What does it take for physicians to take control of their careers? Jonathan Moss joins Dr. Anders Apgar to unpack the business of medicine, financial literacy, career crafting, physician agency, and burnout. From understanding RVUs and contracts to living within your means, this conversation offers practical strategies for sustainable careers.
Physicians spend years learning medicine but often receive little education about how healthcare actually works. Jonathan Moss, a longtime healthcare finance and revenue-cycle executive, explains why understanding FTEs, CPTs, RVUs, contracts, and organizational finances can help physicians make better career decisions while protecting their well-being and professional identity.
The conversation goes beyond financial literacy to explore career crafting, finding meaningful work, building supportive networks, and recognizing when a career no longer aligns with personal values. Jonathan emphasizes living within your means, saving for the future, and creating enough financial flexibility to give physicians choices about their workload, purpose, and future.
Listeners will learn how financial literacy, career crafting, and physician agency can create greater control, flexibility, and satisfaction throughout their medical careers.
Episode Highlights
About the Guest:
Jonathan Moss is a finance and revenue-cycle executive with more than 25 years of experience in healthcare. He has also spent approximately a decade focused on physician well-being and has taught residents about the business of medicine, well-being, and personal finance. His work bridges healthcare finance, operations, and physician wellness.
About the Show:
Direct Well-Being is hosted by Dr. Anders Apgar, MD, FACOG, M.S., a physician leader dedicated to transforming clinician well-being. The podcast creates space for honest, practical conversations about the factors that influence physician well-being, including financial stress, career sustainability, healthcare systems, relationships, and professional purpose.
About the Host:
Anders Apgar, MD, FACOG, M.S., is a physician leader dedicated to transforming clinician well-being. As host of the Direct Well-Being Podcast, he leads honest conversations about the real drivers of distress : financial stress, mental health, family dynamics, and broken systems, for physicians and the organizations that support them.
A trusted voice in health care, Dr. Apgar blends lived clinical experience with evidence-aligned insights. He’s part of the Direct Ecosystem (Direct Self Care, Direct Wealth Care, Direct Practice Care), partnering with organizations like Tend Health, the Well-Being Index, and Champions of Wellness to move the conversation from awareness to agency.
Connect with Dr. Anders Apgar
Websites:
Emails:
General contact: info@directwellbeingpodcast.com
Listener feedback: feedback@directwellbeingpodcast.com
Guest pitches: guests@directwellbeingpodcast.com
Sponsorship conversations: sponsors@directwellbeingpodcast.com
[00:00:00] welcome back to the Direct Well-Being podcast. Thanks everybody for being here. I'm really excited to have Mr. Jonathan Moss here today. Jonathan has been a finance and revenue cycle executive for the past 25 years with a self-proclaimed minor in physician well-being for the past 10.
he's also served as a healthcare finance educator teaching residents the business of medicine, well-being, and personal finance. Jonathan, thank you very much for being with us today.
Happy to be here. Nice to see you.
Yeah, good to see you again. That's, the tip of that iceberg is that Jonathan and I met about 412 years ago.
more like a century. Sometime in the late '80s or early '90s at Wesleyan University, where we were studying various things. Jonathan was probably doing finance and I was doing pre-meds but we met in the gym doing a couple different varsity sports.
Well, we can go into that because I was not doing finance.
I was doing mostly psychology and sociology.
I love it. And, the business of people and, it was after college and then an MBA that got me into finance and then [00:01:00] consulting. Wow. But it's always been about the people and, and the operations so we're gonna go into that, I suspect-
Yeah.a whole lot more.
Don't be giving away the episode too early, Jonathan. Now leading off, you've spent more than 25 years helping physicians, residents, everybody basically understand how healthcare works from a financial and an operational lens. And I just barely am coming to understand 30 later what the heck revenue cycle management means in the first place.
So if anybody else who's listening to this episode doesn't have that clue either, good. you're in good company. But Jonathan, you've also become a life coach for physicians. At least for physician well-being who are trying to navigate the system, people trying to navigate the system.
So the obvious question I think we start with for every physician who feels overwhelmed, when physicians feel trapped, where does agency begin for them? Where do they get that back?
I think that the idea of career crafting is incredibly vital. We can go into some of the research around, physicians needing at least 20% of their work life to be something that they really [00:02:00] enjoy and are passionate about.
And you know when I first learned about that, I don't know ten years ago whenever it was that Stanford and the other folks came up with that research, I thought that was an incredibly low bar right? One day a week you need to be doing what you enjoy. It's like holy cow! Yeah. And so I don't think there's an excuse in the book for physicians not to build towards leaping over that bar and then some right?
Whether it's loving teaching, research clinical work, any particular disease state built toward that and take that on. It's a huge industry and really allows physicians to grow into what they want to do. Why wouldn't ya because being mired in what you don't like doing ... Is recipe in disaster.i-it's not good for you as a clinician, not good for your patient ,not good for the industry .You know you just not gonna be around very long.
We talk a lot about sustainability. That's a [00:03:00] great point to touch on but y-you learn early in training th-that culture putting all that aside f-for becoming a physician ... t-that's what you are supposed to do. We spend years learning how diagnose and treat diseases and putting that first But we also spend little time learning h-how business of medicine actually functions So As you been going through this illustrious career that you have r-really built What surprised you most when you first started working With Physicians About Their understanding about The Business Of Medicine
Well let's dive into that wholeheartedly.I just wanna go back one second to what you've been trained to do, to diagnose, to treat, and the delayed gratification to get there through medical school and residency, et cetera. It does bring me to the nomenclature area, and I know there's a lot of folks that don't like being referred to as providers.
And I prefer the word clinician as a result of that because, you know, provider is really a one-way street, and clinician is what you've been taught to do using, research and, everything [00:04:00] that you've learned to treat the patient. And I just think that is incredibly important to just sort of make sure that you're taking care of yourself as a clinician and not just providing in a one way and burning yourself out in that process.
So getting back to sort of how to navigate the business of medicine and how to keep yourself whole as you navigate one of the things that I've found fascinating as I've Taught, probably several hundred residents at this point. I've had an informal survey that I ask them about three terms, three abbreviations, acronyms and whether they know what they mean.
And a vast majority of 'em don't know what they mean and yet I'd be a monkey's uncle if there's anybody mid-career physician who doesn't know these things. Mm-hmm. And yet it's a school of hard knocks that teaches them what these things are. And those three abbreviations are FTE, full time equivalent; CPT, common procedural terminology; and [00:05:00] RVU, the relative value unit.
Nobody in medical school and hardly any residents that I've met have known what those three things are and yet they become vital to how you're measured as a person contributing to the organization as FTE. What you're doing every day as a physician, CPT, defines every activity you do except when you defecate probably, right?
Mm-hmm[00:06:00]
because, who wants to go into a business where they don't understand how they're gonna be measured, right? And just, be told what to do and then not know what you're going to be measured against. And yet, as I say Goodness knows every physician out there, whether you're in private practice or a big group practice or, owned by a massive system, you're gonna know what an FTE, a CPT and an RVU are doing and how that impacts your career.
Well, and let's get into the RVUs and the identity. medicine is very much taught as a wonderful profession, a whole profession, a service profession. And so at what point during residency should they say, "Listen, you know, you're really doing great work and [00:07:00] saving lives, and congratulations.
That's fantastic, but if you're not pulling the RVUs, you're really relatively worthless." So... And you've been both a wellness coach as well as, a finance executive as well. So how do you teach people to balance their identity between being a good clinician serving the patient population and generating RVUs?
So I don't think there's any particular point in residency where this becomes, you know, the sort of magic learning moment and- a trajectory that should change the course of their career necessarily. one would hope that, the RVUs and the understanding of how you're being measured and how you're being compensated still takes a backseat to your everyday work connecting with patients, coming with, up with diagnoses, you know, working as a care team and effectively, managing patient care access, population health, et cetera.
I think finding a balance though, where you're recognizing [00:08:00] if there are certain areas of work that you're incredibly inefficient at and can't generate the RVUs to, you know, productively fund the time that you're spending, then that might not be an area of work that you should be spending that much time on.
Maybe others are more efficient at certain procedures or certain, you know, appointments and you need to specialize in something that you're more efficient at, enjoy more, et cetera, as I was mentioning earlier around career crafting and making sure that you're spending most of your time hopefully- Mm-hmm
at something you're really enjoying and good at, you know, and find efficiency in.
Yeah. That makes sense. Is there something that every resident should understand, or every physician should understand before signing their first contract or any contracts? Is it one and the same?
I think having advisors, consultants, accountants, folks out there to help you navigate things like signing [00:09:00] contracts makes incredible sense.
And, you know, anybody who's in a hurry and doesn't want something like that's life altering reviewed, I'd say you're making a mistake, right? you don't buy a car or a house on a spontaneous moment. You make sure you read the contract- Right .... and have the small print explained to you and understand what the implications are.
And so certainly earlier in your career when Things like FTE and RVU are unfamiliar. All the more reason to have trusted advisors. It may be if it's your third contract you've gotten more familiar with this, you know exactly what you're looking for. But even then I'd say depending on, the organization you're working with
You'd be well suited to find a professional-
...
To work with.
So the message sounds like you don't have to understand the contract, you just need to know who can teach it to you before you sign it .
Have trusted colleagues on your side. I think again, whether you're in private practice or working for a large [00:10:00] organisation, having some support network, having some trusted folks with different skill sets that you can lean on, that you can vent with, that you can bounce ideas off of.
mentors, peer supporters advisers, I don't care what you call them, but have some folks that you can rely on. You need a posse to be able to make this journey safely.
Yeah. That's a good point. We hear that point repeated with a lot of the folks we're talking to, so that's a really good point to make.
We're trying to teach people the understanding of financial language on this whole podcast. That's really a major driver here. Do you think ignorance about the business of medicine contributes to physician burnout as much as understanding the financial language?
That's been my theory.
That's one of the reasons that I make sure to include, you know, some of those acronyms in my teaching for the residents. I actually give them a little bit of sort of global history, , and national history around health insurance and sort of why and how we've gotten to the point where we are now, the [00:11:00] struggle with healthcare inflation pretty much since the advent of Medicare in the '60s.
and there's some really cool stories, around Medicare developing, the politics around it, how John F. Kennedy's assassination was sort of a piece of like how Medicare legislation came to be how desegregation was tied to Medicare legislation, desegregation of the hospitals, that is.
So there's some really cool stories and I think I've only found one resident in the hundreds that have asked this about Who was actually a history major, right? Everybody's been chemistry, biology, you name it, of course, right? all the hard sciences. Mm-hmm. There was one guy who I was doing this teaching one on one with him and so we went down the history rabbit hole and to talk about some of that stuff.
But I think having an understanding and sort of a perspective on why we are where we are, and then, i help them understand where the organizations today, health systems generally, right? They're in residency, they're at an academic medical [00:12:00] center and their organization is mired in struggles with making sure that they're making a margin dealing with, putting together ACOs, managing a population health initiative, and the physicians are being asked to be, three places at once work to the bone, work harder every year, put in more RVUs, et cetera.
And I just think that the recognition of being able to see both sides of the equation of how the organization is trying to survive and what it's doing to the caregivers and trying to find that compromise along the way and, sort of find the balance.
And you talk about agency a little bit.
I hear physicians all say all the time and, I'm guilty of the same thing, "I have no control." Is that really true that physicians have absolutely no control?
I think we all have the control that we want and need. I share depending on, how long I have if I have an extended period of time I go down a Stephen Covey route in terms of finding [00:13:00] control because Steven Covey has this whole thing about areas of concern and, we all have these global concerns about, war and global warming, et cetera, et cetera, and then finding that area and sphere of influence and control that you can have.
And if you really focus on what you truly have control over, you actually find that your ability to control those uncontrollables becomes greater and greater. So the more you're finding what you're doing in your workplace and in your home can have traction and start to make a difference. and ultimately you can vote with your feet.
There are situations I was just sharing with my partner who's a physician the other day as she was talking about making some changes in her work life and, voting with their feet in terms of how she's working and who she's working for and what shifts she's doing, et cetera, and it makes a difference.
It tells a story. It allows her to feel comfortable in having [00:14:00] control, and it also lets administration know what she values and where she wants to spend her time. Yeah. And I think in the end it has a lot of meaning.
Well let's go back to that, not too far down the rabbit hole but you talk about agency and control basically being a mindset.
So on the other side of that coin is there a sense of learned helplessness among physicians?
Yeah, and all of us who have worked in corporate America, right? I was talking to a gentleman yesterday just from corporate America's side of things, right? We don't feel like we're in control when we don't work for ourselves, right?
When there's a boss, and there's an organization that has its mission, and it doesn't, include our name in it. So we're working for corporate America and we need to manage within that. But understanding sort of the priorities of the organization and where and how they overlap with our own values and priorities I think that's where the sweet [00:15:00] spot is.
Mm-hmm. And findingwhere that can be, again, going back to the career crafting, what do I really value, and is it happening in this organization? And then can I spend more time in that part of this organization because I really love the research that's being done in, you name the area, population health or, what have you.
Mm-hmm.
and if you can't, that might be telling as well, right? If you can't find a spot in your organization where you can find joyful work for at least 20% of your time, again, like, now might be the time to start looking at where you can find that joy.
Really good point. It's been a theory and a theme throughout several of our episodes, so I appreciate you bringing that up again.
and I know it's part of your story too, right? You and I have been friends for decades. We've talked through this, on your journey and as you went through some transitions and struggles and, identifying, maybe you look back at it and said, "Oh, I [00:16:00] wish I knew 10 years ago what I know now because I wouldn't have hit my head against such and such a wall quite as many times," right? Might, might, might have been a dozen instead of, you know, whatever.
Or I may have put down the, those lottery numbers that I saw 'cause I knew them because I wa- 10 years ago.
but I like what you're saying about overlap. So to me, overlap with values, corporate values or company values or practice values, however that is. When your values overlap with those values, that to me signals alignment. And if you can maximize the sense of alignment with your company, and you should do that probably before you sign the contract feel the mission, understand the mission.
If you can maximize that alignment, I think you're going to find yourself in the right place where you can find joy if there's joy to be found
Yeah, absolutely. I think it might be a little ambitious to know that for certain before you sign the contract. I think you should certainly have your eyes wide open and hopefully, you know through the [00:17:00] interview process et cetera, have a pretty good sense that you are finding it there-
And y- you know you do go through a good battery of interviews and meet a good number of people so you should have a really good sense for that before you sign that contract. And then make sure to continue to build those relationships inside the organization so you're constantly learning what's out there and you know where the heartbeat is for the organization and where the mission is, you know struggling and where it's strong.
I have found myself in a position or I put myself in this position a lot to be sort of the interpreter between operations and finance, between clinical work and the administrative work. And help people build those bridges so that they can understand both sides of the puzzle. Yep
and I think that's been something as I say I sorta put myself there very early in my career in consulting. I found [00:18:00] myself at a table with, clinicians and finance people on both sides of the table and I would often like say, "Time out." And like the director, "Cut! Hang on. You just said XYZ," you know acronym.
"I am fairly certain that these folks from the other side have no idea what you're talking about. Can you just explain what you're coming from?" You know or I'd do some interpreting for the finance folks what the clinician's just said or whatever. And that's been a theme for decades for me and I think that, everybody needs to come at it with, eyes open, ears open. Lead with relationship trust and the ability to seek to understand, what is driving certain behaviors certain challenges that organizations or departments or people are having. And then align with them to be part of that solution or to realize that [00:19:00] it's not in alignment with your values and find a place elsewhere, whether it's elsewhere in the organization, elsewhere in your workday, elsewhere within your department, the next department, or across the street at the next organization.
Yeah. I think it's interesting, an oversimplification would be that, administration and finance needs to keep the lights on, so they have to care about what everything costs, and clinicians need to take care of patients, and they need to not care what everything costs. And those seem to be very diametrically opposed, right?
but if in those conversations, to your point, you can put the patient in the middle of the table and make sure that you bake in what is best for the patient in every decision you make, much like you could put what's gonna incorporate wellness into every decision you make, I think you're going to find a system that's going to work a lot better for everybody.
And, there are certainly some great committees out there that are looking at ROI and, efficiency of, certain supplies and what's good for patients. [00:20:00] you can have something at high quality fast or
Durable or whatever, right? it's like the old, pick two because you can't have all three. And that equation comes up in so many different circumstances at work, and in organizations and certainly all around healthcare.
Sure. I wanna go back to something you said because I think it's really important to dive into when you said your partner You had these confrontations with knowing her value.
Do you get a sense of why physicians don't know their own value?
So there's certainly a lot of imposter syndrome that, you know, a lot of physicians have gone through, right? and that feels like it undermines their value and, They're trying to be something that they don't feel comfortable being. And I think it's pretty much hazed into you through your education, right?
And the rigor of the medical education. And that inevitably as we all grow, like imposter syndrome is almost inevitable for anybody who's growing, right? Is that you're gonna, [00:21:00] find yourself in some new territory and wonder, "Do I belong here?" well, you've just gotten promoted, and so yesterday you didn't belong here, and today you do.
But you don't know much more than you did yesterday, and so you're gonna have to grow, and so you have a momentary imposter syndrome. And once again, I think it's that posse and that, relationship that you have with colleagues and supporters inside your organization and outside, right?
Your network. There's an amazing number of people out there who just have their head down. Maybe they have the excuse of being an introvert. I don't go out to lunch with a lot of people," kind of thing. But you have the opportunity to meet people at conferences, to have folks that you've collaborated with in research or whatever it is, to stay in touch with them and periodically, give 'em a thumbs up on LinkedIn or reach out to 'em on a phone call or just send 'em a message saying, "I love what you just published."
and like that support network becomes [00:22:00] incredibly important when you're going through periods of imposter syndrome and times where your alignment is out of whack and you're looking for some perspective, right? Sure.
Nothing better than a trusted friend to give you a perspective.
But while we're talking about it, the next best thing to a best friend is a therapist, right? And so having coaches, therapists, and other supporters, as I mentioned, depending on the challenges that you're facing, there's a slew of professionals out there that are made to help you through it.
Yeah, and I think it's important to mention again that, all the greats have had coaches. The greats of the greats have all had coaches and the coaches weren't as good at what they were at their craft as the person was, but they needed the coach. And the other thing I'd like to make a point with is
I hear you saying is the word connection, and I think connection really does a great job of battling obviously isolation, but also anxiety and depression, as it pertains to life, quite frankly, but also especially in medicine. So I think [00:23:00] that-that's a good point to make, which is find connection either through positive social media outlets, LinkedIn, mentors, therapists, coaches, just friends down the road type of thing.
You also mentioned two terms, RVUs and ROI and one of them is a productivity measure, and the other one feels to me like a value measure. So what's the difference between being productive and being valuable?
Well so you want the finance answer? Cost is in the equation of value.
Okay.
and RVU is just a measure of revenue, right? And so to come up with an ROI, you need to recognize what the cost is. And so let's just talk about it for a second. From a wellbeing sense every RVU has a cost.
I just said that it doesn't have cost in the RVU but we know that it's the blood, sweat, and tears of the physician that went through whatever to end up with the ability to create that RVU. [00:24:00] And so that's where I'm saying is, having that ability to reflect for oneself on the practice of medicine that a physician is you know experiencing and if they're in a grind where there are certain RVUs that is taking more out of their hide than the RVU is worth in terms of dollars in their pocket and dollars in their organization's pocket, well then get out quick, right?
It's a negative ROI when you look at it that way. And I've never really thought about putting those two terms next to each other like you just did but I think that is, an important recognition for that clinician if they're grinding through some part of their practice that is just taking its toll and that there are other areas of medicine and, career pursuits that are a positive ROI.
that's telling. Yeah. And should be emphasized and, work with your mentor, work with your boss, [00:25:00] supervisor, et cetera, to find a way to spend more time doing what you love and what you're efficient at and what you have a positive ROI in.
Yeah. and that's another thing we're trying to do here on this podcast, and that's generate novel ideas
and create new pathways for our clinicians who may be listening with us. we mentioned in your career, Jonathan, that you've done a lot of times speaking with residents teaching and that seems to be one of the best parts of what you do. Are there financial habits that separate physicians who eventually feel free from those who remain trapped?
Or specific to your line of work, are there understanding of the business, what understanding of the business can help physicians feel free
So taking really the first question or the way you posed it at first. In the end, it's not really even specific to a physician. But not trying to keep up with the Joneses by living within your means, paying yourself first, [00:26:00] meaning paying your future self first, right?
Saving for retirement, saving for long-term goals and stuff, and living on the smaller income that generates by putting, away a nest egg allows that freedom, right? That trajectory that you're on to live a financial life that isn't gonna come back to bite you, right? And there are a lot of physicians I wouldn't say necessarily good reasons, but for understandable reasons that they come out of residency and jump straight onto buying the biggest house they can afford, buying the brand new shiny car that they've dreamed about for the last 10 years-
Mm-hmm.
So much when they were driving the, beat up Corolla for, all of medical school and residency.
Uh- Dude, that thing ran like a top. I'm just gonna tell you that right now. We drove that Corolla into the ground.
And, I've shared with residents, "Look, they call you doctor.
You are a doctor, and as a result the bank will give you [00:27:00] a lot of money as a loan towards a mortgage, and you will be married to that mortgage. Please don't sign up for the maximum that they'll give you." It is a recipe an- a disaster. You're gonna be, married to your mortgage. You're gonna be working for the paycheck, and you're gonna be looking for, extra shifts to work 120% FTE, right?
And you're gonna burn yourself out, and you're gonna have children, and you're not gonna see them because you're married to that lifestyle that you created that was some fantasy world. And yet, you know- if you're established and stable, by all means buy a house. if you're pretty sure you're gonna be somewhere for five to seven years then that's great.
You know I have also shared with them if you're not sure don't buy a house because the closing costs are enormous. It's cheaper to rent. And that ultimately trying to keep up with Jones is the bottom line is [00:28:00] that- that's recipe in disaster and come back to haunt you. But on the other side of that living within your means and having that ability to make life choices And this goes back to lever
Of the FTE and therefore the RVU When you have children, when you have changes in, your own health, changes in your interests that you can move the lever of FTE. I'm not gonna work 100% this year, I'm gonna work at 80%, I'm gonna work at 60%. I'm gonna be able to spend more time X, Y, and Z taking care of myself, taking care of my family.
That has an incredible influence on your wellbeing, and yet you can only do that if you made wise choices, coming outta medical school, coming out of residency and putting yourself on the trajectory to live within, this sort of reasonable financial life that you can put together.
[00:29:00] And obviously in some regions of the nation it's harder than others in terms of cost of living and whatnot. But making sure you're on a trajectory where you're living within this means allows you to make adjustments along the way for your own self rather than trying to always pay it be paying the bank and paying debt and trying to keep up with loans.
Yeah. The delayed gratification is another one of those words like resilience that there's like, it means a lot, but, ah do I have to hear that term one more time? And, you know, not buy the cool car or the big house, but I like what Dr. Neil Roy had said in one of our earlier episodes where he talked about the finish line, and every time- Mm-hmm
you pay that future self of yours, you move that finish line closer to where it may be, you know, or to where it was, or to where you want it to be. And so I think imagining that first and trying to pull it back as far as you can, as far as you want to, it's not something that I think comes naturally to everybody.
But thinking of that finish line [00:30:00] first and bringing it back, and I know you know Brian Case too, and he has that graph where the graph, hits the x-axis and that's when you're dead, and you better run outta money by then. Oh, I don't really wanna think about the x-axis anymore, but I like the paradigm of the finish line.
Draw that finish line to where you want it. and quite frankly, as you progress in your career, you're gonna want it to become closer and closer than what you thought it was when you were 26, 28, and like, "I could work forever. This is fine. I can grind." But I think ... You make very good points about looking at the finish line first.
Slow down. You know, my understanding is that you should own a home for somewhere between three and four years before the closing costs that you paid are even going to equate themselves, and that's if you have a 30-year fixed mortgage as opposed to something that's, a variable.
But, that's a good, pretty good rule of thumb I've heard, is like three to four years look into that, or just rent, and if it's not a heck yes, then it's a no. Just rent, And- You'll sign a one-year contract. You might hate the place, but you'll hate the place for a year, and then you can figure something out from there.[00:31:00]
Yeah. Yeah, no, absolutely. And I'll tell you my own experience eh, early in my career I st- strived to maximize my retirement savings. the, wisdom that we share now is, make sure to, Meet the match that your company is providing, so maybe it's 3%, 5%, whatever that they match for the first 5% of your paycheck.
And that's minimum to not leave free money on the table and whatnot. But there's the ability to maximize, you know, at whatever percentage it is. It's- pretty high and keeps going up with IRS guidelines and whatnot. Plus, certain parts of your career you might be able to have a Roth or other retirement instruments that might be available through your company.
And seeking to maximize what you can put away as early on as possible is incredibly supportive. You live on a little bit less money, but one of the things [00:32:00] I always said to myself early on is if I ever need to give myself a raise, I don't need to go and beg the boss for a raise because I don't wanna be groveling, I don't wanna be on my knees doing that and that's not something that is usually very effective.
But I can give myself a raise by just turning the dial back a little bit on what I'm putting away for the future-
Mm-hmm ...
If I come up with some reason that's compelling to do that. And I can't remember in my career a time that I ever did that.
But knowing that I could give myself a raise was supportive and gratifying.
And then, fast forward you've maximized your retirement for a number of years and with market returns etcetera, etcetera, you have a nice nest egg and now you're the last half of our career or the last third of your career and you start being able to make choices. Again, choices for yourself whether it's changing your FT status, whether it's spending some time with a, charity that you love give more philanthropy [00:33:00] or God forbid leave your career and do something completely different because you've had that ability to, put it away early.
You know obviously a lot of folks are coming out of medical school with mountains of debt these days, so that's a big factor that has to be weighed in there. And so don't leave any free money on the table and maybe it's gonna take a little time before you start maximizing your retirement because you want to be paying down that debt appropriately.
But there are certainly programs out there that I hope folks are again finding advisors and resources to get loan forgiveness if they're in, eligible organizations. But, it's a discipline that pays dividends for decades. And the alternative of living Beyond your means and trying to keep up with the Joneses is a recipe for disaster.
Yeah. dividends in two ways too because every dime you put toward that finish line is agency. So you know, if you think about retirement savings as agency and retirement savings as that [00:34:00] finish line, you know, I think that helps motivate you. And that's something that took me far too many years to really grasp and keep going.
Now You're building this great career as a physician coach and, mentor to a lot of people. Is there a point at which you've taken care of some physicians? Is there a standard point at which they usually call you?
So first
you mentioned putting dimes away. Benjamin Franklin had a term "a penny saved is a penny earned," and so I have that in many of my resident teachings. I disagree with Benjamin Franklin. This might be the one place where I disagree with Benjamin Franklin. And I ask them like why do you think I disagree with the pithy short phrase 'A penny saved is a penny earned'?
And I tell them because a penny saved is actually worth more-
Yeah ...
than a penny earned.
Yep. Compounding.
Why is that? Well, so several of them go to compounding which I give them kudos for it, and so strictly speaking it's probably an okay answer or right answer but taxes-
...
is even bigger than [00:35:00] compounding, right?
Because you're talking about compounding 3% interest, 10% interest whatever you're talking about. Taxes for a physician In your tax bracket, every additional dollar that you earn Uncle Sam is taking half of it. Mm-hmm. Right? You save that dollar and that whole dollar is yours to then compound for years on end and that's huge.
And so Going back to that idea of folks working tooth and nail to, work at 120% FTE to keep up with their mortgage et cetera, like it is just running uphill on this treadmill-
...
And saying, "I'm not getting anywhere."
And then bring me back to the question.
the question really was do you have a standard point at which physicians basically call you?
Oh, call me. I have not hung a shingle as a coach. Having said that, I appreciate the folks that I've worked with in wellbeing circles at conferences, meeting [00:36:00] residents, meeting people at work et cetera, it's pretty informal.
And so I wouldn't be able to really answer that question per se because I haven't really officially hung a shingle and started- Mm-hmm .... contracting with people as a coach or anything. Yeah. But I think in general going back to this, analogy of the treadmill when physicians are finding themselves spinning their wheels and finding characteristic of burnout and just not enjoying what they're doing not wanting to go to work and, losing the love and joy of medicine it's time to seek perspective and seek some support from whatever and every and any resource available.
Yep. That's great points. I appreciate that. let's talk a little bit about success. You know, physicians I think, very often they confuse success with endurance, sustainability. Ah, I was in this for so long. in a very recent episode Diane Shannon discussed the [00:37:00] difference between dedication and self-sacrifice.
has working with physicians or, in the systems that you'd work with, has that changed the way you define success today versus maybe when you were grinding back in Springfield?
it's an interesting question. I love, how various folks have found their success and found their purpose at various phases of their career, and recognize that purpose may change over time.
Mm-hmm.
And being open to identifying new purpose, right? you hear about the sad stories of people retiring and dropping dead, a week later because they had no purpose. I've been very proud of seeing physicians use their skill sets, whether it's their clinical skills, their problem-solving skills, their administrative skills, other areas, whether they're in medicine adjacent, or just completely a different charitable cause that as they leave medicine, [00:38:00] find an equivalent purpose let's say or similar purpose that, can sort of magnify their lot in life and, provide that sense of, a difference that they're making on the planet.
Yeah. I like that. Maybe success is just purpose. is there anything, that you believed in the very beginning of your career about medicine and finance that you no longer believe?
I think early in my career I was probably naively thinking that the insurance system wasn't the entire problem and now I think it's most of the problem. although as I mentioned earlier around history and how the United States government was hell-bent on staying out of medicine for a number of years through Truman, et cetera, and, the AMA was adamantly opposed to having government intervention in healthcare and Medicare was seen as intervention.
AndI think it was a [00:39:00] necessary evil back then just from, sort of again as a sort of social safety net, because there were challenges with, retirees, et cetera. But where the industry has gone and the levers that have been pulled and the emphasis that's taken place in terms of how for profit and the insurance industry has moved, it has certainly poisoned medicine and, and made it a drag and, of course things like prior authorization, et cetera, the bane of the existence of oh so many physicians has been a massive hurdle.
And I think it's something that, u- politicians are struggling to now fix. And yet, they created a machine that has been pretty much, disastrous in comparison to other systems in other countries.
Yeah. a lot of good points, but, we've got in front of us and we're gonna try and make the best for what we have now, and, [00:40:00] sustainability in those careers for those...
for our physicians listening especially. Is there anything that we're not talking about the systems that we should be? I know you mentioned the insurance industry, but is there anything we're not talking about that we should be?
maybe we can banter a little bit and think about some of the things that are out there. But I didn't mention, I had a little stint in medical supply industry, right? So I worked for Boston ScientificI was in grad school and then coming out of grad school.
And so that was interesting because I was like, well, it's not really healthcare. It's really more of a biotech medical supply company. But it was fascinating to sort of see the inner workings of it. And then of course being inside academic medical center for a long time I recognize where, those supplies and other, adjacent companies are influencing the work of medicine.
Sometimes for great benefit and sometimes it's creating [00:41:00] additional challenges and additional costs that need to be figured out how to get them covered for certain things. Now usually the research is showing, for a lot of the modalities here's, the average length of stay of this new technology and you're gonna knock three more days off your average patient and that saves serious dough.
but I have to imagine that some of the research has been struggling and I think how we're, now dismantling some of NIH and other, FDA and- and other things, the research may not be quite as trustworthy as it once was.
That has a profound impact on the future practice of medicine.
Yeah. let's go back to the insurance industry and, not to continue to throw them under the bus, but the business of medicine, the systems we are in, do you think physicians own their careers or do you think their careers own them?
I think there are a lot of physicians who feel like their careers own them.
And [00:42:00] like just to sort of wrap this all together, their careers do own them if they're living beyond their means and they can't see any way out because they desperately need this paycheck to be this consistent, to be, the way it always is and, just grind through more RVUs so that they could keep up with their lifestyle.
what we're talking about today is about physician joining their career. And by, you know, living within your means having a little room to breathe allows perspective, allows judgment, allows rational thinking so that if you come to a point where your life outside of medicine dictates a change or your life inside of medicine is dictating a change, what you find joy in is dictating a change, you have that room to breathe, to think, to work with your posse to make a change.
And [00:43:00] sometimes that change might even mean Taking a step back, taking a smaller paycheck, having a smaller FTE status, moving to an organization that isn't as wealthy and you know is gonna pay less. But if it gives you the joy that allows you to run this marathon, that is your career instead of treating like a sprint.
a 40-year sprint doesn't work very well, and so it's about pacing yourself my man. It's about getting into this race and making sure you're pacing. And, I don't think there's a choice other than physicians needing to own their career instead of allowing their career to own them, and sometimes it's just a few changes that will help 'em do that
Said.
And in closing, I hope our listeners think of this episode not only as a financial lesson but, more of an understanding of the owner's manual to the business of medicine that nobody seems to show physicians. and so I'm gonna give you the last word, Jonathan
Which I don't [00:44:00] always do by the way, but in this case we're gonna make an exception. But we like to leave people with an action item. If every physician listening could leave this episode with one new way of thinking, call it like, not one new financial tip but one new mindset in relation to the business of medicine, what would you hope it would be
I would hope that physicians who are listening find a way to take control of their journey.
And whether that's career crafting, whether that's adding resources and supports and adding to their network to help them with the perspective that they need to run this race I think it just, incredibly important that physicians find that agency and find that mechanism to take control