What if the real difference between high-income physicians and truly free ones isn’t how much they earn, but how far into the future they can see? In this first half of a two-part conversation, Dr. Anders Apgar sits down with otolaryngologist and financial educator Dr. Jerry Schreibstein to explore how early money experiences, student debt, lifestyle inflation, and the “financial horizon” shape the choices physicians make every day
Physician burnout isn’t only about hours or systems. It is also about the quiet pressure that comes when income rises but freedom does not.
In Part 1 of this two-part conversation, Dr. Anders Apgar welcomes Dr. Jerry Schreibstein, for an honest look at the money stories physicians carry into their careers. Jerry shares growing up in a blue-collar Brooklyn family, the blunt reality of student loans in an era of double-digit interest rates, and the lecture that first showed him how compound interest works against debtors.
Together they unpack why medical education can unintentionally create financially vulnerable adults, the psychological shift that happens when resident salaries become attending salaries, and the difference between building a lifestyle and building net worth.
The conversation also explores lifestyle inflation, the burden of unpaid call, the value of experiences over depreciating assets, and why a dynamic financial plan, not a rigid endpoint, gives physicians real optionality over how they work and live.
This is not a conversation about getting rich. It is a conversation about choices, time horizons, and reclaiming control.
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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 Guest:
Dr. Jerry Schreibstein, MD, FACS, is a practicing otolaryngologist and President of Ear, Nose and Throat Surgeons of Western New England, with more than 30 years of experience leading a private single-specialty group in Western Massachusetts. He founded MD Wealthcare LLC and continues to advocate for physicians building sustainable careers through clinical excellence, financial literacy, and intentional life planning.
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
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Sponsorship conversations: sponsors@directwellbeingpodcast.com
[00:00:00]
Welcome back to the Direct Wellbeing Podcast, where we have honest conversations about what it really takes to build a sustainable life and career in medicine. Today's conversation with Dr. Jerry Schreibstein was supposed to be one episode. It didn't work out that way, and honestly, that's because the conversation went somewhere much deeper than I expected.
So this is part one of a two-part conversation. Jerry and I start with his story, where he grew up, what money meant in his family, and how those early experiences shaped the way he thought about work, success, security, and eventually medicine. But from there, the conversation leads into something much deeper.
We talk about how money influences behavior, how the choices we make today are often determined by how far into the future we can see, and how our financial horizon, whether we're thinking about next month, next year, or the next twenty years, can completely change the way we approach our [00:01:00] careers and our lives.
So this isn't really a conversation about becoming wealthy. It's a conversation about choices, why we make them, what shapes them, and how understanding money and financial language can eventually give us more control over the lives we are building. There was simply too much here to squeeze into one episode.
So settle in. This is part one of my conversation with Dr. Jerry Schreibstein
There's this moment physicians Spend more than a decade waiting for. You finish medical school, then residency, maybe a fellowship, and suddenly the paycheck changes. You finally made it. So you buy the house, maybe the car, like I did, take a vacation, upgrade your life. After all, you've been waiting your entire educational life for this.
And slowly, something strange happens. Your income goes up, but so does the amount of money you need every month just to keep your life running. And one day you realize something very uncomfortable. You make more money than you ever imagined, but you can't afford to stop working. Today, I want to drill down to talk about how we prevent that from happening, and today's guest is perfectly suited to hash this out.
Allow me to introduce Dr. Gerry Schreibstein. Dr. Schreibstein is a practice otolaryngologist, say that five times fast, with more than thirty years experience leading a private single specialty group in Western [00:01:00] Massachusetts. His interest in financial wellness and reducing physician burnout led him to pursue formal wealth management, education and licensure.
He recently founded MD Wealthcare LLC. Welcome, Gerry. Thanks for being with us.
Oh, Anders, it's a pleasure. We've been talking about this for a while. I love what you're doing on your show, and it's, really great to, be here.
I appreciate that. Thank you for listening. before we get really started and really dig into this, I do want to mention, for Dr.
Schreibstein, the views that we will express are his individual views. They do not represent advice or policy of Bradley Foster and Sargent Incorporated.
And thanks-thank you to that group, to Bradley Foster and Sargent for allowing you to be on the show, too. I know we wanna make sure we're doing the right thing by everybody.
As we get started, let's go back in time. Way back.
Take me back before you were an attending. What did money look like in your family growing up?
That's a great question. So I was raised in a, I like to say, a blue-collar family in Brooklyn, New York. I lived in a rent-controlled [00:02:00] apartment. neither one of my parents finished college. but I don't think we really wanted for anything.
we had clothes and food, and we did some vacations. we really didn't know any better, so I always thought it was a good life. but, it was simple and, we really didn't talk about money. My parents were not very sophisticated about money or certainly about education financing, which we'll get into.
but I, you know, worked hard, always had a job, whether it was a paper route or, working at a ice cream shop, in high school, Carvel ice cream franchise, but, which I ended up doing again in med school, which is a-another st-story for another day. But, you know, really just hardworking parents.
worked hard. They taught me the value of, a hard-earned wage and the importance of education. And for them, for me, going to college was gonna be a big deal, and medical school was even a bigger deal for them. They really didn't fathom what that was like, but you know, so many of those generation revered physicians and, [00:03:00] really thought that was the end-all, the Holy Grail.
Yeah. And you have a specific story about a study abroad program. Tell me about that.
Oh, so let's back up a little bit. I went to Stuyvesant High School in Manhattan, which is a, magnet school and, basically, gifted students. It was exam school. I was fortunate to go there and sort of see a different world about education and learn about, colleges outside of Brooklyn College where my parents had attended part-time.
And, I ended up deciding I wanted to go to, Boston University for the six-year medical program. And, my parents were like: "How are you gonna afford this?" And, oh, they have financial aid, they have student loans. We had really no idea what that meant.
And my other family members, my dad's sister said, "No, you should stay in New York, go to City College. They have a medical program. You can get into med school." And, and I said, "No, I need to get out of New York City. I need to do something different." My whole family live within a block of the apartment where I grew up, and so I needed to expand my horizons [00:04:00] a bit.
And, while in the six-year med program, there's usually two years of, college, four years of grad school. I was young. I was 17 when I started college, and I wanted to take an extra year to go study abroad. So I went, marched into the dean's office, who was in charge of our program, and I remember this vividly to this day.
I said, "Dean..." We'll call him Dean B. I don't wanna get... Yeah, he's long since passed, but, "Dean B, you know, I'm a good student. I wanna, apply to this program to take an extra year, mature a little bit, and study abroad." And he's like, "Tribestein, you're on financial aid. You're not going abroad."
I'm like, "But Dean, I'm, you know, a good student. I'm, one of the top of my class." He said, "Nope, Doesn't matter. We're not paying for you. We're not giving you loans." And, that's when I realized, what kind of a mess I was in or what opportunity I had, depending on which way you look at it.
Wow.
So study abroad was out. And, I think that's a privilege anyway to go study abroad, but it's just [00:05:00] a, an important lesson about, when you are, on student loan or financial aid, you really,sometimes things are limited
Interesting.
I think nowadays maybe it's a little bit more flexible, but this is, 40 some odd years ago, so was a different world back then.
Yeah, I agree. Appropriately, there are a lot of financial aid programs, for those studies abroad for people in financial aid, but that certainly wasn't the case back then. it was stay home and get some work done, get a job, work at home .
I was shell-shocked.
I was shell-shocked, Anders. It was like, whoa.
Yeah.
That was blunt.
Slap in the face. So when you entered medical school, did you actually understand what you were signing up when you borrowed that money?
I would have to say probably no idea. My parents didn't know. It was just like, "Oh,
You're gonna be a doctor. You're gonna make some good money, and you'll pay off the loans." I think that's what I understood. it really wasn't till the, I like to say the lecture that changed everything. The first, week of, med school, at Boston University, they brought in a Princeton economist to talk about student loan and student loan debt.
And in the late '70s, early [00:06:00] '80s, interest rates were 17, 18, up to 20% for some of the health loans. And we're talking now about six, seven percent interest as being high. We're talk- And so they brought in the Princeton economist to say, "Oh listen, this is what happens if you defer your loans.
You're in deferment while you're in medical school, you're in residency, if the loan is 18%, the principal doubles every four years." Which is astounding. You know, if you're an investor and you're a saver, that compounding interest works for you. But if you're a debtor- ... it doesn't.
And so, he showed this crazy curve about someone with $100,000 in debt,18%. Four years later, it's $200,000. And, $100,000 in, 19, $85 is now closer to 300,000. Just for- ... perspective for the listeners. it sounds like a lot. Like, 100,000, it sounds like even more if you put it in today's dollars where, the average med student may have in . Educational debt, right?
Yep. just to get [00:07:00] there. ... you bring it up. why do we teach physicians acid base physiology and, Krebs cycle, but almost nothing about compound interest?
We don't teach them anything about finance, not even compound interest.
We don't even teach them about how to read a balance sheet, how to understand what it means to be in debt, let alone, refinancing your debt and different loan forgiveness programs, which of course, when we were in school, there weren't any of those.
we've come a long way, and it's still extremely complicated.
Yeah. So when did you first realize that high income and wealth were not the same thing?
Oh, boy. so you know, like I said, I came from a blue-collar family, so I didn't really understand anything about wealth or fancy cars But I think sometime during medical school, I got introduced to, Thomas Stanley's book, The Millionaire Next Door, and, I think that sort of opened my eyes about, just because you have income and you can buy things and consume things does not really make you wealthy.
And [00:08:00] Stanley's premise is that, your assets and your net worth are what make you wealthy. So a teacher making 60 or $80,000, $100,000 a year but has a million dollars in the bank between retirement plans and savings may be, relatively speaking, wealthier than the orthopedic surgeon making $800,000 a year, and has like 300,000 in the bank.
Yeah.
Right? So I think that's where I learned about, The people who are truly wealthy, self-made wealth, guys like Warren Buffett or other, people who are billionaires, they actually drive simple cars, and they buy used cars, and they don't necessarily buy flashy stuff.
And, it's obviously extremes, but, that's the kind of case study behind Stan Lee's book, which I thought was really interesting, and it's sort of been something I've observed over the years. I actually know some very wealthy people who you would not know were wealthy.
You hear that story, that theme over and over again.
And I'm sure- Yeah ... if you listened to, my kids, they'd throw me under [00:09:00] the bus about cars and, something I probably should have curbed a long time ago and probably would have a lot more choice these days.
I mean, I think it's, not uncommon for physicians. You're on a deferred life path.
You know, you've gone to, I did it the fast way, six-year med program. But most people nowadays are, four years of college, it may be some extra time for research or community service or gap year, and then they're in medical school and, for another four years, and then, residency training, three to five, six years, right?
So you're getting out in your, early 30s maybe, at the earliest, and now your friends or colleagues who-- your college roommate who went to business school or, just had a regular sales job and, has money in their 401and in their regular brokerage account, they're driving nice cars or maybe even bought a house.
And it's, human nature. you wanna reward yourself, for that effort. you get out of medical school and look at all this hard work, and you see [00:10:00] other people, or just you wanna reward yourself for yourself, not 'cause you're keeping up with the Joneses.
And I think it's a challenge- Yeah
especially if you have debt, you know? And I was fortunate my wife, her parents covered her education. She was a lawyer, when we got married, and we were fortunate to be able to live off her salary, during, residency and during our early, medical school and residency, so I used some of my money to pay off the debt.
But, not everybody is fortunate to do that. But we were fortunate, and we kinda lived very, simple those residency years and early years after residency.
Yeah. And we're gonna dig into that a little bit later in the show. Yeah. don't forget that year of, study abroad, too, that you put in
still
haven't
gotten to do that yet.
Yeah. And one of our kids has, and I encourage it if people can do it, you know, if they can do it from time and money, ... do you think medical education unintentionally creates financially vulnerable adults?
I think we're taking people who are dedicated to service, dedicated to taking care of their fellow [00:11:00] humans, and generally have a really good heart and want to pursue medicine because it's a passion.
and then they get there and they realize what the cost is, and they don't even-- probably don't even think about it 'cause they're blinded by their passion. and ultimately it creates a situation where, it's an unintended consequence. And, we talk a lot about your career choice and specialty, whether you're gonna be a medical specialist or, primary care doctor, surgeon, there's a definitely unconscious and conscious, bias to specialty selection.
I mean, it's no secret that, you don't see a lot of people going into family practice or pediatrics and, it's a burden.
Yeah. Now, you've written specifically about watching colleagues who leave residency and immediately expand their lifestyles. We mentioned that earlier in the episode, but, and you make a very important distinction.
Some are building a lifestyle rather than building [00:12:00] net worth, like the millionaire next door. what happens psychologically when someone goes from a resident salary to an attending salary? What do you see in your financial planning line of work?
I think what you see is all of a sudden their salary may be double, triple, quadruple what they were making as a resident.
They may have time they didn't have during residency. depending on what specialty you're in, what your on-call responsibilities are. so now they have opportunities to do things. And, I think some people see material things as their reward and, for me, that wasn't a reward.
But, some people see it that way and, I can't necessarily blame them, but I think they have to sort of have a broader picture of what their life could be like and if they, maybe there's a saying, right? Live like a resident for an extra year or two. And it really helps gradually grow into that and sort of get your house in order first, right?
Yeah. take stock of where you want to be in three years, [00:13:00] five years, 10 years. have some goals. understand, what your debt burden is, understand if you wanna, get a house or, maybe you may need a new car, right? But understand what that's like and,it's very easy to loan money to physicians, right?
Banks will, loan money to physicians, auto loans, housing loans because cash flow is good.
Yeah.
But that doesn't necessarily mean you can afford it, to have all that debt on top of what your student loan debt might be, if you have it. If you're fortunate not to have loan debt, that's amazing, right?
Yeah. I don't know those people, but it'd be interesting. They can raise their hand. and there's also that oxytocin burst that, of getting that loan too. oh, we're millionaires. Now we have a millionaire loan. Of course, my buddy Darren Gerard was like, we're negative millionaires."
we're a million dollars in debt. Right. At least you're not, at least you're not paying taxes on that. That's a whole other
story, Andrew.
Yes. Taxes.
That's a whole other story. That's an episode in itself.
Yeah. We're trying to keep people on the road and, not burden them too badly with this stuff.
Right. but how much of physician spending is actually [00:14:00] comparison, like keeping up with other doctors? I guess the question becomes how do you truly talk someone down from, "I cannot wait to have this. I cannot wait to have this. I cannot wait to have this"?
I think what you have to do is, try to get people to understand what their own goals are, what really makes them happy, what gives them satisfaction.
You know, as a advisor or a colleague, we can't tell clients what their goals are, but we can try to help them,articulate their goals, their needs, their wants, their wishes, right? and help draw that out from them and do you really need to have the souped up version of that car? Maybe you have the good version, but not the super version, right?
Yeah.
Do you need the turbocharge and the, fancy trim model, right?
The process is start Saying turbocharge and I get excited. Here's true or false sentence here: Lifestyle inflation is one of the most under-recognized causes of physician burnout.
Well, I don't know if it's a cause of physician Burnout. It's definitely a cause of, physician, indebtedness [00:15:00] and physician lack of savings, right? Whether, you know, and so whether that leads to,a challenge to your financial wellness. I don't know if we have that data, but I certainly think is the more things that are required spending, the less, money you have to save or for experiences, right?
So- I'm not saying not to spend, what I'm saying is maybe you spend it,on family experiences, vacations, time away. one of my advisors said, try to avoid buying things that depreciate. Yeah. You know? family experiences don't depreciate. you get a dividend for that memory forever, right?
Yeah.
so those are some things that I like to think about is, when we're, spending, is this something that, The family's gonna remember forever? Is it something I'm gonna remember or my wife's gonna remember? or is it just gonna be a material thing that we're gonna be happy with a shiny object for a few months, a year?
it all depends. I'm not saying like, housing's different. that's a different thing. you'll live in [00:16:00] your house every day. but finding the right balance. I think everything is about balance. Yeah. Right? Finding the right balance, how much to spend, how big of a house to get.
Don't be house poor, you know?
the last episode that I just put on, was really just a worksheet, a homework assignment trying to predict that ghost of how do you feel now and how are you gonna feel in 10, 20, 30 years. that time horizon is really hard to try and predict what is valuable to you now, what's gonna be valuable to you in 10 or 20 years.
that's
the beauty of having a, a plan or an advisor. You can change the plan. The plan's dynamic. you can revisit it. if you have a good financial plan, you can revisit, and as your goals are gonna change, your wants are gonna change, and your financial situation might change.
But if you know what the baseline is, and you stay on that baseline, everything else can be gravy.
I really like what you just said, and let's say it again. The plan is dynamic. The graduating from residency is not an end point, much like marriage is not an end point, it's actually a beginning [00:17:00] point.
It's where you go from here- that kinda determines when your life's gonna be.
you may have children, you may have,family needs, parents to take care of that might affect your plan along the way. But just like, I mean, as a surgeon, you know you have to know several ways to complete the operation.
Mm-hmm. 'Cause the plan that you have in mind when you're going into the operating room, may not be the plan that gets completed at the end of the case. and, you know this as a, a, a gynecologic surgeon, a ENT surgeon, we have certain sayings, and you need to have, like, five ways to find the facial nerve to do a parotid surgery.
Mm-hmm. Because a tumor may be blocking two of those, right?
Yes.
and so it's just like life. You have to have a game plan or a roadmap, but there's gonna be curveballs, and you're gonna have to navigate those curveballs.
Yeah. We all studied Netter, but the patients didn't.
Exactly.
Beautiful
textbook.
And Netter's this, great classic textbook of [00:18:00] anatomy for the non-surgeons listening. and, somehow the nerve patterns are not as they were in the book.
his illustrations were absolutely beautiful in- including the picture of him smoking a giant cigar on the front page.
Love it. Love
it. Yeah.
Classic
you know, one of the things we've been wrestling with on this show is that physicians talk about money as a reward for that sacrifice. We're doing it right now. Yeah. it seems like money eventually becomes the thing that prevents us from leaving the sacrifice. You've been on both sides of this.
Does financial independence change the relationship that you've had with medicine?
So it's interesting because I just had dinner with a couple of colleagues of mine and told them I was coming on the podcast tonight, and we were discussing this, are you in medicine-- How do you perceive medicine in relation to your paycheck?
And, they're senior physicians like myself, and they're like, "You know, we're doing this because we love to do it." And I think that is true, and we all love to do it. But I think, having financial security and having financial plan, [00:19:00] a good financial plan, it gives you optionality, so you can decide.
In my case, I just-- agreed for me not to take call, but I had to pay a certain percentage of my salary to do that. It was great. And after twenty-five years of service at our hospital, you don't have to take call. Yeah. But we're in a private group, and so the group doesn't have that rule.
My senior partner ahead of me negotiated that, but that's something I was willing to give up the income for, to have more lifestyle. maybe once, you're financially secure, you decide to work, point nine or point eight. Andyou hear a lot about the fire movement, save money really hard so you can retire early.
I like to think of it as, a financial independence day. once you m-met your target, then Maybe you see a few less patients. Maybe you take an extra half a day off, Yeah ... and the goal is to really be able to figure out a way to do that all along the way, right? So we talked offline about, going to your daughter's volleyball game.
Yeah. I made it, a [00:20:00] priority to go to my kids' games on Wednesday afternoons, and I would, start the office early and leave a little early and maybe didn't see as many patients that day as I did on Mondays or Fridays, but I knew that was something I couldn't miss, right?
Because you weren't gonna have the opportunity to do that again. The patients will be there in the next season, right? Yes. You know, a few months down the road. But, trying to find that balance and knowing that I was on target for my financial needs, that was really helpful, I think.
Yeah. you can't put a value on that. It's really impossible- ... to do so. I certainly hope your colleagues at dinner tonight were like, "Wow, you're gonna go on the DWE podcast. You're a star."
Well, actually they really wanna know about the Apgar score 'cause that's really what they wanted me to find out, right?
Well, the answer is distantly related, but it fools people into thinking I know what I'm doing.
Exactly.
So.
I did see that in the outline for our talk tonight, what the s- the score was, so.
Yeah. Yeah. I mean, I throw it in there. It's good marketing, right? Yeah. Dr. Virginia Apgar was, some [00:21:00] coattails I could never ride.
She's amazing. this is a sidebar conversation too. the thing about call that the way I considered it, call's really dependent on the specialty, right? Sometimes people get called all night. OBGYN is a particularly, I think, a particularly difficult call.
But call is unpaid overtime. When you do call, you don't get paid any extra for doing it. But trying to get out of it, or if you will, or trying to reduce it, change it, or not be on call in the middle of the night costs you money. How is that fair?
for a long time,physicians at our institutions weren't getting compensated for calls.
So there is a trend, at least in the ENT specialty, where we're seeing more and more physicians getting compensated from the hospitals. But in general, it was considered part of the service to the community, part of your, medical staff duties. And now that you're on the other side in administration, you tell the physicians what their duties are to be on the medical staff, right?
So- Yeah ... it was traditionally felt as, your service to the [00:22:00] community. But it's become more and more burdensome. it creeps into people's lives. and I think the hardest thing is really not knowing what's gonna happen.
You know, where you have the, randomness of call. if you're a obstetrician, you know you're probably gonna get busy most of the time when you're on call.
My-- One of my partner's wives is a OBGYN, so I hear, his stories about her call, night call, and coming home late and not sleeping and it's... It affects, her family life. It affects their relationship, right? so I think call has become more and more burdensome because you don't have control over it.
It's a control thing. Mm-hmm. And so it's after hours. So I think it's a challenge, and I think, patients don't really recognize, what we do, on call. They hear about it, they see it on TV, but I don't think they really understand, what you're giving up to take care of them. Sure.
And, how many holidays you've worked, how many times you delivered babies on, [00:23:00] Christmas or New Year's or whatever religious holiday you might celebrate or, how many, family events you've missed to take care of patients.
And we do that because , we love it, and we do it because we're dedicated.
But I think, I definitely feel like, we've gotten taken advantage of a little bit.
Yeah. and to give patients grace too. You know, most of the time they'd rather not be there either getting medical care, and it is about them, so they shouldn't have to think about that stuff.
you'd want someone to be there for you, right? Yeah. I think that's the other thing that patients don't realize. we are patients too. You know, the system is messed up. You know, this is a whole sidebar, but we understand it because not don't, not only do we work in it, but we have to be patients and our family members have to be patients.
but I do think, call is just one of those things that leads to burnout and it's definitely a, something that affects, your wellness.
Yeah. Yeah, very good points.
Okay, so that's where we're gonna stop for today, but we're not finished. In part two, Gerry and I take this conversation further into financial independence, the choices physicians make as their incomes grow, and what happens when money begins to create something even more valuable than wealth: options.
Options about how we work, how long we work, what we're willing to tolerate, and whether we can finally make decisions based on what matters to us rather than simply what we can afford. We'll also talk about what it means to know your number, how financial emancipation can change your relationship with medicine, and when having enough can actually give you back some control over your career.
And before we're done, Gerry will take on the DWB's toughest questions. So stay with us. Part two of my conversation with Dr. Gerry Schreibstein is coming next week. And until then, this is the Direct Well-Being Podcast reminding you [00:01:00] to take care of your patients by investing in yourself