¶ Financial Advisor for Medical Residents
If you were going to do this again , would you get a financial ?
advisor . No , not in residency . You would just wait till afterwards .
Yeah , Do you think you was good with your money ?
I think I was okay . I wasn't wasteful with my money .
I just you were better than me . I wasn't good with my money . I would have had a little bit more ducats if Most of my money was going to entertain you . That's what it was to see you wrong girl yeah , alfred , edit that yo . What's good , everyone . Welcome back to another episode of docs outside the box in this hot ass basement in new jersey I'm wave .
I'm dr knee darko trauma surgeon I'm also joined In New Jersey he wave . I'm Dr Nidarko he wave Trauma surgeon .
I'm also joined by he wave , he wave , renee , dr Renee .
So she's suffering from heat stroke and , yeah , we here sweating in the basement because we love y'all . Before we jump into this , I just want to say first of all , actually I just need to give a shout out to everybody who's watching us on YouTube , as well as listening to us on the pod . We appreciate it .
I'm telling you right now , if you're just listening to us on the pod , you're getting a great experience , but you're missing out on a lot of stuff that Alfred , our producer , our video editor , is doing , and it's just dope like that . So I just want to say , if you're watching us on YouTube , you're getting the full experience .
If you're watching us on YouTube , you're getting an amazing experience , but I'm telling you there's just a little bit more that you could be getting . So the links are in the show nuts , show nuts , show nuts .
Got it .
In the show nuts . They are in the show notes In the show nuts . There you go . They're in the show notes , where you can catch everything . You can click on our YouTube links .
You can also text us also and let us know what you think about the show , or if there's any future ideas that you think we should be talking about , or if there's anybody that you think that we should interview . This is a great way to reach us directly . You can text us at 833-230-2860 . We get every text message . We look at it , we respond to it .
I've done a better job to every single text message .
I know , trust , trust peace trust , trust everybody , everybody who has sent us a message on instagram or text . My bad , but listen , over the last two to three months we have caught up .
It's just that your brother has been , yo brother has been busy on a lot of things , so I just want to say thank you very much for being patient and we are getting back to everybody on this and , as a matter of fact , listen , let's . Let's jump right into this . All right , Because today no , because we got a question from people who listen to the show .
Right , we got a question .
We got plenty of questions , but we're only going to do one question this time , ok . And then we got two serious topics that we're going to talk about afterwards , okay , so let's just jump right into this . So we got a question from Dr Percy Dr Percy's transitioning from med school into becoming a resident , yay and he texted me a very important question .
Okay , right .
Very important question and I wanted to answer this because I feel , like yo , there's like so many different ways that you can answer this question , so many different ways that you can just give . Let me just jump right into it and you can see you .
What's the ?
question . So it says what's going on . Boss , do you think it's wise to get a financial advisor through Northwestern Mutual ? I met this guy at the Black Psychiatrists of America Conference and for residents residents one option is $50 per month for financial planning . I know your answer you know my answer is gonna be .
Ron Forrest , ron , yes , sir bit me directly in the buttocks so before we , before we answer this , I want to give my experience first with yes , give your experience money your experience runs into my experience well
¶ Life and Disability Insurance Budgeting
. So when I started working as a resident , I was at Morehouse . I was doing mental math with my money .
This is the first time I got a salary and I was splitting it between my mortgage on my house , the utilities for the house , and then you know miscellaneous transportation and miscellaneous , and then hoping by the end of the month that I did not overdraft . And then rinse , wash and repeat , do the same thing again .
I didn't invest any money into any brokerage account . I didn't invest any money into the you know my programs , you know retirement account or anything like that , and I'll get into that later . I didn't have any type of emergency fund . I was not very smart with my money . I'll just leave it to you like that .
And then , once I got into fellowship , I met somebody through Northwestern Mutual who was telling me actually I met them at a party .
There you go . This was at Miami . There you go .
Yeah , we need like . We need symbols that show like red flags and shit .
Alfred , hit us up with something , do something . Jesus Christ , it's a guy I met at a party . Hit the red flags or something .
Yeah , like I don't know , but I should . Basically , the point of this story is I hooked up with someone from Northwestern Mutual and I thought that everything that they were telling me , which was listen , you know , number one thing is you need to get whole life insurance .
Number two is you need to get disability insurance and then eventually , once we get you to a certain point , then you know I'd like to be in charge of managing your money and so forth .
And young , naive knee , I fell for it , right , yeah , and I got a whole life life insurance plan , which basically means that I'm protected for my entire life If something were to happen to me . You know there's a certain amount of money that that's going to be paid to my beneficiaries .
It's there's whole life and , in this term , insurance and someone like me who had no dependents , you weren't married . At the time , nobody was really depending on me . I probably , at most , at most probably needed term life , but really didn't really need life insurance at that point .
Right , I did need some disability insurance , but what I found out was that Northwestern Mutual is one of the most expensive companies to sell disability insurance .
You just putting them out on first street today , because usually you don't say that well , I'm just speaking the truth right now .
Right , speaking the truth . And yeah , so I I bought , or I bought into their plan , and the other thing is I didn't know how I was paying this dude right . This is all I know is that on a monthly basis paid .
You just didn't know how on a monthly basis .
I'm just paying my premiums for a whole life , as well as premiums for my disability insurance , and basically the way how it was sold to me or explained to me of disability insurance is you need disability insurance to protect you if you have any type of injury that prevents you from being able to , in essence , use your hands or use your surgical skills work as
a doctor for 90 days plus and it's better than what you have as your group . You know what you have at your hospital's disability insurance that is covering everybody , that you don't even have to say no to , it's there for everybody . It's better than that because when you decide to leave , you know , graduate .
that's it , you know it goes with you the one that you're paying for , right , the one that you're not paying for . That you know . So , anyway , I signed up for it . I was paying a grip for that and then , almost when we started , you know , when we got engaged and got married , I think I convinced you , to get you convinced me even before we got engaged .
To do what Whole life insurance right ?
To yep hook up with your same you know insurance disability guy and I started down that path as well .
And you asked questions and I remember I wasn't able to answer all the questions very well .
Yeah , you weren't , because I didn't know it , because a lot of stuff was really complicated , I know , but I didn't really ask poignant questions because I didn't know what to ask . I didn't know what to ask . My questions didn't start coming actually until after we got married , which at that point I was in the plan for at least two years , at least two years .
And when we got married , that's when I started realizing I was like hold on a second . We never changed our beneficiaries for our life insurance when a woman starts asking questions .
Yo , I'm telling you , and you ain't got the answers and I don't have the answers . I don't , yeah it was .
it was bad because at that point at point , I think was right at the point at which we started realizing that we were living paycheck to paycheck and we were like we got to do something .
And I remember saying to you that our insurance plans , so the whole life insurance and the disability insurance plans , were making me very nervous because we were putting a lot of money towards them and I wasn't quite sure exactly how it worked out how , yeah , what we were getting . What was the benefit ?
like I could tell you , oh yeah , it's like a bank and all that stuff . But when it came down to the specifics , like what does that mean ? It was right and we weren't making a dent in our student loan debt .
Right , exactly so .
So long story short guys is we . We just started down this path of just learning more about our life insurance , learning more about disability insurance and , straight to the point , we just realized that we were paying way too much .
We were paying more monthly to our life and disability insurance than we were to our student loans .
Yeah , and that didn't seem right . That didn't seem right . This is before PSLF , y'all . So , we were just like this is not right . You know , something has to change .
And , like no surprise , the person who was working at you know Northwestern Mutual , they , they weren't really happy for us to have this type of conversation because we were like , listen , like we got to change something . You got to give us like a lower plan .
We got to get something , you got to decrease something so that we could put some more money towards whatever we need to do . But what he said to us was correct , but also shocking , which is y'all need to budget better . Mm-hmm , right , I need to budget better , and he was right about that and we budget his ass right out .
Yeah , yeah , once we figured out the whole , like you know what we do need to budget better , and the first expense that's going to go is you , yeah
¶ Financial Planning for Medical Residents
.
Because during that whole process of talking with him , figuring out what we're going to do with our budget , we started realizing that there was some products that we were buying or that I had purchased and that I convinced you to purchase . That just wasn't right for us at that time .
Right .
We didn't need a whole life plan at that time we didn't need that type of disability insurance at that time . So it really changed my perspective on things and it really had me thinking a certain way , like damn , like nobody's going to care about your money as much as you .
Exactly Right . Like I tell my pregnant women , don't nobody love your baby more than you do .
And I almost , I almost started the next process with this person , which was yeah , you can start investing money into a quote unquote brokerage account which he would have managed . Yeah , you can start investing money into a quote unquote brokerage account which he would have managed , and I don't think that it would have been favorable for us .
That's the way I look at it . That's my opinion . It may be different for y'all and so forth . So for me , I've always stayed away from Northwestern Mutual . For that reason we moved ourselves away from that .
But to answer this question right from Dr Percy , which is , you know , I met this guy at the Black Psychiatrists of America Conference and for residents , one option is $50 per month for financial planning . The gist of his question , basically , is me transitioning , going into becoming a first year resident ? Do I need a financial advisor ? Right ?
Do I need a financial advisor and my gut , if you were to ask me straight up and to be honest'm gonna say no , I don't think you need one immediately at this time . At this time , I don't think you need one if you , if you , you're in the process of moving down to your spot right now .
I think right now , like my suggestion let me take a look at my notes . My suggestions are I don't think you need anything like absolutely need something right now . The only thing that you need right now is you need your salary . You need a little bit of some cash right now so that you can get , you know , a house or an apartment or some transportation .
I think that's the top priorities right now , which is , you know you got to get yourself a place to live Right , and the big thing is you're you're transitioning from going from student loans to now having a salary , and for a lot of y'all , this is the first time that's ever occurred , which for me , I had a job , like when I was in my early 20s .
No , not a salary , but we're talking about first job .
Right , right .
So this wasn't my first job , that wasn't your first job , but for a lot of people go in medical school , this is their first job , their first job .
that wasn't your first job , but for a lot of people go in medical school .
This is their first job , right , yeah , and that's that's a big deal . So for me , I , I I think the number one thing that you need to figure out is where you're gonna live , and it needs to be reasonable , right . Where you're gonna live , I would say rent .
Don't buy unless you know the neighborhood really well , and even then it's like buying a place you don't even know how your residency is gonna to go after your first year . Maybe consider it after your first or second year , but I would definitely say rent and then try to find someplace that's kind of close to where you're going to be working at , if you can .
Then you're going to need transportation . You're either going to get a , you know Hoopty , that's what you had . You had a hoopty .
I did have a hoopty . Right , that's what you had . You had a hoopty , I did have a hoopty .
Right What'd ?
you have Nissan Stanza . What year 1991 .
And this was you got it , for you got it . You had it since 2002 . Since 2003 . And how long that , no 2002 .
2002 , you're right , you came to school with that , yeah , yeah , 2002 . And you had it till , and I had it till 2008 , how much you pay ? For that joint $900 . It had a radio . It had a radio air conditioning , it had air conditioning . ABS probably not airbags no , definitely did not have airbags , but it got me to where I need to go . What I would say ?
What I would , you know , say that your biggest thing at this point in your life moving from medical school to residency is getting comfortable with your money , getting comfortable managing your money , getting comfortable knowing exactly where your money is going , where you're spending it , how you're saving it . Just getting comfortable getting paid .
So you're going to do all of those things that you just described .
I see what you're saying , but what does that mean ? Comfortable , Because that comfort comes from— .
Well , I'm still talking , so that's why you don't know what I'm talking about , because you interrupted me .
All right , go ahead .
So all of those things that you just said basically culminate in being comfortable with knowing exactly what to do with your money . And the reason that I'm talking kind of 30,000 foot view is because the notion of getting a financial planner right might be that you're not comfortable yet with your money . Right , right , like there's a mindset behind this .
So when you're looking for , you know the place to live , the place to rent you know . When you're looking for , you know what car , when you're going to pay your utilities , how much you're going to pay , all these kinds of things . The whole gist of that is you got to be comfortable getting paid and putting the money where it's supposed to go .
I think , looking back , I think what you're saying basically is is , is is . What you're saying is look y'all , like you can't pay someone to hold your hand with this , like you can't eventually , but you got to figure this out on your own .
Right , and it's know when you need help , and it's not hard at first , right , Because you don't have that many things going on . So what we're breaking it down is look , housing utilities , transportation and , in essence , student loans . That's it .
Those are the four things that you really got to focus on on a monthly basis and , to be honest with you , your student loans you ain't got to focus on on a monthly basis and , to be honest , with your student loans , you ain't got to worry about for the first six months , right ?
so live , transportation utilities and loans , how you gonna take the girls out , okay drinks , that's if they're single and ready to mingle .
You know okay , but you still have miscellaneous money that you can figure out right .
Right , miscellaneous . But that's the thing . Right Is that you have to be comfortable . Vowel service it's kind of like , think about it like this right , when you are a doctor , okay , you have to call for a consult , but you don't call for a consult when you don't know what you're calling a consult for , Right .
So you've got to be able to examine and , you know , evaluate and then figure out , well , what exactly is the problem that I'm trying to solve ? What is the problem that I'm trying to solve ? Then you know which consultant to come in right to ask , and then you know what you should be asking this consultant .
But you know , if you just well , I have money and I want a financial advisor , it's like , well , what's your problem ? Like , what problem are you trying to solve ?
Because the problem that they're going to see is , oh , you obviously don't have all the places where you could be spending your money because I'm one of these places , and so we'll just add that to your budgetary line .
I ain't going to front . $50 a month is not bad .
It's not bad , but I think there's hidden costs that's worth there .
You might be paying higher for something else where you're not sure You're paying for something .
Yep .
And that might be a higher for something else . Where you're not sure you're paying for something , yep , and that might be a higher disability insurance plan , or because ain't nobody taking six hundred dollars to manage your money .
It might be per year . So that's yeah , no this is .
This is what I would say . I would say this is like number one step is , once you got you figured out where you're gonna live and all that stuff , I think you got to put some money away .
You got to stash it in an online savings account , one of them things , one of them joints , I don't know , I'm not going to listen , but you go to NerdWallet , one of those online savings accounts or , if you got one , put like three to six months of expenses away , if you can . Three to six , just expenses , right .
So how are you going to pay ?
Not the whole paycheck , how are you for the light bill , the electric bill , how you're going to pay for rent ? This is just in case something happens , If you got your hoopty and your hoopty breaks down . You just want to try to make sure that you're not trying to go back to your credit cards to do this , or it's not going to put you in financial ruin .
Yeah Right , so you can just go to that bank account real quick and be like yo , like the tire broke , the tire busted . I need to be able to use that cash to pay that off . I think that's the most important thing .
Yeah , so you use that for six months where you don't have to pay student loans . Pay yourself a student loan , you know , a student loan payment towards your emergency fund yeah , that might be . You know , that might be the start of your emergency fund .
And then after that I would . I would sign up , like during that first week or during the orientation week . I think it's really important that you go to human resources and you sign up for some type of automatic investing plan at your program . It may be called a 403B or 401K . Some of them call them cash savings plans . Basically , this is you .
They're like a 407 or 457, .
I think something like that . There's another one yeah .
These are all programs where , basically , you're taking a little bit off of it , right , and the reason why you want to start doing that now is for every little bit that you put away now , it decreases how much you have to pay in taxes right now , right , so if you can put away , if you can get away with , like I don't know , putting away 10 or 5 of your
paycheck into one of these plans and then invest it . We'll talk about that later on , don't even worry about it . Just listen to the concept of what I'm saying .
If you can get away with like five percent of your salary just going into one of these accounts , you're decreasing your tax bill , you know , so that you don't have to pay too much at the end of the year , right ? That's one thing to consider . And then also , you're signing up for disability , a disability insurance plan that is going to be at your program .
We call that group disability , right , that's just in case something catastrophic happens to you . Right ? You're going to sign up for health insurance . Right , and , depending on you know if you're single or what your family structure is .
If you're single , you're probably going to sign up for something that's called a high deductible plan , and that's basically the thought process .
Is , you're so healthy you're probably not going to use the healthcare system much , so your bill , your premium on a monthly basis that you pay to get health insurance , is low , right , and there's some benefits that we could talk about later on . But one of them is you get access to a health savings account .
You could put money in there also , and that decreases your tax bill , yep , but without making you go through . You know , go too crazy . Like these are things that you go to your human resources department and you ask them yo , what's up with the uh , investing plan that you have for us , for residents ?
And then talk to me about disability , and then talk to me about health care and all that like let's , let's talk real quick about that . Yep , right , and then what I would start doing is , once you get all that stuff done hopefully you've gotten that stuff done in the first two months , three months you're starting to get comfortable with your money .
Then I would start doing some research . Because you still got to work , right , you still got to deal with some , you know your attendings . You got to deal with your , your upper levels . You know giving you a hard time . You got to get there five in the morning . You got to leave at six in the evening . You got to make food .
You got to do all these different things . It's tough , it's a lot , it's a lot . And now you , you know . So I would just say , start doing a little bit of some research on student loans . That's what I was saying start doing some research on student loans , how you're going to start making some payments and so forth , and then you know .
If you get to a point where you're like , yeah , I need like additional help , I would say student loan planner is a good place to start , like we had Travis .
Hornsby , we had .
Travis Hornsby on our show . He does a really good job of that , right , and that's like six steps that I listed for you right there . And when you're working with student loan planner , like they're helping you to identify if you qualify for PSLF , right , that's the plan where you know you basically make consecutive payments for 10 years .
If you can make consecutive payments for 10 years at a minimum amount , you know they are going to relieve a whole bunch of your student loan debt and for a lot of y'all listening right now , we thought we was dying with $242,000 of student loan debt . Y'all are graduating with $400,000 . That's a lot of money . It's a lot of money .
So you know we paid ours off straight cash , but I don't know nowadays if that's a viable option .
I mean it's always a viable
¶ Financial Planning for Medical Residents
option . The question is whether or not it's necessary .
Would you do it , though ? Let me ask you a question , if you had an opportunity to do things again , but it's now like , let's say , you were graduating from medical school in 2015 and you're listening to us now .
I would have to see how many years I would have to work before I could get my student loans paid off because I did work at a non-profit and I worked at a school .
Let's say you had like five years left .
Five years Maybe .
Would you stay at your first job for five years ? Maybe , yeah , maybe if , if it were tolerable yeah , I mean you could do anything , right , you ?
went to medical school . You went to residency . Medical school was tolerable , well , residency wasn't , but for a lot of people .
Medical school is tough for a lot of people , but they deal with it though yes you know I'm saying , but you have fun in medical school oh yeah right , a lot of don't have . There are people who don't have that type of fun in school .
Residency can be a beast , you know . So your first year , your first year , was tough . The first year was tough . After that it was actually pretty good .
My five years were tough . Um , you know , I didn't have anybody on my ass like you did , but it was just tough .
Yeah .
You know . But I think that starting with those points , which is like , just focus on your living , how you're going to eat your utilities , then after that , you know , focus on putting some money away for a rainy day fund , then do some automatic investing , go to your human resources department and then start doing some research . Go to an expert on that .
I think that's an amazing start go to an expert on that I think that's an amazing start , yeah , and then if you feel like , okay , I'm like seven , eight months in , or I'm like a year into this , which I think is the best place , or two years in , then maybe you could start considering a fee-only advisor .
And then I don't know if I would in residency , especially if we're talking about kind of the prototypical single resident . You know , nothing has changed with your situation , you haven't added any dependents , nothing like . At that point I don't think I would .
I think , honestly , I would still be using those years in residency if you got a girlfriend , though , a girlfriend is not a dependent , could be the way how they act how do they act ?
you know how you was acting .
I don't know how I was acting . First of all , half the time in residency we wasn't even together . Yeah , so I put your business out on front street so I reached out to .
I reached out to our financial advisor I'm not going to say who it is , but our financial advisor is fee only and I wrote to her and I asked a question about this question and it says I could be wrong , but I feel like resident and fellows don't think they can afford a financial advisor that's not selling them insurance .
I've had a lot of conversations with resident and fellows where I've quoted two payments of $1,500 , so $3,000 total , three stacks y'all and I've had 90% not move forward and only like 10% move forward .
I've referred some of them to we just mentioned student loan planner so they can at least get a better idea of what student loan payment plan they should get set up on whether or not they might qualify for PSLF . Right , that's some nuggets right there .
Major key alert I feel like getting a quality fee-only financial plan in residency or training , even if it's just for a one-time financial plan , would help with setting up a good budget , opting into the program's group DI , if possible , disability insurance is DI to the program's group DI .
if possible , Disability insurance is DI .
And making sure there's a future increase option , know what to look for in their first contract , including knowing whether the upfront payment is actually a repayable loan and talking through anything else they're concerned about . So , based off of that perspective , I think they probably are thinking towards the end .
Yes , you know , towards the end , so that that that I would be comfortable with Hiring a financial planner to basically start managing your money .
You got to be careful of that . I think you need to be very careful . Watch them . Espn documentaries , y'all .
Getting getting a snapshot . There's a reason why athletes ?
there's a reason why athletes be broke man .
Well , getting a snapshot consultation from someone I think is reasonable , right to be like hey , just wanted to get your quick opinion about x , y and z . Can we set up a consultation ? You know ?
Let me just tell you what I was , you know , thinking about what I'm doing currently , so that that way I feel like I'm prepared once I start making that six figure salary and , you know , maybe have a little bit more on my plate to manage . I think that that's reasonable and that's coming from a financial planner , so , so yeah , I don't .
I don't think that hiring someone to manage you is the way to go , but having a consultation , I think is reasonable yeah , yeah , so I , I , that's what I wrote back to them .
I said I don't think you need to get one at this point , particularly since you're transitioning into getting that job . You don't even know if you're gonna have any extra pay extra money to to do that , and I do think that you still need to budget in like fuck around money , right . Like how am I have fun with friends because everything ? Hold up , hold up .
I told you . You keep cursing on everybody , everybody . Everything is a priority . Be on linkedin , right .
Everything is a priority and you need to be able to just say , hey , listen , like , as much as I'm putting money away for the important things , I also need to know that I could put money away for things that aren't aren't like like for me to have fun , that's a priority .
Also , right , recreation can be in your budget . Recreation should be in your budget and , frankly , if you are not putting some sort of recreation in your budget , I don't care . If you put in how much is a movie ticket now , no , it's probably like $20,000 , $20,000 , right , $20,000 for a movie ticket .
It sound like , it feel like it might be right .
So even if you put $20 to go see a movie without any popcorn , I think you need to put in recreation into your budget . Anyone who thinks that a budget basically means that your money is on a diet is really looking at a budget the wrong way . That is not how budgets work . Your money is not on a diet .
You are just knowing where the money is going , where it's being spent , what the priority is that you have in your life , and that's what a budget is .
Yo good question Dr Percy .
Thanks for the question .
Depending on how y'all feel , yo text us , Let us know 833-230-2860 .
I want to know if anybody has gotten a financial planner or advisor while they were in residence if you were going to do this again , would you get a financial advisor ? No , not in residency .
No , you would just wait until afterwards yeah , do you think you was good with your money ?
I think I was okay , but I obviously had a ways to go . I wasn't wasteful with my money .
I just you were better than me .
I'll tell you that right now , I wasn't wasteful , but I didn't really understand . I feel like girls are better
¶ Resident Financial Planning Advice and Banter
than money . I didn't understand how money worked . What do ?
you mean , you didn't understand how money worked , because you was working .
No , I understood save and spend , but you didn't . I never considered it an option for me . Why is that ? I just didn't . It wasn't something that I thought about , just wasn't something .
And you came in older too .
That came to mind , I wasn't that much older . Neat Damn .
But you were older .
Okay .
You was a not .
Listen . What is the next topic ? Neat .
I'm just saying as a non-traditional student you were a non-traditional student I was , I came in with a certain amount . I came in with a certain amount of expertise and information and you came in with a bit more . Is that fair to say ? No , so you didn't have a 401k at your job .
No .
What'd you have ?
If we did have a 401k , I was not part of it , if that's it .
Weren't you like driving dollar cabs .
Anyway , they didn't have a plan . Oh my Lord , what's the next topic ?
When is this podcast episode going to be over episode everybody 833-230-2860 .
Let us know what you think . Tell us what you think about this damn banter . That's what I want . They love this banter I think it's making people feel a very uncomfortable knee why is that ? I'm uncomfortable .
Why are you uncomfortable ?
What's the next ?
topic me . Well , anyway , guys , I wasn't good with my money . So y'all see that If I was to do this again , I would not hire a financial advisor , maybe towards the end of residency , but , to be honest , I just wait till afterwards .
I would follow those steps , I'd make sure my money's right on my own and , yeah , that's what I would do , I might have gotten a consultation .
That's as far as I might have gone . I definitely would have done a student loan consultation , like my last year .
I definitely would have done a student loan consultation because at this point right now I feel like there's a lot of information out there , not only from our podcast but other podcasts and blogs and so forth that I think you can get a really good start on doing things on your own without making too many big mistakes and then eventually , like you said , if you
need a consultation later on down the line , that person , that fee only advisor , is there for you . So , that's how I feel Cool . I would've had a little bit more ducats , if you know , but most of my money was going to entertain you . That's what it was .
How knee . We didn't live in the same city . Wrong city . Wrong girl lying to see you , wrong girl , alfred , edit that . What was the mean that ?
we saw or the video .
Was it a real ? The guy the guy was like . When the guy the guy was like do you remember ? When the guy was like um , anytime , anytime . I remember something that my girl doesn't remember . She goes wasn't me must have been another . Woman must be your side . Chick must be be your other girl .
Speaking about awkward situations , what let's jump into ? Oh , we saw that . Oh , I watched that concert yesterday with Kendrick Lamar's pop-up concert in Los Angeles .
Oh Lord .
Damn they not like us five times . Yo , he don't like Drake . Everybody . Go back to our previous a couple of episodes before where we talked about you know that beef . Here's what I think about . What is it like to have ? What would it be like to go through eminem or to have like your biggest critic in residency , or even as an attending .
Be like the best at their job , or like the most well-written written the most chapters . Be like your biggest ops , because that's what drake's gonna do . Right , like his biggest ops is literally the best rapper out there right now if not one of the best ever has . The has a lot of money .
So what I'm equating it to you is like what if your biggest ops in medicine was like someone who was well written , gone to conferences , all these different things like ? How do you counteract that ?
I'm not like them , I'm not like them , I'm not like them hey hell hold on a second , don't get us jump , please .
I'm not like if you don't know the West Coast dances , one I do know , but that concert was amazing , already wearing blue . That concert was amazing . We saw it on what do you call it ? On YouTube , cuz I think was on Amazon or something like that , but it was great . It was great , loved it , loved it , loved it .
Listen , let's jump into something that we probably should have talked about several months ago . Yes , this is old news , but always relevant news Doctors , nurses , walk out on strike at Ascension St John in Detroit . That was in April . Yeah , this was in April , wearing their white coats and blue scrubs , some with stethoscopes still draped around their necks .
Er docs , nurse practitioners and physician assistants at Ascension St John Hospital in Detroit walked off the job , striking against what they say are unfair labor practices that put patients at risk .
Right , the union , which is the Greater Detroit Association of Physicians , filed an intent to organize with the national labor relations board in may , uh-oh , and have been working without a contract since they organized the group of 43 doctors . Physician assistants are employed by team health , which is contracted to manage .
Okay , you guys know what team health does , right they don't , they may not know what team health all right , team health . Basically they are the ones . What is ? This article staffing they own the well . Team health owns . Team health basically provides the staffing to the hospital and then the doctors work for team health . You get it . Hospital pays team health .
Team health pays the doctors but team health is actually owned by a private equity firm called blackstone yes , so anyway .
Um , what the doctors are saying is understaffing and poor working conditions have created an unsafe staffing situation in emergency department which has led to excessively long wait times for patients in need of care .
Right , and they say some workers carried sign that says no more profits over patients and team health said it worked with with Ascension , st John , to ensure that emergency . Okay , you guys know where this is going . So basically , so the question is no , go ahead
¶ Physician Response to Staffing Issues
. What were you going to say ?
Well , so I read another article . You're reading one article now , but I read another article which is a really short summary of everything that happened . So what it says is that this strike was only a 24-hour strike , so I don't think that the intention was to strike until they reached an agreement . I think it was to show you need us .
All right , you need us . Obviously , there was coverage . I don't know how well the ER was covered . Is that a waste of time ? Well , I think .
That's like telling your kid listen , I'm going to turn the TV off if you keep throwing stuff against the wall .
You turn it off for five minutes and then turn it back on .
I'm going to do this . If you keep putting paint on your hands and putting it on the wall , you know I'm going to do that and then you just never do it , like I wonder if that's the same well , but they did it they just did it for a very short stint . Did they reach a deal ?
so , based on the article I read , they had not necessarily reached a deal . So here , herein lies my problem , not with the strike itself . Okay , what is your problem ? You can be telling a staffing company hey , these conditions are dangerous for patients because we have to see so many patients an hour . The patient wait time is through the roof .
You know , all of these things are outdated in terms of equipment and the staffing company can have the nerve and the authority to go . No , it's not Like . How , how is that possible ? Right , because the doctors , the other practitioners , we're the ones that are actually working .
So what team health did was when the doctors Look at Dr Renee doing this investigative journalism .
I love it when the doctors said hey , wait times are exorbitantly long . Patients can wait , you know , 15 hours , right , or you know we have to see , I don't know . Let's say we have to see 10 patients in an hour . Team Health came back and was like that's not true , because when we averaged it out , well shit , if you average anything out .
There you go cursing again on this podcast , Anyway if you average anything out , the numbers always look good , right ? But this is not only about numbers , right ? So Team Health is so caught up on no , your numbers are wrong that they are forgetting about the impact . There's impact behind those numbers , right ?
So maybe in the last five days the wait wasn't 15 hours , but on those three days that the wait was 15 hours , you had a patient whose troponins were going through the roof , but you didn't see them until they went completely through the roof . You see what I'm saying . I'm like the impact .
You can't just approach patient care with numbers like that is completely a well , of course you can you can , but you shouldn't .
It's happening right now .
Right , you can do that , but it is extremely irresponsible and I think , I think that these private equity firms , these , you know , staffing agencies or whatever . I'm like you got the nerve to speak your language with numbers , but we have context behind our numbers . You don't have any context behind your numbers . Like that's ridiculous , totally irresponsible .
Hold on one second , because on the day that the 15-hour wait actually exists and one person gets hurt , then what team health does ?
is they average out everything and go . Yeah , but you know , only 15% of people who were diagnosed with a myocardial infarction died like hold on a second .
That's still 15 percent of people like but this is , this is look , this is that's irresponsible this is widgetization basically this is like it's different right , like when you are making a tv and you know that there's certain types of products that can go into the TV and sometimes there's going to be some of the products that break .
You know you're like OK it's just the TV Right or whatever it is that you're making that can be manufactured and put in your house , like there's a certain cost to make that product and there's going to be a certain cost that you lose making that product .
But when you're talking about someone's life's , to me I find it very difficult to look at that the same way . But it is right , people , and I think the biggest issue for docs at this point right now is you got a status quo , what you're going to do about the status quo ? Because the the like I hear everything you're saying .
Everything you're saying about it being ridiculous , it being being you know , whatever bad adjective that you want to apply to that , it doesn't stop the fact that it still is going on , right ?
now .
And ultimately , I think it's up to doctors . It's up to .
I was shocked that he got doctors , physician assistants and nurse practitioners which is actually telling , because they all , for the most part , looked at themselves as just employees on the same level I'm assuming and just said we're just going to walk out right right , which is something that you don't normally see right .
Normally you'll probably see maybe nurse practitioners or a very or for the physician assistants . They're gonna go , yeah , but I don't know if you're really gonna see the doctors do it , so I was very interested that I saw that . That stood out to me I was like hmm , so that you know .
The question is is how long are docs going to stand on the status quo in order to see some type of change ? Because if you just go complain about this and we're just going to say it's ridiculous and this and that , what have you ? Nothing's going to change . Right , right , nothing is going to change .
And if we feel like this is a bad way of practice in medicine , then you have to do something to take yourself out of that situation and it may not just be individually , it has to be as a group . Got to do something to change , change the playing field so that it can go back .
I don't know if it should go back to the way how it was , but it just has to be a new frontier where you know we are , as professionals , providing care where it makes sense for the patients , but also , at the same time , it's financially viable for the hospital . Right , because it has to be financially viable also for it to make sense , also Absolutely .
That's the way I look at it . It's like look , what are y'all doing to stop the status quo , and I do think a one-day strike . I don't know if that's really helpful .
Yeah , I don't know that that's really helpful , but I think also that our generation , the generations after us , don't actually know how it was before .
And .
I think that that is part of the problem . They don't actually know how it was before because they weren't in it , right ? That's kind of like you know , if I tell my niece you know about the rotary phone , she's looking at me like what are you talking about ? It's true , it's true . Can I do it for her ?
No way , like I think we did a video on that a long time ago .
I think we did a video on that a long time ago . Yeah , right , yeah .
So , like what do you mean ? A rotary phone ? Like how is that right ? What do you mean ? A Dewey Decimal System ? You actually went and looked at small index cards and tried to find a library . It's like , yes , like that's how you looked for a library book , right ? What's an encyclopedia ? Right ? No-transcript , like before . And so it becomes .
But I do , it becomes this , it becomes a new way of doing medicine , of practicing medicine , when it's like not actually , this was the old way yeah , because I think if you have the old way of doing things as doctors never striked .
No , I'm not talking about .
Let me finish my have . The old way of doing things . Is doctors never strike ? No , I'm not talking about that . Let me finish my point the old way of doing things is that doctors never strike .
Right Now , you have a new age of physicians coming out and they're used to working as employees . And what do employees do when they get together and they realize that they're not getting a good deal ? They strike .
I get that . So what I'm ?
saying is you actually might end up getting the opposite effect . You actually might end up getting more change .
When you have a whole new crop of doctors who don't understand what it's like to be back in the 50s and 60s and 70s and however long , and doctors don't strike , doctors just take care of patients and all that stuff , you might start seeing a bunch of doctors that you know what . Here's my picket line .
I'm jumping on a picket line and I'm staying here for 20 days , 30 days , I get that . So that's one thing to consider .
I think the one thing that hasn't changed , though , is the physician guilt right , which is why , when they said that they were striking , I was like wait what ? And so when I looked at the article , I was like okay , it's only for 24 hours . I get it and I understand why .
Yeah , there's gradations to this , right , right .
This was never going to be like we're just going to hold out until you give us what we want . This was never going to be that and I think that the physician guilt is what doesn't change .
But I think the the structure of practice or the way in which doctors worked with hospitals definitely has were not at all employed by these hospitals , but just had a collaborative agreement to say I will generate the patients and I will bring my patients to your hospital and I will bring my patients to your hospital and you will credential me there so that I can
work with my patients , treat my patients , evaluate my patients at your hospital when necessary , right . So hence , like you know , when people used to have major medical Right , right , and they didn't used to have like just regular insurance for primary care , it was just major medical .
So things look so different now that I think this new generation doesn't even know that that's the way that it used to look Primarily . They see snippets of it , with little private practices here and there , but with all the private practices being bought out now a private practice is not really a private practice anymore .
Most private practices look like they belong to the hospital .
So I think , in order to really give , we're going to have to probably talk about this on another episode to finish it out because apparently Team Health got the boot recently from that hospital .
There's more specifics that we got to go into , so we'll come back to this show or we'll come back to this topic on a different episode , because I think it's really interesting If you work at one of those hospitals , you're one of the doctors there , or if you're one of the other medical Nurse practitioner Nurse practitioner , shout us out , text us at 833-230-2860 .
¶ Negotiating Locum Tenens Physician Rates
Let us know what's going on .
We'd love to talk . Yo see what you got to say , so that's actually interesting . This topic that we talked about the doctor striking . I think that's a natural segue into an article that I read it was from the darwinian doctor .
Um , it's a post called my evolutionary doctor , my income as a my income as a locum tenants physician , right , yeah , and um , in essence he shared the specific details on his income as a locum tenants physician , working seven days a month .
So urologist works only seven days a month , bringing in four hundred thousand dollars a year , which , um , from the outside looking in , sounds pretty sweet , right ?
He talks about kind of transitioning from being a employed urologist where he was making , I think , close to about $600,000 , maybe even higher than that , and then when he switched to being , yeah , he used to make around $600,000 a year as a full-time employed urologic surgeon in Southern California .
So he's saying this year , working seven days a month as a locum tenens urologist , he expects to make about 400 grand . These numbers are pre-tax . And he gives a behind-the-scenes discussion about what it's like quitting his job , transitioning to a locum's job . And then he talks about what happened when he found his first locum job , then his a locum's job .
And then he talks about , like , what happened when he found his first locum job , then his second locum job , then his third locum jobs , and as he's going from each job , the pay is starting to increase . And then , as he's , not only is he is the pay starting to increase , he's getting more comfortable negotiating that .
Listen like I want to get more pay for more work . And you know , once he realizes that , once he even goes back and gets more pay , he's like this work is even more , I'm negotiating even more for you . That's how he was able to really optimize the amount of time that he's away .
So he says that basically , at locum tenant's job number three , he's there for seven days and his starting rate at this job was $2,400 for an eight hour day and then $250 overtime . So in essence , what that means is for $2,400 , he is available for eight hours a day .
Anything that comes through for eight hours a day , that's rounding on patients , that's operating on patients , that's going to the ED to see patients , that is all covered during that first $2,400 . Then let's say he worked there for eight hours and he starts getting phone calls from the ED after eight hours on hour , nine , hour 10 , 11 , 12 .
He's starting to pick up $250 an hour for every time that he has to be in a hospital after that . So he's talking about like with all of that he went back , renegotiated and got it up to $4,200 for an eight-hour day . So he went from once again . He went from $2,400 .
He was like oh , I got those first two numbers wrong To $4,200 for an eight-hour day and then for overtime , $300 . Right .
And for you all . You may be like damn , like that's a big jump , which it is , that's a big jump . And he also goes in and he talks about why . You know , this actually works , not only for him , but also works for the hospital .
So what he's saying also is that he was able to cut out locum tenants companies and he was able to work directly with the hospital and he worked .
He stayed working as a locum tenants , but what he ended up finding out is he kept more of his money and the hospital ended up paying less because they were paying him directly as opposed to paying a middleman , that's right right , so that ended up working for him and like there's more details in this that we just can't talk about this and I'll put the link
in the show notes you can read it . Initial thoughts . What do you think ?
No , I mean , I think this is great , right . I mean , first of all , kudos to him for the transparency . That's number one .
Yo , doctors are not transparent about this , so that was really good yeah .
So kudos to him for being so transparent . Um and two , you know , kudos to him for showing the progression right and not just starting at the end where he just says , well , I get paid for two hundred dollars . It's like , oh , okay .
And then people think like that's just the way it's supposed to be and then they get their first you know pay rate and it's like , oh , you get 2400 , but wait , wait , wait , wait , wait . That's like half of what this guy was talking about right .
So I like that , and I also like the fact that he essentially talks about the , not just the progression , but the fact that he went back and was renegotiating , renegotiating .
So he went back and gave a rate right because we , we and we talked about this , we were talking with someone earlier about , you know , just kind of the locum tenens landscape and how it's so different from the employed landscape .
Right In the employed landscape , the employer says hey , this is how much I'm willing to pay you right to work for me , whereas if you're a locums person , the locums doc is actually the one who's supposed to give the rate . This is how much I think that my work is worth , right , that's what it's supposed to be . That's the way it's supposed to be right .
My work is worth . Right , that's what it's supposed to be . That's the way it's supposed to be Right , because if you have a plumber who comes to your house , you're not going to be like , ok , this is what I'm going to pay you , and the plumber is an independent contractor . Right Is an independent contractor .
You're not going to tell a photographer at a wedding , right Exactly ?
You're not going to tell the photographer this is how much I'm going to pay you . You ask what is your rate ? And so , as a locum stock , we should be telling people what our rate is , not necessarily going to locums job boards and just looking at that rate that they say that they're willing to pay and think , oh , that's the rate that I have to take .
Yeah , yeah , you know I ? I think that , yes , we enjoy working as locums . We left for a certain reason , similar to what this doctor did . But all of the ALs , like I think a lot of people also think that being a locums doc is a panacea . Right , it's not . It's not Like there's some issues with being a locums doc .
You just got to know what it is Like . There's some issues with being a locums doc . You just got to know what it is . But , just truth be told , just know that , like you got to learn how to negotiate your own contracts , you're going to have to learn and when you work as an employee doctor , the same thing , right .
So you're going to have to learn how to develop the confidence to say no , I need more , because X , y and Z , and you have to be able to do that confidently . So just saying that you're going to become a locums is not like everything's going to get cured
¶ Negotiating Locum Tenens Contract Boundaries
for you . Here's actually a very interesting thing I want to tell you about , and it's similar to this topic , but last week I was in the doctor's lounge . I was talking to a neurosurgeon . He's working at the hospital as a locum tenens providing care , and he is traveling from Philadelphia to this spot .
He works there for about , you know , 7 to 14 days , more in the 7 to 10 days range . He's making a really good living . He's enjoying it . He's not . He's like a couple years out of residency and the hospital has asked him to become an employed doc , as they always do right , and he really enjoys it there mm-hmm and he verbally said yes , right ?
He verbally said yes and he admitted he's like I'm not sure exactly why . I said that I really enjoyed here and they're in the process of creating the contract right now and I don't want to do it . He needs to just say no . But I verbally said yes it doesn't matter . That's what he's caught up on , and I was was like listen let me finish .
Hold on , let me finish , let me finish . So . So that's the thing . It's like he's probably going to continue down that pathway of becoming employed , which is he said he didn't want to do . I didn't say that .
He said he didn't want to do that because he thought initially he sounded OK , and then he started thinking about it and as he's getting closer and closer and closer , he feels like he's giving up something , like he's giving up some form of leverage , some form of freedom , some form of independence yeah , for a guaranteed paycheck because he thinks that there possibly
could be some instability at that at that position . So he was like man what do I do ?
and I was like man , like people pleasing on a death on a 10th scale because that's what it looked like to me because , look , there's a reason , guys , when you sign a contract , when you're working at a hospital , the majority of places are going to have you sign like a letter of intent . That's not even a contract , right ?
yeah , but a letter of intent is not binding . I need you to follow where I'm going .
Where are you going ? Okay , so you sign a letter of intent which is not binding . I need you to follow where I'm going . Where are you going ? Okay , so you sign a letter of intent which is not binding , right . But what that does is it starts the engagement quote , unquote between you and the hospital .
Yeah .
They start preparing the paperwork which is , in essence , going to be your contract that you're going to have to sign with them right . But even that signature that you make right there on that letter of intent is not binding . Nothing is sealed until you sign the actual contract agreement and I'm just sitting there trying to talk to this dude .
I'm like , why are you like so caught up ? Because you told them yes , I know why . I want to hear . Why Tell me .
Tell me why he's caught up ? Because he thinks that if he says no , he will screw his chances to continue locums at that facility .
Explain what do you mean by that ?
because what do you mean by that ?
so because he's already working there as a locum ?
of course he is , but he may think that well now , if I say no , will they be so upset that they don't even ask me back as a locum were you there ?
you must have been a fly on the wall , because that's what he said .
I know , I know that I'm I am sure that that's what he said , because that's what you know . I think the normal person would think .
Okay . So what would Dr Renee do in that situation ? First of all , I would have never said yes Okay . But you did , got misunderstood and I happen to you guys ever notice that Dr Renee never does makes any mistake , error , every . She got the answer to everything . Everything is perfect . I would have never done this , I would have never done that .
I would have never eaten the forbidden fruit . I would have never done this . I would have never like come on , man , like everything . You got the like . You ain't do nothing wrong , you ain't make no mistakes , I'm flawless . Um damn . So let's say you had said yes , take it from there .
How are you going to ?
recover . How would you recover ? Give advice to this person .
So I would set a meeting with whomever it is that I said yes to , and I would just tell them you know , I'm not fucking leaving .
Alfred , cue it in . I'm not fucking leaving . Alfred Cue it in . I'm not fucking leaving . I'm not fucking leaving Yo low-key . That's a great movie . Wolf of Wall Street .
They're gonna have to get the national guard To get me out of there . Ha ha ha .
Mm-hmm , mm-hmm , mm-hmm , mm-hmm , mm-hmm , mm-hmm .
My chest is hurting now . Okay , all right , all right , all right , okay , all right , thank you . Thank you , all right . Oh my God , he's going crazy , y'all Ah .
You finished Quaaludes .
So , I would set a meeting with the person to whom I said yes and I would just sit down and say , hey , you know , I've been thinking about , you know , weighing the pros and cons of doing locums and doing employed work , and , after considering everything , I think actually being a locums , I think you would actually get the best out of me , and that's where you
got to flip it . See , that's what .
I'm telling you , that's what I'm saying , what's it gonna be ? Sometimes you just gotta pop up on these so you got to just tell them what . Tell them what . Tell them what it's . So you will get the best out of me if I stay as an independent contractor , because I'm gonna be happy yeah and you want a happy dr knee .
You want a happy neurosurgeon to come in and just be like you know what . When I come in and I work , I get paid commensurate to what I do . I'm excited . I'm already giving you two weeks , maybe even more . Why are you trying to mess that up ? You don't want an unhappy neurosurgeon coming in .
So that's what I would say .
You say like that Not like that .
But essentially that's what I would say is that you know you're going to get the best out of me being a locum tenens . You know I chose to be a locum tenens for , you know , for specific reasons , and I've really enjoyed my time working here .
I love working here with you know , with all of my colleagues and the nurses and everybody , and I think it makes for a really good dynamic and it will allow me to do the best work that I possibly can . So I'm , you know , I'd like to just kind of continue as a locum tenens doc .
But , doc , we can give you that freedom to do what you need to do . We know that you have other things that you want to do and so forth . Like , you give us the schedule but all we need is like 14 days a month and you will have , you know , the rest of the time to do whatever you need to do . You don't even have to do it consistently .
Like , we will work with your schedule . You know , it just seems like it works better for us and for you . You get all the benefits your kids get . You know , all of this loan Excuse me , oh , what I threw . They were going to do loan repayback . They don't know . He didn't know exactly how much it was going to be . But there's going to be loan repayback .
There's going to be the benefits that you're going to get health insurance , all these different things . Doc come on , talk , talk to me . I understand that . Here's the contract .
Yeah , I , I don't want no contract . Um , I understand that , but there are more reasons than the ones that you mentioned .
Oh yeah that are more personal that are more personal reasons oh , can you tell us ?
they're not gonna ask you if you could tell . No , there are more personal reasons that I chose to do locums ? no that , they're just more personal reasons that I chose to do locums . No , that they're just more personal reasons that I chose to do locums , and there really isn't necessarily an offer that you could make me for those specific personal reasons .
Right , these are things that are really out of the hands of what a hospital administrator could offer in a contract or an agreement , and so , like I said , I think you would get the best out of me . There are other obligations , yes , that I have to my family , and I just need that Freedom .
No , I need that flexibility , not just at work , but I need that flexibility at home as well , and so there are just things , again , that are not going to be able to be covered in a contract .
And , before the relationship becomes contentious , because you are going to have expectations of me and if I can't meet those expectations because these other things that I have , then the relationship is going to be contentious , and it's not contentious right now .
It's a very good relationship and I'd like to keep it that way . But employees get a 5% discount at the cafeteria .
Well then , sign me up .
So should we cancel because we have the realtor waiting outside to show you the neighborhood ? All right , guys , I'm joking around , but listen what she just said . That is a masterclass in how to literally say what's important to you .
Stand your ground and just repeat , despite what they have to say , even though they're going to throw in more things to sweeten the pot and so forth .
If you really feel the way how that neurosurgeon felt , which is I said yes initially , but yo , like I just don't want to do it , I just don't feel like doing it , like you got to follow what's in here and you got to be able to articulate that in a way , cause I think when you articulate it that way , they're going to be disappointed , just know , just
trust right trust .
They're going to be disappointed first thing . So before we go on right this is from chris voss of never split the difference one of the things they're not sponsoring the show he's not sponsoring the show , but he gets great advice . You've got to read this book , right ?
It's about negotiations , but one of the first things actually that I skipped , that you actually should say first , is , before you say anything at all , the first thing that you say is you're not going to be happy with what I have to tell you . That way it prepares the person to know .
Okay , I think I've heard this from you multiple times . You're gonna give me bad news have you tried that technique on me ?
So you just want to say you're not going to be happy about what ? I have to tell you what's for dinner tonight You're not going to be happy about what I have to tell you . So that's actually the first thing you should say before you do that . And then you just say the thing why is that ? Why do you say that ?
And then you just say the thing why is that ? Why do you say that ?
Because people need so people need a preparation , right ? So you don't want to say it when you're setting the meeting , necessarily right , but you do want to say it at the outset of the meeting , and doesn't that ?
kind of doesn't that help you also ? Because then you're like okay , I got it out of , I got it , I already got it out of the way .
Let me just start without actually saying the thing . Right , I got it out of the way that I'm about to deliver bad news , so that's the first thing . Um , you don't want to deliver this news over email , that is . That is not the way okay , I'll be doing that .
That is not the way why not ?
why can't you do over email ? Come on now um . It's very imperson , impersonal . People need to feel like .
I can't front you . You be doing that stuff like I . Just I gotta do it over email , but I gotta learn to do it over people need to feel like they had a chance did we break up over ?
email , no me . People need to feel like they got a chance to be able to say their piece you sure we didn't break up over email . Know , we've never broken up over email me .
I could have swear I broke up with you over you've never broken up with me .
If you , if you broke up with me over email , this
¶ Assertiveness in Contract Negotiations
would not be .
I think I use Grammarly . I'll say I'll have it over it . I was like wait , is this something right ? This is preposition . Okay here . Anywho , am I assertive ? Am I assertive enough ? But keep going .
I'm sorry it's kind of like a letter . Right when you get a rejection letter from , like , the college that you really want to go to , you really want them to call you . I regret to inform you what you know . You don't need to read the rest of the letter . First of all , the fact that it's just one page inform it's one page Right .
But yeah , you still don't want to do it over a letter , okay , All right , keep it moving , keep it moving . But yeah , no , but that's the only thing I was going to say . Is that you want to say , hey , you are not going to be happy about what I have to say ?
Verbatim , you could just say that You're not going to be happy about what I have to say , but I'm going to have to decline the offer to be employed , and then you go on . You know , I think you just get the best out of me as a locum doc . It's been going really , really well . I've enjoyed my time here .
I'd like to continue on , but I have some other obligations that really just cannot be covered in an employee contract .
Do you address that ? You said yes first . No , you just say the thing , just say it , just say the thing , because ultimately the answer is no and you bring up the meeting Like you don't wait till the contract comes out no , you don't .
So for example , like Don't do that , don't do that .
Don't wait until they bring the contract to you . Why ? Because they've had their lawyers potentially looking at things right . They've kind of talked well . They gave you .
It came from that , yeah it was a standard , that pdf from four years ago . I'm sure it is um , but you don't know what other things that they've had in play right , so you just especially with what they were saying , that with student loan debt , they they might be right .
They might actually be doing something . They may give you like five percent .
Yeah , whatever . But yeah , I would not . I would just say the thing and make the conversation about that , because you start with well , I know I say yes at first . It's like well , then you still thinking about yes , just say no . The answer is no .
All right To the , to the neuros . All right To the neurosurgeon . Who's listening to what I said ? Then don't listen to what I said , because just listen to what she said . Because I told them to like go to Fiverr and get someone to write the letter for them , and shit . You did not say that , neal . Send it by certified mail . You did not do that , neal .
Stop lying and just make sure you always make sure that the fact that you can just tell a story that isn't true so freely makes me very nervous about what ? Just nervous , very nervous , I don't know . Oh , I don't know who the f did I marry .
That's gonna be the next series , part three , because I guess there was a lady who did part two and this is eight years part two .
this is into I two this is into . I got to speaking of this potting man We've been married 10 years . What's up with this mic thing ? I'm talking about eight years into potting . You would think that I know how to be like , spontaneous on the fly .
So you know that's part of that issue is that I know how to be spontaneous and I'm just Listen to the concept . Listen to the concept which is
¶ Negotiating Locum Tenens Compensation Benefits
follow your heart . And if you don't want to sign that contract , I told him to write a letter and stuff .
You did not tell him to write a letter .
No , I didn't tell him to write a letter , but I do think that you should have that meeting up front with them .
Yeah .
What if they like ? What if they hymn and haw and they stammer ? Should they practice this in front of , like a mirror and stuff like that .
Yeah , Let me practice it with somebody and just you know , have the words that you're have the first couple of sentences yeah , my name is Nii .
And listen . I just don't , you know , want to take this job because it's just not going to work for me . You know Shit , let me do it again .
Yeah , basically like that . I would say have the first three , two or three sentences .
So the first sentence being you're not going to be happy about what I have to say .
Second sentence I'm going to have to decline the offer to become an employee . The third sentence there are just some things , some personal things , that I have to really take care of that , unfortunately , an employment contract is not going to be able to cover . I really enjoy working here .
I'd like to keep it that way and , you know , we have a great relationship right now and I appreciate everything that you've offered , but at this time it's just not going to work for me .
Great advice , great advice . So one of the things in this article that I think you guys should pay attention to is employees cost more than their paycheck . Right , they do , he says . I want to point out one very important point in regards to income . If you're employed , your annual income only reflects part of your whole compensation package .
As an employee , a lot of your pay never hits your bank account . It comes in a form of benefits like 401k match , a pension , health insurance coverage , life insurance , et cetera . While these figures vary widely by employee , you can roughly calculate that your benefits are costing your employer an additional 20% to 40% on top of your base pay .
So if we think about my $600,000 of income as an employee urologist back in Southern California , that might be more equivalent to a total compensation package of 750 stacks to 850 stacks . The same thing is true for locum tenants work , but much to a lesser extent . Right , as a locum tenants , I'm reimbursed for whatever I spend on transportation and lodging .
For me , this means they'll pay my rental car , air ticket and hotel room . This ticket typically comes to about two grand for every seven day stretch . They also cover my medical malpractice .
Yeah , you can't really . So he's saying that he can't really project what the medical malpractice costs him because they do it essentially in a plan with all of the doctors .
So it's just a fraction .
Right , that's just a small fraction of what they pay for everybody , including those who are employed by .
So basically what he's , basically what he's saying , is he he costs the hospital , how much his time is worth ?
Yeah .
Right , which is coming out to about 400 . And then he's coming about 2000 . About $2,000 every month for transportation and lodging , and then $7,000 annual , which is way under the 20% to 40% markup that you get on your own annual salary if you're employed .
So I think , just to wrap this up , because we had a conversation with someone earlier in this today and we were talking about why more people are going into locums when , when you're in residency , more than likely your academic attending is going to tell you don't do locums .
The majority of people who are going into locums are looking because they're trying to get like , they're trying to get control of their life back , they're trying to get control of their schedule , how much they get paid , and they just feel like if they're going to put in this amount of work , then at the end you know they should have some control .
You should have some control and I think that scares a lot of folks is being employed nowadays and not feeling like you are in control of your schedule or having to ask .
You know we've talked about this , you know and I think that that is something that I think a lot of residencies , particularly the attendings , the program directors , they're going to have to get you know , knowledge on locums and be able to give some really good advice on this , because I feel like if you just give a blanket statement of you don't want to do
locums , it's not good for your career . That's actually bad advice .
Right .
It's actually bad If you're listening to this podcast right now and you have your program director or anybody who's who's in your program and they're telling you , just blanketed , like you are , if you're considering locums , that it's a bad idea because it's bad for your career . They don't know what they're talking about , because that's absolutely wrong .
I can understand if they sat down with you and they gave you like hey , I did locums back in a day and this is what happened to me .
Even then , that's you know , I wouldn't say it's just because they had a certain experience doesn't mean that you're gonna have exactly , but just the same way , but just the same way they tell you , listen , you shouldn't need to go get this academic job at this other spot .
You can go there and have a terrible experience exactly you know how many people right now are writing articles about how they left their academic position because you know , uh , responsibility on top of responsibility . On top of responsibility , you're not getting paid more and you're taking charts home with you ,
¶ Locum Tenens Versus Employment Decision
like you know . Just in general , like I just don't see why you would want to turn somebody off from being able to kind of start something on their own Right .
And I think just saying it's bad advice or , excuse me , just saying that it's you know this is bad for your career , just saying it's bad advice or , excuse me , just saying that it's you know this is bad for your career .
I just think that that's the wrong approach and I think you're doing a disservice to somebody who's fresh out , right , you can at least say hey , I know somebody who does locums , or you know , maybe consider it Exactly , see what happens .
You can always come in and come out . That's the way I look at it Exactly . So you know , employment is not a bad thing Um , it can work , you know , depending on your situation . And locums is not a bad thing , it can work , depending on your situation . But you have to , just you have to be able to figure out where you want to land .
Yeah , I think I think for us you know me , we're now 12 years in right .
So 12 years ago when I finished fellowship I went straight to doing locums and I found myself working a lot , but I was really happy because I was able to make my schedule , you know , move around things that were really important for me , like if my nephew had something to do at his elementary school , I was always able to be there for that .
If my parents had doctor's appointments , I remember my dad got diagnosed with prostate cancer and I basically made it to all of his appointments . I made it to , you know , all of his radiation treatments . I was there for my parents , you know . I remember giving them my old you know Volkswagen Jetta .
You know , because I was renting cars all the time , you know . But it just worked out for me . But I was on the road a lot . And then we traded that in like within a year and a half to be employed , and within the first couple of months I was like ah , clinically , I like what I'm doing , but there's a certain level of control .
I feel like I forfeited that I don't like Right . And it took me three years to just be like you know what ? I'm not resigning .
We kind of knew going in that we yeah . We already knew we weren't going to be there , you know , but I we already knew we weren't going to be there .
But I think in general , even if it was in another spot like it could have been in Miami , it could have been in New York , it could have been in wherever it would have been I probably would have been like , no , as an employed doc , and I'm not saying that that's the answer for everybody .
I'm just saying that if you have that itch , if you feel like , hey , locum's is the spot for me , just know that there's a large amount of people who are shifting to that area or who are thriving in there and they are having an amazing time .
So don't feel like you're going to be by yourself doing it just because you know if the folks at your residency don't support that . That's all I got to say about that Boom . So maybe you know I'm going to try to reach out to this the Darwinian doctor and see if he wants to come on the show to kind of talk this and discuss this .
Yeah .
And we'll go from there .
That would be nice .
Any final thoughts , Dr Renee ?
They not like us . They not like us . They not like us , mm-mm-mm , they not like us , eh-eh-eh , they not like us .
And we heard from the algorithms you guys don't care about what happens at the end of the show . Alfred , wrap it up . We'll catch you guys on the next episode of Docs Outside the Box , peace .
They not like us . They not like us .