In this episode I talk with Bob Collins of the Medicus Firm, a physician recruitment firm. Bob has spent many years in this field and gives great insight into the job hunt. Many physicians now use a recruiter to help with searching for the right job.

We talk about the job market and what is hot right now in the medical field, what can a recruiter do for you, and some of the tips he has gained from years in this field. Primary care and psychiatrists seem to be in major demand.

Whether you choose to use a recruiter or not, I think it is valuable to know what they can do for you. In my opinion, using a recruiter is much like using a financial advisor or real estate agent, you can do this yourself, but having someone help guide you may help prevent mistakes in this process.

Key points in this episode

1. Start the process early, particularly if you are in a field that may not be in as much demand.
2. Involve your significant other in the process. Many times a job maybe fine, but the situation is not great because your partner is unhappy with the location.
3. Salary is only one component of a great job. Location and work environment are the other big factors. It can be hard to get all three in one situation. You should weigh how important each of these factors are to you and your family before selecting a position
4. Use all the resources at your disposal to find the job that is your best fit.
5. Stipends and loan repayment are starting to become more common again for in demand fields.

Remember your first job is likely not the one you will stay with forever as healthcare is not immune to the rapid workplaces changes in most fields. Keep up with the job market even if you are in a good situation currently.

You can find out more about The Medicus Firm at www.themedicusfirm.com

More episodes of this podcast are available at www.doctormoneymatters.com

Thanks for listening and please continue to share with your colleagues.

Welcome to the DMM Podcast. I am doing a series on social media and a few of my upcoming guests will be physicians who have used social media to create a strong following. I think it is important to understand the pros and cons of social media, and to realize that many of our patients use it to access information about us as practitioners and for health topics in general. Its also a great way to network and educate ourselves about the latest topics in our fields. Finally some physicians have been able to develop their own brand separate from where they practice and really become immune to local practice issues. I think there is a lot to be learned from those who have used social media well.

Today’s guest Dr. Charles Cochran, started a popular twitter account life of a med student that led to his website as you will hear about during our interview. It has turned in a very popular site and account for medical students worldwide to share their experiences.

I want to thank my guest today Dr. Charles Cochran for coming on today and talking about his experience with building a social media presence. You can follow him on twitter @lifeofmedstudnt and on his website at www.lifeofamedstudent.com

Here is the article about the dark side of doctoring by Dr. Eric Levi. I am excited to have him as our guest on an upcoming episode.

What do you think about social media for physicians? What are the platforms you use? Email me comments@doctormoneymatters.com or send me a message on Facebook or twitter.

As always, thanks for listening and please leave a positive review on Apple Podcast, stitcher or wherever you listen.

This is my first solo episode.

I talk about roboadvisors and the pros and cons of using them. I also review some of the larger and most popular companies providing this service.

What is a robo-advisor? It is a computer algorithm based approach to managing your investments. (Note this generally applies to your stock market accounts) A robo advisor is designed to eliminate the need for an individual to make trading decisions about the stocks or ETFs in an account.  This is not the same as Wall Street computer-based trading which can be millions of trades in a day. Rather, this is designed to simulate a financial advisor in optimizing asset allocation and rebalancing a portfolio when necessary to achieve diversification and some of them are supposed to do tax loss harvesting to reduce the capital gains and possibly reduce some of your income tax as well. These are not generally designed to replace the other aspects of a financial advisor such as goal planning, advice about insurance, tax advice, etc.

So what are the pros and cons of a robo advisor while one benefit is there extremely low cost compared to the average financial advisor most financial advisers range from .75 to 1.25% of your assets under management. Now, there a is a trend of financial advisors going to fixed cost management such as a fixed fee whether you have $100,000 or $2,000,000 under management but those are still the exception rather than the rule.  These advisors are still more expensive than Robo advisors but as noted above, they provide you with a more broad array of advice. If you do end up choosing a human financial advisor make sure you pick a fee-only advisor or a flat cost advisor who holds the CFP designation and is a Fiduciary.

Now getting back to Robo advisors, some of the pros include low cost. The majority range from  free to 0.35% of assets under management, though a few are slightly higher and I’ll talk about those when I discuss the individual ones. The majority of the robo advisors don’t trade individual stocks, rather they use a portfolio of ETFs to give you a wide diversification. In my opinion however, you can generally achieve this diversification with only a few individual ETFs. The second Pro of these Robo advisors is they eliminate this work for you you can just put your money in and basically let the computer do its thing and you don’t have to worry about anything else other than when you end up needing the money.  In my opinion however this is probably not the best way to approach any advisor whether it’s a robo advisor or human advisor after all this is your money you’re putting in if you just put it in and basically ignore what’s happening you are at risk for any number of issues. Always pay attention. It doesn’t mean you have to make the individual trades or decisions but just know what’s going on and that could be as simple as looking at your statements every quarter so that you’re just aware of what’s happening. You may not have any issues and that’s the ideal scenario .

The next benefit of Robo advisors and probably the one that is talked about the most is the tax-loss harvesting. Some of these advisors claim that by optimizing tax-loss harvesting you will improve your returns. If done properly it should override the cost of the majority of these Robo advisors by a significant amount. What is tax-loss harvesting? Tax loss harvesting is where the government allows you to reduce your capital gains and your income tax by subtracting any losses you’ve had from your investments from any games you’ve add so for example let’s say you own an ETF which covered the S&P 500 and that ETF you’ve had it for 5 years and the S&P has done relatively well over the last five years has gained $5,000 so you had a $10,000 investment and it’s $15,000 now I’m not sure if those are the exact numbers but let’s just use that so if you had another ETF let’s say was an international ETF and for whatever reason that ETF did poorly and you lost $4,000 Your gain of $5,000 is subject to taxes if you only sold the position where you had a game but you also have this International ETF where you lost $4,000 so if you take the two together and your Net gain is only $1,000 and you only owe taxes on that thousand dollars. now let’s say instead of a gain of $5,000 you only had a gain of $2,000 and you had the same $4,000 loss on the international ETF well in that case your net loss is $2,000 and that can be used against your ordinary income which for most positions is taxed at a higher rate than long-term capital gains so that tax loss of $2,000 is actually worth more to you because it can reduce your income of let’s say $250,000 to now $248,000 and that’s what you can text on which can be a savings of a few hundred dollars on your taxes.  So why does a robo advisor do this better than humans and what ends up happening is that most years  unless you need to sell the underlying security you don’t want to take anything with a game particularly in a taxable account because you basically reduced your Net game because you have to pay the rest in text so you’re better off holding games for as long as you can but of course within reason because at some point you will have to take the money out when you need it but none like you should be taking every year use them to reduce your regular income as much as possible now as a loss

Okay so that is tax-loss harvesting and if done properly it can help boost your returns. The promise of Robo advisors is that they’ll do this for you so you don’t have to think about it at a fraction of the cost of a human advisor.

So what are some of the cons of picking Robo advisors well one is the cost like I said it’s not free for the most part there are a few that are for me but they tend to have a little bit more limited services. the next is and I don’t know that this is particularly on it’s just that you could probably do this yourself without spending that much time and get almost similar results. Now  in my opinion most of the time you’re probably better off simplifying your accounts as much as possible and doing the stuff that you do need to do on your own just so that you are aware of your finances and no one for lack of a better term screw with you.

Who are some of the companies that have these Robo-advisory services

The most famous ones and probably some of the earliest ones are betterment and wealthfront other companies include wisebanyan and then some of the larger discount brokerages now offer these services such as Vanguard Schwab fidelity. some of the traditional Wall Street firms such as Merrill Lynch and Morgan Stanley also offer these but I don’t have enough information about reviewing them.

So let’s talk about the individual companies now

Betterment

1. 0.25% fees. (0.4-0.5% if you want access to a human CFP, only available on portfolios over $100k Fees not charged for any assets over $2mil
2. Uses low cost Vanguard and iShares ETFs (No trading costs, but the ETFs have their own fees (low cost but are not included in the above management fee)
3. Claim to generate an extra 2.66% in annualized return over 20 years on a $100k portfolio based on
   1. Passive investing
   2. Tax harvesting
   3. Better behavior
4. In my opinion, I would only count the extra (0.4%) for tax loss harvesting as a true gain, because the other 2.2% can be achieved by anyone who uses index funds or ETFs and does a buy and hold philosophy

Wealthfront

1. 0.25% fees
2. Claim up to 2.05% increase in returns due similar factors as Betterment
3. Unique feature called direct indexing (instead of using ETFs, if you have >100k in your account they buy a portfolio of individual securities to improve tax loss harvesting opportunities (Basket of 1000 stocks which always has some losers so you should have more likelihood of being able to take losses against income vs ETF which is the average of all these stocks so if market is up you can’t take a loss even though some stocks are likely down) Link to the methodology on my website. If you do use this feature or even with ETFs you have to make sure that you don’t make any transactions in accounts not managed by the robo-advisor which may conflict with IRS Wash Sale rule A wash sale is the sale at a loss and purchase of the same security or substantially similar security within 30 days of each other. If a wash sale transaction occurs, the IRS may disallow or defer the loss for current tax reporting purposes. More specifically, the wash sale period for any sale at a loss consists of 61 calendar days: the day of the sale, the 30 days before the sale, and the 30 days after the sale. The wash sale rule postpones losses on a sale, if replacement shares are bought around the same time.
4. Features
   1. Passive Plus (Basic robo-advisor service similar to others)
   2. Direct Indexing (Kicks in for free once assets > $100k)
   3. Advanced Indexing (Alternative weighting to traditional market cap ETFs) Kicks in for free once assets > $500k Link to explanation about advanced indexing.
5. Uses Low cost ETFs (Avg fee is 0.12% so net fee is around (0.37%)

Vanguard Personal Advisor Services

1. Hybrid model with Human and robo advisor
2. Need $50k to invest.
3. Fee 0.3% plus ETF costs
4. They give you a dedicated advisor if >$500k managed
5. Mostly vanguard products but can use others (you may incur transaction costs but likely minimal
6. Not quite as much automated tax loss harvesting

Wise Banyan

1. No management fee at all for basic account
2. No trading fees
3. Low cost ETFs (ave .12%)
4. Only for individual taxable accounts or IRAs (No joint accounts with spouse or kids trust accounts)
5. Tax loss Harvesting is extra (0.25% up to $96k. No additional cost after that)

Schwab Intelligent portfolios

1. No management Fee
2. Account Minimum $5000
3. Variety of portfolios (including conservative moderate and aggressive)
4. Pro or con is they maintain a cash position which can be a drag on return (they can also make money by loaning out this cash)
5. Tax loss harvesting available if portfolio > $50k

SoFi Wealth Management

1. 0.25% fee (First 10k free and no management fee if you are existing SoFi loan customer
2. No tax loss harvesting
3. Low account min ($500)

Personal Capital

1. High cost (0.89% up to $1 mil) reduces incrementally downward at higher levels
2. Great App to track investments (free but they will call you occasionally to try to get business)
3. Minimum investment amount $100k

Fidelity Go

1. 0.35% fee
2. ETF only (Fidelity or BlackRock iShares)
3. No tax loss harvesting
4. $5k minimum

DIY (Do it yourself)

1. First don’t bother in a retirement account. (No need to TLH) If you don’t have much interest, use a target date fund.
2. Alternatively use a 2 or 3 fund portfolio of a US Total stock, Total International Stock, and Total Bond fund. If you are far from retirement you can eliminate the Bond Fund. Here is a link to simple portfolios that you can use from bogleheads.org. Most retirement plan providers have some index funds in them and it will save you thousands of dollars over the long run if you take the time to find them when you first start
3. In a taxable account, there are a few simple options. Again you can use a target date fund to keep it really simple, or you can use the multi fund portfolios. In a taxable account, it may make more sense to use a few more funds/ETFs so that you have the ability to TLH.

I personally do the DIY, but I am not sure it is the best over the long term. At the time of this podcast recording, I have no robo advisors, but I do have accounts with some of the companies mentioned. I do not currently receive any advertising from these companies. In my general opinion, the best options seem to be Wise Banyan for those who are just starting out, and Wealthfront for those with more assets to invest. I’m sure the other companies are fine also. Remember I am not a financial advisor, rather a DIY investor. Please do your own due diligence before investing with any of these companies.

Surgery Center of Oklahoma performs routine Insurancectomies. (Cutting out insurance)

As healthcare professionals, we can all agree that the healthcare system in the US is broken. It’s too difficult to maneuver for patients and practitioners alike. Today we talk with Dr. Keith Smith, anesthesiologist and a founder of the Surgery Center of Oklahoma. This practice is a pioneer in cost transparency and as you will hear during our interview, charges a fixed price for many common outpatient surgeries. Dr. Smith and his partners understood many years ago the challenges of dealing with insurance companies and decided to break free by switching to this model. This episode complements the direct primary care model that was highlighted in episode 6 with Dr. Josh Umbehr. Keith was very straightforward in this interview about his feelings about the intervening parties involved in healthcare today, (government, insurance co, etc.) I think many of you listening can relate to these frustrations. The difference is that he is doing something about it, and I hope that by listening to the challenges faced and the benefits gained, we physicians are inspired to take back control about the health care that we deliver.

Dr. Smith definitely gets you fired up about empowering physicians to take charge of their own destinies. Ultimately, costs in the US Healthcare system will be reduced and it is imperative that physicians lead this change rather than have it dictated to us. The Surgery Center of Oklahoma  is one model that is producing results. 4 price decreases in the last 9 years, with no increase in surgical costs and yet the doctors remain well paid and more importantly are independent decision makers.

Click here to learn more about the Surgery Center of Oklahoma. Follow them on twitter @SurgeryCenterOK

Please visit our website at www.doctormoneymatters.com

You can follow our show on:

Twitter @drmoneymatters

Facebook: Doctor Money Matters

Instagram @doctormoneymatters

I encourage healthcare professionals to join our private facebook group, Doctor Money Matters.

If you enjoyed this episode please leave us positive review on iTunes, Google Play, or Stitcher.

Any constructive criticism or topics for future shows can be directed to comments@doctormoneymatters.com

Please remember what you heard on this show is for your entertainment and education only. Please speak with the appropriate experts prior to making decisions regarding your own financial situation.

Thanks again and look for our next episode coming soon.

Are you looking for passive income?  Are you afraid of putting all your investment eggs in the stock market? Have you ever thought about buying real estate as an investment? My guest today had those thoughts when he decided to get into real estate investing after the economic downturn of 2008-2009. Dr. Kenyon Meadows is a radiation oncologist in SE Georgia who has branched out his investments to include real estate in the form of single family homes, hard money lending, and crowdfunding.

Real estate can be a great way to diversify your investment portfolio. There are some real profits to be made if you invest at the right time and locations. It can be a great source of long term passive income, but is not very passive at the outset. As a high income health care professional make sure you protect your assets before buying real estate.

Timing is key, and we have had a long run of very low interest rates. I don’t know if the rates are going up any time in the short term (say next 2-3 years) but likely they will go up in the longer term. This low interest rate environment has pushed many asset classes to higher valuations as investors look for yield. I encourage you to be extra cautious and really do the due diligence before putting your money in.

A transcript of this episode can be found at: http://www.doctormoneymatters.com/episode-10-transcript/

If you are interested in learning more about Dr. Meadows and his company the website is alternativefinancialmedicine.com.

You can also get his book Alternative Financial Medicine directly at Amazon

Please visit our website at www.doctormoneymatters.com

You can follow our show on:

Twitter @drmoneymatters

Facebook: Doctor Money Matters

Instagram @doctormoneymatters

I encourage healthcare professionals to join our private Facebook group, Doctor Money Matters.

If you enjoyed this episode please leave us positive review on iTunes, Google Play, or Stitcher.

Any constructive criticism or topics for future shows can be directed to comments@doctormoneymatters.com

Have you ever thought that you need more business knowledge? Are you considering an MBA so that you can move into the administrative or corporate world? I have thought about it for years. My guest on this episode is Dr. Joseph Kim, MD, MBA.

Photo courtesy of Doximity

He has served as faculty for the American Association for Physician Leadership (formerly known as the American College of Physician Executives). He has written articles for the Physician Leadership Journal (formerly known as the Physician Executive Journal). He has spoken to physician groups about the value of the MBA for healthcare professionals. Listen to this episode before you spend thousands to hundreds of thousands of dollars to get another degree.

I used to think it was vital for physicians to get the MBA degree, but now with all the options for learning out there, the knowledge can be obtained without the expense. Dr Kim is right that the networking the MBA may offer is key, however most people going back for executive MBAs are not getting the same networking benefits that those who attend full time are going to get. I also have seen that many hospital executives that earned a management degree have not gone to high level programs and yet they have worked their way up, so I don’t think you need to spend a lot of money to get a brand name diploma unless you want to work on wall street or at a major corporation.

If you are interested in learning more about Dr. Kim and his company the website is  www.drjosephkim.com. 

His other websites include www.nonclinicaljobs.com and his most recent company Q synthesis a healthcare education and implementation company.

What are your thoughts about how to get the necessary business knowledge or getting an MBA? Comment below or on:

Twitter @drmoneymatters

Facebook: Doctor Money Matters

Instagram @doctormoneymatters

Any constructive criticism or topics for future shows can be directed to comments@doctormoneymatters.com

Please remember what you heard on this show is for your entertainment and education only. Please speak with the appropriate experts prior to making decisions regarding your own financial situation.

This episode is about employment contracts.

This episode is packed with information about what you need to look for before signing the contract. Many health care professionals change jobs more frequently than ever before and even if they stay where they are the terms of employment may change. You need to be aware of the key items in the contract.My guest is Jon Appino of Contract Diagnostics a contract review firm in Kansas City. Jon and his team only deal with physician contracts and have a ton of experience in this field. This is a longer episode, but I encourage you to listen to the end, it could save you major headaches before you sign your next contract.

If you are interested in learning more about Jon and his company the website is www.contractdiagnostics.com

Please visit our website at www.doctormoneymatters.com

You can follow our show on:

Twitter @drmoneymatters

Facebook: Doctor Money Matters

Instagram @doctormoneymatters

I encourage healthcare professionals to join our private facebook group, Doctor Money Matters.

If you enjoyed this episode please leave us positive review on iTunes, Google Play, or Stitcher.

Any constructive criticism or topics for future shows can be directed to comments@doctormoneymatters.com

Please remember what you heard on this show is for your entertainment and education only. Please speak with the appropriate experts prior to making decisions regarding your own financial situation.

Thanks again and look for our next episode coming soon.

This episode is about student loans. If you are or recently were in medical, dental, or other health professional school, you already know that education costs are out of control. Costs at the Univ of Pennsylvania, one of the nation’s best medicals schools was $1200 in 1960, rising to $20000, by 1990 and $58000 by 2016 (according to their website http://www.archives.upenn.edu/histy/features/tuition/1960.html).  This is insanity and completely unsustainable. Incomes have not kept up with this rise and therefore students are almost forced to go into higher paying specialties.

Maybe we should contact our alma maters and tell them that continuing to raise tuitions is jeopardizing the ability of many to enroll in these schools and therefore is a concern in maintaining healthcare access throughout our nation.

My guest is Travis Hornsby of studentloanplanner.com. Travis is an entrepreneur who learned early the value of staying away from debt and now uses his knowledge to help the many Americans burdened by student loan debt.

If you are interested in learning more about Travis and his company visit  www.studentloanplanner.com

This episode is about Direct Primary Care which is an evolution of the concierge medical practices you may be familiar with.  Our guest, Josh Umbehr, MD is a family medicine physician in Wichita, KS who (with his partner Doug Nunamaker) started Atlas MD.

Atlas MD is a low cost subscription primary care practice which maybe the template for lowering costs and improving outcomes. Josh talks about how his practice works and you will be amazed by how much he can decrease costs for the patients, decrease patient volumes for the doctors while being able to maintaining incomes. It sounds like a win-win solution.

Atlas MD is an example of how physician leadership is the best way to achieve cost reduction and great patient care. Josh has been featured on national media to talk about this model and does an excellent job explaining it.

If you are interested in learning more about Atlas MD or the direct primary care model, please visit their website at www.atlas.md

Our guest is Cory Fawcett, MD, a recently retired surgeon in Oregon who has written books for medical professionals including Eliminating Debt which we talked about on the show. It and his other books are available on Amazon or his own website

drcorysfawcett.com

By eliminating debt from student loans, mortgages, practice expenses early, Dr Fawcett was able to cut back on the areas of his surgical practice that he did not enjoy. While he thought it would reduce his income, he actually was not impacted that much and found that he enjoyed his practice more. Too many health care professionals get caught up in the doctor lifestyle and find that they have to continue working extremely hard to maintain it. This can contribute to burnout.

Get off the debt treadmill as soon as possible.