do and every part of the journey. That's how I work seven days a week. That's how I live out of a suitcase. And I'm home for maybe three days a month because everything I do is absolutely fun to me. And I think that's key when realizing, you know, if this is the path I want to pursue, is it actually the path I want to pursue, get those data points, live it, and then figure out, is this how I envisioned it to be?

Dr. Kevin Mailo: [00:17:02] Amazing. Talk to us about the importance of mentors and surrounding yourself with people that build you up, because I know I've certainly, over the years, become much more mindful of who I spend my time with in terms of sharing my dreams, working towards my dreams. Because there are people that build us up in life. There are people who bring us down. Talk to us about how you seek out mentors. I would love to hear that because I bet you, well already, from what you've mentioned, it sounds like you met some incredible people on the journey.

Dr. Shawna Pandya: [00:17:28] Yeah. So for mentors, I think mentorship, I have this view of it doesn't have to be this very formal relationship. It doesn't have to be, hey, will you be my mentor? Because I think there's this unrealistic expectation that this person is going to transform you into the person you want to be. And that comes from within. And I think we don't do a good job with with any type of mentorship relationship setting those expectations that, no, it's you. You're the one who has to set your goals and pursue them and come armed with questions. And that's the approach I've always taken. And then the other part of it is just feeling, realizing the social contract to pay it forward, because I wouldn't be where I am if incredibly busy people hadn't taken time during their careers to invest in me, even though they didn't have to. And the best example I can give of that is someone I've mentioned a lot through this podcast because the first day I ever interned at NASA's Johnson Space Center, the phone rang in my office. It was off campus. I'd lost my passport, I was frazzled. So I picked up the phone and I said, I'm sorry I have to put you on hold. And then I realized that the person on the other end of the line said that was Lieutenant Colonel Chris Hadfield, who is training to be commander of the International Space Station. And I just put him on hold. And so the man was busy. This was 2012. He was training to command an entire space station, but he still found time to take myself and the other Canadian medical student out for coffee, answer questions about space. Why? He has no impetus to do that. All of this, all of the Canadian astronauts, Jeremy Hansen, David Saint-Jacques, they took time to invest in us. That's amazing.

Dr. Kevin Mailo: [00:19:10] That's incredible. That's so inspiring.

Dr. Shawna Pandya: [00:19:13] Right?

Dr. Kevin Mailo: [00:19:13] Yeah, like, what a Canadian hero.

Dr. Shawna Pandya: [00:19:16] He was amazing. I can't say enough good things about him. And so, to me, that really is a lesson in pay it forward. Like, you know, as busy as I get, I also feel a duty to help others, to help answer the questions. I'm involved with [00:19:31] Gosh as a mentor. [00:19:32] Space Prize Fellowships, [00:19:34] sets Canada [00:19:35], Zenith Pathways, Women in Aerospace Medicine. Like there is a very long list that I'm sure I'm forgetting more because once upon a time I was at that stage and I definitely wouldn't be where I am if folks hadn't taken the time from their schedules to invest in me.

Dr. Kevin Mailo: [00:19:52] Wow, wow, wow. What a great story. And so beautiful to talk about paying it forward. Right? Because I think that enriches us immensely when we can take the time and help somebody who's on a similar journey or somewhere further down the path or coming up the path like we are. So powerful. I think that also helps renew our interest in our dreams and energize us and focus us. Wow. Shawna, I'm not going to, I'm not going to keep you longer because I know you're busy. Do you want to share like a book that you love that might be related to this? But that's always hard because I'm putting you on the spot. I didn't give you any prep about that ahead of time.

Dr. Shawna Pandya: [00:20:30] It's very on brand. It's the same book I've been quoting this whole.

Dr. Kevin Mailo: [00:20:33] Go for it.

Dr. Shawna Pandya: [00:20:34] Chris Hadfield's 'An Astronaut's Guide to Earth'. It's very resonated very much with me. A lot of the lessons I've shared this hour have been from that book and also through my own lessons, so totally recommend it.

Dr. Kevin Mailo: [00:20:46] Was that the guy that you put on hold when you... Oh, that guy okay. Yeah. Yeah. Amazing. Amazing. That's truly incredible. Love it. Okay, Shawna, thank you so much for coming on and just sharing your story, sharing your journey. It is so inspiring. As I said earlier, it is rare to meet people that live their dreams so boldly and so fully. And yet dreams are maybe one of the most important things in our lives because they give us so much meaning and joy. And like you said, it's the journey that has to be savored, not just the destination.

Dr. Shawna Pandya: [00:21:20] Absolutely.

Dr. Kevin Mailo: [00:21:21] I love that. Thank you so much, Shawna.

Dr. Shawna Pandya: [00:21:24] Yeah, my pleasure.

Dr. Kevin Mailo: [00:21:25] Thank you so much for listening to your 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.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 welcomes Galen Nuttall, Certified Financial Planner (CFP), to the podcast to discuss some of the ins and outs of financial planning. Galen answers questions about what financial planners do and explains the differences between a financial planner and a certified financial planner.

Galen Nuttall has a background in teaching and a Masters in Education, but his father was a physician (a nephrologist) and he estimates half of his current clients are also physicians. The combination of his ability to teach financial concepts with ease to any audience and his familiarity with physician financial needs gives him great insight to share with listeners.

In this episode, Dr. Dimitre Ranev and guest Galen Nuttall break down some misconceptions surrounding CFPs and the value of financial planners. Galen discusses the value of incorporation for physicians, retirement planning, riding out economic slowdowns, and some advice about taxes. His knowledge is vast and makes for valuable listening.

About Galen Nuttall:

Galen Nuttall grew up watching his dad (a now-retired nephrologist) struggle to make good decisions around his money. It felt like everyone wanted time with him to pitch the latest and greatest financial product. Now that he’s a planner, he sees why so many Canadians are unsure how to invest their money. There are so many options and even the experts seem to disagree. No wonder most Canadians are confused and don't know where to start. 

As a planner, Galen is changing this. With a background and a Masters in Education, Galen is able to explain financial concepts with ease and enjoys imparting financial literacy to people. He says a fee-based financial plan answers the biggest questions around investing with cold, hard facts. Plans should be evidence-based, not based on opinions or preferences. 

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Physician Empowerment: website | facebook | linkedin

Galen Nuttall, M.Ed, CFP: podcast

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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.

Dimitre Ranev: [00:00:34] Welcome back, everyone, to the Physician Empowerment podcast. I'm very honored to have Galen Nuttall as a guest today. I actually met Galen at the Physician Department Conference in June. Galen is a financial planner, he's an investment advisor, and he's a certified, he has a CFP Certified Financial Planning certificate, as well as a Masters in Education, which I find really interesting and actually really important because financial products can be extremely hard to understand, especially when we talk about insurance. I mean, any product and it's so important to be able to explain things, simplify things. And just reading some of the comments on Galen's website, it seems like it's something you do very well and having spoken to you, it's something you do very well. I can say that again. You also have your own podcast, I think it's called a Clean Bill of Wealth. Is that correct? I think you post twice, twice a month?

Galen Nuttall: [00:01:27] About two, yeah, I do about two episodes a month.

Dimitre Ranev: [00:01:29] And you have guests and then you have sort of solo things and you're really good at explaining concepts. Today I just, one of the reasons I have you on is I think people need to realize that investing is a journey and it's a very personal one. There is no one size fits all, even though a lot of people will tell you this is the best thing to do. For example, now the current rage - and I'm not saying it's bad - but the current rage is to do your own investing, low fees, put all your money in an ETF and forget about it. But just like I'm giving an example of medical conditions, so for example, if somebody wants to lose weight, your job as a doctor is to show them all the tools available to them so they can find what's best for them, whether it's exercise or diet or even an emotional thing. Just like that's investing as well. There's different tools and you need to be aware of them because if you're not aware, then you won't find what's best for you. Today I want to talk about the tool of having a financial planner on your side. So I always like to start off with definitions because there's so many definitions in the financial world and it's so confusing. So, Galen, do you mind if we start by I want to ask you, because you do two things. You're a financial planner and an investment advisor. Can you tell me what is, when you put your financial planning hat on, what is it that you do? What is your role?

Galen Nuttall: [00:02:53] Yeah, Yeah, very good question. Yeah. And first off, thank you so much for having me. I definitely enjoyed attending the conference and meeting and we probably could have talked a really long time about financial stuff when we were hanging out after the conference. So I really appreciate being here. Completely. Yeah. And, I mean, and I love what you said about I do have a Masters in Education, I bring that to the table. If anyone checks out any of my videos, I'm usually using a whiteboard. I'm a very big believer in visual learning. Most people resonate with that. So yeah, when it comes to definitions and certified financial planners, so I mean, I guess the easiest way to look at it is certified financial planner is the international designation for financial planners. So the way that you get this designation is you have to have a certain number of years working as a financial advisor and then you take exams. I had to read about 1200 pages worth of textbooks, take multiple module quizzes, and then one three hour exam, then one six hour exam, and then a three month long case study. And then you're part of the certified financial planning body. And every year you vow to uphold the code of ethics of the certified financial planners. And as all good things, you pay an annual fee to stay on their list. And at the end of the day, really, I mean, I'll say why I got my financial my certified financial planner, I was already an advisor for many years and I felt like I was doing a really good job, but I was not able to offer fee based planning, which is that someone... I was coming up against giving people advice and the only way I could get paid before I got my certified financial planner was if they bought something from me. So like, I would, sometimes I'd give people, I would take people through a very lengthy process of discovery, of recommendations, of portfolio construction, of insurance recommendations. And they would say, Galen, I actually am not ready to do any of these things, but I would love to pay you for your time because I realize you've spent a lot of time on this. And I kept having to say no because I was not allowed to take money like the way that a lawyer may bill you by the hour or the way that an accountant may bill you by the hour, I couldn't do those things. So I got my certified financial planner so I could start doing that, which is hourly fee based and planning based, which is someone can pay me for a plan that they can implement wherever they want for themselves or with me. So that was the main reason I got it. So I think that's probably one of the best ways to quote/unquote define it, is that some people say, Oh, you should only work with someone who's a certified financial planner. I'm like, Well, I was in this business for like seven or eight years before I became a certified financial planner and I stand by all the recommendations I gave before I got it. But like, if you meet someone who has their CFP, they're taking it pretty seriously. Like someone doesn't go to all these lengths to to get this designation without being pretty serious about the career. So I would say it's a sign of that. So yeah, that's, that's kind of my journey with the CFP.

Dimitre Ranev: [00:05:40] And when did you get your Masters in Education? When did that happen in sort of your journey as an advisor?

Galen Nuttall: [00:05:48] For sure, yes. I mean, so I started, I taught overseas, actually, I moved to Venezuela when I was 22 and worked for a grassroots development organization. And I was only going to stay there for a year and I loved it so much, I decided to stay longer. And then I got married and I ended up staying ten years and I started working for an international school. And while I was working for that school, they said, Galen, you know, there's like a rule where I could work for a year or so, but then I had to start working towards my teaching degree. So I said - and I never wanted to be a teacher, it was never my thing - but I am, I would say that my superpower is making complex concepts simple, usually through whiteboards. Like that's, I love making financial concepts simple. Almost every meeting I have with people is a shared screen whiteboard meeting, because that's what most people enjoy. So I started teaching, I had to get my teaching degree, and then I went ahead and got my Masters. So I finished my Masters back in like 2010 and I had every intention of continuing to teach. But my wife and I left Venezuela because it was getting too dangerous. We were worried about either me or my son getting kidnapped, so we said, We better leave. We looked all over for other international jobs, but it was around 2008, 2009, economic downturn. So a lot of international schools weren't hiring as much. So we ended up in Canada and there were no teaching jobs to be found. So I made a transition to financial advice. My advisor said, Galen, I think you'd make a good advisor. And initially I said, I am not interested at all. I was like, I don't want to be, I don't want people calling me when the markets are crashing. I don't want to be the guy at the party that's trying to sell you life insurance. And they said, Well, you don't have to work that way. Like you can find your own way of working that works for you. Because I was like, I can't do anything sleazy or salesy or knocking on doors, I don't want to do any of that stuff. So they said, No, you can figure out how to do it without doing those things. So when I started, it took me a little while to embrace it, but I realized that one of my differentiators - because there's like, I don't know, like 20,000 CFP in Canada or something like that - I was like, What's going to make me different? And it's like, I have a Masters in Education. Like I know how to explain things and I know how to tell if someone's understanding something or not. So I went guns blazing into like drawing and educating and like really heavy on that side of things. And so yeah, so I got the CFP in 2010, sorry, my Masters in 2010, I became an advisor in 2013, and then I got my CFP I think in like 2018 or 19, something like that.

Dimitre Ranev: [00:08:08] What kind of education were you doing in Venezuela? What were you, what subjects were you teaching? I'm just curious.

Galen Nuttall: [00:08:13] I was teaching, I was the core teacher for grade five at the International School in Caracas, Colegio International de Caracas. I was the grade five teacher, so I taught basically the core subjects, everything but P.E., everything but Phys Ed and Art, basically. And music, I didn't do music.

Dimitre Ranev: [00:08:28] I'm certainly curious. Did they have any like sort of financial teaching as part of the curriculum? No, because if you didn't have it in Ontario, like when I was growing up, there was no such thing. Right.

Galen Nuttall: [00:08:40] Not really. They've got, I think they've got some pretty good now because I know my son has come home and talked to me about interest rates and borrowing and all these things, and I'm like, All right, all right. Like, I like this. Like if they're at least teaching kids not to take on lots of credit, like bad credit, then I'm pretty happy. So I think they're doing a pretty good, my son was getting pretty into it. But no, we didn't, I didn't teach any financial literacy. I taught grade five. And really, like, one of the things I say is one of the hardest things I've ever had to do was teach fractions to grade five. So I know how to teach anything to anyone. And I really do take it, like I typically start with people and I say, Look, I'm going to take it to a grade five level. If you need me to go more complex, I can, but that's where I'm going to start. And then I let people decide whether they want to go more complex or not.

Dimitre Ranev: [00:09:21] And I'm so, you know, I teach from, I teach myself from McGill. And I think it's so important to have that visual element because to me, I'm a visual person. Not everybody is, right? Not everybody is. But I love the whiteboard. I love drawing things and talking things through. It just, I remember somebody was trying to explain me something about pensions two days ago, and I didn't get it until they drew it and like, Oh, that clicks. So yeah. So I'm glad that you do that because I think it's quite important. My question is, because you told me when I talked to you at the conference that you have a pretty sizable medical clientele. Is that correct?

Galen Nuttall: [00:09:58] Yeah, I'd say like of the last ten clients I brought on, I pretty much, half. Half the clients I bring on are incorporated business owners and the other half are incorporated medical professionals like physicians.

Dimitre Ranev: [00:10:09] How did that happen? Is it just sort of randomly or what?

Galen Nuttall: [00:10:13] Yeah, it's a good question. So when I started as an advisor, again, I was looking at ways of differentiating myself because I thought, What can I bring to the table that will be a value add for my clients? And so I started as an advisor and everyone was talking about, I started hearing about the corporate structure, right? And I was like, How does this thing work? And so I just started studying. Actually, I'll back up one more minute. So my dad's a doctor. So my dad's a physician, he's retired, he's a retired nephrologist, and I grew up watching my dad struggle to make good decisions with his money. Like I grew up in the heyday of cold calling. So he'd get cold calls from, like, stockbrokers and they knew he was a doctor, they'd find his phone number and they'd say, You've got to get in on this penny stock. You know, all this stuff. I remember as a kid going to meet with his stock broker, playing with like, toy trains while he was meeting with his stockbroker, and his stockbroker is telling him how much money he lost in gold that month or whatever. And I remember thinking, like, and I was confused about what my dad did when I was little. Someone asked me, What does your dad do? And I said, My dad's in construction. And my dad's like, What are you talking about? I'm a doctor. And I was like, Well, Dad, every day after school you take us to this old smelly building, we have to put on hard hats, you're telling people what to do. Like, I thought you were in construction. And he's like, No. He's like, my friends and I bought a building and we're renovating it, and we're renting it. And like, so basically what I didn't know as a six year old was that my dad was trying to create a retirement plan through real estate investing. Right? And so when I became an advisor, I started to think, Man, if I could really help people like my dad, like physicians who - I'll generalize a bit - but most physicians I meet, they do enjoy what they do. Obviously, there's high levels of burnout and there's a system that is not functioning very well. But most physicians are very, they really want to serve their patients. They really want to make a difference. They usually enjoy what they do, even though there's good days and bad. And a lot of them don't necessarily want to take on another thing in their life that's going to distract them from their family or their health or their sleep. So a lot of them want to say, Hey, Galen, you know, I trust you. Tell me what you're doing and why, and I'm going to let you manage my stuff and I'm not going to worry about it anymore. So I started studying the corporate structure very heavily. I started meeting with corporate accountants, corporate lawyers. I started meeting with different investment companies that worked with corporate preferred investments. So I just worked really hard to get really good at saying, okay, you're a doctor, you have no pension, What's the best, like, what's the best route that we can figure out for you such that one day you get to flip a switch and you don't have to work anymore if you don't want to. Because you've done all the right things to now be able to retire.

Dimitre Ranev: [00:12:49] Yeah, exactly. And just before we started the podcast, we talked a bit about investing in index funds and just putting money in there. But you were saying a lot of people don't know, Okay, so I'm doing this, but what happens when I retire? Do I have enough to retire if I do this? And how long after that is to be able to do it? So that's that's where you can come in and help figure things out. I was talking to one of my friends who was like, trying to figure out how much he needs to retire to keep his current income. And what he didn't take into account is inflation, right? Like your current income, you have to inflate every year. So it's those little things where somebody who knows what they're doing is really helpful. And I guess my question to you is, so you're saying that about 50% of clientele are incorporated professionals, right? About half?

Galen Nuttall: [00:13:37] Well, almost all my clients are incorporated. Half of them are medical professionals.

Dimitre Ranev: [00:13:43] And, you know, I'm not saying doctors are special, but have you found any differences between sort of your medical incorporated clients and your other professionals? Like do they have anything, any specific interesting quirks or needs that are a bit different, maybe, from accountants or lawyers or dentists?

Galen Nuttall: [00:14:01] Yeah. Yeah. It's a good, it's a good question. So of the last ten clients I've brought on, half of them were incorporated business owners. So, you know, someone who owns a factory or someone who owns some sort of saleable business and then the other half are physicians or osteopath. Brought an osteopath as a client recently, I'd say the biggest, there's not, I mean, the biggest difference from a mechanic's situation is that a business owner can sell their business, and not very many physicians can sell their business, right? Their corporation is basically them, right? Like your corporation is, you know, Dimitre Ranev medicine professional corporation, right? That's, it is you, you are the corporation. So every once in awhile you'll have someone with maybe a clinic or something that they can actually sell, but almost all of my clients are not going to, at the end of the day, sell their business for all this money and then suddenly be able to live off of that. The business owner clients, some of them will sell their business for a lot of money and that's their retirement plan is I'm going to sell my business. The physician, on the other hand, is almost exclusively, you know, what are they going to be able to create an income on their own, whether it be through investing, whether it be through real estate, whether it be through whatever they end up coming up with. So I'd say that's the biggest mechanical difference between the physician and the business owner. Like the straight, like, true blue business owner. From the other side of things, I mean, the biggest thing that physicians have in common is that they typically get a very late start in life due to going from residency where you're not really making a ton of money. You finally start your practice, but you've got $200,000 plus of debt you have to figure out how to pay off. You know, so a lot of physicians I meet aren't really starting to save money until about ten years after a lot of other people might be able to start saving money. So that's the other thing, is there's a very short runway for physicians in general. And a lot of, depending on the specialties, some physicians really don't plan on working long. I have friends who are ER docs who are like Galen, I really don't think my body is going to be able to take work past 55/56. I have clients who are maybe cardiologists or radiologists who say I could probably work to 68, you know, and I mean I'm not picking on them, but it's just the reality, the nature of their specialty. So all that being said, I think that it's so important for physicians to maximize the corporate structure, for physicians to make smart decisions around what they can make, how they can make the most of the corporate structure. Because as we were saying, a lot of people think financial planning, or they think success is paying as little as possible for their investments and they don't know a whole lot else. Like this happens. I meet people and they say, again, I'm really happy with what I'm doing because I know that I'm getting low cost investments, I'm doing index funds, I'm not paying a lot of money, it's really great. And then I'm like, Cool. Do you have, do you know when you'll be able to retire? Do you know if you're doing, are you owning the right kinds of ETFs in your corporation? Because there are some that you should not own inside your corporation, like even at the conference you were showing, Well, don't pick the one that's not a Canadian one because that's going to cause tax problems. And then the whole other conversation is, you know, I'm a big believer, so I think that financial planning for me takes the shape of a tree. So when I talk to people about where they want to be in the future, it's kind of like the leaves at the tips of the branches of the tree and all the work we do for saving money, investing money, saving taxes is growing towards that goal. And, much like a tree needs strong roots, I think a financial plan needs strong roots. And those roots are the protection side of things, like what will happen if you get sick, what will happen if you get injured, what will happen if you pass away prematurely? Like will your tree still stand if that were to happen? Or would your tree fall over? And so, even above and beyond the investment conversation, which is far more complex than just getting the lowest cost investment, there's the whole other side of the coin, which is protecting against what can go wrong.

Dimitre Ranev: [00:17:43] Yeah, exactly. And so my question to you then is with your clients, like, we'll talk about fee structure maybe at the end, but is it sort of like, do you keep them on for long? Like do you see them yearly? What's the usual way you follow up with them?

Galen Nuttall: [00:18:00] Yeah, absolutely. So with my clients, obviously there's a lot of meetings in the beginning, because in the beginning it's very much discovering if like, the first, my first meeting with people is a half hour phone call, and the whole purpose of that phone call is to find out if we're a good fit. Because people have to, I have to be a good fit for them and they have to be a good fit for me. Like I say, I'd say of all the people who call, most people I end up in conversations with, they call me, because they book a time. They hear my podcast, they hear me on someone else's podcast, they book a time and we have a conversation as to whether we're a good fit or not. And I'd say about half of the people I talked to aren't a good fit either. I'm not a good fit for them or they're not a good fit for me. And I'm very picky about, I'm not picky, but like there's a very specific person I want to work with, and other advisors say things like, Well, just bring them on as a client and then if you have to get rid of them later, it's okay. And I don't like that at all. I'm like, I want clients for life. I don't want people that I'm just going to bring on and see if it works. I don't like that at all. So, that's the first step is to make sure that we're philosophically aligned. Like if someone thinks that my job is to beat the market and I can't get them to see what my real job is, then we're probably not going to be a good fit. If someone is, like, a very heavy DIYer who's trying to like get me to join in on their philosophy of market timing, that's not going to work either. There's just certain things that aren't going to work. So, I mean, just since I'm talking about it, like the person that's the best fit for me is the person who is looking for someone to trust. They don't want to do it themselves. They want to understand what they're doing and why. And they want an advisor that's going to patiently explain everything, and an advisor who intimately understands all their options when it comes to corporate investing and understands all their options when it comes to insurance. And someone who's going to be okay with like, yeah, like, I'm not going to try to time to market. I'm not with, with a few exceptions, which I can talk about in a minute. So yeah, so that's the first meeting is to figure out if we're a good fit. Then if we decide we are a good fit, we decide whether we're going to go the fee based planning route or the portfolio management insurance review route, and just depends on the complexity of questions that someone has. So, if someone sends me just a ton of questions like should I be using my spousal RSP, should I be using TSFSAs, how much should I have on side of my corporation? What's an estate freeze? You know, like if someone's got all that going on and they've got quite a bit of assets already accumulated, they're probably going to go for the planning route because if I, if I don't feel confident that I'm going to be able to give them some good solutions without first doing a deep dive into all their structures and everything, then I'm going to say we need to go the fee based route. If someone is maybe less complex and it's a simple retirement plan or they're just starting out, like I have a lot of clients who are just coming out of residency and they're in that year of, Oh, I'm going to incorporate, I'm going to start practice. Like for those people, it's probably, they're not yet a good fit for a plan. So I will take them on and help them in that phase of incorporating, what do I need to do? Like what are some smart things to do with my money? So that's kind of... and then after they become a client, we meet every year at a minimum. We meet any time there's a major life change, like if they buy a house, if they sell a house, have kids. And then I reach out to everyone whenever there's a market downturn--.

Dimitre Ranev: [00:21:13] --I was going to ask.

Galen Nuttall: [00:21:14] So in 2020, I sent, I think in 2020 I called every single one of my investment clients and I said, Hey, you're probably watching the news, you know, or if you are watching the news, we're going to stay the course. And I didn't call everyone this year because when I called everyone in 2020, most of my clients were like, Why are you calling me? Are you going to tell me to, like, sell or buy or anything? And I was like, No, no, no, we're going to stay the course. And they're like, Oh, well, you didn't need to call me. You could just send me an email. I was like, Okay. So then this year I sent an email to all of my investment clients and basically said, We're going to stay the course and why. Or, the one quote/unquote market timing thing is if someone has some tax loss harvesting we can do, which that's another value add a good advisor brings to the table. If you have corporate investments that are in a taxable account and you've actually lost value, let's harvest those losses to offset future gains. Or I said to my clients, if you've got a pile of cash sitting somewhere, I don't know if we're at the bottom yet, but let's start putting some of that money into the market while it's on sale because we're in this, the beginning of this year was one of the five worst beginnings of the year we've ever had. So it's like one of the best five sales we've ever had. Like if you went to buy a car and they said, Oh, in the last hundred years, this is the fifth cheapest this car has been, you'd probably buy the car. So I say to people, like, just put money in and I have a few clients who did have some money kicking around, and they're really happy that they have been putting money in regularly over the last couple of months because they've gotten pretty good returns. And my clients who did it in 2020 got really great returns. I mean, I don't know, as I said, I never know when where the bottom is going to be, and I don't even try to pretend. But when things are on sale, I encourage my clients to buy more. And it's, they've always thanked me for that. So that's things look like when someone becomes my client. And the other thing I'll say is if there is something out there that I think they should know about, like if I've had a client that I think, you know, some private equity stuff makes sense or some market exempt stuff makes sense, we'll look at it. I think there's a product out there that we haven't talked about yet, and I'll kind of, I'll go for a run or a bike or a swim and I'll think about this client and say, Huh, they might be a really good fit for this. Then I'll call them up and say, I was kind of thinking about this, but I'm not moving stuff around a lot. Like that's not not really my style. It's more of a Let's figure out where you need to be, how much you need to put away, and mostly stick to that.

Dimitre Ranev: [00:23:26] So, like, the family doctor of your financial health, you get the annual checkups and and when there is the flu, so the market crashes, you're there to calm things down. So I wonder if it's the process you go through to select your clients that do you have a lot of people sort of calling and freaking out when the market collapses?

Galen Nuttall: [00:23:47] Zero.

Dimitre Ranev: [00:23:48] Interesting. Interesting.

Galen Nuttall: [00:23:50] Zero. Yeah. Nope. Well, part of it is I'm proactive, right? I mean, this year I'm actually mad at myself because I did wait a little bit. I don't really watch the news so I don't always know, I mean, I know enough to know that people are freaking out, right. And like, the news is talking, I call it the apocalypse du jour. And I don't mean to minimize. Like I sent out a newsletter and I posted I think, I don't know I couldn't post on LinkedIn because it was a little too long, but I posted it pretty much anywhere I could post. I sent it to my clients and I personalized it, like each client, you know, the first paragraph was very specific to their situation and the rest of it was the market. People are reacting to world events like the invasion of Ukraine, economic slowdown in China, inflation, all these things. And I don't mean to minimize the impact that those real world events are having on people, and I said the exact same thing in 2020 when I said COVID is having a real life impact on people. Like my dad was one of the first people to get COVID. So, and it was in the early days and we didn't really know what this thing was so it was very scary. So I don't mean to minimize the real world things that are happening, but the people who are reacting to the markets are the ones who are most likely to lose money and the people who are staying the course, as long as the caveat to all that is as long as they started in a good portfolio, they're going to be okay. But if they've got all their eggs in one basket, who knows, right? Or if they've got all their eggs in crypto or one private equity firm, which I saw recently, which kind of blew my mind. I had, I met someone who we did a plan for them and they have every last penny of their investments in one private equity holding. And I was like, This is so insanely risky. Like, and they claim that they're conservative investors. And I'm like, that's another thing I help people do, is they say they're one thing, but they're doing this instead. And so I help them match like what they think they are and what they're actually doing. So, yeah, accurately speaking, I did lose one investment client in 2020. First investment client I ever lost. I wrote everyone and I said, Stay the course. And this person couldn't stay the course. And I said, Fine. So they didn't stay the course. And then in this year, one more client left during the market downturn. But it's a pretty small percentage of my clients. So I shouldn't say no one or zero. There was one each time. So I don't know if that's going to be my average from now on, every time there's a market crash, I lose one client. But I'm pretty proud. I've only lost two in the last three years to that panic because I, you're right. Like it's partially selection and I just help people understand a little bit better. Like one of my first physician clients, I sat down with him and he said, Galen, I am terrified of losing everything in the market, I only want to keep pace with inflation. And this was back in 2013 and he wanted to do like all GICs and stuff. And GICs were like less than a percent or something. And I was like, Why do you feel this way? And he's like, Well, my dad lost all his money with Nortel.

Dimitre Ranev: [00:26:25] Right. Right.

Galen Nuttall: [00:26:25] And I was like, okay. I was like, That is not the only way to invest in the market. And so I showed him a 20 year time lapse of the kinds of portfolios that we're using. And in 08/09, one of the biggest downturns in recent history, I mean, you can find portfolios that only dropped 8% and still did pretty good annual average rates of return since then. So people think, a lot of people think, like I have to be exposed to extreme amounts of risk to be in the markets. And historically, that's just not the truth. Obviously, you typically, like generically, get rewarded for more risk, but that's another big part of what I do with people is I help frame that because sometimes I'll meet people who have sort of a mis, they don't completely understand the markets because they have these horror stories of like an uncle or a dad or whoever. And I'm picking on guys, because guys typically make very brash decisions in investments. They've lost everything in one thing that they did. And they think, yeah, there's research that women make better investors than men.

Dimitre Ranev: [00:27:24] I read that.

Galen Nuttall: [00:27:26] Yeah, it's totally true. Which kind of blows my mind because when you look at all the major investment firms, like the major fund companies and all that, there's not a ton of women on them. And so I'm like, how come if statistically speaking, women make better investors, why aren't there more of them in these boards of like investment fund managers and things like that? So anyways, yeah.

Dimitre Ranev: [00:27:46] Yeah, you're so right because I started my investment journey right after 2008, right? So I was very lucky. Really lucky.

Galen Nuttall: [00:27:53] Yeah. You thought you were a genius.

Dimitre Ranev: [00:27:55] I thought I was a genius. Everything was going up. But I remember talking to people who were, a good 10, 5 to 10 years after they had lost a lot of money, did not go back into the stock market because they're just so afraid. And sure, there is a possibility you lose everything, but that means Armageddon, like apocalypse, like you're not going to be worrying about your retirement plan if the stock market goes to zero. There will be other things happening in the world. So that's great. It's really... Because I think people you know, when I looked at the research for financial planning, the value of financial planning - I talked about this in my presentation - so surprisingly, it was done by Vanguard and Morningstar, which their deal was they sell index funds or mutual funds. So they didn't really necessarily like having financial planners involved, but they found that you guys, if I can say you guys, add some value. And part of it is the psychological thing. So you're there to make sure people realize this is the plan. You're going to retire in ten years. So a drop of 20% right now isn't affecting you. So don't sell everything. That's very valuable. That's probably worth the fee that people are paying if you prevent them from selling all their stocks and never going to stock market for the next ten years. And that's why I want to talk to you today, because I wanted people to know that this existed. Studies in finance are not like medical studies, not rigorous, but there is value to having somebody like you on the team especially, forget about the investments, but the incorporation part, which is complicated. Like I've been incorporated for ten years and I'm still like surprised by some things I learn, right? And having somebody navigate that is really important. So I do have a follow up question because you're very knowledgeable in corporation, but... Is there some?, I've heard about the clichés about why you shouldn't incorporate, but do you practically have clients where you should tell them not to incorporate? Do you have that or do you have clients who have incorporated and you think it was a bad decision for them? And what would make that a bad decision? I'm really curious if you have that experience.

Galen Nuttall: [00:30:12] Yeah, Yeah, for sure. Yeah. And I do want to just echo one thing that you said about the value add of an advisor. The one, the thing that I think that people, sort of the character, the sort of generalization is, okay, I could get 6% with an advisor, but if I cut that fee out, I'm going to get 7% with an index fund. Like because I think the general, like you see these charts all the time where it's like, oh, over the lifetime of your investments, you could save tens or hundreds of thousands of dollars by saving on fees. But that's not the only variable. Like, if that were the only variable, I would totally hang up my hat and say, forget about it. Like you guys go pick your index funds. I just don't even need to be here. That's not the only variable. And then the study that you sent me showed that advisors on average add 3% net of fees value to their client's portfolio. And you say what? Like they, a good advisor will admit that they can't time the market. So it's like, well then how are you making more money? And that's what I say to people is my job is not to beat the market, it's that you would have significantly more money in the future than if you didn't work with me. And if you're like, okay, how does that work? Well, so, it is partially fee, but it's more like you said, like the behavioral side of things. And that 3%, I would venture that if that, if the study they had done were with people with with corporations that had good corporate planning, I think that would be much higher than 3%, especially in Canada, where taxes is such a consideration, either while you're alive or when you're gone. So that's just one thing I wanted to add with that value add is corporate planning, just as one, when you gave your talk that I was there for in Toronto, you were talking about portfolio construction and someone asked a really great question. They said, Are you talking about non-registered or RRSPs? And then you're kind of like, Well, that's a whole nother ball of wax, you know, like a whole nother, like registered versus non-registered is a whole nother thing to know how to invest properly. Anyways I couldn't help but add that to the to the conversation about value added.

Dimitre Ranev: [00:32:05] That's that's the thing, people talk about management fees but your biggest, taxes are the biggest fee you're going to be paying on investments by a lot, by a lot. So if you can get to be tax efficient and I'm not saying like, taxes are important, we all get why we pay them, but if you can be more efficient with the way you pay your taxes, you compound a lot more than if you save an extra 1% fee by not talking to somebody who knows what they're doing.

Galen Nuttall: [00:32:32] Exactly.

Dimitre Ranev: [00:32:34] So that's very important.

Galen Nuttall: [00:32:35] And another thing is debt reduction. That's another big thing that we help people with. Like we oftentimes meet doctors that are very aggressively paying down their debt. They're incorporated, so every dollar they take out of their corporation, they lose $0.30 to taxes, and then they're going to pay off a debt that currently might be at around 4%, I don't know. But it's like you're going to spend $0.30 off taxes to then pay down something that you're accumulating $0.04 per year. We start looking at those things, and I did a plan for some clients who we looked at, they wanted to accelerate their mortgage, they wanted to pay it off in two years instead of five, I think. And we showed them by leaving that money inside of their corporation to compound tax efficiently pre-personal tax, so slowing down their mortgage just by a few years, they were going to have an extra $2 .illion in retirement. And that $2 million means extra trips, bigger legacy, you know whatever that looks like for them just by that one thing of like being really smart with how they take their money out of their corporation. So I can now, I think, answer the corporation question.

Dimitre Ranev: [00:33:35] Yes. And I'll get back to that issue you're talking about. Go ahead.

Galen Nuttall: [00:33:38] Yeah. So I was on another podcast recently and they said, like, I'm not in the financial planning group for physicians because I'm not a physician. But one of my clients did say, like, there seems to be a hot topic in there. I mean, there's a couple of hot topics in there. One would be should you own occupation disability insurance or not? Like I've heard that that's kind of a big thing. Whole life insurance obviously is a huge, divisive, polarizing topic. And the other one was whether you should incorporate or not. And I was like, this is really like, or even if if you should incorporate or not. And I was like, I mean, all my clients are incorporated. The times when I would say that someone doesn't need to incorporate or doesn't need to rush to incorporate, at least from a financial planning standpoint, like incorporation has a legal and an accounting standpoint, I'm going to talk about the financial planning standpoint. So if there's a legal or an accounting reason, that's not what I'm talking about. But from a financial planning, investing, savings standpoint, typically if someone is spending every last penny they make, it doesn't make sense for them to incorporate because you're not really, like the government a few years back there's a thing called integration where basically what they said was they didn't want people to be able to earn money into a corporation, then bring it out personally and be better off than if they didn't have a corporation. Right? They didn't want to penalize people who couldn't incorporate. So they got really, you know, certain things like you used to be able to pay yourself a dividend that you'd save a little bit or you'd sprinkle money to your kids and split income with your spouse, like there are all these things that are really quite diminished now. So like if I meet a physician and I haven't met, I mean, I don't, I mean if I meet a physician who's very early on and they say to me, Galen, I do want to pay down some debt aggressively, I need to buy a house, I need to buy a car, you know, it's my first year in practice, I might say, You know, don't be in necessarily a rush to incorporate if you think you're going to spend everything you make. Because basically you're paying a fee to incorporate from a legal standpoint, you're paying a fee to file your corporate taxes and your personal taxes. So it's like, do you really need that extra cost, which isn't a ton of money, but it is money and it's like, is it worth it? But the vast majority of physicians, I mean, it makes complete sense for them to be incorporated. Although I will say, like I give a talk about incorporation and I say a corporation can either act as a sale that you add to your financial ship that speeds you forward to your destination or an anchor that slows you down from getting to your destination. And the anchor comes into play when people save money inside of their corporation and they don't do anything with it, or they put it into something like a GIC where they're going to lose half of the growth to taxes or they put their money in something like US dividend bearing stuff where they're going to get, the growth is going to get penalized and all these other things. So like the caveat to the generic rule of thumb that I, the accountants that I know say, if you don't need the money, leave it in your corporation. But far too often I meet people who leave it in the corporation and they don't do anything with it. And it's like, okay, you save taxes, which is nice. But there's also this thing called inflation that is eating away at the power of your money if you're not doing anything with it or if you're just invested in very conservative things, you're losing half the growth of taxes and you're not even keeping up with inflation. So that's the caveat to it all. Like you want that corporation to act as a sail. Tax efficient things that are going to push you towards your goal, not like these inefficient things that are going to be an anchor.

Dimitre Ranev: [00:36:43] I mean, how much do we lose in inflation, what, eight, 8%, -8%, just keeping it? More than that.

Galen Nuttall: [00:36:49] Yeah. Inflation, like, yeah, depending on how you calculate it, there's a lot of obviously a lot of talk out there as to how we calculate it and whether we should calculate it. But I mean, at the end of the day, there's ways to achieve tax efficient compounded growth inside of your corporation where it's pre-personal tax. And we've already talked about this, but I mean I'm going to hammer it into the ground, is that every dollar you take out of your corporation like you're losing quite a bit to taxes. And I get why we pay taxes, I'm not saying we shouldn't pay taxes, but if you have, the beauty of the corporate structure is the flexibility on how you pay yourself. Because if someone's just an employee, like if I were, if I'm an executive, well, I'll just say this, if I'm an executive at IBM and I'm not incorporated and the government pays me 350,000 a year salary, I'm going to lose so much of that to taxes. If I'm a physician with a corporation that bills 350,000 a year and I only need to live off of 90, I get to keep a whole bunch of money pre-personal tax to compound for me for the future. So it's really a, I mean if you use it effectively, it's it's an incredible bonus.

Dimitre Ranev: [00:37:52] It's a gift. It's a gift. I mean, I keep saying this, it's a gift to physicians. And I would add the GICs are doing slightly better this year because interest rates.

Galen Nuttall: [00:38:01] Yeah, GICs, they're looking great. I mean when GICs go up, mortgages go up. So you'd have to see. Like I have a client that got a mortgage yesterday for 3.6%. And the mortgage that I got five years ago is like 0.95. But that's back when GICs were doing like 0.85 and now GICs are doing 4.5. So, I mean, actually, yeah, I won't go much into the mechanics, but we are going to see a huge shift in how returns are achieved in the markets because for the longest time, none of our, next to none of our return came from fixed income, for like a very long time. Because things like GICs and treasury bills and all these things that used to sort of prop up a portfolio, were doing nothing. So you had to get all your money from, or most of your returns from higher risk stuff. So it is going to shift a lot of how we get our returns, at least for a little while.

Dimitre Ranev: [00:38:49] I think that's what's so, yeah, that's what's so exciting.

Galen Nuttall: [00:38:51] Yeah, it's all a spiderweb. Like one thing moves, another thing moves, like it all, it all kind of moves together.

Dimitre Ranev: [00:38:56] That's what I love about the market. It keeps shifting and going around. I just want to finish off by saying the whole debt thing, because so I come from Eastern Europe, right? And communist country, right? So that was like a sin. Like it's, you don't go in debt, credit cards. I remember when I when I came to Canada, credit cards were like the devil, right?

Galen Nuttall: [00:39:20] No.

Dimitre Ranev: [00:39:21] And the thing about it, and that's why it helps to have somebody talk to you through things about your belief systems, is there's some bad debt, but there's some good debt. And that's where talking to somebody like you, where you can actually show the math of what bad debt is and good debt is, and and change that belief system, which is untrue, is very valuable. So I want to thank you for taking the time to talk today. I hope I can have you again. I think you're very knowledgeable and you explain things very well. And I have so many questions for you. Is there anything you want to add before we end the podcast? I have so many questions, but we we have to keep the time.

Galen Nuttall: [00:39:58] Yeah, yeah.

Dimitre Ranev: [00:39:59] So I know that you might be training to run a triathlon. So if that's still the case, I wish you all the best, I wish you good luck and thank you for your time today.

Galen Nuttall: [00:40:08] No, thank you so much. This was great.

Dr. Kevin Mailo: [00:40:11] 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.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 Marlies van Dijk, founder of Alberta Health Services Design Lab and Lead of The Pivot Group, to the podcast to talk about human centered design and how to truly innovate for change in health care.

Marlies felt a restlessness in her nursing career that became the realization that she couldn’t influence the change she wanted in the places she was working. She moved jobs a lot, constantly innovating, and then came up on human centered design thinking and started the Alberta Health Services Design Lab. Marlies truly desires innovation that affects change in real ways.

In this episode, Dr. Kevin Mailo and guest Marlies van Dijk discuss what the three box solution to effective innovation looks like, why true change must prepare to bump up against organizational inertia, and how Marlies balances delivering results in her day job while pushing for new change on the side. She addresses how to safeguard time, why not joining committees that are the same old bureaucratic process is better for her, and shares very practical ways to communicate with immediacy between the members of your team. 

About Marlies van Dijk:

Marlies van Dijk currently leads The Pivot Group. Marlies is a registered nurse and has worked as an innovator and change agent in the health and care system. Her most recent experience was as founder and leader of the Alberta Health Services Design Lab. She led this to design new service models across all corners of the health care system. Prior to that she worked in British Columbia to improve care across 25 hospitals in 7 health authorities. She has worked with many national healthcare organizations to improve health care and services. Her passion is co-design as a way of working and hopes to apply her skills to the creation of a world class eating disorder treatment facility with clinicians, patients, community, and government. 

She loves the outdoors and feels most alive when she is on her bike (yes, she is Dutch too!)

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Physician Empowerment: website | facebook | linkedin

Marlies van Dijk, RN and Lead of The Pivot Group: the pivot group | the design lab | linkedin

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 very excited to introduce to you Marlies van Dijk. And Marlies is... you know, Marlies, before I talk about you a little bit, I'm going to say it's a little hard to kind of describe what you do because you do so much and you've had such an incredible career and you've built so much. But Marlies is the founder of Alberta Health Services Design Lab, which is kind of an in-house console consultancy for the Alberta Health Services health care system, essentially for Alberta to help on leadership and direction. But then, as Marlies has grown as a leader in health care, she's now stepped out and formed the Pivot Group, which is nationwide. Super exciting. And every time I talk to Marlies, I'm learning something, I'm inspired, and I am so, so glad Marlies, to have you here today. So can I get you to just start with a little bit about yourself and your journey and how you got here?

Marlies van Dijk: [00:01:39] Yeah, for sure. Thanks for having me. So I started out in nursing and I realized very quickly that I was a cog in a wheel and that I could not influence the change that I wanted to make. And I started working in the nonprofit sector, working grassroots with marginalized communities. And I absolutely loved it. But I quickly felt that I wasn't growing there either. So I went back to the health system and I started leading large scale change initiatives with national organizations, things like, say, for health care now, etc.. And then I went to British Columbia for a while. So I change, you know, quote/unquote, jobs every five or six years. I'm not one of those lifers, which I'm very proud of.

Dr. Kevin Mailo: [00:02:24] I am inspired by the way. Inspired by the way. Keep going.

Marlies van Dijk: [00:02:29] Yeah. No, no pension is going to hold me down for life. There's no way.

Dr. Kevin Mailo: [00:02:32] Good. I love it.

Marlies van Dijk: [00:02:34] And I ended up in British Columbia working with surgeons across the entire province in 25 hospitals. And once I was finished that I came to Alberta and I was given a job because I was creative and I was like, What creative? I kind of know I'm creative, but not like in the traditional sense, like compared to really creative people, I'm pretty straight. But in the health care environment, I think I do stand out a bit that way. So I came to Alberta Health Services and I thought, Well, what am I going to do here? And then I realized there was a gap in the market inside the organization. There was a lot of improving best practice or implementing best practice, closing the gaps. But innovation was, per se, was no methodology for innovating. They talked about it, like I mean, thousands of people have the word innovation in their title, but actually doing it and how do you do it? So I stumbled upon a human centered design, design thinking, and I studied labs across the world and I said, Yeah, this is what we need to do. We need to create a design lab. So yeah, go ahead Kevin.

Dr. Kevin Mailo: [00:03:45] Tell us what human centered design is. Because, you know, the first place I kind of go is patient centered, But we realize that we're ignoring another part of that equation, which is health care providers and frontline staff. So tell us what human centered design means within our health care systems and talk to us at everything from the clinic level in private practice all the way up to large subnational health care organizations.

Marlies van Dijk: [00:04:12] Yeah, I can give you some examples that makes it more tangible. Human centered design is essentially a methodology that's pretty high level that looks at collaboratively making decisions about a product or service that would meet the need of the user. And usually it's out of the box. It is something that hasn't been thought about. We use a lot of analogies from other industries to gain inspiration, but the method is really that walks you through testing, building prototypes, and creating something that which you can feel fast with. So that's human centered design. Examples of, for example, I just came from Vancouver and we led a two day skunkworks project and we called it Hacking Wounds - the year before, Hacking Pain - where we essentially take 75 to 100 people, clinicians, diverse teams who tackle a problem from a different angle and try to come up with unique solutions and test them right then and there. You know, failing in health care is difficult to do because of the stakes, but we also put way too much time into our work six months, 18 months before we actually test it with our users or patients. And so failing is not an option because we've put this much money and time into things, like it's cost us.

Dr. Kevin Mailo: [00:05:36] The cycle is so long.

Marlies van Dijk: [00:05:39] It's so long. Yeah.

Dr. Kevin Mailo: [00:05:40] When I think about starting my companies, it's like, Oh, try something. And if it doesn't work, try something else. But that happens very quickly and at low cost, right? Because as you said, the stakes are high in health care because we deal with patient care.

Marlies van Dijk: [00:05:54] Yeah. And I think human centered design is a method that that is a - well, it's well known to be the innovation method - but we haven't created a lot of space for people to work in that way, in part because we're all about evidence based practice, return on investment, you know, show me the impact.

Dr. Kevin Mailo: [00:06:12] Productivity, output, volume, measurable. Quantifiable.

Marlies van Dijk: [00:06:17] Yeah.

Dr. Kevin Mailo: [00:06:19] Values.

Marlies van Dijk: [00:06:21] Exactly. And I mean, if you look at the three box solution, which I'm a big fan of, which tells you that future customer base is future models or delivering service, you have weak signals telling you something might be doable, but you're not 100% sure. Like, you know, virtual care. Before COVID, we were like trying to ignore it at all costs, right? The US had embraced it long before us, but now we're actually finding that, oh wow, we can actually provide the care virtually in many circumstances. But why did we not look at that sooner? We know it's more cost effective. People don't have to travel. But it's, in essence, we haven't cultivated the space for us to innovate because it's a different skill set than implementing, you know, evidence based practice where you know, what needs to be done. You have a list, right? It's proven and future work and delivery models are not proven yet.

Dr. Kevin Mailo: [00:07:21] And talk to us about the three box approach just in brief. I mean, I just love new ideas out there and get people to look at the world differently. Not in any great depth. Tell us, give us an overview.

Marlies van Dijk: [00:07:34] So three box solution, which I'm in love with, is incredibly simple. So if you Google it, you'll find some great videos. The author talks about we have box one, that's day to day operations. It's what, you know how to operate a hospital. You know how to deliver services at scale. You know your business. We're very good at that. Box two is what is it that you can let go of to create the space to actually look at new service models and new potential future customers? So that's the letting go of phase. You know how we have trouble letting go of things? Everyone does. So you actually have to take some time to figure out what you can scrap so you can create space. And that third box is really about - and he says it should be between 10 to 20% of any organization - should have dedicated resources and people that look at weak signals. There is no recipe, there is no proven methods for how we're going to move forward, because most of our problems are very complex, right? We're not dealing with just taking out an appendix for most of our health issues. We're talking about chronic disease management, delivering care to rural communities. Those are complex problems that it all depends on the local resources to know how you're going to navigate that. So that's a quick summary of the three box solution.

Dr. Kevin Mailo: [00:08:56] I love that. And let's shift gears a little bit. And one of the things, so Physician Empowerment, we host a lot of educational events. We've got monthly small groups with a small group of physicians where we tackle aspects of practice or health care or finance. We also have our national conferences and other events like that. And, you know, whether it's in the formal discussions or a hallway conversation, you know, somebody next to the coffee urn is talking about the culture of large organizations. And specifically what I'm getting at is the struggle to overcome organizational inertia. Right. Like an object at rest wants to stay at rest. And so, you know, and it's a source of burnout. It is because I've heard many physicians, especially kind of mid-career, you know, 10 to 20 years in where they came into the profession, they came into health care - and this applies across the board, it's not specific to physicians - they've come in with a certain energy, a certain zeal, a desire to go beyond patient care, to build better systems, to improve delivery, and being people centered is part of it. And they come up against organizational inertia. And I've heard this from doctors coast to coast. I hear it from American physicians as well. And so what does a physician in that position do when she or he is in a leadership role and they're trying to say, okay, how do we break past this organizational resistance to change? Even thinking about new ideas, it's not, you know, it's not even a case of like getting to change and taking steps and trying something new. It's like even having the discussion of could we do things differently? It's like we're going to shut that down.

Marlies van Dijk: [00:10:54] Yeah, well, I've lived it my whole life up until very recently. I've survived in the health authorities across Canada until now, and I decided to leave on my own fruition, believe it or not. But a couple of things. And I of course, I'm super passionate about this, but the first thing to know is you need to find some others who are like you, which sounds easy, but it's not, right? You need to find some fellow, and I call them rebels. I know for some people that might be too much, but you need some people who are innately dissatisfied with the status quo. But they are hopeful because if you're dissatisfied with the status quo and you are miserable and don't see any hope, then you know that's not fun to work with. So you need people who have not given up the spirit. I also have learned over time that you have to avoid the formal structure of a health organization. You have to do it on the edge. This is not something that's going to be in an operational plan. This is not going to be approved by the CEO with the multi year implementation plan. Real change happens on the edge where you start small with a group of people and see if it has some legs before you start talking about it. And that is hard to get your head around in the way that you feel like you're manipulating the system, which is exactly what you're trying to do. You also need to really embrace the fact that you're not going to be super popular. I knew from day one that people thought I was a loose cannon, wildcat, tornado. You know.

Dr. Kevin Mailo: [00:12:34] All compliments, by the way, as far as I'm concerned. All compliments. I love it. Just keep rolling them off.

Marlies van Dijk: [00:12:39] I remember talking to a leader and I said, hey, I want to do this. And she said, Walk to the elevator. She goes, Marlies, two suggestions for you. Watch your back, first of all. And second, you need to learn how to walk before you fly. She opens the elevator, steps in, and goes up. And, you know, I stood there and I said, No way in hell am I not going to fly. So you have to really believe in yourself in the sense that you can, that you're not going to back down to keep the job, to keep the pay. Although I have to say, I have really focused and I've told you this earlier, people said, how come you haven't gotten fired? Like, how is this possible?

Dr. Kevin Mailo: [00:13:19] Love that. Love you.

Marlies van Dijk: [00:13:20] And it's an interesting question. I, I think I really, the reason I've survived is I'm quite a doer. I'm action oriented, so I deliver. So I've always made sure that I'm focusing on something that people know, Oh, Marlies does that. Oh, she delivered that. Yet on the side, I do my innovative stuff and I change stuff. So I make sure that I'm not just all about innovation and trying new things. I actually have a day job. And on the side is where you try these new things. And then the very last thing that is really worth mentioning is accepting this fact that people might not like you, they might think you're likable, like I think people think I'm friendly and they can laugh with me, but they know it's, you know, they're not quite sure what to make of me.

Dr. Kevin Mailo: [00:14:09] It's coming.

Marlies van Dijk: [00:14:10] Right. They're like, Oh, God, what's she going to say? Yeah, but managing the discomfort and being really, like, comfortable with getting the answer no. Like, I didn't care. Like, I would get ten no's, I didn't care. I'm like, Yeah, okay, I knew that was coming. All right, go around this person. Go talk to so-and-so. I'm going to manipulate so-and-so and I'm going to talk to so-and-so. And I was continually navigating.

Dr. Kevin Mailo: [00:14:35] It's a hustle, It's a hustle. I love it. It's a hustle.

Marlies van Dijk: [00:14:41] Right. It's a huge hustle. And some people aren't hustlers. I am a natural hustler, like I am an extrovert.

Dr. Kevin Mailo: [00:14:50] I am totally a hustler. Love it. Yeah. You and I are very much on the same wavelength.

Marlies van Dijk: [00:14:56] Yeah.

Dr. Kevin Mailo: [00:14:56] Yeah.

Marlies van Dijk: [00:14:58] And so, I mean, I think I also knew that I would get down, like there was times where I was completely deflated, demoralized, burnt out. But I took those those times to recharge and to forgive myself for not succeeding and to lay low for a little while. And then I knew my energy would always come back. And it did again and again. So I just was sort of watching my cadences. And I also knew with my supervisors, because I did have them, believe it or not, that I would need to make them happy too, and make them look good. And I, I focus on that quite a bit. But then, you know, I would time my jabs or time my challenges so that I wasn't burning out my supervisors with me as a nutbar employee. But actually, you know, she's delivering. Oh, and it's worth listening to her at times when the message isn't what they wanted to hear.

Dr. Kevin Mailo: [00:15:55] I love that. And I think it's also important, as we're trying to invoke change, is to focus on core values. Right? Like this is about making things better for patients and frontline staff. I feel like that's always a centering, that's always a great centering point. It's like, listen, I know we're disagreeing here and I know you didn't want to hear it, but I'm just trying to tell you that this, from my perspective, is a step forward in patient care or a step forward in caring for our burnt out frontline staff.

Marlies van Dijk: [00:16:30] Right. And just even to build on that, doing a 'Yes and', is people quickly realized I wasn't a climber. They knew, once they realized that I was not there to try to climb the the bureaucracy which is what most people are into, let's just be honest.

Dr. Kevin Mailo: [00:16:46] I'm not. But yes I get that.

Marlies van Dijk: [00:16:53] Yeah. Yeah. Yeah, exactly. So once people realized I wasn't in that game, that's a whole other game, you know, that's a Game of thrones. Like, you know that, like it's like, it's cutthroat, killer. I wasn't part of that. So, for example, if I did a project and I wasn't acknowledged or I wasn't thanked, I didn't care and I honestly didn't care.

Dr. Kevin Mailo: [00:17:18] You know what, though? Clearly you're making waves because here you are on the podcast, right? Right. But I mean that, I mean that, right? Because actions speak louder than the words of an email or some little placard or whatever have you.

Marlies van Dijk: [00:17:33] Well, and I think too, I started to realize you could influence without being high up in the hierarchy, even more influential potentially. And they talk about the 3% influences 80% of the organization. You can be an influencer without that position. And so I when I first came to Alberta Health Services, I started tweeting, and I was like, Why is no one talking outside of the formal email process? And that was fairly new in 2015 and comms just talking about we can do better. And health care suffers from X, Y, Z. I have been told by the communications team that I walk the line just right, just a fine line. I say enough about generally speaking and health care. I don't point fingers. But I learned how to be critical yet hopeful and not pointing fingers. So just that wasn't a role navigator. And so my voice mostly came to me through social media. I didn't wait for a committee meeting or something, you know.

Dr. Kevin Mailo: [00:18:42] Oh, exactly. Right? And I think the other thing is, is focusing on actions, not individuals when we're directing criticism. Right? Or focusing on the process, not on the individuals that set it up or run it, because that gets very emotional when we personalize like that. And there really isn't any role for that. Do you know what I mean? Like.

Marlies van Dijk: [00:19:03] No. Absolutely.

Dr. Kevin Mailo: [00:19:04] I don't think it moves anywhere when we start getting into finger pointing.

Marlies van Dijk: [00:19:09] Exactly. And I also think, to build on that, is I was invited to many committees and I actually have a rule that I don't join committees on a regular basis, like I'm not a member.

Dr. Kevin Mailo: [00:19:22] You'll come in, you'll speak.

Marlies van Dijk: [00:19:23] A committee land for me is like, no, no. But I got invited to an innovation committee and I was like, Oh geez, I'm innovation. I guess that makes a lot of sense. And oh, there's a there's some VP's there. Oh my God, VP's this is Whoa. I went to the first meeting and I realized this is nothing about innovation. This is just another bureaucratic process of committee meetings. And I knew that the end game, there was nothing there. I could sense it. And so I actually resigned from the committee after the first meeting. I wrote a nice note. I apologized, but I'm --

Dr. Kevin Mailo: [00:19:59] Yeah, powerful. You know, you're your most important resource.

Marlies van Dijk: [00:20:02] Yes. My time is really important.

Dr. Kevin Mailo: [00:20:03] Where are you gonna spend your time?

Marlies van Dijk: [00:20:04] Yeah, yeah.

Dr. Kevin Mailo: [00:20:06] I love it. I mean, it's wisdom for all of us in health care. We're the rate limiting step. If I'm busy translating the Bible into Klingon, I'm probably not doing something else more important.

Marlies van Dijk: [00:20:20] Yeah, it's easy to get sucked into the way things, the way they design change. And I, somebody in the hallway saw me shortly after that, and they said, How did you get out of that committee? I want to do that too, but I can't. And I said, well--

Dr. Kevin Mailo: [00:20:36] You run a course on that.

Marlies van Dijk: [00:20:38] -- why can't you? Like, let's get real here. It's all a figment of our imagination. What's happening there? Like, it's just fluff. And I just made really careful calls on that without, you know, offending anyone.

Dr. Kevin Mailo: [00:20:52] I just say I think I'm more effective not being on the committee. Right. Like, politely declining. I like that.

Marlies van Dijk: [00:20:59] Yeah. And call me, call me when you need me. I'm here.

Dr. Kevin Mailo: [00:21:02] So talk to us about practical ways to communicate. And let me just send my big gripe. I hate email. I think it's a giant step backwards in human communication. Like I feel like spoken language, written language, the printing press, really great developments in human evolution. Email was like a step back because how do you address a complex issue going back and forth over an email string with like five other people on it? Right? So for those of you that email me personally, you'll find that I have on my signature line a little thing that says, I never check this, I'm real hard to get a hold of. And so I'm old fashioned. I want to pick up the phone or go meet with somebody because if it's something complex, it's probably best addressed that way. But that's just one example, and that's my own personal perspective on it. I mean, in the end, yes, emails have to go back and forth and in the end there has to be some kind of formal written summary of what was said, what was decided at meetings or whatnot. But in the end, I think we're just so much more effective when we communicate verbally or face to face.

Marlies van Dijk: [00:22:08] Right.

Dr. Kevin Mailo: [00:22:08] So talk to us about some very practical approaches. I mean, we covered some of them, but I want to hear more because this is, these are the things that that courageous health care leader listening to this podcast who wants to do more, wants to get out there, wants to begin hustling to improve their health care system, but what does she or he need to really hear on the how? You know. What do they need for tools?

Marlies van Dijk: [00:22:31] Well, I always, you know, made it my mission to get, to have a relationship with the highest person in the organization. And you can imagine that wasn't going to happen through email. So I would use Twitter or LinkedIn. So DM people directly. And ultimately texting is of course, my love. But I, you know, my teammates at Pivot, we communicate through Discord. You're probably wondering why, we just picked Discord because some people are on it. And actually I love it. It's instant. But of course I'm not in a health organization. But when we were in a health organization we used, of course, Slack, and methods to communicate quicker about logistics. Like you don't want to email logistics. That's just painful. Right? But I did have one of my teammates say, You know what? I got a text from you, I got a tweet, I got a...

Dr. Kevin Mailo: [00:23:26] There we go.

Marlies van Dijk: [00:23:27] And I was like, Yeah, this is yeah, I am a little bit intense at times. Answer me, no. So I think just also what I've learned is just having fun with your teammates like at the design lab, we were like family, like it was crazy. We fought like cats and dogs and and still loved each other. So being able to create a relationship in your team where you actually really like each other and appreciate each other for who you are allows you to work much faster because you can say, Oh my God, I'm sorry, but this PowerPoint needs some help. People don't want to give negative feedback very easily. And we talked about radical candor on my team and we would have to detox people when they joined the lab because they were, the bureaucratic detox, right. Like, and the first time someone, you need to be able to challenge the boss. If you're not challenging the boss and your team, you do not have a psychologically safe team and your products are probably crap. Because no one wants to say, Hmm, I want to--

Dr. Kevin Mailo: [00:24:34] -- throw this one in the trash. Let's start over.

Marlies van Dijk: [00:24:36] Yeah, Yeah. And so I have, I think people, I've been told have never worked for someone who gives this kind of feedback, like, ever. And I'm like, Wow. Like, do we just go along and say, good job? Good job, employees, you're awesome. And yet the work is shit and you know it. So intervening early to create that iterative feedback about what about this and what about this and how can we make this better? I think it's a culture of where you can, everyone can improve the products you produce because I've seen in formal systems people can work for eight months on something and it's not good, but it's too late to comment because you've spent that much time.

Dr. Kevin Mailo: [00:25:19] Yeah. It's like a rocket that's never going to launch. I'm never going to launch properly.

Marlies van Dijk: [00:25:25] Right. And I think the Gantt chart and the project management planning for complex problems is an absolute joke. It's like it's a human system. You think you're going to map out for six months what you're going to do? Like what planet are you from? Like, that's never going to happen. So I have a joke on my team, like if a leader is really into Gantt charts and project management, go to Google. There's tons of templates. I want you to spend half hour on a Gantt chart, make it look good with colors. They love red, blue and yellow for some reason. Do a dashboard, put it in front of their faces and they'll come right down, like they see order. They see a plan. Because that's what we're trained, we're trained to think, you know, and good business etiquette is a plan. And so, I mean, I'm sounding horribly manipulative, but that's how we kind of work. We feed the the top, you know, a really canned project management plan. And then underneath you work more in an agile way where you're not living to that Gantt chart because you know you're going to get information within two weeks that's going to throw your whole plan into the garbage. So we play the game. You have to play the game on the outside and have another game on the side.

Dr. Kevin Mailo: [00:26:41] Love it. Now, here's one more one that I'm going to put you. And I think we can just keep going because I absolutely love this. Absolutely love it because I'm passionate about seeing health care done better. You know what I mean?

Marlies van Dijk: [00:26:54] No, I get it. Yeah.

Dr. Kevin Mailo: [00:26:56] Let me be blunt. Let me let me follow your path. When we talk about closing down beds because we don't have adequate staff, that's kind of like the airliner that you're about to board, that you're boarding, it's about to go for a transatlantic flight, and they're like, oh, by the way, three out of four engines are working and we're down a few crew members, but we're pretty confident we're going to get through our transatlantic flight, you know? So I'm passionate about seeing things done better. And yet the issue is that I feel like health care is always in crisis. I mean, you know, there's no margin within the system. And I hear this coast to coast from Canadian physicians who are like, yeah, I want to do change, but as a leader, I'm putting out fires all the time, right? As an organization, we're putting out fires all the time.

Marlies van Dijk: [00:27:47] We're designed. Yeah, we're designed to not be in the news. That's what we're, that's how we operate. How can we not have a headline that makes us look bad?

Dr. Kevin Mailo: [00:27:56] Yeah. So how do you get past that? That crisis in front of us a week, a month ahead from now, and really make space mentally, emotionally and in our calendars for real change? Do you have any ideas?

Marlies van Dijk: [00:28:14] Yeah, it's a really tough one. If you are a full time clinician, it's going to be hard to carve out space because the mountain of work and the mountain of people is just growing of who needs to see you. So maybe going back to that three box solution, finding out what you can let go of and actually creating time and space to be, to bring bring people together to look at different ways of skinning this cat. We're holding on to old models, right? Old models of delivering service. It's clear we cannot ensure that every Canadian has a family physician. I know that might be like a gas for some people listening, but with chronic disease rise the age, the cost of the system--

Dr. Kevin Mailo: [00:28:59] Oh if you've seen what I've seen in the ten years that I've been in practice or so, I say, Wow, it really, really changes. I mean, sorry, I'm just going to interrupt because--

Marlies van Dijk: [00:29:08] Yeah, yeah.

Dr. Kevin Mailo: [00:29:09] Like you get a young person, like in the emergency department where I work, you know, a young person, 25 years old, has a fall. I mean, you may, they may dust themselves off and you may examine them, they may not require an x ray. Right? And yet, if that same person was an 85 year old on a blood thinner that has a fall, like they're getting a lot done in the emergency room. Yeah, a lot of time there. And then they're getting admitted. Right? And so, you are absolutely right when you talk about like, how are we going to, how are we going to service an aging population with a growing list of chronic diseases?

Marlies van Dijk: [00:29:46] Yeah, it's going to like, you know, I'm from Europe myself. I grew up there and I go there a lot. And, you know, when we're spending 85% in the last year of life, we need to start asking ourselves is, is that what we should be doing? And what about, what could we not potentially do and how do we navigate that? Why are people dying in the ICU? I've heard numbers up to 84, 85% of non reversible deaths are happening in the ICU of acute care facility. And it's like, that's $4 / $5,000 a day when it was not reversible. We know these things, right? So, I mean, there's, this is a huge conversation, but...

Dr. Kevin Mailo: [00:30:28] These are big conversations. But it starts by having the conversation for change.

Marlies van Dijk: [00:30:35] And to challenge people. But I think in the end, making sure that you don't burn out is number one. Tackling something that you can make your project that you get some satisfaction from because you say to me, oh, you've done so many great things and I feel like I've barely done anything. Like I'm hard on myself. And most innovators and entrepreneurs and change agents are. They're like this is pathetic. What have I done? And that is the part about being a change agent. Like, I remember seeing one of my VP's in the cafeteria one day and I was talking to him and I was like, on fire. I was in a great mood and all of a sudden he goes, Wow, are you not happy in your job? And I said, What? What are you talking about? And then I realized, Oh, no, this is, I'm wired this way. I'm dissatisfied with the status quo, but I'm willing to tackle it. But he wasn't used to it, like he he thought, you know, he was surprised that I sounded the way I did. So that is, that is definitely a criteria for being a change agent, that you're not happy.

Dr. Kevin Mailo: [00:31:47] I love it. I absolutely love it. Marlies, I want to just keep going. But I know we have to wrap this up, which just means we'll have to get you on again to talk about these issues because there is such a hunger out there with physicians who, you know, physicians and other health care providers who are passionate about what they do and the system they work in. And they want change. They want tools. And you often feel alone in this, but you realize you're not. And the wisdom that I'm going to, I'm going to take away is, find those allies, find those people that are like minded as yourself, and begin to connect with them and see what you can do to start the conversation.

Marlies van Dijk: [00:32:28] Yeah. Find your wolfpack.

Dr. Kevin Mailo: [00:32:30] Yeah, I love that. Love it. So again, Marlies, I really want to thank you. And for those of you that are interested, again, it's The Pivot Group that Marlies founded, which is her national consultancy, and it's really incredible.

Marlies van Dijk: [00:32:44] Thanks for having me, Kevin.

Dr. Kevin Mailo: [00:32:45] Thank you so much.

Marlies van Dijk: [00:32:46] Bye.

Dr. Kevin Mailo: [00:32:47] 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 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 KMailo at PhysEmpowerment dot ca. Thank you again for listening. Bye.

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Dr. Kevin Mailo welcomes Dr. Mandy Brisebois, physician and Certified Health and Wellness Coach, to the show to address the reality of interpersonal conflict and how to resolve it. Dr. Brisebois specializes in helping practitioners work through conflict and shares her experience with listeners. 

Dr. Brisebois clarifies that conflict is the end result of missing the boat on necessary steps that come beforehand. She identifies that communication, collaboration, aligned expectations, and knowing each other’s goals are all conversations that should be happening amongst colleagues in order to avoid clashes. However, knowing how to resolve conflict when it does arise is vital, especially in pandemic times of stress and overwork.  

In this episode, Dr. Kevin Mailo and guest Dr. Mandy Brisebois discuss how to address conflict or tense exchanges in the moment, with Dr. Brisebois offering ways to change how we think about the exchange and how to open conversation before walking away. Dr. Brisebois shares what process she has learned to identify conflict, how she takes people through conflict resolution, and the necessity of psychological safety in the workplace in order to foster the communication required.  

About Dr. Mandy Brisebois:

Dr. Mandy Brisebois uses her influence in high level leadership positions to advocate for physician integration into our health systems. Ultimately a deeper understanding of our complex systems will enable physicians to maximize their impact and promote patient care in the most effective capacity. Ultimately this strategy contributes to less conflict in the work environment, and fewer practitioners modifying their practice due to burnout.

Dr. Brisebois is a certified Wellness and Executive Coach (with specialization in healthcare in process), a General Internal Medicine and Palliative Medicine Specialist, as well as having extensive training in conflict, negotiation, mediation, equity, diversity and inclusion. She has served as the Medical Director for a large 290 bed hospital, the Medical Director of the Covenant Palliative Care Institute, as well as an Associate Chief Medical Officer of Covenant Health. She is completing her Masters of International Health Leadership through McGill University and has trained at multiple world renowned organizations including the Mayo Clinic, Berkeley, Oxford, UBC, and the Justice Institute of British Columbia. Her leadership specialty is helping practitioners and teams find success through conflict, and learn from these successes to create happier, more efficient and more effective healthcare teams. She has spoken at many international events, and she is a published author in her fields of expertise.

Resources discussed in this episode:

• Canadian Medical Association statistics on physician wellness
• Crucial Conversations
• Edmonton Zone Medical Staff Association

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Physician Empowerment: website | facebook | linkedin

Dr. Mandy Brisebois, MSc, MD, FRCPC, AoDI, CEC: website | 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 Phys Empowerment.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. Kevin Mailo: [00:00:35] As I've mentioned before, for those of you that have joined us on our webinars or podcasts, you know who I am. I'm Dr. Kevin Mailo, one of the co-hosts of the Physician Empowerment Podcast and one of the co-founders of Physician Empowerment, and who I have with me today is a colleague and a friend whom I really admire, not only for her clinical work, but for her incredible leadership. So joining me today is Dr. Mandy Brisebois, and Mandy is a general internist with a hospital based practice. She specializes primarily in palliative care and chronic disease management, but she's also held numerous leadership roles, including Associate Chief Medical Officer and Medical Director at a major community hospital. And Mandy, over the course of her career, has really taken leadership to another level. And one of her areas of focus as a medical leader is conflict resolution. And so that's what we're going to be talking about. And it's going to be interesting because we get a lot of training in medical school and residency on how to navigate a difficult patient encounter. But what we're going to focus down on today is interpersonal conflict between physicians. And I don't need to go to any great length about how common this is, but we certainly know what occurs. And with that being said, Mandy, why don't I let you take it from here as far as introductions and where you want to want to go with our talk today.

Dr. Mandy Brisebois: [00:01:58] Sounds great. Thank you so much, Kevin, for having me here. And it's just been such a pleasure to talk to you. I wanted to be on this show and also really specialize in this conflict work because I think we're in a really bad spot and physicians have been through a really tough time through the pandemic. We've been bogged down and a lot of us don't have much capacity to really be on our best behavior all the time. And I don't think in medical school we get taught how to manage conflict. In fact, I know we don't because in my role as medical director and the ACMO role, I had to manage so much conflict with colleagues and I had no idea what I was doing. And it wasn't my fault. And I thought for a long time that it was my fault. And so I went and got training and this is why I've got so interested in it, because I've got extensive training now in conflict negotiation and mediation. And I realized that there's a process and that we actually can learn how to take care of conflict.

Dr. Kevin Mailo: [00:02:58] Awesome. So what are some of the contributing factors then to conflict? Like talk about the ingredients for interpersonal conflict. I mean, one of the big ones coming out to me is like limited resources, right? For physicians as we try to deliver the standard of care to our patients. But tell me a little bit more about what do you think contributes to a conflict prone environment for health care providers?

Dr. Mandy Brisebois: [00:03:23] That's an excellent question, and I love that you bring up the resources because it's typically what we go to is what's limiting me. And the conflict, usually I say if we have conflict, we've kind of missed the boat. Conflict is the end result. The beginning is the communication, the collaboration, the expectations that are aligned, actually knowing what each other's goals are and having those conversations. And because we haven't really been taught how to do that, we end up just going, I don't have enough resource or I can't take care of my patient. And we shrug our shoulders and then we say to somebody, Give me more resources. And we don't actually know how to talk to them about what is the problem. And we don't know in the moment to say to someone, let's say a physician colleague talks to you in a very terse way, how do you manage that rather than walking away kind of thinking, Well, my day is really bad. I'm just going to, it's going to get worse now. Instead of talking to them in the moment and solving it and then it's over and you know your colleague better and your day is actually better when you learn how to solve those in the moments and you learn how to actually go through the problems and see what they are. It's not just about a resource thing. You have to actually nail it down to a solvable, neutral problem that you can solve. And it takes a lot of work and skill to figure out how to do that. And so I think we need to practice on it and learn how to do it.

Dr. Kevin Mailo: [00:04:47] So finding shared interests then is a key part of this.

Dr. Mandy Brisebois: [00:04:51] Yeah, and especially with big organizations, I keep saying that we are part of these massive organizations now. They have multiple strategic plans. Most of the time we're not really aware of what the strategic plans are, and so we want a resource. We don't know where it fits in our organization's strategic plan because we haven't, well, maybe we haven't looked at the Internet. The expectation that we're supposed to look on the Internet hasn't really been connected to us either. And even our leaders aren't really sure, like, what am I supposed to give to my colleagues? What do they care about? How do I connect the organizational goals with our goals as physicians? And when we don't connect, then we don't communicate. We don't know how to move forward and to really action on our knowledge, which is clinical care. And so I'm really trying to promote if we get these conflict situations under control and learn how to talk to each other about hard things that we actually learn about each other, we learn more about our jobs and we want to come to work instead of just sort of putting our heads down and walking in the door and going home.

Dr. Kevin Mailo: [00:05:55] Yeah, I think that's it. You know, as far as like when morale falls, I think a lot of people do just honestly just want to get in, get out and get through it. But that means people aren't invested in health care systems in which they work in, right. Because people sort of, I think, throw up their hands and feel disempowered. So how do you go about that process of learning to say those initial, start that conversation? I think that's probably one of the hardest steps is to say, I'm identifying a conflict here. How do we, how do we get to that point ourselves personally as individuals working within the health care system? And then what practically do we say when you talk about sharing in the moment or notifying a medical leader? How does that look? How should that look?

Dr. Mandy Brisebois: [00:06:42] It's so hard because we're not really used to it. We're not really used to responding to behavior that we're not comfortable with. And it is important to remember there's so many cultural differences between people that sometimes someone maybe seems very terse or no expression, and that just might be the way they are. So one of the things they say that if you notice something at work and somebody says something to you, let's say it seems quite aggressive because this happens a lot, someone's like, they were really aggressive and demeaning. And I'll ask them, Well, what did they say? And only 7% of what we understand are the words. So the rest of it is the tone of voice, the mannerisms. And often when they tell me the words, what they remember the words being, it didn't seem like it should be something that you would be so upset about because I wasn't there. And often when these people get feedback after the fact, they don't know what they did either. So what I tend to do is if someone, and you have to develop your own little things, but if someone says something to me in quite an aggressive tone, often I'll just do a little tear. I'm like, Oh no. Or I'll say, Ouch. Or I'll say to them, Are you okay?

Dr. Kevin Mailo: [00:07:50] Right.

Dr. Mandy Brisebois: [00:07:51] And they'll be like, What are you talking about? And I'll say, Well, this just wasn't the reaction I was expecting from you. I really thought we were on the same team. I'm worried I said something wrong. Can you tell me where you're at? And when you flip it around like that, people sort of go, Yeah, I'm having a terrible day. I've got 15 people in the Emerge, you know, what did you interpret? And I'm like, I just thought you were really upset with me. And most of the time they say, No, actually I'm not. I'm just really stressed. Thanks for saying something. Now, if they don't say that, I was talking to someone else and someone else said, What if they say screw you? And you start to think, Well, that would really feel bad. But you know what? I say the same thing because if someone says that I don't like it, that you're talking to me about this, I'll just say, But I really want to work with you. And when I got on this team, I was excited to hear what you had to contribute to the team. And for me, I can't be a part of that if I don't really understand what you're saying or I feel you're yelling at me and I want to be part here. And how do you think we can move forward? Or I'll say to them, what kind of tone of voice do you think you're using? And they'll sort of look at me and go, What are you talking about? And I had one person say, Well, I'm in the military, so I don't know. That's just how I talk. And I said, Oh, that's good to know. Like, you start to know each other.

Dr. Kevin Mailo: [00:09:11] Yeah, well.

Dr. Mandy Brisebois: [00:09:12] It's fun.

Dr. Kevin Mailo: [00:09:13] Yeah, well, that's that's what I sort of discovered as I get a little bit older and a little bit wiser. I saw personalizing things that I came across, whether that's a patient that might be irritable or an allied health colleague or a physician colleague, it's just peeling back that layer. Peeling back that layer just a little bit to find out what's going on. Because very often it's that old iceberg theory that comes up, which is we don't know 1/10 of what someone's really dealing with beneath the surface. Right? And I'll never forget watching one of the most egregious outbursts from a physician towards another staff physician when I was a medical student. And it was later in the week that he just sat down and described how his whole life was falling apart on a personal level. And that's when I realized, like hurt people hurt. And I don't think that's an excuse and to say, okay, well, we're just not going to deal with it. That's that's not right either. But it's about saying, okay, now there's another issue here, right? We're not talking about beds or discharges. We're actually talking about something else. So now we are going to deal with it. It's an opening.

Dr. Mandy Brisebois: [00:10:20] Yeah, exactly like you said, it's an opening and that person may go home and kill themselves. And I'm not trying to be depressing.

Dr. Kevin Mailo: [00:10:27] Oh, God, I completely agree. I have looked at the stats - for anyone that's listening to this podcast that I'd encourage you to look at the Canadian Medical Association statistics on physician wellness. There was a great publication that came out in 2017, 2018, and I think there is now post pandemic data that's coming out and it's staggering. And I think we all need to give one another some compassion and some space because the job is incredibly stressful, but so are many of our personal lives.

Dr. Mandy Brisebois: [00:10:54] Yeah, and don't give up on people. And I always say, just take a pause if something seems off, because after the fact, it is so hard to go over who did what and who said what. And especially if you go to a supervisor or something, we really try, it's called the Vanderbilt model, where you really start with this coffee chat and you just sit down with someone. I say, don't wait for coffee, do it right then, but talk to someone, look at them in the eyes and say, I actually care about you. I mean, you may not think I do and we're not, maybe we're not perfect friends.

Dr. Kevin Mailo: [00:11:28] Yeah, Maybe we're never going to get together --

Dr. Mandy Brisebois: [00:11:30] Yeah.

Dr. Kevin Mailo: [00:11:31] -- and go hang out outside of work. But I do care.

Dr. Mandy Brisebois: [00:11:34] Yeah. And I'm invested in health providers, whether it be a nurse, a physiotherapist or a physician. And I really do want to be here. And if you don't want to talk, just recognize. I recognize something. And if you ever have a chance to talk, I want to talk to you about it, but I'm just letting you know how I feel so you know that those things impact me at work too. And they sort of make me wonder whether I want to be here too. And when you say it that way, people start going, Oh, I'm impacting other people's work as well.

Dr. Kevin Mailo: [00:12:02] And I think physicians, we're all by and large, very conscientious. So that I think is a very powerful statement when you say you're impacting me because that that is kind of a a cue for us to evaluate our behavior.

Dr. Mandy Brisebois: [00:12:17] Yeah. And I try to make things, it's really important... I was just talking to somebody else and I said, it's so important to not tell people what to do or what they should do differently because we all want to be different, but no one wants to be told to be different, but really putting it on how it's making us feel and that it's their behavior, it's not them. That it just isn't that you think they're a bad person, it's just that moment that made you feel that way and then really focusing on the positives and you're talking about what to do about it. Well, you do that in the moment. And you know, if it doesn't work and something happens again and you do it again and it doesn't work and you have to get an adviser or a supervisor or whoever is above you involved, if you've said something in the moment, that person will not be surprised. Because you'll have twice said something and you'll say, How do we resolve this? And I'm like, Well, we're not resolving this. Well, I'm going to have to then get some help because I don't have the tools I need. And if you say it like that, like I don't have the tools I need to resolve this instead of someone getting called out of the blue with some complaint they didn't know it was coming because then they're coming into the conversation already unhappy.

Dr. Kevin Mailo: [00:13:26] Right. So, Mandy, you alluded earlier to a process. You said there are steps to go through conflict resolution. Can you give us an overview of that? I mean, obviously, we don't have the time to go into this in a whole bunch of depth, but I would absolutely love to hear this because, I mean, it's probably not that much different when it comes to care. There's a history, there's a physical, there's a lot of tests. I mean, we just we go through a process. So take us through an overview of that process of conflict resolution.

Dr. Mandy Brisebois: [00:13:55] I love this because I always say internal medicine is easy and everyone goes what are you talking about? Well, it's just you categorize things and stepwise, stepwise, stepwise. So this is exactly the thing. So I say, look, we have emotion. So we got, I call it the rant, but whatever it is, you've got to package that somehow, like deal with it. Some people have written me 15 page letters. They're like, This is great, let's send it off. Nope, this is just for you to think about. But you have to get that out and you have to be okay with it and recognize that emotions are normal and it's really hard. So give yourself that. That's the first thing. The second thing, though, is knowing where the place for that is and where the place is not for that. You take care of that and then you go through the process of conflict. I call it conciliation because conflict's never resolved. It's still there.

Dr. Kevin Mailo: [00:14:39] Yeah.

Dr. Mandy Brisebois: [00:14:40] So the first thing is what is the issue, as we say in conflict teaching. And the issue is the problem and the problem isn't He yelled at me. The problem has to be solvable and it has to be very clearly neutral. So it has to be something like if someone's yelling at you, I want to know how we communicate in the workplace to effectively get work done. And what's the process, so another problem would be what would the process be if you feel somebody is behaving in an unprofessional way in the workplace? Those both things are solvable. Both of them are very neutral. You're not using this, Crucial Conversations is a great program and it talks about victim, villain, and helplessness. And when you hear people talking about being a victim or you're a villain or I'm helpless, conversations will not occur, So it's very good to recognize that and keep everything neutral. So I spend an hour with people, actually, and outline the problems. It takes a lot of practice to learn how to do that. So you actually look through the problems, map them all out. People always come with to me with one, and there's actually 18 solvable problems. And when they look at them, they go, Wow, that's really an easy one. Like, I easily can come up with a solution to that. It's just like internal medicine. And so we do that. Then I send them home and I say, I want you to think about these problems and you tell me why you care. And this is really digging deep. It's very reflective. The why do you care if you communicate well with your partners? And it's all about I want to enjoy my work. You know, I want to be able to effectively work. I actually want to have a job. I need my job for for my livelihood. I don't want to take shifts. I'm not taking shifts now. So I'm losing money because I don't want to be there. So there's all these different things. Or it comes in it is infiltrating my family. So really, what do they care about? So then they come back. The next step is we talk about the stakeholders. So who's involved? You know, sometimes it's one person, but sometimes you have a whole team and there's multiple different people. And we go through that. And then I have the person think about what those stakeholders, they care about. And we're just guessing. But it's putting you in that position that you really think about them. And as you said before, what are they going through? They may collapse in tears when they turn the corner. You know, they may be getting separated, their child may be sick. They may be taking care of an elderly person. You don't know. So I always say, guess. Just go through it and think. And we create a, I call it a conflict roadmap, and we create this roadmap. And then I let the person decide, What do you want to do with that? And most people want to meet with the person that they had this thing with. And I usually offer to go sit with them while they're doing that, or I'll coach them through how to actually take that meeting in a really, again, really neutral, neutral language, positive way and just collaborating. And we send the person that we want to meet with, this roadmap beforehand. And it's amazing. The meetings are amazing.

Dr. Kevin Mailo: [00:17:33] Wow.

Dr. Mandy Brisebois: [00:17:34] Because physicians see that you worked so hard. I really want to be better. I really want to be your colleague and look at all the work I put into it. I want to hear your perspective. I guessed but now you tell me and then you can have a conversation about those things. I had one person come back and say, This was so amazing and someone who would never really share, they went back to their team, they shared everything and they're like, We got to get the team to do this. Because it bonds you. It bonds you together. That you both have some common goals. You see common things together. And it seems so easy when you've done it once. But it takes, it takes practice and courage and the ability and being in a safe place. And this, I keep encouraging organizations let people in your organization be in a safe place where if someone comes back at them and doesn't respond well multiple times, that you have a place to go and someone takes you seriously, that you're trying to do this. So this is the whole thing about psychological safety in our workplaces that we have to take it seriously so we can communicate in the moment.

Dr. Kevin Mailo: [00:18:38] So how do we create psychological safety? I hear that term so much, and I think it's amazing because I didn't hear that term 10, 15 years ago. Right. Or it wasn't that common. But how do we create robust organizations where we feel, number one, that we can share, number two, that we're heard, and number three, that it's safe as we do so. Right. We're not worried about retributive behavior or being silenced. Talk to, talk to us about that. I think that's so powerful.

Dr. Mandy Brisebois: [00:19:11] We need some brave people because it takes vulnerability and it takes bravery in the workplace. And I've sat in situations with my team talking about my son when he was suicidal or drug addiction with family members, really vulnerable, having chronic illness. And it's amazing when you start being vulnerable, people are vulnerable back and you start to develop these dialogs. And so if one person sees somebody model this behavior, so if someone talks to me in a really offensive way from my perspective and I say in front of all the residents and the nurses there, you know, oh, ouch. I'm, I'm really trying hard. You're modeling for all those people. And if it turns out well, which usually it does, honestly, it flips the behavior immediately when you say something like that. I've had patients laugh because they say, what is this emotion? Like I'm yelling, I'm angry. But it really gives people that ability to open up. So I think we need brave people that can model this, that can mentor it. And once you're actually on the ground doing it, it's not something you read on the Internet. Like we can write for our organizations all we want, that we have psychologically safe environments. You have to see it in action to feel safe enough to come forward, because many people have had experiences where they do try to come forward and they don't have that experience. And that's where we need to jump in. And that's some of the work I'm doing where people are stuck in those situations and I'm helping them work through it in that regimented way so we can take that road map to the stakeholders and say, we're really trying to help fix this problem and the organizations do care right now. We have to just come in a regimented way and really show them how we can do it better.

Dr. Kevin Mailo: [00:21:00] And what should medical leaders, like high level medical leaders, be looking to do, practically speaking, to begin to implement this? You know, we talk about modeling it in an encounter or a one on one or in meetings, but at an organizational level, what do we need to be doing?

Dr. Mandy Brisebois: [00:21:18] I think people are afraid in a lot of organizations to say anything. They don't want to jeopardize their relationships. They're working with people and just coming to work and going home is good enough. And I think that organizations and high level leaders need to find strategies for people to report things in safety, whether it be a click of the button that they can just click. And hey, if you have eight complaints about someone, it is, you know, in a lot of regions in bylaws that you can actually move forward without having to put your name forward. I think that people need to know that it's not just the concern that will go forward, but something will occur and they may not know what occurred, but they'll know that that behavior is stopping. And if they don't see it stopping, that they can go back. Because if we don't have those methods for people to move forward and really take it seriously, like really trust the people that we're--

Dr. Kevin Mailo: [00:22:18] We're talking credibility. We're talking credibility.

Dr. Mandy Brisebois: [00:22:20] Yeah. If someone says that this was very hurtful, it doesn't mean that the words were hurtful, but something about the interaction made it hard for them to work. And so instead of just sort of, sometimes they go to the person and say, well, what happened? And they're like, nothing. I didn't do anything. And they're like, okay, they didn't do anything. And that ends. Instead of that, they can say, What could it have been that this person felt so impacted? And you can actually work through it with the person who felt so impacted and say, What do you think it was? And really dig, it's called appreciative inquiry. You just keep asking these questions to find out what it was. And sometimes you get to an issue that actually didn't have anything to do this situation, or maybe it did, and the person who was talking to them had no idea about what they were getting into or what they were saying, or they didn't realize that something at home was impacting them, even. The person who is being a little aggressive or whatever it may be. So I think it takes conversations, it takes time. And so this means that organizations and physicians need to invest the time and say this is important, that we actually get to know each other, because we can have really great workplaces. And this is the message I'm trying to send that please don't give up hope, because if we do stick together, if you have trouble, we reach out to each other and try to work through this process and get some help. But it's solvable.

Dr. Kevin Mailo: [00:23:43] Wow. Wow. Mandy, this was absolutely amazing. And I hate to wrap it up.

Dr. Mandy Brisebois: [00:23:53] I know we have to go.

Dr. Kevin Mailo: [00:23:54] I know. I know. I don't want to. We are absolutely, absolutely going to talk again because I'll tell you why I think this is so relevant for Canadian physicians is to echo past CMA President, Dr. Smart, we are looking at crisis in our health care system. And crisis in our health care system means fewer and fewer resources for a sicker and sicker population that is aging. And this is going to bring more and more physicians in conflict with one another and in conflict with medical leadership and allied health. And we need the tools to navigate this. And obviously, this isn't the solution. The solution is more resources, which we have to advocate for separately. But the big one is that inevitably things are going to get worse before they get better. That is my own opinion. So how can we weather this storm and how can we come out as a profession, not only having gotten through it, but thriving and growing as a profession? Because I think there's a lot to be learned and I think things got, we learned a lot through the pandemic. And I think there's more to be learned and that the profession is an ongoing effort to modernize and improve.

Dr. Mandy Brisebois: [00:25:03] And we need to stick together, as you said.

Dr. Kevin Mailo: [00:25:05] Absolutely, care for one another, care for one another. You know, I try to treat my colleagues like patients, not, you know, not in a paternalistic way here, but in a notion of compassion. Right. Like just have some compassion for your colleague who might be exhausted, working long hours or dealing with a health issue or mental health issue or whatever. A little bit of compassion goes so far. So far.

Dr. Mandy Brisebois: [00:25:31] Absolutely.

Dr. Kevin Mailo: [00:25:32] So with that being said, we'll open it up to the chat if anybody has got any questions. But otherwise, I am so, so grateful to have had you on here, Mandy. It was just amazing and I cannot wait to interview you again on the podcast and have you do another webinar because I think people need this. I think we all need this.

Dr. Mandy Brisebois: [00:25:55] I need it. I coach, I can't coach myself, but I do, I get coaches to coach me through my own thing, so...

Dr. Kevin Mailo: [00:26:00] It's wonderful.

Dr. Mandy Brisebois: [00:26:01] Yeah, you've got to do it and I will put a plug if you're in the Edmonton zone, I am doing this work through the Medical Zone Staff Association, so go to their website if you need any help, like as a leader or someone in your organization and you want some advice or you want to learn how to do this, I'll help you through it.

Dr. Kevin Mailo: [00:26:18] Absolutely. Absolutely. Thank you again, Mandy.

Dr. Kevin Mailo: [00:26:22] 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 Phys Empowerment.ca, P H Y S Empowerment.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 Past President of the Canadian Medical Association (CMA), Dr. Katharine Smart, to the podcast. Dr. Smart shares how leadership roles can enhance the success of wellbeing within our careers. 

Dr. Smart details how the child health program she spearheaded in the Yukon came to be, and explains how wellbeing for patients and physicians alike is balanced in her program. She carries a lot of passion for the work and is a passionate person by nature. This passion helped Dr. Smart when she became the President of the CMA just as the pandemic was getting extremely difficult. Her authenticity is what she carried into that role, and as she advocated for colleagues she worked to state clear facts and distill where things were truly at.

In this episode, Dr. Kevin Mailo and guest Dr. Katharine Smart really dive into what wellness looks like for physicians in the dark time healthcare is currently experiencing. Dr. Smart believes that having a voice and connection to work through leadership opportunities is a vital part of avoiding burnout. She explains the variety of ways leadership can take shape. She also addresses releasing the fear of failure to realize that what we call ‘failure’ is really a necessary part of growth. Drs. Kevin Mailo and Katharine Smart have an enlightening conversation about burnout, mentorship, and the power of letting go of perfectionism in this must-hear episode.

About Dr. Katharine Smart:

Dr. Katharine Smart is a pediatrician in Whitehorse, Yukon and Past President of the CMA. Her work is centred on developing collaborative partnerships with community and government services to serve marginalized children using a model of social pediatrics. She works primarily with children who have experienced trauma and adverse childhood events, and she witnesses the broad and lasting impact these events have on children and their development daily. She is passionate about improving services for marginalized children in an effort to change their life trajectory.

In addition to her community-based work, Dr. Smart enjoys acute care and provides on-call services to the hospital. Before moving to the Yukon, she was a pediatric emergency medicine physician at the Alberta Children’s Hospital in Calgary. Dr. Smart is the past president of the Yukon Medical Association.

Resources discussed in this episode:

• Canadian Medical Assocation (CMA)

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Physician Empowerment: website | facebook | linkedin

Dr. Katharine Smart, Pediatrician and Past President of CMA: website | instagram | twitter

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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 onto today's episode.

Kevin Mailo: [00:00:35] Hi there. I'm Dr. Kevin Mailo, one of the hosts of the Physician Empowerment Podcast. And today I am extremely, extremely excited to introduce everyone to Dr. Katharine Smart. And Dr. Smart is the past president of the Canadian Medical Association, and her term is recently expired as president of the Canadian Medical Association. She is kind of a super doctor. She is a pediatrician based in the Yukon with a practice centered on the emergency department, as well as community based clinic. And I'm honored and excited to be joined today by Katharine. Katharine, why don't you tell us a little bit about yourself and your work.

Dr. Katharine Smart: [00:01:17] Sure. Thanks, Kevin. Excited to be here as well. And thank you for all your work. So, yeah, I've been in pediatrics now for over 20 years. I started my career as a pediatric emergency medicine physician at the Alberta Children's Hospital in Calgary, but I've always done work in northern Canada, time in northern Manitoba, I had the opportunity to work in Nunavut as a pediatric resident, so I've always had a passion for rural and remote medicine as well. And an interest in First Nations health and Indigenous health. So I had the opportunity to move to the Yukon five years ago to create a child health program there. At that point in time, they had an amazing group of six pediatricians who were coming up twice a year for four days a month and providing services to kids in the territory. But as you can imagine, four days a month of pediatric coverage, no call coverage, nothing to support acute care was probably not really enough. And and in talking with those colleagues, they definitely saw the role for for more supports for children. So I moved there with my husband, who's an orthopedic surgeon, and the two of us built two new programs, me in pediatrics in him and orthopedic surgery. And that's what I've been doing clinically for the last five years. So now we've got four pediatricians, child psychiatrist, a social worker, a neonatal and pediatric medevac program, outreach to all our Indigenous communities, lots of partnerships with schools, mental health and our First Nations communities. And I'm really proud of our program and the work that we do to serve kids and families in the Territory.

Kevin Mailo: [00:02:40] That sounds absolutely outstanding. Now, I'll always just kind of pitch, but are you guys recruiting?

Dr. Katharine Smart: [00:02:46] Not currently. We're actually fully, fully staffed at the moment. Yeah, I think it's a testament to our program.

Kevin Mailo: [00:02:53] I would absolutely agree.

Dr. Katharine Smart: [00:02:54] Yeah.

Kevin Mailo: [00:02:55] I would absolutely agree.

Dr. Katharine Smart: [00:02:57] So, you know, Kevin, I know one of your passions is wellness. And when we designed the program and just the way we operate our clinic, that was one of the foundational principles for me. And I think one of the advantages of creating a program we've already been working for a long time is you kind of see the pitfalls. So I thought a lot about that and the way we structured the way we work. And we work as a team, the four of us, we support each other. The person who's on covers all the patients, they cover the inbox, the EMR, any emergency.

Kevin Mailo: [00:03:24] So when you're off, you're actually off.

Dr. Katharine Smart: [00:03:26] You're off. Yeah. And we still schedule in such a way that there's a lot of continuity. You know, most patients are follow ups. It'll be the same pediatrician, but they're always covered. So if something comes up, something's unexpected. There's no holes in care. But exactly for us workers, when we're off, we're off. And we have that total confidence in our colleagues, they're covering. So that structure, I think, has made it quite desirable. Another...

Kevin Mailo: [00:03:49] Isn't that amazing. It's rare. It's rarer than it should be.

Dr. Katharine Smart: [00:03:53] The other key piece I think to our success is, you know, I knew that we'd be dealing with a variety of challenges and a lot of our patients have a lot of social challenges. So I was able to negotiate with the government an alternative payment model. So we get paid a combination of a daily rate plus fee for service for after hours coverage. So I think we're well remunerated. It covers our time. It allows us to work in different ways, right, being very patient centered.

Kevin Mailo: [00:04:20] Creative. If it needs a phone call...

Dr. Katharine Smart: [00:04:22] It needs a phone call, a video call, an email, doesn't matter, right? Because we're just being paid to look after patients. And we do it in the right way that works for patients.

Kevin Mailo: [00:04:30] What a great example of how when the economics of health care align with well being and best patient outcomes. Isn't that wonderful? I love it. It's so important.

Dr. Katharine Smart: [00:04:39] Yeah, it's so important and it's made it possible for us to recruit and retain, but it's also made us desirable for locums because they know they're coming into a well run clinic.

Kevin Mailo: [00:04:47] Oh yeah.

Dr. Katharine Smart: [00:04:48] With a clear plan, clear ways things are covered. They're going to be well paid for their time. So it, and like you said, the win of that is now it's sustainable. We have great people. We're all aligned. We know what we're doing. We know our purpose and those things have come together. And that really links to me to one of my principles, which is I think solutions have to work for patients and physicians. And when they do, that's when you get the best wins. And I think our program is an example of that.

Kevin Mailo: [00:05:11] I absolutely love it. Let's talk briefly about your work as president of the Canadian Medical Association, because what really caught my attention was listening to you speak so boldly and courageously about the crisis facing our health care system. And I think we're all feeling that. I know we certainly get word through Physician Empowerment about physicians coast to coast struggling to deliver care under a health care system that's, frankly, under-resourced. So first off, I want to sincerely thank you for that advocacy because, you know, it's there, but we need to start talking about it. And you have done such a powerful job. And I would encourage anybody to look up Katharine's media interviews at CBC and some of the others that have been just remarkable in terms of crystallizing some of the issues that we're faced with. Do you want to just talk a little bit about that briefly, because the crisis isn't about to go away. We always try to create evergreen content, know things that are going to be relevant ten years from now. I worry this podcast is going to be just as relevant in ten years. If I can be blunt. So tell us about what's going on in Canadian health care.

Dr. Katharine Smart: [00:06:14] Yeah, for sure. I worry about that too, Kevin, and thank you for your kind words. Yeah, it was a really interesting journey into this role and it's quite a long landing kind of launchpad into becoming the CMA president. You know, there's the election, it's few years before then, you're the election year present, etc. So, you know, when I put my name in for this, it was pre-pandemic, when I found out I won the election, it was just like the month before the pandemic was declared. And then I came into the role of president-elect sort of a few months into the pandemic and then became the actual president kind of a year into the pandemic when things were really starting to get difficult, I think we were starting to see a lot of less social cohesiveness around how we were approaching the pandemic. There was, you know, vaccines were out, vaccine passports that was controversial, mandatory vaccines for health care workers. We were starting to see that narrative shift from health care as heroes to a lot more harassment and intimidation of health care workers, protesters outside a hospital. So things were really heating up. And of course, at that point, we were deep into the ICU crises with hospitals being overwhelmed, people not being able to receive care. And it was a really tense time. So I would say that the role I ended up being in was certainly not what I thought I was going to be doing when I when I took this on. But I felt an immense sense of privilege to be able to speak for my colleagues, because what I would say is, you know, whenever as a physician, I felt so proud of my colleagues because of the tremendous work they've done over these past two years. I mean, always people are doing tremendous work, but people have really had to rise to this challenge in a way that we haven't seen. And to be the person out there representing this profession to the public and publicly, I took that very seriously. And it's really meaningful for me to hear feedback from colleagues who felt that I did it justice. And that was my goal. And my personality is, I'm a straight shooter. If you ask my opinion, you're going to get it. I'm not always right, but I'm going to tell you what I think. And I tried to carry that authenticity into my role as CMA president because I felt my job was to state the facts and to state what I was hearing from colleagues and to put it out there, really distill for people this is where we are. And I, your question, what's the state of Canadian health care? I mean, I don't think it is an overexaggeration to say we are at, I think the low point that we've probably ever been at in our system. And it's not in one place, right? We are now seeing this across the system. It doesn't matter what you're talking about, from community clinics to emergency departments to inpatient wards to long term care to home care, it doesn't matter. There's no part of the system that's working well. There's no group of physicians who would say to you right now, I can deliver the care I want for my patients, Everyone is struggling. And the problem is fundamentally about access and being able to deliver care to patients in a timely way. And in none of those settings is that happening. And I think that's leading to the burnout and moral injury that we're seeing amongst not only physicians but across health professions. And that's now leading, I think, to the staffing challenges we're seeing as people are starting to walk away because they just can't compromise themselves any further, you know, both professionally, ethically, physically, mentally. The toll has been massive. And I always say the health care system, to me, it's the people. A hospital bed means nothing without the expert care of the staff. And it's not only doctors, as you and I know, it's the nurses and other parts, pharmacists and cleaners and everyone who comes in and supports that patient. And the fact that we have a system now that is eating those people alive and spitting them out is deeply worrisome because that is the most precious resource. And right now we have not invested adequately in the people to make them feel valued, and we're paying that price. And these are not resources that are easily recaptured.

Kevin Mailo: [00:09:58] Like when I think about my incredible nursing colleagues, for instance, that have decades of experience and I rely on them in the emergency department for their intuition and their experience and their knowledge. I mean, when somebody like that walks, there isn't going to be suddenly a replacement. There's no money for that. Do you know what I mean? And we're faced with this across the health care system. And, you know, the term that's getting thrown around in the Western world, kind of in terms of people being dissatisfied with their jobs are struggling, is that quiet quitting, right? You know, it's that person that decides to retire. It's that family physician who decides to retire this year instead of three years from now because she's burnt out. Do you know what I mean?

Dr. Katharine Smart: [00:10:42] Oh, absolutely. Absolutely.

Kevin Mailo: [00:10:43] It's, you know, a nurse that doesn't want to pick up that overtime shift because she or he is burnt out. Right? These are the things that are happening quietly and leaving fewer and fewer of us to work in a system that's putting more and more pressure on frontline staff.

Dr. Katharine Smart: [00:11:02] 100%. And that's the vicious cycle, right? Because now the people showing up are showing up to a system that's struggling more and more and more. So it just keeps building. And I agree. I think the other thing that people don't understand enough I mean, you and I understand it as providers, but the public doesn't understand is just what you said. You know that nurse who's been there 15, 20, 30 years in an ICU or an emergency department, that the skill of that person.

Kevin Mailo: [00:11:26] Goodness.

Dr. Katharine Smart: [00:11:26] The knowledge, you cannot replicate that. And then the mentorship that they provide.

Kevin Mailo: [00:11:31] Oh, my goodness.

Dr. Katharine Smart: [00:11:31] Not only to junior nurses, but junior doctors. Right. How many times did you have your butt saved as a junior doctor by - and even as a senior experienced doctor - by experienced nurses--

Kevin Mailo: [00:11:41] -- how about as a staff --

Dr. Katharine Smart: [00:11:42] -- like all the time, even today, right. Like Kevin hey, I think you missed this or that dose was wrong or actually this. Like, the reality is we all need each other. And when we lose those people, experienced anyone in any of the health professions, with them walks wealth of experience, insight, compassion, ability to mentor others. And that's what creates resiliency and safety in our system. And it's intangible, right, because we don't have a way to really track it.

Kevin Mailo: [00:12:07] It's our culture, it's our folklore, it's our essence. It's in the health care system.

Dr. Katharine Smart: [00:12:13] And it's irreplaceable. And those are the people we're losing.

Kevin Mailo: [00:12:16] It is, right? And also, you know, another thing that we've noticed is physicians that are exiting the public health care system and working more privately because they're burnt out and they're struggling with working conditions in the public health care system. So these are huge challenges that we're faced with. Huge challenges.

Dr. Katharine Smart: [00:12:35] Absolutely. And I think the real, at the heart of this is that providers are tired of having these systems failures downloaded onto them as individuals, both to be held to feel responsible for trying to prop up a broken system, to feel responsible for the bad outcomes that are coming from this broken system and at times being held liable and medically responsible for outcomes, which are nothing to do with them and not their fault.

Kevin Mailo: [00:12:59] Yeah, these are system-based issues, you know.

Dr. Katharine Smart: [00:13:02] 100%. So there's huge risk right now for people as well. I think both emotionally but also legally, all of these things. So it's, I think it's a really challenging, challenging time.

Kevin Mailo: [00:13:14] So you mentioned, you and I have talked about burnout and clearly we're both very passionate about it. Today's topic is fascinating, that you brought forward is leadership as an antidote to burnout. I'm fascinated. I want to hear it, about this. What does this mean? How is leadership an antidote to burnout?

Dr. Katharine Smart: [00:13:33] Well, what I've been thinking a lot about, right, is just what you and I have been saying. Like here we are, things are dire, but what we know is the people in the system are amazing. They're resilient, they're highly competent, they bring really an incredible skill set. Anybody in health care to me is the type of person I want to be friends with and have over for a beer, right? They're just my people. So what I've thought a lot about is so many of these things are out of our control, right? The systems pieces. In some ways we can't make it totally different tomorrow. SSo what can we do and where can we be putting our efforts or framing up our roles and our moments in the system to feel like we can regain some control and choose things and pass forward that make us feel like we're still contributing to making things better when it can feel so hopeless. And for me, and that's part of been, part of my experience in my journey as a leader, as president of the CMA and now as past president, has been through leadership. And I think what I would like younger doctors to consider is, is developing your leadership skills a way that you can feel you can start to position yourself to harness some control over what happens next. So maybe that's in a small way, in the way you design your clinic, the way you run your department, the way you show up in your staff meetings, in your hospital, in your community. Maybe it's more broadly as a representative in your PTMA, maybe it's getting involved with the CMA. There's all different things people can be doing, but I really believe that having those leadership skills, starting to see yourself as a leader, so that you start to feel you're someone who could be part of that change, however small. I think those are those steps to regaining sort of our power and feeling like we can be part of the solution. And I think to me it can be that antidote to hopelessness or burnout is that sense of, okay, it's not perfect, but I'm part of the conversation and I feel like I've got the skills to show up that way. And I think developing those leadership skills is really important so that you feel you can be at the table.

Kevin Mailo: [00:15:27] I think that's incredibly powerful because it is a source of burnout when people feel disconnected from their workplace. And that's not just specific to health care, that's across multiple industries, right? People don't feel like they have input, feel like they have a voice. And so giving yourself a voice by becoming a leader can be very, very powerful. What are some practical ways that people can do that? Right, like you mentioned, getting involved, but people say, Well, I've never been in a leadership position before, and I'm a big believer in at some point everyone has to jump, right? You know, at some point we have to deal with the uncertainties that life throws at us. We do it in medicine all the time, but we don't think about it in other aspects of our life, whether it's finance or leadership or practice management. But, you know, talk to us about, like, practical, small steps that we can take to get involved without feeling we're in over our heads and without that fear of failure, which I think is another thing we struggle with in the profession.

Dr. Katharine Smart: [00:16:22] Yeah, absolutely. I think those are all great questions. And I think the first thing is, you know, be flexible with yourself about what being a leader means, right? It doesn't always have to mean being the top person or having a really prominent role or even a role with a title. Being a leader might just be how you show up with your colleagues that day. You may just decide I'm going to show up and I'm going to make a point of really checking in with people authentically and leading that way within my cohort of friends and colleagues. That may be how you show leadership. I think find a mentor, right? Look around you, look at people who you admire or just show up in a way at work or in a leadership role in a way that you think, Yeah, I respect that, I'd like to be like that, and talk to them about their journey, what they've learned. I think people have a lot of wisdom to share that have been doing this longer that can tell you These were some of the pitfalls, these are things I wish I would have known, these are things that helped me. So don't be afraid to create that network. I think we're getting better at that as physicians, we're finding each other in these different informal and sometimes formal groups, like minded people, and we're trying to build each other up. Right? And I think that's really, really important. So lean into those opportunities, look for them. I think there's also some more formal opportunities. You know, the physician leadership courses that are available can be really helpful. And I've taken some of those myself over time that I found really valuable in terms of crystallizing my skills. I think we all come with a variety of skill sets, some things to help us, sometimes things hinder us. But the more you have insight into yourself and your own personality, what your strengths and weaknesses are, and can start to kind of put a framework around some of the challenges that we encounter as physicians and as leaders. I think that can build your skills and you show up feeling more confident and it gives you, just like you show up to a code with a plan, being able to show up to difficult communication situations, difficult, you know, organizational situations. If you come there with a framework of how you're going to deal with it, I think you feel less afraid, less intimidated, less afraid of failure because you actually kind of have a plan about what you're going to do. So I think building all those things can really put you in a position where you feel more empowered to take those leaps of faith and take things on. And then I think it starts to build from there, right? Once you see how you do, then you can start to build the confidence to take on more and more roles, and eventually you'll probably find yourself mentoring other people. And there's a lot of learning in those opportunities too.

Kevin Mailo: [00:18:43] Absolutely love it. Talk to us about the importance of passion when it comes to leadership roles, and I'll mention that I could really sense passion behind your vision of setting up the pediatrics program in the Yukon and serving those communities and serving your patients. So passion fuels leadership. But talk to us a little bit about what that means in our lives. Right? It's not just about sitting on a hospital committee so we can say we sat on a hospital committee.

Dr. Katharine Smart: [00:19:10] Yeah. So important. And it's funny you ask me about that because I've self-diagnosed myself with excessive passion syndrome. I call it hashtag EPS. So other people are welcome to join me in that diagnosis.

Kevin Mailo: [00:19:22] I love it. Yeah, I love it. That's why I spend all my time in Physician Empowerment.

Dr. Katharine Smart: [00:19:27] Yeah, No, totally. So, you know, in terms of passion, I think for me that's been something that I've really recognized I need to lean into in my career because it's really, I think, what makes me me, right? So again, I think part of figuring out how you want to show up as a leader, as a physician, is understanding yourself and what really drives you. So what I know about myself, that's why I've created my own DSM criteria for myself, is that I am a very passionate person. Now sometimes that gets me into trouble. Passion is not, doesn't always play out well, right? Because sometimes you're so passionate about what's going on that it can be overwhelming for people.

Kevin Mailo: [00:20:00] That was my question? Yeah, how do you navigate that when other people are like kind of lukewarm?

Dr. Katharine Smart: [00:20:05] Yeah, it could be a lot, right? And I know that I can be sometimes a lot and sometimes it can make you very emotional and sometimes, you know, tempering that so that it's not overwhelming or that it's appropriate, right? Because we don't always get what we want by being super emotional. Not that that's always good or bad. But again, it's just realizing, right? It's good and it's bad. It's got pros and cons. But for me, when I'm doing things I'm passionate about, that's when I hit my flow, right? That's when I know I'm doing the right things because that's where I feel excited, I feel that meaning, I can see myself being successful. I can see myself achieving things because I think often that passion is contagious. It gets people on board with you. You feel people find you authentic because they can tell you're really committed to it. And I think things I've been able to do where I've had success have been because I've fueled that with the passion that I feel. And for me, passion directly relates to purpose, right? Because I think that's the other value that really matters is you have to know your why and what your purpose is. And again, the beautiful thing about health care is there can be a whole variety of purposes for people. For me, I like building things. I really enjoy finding problems, trying to solve them, looking for solutions, and feeling like I'm creating something. So for me, that's kind of my why and it gets fueled by my passion. So that's why the Yukon opportunity was sort of perfect for me. I think I was at a point in my career where I had enough wisdom, having seen the health system for a long time, I knew kind of things I thought would work and not work. It was an environment that I felt passionate about. It was a patient population I felt passionate about, and I could see the ways to bring the various components of the system together in a way that could really serve patients. And I could feel like we were making an impact, but also doing it in a way that allowed me to feel like I could create a job that I felt I had some reasonable life balance in. I was, it was meaningful. I was able to create a group of colleagues that shared my vision and passion, and we have shared our values and view of how we wanted to deliver care, and then create that. And so that, for me, really kind of ticked all those boxes. But I think when you bring passion to your purpose, that's kind of the magical thing. And that's where I think things really start happening. And I think those are, again, why, in my view, leaning into leadership for people who are interested in that can really create those opportunities. Because once people start seeing you as a leader, you're able to make more things happen because people come to you and you have more opportunity to share your ideas and solutions and then you start to be part of seeing things change. And I think once we start to feel things changing and getting better, even if it's small, that fuels a lot of hope. And I think that's what people need right now in the system, is hope that it could actually be different.

Kevin Mailo: [00:22:38] Talk to us about failure and setbacks, and I'll frame it a little bit in terms of the broader medical culture. And one of the things we struggle with in medicine is failure, right? I mean, we're highly selected against it and we're not used to having setbacks. We're not used to failing. And we often try to fail privately. But leadership roles mean public failures. Right? And it can be as much as you get shot down at a committee meeting, it can be a giant flop with your clinic, it could be a major dysfunction at a hospital level, right? I mean, there are scales of failure, but failing. How do you approach failure or what wisdom do you have in this space, Katharine?

Dr. Katharine Smart: [00:23:20] I think that's so critically important. And I think our fear of acknowledging failure as an unavoidable part of career development, personal development, growth across the spectrum is actually a real problem, right? Because we all are going to fail. No one's perfect. The perfectionism in medicine, I think, is part of the weird hidden curriculum that drives all sorts of strange behaviors and interactions and ultimately, I think often doesn't create the best patient care because we're doing things that are performative just because we want other people to think we're good, not necessarily because it's the right thing to do. So I think that that fear of failure is really behind a lot of problems. You know, and I've absolutely had failures. I've had failures with relationships with colleagues, I've had clinical failures where I've made the wrong decision or the wrong diagnosis. I've had personal failures, where I've let down people that I care about in my life, or haven't shown up maybe the way I wanted to. I think like everyone I've had all those things happen. But how I try to approach it, and I think partly why I am where I am today is because of some major challenges I had at one point in my career professionally, with colleagues, where I was just in a clinical situation that I really didn't feel comfortable in and I had to make some major decisions about what I was going to do with my career at that point. But I really leaned into that as an opportunity for self improvement, right? I really reflected on that moment in time in my career and thought, you know, why did this turn out the way it turned out? What do you feel proud of in terms of how you handled it? What do you wish you'd done differently? How could you have made this more positive? What could you have done that would have been better and gotten a better outcome? And I took that as an opportunity to really develop some additional skills. I thought, okay, I don't think I communicated as well as I could have. So I took a course on communication. Right? I thought, you know, I don't want things to be like that again. So I took a course about getting to understand yourself better and how you show up as a leader. So I really tried to take that as not an opportunity for the blame and shame for anyone involved --

Kevin Mailo: [00:25:23] -- or to retreat --

Dr. Katharine Smart: [00:25:24] -- including myself --

Kevin Mailo: [00:25:25] -- or to retreat --

Dr. Katharine Smart: [00:25:25] -- or to retreat. But I really leaned into it, right? I was like, You've got to lean into this failure. Like, what could this mean for you and what can you take from this? And how do you leverage this moment to improve yourself? Because I think everything in life has a lesson in it, and you can either choose to be made smaller by it, you can choose to let it defeat you, or you can choose to not own your part in it, right? Because no matter what happens, you always have a role. And I thought, I've got, I'm either going to let this sort of destroy me or I'm going to lean into it and I'm going to come out better. And I think I did come out better. And I suspect I probably never would have became the president of the Medical Association had that not happened to me. So I think that we shouldn't be afraid of our failures. I think we shouldn't be afraid of knowing that we're never always going to be perfect. And that's okay. But we've got to stay open to what's the lesson here for us and how can I emerge from this a better version of who I was? And be okay with the fact that it took a failure to get there.

Kevin Mailo: [00:26:22] Wow, absolutely love that. And even just celebrating the journey and the process. And that's another thing in medicine, we're very goal oriented, like, okay, I just want to set this up or establish this or have this new process of doing things. But the reality is, is that we may not get there. Right? But in the process we've learned something about the system we work in or we've learned something about ourselves that allows us to become more powerful as leaders and more effective in communicating that vision and that passion.

Dr. Katharine Smart: [00:26:53] I totally agree.

Kevin Mailo: [00:26:54] It isn't just a saying that failure is an ingredient of success. Failure truly is key to success. You haven't tried if you haven't failed.

Dr. Katharine Smart: [00:27:03] I agree, and I don't think you're going to find any successful person in any walk of life who hasn't failed multiple times across spectrums of their life. That's just the journey, right? It's not a straight line from A to B, it's up and down. And again, I think the most interesting people are often the people that have been through some really hard things. And that's where we find ourselves, often, and find who we really are. And I think we have to be open to that. And again, I think this is why community is so important, right? Being able to talk honestly about this with each other, normalize, normalize failure, right? Be like, hey, man, this is part of it. Like, you know, one of the most powerful things that happened to me - I'll never forget this - I was a new attending, so I was a peds emerg doc in Calgary. I'd done my fellowship there. So on June 30th I was a resident, a fellow, and then July 1st I was attending physician. We've all had that transition. But, you know, in my case, like a pretty straightforward transition, right? The department I trained in, worked in, I'd had a lot of independence as a fellow, so it wasn't really all that different. But all of a sudden my anxiety around what I was doing was like ten times what it had been the day before. And I was just like perseverating about all the patients I was seeing, potentially making mistakes, and it was getting overwhelming, like it was like anxiety that was like I couldn't sleep, like it was a problem. And I talked to a colleague, a good friend of mine who's still a close friend, a more experienced emerg physician, and she said something to me that was really helpful. She said, Katharine, if you imagine the best doctor you know, like someone you really respect clinically, you think they're excellent. I was like, okay. She's like, Do you think they're right 100% of the time? And I was like, No, that's impossible. She's like, Right, so say you're amazing and you're right 98% of the time, which no one's even that good, you know that, right? That still means every month you're seeing thousands of patients, there's going to be several like 20, 30 or more patients where you were wrong. Now, most of the time we're lucky that the natural history of things is nothing untoward happens or people come back and there's this second go and it's fine. But other times, sometimes, bad things are going to happen and you're going to wish you'd done something different. She's like, What you have to understand is it doesn't matter if you're the very best of the very best, that is part of this work. It's always going to happen. It happens to all of us. And you have to let go of this pursuit of being perfect because it's impossible. And that was so powerful for me. It really allowed me to step back and go, You're right, I'm going to have, and even mistakes I don't know if that's even the right word, right?

Kevin Mailo: [00:29:23] I mean, it's a process of self forgiveness and learning to forgive ourselves before the event happens.

Dr. Katharine Smart: [00:29:30] That's right. And that really helped me. And then what I realized and what I tried to really march forward with from that in my career was, Okay, instead of seeing this as as bad and blaming, let's see this as learning, right? So when I had a case that bounced back or something went differently, really, honestly, look at what happened and ask yourself, could I have done something differently? And sometimes the answer is no, right? Sometimes you look at the care you gave and you're like, Given what I knew in that moment, I wouldn't have done anything differently. Other times you're like, You know what? The patient told me X and Y and I didn't really listen or I didn't pay enough attention --

Kevin Mailo: [00:30:03] -- I was distracted --

Dr. Katharine Smart: [00:30:04] -- and I should have done something else. Right? But I committed in that moment to really look at these, if you want to call them failures or misses or even going to term them, as opportunities to become better. And so that really shifted the way I felt about it from blaming and shaming myself to being like, No, I'm a continuous learner. I'm going to lean in to these moments. I'm going to make sure it makes me a better doctor, and I'm going to talk to my learners about this, right? I'm going to be overt with them about how I think, how I approach the things I do. And hopefully give them a framework too that allows them to be kinder to themselves. Because some of this is about kindness to yourself.

Kevin Mailo: [00:30:40] Absolutely. And just creating a culture of humanity within our health care system. We are not a bunch of metrics. Right? And it is not just about tracking a bunch of bounce back rates or whatever, a bunch of statistics. It's about creating a human health care system that ultimately is there to support the frontline workers and it benefits patients, right, when you're not paralyzed with fear going in to work.

Dr. Katharine Smart: [00:31:08] 100%. And I think the problem is operating from a place of fear iin medicine actually can cause a lot of harm. Because doing unnecessary things to people because you're anxious or fearful is actually harmful. Right? So we need to acknowledge that as well.

Kevin Mailo: [00:31:22] Yeah, without question. Without question. So I think we should probably begin to wrap it up. But we'd love to have you back on again because there was just so much here. Katharine, do you want to share any kind of closing thoughts or reflections or just something for physicians to take away with them today?

Dr. Katharine Smart: [00:31:40] Well, I think if I could say anything to physicians right now, it would be a resounding thank you. I mean, people have just shown up incredibly in this time. They've shown up in the system. They've shown up for their colleagues. They've shown up as leaders in the media and social media for their communities, for the country. I mean, I think it's really been incredible just to see how people have stepped up in this unprecedented time of a global pandemic and just tried to look for any way they could make a contribution. And people have done it in so many different ways and all of it's been needed and necessary. And I've felt so proud to be a physician. I've felt so proud and privileged to represent all of you as my colleagues. And I just really want to say thank you to people for the work that all of you are doing and continue to do, and that I hope that we can continue to support each other, even though it feels like dark times. I know the only thing that's going to get us out of this is the people in the system. So make sure you're looking after yourself. Don't sacrifice yourself on the altar of medicine. That is not the solution here. But continue to show up the way that works for you. Lean into your passion and purpose and most importantly, lean into your colleagues, who I know will be there to to support you when you need it.

Kevin Mailo: [00:32:49] Wow. Absolutely amazing. Again, I really want to thank you for being here today and speaking to us, Katharine. And again, I think on behalf of many, many physicians across the country and patients as well, thank you for your advocacy in getting us through the pandemic. But afterwards as well, and everything you do to improve this, the public health care system that we all love and cherish. And so, again, thank you so much,Katharine.

Dr. Katharine Smart: [00:33:17] Thanks for having me.

Kevin Mailo: [00:33:19] 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 Phys Empowerment.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. Nour Khatib, emergency physician and speaker, to the show to talk about her journey through finance and medicine. Dr. Khatib explains why he introduces her as a “Med School dropout” and shares how both her career backgrounds are valuable to her.

Dr. Nour Khatib divulges that in her first year of medicine at McGill she experienced burnout and spoke to administration who gave her a year off. During that year she enrolled in business school and ended up with a financial job at Pratt and Whitney. However, she returned to McGill several years later despite enjoying her financial job and she explains why to Dr. Mailo.

In this episode, Dr. Kevin Mailo and guest Dr. Nour Khatib discuss why learning something other than medicine can be a very powerful personal growth experience, the importance of the advice to “pay yourself first”, and why self care and personal wellness are such key components of a successful career as a physician, alongside financial literacy. Dr Khatib’s story and advice very much align with Dr. Wing Lam’s CBE (Continuous Business Education) theory and this episode helps to explain why it’s important practice.

About Dr. Nour Khatib:

Dr. Nour Khatib MD CM, MBA is an enthusiastic and dynamic emergency physician and financial professional with keen interest in Quality Improvement, Patient Education and Global Health. She completed her family medicine training at Sunnybrook Health Sciences Center and did further training in emergency medicine at the University of Ottawa (CCFP-EM). With extensive experience and a professional record as a financial and business analyst, Dr. Khatib has excelled in both international and local firms with determination, hard work, and resourcefulness. Utilizing a broad acumen in healthcare, finance and business practices, she aims to solve issues regarding the quality of healthcare and the patient experience.

Resources discussed in this episode:

• “Millionaire Teacher” by Andrew Hallam
• “Your Money or Your Life” by Joe Dominguez and Vicki Robin
• “Beat the Bank” by Larry Bates
• Dalai Lama XIV quote
• Dr. Glaucomflecken
• Takotsubo Cardiomyopathy
• CEGEP

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Physician Empowerment: website | facebook | linkedin

Dr. Nour Khatib MD CM, MBA: Emergency Physician and Speaker: linkedin

Transcript:

Kevin Mailo  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 and 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.

Kevin Mailo  00:34

Hi, everyone. I'm Dr. Kevin Mailo, one of the cofounders of Physician Empowerment, and one of the cohosts of the Physician Empowerment Podcast. And tonight, I am very, very excited to introduce to you Dr. Nour Khatib. And Dr. Nour Khatib is a Med School dropout. And she has had a very exciting journey. And we are very happy to have her as part of our team here, speaking at our webinar, and hopefully speaking at some of our future events as well, because she's just so incredible, not only in her medical career, but also in the sphere of teaching and public speaking. And I don't know that I can introduce you properly, Nour. I think it's probably better if I just let you go. And tell us a little bit about your story. And why I introduce you as a Med School dropout.

Dr. Nour Khatib  01:24

Sure thing. Absolutely. Nice to meet everyone. Thanks for joining tonight. So yeah, Kevin's right. I am a Med School dropout. But I'm currently an emergency physician so how does that work? So what happened with me is I studied in Quebec, I studied in Quebec and I went to CEGEP and that's when you do, you can get into Med School two ways: do an undergrad, or go through quote/unquote the fast track where you can get into pre-med and you've got a guaranteed position into getting into Med School. So I thought, I was studying at Marianopolis College, which was one of the CEGEPs, there and I thought everybody was applying to Med School, maybe I should apply too. I didn't know what I wanted to, I was 18. But I did apply to Med School and I got in and I started. And within two months, I was like this linear path is scary. I don't know if I want to take this linear path. It felt like that's it, my entire life for the next 10 to 15 years is already laid out. And the path is not going to be changed. And I felt all I will know is medicine. And that, in addition to the worries of medical school, was frightening to me. I come from a family of, previously were refugees. We didn't, no one in my family had an undergraduate degree. In fact, they were all working in business or working as entrepreneurs, and just trying to make things happen, not medicine-related not science-related. So I thought to myself, 'What am I doing going into medical school?' Two months in I decided I'm completely burnt out, especially with all that overthinking and overwhelm at the age of 17 or 18, which I still think is too young to be committing to any of this. But that's a different story. And I went to the - it was McGill - so I went to the administration office and I spoke to them, I told them how I was feeling. And they're like, yep, we recognize this. It's called burnout. You're experiencing it, and now we have a solution to your burnout, you're going to take a year off. Doesn't work like that. A solution to burnout is not just a year off. But that's what they said, I was 18 and they gave me a year off. So I decided to take it. In that year off - really within two weeks - I thought to myself, I can't take a year off, that's, you know, Type A personalities, we're not going to take time off. I ended up enrolling in business school. I ended up enrolling at the John Wilson School of Business, doing some finance courses, and absolutely loving it. And thinking to myself, 'Hey, I fit in'. You know? I fit in here. It makes sense to me. It's so exciting, there's presentations, no one's lives are at stake, it's great. And there's no linear path. That part was great because I didn't have to do another degree after or post grad or decide on what specialty. That's it. I can start there, continue, and literally the world is my oyster, I can work in finance or business in any field I want. A year later, McGill gives me a call and they're like, 'Well, you haven't been responding to our emails. So do you want your spot because it's kind of a guaranteed spot, something that's super coveted'. I was like, 'Oh, thank you so much. I actually am in finance now, I switched careers, please give my spot to someone else'. And of course, they've got tons of people to give the spot to and they went ahead and did that. So I worked in finance. I worked in finance and I did co-op and I ended up at graduation, had already worked for three companies after doing some co-op, and the third company basically offered me a contract. And it was Pratt and Whitney Canada. It's an airplane engine manufacturer. And I loved working there. I can't tell you that I loved the job itself. But working there, being in a team, having projects together with engineers, financial analysts, all sorts, I was thriving in that environment. But come and ask me if I liked what I was doing on an Excel spreadsheet? Excel is dear to my heart this very day, but no, not for the rest of my life. I can't imagine myself doing that for the rest of my life. But I loved being in that company. And had I not left, I would have been there forever.

Kevin Mailo  05:41

Wow. So okay, so you're, you're at this great company? How did you un-drop out of Med School? Nour, tell us how you un-dropped out of Med School?

Dr. Nour Khatib  05:52

Sure. So the way it works is, really it just goes to show you that sometimes just stars align and, you know, I never used to be a believer of that, but really, like, there was an opportunity, and I kind of went for it. That year, my prerequisites were going to be expired, that like eight years out--

Kevin Mailo  06:15

-- yeah, Med School prerequisites, yeah.

Dr. Nour Khatib  06:18

And then I heard from a friend of a friend that McGill are removing their  MCATS. And I never thought about going back to Med School. Why would I? Pat and Whitney was paying for my MBA, I had already gotten promoted twice, I'm in the middle of the recession in 2008, and I had a job and life was good. There's no reason for me to think of leaving. But someone, there was a seed that was planted that, hey, McGill has removed their MCATs, now it's easier for you to apply. So I decided to look into it. Because there's no way I would have studied for the MCATs, there's no way I would have like been wanting it enough. I decided to, you know what, I'm going to apply, and I'm going to see what happens. And I ended up going for it. I spoke to my manager at work, and the VP Finance of the company, and we were close, like we were, you know, and I told them about what I was thinking. And what they told me is, they're like, 'You know what, you're gonna get bored here. You like it now but you're gonna get bored, you're gonna get promoted, and you're gonna not enjoy the job at some point. You like who you're working with, but they could change. You need to love your career.' And that's, and they told me, they're like, we will write you your reference letters, just go for it. And I decided to go for it. And it felt like I had nothing to lose, I didn't have the pressures of the first time or the pressures that my colleagues had. And that's something that I've told a lot of my friends who, or a lot of people, friends' kids who are trying to get into Med School, I tell them learn something else first. Learn something else, find something else. And don't let it be a one path, a linear path, to the finish line. Because you're living throughout this journey. It's still life, you're not, you don't start living when you graduate, you're living throughout it.

Kevin Mailo  08:17

You know it, that's very powerful. That's very powerful. I like that a lot. So you got in.

Dr. Nour Khatib  08:24

And the thing is, though, all throughout this, whether it's the finance degree or the MBA, I can tell you for certain, none of the personal finance knowledge that I know today came from that. It was all theoretical. It was all, you know, project based, case based for certain companies, and theoretical. Just because I have a finance degree and an MBA does not make me better at personal finance than Kevin. Absolutely not. It's really when I started to make money after residency, and I sat back and I said, 'Oh, okay, so now I'm making money. Now I'm paying off debts. What do I do now with this?' What is there to do? Like, do I go to a financial advisor and just say, here, you do everything? Or do I take care of it myself? So that was hard. The first year out of residency is always difficult. Whether it's, you know, you're doubting yourself, your competence, you're just trying to learn the ropes, you've taken over a practice, which in itself is entrepreneurial and business-minded to begin with. And the first year out, I did a lot of working of course, and learning medicine and building that confidence in medicine, in the first few years out. But what I tried to carve out is a little bit of time every week to look into and learn about personal finance.

Kevin Mailo  09:50

Can I stop you there? Wing came up with a great term for this, and it's not just about personal finance, but it's also about practice management. And he calls it C B E. And that is Continuous Business Education. Just like we constantly invest in our knowledge and skills as physicians, we need to constantly invest in our knowledge and skills as investors and practice managers, or, you know, those that run our practices. So I'll let you continue, though. Keep going.

Dr. Nour Khatib  10:19

Oh, no worries. I mean, what did that involve? First of all, I felt defeated right from the start. Because I was like, hold on a second, you were in finance, and you worked in the field, and you don't know what you're doing with your money? Like, that's embarrassing. First of all, I told myself don't admit it to anyone, but here I am. Which is totally fine. It really goes to show you that you do not need to have a degree, these things that you're learning are for yourself and through other people's mistakes. And the quicker you learn them, doesn't matter how far out you're in, but the quicker you decide, and take the initiative to learn from other people's mistakes, the more likely you're going to succeed. And the more freeing it is, once I decided that I am going to be taking care of my own finances, doing my own budgeting, realizing that number one is I pay myself first. And I break down what I earn and from where and I actually know where things are coming from. And in the beginning, in the first few months, I wasn't sure where my money was coming from. I was like, from here, from here, from there, what am I spending it on? Oh, probably like, you know, food and rent and before, you know, before owning anything, what? No, that's probably where it went. But the truth is, I needed to break it down and really study and analyze where things are coming from.

Kevin Mailo  11:40

Can I stop you there? Talk about paying yourself first. This one's thrown around in finance all the time, it's a very old term. Just share with our audience of what it means, because there's going to be some out there that don't know, or you know, don't think about it expansively enough.

Dr. Nour Khatib  11:55

Sure. I'll just give you an example of, like, what I do first. So what I do is - and when they say pay yourself first, the underlying meaning is really live within your means, and know the measures of what you're dealing with in terms of your money - but here's what I do. Every 15th of every month, right? Like between the first and the 15th, you pretty much make, everything starts coming in from whatever sources that you're working, right? And then towards the 20th of the month or so I decide, okay - and I'm incorporated, so this example kind of goes to those who are incorporated, but it doesn't matter it'll fit both - I first give myself a salary, and pay my taxes on that salary, and I'm living within that salary means. Everything else goes to savings.

Kevin Mailo  12:44

Wonderful.

Dr. Nour Khatib  12:46

So let's keep numbers simple. Let's say I pay myself $10,000, and everything else goes into the corporation, or goes into wherever you decide to put it if you're not incorporated. But let's say that $10,000 I think to myself, okay, what am I going to do with this $10,000? What do I, how much do I need? And I'm just giving you a round number. Let's say I just need $3000 or $4,000 just to live that month, whether it's a mortgage, food, gas, whatever it is, that's aside. And now, what am I doing with the rest? Well, I'm putting some in my TFSA. I am putting a few in my savings accounts. And my savings accounts are funny looking. So I've got like six. Why do I have six? I have one emergency fund. I have one car fund for when my car breaks down six, seven years from now. And I have a vacation fund. And what else? I'm interested in flight school. So I have one for flight school.

Kevin Mailo  13:39

Wow. Of course you do, Nour, of course you're gonna be flying airplanes. Honestly, it's amazing. It speaks to dreams. And you're one of those people that obviously lives your dreams. I admire it and respect it immensely. Keep going, keep going. Sorry.

Dr. Nour Khatib  13:55

Once I put enough money in the vacation fund, I know I can take a vacation. So that's every month, that's how I divide things up. And that feels in itself super empowering. Just the fact that you've laid out your dreams, you've laid out what you want to spend your money on, you've already paid yourself. And you know, you can't go over that.

Kevin Mailo  14:17

Well and it gives you space to really enjoy things. Right? You know what I mean? If you have a budget, and you're like, okay, we're going out for a great dinner tonight. And this is something we budgeted for and there's money for it, we're gonna drop 200 bucks on great food and great wine and not feel one ounce of guilt for it because we saved and, you know, planned for it. It's such a powerful thing, right? It's more than just money. More than money, it's more than dollars and cents. It's really about building a better life and being happier and more at peace with your finances, which are a big part of our everyday existences. Can I go a little bit further on paying yourself first, right? Because we talked about like month to month budgeting, but the notion of paying yourself first is you can go past that as well and you can look to the future. And really, you know, that paying yourself first means that you are setting aside money that you're investing every month, every year, for a time in your life years or decades from now, when you are older, and need to be taken care of, right? And it's not just, you know, those frail years, you know, in the final decade or two of our lives, but it can actually be much sooner. And I think many of us who work in medicine are reminded of that on a daily basis, people who become sick or disabled at tragically young ages. And I don't want to be all doom and gloom, but there's this idea that as we age, we have to create more space for our well being. And I'll just share my own personal story. I remember graduating less than 10 years ago, I graduated in practice in 2013. And I remember loving the night shifts, and you're an ER doctor, right Nour, you know, you understand it. I loved the night shifts, I was working, I was fast. I was, you know, I felt great. I would go to the gym after, you know, a night shift and then go to sleep, wake up, go do it again. Of course I did, right?

Dr. Nour Khatib  16:09

After a night shift?

Kevin Mailo  16:11

And then, you know, because I mean, because I'm an ER doctor, I should have gone for a bike ride as well, right?

Dr. Nour Khatib  16:15

With your Patagonia.

Kevin Mailo  16:16

Yeah, exactly. Like Dr. Glaucomflecken which, by the way, I should send that link out, it's great. Or he's got a number of those skits. But you know, the bottom line is that for myself, within five years of doing that, and working at that pace, I was already feeling tired. And that's when I realized things need to change. And I was shocked at how quick that came. You know what I mean? Like, I was like, oh, well, I'll get tired in 20 years. No, I got tired within five years. You know, four young kids, you know, careers in the household. There was a lot going on. And so, you know, I downshifted and one of the reasons why I was able to downshift is during that time, thankfully, that first five years, I was doing a lot of paying myself first. I was investing in a lot of real estate, not doing it perfectly, not necessarily doing it with a really clear plan, but I was doing it. And I got to a point where I could actually pause and say, 'You know what, I don't need to work these night shifts anymore'. And so I moved off them within five years of practice. So that's just my own little piece. My own little story. Yeah. So it's this idea that there's going to come a time in our lives, there really does come a time in our lives, when we just want to be doing something else. Right, whether it's focusing on family, passions, hobbies, you know, even just our personal well being, even just sleeping more, you know? I had a doctor told me she has not slept since residency, right? You know what I mean? These things happen all the time in our lives. And so just creating that space to live a better life. And, you know, practice how we want to practice is so important. And a cornerstone to that is paying ourselves first, is, you know, putting away money, learning to invest it, and growing that nest egg, so that we take that pressure off to earn. So sorry, I'll let you continue, and hopefully not have any more interruptions from my busy...

Dr. Nour Khatib  18:07

Oh, no, please, please.

Kevin Mailo  18:09

It's really cute.

Dr. Nour Khatib  18:10

You and your daughter are totally welcome. One thing you mentioned, you mentioned, you know, we don't want to be doing this all our lives, we want to move on to other things and hobbies and whatnot. What I learned early on, and I'm so glad I learned it early on - and even for you, Kevin, it looks like you've learned the importance of all of this early on, and I'm thankful for that - is don't wait for these hobbies. Don't wait for the things you want to do. Don't let it be a linear path. I did not want medicine to be a linear path. I promised myself, had I returned the second time, that it like, if I were to continue--

Kevin Mailo  18:51

-- I love how you, I gotta interrupt, I love that you say 'return the second time'. To Med School. I don't meet a lot of people who say that sort of thing. Okay keep going.

Dr. Nour Khatib  18:59

I thought to myself, if I was going to return, I was going to take this as a life experience. I am not going to be a person in, like with my head in the books all the time. I was, because trust me, you go from finance, when you go from finance to try to learn physiology, you're, you know, like, yeah no, it was a disaster. And of course my head was in the books all the time trying to catch up, really. But the truth is, I told myself, this is not just going to be me, it's not going to be the linear path. Because if it is, I will burn out right away. And I realized that one year out, is that I had colleagues doing 20 shifts a month. And you know what? They're doing it, but really, is that longevity? Is that sustainable? Probably not. I don't do that much. I don't do that many shifts a month. I work probably every day a month, but not necessarily in emergency medicine.

Kevin Mailo  19:50

Well, and this is exactly it. And this was the advice that, you know, I'd gotten years ago in residency and that is a career in medicine is not a sprint. It is a marathon. And by creating that financial space to have a more balanced life, to sleep, to exercise, to eat right, to all the things you need to be doing that you would tell your own patient, means that you are going to be able to really enjoy your career for the long haul and really do your best medicine. You know, my patients are so much happier since I slowed down. If I can be perfectly honest. And it's wonderful. I just I love love being there.

Dr. Nour Khatib  20:26

You probably miss it, too, if you haven't gone in a few days. You miss it.

Kevin Mailo  20:30

A little bit, a little bit. This unbeatable summer weather. I don't know about that right now. But yeah, like, and it's just wonderful to share in it. You know, I picked up a Takotsubo cardiomyopathy, there are gonna be some people that are just rolling their eyes, like what does that mean? You know, because they sat there and talked to an elderly gentleman who said he was really experiencing childhood trauma. Right? Yeah. And I would never, like, you know, I just had that time because I wasn't in that big rush. You know, just enjoying my job more. And so anyhow, I mean I love this, Nour. I love what you're sharing. Keep going. We've got a little bit more time. Tell us a little bit more about your journey.

Dr. Nour Khatib  21:07

And so where was I? So let's say a year out. A year out, I decided I'm going to teach myself personal finance. How did I do it? Whether it's reading blogs, reading certain books that have helped others? A couple of books that have helped me are...

Kevin Mailo  21:22

What are your favorites, what are your favorites?

Dr. Nour Khatib  21:23

"Millionaire Teacher" was my favorite because it just hit all the points. Yeah, it just hit all the points. And it was very basic. It wasn't too complex. And it was one of my favorite recommendations. "Beat the Bank" is a pretty good one, too. Thing is, once you start reading these, they all say the same thing in the end. And one that I'm currently reading, and I know I will be rereading, is "Your Money or Your Life?"

Kevin Mailo  21:45

Oh, I like that.

Dr. Nour Khatib  21:46

And the whole concept of that one - and it was written, I believe in the 70s or 80s, but then it was revamped in 2018 for nowadays - "Your Money or Your Life", the concept is, if someone were to put a gun to your back and say 'your money or your life', obviously, you know, you'd say, here take all my money.

Kevin Mailo  22:04

Absolutely.

Dr. Nour Khatib  22:05

But the truth is, our rat race towards money is costing us our life. And just because it's not as dramatic as a gun to your back, it's prolonged. You are losing life, because we are chasing money in a way that is a poor relationship with money. We are working more and exhausting ourselves to make more, rather than trying to work smarter or work and be happier in our job.

Kevin Mailo  22:33

So I'm going to interrupt you there. And I'm just pulling up the quote right now. But there's this great quote from the Dalai Lama when he was asked about what surprised him the most in humanity, and he said, "Man himself, because he sacrifices his health in order to make money. Then he sacrifices his money to recuperate his health." You know, and he is so anxious, what does it say here? Sorry, I'm just, I'm going off, but it's so anxious about the future, he doesn't enjoy the present, right? And it's so true, Nour. It's so true, what you're sharing, that we just get caught up in this rat race of earning, thinking, oh, I'll live next year, or I'll be happier next year. I'll be healthier next year, but we really shouldn't be living like that.

Dr. Nour Khatib  23:16

100% 100%. And it's, you know,what, not every day is perfect. The last few weeks for me have been rough, I have to say. I worked, I ended up, I would say the first year out was rough. A few years after that, trying to, you know, get things along was great. And then you start getting, you go through this burnout phase of the whole profession is collapsing on itself, unfortunately. And you really just have to step back and realize these are systemic problems. That your job is to take it one patient at a time, and take care of whoever's in front of you right now. And just do the best you can with the intentions and with the resources that you can. And just be, every day ends and a shift ends. Right? At the end of it, it's over and you've tried your best, and that's all you can say to yourself is that you've done everything you can at that time. And then you can move on to helping others. The problem is in our profession, is there's all this cumulative PTSD from the horrible cases that have gone wrong. And that that takes a toll on us. And I honestly do think every doctor needs a therapist. Every doctor needs a therapist, every person needs a therapist. But whether it's in the good times or the bad.

Kevin Mailo  24:32

I think that's incredibly powerful, incredibly powerful.

Dr. Nour Khatib  24:36

Let the therapist see your good times, hearing your good times in order for you to be able to go through your bad times.

Kevin Mailo  24:41

I look at it like going to the gym or eating right. It's something you should make a part of your life. Not something you just do here and there or when things get bad. That is exactly my view as well. Everyone should have one. Everyone should have one. We deal with a lot of sadness and trauma and heartbreak in this job. And we don't necessarily internalize that, because we're so highly trained. But the truth is we deal with a lot, across all specialties, across all specialties. And there's a lot of stress associated with it. We deal with a lot of risk, right? We don't necessarily internalize that either, how much risk we deal with when we discharge patients, you know, your psychiatrists, you decide not to form that patient, there's a risk they could go out and harm themselves, right? Like there's risk to everything we do, even as a radiologist. Is it a thing? Or is it not a thing? Right, but it's true. It's true. You know, that's a very beautiful observation, though. About he importance of ongoing mental and emotional health.

Dr. Nour Khatib  25:45

100% 100%.

Kevin Mailo  25:49

Yeah. I love it.

Dr. Nour Khatib  25:51

And so like I mentioned, I don't do as many emergency shifts as, let's say, the typical emergency doctor. But I still consider myself as I am an emergency physician. It is my profession. I might be doing surgical assist, cardiac stress test clinic, event doctoring, I do speaking on the side to corporations.

Kevin Mailo  26:14

Of course you do, Nour. Of course you do. Okay, keep going,

Dr. Nour Khatib  26:17

I teach people about personal finance. And I, you know, I enjoy doing all these different things. One thing that I  - remember earlier, I was saying, don't wait for your hobbies, don't wait to do your hobbies later, try to pick them up and do them now, whatever it is that you enjoy it just make it part of your life, just like how you schedule a shift - so I do Muay Thai kickboxing. I'm a voiceover artists that does work on the side for commercials just for fun. It doesn't pay much, but I enjoy it. So if you ,like, I've done a few commercials on the radio and one for Hershey's as well. And it's just something I enjoy doing. And it's something that I think everyone needs to find what it is they like, whether it pays or doesn't pay, just make sure that it's part of your life.

Kevin Mailo  27:00

You know, I really, really love that. So we're kind of coming up on 30 minutes. I'm shocked at how quickly it's flown by. And then we obviously have to get you back on another webinar and on to like a formal podcast episode as well. Because there's just so much wisdom here, right? I mean, one of my reflections on this financial journey for myself in talking to physicians coast to coast about money, is that the world is full of knowledge, facts and information. I mean, go on YouTube, you learn about real estate, you buy crypto, you learn about buying crypto, you can learn about day trading, learn about all these things, but that that wisdom, what you're sharing today, Nour, is in such short supply in our world in many respects. And, you know, a lot of us are chasing money or, you know, trying to earn or trying to invest. But not asking ourselves what do I really want in life? You know, and does my financial plan align with my life's goals? But I just, I love what you shared. And I just want to recap that notion of paying yourself first, right? Setting a budget, living within the budget, enjoying the budget, celebrating it right? Like if you've got 10 grand for that vacation, go and blow that 10 grand on a vacation and really enjoy yourself. And do it knowing that you've already paid yourself, then you've already filled up your investment accounts, and you've already made that move in real estate or done whatever. So that you have space to live right now. Knowing that also that future version of yourself that is older, sicker, tired, doesn't want to work those night shifts, doesn't want to do that call, that person is also taken care of. And I think that's so, so important. So I gotta wrap it up. But I'd love to hear any final thoughts you have, anything else you want to share about yourself, about your journey.

Dr. Nour Khatib  28:49

It's really been about learning, making mistakes, ups and downs. And that's what life is no matter what. The quicker you realize that what your business here is called, physician empowerment, is about feeling empowered with regards to your finances and your life. And don't let medicine win. You are in control of medicine. You are the captain of this ship, and you're going to be steering it. Do not let medicine take over your life. It is a tool we use to help people, but physician heal thyself first.

Kevin Mailo  29:29

Wow. Wow. That was incredible. And so true. So I think we're gonna, I think we're gonna wrap up there. I'm so, so glad and so, so grateful to have you on tonight like this. Thank you so much, Nour.

Kevin Mailo  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 wellbeing, then come and join us at physempowerment.ca - P H Y S empowerment.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, one of the co-founders of Physician Empowerment, hosts the show this episode to talk with guest Rod Burylo about financial advice, banking, and fiduciary duty. Rod Burylo is an expert in the industry, Chief Financial Officer of the Empowerment Office, and the author of “The Wealthy Buddhist”, and shares a wealth of insight with listeners.

Rod Burylo defines some of the roles that exist within the financial industry, helping to clear up confusion surrounding the types and quality of advice available to consumers. He breaks down exactly what it is that differentiates a personal banker from an investment advisor from a portfolio manager.

In this episode, Dr. Dimitre Ranev and guest Rod Burylo explore the advisor options that exist in the financial industry for professionals like physicians. Rod defines and explains what fiduciary duty means and who in the industry actually has it. He demystifies the role of portfolio managers and explains how a portfolio manager is empowered to work with finances and investments on behalf of their client through fiduciary duty. The conversation Dimitre and Rod have shines light on how accessible portfolio managers are, and provides important clarity on how roles within the financial industry apply directly to specific services listeners may want.

About Rod Burylo:

Rod Burylo is the Manager of IFM & EMD Services at Axcess Capital, providing governance and risk mitigation support to capital raisers and investment managers.

Rod has worked within the financial services industry for over 30 years in a wide range of roles including Director, Chief Compliance Officer, and Director of Marketing. He has extensive experience in the exempt market sector as past CCO and owner of Canada’s largest Exempt Market Dealer.

Rod is a Canadian Advisor of the Year Award winner, 2019 Champion of Financial Literacy Award Finalist, international speaker, and author of three books.

Resources discussed in this episode:

• Axcess Capital Advisors
• Empowerment Office
• “The Wealthy Buddhist: Buddhist Ethics, Right Livelihood, and the Value of Money” by Rod Burylo

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Physician Empowerment: website | facebook | linkedin

Rod Burylo, CIM FCSI: Chief Financial Officer at Empowerment Office: linkedin | book

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Transcript:

Kevin Mailo  

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 and 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.

Dimitre Ranev  

Welcome everyone to the Physician Empowerment Podcast. I'm really honored to have Mr. Rod Burylo today as guest. Rod is a renaissance man in the financial industry. He wears many hats and has many roles, but currently his projects are that he's the manager of Investment Fund Services for Axcess Capital. He's also a consultant to portfolio managers, accountants and professional associations. And, importantly to us, he's the Chief Financial Officer of the Empowerment Office. He's an Advisor of the Year award winner, media contributor for over 30 years including for the CBC Radio and other leading newspapers. He's also an excellent teacher, which I can attest to because when I first met Rod a couple weeks ago actually, he explained a concept to me that I could not understand and it just clicked. And that's how I know that somebody is a good teacher when they can simplify something that's hard to understand. It's not surprising, because you've had over 20 years of international teaching experience, right? In many topics. I think currently, you mostly talk about professional ethics in alternative investment strategies. And finally, I do want to mention that Rod has published a book in 2019 that I find very interesting and I hope we can talk about it in the future. It's called the "Wealthy Buddhist: Buddhist Ethics, Right Livelihood, and the Value of Money". So again, Rod, thank you for joining us. What I do want to talk about today is an issue that I've noticed talking to other professionals, doctors, is there seems to be quite a bit of confusion about the actors who are involved in the financial advice industry. And specifically three things. We don't necessarily understand what the different roles are, what the different skill sets are, but also what is the duty to the client, to us, because I mean, we're seeking their help. For example, to give an analogy with medicine, obviously when you go to a doctor, you can make a couple of assumptions, not always true, unfortunately, but most of the time should be true. First of all, that they have a license to practice medicine in Canada. And secondly, they have a duty of care to their patients. But that's not as clear to me or to other professional, to other people I talk to, when it comes to financial advisors, or people doing financial advice. So Rod, I guess, do you find that that confusion does exist? And what are some reasons you think it does exist within us, within people that are looking for financial advice?

Rod Burylo 

Yeah, that's a wonderful question and very important. Definitely confusion exists around that, not only amongst consumers, people that would seek out financial services persons, but honestly, there's confusion amongst the people within the financial services industry, as well. So there are some people that are in different roles that think that they have a greater responsibility than they in fact have. And then there's others that, unfortunately, might miscommunicate to consumers about that level of responsibility, perhaps setting false expectations around that. Why is that confusion there? Well, you know, I think there's a few reasons. One of them certainly is that there's a very, very wide range of participants in the financial services industry, and depending upon their level of licensing, or registration, or the types of organizations they're working for, their responsibility could vary greatly. Another reason for the confusion is that the people participating in the industry might misunderstand what their registration category requires of them under certain circumstances. And the final place that some confusion might come in is around notions of fiduciary duty, for example, where it's generally accepted that it would be up to a court to decide or judge to decide if, in a particular circumstance, a particular financial services person had a fiduciary relationship at that time. So there's a lot of questions that can arise from this.

Dimitre Ranev  

Right. And we'll talk about the fiduciary duty a bit later, because that sort of blew my mind. I made some assumptions about what that meant and I think it's important everybody understands what it actually means and that it's not as common as you think it is. So I feel like when there's this risk confusion, it's really important to go back to first principles and just definitions, like defining who does what, that's a good place to start. I've looked at some of the actions that I've encountered in my financial journey and perhaps, Rod, you can discuss about what the role is and what their skills are and how they can be useful to professionals. And the first one that a lot of us encounter, not all of us, are personal bankers. Can you comment on on how they fit in in just the financial team of somebody like a doctor?

Rod Burylo  

Yeah, a personal banker - I actually had a role of a personal banking representative with Royal Bank back in about 1990, and so I can speak to that, you know, from actually doing that job - so one of the ways that we categorize responsibility in the financial services industry is one category is often referred to as a guidance role. And as a rule of thumb, people that we typically find in the historical banking type roles, the personal banking representative roles, would have what we call a guidance role, which means that their responsibility is to help guide a consumer make a choice, which is a long way away from more more onerous obligations they might have. And often the people in those basic branch roles have, what I would say in my opinion, very minimal education or licensing requirements around that, often they have something as basic as a mutual fund registration category, which really is just one course. This might surprise a lot of consumers out there, but historically a mutual fund registration category did not even require a structured continuing education requirement, where almost every other category license or registration in the industry required that. Where it didn't not even require that, there was not even a requirement to take ethics classes for most of these people going forward. So it'd be a very basic, introductory, you know, grade one level of education that's required. And they're typically dealing with proprietary products from that institution. And their obligation is to help someone choose amongst a fairly limited range of products and services. And again, this is stereotypes, but this is a very useful way of looking at it for most consumers most of the time.

Dimitre Ranev 

So if you do want to get, and correct me if I'm wrong, but if you want to get a line of credit from that bank, you would go to them, or if you want to get a loan, is that where you'd go to, is the personal banker? But specifically to that bank? Or am I misunderstanding this?

Rod Burylo  

Well historically, like when I was a personal banker with Royal Bank, there was a mandate to develop relationships with certain market segments. And we used to call them, you know, at Royal Bank, VIP clients, for example. And there was a requirement to build relationships with those people, understand their needs, and present to them a range of possible bank services, including lending services, credit services, but it might also include savings accounts, you know, basic investment accounts, through mutual funds, and those kinds of things. But, you know, I've been a VIP client of Royal Bank for a very long time. And I don't mind saying that, I'm not critical of them, but nobody has reached out and contacted me to build a relationship with me in a very, very, very, very long time. You know, so what I was taught back in the 1990s about trying to have a relation, this know your client philosophy that's a critical part of the financial services obligation, I don't know how that's showing up in the relationships that I have. So I wouldn't, if I was a consumer, I wouldn't expect very much in terms of obligation from these people. And I wouldn't expect very much in terms of true advice and guidance. And I want to say something that might be considered a little off color, and I have to tell you I've never been sued yet, even though I've been a critic of the industry for a very long time, but I don't intend to do it anytime soon. But, you know, here's the one of the ways that we would often look at many of the people in the banking industry is - and this has been really candid for your audience - there's no money in being a personal banker. And I never saw anyone that I thought was excellent at that stay in those roles, because there's not money being made. So they do one of two things. Either they, and again, this is a gross generalization, but they tend to want to work up the bank ladder, so increasingly stepping away from the consumer. So I would see really good people in the banking system not dealing with consumers anymore, because they went a different direction, or they left the banking environment entirely and went on to a different situation where they had a wider range of products and services, or they were in control of their business or their practice. So for example, there was a time in the 1990s, where myself and some of my friends at Royal Bank went to Investors Group. And at Investor's Group we felt we had a wider range of products and services and a different business model. Our compensation was more greatly tied to the successful outcomes of the consumer than they were previous to that. So that would not be the place that I would go to for sophisticated financial advice. You don't tend to have entrepreneurs with multimillion dollar businesses working at the bank. And so as a consumer, if that's you as a physician, you've got to find, in my opinion, you've got to find people who are living a life more like yours in the sense that they are entrepreneurial. They're buying buildings, they have staff, you know, they're creating personal wealth from their efforts, they have advanced education, and so on. They're far more likely to get you and get the kinds of services that you might need in my opinion.

Dimitre Ranev  

That makes sense. I laugh because I'm also a VIP client for RBC and I don't remember ever getting a call from anybody there. It's interesting, I guess back in the day they used to do that. Alright, so there's a limited role for personal bankers, in that case, for our audience. So let's move up the ladder, maybe it's not even a ladder here, but what about investment advisors? What's... this is where I started getting confused. What are investment advisors? What is their role? And what is their duty?

Rod Burylo  

Yeah, so that's a really good question. And this actually is interesting you should be asking about this now, because we've just come out of a year of some fairly significant developments in that regard. So when we use the word advisor in Canada, historically, one of the reasons there's confusion is there was not what we now call title protection. So - Quebec had title protection, but most of Canada did not - and so there were people out there using the word advisor without it being regulated, you know. So a consumer would go 'Well he's calling himself a financial adviser, or she's calling herself a financial advisor', and I'm not sure at all what that means, and you can understand why the confusion would be there. But historically, a lot of those people would have beyond a basic licensing or registration, and would start to more often see a designation. So when I say the word licensing or registration, I'm referring to someone that is registered to sell mutual funds or licensed to sell life insurance, where a designation in financial services industry tends to refer to some kind of more sophisticated financial planning education. These people tend to be more holistic. And you'll see letters after their names in Canada, like CFP, for example, which is probably the most common in that category. There were some really cool things that happened last year, two of them actually that are really worth noting. One is we had something called Title Protection for the rest of Canada confirmed last year. And what that means going forward, if you find - this is how it's supposed to work - if you find an a financial services person that's referring to themselves as a financial advisor or a title very similar to that, they are supposed to have a recognized credential from an approved credentialing body. And the last we heard in Canada is there was some expectation there would be single digit number of these credentialing bodies approved. So there used to be a whole bunch of them, anybody could open up a business saying 'I'm going to provide a credential to financial services people, charge them a fee to get the credentials, and then charge them an annual fee to keep these things up' and make a business out of it. And sometimes consumers weren't really getting, you know, a sophisticated quality. So there was a movement in Canada that said no, if you're going to call yourself an advisor, you have to have one of a short list of credentials, and the bodies that are providing those credentials have to be approved. So historically, there would be more confusion than I think there will be kind of starting from now. So that was the first thing that happened last year. The second thing that happened last year was something called client focused reforms, or CFR is often the acronym. And there was two stages of the introduction of client focused reforms but the crux of it was last year is that it was supposed to oblige people in the financial services industry, both individuals and the companies in that industry, to have to put the needs of the clients first. And this should be shocking to a lot of people that - and I think you and I talked about this a couple of weeks ago - it's only last year that there was even a nationally recognized requirement to put clients first and manage conflicts of interest around product distribution and those kinds of things that never existed before. So theoretically, for everybody, we should start to see as of this year, some improvement, some clarification, but I do want to stress, nothing and anything that we saw about these client focused reforms uses the word fiduciary duty. And I do want to comment, and I want to say to your audience out there, in the introduction you talked about me consulting to professional associations, one of the roles that I've had in Canada is helping these professional associations draft policies and procedures, as well as codes of ethics and mechanisms for enforcing codes of ethics and those kinds of things. So I'm a weird guy, I actually have a binder in the room behind me, it's got all these codes of ethics from different professional associations like CFAs, and I study them. Because - you didn't mention this - but my specialty in university in the 1980s was applied ethics, my postgraduate research was actually in Biomedical Ethics at the Foothills Hospital here because I thought I was going to go to law school with that and have my kids early and I ended up in this industry. So, you know, the study of ethics as a practical study, but also kind of more academically, is something that means a lot to me. So when I've looked at these codes of ethics for these credential people, they're very careful in there not to say that anybody has a fiduciary duty. And in fact some of them will say things like, you may have, in certain circumstances based upon the relationship with the client, blah, blah, blah, a judge will decide, but there is no confirmation in any of that stuff that someone has a fiduciary duty, even with these client focused reforms. Putting the client first is not the same thing as having a fiduciary duty. Because let's say that I have a very limited range of products and services, because I work for a big company, in everybody's mind is that as long as I'm helping them choose from my products and services with their interests in mind, I'm okay. But it's not obligating me to go out and find the best solutions, just solutions that are okay for the client but not necessarily the best solutions. So that's kind of where we're at today from all of that, so improving, but probably still quite a bit different than most people thought that they were getting from these relationships.

Dimitre Ranev  

So a couple of things that surprise me. So the whole title protection... so what you're saying is - this is a metaphor using, again, the medical industry - is last year, a doctor could just say he's a doctor, and then wouldn't have to prove they were a doctor, no licensing would be required, or a dentist would just say 'I'm a dentist', and that the financial industry was doing that until last year. Now there's an - oh I guess Quebec wasn't but Ontario and all the other provinces - that's very surprising to me. But I'm glad it's changed, it's great it's changed. And the other thing you mentioned, and I think maybe we'll move on to fiduciary duty here, but you talked about how if they - what did you say that they have as opposed to fiduciary duty, you have to do the best for the for the client? Well, what is that phrase that they use?

Rod Burylo 

Putting the clients first before all other needs.

Dimitre Ranev  

But if they can only sell you a specific product, they won't go above and beyond to find other products. So, for example, it's a doctor just giving one pill for depression, because they work for that company. Okay, got it.

Rod Burylo  

Yeah, it would be more like that. So we have a standard that applies to most people in the financial services industry, which is one of the standards is called the standard of suitability assessment. And so if you came to me and said, 'Hey, I'm looking at an investment, is this suitable?' It's like saying it's either okay or not okay. And the suitability assessment is based upon things like your risk tolerance and your personal objectives. But nowhere in there is the obligation to ensure that it's the best solution to your problem. It's just an acceptable solution. So if you say, I want a cash flowing investment, and I find a cash flowing investment, we know everybody might say that suitable, but it's not necessarily the best.

Dimitre Ranev  

I understand. So maybe we can go back to to the actors, but I think it's a good time to actually talk about fiduciary duty. Talk about that specifically, because that's where.... it's funny that the way I met you, right, is I was talking about fiduciary duty and obviously I didn't know what I was talking about so ou were typing furiously, I need to talk to Dimitri, to Kevin, and then you gave me a twenty minute lecture. And I'm like, okay, now I understand. So thank you very much. No, don't apologize. I really thank you. And I actually, when I did the presentation later on, I talked about that. So I thank you, but can you educate the rest of the audience about what fiduciary duty means? And I guess what percentage of people actually have that in financial industry?

Rod Burylo  

Yeah, so the concept of fiduciary duty is, as we've been talking about, is a requirement to put the client's interests ahead of all other interests. It's an interesting principle, but it's sometimes hard to see how that actually plays out in a very specific role or a specific client relationship. So one of the ways I like to talk about this is let's go back to that banker role, when I talked about a traditional role of a banker type investment person as being about guidance. That's often how that category is referred to. The next category up is often what has been referred to as an advisory category, which is not - so guidance is helping someone make a choice, advice is more telling them what their choice should be. The practical application of fiduciary duty now, which is the highest standard, is really the advisor just making the choice for the client. And so let me explain to you how that plays out. In all the various registration categories in Canada in the investment space, one of the ones that is considered to be the highest is what we call a Portfolio Manager Registration Category. And that is a category that's granted by two types of entities in Canada. One is a provincial securities regulator. The other is IROQ, which is where you would find your stockbroker type people as well, because their responsibilities overlap a little bit depending upon where the advisor is actually working. But the concept of the portfolio manager in that space is similar in the following way: a portfolio manager has a discretionary ability to manage money. So let's say I'm your portfolio manager, and I've worked with several of these in Canada, by the way, and these roles, and you decide that you want me to be your portfolio manager. And you're going to allow me to look after $100,000 of your money. Once I determine your risk tolerance and your objectives, and we have that conversation, and I come up with kind of a sample approach to helping you based upon your parameters, I am now just empowered to go ahead and do that. So let's say I'm your portfolio manager, and we decided we're going to allocate some of your funds to buying a publicly traded bank, Royal Bank, I just go buy Royal Bank. I don't ask you. That's the difference. And one of the reasons you have to have a fiduciary duty there is because you are not participating in the process, I'm just going and making the purchase. And if I don't like Royal Bank anymore, in that category, let's say I want to switch you to TD for whatever reason, I don't call and ask you, I just switched you to TD. So you can imagine if I didn't have your best interests at heart, I might be funding some private equity deal that my brother is managing and I've got a back end piece of and, you know, I'm clearly not objective in these matters, I clearly have conflicts of interest that are not being disclosed. So a regulator would come along and say, 'Wow, you're just basically doing whatever you want to do with Dimitre's money.' Of course, you have a fiduciary duty there. Because in that case, it's the nature of the power you have in the relationship. It's hard to say a banker has a fiduciary duty if I say to you, 'Hey, do you want to have the Canadian Equity Fund or a Canadian Balanced Fund?', and you go, 'Well, I'm kind of conservative, blah, blah, blah', you're Balanced Fund, you know, we only got so many of them, and it's huge. And nobody gets too anxious about that, because you're kind of making the decision with my guidance. Where on the other end, I'm just doing it. And so the number of people that that have that registration category in Canada is actually fairly limited. It's surprising. And this is one of the reasons I talk to you about that. So the people that actually have a fiduciary duty, what I would say, as a matter of fact, as a matter of merely having that registration category, it's understood you have one, those numbers of people are fairly small in the grand scheme of things. And to get there, by the way, you have to have advanced education, you have to have certain number of years in training, being supervised by people in that role, you can't just show up and say I want to be a portfolio manager. It is a process. You know, where mutual fund licensing categories and stuff like that are pretty straightforward. You spend a month studying a class, you pass a course, you're up and running. These other things take possibly years and require advanced designations to get there. So I have some advanced designations that were required of me to be in these kinds of supporting roles in that environment. But you can't just automatically do that. So the other way that a person could have a fiduciary duty is if the nature of the relationship is such that you are really reliant upon me, I have a lot of power and influence over you, perhaps a senior or - and I don't mean to say that all seniors are vulnerable, I'm not gonna do that - but there's a concept in Canada that was established as part of those CFR reforms, called the vulnerable client. So a client that's particularly perhaps reliant upon a person's opinion and so on. If there was a problem in that relationship, and this person was not a portfolio manager, they're just a regular advisor, and they went to court, a judge might decide that in that particular circumstance, that person did have a fiduciary duty. But I gotta tell you, I've been at this a long time, and I don't think those kinds of court cases are all that common. You know, we don't hear about that. And there's one more thing I want to say about the portfolio manager stuff that sometimes blows consumers away. And because a lot of this stuff, you might say, well, what does that mean for me, what do I really care if, you know, if they have this duty towards me, or if I'm not going to sue them, what difference does it make? But there's some real practical problems. So I'm going to give you one for example. And I wrote a paper in 2007 called Move It or Lose It, and it was a discussion of why I thought the market was going to drop. I got a little lucky with that topic, because in 2008 the correction started. I got lucky. And the last time I did this speech I was actually in Las Vegas, I was speaking to a conference of advisors, Canadian advisors in Las Vegas, and a lot of the advisors used to push back when I would say things like, I think the markets going to correct and so on. And the very next day after that last speech, Lehman Brothers announced their bankruptcy and the market started to freefall. But here's one of the reasons why advisors get upset about that. If I tell a bunch of mutual fund advisors, for example, or stockbrokers even, that the stock market is going to drop, we think it is, what do they do with that information? Consumers might think their job is to help people buy low and sell high. And if the market is going to drop, maybe suggest that they sell and wait for the market to drop and buy back, and we have these fantasies that this is going to happen or maybe we saw TV shows and stuff like that, but here's the reality of it. If you're a person that's not a portfolio manager, it means you have to talk to every single client about a trade. They have to approve every single trade. I don't get paid to do trades, to move people from one product to another, you're not - that could be churning, right - so most of the time people are moving money from one portfolio of mutual funds to another, trying to change the market, I'm not getting paid. But the mere fact that I'm reaching out to possibly hundreds of clients, which could take months - that's assuming they're in Canada and they're not snowbirds and any other thing that could complicate it, they're not in the hospital - I've got to somehow get to all of these people while the market is doing this, and get signatures and confirmations from everybody. It's a nightmare. The thought that most of the people in the industry could actually effectively help people sell high and buy low in these environments, it's not realistic even in the slightest. So who do they call? They might call their mom and dad, they might do their own account. You know, if Dimitre's their buddy and Dimitre's got a bunch of money sitting over there with the bank, we're trying to get over, Dimitre I got some news, we got to act now, man, because I'm trying to get.... but the reality is most of the clients never get the call. And so what do they teach these people? They teach those types of advisors to tell their clients, don't worry, these are not your numbers, you're gonna retire in 20 years. And they coach them to be complacent, or calm, depending on, these are politically charged expressions, I acknowledge. They encourage them to be calm and try to get them to reframe how they think about this, but it's in part because they can't actually help them buy low and sell high as a scalable activity. It can't be done. And so let me connect the dots for everybody out there. This is one of the reasons why the concept of a portfolio manager is so important. Because if I'm a portfolio manager, I don't have to call everybody. I can trade $10 million worth of Royal Bank in seconds on the computer for hundreds of clients. It's very fast, it's very effective, it's very cheap for the client, because I'm doing it all now. But to do that, I need to have full responsibility for everything that I'm doing, and therefore a fiduciary duty. So here's the takeaway, most of the people can't be an environment where they can have a fiduciary duty, most consumers will not benefit from that environment, we should want those people that are portfolio management have fiduciary duty, not just because they have that duty. But because since they have that duty, they're in an environment where they can do things very quickly and effectively. And that's one of the reasons why I try to teach consumers about what these different categories look like, so that they can not only manage your expectations, but hopefully get better relationships that are more effective for them. Does that make sense? I know that's a lot of information.

Dimitre Ranev  

No, it makes sense. And two things I want to sort of expand on. It's funny, because when I used to have a, I guess a portfolio - I didn't have, I never had a portfolio manager - but had an investment advisor, I used to get those emails when the market went down saying oh, you shouldn't shouldn't worry, you're in for the long haul. So that's interesting that it's almost automatic, I guess, because they can't do much. But second, you had a great analogy that I seriously stole, thinking about a surgeon, right? If a surgeon has to call about every cut he makes and ask the family 'Can I cut here?' Okay, sure. 'Can I cut there?' Okay, sure. That's the difference between a portfolio manager and an investment advisor. An actual portfolio manager does not have to call for every single trade. So my question to you then, is how accessible are portfolio managers for, again, for professionals such as doctors? What are the fees like? Does it make sense for people to, I mean, is it accessible? How about this, let's just start with the accessibility question.

Rod Burylo  

And actually, there's some irony around this as well. And I'm here not to speak in favor of any particular portfolio manager. I want your audience know I'm not marketing or promoting anybody. But as a general concept, here's one of the cool ironies about the portfolio manager concept, is you might think that because these tend to be the most sophisticated, the most educated, the ones with the greatest responsibility, that that means they're also the hardest to find or the most expensive, right? But here's part of the irony. If I can effectively trade 10s of millions of dollars just by doing this, then that means I can actually scale my service to a wide range of audiences. So most of the portfolio managers that I've dealt with in Canada have minimums, some of them had quite low minimums, and sometimes $50,000 minimums. Which shocks people to think that I can actually get the best, in my mind, the superior category of management for a relatively small account size, in part because of the scalability of it. Now as a practical sense, I tend to see most portfolio managers starting with 100,000 minimum, and then you get up to bigger shops that will do million dollar minimums, but mostly because they can. They just say we're not going to look after retail consumers, we're going to do a hard line at a million dollars. So within this category of Portfolio Manager, what you might find for those that are providing services on what we might call a smaller account, let's call it 100,000, they probably have what we call a very systematized or pooled approach. So you and I, with our 100,000 and a portfolio manager are participating in pools that they've created. They're not buying and selling for you and I specifically, they're buying and selling within the pool. And so we happen to be participating in the pool with small dollars. It's not a unique range of investments for us, it's not a unique portfolio, but it's very effective. As you have more money, some of these portfolio managers will provide what's called a Separately Managed Account or an SMA. An SMA account would be me saying to Dimitre, oh Dimitre, you're gonna give me a million dollars? I'm going to create something especially for you. Now, it might look a lot like the pool funds. They're portfolio managers, they're just human, they can only analyze so many stocks, they can only be good at so many strategies. But there could be some tailoring to the client. So let's say a doctor has a corporate account, the taxation of investments in a corporate account are going to be different than in an RRSP. And so it would make sense that if you're talking to a portfolio manager, you could say, 'Hey, this is corporate money so we should have a slightly different strategy', which makes sense. If it's in an RRSP, it might not matter. But I typically see separately managed accounts starting at around a million dollars. But I've also seen some 800,000, half a million dollars, and it kind of depends upon the portfolio manager. You know, so they can make a choice, if Dimitre says, you know, I've got $5 million but I'm gonna give you half a million dollars to start, I might be inclined to say I'm going to treat you, you know, because I want to get the rest of it, I'm going to really pay attention to your half a million dollars, not my normal minimum, but I'm going to do it for you, because I'm looking at a bigger picture. You know, or Empowerment Office, for example, one of the groups that I'm working with, representing doctors as a collective has some negotiating and bargaining power with portfolio managers to begin to reduce the price or reduce the level that they'll do these tailored approaches. So what's the price of that, that's one of the things you asked. I would say you typically would be looking - and depends upon the services provided by the portfolio manager - if the portfolio manager is just providing security selection, so buying stocks, bonds, private offerings, trading those for you, and they're not doing anything else, they're not doing estate planning or tax planning, you have other resources for those, you might be looking at a price, let's say 1%, 1.5% of assets under management in that range. If they start adding on other pieces like financial planning pieces, then you can start seeing the price go up, and usually I see it start maxing out around 2%. But I gotta say there's a wide range of possibilities in there, because if the portfolio manager is picking other products, those products could have prices in them as well. So I might be charging a fee to help, you know, to buy a fund, a third party fund that's been created, but there could be fees embedded in that fund. And that's one of the things consumers have to be very, very careful of, is sometimes a manager of investments might say, 'Hey, I'm only charging you 1%'. So they walk around thinking that the cost of management is 1% because that manager only has to talk about what they are actually charging themselves, where the other products could also have fees associated with them. But let's say as a walking around concept, somewhere between 1% and 2% would be normal. And again, depending upon the level of other services being provided within that relationship.

Dimitre Ranev 

So a couple of points, it already seemed to me, but first of all, it does sound like it's accessible to most professionals. So I think there's a misconception that for a portfolio manager to be actually wanting to take your business we're talking about a million dollars or half a million dollars, but I think that's more coming from the idea of hedge fund managers, which can go up to 25 million, right? So that's good to know it's accessible. Secondly, it's interesting that the fees can start at 1%. Because that's actually lower than a lot of mutual funds. That's surprising to me.

Rod Burylo  

Well and isn't it ironic that I'm making a case that buying a bunch of mutual funds, where the mutual fund advisor can't readily buy and sell on their own volition, they have to come to you for everything, meanwhile the portfolio manager is buying and selling and trading, I typically see the performance better, I typically see a lower cost, it makes a bunch of people like us go, why in the world would you not go to a portfolio manager? Why would you not go? And the only reason that I can come up with typically is - well, there's two reasons - is I don't quite have enough money to get started with the portfolio manager, or the person wants to do a lot of the stuff on their own and try to bring down that 1% to, you know, let's say ETF type prices of .1 or .2 or or .3, that kind of thing. But I don't mind telling you that I have the top designation with the Canadian Securities Institute, but I don't buy all my stocks on my own. I buy all my own private offerings through my own analysis and my own contacts. But I have relationships out there that helped me understand public markets. And there's nothing wrong with that, some of the best people I know in our industry still go to other people for help. And I don't mind paying a little bit if it shows up in the performance overall.

Dimitre Ranev  

I have so many questions. But you know, we're running out of time. A couple of more here. So, for example, would a portfolio manager have access to alternative investments, such as limited partnerships or things that, for example, as a DIY investor would never be able to invest in?

Rod Burylo  

Yes, yeah. In fact, the portfolio managers I've worked with in the past have tended to have a strategy or a skill set, that's not common. And the reason why I've looked for that, not only for employment opportunities as a consultant in that space, but as a consumer of investment services, is I subscribe to a variation of what we call the efficient market hypothesis. Which basically states that information is so available to everybody out there all the time, you know, everybody's sitting there on Bloomberg access and on terminals, that everybody has the same information. And if you don't have information that's available, that means you have insider information. So you're likely in the realm of possibly committing a crime. So if we all have the same information and the same analysis at the same time, why would you think that the prices of securities are not the right prices? That's what we say about being efficient. So what portfolio managers will often do is, because of that efficiency, is they'll apply strategies or approaches that help bring value to the process. So I'll give you an example. You said it already, limited partnerships and private securities, offerings that consumers can't get in on their own, you know, if I got a billion dollars as a portfolio manager, and I'm allocating, you know, 1%, to different offerings, I have millions of dollars to go buy an apartment building. And I can buy it like that, and allocate funds there, and so get these clients participating in something they wouldn't have participated in. So a portfolio manager, in my mind, the best ones, for the best price, given the best value, are doing more than just buying stocks and ETFs. They're doing those things. And I'll give you one more example. And this now sounds more hedge fund-ish. But one of the portfolio managers I worked for in Canada for several years, was an option strategy specialist. And options strategies are hard to scale up for an individual, but they had hundreds of millions of dollars under management, very effective team, so if somebody was interested in the hedging power of option strategies, if they were interested in it, I always said it makes more sense to go to a big group where there's a whole team doing it for hundreds of people in the order of hundreds of millions of dollars, then you trying to figure it out on your own. You know, so they're trying what I would call the secret sauce, what's the secret sauce with that portfolio manager? What are they bringing to the table in terms of value? Can they articulate it? If they can't, that might be a warning sign, you know. Doesn't mean they're bad, but it might not necessarily mean you're getting a special value out of it.

Dimitre Ranev  

The robinhood, the trading app, was pushing option strategies for people for $10. But that's not a good idea. Two follow-up questions then. So number one is, you know when you look at the whole active versus passive debate - which  is very cloudy and confused, and quite frankly, on both sides, I think dishonest - because when you look at the passive debate, they always compare returns to just a slew of different things like mutual funds. Is there any actual studies, and I know studies are hard to get in financial industry, looking at specific portfolio managers and how well they do compared to the market? Is there actually anything out there, and I'm talking about portfolio managers, forget about mutual funds or the other definition of active investments.

Rod Burylo  

I'd say there's a lot of portfolio managers that don't outperform the market and that have their fees. And fees go up, the more active they are, or they're more they're trying to do unusual things, that generally means that the price is going up. And yeah, as a rule of thumb, they don't tend to outperform the market. And even if they did in one year, you know, there's a lot of studies that suggest that that's not a replicable thing. You know, they had a good year, and maybe, and so one of the things about taking risks with securities, a risk is, by definition, a risk. It could pay off. And it might not. To have an unusual performance relative to a benchmark, it means you've got to take on some unusual level of risk to do that. And by definition, that means sometimes that risk will pay off, and sometimes it won't. What's bad for consumers is to try to follow performance of a portfolio manager and, you know, say oh, they had a really good year, and I didn't like my current portfolio, I'm going to move over there, you know. And there's often really good reasons to move, don't get me wrong, but moving because you're chasing someone's really good year last year, is probably not the way to go. You know, so yeah, I think some of this comes back to that concept of the efficient market hypothesis. If we all have the same information, you know, I don't mind telling you, sometimes I've done my best by just buying a bunch of big blue chips with dividends and sitting on them for, like, 5, 6, 7 years. And then I go back, and I go, you know, Google, you want to have some fun, go out there and Google, 'if I bought Royal Bank 10 years ago and sat on it', you know. Now remember, you paid one fee to buy it, you probably have no ongoing fees, what your return would be... but the thing is, so here's one of the reasons I invite you guys to continue to follow Dimitre's podcast, because you get someone like me, an industry person who calls out the industry, for, you know, it's, I won't call it deception, but let's say some lack of clarity over value proposition. And there's a chapter in my book called Is The Financial Services Industry Trustworthy? And, you know, I generally argue that it's not trustworthy, but I have a very specific meaning when I say that, you'll have to read it to get it. But yeah, I would just be really super careful of a bunch of people who are just saying, I'm going to go buy some stocks for you, and I'm going to be better than the market. This is one of the reasons I focused on portfolio managers that have a secret sauce. Are they doing something that I can't do on my own, because if I can do it on my own, I might as well do it on my own. You know, and this is where I look for private securities or something else in there. I'm a fan of private securities myself, but I don't often get those from portfolio managers, I find that I can source them on my own. But I'm in the industry, I've been at this a long time, so I know that people. If you don't know that people, it might be hard. You got to know the people that know the people and you'll have the best opportunities.

Dimitre Ranev  

So to summarize for an investor, the advantages of a portfolio manager is, first of all, there's fiduciary duty.

Rod Burylo  

Correct.

Dimitre Ranev  

Which is the thing that you really want. Secondly, you have access to different investment vehicles, which most people don't have access to. Thirdly, you save a lot of time, you don't have to worry about rebalancing your portfolio or buying or selling stocks, that's done by the manager. Fourthly, the fees are - and again, obviously, you have to look at different managers - but 1% fee, I'll tell you, it's very reasonable to me. And I'm saying this as a person who does DIY investing, but that's a very reasonable fee. And it's much better than the average of mutual funds in Canada, which is about, say about 2%, I believe.

Rod Burylo  

Last I heard.

Dimitre Ranev 

The disadvantage is that there is an entry fee. So there's a bit of a barrier, but I guess for professionals, like doctors, it's $50,000. So even, I would say 100,000 isn't necessarily a barrier. Might be a barrier for, unfortunately, some people who are not professionals. Is that a fair summary of what you said, Rod?

Rod Burylo 

Yeah, I think you've captured that very, very well.

Dimitre Ranev  

So my last question to you - and again, I have actually have a thousand questions, but we have to we have to wrap it up - is if somebody is interested in having a portfolio manager, is there a resource, for example, I know psychologists have a website where you can find a list of psychologists, is there a resource for portfolio managers or do you just have to do it by word of mouth? How does it usually work?

Rod Burylo  

Yeah, you could look at a record of registration categories for people. So for example, in the past I've pulled out entire lists, say from a brokerage firm, like a stock brokerage firm, a list of all the dealing representatives there, and which ones have the portfolio manager registration or not. But doing that I don't think is the most useful of exercises, because just because you found a registrant like that, it doesn't mean that they're doing anything special or, you know, have a compelling offering. It'd be like finding a hamburger place. I found one, there's a million of them, is it a good hamburger place or not? So I would go back to, you know, word of mouth is a useful thing. One of the things that we try to do with physicians through Empowerment Office, is provide vetted portfolio managers, ones that we have identified and vetted, either they already have an attractive price or we've worked on the price a little bit, so that it's more attractive to our audience, to physicians, for example. But I would always go with a referral or word of mouth in that space. And, you know, asking your buddies, if they've got some - one of the challenges is that you could go ask your friend who's a physician if you've got a portfolio manager, and they might not know that that has a very technical meaning, they might just think it's managing their investments. But one of the things, let's say you had a short list of these types of people, you can look on regulatory websites to see if they have any complaints against them, any sanctions, that would be a useful thing. But that might just tell you that they haven't gotten themselves into trouble, that doesn't necessarily mean that they're excellent, that's a different thing, right? So I would go with word of mouth. And then there's one other thing that you might contemplate. There are certain associations in Canada where, let's say they have a designation of a particular kind, like a CFP designation, where they'll have lists of these advisors and will also say what registration category they have, like, possibly Portfolio Manager. And I like those kinds of resources, because that starts telling me a little bit more about the overall character quality of the person. And another thing you could do is, if you've got a topic that you're excited, I know, we're going to talk about ESG at some time in the future, but there are associations in Canada where they look, for example, a Responsible Investment Association in Canada, that tends to attract advisors that are interested in ESG topics within this overall realm of responsible investing, that will list off all the advisors in there. And then if they're portfolio managers or not. And so if you've got a topic that you're really interested in, and want to try to find a portfolio manager that specializes in that space, there might be lists out there to do that. I had a company in 2004, you referenced for the audience that I won an Advisor of the Year Award, that Advisor of the Year Award was for a business we created called Canadians Retiring Abroad. And so if you're interested in retiring abroad, you would find us. But it was because not necessarily that we were excellent - I thought we were good - but because we had made sure that that we could clearly communicate what our differentiator, what our special topic was. So if you wanted a special topic, call us, if that's not your topic, you know, go talk to somebody else. So sometimes there's associations out there. But, you know, if you've got friends out there that are really interested and they want to talk one on one, you know, the two of us together on how to select an investment advisor, we could do a whole discussion on that at one point, the things that I would look for. But it's not necessarily as easy as it sounds.

Dimitre Ranev  

That was, I had one. I had a question about that, but I feel like that's a whole topic for podcasts. It's not a five minute question. Listen Rod, I really appreciate your time and your wisdom. And I'd love to have you back. There's so many more things I want to ask, but thank you again for coming and for talking about this. And hopefully we'll talk soon. And I have to get that book and give it a read.

Rod Burylo 

And very good to talk to you and you provide an excellent, important service to your audience. I really mean that. So thanks a lot for having me on.

Dimitre Ranev  

Thank you.

Kevin Mailo  

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.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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Kevin Mailo, co-founder of Physician Empowerment, talks with another fellow co-founder, Dr. Dimitre Ranev, about finance and investing. Dimitre is also co-host on the Primary Medicine podcast and along with being a practicing physician, gives talks on stocks, tax planning, and the like.

Dr. Ranev acknowledges that he wasn’t always knowledgeable about financial health. He credits Kevin with spurring him into the initial research which is when he discovered he had an affinity for it. He invests in equities, crypto, and is looking at moving into real estate as well. While he manages his portfolio himself, he stresses that not everyone is equipped to do so or will enjoy it.

In this episode, Kevin Mailo and Dimitre Ranev discuss the journey towards financial savvy and how wealth is about more than simply money. While Dimitre enjoys managing his own finances, Kevin does not, and they encourage anyone who would rather not stress about their investing to delegate that task to a professional. Every successful athlete has a team behind them and according to Dimitre, physicians are no different. It’s just as important to care for your mental health and the wealth of your well-being by putting your best support team in place.

About Dr. Dimitre Ranev:

Dr. Dimitre Ranev is a family physician based out of Ottawa, Ontario, and Gatineau, Quebec. He is a  faculty lecturer at McGill University. He is a gifted teacher known for engaging his audience with clear, concise explanations. He is passionate about financial education, as it is the path to personal and professional freedom. 

Resources discussed in this episode:

• Primary Medicine podcast
• 'How is my Financial Health, Doc?' podcast by Vu Kiet Tran

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Physician Empowerment: website | facebook | linkedin

Dr. Dimitre Ranev | Medical Doctor / Faculty Lecturer at McGill University: linkedin

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Transcript:

Kevin Mailo  

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 and 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.

Kevin Mailo  

Hi there. I'm Dr. Kevin Mailo, one of the cofounders of Physician Empowerment and one of the cohosts of the Physician Empowerment podcast. And I am so excited to bring to you today another cofounder/cohost, Dr. Dimitre Ranev. And Dimitre is very close friend of mine. We did family medicine training together all those years ago at McMaster family practice in downtown Hamilton. It's been a lot of years of friendship, and starting Physician Empowerment together and podcasting together on the Primary Medicine podcast. And so I'm so excited to launch our newest project, which is the Physician Empowerment podcast. So Dimitre, why don't you introduce yourself, share a little bit about yourself, talk about your practice. Tell us a little bit about who you are.

Dimitre Ranev  

Yeah, sure. So that's still my practice first. Currently, I practice in both Quebec and in Ontario, I live in Ottawa, but I cross the bridge to Gatineau, which is the small town across the river. And I am a family doctor but I found a niche, which is that I do trans care and sexual health. In fact, I teach those topics at McGill University as well. So that's my sort of my medical hat. In Ottawa, I work for Executive Health, I'm part of the Telus Health team, where I get to meet executive people and actually do the good old medicine, you know, spending half an hour with somebody, forty minutes, new preventive care, which you don't have time to do anymore. But at least I get to do that in Ottawa. And I learned a lot from these people, because they're executives, they're motivated and talking to them is always very illuminating experience. And there's a lot of wisdom. So I'm very fortunate to be exposed to that as well. But I'm also involved with Physician Empowerment. I'm also involved with the Primary Medicine podcast, I love podcasting. I love talking to people. I love learning things from people. And that's why I'm excited that we're starting this because we have a lot of interesting people to talk to. Colleagues and so forth.

Kevin Mailo  

Yeah, there's so much there. So we graduated over 10 years ago, we entered practice over 10 years ago. Why don't you go ahead and tell us a little bit about your financial journey. So you educate in finance, you are, you know, a teacher in finance. And Dimitre, for those of you that have not been to one of our conferences, does some incredible talks on tax planning, as well as the markets. So equities, bonds, crypto, you do so much, and you know so much, but I know you weren't always there. So why don't you go ahead and share a little bit about your journey on that path to finance.

Dimitre Ranev 

Yeah, so it's interesting. The path to finance was spurred on by you. Because before the idea of the Physician Empowerment came up, my financial background was put your money and cash in the bank and collect interest. That was my retirement plan. But when you sat down and said, listen, we need to do this project. Doctors are not financially literate. And this is an issue because it's affecting their livelihood and retirement. That's when I sat down and started looking at investing, looking at investing in stocks and bonds. And I love this stuff. I was like, I was skeptical. I didn't think I'd love it. I don't know, maybe you felt something in me because you asked me to do this part of the of the talk. But I was so immersed. And you know, I made this huge presentation. And it I felt like that was me, like teaching this and understanding this was me, I felt in the flow of things. And you know when you work on something, and it doesn't feel like work. That was me when I was doing that. So I thank you for all this financial education, I wouldn't have started that journey unless you had spurred it on. But I feel like it's something that I love doing. I love teaching as well.

Kevin Mailo 

Yeah. And so you've done a ton. Like I said, you give this great talk on, you know, tax planning, you know, understanding the taxation system, which many of us do not understand. And these are things that none of us gets teaching in, throughout our med school and residency years. And unless you really go out and seek that information, you just don't know. And it's scary how much you don't know that you don't know. That was kind of the eye opener for me in finance. And I think that was probably it for you as well, Dimitre. So, you know, you're known nationally for your work as a financial educator of fellow physicians. Tell us about your own personal financial habits, right, you know, in terms of whatever you feel like sharing in terms of personal spending, and investing, crypto, some of these spaces that you've been in.

Dimitre Ranev  

Yeah, of course. I think one thing that I really want people to understand is that your investment journey is very personal. And you have to find out what works for you and what works for you may not work for everyone. And that's why it's important to talk to people and see what they're doing and learn from them. But personally, you know, I started off investing in mutual funds before I realized that perhaps wasn't for me. And currently what I do is I have an investment portfolio in crypto because I'm a millennial and that's what we do. And as I said in the conference, it's great practice for not freaking out, because crypto goes down 30% one day, and that's okay. So it's training, it's training to be strong, and not sell when you shouldn't. But most of my investments are in equities. So I do dividend investing, I do investing in index funds, and I use some technical analysis to try and, you know, have more control over when I buy and sell things. So that's most of my investment journey. I'm looking into investing in real estate, actual real estate, as well, because I think it's it's important to diversify, and have something more physical than, you know, ETFs and dividends, and also invest in precious metals. So I've touched a bit of everything really. I really have to get into real estate more, but I've touched a bit of everything.

Kevin Mailo  

That's outstanding. Yeah. And for those of you, again, that have been to our conferences, you'll know that Dimitre and I have this nice little rivalry between real estate and the public markets, going back and forth, because I really believe in real estate, but I do invest in equities as well. And so, Dimitre, you know, you manage, you day trade, or, well, I don't even know if I'm using the term correctly, you manage your own portfolio, right? You do self directed investing. Many physicians do it, but I can share with you, you know, having done this for years, many physicians do not do it well. yeah. And one of the things that I struggled with, when I briefly tried this, was, here I am working an exhaustive shift in the emergency department, I am out of mental bandwidth to spend analyzing, you know, my stock portfolio and trying to make plays here, right? And I just found that I was frankly tired and didn't have a head for numbers, still don't have a head for numbers, and ultimately delegated this off to a very high quality manager, which I am so much happier for. But I know there are physicians that are still trying to do it themselves because they want to save on fees. My own opinion is I don't necessarily think that's wise, not only in terms of, you know, the returns or potentially protecting you against some downside losses, like we're seeing this year on the market, but more just in terms of like, personal wellbeing, and work life balance, like do you really want to go and do a second job after your clinical work, managing your stock portfolio. But I know, Dimitre, you do this, and you do it very well. And you're respected for your work in this. Tell us a little bit about how you do it, right, like your headspace, you know, how you create time to do it, how you manage risk, which I think a lot of physicians struggle with as well is tolerating risk in their portfolios. So why don't you share a little bit about your perspective or your philosophy? How about that, in this space of self directed investing?

Dimitre Ranev  

That's a great question. And I would start by saying, what's really important is to know yourself, and to realize that doing your own investing, or self-directed investing, isn't for everyone, even though people tell everyone, you should do this because your fees are low. If you can't find the time to do it, then it makes sense to pay an extra fee for somebody else. If you don't enjoy doing it, or if every time you open your account, you're having a panic attack, then paying the extra fee to somebody to help you is fine because I realize that you need to have a team just like you know, an athlete has a team, right? They have doctors, they have psychologists, we have to have a team as well. And part of the team is somebody who helps with financial planning. It could be yourself if you like doing it, or a financial advisor or even a portfolio manager. So again, people need to realize that self-directed investing isn't for everyone, even though it's sold for everyone, it's not. In their headspace I'm in, I don't do day trading, by the way, that's a loser's game, unless you are really smart and you can do that for a living, you're not a doctor. You could say that I do swing trading or I mostly do trading on long periods of time. But it's about having a habit. It's about saying, I'm going to check the portfolio a specific day every month, I put it in my calendar, and it's the thing I need to do just like brushing my teeth or going for a run and exercise. And after a while you do that you have to have a habit, some kind of headspace where you're saying once a month, I'm going to check the portfolio, twice a month, I'm going to check the portfolio and you do it. And the thing is, the more you expose yourself to this the more comfortable you become and the easier it is. But that's my headspace. And that's not everybody's headspace. Again, you don't enjoy that. I don't think you would enjoy checking your portfolio once a month, right? So if you don't enjoy that, don't feel like you should be forced to. There's people that can help. And, again, how much is your time worth?

Kevin Mailo  

That's the big one.

Dimitre Ranev  

How much is your time worth? Yeah. It is that extra fee of 1% worth spending when you can be doing something else you enjoy, right? With your family or going for a run or going on vacation. Ask yourself that. I've learned that the hard way. Stuff I don't enjoy doing I just delegate now. I don't, I delegate, I don't enjoy doing some things. And I'm like, well, somebody else will do it for me,

Kevin Mailo  

And that, for myself personally, was a big growth step. But as physicians, we tend to micromanage. And I think it's a very good thing, when it comes down to procedural work, making sure that we're really taking that history carefully, getting to the diagnosis, looking real carefully at that CT or whatever. I get that, that's important, that's what we're trained for, that's we have to do. But when it starts to, you know, spread to other areas of our life, it can be really counterproductive, right? And, you know, hospital based physicians, we work with a whole team. Everybody from our registration clerks, to, you know, our cleaning staff, to our nurses, to nurse practitioners, we're all part of a team. And there's an element of delegation across all of that, you know, and people delegate up to me, or I delegate down to them, or whatever. And in our financial lives, it should be no different. And the really sophisticated investors, the really high net worth individuals, on the things they don't understand or do not want to do, and don't have the mental bandwidth to do it, they actually delegate out. They're happy to pay somebody...

Dimitre Ranev 

100%.

Kevin Mailo 

They're happy to pay somebody to make them more money. And I learned that the hard way in real estate, I used to manage my own doors. And my goodness, was that a lot of work. And I am so past that, right? And so much happier. Right? What I'm paying in management fees on my doors, way better than dealing with these things myself. So this is where delegation just isn't about creating wealth. It's about building a better life, because if you're not enjoying your life right now, then, like, what are you doing? Right? And that was the question I looked in the mirror and asked myself a few years ago. Like if I'm not happy now, when am I going to be happy? Delegation has been a big part of that, especially in my financial life. So I like sharing that. Because I think that's important. And many physicians struggle to get out of that micromanaging mindset.

Dimitre Ranev  

It's, yeah, we we do. And to me, it was a revelation as well. And it was through Physician Empowerment that it sort of... and from listening to people talk actually, again, in my executive health position, we have time to chat. And that's one thing that people say: delegate. Why am I happy right now, it's because I'm not dealing with every little thing. These guys have a team of 200 people under them, right? They can't deal with every little thing. They cannot micromanage, they'd go crazy. So it's something that you need to sit down and ask yourself, what can I do? What is possible in terms of my financial health? And if it's, and if I'm not comfortable doing this, finding somebod. There's lots of people that can help: financial advisors, portfolio managers.

Kevin Mailo  

Great accountants, tax lawyers, there's so much out there, like a bookkeeper, right? You know, small things like that. You know, that make such a big difference in our financial lives.

Dimitre Ranev  

I was listening to a podcast, a financial podcast about Tiger Woods. And it just, again, he has such a big team. Like he's a talented person, but he's talented enough to know that it takes a team to make this athlete, it takes a team to make a good doctor. Again, you don't want to be in a position where you're doing your finances, you hate doing it. And because you, something that happens, the stock market goes down 20%, you make a medical error because you're thinking about that as opposed to thinking about the patient in front of you, right?

Kevin Mailo  

Yeah, I remember that actually vividly from the 2008/2009 financial crisis. And I remember having preceptors that just couldn't get off their computers, constantly glued to their portfolios, constantly thinking out, you know, they were late walking into the room to go see a patient and remember, I was young back then, right? Like, I didn't have any money, I had debts, right? Is there any chance you're gonna wipe out my debts? Like, that's all I was thinking. Maybe the bank will crash and I don't have to pay those hundreds of thousands of dollars, right? That was the one hope I had. You know, and I remember, like, watching it affect them. And so these are the things that we need to be mindful of, right? Like, our success in our clinical careers really depends on where our headspace is.

Dimitre Ranev 

Exactly.

Kevin Mailo  

You know what I mean? And this is why Physician Empowerment is so much more than money and why we talk about wellness and practice management. Because, you know, when we are really, really working in internal harmony, we're very successful in our professional lives, and successful in our financial lives. And so being mindful of the effect of our finances on our practice and personal lives is so, so huge. It really truly is mindfulness.

Dimitre Ranev  

It is. I think I'm gonna just end by saying, and I was talking to Vu and he said something really, really important. You know, how he talked about tests having specificity and sensitivity, right?

Kevin Mailo  

Yeah. And sorry, let me let me just reference this is Vu Kiet Tran.

Dimitre Ranev  

Great guy.

Kevin Mailo  

Yeah, he's got his own podcast. He's an ER doctor based out of Toronto. But anyhow, continue.

Dimitre Ranev 

So tests have specificity and sensitivity. But doctors have specificity and sensitivity too. If a doctor is irritated, or in a bad mental state, his specificity for diagnosing something is not good. Like if you didn't sleep last night, because your portfolio cratered. And you're thinking about that you're not, you're gonna misdiagnose, right? You have your own specificity and sensitivity. So you have to take care of that. So you know, that's funny that going through this investing journey, that's what I learned the most, is just being mindful. Just being mindful, because the stock market is a brutal mistress. It's going to spit you out. It's going to tell... you know, you have this ego as a doctor, right? Like, I'm always right. The stock market doesn't care. She doesn't care about your feelings. It's a great educator, I think, if you can stand it. And I think it's been very productive in terms of making me more mindful and a better person. But if you don't enjoy that, you can learn this harsh thing other ways. So get somebody else to do it for you. I think that's my biggest advice. Be true to yourself. Sit down, ask yourself, do I really need to do self-directed investing? Do I enjoy it? Or can I find somebody else? So that's the first thing you need to ask yourself before you go into that.

Kevin Mailo  

Yeah, exactly. I love it. Absolutely love it. So listen, I think we're there. I'm not gonna keep you any longer. I absolutely love the episode, really excited that you're going to be hosting, you know, and bringing so many great stories, so many great experts forward to talk about finance.

Dimitre Ranev  

And, again, you see, they have their own personal journeys in investing. And I'm hoping that our audience can pick some things from them, and do things like they do, and see what works for them.

Kevin Mailo  

And there are many, many paths to wealth and financial security. So don't feel like you have to follow somebody else's. Dimitre and I have very different paths to financial security, and we're both doing great. You know, but I'm hoping to come over to a little bit of real estate.

Dimitre Ranev  

Yeah, I'm coming over. I'm coming over.

Kevin Mailo  

Yeah, I know. I know.

Dimitre Ranev  

I'm a believer.

Kevin Mailo  

Finally, finally, after years and years.

Dimitre Ranev  

What, seven years? Yeah, seven years.

Kevin Mailo  

Exactly. So listen, that's it. I just want to thank you.

Dimitre Ranev  

It was such a pleasure, Kevin, to talk to you and all the best.

Kevin Mailo 

Really loved it.

Dimitre Ranev  

Take care.

Kevin Mailo  

Thank you so much.

Kevin Mailo  

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.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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Kevin Mailo, co-founder of Physician Empowerment, talks with fellow co-founder Dr. Wing Lim about having a growth mindset and allowing yourself to not be an expert in everything. Dr. Lim shares how CBE - Continuous Business Education - is a cornerstone to his success and to what Physician Empowerment seeks to share with others. 

Dr. Lim discusses how a conference he attended was the first place where he was challenged to step outside the need to know it all. At that conference, attendees were challenged to tell themselves “I’m an idiot outside of my own field” as a way to open themselves to learning from others who are experts in different fields. That ability to access humility is necessary for a growth mindset and personal empowerment. 

In this episode, Kevin Mailo and Wing Lim explore how Continuous Business Education includes surrounding yourself with professionals in other areas who can build on expertise in fields that are not your strength. This ability to allow others to take tasks from you allows you to focus on what your specialty is and contributes to growth in many areas and contributes to not just financial wealth but wealth in terms of time and wellness. They discuss the necessity of “decompressing perspective changes” and paradigm shifts in the service of finding your own dream instead of following the path of someone else’s.

About Dr. Wing Lim:

Dr. Wing Lim completed his Medical Degree at the University of Alberta in 1991 & Family Medicine Residency in 1993. Later he qualified for the FCFP designation in 2005 & 2019. His practice is focused on preventive health & Geriatric Home Visits, for which he received the Alberta Centennial Medal in 2005. Apart from his clinical & teaching roles, Dr. Lim has extensive experience in Practice Management and Business Development. He co-launched the Sherwood Park Primary Care Network in 2007 (currently 90+ physician members). In 2009, he founded the Synergy Medical Clinic, which grew from 12 to 37 physicians over the following ten years, serving a panel of 50,000+ patients. He also co-developed the Synergy Wellness Centre, a 75,000 sq ft integrated medical-professional destination providing 55+ medical modalities by various specialties & allied health professionals, with over 500,000 patient encounters annually. He is currently co-developing a 165-bed Senior retirement facility with the provision of comprehensive care from independent, active living to secured Dementia care. Dr. Lim is passionate in 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.

Resources discussed in this episode:

• Synergy Wellness Centre
• Synergy Medical Plus

—

Physician Empowerment: website | facebook | linkedin

Wing Lim, BMSc, MD, CCFP, FCFP: website | linkedin

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Transcript:

Kevin Mailo  

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 and 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.

Kevin Mailo  

Hi there. I'm Dr. Kevin Mailo, one of the cohosts of the Physician Empowerment podcast and one of the cofounders of Physician Empowerment. And on today's episode, I'm very excited to bring to you my fellow cohost/cofounder, Dr. Wing Lim, and Wing is a very close friend of mine, a mentor, like a father figure to me. You're a lot to me, Wing, and we've had an incredible journey together. We met years ago. And we've done so, so, so much together, but let me introduce you to our audience. Wing is a family physician based out of Sherwood Park, Alberta, just east of Edmonton, and practice focused mostly on the care of the elderly. But I think saying that you're a family doctor really does not describe you in any anywhere close to its fullest sense. Because you are so much more than your medical practice. You are a real estate developer, a business person, an educator. So why don't you go ahead and share today a little bit about your journey, because I'm inspired by your journey of going from a struggling family doctor in the early 90s to what you are now and how you got there. So just go ahead and share with us what that was like. And I'll interrupt from time to time with my questions.

Wing Lim  

Sure. Thank you so much for the kind introduction. And yes, Kevin and I, we met half a dozen years ago, maybe? And we instantly clicked and I caught his stream about this Physician Empowerment thing. And I thought, you know, I was actually a speaker, right? But honestly I didn't know I was actually a guest speaker in the Toronto conference. Humble beginning.

Kevin Mailo  

That's one of the most exciting things, is we have somebody that comes to our conferences, and then the next year they're like, but now I want to speak and share and I love it. Absolutely love it.

Wing Lim  

Exactly. They say vision is not taught it's caught. So I caught the vision and here we are doing podcasts and webinars and seminars and masterclasses together, right, and so my humble beginning... I was U of A graduate, a family med grad. In those days, we have about one hour of health economics education. So I graduated with nothing, zero how-to--

Kevin Mailo  

-- Wing, I'll be happy to share with you that it is 100% more now.

Wing Lim  

Two hours?

Kevin Mailo 

A whopping two hours.

Wing Lim  

So I was so risk averse. But you know what, I was offered practices for free at that time. That's in the early 90s. And practices were given away, nobody was buying practice. And a lot of people left to the US, I suppose you can go to anywhere and they'll give you a Green Card, match your spouse, match your kids work/school. But I didn't go, I was so risk averse, and I stayed right in Edmonton. Right? And so as I walked into this dream practice, and it cost me more money than I could afford. So we borrowed this big amount of money to us at that time. And my wife actually gave up her profession, and joined me to chase my dream building a clinic. I thought I got my own x-ray and my own lab. This is my mini emergency department. So at that time, I actually wanted to be like the emergency department. So we ran 100 hours per week - that was 20 hours work cut from 120 hours a week of residency. And off we went: 16 months, not a day break, 16 to 24 hour days. We went home at 11pm, my wife and I, you know, and mow the lawn and at the next year's Block Party, 'Oh, you're the guy that mow the lawn at 11 pm'. And then the first year, I was thrown in this painful story, first year we found that oh, we didn't save money for tax. And then we have to pay tax, oh my goodness. And then the first Christmas, actually, Alberta Health does not pay for two weeks. So we didn't have money to pay ourselves. We cough up some money to pay our staff. And then the following year at Christmas, we faced an eviction. The previous landlord died, an old physician died in Spain, the new landlord came and doubled the rent and we went to court and we lost. And I remember that we got 30 day notice November 30th. So the next 30 days is to move a clinic pronto. And we have a newborn baby and we spend the first kid's Christmas in the construction site. It was just... I wonder if I still have PTSD from that. And then just like we got three kids, three kids in four years, something like that, five years, right? It's just like you - and you understand right Kevin, you got four kids right, we got three kids all close - so life just happened. And you just got hit by the upside of the of the head. And I told people that I didn't go to business school, I went to the school of hard knocks. Right? Everything that we bump into, the mistake that we make, was so very costly. And then we pay high tuition in terms of money and disappointment and distress. And so fast forward. This is my 30th year of practice. And so now I'm in a group practice, 30+ physicians, it turns out to be one of the largest practice in Alberta. We actually, I think, officially we're the biggest client for Telus Health in Alberta. I've read the EMR. And our panel size is about 50 to 60,000 patients which is half of the county. And we built a building, a medical professional building, that is 75,000 square feet with five acres of parking. And we handled collectively in the building, not just our clinic, 2000 patients a day, and that's about half a million visits a year. And so when you look at that, wow, how did I arrive here, right? Today I wake up sometimes I pinch myself. If I met some of these movie things, you meet your future self, like you say, 'Are you kidding me?' I was so risk averse that when before I even bought my practice, my preceptor in my family residency program, was willing to cough up money and risk and start a brand new clinic just to have me show up to work. And I was so scared. I said, what if nobody comes to see me? From zero, I can't even pay rent. And my wife laughed at me. She says you're such a scaredy cat. And there's a Chinese dish called the soy sauce chicken. She says somebody's giving you a chicken, you just skip the soy sauce and you're too scared. I was that risk averse. And we just finished building a senior home that we launched a year ago: 156 units, six stories high, award winning building that is filling up pretty good. And we signed collectively a $43.5 million loan. So from a guy who's afraid of putting on soy sauce, for soy sauce chicken, to that. It's a journey. It's a journey.

Kevin Mailo  

It's an incredible journey. And so you touched on one important thing that a lot of physicians, I think, struggle with, and we've talked about that before, is the ability to tolerate risk. And I think some of it comes from our training, that we are inherently risk averse. But also the fact that I think we deal with a lot of risk fatigue by, you know, you go to work, and you honestly if you really look at it, you make life and death calls all the time, whether you're a radiologist or a psychiatrist, an ER doctor, a family doctor, whatever your practice background, you're dealing people's lives. But I think it doesn't leave a lot of space for us to be risk takers in our financial lives. Or - I don't want to say risk takers, I don't even like that word - risk managers. Because there is no reward without risk in finance, right? Wing, you to date - that's how I describe it now - to date have executed $100 million in new developments, of which you've been the principal. And there's more coming, right, but somewhere along the line, your mindset changed. And you learned to manage risk from being the fraidy-cat new grad to a real estate developer that, like you said, signed $43 million in loans. So talk to us a little bit about how you got there. And this is the term that we use at Physician Empowerment - that came from you, Wing -  CBE. Like medicine, we have CME, which is Continuing Medical Education. In order to develop ourselves financially and build wealth and create financial security and to build efficient, effective medical practices, we need to have CBE, Continuous Business Education. So why don't you share with us a little bit about your your journey in this space?

Wing Lim  

Sure. So what is underneath the CBE is a growth mindset. Right? If you don't have a growth mindset, they say if you don't have a goal in life maybe you have arrived if you don't know where you're going. Right? So I think first step to the growth mentality is to give ourselves permissions, give ourself permission to acknowledge where we're at, right? I like this idea - I went to a big conference and they say, go to the mirror and look at your image and say, I'm an idiot, outside of my own field. And when the first time looked at this, I laughed and was deep down was mad. I'm not an idiot, I'm a doctor. But if we are truthful to ourselves, we are all idiots outside of our own field, that's why I have friends who said, that's why I want to be a specialist. I don't want to be a general practitioner that needs to know everything about everything, but I will know this and this might feel right. So outside of our field, which we spent so many years, how many years do we spend in school? Oh my goodness, right, a few decades. And so we have missed out learning a lot of stuff. So by the time we finished medicine, we've finally hit the real world, and all these book knowledge, all these stuff, clinical trials, and all that, suddenly doesn't apply, the evidence based science paradigm doesn't apply. So we need to have the mindset, and the first step is to acknowledge that, okay, I'm starting something brand new, right? Give myself permission that I know nothing. I'm going to start from scratch, and then learn something new, every day, do something new, every day. And so I went to another conference, leadership conference, a global leadership conference, and to be up there, you got to be somebody, like this conference where they interviewed 23 year olds, why 23 who actually happens to have, like, 13 million followers, he made it. And one of the speakers, he said, I'll give you an assignment, I'd like you to get a bunch of friends together, fine, not your regular medical, professional friends, other friends, that you need to have a two hour discussion that you have nothing to contribute, that you know nothing about, and just take it in and let them talk on things that you don't understand. So that you don't say, let me teach you on this. Right? And he says, I challenge you. This is your homework after this leadership conference, go and find somebody that you can have a two hour conversation and you just got nothing to contribute. You just open your ears and learn. And for me, that's not hard. My kids are young adults, they talk in language I don't understand. My son is a musician, him and his friends are into all these high tech stuff, web stuff, and music stuff, anime stuff that I understand every English word, there is nothing I can contribute. So how often, when's the last time you learned something new with something that you haven't done and something you didn't go to school for? Once we give ourselves that permission to learn, the license to learn, we suddenly become humble again. We climb a mountain, we thought we're at the peak and we're the big fish, now we start all over again, as a new new discipline, just like a new language. Right? And to me personal finance was one of those. Right? I was at a crossroad. Like I went to school. And when I graduated, finished my residency, I was doing literally everything I went to school for. Deliveries, hospital admission, psych stuff, psychotherapy, home visits, you know, mentoring kids, mentoring youngsters, young interns and residents. I did everything, but 100 hours per week. Do I feel really actualized? Professionally, I probably was. But I felt so stuck in life. So that's why I thought I knew nothing about this real life thing, especially personal finance and corporate finance. The business side, I need to start and learn something I haven't got. And so step number one is permission to learn something. Second is to prioritize. So when I got my CCFP - sorry, the first FCFP, right, you know, for those of us in a family med, we belong to the College of Family Physicians, but you need a 10 year thing, right now it's a lot more to get your FCFP. So I was invited to go for convocation right and I have a very pragmatic wife who used to be a financial planner. And she said that there hadn't been kids, right. Nice that you could go to a convo, but can you put this new title on the table and we eat it as dinner? No, no, it was joke, it was a joke. We didn't want to put down any any title or degrees, right, for some of us we got more degrees than a thermometer. Kudos to all of you. But the pragmatic side, does it change us financially? I also have colleagues after 16 years of family practice, went back and did a residency - one become a dermatologist, one became ortho, you name it, right. So at the end of the day, do we change this training time for money trap? Right? I was saying to myself, if I trade my day job to a night job, I go back to school, keep this up and is still trading time for money. Or one of the speakers in Toronto is trading live energy for money. I'm no better off. So I want to learn differently. o and then some mentors popped up. One mentor - he's a physician who's now in the 80s, Dr. George Wickham - and George says, 'Wing, how would you like to earn 1% of 100 people, or 1% of one person?' I said what kind of question is that, George? He says let me repeat right and said, I actually understood your question. I just find it shocking. I knew how to do 100% of one person there was 100 hours a week. And if I don't perform, there's nothing coming in. When we take a holiday you got a double loss. I'm sick and tired of it and kids are coming, everybody needs a piece of me, I was just burning out. And the government is getting more more hostile on us and I'm sure everybody relate on that. My patient demands, government the regulations, to college, you name it, right. And so I began to think okay, what is life like in the real world? How can we learn to be better and different? So the big number two step for me was actually the prioritization of investing time and money for an education. Right? Instead of taking a residency, a second residency, I'm taking, quote, a residency in mastery of wealth. So that was my residency. So my mentor says, 'How would you like to do, prioritize 8 to 12 hours a week and create a different future?' Life is either by design or by default. Right? If we don't design it, it's by default, somebody else's default? Not our default. Right? Some health economists trying to do design your and my life on our pay structure, and that's our default. That's why we're stuck. Right? The tax system is fixing us, especially recently, more and more hostile to us physicians, were incorporated or even non incorporated, right? The ERP structure, right? Like everything, it's somebody's default. So how do I, how do we design a life to have a different future for us and our family to enjoy life, enjoy our profession, and have some life? Right? And so the key is to prioritize time, effort, brain space, and money to put aside and say, this is my ongoing CBE Continuous Business Education.

Kevin Mailo  

Wow. Wow. Absolutely love that, Wing. It's, this isn't, you know, we talk about this at Physician Empowerment all the time. This is so much more than dollars and cents and money. We teach a lot of money. We teach a lot of finance, we can get into a lot of details. But the bigger question all of us needs to be asking is our why. And what Wing is touching on I think is so important here, is this notion of living our lives by design, not getting tossed around in the ocean of government regulation, fee structures, taxes, overhead, the cost of living, but being able to take control. And it's not only about making money and creating that financial security, but it's also about practicing better medicine. That we just aren't beholden to these forces that drive our practice decisions as well. So I think it's just so important, what you're sharing, Wing. And like you said, it's not necessarily an easy journey, I think for a lot of us, I'll reflect on my own life, it's very easy to just go back into our clinical work, and just do it because we're so highly trained. And we're good at it. Do you know what I mean? Like, it took me a long time to really step out and learn to invest in real estate, and do it well, you know, learn to start another company, and do it well. Like for you, Wing, to become a real estate developer, that took time, right? But it's also, it's not just the time, it's that mental effort and that vulnerability, to step out and say, okay, I'm about to do something I have no clue about. And I'm about to sit in a room full of people that I know a fraction of what they do in the area we're about to discuss. And it's hard, for us as physicians, because it's very easy to say, well, yeah, I'll just go back into the clinic and you know, bill that X amount of dollars, or I'll go back to the hospital and bill that X amount of dollars, and not think about it. But we're ultimately trading our time and our energy for money. And as we get older, that trade becomes less and less beneficial if I can be frank.

Wing Lim  

Right. So I learned from lots of great masters and I've got a lot of these one liners that became an internal monologue right now. So one of which is: the enemy of good is not bad, I'm sorry, the enemy or best is not worst, the enemy of best is good. Because we are good at what we do. Right? What we thought we're good in this bubble, which is called the healthcare system. Right? Opportunity costs is the best. But what else is better for us and our family, for our future, for our profession as a body together? And if we don't leave our comfort zones, get a little bit risky, get a little vulnerable, eat a few humble pies, we'll never ever change our future.

Kevin Mailo  

Absolutely, absolutely.

Wing Lim  

They say, 'What's your five year plan?' Look at the last five years.

Kevin Mailo  

But it's true.

Wing Lim  

Nothing changes.

Kevin Mailo  

It's true. Right? It's absolutely true. And it really is about, like, you know, being willing to put ourselves out there, being willing to grow personally. And it's not just about like, you know, CBE for me and I think for most of us isn't just about reading more. Or, you know, dedicated teaching. Obviously, there's a role for that. I mean, come to our conferences, grab great books, there are great podcasts out there. There's so much, right. But it's more than knowledge, it's experience. And it's about actually getting out and stepping foot into some of the spaces that maybe we're not as comfortable with anymore. Meeting some of these people. What do you want to say to that, Wing?

Wing Lim  

I'm going to say one thing, what is more important than knowledge that you could buy, is perspective that you may or may not be able to buy. If you get a different perspective it'll let you change everything. Right. That's how movers and shakers, how they disrupt the world. Create needs that is not even fathomed by humankind. So these decompressing perspective changes, paradigm shifts, happen in my life a few times. And all you need is one glimpse, you bring it, decompresses, like the what do you call it, when you drive when you call that the airbag can be deployed, you can't put it back. My brain got decompressed. Right? I could not put it back. And I start to morph, this is a metamorphosis, is an evolution. You evolved to be somebody else. So right now, umpteen years later, I say, okay, now I can tell you I do double major now. My double major is health and wealth.

Kevin Mailo  

No, it's absolutely true. Right? It is, it is. And I mean, one of those things is just creating time in our schedule to have those moments. And it doesn't have to be anything big and dramatic. I mean, it doesn't mean, you know, going and doing hallucinogens on some beach, some abandoned tropical beach, right? Like you don't have to go out and have those moments, like create space to go for a walk, you know, a long walk a few times a month. And just think your thoughts, don't have any distractions, don't have a podcast, don't even have this podcast in your ears. Like, just go out there and think your thoughts and think about what you want in life, and how you're gonna go out and get it. Right. But yeah, just stepping out of that narrow lens that we look at in our daily lives.

Wing Lim  

Yeah. And we're all busy, right? Nobody's not busy, right? So I'm going to give a personal model I'm going to share here. It's called consistent quality, part time effort. And we have that consistency is like cruise control, right? Set it at 110. Right. I'm amazed at a lot of miles that I drove, I'm sure a lot of you, right, when you get on cruise control, I found that I pass more cars. If I don't remember, like, I pass people but they pass me, right. So consistency, quality, part time effort. And all these real estate deals that I have done, I haven't quit my profession yet. I still have a practice to run. Right? I didn't, I can't drop shifts. I have no shifts. I have a panel of agents, but to drop shifts, they're still on my panel. I'm still on call from my--

Kevin Mailo  

I know, in the emergency department, a big long letter about things you got to deal with, you know,

Wing Lim  

Exactly, yes. So, and all these stuff that I created - and thank thank God everyday for that and it's always a team effort, you learn to leverage, but that's not the name of the talk today. It was all part time. Right? And you can do this part time guys. Right? So I challenge everyone to really find, dig deep and look at yourself, look at your future, look at your family future. What are you worth? Are you worth what the healthcare system tells you? Are you worth? What the structure that cooked up by some health economists? Are you worth that? Are you worth it? What's your future, family future, if you want to design it, if time and money were no object? If success is guaranteed? Dream a little bit! What if, what if, what if... right? And see what comes out.

Kevin Mailo  

And I think that's one more thing that we're going to touch base on is, like, you know, this path to wealth, or success, or whatever you want to call it, this isn't someone else's path. This is about finding your own. This is finding your own passions, right? So you gotta dream to build some massive, efficient clinic, you know, that transforms healthcare in your area, I mean, maybe that's where you want to go, right? Or if there's a research interest, or, you know, an academic interest that you've got, but you need to create space in your schedule, which means you got to, you know, sort of your finances to do it, then go, right? Like, it's about finding your path, not about following somebody else's. And, you know, at Physician Empowerment we always laugh that we don't have a lot of answers, we got a lot of questions, right? And it's those internal questions you ask yourself, your own why, that helps you light that fire and helps you inspire yourself to go out there and chase your dreams. Because life is short and it is flying by. And, you know, I think it's so important to use that CBE, that Continuous Business Education to go out there and really develop your passions, right? Don't turn, you know, don't live them. You know, don't look at them as some dream on the horizon, but live them every day, which I think is so powerful.

Wing Lim  

Yeah, so I think the CBE is basically part of the personal growth program.

Kevin Mailo 

Yeah, it's bigger than CBE.

Wing Lim  

Actually when you dig deep, a lot of this lesson, that's when I speak on and teach on practice transformation, we don't call it practice management. It's a transformation that you transform yourself. And even in the wealth strategy course we teach at a masterclass which is the next week--

Kevin Mailo  

-- yeah, that's every month if anyone's interested, just let us know. We run a monthly class on wealth creation and CBE.

Wing Lim  

Yeah, exactly. And part of that is really not just about money, right? And we're going to touch about the three dynamic teams and the talent management, right. So we talk about a lot of things - how to manage your time, your talent, other people's talents, and the treasure, right? So it's so poly dimensional, and you would change deep in to be a bigger person, right? And wealth is exactly that, it's not just money, right? So look forward to empowering a bunch of people. That's why we started Physician Empowerment together. We want to ignite you, inspire you. Right? And our story is not your story, right? Of course not. And my success is not, may not be your definition of success, but we want you to share your story of success. We want to inspire people to achieve their dreams, and together with a better profession and better society.

Kevin Mailo  

Yeah. That is the dream, right? Is to see physicians not only financially secure, but truthfully, living their best life, being their healthiest, being their happiest, but also doing their best medicine. Because when we answer those big questions about finances, and we create, you know, that balance in our lives, then we are doing our best medicine, and we are serving our patients and we are serving our communities. And that is the dream. And that is what is so exciting about Physician Empowerment. So with that being said, Wing, I think we're gonna wrap it up. This was amazing. I'm just so glad that we're launching the podcast finally. It's an exciting step forward. I really love it.

Wing Lim  

Yes, I look forward to, yeah, we have a whole host of people we want to interview, interesting people, colleagues and otherwise, that I look forward to all these podcasts coming up.

Kevin Mailo  

Awesome. Thank you so much.

Wing Lim  

Thank you.

Kevin Mailo  

Take care, everyone.

Kevin Mailo  

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.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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Kevin Mailo, one of the co-founders of Physician Empowerment, talks with fellow co-founder Dr. Wing Lim about wealth mindsets. They explore not just financial health, but personal and practice-oriented wealth habits that lead to greater well-being and sustainable growth. 

Dr. Wing Lim, founder of Synergy Wellness, references a wakeup call he received from his mentor, Dr. George, in the form of the question “How would you like to make 100% of one person versus 1% of 100 people?”. This led Dr. Lim to what he calls a “brain decompression” that has informed the wealth mindset journey he’s been on ever since. 

In this episode, Kevin Mailo and Wing Lim discuss a 100 year old concept called ​​The Three Dynamic T's of Success, which they currently host a masterclass on. The three T’s are time, talent, and treasure, and Wing Lim breaks down how each T is key to success. If you can learn to manage time, talent - people, teams, other people’s talent - and treasure/money, you will have tapped into an endless source of wealth from which your success can be fuelled. Dr. Lim shares his personal insights on exactly how the three T’s have made the difference for him.

About Dr. Wing Lim

Dr. Wing Lim completed his Medical Degree at the University of Alberta in 1991 & Family Medicine Residency in 1993. Later he qualified for the FCFP designation in 2005 & 2019. His practice is focused on preventive health & Geriatric Home Visits, for which he received the Alberta Centennial Medal in 2005. Apart from his clinical & teaching roles, Dr. Lim has extensive experience in Practice Management and Business Development. He co-launched the Sherwood Park Primary Care Network in 2007 (currently 90+ physician members). In 2009, he founded the Synergy Medical Clinic, which grew from 12 to 37 physicians over the following ten years, serving a panel of 50,000+ patients. He also co-developed the Synergy Wellness Centre, a 75,000 sq ft integrated medical-professional destination providing 55+ medical modalities by various specialties & allied health professionals, with over 500,000 patient encounters annually. He is currently co-developing a 165-bed Senior retirement facility with the provision of comprehensive care from independent, active living to secured Dementia care. Dr. Lim is passionate in 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.

Resources discussed in this episode:

• Synergy Wellness Centre
• Synergy Medical Plus
• Confucius quote

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Physician Empowerment: website | facebook | linkedin

Wing Lim, BMSc, MD, CCFP, FCFP: website | linkedin

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Transcript

Kevin Mailo  

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 and 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.

Kevin Mailo  

Hi, I'm Kevin Mailo, one of the co-founders of Physician Empowerment. Tonight we're hosting a webinar. It's a beautiful summer evening out there. And I'm not going to keep this too long, because I'm headed off for some water skiing for the first time this year, yeah, so I'm really happy about that. And I'm very happy to have my fellow co-founder here as well, Dr. Wing Lim. And tonight what we're going to be talking about, Wing and I are going to be discussing wealth mindsets. I think this is such an important topic for physicians, because many of us have access to knowledge, many of us have access to credit, we have high incomes to invest, but one of the things that, you know, I found over this journey of educating physicians in finance is that there's a lot of facts, knowledge, and information out there in the world - we can go on the internet and find that very easily - but wisdom and experience are in short supply. And so we try to hit to some of these deeper notes by covering some of these more profound topics. And one of the ones that we want to discuss, and only in brief, because there are entire books written about this, is the notion of wealth mentalities. And I'm interviewing Wing today, because it's really exciting to hear his journey. And if you want, you can go back to one of our founding episodes to hear Wing's entire origin story. But in brief, you know, Wing, you started out as a family doctor in general practice in the early 90s, kind of doing it all - hospital-based, clinic-based, psychotherapy, delivering babies, you did it all. Why don't you tell us just the start, the first question I got for you is just tell us a little bit about your journey.

Wing Lim  

Yeah. So I'm a U of A grad, graduated a long time ago, early 90s. Yes, that was a time when practices were given away because people were leaving the province, there was a guy called Ralph Klein - those who called it the Ralphonomic Days for those who knew about Alberta - and I lost 98% of my classmates to US, so I was the two percent who stayed behind. Anyways, practices were given away, but I was crazy enough to have actually bought a practice with money that haven't got. So it was a solo practice and there is a built in lab. Those days, you can still have a lab in your clinic, believe it or not. And I have an X-Ray clinic next to me, so I'm running like a mini emergency department. I loved it, so bought it, ran it, 100 percent ownership, and my wife gave up her career. And so we built a clinic together at 100 hours per week. So that was the starting point.

Kevin Mailo 

Yeah, so that's a lot. So you're working these long hours, you're struggling to balance tax payments, overhead, your time, you've got a young family, you're in the thick of it. And let's flash forward to where you're at now, you know, as a family physician with a great practice still, but you also are a real estate developer, having originated over $100 million in new developments. And, you know, take us through the couple of the highlights on that journey. And obviously, that's not going to be the whole journey. But take us through some of the points where your mind changed, right. There's something about you along that journey that changed.

Wing Lim  

Yeah, I think point number one is going to the school of hard knocks. You got hit by the upside of the head really fast. At least at my med school at U of A, there was one hour of teaching on health economics that is not about your personal health economics, it was about the hospital budget, provincial budget, bored to death, that kind of stuff. So personal finance budget, how you bill, we didn't even know we have to save money for tax. So that was first smack on the head. And then very soon we got evicted. The landlord took over and doubled our rent, we went to court, lost. So we spend my firstborn child - he's 25 now - so anyway, so we spent the first Christmas at a construction site because we get evicted right around Christmas. So that was another smack on the head. So we're running as hard as we could and then we're stuck and kids were coming. We got three kids within each 18-19 months apart, right? So my wife cannot work as hard. I cannot work as hard. So how are we going to do that when we keep trading time for money, and feel like I'm on a treadmill and running faster and faster like a stress test, the way booze protocol, I'm ready to fall off. So that was a wake up call, rude awakening, and then a critical mentor. They say when the student's ready the teacher shows up. So my mentor, Dr. George - you know, he's still a friend of mine, now he's in his 80s - and Dr. George asked me a critical question that decompressed my mind. And he said that he asked me 'Wing, how would you like to make 100% of one person versus 1% of 100 people?' I said can you repeat the question, George? I'd done very well at 100% of one person at 100 hours per week, and I'm going nowhere, right? Everything I went to school for I was doing, and I thought I should be actualized, I should be happy. But I got stuck. And the just trading time for money thing is not working out. So when he asked 1% of 100 people, that decompressed my brain and that is like an airbag in the car when this deployed. You cannot push it back. So I have been decompressed since I've been thinking about 1% 100 since, and it's a 20-some year journey.

Kevin Mailo  

So again, one of the learnings in your journey as you develop this wealth mentality, and I should share with everybody that when you have been a personal mentor to me in this space, that I was on that hamster wheel over five years ago when we met - six years ago, now, when we met - trading time for money, exhausted, working long hours, and asking myself, 'Where am I really headed in life?'. And, you know, I was a bold dreamer, you know, and that's partly why I founded Physician Empowerment, but struggling with the concrete, the ingredients that I needed to get where I was going. So you talk about taking 1% from people, but that sounds like team building to me. Tell me about a little bit of the team building journey that you've gone on, because you started out in solo practice, now you're part of a large group practice, that's practice transformation. We teach that in our small groups, but just give us a little bit of a teaser as to what that means for you.

Wing Lim  

Solo practice means you do everything by yourself. If you got to do it, do it yourself, right? So we always have that mentality that we do it ourselves. And that's got to change, right? Everyone learns to leverage, learn to exceed yourself, that you got to decompress and learn how to work with other people. So then I worked at create a multidisciplinary clinic, we ended with six physicians, and then I was ready to give up my practice, I was so burned out with the provincial health care, yada, yada. And then I went to a conference, came out, I dug my residency dream, I said 'I want to build a wellness Wellness Center', and fast forward about 10 years, 11 years ago we build this giant clinic, 75,000 square foot Wellness Center at the clinic. My family medicine clinic as the anchor tenant. So right now I have 30-some colleagues. It is one of the largest clinics in the province and we do a panel size about 50-60,000 patients, which is half of the county. And the building serves about 2000 clients a day, like with all the paramedical and medical services.

Kevin Mailo  

Yeah. Because you have a whole bunch of specialists there, as well as, you know, pharmacists, chiropractic, physio, all of that.

Wing Lim  

Yeah, exactly. Yeah.

Kevin Mailo  

Yeah. So very comprehensive. So this is living a dream for you.

Wing Lim  

It is living a dream. Yes. And it's not just my dream, people embrace it. Now it's a lot of people's dream come true. Lots of people's dream practice come true.

Kevin Mailo 

It's a shared dream. Yeah. And I remember you talking about how important it's been for you to ensure that every physician within your group feels cared for and valued, right? That the strength of the clinic depends on the well-being of every individual physician.

Wing Lim  

Correct. Yeah, exactly. You would only win if everybody wins, right? That's the big win. And that's one of the transformation of the thinking. Right?

Kevin Mailo  

Let me just segue into what that is. That's a wealth mentality. That's the idea that the more generous we are with the people in our lives, with our communities, in terms of our time, our expertise, and even our money, the more that comes back to us, right? Because people want to join with someone who radiates that, and so it's that prosperity mentality, right? Like, because we're in a group practice doesn't mean that we're taking from one another here, that we're reducing one another's billings or increasing one another's overhead, that we can actually come together, and in more practical terms, boost revenue, and reduce relative overhead, in addition to delivering better practice, or better medicine in our practices, and delivering better care for our communities. And I'll just put a little plug there because Synergy Medical sees both. I work in the hospital as an ER doctor, you know, a few blocks away from Synergy, and it sees 10 times more patients per day than my entire hospital. You know, so it really speaks to what you've built, Wing.

Wing Lim  

Well thank you. And part of the learning is to learn to think outside of the box. I think we went to school to be the best we could be professionally. Since pre-med days, we study for ourselves, we get a good GPA, get a good MCAT score, get in, and then you learn and you always for yourself is just one off, right? But when you go into the real world, you got to drop that thinking and do team play. In fact, I came across a concept that is 100 years old. And in a masterclass we're actually diving into this, and this is called The Three Dynamic T's. The Three Dynamic T's of Success. So in the real world to have professional success, it's not just your GPA or how smart you are, how special you are, it's about three dynamic T's and the first T is time, the second T is talent, and the third T is treasure. So when you manage these three T's, then you and your team will be unstoppable. So a masterclass is going to go through a lot of this in depth thing, so we invite everybody to check us out on masterclass which is a 12 month program. You start the one on time. So if you can manage time, manage talents - which is people and teams, other people's talents - and you can manage treasure - which is money - then you would truly be successful. In fact even when you work for fee for service, calculation model, or a fixed budget, or you work for public health, each enterprise, whether it's public or private, to be successful, these three dynamic t's need to be worked on.

Kevin Mailo  

Yeah. And this really speaks to another core physician empowerment concept called 'you is the most important investment'. And really what that is, is the idea that, you know, your practice, your financial stability, your personal well-being, depends on constantly investing in yourself as an individual, right? That it is not about just endless personal sacrifice, but that we are, you know, focusing on our well-being in terms of, you know, sleep, exercise, eating right, and maintaining healthy relationships. And this is something that, you know, we pay a lot of lip service to within the profession, but be mindful that as fee-for-service earners, the vast majority of us, or at least al of us trade time for money in our clinical work, the importance of being able to stay in this not as a sprint, but as a marathon. And so time is a key component to that. And even being able to outsource, being able to trust professionals in our financial and practice lives, so that we are focusing on the most important tasks, I have found to be personally transformative along that journey. When you talk about that T. Do you want to talk about talent as it relates to delegation and outsourcing, Wing, because I think that's another important topic. And if I can be blunt - and, you know, we try to be straight here on Physician Empowerment - let me be blunt, many physicians struggle with micromanaging. I certainly have done it over the years, right? So we have this mentality of, well, if I want it done, I gotta do it myself. And I'm gonna do it properly. And that means it's going to be me. And let me be the first to say, that is exactly what I want out of my surgeon. If somebody is cutting me open, I want to make sure that my bowels are getting sewn up extremely meticulously, right. And same goes with, you know, when I'm caring for critically ill patients and these sorts of things. But as we zoom the lens out a little bit, and look at how our clinics function, how our hospitals function, how our financial lives function in terms of, you know, whether it's real estate, or investing in the markets, that micromanaging can really trip us up. And it's not only in terms of not reaching our financial goals, or our practice goals, but even in terms of our well-being. That there is a limit to how much any one person can micromanage before they start to really hit the wall and become exhausted. So tell me a little bit about that, then, Wing. Talk to me about that second T, talent, as it relates to delegation and outsourcing.

Wing Lim  

The micromanagement, I think, it's our trademark. If you looked up the dictionary, you see our pictures in there. And the micromanagement thing, other than just being super focused on success, and no error, no mistake, we are a very mistake-adverse culture because if we make mistakes people die, people suffer, and we lose our license, potentially, we get complaints, blah, blah, blah. So we're very mistake-oriented culture, so we don't trust people. But it's a micromanagement issue. It's an issue, like you need to see a therapist, right, and it's a mistrust. The lack of ability to trust others. And I think the many more years we stay in tertiary care, the more we do that. So the first thing is to undo some thinking deep down, you give yourself permissions, right, I've learned a long time ago, if you give yourself some permissions, you can actually learn to decompress and learn and grow. And first thing was, I'm not the smartest guy, right? And I think as a family physician, as a primary care provider, it's easy for me to do because I always refer. But even specialists, they specialized and when people would always refer out they would say, 'this is not my field', right? So I'm not, I don't need to be the smartest guy, I'm not the smartest guy. So there are lots of talents out there. There's an ancient Chinese saying, "Three people walking, two of them are my teachers". Okay, this is actually a saying from Confucius. And he's not confused. Right? And so that is social, we can learn from everyone, every member on the team. So thinking change number one for talent, is 'I'm not it', right? I need other people that grows, if I'm not the smartest one, I need other people that grows to the next phase, which is called interdependence, right? We've become from dependence to independence, and then now interdependence. And I think that is a breakthrough. It's easier said than done, but we got to lean on it. And healthcare is morphing, man. Right? If you look at how we do things in hospital, we have robotic arms now, I mean, the people from third world with a surgeon here working with a surgeon there, right? Like, we're changing. We've been expected to work with a paramedical professionals, you know their MPs writing orders right next to you.

Kevin Mailo  

Our MPs at the hospital are phenomenal. Phenomenal. I feel very privileged to be working with our MPs, because I feel like they helped create one of the best emergency departments in the country. And again, that was a process of learning to work, you know, in an interdisciplinary mindset, and learning to let go a little bit. And it's been just great.

Wing Lim  

Yeah, exactly. And once you respect people for what they are contributing, even down to the most, quote, junior person.... I think we have this elitism that's another one we need to fight against. These are cocooning off the shelf, one of which, that leads to pride and arrogance, honestly, is that elitism, right? Like I'm holier than thou and smarter than thou, I belong to the smartest group, I think the sooner we break away from that, and we say, hey, we need each other, the sooner you respect the talent. And the talent is in things that you might not think is important clinically, but it's very, very important. And one example was there was a study going around with complication rates in ICU. They found that the ICU, the highest performing ICUs across the country with the lowest complication rate, come from one single parameter, how easy it is for the lowest ranking person with these knowledge, how easy it is for that person to say, 'Hey, I think we got a problem'. And the ICU group that had even the janitor or anybody, right, supportive staff, will say, 'Hey, I think we got a problem'. If the team listens to that angle, they have the best safety and the least amount of complication.

Kevin Mailo  

You have that parallel in the airline industry, where everyone is empowered to speak up and errors, when they are caught, are actually celebrated. And I think that's very powerful. So let's just shift a little bit here, staying on this second T talent. Talk to us about our financial lives, like another one that I see physicians do, I mean, I see physicians not wanting to pay an accountant, they do their own accounting. I see physicians who do their own bookkeeping, which is just, I feel like, overwhelming for me. I see physicians trying to manage their portfolios, talk to us about that, right? Because I see the whole spread. And it's not just about making gains financially, and managing that other T treasury. But it's about, like, our well-being. I mean, for myself personally, working, you know, a 10 hour shift in the emerg, coming home and trying to stare at my books, trying to pick stocks, feels absolutely overwhelming. And I'm certain I would screw that up a whole bunch. And then the couple of times that I've tried it, I have screwed up massively and learned my lesson. So I outsource, right, I have professionals that manage real estate for me, bookkeeping, accounting, and my equities. So talk to us about that in our financial lives, that micromanaging, because I think that's another big one.

Wing Lim  

So the T that's talent in the personal finance and corporate finance world is even more pertinent, because you cannot do it all. Right, so the DIY mentality, it goes right back to the mentality that I made, I'm the smartest one I can't trust anyone. Right? And if you want to be that special, you are guaranteed to be small. The S is not Superman, it's like you are super small. So you got to trust me when, if you become a specialist and okay I DIY and do all those do stocks or do crypto, good for you, it becomes a habit, a hobby, good for you. And we're not knocking anybody. But it's a team sport, right? We went to school to play solitaire, but then when we graduate, this is a team sport, right? And so you need to learn how to do a team. And so in finance, more importantly, it's a team sport. You need team members, each with their strength. They don't have to be perfect, right? You have the accountant, you have the lawyer, you have a bean counter, you have a guy who... it's just like Dorothy going to see the Wizard of Oz. She's got all these characters that each have their defects, one has no courage, one has no heart, one has no brain, right? And so these actually, I have been taught, that puts it into all your consultants.

Kevin Mailo  

To come back to your point, when this bit on an element of humility, I'll just share one personal story that actually came from today. And you helped me with this. I have a property that I can't sell, I can't rent, and so I'm putting it on AirBNB and I've hired a company to do that. I outsourced. And it's eye-watering, they need a $45,000 check to get the house ready, you know, to stage it, to furnish it, everything. And, you know, I'm so tempted to just like move funds from my PC, pay myself that $45,000, and then write the check off to this company. And I paused and I phoned my accountant. I rarely rarely have any answers in this space, I only have questions. But I'm thankfully very fortunate in that I'm ready to ask questions, even the so called dumb ones, and I just go ahead and ask him, I said, 'Is that smart?' Or should I be loaning money from my PC, or should I be using a line of credit? And he said based on, you know, the nature of the purchases and the property and everything else, line of credit. Wow, wow, right? Huge saving 1000s of dollars right there, huge pressure off me, I'm so happy I did that, maybe, you know, 100 bucks for that phone call, worth every penny of it, right? And so that's a growth for me, right? That's, you know, learning to be humble enough to ask questions. Understanding that I don't have the answers. And we actually do this in practice. When I'm in the emergency department, I feel like I'm in over my head, I pick up the phone and call a consultant. You know, we've got a patient in front of us in clinic, we refer on to a consultant. I mean, you mentioned that earlier, Wing, but it's important to think about that in terms of our financial lives as well, which I think is so powerful. So that was, like, actually today, off went the check.

Wing Lim  

You shared and you demonstrated that you actually picked a team member that is valuable. Right? So, but if you didn't pick the right team member, you won't have got that answer. So part of this talent thing is you become a talent agent. Right? People ask me, 'How do you do such big projects?' I said, 'Oh, it's easy. I chum around people who are smarter than me.' Right? If your why is big enough, the house will come to you. I'm not good at engineering at all, right? One day I found myself in a room with 18 engineers around me and 2 architects building this big senior project that is today worth $52 million that we just launched last year, right? So here's the brightest engineering minds in the city, and they're circling around me asking me questions. Well, I chum around with people who are way smarter than me. So when you put the right team together, so it's a talent show where you hunt for the talent, and you hunt for the right talent for the right thing. And then you're going to win, you're going to win because you got the best team, you got the A Team. I'm dating myself with The A Team, Mr. T.

Kevin Mailo  

Yeah, but it's true. And, you know, like, certainly this AirBNB thing that I'm doing, it is not cheap. I am paying a lot upfront, and I'm paying a lot for management fees, but I am so much happier. Number one, I know it's going to work far better than if I did it myself. And number two, more importantly, I am happier. Because I do not want to be going and trying to turn over a space and micromanage cleaners and everything else, right? It's about our personal well-being along this financial journey that is not simply about getting to a certain number, a certain net worth, a certain cash flow. It's really about building a financial plan that works in our personal lives. That works with our practice lives. I think that's so important. So important.

Wing Lim 

Exactly. The other example is, tying the three T's together, is if you DIY everything yourself, you're gonna miss some advice, and tax is single handedly the biggest expense in our life. And if you don't get the right tax advice or, worse, get the wrong advice, you could be wasting a lot of money. I spent the time, sought out a smart guy in insurance and in tax, and I went home and ran it by my team and I saved about $350,000 in tax based on that one piece of advice.

Kevin Mailo  

Yeah, that is exactly it. And you know what, we have seen that on our Physician Empowerment conferences, people come up and they go, 'Oh, my goodness, I wish I knew this 20 years ago'. And it's never too late. Right? Like that's the most amazing thing about anything in life - any stage, anything in life, is that nothing is ever too late. So if you have those kinds of questions, start asking them, start going to people, start building that team, begin now. It can be so powerfully transformative. And I have missed out on far more deals than I had been part of. And that's okay, because guess what, Warren Buffett didn't buy Walmart, didn't buy Amazon, and he's doing just fine, right? So it is never too late to be okay. And better than okay, it is never too late to thrive in our financial lives and in our practice lives. Tomorrow is always a new day.

Wing Lim  

So more important than the actual talent that we thought we need to possess, is to ask the question why? And ask the right questions. What questions are we supposed to ask? Now interestingly, the word knowledge, which is a Greek word, but in Chinese the word knowledge is actually two characters: learn, ask. So knowledge in Chinese thinking is 'learn to ask questions'. So that the more knowledge you got, that means that the more questions you learn to ask, you just ask smarter questions. So what we hope to empower people at Physician Empowerment, it's a peer to peer empowerment process, is to empower you to ask better questions to your own team. How do we assemble the right team, keep asking questions, and in doing that you have an enlightened path. Right? And then you can reach your own goal, which is different than mine or yours, right?

Kevin Mailo 

I love that. I absolutely love that, Wing. So I think we're going to actually start winding it down. We don't want to make these too heavy. We don't make these too long. And I'll just share a little bit of my own wellness with those that might be a little bit late joining, is that I'm about to go waterskiing, and it's a beautiful summer night, and I'm not going to miss that. Anyhow, being out on the lake, on the boat, it's going to be great. So we are going to wind it down here. I've really, really, really loved this. I'm always inspired when we talk like this, because it's these bigger questions, right? It's learning to take risk. It's learning to ask the big questions, why. It's learning to be humble enough to reach out to people in our practice lives, in our financial lives, that are going to help us soar. That it doesn't have to be a one person show. So we have quite a few people who've joined us in the webinar. And I'll just put it out there briefly for anyone that wants to ask questions, go ahead and type them into the chat. But otherwise, I'm also just happy to wind it down. Because this was great. And this is only a start of what we're going to be covering in this area because there's so much... you know what, when I reflect on practice success or financial success, it's about grit. And this is some of the process of building grit, just that inner toughness, that inner resiliency to keep going when you feel like giving up. And so I'd invite anyone who's interested, just reach out to us, go on the website or sign up for emails, but like we are super accessible, you reach out to us over email, phone. And if you want to know more about our masterclass or conferences, we're always happy to talk about them. But at any rate, I think I'm gonna wrap it up there. And I really want to thank everyone for joining tonight. And Wing, I really want to thank you, again, for just sharing so much wisdom.

Wing Lim  

Well, thank you. It's always fun and we hope to see more of everyone. Thanks.

Kevin Mailo  

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.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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