Interview with Dr. Brian S. Foley
In today's episode, Dr. Brian Foley shares valuable insights on how the midcareer physician can achieve financial freedom.
Dr. Brian Foley, known as the Wealthy Doc, pursued a medical degree at Upstate Medical University of the State University of New York and completed his Physical Medicine and Rehabilitation Residency at the Ohio State University College of Medicine. Alongside his clinical career, he attained a traditional MBA in Finance from Indiana University's Kelley School of Business. Since then he dedicated himself to educating medical professionals on financial matters through his blog and book.
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Wealthy Doc's Guide to Achieving Financial Freedom
Dr. Brian Foley's background stems from a humble upbringing in rural upstate New York. His journey through medicine and later an MBA in finance, drove his desire to help fellow physicians make better financial decisions. This led him to create the Wealthy Doc blog and write the book Wealthy Doc’s Guide to Achieving Financial Freedom.
Dr. Brian Foley's blog, “Wealthy Doc,” initially began as a resource to help students and residents navigate financial complexities while pursuing their medical careers. Over the years, it has evolved to cover a wide range of financial topics. These include insurance, investing, and real estate, with a focus on providing valuable insights to physicians and high earners.
His book, “Wealthy Doc’s Guide to Achieving Financial Freedom,” delves deeper into these subjects, offering guidance tailored to the unique financial challenges faced by physicians.
Strategies for Midcareer Physicians to Enhance Their Incomes
Dr. Brian Foley mentioned several ways for physicians to increase their income:
- Negotiating Contracts: Physicians can negotiate better compensation packages before accepting a job, utilizing leverage when they are in demand. It's important to understand one's value in the job market by researching salary surveys and talking to colleagues.
- Expense Reduction: Reducing personal expenses can be an effective way to improve financial health, with tax advantages for those who spend wisely.
- Multiple Income Streams: Diversifying income sources through investments like stocks, bonds, real estate, and other passive income streams can boost income with minimal investments of time.
Regarding real estate, Dr. Foley emphasized that while it's a popular choice, it's not obligatory for physicians. Real estate can be a valuable asset class, and options range from passive investments like Real Estate Investment Trusts (REITs) to more active ones like owning rental properties, syndications, or funds.
He noted that syndications have higher risks and require more knowledge, making them more suitable for experienced investors. Funds offer a middle ground, providing diversification with passive management.
Summary
Dr. Brian Foley emphasizes the importance of achieving financial freedom for the midcareer physician. He wrote his book, “Wealthy Doc's Guide to Achieving Financial Freedom,” as a resource for physicians starting to practice. This insightful guide offers a physician's perspective on financial management and practical tips from real-life experiences. You can find his book on Amazon.
NOTE: Look below for a transcript of today's episode.
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Links for Today's Episode:
- Wealthy Doc's Guide to Achieving Financial Freedom on Amazon
- Dr. Brian Foley's Website
- Dr. Brian Foley's LinkedIn Page
- How to Run Your Business and Master Your Finances – 176
- How to Prepare Financially for a Career Pivot with Ryan Inman – 071
- Top Advice for Generating More Money with Less Hustle – 300
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Transcription PNC Podcast Episode 316
- Interview with Dr. Brian Foley
John: Today's guest is a fellow online educator, but in his case, he uses a blog to help educate physicians and other clinicians about finances, investing, and other important topics. I've been following him for years, but when he published his book recently, I knew it was time to invite him onto the podcast. So let's welcome Dr. Brian Foley to the show. Hello, Brian.
Dr. Brian Foley: Hey, thanks. I'm honored to be here. I have a lot of respect for you and your work, John. I've been following you for a long time. I enjoy your podcast and I've had many friends and colleagues on your podcast, so I'm glad to finally be included.
John: Excellent. I'm glad to hear that. We're just among friends here, so I thought I could pick your brain, and basically what I think, the way I look at it is my listeners, for the most part are either just interested in learning something new about careers or about finances. They may be burned out, they may just be frustrated, maybe looking for a new career. But I think there's a lot of things you can teach us today that our listeners will benefit from. So I appreciate you being here today.
Dr. Brian Foley: Yeah, I hope to help.
John: All right. Now, we usually start with just getting a little bit of background. I do have a little intro that I will record separately before we actually start talking. But I'd like to get your version of a little bit of what you think is important about your background and how you came to create the blog and write the book and all that kind of thing.
Dr. Brian Foley: Sure. Yeah. I grew up rather poor, which becomes relevant when I talk about these financial issues. Kind of a loving family in upstate New York. When I say New York, people think of the city, but it's really quite rural. And I was interested in science and I liked people. So like a lot of people that go into medicine and trying to figure how to combine those two interests. I was a chemistry major. I thought I'd be a scientist, but then I realized, one, I'm not that great at it and two, I didn't want to live in a lab. A lot of my friends were pre-med and I just learned more about it and went with that route.
After medical school, I specialized in physical medicine and rehab. And that's kind of a wide field. It's one that a lot of even doctors don't know much about. But briefly, the inpatient work is with spinal cord injury, head injury, traumatic brain injury, things like that. I do more of the outpatient, which is musculoskeletal, kind of non-operative orthopedics, nerve testing. We overlap a little bit with anesthesia pain, things like that. And like a lot of neuro docs especially, I think we tend to have a lot of outside interests. And so I was always interested in a lot of things, reading, writing, different kinds of career, and business.
And after meeting a lot of physicians who weren't really making a lot of good financial decisions, and were a little bit overconfident maybe in their burgeoning skills, I decided to get an MBA. I specialized in finance in the MBA and that became very helpful in my own life and in helping fellow colleagues as well.
John: That's a lot. I want to reflect on a couple of things. There's a picture of your house in the book, by the way, which we're going to talk about in a minute. That'll give the listeners and the readers an idea of what you're talking about in terms of the starting out in a more of a poverty situation. I'm just thinking of things where I can relate to you. So I was a chem major too, so go chem school.
Dr. Brian Foley: All right. All right.
John: I actually worked as a food scientist for two years before finally getting into med school.
Dr. Brian Foley: Yeah, I worked for one year at DuPont actually.
John: Did you? Okay.
Dr. Brian Foley: Yeah. Yeah.
John: That came in handy, didn't it?
Dr. Brian Foley: Yes. Yes.
John: It comes in handy every day actually, if you think about it.
Dr. Brian Foley: It does.
John: And I really love physiatrists. As a family physician, I worked in occupational medicine. Nobody could help me out better than a physiatrist when I couldn't get someone feeling better. And you're still doing that, right? You're practicing full-time?
Dr. Brian Foley: That's good to hear. I'm part-time, yeah.
John: Part-time.
Dr. Brian Foley: Part-time.
John: Okay. Now, you decided along the way to do a little segue or a little squeeze in a little MBA. Now, that's not typically, especially the school you went to is very well known. And so, tell us how you managed to fit that in and balance that with what you were doing clinically.
Dr. Brian Foley: Yeah. I didn't realize how unusual my path was, but the North American Spine Society asked me to give a talk in Toronto to the spine surgeons mostly about my background because they said, they've been looking around, they haven't really found anybody who's a physician who has a business degree, who worked in private practice, who worked in academia and who is employed physician, salaried and non-profit. And I've done all three. I was in private practice for about five years. And then I went into academia and at that time I found out that when you're on the faculty, the school will pay for your tuition.
John: Perfect.
Dr. Brian Foley: And so I said, "Does that count even the MBA because per credit, that's a lot more." They said, "Yeah, it doesn't matter." I had a friend who's a colleague, I don't know if he's smarter than I am or not, but he chose wine tasting as his choice semester after semester. So I did my MBA instead. That was a great opportunity for me. Because in academia it was a pretty light schedule and there's a lot of flexibility. So in the evenings, I was already on campus, so I did in-person. Hard-core full MBA was three years, the evenings and weekend. So it was definitely a lot of work, but I really got a lot of that and I enjoyed it.
John: Well, you answered a question a lot of times I get, and that's "Should I get an MBA? Do I need to get something like that?" And my answer usually is "It's great if you can do it, but get your employer to pay for it, if at all possible." Why go spend $60,000 or whatever it might be? Now my podcast is sponsored by an MBA program at the University of Tennessee. So I definitely am not going to bad mouth the idea.
Dr. Brian Foley: Yeah. There's a lot of benefits to that formal training if you have the interest. Now, I did it mainly because I have the interest. I actually gave a talk at the White Coat Investor annual conference on that very topic. Should physicians get an MBA? And if I had to pick one word, I would say no. But it's mainly because if you go to a talk and someone says don't do it, and that talks you out of doing it, then you probably didn't have enough motivation to get yourself through it because it's a lot of work.
But I think if you have interest and you want formal training, it was helpful to me. The job I have now was from that, directly from that. I was recruited because of my business training and it's helped me be more rigorous in my own financial investments and advice to others. It gives me credentials. It opens up doors for speaking and writing. So it's very, very helpful for those who are interested and can pull it off.
John: Okay. Then I'm going to ask one other question that's kind of related to that and to see what your answer is here. Let's say that I happen to have the opportunity to get the MBA during or immediately after med school, or should I go wait and do the executive MBA, which I think basically is what typically we would call what you did. What's your answer to that question?
Dr. Brian Foley: Well, technically mine was not the executive MBA, but the executive MBA I think there's a more brief kind of accelerated version, especially in healthcare. If they take advantage of your healthcare experience, they might be a year, a year and a half. So it's maybe more expensive, but less of a time commitment. So, there's pros and cons of different MBA programs.
When to do it. I think a lot of these decisions are very personal. What's going on in your life, what's your situation. From a pure financial standpoint, I would say start your medical career. That's the way I did it. Or do an MD/MBA. If you have that option, that's a really affordable and good time to do it. When you're a starving student, you're studying anyway, you add on an extra semester or a year even, and you come out with dual degrees. That's a nice option. A lot of my colleagues have done that. But later in life, I think you can afford it. You can take time off, do it on weekends and add your credentials.
Now, most people who get an MBA just across the country, not physicians, but all people who get MBAs generally look for an income boost. And generally, they do get a very significant boost. For physicians that isn't necessarily the case. I think we have to be very focused on what exactly do I want from that degree? Could I get those skills and talents in some other fashion?
If I want to learn negotiation, if I want to learn finance, there's a lot of ways online, some of them even for free. There's actually a book and a website called the No-Pay MBA. So there's a lot of online sources. For me I need formal structure in the school and the class to go to, it's just how I learn best personally. But there's a lot of options out there.
John: Now, it sounds like you had a lot of interest in finance and investing and planning for the future and so forth, but if I remember correctly, you did finish the MBA before you started the blog or somewhere in there.
Dr. Brian Foley: Yes.
John: I have a feeling you could have probably started before that, but anyway, that's the way it was. So tell us now, what's going on with the blog? You've been doing that a long time. There is a lot of information. When I look at it, basically it's just tons of free information, not just blog posts, but how-to and other things. Tell me more about the blog so people understand what they might get from that.
Dr. Brian Foley: Great. Thanks for your compliment. I appreciate that. I started the blog really to help the students and residents that I was working with. They were really interested in finances, and they're overwhelmed with how much they have to learn just to be a good doctor. So they couldn't sit down and read textbooks and finance, even if that were interest of theirs. At the time, this was 2007 when I started this, so there were blogs that started a few years earlier, but it was still kind of fledgling.
And the students would say, "Well, the books you recommend are great, but is there a website I can go to?" And at the time I searched and there wasn't really. But Bernstein has post Efficient Frontier that he wrote starting in 1998 that I followed, but it was really only investing. It was very technical, so it wasn't helpful to the residents. I started this really to help them. And I've just added it as I add content and have thoughts, I'll put that in. A lot of attendings have told me that's helpful. I gave lectures and it kind of spun off from there to give public speaking and eventually the book.
John: Okay. Now, if I remember, again, I haven't read every page of the blog, but, there's stuff about insurance, there's stuff about investing, and then you get a little bit into real estate. Actually, a lot of this is covered in the book. I'm assuming some of it you've written about before as well. So tell us more about just kind of the smattering of different types of related topics you might cover.
Dr. Brian Foley: Yeah. I try to focus mostly for physicians or other high earners who don't know a lot about finance. Probably 80% to 90% of it is really basic finance is true for anyone, helpful to anyone. But some of it is specific to physicians starting late, maybe being overconfident, over trusting, having a lot of debt. Those kind of things that resonate a lot with physicians.
I have several posts that are just overview of the basics. And then how to structure the overview thinking of personal finance, but then I do deep dives into disability or other things that may interest the readers as well. So, hopefully there's something for everyone if you search in there.
John: Now, because I have a different perspective in terms of talking to a lot of physicians that are frustrated and find that medicine isn't exactly what they thought it was going to be. It doesn't mean they don't want to continue to do it in some fashion but there's a lot of unrest and dissatisfaction.
I was toying with calling today's episode of the podcast "Why the Mid-career Physician Must Achieve Financial Freedom." And so, I put that question to you, and I have my own ideas, but I feel like it's important that a mid-career physician do achieve financial freedom. And so, maybe you can give me your thoughts on why that might be, and then we can talk about some of the simple things we should probably do to achieve that.
Dr. Brian Foley: Yes, I agree completely with you. Sure, I hear that a lot, but I think we probably should hear it more. A lot of physicians don't have a lot of interest or experience in finance, and a lot of them are very confident, especially starting out at 30, 35 years old. "Hey, I have a good income. I love my career. Why should I care about finance? I have a money guy for that. I want to delegate it."
And my answer, and this is what I would tell my 30-year-old self. I'm in my mid-50s now. I would tell my 30-year-old self, okay, I'm glad you love it. I'm glad you're good at it. I'm glad it's a nice career, but work may change. Your regulatory environment may change. Instead of having private practice, maybe you're working for a big company, you'll always agree. Maybe you'll run into some health crises or you need to take time off for your spouse. Maybe your interest will change. You'll find, "Hey, I'm really more interested in the psychology and psychiatry than I am in my interventional things that I'm doing."
I told a lot of names from my blog. At one point I thought maybe FI by 50 was a title. FI is financial independence, meaning you don't necessarily need to work to cover your expenses. And that's what I recommend for most physicians. Now, I started out age 31, and at the age 48 I was financially independent. That's about 17 years. The numbers say that if you save somewhere between 30%, 35%, 40% of your gross income, that's about 50% or half of your net income in 17 years you'll be financially independent.
Now, I never had a fixed savings rate, but it worked out about that in the end. So, for some, especially physician couples that have two incomes or they're married to an attorney with a high income, some people just save one and live on the other. And by 50 they are usually independent.
Now, does that mean you have to quit your work? Absolutely not. But what I found is it gave me the confidence to say, "You know what, at 50 I'm going to go part-time." So, I do three days a week clinical now, and I've done that for the last six years. And that's been wonderful.
Now, physicians think that they don't have the clout to negotiate, especially for a big employer like I work for. A $3 billion eight-hospital system. But being financially independent gave me a little boost of confidence to say, "You know what? I can do this. And if it doesn't work, it doesn't work." And they said, "Oh, yeah, I would love to have you in any capacity. Of course." To replace a physician who's experienced and live with the system is very expensive to them. And so, they're willing to help. For that reason, I think it's great to be financially independent, to give yourself options.
John: Yeah, absolutely. Again, because I have a biased view, I'm talking to people as they're burned out and so forth, it's like, I think a lot of the specialties that we are in, they're interesting, they can be very exciting, but they can be draining. To practice 20, 25 years doing something intense with long hours, you don't realize that stamina doesn't always persist. And if you are not financially free or already set in some fashion, then you really start to feel trapped. And like you said, if you do have the financial freedom and you decide you want to keep working, like you said, three to five days a week, whatever it might be, you don't have that burden anymore that you don't have options.
Dr. Brian Foley: I agree completely. If you had asked me "Are you burned out at 50?" let's say, I would've said, "No. I love what I do." But I cut back and after looking back, I have a fellow, friend, blogger, and he has this blog called Crispy Doc. He was a little bit crispy.
John: Crispy, yeah.
Dr. Brian Foley: He wasn't burned out. And that's kind of how I felt looking back. I love my job. I love my clinical work, but I will say I do love it a lot more now that I do less of it. And I'm less dependent on it, and I'm a lot more willing to mentor and teach. And I even had meetings on my day off. I really enjoy it more now that I'm not forced to be on that treadmill counting every WRV and worried about covering overhead while I'm on vacation, things like that, that add stress that you may not even realize until it's gone.
John: Now, all these things are covered in the book, right? And how to achieve that, and how do you get more income. I wanted to get a little deeper into that particular topic. You brought it up about how you were able to get a little more leverage. But I think you go in the book a little more detail. So, what kind of things can a physician do to get more income without changing their career or moving to another facility or something?
Dr. Brian Foley: Yeah. I think there's a lot that physicians can do on the front end, especially that's the best time to negotiate your job is before you sign up. And once you set that track, that salary, if you're at that same institution for a long time, it's really tough to have a big change, 20%, 50% increase. But before you start and they really want you there, that's a great time. You have a lot more leverage than you realize. I think learning some basics of contract negotiation or getting someone to help you with it, reviewing your contract, knowing your value in the marketplace, looking at surveys.
There's a lot of them out there now. AMGA, MGMA, SullivanCotter Online, Medscape, Doximity, there's PayScale and salary.com. Look at all those for your specialty and get an idea and talk to your friends and colleagues if you have a few that are willing to talk to you about salary and options. So that you know you're going into that getting your value because there's a lot of variation within this chosen specialty that you have.
Some people feel like, "Well, I'm in this X specialty, or I'm in primary care and my income is limited." And there's some truth to that for sure, but there's a lot of leeway in negotiation. In anything, if you do a work job negotiation, you don't need an MBA to learn some basics from negotiation. That will help you a lot.
The second point I would say is we're talking about income and that's great. I'll talk a lot about that if you want me to, but reducing your expenses is the best way for physicians to get ahead, in my opinion. They don't always want to hear that, but most doctors overspend in my opinion. And it's easier to cut your expenses. There's tax advantages to doing that. If you're already making $200,000, $250,000, $300,000, you're in the top 5%, maybe 3%, 10% depending on where you live and what you do. So, getting that extra $20,000, $30,000, if that takes you a lot of work, a lot of risk, a lot of stress may not be the best way to achieve your goal.
And thirdly, I was really sold the idea of multiple streams of income early on. And this passive income is maybe not the best phrase for it, but latent income, recurring income, horizontal income, something like that where you put out a book or a course or a project, and you continue to get income. Or you buy a bond or a stock, a dividend paying stock or invest in a private company, and that continues to produce income. Real estate, obviously is a great choice for a lot of physicians. Produces ongoing income and capital appreciation. Those are great ways to boost income without doing the extra labor as well.
John: Do you have a favorite, since you brought up real estate. There's a lot of ways to invest in real estate. It's not always as easy, it's not always passive, but what about you? Do you have a particular preference when it comes to using real estate as part of your overall approach to maintaining that income?
Dr. Brian Foley: I do. I've been invested in real estate my whole career, which is basically 25 years as a physician. I will say clearly, emphatically is absolutely not required. It's very popular right now. There's a lot of blogs and conferences and it's a booming market and a lot of doctors are interested for very good reasons, but realize it is not required. And everybody from Harry Markowitz who started Modern Portfolio Theory to Warren Buffet, to the Vanguard founder, Jack Bogle, all say a mix of stocks and bonds is all you need. So, you can do investing simply as a physician without any difficulty.
But having said that, if you want to add real estate, I do think it makes sense. It's a separate asset class, so it doesn't always go up and down when stock and bonds go up and down. You can buy it fairly easily and passively as a REIT, Real Estate Investment Trust. From companies like Vanguard, Fidelity, TIAA-CREF, they all sell these that you can just buy in. You don't have a tenant to worry about.
AAA leases are a little more involved, but they're still kind of passive. I've invested in medical office buildings, surgery centers, some physicians have options for hospitals. I've owned several single-family homes as rental units. And now I'm doing more funds and syndications and apartment buildings, things like that. The benefits are many, but appreciation. These assets tend to grow over time. Depreciation, which is a tax benefit to physicians. Then you can write off some expenses and then you get some cashflow coming in. So there's a lot of arguments to get involved if you have some interest.
John: Yeah, it sounds like start with the simpler ones perhaps unless you have to invest a lot of time. I'm not investing in the syndicate, for example, but it sounds very attractive. And when I get hit retirement, if I'm getting some kind of cash out from real estate or I am a part owner in an urgent care network, blah, blah, blah. Well, then I might have a bunch of cash, I would consider it, but I would definitely have to really dig into to learn about those, but they sound like an interesting option.
Dr. Brian Foley: Yeah. For those who don't want to, I think funds are another option somewhere between REITs and syndication. A fund is private, usually you have to be an accredited investor, which almost all physicians are if they work, and make $200,000 for an individual or $300,000 a couple, or have a million dollars in assets, you can be eligible for a fund.
And they buy multiple properties, usually in multiple regions of the country. So you have more diversification. Syndications are a very concentrated investment in one facility, and so you're susceptible to economic changes, to fraud, and there's a lot of risks. So you really have to be pretty knowledgeable. And I'm a little aware, there's a lot of physicians jumping in the syndication without really understanding what it is, and they've gone really well in the past, but that doesn't mean they're going to continue.
John: I think the pandemic threw things for a loop for a while there. I don't know if they've recovered from that or not at this point.
Dr. Brian Foley: They did. Yeah. I was lucky. I had some single-family homes at the time. But everybody was able to pay the rent. I didn't have to worry about eviction, but I was lucky.
John: Nice.
Dr. Brian Foley: If you have just one or two rental houses and you lose your tenants, you can be really hurting. So that's the argument for having a small investment in a larger property with a group of other people. You get a little more protection there.
John: Good advice. Yeah. You always got to be diversified and protecting yourself and also do your research. Okay. First, I don't think we mentioned the website's address, maybe you did, but it's wealthydoc.org, right?
Dr. Brian Foley: That's correct. If you go to wealthydoc.com, you'll be diverted to the .org.
John: Okay. Cool. And like I said, we talked a little bit about what's on there, but now tell us more about the book in terms of why should I buy the book and where should I buy it?
Dr. Brian Foley: Yeah. I wrote the book for those who are starting out in practice. Basically I wrote it for my 30-year-old self of the things I wish I had known that would kind of set me on the right track for the future. I tried to make it pretty readable. I had a lot of help. Writing a book, it's a lot harder than it seems it should be. To make it readable, I put in some personal stories about what I've been through, try to share some tips from school of hard knocks. If you just want straight-up good financial advice, you can go to the Personal Finance For Dummy series or something like that. But if you're interested in a fellow physician who is doing his best to be honest and teach what he has learned, it's a good source for that. It's not the only one out there, but I wanted to put my voice in the mix.
John: Well, I think too, because it's from the physician's perspective, we all kind of go through the same things, more or less. Everyone's path is a little different, but we all put things off while we're in our training. Most of us have loans we have to deal with. As I read through it, it just flows naturally. Oh yeah, this is what I needed then, and then later on I needed this.
And so, I definitely recommend it. You can get it at Amazon, like you said, very easy. And it's easy to read and it's probably not 600 pages, it's not scientific, it's an actual good advice and information. I think it didn't hurt that you got the MBA along the way to talk about some of the slightly more technical things.
Dr. Brian Foley: Great. Thank you.
John: All right. Any advice you have for us before we go? I guess we're running out of time here in terms of just knowing a little bit about my audience, they might be in the middle career since that's what we were focusing on. Mid-career, feeling a little frustrated, a little helpless. What advice do you have for them in general and regarding their finances?
Dr. Brian Foley: Yeah. I think there's a lot of time for hope. There's a lot of resources out there now like websites and blogs and podcasts like yours, groups on Facebook and other social media outlets can bring people together, physicians to collaborate on what's a good side gig and how do you benefit from.
I didn't talk about the tax benefits, but having a little bit of side income can help. You can have a solo 401(k) or a SEP IRA to put aside a little bit more money there. And you can write off some of your expenses. As well as having a creative outlet outside of medicine can sometimes, even if you're going to continue, like my blog, I really enjoy the creative writing outside whether it's financially successful or not. And that helps me feel a little bit rejuvenated when I go back to my career.
If you're thinking about another career outside of medicine, my advice is to dabble in it while you're a physician. And I certainly did a lot of that. If you can cut back a little bit, maybe drop a call or cut back a half day here and there and add some moonlighting daylighting. Some of the things that I have done despite me saying increasing your income isn't the way to go. I did find benefits of doing that.
Some examples, because I think a lot of your audience may be interested in some of those. I've done IMEs. I've done some medical consulting for investment banks. I've had five or six different medical directorships. I've done some medical informatics where I taught fellow physicians how to use our EMR well.
There's paid surveys, file reviews, lawyers and insurance companies and state workers' comp boards are really interested in physicians and input and want to pay them. They realize they make good money and they want to. There's opportunities for coaching your peers. Once you learn something, you're a little bit ahead of someone else. You don't need to be the world's best expert, but just being a little ahead of your peers, you can give other people hope and encouragement and show them how.
Next thing you know, you'll be doing what I'm doing, paid speaking and teaching and writing and you can open up a whole new world. And then if you find, "Hey, I love this better and I'm making a good income" then you can transition maybe a little bit earlier out of medicine.
John: Yeah. I like that. The coaching, the lecturing, speaking, and so forth for particularly what you're combining what you know about medicine and then about, in your case, finances and where those two things meet. And so, there's this whole audience of people that haven't gotten there yet that just want to learn something either face to face or in written format or whatever. And so, that's a great side business.
Dr. Brian Foley: Yeah, I agree. And if I can help anyone please feel free to reach out. If you go to my website, there's a contact section. You can email me. I don't have any paid services. I'm not here to make money off my colleagues, but I'm glad to share what I know.
John: And they can reach out at LinkedIn too, I believe. Is that possible?
Dr. Brian Foley: Yes, sure. Yeah. About most of the social media platforms out there.
John: Okay. Excellent. Well, we are out of time now, so we could go on for hours I think. We've only touched on three chapters in the book if that. But I really appreciate you being here today, Brian. This is very useful and educational and I encourage everyone to get the book and follow up with you if they have questions.
Dr. Brian Foley: Thanks, John. My pleasure.
John: All right. I hope to see you again sometime and maybe get you back on the podcast. And with that, I'll say goodbye.
Dr. Brian Foley: That'd be great. I'll see you.
John: Bye-bye.
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Transcription PNC Podcast Episode 316
- Interview with Dr. Brian Foley
John: Today's guest is a fellow online educator, but in his case, he uses a blog to help educate physicians and other clinicians about finances, investing, and other important topics. I've been following him for years, but when he published his book recently, I knew it was time to invite him onto the podcast. So let's welcome Dr. Brian Foley to the show. Hello, Brian.
Dr. Brian Foley: Hey, thanks. I'm honored to be here. I have a lot of respect for you and your work, John. I've been following you for a long time. I enjoy your podcast and I've had many friends and colleagues on your podcast, so I'm glad to finally be included.
John: Excellent. I'm glad to hear that. We're just among friends here, so I thought I could pick your brain, and basically what I think, the way I look at it is my listeners, for the most part are either just interested in learning something new about careers or about finances. They may be burned out, they may just be frustrated, maybe looking for a new career. But I think there's a lot of things you can teach us today that our listeners will benefit from. So I appreciate you being here today.
Dr. Brian Foley: Yeah, I hope to help.
John: All right. Now, we usually start with just getting a little bit of background. I do have a little intro that I will record separately before we actually start talking. But I'd like to get your version of a little bit of what you think is important about your background and how you came to create the blog and write the book and all that kind of thing.
Dr. Brian Foley: Sure. Yeah. I grew up rather poor, which becomes relevant when I talk about these financial issues. Kind of a loving family in upstate New York. When I say New York, people think of the city, but it's really quite rural. And I was interested in science and I liked people. So like a lot of people that go into medicine and trying to figure how to combine those two interests. I was a chemistry major. I thought I'd be a scientist, but then I realized, one, I'm not that great at it and two, I didn't want to live in a lab. A lot of my friends were pre-med and I just learned more about it and went with that route.
After medical school, I specialized in physical medicine and rehab. And that's kind of a wide field. It's one that a lot of even doctors don't know much about. But briefly, the inpatient work is with spinal cord injury, head injury, traumatic brain injury, things like that. I do more of the outpatient, which is musculoskeletal, kind of non-operative orthopedics, nerve testing. We overlap a little bit with anesthesia pain, things like that. And like a lot of neuro docs especially, I think we tend to have a lot of outside interests. And so I was always interested in a lot of things, reading, writing, different kinds of career, and business.
And after meeting a lot of physicians who weren't really making a lot of good financial decisions, and were a little bit overconfident maybe in their burgeoning skills, I decided to get an MBA. I specialized in finance in the MBA and that became very helpful in my own life and in helping fellow colleagues as well.
John: That's a lot. I want to reflect on a couple of things. There's a picture of your house in the book, by the way, which we're going to talk about in a minute. That'll give the listeners and the readers an idea of what you're talking about in terms of the starting out in a more of a poverty situation. I'm just thinking of things where I can relate to you. So I was a chem major too, so go chem school.
Dr. Brian Foley: All right. All right.
John: I actually worked as a food scientist for two years before finally getting into med school.
Dr. Brian Foley: Yeah, I worked for one year at DuPont actually.
John: Did you? Okay.
Dr. Brian Foley: Yeah. Yeah.
John: That came in handy, didn't it?
Dr. Brian Foley: Yes. Yes.
John: It comes in handy every day actually, if you think about it.
Dr. Brian Foley: It does.
John: And I really love physiatrists. As a family physician, I worked in occupational medicine. Nobody could help me out better than a physiatrist when I couldn't get someone feeling better. And you're still doing that, right? You're practicing full-time?
Dr. Brian Foley: That's good to hear. I'm part-time, yeah.
John: Part-time.
Dr. Brian Foley: Part-time.
John: Okay. Now, you decided along the way to do a little segue or a little squeeze in a little MBA. Now, that's not typically, especially the school you went to is very well known. And so, tell us how you managed to fit that in and balance that with what you were doing clinically.
Dr. Brian Foley: Yeah. I didn't realize how unusual my path was, but the North American Spine Society asked me to give a talk in Toronto to the spine surgeons mostly about my background because they said, they've been looking around, they haven't really found anybody who's a physician who has a business degree, who worked in private practice, who worked in academia and who is employed physician, salaried and non-profit. And I've done all three. I was in private practice for about five years. And then I went into academia and at that time I found out that when you're on the faculty, the school will pay for your tuition.
John: Perfect.
Dr. Brian Foley: And so I said, "Does that count even the MBA because per credit, that's a lot more." They said, "Yeah, it doesn't matter." I had a friend who's a colleague, I don't know if he's smarter than I am or not, but he chose wine tasting as his choice semester after semester. So I did my MBA instead. That was a great opportunity for me. Because in academia it was a pretty light schedule and there's a lot of flexibility. So in the evenings, I was already on campus, so I did in-person. Hard-core full MBA was three years, the evenings and weekend. So it was definitely a lot of work, but I really got a lot of that and I enjoyed it.
John: Well, you answered a question a lot of times I get, and that's "Should I get an MBA? Do I need to get something like that?" And my answer usually is "It's great if you can do it, but get your employer to pay for it, if at all possible." Why go spend $60,000 or whatever it might be? Now my podcast is sponsored by an MBA program at the University of Tennessee. So I definitely am not going to bad mouth the idea.
Dr. Brian Foley: Yeah. There's a lot of benefits to that formal training if you have the interest. Now, I did it mainly because I have the interest. I actually gave a talk at the White Coat Investor annual conference on that very topic. Should physicians get an MBA? And if I had to pick one word, I would say no. But it's mainly because if you go to a talk and someone says don't do it, and that talks you out of doing it, then you probably didn't have enough motivation to get yourself through it because it's a lot of work.
But I think if you have interest and you want formal training, it was helpful to me. The job I have now was from that, directly from that. I was recruited because of my business training and it's helped me be more rigorous in my own financial investments and advice to others. It gives me credentials. It opens up doors for speaking and writing. So it's very, very helpful for those who are interested and can pull it off.
John: Okay. Then I'm going to ask one other question that's kind of related to that and to see what your answer is here. Let's say that I happen to have the opportunity to get the MBA during or immediately after med school, or should I go wait and do the executive MBA, which I think basically is what typically we would call what you did. What's your answer to that question?
Dr. Brian Foley: Well, technically mine was not the executive MBA, but the executive MBA I think there's a more brief kind of accelerated version, especially in healthcare. If they take advantage of your healthcare experience, they might be a year, a year and a half. So it's maybe more expensive, but less of a time commitment. So, there's pros and cons of different MBA programs.
When to do it. I think a lot of these decisions are very personal. What's going on in your life, what's your situation. From a pure financial standpoint, I would say start your medical career. That's the way I did it. Or do an MD/MBA. If you have that option, that's a really affordable and good time to do it. When you're a starving student, you're studying anyway, you add on an extra semester or a year even, and you come out with dual degrees. That's a nice option. A lot of my colleagues have done that. But later in life, I think you can afford it. You can take time off, do it on weekends and add your credentials.
Now, most people who get an MBA just across the country, not physicians, but all people who get MBAs generally look for an income boost. And generally, they do get a very significant boost. For physicians that isn't necessarily the case. I think we have to be very focused on what exactly do I want from that degree? Could I get those skills and talents in some other fashion?
If I want to learn negotiation, if I want to learn finance, there's a lot of ways online, some of them even for free. There's actually a book and a website called the No-Pay MBA. So there's a lot of online sources. For me I need formal structure in the school and the class to go to, it's just how I learn best personally. But there's a lot of options out there.
John: Now, it sounds like you had a lot of interest in finance and investing and planning for the future and so forth, but if I remember correctly, you did finish the MBA before you started the blog or somewhere in there.
Dr. Brian Foley: Yes.
John: I have a feeling you could have probably started before that, but anyway, that's the way it was. So tell us now, what's going on with the blog? You've been doing that a long time. There is a lot of information. When I look at it, basically it's just tons of free information, not just blog posts, but how-to and other things. Tell me more about the blog so people understand what they might get from that.
Dr. Brian Foley: Great. Thanks for your compliment. I appreciate that. I started the blog really to help the students and residents that I was working with. They were really interested in finances, and they're overwhelmed with how much they have to learn just to be a good doctor. So they couldn't sit down and read textbooks and finance, even if that were interest of theirs. At the time, this was 2007 when I started this, so there were blogs that started a few years earlier, but it was still kind of fledgling.
And the students would say, "Well, the books you recommend are great, but is there a website I can go to?" And at the time I searched and there wasn't really. But Bernstein has post Efficient Frontier that he wrote starting in 1998 that I followed, but it was really only investing. It was very technical, so it wasn't helpful to the residents. I started this really to help them. And I've just added it as I add content and have thoughts, I'll put that in. A lot of attendings have told me that's helpful. I gave lectures and it kind of spun off from there to give public speaking and eventually the book.
John: Okay. Now, if I remember, again, I haven't read every page of the blog, but, there's stuff about insurance, there's stuff about investing, and then you get a little bit into real estate. Actually, a lot of this is covered in the book. I'm assuming some of it you've written about before as well. So tell us more about just kind of the smattering of different types of related topics you might cover.
Dr. Brian Foley: Yeah. I try to focus mostly for physicians or other high earners who don't know a lot about finance. Probably 80% to 90% of it is really basic finance is true for anyone, helpful to anyone. But some of it is specific to physicians starting late, maybe being overconfident, over trusting, having a lot of debt. Those kind of things that resonate a lot with physicians.
I have several posts that are just overview of the basics. And then how to structure the overview thinking of personal finance, but then I do deep dives into disability or other things that may interest the readers as well. So, hopefully there's something for everyone if you search in there.
John: Now, because I have a different perspective in terms of talking to a lot of physicians that are frustrated and find that medicine isn't exactly what they thought it was going to be. It doesn't mean they don't want to continue to do it in some fashion but there's a lot of unrest and dissatisfaction.
I was toying with calling today's episode of the podcast "Why the Mid-career Physician Must Achieve Financial Freedom." And so, I put that question to you, and I have my own ideas, but I feel like it's important that a mid-career physician do achieve financial freedom. And so, maybe you can give me your thoughts on why that might be, and then we can talk about some of the simple things we should probably do to achieve that.
Dr. Brian Foley: Yes, I agree completely with you. Sure, I hear that a lot, but I think we probably should hear it more. A lot of physicians don't have a lot of interest or experience in finance, and a lot of them are very confident, especially starting out at 30, 35 years old. "Hey, I have a good income. I love my career. Why should I care about finance? I have a money guy for that. I want to delegate it."
And my answer, and this is what I would tell my 30-year-old self. I'm in my mid-50s now. I would tell my 30-year-old self, okay, I'm glad you love it. I'm glad you're good at it. I'm glad it's a nice career, but work may change. Your regulatory environment may change. Instead of having private practice, maybe you're working for a big company, you'll always agree. Maybe you'll run into some health crises or you need to take time off for your spouse. Maybe your interest will change. You'll find, "Hey, I'm really more interested in the psychology and psychiatry than I am in my interventional things that I'm doing."
I told a lot of names from my blog. At one point I thought maybe FI by 50 was a title. FI is financial independence, meaning you don't necessarily need to work to cover your expenses. And that's what I recommend for most physicians. Now, I started out age 31, and at the age 48 I was financially independent. That's about 17 years. The numbers say that if you save somewhere between 30%, 35%, 40% of your gross income, that's about 50% or half of your net income in 17 years you'll be financially independent.
Now, I never had a fixed savings rate, but it worked out about that in the end. So, for some, especially physician couples that have two incomes or they're married to an attorney with a high income, some people just save one and live on the other. And by 50 they are usually independent.
Now, does that mean you have to quit your work? Absolutely not. But what I found is it gave me the confidence to say, "You know what, at 50 I'm going to go part-time." So, I do three days a week clinical now, and I've done that for the last six years. And that's been wonderful.
Now, physicians think that they don't have the clout to negotiate, especially for a big employer like I work for. A $3 billion eight-hospital system. But being financially independent gave me a little boost of confidence to say, "You know what? I can do this. And if it doesn't work, it doesn't work." And they said, "Oh, yeah, I would love to have you in any capacity. Of course." To replace a physician who's experienced and live with the system is very expensive to them. And so, they're willing to help. For that reason, I think it's great to be financially independent, to give yourself options.
John: Yeah, absolutely. Again, because I have a biased view, I'm talking to people as they're burned out and so forth, it's like, I think a lot of the specialties that we are in, they're interesting, they can be very exciting, but they can be draining. To practice 20, 25 years doing something intense with long hours, you don't realize that stamina doesn't always persist. And if you are not financially free or already set in some fashion, then you really start to feel trapped. And like you said, if you do have the financial freedom and you decide you want to keep working, like you said, three to five days a week, whatever it might be, you don't have that burden anymore that you don't have options.
Dr. Brian Foley: I agree completely. If you had asked me "Are you burned out at 50?" let's say, I would've said, "No. I love what I do." But I cut back and after looking back, I have a fellow, friend, blogger, and he has this blog called Crispy Doc. He was a little bit crispy.
John: Crispy, yeah.
Dr. Brian Foley: He wasn't burned out. And that's kind of how I felt looking back. I love my job. I love my clinical work, but I will say I do love it a lot more now that I do less of it. And I'm less dependent on it, and I'm a lot more willing to mentor and teach. And I even had meetings on my day off. I really enjoy it more now that I'm not forced to be on that treadmill counting every WRV and worried about covering overhead while I'm on vacation, things like that, that add stress that you may not even realize until it's gone.
John: Now, all these things are covered in the book, right? And how to achieve that, and how do you get more income. I wanted to get a little deeper into that particular topic. You brought it up about how you were able to get a little more leverage. But I think you go in the book a little more detail. So, what kind of things can a physician do to get more income without changing their career or moving to another facility or something?
Dr. Brian Foley: Yeah. I think there's a lot that physicians can do on the front end, especially that's the best time to negotiate your job is before you sign up. And once you set that track, that salary, if you're at that same institution for a long time, it's really tough to have a big change, 20%, 50% increase. But before you start and they really want you there, that's a great time. You have a lot more leverage than you realize. I think learning some basics of contract negotiation or getting someone to help you with it, reviewing your contract, knowing your value in the marketplace, looking at surveys.
There's a lot of them out there now. AMGA, MGMA, SullivanCotter Online, Medscape, Doximity, there's PayScale and salary.com. Look at all those for your specialty and get an idea and talk to your friends and colleagues if you have a few that are willing to talk to you about salary and options. So that you know you're going into that getting your value because there's a lot of variation within this chosen specialty that you have.
Some people feel like, "Well, I'm in this X specialty, or I'm in primary care and my income is limited." And there's some truth to that for sure, but there's a lot of leeway in negotiation. In anything, if you do a work job negotiation, you don't need an MBA to learn some basics from negotiation. That will help you a lot.
The second point I would say is we're talking about income and that's great. I'll talk a lot about that if you want me to, but reducing your expenses is the best way for physicians to get ahead, in my opinion. They don't always want to hear that, but most doctors overspend in my opinion. And it's easier to cut your expenses. There's tax advantages to doing that. If you're already making $200,000, $250,000, $300,000, you're in the top 5%, maybe 3%, 10% depending on where you live and what you do. So, getting that extra $20,000, $30,000, if that takes you a lot of work, a lot of risk, a lot of stress may not be the best way to achieve your goal.
And thirdly, I was really sold the idea of multiple streams of income early on. And this passive income is maybe not the best phrase for it, but latent income, recurring income, horizontal income, something like that where you put out a book or a course or a project, and you continue to get income. Or you buy a bond or a stock, a dividend paying stock or invest in a private company, and that continues to produce income. Real estate, obviously is a great choice for a lot of physicians. Produces ongoing income and capital appreciation. Those are great ways to boost income without doing the extra labor as well.
John: Do you have a favorite, since you brought up real estate. There's a lot of ways to invest in real estate. It's not always as easy, it's not always passive, but what about you? Do you have a particular preference when it comes to using real estate as part of your overall approach to maintaining that income?
Dr. Brian Foley: I do. I've been invested in real estate my whole career, which is basically 25 years as a physician. I will say clearly, emphatically is absolutely not required. It's very popular right now. There's a lot of blogs and conferences and it's a booming market and a lot of doctors are interested for very good reasons, but realize it is not required. And everybody from Harry Markowitz who started Modern Portfolio Theory to Warren Buffet, to the Vanguard founder, Jack Bogle, all say a mix of stocks and bonds is all you need. So, you can do investing simply as a physician without any difficulty.
But having said that, if you want to add real estate, I do think it makes sense. It's a separate asset class, so it doesn't always go up and down when stock and bonds go up and down. You can buy it fairly easily and passively as a REIT, Real Estate Investment Trust. From companies like Vanguard, Fidelity, TIAA-CREF, they all sell these that you can just buy in. You don't have a tenant to worry about.
AAA leases are a little more involved, but they're still kind of passive. I've invested in medical office buildings, surgery centers, some physicians have options for hospitals. I've owned several single-family homes as rental units. And now I'm doing more funds and syndications and apartment buildings, things like that. The benefits are many, but appreciation. These assets tend to grow over time. Depreciation, which is a tax benefit to physicians. Then you can write off some expenses and then you get some cashflow coming in. So there's a lot of arguments to get involved if you have some interest.
John: Yeah, it sounds like start with the simpler ones perhaps unless you have to invest a lot of time. I'm not investing in the syndicate, for example, but it sounds very attractive. And when I get hit retirement, if I'm getting some kind of cash out from real estate or I am a part owner in an urgent care network, blah, blah, blah. Well, then I might have a bunch of cash, I would consider it, but I would definitely have to really dig into to learn about those, but they sound like an interesting option.
Dr. Brian Foley: Yeah. For those who don't want to, I think funds are another option somewhere between REITs and syndication. A fund is private, usually you have to be an accredited investor, which almost all physicians are if they work, and make $200,000 for an individual or $300,000 a couple, or have a million dollars in assets, you can be eligible for a fund.
And they buy multiple properties, usually in multiple regions of the country. So you have more diversification. Syndications are a very concentrated investment in one facility, and so you're susceptible to economic changes, to fraud, and there's a lot of risks. So you really have to be pretty knowledgeable. And I'm a little aware, there's a lot of physicians jumping in the syndication without really understanding what it is, and they've gone really well in the past, but that doesn't mean they're going to continue.
John: I think the pandemic threw things for a loop for a while there. I don't know if they've recovered from that or not at this point.
Dr. Brian Foley: They did. Yeah. I was lucky. I had some single-family homes at the time. But everybody was able to pay the rent. I didn't have to worry about eviction, but I was lucky.
John: Nice.
Dr. Brian Foley: If you have just one or two rental houses and you lose your tenants, you can be really hurting. So that's the argument for having a small investment in a larger property with a group of other people. You get a little more protection there.
John: Good advice. Yeah. You always got to be diversified and protecting yourself and also do your research. Okay. First, I don't think we mentioned the website's address, maybe you did, but it's wealthydoc.org, right?
Dr. Brian Foley: That's correct. If you go to wealthydoc.com, you'll be diverted to the .org.
John: Okay. Cool. And like I said, we talked a little bit about what's on there, but now tell us more about the book in terms of why should I buy the book and where should I buy it?
Dr. Brian Foley: Yeah. I wrote the book for those who are starting out in practice. Basically I wrote it for my 30-year-old self of the things I wish I had known that would kind of set me on the right track for the future. I tried to make it pretty readable. I had a lot of help. Writing a book, it's a lot harder than it seems it should be. To make it readable, I put in some personal stories about what I've been through, try to share some tips from school of hard knocks. If you just want straight-up good financial advice, you can go to the Personal Finance For Dummy series or something like that. But if you're interested in a fellow physician who is doing his best to be honest and teach what he has learned, it's a good source for that. It's not the only one out there, but I wanted to put my voice in the mix.
John: Well, I think too, because it's from the physician's perspective, we all kind of go through the same things, more or less. Everyone's path is a little different, but we all put things off while we're in our training. Most of us have loans we have to deal with. As I read through it, it just flows naturally. Oh yeah, this is what I needed then, and then later on I needed this.
And so, I definitely recommend it. You can get it at Amazon, like you said, very easy. And it's easy to read and it's probably not 600 pages, it's not scientific, it's an actual good advice and information. I think it didn't hurt that you got the MBA along the way to talk about some of the slightly more technical things.
Dr. Brian Foley: Great. Thank you.
John: All right. Any advice you have for us before we go? I guess we're running out of time here in terms of just knowing a little bit about my audience, they might be in the middle career since that's what we were focusing on. Mid-career, feeling a little frustrated, a little helpless. What advice do you have for them in general and regarding their finances?
Dr. Brian Foley: Yeah. I think there's a lot of time for hope. There's a lot of resources out there now like websites and blogs and podcasts like yours, groups on Facebook and other social media outlets can bring people together, physicians to collaborate on what's a good side gig and how do you benefit from.
I didn't talk about the tax benefits, but having a little bit of side income can help. You can have a solo 401(k) or a SEP IRA to put aside a little bit more money there. And you can write off some of your expenses. As well as having a creative outlet outside of medicine can sometimes, even if you're going to continue, like my blog, I really enjoy the creative writing outside whether it's financially successful or not. And that helps me feel a little bit rejuvenated when I go back to my career.
If you're thinking about another career outside of medicine, my advice is to dabble in it while you're a physician. And I certainly did a lot of that. If you can cut back a little bit, maybe drop a call or cut back a half day here and there and add some moonlighting daylighting. Some of the things that I have done despite me saying increasing your income isn't the way to go. I did find benefits of doing that.
Some examples, because I think a lot of your audience may be interested in some of those. I've done IMEs. I've done some medical consulting for investment banks. I've had five or six different medical directorships. I've done some medical informatics where I taught fellow physicians how to use our EMR well.
There's paid surveys, file reviews, lawyers and insurance companies and state workers' comp boards are really interested in physicians and input and want to pay them. They realize they make good money and they want to. There's opportunities for coaching your peers. Once you learn something, you're a little bit ahead of someone else. You don't need to be the world's best expert, but just being a little ahead of your peers, you can give other people hope and encouragement and show them how.
Next thing you know, you'll be doing what I'm doing, paid speaking and teaching and writing and you can open up a whole new world. And then if you find, "Hey, I love this better and I'm making a good income" then you can transition maybe a little bit earlier out of medicine.
John: Yeah. I like that. The coaching, the lecturing, speaking, and so forth for particularly what you're combining what you know about medicine and then about, in your case, finances and where those two things meet. And so, there's this whole audience of people that haven't gotten there yet that just want to learn something either face to face or in written format or whatever. And so, that's a great side business.
Dr. Brian Foley: Yeah, I agree. And if I can help anyone please feel free to reach out. If you go to my website, there's a contact section. You can email me. I don't have any paid services. I'm not here to make money off my colleagues, but I'm glad to share what I know.
John: And they can reach out at LinkedIn too, I believe. Is that possible?
Dr. Brian Foley: Yes, sure. Yeah. About most of the social media platforms out there.
John: Okay. Excellent. Well, we are out of time now, so we could go on for hours I think. We've only touched on three chapters in the book if that. But I really appreciate you being here today, Brian. This is very useful and educational and I encourage everyone to get the book and follow up with you if they have questions.
Dr. Brian Foley: Thanks, John. My pleasure.
John: All right. I hope to see you again sometime and maybe get you back on the podcast. And with that, I'll say goodbye.
Dr. Brian Foley: That'd be great. I'll see you.
John: Bye-bye.
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