It’s rare to encounter a physician as good in finances as they are in the work world.
And for a good reason.
Medical jobs have the highest rates of burnout of all professions.
Physicians just don’t have time to care about investing, retiring early, wealth, etc.
But today’s guest – Dr. Elisa Chiang – did. And the results speak for themselves.
Elisa is a board-certified ophthalmologist and fellowship-trained oculoplastic surgeon who, in her words, “Has worked both in private practice as well as for a bureaucratic hospital system.”
After experiencing burnout, she decided to go all in investing to achieve early retirement and escape the medical industry.
Fast forward to today, she’s a wealthy life coach that helps other people like her (physicians just like you) to make better life choices with their finances that serves their needs.
The work of people like Elisa gets us excited about the future of personal finance in the physician work world.
If you’re a medical professional that:
- Struggles with burnout.
- Experiences second thoughts about their medical career
- Are confronted with big decisions like marriage, investments, retirement, moving, etc.
You’ll find this episode quite helpful!
The Grow Your Wealthy Mindset Podcast
Contact Finance for Physicians
Full Episode Transcript:
Daniel: What’s up guys? Hope you’re having a great day. I think it’s safe to say that there are a lot of problems with the current healthcare system. Unfortunately, many physicians feel like a cog in the system’s wheel. Powerless and even handcuffed. There’s also this misconception that physicians will go into practice and money in itself is gonna solve a lot of these problems, but that’s just not true.
Daniel: My guests today experienced many of these pressures herself. However, that all changed for her when she discovered life coaching. Life coaching opened her eyes to this idea of mindset and the idea that you’re in more control than you often think, even if you feel like a cog in the wheel. And this idea of defining your ideal life and using money as a tool to accomplish it.
Daniel: Now, she’s working today as a life coach for physic. And helping them to do exactly what. she did. My guest today is Dr. Elisa Giang. She did her MD PhD and then trained to become an ophthalmologist and oculoplastic surgeon. Early in her training, she began digging into the world of personal finance and eventually began buying real estate.
Daniel: After training, she went into private practice and then into full-time medicine working for a hospital, but with plans to eventually start her own practice. And then Covid hit and halted her plans to begin her own practice. However, it also allowed her to discover life coaching. And in the end, change her own life trajectory for the better.
Daniel: Fast forward to today and she’s quit her full-time hospital job and is working part-time as a physician in a position she actually enjoys. And has started her own life coaching business for physicians to help other physicians with the challenges she faced. Today we’re gonna talk about her story and how she made the shift to living her ideal life.
Daniel: We’re gonna talk about her experience, learning personal finance, and beginning to invest in real estate. She shares her opinion of the biggest disadvantage of real estate investing that you don’t often hear from a lot of the gurus. We also talk about how she discovered life coaching and how it completely changed her life trajectory for the better.
Daniel: And then we talk about how you can start moving more toward living your ideal life. This was definitely a fun conversation that I’m sure you’re gonna enjoy, and I’m really excited to introduce you guys. So without further ado, let’s jump into today’s episode.
Daniel: Elisa, thanks for joining me on the podcast.
Dr. Elisa: Thanks so much for having me.
Daniel: Yeah, I am really looking forward to our conversation. We were just chatting about it a little bit, but I really think we’re on the same page about money and how it can be used as such a great tool. Not just to become like rich per se, but really to kind of lean into living your ideal life.
Daniel: And I know you’ve done a lot of work around like coaching and mindset, and those are all some of my favorite topics. So I think we’re really gonna have a great conversation today and I’m really looking forward to it. But before we jump into some of your work and what you’re doing to help physicians, I would love it if you could share a little bit about your experiences, kind of going through professional changes.
Daniel: And I know you’ve had a lot of ups and downs and so I’d love it if we could maybe start.
Dr. Elisa: Yeah, so I started on my, I guess, financial journey pretty early on. So medical school is unfortunately getting extremely expensive, just like undergraduate and all education in the United States. And I really didn’t want to take out all the loans for medical school.
Dr. Elisa: So I decided to go the MD PhD route, or MSTP, which stands for Medical Science Training Program which is funded by the NIH. And I was lucky enough to actually get into on those programs. So I spent eight years doing the MSTP program, getting my MD and PhD in order to avoid just even getting all the financial loans.
Dr. Elisa: My medical school, I believe the tuition was somewhere around $47-$48,000 a year. I went to Case Western Reserve University Medical School. So I think that was probably my first really big financial decision. I mean, in undergrad I took out loans for undergrad. But, you know, my parents really helped me a lot and so my total loans were I think around $18,000.
Dr. Elisa: So really not something really reasonable as compared to the average medical student loan debt is over $200,000. And that’s actually increasing with time. And I mean, that’s a mortgage on a house in most of the country.
Dr. Elisa: So it’s really a lot to start your life that way, especially when physicians really start getting paid. And you do get paid during residency and I don’t want to, you know, you get paid around $50-$60,000, which compared to average Americans is kind of a average American salary.
Dr. Elisa: But given all the time and debt that you’ve already accrued to get there, and then residency can be anywhere between three years and six years, and then fellowship can add one to three additional years. So by the time you’re actually making a physician salary, you’re much later in your life than a lot of other professionals.
Dr. Elisa: If you wanna compare to engineers, accountants, or even lawyers. Lawyers have three years of law school, but then go straight into practicing law as opposed to four years of medical school and then that three to seven years plus one to three years of additional training, for you being paid, but really at a much lower level.
Daniel: So you finished training and everything became perfect, right?
Dr. Elisa: Apart from it. So it’s funny, I did the PhD in Neuroscience and it was actually, when I was doing that PhD, when I really started to delve into personal finance and investing, and part of it was that the MD PhD program being eight years, and I did it in Cleveland, Ohio.
Dr. Elisa: A lot of us, I shouldn’t say a lot, but there were a substantial number of the MSTP students who actually bought a house during that time, cuz it was long enough. And housing in Cleveland was cheap enough. And this was before that housing crash in 2008, where back in 2002 when I started, anyone could get a mortgage essentially, right?
Dr. Elisa: Like, it was just super easy. So I actually bought the house I grew up in from my parents because my parents and moved. And they helped me out to make that happen. And so then after doing that whole, getting a mortgage process, I was like, “Oh, I really should learn more about finances.”
Dr. Elisa: started reading about finance at that point. Read a lot of the Motley Fool. Started investing into the stock market. My parents had also told me that now when I first graduated undergrad, that I should start putting money into a Roth IRA. They didn’t really explain what a Roth IRA was, so I spent a year working between from the time that I finished undergrad to when I went to medical school and then spent that year applying.
Dr. Elisa: And so I did actually contribute to my Roth IRA. So It just sat in cash actually for a while cuz I didn’t realize you had to invest it. And then when I started learning about personal finance, that’s when I started learning about investing it. So I started investing that Roth IRA money. Later on I read Rich Dad, Poor Dad and got really interested in real estate.
Dr. Elisa: And that’s also when the idea of financial independence really hit me first because I was kind of unhappy in grad school. And part of it was that I had the PI I worked for was very much a micromanager. And my thought at that time was, I really don’t want to have a boss. I want to be able to either work for myself or not have to work for money as soon as I can.
Dr. Elisa: And so I actually started investing in real estate as a grad student.
Daniel: That’s early. So it’s interesting, it seems like a lot of times, in families that I’ve worked with personally or people I’ve talked with that the higher, or it’s like the more that they dislike their work environment, it almost pushes them into other things like real estate or side hustles or even motivates them to get into learning personal finance.
Daniel: Was that true for you or was it just kind of along the progression of that educating yourself?
Dr. Elisa: No, I think it was true for me. I think it was being unhappy as a graduate student. So I wasn’t even like truly working yet, but I already had this idea of, well, if I had money to live on coming from somewhere else, then I wouldn’t necessarily have to be here working for money.
Dr. Elisa: And I think a lot of physicians now really feel that way with physician burnout being super high, anywhere between 40%, 50% depending on what reports you look at that physicians are looking for a way out. Looking for a way to have income some other way than just practicing medicine.
Daniel: Do you think that for you, has that been a solution that you thought it would be to that underlying issue?
Daniel: Like in terms of investing in real estate has that become the solution you thought it would be?
Dr. Elisa: Yes and no. There are a lot of physicians I think who, so honestly, like back when I was even a med school student, I thought a lot of physicians invest in real estate. And like I knew some of my medical school friends whose parents had investment properties.
Dr. Elisa: So I just kind of actually thought that was part of the norm, that people who had a lot of money investment in real estate, especially I think reading Rich Dad, Poor Dad had to kind of seem that way. And a lot of wealth has been built by real estate investing. When I was unhappy during grad school, I kind of made this plan on how I could become financially independent within about 15 years of working as an attending.
Dr. Elisa: And I wasn’t necessarily calculating real estate into that. I was just calculating, okay, how much of my income do I have to keep saving and investing and the compound interest and the stock market returns continue to be.
Dr. Elisa: You know, what their historical returns are. Like, how long it would take. And it’s very manageable for physicians if they essentially continue to live within their means and not really blow up their lifestyle once they become an attending to actually reach financial independence in 15 years.
Daniel: Yeah. Yeah. That’s very, very reasonable. I think, especially if you can keep that lifestyle modest. I mean, you can be very modest and make it happen really fast. But I always joke with people, they’re like, “Hey Daniel, how are you gonna help me retire?”
Daniel: I just had a buddy ask me the other day and I’m like, “Well, can I talk into living in a trailer park” and reducing, you know, we can make it happen fast if that’s the case. But you know, they have a really nice house and living lifestyle. So, did your work in medicine improve over the years? Like, I know you had some, not great experiences that motivated you start getting into real estate early on, but how did that progress?
Dr. Elisa: Yeah, so I actually flipped two houses during, so I actually finished grad school, a little off cycle. And I had the option to be either going back to medical school, the third and fourth year of medical school earlier and giving up all my elective time. Were just waiting to go back in July. So I essentially had, I think seven or eight months off, and that’s when I really just kind of delve into the real estate investing.
Dr. Elisa: So I ended up buying, you know, a foreclosed house, fixing it up, selling it, and then doing it a second time. And I made money on it and it was exciting and but it was a lot of work and it did feel like, quote, risky. And at that time it was the 2008 crash was the time I was doing that. So I was able to find foreclosed homes at really low prices.
Dr. Elisa: I mean, nothing that you can find like that now. So I think it, it did work then. But, what happens was, I went back to medical school. I kind of did my rotations and actually spent time where it was like, “Well, this is okay, but I’m not sure I wanna do this for the rest of my life.”
Dr. Elisa: But I eventually fell into Ophthalmology, which I really enjoyed. And went to residency and fellowship and I actually loved residency and fellowship.
Dr. Elisa: So at that time I didn’t do any real estate investing. I continued to put money into my Roth IRA and into my 403B at that time. And continued kind of to be responsible financially, but with the idea that I probably would invest in real estate again as an attending.
Dr. Elisa: So with my first attending job, I moved to Virginia to an area that I really didn’t know that local real estate market at all.
Dr. Elisa: And I didn’t have the mindset of like, “Oh, I can invest in Cleveland where I went to med school while I was living in Virginia.”
Dr. Elisa: The idea of just, I don’t know at that time I just didn’t have that mindset that was something I could do. So I started looking in the Virginia market, but it was a completely different market.
Dr. Elisa: So I was in the Virginia Beach Chesapeake, Suffolk area. And it’s very high military area. So there are actually a lot of rentals. There’s a lot of transient population, but that also made it so that seemed like there was a lot of supply of rentals. So I myself started renting a house.
Dr. Elisa: It was this beautiful four bedroom house with granite countertop in the kitchen, like hardwood floors on the first floor. Like a beautiful house, I think valued around $450,000 that I was renting for $1,800 a month. Which from a real estate investor standpoint doesn’t like make sense. But I think probably what happened was someone bought the house and couldn’t sell it because they were underwater.
Dr. Elisa: So they were renting it and that was the situation they were in. So I was thinking, well there’s a lot of houses like that in this market, then this doesn’t make sense to, I mean, I don’t know what house I could buy to rent to actually cash flow well. So when that job didn’t work out, and it was a actually a pretty good job as an employee, but I mean there I had reasons for leaving. And I interviewed around the country again and I decided to actually go back to Cleveland partially so that I could get back into the real estate investing because I knew the Cleveland market.
Dr. Elisa: I had contractors I had worked with. I knew realtors. So having that team already established and knowing that Cleveland was a good real estate market to invest in actually drew me back to being home as well as just having friends, back in the Cleveland area that I made during the time I was there, and my husband also having friends.
Dr. Elisa: So there were other reasons to come there, but the real estate was definitely one of the things that I was thinking about.
Daniel: What was it about the job that didn’t work out?
Dr. Elisa: I went to that job in thinking that I would become a partner in the practice and at some point I realized that the owner of the practice was not someone that I was likely to be a good business partner with.
Daniel: That’s the tricky part about partnership. Yes. It’s kinda like getting married in some ways and there’s a lot of times not similar values or vision for the business, and that’s hard to find. That’s hard to identify on the front end, like when you’re looking for a job. I mean, that’s very difficult to, so we see that a lot as that partnership doesn’t end up working out. And typically it’s because of like values or vision conflict or just the practice sales, just some sell out or something like that.
Daniel: But, so then you moved back to Cleveland and it allowed you to get into real estate. What was the job like in medicine in Cleveland?
Dr. Elisa: Yeah. So unfortunately get back in Cleveland, I took a job at a big hospital system, which I kind of didn’t really wanna do. I know, right? Like ‘cuz I was in a nice private practice where it was no well staffed, like I said, as an employee was actually a good job.
Dr. Elisa: It was just that I had really had wanted to be a partner and when I didn’t see that happening and I was also..
Daniel: You meant like a reverse on autonomy.
Dr. Elisa: Yeah. Well, so my idea was that I would come back to Cleveland, work for the hospital for a while. Like get to know the other doctors in the area. Build some relationships and then go start my own private practice. And I had negotiated a non-compete so that there was space to do that, but then the pandemic happened.
Dr. Elisa: And so I actually was at that point where I was like, okay in the beginning of 2020, okay. By the end of this year, I’m gonna leave and I’m gonna start my practice.
Dr. Elisa: And then the pandemic hit. And I saw what that did.
Daniel: You were gonna leave in 2020?
Dr. Elisa: Right. So I moved in 2019 and I was definitely gonna stay at least the one year so I could have my signing bonus.
Daniel: And then Covid blew up everything like it. And so how did that pan out for you?
Dr. Elisa: Yeah, so I ended up staying there through Covid and was lucky in the sense that I wasn’t laid off or I did have to work without pay, which I have friends during the pandemic where they literally kept working but weren’t being paid. You know, friends working in private practice, I had other friends that were laid off from medicine.
Dr. Elisa: It’s funny, you have a medical pandemic and you’ve got doctors who don’t have jobs.
Daniel: It’s backwards.
Dr. Elisa: Yeah. I did stay and then at some point I realized that I wasn’t sure that I wanted to start a private practice in this kind of environment. Where you never know, like, you know when you’re just gonna be shut down and you’ve got staff support and you’ve got a lease on a building to pay and you don’t know when you can reopen and just all the regulations of medicine and reimbursements going down.
Dr. Elisa: So I’m a Oculoplastic Specialist and the pre-authorizations for the surgeries I do are getting harder and harder and making it so that it’s just more difficult. I mean, in medicine we celebrate when our reimbursements don’t get decreased, when they just stay the same. But with inflations, we know that staying the same still means a decrease.
Dr. Elisa: Right. And we still have staff to pay. We still have all the equipment to buy. We still, you know, medical equipment is marked up in price probably because this, I mean, you just labeled medical equipment and the same things, selling now costs way more. Right?
Daniel: And what about the real estate? Did you start investing in real estate again?
Dr. Elisa: I did. Yeah. So I bought some long-term rentals in Cleveland. I also bought a short-term rental. And I started investing in syndications as well.
Daniel: Okay. What do you think about real estate? What’s something like the real estate gurus don’t tell you about real estate? That it sounded like you had some, you, I can tell you’re not like all roses and sunshine about real estate, or maybe that’s what I’m gathering from our conversation so far.
Daniel: And sometimes I get that impression from some of the gurus and air quotes. But are there things that you think that are often overlooked when you’re hearing people talk about real estate or what are some things maybe you didn’t know going in with real estate that ended up being not as roses and sunshine as you thought they might be?
Pablo: So in the beginning, if you’re gonna be an active real estate investor, like with long-term rentals or short-term rentals, like there is a steep learning curve and there is a lot of time involved. And to get positive cash flow, especially, I mean real estate recovered from that 2008 crash and basically anyone who’s been investing real estate, probably from 2015 to 2020 is done great.
Pablo: Just cuz the market has just kept going up, with appreciation and rents increasing. And then during the pandemic actually, things have still improved with the housing shortage essentially, or housing scarcity. People wanting to move to have more space. Specifically it’s been a definitely different market.
Pablo: Short-term rentals definitely went up during the pandemic ‘cuz people weren’t as keen on being in hotels with lots of people and wanting to have their own space. So, I think there is a lot of money to be made in real estate. And real estate is still a great way to diversify your investments and a way to build wells.
Pablo: But you really want to know your numbers well. You make your money when you buy. And so you don’t wanna get so excited and buy into a property just to have negative cash flow and actually lose money. And I think also there’s a lot of physicians who grow into real estate, like wanting the tax benefits and the tax benefits can be great, but you don’t want to let the..
Daniel: Tax tail Wagner.
Dr. Elisa: Yeah. Wag the dog. That’s what I was thinking was like, what’s that say? Because right in the end, you don’t wanna lose money. You still need to make money on the real estate. You don’t wanna just do it just for the tax benefit because a lot of the tax benefit, depending on what you do in the future, you’re gonna end up paying those taxes later, right?
Dr. Elisa: When you sell the property, it’s just deferred depreciation. You recapture that depreciation when you sell the property. Unless you do a 10 31 Exchange.
Dr. Elisa: And 10 31 exchange is not, I mean, yes, it’s very doable, but you have to identify a new property living butt eye within 90 days and have everything work out and things can fall through.
Dr. Elisa: And I’m not saying that it doesn’t work, it does work, but it is work and a lot of physicians are busy and you really need to spend all the sufficient time to educate yourself to really know what you’re getting into. ‘Cuz I know a lot of physicians who’ve gone to real estate investing got really excited. You know, bought a property or bought multiple properties or bought like a apartment complexes their first go and, you know, didn’t.. I’m gonna say everyone’s gonna make some mistakes. That’s just the way it is.
Daniel: You must be perfect..
Dr. Elisa: Yeah. But with real estate, like some mistakes can be really expensive. So I often say like, it is better to kind of start smaller smart, start with a duplex or a single family instead of starting with a whole apartment complex.
Dr. Elisa: And if you start with like a 20 new apartment complex, you might be multiplying your mistakes by 20 as opposed to if you just got a single property.
Daniel: Yeah, I very well said. I think I completely agree with everything you’re saying. I think the whole, I always get a little fired up about the passive income label.
Daniel: I agree in some ways with the concept and I know why they use it, but like passive income equating to real estate, especially direct ownership sometimes causes this confusion that it’s like actually passive. When you own a property, it requires a lot of hard work and it’s not passive at all.
Daniel: Especially at first. And there’s a lot of mistakes that you can make and you have to have thick skin. And it’s hard when people say, I have a hard situation and I’m renting from you. Maybe I’m getting divorced or something, and can I skip a couple months rent? And like, you have to be firm or contractors don’t show up.
Daniel: And I mean, there’s a lot of things that come with real estate that I think, you know, you hit on that are really helpful for people to understand before ideally they get into it. But it can be a fantastic tool to grow wealth and achieve your goals or whatnot. But at this point though we haven’t hit on this whole coaching business that you’re developing. And so how did you go from what we’ve talked about so far to then getting into life coaching for physicians? Right.
Dr. Elisa: So I found life coaching as part of the pandemic. Actually, to me, the pandemic had many gifts. And one of them was Peter Kim, who is Passive Income MD, we talked about passive income.
Dr. Elisa: I’ve been following him since I think 2016. So for a long time. And he put on the Leverage and Growth Summit where Sunny Smith spoke and she’s a Dr. Sunny Smith and she’s a life coach. And that’s where I first heard about life what a life coach was like.
Dr. Elisa: I never heard what a life coach was. And so I started listening to the Life Coach School podcast and you know, I had read books on like how to be happier and like kind of what we call self-help or self-development books. And none of them really stuck very much. But when I listened to this particular podcast, it really actually affected my mindset. It really made me like realize like,
Dr. Elisa: “Oh, like I can see how this works.” Brooke Castillo has something which is called the model where you have circumstances in the world and then you have your thoughts about those circumstances. And those thoughts are actually what paint your life in a way.
Dr. Elisa: it’s how you think about things is affects how you feel about everything. And I could see how that was true and I could see through her examples, like, yes.
Dr. Elisa: And the fact that you are not actually your thoughts, you really can work and change your thoughts. And from how you’re thinking and feeling is really how you take action and those actions get you the results in your world.
Dr. Elisa: So by actually stepping back and being a watch of your thoughts and asking yourself like, “Is this really true? Do I wanna be thinking that? You know, does that serve me?” Really made me understand how much I was creating my life. And of course, you know, in some ways I created a great life, right? I am a physician, I’m an Oculoplastic Specialist, and I have a beautiful house I live in and I have a wonderful husband.
Dr. Elisa: And, you know, there are a lot of great things in my life, but of course there are other things where I wish we were better. And working at that hospital system was really, I was definitely experiencing burnout, especially with the pandemic. And, you know, there were times where I worried about like, “Am I gonna get a called to be in the ED? Am I gonna be called to the ICU? Am I gonna be exposed?” Like, you know, in the beginning we really thought Covid was very life-threatening. And it is, now that we have the vaccine, it’s definitely much better. But even if it’s not like threatening, and there’s a lot of people I know who’ve gotten covid and had long-term effects from Covid, none of which are fun or things that I wanna have.
Dr. Elisa: So that’s how I discovered coaching. And because of the pandemic, I had a lot more time on my hands. I wasn’t seeing my friends. I also wasn’t working as much for a while because we kind of were shut down. We were just seeing merchant patients for several, for like two months maybe. Or probably not even that long.
Dr. Elisa: But my surgeries were stopped for I think about two months. And so by having that extra time, I really just kind of delve more into what coaching was. Start, started doing self-coaching scholars. And then certification came out through the Life coach school in September. So I initially actually did certification just to kind of learn the tools better to really help myself.
Dr. Elisa: But as part of doing a coach certification program, of course you actually have to coach other people and I just really enjoyed coaching other people. And so by the end of that certification, I started thinking, so remember before the pandemic, I was thinking I was gonna leave and start my own private practice.
Dr. Elisa: And then here I was thinking, well, maybe it would be better to start my own coaching practice and go working part-time as a physician. And that’s basically what happened. So I left the hospital practice to a part-time job and started my coaching business. And really decided to coach physicians on money and money mindset because of the financial background I had.
Daniel: Yeah. That’s awesome. And has that mindset is a big deal. And you were thrown out a few big concepts in coaching and that I think are important, like the mindset. And helping you define your ideal life. It sounds like you had like a really quick shift where you were like, you weren’t aware of what it really was or how it worked, or maybe even what mindset was to the point where you’re like, I want to be a life coach.
Daniel: How quick was that? From start to finish?
Dr. Elisa: From the time I first heard about coaching I was, till the time I became a certified coach was about a year. So yeah..
Daniel: It was, it’s super fast. And it’s a kind of a 180 in some ways, but it is, you are coaching physicians and you’re still a part-time physician as well.
Daniel: I have worked with coaches many times over the years. It’s kind of like a normal thing in entrepreneurship or business circles or whatever, but in medicine or for physicians, it’s been kind of a newer thing. Like it didn’t used to. I’d say like 10 years ago it was like a foreign thing.
Dr. Elisa: I agree. Even five years ago, I would say it’s a foreign thing. There have been a lot more physician coaches that have, I think actually the pandemic has really spurred. It was like a breaking point for physicians. For physicians really. I mean, I sadly know physicians who commit suicide over the pandemic, right?
Dr. Elisa: And I mean, one that got, Covid got better, but just the survivor guilt. And I didn’t know her personally, but I read her story. And also during the pandemic I got onto Facebook a lot more. I wasn’t really into social media before, but because of the social isolation, I kind of went to Facebook in order to fill in that social need and got into a lot of physician Facebook groups and starting with like Covid specific physician Facebook groups, but then kind of expanding more and so just kind of talking to more and more physicians.
Dr. Elisa: And yeah, we’re, we really are burnt out. Like we’ve kind of lost our profession in a lot of ways. It used to be that most physicians either work for themselves or for another physician, and we’re mostly in physician owned practices and mostly in private practices where physicians had a lot of autonomy.
Dr. Elisa: But just recently now more physicians actually work as employed physicians, either to a corporation or a hospital system. And a lot of these corporations or hospital systems are not run by, physicians. Are run either for profit so people who wanna actively make money off the physicians working or not to talk down on nurses.
Dr. Elisa: But a lot of these healthcare systems are actually run by nurses and they don’t necessarily understand medicine the way a physician understands medicine.
Daniel: I think back, back in the day, I guess I never experienced this as a patient or, but before our time, I think where the physician was like the neighborhood physician and you just kind of, they had their own practice. Everybody had their own practice and you go to see them and then you pay ’em for the visit. Maybe there wasn’t even insurance involved. I don’t know how it worked. I think it was a lot simpler and they had their own practice and they had their patients and it seemed like a pretty simple environment.
Daniel: But I think the biggest difference is they had control and they were able to practice medicine, how they envision practicing medicine, like in the interest of the patient. And so it seems like the shift that’s happened over time of the local entrepreneur, doctor owning his own practice or her practice is that they’ve sold out to the system, the hospital system or the monster group or the private equity deal.
Daniel: And that pulls, or is basically giving up control slowly, probably over time to the point though now where the control is like very little or maybe none. And that when you have, I think when you’ve put in like a serious amount of time and effort and like blood, sweat and tears into developing a skillset and you have patience and then to not be able to do it on in the best interests makes you want to go crazy.
Daniel: Like it’s frustrating, extremely frustrating, I think. I look back to that model back in the day. I think there’s some things could be learned from that. And I think it’s a great case for entrepreneurship in. Some ways but it’s like we’re going, it still feels like, to me going the other direction.
Dr. Elisa: Yes. So unfortunately we don’t really learn much about the business of medicine in medical school or in residency or fellowship. And we think about it, residency and fellowship programs are typically at hospitals and hospitals wanna be staffed by physicians. So I think there was a time where basically hospitals gave privileges to physicians, but the physicians didn’t necessarily work for the hospital. They weren’t employees for the hospital. They had privileges so that they would admit patients and work within the hospital, but they kind of build separately. And now hospitals are just employing physicians and as W2 employees.
Dr. Elisa: So it’s a very different model. And so there is a lot less autonomy and then there is an insurance part of it. And so we’ve had a lot of great medical advances over the decades, but a lot of those medical advances are more expensive to pay for. And so coming out of pocket for that, when you think back to the 1950s doctors, a lot of patients back then could afford just a paid for their medical care out of pocket because you didn’t have expensive MRIs and CT scans or drugs that cost a hundred thousand dollars a year ,right.
Dr. Elisa: Those just, it was much more affordable. And now when you think about insurance, like if you think about car insurance, you get car insurance. When you get in a car accident, you don’t use your car insurance to put oil in your car or for your general maintenance. Right. But when you think about health insurance, people think that the health insurance should be paying for everything like the oil for the car. And that’s really not what insurance from the word insurance is really meant for. It’s meant for to cover a catastrophe. It’s not meant to cover like your day-to-day.
Daniel: Yeah. I think that’s the best use of insurance. That’s what it, like another, an example of this would be like short-term disability insurance is something, if you’re gonna have children, the odds are you’re very likely gonna use that. And short-term disability is not very catastrophic for most physicians.
Daniel: And it can be pretty expensive to get that kind of insurance, because it’s gonna pay out most likely. And it’s not, it’s just doesn’t reduce your risk that much by owning it because it’s not that catastrophic of a situation versus long-term disability insurance is like millions and millions of dollars if you can never work again.
Daniel: It’s extremely expensive, but it’s also extremely low risk to be permanently disabled from work. But that’s like the ideal. And we learned this. I actually, you know, I went through like the financial planner training and if you do the good training, they teach you about the true best use of insurance, and it is where you have the two factors. Like the high cost and the low risk or low probability.
Daniel: That’s where insurance works really well is when you have those two things. But like healthcare, like you said, you pointed out, and I haven’t really thought of it exactly that way because I just think of health insurance as a thing, but that is completely true. It’s like when you have healthcare paying for like $5 cost or prescriptions or general practitioner visits, or it’s built in that you get a checkup or whatever in your health insurance that’s not a catastrophe at all.
Daniel: Now, open heart surgery obviously is catastrophe…
Dr. Elisa: Like getting cancer. Getting a car accident, having even, you know, your arm or leg broken, having to go to the OR to fix that. I mean, those are things that you want insurance for, but your annual visit to your PCP, paying that out of pocket, that’s something where like if you go to a direct primary care practice, which are bringing up more physicians who aren’t accepting insurance, you’re like, you might pay like $350 for that annual visit and then maybe $200 for any kind of sick visit that’s totally within range.
Dr. Elisa: I mean, I’m not saying that’s cheap, but like, think about what you pay for a plumber to come to your house. Right? Like it’s kind of in line with those prices.
Daniel: Yeah. So I personally think entrepreneurship is a one of the multiple solutions that are out there for physicians to kind of get away from this healthcare mess that’s out there.
Daniel: The cool thing about entrepreneurship and really what kind of made me think of this is you are a great example of it in that you’re using, basically entrepreneurship is the best way professionally to solve problems in the world. So you realize that there were a lot of physicians that needed help with some of the things we’re talking about, like mindset and identifying what their ideal life looks like and helping them kind of make progress towards that.
Daniel: And you created a business to help them accomplish that. And that’s the best, I mean, that’s a fantastic example of entrepreneurship. And that’s the best, my opinion, that’s the best reason. I mean, it’s on the opposite end of the spectrum. for example, starting a business just to make money, not so healthy, I don’t think.
Daniel: But starting a business to help people solve a problem that you have direct knowledge about and care about, that’s fantastic.
Dr. Elisa: Yeah, you know I really think having a mission, a why that’s outside of just making money really puts you in a position where it’s like, exactly what you’re saying.
Dr. Elisa: What problem are you solving? And in 2019, data shows that 24% of physicians over the age of 65 have a net worth of under a million dollars. Well, unless they have a pension, which not very many physicians do, like they can’t retire. Right. And I think after having a whole career as being a physician, like that’s really unfortunately sad.
Dr. Elisa: And I know that’s probably true among the general US population that a lot of people won’t bill to retire if they don’t have pensions, because it’s not having the foresight of saving investing throughout their careers. But, you know, I guess physicians are my people. And so those are the people I wanna help.
Dr. Elisa: And I just see so many physicians who just feel so tied to their jobs, like feeling handcuffed because of the high student debt burden. Or you know, having just the grown their lifestyle to a way that, you know, like you said, like, well if you go live in a trailer park, you could probably retire tomorrow.
Dr. Elisa: But you know, once you get accustomed to a certain standard of living, it can be hard to cut back. And so when you look at, okay, be miserable and keep working so that I don’t have to give up all these other things, well, that’s where the mindset piece really comes in. You know, I talk to a lot of physicians about spending money for they value, right?
Dr. Elisa: Do you really value having the fancy car or do you just really need to get a reliable car that will take you to and from where you wanna go? Because that difference in car payment could be huge and could really be a difference between getting to financial independence earlier than later, or being able to spend that money elsewhere where it really could bring more joy like going part-time cause you don’t need as much income or, you know, taking more vacations so that you have more time to rest and rejuvenate or investing in self-care in some other ways, like having someone come clean so that, that frees up your time. There are many ways to use money. I mean, money really is a tool.
Dr. Elisa: It’s money itself is not going to bring you happiness, but the way you spend money can affect your happiness.
Daniel: Yeah, but it’s about how you use it. It’s not about how you stockpiling and like a big gold bank account. I mean, there is a little bit of security that comes, especially from going to zero to like some level of flexibility.
Daniel: It’s pretty stressful to be month to month. So you know, but once you get past that hump of like, I have enough to pay my bills, having more money after that point. And a lot of the happiness research confirms this, is not that big of a return on happiness and maybe even not any at all.
Daniel: Where it comes into play at that point is more about how you’re using the money or what are you using the money on as a tool to. So I see a lot of physicians like, hardcore fire, working really hard to get out basically quick or side gigs working more to same sort of reasons, like to get out. Or just working in a job because I have to keep up the lifestyle.
Daniel: But in the same conversation, maybe they bring up that like their family’s the most important thing to them. And so that to me is like a classic issue that everybody struggles with at times is like there’s this cultural pressure to have more of everything I think that we all feel.
Daniel: And so it’s like the solution is to work harder to get more. But a lot of us have other things that are potentially way more important that we’re not quite, it’s like cognitive dissonance.
Dr. Elisa: For sure. How often do you care? Oh I’m working for my family, so my family can have all these things when really your family wants your time. Right? They want your love. You know, children have just as much fun playing with the cardboard box that the toy came in, then the actual toy itself. Right. It’s not about how much money you can give.
Dr. Elisa: It’s really, I mean, there is a certain minimal standard of need. And there have been research studies on this and the numbers have differed. I mean, one study was around 72,000 for an individual. Another study was a little higher, more than the six figures. But your average physician definitely makes enough where the income is not the issue.
Dr. Elisa: It’s how you’re using that money as a tool to actually move your life and more money isn’t going to create the happiness. There’s plenty of wealthy people who are unhappy. So having money can solve problems, right? Like you can pay to make kind of problems go away. So certainly having money can be helpful from that sense.
Dr. Elisa: And there has been happiness studies on where different ways of how you spend your money can actually increase your happiness, but just having more money in itself isn’t going to create more happiness. And then for the people who are really going gung ho to get to fire really fast, it’s, you know, tomorrow’s not guaranteed, right?
Dr. Elisa: So how much would it suck? And I know of a physician where, you know, her father died I think a year or two after he retired and he had spent, you know, his whole time like waiting and saving and then he didn’t really get to enjoy it. So life is really to enjoy in the present. And it’s a balance, right?
Dr. Elisa: We still have responsibilities. We still need to have enough income, however it’s coming in to build, to pay for our basic needs. But above that, once you get to the point where you’ve got that extra, where you put it, you know, maybe making less with and spending more time with your family would actually bring you more happiness.
Dr. Elisa: So it’s not just about the money.
Daniel: Yeah, I think so. I think coaching, you can do this kind of thing yourself. Go through like this thought exercise of saying like, what’s my mindset? Like let’s take stock of how that’s affecting things. Or like, what does my ideal life look like? What do I want?
Daniel: What’s most important to me? Like, and how am I in alignment with that? And if you’re married, you know, your spouse has to kind of be involved in that or should be involved in that typically, I think. But I think coaching is a great way to also do that with the help of a third party because that’s a difficult exercise to do, to administer on yourself, I guess.
Dr. Elisa: Yes, for sure. And I have my own coaches that I go to because I’ve got a human brain and there are a lot of times where we think something is a fact when it’s really just a thought and we are blocked from actually seeing that. And so that’s the job of a coach is really to show you your thoughts and that they are thoughts and that you can actually change them if you wanna change them and to help you get into changing them.
Dr. Elisa: And it’s all kind of incremental work, right? So that you can actually see that happiness is actually available to all of us now. And I know that sounds like really pie in the sky or really rosy, but you know, it’s true. Like if you kind of just sit right now and just think about the last time you were really happy and just recreate that whole vision in your mind, like close your eyes and put yourself there.
Dr. Elisa: Like you can create that feeling in your body. And that’s what I find so powerful. And of course it can take some effort to get there. Definitely when I started this work, it was much easier to create negative feelings, like fear in anxiety than it was to create things like positive feelings like happiness and excitement, but with effort, with the assistance of a coach.
Dr. Elisa: If you aren’t finding that you’re able to do it yourself, like it’s really possible for anybody. Yeah. And also I also just wanna bring up, like, you were also talking about, like, you know, trying to get to fire as soon as possible is that then once you get to the point where you are financially free, if that’s all you’ve known, like I don’t like, there’s gonna be a sense of arrival fallacy there, right?
Dr. Elisa: It’s like, okay, now you’re there. Now what? Right? Like, you’re gonna think you’re insulin gonna be happy and you probably will be happy when you like, hit that number. But you may also still have the fear of losing the money. The money not lasting. Are you really financially independent?
Daniel: What’s your identity if your identity has been tied up in work? Mostly?
Dr. Elisa: Yeah. A lot of physicians, Denny is very much tied to being a physician. So if you’re no longer a physician, like who you are, and there is a little bit of stigma. It’s like, “Oh, like you train for so long, like, why wouldn’t you practice more? Like, don’t you wanna keep helping people?”
Dr. Elisa: And you know, you’ll face that. I think there are a lot of reasons to actually kind of look at like, you know, what’s your reasoning? How could you practice medicine on your own terms and be happy. I’m all for getting financial independence and the sooner the better so that you can actually tailor your practice of medicine to practice on your own terms, to do what you like to do, to, if there are certain types of patients you prefer not to see.
Dr. Elisa: Not seeing those patients. And I think, you know, private practice is probably the best place where you can really implement that kind of practice where you get to do the part of medicine that you wanna do. ‘Cuz I think most physicians do actually enjoy the practice of medicine once you take away a certain level of the regulations.
Dr. Elisa: Or the pressures by corporate the having to see, you know, X amount of patients and X amount of time to bring in X amount of dollars. If you can kind of strip the things that you don’t like away from this, I think most physicians would actually like to continue practicing medicine.
Dr. Elisa: And, you know, maybe not five days a week, maybe it’s three days a week, maybe it’s two days a week. But we do need doctors. And so while I wanna help physicians get to financial independence, I don’t want necessarily for every physician to jump shift and not practice anymore. Right.
Daniel: Yeah. I think, it’s interesting. I see it as a third party perspective, so it’s a little easier for me to see it, but like, it’s like I see this direct correlation, the more I hate my job equals a higher focus on fire. ‘Cuz which kind of makes sense ‘cuz it’s like I gotta get outta here, like this thing’s which. But the problem is the fire thing kind of tends to push you into it further cuz you’re like, I gotta work more to make more, to get fire sooner. And then also it’s like what’s your real reason for doing it?
Daniel: So I think what you’re saying and what coaching can do and or this thought exercise can really do is like, let’s just peel back the layers on what’s going on here. Like, why? Asking why a bunch of times. Yeah. So like why are you hardcore fired? Maybe it’s ‘cuz I hate my job.
Daniel: Okay. Why do you hate your job? ‘Cuz the system sucks is a common example. . Okay, so what parts about it suck? And then, identify those and the what If there was a way you could do medicine in a system that didn’t suck, how would you feel about that? And a lot of times, people kind of have the light bulb moment where they’re like, “Hmm, that would actually be pretty sweet.”
Daniel: And then I have even interacted with people that have made that transition. It’s like their fire alarm goes down. Like they’re like less fire when they transition into this new professional environment where they’re like, I actually enjoy or love my work and maybe I’m helping solve the problems in the whole messed up system that have been frying me for years.
Daniel: Like in your example, like you’re helping other people solve these problems you were going through and experience yourself. And that’s much more rewarding than just kind of being that cog in the wheel and just saying, “I’m gonna be fire. I’m gonna be a cog in the wheel, and go fire as hard as possible.”
Dr. Elisa: Yeah, definitely. And I love the why. I mean, you keep asking why you get to the root of it. You know, ask why at least five times and actually solve the principle problem essentially.
Daniel: Yeah. As we wrap up I know this is a fun conversation and I kind of want to keep going, but I know we got, we’re busy people, so we gotta put a limit on it.
Daniel: I know you have your podcast and your website, what’s the best place for people to find you and some of the stuff you’re putting out there?
Dr. Elisa: Yeah, so I think my podcast is a great resource, is the Grow Your Wealthy Mindset podcast. You can learn more about me and my website, which is growyourwealthymindset.com.
Dr. Elisa: You can follow me on Instagram at Grow Your Wealthy Mindset, and I’m on Facebook as well.
Daniel: Awesome. It’s been a fun conversation and I really appreciate you coming on to chat with me.
Dr. Elisa: Yeah, it was great. And I’d love to come back any other time. We can discuss so many more things.