Physician Empowerment (Kevin Mailo, Wing Lim, Dimitre Ranev)

Détails du podcast Épisodes (62)Liens (143)Score RSS (63%)Contenu lié (100)

Explorez tous les épisodes de Physician Empowerment

Plongez dans la liste complète des épisodes de Physician Empowerment. Chaque épisode est catalogué accompagné de descriptions détaillées, ce qui facilite la recherche et l'exploration de sujets spécifiques. Suivez tous les épisodes de votre podcast préféré et ne manquez aucun contenu pertinent.

	Date	Titre	Durée
	30 Mar 2025	64 - Insurance: The Why What Who When & How with Galen Nuttall at Maxim Advisory Group	00:38:44
Want to dive deeper into topics like this? Master your journey with Physician Empowerment’s Masterclass Membership—your gateway to exclusive content, expert-led sessions, and actionable strategies to elevate your personal and financial well-being. Learn more and join us today! https://www.physempowerment.ca/masterclass — In this episode, Dr. Wing Lim welcomes Galen Nuttall, a Certified Financial Planner specializing in working with medical professionals, to the podcast to discuss the vital role of insurance in financial planning for physicians. Galen explains how insurance protects income, mitigates risks, and serves as a strategic tool for long-term financial security. He emphasizes the importance of understanding different types of insurance, such as life, disability, and critical illness, and how they fit into different career stages. He and Wing highlight the need for physicians to take a proactive approach to financial planning, ensuring they are properly protected while advancing their wealth and tax goals. Dr. Lim and Galen Nuttall focus on how insurance can be more than just a safety net. They explore how it can also be a powerful tax and investment tool. Galen shares personal anecdotes, including how his perspective on life insurance shifted after witnessing its real-life impact. The conversation touches on common misconceptions, the importance of structuring policies correctly, and how physicians can build a strong financial foundation by integrating insurance into their overall financial plans. About Galen Nuttall, M.Ed, CFP: Galen is a teacher turned Certified Financial Planner. He lives in Belleville, Ontario with his wife, two children, and crazy dog Taco. He grew up watching his dad (a now-retired nephrologist) struggle to make good decisions around his money. It felt like everyone wanted time with him to pitch the latest and greatest financial product. As a CFP who also has a Masters in Education, Galen loves making complex financial concepts simple - usually by using stick figure drawings. He is a partner at the Maxim Advisory Group and works with skilled financial planners with many years of experience. He loves spending his time interviewing fascinating people for his podcast and getting outdoors, whether it be on the backyard rink or going to the beach with his family. __ Resources discussed in this episode: Podcast: A Clean Bill of Wealth Podcast with Galen Nuttall, M.Ed, CFP __ Physician Empowerment: Attend an upcoming Empowerment Retreat Join the Physician Empowerment Masterclass now Website: PhysEmpowerment.ca Galen Nuttall, M.Ed, CFP: Website: GalenHelpsDocs.com LinkedIn
	15 Aug 2024	49 - Medical Entrepreneurship with Dr. Eileen Heo	00:26:58
Dr. Wing Lim hosts Dr. Eileen Heo in the first episode of a new series about medical entrepreneurship. Eileen graduated from the University of Toronto Medical School and then did a family medicine residency at UBC, across the country. Upon completing residency, she moved back to Toronto where she is in her first five years of real practice. Wing talks with her about why she chose not to open a clinic and instead went into being a hospitalist. Dr. Eileen Heo and Dr. Wing Lim discuss what it is about working in a hospital that Eileen finds so compelling and they also address the family medicine crisis in Ontario, which is also more or less nationwide. Eileen honestly shares that fee increases are not keeping pace with inflation and the related difficulties of wealth building as a medical practitioner. This led her to her non-medical entrepreneurship in educating herself about financial well-being through studying investing, stock options, e-commerce, and managing personal finances. Wing and Eileen shed a lot of light on why understanding finance is such an important investment for any physician. __ Contact Dr Eileen C D Heo, BMSc, MD, CCFP: email: eileen.cdh@gmail.com Physician Empowerment: Attend an upcoming Empowerment Retreat Join the Physician Empowerment Masterclass now Website: PhysEmpowerment.ca
	30 Aug 2023	26 - Corporate Structuring Strategies with KPMG Tax Lawyer Jason Pisesky (masterclass faculty)	00:36:07
Dr. Kevin Mailo hosts Dr. Wing Lim interviewing KPMG tax lawyer Jason Pisesky, a Masterclass faculty member, about corporate structuring strategies and corporate tax planning. Jason pulls from a wealth of practical knowledge and experience to shed light on what to do and what to avoid with a PC. Dr. Wing Lim asks Jason to first explain the SBD, small business deduction, of $500,000 and strategies Jason advises around that amount. There are things to consider in how you structure your PC that will affect the SBD in the future, and Jason explains what those considerations are. Wing and Jason break down their discussion in ways that offer insight to physicians regardless of which career stage you’re currently in. In this episode, you’ll learn from KPMG tax lawyer Jason Pisesky how to set up PCs between spouses in similar career fields, or with partners, that offer the structure for corporate taxes. He breaks down why it may not be the best advice to invest everything into your PC, things to consider for future sale options, and when to start a trust if you want one. Above all, Jason shares that investing and structuring with intention is the best way to plan ahead and advises talking to a professional if you haven’t started tax planning yet. About Jason Pisesky (masterclass faculty): Jason’s practice covers a broad spectrum of taxation law matters including corporate, personal, farm and estate tax planning as well as representation in dispute resolution and litigation matters Jason joined KPMG in January 2021. Prior to starting at KPMG, he spent over six years working at a leading western Canadian boutique tax law firm. Jason has experience in both the tax dispute and tax planning for both personal and corporate taxpayers. Jason has worked with small and medium-sized owner-managed operations to reorganize structures in a tax-efficient manner, acting as counsel for vendors and purchasers in arm’s length deals as well as families in the midst of related party estate and succession planning. He has argued on behalf of taxpayers in many contexts and obtained favourable results for taxpayers from auditors, appeals officers and lawyers at the Department of Justice. Jason has appeared before the Alberta Court of Queen’s Bench. Resources Discussed in this Episode: Physician Empowerment Masterclass — Contact Information: Physician Empowerment: website \| facebook \| linkedin Jason Pisesky: website \| linkedin __ Transcript Dr. Kevin Mailo: [00:00:01] Hi, I'm Dr. Kevin Mailo, one of the co-hosts of the Physician Empowerment podcast. At Physician Empowerment, we're dedicated to improving the lives of Canadian physicians personally, professionally, and financially. If you're loving what you're listening to, let us know. We always want to hear your feedback. Connect with us. If you want to go further, we've got outstanding programming both in-person and online. So look us up. But regardless, we hope you really enjoy this episode. Dr. Kevin Mailo: [00:00:34] All right. It looks like we've got everyone here. I am so sorry. Three years into everybody using Zoom, I still struggle with it, but we are slowly, slowly getting there. So at any rate, I want to thank everybody for joining us for the webinar tonight. I'm Kevin Mailo, one of the co-founders of the Physician Empowerment podcast. And our programming, as you know, we cover a wide spectrum of topics and today we are very, very glad to have Jason Pisesky returning back on the webinar, back on the show, to talk about tax hacks for busy physicians, busy medical professionals. And what we're going to be covering today is corporate structuring, one of the most powerful wealth creation vehicles that physicians enjoy in this country is the ability to be incorporated, to set up holding corporations. But it has to be done properly. And that's why we're bringing in an expert. So Jason is a tax attorney who works with KPMG. He is a KPMG tax attorney. And so he has an incredible, not only knowledge base, but a whole well of experience to draw on. So I'm going to be stepping back and Wing's going to be interviewing Jason. And if you like what you're hearing, you want to know more, come and join us for the Masterclass because this is what we teach. And Jason, of course, is one of our faculty members. So again, thank you, everyone, for being here tonight. And why don't I let you take it away, Wing? Dr. Wing Lim: [00:02:02] Okay. Thank you, Kevin. Yeah. So welcome, everyone, to tonight's exciting episode. I'm Dr. Wing Lim. As most of you know me, some of you don't. I'm one of the co-hosts and co-founders of Physician Empowerment. So Jason and I went back quite a while. For those of us that haven't met Jason yet or haven't listened to a previous podcast, Jason and I went back, we were classmates on the dance floor and he was a really nice dude. He was openly admitted to be the teacher's pet. The teacher, the dance teacher, said that. He's a super nice guy with he doesn't have an ego problem. And a number of years later I went into some corporate tax planning pickle and then I dialed up his phone number and said, Hey, Jason, I think you're a lawyer, right? I think you can help me. So that's how we started to talk about a lot of these fancy corporate structuring that that he's doing on a daily basis. So welcome to the show, everyone, and welcome to the show, Jason. So Jason, so you and I were talking the other day about some good and bad stories in corporate tax planning. So you have two different cases you have in your file, in your portfolio of clients. Can you tell us the difference? And we can go from there. Jason Pisesky: [00:03:15] Absolutely. Happy to be here. Thank you very much. And Kevin as well for the very nice intro. Thank you. So, yeah, we were chatting yesterday and just about all the different aspects, facets there are to corporate tax planning and wealth building, just some of the things I've seen. And we got talking about the issue of corporate association. So there's many different types of relationships in the Income Tax Act. There's related association, there's affiliation, there's connected, foreign affiliates, all these different terms for how different taxpayers can be linked to one another and what that means. For your small business corporation, one of the big ones is association. If you're associated, that means you have to share certain benefits. But there can be certain benefits on top of that too, to actually being. So it's not all consequences. What we were talking about was the approach to corporate investing. If you are associated corporations, you have to share the small business deduction. We talked about that a little bit in our last show. Small business deduction gets you the low rate of tax on generally the first $500,000 of income earned corporately on active business income. Jason Pisesky: [00:04:20] So if you're associated, you have to share that amount, that 500,000. By the same token, if you're associated, I'm sorry to back up, when you earn investment income, that might start to reduce your small business deduction. Even if you're just one company and you're not sharing with anyone. And so we got talking about kind of some ways to structure around those two problems, not wanting to share, not wanting to reduce the small business deduction either. So we're talking about a client I've worked with in the past. It was two medical professionals. I've seen many ways done, many times done this way. The idea is you just have two different doctors, doctor/dentist, doctor/lawyer, and they each just have their own PC and they don't have any cross-shareholdings in each other's PC. So they just wholly owned their own. And that's the way to avoid association. Association arises once you start to own some shares of the other one, it can start to cause a problem. Not automatically, but once you cross certain percentage thresholds. Dr. Wing Lim: [00:05:20] So can we just stop there? Because I think we need to clarify this thing because not everybody may be on the same page. Right? So this is, you're talking about husband and wife. They're both professionals, let's say, pick this first case that they have both medical professionals. They both own a PC, and there are certain tax advisors, accountants would advise them, hey, you know, you can share a PC together. Right? And then so you're talking about the nuances about is this a good or a bad thing to do? Is that what we're diving into? Right. Jason Pisesky: [00:05:49] Yeah. Or even, hey, just, you know, both of you be 50/50 shareholders in each other's PC. Just, you know, if one doctor has an up year, one has a down year, then you can maybe pay some dividends or shift or share in the growth across both of them. Yeah. So kind of a couple of different avenues to why you may get there, but the likely ideal structure is to have both of them having one PC, both of them doing their own thing, and both of them getting that full 500,000 shelter on the income until the investment base grows big enough. And then you have different problems. And what I've seen in other files is, for example, I had one where, again, it was it was two professionals. One of them had ceased kind of working and was just going to be the stay-at-home spouse. But they had kind of some cross-shareholdings. The one who had stopped working had been very successful and had built up a multi-million dollar portfolio in the PC. And then they were finding, though, that the investment income in that, call it the inactive PC, was starting to reduce the small business deduction in the active PC and starting to reduce the ability to kind of grow this tax-deferred base. Yet there's some easy steps you can go through to sever that association, to get rid of those shareholdings, change them into different shareholdings, transfer them over, repurchase them, lots of different avenues to kind of fix the problem as to for when they came to us. But yeah, and it's one of those things that happens organically, happens over time. And if you don't have that good advice at the outset, then, again, it wasn't a problem for the first, you know, three, four, five years. But after many, many years of working and building up this wealth, you start to have these relationships that maybe you didn't expect or you definitely probably don't want. So. Dr. Wing Lim: [00:07:32] Right. So I can totally relate. That's exactly us, right, some of you know, my wife and Jason definitely knows us both, and that's when I went to Jason because we had, over the years, right, we didn't have these nice seminars and webinars to go to. We didn't have the good mentors and advisors. We just bumble along the way. And before long, so I have a bunch of corporations, she has a bunch of corporations and everything collided, right? We share some of them, not all of them, and become a big spider web. And by the time we want to think about, oh, do we, can we take a SBD, small business deduction, it becomes like separating a Siamese twin, pair of twins. Right? Becomes very difficult. So what are the consequences? You talk about this erosion of the small business deduction. Can you bring everybody up to speed. This 2017, 18 new tax rule that came and stayed? How that would have impacted like this couple, this doctor / dentist couple with this erosion, what would that mean in tax load? Jason Pisesky: [00:08:34] Absolutely. So corporations generally have a favorable tax rate, kind of no matter what your situation is. You know, at the height, again, we have this across cross-Canada audience. So the starting place, once you work through all the math, is, you know, in the low to mid 20s for the corporate tax rate, 23, 24, 25%, on active business income. We're going to talk about active business income right now, which everyone here would be earning from their medical practice. So that's your starting place. However, for small businesses, for small business corporations, there's a benefit, the small business deduction, that gives you a lower rate of tax for the first $500,000 of income. Slight variances across different provinces. Sometimes there's a provincial rate versus the federal, a different 500,000 amount. So it's not always 500,000 depending on the province you're in. But yeah, and that will drop it down to the low teens, low to mid-teens. So again, 11 to 12, 13% depending on the province you're in, and that's where the advantage comes. So you earn $100 of active business income and you don't need to take it out to spend it. Buy bonus or dividend. Then you just keep it in. And so instead of if you had maybe earned that personally, you would have paid up to 50, up to or even above 50% tax, depending on some provinces and tax rates. And then you'd only have, you know, $48 left to invest, leave it in the company and you all of a sudden might have 88, $89 to invest. So that's the advantage of having the small business deduction and why you don't want it reduced. And then but you also have to be mindful of how you are, you know, you have that $88, call it, you invest that and then it's going to start generating investment income or capital gains. Jason Pisesky: [00:10:21] So you have to be mindful of tracking that as well, because once you have too much investment income, that can also start to reduce your small business deduction. And then there's also, the third one is there's also rules around once you reach a certain size, once you have, it's a very large amount, kind of I think it's right now 15 million and then it gets phased out slowly. So that's a far down the road concern for most. But yeah, those are the concerns of why you want it and how you start to lose it. And then planning around it is do we move those, we move those investments out of the PC, and if you're you're married and have a spouse, then you can try to put those into your spouse's hands. And like I was saying with that first example of the couples who have one corporation for one doctor, one corporation for the other, you can do the same thing if you have a spouse who doesn't have the advantage of being able to use a PC, their stay at home spouse, or they are just in a profession or a career where they don't have access to them. Which is most, then yeah, you can maybe make an investment corporation in that person's name and just figure out how to shovel all the assets into that other person's hands to go there. And then the income earned on that won't affect the small business deduction in the prime active business generating PC. Dr. Wing Lim: [00:11:39] Right, now so can I make a couple of points and observation? Number one, this husband and wife, the two spouses having separate corporations, even for yeah, medical versus non-medical corporations, right? Like for me we're not a double medical income, right? I'm a medical income. My wife has a bunch of corporations that are non-medical. But, and so this separation is not just good for tax planning for those of us, and a lot of the listeners are real estate investors, right? And when you want to apply for mortgages, you need your lending power. You know what? Everybody has a ceiling, right? Some banks, three, four, five high is probably 11 doors that they will lend you. Right? And again, we didn't know better, so we cosigned the loan for all of the properties that we had and then found that, oh-oh, when the time comes, we have capital to grow, now they say no, because you already exceeded that, right? So again, it makes sense to have husband and wife separate the corporations, right? Especially if you're going into investments, then you won't, you again have to, like double the amount of small business deduction, now you have double the amount of credit rooms to grow in the real estate empire. So that's one observation. That's not exactly tax planning. Secondly is, yeah, I have colleagues that have such a good year. They're up in the years and the stock portfolio did very well and their, I think their passive income that year I think exceeded - I forgot how much - I think first 50,000 they give you free, right? By the time you're 150,000, the small business deduction has gone. And then so this poor chap ended up losing the whole small business deduction. And so that was a very, very painful year. I would have thrown up if the accountant just said, cut the check. Right? I would have thrown up. Jason Pisesky: [00:13:30] Yeah, you got the numbers right there. Yeah. So the first 50,000 of income, investment income to shelter doesn't affect your small business deduction. And the policy behind that being like, hey, corporations have to keep some money on hand to pay their current expenses, working capital, so and yeah, you shouldn't just have to keep that in burlap bags tucked under the bed. You can put that in a savings account and earn some interest. That's the reasoning behind it. But yeah, once you go above 50,000 of investment income, which includes capital gains, the taxable portion, it starts reducing the small business deduction that 500,000 on a 5 to 1 basis. So every dollar, so $50,001, you lose $5 of your small business deduction. So by, once you have 100,000 above 50,000, i.e. the 150 you talk about, your small business deduction is completely ground away. And you may have, you may find yourself having, you know, an extra 10 to 15% tax on that 500,000, which is, let's see if can do quick math in my head. You know, an extra $75,000 of tax. Now I'm self-conscious and want to double check that, but... Dr. Wing Lim: [00:14:35] Well, it is very painful. How about that? Jason Pisesky: [00:14:39] Yeah. 75. There we go. All right, good. All right. If it's a 15% spread between the two, it's kind of in and around there. It'll be 10 to 15%. So. Dr. Wing Lim: [00:14:48] Right. So suddenly you cough up with that because you had a good year. And when you think about, Wow, this guy is very successful. But when you think about it, by the time we retire, 150k, you hope there's 150k. 150k doesn't go very far by the time we retire, most of us, right? And so that's important. And the problem is this guy was not old enough to retire. They were just winding down. Still have an active PC. Right? And so this is very, very painful. The other observation is a lot of my colleagues, and they talk to their everyday accountant, they're advised to invest everything inside their PC. Right? And so, Jason, would you advise that or would you advise against that? Jason Pisesky: [00:15:29] I would generally not for the one reason we talked about. The three big reasons come to my mind immediately. One, we talked about, hey, you're going to have to start to juggle this small business deduction as the portfolio grows and you'll probably start to get very annoyed at playing that game and having to time everything, to the non-tax reason, creditor protection. You generally want your assets not sitting right next to the business where if the business gets sued they're exposed. And so, yet professionals have a bit of extra layer to deal with there. We talked about this a little bit on the tax ID, we'll talk about it in two weeks time on the Masterclass. But professional corporations, you generally don't have that same type of corporate shield that someone who's just doing real estate or, you know, running a general store or whatever in a corporation would where there's a liability that arises because of the profession, the professional and the PC are usually equally on the hook. And there's insurance and things, of course. But for that reason it's also advantageous to kind of move things out of the PC to the extent you can into, again, ideally a spouse's hands if that's tenable to someone. And then the third reason is if you have a business that may be salable in the future, capital gains deduction, which shelters currently $971,000 of capital gains, it becomes harder to access as you have a big build-up of what we would call inactive passive investment assets in the corporation. So again, not all PCs are salable, but if it is or, you know, if there's a clinic or something else, usually having the investments not with the shares that may be sold is advantageous. So most generally advise to not just keep it all in the PC, even though that's simple and maybe hey, the first couple of years you do that, but long term you want a better, more nimble structure. Dr. Wing Lim: [00:17:23] Right. So while most accountants told us that medical practice were nothing, but practices are sold, right? Not very frequent, but they are. I'll give you an example. 30 years ago I bought a practice, right, that's when nobody wanted to buy a practice, I did. I borrowed money I hadn't got, bought my dream practice at the time. We just talked to friends who sold their practices at our clinic. We are in a joint clinic, new doctors come and buy out the old doctors, right? So these things do happen, right? And so I think that what you talk about is not totally out of date or irrelevant. It is irrelevant for some people who are planning to retire. Right? If they're lucky enough to be bought out, they want to be sure because this purification, that's what you're talking about, with the purification rule. There's the time of the sale and T-24 months. Right? Two years prior, you better plan your purification. Right? Jason Pisesky: [00:18:18] Yeah. And I think even like ten years ago, I would have probably said, like you probably know, like based on your medical field if your PC is salable, but, and I don't know what the kind of what you're hearing from, you know, all the back channels, but what I'm starting to see is much more consolidation and there actually is a push, I know like it's happening with optometry, with dentistry, where they are having big conglomerates come in and try to snap up practices and build a big portfolio. And, you know, I don't know the exact inner workings, but it looks like kind of like, you know, make a public company model where you just, you know, own hundreds of practices across the country. And so I would say if, definitely you're on the younger side, you never know. So I think you kind of proceed on that basis of, Hey, I may be able to sell this. And so if it just, you know, is a little more kind of work expense and complexity, but I kind of set myself up for that potential down the line that would think it's it's worth it just based on how much the field is changing right now for medical professionals and kind of... Dr. Wing Lim: [00:19:20] Yeah, so now in Alberta, we're not, we're still mostly fee-for-service, right? So we did our physician and empowerment talks. We were in Mexico, Kevin and I, teaching in Mexico and there's this very senior guy, he was high up in CMA and all that, and he retired and he sold his practice for a very high price. He had a very nice panel. So in Ontario it's capitation model, right? So you have the whole panel and each panel carry, every patient has a price tag, multiply I think 200 bucks times our number of patients, right? And so basically he sold it, the whole panel. And he was very happy. Right? So these things are actually more relevant than what we like to think, right? So I just want everybody to just maybe tuck it, file it somewhere in your brain and say, don't just dismiss this. Right? It might apply to you. And that's a lot of money. Right? So right now is, what, $915 thousand dollars, almost? Jason Pisesky: [00:20:16] 971. So if it's not, and it's indexed to inflation, so if it's not a million next year, it will be by 2025, especially with inflation the way it's currently going. So even a million bucks of shelter. Dr. Wing Lim: [00:20:30] So yeah, exactly. And if you're not even, so if you're practicing just over a million at least whatever you sold it for, then it's tax-free, right? And then for those that are advantageous to have a spouse in there, whoever else to share the PC, I think each one have that capital exemption, then it could potentially be a big thing. And some people, they have a practice, not just a medical practice, they have a business side, let's say an esthetic practice, right? I know of one of our consultants, Mark Friesen, he's one of our consultants that work with some of our clients, and he worked with a Calgarian physician who had a cosmetic practice. And Mark is an accountant. He's kind of a CFO for hire. And helped to shape the practice in two years time, so they sold it for a very good price to a conglomerate, right? And only because they did all the right accounting, right tax planning, right structural corporate planning. Jason Pisesky: [00:21:26] Mhm. Happens a lot in dentistry. You'll have the dental business and then the hygiene. The hygienist business. Dr. Wing Lim: [00:21:32] Right, Right. Jason Pisesky: [00:21:33] So yeah, absolutely. Again you'll have hey, maybe you start a clinic and you have a building in there too. Or maybe you want to sell the building. There's opportunities there. So. Yeah. Where are you, where are you keeping things. I would say the rule of thumb is not just to keep it all in the PC. I'd say, yeah, you kind of need that advice and that, the long view range of where I may be in 20-30 years, what my exit plan looks like. And sometimes an admission of I have no idea what my exit plan might look like. I just need to, you know, set the chess pieces in the right place. So whatever comes, I'm in a good spot. Dr. Wing Lim: [00:22:04] Right. Now we're on the topic of small business deduction, I want to just dive into other things because a lot of physicians later on, they join venture with other people, other physicians or other businesses they encounter, or investment or real estate, they're going to different joint ventures, partnerships. But I think last time you talked about a lot of the tax ID, and I heard that if you're not careful, you end up everybody and their spouses, everybody shared one small business deduction of 500,000. So can you walk us through some of the bad or good and bad scenarios of how that could happen? Jason Pisesky: [00:22:40] Absolutely. So I mean the most popular model, tax aside, for professionals to work together is a partnership. You know, the LLP, that's what 98% of all legal arrangements are for lawyers, sorry, accountants are just LLPs, partnerships, limited liability partnerships. So the starting rule with nothing else is that you kind of share one small business deduction between all the partners when you have a partnership. There were some old rules where you could kind of have two PCs and you have a PC providing services to the actual partner PC and then everybody got their own small business deduction. That was shut down maybe 2018, 2019, I don't think earlier. Yeah. So. But now, you kind of go back to the default rule, Okay, everybody shares the small business deduction if you're a partner. But there are other, so there are other arrangements out there that may give access to allow people to work in some way together or collaboratively in a way that isn't a partnership and everybody gets their small business deduction still. There are joint ventures, there's cost-sharing arrangements. Those are the big ones. You just have to be very careful with the wording of the arrangements to make sure you're not a partnership at law because a judge will look through it and say, fine, you slap the label on it of this, but when I actually look at it, it is a partnership. So there are ways for professionals to work in tandem, to some extent at least, and be able to still protect their small business deduction and not have to share it with the other professionals. Dr. Wing Lim: [00:24:19] Right. So let's say if some doctors, they got together and say, Hey, we want to buy this piece of land or just buy, start a new corporation, buy a strip mall medical building. So if they structure it incorrectly, then maybe it would collide with everybody's whole codes or PCs? Jason Pisesky: [00:24:38] Yeah. And so that kind of circles us back to the association problem where we said we're like, Oh, you have two spouses, you should both just have your own PC. Because what can happen is, say you have two unrelated professionals who both have a PC, they're the only shareholders of it, and they say, Yeah, let's buy this piece of farmland and they buy it in a corporation that they both own 50/50, then you're probably all going to end up associated and you're going to be sharing the small business deduction with this unrelated doctor who you're not even carrying on a medical practice, he is just a buddy of yours who you're not carrying on medical practice with at all, in partnership or otherwise. And because of an investment you've made, you end up sharing the small business deduction. Dr. Wing Lim: [00:25:19] Right. Yeah. So I seem like I'm belaboring this, but I've seen a ton of this, right? I've been to some real estate clubs for 12 years, investment clubs, and I certainly know people who were avid real estate investors, right? They just keep forming partnerships and JVs and corporations and some, they begin to go into limited partnerships. Right? So but yeah, so basically, I tell my friends, you're just jeopardizing everybody's SBD if you have a good year, if you sold that building, that multifamily or whatever, you're going to have a tax problem. Right? So then for people who already have the spider web, or even with a spouse or non-spouse, other business partners, what would be your advice, Jason, to them? Jason Pisesky: [00:26:04] I think talk to someone. I know, I like the term spider web, I see it all the time of you know oh I'm doing a new thing, pop up a new company, I'm doing a new thing, pop up a company, and it kind of sounds like maybe people could take two minutes like, Oh, Jason is saying, you want lots of companies, you want companies for everything and to protect all your stuff, that may or may not be the case. It's, you know, everyone's situation is completely unique. We have lots of clients who come in and they have the spider web and we end up kind of collapsing in on itself because, hey, you have too many, too many things going on. And your life is just kind of overly complex without giving you the benefits maybe you thought you were getting from it. So again, we have a handful of files right now, I always have a handful of files on the go, where we are, yeah, we have ones where we're adding complexity because they come to us and hey, you could really benefit from having some more entities and moving some things around. And we have some where they come to us and we have, hey, you have too many for what you have going on. Let's amalgamate them. You know, combine some companies together, let's dissolve them, and then simplify a bit and then rethink about what kind of complexity you want and what's going to benefit you. So that's the blessing and the curse of being a small business owner is it's highly customizable. Everybody goes through it entirely different, like what kind of investments you want to make first, if you want to get into real estate, if you want to build an investment portfolio, then jump into real estate down the line, completely changes and shapes how your structure grows out. But just being intentional about it, I think, and speaking to professionals. Dr. Wing Lim: [00:27:34] Intention, yeah. Intentionality I think is a big one. But most of us don't. We just kind of wing it, right, all the way through until we got caught in a spider web. So yeah, there's so much we can cover. Now, just one last question. Right? And then we'll open this file and then we'll be done. So at what point in our career, typical professional career, would you say that it's worthwhile to consider a family trust of sorts? Jason Pisesky: [00:27:59] Um, for a professional, it's probably once you have kids, if kids are in your future, again, no real rule of thumb. I think it makes sense to chat with your accountant and your lawyer about it and find the right time, but I don't think you really need one immediately. So traditionally we would keep trusts around for 21 years. If people have heard the 21 year rule. Like trust can extend for decades and decades and decades. But there's a taxable event at the 21 year rule where, 21 year mark, where the trust is, basically it's deemed to, for tax purposes, to die. It, all of its property is deemed to be disposed of, reacquired, there's a taxable event if there's an accrual of value in there. So again, that sounds scary. There's ways to deal with that. You can transfer property out of the trust, you can roll it out, and then things continue on. The big, one of the big benefits of the trust is around sale planning and structuring. And so, you know, if you put a trust in too early, then you might miss the sale date. So I would say you don't want one fresh out of med school unless you kind of are going to be someone who kind of slowly grows and builds practices and then sells them and builds a practice and then sells it, maybe that makes sense. But I would say, yeah, graduate med school, build your practice, grow a little bit of wealth, start a family. And that's kind of when you want the family in family trust, right? Dr. Wing Lim: [00:29:20] So what you're saying is there's a because there's a 21 year lifespan, you don't want to start too early. But then when you have kids and then you build some wealth, maybe some wealth outside of your PCs, right, and then it gets, when the spider web is starting to emerge, right, maybe it's time to consider a family trust, right? Jason Pisesky: [00:29:39] Yeah. And I would say a good, to send people away, a good indicator of when you may be ready is when you start having another corporation. Hey, I want to start a real estate investment corporation. Because again, there's restrictions in most provinces on who can actually be in a family trust that owns shares of a PC. So in Alberta, for example, it can only be the professional, their spouse, and children under the age of 18. So that's restrictive. Otherwise you could have anyone under the sun in your family trust if you have a real estate company. And so yeah, but then it's great because you can have these things right under the family trust. And so, yeah, having that family trust at that point, that's kind of a good indicator of definitely when hey, I should talk to someone and see if now's a good time because I'm going to start a bunch of real estate things on the side. Should I do it under a family trust? And get that creditor protection, get the benefit to the family. And again, those may be more easily sold entities, too, whether they get the capital gains deduction or not, the ability to share proceeds amongst beneficiaries. Dr. Wing Lim: [00:30:42] Right on. Well, so good. So thank you, Jason, again for a wealth of information. I don't want to make this going on and on, I think there's a lot here to be digested and I want to thank you for bringing your wealth of knowledge and experience every day, a very live example that pertain to us. And of course, the different people here have different backgrounds, different scenarios, and different stages of life. And I think we're going to systematically look into these at future sessions in our masterclass and future podcasts. So thank you again, Jason. And so I guess, is it fair to summarize that this word that you bring up, this intentionality, right? We cannot just go in blindly and just go and wing it, right? I think we start a PC with, okay, what do we need, a PC, that was one step, that one thing we need to cross. Make that decision. Okay, I need a PC and then somebody says you need a whole code. Should I do it? Should I not? The spouse, both of the careers, and then there's a bunch of others. Right? So I guess what you're telling us today, the take-home message, is so that we have this intention to deal with this and when things get a little complicated, don't just be complacent with just what you think you know. It's time to maybe ask some professionals. Jason Pisesky: [00:32:00] Yeah. I think that's well said. Yeah. The intention is important and, again, once you start to have some material accrual of wealth in the PC, that's when it's time to start thinking about do I need to add some complexity? And once you're starting to make different kinds of investments, again, the second opinion, it's talking to other people and just seeing what's going on and what's available. You don't want to go, you know, as with doctors and their patients, you don't kind of want to go 25 years never talking to a doctor and then show up riddled with issues. You know, you don't kind of want to go 25 years without talking to a tax planner or somewhere if you're building some complexity into your life. Dr. Kevin Mailo: [00:32:40] That was kind of what I was doing, Jason So you're saying I shouldn't. Jason Pisesky: [00:32:43] Are we talking about the medical part or the plotting part? If you've not seen a doctor in a while... Dr. Kevin Mailo: [00:32:49] No, no, no, the doctor thing I'm doing. But yeah, certainly the tax planning, I really got to sit down with you at some point and begin to sort this out, because you're absolutely right, both of you, about being intentional behind this. And also one other point that you made, Jason, is being that everybody's situation is unique and that's why there is no cookie-cutter solution here. You need to sit down in front of a professional, a great accountant, a great tax lawyer like yourself, and really sort through what you need to be doing for you, not what a colleague did or someone else that you share clinic space has done, it's about what you as an individual need to do and it needs to align with your broader life goals in terms of retirement and wealth creation. Jason Pisesky: [00:33:32] Yeah. And I think I may have said the benefit or the curse or the benefit of the cost, like, you know, you're not someone who's just working at a bank. You have a great pension or, with the government, even more. And they have, you know, a great guaranteed pension that's going to look after you. You're most likely out-earning those people. But that does put the onus on everyone on this call, you have to think about it. And if you, and it can be, you know, orders of magnitude between the people who put the thought into it and are intentional and get those extra percentage points every year compounded. There's tons of calculators that say, you know, adding 1% every year to your growth magnifies it. And here we're talking about not 1%, you know, tax savings is often your biggest expense in any business. And so again yeah, just over the life of your career, it's a huge opportunity. Again, everyone will probably be fine if you do no tax planning, but the opportunity is there to just really blow things out of the water. So. Dr. Kevin Mailo: [00:34:30] I love that. I love that. All right. I think we should wrap it up. We always say we're going to keep this like, short, like 20 minutes, 30 minutes. But we always go over and I love it because what you have to share is just so outstanding, Jason And it's real value to the physician community where we're all busy, we're all working. So again, thank you so much for joining us today and we look forward to having you back again. Jason Pisesky: [00:34:54] A pleasure, as always. Thanks for having me and thanks for riding shotgun with me, Wing. Pleasure, as always. Dr. Wing Lim: [00:35:00] Well, yeah. Thank you. Thank you again, Jason, for your valuable time. And we look forward to more episodes together. Dr. Kevin Mailo: [00:35:08] Thank you so much for listening to the Physician Empowerment podcast. If you're ready to take those next steps in transforming your practice, finances or personal well-being, then come and join us at PhysEmpowerment.ca - P H Y S Empowerment dot ca - to learn more about how we can help. If today's episode resonated with you, I'd really appreciate it if you would share our podcast with a colleague or friend and head over to Apple Podcasts to give us a five-star rating and review. If you've got feedback, questions or suggestions for future episode topics, we'd love to hear from you. If you want to join us and be interviewed and share some of your story, we'd absolutely love that as well. Please send me an email at KMailo@PhysEmpowerment.ca. Thank you again for listening. Bye.
	30 Aug 2024	50 - Key Wisdom in Building a Financially Vibrant Practice with Dr. Sajid Syed	00:40:25
Dr. Kevin Mailo welcomes dentist and implantology expert Dr. Sajid (Saj) Syed to the podcast to talk about practice building. Dr. Syed currently owns three dental practices in Ontario, all very successful, and he discusses his journey into dentistry and the business side of things with Dr. Mailo. As he says, “...the profession is 85% business and 15% actual dentistry” and emphasizes the importance of quality training to rely on and of not overthinking opportunities that arise. Dr. Syed did not start his medical career wanting to be a dentist. He began with a desire to do cardiology. But once he entered dentistry at the suggestion of a friend’s father, he was hooked. Kevin prompts Saj to explain how he’s moved beyond simple dentistry into being a highly skilled technician specializing in full mouth reconstruction and implant dentistry and then becoming a successful business owner. Saj and Kevin discuss the necessity of not over-analyzing goals, having a very skilled team around you, and prioritizing customer service when they talk about how to approach entrepreneurship. Dr. Syed draws on his multiple-practice ownership experiences to impart sound advice and financial tips for any medical professional looking to branch into business ownership. About Dr. Sajid (Saj) Syed: After graduating from the University of Saskatchewan in 2003, Dr. Syed began practicing dentistry in Estevan, Saskatchewan, where he worked for two years before moving to Ontario. In 2005, Dr. Syed purchased a practice in Dunnville, using his unique style and service improvements to maintain the quality care the Dunnville community has always enjoyed. Dr. Syed continued to expand his business, purchasing Pavillion Dentistry in 2009. He is dedicated to providing the residents of St. Catharines and surrounding communities with excellent dental care and personalized service. In 2021, Dr. Syed purchased Lakeside Dental in Stoney Creek. He and his family now live in Stoney Creek, where they love being part of a smaller community. Dr. Syed enjoys all aspects of dentistry, with a special interest in complex cases like dental implants, full mouth reconstruction, and orthodontics. He has a passion for performing life-changing treatments that increase a patient’s quality of life by providing them with a fully functional smile. Recently, his dedication and hard work were recognized when he became a Diplomate of the American Board of Oral Implantology, the highest level of competency in implant dentistry. He is also an Associate Fellow and a Fellow of the American Academy of Implant Dentistry. Aside from being a big promoter of continuing education, Dr. Syed also mentors other general dentists wanting to enhance their clinical skills in implant dentistry. Outside of work, Dr. Syed loves spending quality time with his wife and two children. He also enjoys staying fit and playing tennis. __ Dr. Sajid (Saj) Syed: Dentistry Dunnville Pavilion Dentistry Lakeside Dental Physician Empowerment: Attend an upcoming Empowerment Retreat Join the Physician Empowerment Masterclass now Website: PhysEmpowerment.ca
	30 Mar 2024	40 - Capital Gains in Real Estate Investments with Jason Pisesky	00:44:17
Physician Empowerment Masterclass Faculty Member and tax lawyer Jason Pisesky returns to the show to talk with Dr. Wing Lim about capital gains in real estate investments. Jason and Wing explore everything to do with real estate from tax to property depreciation and personal versus corporate real estate purchases. Jason addresses how the Income Tax Act applies to real estate and the nuances involved with the PRE or Personal Residence Exemption. He explains some of the insights that apply to buying and flipping houses, up markets and down markets, and depreciable capital property. Personal versus corporate purchases, income versus capital gain, and active versus passive axis are discussed in broad terms, enough to give a clearer understanding of what Jason will be addressing in greater detail in future episodes and at the Physician Empowerment Live Conference in Toronto in May. The knowledge Jason shares is foundational and directly applicable to anyone with an investment mindset. – About Jason Pisesky: Jason is a tax lawyer with an international accounting firm, KPMG. His practice background is extensive and includes personal and corporate tax planning as well as litigation and dispute resolution. Whether you are scaling up your practice or winding it down, proper coordination between a tax lawyer and your accountant can ensure you're doing it right. Jason is one of Physician Empowerment’s professional Masterclass Faculty members. __ Interested in going further in your financial journey? Join our national conference and meet the PhE team live in Toronto this May 25 and 26th: https://www.physempowerment.ca/live __ Physician Empowerment: Register for the Physician Empowerment Live Conference in Toronto on May 25 - 26, 2024 Join the Physician Empowerment Masterclass now
	15 Oct 2024	53 - The Burnout Crisis in Canada’s ERs	00:25:34
Dr. Kevin Mailo welcomes Dr. Kerstin de Wit, a Professor of Emergency Medicine at Queen’s University and a very active clinician and researcher practicing both emergency medicine and thrombosis medicine. Dr. Kerstin de Wit was interviewed for an article in the National Post that featured survey data from her latest research into high levels of burnout amongst emergency physicians. Her research was published in June’s edition of the Annals of Emergency Medicine and it reveals the levels of emotional exhaustion and depersonalization aspects of burnout spiking in emergency medicine personnel. Dr. de Wit’s study compared physician burnout levels during 2020, the first year of the pandemic, to levels reported in October 2022. The initial survey revealed that roughly 50% of physicians participating in the survey exhibited high levels of burnout already. In 2022 the levels had increased significantly. Emotional exhaustion, one of the two measured elements of burnout, had increased by an absolute 16% of the cohort, and depersonalization had increased by an absolute 12% of the cohort. Dr. Mailo and Dr. de Wit discuss how alarmingly high the revealed levels of burnout are, the realities and consequences of depersonalization, the quotes from the study that revealed how people feel about the broken state of healthcare in Canada today, and what can be done to lessen the burnout and mend the damaged healthcare and ER departments across Canada. This is a key episode about emergency medicine and the burnout crisis that will take serious intervention to turn around. About Dr. Kerstin de Wit, MD: Kerstin de Wit holds a Tier 1 Canada Research Chair in Emergency Venous Thromboembolism and is a Professor in the Department of Emergency Medicine at Queen’s University. She works clinically as an emergency physician and thrombosis physician at Kingston Health Sciences. Dr de Wit was trained in internal medicine, emergency medicine, and research in the UK. She completed a Thrombosis Fellowship in Ottawa in 2013. Since then, she has worked in both emergency medicine and thrombosis. She leads a research program which focuses on the diagnosis of bleeding and clotting disorders in the emergency department and is funded by CIHR. Dr de Wit is the Queen’s University Clinician Investigator Program Director and the Research Director for the Department of Emergency Medicine. __ Resources discussed in this episode: “A Longitudinal Survey on Canadian Emergency Physician Burnout” Annals of Emergency Medicine, Volume 83, Issue 6, P576-584, June 2024, by Kerstin de Wit, MBChB, MD; Anna Tran, BSc; Natasha Clayton, CRA, RA; Caroline Gérin-Lajoie, MD; and Mathew Mercuri, PhD, PhD “‘I don’t think I’ll last’: How Canada’s emergency room crisis could be killing thousands” by Sharon Kirkey, National Post, July 19, 2024 __ Dr. Kerstin de Wit: Queen’s University Emergency Medicine Faculty: Dr. Kerstin de Wit, MD Kerstin de Wit on X/Twitter Physician Empowerment: Attend an upcoming Empowerment Retreat Join the Physician Empowerment Masterclass now Website: PhysEmpowerment.ca
	30 May 2024	44 - Work Life Balance with Dr. Yatin Chadha	00:29:11
Dr. Kevin Mailo is joined by friend and ‘beyond MD’ podcast host Dr. Yatin Chadha in a conversation about why the balance of personal fulfillment and wellness is so important to keep in alignment with both work and finance. Dr. Chadha continuously explores personal and professional growth in his own life and it’s this experience that he draws on to illustrate how his mindset ensures the key relationships and goals in his life thrive alongside work. One of the first things Dr. Chadha addresses is the need to continue to find meaning in the work we do. He explains that he is continually asking himself what he can do to make his week better and answers that question by rotating focuses within his practice, pursuing additional education, honing a variety of skill sets, and finding the rewarding aspects of his daily tasks. Kevin and Yatin discuss the difficulty of focusing amidst today’s constant bombardment of distractions, the difference between time spent and the quality of time in terms of productivity, and how to assess what your mind needs to be challenged in the future. Dr. Chadha will join the conference later in May to share even more of his inspiring insights and knowledge. – About Dr. Yatin Chadha: Dr. Yatin Chadha is a practising radiologist in Toronto. He’s passionate about promoting financial literacy in the healthcare community as he believes exposure is lacking during training, leaving many unprepared as they transition to practice. This led him to create the beyond MD podcast. Outside of work and podcasting, Yatin is an avid golfer and proud father of 2 boys. __ Resources discussed in this episode: beyond MD with Dr. Yatin Chadha podcast “Balance: How to Invest and Spend for Happiness, Health, and Wealth” by Andrew Hallam __ Physician Empowerment: Join the Physician Empowerment Masterclass now
	15 Nov 2023	31 - Financial Education Awareness in Medical School with Christian Wigmore	00:32:07
In this episode of the Physician Empowerment Podcast, Dr. Kevin Mailo engages in an insightful conversation with Christian Wigmore, a medical student at UBC and the mastermind behind Budget Your MD. Together, they illuminate the critical role of financial literacy within the realm of medical education and practice. The discussion spans pivotal topics such as navigating student debt, management of lines of credit, and the influence of interest rates. Christian introduces his business, Budget Your MD, a debt projection tool and visual aid that empowers medical students to foresee their financial trajectory across various scenarios. The discourse places a strong emphasis on cultivating balanced financial habits that harmonize with professional ambitions, family life and personal dreams. Christian envisions a future where financial education seamlessly integrates into medical curricula, fostering a supportive community for open financial discourse within the medical community. Such an initiative, he believes, will play a pivotal role in alleviating burnout issues among physicians, ensuring a brighter, more empowered future for the medical profession as a whole. By melding financial wisdom with medical expertise, Christian and Dr. Kevin Mailo discuss how physicians can work toward a more prosperous and balanced lifestyle in the world of healthcare. About Christian Wigmore During Christian's first year at UBC Medical School, he noticed the lack of financial education integrated into the curriculum. Recently completing his double degree in Business and Biology, the importance of financial literacy heading into medical school was top of mind. He thought… we will be running small businesses and managing our personal finances in 6 years. Understanding the basics of finance is crucial to ensure we don’t A) get taken advantage of by financial institutions and B) don’t end up losing all the money we make in the process. All this, and much more, led Christian to start Budget Your MD. He tends to think of it as a passion project that he is slowly building as he progresses through medical school. Noticing the topics and problems his colleagues are interested in at each stage in the game. Christian hopes to one day play an integral role in changing how finance is discussed in the medical field. To not avoid these conversations, but rather dig deep to help one another live our best financial lives as physicians (because if we’re being honest, our finances play a role in our health and wellness). -- Physician Empowerment: website \| facebook \| linkedin Christian Wigmore/Budget Your MD: website \| instagram \| email \| -- Transcript: Dr. Kevin Mailo 00:01 Hi, I'm Dr. Kevin Mailo, one of the CO hosts of the Physician Empowerment Podcast. At physician empowerment, we're dedicated to improving the lives of Canadian physicians, personally, professionally, and financially. If you're loving what you're listening to, let us know we always want to hear your feedback. Connect with us. If you want to go further, we've got outstanding programming, both in-person and online. So, look us up. But regardless, we hope you really enjoyed this episode. Dr. Kevin Mailo 00:34 Hi, I'm Dr. Kevin Mailo, one of the CO hosts of the Physician Empowerment Podcast. And I have today with me, our guest on the pod, Christian Wigmore. And I'm not introducing him yet as Dr. Christian Wigmore, because Christian is a medical student at UBC. And he founded a very interesting venture called Budget Your MD, and I wanted to share it because Christian connected with me over social media, we got talking, we had one of those great phone calls that I think was supposed to be probably five or 10 minutes. And it wound up being like an hour or two talking life, talking dreams, talking finance, talking career. And then of course, Christian joined us at our conference in 2023, and it was amazing to meet him in person. And we've stayed in touch ever since. So, I'm very glad to have you here, Christian. I love your passion. I love what you're trying to do for your fellow learners but I think there's a lot of wisdom here for us going through our careers, like I'm a mid-career physician, and I love your message. So, tell us a little bit about like your background. Tell us a little bit about what you were doing before medical school. And what you did you know, once you entered medical school? Christian Wigmore 01:41 Okay, well, first off, super glad to be here. I can think back to when I messaged you first on, I think it was LinkedIn. And I think I might have messaged like six or seven other people, no answers, but you answered me right away, and then we get on that phone call. And then off we go to the conference in May. It's been cool to get to know you. It's so yeah, super glad to be here. So yeah, my name is Christian. I'm a fourth-year medical student at UBC. My journey has been pretty centred around medicine to start. I knew kind of in high school, I wanted to do medicine, you go to university, you do the sciences. But funny enough, like if you are UBC grad or you know how UBC medical school works, you get to drop your worst year. And I met my wife in second year and got like the worst grades. Dr. Kevin Mailo 02:27 Was it worth it? Christian Wigmore 02:31 Oh, well, I'm still married to her, right? So, I got the worst grades that year and I knew I needed to have a little bit extra time before that bad year can be dropped before getting into medical school. So I was like, What am I going to do? I grad with a science degree, that's going to leave me doing what? I know I don't really have an interest in something outside of medicine with a science degree. So, why not start taking some business courses, right? So I started doing business courses, and I realized, wow, I kind of liked this stuff. And you know, that wheel starts turning and I realized, okay, maybe if I start doing summer courses and push a little harder, I can grad with a science and a business degree. And so that ended up taking me five years. And after that, I found a small little internship in the midst of COVID with a financial advisor and kind of was able to be his associate and just watch the way he ran his business. And it wasn't only finance, but it was kind of more of like the operation side and entrepreneurship that really started to make me realize that there's that world out there. Like they don't teach any of that in science, you don't really learn any of it in high school. And so that got me excited. But that year I got into medical school, right? And that's the golden ticket everyone's waiting for is they think about medicine. And so after medical school, I went, but I guess over that time, the business mind was still kind of ticking at times. Dr. Kevin Mailo 03:46 So, when calls that the white coat, black suit mentality, right? Do you wear the white coat when you're in your clinical work and the black business suit when you're managing your finances or your practice? So yeah, keep going, keep going. Christian Wigmore 04:01 Totally. So like, I think originally, I was always believing that I would kind of wear that black coat, I guess like in my own personal finances, thinking about the ways that I'll eventually run a corporation through my medical practice or something like that. But what I started to notice is just the lack of any financial topics, discussion, or education at medical school. And then I realized I have friends around me that didn't necessarily have that same mind. And I said, Well, why don't we start talking about this stuff more? What? Why is this something that's never spoken of? The preceptors we work with don't really talk about it. And sure it maybe doesn't apply to us immediately as a first-year medical student, but eventually it will. So, when will this part of our education come into play? And I speak to people higher up than me, doesn't really seem like it's ever happening. And then I said well, you know, between studying and doing other things I kind of like finance and I probably know enough that I can make a few Instagram posts, so I start Budget Your MD is the name that I call it, right? And start to make little infographic posts and see how it goes. And at that time, it's still slow growing, and students are slowly finding out about it. But what I find is, as I go through each year of medical school, I'm able to see the questions, and topics and interests that students would have at that time. Like, I'll give an example in first year, it's the line of credit, like, what does that mean? I all of a sudden have been given sorry, $350,000 from a bank. What does that look like for me as a medical student? What is interest? How does interest even work? And you know, which bank offers the best package? And so that's kind of what I've used as an area to at least keep people interested on things that they're currently going through. And as now I go into fourth year, I realized disability insurance questions like that. Things that come up that are these decisions that require a little bit of financial savviness to understand, are being put on people's plates, right? Dr. Kevin Mailo 05:58 I love that and so, you know, what are some of the big issues that and let's go a little bit beyond medical students to, you know, residents to fellows, people in early year practice. What are some of the struggles that people face in these early years? Because I think the big one for medical students is blowing through that line of credit, right? I remember, when I went through, it was low, ultra-low interest rates following the financial crisis, right? And so it was like how wasn't that bad, but interest rates have gone up massively, right? And so we have learners that are struggling with the thought of this interest piling up. But we also have a lot of physicians who have personal lines of credit used for consumer purchases, and it went from being tolerable to being very painful. If you think of it this way, and there's just little thing, and then we'll get back to the interview. But if you have a personal line of credit that you used for whatever home renovations or consumer purchases, whatever it is, and that line of credit is $1,000 a month of service, it's like $2,000, having earned because you have to pay personal tax on the money that you're going to use to service your line of credit. So, that's a really big hit. That's like working, you know, a whole long, busy clinic day, at a minimum, just to service that line of credit without even paying down the balance, right? So people are starting to feel the pinch of interest rates. But let's go back a little ways. And just talk me about what it is some of the issues that you see in you know, people that are now going through residency, although there's a little bit of income coming in, but there's a little bit of tax planning that has to start to begin. And also like in those early years of practice? Christian Wigmore 07:40 Yeah. It actually reminds me of, I spoke with, I think it was the residence of doctors of BC when I think one of their whether it's the president or not, he showed me a presentation, at one point about the debt levels that residents have, when they start residency, this might just be BC specific, and when they end. And my thought had always been well, it would go down, right, like they finally started. Like you should be able to kind of work it down a little bit. 50% of it goes up, but of the students, 50% of residents will have more debt when they finish residency. And so things that mean, you have always talked about, but like, let's think it's got to be something rather than actually needing the fancy car or needing something. It's a mindset, potentially that's causing people to do this. Now, we always have to, like put in disclaimers, there's family circumstances, things that are out of– Dr. Kevin Mailo 08:33 Yeah, I mean, when you're like in my household, when we were both going through medical school, we paid the nanny more than I made. Because we were both working like 80 hours a week and we had young kids and she was hitting overtime by Wednesday afternoons. So, yeah, you're right there, family circumstances, totally. And personal circumstances. Christian Wigmore 08:51 There's potentially a mindset, right? And I have this funny little line that I heard from a physician at one point, and it goes, “If you spend like as a doctor, when you're a student, you'll live like a student when you're a doctor.” And that one hit me right away, right? Because it's that thought that if you blow up the line of credit through medical school, and you finally get into practice, and you think that pearly white income that you'll eventually earn will pay it all off, you start to realize that all that spending you did as a student, basically wrecks any of the beauty of having a higher income, I guess, as a doctor, eventually. Dr. Kevin Mailo 09:26 And there's a huge tax penalty now, right? Like, that's the other reflection I have, you know, in your generation compared to mine, like, I mean, and it was even better years ago. But, you know, I graduated like 15 some years ago, it have been 10 years in practice. So, what am I, totally getting my numbers wrong. It'd been 10 years in practice, but like I was, you know, at a place where like, we could pay down the line of credit relatively easy with income splitting through the PC, and dividends to spouse. Personal Tax rates were lower and now it's different. And the cost of living has gone up, right? So, your base cost for food, clothing, shelter, transportation has gone up. So, there's less and less margin to pay off personal debt, right? Between taxes and the cost of living. And you're right, it's so critical to get this right in the early years of practice. Christian Wigmore 10:20 Yeah, and I feel like what we're talking about here is just it's like, it's personal financial management. Like we're, there's kind of like, there's personal finance, and there's like your corporation management, all that fun, financial things that like we could all learn as doctors, but it's the personal side, the personal financial management that's so important. That could begin right as they get into medical school as they go through medical school, into residency, and then into practice. That is honestly the saving grace that appears like these days to save you from some of the hardships of feeling like you have to go to clinic every single day, or work that extra call shifts to pay for all the luxuries that have kind of built up over time, right? And so that's what I think of as like the end game in a sense when I see myself and I see the students around me of thinking about what do the decisions that we make right now as students and kind of the habits in a sense too that we make right now as students and the expectations that we make about what it'll be like when we start to make money. How that will actually impact our career, and how we can still be as healthy as possible as doctors in not only our lives as physicians serving our patients, but also in our financial lives, right? Dr. Kevin Mailo 11:35 I couldn't agree more and it's so important to get that alignment right. Between what are your career goals and your personal goals, right? Because if you say, you know, I want to be healthy, I don't want to work in excessive number of hours, I want to minimize the number of call or night shifts I'm doing or whatever, or clinic days I'm doing in a month. Well, you have to have financial goals that align with that. Because if you don't, well, you know, I mean, your mortgage company doesn't care. You know, what, how many hours you want to work in a week that mortgage comes due every month, right, or the grocery bill or whatever else you're facing. And so it's again, it's being holistic in our lives, and looking across and seeing Okay, well, what do I really want? And then what financial decisions am I making that align with it? Especially the big ones, right, like mortgage and those kinds of things, like the big permanent purchases. Christian Wigmore 12:30 Yep. Yeah. It's interesting and I think it like it ties in to, you know, we are offered this $350,000, when we've never had money before, there's like that aspect of like, quickly, your life-changing in the financial world. But then I assume, you know, I'm still like, early in the game, but I assume the moment I start making an income that is substantial enough, the bank's gonna come to me and say, Hey, here's this fancy mortgage, you can have it and but this million dollar house, and they make you feel like you can afford it. Because, in a sense, if you're willing to sell your life, you can, right? And it's those trip falls are like the traps that I think are just so important to be educated on as we're going through, to be aware and know the implications, right? Dr. Kevin Mailo 13:13 And this is also another thing that we teach us at the conference. And I alluded to this, you know, when you were there as well Christian, is the notion of an hourly rate. Every one of us has an hourly rate, what we're worth per hour what we can bill. Remember that there's a tax penalty associated with that, right? So, if you're, you know, if you're billing $300 an hour, your after-tax income on that is actually going to be substantially less. So, when you say, how many 1000s of dollars do I have to pay on a mortgage every month and property taxes, and utilities, and maintenance, and repairs, and vehicle payments? Well, now you can actually calculate and, you know, I'm happy to show anyone that's interested, how many hours in a month you're gonna have to work just to maintain those big expenditures, right? And then how many hours are left for fun? And the bigger one is, how many hours are left to save for retirement? Which again, the sooner we start, the sooner we are better off. But if we if you know, we're struggling for 5 or 10 years to pay off a line of credit, then we've already really short in the compound growth curve, which is so vitally important not to do. Christian Wigmore 14:25 Yeah, and something that like, is underrated and not maybe spoken about as much is student loans nowadays, like the government has announced that they're not charging interest on those. So, we already have it easier than the previous like, the generations before us, right? Like my student loans right now, if things don't change, I don't pay interest on it ever. Like I just have to make the minimum payment and it doesn't go up over time. Like that is a huge advantage. Dr. Kevin Mailo 14:50 That’s a good deal. Christian Wigmore 14:51 I know, yeah, pretty sweet. Yeah, almost say thanks to the guys over the line that did it first and then Canada felt like they had to follow suit, but like, yeah, the only interest-bearing debt that we're going to have coming out of is the line of credit. And you have to jump into that a little bit to pay tuition, the student loans never cover it fully. But it is still a variable cost in my mind of kind of your lifestyle and things like that, that really push that number up. Dr. Kevin Mailo 15:18 It totally. And I mean, I'm sympathetic to it as well. I mean, you know, when you consider, you know, broader, you know, sort of North American or Canadian society, there are very few people that are forced to delay gratification the way doctors are. Like, some of us go a decade or longer in school. In fact, it's actually much longer some of us regularly go like 15 years from undergrad to practice. Like that is a very long road, right? And it's natural to want the nice things in life. Right? You actually do deserve them, right? The message here isn't, you know, that you've got to live this extremely austere existence, that it's craft dinner and ramen noodles every night. No, it's, there's just got to be some balance, right? Because there's a very real cost to that lifestyle creep and remembering that if we're 10 years behind the average adult in entering, practicing and earning in our prime, it's also 10 years that we've lost on the compound growth curve. Again, it's another big impact. Christian Wigmore 16:25 Yeah, I've used the example sometimes with students, as we kind of talked about our debt of what would it look like if you just became a red seal electrician right off the bat, and you saved 15% of your income over time? The amount of time it would take us as physicians, who are thought to have made/make so much more money than a red seal electrician to catch up to that person is incredible. I don't know the math in my mind, I'm not that much of a whiz. But like, it would take so long to catch up to that person for the compounding that they would achieve over those years that we're studying. Yeah. It blows my mind sometimes. But that just only solidifies the point of just good, sound, basic financial knowledge, just for basic, like, you know, your own finances, things like that. Dr. Kevin Mailo 17:10 And the other reflection is, you know, again, another observation about younger generations coming through, they don't want to work the 70-80 hour workweeks that older generations of physicians have worked. And I actually think that's a wonderful thing. I think that's an example to the entire profession, that we should all be working fewer hours. The job is stressful, we deal in people's lives, and more should be spread, more duty should be spread across a larger group of physicians. Absolutely, right? It shouldn't be two rural physicians holding up a town, you know, in a remote part of Canada. It should be four, do you know what I mean? And this applies everywhere across our healthcare system. But again, if we're going to cut back those hours, our finances have to align with that broader goal. And so it's about like being mindful and intentional. And reflecting on what do we really want our ideal work week to look like? Because yours was actually very interesting. I really liked yours. You don't have to share it. But it was great. It was really balanced. Christian Wigmore 18:14 Yeah, I'm happy to share like my dream in the future. Like, I think, first and foremost, for myself, like this is getting a little bit more personal into how I feel. I'm like a family man first. I've always been that way. Like, my dream is to be able to go to my daughter's soccer– Dr. Kevin Mailo 18:27 I love it. Trust me, do it all. Christian Wigmore 18:29 –basketball game. Like that’s– Dr. Kevin Mailo 18:27 That's wonderful. Don’t miss any of those moments. Sorry, I’m going on and on. Christian Wigmore 18:34 –I want to be able to drive my son and his buddies to the basketball game and hear them get hyped up to some Eminem or something on the way to the game. Like I want to be there for those moments, right? And so I think like, if I could work clinic two-three days a week, and then have two or three days a week that are more flexible, that they could be, you know, those moments with my kids, or be moments where I'm getting to pursue Budget Your MD and kind of push those things forward. Dr. Kevin Mailo 18:58 A passion. Christian Wigmore 19:00 Yeah, exactly. That gives me the balance, right? That allows me to really be the doctor, I want to be on those two to three days. And then be the dad I want to be hopefully, be the husband I want to be, and then still kind of use that other part of my brain that sometimes has to be shut off at times. Right? Dr. Kevin Mailo 19:15 I absolutely love it. What an inspiring message. So okay, let's tell us a little bit more about Budget MD. We touched on and then we went on on all these tangents. Tell me a little bit more like what what do you do right now with it? Christian Wigmore 19:31 So, the thing that I would say we provide or I provide the most value on is something I call the debt projection tool and I know of honestly centers around everything we talked about today. And I made it originally for myself, I was just interested, okay, if I have this much debt currently, and say I want to go into family practice, which is what I want to go into, or what if I want to do internal med or ER. What would those differing incomes look like in terms of eventually being able to pay off my line of credits, my student loans? Like how long would it take me to get to financial independence and if I want to save a little bit along the way? And so I took some Excel courses through my business degree and know three or four formulas. So, it's not the cleanest Excel spreadsheet in the world, but it works. And what I allow myself to do is to plug in, okay, this is my age, this is the specialty I might think of doing. And I even have like the house I may want to buy it some age, the interest rate that approximately it could be at at that time, and the downpayment, I could approximately have, and I even have in there, how many kids I would want to have. I just do an average, I think it's like just under $14,000 a year for a kid from the age of like, zero to 18. I've never been a parent before, so, I have no idea. That's what I found on the internet, right? So, maybe it skews a little bit more expensive into the later years as you're paying for universities and stuff if that's something you want to do versus the beginning. But you can correct me if I'm wrong there. But basically, the goal of this tool is to help what I find to be two groups of students. And this is what I get passionate about, there's students that are, A. super worried about their finances, like I've met a few that like, I have so much debt, I'm never gonna be able to pay it off. Dr. Kevin Mailo 21:09 That was me. Christian Wigmore 21:10 It's hurting their ability to learn. And I'm like, you're gonna be fine. Like, you actually need to be told that, like you're doing a great job, and like be able to move on with just learning and know that things are going to be okay, that's one group. And then the other group is the, oh, I'm going to be a doctor one day, it's completely fine. Yeah, I do DoorDash every single night because like, you know, we'll make a good income at some point and pay it off. And so it's those two groups that fill up this debt projection that I have, and kind of give their example scenarios. And I can show them well, okay, person A, that's worried about their life, you're going to be okay. You're like this is kind of your projection, approximately, like none of this is exact, but it gives them an idea that the debt will eventually get paid off and kind of eases some of their worries. Group two sees on their projection that with their current debt and spending, the curve only just continues to go up, it's almost like, you're not going to be able to pay all this off. And coincidentally, they're the people that say they want to buy a $3 million house, and then that mortgage payment really causes the curve to continue up as well. But it, my goal with that is to just start the conversation, right, is to get that part of there, get the light switch moment to go and realize that, okay, the current habits and mindset I have, are maybe a little bit off from what I need to currently be doing to make sure I'm setting myself up to succeed, not only as a physician, but in my own independent financial life. Dr. Kevin Mailo 22:39 I love it. Christian Wigmore 22:40 So, that's my big like, that's the one I really have fun with because I kind of like Excel, and they send over the projection, I do it completely for free, and I send it to them. And then I offer them 30 minutes to chat about it too if they want to. And so, that's been super fun. It's kind of an extra thing I'll do in the mornings or the evenings, I'll fill those out for people. It's not AI-generated at all, at this point. So, I'm still collecting some things together on my own computer, but I'm one of those rare breeds that likes to see an Excel spreadsheet. So Dr. Kevin Mailo 23:10 Yeah, I love it. So, where do you want to go with it? Right? Because obviously, we're gonna hear more about it. You're in the early stages. Where do you want to go with it? Like, what's your dream, in terms of the profession? Christian Wigmore 23:22 Yeah. So, my dream, in terms of the profession would be to like, almost not solve but help in the world of, you're gonna get my mind going too fast here, Kevin, when you ask me what my dreams for this thing like, it's so like– Dr. Kevin Mailo 23:41 No, no. Like, I just did a podcast episode on dreams. It'll come out before this one. I'm a very big believer in being open about our dreams. So, talk about your scope. Christian Wigmore 23:55 So, like a broad dream would be to change the way that financial education is brought into the medical programs across Canada. Like let's start Canada first, we don't need to go worldwide. I don't need to dream that big. Like if we could somehow incorporate financial education into the undergraduate medical degree, and whether that just be evenings or a lunchtime money talk or something to not only help students become aware of the pitfalls as they transition into residency and practice. But also just to be aware of kind of the habits that we've been speaking to a lot over the past, I don't know how long we’ve been– Dr. Kevin Mailo 24:37 I love it. Yeah. Christian Wigmore 24:40 So I mean, that's the number one goal, right? And then after that, like, I hope that that could evolve into like a better community in medicine that is willing and I think Physician Empowerments already absolutely spearheading this, but a community where doctors feel more safe to talk about this stuff, right? Like, it's rare, like as a student, have I ever had a preceptor bring up, you know, billing or how they're like clinic rents and stuff like that? No, I haven't. And if there could be a community where students can ask about this stuff, where people further down the line can give advice about these are the some of the mistakes I made as a student. And that doesn't have to be like physician to student that can be, you know, 20 years experience position to first five years practicing physician, just the space like that would be awesome. Just to provide that advice and care almost for the future generation of physicians. And I think in general, the dream, like, macro of all of that, is that that could then some, in some way help aid like the issues that we see in medicine as a whole right now, like the burnout issues, like that's the big word. Dr. Kevin Mailo 25:48 Oh, without question. Christian Wigmore 25:50 And I think me and you align on this that, like if personal finance, can be focused on more and physicians understand how that binds them, I think we can, hopefully, turn the dial a little down on the burnout rates. And that's the goal, right? Like, that's the hot word these days. And in medicine, practicing physicians is burnout, right? Dr. Kevin Mailo 26:10 Yeah, I'll just go on, I'll go climb on my, you know, pedestal on this one and go. I teach wellness, right, that's one of the things we teach at Physician Empowerment, and I've done CME events for it. And I'm going to be blunt. I mean, you can do all of the mandated wellness modules online, that the system tells you to do. You can do yoga, you can journal, you can meditate, I do all of those things, you can do all of that. But if you are unhealthy, working 70 hours a week, no amount of extra stuff you do is going to make that better. If you're healthy number of hours a week is 40, then you just have to come down, the only way to come down is to be financially secure. Financial Security underpins all wellness, in our profession, in my opinion. The other big one, and we sort of touched on this before we started recording, was leadership. When we want to transform the system and make it better for our patients, better for us, better for our allied health colleagues, we need to be involved. We need to be able to sit on those committees, we need to advocate, we need to be a voice, we need to be present, truly present. That will only happen when we're cutting down on 70-hour work weeks, and we have a little bit more balance to get involved. Again, truly believe that and again, that is underpinned by financial security. Christian Wigmore 27:37 Yeah, and, you know, it almost feels odd as a student right now talking to a physician who's current practicing to like speak about this financial stuff, because it almost feels weird, to be honest. Like we're doctors. And I think at the conference, Wing spoke about this, about where there's this altruistic mindset that's kind of ingrained in us that we're supposed to just work like crazy and not think about the finances, because we're serving, and I 100%, like, have that heart to serve. But I think it's gotten to a point these days where like, you have to start to think about that weird financial pit in your stomach because it has all these implications we've been speaking to, right? Dr. Kevin Mailo 28:16 You will do your best care when you are not burnt out, when you are not exhausted, and when you're not overbooked and worrying about the overhead. That is what your patients deserve. A rested physician who is in control of her/his schedule, that's what's so powerful. And that's what will lead to better patient care. So, to serve, it means to serve ourselves first or to be to be our healthiest first is in my opinion. Christian Wigmore 28:42 Yeah. And like, honestly, Kevin, I appreciate you saying all that. Because I think that some of the mindsets I've come to I would never be able to come to just as a fourth-year medical student, you know, learning– Dr. Kevin Mailo 28:54 It's hard to talk. Christian Wigmore 28:55 Yeah, it is. And like, No, there's no medical student out there that's thinking about these things. We only hear of it from people like you and Wing and all these other physicians that are starting to talk about this stuff that we can begin to create some of these ideas of important topics and frameworks that it will matter later down the road. But what's so awesome about this conversation is that hearing them then allows you to have the advantage of applying them early. I think that's the key that I get excited about. Because talking about them, you know 10 years into practice is awesome and super important, has a role but there's such an advantage to thinking about it or like– Dr. Kevin Mailo 29:32 I couldn't agree more. I couldn't agree more. Christian Wigmore 29:35 Because you're making lifetime decisions. Even the specialty you go into like that's bigger than the house you end up buying, the house you end up buying it's high up there too, but the specialty end up choosing, like think about this stuff like it. That's your life like you're signing, we're all in medicine to– Dr. Kevin Mailo 29:50 It's very hard to retrain. Christian Wigmore 29:51 Think about your life to go do that, like be ready. You know what I mean? Dr. Kevin Mailo 29:52 Very hard to retrain. I'm envious of our nursing colleagues who are able to cycle through different aspects of nursing over the course of their career in health care. Because we really struggle with that in medicine, it's very hard to retrain, and understandably so I mean that there has to be a lot of technical proficiency. So, I thought this is absolutely amazing. I would encourage listeners to check out Budget Your MD. I know more is coming from you, Christian. That's why we want to bring you on the show because this is going to be a lot more than just medical students and residents, right? I think all of us should be going through this exercise. So, get building those spreadsheets, no I’m just bugging you. No, we look forward to the other offerings that are coming. And you do so much education as well. I know over Instagram and other other places. So, I again, encourage people to check it out because it's the what you teach is so true. And it's been great connecting, and great having you on the show. So, we'll we'll definitely have you on again. Christian Wigmore 30:49 I appreciate your mentorship. Thanks for having me on. It's been so good to chat about some of these things. Dr. Kevin Mailo 30:54 Wonderful. Dr. Kevin Mailo 30:56 Thank you so much for listening to the Physician Empowerment podcast. If you're ready to take those next steps in transforming your practice, finances, or personal well-being, then come and join us at PhysEmpowerment.ca - P H Y S Empowerment dot ca - to learn more about how we can help. If today's episode resonated with you, I'd really appreciate it if you would share our podcast with a colleague or friend and head over to Apple Podcasts to give us a five-star rating and review. If you've got feedback, questions or suggestions for future episode topics, we'd love to hear from you. If you want to join us and be interviewed and share some of your story, we'd absolutely love that as well. Please send me an email at KMailo@PhysEmpowerment.ca. Thank you again for listening. Bye.
	30 Sep 2022	03 - Investing and Delegating with Dr. Dimitre Ranev	00:19:44
Kevin Mailo, co-founder of Physician Empowerment, talks with another fellow co-founder, Dr. Dimitre Ranev, about finance and investing. Dimitre is also co-host on the Primary Medicine podcast and along with being a practicing physician, gives talks on stocks, tax planning, and the like. Dr. Ranev acknowledges that he wasn’t always knowledgeable about financial health. He credits Kevin with spurring him into the initial research which is when he discovered he had an affinity for it. He invests in equities, crypto, and is looking at moving into real estate as well. While he manages his portfolio himself, he stresses that not everyone is equipped to do so or will enjoy it. In this episode, Kevin Mailo and Dimitre Ranev discuss the journey towards financial savvy and how wealth is about more than simply money. While Dimitre enjoys managing his own finances, Kevin does not, and they encourage anyone who would rather not stress about their investing to delegate that task to a professional. Every successful athlete has a team behind them and according to Dimitre, physicians are no different. It’s just as important to care for your mental health and the wealth of your well-being by putting your best support team in place. About Dr. Dimitre Ranev: Dr. Dimitre Ranev is a family physician based out of Ottawa, Ontario, and Gatineau, Quebec. He is a faculty lecturer at McGill University. He is a gifted teacher known for engaging his audience with clear, concise explanations. He is passionate about financial education, as it is the path to personal and professional freedom. Resources discussed in this episode: Primary Medicine podcast 'How is my Financial Health, Doc?' podcast by Vu Kiet Tran — Physician Empowerment: website \| facebook \| linkedin Dr. Dimitre Ranev \| Medical Doctor / Faculty Lecturer at McGill University: linkedin -- Transcript: Kevin Mailo Hi, I'm Dr. Kevin Mailo, and you're listening to the Physician Empowerment Podcast. At Physician Empowerment, we're focused on transforming the lives of Canadian physicians through education and finance, practice transformation, wellness, and leadership. After you've listened to today's episode, I encourage you to visit us at physempowerment.ca - that's P H Y S empowerment.ca - to learn more about the many resources we have to help you make that change in your own life, practice, and personal finances. Now on to today's episode. Kevin Mailo Hi there. I'm Dr. Kevin Mailo, one of the cofounders of Physician Empowerment and one of the cohosts of the Physician Empowerment podcast. And I am so excited to bring to you today another cofounder/cohost, Dr. Dimitre Ranev. And Dimitre is very close friend of mine. We did family medicine training together all those years ago at McMaster family practice in downtown Hamilton. It's been a lot of years of friendship, and starting Physician Empowerment together and podcasting together on the Primary Medicine podcast. And so I'm so excited to launch our newest project, which is the Physician Empowerment podcast. So Dimitre, why don't you introduce yourself, share a little bit about yourself, talk about your practice. Tell us a little bit about who you are. Dimitre Ranev Yeah, sure. So that's still my practice first. Currently, I practice in both Quebec and in Ontario, I live in Ottawa, but I cross the bridge to Gatineau, which is the small town across the river. And I am a family doctor but I found a niche, which is that I do trans care and sexual health. In fact, I teach those topics at McGill University as well. So that's my sort of my medical hat. In Ottawa, I work for Executive Health, I'm part of the Telus Health team, where I get to meet executive people and actually do the good old medicine, you know, spending half an hour with somebody, forty minutes, new preventive care, which you don't have time to do anymore. But at least I get to do that in Ottawa. And I learned a lot from these people, because they're executives, they're motivated and talking to them is always very illuminating experience. And there's a lot of wisdom. So I'm very fortunate to be exposed to that as well. But I'm also involved with Physician Empowerment. I'm also involved with the Primary Medicine podcast, I love podcasting. I love talking to people. I love learning things from people. And that's why I'm excited that we're starting this because we have a lot of interesting people to talk to. Colleagues and so forth. Kevin Mailo Yeah, there's so much there. So we graduated over 10 years ago, we entered practice over 10 years ago. Why don't you go ahead and tell us a little bit about your financial journey. So you educate in finance, you are, you know, a teacher in finance. And Dimitre, for those of you that have not been to one of our conferences, does some incredible talks on tax planning, as well as the markets. So equities, bonds, crypto, you do so much, and you know so much, but I know you weren't always there. So why don't you go ahead and share a little bit about your journey on that path to finance. Dimitre Ranev Yeah, so it's interesting. The path to finance was spurred on by you. Because before the idea of the Physician Empowerment came up, my financial background was put your money and cash in the bank and collect interest. That was my retirement plan. But when you sat down and said, listen, we need to do this project. Doctors are not financially literate. And this is an issue because it's affecting their livelihood and retirement. That's when I sat down and started looking at investing, looking at investing in stocks and bonds. And I love this stuff. I was like, I was skeptical. I didn't think I'd love it. I don't know, maybe you felt something in me because you asked me to do this part of the of the talk. But I was so immersed. And you know, I made this huge presentation. And it I felt like that was me, like teaching this and understanding this was me, I felt in the flow of things. And you know when you work on something, and it doesn't feel like work. That was me when I was doing that. So I thank you for all this financial education, I wouldn't have started that journey unless you had spurred it on. But I feel like it's something that I love doing. I love teaching as well. Kevin Mailo Yeah. And so you've done a ton. Like I said, you give this great talk on, you know, tax planning, you know, understanding the taxation system, which many of us do not understand. And these are things that none of us gets teaching in, throughout our med school and residency years. And unless you really go out and seek that information, you just don't know. And it's scary how much you don't know that you don't know. That was kind of the eye opener for me in finance. And I think that was probably it for you as well, Dimitre. So, you know, you're known nationally for your work as a financial educator of fellow physicians. Tell us about your own personal financial habits, right, you know, in terms of whatever you feel like sharing in terms of personal spending, and investing, crypto, some of these spaces that you've been in. Dimitre Ranev Yeah, of course. I think one thing that I really want people to understand is that your investment journey is very personal. And you have to find out what works for you and what works for you may not work for everyone. And that's why it's important to talk to people and see what they're doing and learn from them. But personally, you know, I started off investing in mutual funds before I realized that perhaps wasn't for me. And currently what I do is I have an investment portfolio in crypto because I'm a millennial and that's what we do. And as I said in the conference, it's great practice for not freaking out, because crypto goes down 30% one day, and that's okay. So it's training, it's training to be strong, and not sell when you shouldn't. But most of my investments are in equities. So I do dividend investing, I do investing in index funds, and I use some technical analysis to try and, you know, have more control over when I buy and sell things. So that's most of my investment journey. I'm looking into investing in real estate, actual real estate, as well, because I think it's it's important to diversify, and have something more physical than, you know, ETFs and dividends, and also invest in precious metals. So I've touched a bit of everything really. I really have to get into real estate more, but I've touched a bit of everything. Kevin Mailo That's outstanding. Yeah. And for those of you, again, that have been to our conferences, you'll know that Dimitre and I have this nice little rivalry between real estate and the public markets, going back and forth, because I really believe in real estate, but I do invest in equities as well. And so, Dimitre, you know, you manage, you day trade, or, well, I don't even know if I'm using the term correctly, you manage your own portfolio, right? You do self directed investing. Many physicians do it, but I can share with you, you know, having done this for years, many physicians do not do it well. yeah. And one of the things that I struggled with, when I briefly tried this, was, here I am working an exhaustive shift in the emergency department, I am out of mental bandwidth to spend analyzing, you know, my stock portfolio and trying to make plays here, right? And I just found that I was frankly tired and didn't have a head for numbers, still don't have a head for numbers, and ultimately delegated this off to a very high quality manager, which I am so much happier for. But I know there are physicians that are still trying to do it themselves because they want to save on fees. My own opinion is I don't necessarily think that's wise, not only in terms of, you know, the returns or potentially protecting you against some downside losses, like we're seeing this year on the market, but more just in terms of like, personal wellbeing, and work life balance, like do you really want to go and do a second job after your clinical work, managing your stock portfolio. But I know, Dimitre, you do this, and you do it very well. And you're respected for your work in this. Tell us a little bit about how you do it, right, like your headspace, you know, how you create time to do it, how you manage risk, which I think a lot of physicians struggle with as well is tolerating risk in their portfolios. So why don't you share a little bit about your perspective or your philosophy? How about that, in this space of self directed investing? Dimitre Ranev That's a great question. And I would start by saying, what's really important is to know yourself, and to realize that doing your own investing, or self-directed investing, isn't for everyone, even though people tell everyone, you should do this because your fees are low. If you can't find the time to do it, then it makes sense to pay an extra fee for somebody else. If you don't enjoy doing it, or if every time you open your account, you're having a panic attack, then paying the extra fee to somebody to help you is fine because I realize that you need to have a team just like you know, an athlete has a team, right? They have doctors, they have psychologists, we have to have a team as well. And part of the team is somebody who helps with financial planning. It could be yourself if you like doing it, or a financial advisor or even a portfolio manager. So again, people need to realize that self-directed investing isn't for everyone, even though it's sold for everyone, it's not. In their headspace I'm in, I don't do day trading, by the way, that's a loser's game, unless you are really smart and you can do that for a living, you're not a doctor. You could say that I do swing trading or I mostly do trading on long periods of time. But it's about having a habit. It's about saying, I'm going to check the portfolio a specific day every month, I put it in my calendar, and it's the thing I need to do just like brushing my teeth or going for a run and exercise. And after a while you do that you have to have a habit, some kind of headspace where you're saying once a month, I'm going to check the portfolio, twice a month, I'm going to check the portfolio and you do it. And the thing is, the more you expose yourself to this the more comfortable you become and the easier it is. But that's my headspace. And that's not everybody's headspace. Again, you don't enjoy that. I don't think you would enjoy checking your portfolio once a month, right? So if you don't enjoy that, don't feel like you should be forced to. There's people that can help. And, again, how much is your time worth? Kevin Mailo That's the big one. Dimitre Ranev How much is your time worth? Yeah. It is that extra fee of 1% worth spending when you can be doing something else you enjoy, right? With your family or going for a run or going on vacation. Ask yourself that. I've learned that the hard way. Stuff I don't enjoy doing I just delegate now. I don't, I delegate, I don't enjoy doing some things. And I'm like, well, somebody else will do it for me, Kevin Mailo And that, for myself personally, was a big growth step. But as physicians, we tend to micromanage. And I think it's a very good thing, when it comes down to procedural work, making sure that we're really taking that history carefully, getting to the diagnosis, looking real carefully at that CT or whatever. I get that, that's important, that's what we're trained for, that's we have to do. But when it starts to, you know, spread to other areas of our life, it can be really counterproductive, right? And, you know, hospital based physicians, we work with a whole team. Everybody from our registration clerks, to, you know, our cleaning staff, to our nurses, to nurse practitioners, we're all part of a team. And there's an element of delegation across all of that, you know, and people delegate up to me, or I delegate down to them, or whatever. And in our financial lives, it should be no different. And the really sophisticated investors, the really high net worth individuals, on the things they don't understand or do not want to do, and don't have the mental bandwidth to do it, they actually delegate out. They're happy to pay somebody... Dimitre Ranev 100%. Kevin Mailo They're happy to pay somebody to make them more money. And I learned that the hard way in real estate, I used to manage my own doors. And my goodness, was that a lot of work. And I am so past that, right? And so much happier. Right? What I'm paying in management fees on my doors, way better than dealing with these things myself. So this is where delegation just isn't about creating wealth. It's about building a better life, because if you're not enjoying your life right now, then, like, what are you doing? Right? And that was the question I looked in the mirror and asked myself a few years ago. Like if I'm not happy now, when am I going to be happy? Delegation has been a big part of that, especially in my financial life. So I like sharing that. Because I think that's important. And many physicians struggle to get out of that micromanaging mindset. Dimitre Ranev It's, yeah, we we do. And to me, it was a revelation as well. And it was through Physician Empowerment that it sort of... and from listening to people talk actually, again, in my executive health position, we have time to chat. And that's one thing that people say: delegate. Why am I happy right now, it's because I'm not dealing with every little thing. These guys have a team of 200 people under them, right? They can't deal with every little thing. They cannot micromanage, they'd go crazy. So it's something that you need to sit down and ask yourself, what can I do? What is possible in terms of my financial health? And if it's, and if I'm not comfortable doing this, finding somebod. There's lots of people that can help: financial advisors, portfolio managers. Kevin Mailo Great accountants, tax lawyers, there's so much out there, like a bookkeeper, right? You know, small things like that. You know, that make such a big difference in our financial lives. Dimitre Ranev I was listening to a podcast, a financial podcast about Tiger Woods. And it just, again, he has such a big team. Like he's a talented person, but he's talented enough to know that it takes a team to make this athlete, it takes a team to make a good doctor. Again, you don't want to be in a position where you're doing your finances, you hate doing it. And because you, something that happens, the stock market goes down 20%, you make a medical error because you're thinking about that as opposed to thinking about the patient in front of you, right? Kevin Mailo Yeah, I remember that actually vividly from the 2008/2009 financial crisis. And I remember having preceptors that just couldn't get off their computers, constantly glued to their portfolios, constantly thinking out, you know, they were late walking into the room to go see a patient and remember, I was young back then, right? Like, I didn't have any money, I had debts, right? Is there any chance you're gonna wipe out my debts? Like, that's all I was thinking. Maybe the bank will crash and I don't have to pay those hundreds of thousands of dollars, right? That was the one hope I had. You know, and I remember, like, watching it affect them. And so these are the things that we need to be mindful of, right? Like, our success in our clinical careers really depends on where our headspace is. Dimitre Ranev Exactly. Kevin Mailo You know what I mean? And this is why Physician Empowerment is so much more than money and why we talk about wellness and practice management. Because, you know, when we are really, really working in internal harmony, we're very successful in our professional lives, and successful in our financial lives. And so being mindful of the effect of our finances on our practice and personal lives is so, so huge. It really truly is mindfulness. Dimitre Ranev It is. I think I'm gonna just end by saying, and I was talking to Vu and he said something really, really important. You know, how he talked about tests having specificity and sensitivity, right? Kevin Mailo Yeah. And sorry, let me let me just reference this is Vu Kiet Tran. Dimitre Ranev Great guy. Kevin Mailo Yeah, he's got his own podcast. He's an ER doctor based out of Toronto. But anyhow, continue. Dimitre Ranev So tests have specificity and sensitivity. But doctors have specificity and sensitivity too. If a doctor is irritated, or in a bad mental state, his specificity for diagnosing something is not good. Like if you didn't sleep last night, because your portfolio cratered. And you're thinking about that you're not, you're gonna misdiagnose, right? You have your own specificity and sensitivity. So you have to take care of that. So you know, that's funny that going through this investing journey, that's what I learned the most, is just being mindful. Just being mindful, because the stock market is a brutal mistress. It's going to spit you out. It's going to tell... you know, you have this ego as a doctor, right? Like, I'm always right. The stock market doesn't care. She doesn't care about your feelings. It's a great educator, I think, if you can stand it. And I think it's been very productive in terms of making me more mindful and a better person. But if you don't enjoy that, you can learn this harsh thing other ways. So get somebody else to do it for you. I think that's my biggest advice. Be true to yourself. Sit down, ask yourself, do I really need to do self-directed investing? Do I enjoy it? Or can I find somebody else? So that's the first thing you need to ask yourself before you go into that. Kevin Mailo Yeah, exactly. I love it. Absolutely love it. So listen, I think we're there. I'm not gonna keep you any longer. I absolutely love the episode, really excited that you're going to be hosting, you know, and bringing so many great stories, so many great experts forward to talk about finance. Dimitre Ranev And, again, you see, they have their own personal journeys in investing. And I'm hoping that our audience can pick some things from them, and do things like they do, and see what works for them. Kevin Mailo And there are many, many paths to wealth and financial security. So don't feel like you have to follow somebody else's. Dimitre and I have very different paths to financial security, and we're both doing great. You know, but I'm hoping to come over to a little bit of real estate. Dimitre Ranev Yeah, I'm coming over. I'm coming over. Kevin Mailo Yeah, I know. I know. Dimitre Ranev I'm a believer. Kevin Mailo Finally, finally, after years and years. Dimitre Ranev What, seven years? Yeah, seven years. Kevin Mailo Exactly. So listen, that's it. I just want to thank you. Dimitre Ranev It was such a pleasure, Kevin, to talk to you and all the best. Kevin Mailo Really loved it. Dimitre Ranev Take care. Kevin Mailo Thank you so much. Kevin Mailo Thank you so much for listening to the Physician Empowerment Podcast. If you're ready to take those next steps in transforming your practice, finances, or personal well being, then come and join us at physempowerment.ca - P H Y S empowerment.ca - to learn more about how we can help. If today's episode resonated with you, I'd really appreciate it if you would share our podcast with a colleague or friend and head over to Apple podcasts to give us a five star rating and review. If you've got feedback, questions, or suggestions for future episode topics, we'd love to hear from you. If you want to join us and be interviewed and share some of your story, we'd absolutely love that as well. Please send me an email at KMailo@physempowerment.ca. Thank you again for listening. Bye.
	15 Sep 2024	51 - Insights on Boundaries, True Wellness, and Self-Forgiveness with Dr. Iuliia Povieriena	00:38:21
Dr. Kevin Mailo welcomes Dr. Iuliaa Povieriena as his guest in this episode to talk about boundaries and wellness. Dr. Povieriena is a hospitalist based out of Georgetown in Ontario and also a Lifetime Physician Empowerment Masterclass member. She discusses how she found balance for herself by re-applying her time outside of work to things that she loves like dance and yoga. She and Dr. Mailo talk about how to maintain non-negotiables for personal wellness. The pressure to sacrifice personal time to work is high, especially as a medical student or resident, and the things sacrificed contribute to stress and an inability to carve that time back out later in medical careers. Iuliia and Kevin talk about devoting time to things we love and not striving for perfection in them, necessarily, but simply maintaining the joy of those activities as a way to regulate stress. Setting boundaries around our time, not immediately saying yes to covering shifts, keeping an evening class commitment, and prioritizing family and non-negotiables are all aspects of true wellness touched on by Dr. Mailo and Dr. Povieriena that keep us healthy and engaged in our careers without burnout long-term. About Dr. Iuliia Povieriena: Dr. Povieriena is a Hospitalist at Georgetown Hospital and has been a physician since 2020. She is a primary care physician with a strong interest in inpatient care, and palliative and geriatric medicine. Iuliia finds her work very meaningful and enjoys spending time with patients. She also has experience in GP psychotherapy, which she says was one of the best jobs she ever had. Dr. Povieriena is a firm believer that everyone deserves an equal opportunity to pursue their passion in medicine and would like to express gratitude to all women who have paved the path for the female physicians of today. __ Resources discussed in this episode: “Burnout: The Secret to Unlocking the Stress Cycle” by Emily Nagoski PhD and Amelia Nagoski DMA “Fck No!: How to Stop Saying Yes When You Can’t, You Shouldn’t, or You Just Don’t Want To”* by Sarah Knight 17 Questions That Changed My Life by Tim Ferriss __ Dr. Iuliia Povieriena: Iuliia Povieriena, MD on LinkedIn Calming Chamomile on YouTube Physician Empowerment: Attend an upcoming Empowerment Retreat Join the Physician Empowerment Masterclass now Website: PhysEmpowerment.ca
	15 May 2024	43 - Key Skills as We Grow in Our Practice Lives with Dr. Dimitre Ranev	00:27:15
Dr. Kevin Mailo welcomes close friend Dr. Dimitre Ranev back to the podcast to share some practice lessons learned in the past months. Dimitre addresses the value of delegation to medical practice and for mental health. Physician Empowerment has touched on the topic of delegation before but Kevin believes hearing about a subject that is key to growth from different perspectives is a major factor in determining happiness. Delegation can be a challenge but both Dr. Mailo and Dr. Ranev believe it is incredibly valuable. Delegation, as defined, is the transferring of the responsibility of a task from oneself to somebody else. In studies of health professionals, doctors, and professionals in general, Dimitre found evidence of the advantages of delegating. What Dimitre and Kevin explore is how to delegate, which tasks to consider moving to somebody else, and vitally, who to delegate to. Building a trusted team is the path to being able to delegate with confidence. Having others contribute to getting tasks done increases available time and, by extension, revenue. But it also relieves stress, improves wellness, and allows a focus on the most valuable aspects of the work. – About Dr. Dimitre Ranev: Dr. Ranev is a duly qualified medical practitioner in the province of Ontario and Quebec. His primary practice is in Gatineau, Quebec. He currently specializes in sexual health, LGBTQ+ health, and fertility health. He also provides private consulting for Telus Health in preventative care. He has past experience with home and palliative care as well as Geriatric rehabilitation medicine at Gatineau Hospital. In Ontario, Dr. Ranev has past experience with home care, nursing home care, and student health. He has a special interest in Medical Education being the co-host for the Primary Medicine Podcast and holding a position of Faculty Lecturer at McGill University. __ Interested in going further in your financial journey? Join our national conference and meet the PhE team live in Toronto this May 25 and 26th: https://www.physempowerment.ca/live __ Physician Empowerment: Register for the Physician Empowerment Live Conference in Toronto on May 25 - 26, 2024 Join the Physician Empowerment Masterclass now
	30 Dec 2023	34 - What Time Management Actually Is	00:22:12
In this insightful episode, Dr. Kevin Mailo and Dr. Wing Lim engage in a profound conversation about self-control in time management. The discussion unfolds with a reflection on the evolution of time management concepts from one-dimensional to multi-dimensional approaches. Dr. Wing Lim introduces the audience to the Franklin Covey time management matrix, emphasizing the importance of not just handling urgent tasks but also allocating time to nonurgent yet crucial activities. He delves into the concept of significance, urging listeners to consider the long-term impact and purpose behind their actions. The episode further explores the notion of creating more time tomorrow by investing time today. Dr. Wing Lim introduces the concept of a "permission funnel," comprising permissions to eliminate, automate, delegate, procrastinate strategically, and concentrate on essential tasks. The episode concludes with a powerful reminder of the preciousness of time and a preview of future discussions, including an upcoming episode on delegation—a key component of effective time management. Overall, the conversation serves as a guiding light for physicians looking to regain control of their time and live a more purposeful and fulfilling life. About Dr. Wing Lim In 1993, Dr. Wing Lim embarked on his journey as a family physician, facing immense challenges in his first year. Despite putting in 100-hour workweeks, financial struggles, a receptionist issue, and the threat of eviction were formidable obstacles. Rather than retreating, Dr. Lim embraced these challenges, teaching himself Practice Management and transforming his approach. This resilience and newfound expertise turned his practice from that of a struggling "lone wolf" to the founder of one of Alberta's largest medical clinics. Dr. Wing Lim's story is a testament to overcoming adversity, highlighting the transformative power of learning and adaptation in the dynamic landscape of healthcare. Resources discussed in this episode: Stephen Covey: StephenRCovey 7 Habits of Highly Effective People: franklincovey.com Dragon Dictate: dragondictations.org Rory Vaden -- Physician Empowerment: website \| facebook \| linkedin Dr. Wing Lim/Synergy Wellness Centre: website \| linkedin \| Synergy Wellness Centre -- Transcript: Dr. Kevin Mailo 00:01 Hi, I'm Dr. Kevin Mailo, one of the CO hosts of the Physician Empowerment Podcast. At Physician Empowerment, we're dedicated to improving the lives of Canadian physicians, personally, professionally, and financially. If you're loving what you're listening to, let us know, we always want to hear your feedback, connect with us. If you want to go further, we've got outstanding programming, both in-person and online. So, look us up, but regardless, we hope you really enjoyed this episode. Dr. Kevin Mailo 00:35 Hi, I'm Dr. Kevin Mailo, one of the CO hosts of the Physician Empowerment Podcast, and you guys probably already know that, because that's how I introduce myself every single time I'm on the show. And today, I've got my fellow co-host, Dr. Wing Lim, and again, I think most of you know who Wing is and what he does. And he's the one that leads our master class and does a phenomenal job teaching the ins and outs of high-level tax planning, wealth creation strategies, real estate investing. But there's a lot here with Wing. And that's why I look to you Wing like a mentor because I've learned so much from you, in so many facets of my personal and professional life. And one of the things in my personal life that I learned from you is the notion of time management. And so that's what we're going to cover today. And I'm very interested to hear your thoughts on how it is you've achieved so much in real estate development, full-time practice, a family, travel, you've done so much. And a lot of this comes down to not only goal setting but time management. So, why don't you talk and share some of your thoughts on this? Because I'm very interested to hear about it. Dr. Wing Lim 01:49 Yeah, thank you, Kevin, for a very kind introduction. And I say when people talk up on you, you wish you would live up to it. And so I love doing this because every time we share with our colleagues, we're more alike than different whatever your specialty, and now listenership is not just in with MDS, right, they're out of medical professionals that they're dialling in. So, we all dealt with this problem that we're time broke, right? And at first time I heard this term, this is like 25 years ago, maybe, what does time property mean? Well, because there are people who trade time for money, and that's us, right? We trade time for money. You don't have trade time, you have no money, right? So, you keep trading time for money. And then the problem is, then very soon, you run out of time, right? So, you and I went through gruesome training, we all did, right? 120 hours way back residency, when we did one in two calls, one in three calls, 36 hours straight. Right? And even when I started my practice, 100 hours a week, so you pretty soon run out of time. So, then we take these time management courses, we pay for it way back? And then what do you get? Right? So, I think all of us understand that we need to manage time. So, I think all of us would at least have a to-do list. You know, we have this to-do list every day you put down, right? And then I learned as I go and then I learned that that doesn't work. How many of you and I will look at the to-do list and we actually get better? In fact, what you're doing on a to-do list is just bumping, right? You're just doing it based on urgency. So then, some 10 years later, decades later, the thinking and time management's like medical journal, right, like medical thinking, it's changed. So, that's called a one-dimensional time management. And you've just bump things, in fact, nobody could control time, time is a commodity that you cannot control. Time goes on whether you do it or not. And the truth is, most of us can do the urgency, but time management or event control, let's call it better event control. It's a very emotional base thing. Right? You and I have said, Okay, I gotta get these charts done. I gotta do that stupid medical legal report or WCB report. And you were so stressed out, that you ended up clicking on a mini-series six episodes later of the Netflix. Right? Ya know. Dr. Kevin Mailo 04:12 No, It's true. And a lot of it is we feel overwhelmed by how much we have on our plates. And so then it becomes very easy to procrastinate or distract ourselves. And it can even be distracting ourselves, not just with like idle leisure, but even distracting ourselves in work. Right, that rather than doing the hard stuff, you know, maybe we go do some errands around the house or, you know, get some shopping that's not urgently needed to be done. Even just going to work and doing more paperwork. Dr. Wing Lim 04:44 Yep. And then we just keep being busy, right? But keeping busy doesn't mean keeping being productive. Right, so I'm the perfect Master of this. I have 15 things on my to-do list today and I only got four done, right and every day you just keep bumping it right? So, that's called the first dimension. There's actually different dimensions, polly dimensional. So, dimension one is the to-do list, and it's based on urgency. Okay, which one do you bump? And we know that that's not adequate. Now then comes the 80s and 90s. And then there's a guy, Franklin Covey. I don't know how many of you heard of Franklin Covey. I used to have a big binder, called Franklin Covey binder, but that's how you organize the life, and Covey “The Seven Habits of Highly Effective People”, right, he’s the guy. Dr. Kevin Mailo 05:31 Oh, Stephen Covey. Dr. Wing Lim 05:34 Stephen Covey? Yes. Dr. Kevin Mailo 05:35 No, I got you. No worries. Dr. Wing Lim 05:37 Yeah, yeah. So, there are two companies that join, right? So, Frank. Anyways, the two companies and so that's called Franklin. I used to have these big Franklin folders. And they go into the urgency and importance, right? This is called a time management matrix, where some of you have heard it from The Seven Habits of Highly Effective People, right? So, you have the urgent, nonurgent, important, not important, then you got four possibilities, right? And most of us still deal with urgent/important things. This is actually people who, like you'd practice within ER, you're dealing with urgent, important things, right? But nonurgent, and not important things get ignored. Right? And that's why they say, why do people not read more? And the Maestro says because books don't ring? Right? You will always answer to the phone, to the urgent things, but they're important things that we don't deal with. So us physicians and medical practitioners, are no tourists dealing with more urgent stuff, and we push the important things away. And then it fights back, I have literally met colleagues that forgot to file taxes for seven years. And the CRA came to the door and garnish their wage. How do you do that? Right? Because you keep doing the urgent one, right? And you forgot about it? So, this Time Matrix thing helps people to do okay, I need to apportion the time, right? Dr. Kevin Mailo 07:00 Well, I was just gonna say even if you don't internalize it, so rigidly and for anybody that has not read Stephen Covey's The Seven Habits of Highly Effective People, I strongly recommend reading it, but even just to be able to have that mental pause, when something comes in front of you, whether you hear about it, or you read about it, or somebody you know, you're reminded of it in your head, say, is this truly urgent? Is it distracting me from what's important that I have to get done to move ahead on this project with this goal? Sorry, please continue. Dr. Wing Lim 07:34 So, it's absolutely important exercise. So, for those of us who are still stuck with this linear thing called the to-do list, you need a second now y-axis to create the importance. And so you and I need to apportion our days, that the toughest one, or the nonurgent, but important things. Buying tax return, doing your tax planning, right, you know, those things are super important. If you don't invest in these relationships then relationships blow out, right down the row. And so definitely, that is important. But then at the end of the day, you are still juggling different things. And the biggest thing and the motive here, the MO is to do more things, right? But there's still not enough time of the day, right? You still don't create time. So, then I attended a leadership conference, I think during COVID or pre-COVID. And the guy said there's a third dimension, oh, what is the third dimension? The third Dimension is called significance. Right? You don't just deal with what is there, you deal with what is the long-term significance. The longer significance is not just what is important, is way beyond that. I went to a leadership conference way back a big 20,000-people thing in the States and they talked about legacy, what you're left with, and after that, that conference, that's how I gave birth to, dug up my dream and gave birth to Synergy Wellness Center. But these things are life-changing. What is significant to you, what is the endgame? And so when you throw in the X, Y, and Z axis, it changes what you're going to do. It may change your priority and change what you do. You've been doing things for so many years for decades. Isn't why you're still doing it. Right? You need to ask why? Why am I doing this? You're running on a treadmill now for 10, 20, 30 years, trading time for money, right? We're talking a lot of colleagues and say, I'm like 40 some year old practitioner. I got X number of dollars in debt. I can't afford to retire. Why am I doing this? Right, and a lot of people have that midlife thing awoken and say this is getting nowhere and that's why there's so much attrition people walking out of the profession. Right, so until we find out why we don't know what we're doing. And then there's this guy call. I forgot his name. Now, Rory, somebody, Rory Haun there we go. Rory Haun, give him the credit for doing this. And he says there's this funnel that you can help create time. Right? You really you can create time? You mean like other than the Avenger Timestone? You can create time? And the question is what can you do today, to create more time tomorrow? Wow, that's absolutely amazing. How do you create more time tomorrow? Well, are there things that you can do today? So, that you don't have to do it tomorrow? Okay, give you an example. Right. And you and I do charts, do things every day, right? We have chart work to do. If you have a way to let's say, create a macro in electronic medical record system EMR, it does the template for you, or those of you dictate, Dragon Dictate. Kevin you’ve tried that, right? Things that could save you time, right, then you get this ROTI, return on time invested. So, what can you do today that invest a little bit more time so that you reap the benefit? And the equation that I got was 30 times 30. So, whatever tasks you want to give up to make it disappear, you invest 30 times the time you spent. So, for example, a five-minute task, you invest 150 minutes, okay, simple math. What is the five-minute task, something that your staff could do? And so the problem that we have is we are our top enemy. We’re the worst enemy because we want to do it. If you do want to do right, do it yourself. The more years we spend in tertiary care settings, the more we don't trust people, right, we just trust ourselves. I have, especially colleagues, if you refer them, they redo all the investigations all over because they don't trust anyone. So, this mistrust becomes difficult for us to delegate. And that's a different session we're going to talk about it's just delegation. But to delegate, you need a process, but the time we're talking about time management here, event control is a five-minute event you want it disappear in your daily life. It could be doing a chart, doing something that your clinic work. Invest 30 times 150 minutes to teach, delegate one of your staff to do the job for you. And then poof, you're earn five minutes per day. What if is an hour, 30 times, invest 30 hours. And that could be learning EMR. By learning EMR, what shortcuts can I do, so that I make these stupid things disappear? Right, prescription refills, you name it, and you invest 30 hours. I have colleagues who would not have 30 hours to get for anything. But you know what, if you invest the 30 hours, you earn one hour a day. And why don't we do it? Dr. Kevin Mailo 13:02 It pays for itself in a month, and you still have your career to run. Dr. Wing Lim 13:06 You want to make more money and you might keep a relationship that you cherish or sports or some hobby that you don't have to kill. Dr. Kevin Mailo 13:14 You know, I mean, even just reflect like in, you know, in our personal lives, the parallel is children. I mean, you can sit there and you can clean up after your children. But at some point, you just need to teach them how to scrub floors, and tidy up the house and do their laundry, even if it's like you said, 30 times that it takes you to just do this task yourself. But you realize that ultimately you're creating more time for yourself and less stress, Right? And so this dovetails with every aspect of our lives. It is just willingness to put in a little bit of front-end investment in time to make our lives easier and simpler. Moving forward. Dr. Wing Lim 13:58 Right, exactly. So, let's just end this episode with a funnel, okay, this funnel is called the permission funnel. We need to give ourselves emotional permission, okay? I can give myself emotional permission but once you give yourself emotional permission, then you can move forth. So, the first question, the first permission you give yourself is to eliminate. Elimination that's one. Can I do without this? Okay, can I do with all these things? Say no. Say no, no, no no for people like me who was a yes man, mostly, it's a very difficult thing. But if we want to get on top of this time management thing or more control, event control thing. We have to say no, can I do without it? So, the first permission is the permission to say no and exit out. I don't want to do it. Permission number two is can we all automate. Right? We’re in an automation world. AI is gonna run the world. AI can read CT scans, better than we could, right? So can we automate? If you can automate, you're done. But the automation is not just AI, just technology. Automation means systemization. Can you have a system in your workplace, in your practice, in your finances, in your home life? Is that something that can be systemized? Right? And, of course, that's a different topic altogether. Can you systemize it? Or can you use technology to do it? Once you can automate, you’re done. The third permission is permission to delegate. Okay, and we're going to have a whole talk about delegation. Can we delegate that away? And the fourth permission is, can I procrastinate? So, you thought procrastination is a bad thing. Yes, it is. Procrastination is the assassination of motivation, as somebody once said that, but there are things that we should procrastinate because we have a finite amount of time, right now. So, things that don't fit that grid, X, Y, & Z grid. You need permission to procrastinate, to go back to the funnel, okay? So, you either procrastinate, or you number five, concentrate. And whatever goes into the concentrate is like the filtration. You put all your time, energy, effort, you and your team into the concentrate, and get it done. And that's how people move and shake the world. Right? Dr. Kevin Mailo 16:33 It's very powerful. Dr. Wing Lim 16:33 And it's never been to me, I've lost so many people right in this space. But this actually did it for me, this crystallizes everything. Dr. Kevin Mailo 16:48 Very powerful, very powerful. You know, I'm reflecting on when we were in Mexico in 2021, teaching with Physician Empowerment. And I remember coming across some wisdom that you shared as well, Wing because I think I actually had to deliver that talk. But I know that it was your wisdom and your knowledge in this space of time control. But one of the key elements here is that it's not actually time control. Because like you said, time is passing us by. It's truly self-control. It is self-control. It's knowing your priorities, setting them, and then sticking with them, even if that means saying no. And it's not just no to external requests on your time, your staff, your colleagues, your family, friends, whomever is asking for your time, but it's even that internal voice telling you, oh, but go do this, it's easier, right? Or this is important now. When it truly isn't, if you're honest with yourself, and that's about, again, self-control, not time control. And I think that's very powerful. Because when you look at people who have achieved enormous things, you know, heights in, you know, reached enormous heights, in business, politics, athletics, whatever. Fundamentally, they have the same number of hours in a day, as we do. Chosen, like you said Wing, to concentrate and focus. And it is fundamentally self-control, whether you're an athlete, a performer, you know, a business or political leader, or you know, even just a great dynamic physician, it comes down to self-control. And I think that is so, so powerful. And so key. That's certainly what I've taken away from listening and reflecting in this space. Dr. Wing Lim 18:40 Mm-hmm, exactly. So, if we could apply these simple principles in every facet of our life, then we can have some freedom. But at the end of the day, we yeah, we only live one life, right? And we're getting older one day at a time, right? So, the sooner we get this in our brain, the sooner we reorganize our life and control our life. Then you get your life back and have more freedom. Dr. Kevin Mailo 19:10 The only other reflection I really had was just how precious time is. And I did not appreciate this 20 years ago when I was a teenager. But I blink and a decade has gone by, I blink and another decade has gone by. And so the challenge is to ask yourself, what am I doing right now, with the time that I have, especially realizing that we don't know how much of it we actually have here. And I think that allows us to focus down and say, Okay, this actually isn't a priority. And I'm not going to worry about it. I'm not going to that meeting. Or I'm not doing that, you know, answering that email, because, frankly, it's not going to be something I'm going to remember a year from now, let alone a decade from now in my life, right? And so, again, just recognizing how precious these years in our lives are and that these years are comprised of a million small moments and countless hours that do drift by if we don't exercise that self-control. Dr. Wing Lim 20:13 Mm-hmm, exactly. Exactly. Dr. Kevin Mailo 20:16 Yeah. No, it's It's a wonderful topic. I think we could go on and on about it. But we are going to do a future episode where we cover delegation, right, which I think is the key to effective time management. Is being able to hand tasks off, or as you said Wing, we automate a process. Yup. So, we'll cover that in a later episode. And I'm really looking forward to it. Because again, these are the things I think speak to all of us regardless of specialty, regardless of stage of career, I think we all feel too busy. And we want a way out, we want things to be better, and they can be unconfident in it. Dr. Wing Lim 20:58 Exactly. So, imagine you could go home at five o'clock, six o'clock, whatever, and be done with work, wouldn’t that be a dream? Dr. Kevin Mailo 21:06 True. Totally done. Yeah. Awesome. Thanks so much. Dr. Wing Lim 21:12 Thank you, everyone. Dr. Kevin Mailo 21:15 Thank you so much for listening to the Physician Empowerment podcast. If you're ready to take those next steps in transforming your practice, finances, or personal well-being, then come and join us at PhysEmpowerment.ca - P H Y S Empowerment dot ca - to learn more about how we can help. If today's episode resonated with you, I'd really appreciate it if you would share our podcast with a colleague or friend and head over to Apple Podcasts to give us a five-star rating and review. If you've got feedback, questions or suggestions for future episode topics, we'd love to hear from you. If you want to join us and be interviewed and share some of your story, we'd absolutely love that as well. Please send me an email at KMailo@PhysEmpowerment.ca. Thank you again for listening. Bye.
	15 Jan 2023	11 - Humour and Boundaries in the Private Practice with Dr. Bradley Block	00:22:09
Dr. Kevin Mailo welcomes Dr. Bradley Block, otolaryngologist and host of the podcast ‘Physician’s Guide to Doctoring’ to the show for a discussion on using humour and setting boundaries in private practice. Dr. Block has a wealth of insight that he happily shares. Dr. Block shares a rule he received from Scott Dikkers, founder of The Onion, on not punching down in using humour. The role of humour is to “comfort the afflicted and afflict the comfortable” and he shares examples of what that looks like in practice as a physician. Humour is a great way to increase rapport with patients and get them into a more relaxed state. In this episode, Kevin Mailo and guest Brad Block talk about humour and how best to use it with patients, the flip side of how to carefully deliver bad news, why body language and non-verbal cues matter when interacting with patients, and how to draw important boundaries in private practice. While the instinct is to give everything to patients, a firm boundary for yourself and your self-care is vital to maintaining positive engagement with patients. This episode is both entertaining and enlightening. About Dr. Bradley Block: Bradley Block, MD, is a private practice otolaryngologist on Long Island, New York, where he lives with his wife and three young sons. He is a partner at ENT and Allergy Associates and creator of the Physician’s Guide to Doctoring Podcast. He realized that rapport was the key to gaining trust, seeing patients efficiently, enjoying his practice, and building his reputation. He tried to find a podcast that would help him improve at doctor-patient communication, but there was none, so he created Physician’s Guide to Doctoring! The topics quickly expanded to “everything we should have been learning while we were memorizing Kreb’s Cycle,” and it is now a practical guide for practicing physicians, physicians-in-training and all allied health professionals. He is available as a keynote speaker on improving the patient experience, doctor-patient communication, and running office-hours efficiently. Brad, or Dr. Block as his parents call him, went to med school at SUNY Buffalo and graduated with research honors. He then went on to his ENT residency at Georgetown. He enjoys spending time with his family, surfing (yes, there is surfing on Long Island), skiing (there is no skiing on Long Island), smoking meat, exercising, and finding any excuse to quote an 80s movie. “I’m not saying I’d build a summer home here, but the trees are actually quite lovely.” Resources Discussed in this Episode: Scott Dikkers, The Onion — Physician Empowerment: website \| facebook \| linkedin Bradley Block, MD - Private Practice Otolaryngologist / ‘Physician’s Guide to Doctoring’ Host: website \| podcast \| linkedin __ Transcript Dr. Kevin Mailo: [00:00:00] Hi, I'm Dr. Kevin Mailo and you're listening to the Physician Empowerment Podcast. At Physician Empowerment, we're focused on transforming the lives of Canadian physicians through education in finance, practice transformation, wellness and leadership. After you've listened to today's episode, I encourage you to visit us at PhysEmpowerment.ca - that's P H Y S Empowerment dot ca - To learn more about the many resources we have to help you make that change in your own life, practice and personal finances. Now on to today's episode. Dr. Kevin Mailo: [00:00:34] Hi, I'm Dr. Kevin Mailo, the co founder and co host of the Physician Empowerment Podcast. And today I am very excited to be joined by Dr. Bradley Block, community based ENT physician down in New York and the founder of the Physicians Guide to Doctoring. And Brad, why don't you tell us a little bit about your practice background and what you're going to talk about today. Dr. Bradley Block: [00:00:58] So I'm a general ENT and not realizing that going into general practice, private practice ENT would be mostly office hours. So, you know, in residency we're doing like four days a week in the operating room, half a day, maybe a full day of office hours, you know, and then lecture and the rest. In private practice, general ENT, we spend maybe four and a half days a week in the office and then another half day in the operating room, maybe a little more in the O.R. than that for some, but very, very office hours. And we see a lot of patients. And so what we're going to be talking about today is how I make sure that the patient experience is as positive as possible. Right? And so the reason that I founded my podcast, The Physician's Guide to Doctoring, is I noticed that there were a lot of experts out there that were helping people interact with other human beings, right? The interactions between salespeople and their customers, the interactions between people trying to date successfully or leaders and executives. But there weren't, there were these people with that expertise, but they weren't really focused on physicians. So I thought, you know what? I would love to hear what they had to say about specifically the physician-patient interaction. How do I get an audience with them? Well, start a podcast and then I can give them a call. And the physicians got to doctor and kind of sprouted from that because it became, really answers any questions that physicians might have that help us be better at physicianing. You know, it is either going to be the Physician's Guide to Doctoring or the Doctor's Guide to Physicianing. So better physicianing, whether it's in the office or interacting with our staff or being better community members, community leaders, public health issues, anything, anything that could help us be better doctors that we're not typically taught in our training. Dr. Kevin Mailo: [00:02:55] Perfect. I love that. It is so true. I mean, this is the thing that we talk about at length here on the podcast. But in reality, during those training years, med school residency and those early practice years, we don't get a lot of training on that, right? And then the realities, as you alluded to, Brad, of going into practice and realizing that you don't have an hour for every single patient, right? So your patients need to feel valued, they need to feel heard, they need to feel that their concerns are important. And yet at the same time, you are running a practice where things have to move along, right? Because there are financial considerations to this. You know, you have to, you are a limited resource as a physician. We all are. And so how do we serve our community? How do we serve our patients as a whole? By being efficient, yet at the same time maintain that human connection, which I think is so, so important. So take us through. Take us through your approach. What have you learned? Maybe even share some failures or struggles. Tell us a little bit of wisdom, Brad. Dr. Bradley Block: [00:03:58] So one of my favorite guests was Scott Dikkers, who founded The Onion. And I had him on on How to Be Funny. And he wrote a book called How to Be Funny, How to Be Funnier, and the finale to the trilogy, How to Be Funniest. And so he had a great rule for physicians and really for anybody, essentially don't punch down. But what it comes down to is the role of humor is to comfort the afflicted and afflict the comfortable. And so when you're deciding whether or not you want to make a joke, because if you joke around with your patients in the office, that is a great way to connect with them further, right? It's a great way to establish more rapport, to establish trust. People learn better when they're in a more relaxed state. And so you're going to decrease that cortisol that's coursing through their blood vessels when they're in the visit. So it helps them retain what you've what you're talking to them about and understand better. So there's a lot of roles for humor in the in the exam room. And so you always have to make sure you're using it to afflict the comfortable and comfort the afflicted. And so the afflicted in this case is your patient, right? And so you never want to make fun of the patient at all by any means. And then so who can you make fun of? Really, anyone. As long as you're punching up. Like you can make fun of the disease, you can make fun of the electronic medical record, you can make fun of yourself, although you have to be careful because you don't want to use humor that makes you look less competent at what you're doing. So you don't want to look like you're using like slapstick humor to look like you're bumbling. You can make fun of the institution. So there are lots of things that you can make fun of. And you said, look, one of my failures. So how do you recover from a failed joke? That's easy. You can use the same joke every time because even though it's the same thing to you, each encounter is a different patient. So you could always say, Oh, all right, I got it. That wasn't funny. I'll stick to doctoring. I won't, I won't make my foray into stand up anytime soon. So, you know, it's a quick and easy way to recover from a joke, but just identify that you made a bad joke because that can really sour the relationship. Dr. Kevin Mailo: [00:06:09] Excellent. Talk to us about not using humor. Talk to us about bad news. Dr. Bradley Block: [00:06:16] Bad news. Okay. So. So a great way... so you have to have a system when you're breaking bad news. You can't go in there without having a plan, just like when you're doing a surgery. You have a plan going into the operating room, right? If you're doing a procedure. When you're breaking bad news, you need to think first about how you're going to break the bad news. And a lot of times what you can do is you go through the steps with the patient of what's gotten you to this point. And what that helps them do is that helps kind of soften the blow as you're getting the bad news, as they're getting the bad news, because they can tell what's going on. So do you remember you came to me with that bump on your neck, right? And we weren't sure what it was. You'd already treated it with antibiotics. It wasn't going down. And so we decided to image it with an ultrasound. And that ultrasound, it really didn't come back with anything specific. So we decided to do a needle biopsy. Right? And what were we, you know, we were worried about that needle biopsy with was the possibility of cancer. Well, we got the results back, and unfortunately, that is the result, that it was cancer. And it's always important to use those words. Right? You don't want to say tumor, you don't want to say mass, you don't want to say malignancy, like use the C-word. Use the, you want to be frank about it. So you can kind of ease them into it that way. And once they have the news, you have to give them a chance to process it, right? So just let them, give them some time to sit with it. You can even give them some time to talk to someone. Would you like to call a family member right now? Would you like to... Listen, you have as much time as you need. Call one of your family members. Talk to them about it. I'll be back in a few minutes. And when you guys come up with some questions, we'll go over them. And then another thing they're going to need is they're going to need a clear delineation of next steps. And oftentimes, we don't have all of the steps, but they need to know what's happening next and it needs to be given to them with a good amount of confidence. Now we're talking about confidence. This is where we get into non-verbal communication. And so non-verbal communication can really be broken down into two different types, right? You want to convey interest and authority. Dr. Bradley Block: [00:08:45] So when you're conveying interest, that's more like facial expressions and body language. I really love the term body language, but helps people to understand what's being said. So you convey interest, you know, keep eye contact, make sure you're actually emoting with your face. Right? Some of us get kind of stone faced, so you're emoting with your face and then the cadence and the volume of your voice can convey that authority. So when you're conveying that information, you want to convey it with that authority. So you're giving the bad news. You're emoting with the patient, right? And you are demonstrating that you have authority over what's going on with them. Like you're demonstrating your expertise. So. And then you need, that's when you come up with the plan. You don't want to go too many steps ahead as much as they will want you to. But what you do is you give them a clear follow up. So the next step, we're going to order this imaging. In m field, it would probably be okay, we're going to get a CAT scan to the head and neck with contrast, we're going to get a PET scan, and then you're going to follow up with me two weeks later. I want you to write down all of the questions that come up. I'm not going to have many answers now, but I'll answer what I can. But as you're processing this, you're going to come up with a lot of questions. Make sure you write them down, because each visit is going to be a lot more information than the last one. You might forget the questions that you have, so make sure you write them down and make sure you come with somebody. You don't want to come by yourself to these visits because of the volume and the complexity of the information that you're going to be getting. The reason I'm using cancer is the example just because in my field, that's usually what ends up being the bad news, and it's common in other fields as well. So those are a few bits of advice for how you break the bad news and how you kind of walk them through what's going to be happening next because they're going to feel like they've been cast out into space with no gravitational pull to bring them back and they don't know what's going, what side's up and what's down. So you give them some touch points to hold on to, and then you go from there. Dr. Kevin Mailo: [00:11:01] So, many of our listeners are family physicians in private practice. And again, one of the big things that we feel is that time pressure and one of the commonest things - you probably don't get it as much as the specialist, but we get it all the time in family medicine - is that And what about this? And what about this? Right? And as patients struggle to access primary care, they often will come in with a laundry list of complaints or issues that they want worked out in that 50 minute appointment. And I completely sympathize with those patients. I do the same thing when I go see my own family doctor. So what do you do when you're having one of those days and you are running behind and not like 5 minutes, you're an hour behind because maybe it was a couple of difficult conversations around cancer. Maybe there's a whole bunch of loose ends. Maybe something blew up at the hospital or the O.R. and you're late getting into clinic, whatever. How do you navigate that data? How do you keep your composure? How do you make your patients feel valued? How do you speak to them honestly about what's going on, when, you know, for many patients, it's not easy, right? People got child care to coordinate. They got careers. You know, some people take a bus to get to the other side of town and see you. Tell me what that looks like. Dr. Bradley Block: [00:12:13] So as an otolaryngologist, this happens as well. Dr. Kevin Mailo: [00:12:15] Okay. Dr. Bradley Block: [00:12:16] You know, I've got a patient that comes in with an active nosebleed and they also want to talk about their CPAP machine. Oh, and also they've been having some dizziness lately, probably because they've lost a bunch of blood from the nosebleed. But, you know, they assume that it's something from their inner ear. Everyone assumes it's coming from the inner ear. I can't tell you how many people I see when it's like, Oh, yeah, it's my earwax that's causing my dizziness. Okay, so just for the audience, earwax doesn't cause dizziness, okay? It's a skin issue. Can cause hearing loss. But okay, so it's important to create boundaries. Now, I recognize that you said some of these patients are coming, they took three busses to get there, but you still have to create those boundaries. And I've gotten better at it as I've gotten along in my practice. Like I used to have patients, like they come in and they can't hear anything. Why? Because they have bilateral middle ear effusions. I could do a myringotomy at the time, but like you said, I've already got four patients waiting. So you know what? That procedure is going to have to wait. They're going to have to reschedule, make an appointment, and we can do bilateral myringotomy, maybe with tubes, we'll see. So I've gotten, I've gotten better about that. But yeah, that happens to me. I would make, when they come in, right, if they come in with that list at the get go, give them the choice of what they want to talk about. Okay. You get to pick two things and I get to pick one thing, but we're only going to talk about three things today. Or vice versa. I get to pick one. I get to pick two. You get to pick one. So whatever you feel comfortable doing as the physician. But they don't get an infinite list of things to discuss. And if you're already out the door and they say, Oh, wait a second, I also want to talk about this, Great, I'd love to talk to you about that. Unfortunately, we've run out of time. I do have three other patients waiting. We've covered a lot today. We talked about X, we talked about Y, we talked about Z. But we don't have time to talk about that too. So just schedule your follow up. It sounds like an issue that you should probably discuss within 3 to 4 weeks or whatever timeline you decide. But it's important to draw those boundaries. And as physicians, we're not trained to. We're trained to give up everything. Stay late, like miss your kid's birthday. I got a patient they wanted to be squeezed in today. It was my kid's birthday today, right? I'm already in the, you know, I'm already getting home late enough. Dr. Kevin Mailo: [00:14:29] Exactly. Dr. Bradley Block: [00:14:30] Like, no, no. Like, you can see one of my partners, or I can see you within the next couple of days. But no, I'm sorry. I just. So you have to get better at drawing boundaries. And you do that by keeping the patients to just a couple of issues. Dr. Kevin Mailo: [00:14:44] You know, one of the things that I found helpful in the emergency department in my own practice is very often I'll take, I'll sit down with patients and I'm later then I said I would because inevitably I get called away to an emergency, something more urgent in the department, I get interrupted to deal with a result or something like that. I come back, I sit down with my patient, I apologize that I'm late, but I say this is important for me that I give you time and it's important for you that you get time. So now I've created time for you because I'm now towards the end of my shift. Let's say if it's something serious or complex, like a geriatric patient, there are a whole bunch of issues. I want to sit down and make sure that I am not rushing that. And as you alluded to earlier, Brad, that body language is everything. I make every effort to sit at eye level or lower than my patients and be near with them and never look like I'm in a rush when the department is busy. I really try to create that space in that time. And that's even about setting boundaries with other patients or residents or whoever wants your time. Right? And just saying, I have to go in here for a couple of minutes and sit down and talk to a patient, really convey or go over the issues. So I think that thing about boundaries is so important. And in terms of our self care, we do a better job when we're caring for ourselves, right? If you were running late today for your child's birthday, seeing that patient, I mean, how good is that patient interaction going to be? Right? Because there's probably going to be some degree of frustration or angst or worry that carries in your voice as you interact with your patient versus any other day, Brad, when you could have sat down and created that space for them. So I think it was such a powerful observation that you made in terms of setting those boundaries. Dr. Bradley Block: [00:16:30] Yeah, the non-verbal cues, they can pick up on that, they can pick up when they know that you're rushed. But it's also important that you convey those non-verbal cues. So sometimes, as I said earlier, we're a little stone faced, myself in particular, and they have trouble reading that we're interested. So it's, you can't fake it, but you can make sure that you're conveying it. And that helps those visits to actually go, those other visits to go faster. And when they feel like they're being heard, they feel like they're being understood, that you're more likely to move through the visit faster than if they're getting frustrated because they don't feel like they have your full attention. And that's often why they need to repeat themselves over and over. Another reason why they end up repeating themselves is because there's something that they're not saying that you need to get them to say. And sometimes it's important to really pull that out of them. And like, and I find it a good way to do that is say, What's bothering you about this? Like, right, people come to see me with with globus, right? They feel like they've got something stuck in ther, there's nothing actually stuck in their throat. What are you, what bothers you about this? Do you, do you think you might have cancer? Dr. Kevin Mailo: [00:17:41] Right? Dr. Bradley Block: [00:17:42] Yes, I do. Well I'm going to do this exam. And by putting this camera down your throat, I'm going to be able to see whether or not there's cancer. And if I can't see anything like it's extraordinarily unlikely that there's anything there. Right? So getting them to verbalize what's bothering them about their particular symptom can often get you over that hump where it seems like you're just going in circles, you're saying the same thing, they're saying the same thing. So a good question like that can move things along nicely and then everyone leaves the visit feeling more satisfied. Dr. Kevin Mailo: [00:18:12] Yeah. Boy, I love that. So, Brad, this was absolutely outstanding. I don't want, I mean, I think we can go on and on and on. But give us give us your wisdom. Give us your insights. We have a lot of young listeners who are here. And I think even for for those of us that have been practiced for years, this is the one part of the job that we continue to evolve on. I continue to be humbled throughout my career by the things that patients have shared with me that were unexpected, that if I just took time and listened, I really came to appreciate the patient's perspective. So share share that wisdom with us, share your insights on how we can keep that humanity in medicine that's so important not only for our patients, but for ourselves as well. Because medicine is not a business. Medicine is not a technical skill or a set of knowledge. It really is a human, a human career. Dr. Bradley Block: [00:19:05] Really, it goes back to what you said, right, about making sure you're taking care of yourself. Because if you are hating life, you're going to resent your patients for it, right? If you're burning out, you're going to resent your patients, and that's going to put up those boundaries, it's going to take away from their care. And it's not their fault that you've made these decisions or the system has put these these things upon you so that you can't take care of yourself. So you really, it's really important for that self care. And it's not just lip service, right? Like we've all been in that, I've been in that place where I've resented, I've resented it, I've resented the patients because I've burned myself out. And that's where the boundaries come in, wherever you decide to put them, wherever you decide it works for you that you can really enjoy. And I'm in that place again. I'm in that place again where I'm really enjoying what I'm doing. I mean, I do plan on retiring at some point. I'm not going to do this for, I'm not going to, you know, I'm not going to be those people that's like, oh, it's my passion. I enjoy it, right? But I definitely enjoy it. It's, I'm not in that bad place anymore because I figured out how to make those boundaries. So self care boundaries, all that, all that stuff, wellness stuff that we say, it really does make sense. It's just every person has a different way they need to go about doing it. You got to figure out what works for you and that might evolve as you practice. But yeah, you've got to look out for number one first. Dr. Kevin Mailo: [00:20:33] Well, I absolutely love that. So again, for our listeners, I'd encourage you to track down Brad's podcast, The Physician's Guide to Doctoring, and he has got so much great material, so many great episodes with amazing guest speakers. So I'm very honored to have had you today, Brad, joining us on the Physician Empowerment Podcast. And for anyone listening, if you want to be a guest, we're always looking to hear from members of our profession and hear their perspectives and hear what they've got to share. So again, thank you, Brad. Absolutely loved it. Dr. Bradley Block: [00:21:06] Thank you, Kevin. It's been a lot of fun. Dr. Kevin Mailo: [00:21:09] Thank you so much for listening to the Physician Empowerment Podcast. If you're ready to take those next steps in transforming your practice, finances or personal well-being, then come and join us at PhysEmpowerment.ca - P H Y S Empowerment dot ca - to learn more about how we can help. If today's episode resonated with you, I'd really appreciate it if you would share our podcast with a colleague or friend and head over to Apple Podcasts to give us a five star rating and review. If you've got feedback, questions, or suggestions for future episode topics, we'd love to hear from you. If you want to join us and be interviewed and share some of your story, we'd absolutely love that as well. Please send me an email at KMailo@PhysEmpowerment.ca. Thank you again for listening. Bye.
	15 Mar 2024	39 - You as the Most Important Investment with Dr. Michelle Jackman	00:30:53
Dr. Kevin Mailo welcomes physician coach, Physician Empowerment masterclass student, and 2024 Physician Empowerment conference speaker Dr. Michelle Jackman to the show today. Physician Empowerment not only focuses on financial health but on the mental and emotional health of physicians as well. Dr. Jackman’s coaching aims at that need for emotional well-being and improves the mental health of physicians throughout their careers. Dr. Michelle Jackman came to physician coaching during Covid, by asking questions about her own career path and satisfaction. She worked with Dr. April Elliott, an executive coach, and Dr. Nadeem Lalani, a physician coach, and the self-awareness she gained guided her into leaving the career path that wasn’t satisfying her and into coaching instead. She describes coaching as allowing us to prioritize ourselves and allowing us to make a commitment to ourselves and not just to our jobs and demands. Dr. Mailo and Dr. Jackman discuss all aspects of physician coaching from acknowledging strengths and learning from accomplishments to evidence-based neuroscience and how our brains can be rewired to change our thought patterns. Michelle offers small group and one-on-one coaching and she describes the benefits of both to Kevin. She affirms that asking for help is not a sign of weakness but of strength and encourages physicians to seek out coaching if they need support. Dr. Michelle Jackman will be at the Physician Empowerment Live conference in Toronto on May 25 and 26. – About Dr. Michelle Jackman \| physician coach, PhE masterclass student, 2024 PhE conference speaker: Dr. Michelle Jackman is a practicing pediatrician, born and raised in Ontario. She grew up in the City of Kawartha Lakes and is a University of Toronto Alumni OT1. She completed three years of surgical residency at Queen’s University in Kingston and earned her FRCPC in pediatrics in 2008. Dr. Jackman has been clinical lead at the Pediatric Centre for Wellness & Health at Alberta Children’s Hospital since it was established in 2012. Her clinical passion focuses on supporting children and youth at risk for obesity through this multi-disciplinary program. Her clinical expertise is in supporting children and youth with mental health and metabolic and mechanical co-morbidities of obesity to achieve their best health. She recently completed her executive coaching certification and coaching mastery program through Erickson International and is passionate about bringing coaching into the medical field to help her colleagues navigate challenges, excel in their professions and increase their fulfillment in all aspects of their lives. Michelle lives in Calgary with her husband and daughter. She enjoys making her daughter laugh and being out in nature and mountains on bikes, skis and horses. __ Physician Empowerment: Register for the Physician Empowerment Live Conference in Toronto on May 25 - 26, 2024 Early Bird pricing ends March 15 Join the Physician Empowerment Masterclass now
	30 Jul 2024	48 - Mythbusters in the Financial Marketplace with Nick Giovannetti	00:45:26
Dr. Wing Lim hosts Physician Empowerment Masterclass Faculty Member and Certified Financial Planner Nick Giovannetti in a myth-busting conversation on the financial marketplace. Win and Nick discuss the good and bad aspects of the industry, what to look for, how to verify information, and why research is important before entrusting your wealth to an advisor or team. Nick Giovannetti explains that the relative ease with which licensing can be attained in the financial industry leads to some advisors not being proficient in areas where they may claim proficiency. He advises anyone looking to work with a financial advisor to perform due diligence - to search how long somebody has been insurance licensed or, if they are less experienced, do they have a good team around them. It’s alright to ask questions about somebody’s abilities. Wing and Nick talk about why everyone should background check where information is coming from, perform peer review, encourage the financial team members to work together, and why we should not be afraid to explore other financial planning options if we’ve outgrown our current team. This episode myth-busts common misconceptions, addresses concerns, and offers sound advice on everything in the financial marketplace. – About Nick Giovannetti: Nick is a Certified Financial Planner® with a fully Integrated Wealth Planning Team. His approach to financial planning centers around a deep understanding of clients' goals and objectives, fostering long-term relationships built on trust and transparency. Nick is one of the professional Masterclass Faculty members of Physician Empowerment. __ Contact Nick Giovannetti: LinkedIn Physician Empowerment: Attend an upcoming Empowerment Retreat Join the Physician Empowerment Masterclass now Website: PhysEmpowerment.ca
	15 Oct 2022	05 - Med School Dropout with Dr. Nour Khatib	00:30:49
Dr. Kevin Mailo welcomes Dr. Nour Khatib, emergency physician and speaker, to the show to talk about her journey through finance and medicine. Dr. Khatib explains why he introduces her as a “Med School dropout” and shares how both her career backgrounds are valuable to her. Dr. Nour Khatib divulges that in her first year of medicine at McGill she experienced burnout and spoke to administration who gave her a year off. During that year she enrolled in business school and ended up with a financial job at Pratt and Whitney. However, she returned to McGill several years later despite enjoying her financial job and she explains why to Dr. Mailo. In this episode, Dr. Kevin Mailo and guest Dr. Nour Khatib discuss why learning something other than medicine can be a very powerful personal growth experience, the importance of the advice to “pay yourself first”, and why self care and personal wellness are such key components of a successful career as a physician, alongside financial literacy. Dr Khatib’s story and advice very much align with Dr. Wing Lam’s CBE (Continuous Business Education) theory and this episode helps to explain why it’s important practice. About Dr. Nour Khatib: Dr. Nour Khatib MD CM, MBA is an enthusiastic and dynamic emergency physician and financial professional with keen interest in Quality Improvement, Patient Education and Global Health. She completed her family medicine training at Sunnybrook Health Sciences Center and did further training in emergency medicine at the University of Ottawa (CCFP-EM). With extensive experience and a professional record as a financial and business analyst, Dr. Khatib has excelled in both international and local firms with determination, hard work, and resourcefulness. Utilizing a broad acumen in healthcare, finance and business practices, she aims to solve issues regarding the quality of healthcare and the patient experience. Resources discussed in this episode: “Millionaire Teacher” by Andrew Hallam “Your Money or Your Life” by Joe Dominguez and Vicki Robin “Beat the Bank” by Larry Bates Dalai Lama XIV quote Dr. Glaucomflecken Takotsubo Cardiomyopathy CEGEP — Physician Empowerment: website \| facebook \| linkedin Dr. Nour Khatib MD CM, MBA: Emergency Physician and Speaker: linkedin Transcript: Kevin Mailo 00:00 Hi, I'm Dr. Kevin Mailo, and you're listening to the Physician Empowerment Podcast. At Physician Empowerment, we're focused on transforming the lives of Canadian physicians through education and finance, practice transformation, wellness, and leadership. After you've listened to today's episode, I encourage you to visit us at physempowerment.ca. That's P H Y S empowerment.ca to learn more about the many resources we have to help you make that change in your own life, practice, and personal finances. Now on to today's episode. Kevin Mailo 00:34 Hi, everyone. I'm Dr. Kevin Mailo, one of the cofounders of Physician Empowerment, and one of the cohosts of the Physician Empowerment Podcast. And tonight, I am very, very excited to introduce to you Dr. Nour Khatib. And Dr. Nour Khatib is a Med School dropout. And she has had a very exciting journey. And we are very happy to have her as part of our team here, speaking at our webinar, and hopefully speaking at some of our future events as well, because she's just so incredible, not only in her medical career, but also in the sphere of teaching and public speaking. And I don't know that I can introduce you properly, Nour. I think it's probably better if I just let you go. And tell us a little bit about your story. And why I introduce you as a Med School dropout. Dr. Nour Khatib 01:24 Sure thing. Absolutely. Nice to meet everyone. Thanks for joining tonight. So yeah, Kevin's right. I am a Med School dropout. But I'm currently an emergency physician so how does that work? So what happened with me is I studied in Quebec, I studied in Quebec and I went to CEGEP and that's when you do, you can get into Med School two ways: do an undergrad, or go through quote/unquote the fast track where you can get into pre-med and you've got a guaranteed position into getting into Med School. So I thought, I was studying at Marianopolis College, which was one of the CEGEPs, there and I thought everybody was applying to Med School, maybe I should apply too. I didn't know what I wanted to, I was 18. But I did apply to Med School and I got in and I started. And within two months, I was like this linear path is scary. I don't know if I want to take this linear path. It felt like that's it, my entire life for the next 10 to 15 years is already laid out. And the path is not going to be changed. And I felt all I will know is medicine. And that, in addition to the worries of medical school, was frightening to me. I come from a family of, previously were refugees. We didn't, no one in my family had an undergraduate degree. In fact, they were all working in business or working as entrepreneurs, and just trying to make things happen, not medicine-related not science-related. So I thought to myself, 'What am I doing going into medical school?' Two months in I decided I'm completely burnt out, especially with all that overthinking and overwhelm at the age of 17 or 18, which I still think is too young to be committing to any of this. But that's a different story. And I went to the - it was McGill - so I went to the administration office and I spoke to them, I told them how I was feeling. And they're like, yep, we recognize this. It's called burnout. You're experiencing it, and now we have a solution to your burnout, you're going to take a year off. Doesn't work like that. A solution to burnout is not just a year off. But that's what they said, I was 18 and they gave me a year off. So I decided to take it. In that year off - really within two weeks - I thought to myself, I can't take a year off, that's, you know, Type A personalities, we're not going to take time off. I ended up enrolling in business school. I ended up enrolling at the John Wilson School of Business, doing some finance courses, and absolutely loving it. And thinking to myself, 'Hey, I fit in'. You know? I fit in here. It makes sense to me. It's so exciting, there's presentations, no one's lives are at stake, it's great. And there's no linear path. That part was great because I didn't have to do another degree after or post grad or decide on what specialty. That's it. I can start there, continue, and literally the world is my oyster, I can work in finance or business in any field I want. A year later, McGill gives me a call and they're like, 'Well, you haven't been responding to our emails. So do you want your spot because it's kind of a guaranteed spot, something that's super coveted'. I was like, 'Oh, thank you so much. I actually am in finance now, I switched careers, please give my spot to someone else'. And of course, they've got tons of people to give the spot to and they went ahead and did that. So I worked in finance. I worked in finance and I did co-op and I ended up at graduation, had already worked for three companies after doing some co-op, and the third company basically offered me a contract. And it was Pratt and Whitney Canada. It's an airplane engine manufacturer. And I loved working there. I can't tell you that I loved the job itself. But working there, being in a team, having projects together with engineers, financial analysts, all sorts, I was thriving in that environment. But come and ask me if I liked what I was doing on an Excel spreadsheet? Excel is dear to my heart this very day, but no, not for the rest of my life. I can't imagine myself doing that for the rest of my life. But I loved being in that company. And had I not left, I would have been there forever. Kevin Mailo 05:41 Wow. So okay, so you're, you're at this great company? How did you un-drop out of Med School? Nour, tell us how you un-dropped out of Med School? Dr. Nour Khatib 05:52 Sure. So the way it works is, really it just goes to show you that sometimes just stars align and, you know, I never used to be a believer of that, but really, like, there was an opportunity, and I kind of went for it. That year, my prerequisites were going to be expired, that like eight years out-- Kevin Mailo 06:15 -- yeah, Med School prerequisites, yeah. Dr. Nour Khatib 06:18 And then I heard from a friend of a friend that McGill are removing their MCATS. And I never thought about going back to Med School. Why would I? Pat and Whitney was paying for my MBA, I had already gotten promoted twice, I'm in the middle of the recession in 2008, and I had a job and life was good. There's no reason for me to think of leaving. But someone, there was a seed that was planted that, hey, McGill has removed their MCATs, now it's easier for you to apply. So I decided to look into it. Because there's no way I would have studied for the MCATs, there's no way I would have like been wanting it enough. I decided to, you know what, I'm going to apply, and I'm going to see what happens. And I ended up going for it. I spoke to my manager at work, and the VP Finance of the company, and we were close, like we were, you know, and I told them about what I was thinking. And what they told me is, they're like, 'You know what, you're gonna get bored here. You like it now but you're gonna get bored, you're gonna get promoted, and you're gonna not enjoy the job at some point. You like who you're working with, but they could change. You need to love your career.' And that's, and they told me, they're like, we will write you your reference letters, just go for it. And I decided to go for it. And it felt like I had nothing to lose, I didn't have the pressures of the first time or the pressures that my colleagues had. And that's something that I've told a lot of my friends who, or a lot of people, friends' kids who are trying to get into Med School, I tell them learn something else first. Learn something else, find something else. And don't let it be a one path, a linear path, to the finish line. Because you're living throughout this journey. It's still life, you're not, you don't start living when you graduate, you're living throughout it. Kevin Mailo 08:17 You know it, that's very powerful. That's very powerful. I like that a lot. So you got in. Dr. Nour Khatib 08:24 And the thing is, though, all throughout this, whether it's the finance degree or the MBA, I can tell you for certain, none of the personal finance knowledge that I know today came from that. It was all theoretical. It was all, you know, project based, case based for certain companies, and theoretical. Just because I have a finance degree and an MBA does not make me better at personal finance than Kevin. Absolutely not. It's really when I started to make money after residency, and I sat back and I said, 'Oh, okay, so now I'm making money. Now I'm paying off debts. What do I do now with this?' What is there to do? Like, do I go to a financial advisor and just say, here, you do everything? Or do I take care of it myself? So that was hard. The first year out of residency is always difficult. Whether it's, you know, you're doubting yourself, your competence, you're just trying to learn the ropes, you've taken over a practice, which in itself is entrepreneurial and business-minded to begin with. And the first year out, I did a lot of working of course, and learning medicine and building that confidence in medicine, in the first few years out. But what I tried to carve out is a little bit of time every week to look into and learn about personal finance. Kevin Mailo 09:50 Can I stop you there? Wing came up with a great term for this, and it's not just about personal finance, but it's also about practice management. And he calls it C B E. And that is Continuous Business Education. Just like we constantly invest in our knowledge and skills as physicians, we need to constantly invest in our knowledge and skills as investors and practice managers, or, you know, those that run our practices. So I'll let you continue, though. Keep going. Dr. Nour Khatib 10:19 Oh, no worries. I mean, what did that involve? First of all, I felt defeated right from the start. Because I was like, hold on a second, you were in finance, and you worked in the field, and you don't know what you're doing with your money? Like, that's embarrassing. First of all, I told myself don't admit it to anyone, but here I am. Which is totally fine. It really goes to show you that you do not need to have a degree, these things that you're learning are for yourself and through other people's mistakes. And the quicker you learn them, doesn't matter how far out you're in, but the quicker you decide, and take the initiative to learn from other people's mistakes, the more likely you're going to succeed. And the more freeing it is, once I decided that I am going to be taking care of my own finances, doing my own budgeting, realizing that number one is I pay myself first. And I break down what I earn and from where and I actually know where things are coming from. And in the beginning, in the first few months, I wasn't sure where my money was coming from. I was like, from here, from here, from there, what am I spending it on? Oh, probably like, you know, food and rent and before, you know, before owning anything, what? No, that's probably where it went. But the truth is, I needed to break it down and really study and analyze where things are coming from. Kevin Mailo 11:40 Can I stop you there? Talk about paying yourself first. This one's thrown around in finance all the time, it's a very old term. Just share with our audience of what it means, because there's going to be some out there that don't know, or you know, don't think about it expansively enough. Dr. Nour Khatib 11:55 Sure. I'll just give you an example of, like, what I do first. So what I do is - and when they say pay yourself first, the underlying meaning is really live within your means, and know the measures of what you're dealing with in terms of your money - but here's what I do. Every 15th of every month, right? Like between the first and the 15th, you pretty much make, everything starts coming in from whatever sources that you're working, right? And then towards the 20th of the month or so I decide, okay - and I'm incorporated, so this example kind of goes to those who are incorporated, but it doesn't matter it'll fit both - I first give myself a salary, and pay my taxes on that salary, and I'm living within that salary means. Everything else goes to savings. Kevin Mailo 12:44 Wonderful. Dr. Nour Khatib 12:46 So let's keep numbers simple. Let's say I pay myself $10,000, and everything else goes into the corporation, or goes into wherever you decide to put it if you're not incorporated. But let's say that $10,000 I think to myself, okay, what am I going to do with this $10,000? What do I, how much do I need? And I'm just giving you a round number. Let's say I just need $3000 or $4,000 just to live that month, whether it's a mortgage, food, gas, whatever it is, that's aside. And now, what am I doing with the rest? Well, I'm putting some in my TFSA. I am putting a few in my savings accounts. And my savings accounts are funny looking. So I've got like six. Why do I have six? I have one emergency fund. I have one car fund for when my car breaks down six, seven years from now. And I have a vacation fund. And what else? I'm interested in flight school. So I have one for flight school. Kevin Mailo 13:39 Wow. Of course you do, Nour, of course you're gonna be flying airplanes. Honestly, it's amazing. It speaks to dreams. And you're one of those people that obviously lives your dreams. I admire it and respect it immensely. Keep going, keep going. Sorry. Dr. Nour Khatib 13:55 Once I put enough money in the vacation fund, I know I can take a vacation. So that's every month, that's how I divide things up. And that feels in itself super empowering. Just the fact that you've laid out your dreams, you've laid out what you want to spend your money on, you've already paid yourself. And you know, you can't go over that. Kevin Mailo 14:17 Well and it gives you space to really enjoy things. Right? You know what I mean? If you have a budget, and you're like, okay, we're going out for a great dinner tonight. And this is something we budgeted for and there's money for it, we're gonna drop 200 bucks on great food and great wine and not feel one ounce of guilt for it because we saved and, you know, planned for it. It's such a powerful thing, right? It's more than just money. More than money, it's more than dollars and cents. It's really about building a better life and being happier and more at peace with your finances, which are a big part of our everyday existences. Can I go a little bit further on paying yourself first, right? Because we talked about like month to month budgeting, but the notion of paying yourself first is you can go past that as well and you can look to the future. And really, you know, that paying yourself first means that you are setting aside money that you're investing every month, every year, for a time in your life years or decades from now, when you are older, and need to be taken care of, right? And it's not just, you know, those frail years, you know, in the final decade or two of our lives, but it can actually be much sooner. And I think many of us who work in medicine are reminded of that on a daily basis, people who become sick or disabled at tragically young ages. And I don't want to be all doom and gloom, but there's this idea that as we age, we have to create more space for our well being. And I'll just share my own personal story. I remember graduating less than 10 years ago, I graduated in practice in 2013. And I remember loving the night shifts, and you're an ER doctor, right Nour, you know, you understand it. I loved the night shifts, I was working, I was fast. I was, you know, I felt great. I would go to the gym after, you know, a night shift and then go to sleep, wake up, go do it again. Of course I did, right? Dr. Nour Khatib 16:09 After a night shift? Kevin Mailo 16:11 And then, you know, because I mean, because I'm an ER doctor, I should have gone for a bike ride as well, right? Dr. Nour Khatib 16:15 With your Patagonia. Kevin Mailo 16:16 Yeah, exactly. Like Dr. Glaucomflecken which, by the way, I should send that link out, it's great. Or he's got a number of those skits. But you know, the bottom line is that for myself, within five years of doing that, and working at that pace, I was already feeling tired. And that's when I realized things need to change. And I was shocked at how quick that came. You know what I mean? Like, I was like, oh, well, I'll get tired in 20 years. No, I got tired within five years. You know, four young kids, you know, careers in the household. There was a lot going on. And so, you know, I downshifted and one of the reasons why I was able to downshift is during that time, thankfully, that first five years, I was doing a lot of paying myself first. I was investing in a lot of real estate, not doing it perfectly, not necessarily doing it with a really clear plan, but I was doing it. And I got to a point where I could actually pause and say, 'You know what, I don't need to work these night shifts anymore'. And so I moved off them within five years of practice. So that's just my own little piece. My own little story. Yeah. So it's this idea that there's going to come a time in our lives, there really does come a time in our lives, when we just want to be doing something else. Right, whether it's focusing on family, passions, hobbies, you know, even just our personal well being, even just sleeping more, you know? I had a doctor told me she has not slept since residency, right? You know what I mean? These things happen all the time in our lives. And so just creating that space to live a better life. And, you know, practice how we want to practice is so important. And a cornerstone to that is paying ourselves first, is, you know, putting away money, learning to invest it, and growing that nest egg, so that we take that pressure off to earn. So sorry, I'll let you continue, and hopefully not have any more interruptions from my busy... Dr. Nour Khatib 18:07 Oh, no, please, please. Kevin Mailo 18:09 It's really cute. Dr. Nour Khatib 18:10 You and your daughter are totally welcome. One thing you mentioned, you mentioned, you know, we don't want to be doing this all our lives, we want to move on to other things and hobbies and whatnot. What I learned early on, and I'm so glad I learned it early on - and even for you, Kevin, it looks like you've learned the importance of all of this early on, and I'm thankful for that - is don't wait for these hobbies. Don't wait for the things you want to do. Don't let it be a linear path. I did not want medicine to be a linear path. I promised myself, had I returned the second time, that it like, if I were to continue-- Kevin Mailo 18:51 -- I love how you, I gotta interrupt, I love that you say 'return the second time'. To Med School. I don't meet a lot of people who say that sort of thing. Okay keep going. Dr. Nour Khatib 18:59 I thought to myself, if I was going to return, I was going to take this as a life experience. I am not going to be a person in, like with my head in the books all the time. I was, because trust me, you go from finance, when you go from finance to try to learn physiology, you're, you know, like, yeah no, it was a disaster. And of course my head was in the books all the time trying to catch up, really. But the truth is, I told myself, this is not just going to be me, it's not going to be the linear path. Because if it is, I will burn out right away. And I realized that one year out, is that I had colleagues doing 20 shifts a month. And you know what? They're doing it, but really, is that longevity? Is that sustainable? Probably not. I don't do that much. I don't do that many shifts a month. I work probably every day a month, but not necessarily in emergency medicine. Kevin Mailo 19:50 Well, and this is exactly it. And this was the advice that, you know, I'd gotten years ago in residency and that is a career in medicine is not a sprint. It is a marathon. And by creating that financial space to have a more balanced life, to sleep, to exercise, to eat right, to all the things you need to be doing that you would tell your own patient, means that you are going to be able to really enjoy your career for the long haul and really do your best medicine. You know, my patients are so much happier since I slowed down. If I can be perfectly honest. And it's wonderful. I just I love love being there. Dr. Nour Khatib 20:26 You probably miss it, too, if you haven't gone in a few days. You miss it. Kevin Mailo 20:30 A little bit, a little bit. This unbeatable summer weather. I don't know about that right now. But yeah, like, and it's just wonderful to share in it. You know, I picked up a Takotsubo cardiomyopathy, there are gonna be some people that are just rolling their eyes, like what does that mean? You know, because they sat there and talked to an elderly gentleman who said he was really experiencing childhood trauma. Right? Yeah. And I would never, like, you know, I just had that time because I wasn't in that big rush. You know, just enjoying my job more. And so anyhow, I mean I love this, Nour. I love what you're sharing. Keep going. We've got a little bit more time. Tell us a little bit more about your journey. Dr. Nour Khatib 21:07 And so where was I? So let's say a year out. A year out, I decided I'm going to teach myself personal finance. How did I do it? Whether it's reading blogs, reading certain books that have helped others? A couple of books that have helped me are... Kevin Mailo 21:22 What are your favorites, what are your favorites? Dr. Nour Khatib 21:23 "Millionaire Teacher" was my favorite because it just hit all the points. Yeah, it just hit all the points. And it was very basic. It wasn't too complex. And it was one of my favorite recommendations. "Beat the Bank" is a pretty good one, too. Thing is, once you start reading these, they all say the same thing in the end. And one that I'm currently reading, and I know I will be rereading, is "Your Money or Your Life?" Kevin Mailo 21:45 Oh, I like that. Dr. Nour Khatib 21:46 And the whole concept of that one - and it was written, I believe in the 70s or 80s, but then it was revamped in 2018 for nowadays - "Your Money or Your Life", the concept is, if someone were to put a gun to your back and say 'your money or your life', obviously, you know, you'd say, here take all my money. Kevin Mailo 22:04 Absolutely. Dr. Nour Khatib 22:05 But the truth is, our rat race towards money is costing us our life. And just because it's not as dramatic as a gun to your back, it's prolonged. You are losing life, because we are chasing money in a way that is a poor relationship with money. We are working more and exhausting ourselves to make more, rather than trying to work smarter or work and be happier in our job. Kevin Mailo 22:33 So I'm going to interrupt you there. And I'm just pulling up the quote right now. But there's this great quote from the Dalai Lama when he was asked about what surprised him the most in humanity, and he said, "Man himself, because he sacrifices his health in order to make money. Then he sacrifices his money to recuperate his health." You know, and he is so anxious, what does it say here? Sorry, I'm just, I'm going off, but it's so anxious about the future, he doesn't enjoy the present, right? And it's so true, Nour. It's so true, what you're sharing, that we just get caught up in this rat race of earning, thinking, oh, I'll live next year, or I'll be happier next year. I'll be healthier next year, but we really shouldn't be living like that. Dr. Nour Khatib 23:16 100% 100%. And it's, you know,what, not every day is perfect. The last few weeks for me have been rough, I have to say. I worked, I ended up, I would say the first year out was rough. A few years after that, trying to, you know, get things along was great. And then you start getting, you go through this burnout phase of the whole profession is collapsing on itself, unfortunately. And you really just have to step back and realize these are systemic problems. That your job is to take it one patient at a time, and take care of whoever's in front of you right now. And just do the best you can with the intentions and with the resources that you can. And just be, every day ends and a shift ends. Right? At the end of it, it's over and you've tried your best, and that's all you can say to yourself is that you've done everything you can at that time. And then you can move on to helping others. The problem is in our profession, is there's all this cumulative PTSD from the horrible cases that have gone wrong. And that that takes a toll on us. And I honestly do think every doctor needs a therapist. Every doctor needs a therapist, every person needs a therapist. But whether it's in the good times or the bad. Kevin Mailo 24:32 I think that's incredibly powerful, incredibly powerful. Dr. Nour Khatib 24:36 Let the therapist see your good times, hearing your good times in order for you to be able to go through your bad times. Kevin Mailo 24:41 I look at it like going to the gym or eating right. It's something you should make a part of your life. Not something you just do here and there or when things get bad. That is exactly my view as well. Everyone should have one. Everyone should have one. We deal with a lot of sadness and trauma and heartbreak in this job. And we don't necessarily internalize that, because we're so highly trained. But the truth is we deal with a lot, across all specialties, across all specialties. And there's a lot of stress associated with it. We deal with a lot of risk, right? We don't necessarily internalize that either, how much risk we deal with when we discharge patients, you know, your psychiatrists, you decide not to form that patient, there's a risk they could go out and harm themselves, right? Like there's risk to everything we do, even as a radiologist. Is it a thing? Or is it not a thing? Right, but it's true. It's true. You know, that's a very beautiful observation, though. About he importance of ongoing mental and emotional health. Dr. Nour Khatib 25:45 100% 100%. Kevin Mailo 25:49 Yeah. I love it. Dr. Nour Khatib 25:51 And so like I mentioned, I don't do as many emergency shifts as, let's say, the typical emergency doctor. But I still consider myself as I am an emergency physician. It is my profession. I might be doing surgical assist, cardiac stress test clinic, event doctoring, I do speaking on the side to corporations. Kevin Mailo 26:14 Of course you do, Nour. Of course you do. Okay, keep going, Dr. Nour Khatib 26:17 I teach people about personal finance. And I, you know, I enjoy doing all these different things. One thing that I - remember earlier, I was saying, don't wait for your hobbies, don't wait to do your hobbies later, try to pick them up and do them now, whatever it is that you enjoy it just make it part of your life, just like how you schedule a shift - so I do Muay Thai kickboxing. I'm a voiceover artists that does work on the side for commercials just for fun. It doesn't pay much, but I enjoy it. So if you ,like, I've done a few commercials on the radio and one for Hershey's as well. And it's just something I enjoy doing. And it's something that I think everyone needs to find what it is they like, whether it pays or doesn't pay, just make sure that it's part of your life. Kevin Mailo 27:00 You know, I really, really love that. So we're kind of coming up on 30 minutes. I'm shocked at how quickly it's flown by. And then we obviously have to get you back on another webinar and on to like a formal podcast episode as well. Because there's just so much wisdom here, right? I mean, one of my reflections on this financial journey for myself in talking to physicians coast to coast about money, is that the world is full of knowledge, facts and information. I mean, go on YouTube, you learn about real estate, you buy crypto, you learn about buying crypto, you can learn about day trading, learn about all these things, but that that wisdom, what you're sharing today, Nour, is in such short supply in our world in many respects. And, you know, a lot of us are chasing money or, you know, trying to earn or trying to invest. But not asking ourselves what do I really want in life? You know, and does my financial plan align with my life's goals? But I just, I love what you shared. And I just want to recap that notion of paying yourself first, right? Setting a budget, living within the budget, enjoying the budget, celebrating it right? Like if you've got 10 grand for that vacation, go and blow that 10 grand on a vacation and really enjoy yourself. And do it knowing that you've already paid yourself, then you've already filled up your investment accounts, and you've already made that move in real estate or done whatever. So that you have space to live right now. Knowing that also that future version of yourself that is older, sicker, tired, doesn't want to work those night shifts, doesn't want to do that call, that person is also taken care of. And I think that's so, so important. So I gotta wrap it up. But I'd love to hear any final thoughts you have, anything else you want to share about yourself, about your journey. Dr. Nour Khatib 28:49 It's really been about learning, making mistakes, ups and downs. And that's what life is no matter what. The quicker you realize that what your business here is called, physician empowerment, is about feeling empowered with regards to your finances and your life. And don't let medicine win. You are in control of medicine. You are the captain of this ship, and you're going to be steering it. Do not let medicine take over your life. It is a tool we use to help people, but physician heal thyself first. Kevin Mailo 29:29 Wow. Wow. That was incredible. And so true. So I think we're gonna, I think we're gonna wrap up there. I'm so, so glad and so, so grateful to have you on tonight like this. Thank you so much, Nour. Kevin Mailo 29:47 Thank you so much for listening to the Physician Empowerment Podcast. If you're ready to take those next steps in transforming your practice, finances, or personal wellbeing, then come and join us at physempowerment.ca - P H Y S empowerment.ca - to learn more about how we can help. If today's episode resonated with you, I'd really appreciate it if you would share our podcast with a colleague or friend, and head over to Apple podcasts to give us a five star rating and review. If you've got feedback, questions or suggestions for future episode topics, we'd love to hear from you. If you want to join us and be interviewed and share some of your story, we'd absolutely love that as well. Please send me an email at KMailo@physempowerment.ca. Thank you again for listening. Bye.
	31 Mar 2023	16 - Charting and Setting Boundaries with Dr. Sarah Smith	00:33:10
Dr. Kevin Mailo welcomes Dr. Sarah Smith to the show to talk about the time investment of charting and how to set boundaries on how much work eats into your personal life and well-being. Dr. Smith is a practicing rural physician who does everything from family medicine to emergency, and she is also the Charting Coach whose program has helped hundreds of physicians. Sarah shares her personal story with Kevin and explains how her practice in Australia eventually became a burden due to all the paperwork, the undone charting. She says she loved the people but hated the paperwork burden. She struggled under the weekend-eating charting until she had a realization and really took stock of how she spent time in her day. That led to imagining how she could change her time usage to better suit her. In this episode, Kevin Mailo and Dr. Sarah Smith explore Sarah’s “a-ha moment”, how she coaches physicians to view their time and the work they take home, and why a mindset change and the phrase “you see the patient, you close the chart” becomes one of the keys to more efficient time usage. Sarah advocates for well-being in terms of physicians reclaiming their personal and family time by focusing on the ways in which they are in control of their own clinic time management. About Dr. Sarah Smith Dr. Sarah Smith is the Charting Coach for Physicians. She is a Rural Family Physician and Certified Life Coach through The Life Coach School. She helps physicians get their admin and paperwork done more efficiently to create time for the things they love. Dr. Smith has spent the last three years coaching hundreds of Physicians, over 1000 hours of coaching, in the specific area of “getting home with today's work done”. Resources Discussed in this Episode: Save the Date for May 6-7, 2023 in Toronto Dr. Sarah Smith on LinkedIn ChartingCoach.ca — Physician Empowerment: website \| facebook \| linkedin __ Transcript Dr. Kevin Mailo: [00:00:00] Hi, I'm Dr. Kevin Mailo and you're listening to the Physician Empowerment Podcast. At Physician Empowerment, we're focused on transforming the lives of Canadian physicians through education in finance, practice transformation, wellness and leadership. After you've listened to today's episode, I encourage you to visit us at PhysEmpowerment.ca - that's P H Y S Empowerment dot ca - to learn more about the many resources we have to help you make that change in your own life, practice and personal finances. Now on to today's episode. Dr. Kevin Mailo: [00:00:34] Hi, I'm Dr. Kevin Mailo, one of the co-hosts of the Physician Empowerment podcast, and today I'm extremely excited to introduce to you - I say I'm excited every time - but I am very excited to introduce our listeners to Doctor Sarah Smith. And I'll say a couple of words about Sarah and her practice background, and then I'll let her talk and share her journey because it's really quite remarkable. Sarah is a rural family physician who kind of does it all - family based practice, palliative care, long term care, hospitalist, and emerg - she does it all as a rural physician. She is originally from Australia and immigrated to Canada about ten years ago and I assume came for the great weather and beaches. And today what Sarah is going to be sharing is strategies around charting and practice optimization because this is something we all face in practice, right? Whether you're a radiologist or you are a family doctor or a surgeon, you've got to chart what you're doing. And we don't get a lot of training around that. We get a lot of training around like the medicine and making proficient notes. But how do you be efficient about that? How do you communicate effectively? And that's what we're going to touch on today with Doctor Smith. And with that being said, Sarah, why don't you go and tell us a little bit about your personal and professional journey that led you to this point. Dr. Sarah Smith: [00:01:54] Hi, and thank you so much for having me, Kevin. It's really, really fun to be here. So yes, I'm from Australia and I had been in full time family medicine in Australia, having finished up all of my hospital years that we do in Australia after graduation. And we then as a family decided we wanted to see something different, so we packed up, full time family practice, I'd just got to that fun point five years in where I understood the billing, the patients, my panel, everything was kind of like ticking along quite nicely except for the paperwork. And we'll come back to that. And then we decided, you know what? We really want to see something different now. So we packed up and went around Australia for a year and a half, which was super fun. So I highly recommend semi-retirement. I think that process of giving up full time family practice, the disappointing all your patients, the little grief journey that happens when you're leaving people behind because you've loved and looked after these people for a solid five years. But the lesson on the other side of that, that you are replaceable and that's a beautiful thing as a physician. I think that was a lesson I didn't expect to learn that early in my journey. And what it did is created less of that feeling trapped in family medicine and more of that ability to figure out, Oh, this, it can be different, it can look different. I can kind of reinvent myself and it's all going to be okay. So that was part of the exiting family medicine. So we then went around Australia, I locumed for that year and a half back in emergency departments, which was super fun in the middle of frickin nowhere in Australia. And then at the end of that journey we were just sitting around as a family wondering what to do next with ourselves, and Canada had some openings, so we came here for a year and we stayed. So back in full time family medicine. And then this paperwork problem reemerged. Dr. Kevin Mailo: [00:04:05] So it followed you? Dr. Sarah Smith: [00:04:06] It followed me. Dr. Kevin Mailo: [00:04:07] One continent to another continent. Dr. Sarah Smith: [00:04:09] Right, across continents. Totally different government system, billing system. Even the way we see patients in Canada, different from Australia. So in Australia it's one room, that's your office and your patient room. So you've got to exit one patient before you can get your next one in. So you're really limited in the number of patients you can see a day. Like it really puts a significant time delay in turning over appointments, versus in Canada I had an office, two consultation rooms, somebody to usher my patients in, tell them to get undressed and put gowns on, or anything of that nature. So it was a totally different practice and - boom. I'm back to this point in my family medicine day, where I don't know when I'm going to be home. Hours after the last patient left. I get a text from husband almost every day saying, When are you home? Because it's dinnertime. So I hurry up and pack up and head home knowing full well I'm not done, nowhere near done. After family time is done for the night, I'm back on the computer. Hours and hours every night. And my weekends were also disappearing in, I've got paperwork. Like this was a common thread that I was noticing. And throughout my career I'd asked every mentor, How do we do this? How do we do the paperwork? What do you do to overcome like the paperwork? It was just all consuming. My mind was constantly thinking about the work that wasn't done, and it was a huge burden. And so that was where I found myself. Unhappy. Dr. Kevin Mailo: [00:05:48] You bet. And I think what you're sharing is the same frustrations that physicians coast to coast in this country face with, you know, what appears to be ever growing paperwork and EMRs have not necessarily helped this. And so before we dive into, you know some specifics around, you know, charting and workflow, talk to us - I mean, you touched on this - but talk to us in more depth about the why. Why is this so important in our lives? And I'll share a couple of my own thoughts on this. But why do we need to be doing better with our charting? Dr. Sarah Smith: [00:06:23] Yeah. So my big a-ha, I was standing somewhere in my living room, in my house somewhere, and my kid's in grade ten at that point. He's older now and I just, and it's still emotional a little bit, of course I'm going to miss it. I'm going to miss his last two years of being at home. Because of the paperwork. And that for me was enough. In addition to that, when I'm looking after physicians, it's about, they're diluting their income. They're under-earning even if they're earning. You've earned the money in the room most of the time, like occasionally, if you're doing it same day and you're in that file a bit longer, you might get some time modifiers depending on which part of the country you're in. But for the most part, we have earned the money in the room. Now, if we listen to what doctors are saying, that every hour of time with my patients equals an hour of admin time, now we're diluting our income, right? If you actually work out your hourly rate at that point, significant difference. Dr. Kevin Mailo: [00:07:33] Oh, massively, massively. Right? And this matters. I mean, it's actually something we teach at Physician Empowerment's finance classes, right? Is that we discuss the notion of hourly rate. And the hourly rate doesn't just include your clinical work, it includes your administrative time and charting time. Right? You know, and it's not about creating more space to see more patients. It's about doing better on the ones we've got so that we create more time for ourselves and for our families. Dr. Sarah Smith: [00:08:06] Yeah. When I was in this moment, before I changed it, my days felt heavy, trapped, drowning, overwhelmed, I dreaded work. I was seeing as many people as I could fit in in a day, and that was too much. And then every single request that came in, like, now we want you to monitor, you know, whether they're a smoker or not. Now we want you to measure their height and weight once a year. Any other requests just felt like they were stripping me of anything I had left. It was, the ask was too much. And so it felt like I had no control over my clinical day whatsoever. It was already packed. Don't ask me to do anything. Dr. Kevin Mailo: [00:08:52] It's a lack of control. Dr. Sarah Smith: [00:08:53] I can not do it. Dr. Kevin Mailo: [00:08:55] And that is tied to well-being across many, many industries and fields, is a sense of lack of control and disconnectedness. Please keep going. This is very good. Dr. Sarah Smith: [00:09:07] Then I would take three forms home on the weekend. Right? At the end of the consultation they hand you a form, Oh, can you get this done? When you get a minute? My brain would say, There's an hour of my life gone. That was a sentence my brain had about this form. And it wasn't just an hour. If I took those three forms home for the weekend, I would tell my family, I can't go to that barbecue. We can't go to the lake. I have paperwork. I would spend all weekend cleaning my cupboards, washing down, you know, the kitchen was sparkling because I was procrastinating these forms. And then I'd go to work Monday morning having not done them. When I finally did them, I got 90 bucks, right? For three forms. Dr. Kevin Mailo: [00:09:50] Right. What is that worth? What was that worth over your weekend? Dr. Sarah Smith: [00:09:56] Right? If like the actual amount of money I got for those three forms, maybe maximum 500 bucks, but not worth a whole weekend of, I can't I've got paperwork. The mental energy attached to that, the disappointedness I had about myself not getting them done, even though I'd given up a whole weekend for it. So maddening, just maddening. And the fact that it had been there at the beginning. I took these two years off thinking I'm in a better place, get to my next workplace, new continent, same things happening. I'm like, What has gone wrong? Dr. Kevin Mailo: [00:10:31] Absolutely true. Right? So this isn't just about money and our hourly rate. This is about, this isn't just about time management. This is much bigger. This is about our personal well-being. And our psychological well-being. We should all have healthy boundaries between our places of work and our homes, and the charting issue erodes that massively. Massively, right? And it's important to be able to set up boundaries, right? We talk about boundaries with our patients. We talk about boundaries with colleagues, but it's also boundaries with ourselves in terms of charting and paperwork. And it's not just about saying no to another useless meeting or saying no to another committee that you didn't really want to sit on, if I can be blunt. It's also about saying no to that impulse to do more paperwork, right. Or just, you know, putting too many patients in and not having enough space or time to chart properly. Dr. Sarah Smith: [00:11:29] The other thing was when I would chart in the evening after everyone's gone to bed, or in the morning, you know, get up at four in the morning because I was too tired the night before. Dr. Kevin Mailo: [00:11:40] Oh, goodness. Dr. Sarah Smith: [00:11:40] Didn't think I was hurting anybody. It was only it was like, well, there's no one else awake, so it's not hurting anyone to do it then. And I heard this from a physician recently as well in my program that, you know, I wasn't hurting anyone when I was charting in the morning, but I realized I was hurting myself because I wasn't getting the sleep I needed, which meant the next day wasn't as efficient. My brain was already tired before I even turned up because I'd already been on the computer for three hours before work even started. So it is impacting our lives even when we're trying to hide it in the minor hours of the evenings or mornings. So. Dr. Kevin Mailo: [00:12:19] Well, and even just, we're just not as joyful in our personal lives. I mean, how do you feel about going to the gym after getting up at four in the morning to chart? Well, how much mental energy do you have for your practice or yourself or your family life? Dr. Sarah Smith: [00:12:33] Yeah, I hadn't exercised in years and I wasn't alone. When I'm talking to physicians who are in the pain of this right now, haven't exercised in years, haven't picked up a book in years, haven't sat on the couch and watched a movie with my family without thinking about work for years. I haven't had a weekend for years. This is not uncommon. Like literally all weekend, I've got no other hobbies anyway, I might as well just do my paperwork. It just becomes a familiar and comfortable cycle that if we're not aware of it and taking notice of it, it starts to just be there as a thing. Dr. Kevin Mailo: [00:13:10] Absolutely. Absolutely. So, Sarah, take us through your process. What's your approach? So we know how important this is, not only about practicing better medicine, but about being happier, being more psychologically healthy. Talk to us about your process. Tell us how that works. Dr. Sarah Smith: [00:13:31] So, all of us work in different environments, we have different EMRs, different staff, different patient appointment lengths, different things we're doing in our clinical day. So some of us will be family physicians, some of us will be other specialist types, but we all have to see patients, do the documentation, and then we have the rest of today's work. So we start separating it out into the patient protected time where we're seeing patients and closing charts. And then we have the rest of today's work, which, you know, for a number of years I didn't even notice that work as an actual math, right? So it was just stuff that happened to me during the day. My inboxes, my messages, my forms. There was no think to it, it was just other randomness about my day. It wasn't something I was ever paying attention to and I was never doing efficiently. So, for instance, when I was first noticing my clinical day - and I think that's where we start, we just notice first what's happening - we see patients, then we come out, we sit at our desk because maybe some intention of doing the work, right, of the documentation from that encounter and what happens, Oh, there's three patients waiting. Off I go, next patient, right? Or I sit down, I see that blinky thing in the corner that says I have things in my inbox, so I open it up, I look at the first one, I'm like, Well, I don't have time to do that right now. So I close it. But instead of doing the documentation, I go to the next thing on that work list. Oh, I don't have time for that either. So now we're doing work twice, right? Dr. Kevin Mailo: [00:15:12] Wow, yes. Dr. Sarah Smith: [00:15:12] And we're task switching, so we are draining our decision making. Dr. Kevin Mailo: [00:15:19] Yeah. Absolutely. Dr. Sarah Smith: [00:15:20] So we've come out of the room, we've spent two minutes effing around in our inbox or thinking about, Oh, I've got three patients waiting five minutes, ten minutes, forty-five minutes behind, and off we run to the next patient. So what are we doing now? We're taking that last encounter and we're packing it into our working memory. Now physicians are very, very amazing with our working memory, right? We can pack in a huge amount in there. And we've done it for so long that we just do it automatically. But you're in the next patient's room, you're listening to that story, you're wondering about the minutes behind you, and the things in your inbox that are kind of starting to collect. And then you're like, Oh yeah, I mustn't forget to do that referral that I said I would do for the patient number one. Oh, hang on, there's somebody in front of me talking. Wait a minute. Kind of rewind back into them. Kind of, Remind me again, what did you say? You kind of, so you're not even present in the room. Okay. So by the time we get anywhere close to the end of the morning, our brain is exhausted. We've been doing all of this stuff. Dr. Kevin Mailo: [00:16:33] Absolutely. It feels like an emergency shift. The task switching, the carrying a whole bunch in your head simultaneously, without question. Dr. Sarah Smith: [00:16:42] You get to lunch and you're like, okay, I'll get at least some of those charts done. So you, with all very good intention, jump into your charts. Or maybe you think, Oh no, the inbox is more important. So you jump into the inbox, whatever it is you decide to do, you kind of just do it the way you have always done it for a number of years, right? There was no teaching on this. It was just whatever we happened to think was most important or prioritized. Or maybe we just sit there for the first ten minutes of lunch thinking, well, where do I even start? There's so much to do. And even that level of, that was the energy you needed to start. And you're using it to figure out what do I do first? But it really doesn't matter what you do first because it all needs to be done, right? Then we hit the afternoon. Woof. Hyped. If we're lucky, we've had water and food. Some of us have run so far behind, we're running into the afternoon having not stopped at all. Our bladders get bigger, our working memory is working really hard right now. Multiple tabs open. Okay. It's exhausting. It's exhausting. So we teach you, you see a patient, you close the chart, you see the patient, you close the chart. That's our patient protected time. What is left? What's left is the rest of today's work. Now we need to figure out how much is that? What is that worth in time? If I was to sit down and with the time to say yes to that inbox, what's it going to take to empty out two days work? Not the backlog, not yesterday's charts, not like last week's labs. We're just thinking about what is the work of today. And actually starting to just be curious about that. So that's the starting blocks, is noticing, measuring, starting to be curious about how could I change this and do it differently. Dr. Kevin Mailo: [00:18:41] Absolutely. Absolutely. So what approaches do you take in terms of like, a charting review. If you can take me through where to start on making things better with a client. What does that start with? Dr. Sarah Smith: [00:18:59] Yeah, so we're trying to find your most simple solution to getting your charts done. And so you might type, you might dictate, you have a process that you're already familiar with. We want to optimize that. So we're not wanting you to change your EMR or learn a new system or buy a scribe. This is not how it works. This is about you in the environment that you work right now, right? So this is you with your EMR, your staff right now, the patients you have, and saying, if I wanted to see patients and close charts, now what? What already exists at the end of this consultation, how long does my charting take? What is in my note and why is it in there? You know you are the boss of your note. You know what needs to be in your note. We need to, obviously, what happened, what were the pertinent features that support the working diagnosis and the differential? What was the plan? What was the education given? What was needed for insurance, if you're in the US right, to be able to get some things approved. So whatever that looks like. Now we've got neurologists, rheumatologists, neuroophthalmologists, psychiatrists, who thought this was impossible, too. Family doctors think it's impossible. And they're doing it. Seeing patients and closing charts. So it's not impossible. And if there's any other message, it's that you can create impossible if you want to. But it is not like a tomorrow we're going to have, it's a if you want this, what do I want to work on first? What looks like low hanging fruit about this idea, right? Dr. Kevin Mailo: [00:20:47] I love that. Dr. Sarah Smith: [00:20:48] And stepping towards the very first step towards it and just not giving up. If we quit, we just get what we have right now. Which is disaster. Horrible. Don't like it. Unpleasant. I'm done with this. And if it's, I want something different, it's like any goal you've ever run towards, right? It's uncomfortable. It's different. It takes a lot of mental energy to do it differently, but it's figuring out what would make this easier for me. We come up with, we come up against a lot of objections, right? Dr. Kevin Mailo: [00:21:23] How often do you see that there's just too much getting put down in the EMR? Like it's too verbose. Do you see that a lot or is that not a major issue? Dr. Sarah Smith: [00:21:32] So the too much, too verbose, or it's got to be perfect. Absolutely part of this journey, right? Absolutely it's part of this journey and it's the noticing why you're doing that. So what is in your note and why? Right? And I often say, this is one of the little marks, who are you imagining is reading your note? Like, actually get a picture of that person. When you recognize who they are, and it may be someone from your past, so for me, it was a white haired white guy professor. Right? And he was a little frightening in my medical school. And he didn't like me at all. When I realized I thought it was him who was going to look over my shoulder at my notes, I'm like, Why would I let him decide to give up my evenings and weekends. Just one of the tricks of like, that different perspective. Is that, Oh, interesting. Dr. Kevin Mailo: [00:22:34] Absolutely. Absolutely. What about the role of templates? Talk to us about that. Dr. Sarah Smith: [00:22:41] Yeah, Anything that helps you. Like, so the template. So there are, you know, Facebook sites where people share templates and that, maybe that's not the right option for you. We want something that you're going to use without having to edit it too much. Same with your short phrases and other things you pull into the chart. If you pull them in and then edit them for the next three minutes, that's ridiculous. Stop it. Find something that works for you. Do I use templates? Not really. Like, I've got like a three in total that I use. I don't, that's not my style. But this is not about me. This is about you. What's going to make it more simple, easy, faster for you. That is what we're looking for. And that's what we're always looking for when we're talking to physicians is, I'm noticing, you know, what they're doing right now and how they could make some easy changes. That's what we're doing, we're just kind of taking a look at what's already happening and optimizing that. Dr. Kevin Mailo: [00:23:43] Do you find that there's a difference between family physicians and, let's say, clinic based specialists or the issue is pretty much the same? Dr. Sarah Smith: [00:23:52] So yes and no. So when we're looking at if consultant specialists, so somebody is going to be seeing this patient once, it's somewhat different than the family doctor who's seeing them over like that continuity. So there is differences in the content of what's required within that appointment and the who is receiving the information that's being gathered in that consultation. So there absolutely is different reasons for these consultations, different objectives at the end, but that's also important. So what is the objective? What is the question I'm being asked when I'm seeing this patient, could help you run this consultation more efficiently. So running the consultation has its own skill sets. And for instance, if a psychiatrist is being asked which medications might most help this patient, they're not necessarily being asked, have we got the diagnosis right? So it could actually change the objectives of how we're going to approach this consultation. Dr. Kevin Mailo: [00:25:07] Got that. What about the laundry list of issues that comes up? I mean, I remember that from my family medicine training. You still see it in the emerg occasionally, especially with our geriatric patients. Right? We have to sit down and go, wow, there's a lot here, you know, a patient comes in with a family member or loved one. So talk to us about that. Is this a, is this a time management thing where you say, listen, these all are important issues should we reschedule so we can go through these with a little bit more time, you know? Or is there also an element of charting here? Talk to us about what this looks like. Dr. Sarah Smith: [00:25:41] Yeah. So this is like a really broad topic and that's okay. Let's try and handle it from a few different places. So the patient comes in and says, you know, I've got back pain, I need my meds renewed, and, you know, by the way - it's usually when you put your hand on the doorknob to end the consultation - and by the way, right? Or here's my list. I haven't been able to get in with you for a while. So it's again part of this taking notice of our clinical day and what we always do. So if your next access visit is in a month, but physicians will often say yes to the ask in the room because they know it's a month away until they can get the next patient in, like to get them back in. Notice that. Notice that. Oh, I see the way I've designed my appointment schedule, it's fully booked for four weeks. That's not helping me because now I say yes to the list in the room because I've got nowhere to put them next week. Oh. Now what about our appointment list? So in Canada the really nice thing about physicians that I've noticed, Canada to US it's a little bit different, is the level of autonomy that we often have in Canada. Not all of us, but many of us. So that appointment list is set up that way because that's how everybody else has set it up. If we actually think about, well, what would help me? Oh, I could get them in next week. That would be helpful. Now what? How could we start to think about that? So just, it's taking a step back from the busy and saying, well, why am I making these decisions? Because they are the executive decision maker. You are the executive decision maker in your appointments. Number two, our patients never, ever, ever understand how long it takes to do back pain. How long it takes. How long it takes to renew scripts. No idea. Okay. Dr. Kevin Mailo: [00:27:51] Yeah, the way I heard it when I was taught, actually when I was in Edson, I forgot to mention on the podcast, Edson is a very special place where you practice where you live, Sarah, because I spent nine months there during medical school, um, during my clerkship years. But I remember one of my preceptors saying exactly that - the patient comes into the encounter with one agenda and you have your own agenda, right? Like they want something for their back pain and you want to make sure that it doesn't need imaging, that there are no red flags there. Right? And of course, you know, treat it. But, you know, it's about reconciling those differing agendas. Dr. Sarah Smith: [00:28:29] Yeah. And so it's not about I don't have time for this or I've got too many patients today or I, you know, it's nothing to do with it. Right? Patients are always self-centered. Of course they are. They don't care that you haven't peed today, that you haven't had lunch yet. They've got their idea of what they want, but it's up to us to guide them in what I can do for you well, right. So, I would like to have the opportunity to do a good job for this back pain. Right? So we're going to do the normal important things like check for red flags, hear a little bit of the problem, and then deflecting it to the next appointment is not about I don't have time today. It's about, I want to do a good job for this. Let's rebook that. So it's, is this a one problem per visit? No. You are still the boss. So it's about saying I am making the choice to say yes to this request or deny this request. I am deciding to say yes to this little old lady because I know she's traveled three hours and her daughter lives in B.C. and now is here in Edson with her. I'm going to say yes to spending that little bit more time here today at the cost of, of course I'm going to be running 20 minutes behind at the end of this, that's okay, I've decided to. Rather than, Oh, I can't believe they did this to me. Don't they understand I only have 15 minutes or 10 minutes? Don't they understand I only get paid $31, $38 for this? Like, whatever that internal frustration is that we're hearing, it changes when we start to be the decision maker, the one who is in control of this clinical encounter. Dr. Kevin Mailo: [00:30:22] Absolutely. Dr. Sarah Smith: [00:30:23] That's the change. That's the biggest change. So when somebody brings a list in. I'm totally fine. I'm not immediately going to that place of, of course they did, is what my brain said. Of course they brought a list. Dr. Kevin Mailo: [00:30:37] It's that notion of acceptance. Dr. Sarah Smith: [00:30:39] And it's totally fine because I know how to handle a list, a request, I know what I will say yes to, and I know when I'll say no. And even when the patient has a grumpy face, says something different than what I was expecting other than a loving comment, it's okay. I can hold space for me to be okay that I'm doing the best I can with what I'm given. Dr. Kevin Mailo: [00:31:01] Good. I love that. So, Dr. Smith, Sarah, we actually have to wrap up. I can't believe it went by as quickly as it did. Absolutely loved it. And this is so important to physicians. You know, I just keep coming back to your personal story and what charting meant to you or disorganized charting meant in your own life. Right? And I think that's so powerful to share that, because I think we're all feeling feeling that, you know, regardless of practice, background, we struggle with it. I'm just going to leave a teaser out there for our listeners. But Doctor Smith also goes much broader than this and discusses practice optimization or what was your term for it, Sarah? Dr. Sarah Smith: [00:31:44] Sustainable clinical medicine. Dr. Kevin Mailo: [00:31:46] Love that, love that. And so we're going to get you back on the show later to hear more about this because obviously it's more than just what we're doing and charting. And so again, I sincerely want to thank you for your time today on the podcast, Sarah. Thank you so much. And if anybody is looking her up, she is the charting coach. Dr. Sarah Smith: [00:32:05] Yeah, ChartingCoach.ca Dr. Kevin Mailo: [00:32:07] The ChartingCoach.ca. Love it. Thank you so much. Dr. Kevin Mailo: [00:32:12] Thank you so much for listening to the Physician Empowerment Podcast. If you're ready to take those next steps in transforming your practice, finances or personal well-being, then come and join us at PhysEmpowerment.ca - P H Y S Empowerment dot ca - to learn more about how we can help. If today's episode resonated with you, I'd really appreciate it if you would share our podcast with a colleague or friend and head over to Apple Podcasts to give us a five star rating and review. If you've got feedback, questions or suggestions for future episode topics, we'd love to hear from you. If you want to join us and be interviewed and share some of your story, we'd absolutely love that as well. Please send me an email at KMailo@PhysEmpowerment.ca. Thank you again for listening. Bye.
	30 Jan 2024	36 - Individual Pension Plans with Nick Giovannetti	00:42:18
Dr. Wing Lim hosts Physician Empowerment Masterclass Faculty Member and Certified Financial Planner Nick Giovannetti on the show today. Wing and Nick talk about Individual Pension Plans, or IPPs, breaking down how they work, who qualifies, and what sorts of benefits they provide for physicians. Nick has a wealth of knowledge about CPPs, RRSPs, and IPPs that he shares in this episode. Nick Giovannetti explains that IPPs are not a new financial tool, they’ve been around for over thirty years in Canada. But RRSPs have been around longer and are less complicated than IPPs to administer. There are more complex forms and filings to fill out for the CRA where IPPs are concerned and Nick says the lack of awareness about IPPs and the fear associated with the complexity prevents some accountants and planners from informing their clients about the IPP benefits. So Wing and Nick dive into exactly what an IPP is and how you can best benefit from it. They cover everything from contribution limits and family member beneficiaries to buyback and defined contribution versus defined benefit pension plans. This episode gives an overview of why Individual Pension Plans are worth exploring. – About Nick Giovannetti: Nick is a Certified Financial Planner® with a fully Integrated Wealth Planning Team. His approach to financial planning centers around a deep understanding of clients' goals and objectives, fostering long-term relationships built on trust and transparency. Nick is one of Physician Empowerment’s professional Masterclass Faculty members. __ Resources mentioned in this episode: “Kentucky Fried Pensions” by Christopher B Tobe and Kenneth C Tobe -- Physician Empowerment: Physician Empowerment Masterclass Live Conference 2024 -- Transcript Dr. Kevin Mailo: [00:00:01] Hi, I'm Doctor Kevin Mailo, one of the co-hosts of the Physician Empowerment podcast. At Physician Empowerment we're dedicated to improving the lives of Canadian physicians personally, professionally, and financially. If you're loving what you're listening to, let us know! We always want to hear your feedback. Connect with us. If you want to go further, we've got outstanding programing both in person and online so look us up. But regardless, we hope you really enjoy this episode. Dr. Kevin Mailo: [00:00:35] Hi everyone, so glad to have you out tonight for another webinar featuring the topic of IPPs, Individualized Pension Plans, which were in fact established by the federal government back in the 90s. They were not very well known until last 5 or 10 years when they've started to take off. But there are a lot of ins and outs to using these properly, and they have certain advantages over RRSPs that incorporated professionals really need to be taking a close look at. So to go on this deep dive, well, I shouldn't say it's that deep a dive, the deep dive is going to come with the masterclass. So if anybody's interested in that, do reach out to me and we'd be happy to talk further about having you join the masterclass, because this topic is dense. So Wing is going to take us through it tonight, and he's going to do it with one of our masterclass faculty, Nick Giovannetti. And Nick is an Integrated Wealth Planning Specialist, holds a lot of designations, and he and our other masterclass faculty member, Simon Wong, have done a ton of outstanding teaching on topics like this. Because you want to know what it is you're you're using when it comes to wealth creation and advanced tax planning. That's where these topics are so, so powerful to cover, like we're going to do. So again, if you have questions, you're interested, reach out to us. But let me take it from there, Wing, and hand it off to you. If you want to go ahead and introduce Nick to everybody. Dr. Wing Lim: [00:02:08] Sure. So good to see everybody and hear everybody's voices later. And yeah, this is very exciting episode in December this year. And we thought we'll wrap up the year by something that is really important. And that's about the RRSP, IPP, and the pension world. And like we said in the intro on social media, we're going to unpack this mystery box. So our guest today for our fireside chat is Nick. And Nick has a lot of designations. And he's actually also a multi-talented Renaissance man, I guess, he was previously an international recording artist. You might want to explore that on the different dimension of him. And we just talked about one of his designation is about cash flow personalities. Right? And we'll probably do an episode on that, definitely will be a lot of fun. But today we're going to talk about this project, sorry, this platform. There's RRSP that everybody probably heard about and some people do RRSP, some people don't believe in RRSP. Right. But then there's IPP pension world. So Nick, maybe you should walk us through, when we talk about this, you said you got to bring in CPP too, so may as well bring in CPP, RRSP, IPP. So walk us through a little bit of a history lesson and how it's pertaining to incorporated professionals. Nick Giovannetti: [00:03:33] For sure, yeah, thanks for having me, everyone. Like Kevin had mentioned, you know, the Individual Pension Plan, it's not a new financial tool. It's actually been around for over 30 years here in Canada. And as we know, the RRSP or the Registered Retirement Savings Plan has has been around even longer than that. It's been around since the 50s, and it was actually something introduced by the Canadian Medical Association because physicians even back then, yeah, physicians even back then were saying-- Dr. Wing Lim: [00:04:02] -- one for us-- Nick Giovannetti: [00:04:04] -- hey, we need a retirement vehicle. We need something tax sheltered. They'd done a lot of research back then, and to them it made sense to say, hey, where can I put money now, get some tax relief today, invest and grow that pot of money in a tax sheltered environment? And then I can strategically, you know, pull it out in the future and give myself predictable and secure income, something that I can count on in the future. So that's really what happened in the early 90s, was that small/medium business owners, they wanted pension plans. You know, a lot of people look at especially medical professionals around the hospital, how many of your coworkers and colleagues in the hospital have pension plans? And that's something that I think a lot of physicians look at and say, what if I could have that? What if I could even just contact the Healthcare of Ontario or OMERS or Teachers Pension and say, hey, can I just contribute to this? Can I become a plan member? And then I can also have a defined benefit pension in the future. Nick Giovannetti: [00:05:07] So physicians are not alone. Business owners have been wanting that, self-employed people have been wanting that. So in the early 90s, the first ever one of one, so one person to one company pension plan was allowed by the Income Tax Act. And it's called an Individual Pension Plan. So you could be one business owner, have one pension plan, and you're the only plan member, but you can take advantage of all of the rules that all the other pension plans in Canada follow. So everything that everyone is very fond of, federal government workers, teachers, firefighters, police, you can benefit from those same retirement savings rules. So from contribution limits to tax deductions to predictable guaranteed income in the future, you can create your own. And it's been around a long time. So if you're a physician that is incorporated, you should really look at this as part of your overall planning. Dr. Wing Lim: [00:06:05] So how does it compare to RRSP that everybody knows? Nick Giovannetti: [00:06:09] So there's a few key takeaways or few key differences and one would be that the RRSP happens on a personal level, and the Individual Pension Plan happens on a corporate level. So what I mean by that is if you want to participate in an RRSP, you're going to have to pull money out of your corporation, pay some tax, and then you're going to have to then contribute to an RRSP with your after tax personal income, and then hopefully get a tax refund on the personal side. Now the RRSP is also limited to a certain amount of contribution room, so I'll touch on that in a second. The Individual Pension Plan side, it works a little bit differently. So you can actually earn money to your corporation and if you have a pension plan, the corporation can right away save that money into a pension before any tax has ever happened on those dollars. Okay, so that's one of the big key advantages. So then the second one I touched on was contribution room. So Registered Retirement Savings Plans are capped to 18% of your salary that you pay yourself or bonus, so it's got to be salary or bonus, on the personal level, defined benefit pension plans can get as high as 30% of salary, which is a big difference. We get into, you know, a difference of 30 grand a year to 50 grand a year when it comes to maximum savings room. And on the pension side, because the government really treats pension plans favorably, you have a lot of additional ways you can put money in a pension plan. So I'll touch on a few of those. Nick Giovannetti: [00:07:46] First one is, the government cares about what the rate of return in an Individual Pension Plan is, and what they want to see is a minimum 7.5% rate of return and a maximum ceiling of it's about 9.375. They want to see pension plans grow in that window, averaging every three years. And if your pension is not growing at that rate, you're actually allowed to put in more money. When we look at the RRSP, nobody cares if your RRSP grows at 7.5%. You care, but the Government of Canada is not going to let you put more money in if your investments are not performing well enough. So you got a fail safe there. And you can also do strategies like dry powder hedging, where you purposely underperform your investments so that you can put in more money. So there's some unique strategies there. I would say another one is, defined benefit pension plans your income is based on a formula. So you know, very predictably, what are you going to have as an income stream in retirement, whereas your RRSP, it's totally up to you how you want to pull the money out. Some people pull out a lot quickly, some people don't pull out enough, some people just do the minimum that the government wants to see you pull out. So there's a lot of room for error on the RRSP side, where the Individual Pension Plan can be more predictable and easier to plan around because it's been created for you by a formula. Now there's a few different, Wing, that we could dive into. But I'll punt it back to you and we'll see where we go. Dr. Wing Lim: [00:09:28] So I guess it's a good time to talk about these formulas. Who writes these formulas? Who dictates these formulas? Nick Giovannetti: [00:09:36] It's a great question. So it's a legal framework that goes back to when the first Income Tax Act was created. Your pension plan could be structured in a way so that you're going to have, you know, a flat benefit. So it might be I paid myself this much salary, I worked for my company this many years, I'm this certain age, so I get a flat benefit based on a formula of a couple factors like that. There's also another factor which could be career average earnings. So it doesn't matter if you paid yourself lower salary in the beginning and then you upped it later on, you know your pension could be calculated on an average. You could also do it so that it's a final or best average earnings. Or a percentage of contributions. So these formulas, when you set up and register your Individual Pension Plan, the CRA actually has a registration form. And on the form you're going to check off these boxes of how do you want that formula to be identified. And it's in the Income Tax Act as to how that calculation will be made. Dr. Wing Lim: [00:10:41] Right. So this is way more complicated than RRSP. Right? So maybe we could just maybe help, maybe I will use a layman's way to bring everybody on the same page. So basically if you work for a big firm you have a nice pension plan. Right? And the employer and the employee are different people. But now with this IPP platform, they allow professionals or business owners to actually be the same person, that the employer/employee is the same entity, well same person, right, different entities. But to ensure that the benefactor of the pension plan gets so much dollar sometimes guaranteed and so that's why they have these elaborate formula. Right? But then who is funding it, well in our case it's the PC. So if you come to our masterclass, the whole series is called Fat PC Skinny, right? So you want to have a fat PC but you want a skinny me, but not a starving me, right? So you definitely want the money to come out, especially in the golden years, right? That you've done your hard work. And so you want the pension to come. And now is a way to efficiently fund this piggy bank called IPP. Right? And so that's why there's a lot more calculation than RRSP. So let's look at, yeah there's some difference. What about some similarity? At age, what, 71 both plans have to kind of be put an end to it. Can you elaborate on that, Nick? Nick Giovannetti: [00:12:11] For sure, yeah. So the similarity there is that the government of Canada, so the Income Tax Act wants you to have to start pulling money out of either an RRSP or your pension plan by age 71. You can, in an RRSP, decide to pull it out earlier, and you can do so with a pension plan as well. Some pensioners I've seen start an IPP and actually turn on their pension income as early as their mid 40s. So you have a lot of flexibility there as to when you want to start drawing the money out of these accounts. But traditional retirement age in Canada is 65, and you can delay that to 71 if you want to push it off as far as possible. Dr. Wing Lim: [00:12:55] So with IPP, you still have to do the like the RIFF and all that, right? Like there's to pull the money out there's no difference whether you have RRSP, IPP. Is there a difference the way that you pull the money out past 71? Nick Giovannetti: [00:13:07] Yeah, that's a great question. So with an RRSP it gets converted to, you mentioned it, it's called a RIFF. It turns into a Registered Retirement Income Fund. And the government will have a calculation as to how much you have to pull out each year as you age. And you're going to be doing that through wherever it is, your money managers, your trading, what have you. You have to pull out that minimum, but you could ultimately pull out whatever you want. With an Individual Pension Plan, you actually have three different options to how you want to pull the money out. So the first option is whoever's managing your Individual Pension Plan, you're going to just instruct them and sign the form that I'm retiring from my corporation and they will ask you, how do you want to pull out the money? Do you want monthly installments based on your defined benefit formula, or do you want a one year, once a year, lump sum, boom here's my payment? So that's the first way you could. So the money manager continues managing your money. Same with a RIFF and you're just getting your distributions. Okay? The second way, if you don't want any market risk, you can actually take your defined benefit pension that you save for yourself and you could go to a life insurance company and you could actually buy something called a copycat annuity. Nick Giovannetti: [00:14:24] So these are available even now for teachers, firefighters, police officers, doesn't matter. If you have a defined benefit pension, you can go to an insurance company and buy something called a copycat annuity. Now the word copycat means whatever your income you are guaranteed to have, so the distribution let's just say it was 200 grand a year of pension income, the annuity will guarantee you that paycheck every year for a certain chunk of whatever your investments were in that defined benefit plan. And then depending on interest rates and annuity rates, you might actually have a little extra so you'll get paid a bit of cash and you'll have this guaranteed income the rest of your life. Now, the third way is you could shut your Individual Pension Plan down entirely and go right back to RRSPs. So we call that a wind up. So you could shut it all down back to RRSPs or into a RIFF, and you're going to have a certain amount of your pension that's allowed to transfer. So it's a tax free transfer back to the old way. But generally speaking, you will have a chunk of money that is extra that can't transfer back to an RRSP. So you'd have to take that as an income the year you decided to do a wind up. But you actually have three different ways that you could collect. Dr. Wing Lim: [00:15:47] Right. Okay. So you got more choices, more diversity, right? More versatility. That's great. Let's talk about defined benefit versus defined contribution: DB versus DC. Because as physicians we haven't heard a lot about it, we just know that most people nowadays have a defined contribution plan meaning that the company would match you. Right.? Some of you may, listeners, may be working for a big hospital. You might be in a pension plan already. So defined contribution meaning that they define how much you contribute. They did not define how much you get, which is the benefit. And way back, there's every plan is a DB plan and now who's left with these juicy DB plans indexed with inflation? Well, our Premier, our Prime Minister, a lot of politicians do, but most corporate owners they only define a contribution not define benefit. So let's talk about DB and DC in the IPP world. Nick Giovannetti: [00:16:46] For sure, yeah. So a defined contribution pension, I think you already touched on it, Wing, the only thing defined is the amount you can contribute. And it's actually the same contribution amount to that of an RRSP which is 18% of your salary up to the maximum allowable each year. So you can put in 18% of your salary. And then when you retire, it generally just turns into a RIFF. So same as RRSPs, right? So you're going to have the choice of taking out the minimum that RIFF allows or as much as you want, but whatever you pull out of that is going to be taxable income when you pull it out. So there's nothing really more predictable about a defined contribution pension than that of an RRSP. It's just that defined contribution pensions you can contribute through your corporation, whereas an RRSP you contribute personally. Now defined benefit pension, what's defined is your benefit, the predictable guaranteed income that you're going to receive for the rest of your life. And Wing touched on it, it could be indexed to inflation, meaning that if the cost of living goes up 3%, then your pension distributions next year will go up 3%, right? That just happened with Canada Pension Plan. Everybody got a 6.5% bump to their income because inflation changed in Canada. It was a big bump to the cost of living. So everybody collecting those defined benefit Canada pension plan cheques got a nice bump. So defined benefits are formula based on what you're going to receive in the future. Defined contributions are really a corporate version of an RRSP. Dr. Wing Lim: [00:18:30] I guess some people have a fear that if they're stuck in a DB thing, that they, if they don't have a good year, they can't contribute. Right? But you say that it's just like the RRSP, right? And if there's a year, let's say you fallen sick or you had a bad year, you took a sabbatical, and you cannot contribute that much into the IPP, would it collapse? Nick Giovannetti: [00:18:52] That's a really great question. So it was, I believe it was the end of 2020 where if you're a connected person to your IPP, meaning I own 10% or more of the shares of the company that is sponsoring the IPP, so in most cases for a physician, it'll be your MPC sponsoring the company, you own all the shares, or hopefully you own at least more than 10%. You're what's called a connected person. You don't actually have to contribute to your IPP at all because you're a connected person to that pension. You own majority share of the company sponsoring it, or at least 10% of it. Your family members are also connected. So if you added a spouse or children, you don't have to contribute for them either. So a lot of the fear, Wing, of having to contribute to an IPP to top it up or boost it up, if you go on sabbatical you're behind, maybe you don't have the cash flow that year, a lot of those fears are now gone. If you were to have an IPP set up and you didn't own the company and somebody set that up for you, they would be liable to fund it the same way that if you worked for the hospital, teacher, firefighter, whatever, they have to top it up, right, General Motors, big union companies, they have to top up their pensions. So you have some flexibility as the owner. Dr. Wing Lim: [00:20:08] Right. And for the years that you didn't contribute full amount, then there is buyback or catch up. Right? There's this feature? Nick Giovannetti: [00:20:16] There is, yeah. So even if you've been incorporated let's say for 15 years and you've never had an IPP and you decide to open an IPP right now, they can do a calculation and they look at pension adjustments, your RRSP room, your your current RRSP balance, how much you paid yourself in the past and they can go back in time and say, okay, Doctor Lim, you have a catch up of 300,000 just for setting up a pension and never paying yourself salary again, but you just have, you still currently have 300 grand of room. And then you could pay yourself a salary that year, have a percentage of salary and carry forward. So you do have the ability to buy back, but it will be offset if you took care of some, if you were contributing to RRSPs. because they're going to do a pension adjustment to offset what did you put in RRSPs? What were your unused room? How well did the RRSP perform? And then that will work into the calculation of the buyback. Dr. Wing Lim: [00:21:17] So if you have had an RRSP and you're contemplating starting IPP, so what happens to the RRSP once you start the IPP? Nick Giovannetti: [00:21:25] So if you want to participate in the buyback, then they're going to use your RRSP balance as part of the calculation. And what will happen is, high level example, when you have 500 grand to buy back but based on the pension adjustment calculation, you have to take 250 grand from your RRSP, and it's called a qualifying transfer, it's tax free, you have to move 250 grand from your RRSP over to your pension, and then it would allow you 250 grand room to contribute. The rest of your RRSP, whatever's over and above that minimum transfer, you could leave it external, leave it as an RRSP, or you could bring it into your pension under a secondary account known as an additional voluntary contribution account. Dr. Wing Lim: [00:22:15] Right. So there's a lot of flexibility. And then there are certain age related benefits, right? With the room, contribution room versus RRSP. So when does the gap start to widen big enough to be meaningful? Nick Giovannetti: [00:22:30] Yeah. So, defined benefit pension plans, the formula of the matching of the salary is about 12.5% of your salary when you're 18 years old for a defined benefit plan. And RRSPs are 18%, and defined contribution plans are 18%. But by the time you're 38, the defined benefit matching curve has caught up to the 18% already. It's a little over 18% by the time you're 38. And then from the age of 38 all the way to 71, it gets as high as almost 30% of salary. So really, you'll see a lot of people heavily look at Individual Pension Plans if they're going to do the defined benefit schedule. A lot of people will heavily look at it when they reach 40. Dr. Wing Lim: [00:23:18] Right? So 40 is kind of the turning point. Nick Giovannetti: [00:23:21] The turning point for most, unless they have one of the combination registrations, so their pension has both types. You can have it where you have both types, a defined contribution and defined benefit. So if you registered it that way, a lot of those professionals will just start whenever they start, because you don't lose contribution room and you can just convert it over whenever it makes sense. Dr. Wing Lim: [00:23:43] Right. So you talk about a lot of these calculations that have to be done right. And if it is not, I heard that there's very stiff penalty from CRA. Right? And so who does all this, all these calculations? Nick Giovannetti: [00:23:59] Yeah. So when you have a pension plan it's really important to have a good team. So as part of that team you need actuaries. There's got to be an actuary or a team of actuaries that's calculating all the math behind these complex pension calculations. And there's a lot of them out there, lots of different companies doing that. So it's important that's kind of step one. You could go a step further and make sure on that team you have pension lawyers. And it's good to have pension lawyers because they can also help with a lot more of the compliance factor of your pension plan, because you will be registering it with CRA as Doctor Wing Lim pension plan, registered pension plan. So it's important to have a team that is familiar with pensions, they're able to help you manage the non-investment related factors, and then you'll have an investment team that takes care of the money. And hopefully you have an accountant and a planner that help you with the distribution and the planning side. Dr. Wing Lim: [00:24:56] So the beneficiary of these plans, so it could be me, the doctor, the spouse. What about kids? Nick Giovannetti: [00:25:02] Yeah. So you you can, you can absolutely name your children as beneficiaries, and you can even add children to an Individual Pension Plan if they work at all or have any level of employment with your corporation. Dr. Wing Lim: [00:25:17] So if they're employed, not a dividend, not T5, but they have to be T4 as well, right? Nick Giovannetti: [00:25:23] That's right, yeah. Dr. Wing Lim: [00:25:24] Right. Then they could be part of the IPP itself. But for the beneficiary let's say after you turn 71, right, you want to take money out. So kids probably well grown up by then, so they don't, do they have to be employed by to get the benefit, they don't have to be, right? Nick Giovannetti: [00:25:40] So if they, if you wanted to make them a beneficiary so if you passed away where would all these assets go, no, they don't have to work for your company to be a beneficiary. But if they wanted to be a plan member because you're looking for some different intergenerational wealth benefits, then at some point they would have to have an employee relationship with your company. I've seen the employment income as low as $3,500. I've seen some people hire their kids to do admin and social media work. Maybe they pay them 10, 15 grand for that. Whatever you do, they just have to be paid at least minimum wage for whatever job it is that they're doing. And they could be added with just one year of service. Dr. Wing Lim: [00:26:23] One year of service. And this applies not just to kids, but to the spouse as well. Right? Nick Giovannetti: [00:26:28] 100%. Yeah. So a lot of professionals and business owners will find work for their spouse to do, and then they can add their spouse to their pension plan, and the company can contribute to that spouse's pension plan. Right? Because most likely a pension plan contribution room will be quite a bit higher than that of an RRSP. Dr. Wing Lim: [00:26:49] Right. Yeah. And so this, we talked about TOSI in other episodes. Right? Test on, Tax On Split Income. So it's pretty harsh, but IPP is just one really smart, astute and legal way that you can do the income splitting, especially in the latter days, when you're drawing money out. Nick Giovannetti: [00:27:06] Exactly. Yeah. It's a very black and white way to get money into your spouse's hands by paying them legitimate T4 income, so salary or bonus, and saving for their retirement. And in the future you mentioned pension plans you can do income splitting on the income that comes out of it. So these are very CRA-approved registered pension plans that there's a lot of peace of mind knowing that that part of your strategy is ironclad. Dr. Wing Lim: [00:27:37] Right. And so who are not eligible for IPPs? Nick Giovannetti: [00:27:41] So those that wouldn't be eligible are those that are paying themselves out of their corporation dividends or capital gains. So if you're doing pipelining, capital gains stripping, and that's your only source of income out of the company, or non-eligible dividend, then those would not qualify for pension contributions. Dr. Wing Lim: [00:28:02] So if you have done T5 all along, right, and then you have never given yourself T4, then there is no room. Is that true? Nick Giovannetti: [00:28:10] So that means you won't have any buyback room. That's correct. Now you could change today. So you could say, because pensions are based on current year, RRSP contributions are based on previous year income, so you could decide in the year I'm going to pay myself salary this year and open a pension that year and participate in the pension that year. Dr. Wing Lim: [00:28:31] What about if you're not incorporated? If you don't have a PC, you're sole proprietor. Can you do IPP? Nick Giovannetti: [00:28:37] No. So you do need to have a corporation. Now another corporation could do an IPP for you. So if you worked for another clinic and they were employing you, they could register one for you, but you would now be a non-connected person. So they would have to fund that pension plan. And a lot of employers wouldn't do that because of the risk. Dr. Wing Lim: [00:28:58] Right. Yeah. I want to point this out because there are always exceptions to the rule. Right? And so that's what because some of our listeners, they, the first five years of practice, they haven't even incorporated yet, or they say the accountants told them there's really no reason if you spend it all, then you don't need a PC. And I have a colleague, 30 years after they started the practice, the accountant still says no need for PCs, and all these benefits, these powerful strategies, don't apply to them. Right? Or my personal story, my accountant way back said, no, don't believe in T4, only give yourself T5. So the first 20 years of my practice I only got T5, zero T4. So by the time I knew about IPP, my buyback is really small amount, right? And I wish I knew, right, I wish I knew earlier. And so that's why for people who are in the early or mid part of your career, this is something to plan. Nick Giovannetti: [00:29:52] Yeah. And I've heard all kinds of stories. And you bring up a good point because your accountant didn't only talk you out of being able to participate in your own IPP, but your accountant also doing what they did for you there, they talked you out of participating in Canada Pension Plan, because when you make the decision not to pay T4 income to open an IPP or an RRSP, you're also shutting yourself down from getting any Canada Pension Plan. Dr. Wing Lim: [00:30:20] Now this is really interesting because a lot of accounting accountants of my vintage, right, 30 years ago, but even newer ones I'm shocked to hear as they now you invest better than CPP. Do you want to make a comment on CPP? Nick Giovannetti: [00:30:36] Yeah, I mean, I've heard all kinds of very competent investors think that they can outperform Canada Pension Plan. Um, Canada Pension Plan is probably one of the best run pension plans in the entire world. And in order for you to compete with that, we could dive into that maybe in the masterclass or in another session, but if we wanted to calculate what you would have to earn, consistently guaranteed every year from now all the way till you pass away, to be able to recreate what Canada Pension Plan created for 6 to 7 grand a year worth of savings, it would be a very, very difficult thing for anybody to do, even an astute investor. Dr. Wing Lim: [00:31:19] Right. So CPP is a good thing. Right? And so when you offer RRSP and IPP, you also offer CPP right? Nick Giovannetti: [00:31:26] You do by default, you get two pensions. Dr. Wing Lim: [00:31:28] Yeah. Now, so then let's go back further about this accountant thing. And I'm not trying to belittle or badmouth any accountants. But a lot of accountants and advisors are so against IPP or so ignorant about IPP. Why is that? Nick Giovannetti: [00:31:46] That's such a great question. And from what I've come across, a lot of it is lack of awareness and fear. Or they're looking for something easy because it's easier for an accountant to pay a dividend. Right? There's a little more work involved if you pay T4 and you got to remit tax at source, they got to make sure they account for Canada Pension Plan, they got to do your pension adjustments, like there's reasons why it simplifies their life. And I've actually heard an accountant one time say to a physician, I was on this joint call, I don't mind paying you salary but I'm going to have to download all that work to you, Mr. and Mrs. Physician. It was the most unbelievable comment I'd ever heard. And sure enough, they asked me after the call, can you help introduce me to an accountant that would do this work for me? So it's not that big of a deal. A lot of it is very simplified. They do it for a lot of other business owners, because a lot of other business owners do have IPPs, so they have to do the salary. Dr. Wing Lim: [00:32:48] I'm just saying that this is a few years ago, 2020 before Covid, right? I read some stats that of all the eligible people in Canada for IPP, which is like millions, only 2% were implemented, right? The market penetration is like 2%. That's abhorring right? Nick Giovannetti: [00:33:08] Yeah. And again, a lot of that is it's lack of awareness and fear. So I've seen, I've seen what kind of benefit an accountant that is forward thinking and stays on the top of their game with pension plans, how well their clients have done and they stand out from the rest. And that's probably some of the 2%, because why would a business owner know to ask for an Individual Pension Plan if it didn't come from their accountant or their planner? And a lot of financial planners know very little to nothing about Individual Pension Plans. And where I say the fear comes from is because there is filings with CRA that need to be done. It's either done by your administration team or your planner or your accountant. And if they screw up, I've seen people wait years to get their pensions off the ground, and there's all this compliance problems and they're just not doing it properly. So again, if you're working with a team that's familiar, this stuff is like cakewalk, right? They do these things in their sleep and you get a lot of benefit. Why so many are afraid is because it is complex. It's more advanced planning. And just not everybody's prepared for that. Dr. Wing Lim: [00:34:17] So don't just find somebody that would just wing it, just by my name. This is not a place for somebody to wing it. This is complicated stuff. It has to be done properly. Nick Giovannetti: [00:34:28] Yeah. I've seen the big banks steer away from things that are complicated because they can't scale. So why do they push RRSPs even? It's because it's easy. You just sit with them, you meet for five minutes, you sign a form, boom. You got an RRSP, right? That's scalable. That's easy for them to administer. So even the big banks have participated in why only 2% of the eligible population are doing it because a lot of people deal with the bank. Dr. Wing Lim: [00:34:59] Exactly. Now. So this is awesome, Nick. Final question topic is messy one. Pension world. So if we can now do our own pension plan, what about different badging together like MEPs of the world? Even our medical associations are tapping into this thing. Can you just give us a quick overview of what that is about? It's a very mysterious world. Nick Giovannetti: [00:35:23] Yeah. I mean, there's a lot of different pension types out there. There's Individual Pension Plans, there's Multi-Employer Pension Plans, there's Joint Employer Sponsored Pension Plans, there's Specified Multi-Employer Pension Plans. So pension plans are a complex world. They're actually an entirely different section of the Income Tax Act than that of the RRSP. It's got its own section because there's so much complexity of how you can put these together. And I'm sure you'll see if you dig into this world, there's so many different ones out there. And the biggest thing that I find is that a lot of pension plans have been rolled out, and they may claim to be something that sounds great and polished, but until you know the underlying way it was registered and all those little details of how much do I contribute, does my company sponsor it or do you sponsor it? Who has control? What if I don't like how you're managing it? Can I take it and go somewhere else? Can I add my kids to this plan? So there's so many things there. What about indexing, right? What happens if there's a market correction? So there's so many things out there that you do need to make sure you're aware of. And one thing I find that most business owners and professionals want is flexibility and control. And the IPP generally checks off both those boxes. Dr. Wing Lim: [00:36:52] Right. Because there are talks, right, because we're busy professionals just nose down, bum up, working to our bones. And so we don't have time to think about, oh, if some big brothers sisters come and create this plan, even our own association or a fragment of our administration, right, we thought then they must do a better job just because there's bigger group of people, more asset under management that the sexy term AUM. But like you say it may not be managed well. Right? So I listen to podcasts and there is a book called The Kentucky Fried Pension. And this is a guy who is a whistleblower, which is actually a paid job in the US, and he was investigating the Kentucky State Pension and how screwed up, this is like you say, the firefighters, nurses, policemen, that how not just mismanaged, but there is just hankie panky mismanaged, like funds got stolen, siphoned to Wall Street, some favorite pals, you know, who worked there and get whatever kickback. It's just, bigger doesn't mean better. Nick Giovannetti: [00:37:59] That's so true. And you know what I, the most interesting thing I've heard recently, Wing, was there's a pension plan out there that is saying that they're going to give you a defined benefit income stream. So predictable guaranteed income stream. But when you look under the hood and the mechanics of how it's built, it's built like a defined contribution pension. Dr. Wing Lim: [00:38:22] Mhm. Nick Giovannetti: [00:38:23] Well defined contribution pension plans don't have any of the defined benefit fail safes. If the pension underperforms you can't put more money in. Dr. Wing Lim: [00:38:34] Mhm. Nick Giovannetti: [00:38:35] Right? Based on my age I can't put more money in. If there's massive market problems, can't put more money in. If I retire early, right? All these fail safes that define benefit pensions have to give people security in retirement, because anything could happen. Retirement could be 30, 40 years. Right? Look at Sears. Those pension plans were mismanaged and people lost their pension. So it matters. What are the fail safes? And if you claim a defined benefit income for the rest of someone's life, but you don't have any of the fail safes, and your contribution schedule is that of a lesser contribution room, how could you promise that? Dr. Wing Lim: [00:39:19] Right. I just want to address one more misconception, and then we'll move on to the next one, which is Q&A, and that is, there's different brands of the IPP. And you may have heard even in the physician world. And they package them, call themselves something else, but in front of CRA, there's only one thing. It's called IPP, right? You can say mine is curry chicken, mine is kung pao chicken, mine is coconut Thai chicken, curry chicken, but at the end of the day, there's only chicken. CRA only recognizes chicken, right? Not the fancy brand. And sometimes they mislead people. I don't know if it's consciously or subconsciously but that's what we want to educate on our listeners what is an IPP. And that's just it, right? There may be different ways they twist it, but at the end of the day, IPP is an IPP is an IPP. Nick Giovannetti: [00:40:14] Well, and I can give you a good example. Everybody here I would assume is familiar with the term Group RRSP. Group RRSP is not defined in the Income Tax Act. It's a made up term for RRSPs that are pooled benefits through a group. But if you look up Group RRSP in the Income Tax Act you won't find it because the underlying what CRA recognizes as the investment is just RRSP. You could call it fancy banana, but it's an RRSP. So again IPPs will follow the IPP rules and registration. They could be registered as defined benefit only or as a combination. So that might be one kind of flexibility piece. But just be aware of how it's registered. Dr. Wing Lim: [00:41:03] Right on, okay. So I want to thank Nick for so much wisdom, so much knowledge, so much information and the perspectives. Right? So we actually blown by quite like instead of half hour, way over. So we'll stop here the official one. Dr. Kevin Mailo: Thank you so much for listening to the Physician Empowerment podcast. If you're ready to take those next steps in transforming your practice, finances, or personal well-being, then come and join us at PhysEmpowerment.ca - P H Y S Empowerment dot ca - to learn more about how we can help. If today's episode resonated with you, I'd really appreciate it if you would share our podcast with a colleague or friend and head over to Apple Podcasts to give us a five-star rating and review. If you've got feedback, questions or suggestions for future episode topics, we'd love to hear from you. If you want to join us and be interviewed and share some of your story, we'd absolutely love that as well. Please send me an email at KMailo@PhysEmpowerment.ca. Thank you again for listening. Bye.
	30 Apr 2024	42 - T4 vs T5: Battle of the Taxes	00:41:28
Physician Empowerment Masterclass Faculty Members Nick Giovannetti and Simon Wong, both Certified Financial Planners, join Dr. Wing Lim as he referees a battle royale between T4s (represented by Nick) and T5s (represented by Simon). What’s best for incorporated professionals to pay themselves and why? What are the features of T4s and T5s? What do two financial planners advise? This episode will answer all these questions and prepare for more in-depth explorations in a future Masterclass. Accountants historically didn’t offer choices between T4s and T5s but the wind is changing, and now there are different champions for each camp. Nick Giovannetti explains Canada Pension Plan benefits that come with a T4 while Simon explores the potential to do better investing on their own, as made possible by a T5. Nick and Simon debate the benefits, challenges, expenses, and lower personal tax rates between the T4 and T5, showcasing both pros and cons from a financial and accounting perspective. This episode seeks to break down in simple terms who would be best served by a T4 versus who would do better with a T5 and why there is such a split between accountants. The information here is expansive, solid, and based on extensive mutual experience. Don’t miss this episode or the Masterclasses each Faculty Member contributes to in the future. – About Nick Giovannetti: Nick is a Certified Financial Planner® with a fully Integrated Wealth Planning Team. His approach to financial planning centers around a deep understanding of clients' goals and objectives, fostering long-term relationships built on trust and transparency. About Simon Wong: As an Integrated Wealth Planner, Simon’s expertise lies in simplifying complex financial concepts into clear, actionable insights, forming the cornerstone of his Financial Plans. He specializes in navigating individuals and businesses through the intricate landscape of finance, utilizing his extensive knowledge and experience to foster their financial success and stability. Simon’s academic and professional credentials, including an MBA in Accounting and a prestigious trio of designations - Certified Financial Planner, Chartered Investment Manager, and Chartered Life Underwriter - empower him to provide holistic and strategic financial advice. His career spans beyond traditional wealth planning, enriched by collaborations with elite asset management firms and a notable tenure at a leading accounting firm. __ Interested in going further in your financial journey? Join our national conference and meet the PhE team live in Toronto this May 25 and 26th: https://www.physempowerment.ca/live __ Physician Empowerment: Register for the Physician Empowerment Live Conference in Toronto on May 25 - 26, 2024 Join the Physician Empowerment Masterclass now
	30 Apr 2023	18 - Benefits of a Tax Lawyer with Jason Pisesky	00:31:49
Dr. Wing Lim takes the lead in interviewing KPMG tax lawyer Jason Pisesky. Jason explains the specialties of a tax lawyer, how they operate with accountants, and how tax lawyers like himself benefit incorporated physicians with their knowledge. Jason will also be part of the roundtable AMA at the May 6 and 7 Toronto conference. Dr. Lim actually met Jason Pisesky in a personal capacity before working with him - they met at a dance class. Wing says this is the benefit of meeting professionals and staying in contact, sometimes in the future you realize you need a person with specific expertise and you already have someone to contact. Wing talks about his personal experiences working with Jason and asks Jason to share his insight on taxation law. In this episode, Wing Lim and Jason Pisesky examine exactly how lawyers become specialists in taxation law. Jason details how familiarity with tax strategies leads him to new ways of benefiting clients, the differences in liability between accountants and lawyers, the cost analysis of hiring a tax lawyer versus ROI, and what tax laws have changed since 2017 that directly impact professionals like physicians. Jason’s knowledge is profound and very applicable to doctors today. About Jason Pisesky Jason’s practice covers a broad spectrum of taxation law matters including corporate, personal, farm and estate tax planning as well as representation in dispute resolution and litigation matters Jason joined KPMG in January 2021. Prior to starting at KPMG, he spent over six years working at a leading western Canadian boutique tax law firm. Jason has experience in both the tax dispute and tax planning for both personal and corporate taxpayers. Jason has worked with small and medium-sized owner managed operations to reorganize structures in a tax efficient manner, acting as counsel for vendors and purchasers in arm’s length deals as well as families in the midst of related party estate and succession planning. He has argued on behalf of taxpayers in many contexts and obtained favourable results for taxpayers from auditors, appeals officers and lawyers at the Department of Justice. Jason has appeared before the Alberta Court of Queen’s Bench. Resources Discussed in this Episode: Save the Date for May 6-7, 2023 in Toronto Jason Pisesky on LinkedIn KPMG TOSI — Physician Empowerment: website \| facebook \| linkedin __ Transcript Dr. Kevin Mailo: [00:00:01] Hi, I'm Dr. Kevin Mailo and you're listening to the Physician Empowerment Podcast. At Physician empowerment we're focused on transforming the lives of Canadian physicians through education in finance, practice transformation, wellness and leadership. After you've listened to today's episode, I encourage you to visit us at PhysEmpowerment.ca - that's P H Y S Empowerment dot ca - to learn more about the many resources we have to help you make that change in your own life, practice and personal finances. Now on to today's episode. Dr. Kevin Mailo: [00:00:34] All right. Hi, everyone. I'm Doctor Kevin Mailo, one of the co-founders of Physician Empowerment. And today we've got Dr. Wing Lim, another co-founder, interviewing Jason Pisesky. And Jason is a tax lawyer with KPMG. And the three of us go back a number of years, but today's topic is probably going to be one of our best, one of our most relevant and very unique because this is not something you typically find when you sit down with your accountant, your financial planner, or even your regular lawyer. And what Jason is going to be doing is getting interviewed by Wing as they go through different aspects of tax law and why this applies to incorporated physicians and why everybody should be consulting with tax lawyer as we go through our financial lives. And so with that being said, I think I'm going to step back. I'm going to let you, Wing, go for it and let's get started. Dr. Wing Lim: [00:01:33] Okay sure. Yeah. Welcome, everyone. And so, yeah, I'm Dr. Wing Lim. I'm one of the co-founders of Physician Empowerment. And so this webinar series slash podcast, because every webinar will be reincarnated as podcast and I'm working on still the proper motto, but we interview interesting people on interesting topics that will impact physicians' lives, will help physicians live better lives. And with that, Kevin, I'm reminded me to put a plug in May 6th and 7th. Make sure you guys register for that. This year it's going to be Dynamo and May 6 and 7, it's going to be jam packed with information. And we're actually going to invite Jason in Sunday, the 7th, as part of the panel discussion. And it's basically roundtable AMA, ask me anything about, well, planning and whatnot. So Jason and I went back a while back. So this is supposed to be a fireside chat, sorry, I couldn't find a fireside background. And Jason, as you can tell, is a really lovely dude and he doesn't have a big ego, unlike most other tax lawyers I've met. And so actually I met Jason probably five years before we talked on a professional basis. So I met Jason on a dance floor of all places. And why would we meet on a dance floor? Because it's one of those life up to 50, what are you going to do when you turn 50? And my wife says, Let's go dance and it took her only four years for me to say yes and dance like Pinocchio. Dr. Wing Lim: [00:03:07] And my kids corrected me and say, No, Dad, Pinocchio can dance. Okay, I stand corrected. I can't even dance like Pinocchio. And that's where we met at Dance lesson. Right? And so we had a lot of fun in the class. And then a number of years later, Jason, how much of that do you remember? I was kind of stuck in a spot, right? And I was doing major corporate reorg in a few tax strategies. And we hired a tax lawyer. No, sorry. Yes, we hired tax lawyer through a specific accountant who trapped himself as the tax accountant. And then we were just stuck because the building was crazy. What they proposed was ridiculous in terms of price, and they're not very honest with their pricing with the billing practice. And then anyways, I turned over to to Jason and said, Jason, I think you're a tax lawyer, right? And then we went and turned on the file and Jason and his group, there was a top tax firm and they revamped a bunch of things and I got up really, really happy. So that's how we met. Hey, Jason, how much of that do you recall? Jason Pisesky: [00:04:10] I remember most of it, although, yeah, it's now been I think I've stopped dancing because of COVID in late 2020. Obviously shut down because of COVID and then started doing private lessons just with, you know, 2 or 3 people in the room at a distance. But yeah, now it's been probably two years since I've been dancing, so you need to get back to that. Yeah. Dr. Wing Lim: [00:04:30] Yeah, it's been a while. Yeah. And then so the topic today is why, when do I need a tax lawyer. Right? So let me maybe prep something for everyone - everyone dialing in or future podcast listeners - we all, most of us are incorporated. And even if you're not, you're still a provider. You will have an accountant, you will have a lawyer. And isn't that enough? Right? Why would we ever need a tax lawyer unless we get audited? I think that's the everyday doctor's first notion of it. And so, and I reached a point because as you know, when you build your businesses and of course I do a lot of entrepreneurial stuff and real estate, so each time you start a venture, you start a company. So before you know it, I've literally have a spider web of so many corporations. I think by the time I brought it to Jason, I have about 8 to 12 companies and every year there's just money flying everywhere and it's just become bonkers, right? And my accountant can't even keep track. And actually one of my ex bookkeeper made a six figure mistake in these loans, and it would have been a disaster. So we said we need to simplify, right? And then we built a strategy to have a family trust. We did major reorg. There was pipeline, there was a few strategies we're doing and then so we just needed somebody to clean it up and have a look in from the tax code, right? So, Jason, when you encounter professionals, business owners, especially doctors included, why do they come to you? Jason Pisesky: [00:06:04] Yeah, so, and that's a great kind of summary of how people often do come to us is, you know, the structure has just grown to a level of complexity where it's hard to keep track of and it's good to have even just a second set of eyes to look at it, at where you've ended up. So you definitely hit the nail on the head of the easy answer of when the tax lawyer comes in, is when a dispute comes in. That's definitely a subset of tax lawyers. I, small mix of my practice, I do spend more time on the planning side, which is, of course, where I met you, so on the planning side, it's kind of a mix of tax lawyers, we kind of exist in the middle between the accountants and lawyers because tax for both of them is a specialty. I think people kind of inherently know that for lawyers, you know, you have family lawyers, criminal lawyers, real estate lawyers, litigation lawyers. I think sometimes people don't realize that with accountants, not every accountant is a tax accountant. There's auditors, there's evaluators, there's compliance people, there's all different kinds of accounting. And even amongst taxation, there's different kinds. There's indirect taxation - ie GST - international, there's M&A tax, there's domestic, international, US, all these different types of tax too. Jason Pisesky: [00:07:20] So I think people, first of all, need to kind of appreciate that, that not every accountant knows exactly the same things and what to look out for in every type of file. So, and that's a good thing about tax lawyers is we kind of exist in that middle ground and where a lot of people come to us, and kind of it was your experience of, you know, you may have an accountant who is not a tax specialist who needs that tax expertise and they'll come to a tax lawyer because we're very non-threatening, am not going to take anyone's accounting work. I'm not an accountant. I don't want to do your financial statements and bookkeeping and all that stuff. I want to help with the tax side of things. By the same token, you may also have an accountant who is really strong in tax. There are lots of them and they may be doing something complex and your lawyer may not feel comfortable doing that and assisting with that. Right? They might be a general practitioner or just a corporate lawyer who doesn't do very much in tax. And so they feel that, you know, the transactions are sufficiently tax motivated. You know, you want to make sure you do it right so you don't trip up with Canada Revenue Agency. Jason Pisesky: [00:08:25] And so they, again, bring in a tax lawyer specialist side to assist on the the lawyer side, the corporate side, to make sure things are done correctly and with the code. And that kind of circles back to the point of - and I'll use the analogy, I think everyone here is probably a doctor everyone's familiar with, you know, the GP, right, for medical practitioners, and in order to speak to a specialist, you have to go to your GP first. You know, if you want to talk to a heart or a brain specialist, you have to get referred to them, at least in our province. That's not the case with tax lawyers, or accountants and lawyers, I should say, generally. And that was your experience, right? You wanted a second opinion. You didn't have to go back to your, you know, your general practitioner and wait 6 to 9 months. You were able to pick up the phone or meet me on the dance floor and say, Jason, I want a second opinion here. Can you give me one? Which is, and there is a sizable amount of work to do, just kind of pick up the phone and say, Hey, I'm not sure things are right or I just want a second set of eyes or, and what also happens when you do have an accountant or a lawyer who's the GP type and there's certainly nothing wrong with it, having a GP for an accountant lawyer is great. The job is to just issue spot and again make those referrals. Sometimes you disagree though, but sometimes GP's can also be on the more conservative side because if they're not super deep into the tax things, they can be put off by maybe advanced strategies and say, Ah, it's too complex. I don't understand where the win is there. Why would we do that? Let's keep it simple. Um, so yeah, being able to just pick up the phone and talk to a specialist if you've heard, you know, a great idea on this, on these webinars or this podcast, you say, you know, Wing's telling me that this is a good idea, I want to explore it, and your accountant kind of maybe has never heard of it before or is afraid to try it. Then again, talk to me directly and then I can kind of speak to your accountant to explain it to them myself or another tax lawyer, of course, can kind of explain it to them and get them onside and make them feel comfortable with it. Dr. Wing Lim: [00:10:21] Yeah, so let's dwell there a little bit because I've got a few horror stories to share. Um, yeah, so I have some colleagues - I'm in a partnership - and I've deliberately planned for them to retire gracefully, right? I know, I tell people I'm not a tax lawyer, I'm not an accountant, I'm a doctor, but I know enough just to be dangerous. Right? So we structure our company carefully so that when they retire, they can be bought out and take advantage of the lifetime capital gains exemption. And then to do that, you need to purify your company. That's another concept. Sorry, guys, we just throw these things out because they are relevant but we will delve into them later on. So actually, definitely by the end you'll know how valuable Jason is. Jason will be coming back. And actually I'm drumming up something called a tax series that I want to have Jason come in on a podcast level. Right? And I'm thinking like tax hacks for busy physicians, something like that. And we'll dive into a few of these. Yeah, so anyways, and so ten years came and gone and their accountant says oh no you don't need to purify, purification is for people who are dead. So, what? And so a lot of, we find out a lot of accountants are so risk averse, right, and so compared to them like how do you see, it's the same tax code, right? How do you guys see it differently than the average GP accountant? Jason Pisesky: [00:11:49] Um, I think it just comes with that experience. I mean, I, from practically day one that I kind of stepped out of law school and right into a tax law firm, I was doing kind of the advanced strategies and that is definitely an advantage of the lawyer side where the career of an accountant is much longer to get to doing tax practice. You know, you've got to spend a couple of years just grinding through audits, usually at a big four accounting firm. Then you enter as a specialist, they're called. Then you have to slowly work your way up. Then you have to take the tax specialist program put on by the Tax Foundation. And then you have to switch to your tax group. So to become a tax specialist in accounting sometimes takes ten, 15 years and then they start to work on, oh, I want to roll over some assets, I want to do an estate freeze, I want to, again, these kind of more routine transactions, whereas again, kind of right out of law school while I was still articling, the first thing that kind of appeared on my desk was some of these strategies. And so I think just that familiarity with them and kind of a good understanding of the risk levels just because from day one that's what I've been working with. The familiarity of them I think is probably biggest one. And yeah. Dr. Wing Lim: [00:13:03] Yeah. So to finish the story, so my partners eventually, one got bought out, one did not, the one got bought out because the passive income was too good, stock market was too good. They ended up with losing this small business deduction and ended up with 53% tax bracket. And accounting just gladly says right a tax and and this guy makes a lot of money, so that year was $530,000 of tax. I would have thrown up. Right? So, and the other guy did not listen. Finally there's a time to be bought out and this guy did not purify the company, so he said no. And then the chance is gone. Now the company has no money to buy him out. And then I met another lady - so I think I send that person to to Jason - so the husband died, right? And unfortunate, so this is a fresh widow. And the husband got bought out by the company. And except the money was given to the kids and my friend was given a tax bill. And so because, again, did not do it right, did not purify, did not do the lifetime capital gains exemption. So this poor widow, fresh widow, apart from morning and running the funeral, was told by her accountant, say, did your husband invest in something? There's a T5 for $400,000 and now you have a tax bill of $200,000 due in two months. It's just such a horror story. Right? And so she didn't see the money, but she has to cough up 200 grand. And if she's not liquid enough, then she would have been in trouble, right? You know. So do you see horror stories like these, Jason? You must have seen some of these. Jason Pisesky: [00:14:55] Absolutely. And I mean, the hope is always that you can turn the horror story around because not a small portion of the practice comes from people who, oh, I've built this business over the last 20 years, I'm ready to retire, I just got this offer in the mail, help me structure this for sale. And it's well, again, often we can help, but it is usually more complex and expensive when you're doing it on the precipice of retirement, when again, you have to do these purifications, take all these extra steps, where again, but I'm sure, again, speaking to, you know, medical analogy, the preventative care doing it all along usually leads to a much better end result at the end of the day, the last stages of the business as well. Making sure that you, you know, if you're generating tons of surplus money, you have a place for that to go that you don't have to purify as much, making sure you have the right types of shares and the right types of places to get the most efficient tax treatment at time of sale. Dr. Wing Lim: [00:15:52] Right. So I think most of, I'm talking about personal experience, most of my tax advisers are very conservative. Right? This side, you never get audited, this is the side that you may get audited. And so they say, remember the first accountant, you'll never be audited with me. But of course, I pay taxes through my nose. And ten years later, I went to seminars, webinars, whatever, and I say his name was John Whatever, John, can we do this now? He said, yes. Could have done it last year. Yeah, could have done it ten years ago. Yeah. Right? Wow. Like the tax implication was huge. Right? And so as our financial IQ goes up, these advanced tax strategies show up. And then you find that, oh, people who are high up in the high net worth sphere, some of them do it every single year. You know, but then the accountants don't want to touch it. And then so my first tax lawyer met, he says, I stamped approved my advice and I go to court on your behalf. Right. And he told me that the difference is the penalty. The accountant versus the lawyer. So do you want to expound on that a little bit, Jason? Like, how much are they liable? Jason Pisesky: [00:17:05] Sure. Yeah. So at least in Alberta, and I think several other provinces, accountants have the ability to limit their liability as low as the fees paid. So they come up with a complex tax strategy that's going to save you $1 million, but something goes wrong. Whose fault it is? Who knows? The fees may be limited to, sorry the liability may be limited to just the fees paid. So you're fighting with the CRA. You owe them a million bucks, but you only pay the accountant the $50,000. That's what you can get back. Off you go. Lawyers generally do not have the ability to limit their liability. So, and that's an important point. Lawyer's fees are often higher than accounting fees, but that comes with kind of you're paying almost for insurance at that point too, where if something goes wrong, you have the ability to, you know, the lawyer is liable for that amount. And generally the the lawyer's kind of liability funds are, take that into mind, too, that lawyers have higher liability as well. So that's definitely a relevant consideration when you're choosing between a tax accountant and a tax lawyer. Yeah. Dr. Wing Lim: [00:18:17] Right, Right. Yes. Now, talking about cost, I often have people say, well, I don't want to pay the money to see a tax lawyer. And last month our webinar is with Goran, and some of you were there, and he's a tax strategist and he's not a lawyer. And so Goran and Jason, they do work together and he threw a lot of these things out. Right? And people said, well, how do we do that? And then somebody is typing in the chat and say, sounded expensive. Right. So then, so okay, let's address the elephant. Doctors are cheap. Doctors go to seminars, learn to DIY yourself to financial independence and the wealthy land right? You know. Hello. Hello. Hello. You never went to school. How do you think you can DIY? Right? But doctors are cheap, right? They want to fire all their advisors and buy some index funds and then buy some crypto on the fly and be rich. So what are kind of the costs? You know, we have a national audience, right? Nationwide. How much a tax lawyer is worth? Like, do they charge by the hour? Do they charge by the case? Jason Pisesky: [00:19:26] It depends. Usually by the hour. Although if you're kind of doing something kind of more routine planning, I am comfortable block quoting and saying this is what that particular strategy for you, based on all your circumstances, should cost and sticking to it. I do that quite a bit because I find clients do like that. You know, we can all quote in ranges and say what your hourly rate is, but then, you know, what does that really mean? Of course you give a range and the client sees the low end of the range and the professional sees the high end of the range. So I do find it to the extent possible, it is always great to give a fixed quote because everyone knows what it is. And oftentimes for when I can give a fixed quote, it's for a strategy where the the benefits are easily calculated. So I can say, you know this planning strategy, whether it's on a sale, whether it's a kind of annual planning, it's going to result in tax savings of X, it's going to cost you Y, X is bigger than Y, why would we not do this? On hourly rates, but so that's where, again, it's, you know, relatively predictable what's going to be involved. You know, assuming people have clean minute books and no skeletons in the closet, once you start moving into more bespoke unique things, hourly rates are definitely relevant. It's hard to to tell you exactly, I mean fresh out of school I'm sure there's tax lawyers somewhere in this country where their rates are, you know, $200 an hour. I know there's some in Toronto their rates are over $2000 an hour. So it does depend on seniority, what region you're in. Good thing about tax practice, though, is it's national. So you do have the opportunity to pick your professional, generally speaking, across the country because our tax code is a national code and I can work on someone who has an issue in Ontario with the national tax code as well as someone in Alberta. So yeah. Dr. Wing Lim: [00:21:15] Yeah. So there's a wide range of course there, hundreds of dollars per hour. Right? And then people say, well, you know, do you get the money worth? So I can say from my personal experience, yeah, we did a strategy where Colombo, I think my fee was about 30, 35, and we saved about $375,000. So the net savings was about $300,000 north of it. So and I talked to my colleagues, just I tell people I put the money where my mouth is, where everything I share, I've done it, right? And so people chase the returns, chase stock, the stock is hot, right? Go up, crypto hot or this real estate is really good, flip it. Make the money. Well, are you ever going to make that kind of return? 10 times. 100 times, right? Like, but if you don't, well, first of all, when you put it like that, it's a no brainer, right? You spend 30 K and save 300. But most people don't even understand that, right? They're just chasing the DIY index fund. Jason Pisesky: [00:22:16] Absolutely. And that's usually the conversation I do have with people. And it's always good to have it at the outset, right? I mean, if I went to you and said, hey, pay me 20,000 and I'll give you 200,000, you know, if that's, and that can usually be fairly easily quantified close to the beginning, maybe not precisely if you're talking something more complex like a sale or something, maybe it's you know, it's going to depend on some of the attributes of the companies. But you can often get pretty close to, you know, what the advantages are to a plan. And again, they're not always pure tax savings. Sometimes they're tax deferral, which is more confusing, where you've saved immediate tax, but the tax has been kicked down the road and it'll have to be paid later. But that does have advantage if you've deferred tax in a company and you can invest it, you know, a higher starting nest egg. Yeah, so the ability to kind of talk about those advantages, that's definitely great for a tax practice generally. I know I sometimes feel for my family and criminal law colleagues who, it's much more uncertain what someone is willing to, I don't want to go to jail, I'll pay any amount not to go to jail, until you get $100,000 bill. And it's like, well, how long was it in jail, really? Like, you know, I want my kids, you know, 100% access to my kids. Right? And again, until you get the massive bill from your lawyer and maybe you just ended up at 50% anyways, but you got your lawyer to fight for that. So I do like tax practice generally because you can, it is math of here's my fees, here's the savings. Yeah. And so I think clients generally appreciate again that and I think you probably know those numbers because you know how I draft my reporting to you. I set them out. I'm like, here's itemized exactly what we did and the results you got from it. Yeah. Dr. Wing Lim: [00:23:55] Right. And then I kept sharing with my colleagues as we lived through especially the last few years, CRA has been changing dramatically how they deal with business owners, professionals, especially medical PCs. Right? So, and every time I heard about something, I have to pick up the phone and talk to somebody smart like Jason or my other tax consultants. Right? So what have you seen since 2017? What big changes are there and how does that eat us up as professionals? Those new tax laws. Jason Pisesky: [00:24:29] I mean, the big one is the the TOSI, the tax on split income, which I don't know if you've talked about it on past ones, basic rules kind of being before the TOSI rules, I'll call them, people used to have spouses and children being shareholders of their active PCs and they would pay dividends to them. It's great if you had a non-working spouse, you could take advantage of their lower brackets. Same if you had kids going to university or, you know, buying their first home or a first car, you can kind of put the money right into their hands, use their brackets as opposed to taking it all at your high brackets. So those rules came out in 2017 and they were definitely a wrench. And they changed the tax landscape. There have been some other changes. I think it was, gosh, now I can't remember it was before or after that, they also changed the - I think it was after - the ability to practice in a partnership and have kind of the ability to have everybody get their small business deduction, the 500,000. Yeah, that was a big, that was a big one. It used to be able to have, and I knew of them, you'd have practices of, you know, 50 to 100 doctors in a clinic. And despite the size and the revenue, everybody was able to get their small business deduction. That's not the case anymore. They've closed that with a very, very complicated series of rules. And then, so now it's kind of like everyone shares one crack at it, the one $500,000 limit, as opposed to everybody having their own $500,000 limit. So the general... and I don't, I think it's unfair, although maybe I'm biased, Parliament does definitely have a take that professionals generally, be they accountants, lawyers, doctors, you know, that they're not business owners, which I strongly disagree with. I don't know what that means. You know, we go out, we get clients, we drum up business, we start clinics, put up signs, all these things, and take significant risks. But they seem to like to treat, or seem to be trending towards the direction of, you know, they should be treated like employees. It's not fair for them to have PCs. And so think that I haven't seen anything softening that tone of, you know, professionals need to be treated differently than a business, you know, producing widgets or whatever the classic university example is of your textbook business, and economics is my undergrad, it was always the widget factory they used. Jason Pisesky: [00:26:56] But I think a lot of times I'm sure a lot of people on this webinar and a lot of people listen to this podcasts spend a lot of sleepless nights at times thinking about, you know, if their business has been going through a rough patch or how they're going to grow or what the next year looks like, and how they're going to retire because they don't have a pension plan like like someone who's, so yeah. And we see technicals come out where there's a technical recently where CRA made some off the cuff comments about a medical professional that was working for a hospital, that kind of a bit of a uproar there about, again, were they really in business if they were just working directly for the hospital as a director? And so kind of a lot of off the cuff comments and material tax changes as well, that they don't necessarily... I mean, the rules that talked about TOSI, and changing those rules around the $500,000 limit so people couldn't get multiple, those don't just go after doctors, but they definitely impact doctors materially. Dr. Wing Lim: [00:27:54] Right. Now so we need to wrap the formal part up and then we'll open up to Q&A. But I think, I've been around three decades and I've seen a lot of changes, and definitely it's eaten up autonomy from professional level and also from the taxation point of view. Right.? Our take home pay has been less and less, not just from our respective colleges and provincial payment mechanism, but also from the taxation point of view. It's less and less friendly, right? And if you don't understand it, if your tax accountant is having this, your accountant is having same lesson plan as 20 years ago, it's like Mrs. Jones teaches English for the last 20 years, the same Macbeth, same same playbook. Right? So it's changing, right? And I definitely see way too many of my colleagues still using the same outdated tax strategy. And then so, a lot of these off - what we call it - the off cuff discussion, right? And people like you, Jason, read those all the time. That's your pastime. Right? And then you can tell us, well, hey, is this a smart one or not so smart one, right. For example, one is just did one prescribed rate loan for my daughter. And who just getting her first condo and based out of college and I'm exactly the guy sitting next to me his daughter in the same boat said, have you heard of this? He said, No, I haven't. So if you plug in with smart people, you get smart advice and that could change dramatically, dramatically your cash flow, your long term tax planning, even estate planning. Last mastermind we had was, masterclass, was beginning with the end in mind, right? With estate planning all that, it could be huge difference to your offspring. Right? So anyways, I just want to wrap it up and say we need - our goal here at Physician Empowerment is not to sell you guys anything but to share our ideas and to disrupt you so that you can think, and to equip you so that you can ask smarter questions next time you meet with your accountant or with your tax consultants. Right? So I want to thank Jason and we'll have Jason back again May the 7th. Virtually, him and other panelists will talk and we'll open for Q&A at the end of our whole weekend. Okay, so and Jason, yeah, as I said, and Kevin introduced, he works for KPMG. It's a national firm. It's one of the biggest firms in accounting. And he is in the law division. And I heard that you're doing your West Coast division, right? Right now. Jason Pisesky: [00:30:28] Yes, I'm working towards starting up kind of western Canada arm, to the extent it does exist in Calgary and Vancouver, but we're seeing kind of a bit of an expansion and stuff. So looking into that. Dr. Wing Lim: [00:30:39] Yeah well so congrats and hope everything turns out good. So I definitely thoroughly enjoy our friendship and every time I get smart advice from Jason. Dr. Kevin Mailo: [00:30:53] Thank you so much for listening to the Physician Empowerment Podcast. If you're ready to take those next steps in transforming your practice, finances or personal well-being, then come and join us at PhysEmpowerment.ca - P H Y S Empowerment dot ca - to learn more about how we can help. If today's episode resonated with you, I'd really appreciate it if you would share our podcast with a colleague or friend and head over to Apple Podcasts to give us a five star rating and review. If you've got feedback, questions or suggestions for future episode topics, we'd love to hear from you. If you want to join us and be interviewed and share some of your story, we'd absolutely love that as well. Please send me an email at KMailo@PhysEmpowerment.ca. Thank you again for listening. Bye.
	21 Feb 2025	Bonus Episode - CMHC and the Real Estate Lending Process	00:38:08
Want to dive deeper into topics like this? Master your journey with Physician Empowerment’s Masterclass Membership—your gateway to exclusive content, expert-led sessions, and actionable strategies to elevate your personal and financial well-being. Learn more and join us today! https://www.physempowerment.ca/masterclass — In this episode, Dr. Wing Lim talks with financing expert Gaurav Sobti about the real estate investment financing landscape. They explain the differences between residential and commercial financing, heading into a deeper exploration of the complexities involved in financing the different types of real estate. Wing and Gaurav’s discussion highlights the variety of lenders beyond traditional banks, including credit unions, insurance companies, and non-bank lenders. They also explore the complexities of commercial lending and the role of personal and group guarantees. A major topic covered is the CMHC Select program, a government initiative to encourage multifamily housing development through favorable loan terms. The program aims to promote affordability, accessibility, and energy efficiency in housing. Wing and Gaurav talk about how this initiative has significantly impacted the real estate market, making multifamily investing more attractive and accessible. They also examine market volatility, interest rate trends, and the importance of working with knowledgeable professionals in financing. This episode serves as a guide for Canadian investors looking to strategically navigate the real estate lending process. About Gaurav Sobti, CPA, CA, CFA: Gaurav Sobti has 10+ years of financial services experience across real estate, investments, finance and accounting. Gaurav’s most recent formal role was with a national real estate finance firm where he was responsible for originating and underwriting commercial mortgage transactions with a specialty on CMHC-insured (multi-family) financing. Prior to that, he spent 4+ years at a private investment fund which had a mortgage investment fund. Prior to that, Gaurav worked at Alberta Teacher’s Retirement Fund Board on the private investments team focused on private equity transactions. Gaurav was part of a top-performing team that managed a $3Bn institutional grade portfolio. Gaurav started his career at Deloitte, one of the largest accounting/advisory firms in Canada and worldwide. By training, Gaurav is a designated CPA, CA and CFA Charter holder. Gaurav is a licensed mortgage associate. Gaurav Sobti on LinkedIn Create Commercial Mortgage Services __ Physician Empowerment: Attend an upcoming Empowerment Retreat Join the Physician Empowerment Masterclass now Website: PhysEmpowerment.ca
	15 Apr 2023	17 - Storytelling and Humanizing Medicine with Dr. Alika Lafontaine	00:45:23
Dr. Kevin Mailo welcomes Alberta-based anesthesiologist and first Indigenous president of the Canadian Medical Association, Dr. Alika Lafontaine, to the show. Dr. Lafontaine talks about the importance of narrative, our personal narratives and the stories shared about medicine and with patients, to create hope and foster well-being. Dr. Alika Lafontaine shares his personal story, some of the struggles he faced with learning and growth in his early years and the ways in which narratives offered to him affected his outlook. He tells about how his parents helped shape him in positive ways and the personal self reflection ability he developed through performing with his siblings. His experiences, good and bad, have shaped how he views medicine and the importance of the stories told within the profession and to each other. In this episode, Dr. Kevin Mailo and Dr. Alika Lafontaine address the question of what you’re willing to sacrifice to the altar of medicine as a physician. They examine how the narrative we have with ourselves influences how we do medicine, and how the narrative we have about medicine influences the experiences we have with patients. Alika shines a light on reframing perspectives and realizing how the narratives we tell ourselves about others contributes to bias and exclusion in treatment. This is a powerful episode about the possibilities of medicine and the vitality of connection with oneself and others through the stories we tell. About Dr. Alika Lafontaine Dr. Alika Lafontaine is an award-winning physician and the first Indigenous doctor listed in Medical Post’s 50 Most Powerful Doctors. He was born and raised in Treaty 4 Territory (Southern Saskatchewan) and has Metis, Oji-Cree and Pacific Islander ancestry. Dr. Lafontaine has served in medical leadership positions for almost two decades. At the Alberta Medical Association, he has served on the representative forum (since 2012), the nominations committee and the Indigenous health committee, and he is a current board member. At the Canadian Medical Association, he has served as an Alberta AGM delegate, has been a member of the appointments committee and has chaired the governance council of the Canadian Medical Association Journal. At the Royal College of Physicians and Surgeons of Canada, he has served on the Indigenous health advisory committee and search/selection subcommittees, he has chaired the regional advisory committee (western provinces) and he is a current council member. He is a member of the board of HealthCareCAN. He has also served as vice-president and president of the Indigenous Physicians Association of Canada. From 2013 to 2017 Dr. Lafontaine co-led the Indigenous Health Alliance project, one of the most ambitious health transformation initiatives in Canadian history. Led politically by Indigenous leadership representing more than 150 First Nations across three provinces, the alliance successfully advocated for $68 million of federal funding for Indigenous health transformation in Saskatchewan, Manitoba and Ontario. He was recognized for his work in the alliance by the Public Policy Forum, where Prime Minister Justin Trudeau presented the award. In 2020, Dr. Lafontaine launched the Safespace Networks project with friendship centres across British Columbia. Safespace provides a safe and anonymous workflow to report and identify patterns of care; patients and providers use the platform to share their own experiences and contribute to system change without the risk of retaliation for sharing their truths. Dr. Lafontaine continues to practice anesthesia in Grande Prairie, where he has lived with his family for the last 10 years. Resources Discussed in this Episode: Save the Date for May 6-7, 2023 in Toronto Dr. Alika Lafontaine Val Arnault-Pelletier Dr. Krishna Kumar — Physician Empowerment: website \| facebook \| linkedin __ Transcript Dr. Kevin Mailo: [00:00:01] Hi, I'm Dr. Kevin Mailo and you're listening to the Physician Empowerment Podcast. At Physician Empowerment, we're focused on transforming the lives of Canadian physicians through education in finance, practice transformation, wellness and leadership. After you've listened to today's episode, I encourage you to visit us at PhysEmpowerment.cam- that's P H Y S Empowerment dot ca - to learn more about the many resources we have to help you make that change in your own life, practice and personal finances. Now on to today's episode. Dr. Kevin Mailo: [00:00:35] Hi, I'm Doctor Kevin Mailo, one of the co-hosts of the Physician Empowerment Podcast. And today I'm very, very excited to be bringing on current president of the Canadian Medical Association, Dr. Alika Lafontaine, who is an Alberta-based anesthesiologist who is also our first Indigenous Canadian Medical Association president. And today we've got Alika on the show to talk about the power of narrative in our personal and professional lives as a way of connecting with one another, but even connecting with ourselves. And this is one of the central themes of Physician Empowerment, where, you know, we come together and we talk about our practice journey or our wellness journey or our financial journey, but it's important to discuss, you know, not only, you know, facts and figures, data, but it's important to share our struggles, our failures, our successes and what we learned from those. So with that being said, Alika, why don't you say a few words? Tell us about yourself. Dr. Alika Lafontaine: [00:01:39] Yeah, absolutely. So first off, thanks for inviting me on to the podcast today. I think that the subject of narratives and the stories that we hear and the stories we tell ourselves about medicine is something that has definitely gained greater focus in this year. You know, when you talk about moving people just generally, before getting into my own story, people are moved by where they think they're going, not necessarily where they're at. You know, I think when you talk about why we get stuck is because we get so focused on, you know, what's going on in the moment. But when you talk about really being motivated, when you talk about big system change, when you talk about doing things differently, it's because we get caught up in a narrative that has this imagined, like a better world, a better place, you know, somewhere that we should aspire and you know, work towards getting towards. And that definitely has application in my own life. So when I was young, I grew up in a great family, two parent home, my dad made enough for my mom to stay at home and raise us five kids. We weren't a rich family, but we always had enough food on the table. We had a warm home. Like we didn't go vacation in exotic places, but we had a lot of fun together. Right? And my mom was a first generation immigrant from the island of Tonga. She came to California before meeting my dad and coming up to Saskatchewan. My dad was a Metis kid who grew up in small town Saskatchewan, a place called Lestock. And together they raised a family where we were really taught that, you know, community was super important. You know, respect for oneself and each other was super important, but really, really central to their message of where we could get to if we worked hard was the idea of education. My dad was the first one to go off and get an undergrad and a master's degree in his family. My mom gave up her education dreams and she reminded us, you know, I'm here for you. I've lived my life. Now I'm here to support you. So you need to go off and, you know, achieve that next step so you and your family can continue to have a better and better life. Right? Similar narrative to a lot of things that we've all been taught, you know, in the generation that we grew up in. And I remember in grade school, my teachers were very concerned around, you know, grade three, grade four, grade five about my ability to read. And it wasn't that I couldn't pick up concepts, its that I had a very difficult time expressing myself in a way that they could understand. So I would mispronounce letters. I had a very bad stutter. I think all of these things created a lot of anxiety for me, you know? And as a result, I had a great difficulty reading out loud to teachers. Dr. Alika Lafontaine: [00:04:39] And they did a lot of work to try and figure out what was going on, but eventually reached a point where they sat down with my parents and me and they told my mom and dad, you should plan for him not to graduate high school. He's not going to do anything else with his life. And I remember that moment in the vehicle after my mom was holding me and she was kind of rocking me back and forth. And she was telling me, you know, you're not broken. You're not broken. And that really set into me, you know, this narrative that I told myself growing up, you know, I have to prove to each other that, to other people, that they're wrong about me. You know, I have to live up to, you know, not only the dreams that my mom had, but also I have to, like, prove to myself that I'm not broken. Right? And, you know, my parents, to their credit, they put a lot of time into me. My mom doubled down with kind of taking care of us at home by, you know, becoming a teacher for me and home school. You know, eventually my younger siblings were pulled out of school so we could all do home school together, which I think was was really positive for me. So my two older brothers continued on to high school, but me and my younger siblings, we all took home school together. My dad went off and he had been trained as a teacher. He had gone to law school for a little bit, went off and did his master's in educational administration. So he went down to the States and got some extra training in different learning techniques, whether it's a mix of what they did or whether I grew out of it or whether it was, you know, addressing ear infections that I had when I was a kid, for whatever reason, I started to turn a corner. And it was interesting because I was labeled as learning disabled. So a learning delay with a speech impediment when I was younger, and a few years later I was labeled as gifted. And so now suddenly I had a completely different narrative that was going on in my life. And you know, that really propelled me, I think, through a lot of the frustrations that we all go through when we're trying to get into medicine and, you know, going through med school and other things. You know, what is it that drives you to, you know, do what you do? And obviously, I had the same sorts of things that I wanted, that a lot of people that come into medicine want, where we want to help people, we want to have a life of meaning, you know, these other things. But there was the added motivation that I had that I had to prove myself, right? Dr. Alika Lafontaine: [00:07:09] And I think those things together, you know, not just having my own life story, but also sharing a lot of the stories that we all have when we come into medicine, it made me particularly sensitive to burn out this belief that I had to be everything to everyone. This intense disappointment when I didn't succeed. I remember in my first year of medicine getting a, I think it was like a 74 on a histology exam, average person they're like, oh, 74 that's probably not a big deal. I thought my my life was over. I went over to the histology professor and I asked them for extra tutoring help. And I remember that whole first few weeks just really feeling out of place. I was meeting these kids who came from multigenerational physician families, people that were fairly well off. I was the only Indigenous kid in all four years at the time. And the teacher, instead of reassuring me, said, You know, it's probably not the end of the world if you don't pass first year and repeat it. And kind of waving me away and I remember walking out of that room and saying to myself, I'm done, I'm done med school, I'm not going to continue on in a place that I don't feel like I belong and I'm not going to be able to succeed. And I walked down that hallway and I met Val Arnault-Pelletier, she's a current lead for the Indigenous program over at University of Saskatchewan right now. So she's been there for a very long time, helping many, many kids like me get through the challenges that I know I shared with many, many people. And, you know, she really helped me along with many, many coffees with the dean over the next four years to help me tell a different story to myself that it was okay not to always be perfect in every situation and that there was a lot of learning and growing that had to go through and I had to give myself space to do that, you know. So my life's interesting in retrospect now because I can see how the very negative narratives that I was taught were both heartbreaking but also motivating. But then the very things that brought me into med school were the very things that broke me early on in med school as well, you know. And so I've learned different stories about myself over and over again over my career. I continue to learn different stories about myself. And I think when we talk about telling stories, it's not only about stories that sweep other people up in movements to create a better type of health care system. It's also stories that we can believe, so we can thrive, so we can address a changing world around us in a way that's maybe a lot more healthy than we did before. Dr. Kevin Mailo: [00:10:05] Yeah, that's so powerful. I mean, I think what you're touching on is what perception can do in our lives, right? I mean, you know, the same events occur to us, but our perception changes our experience of that set of events in a given moment in our lives. So before we get to, you know, our relation to other people in narrative and storytelling, I like the word storytelling. How do you look inward? What does that process look like for you? Because I think everybody's a little bit different. You know, some people will go take a vacation by themselves. I drive with the radio off in my truck for a few moments here and there and just reflect or people will meditate. But what does connecting with our own narrative look like for you, and looking inward look like for you? Dr. Alika Lafontaine: [00:10:56] It's interesting how you have a lot of experiences that seem very disconnected over your life. But then when you end up doing something really meaningful, it seems like everything kind of converges into a single point, right? And you realize, hey, that thing that I thought was very different than what I ended up doing maybe is at the core of why I do what I do well. Right? So another thing my mom really encouraged us to do when we were young was to sing together, I was actually part of a boy band for like two decades, right? It was, it was me and my five, the five of us siblings, like touring across Saskatchewan, Manitoba, Alberta. Eventually it was Canada-wide, we toured parts of the US and performed in the Pacific Islands and things. But over those two decades of performing, you start to get a real sense for feeling the emotions of the people that you perform for, but then becoming hyper aware of your own feelings. Because if you're not, you actually can't give a good performance. Dr. Kevin Mailo: [00:11:53] Wow. Yeah. Dr. Alika Lafontaine: [00:11:54] And so, I, over the years of performing with my family, really had a lot of opportunity to verbalize the way that I was feeling, reflect on how I was feeling, you know, inject that into this performance piece. So we were vocalists, like it was an R&B kind of pop group. We wrote our own music. We published three albums over the time that we were performing. This was all before YouTube, so you're not going to find a whole lot of stuff on us online. Dr. Kevin Mailo: [00:12:25] So I can't just look you up on TikTok. Dr. Alika Lafontaine: [00:12:27] No, no, you can't look me up on TikTok. But we ended up doing some pretty big shows. Like when EPTN opened, we were part of kind of the opening set, we opened for Susan Aglukark, I think was right after us. We were on the Inspire Awards, which back then was called the National Aboriginal Achievement Awards. So that had viewership of like 2, 3 million people across the country. So I had a lot of opportunity to self-reflect and understand why I did the things that I did. Now you can obviously be educated about something but not be able to, in the moment, manage yourself. So I mean this isn't to say was like a philosopher at the time of being in med school, but I did have tools available to me to understand myself. And some experiences where I could sit back and say to myself, Well, this is what we did when we wrote this song. This is what we did when we prepared for this set. So maybe I'll sit down and kind of figure out exactly where my head is at with all of this. And I think when you're looking at yourself, there's two parts that I found really, really useful. And it's different for everybody, but two things that I've found really useful. The first is being brutally honest with yourself about how you're feeling in the moment. Dr. Kevin Mailo: [00:13:35] Wow. Yeah. Dr. Alika Lafontaine: [00:13:37] You know, it doesn't make a ton of sense to deny yourself the reality that, hey, I'm sad, I'm happy, like all this other stuff. And then the second part is linking that and understanding how the things you experience trigger those emotions and put you into different cycles. Right? And I get caught up in them just the same as everyone else. I mean, we all know that there's unhealthy habits that we get into once we get into heavy call, right? I mean, you're up at 3 am, you had a horrible night, maybe in extremely horrible nights you had bad patient outcomes or some sort of disagreement with a colleague or other things. There are natural like things that we reach out for whenever we're feeling like that. Right? And so being able to understand those two parts of myself, I think has been really helpful. And I think when you're looking at how do you bridge, how you feel about yourself to now interacting with the world, it's negotiating with yourself about what exactly you're going to give the world to bring the world to that point where it can give you what you're looking for. I had a physician that did research projects under when I was a medical student. His name was Krishna Kumar. He was a neurosurgeon in Regina. And, you know, consistent with my story, I picked the hardest thing I could think of once I got into med school as far as what I was going to go after, as far as, you know, residency and is this true or not? I'm not really sure. But 19 year old me thought that this was what what I should chase after. So I wanted to do neurosurgery. And so I followed around Dr. Kumar for a couple of years. And this guy, I mean you won't find a harder working physician anywhere. 16 hour days, 12 hour surgery standing up, working on Saturdays and Sundays, flying around the world, doing presentations. He had the largest research body for spinal cord stimulation, I believe in the in the world at the time that I worked with him. So I kind of fell in this opportunity with this amazing physician. And I really poured my heart and soul into it for the first, like year and a half, showing up his house at 2 am to do presentations, being available any time of the day to to sit down and do different things, following around inside the OR and other places. But he noticed halfway through my second summer, I became a little disinterested in what was going on. And at that time I'd actually met my now wife, and I remember him sitting down with me over lunch and he had this thing where he'd like, peel radishes and like, give you slices as he was eating. And he's like giving me these radish slices as we're chatting. Dr. Kevin Mailo: [00:16:21] It's funny how we remember... Dr. Alika Lafontaine: [00:16:22] Oh, yeah, totally. Dr. Kevin Mailo: [00:16:23] .. those things in the moment, right? Yeah. Dr. Alika Lafontaine: [00:16:26] Yeah, sense and sounds. And I still remember how he looked and and all that stuff. And he's, he's chatting with me about work and then he makes a turn in the conversation, asking, like what's going on. You know, you seem just a little bit distracted, was the word that he said. And I told him about this amazing girl that I'd met. And I'm sorry if it seems like I'm not paying as much attention, she's just really incredible and all this other stuff. And Dr. Kumar was not an emotional guy, right? He was a warm guy, don't get me wrong, but he was very business. Right? And I noticed a softening that came over him. He reached his hand out onto my shoulder. He wasn't big for physical contact, but it was like a very, like fatherly touch. Dr. Kevin Mailo: [00:17:11] It meant something. Dr. Alika Lafontaine: [00:17:12] It totally meant something. And he leaned in and he said, you know, Alika, don't sacrifice your life on the altar of medicine. It's not worth it. And then we went back to talking and, you know, it never came up again. And I look back at that moment as really formative for me. I don't think I realized just how much it impacted me until later. But you have this person who, world leader in what he does, sacrifices almost all of his life to medicine, raised a beautiful family, had a good relationship with his wife and kids, but he missed out on a lot of important events in his family's life because he was focused on creating those moments for other folks who were sick and otherwise. And, you know, he's telling me, don't sacrifice too much. You know what I mean? And so it's interesting when you think about the stories we tell ourselves about our contribution to medicine and how much we need to give and all these other things. And the reflection of someone like him at the waning years of his life that maybe what we think we're getting out of medicine isn't really worth the amount that we think we're getting out. Dr. Kevin Mailo: [00:18:29] I think that's very powerful. And, you know, my own reflection on that is that we can give the health care system, our communities, our best when we are at our best. And part of that process involves self rejuvenation and having a notion of self outside of the profession because it's, I think, very easy for medicine to become quite consuming to the point that you look in the mirror and you say, Well, I'm such and such type of doctor. Right? Or our credentials. But the real us is so much more. It's all the way back to those formative years in our childhood, even the inner child, if you want to call it that, but our relationships with the others, but even with ourselves. And that's a very powerful observation. So how do you set that balance then, Alika, of, you know, the professional self and the personal self? And that's a concept we actually talk about at our wellness events, is the notion of different selves, that there's a financial self, a personal self, a professional self. How do you find that balance between personal and professional self? Dr. Alika Lafontaine: [00:19:34] So as someone who has been both balanced and unbalanced throughout my life, I think the first thing to recognize is that there will be times when you'll be completely unbalanced. Right? So this year, as president of the Canadian Medical Association, has been all consuming. And it's just the nature of, you know, the value add that I want to provide to colleagues across the country, but also just the nature of the work. Right? Residency is all consuming, right? Early practice, to some degree, can be very all consuming. The first time you take a leadership position as, you know, someone in your department contributing or elsewhere, it can be all consuming for a period of time. Right? And so I think that there's times and seasons to everything. And just to be aware that balance 100% of the time is probably not, it's not the accurate way of describing it. Dr. Kevin Mailo: [00:20:32] It's very hard to do. Dr. Alika Lafontaine: [00:20:34] The way that we work. Yeah, yeah, the way that we work in medicine. So I think the goal is to work towards balance and at times achieve it, but then recognize that from time to time it's unbalanced and just own those moments, right? And if it's too unbalanced, reorganize your life so it becomes less unbalanced, but it will remain unbalanced from time to time. Right? So that's kind of the first part. I think the second part is that when we look back, so I'm a big student of history, right? So I think one of the best ways for us to understand where we're going is to know where we came from. And if you look at the medical system and what a lot of us would refer to as very unbalanced practice patterns, I think the world has changed a lot from the times of folks that we train under who've been practicing for, you know, 40, 45 years. Right? If you go back even 20, 25 years, a physician in a community was at the center of a lot of the work in the community. Right? When you volunteered at the hospital, you were also volunteering at your community. There wasn't a division between the two things, right? You could especially see this in small town Canada, where your doctor was also someone who interacted pretty closely with the Parents Council, the community association, you know, the mayor's office, like all these things. Dr. Kevin Mailo: [00:21:56] Like people look to you. Dr. Alika Lafontaine: [00:21:57] People look to the doctor or doctors as part of building up the community. Now, since that time, that's shifted, right? And so we introduced these new divisions into the way that society interacted, but we didn't update the way that we saw ourselves. And so there was a turn in the late 90 seconds, early 2000, where there was like this value extraction, for lack of a better word, that occurred where people leaned into this narrative that we had that we were willing to sacrifice on the altar of medicine in order to get, you know, meaning out. But that meaning increasingly disappeared from the practice of medicine. You know, we still had those moments where we really connected with patients. I mean, I've had lots of experiences that I mean I'll always treasure that I've had with patients, both good and bad. But the job itself become became much less of a place where you could you could wear dual hats at the same time, you know, be a part of the community, be a part of your family, be a part of, you know, work. Right? And I think that value extraction has continued up until today and it accelerated, I think, in the last five years. And it wasn't until COVID came along that I think a lot of us sat back and realized just what was happening. We were moving too fast. Dr. Kevin Mailo: [00:23:25] No question. I mean, there's no limit to what this career can ask of us as individuals. Truthfully, there is no limit. Dr. Alika Lafontaine: [00:23:34] Yeah, Yeah. And so with that pause that COVID gave us and that opportunity to reevaluate what was important, and I think it was a moment where we, a lot of us honestly sat there and said, Do I want to live and die for this? I remember March of 2020 coming back from a canceled leadership gathering because of this unknown virus that was floating around. Touching down, going into work, we started putting masks on patients who were coming down from the floor. We started continuous masking. We were told we're going to run out of masks if we, you know, continue to do this. We're going to run out of protective equipment. And so there was strong efforts to really, really slow down the utilization of this, which to many of us, we felt like there was no protection. Dr. Kevin Mailo: [00:24:24] Yeah, there were those moments. Absolutely. Absolutely. Dr. Alika Lafontaine: [00:24:27] Yeah, yeah, yeah, absolutely. And so I remember coming home from work that, the second night that I had been back, and sleeping in the garage. And I actually slept in the garage for like the next three, four weeks. I know many of my colleagues that slept in the, because you didn't want to get your family sick. Dr. Kevin Mailo: [00:24:44] You didn't know. And that's when it becomes so real. What we might be asked to give up. Dr. Alika Lafontaine: [00:24:52] Yeah. And I think a lot of us sat there for the first time in our careers. I mean, we always knew it in the back of our minds that it could be possible. But we were actually confronted with that moment of if someone was dying in front of you and you could get infected, were you willing to die for that patient and were you willing to potentially make people that you loved very sick and potentially die as well. You know, it's, I think it's easier right now to look back and, you know, say to ourselves, well, we know this now and all these other things. And I think pre-vaccine, it obviously was a completely different game. You know, we didn't have what we have now. But I really think in that moment, a lot of us realized for the first time, I don't, I think there's a line to what I'm willing to give. You know, and I know for myself, I never actually defined a line of how far I'd go in order to, you know, sacrifice for the health care system. And I think that was the beginning of me realizing I really do need to make sure that the most meaningful parts of my life are protected. And that I can find a way forward to separate, you know, the story I tell myself about the doctor that I want to be and the kind of person I want to be in the rest of my life. And I see that that conversation going on in the minds of a lot of colleagues across the country still. Dr. Kevin Mailo: [00:26:16] And I think you're absolutely right what a powerful experience the pandemic was, because in that, in those moments, you know, we're worried about catching the virus, getting sick or getting a loved one sick. You know, it crystallized that reality of what medicine asks of us, but in reality, day to day, medicine is chipping away at us or some of us in terms of our health and well-being or our relationships. Right? You know, when you're, you know, you're working those long hours or you're constantly on call, you're constantly exhausted, you're constantly tired, how present are you for the people in your life? How present are you for yourself, for your own wellness? And, you know, it's just those those things aren't so explicit because we say, well, it's just one more night shift or it's just, you know, one more week of call and I'll be off for a few days or whatever. Right? But in reality, these are big asks of us in terms of our well-being. And we just don't necessarily recognize them because they're built into the culture of medicine. Like you said. You know, it's begun sort of, it's ubiquitous. Dr. Alika Lafontaine: [00:27:25] And sometimes it's pretty striking things that in the moment you think are so normal, but in retrospect, you're like, wow, that was really abnormal. I mean, I remember in residency knowing that at 72 hours of no sleeping, I would just kind of collapse on the floor and fall asleep. Right? And I know that it happened multiple times. Like I'd, I would push myself past what I could do and then keep on going. And I'd go home at the end of the day and I'd wake up on the floor at like 1 am and young kids and my wife had just kind of, step over, let me sleep there. They put a pillow under my head and threw a blanket on me. But, like, they they knew that it was more disruptive to try and wake me up and get me to bed than it was just to let me lay there. And I just thought it was something that everyone just did. And then you get out into the real world where you're not interacting with just doctors anymore and you realize that that's not normal at all. Dr. Kevin Mailo: [00:28:24] So talking about narrative, we talk about relating to ourselves and connecting to our self with our own stories. And I thought this was so powerful to go back through the decades of your life and see those moments, like you said, like cutting what was it, radishes on a kitchen counter, you know, in the middle of the night. And so talk to us about narrative as it relates to one another professionally. Right? And talk about, you know, how narrative relates to our patient encounters. Because I think there's a lot of beauty there. Dr. Alika Lafontaine: [00:28:54] Yeah, absolutely. And we we've talked so far a lot about, you know, our personal narrative that we have with each other or with ourselves. And then we we talked a bit about that value exchange that goes on between us and kind of the broader narrative of what is medicine and what does medicine expect of us? I think when we're interacting with each other, there's the narratives that we also tell ourselves about what other people think about us and how they interpret what we do. And then there's also narratives that we project onto other folks, you know, so I've obviously done quite a bit of work in the area of equity, diversity, inclusion, anti-racism, etcetera. And part of the way that I now explain things has come from my own feeling about performing and audiences. You know, I think people to a great degree are always well meaning. And they're being taken on this emotional journey that they may or may not be consciously aware of. That's not to say that unconscious bias is what drives inequity and exclusion and racism, etcetera. But it helps to frame things in a way that people can plug into emotionally instead of just telling them that you're like a bad person, right? The worst, the worst feeling I think for a physician is to be told after 36 hours of being on call that you don't care about patients. Dr. Kevin Mailo: [00:30:22] Exactly. Nobody's going to work trying to screw up here. Dr. Alika Lafontaine: [00:30:25] Yeah, 100%. And I think if you take that as a starting point for the majority of people, that's a place that you can have people come together more easily than other places. It also gives someone the opportunity to be more harsh with themselves than you are with them. Because the truth is, if people want to change and recognize that they're creating bad experiences for those around them and potentially harm, you know, because sometimes the decisions that we make, because of bias and other things, actually do create harm. If you want people to be introspective and actually change, they're going to be way more harsh with themselves than you could ever be. Right? And so that's kind of the first point. The second point is that we're often swept up by these things because the ways that we thought about things kind of worked. You know, even going back to what I was talking about with physicians who sacrificed their life and, you know, spent all their time at the hospital, you know, 25, 30 years ago, it worked for them. They were still able to see their family. They were still able to be a part of the community and all these things. But the world changed, right? And I think that that's the same case with a lot of the stories that we project on to other people. At some point that story made sense, right? At some point that story was true. But it's whether or not in that moment, is that story true? Is that story adaptive? And I think increasingly people are realizing that stories that tend to be pretty prevalent can lead to significant, you know, harm and pain for folks and especially patients. So one of the things that I've had the chance to be an advocate for and, you know, participate to some degree as president is, like, in the area of forced sterilizations for Indigenous women. And I and I remember as a resident, that there were situations where, you know, the surgeon would lean over, your patient would be under a spinal like doing a C-section or whatever, and they'd say, okay, I'm going to clip your tubes. And then a tear would roll down their face. And in the moment, I would sit there and think to myself, Oh, my spinal must not be working. So then I'd go grab the ice, I'd like check whether or not things are moving around, I'd peek over and see whether or not they externalized the uterus, which can sometimes cause referred pain up into the shoulder. It just never crossed my mind that they did not feel that they had a conversation where they were fully informed that this was happening. And in retrospect, it's easy for me to see what could have happened. Right? But I think for a lot of folks who are currently practicing, if you want to understand how to be a better physician, you have to be open to, you know, reframing what you thought you were doing and how you thought you were affecting other people and why people were reacting in the way that they did to you, into a way where you give some space, Hey, maybe I just didn't see what was going on. Maybe I actually was, you know, I don't think a lot of folks realize just how how hurtful it is when you meet, you know, an Indigenous person with a traditional name and you don't even try and pronounce it. So some folks, yeah, and people think, well, I'm being respectful, right? When in reality, like, it's very, very hurtful. Right? But you wouldn't know that unless you actually were able to talk to someone about it. That's not something that's a classic narrative that you would pick up just from day to day life. And so, you know, I think when we talk about patients and each other and other things, we have to get to the point where we can talk about the stories that that we believe and project on to other folks and also hear them tell us what are they feeling. Dr. Alika Lafontaine: [00:34:07] And I do feel that we we should celebrate to some degree that we are in a place where we can say racism out loud, sexism out loud, discrimination out loud. And I do hope as we continue to move forward, we'll start to realize that the goal is not to get rid of everyone who has those those thoughts or those feelings, because that's kind of a part of the world that we grew in, grew up in. Right? Those are the stories that we heard and adopted. But instead try and help people not to, you know, mindlessly act in a way that's harmful to other folks. Like that, I think, is the actual end point. Because when you when you talk to patients about, you know, racism, what do they want? They just want the harm to stop. Right? They don't necessarily need, you know, every racist thought or other things to be eliminated from the provider's mind. What they actually want is for the actions to stop. And I think if we approach it from that point of view, it's a very different, it's a very different problem. It's a much more achievable problem. Solvable problem. Dr. Kevin Mailo: [00:35:10] But I think it's so powerful when we hear the stories of what patients have experienced going through our healthcare system with systemic racism or sexism and hearing the stories on an individual level, like the case of that patient having her tubal ligation really with no with no discussion or consent. Proper consent at least. And so those are the kinds of things that can be very powerful to motivate us, to help us to see things from another's perspective. Dr. Alika Lafontaine: [00:35:44] And I think that that brings us closer to what we actually want to get out of medicine. And this goes back to like the the the the altar analogy, is not that we can't get meaning out of medicine, it's just that the world has changed. So we have to change too, like our meaning has to change. You know, the way that we get it has to change. And I think at the very beginning of all of this, like you talked a lot about, or you mentioned burnout and the need for wellness and, you know, having people step back and realize there's different parts of who they are and what their needs are and and other things. And 20, 30 years ago, we wouldn't talk about that. Right? And I think today we have to confront it because that's a necessary part of the new story we have to tell ourselves so we can start to thrive in medicine again. Dr. Kevin Mailo: [00:36:25] And I think it's important to use, you know, storytelling and shared experiences to humanize medicine because too often I think we look at it from a very technical perspective. I mean, you know, you come into the emergency department and you're there to, for instance, you know, on shift and you're there to say, Oh, you're not having a heart attack. You rule out anything serious, but maybe that patient's having chest pain because you need someone to talk to. You know, that they're struggling with anxiety or depression and it's presenting, you know. But when we don't create that space to hear people's stories, we end up being very technical. But there's a downside. It's not only, you know, that the patient has lost out, but so have we, because some of the most meaningful moments in my practice have been when I actually just sit and listen to a patient. As we humanize the experience in medicine and humanize our interactions not only with our patients but with one another, I think we feel more connected to our jobs and we derive more meaning from it and we do better care. Dr. Alika Lafontaine: [00:37:26] And, you know, this has me thinking about, you know, something that that's come up over and over again with with being president of the CMA, and that's how do you get unity within the profession towards things that will not just help us, but also help patients. Right? And my mind over the past year has gone back a lot to this whole idea of social cohesion. You know, this idea that we're, we have shared values, we have shared problems, and we find shared solutions together. And I think increasingly, what's the number one challenge of patients across the country? It's access. It doesn't matter which part of the ideological spectrum you're, right, how much you think government should be involved or not involved in your life. You know, if you're sick, you want access to care. You want access to to people that, access for people that you care about. And the polarization that we have, I think, has introduced this idea that somehow we'll get that access if we're right, if only people would do our solution, you know, everything would work out. When in reality, I think the way that we improve access is to improve cohesion within the health care system and between like the people that provide us care and the people who are coming for care. If you don't feel united with your provider, you're not going to share with them what's actually on your mind. If you don't work in a team where you feel like you can lean on them, you're not going to be able to find those moments where you can create additional time that you didn't have the day before because now you're working with the team that you're working well with, right? Dr. Kevin Mailo: [00:38:55] Absolutely. Absolutely. It's so true. I mean, just again, it's that shared experience, not that we have to agree on everything, but like access will improve when we identify it as the key, key priority that we need to address in our health care system currently. So, Alika, this has been absolutely outstanding and we would love to get you back on the show. Right? Just to hear more of your experience, you know, more of your wisdom in this space. But we would love to hear your final thoughts on what narratives meant in your life and how we can use it in our day to day. Because I think it's important to have medical education meetings, programing that's based around narrative. But I also think it's important that we can integrate narrative into our day to day interactions with patients, allied health and even one another, because I think that binds us together. I think that's cohesion, as you talk about. But practically speaking, how can we integrate, how can we integrate this into our day to day practice lives or our leadership roles? Dr. Alika Lafontaine: [00:39:59] Yeah so I'll maybe just touch on one thing, and that's the importance of narratives driving emotion. You know, why do we believe different stories is because we think we're going to feel different ways, right? And that was a lesson I learned from performing. You know, people didn't come to listen to you sing they didn't come to see you, they came because they thought they were going to get a feeling out of them showing up. And I would say in the moment that we're in right now, there's a lot of hopelessness that's going on. And the reason why people are drawing back from clinical practice, why they're leaving for other things, is because they think if I sit still and continue doing what I'm doing, this hopelessness will continue to build. Right? And so when we talk about the stories we tell ourselves, it's really important to find hope in the hopelessness and to ensure people act in a way that can actually generate hope again. You know, and so that's one part of of the point. The second part is that hopelessness, I think, transitions at some point into indifference. You know, you can see it with certain patient interactions that you had, you know, coming across folks who show up because they're going to die otherwise. But they really have no hope that the system is going to help them. Right? They come in very indifferent. You know, you're just going to be like every other physician, every other health provider that I've ever met who hasn't been able to actually help me get out of this hopelessness. And that is a much more difficult problem to confront. Indifference is many magnitudes worse than hopelessness, regardless of how bad it feels, right? Dr. Kevin Mailo: [00:41:42] Yeah, that's a very powerful observation. Dr. Alika Lafontaine: [00:41:44] Yeah, and so we have a moment right now where we can really focus on doing things that will generate hope. I mean, you look at what's going to happen with the budget later on this month. I do honestly feel that there are going to be some very significant changes in the way that we collect data. The fact that we're going to share depersonalized data between jurisdictions now. We haven't really done that except in huge emergencies like having a unique patient identifier across the country means you now can compare all databases, I mean there's all these different things. The regional license opening up on May the 1st in Atlantic Canada, you know, finally taking a measurable step towards having folks be able to register once for a license and be able to practice in multiple jurisdictions simultaneously. That could transform practice in a lot of different ways. Suddenly, you meet somebody at a conference and you know that you all share a regional license. You could set up a virtual team together the next day. You know, you wouldn't have to worry, how am I going to practice if you move from, you know, a place like New Brunswick to Nova Scotia for school, for example, you know, you could keep your family doc. Because now your family doc's licensed to work in Nova Scotia, they can follow you where you go. You know, there's all these like, really amazing changes that could happen. But we haven't done the greatest job in helping people understand the hope in those actions. Dr. Kevin Mailo: [00:43:07] Right, Right. The emotion that sits there. Dr. Alika Lafontaine: [00:43:10] Yeah, 100%. And so, I think if we can focus on being authentic, because I think false hope is almost worse than remaining hopeless, you know, but we can take people to places where things are very likely to actually change practice, you know, actually make things better. It's important that we all kind of lean in and do that right now because once we start to become indifferent and once indifferent starts to spread and entrench itself across the health care system, it's going to be even harder to change things. Dr. Kevin Mailo: [00:43:44] Absolutely. Absolutely. All right. I think we should wrap it up. But this was outstanding. It was just great. And I really want to sincerely thank you for your time, Alika, because I know you're busy. And on behalf of the profession, and I know you get a lot of thanks, I just want to share another thanks for all you've done to advocate for the profession, but also, again, you know, to advocate for Indigenous voices within our health care system to start meaningful, meaningful change towards one of the most marginalized groups in our society. So, again, thank you. And, you know, we should have you on the show for sure at another point. Dr. Alika Lafontaine: [00:44:23] All right. Thanks for having me. Dr. Kevin Mailo: [00:44:29] Thank you so much for listening to the Physician Empowerment Podcast. If you're ready to take those next steps in transforming your practice, finances or personal well-being, then come and join us at PhysEmpowerment.ca - P H Y S Empowerment dot ca - to learn more about how we can help. If today's episode resonated with you, I'd really appreciate it if you would share our podcast with a colleague or friend and head over to Apple Podcasts to give us a five star rating and review. If you've got feedback, questions or suggestions for future episode topics, we'd love to hear from you. If you want to join us and be interviewed and share some of your story, we'd absolutely love that as well. Please send me an email at KMailo@PhysEmpowerment.ca. Thank you again for listening. Bye.
	15 May 2023	19 - Side Hustles and Passive Income for Physicians with Dr. Jordan Frey	00:35:50
Dr. Dimitre Ranev steps in to host Dr. Jordan Frey, plastic surgeon and writer of The Prudent Plastic Surgeon blog, on the show. Dr. Frey’s blog addresses finances and passive income for physicians which is what he and Dr. Ranev discuss for listeners. What side gigs are available and how are they found? Jordan started his blog as a passion project and for the first six to nine months did not monetize it to ensure he could maintain quality content. He shares how the audience grew quickly and monetizing it became an easy choice. It now provides him with a solid side income that he appreciates not just financially but because he enjoys writing the blog so much. In this episode, Dimitre Ranev and Jordan Frey talk about why addressing finances for physicians is not a taboo subject and should be more openly examined. Jordan explains the different sources of side income available to physicians, from blogs and podcasts to medical knowledge surveys, medical chart and insurance claim reviews, and of course real estate. Jordan provides real life insight into what each income stream requires and how to find one to pursue. About Jordan Frey, MD Jordan Frey is a plastic surgeon specializing in microsurgery and breast reconstruction. His hope is to spread the principles of personal and financial well-being to other physicians, trainees, and people of all walks of life by sharing his journey on this pathway of fulfillment, purpose, and happiness. Jordan runs and writes for The Prudent Plastic Surgeon blog and is also co-founder of BeautyTune.me. Jordan lives in Buffalo, NY with his wife Selenid, a college professor, and three boys, Samuel, Emery, and Camilo. Resources Discussed in this Episode: Save the Date for May 6-7, 2023 in Toronto Jordan Frey, MD on LinkedIn The Prudent Plastic Surgeon blog “Physician Side Gigs to Make You Passive Income” by Jordan Frey, MD, posted on MedPage Today December 16, 2021 — Physician Empowerment: website \| facebook \| linkedin __ Transcript Dr. Kevin Mailo: [00:00:01] Hi, I'm Dr. Kevin Mailo and you're listening to the Physician Empowerment Podcast. At Physician Empowerment, we're focused on transforming the lives of Canadian physicians through education in finance, practice transformation, wellness and leadership. After you've listened to today's episode, I encourage you to visit us at PhysEmpowerment.ca - that's P H Y S Empowerment dot ca - to learn more about the many resources we have to help you make that change in your own life, practice and personal finances. Now on to today's episode. Dr. Dimitre Ranev: [00:00:35] Welcome back, everyone, to the Physician Empowerment podcast. We have a very special guest today. It's Dr. Jordan Frey. He's a plastic surgeon based in Buffalo, New York. And he also runs a blog called The Prudent Plastic Surgeon, where he shares his financial journey and helps full-time physicians like us achieve financial independence. Tell me a bit about, Jordan, about the blog. You it started how many years ago? Dr. Jordan Frey: [00:01:00] It's been about two and a half years ago now. Yeah, And it started really at the end of the end of my fellowship. And I always joke, it was just, I was in a bedroom in Brooklyn because I did my training in New York City. My wife and kids had already moved to Buffalo, where I am now, as an attending, and we basically stopped renting out our apartment and I was just staying with her aunt in Brooklyn. But basically at the end, to backtrack a little bit from that, you know, towards the end of my training, I realized that I was feeling burnt out, which was a surprise to me. And I'd been feeling these symptoms of burnout for a long time. I didn't know that they were burnout. And I finally sort of came to terms with that, and so then started looking at what was causing it and which was obviously multifactorial. But a huge part was my financial situation, which was really stressing me out. And I realized that my financial well-being was really nonexistent and that was hurting me a lot because I was, you know, I was nearing the end of my training and people were telling me, oh, it's going to be great. You're going to be a plastic surgeon. You're going to be making all this money. And I was just like in my head going, No, you don't understand. It's not great at all. I, you know, I have half $1 million of student debt. I have credit card debt. I have literally no savings, no investments. I have a family, like this is not good. And yes, my salary is going to increase, but I'm just being told like I have to buy a big house, I have to buy a fancy car, I have to buy fancy clothes, like all this stuff, because now I'm going to be a doctor, like an attending physician. And so I felt really stressed about that. And long story short, my wife and I, we made a conscious decision that we were going to learn about personal finance and start getting our finances under control. Over the course of months, we began to do that and then started managing our own finances and we created a financial plan. And the shocking part to me was just having that plan. My financial well-being really shot through the roof and I actually felt my symptoms of burnout improve, even though, you know, my actual money situation hadn't changed. I was still in training. We still lived in New York City. Dr. Jordan Frey: [00:03:16] We still had just as much debt and everything like that. But now I had a plan and I just said, okay, if I follow this plan, I can get out of debt, I can reach financial freedom, I can practice on my own terms. And that was just so powerful. And then, you know, there's this taboo in medicine that if we think about money, that's a bad thing, because we didn't become doctors for the money, which is true. But it's also true that it's okay to think about money. And I experienced that once I started thinking about money, I actually became a better doctor. I was more able to focus on what I loved about medicine. So that was really surprising to me. And then I started this blog basically for two-fold reasons: to try and break that taboo and also to show people that you can start in such a bad position like I was starting in and still make steps to improve and to create the ability to reach financial freedom, which I'm not at yet. I'm still very much in the process, but it's fun sharing that. So that was kind of a long-winded answer to your question, but that's where the blog was born out of. Dr. Dimitre Ranev: [00:04:24] So I actually, I went through your blog. It's a great blog. I really suggest our listeners take a look. And I did notice a bit of pushback, actually. Early on, you had some comments saying, oh, you know, you shouldn't worry about money. This, you're not in it for this. I can't paraphrase specifically, but I remember reading some of those comments. Dr. Jordan Frey: [00:04:42] Yeah. Dr. Dimitre Ranev: [00:04:43] I'm just wondering, how much pushback did you get? Because you got some on the website, but were you getting more from your colleagues or...? Dr. Jordan Frey: [00:04:51] There definitely was some. Yeah. It's, one of the very first comments that I had was a really negative one. Someone just saying like, this is totally... Just basically saying like, this is BS. Like why are you doing this? Why are you worrying about this? And I was actually like, Man, if I got this kind of an emotional response, I'm on to something. Dr. Dimitre Ranev: [00:05:13] Yeah, yeah. Dr. Jordan Frey: [00:05:14] And I think it's just that. It's because it's hardwired in and there is just, it's a taboo, it's something that I fell for where people just say, like, if you're thinking about money, you're not a good doctor. And it's not, I'm not thinking about money in the sense of like, oh, I'm trying to squeeze every penny I can out of my patients or something like that. Like it's the complete opposite. It's just like, Hey, we're blessed to be high-income earners, but doctors are really bad with money because we have a bad money mindset. We spend money poorly. We don't have any financial education. So there's a lot of pushback because people are just stuck in that traditional thinking. And my response is always like, look, patient care is still what's number one. It's just this, our financial well-being, it's an important part of our overall well-being. And if we neglect our overall well-being or any part of it, we're making ourselves worse doctors for our patients. And that's what I experienced firsthand, which is scary to say, because I did realize I was providing, you know, worse patient care because I wasn't totally focused and wasn't totally enjoying medicine. And when we enjoy medicine, that's when we're at our best. So I get that. And then the other form of pushback, I get a lot - kind of publicly and people just talking to me - is they're like, you know, Oh, you're always talking about financial freedom, which is this idea that you can, you don't have to work anymore. You're financially independent and you're only, you know, I'm in my third year of practice out of training. Like, why do you want to retire so early? And the truth is, I don't want to retire at all. I really love what I do. Like, I get really amped up and excited to go to work every day. But I do know that I am happier knowing that I can work because I want to, not because I have to. Which again is not a point, is not where I am currently, but that's where I aspire to be. So, you know, and I think my argument is always, Imagine if there was a world, you know, you're in Canada, I'm in the US, regardless of country or whatever, right, imagine if there was a world of doctors that were financially independent. That could work because we want to, not because we have to. And how we could change medicine for the better. Because right now there's so much bureaucracy and administrative restraints on what we're able to do. And a lot of doctors work at jobs they don't like because they need the paycheck and put up with things from insurance, you know, from whatever, because we kind of have to and if we could take back that control, I just can't even fathom how much of a positive impact that would have on just patient care. Dr. Dimitre Ranev: [00:08:06] Yeah, but it also, if you're financially secure, you can stand up for your patients better as well. Dr. Jordan Frey: [00:08:11] Exactly, yes. Dr. Dimitre Ranev: [00:08:12] I mean, people don't realize that. But you can put your foot down and say, fire me if you want to, I don't care. I'm going to do the right thing for the patient. Dr. Jordan Frey: [00:08:21] Exactly. Yeah. So that's so powerful. Dr. Dimitre Ranev: [00:08:23] And that's true across the board, whether it's in the US, Canada or anywhere in any other country. And I think what you mentioned, you know, what's the specificity, what's the patient, the skill of a doctor who's thinking about his finances - well, he's he or she's examining you - right? Like they're not paying attention to you because they're worried about making the mortgage payment. So it's so interesting, the pushback, because we got the same amount of pushback when we started Physician Empowerment. This 'you can't talk about money'. You can't. But it's so important. Dr. Jordan Frey: [00:08:56] So important. Dr. Dimitre Ranev: [00:08:58] So let's talk about money. And I want to talk about, there's this great article that you published and I'll share as well, hopefully in the podcast, where you talked about side gigs. And I guess, what would you define as a side gig for a physician, Jordan? What's your definition there? Dr. Jordan Frey: [00:09:15] I think, you know, it's pretty broad, sort of anything, anything outside of your main clinical gig or job, if you'd call it. You know, I'm a W-2 employee, which just means I'm an employed physician for a hospital. So sort of anything outside of that, I consider a side gig. Dr. Dimitre Ranev: [00:09:37] And you have some examples and I'll now go through them. I don't want, I want to start with maybe the one that you have the most knowledge with. Well, a lot of knowledge with, I wouldn't say the most, but blogging and just the website process and the podcasting process. So I'm assuming you enjoy that a lot. Like you blog. You enjoy the blog process. Dr. Jordan Frey: [00:09:57] For sure. Dr. Dimitre Ranev: [00:09:58] And have you, if you don't mind me asking, have you monetized that? Like, does it bring you any income in any way? Dr. Jordan Frey: [00:10:06] Yeah. No. I don't mind you asking at all. Yes, it does. And it started out, so like I said, it's about two and a half years. The first, like 6 to 9 months of it, I didn't monetize it at all. And I had some opportunities to. But I really kind of just said, you know, I want to take the first while - I initially said a year, but then it kind of took off quicker than I even anticipated or had hoped - but I wanted for the first 6 to 9 months to be purely just focusing on content, making sure that I could provide really good content and hone my skills in terms of writing and providing value and that sort of stuff. And then it started to get to the point of where I was doing that, and people were asking me for resources and advice that I couldn't sort of, I could provide in a general sense but not as specific. So things like, okay, I need to refinance my loans. Can you help me do that? And so I obviously am not a loan refinancer, but I could say here, this is who I used. These are companies that I trust that I've personally vetted, or things like that. Things like I need disability insurance, who should I use? And that I could say, well, this is who I used or this is who I know will get you what you need and be fair about it. So things like that. And it's obviously slow starting out. You know, I always tell people this is not something where, like if you're looking for this to be immediately a source of income, I think there's better ways to do it. And we'll talk about that because there are times people come to me and say, I want side gigs that are going to give me immediate money. This isn't really it, but if you stick with it, it will become a significant source, like so after that initial year, you know, the following calendar year, it made me, you know, somewhere like low five figures. You know, like 15,000, 20,000, something like that. But then in the second year now, it's making me in the six figures. So it's a significant source of income. Dr. Dimitre Ranev: [00:12:32] Right. Dr. Jordan Frey: [00:12:33] And it's fun because that ties in with, all of those sources of income from the blog tie in to my why with the blog which is just providing people avenues to reach financial independence. So whether it's things like the course I offer helping people to reach financial independence, whether it was, in the past I've done coaching, I don't do that now. So whether it's that or whether it's through other referrals or sponsors I have that I've used myself in my journey that I can help recommend to other people to accelerate their own journey. Dr. Dimitre Ranev: [00:13:08] So it took a lot of sweat equity, but it paid off. And obviously you do it because you enjoy it. That's the first thing you have to enjoy it. Dr. Jordan Frey: [00:13:17] If you break it down as like in a, you know, how many dollars per hour, I don't know how much it is, but it is a lot of work. But if you enjoy it, it's worth it. And that was the worst advice I got when I started doing this, was someone who's very well established in the field and probably was speaking from some point of self-preservation, but basically said like, you should not do this. It is a bad idea to start a blog on physician finance. And I try to tell people the opposite of that. Like, if you love it, if this is really something you're passionate about, you should do it. And I'm always, there's people that I've talked to and helped that have started their own sites or podcasts, you know, around this area. And there's no shortage of need for unique perspectives in this area like what you're doing. So if you are passionate about it, it is really a great thing to do and you can certainly monetize it and make it into a very viable side gig. It's just one that you plant the seeds and you have to water it and kind of let it grow. It's not an immediate one. Dr. Dimitre Ranev: [00:14:23] I'm curious, you have a course and how long did it take you to sort of, to get that done from the beginning, the idea, to the actual recording it, like how many hours do you think you spend or how many months did it take? Dr. Jordan Frey: [00:14:38] It took probably like a full year. And it's gone through a few iterations and improvements. So yeah, because you start out and you say like, I have this idea for a course and so my course is, it's really for anyone, but it's really geared for young physicians who are kind of starting and saying, I'm at the beginning of this process. I don't really know much about personal finance or how to develop the right habits or how to create a financial plan, how to set my course to financial freedom. So sort of starting from there. And so it takes, you know, going through and planning out what topics do I need to hit, what order, developing a script and then recording everything, doing video editing, which I didn't do myself. I outsourced that. Dr. Dimitre Ranev: [00:15:26] It's very time-consuming. Dr. Jordan Frey: [00:15:29] Yeah, very time-consuming. And then developing the, you know, different downloads and resources. And then once you actually have the course, guiding students through it, which is a process. I am fortunate in the sense that my wife has a PhD in education and so is really like... Dr. Dimitre Ranev: [00:15:50] She had pointers. Dr. Jordan Frey: [00:15:51] She's like okay, you need, yeah, you need to develop learning objectives for everything. And so could kind of help throughout that. But it's definitely a process. Dr. Dimitre Ranev: [00:15:59] And do you offer your course only through your website or do you offer it through other like teaching websites? Just curious. Dr. Jordan Frey: [00:16:06] I offer it only through my website mostly because that's the only way I know how to do it, I guess. Dr. Dimitre Ranev: [00:16:12] Right, Right. No, I am just so curious. Dr. Jordan Frey: [00:16:14] It's only through my website. It's evergreen. So like, at any point anyone can sign up for it whenever it's right for them and it's kind of self-guided but with access to me throughout. So, yeah. Dr. Dimitre Ranev: [00:16:28] Okay. So you're there. You're sort of there for Q&A, for first-hand guidance. Dr. Jordan Frey: [00:16:33] Yeah, exactly. So I offer like, anyone who is in the course gets personalized coaching with myself, gets access through email and phone calls, you know, as our schedules allow. So I didn't want it to be something where it's just like, you know, okay, you just have the recordings and you're on your own. Like, no, it's... I wanted it to be able to be personalized. Dr. Dimitre Ranev: [00:16:54] Yeah. And as a teacher for both, I think educators really, getting the contact, it's just you get energized from it, from talking to somebody and helping them. Dr. Jordan Frey: [00:17:03] Totally. Yeah, exactly. Dr. Dimitre Ranev: [00:17:04] So you need that. That's great. I didn't know you had the interactive component there, but that's amazing. And again, our listeners should check it out. I think it looks like a really interesting course as well. So that's sort of one side. That's more niche, I guess. You have to like writing, you have to like teaching. You have to like helping people. Dr. Jordan Frey: [00:17:21] Yeah. Yes. Dr. Dimitre Ranev: [00:17:22] Let's talk about some more, I guess, general ones you can use. Just leverage your medical knowledge. And you mentioned those in the article as well. One of them is medical surveys. I like your approach to that, that you say that you should only do them if - I guess you're saying if you have nothing better to do, maybe, maybe phrase it better than me. But yeah, don't do them if you're supposed to spend time with your family or do something else. But if you have the extra 30 minutes while you're watching your sitcom or Netflix, you can do one. How did you, did you sign up for them, or did they come looking for you? Because in my case, they came looking through LinkedIn, they found me. I use the analytics. But did you look for surveys or how did you enroll in that? Dr. Jordan Frey: [00:18:07] I initially did look for them, you know, and I was starting out, I was basically, you know, a new attending. And yeah, so I looked up, you know, medical survey companies and just signed up for them. And essentially what I would do is just yeah, wait for ones that I thought was a good fit. And they kind of come in a few different flavors, like some of them come and they say, you know, hey, this is a completely online survey and it's 15 minutes and we'll pay you 50 bucks. And that's what I mean, like you shouldn't, I wouldn't carve out other valuable time or other family time or something. These are ones that like, if I happen to be sitting there and just in a moment where I'm in the surgeon's lounge, like doing nothing, like scrolling through ESPN or something like that, and I have 15 minutes, I say, Oh, well, yeah, sure, I'll do this. And those are not ones that are going to, you know, get you to the point where you go, Oh, I'm making significant amount of income from doing these 15 minute surveys. But what it does is the more of those you do, those companies start to recognize and say, okay, this is someone who has a lot to offer, who's willing to contribute. And you start getting these ones that say, okay, this is actually a phone interview for 30 minutes. And we're going to pay you 300 bucks. And then it starts evolving to where those companies, and then you start getting on the radar of other companies where you can even set your own rate. And I set my rate at - which this is a totally arbitrary thing - I just said, I basically within my head and with my wife even, said, okay, how much would it take for me to say, Okay, I'm going to set aside an hour of my time? And we said $500. So I set a rate of $500 for an hour. And that's what I say. And companies can say, Well, that's too much. Or they can say, Oh, that's a fair amount for these opportunities. So they come along and these companies will approach you and say, I have someone who is looking to understand the breast reconstruction landscape or how you utilize breast implants and breast reconstruction, because that's something that I do. That's a focus of my clinical practice. And then I say, okay, yeah, I know a lot about that. I meet the criteria that the company is looking for, that's my rate, $500 an hour. And they say, okay, great, they want to talk to you and we schedule it and then you get that. And those opportunities start coming up more and more. So it starts off slowly and then it can build up and it can really be something significant. Not myself, but I know people who make tens of thousands of dollars each year doing that. So that's one way. And then the other way, of course, is if you, within your field of medicine, if there's certain products, whether it's pharmaceutical or actual devices that you use a lot and you believe in and aligns with your sort of clinical values, you can just approach those companies and be like, Hey, do you want me to do talks for you? Is there anything I can do to help you with your stuff? And a lot of times they'll approach you if you're a real user of their products. And honestly, that's not something that I have done to this point. But that's certainly something I know other physicians have done very successfully. Dr. Dimitre Ranev: [00:21:38] And another way to leverage your knowledge, but yeah I can attest for the surveys. I'm sort of in the same steps as you, now I'm getting to the interview part so it happens. For our listeners, I would say M3 Global seems to have a - I into it - seems to have also a Canadian area and the analytics is the Canadian one. So if you guys are interested, you could take a look and yeah, just like you're sitting in the lounge and you can do one in 15 minutes, it's worth your time. I would again agree with you. Anything more than half an hour, though? I don't know unless it's a phone call. Dr. Jordan Frey: [00:22:13] Yeah. Dr. Dimitre Ranev: [00:22:13] But 15 to 30 minutes is, it's the right spot for me. Dr. Jordan Frey: [00:22:17] Yeah, 30 to 60 I kind of reserve for phone calls because they tend to, you give more value to the survey company as well and you get compensated better. And I'll say, too, it then evolves into something where you can refer colleagues to these survey companies and you get compensated for those referrals, and sometimes really nicely because they run promotions. So there's a lot of ways that you can kind of leverage that that makes sense as a doctor. Dr. Dimitre Ranev: [00:22:49] 100%. So listeners, look into it if you like pressing buttons and doing surveys. Dr. Jordan Frey: [00:22:55] Yeah, exactly. Dr. Dimitre Ranev: [00:22:56] The other thing I want to ask you about, again with the idea of leveraging your knowledge, medical chart reviews, and perhaps insurance claim reviews as well. Have you done both of these or are you still doing any of these things? Dr. Jordan Frey: [00:23:09] I haven't personally done those just because of time commitment and obviously the blog and stuff, that takes a lot of my time and tends to be a focused side gig of mine. But I know a lot of colleagues who do this and it's really beneficial. And I know initially people get, or doctors get this really like kind of bad feeling when they're like insurance reviews, Oh, insurance is the bad guys or, you know, medical chart reviews are like, you know, they're the bad guys or expert witness work lawyers, they're the bad guys. But you have to think - and the more I've learned about this and got on the inside of it - because those were kind of my initial reactions... Dr. Dimitre Ranev: [00:23:51] Mine too. Dr. Jordan Frey: [00:23:51] ... You know, it's really kind of a disservice if you have that reaction because like it or not, again, depending on where you are in the world and stuff, but pretty much everywhere, you know, lawyers, malpractice cases or whatever, insurance claims chart review, these things are just realities of medicine currently. And yes, once we all become financially independent doctors, hopefully we can eliminate that. But there are current realities and there's a need for ethical, responsible, knowledgeable physicians to assist with this. And a lot of times - and this is making a sweeping generalization - but a lot of times the physicians who maybe are doing this aren't as knowledgeable or as plugged in as they could be. And I'll give an example of this. You know, even myself doing, again on the US side, we have private and public insurance, but it's largely private. And so, you know, I'll have these surgeries that I'll need to do. Like sometimes I'll get a surgery that's a combined case. So a patient that has breast cancer is getting a mastectomy. So it's getting their breast removed to remove the cancer, and then getting breast reconstruction, which is by law a protected and covered procedure for them, for psychosocial reasons and everything that's been shown to be beneficial. But anyway, sometimes these, which you would think is just like it comes across an insurance person's desk and it's like, okay, yes, that's obviously covered, sometimes these get denied and then I have to do peer to peer review and I'm doing a peer to peer review with like, you know, a psychiatrist or something, who, to be fair to them, doesn't quite understand. But then like continues to deny this claim, which is just a horrible thing. And if there was just someone on the other side who was a little bit better educated or familiar with the procedure, familiar with this area, it would go a lot smoother and be better for patient care. It'd be better, frankly, for the insurance company because ultimately they are going to have to accept this because it's literally a law in the US and now they're just wasting their own resources at this point. So it's beneficial on all sides. And same thing with the malpractice review. You know, people worry about, oh, I'm just screwing - I guess, pardon my language on that - but I'm just screwing other physicians because I'm like testifying against them or something. A) that's not really the case. A lot of times you're supporting physicians who are being sued by patients or other entities or something like that. But you want to protect good patient care, and that's what you're doing by offering your services. You know, you are a very qualified, knowledgeable person. You want to make sure that qualified and knowledgeable physicians are being supported or if there is actual malpractice happening, that patients are being protected. So in that sense, I do think it's really valuable. And, so yeah, it is. And you get compensated well for doing that for your time. And it's actually pretty, I don't want to say easy to get plugged in, but like the opportunities are there. Dr. Dimitre Ranev: [00:27:28] Yep. Dr. Jordan Frey: [00:27:28] Like there is, there is a need for your knowledge and expertise in these arenas and you just kind of need to know where to look for it. But once you get started, like it's certainly possible if you are looking to get out of clinical medicine for whatever reason, to completely replace your income by doing these sort of endeavours. And alternatively, as a side gig, it can make you a good amount of money as a side gig. So definitely things to look into. And again, I haven't at this point because my other side gig, my other passion, kind of takes up that time. But it's something I'm learning more and more about and I'm even, you know, taking a course to learn about expert witness work and kind of how to find it, and how to be the best at it, because it is something in the future that I think I will do. Dr. Dimitre Ranev: [00:28:26] So I did insurance check reviews and I agree with you. If anything, it also helps you as a doctor to your patients being able to, when they do have to deal with insurance companies, you know how the process works so you can actually advocate better for them. Dr. Jordan Frey: [00:28:40] Yeah, that makes sense. Dr. Dimitre Ranev: [00:28:41] Yeah. And I've done that before and it pays very well. It pays better than clinical work and you need good guys there. You're right. You need good guys because it helps everybody. Patients, insurance companies, the system. And there's a lot of demand in Canada, in the US obviously. So if a listener is interested, I can give, I mean, I know with the companies in Canada what they are, but obviously this is different, but I can give some references. So I know we're close to the end, even though I have like a thousand questions here, but I'll finish off because, you know, Physician Empowerment talks a lot about real estate. So real estate also could be a side gig, obviously. Dr. Jordan Frey: [00:29:21] Yes. Dr. Jordan Frey: [00:29:21] And just quickly, I know you have to go soon, but can you tell me a bit about that? Like how you got into real estate, how much time are you spending on it, and what specific things you invested in when it comes to real estate, if you don't mind. Dr. Jordan Frey: [00:29:33] Yeah, I really enjoy real estate and think it's an awesome side gig, particularly for physicians. And I say that now. The first time I heard other physicians talking about real estate investing, I had what I think is a typical response, which is, What are you crazy? Like, don't have the time for this. And I do probably what's considered the most time-intensive form of real estate investing, or active real estate investing. So what I do is - and I say I, it's my wife and I - but we buy small multifamily properties like duplexes or triplexes within the Buffalo, New York area, which is where we live. You certainly don't have to buy them where you live. You can do it from afar, but we enjoy investing in our community, so we buy them and we rent them out and we manage them myself, my wife and now my brother who we've hired on to kind of assist us with it as we've grown the number of properties that we have. But it's really, really a powerful thing for a number of reasons. Obviously, you get cash flow from the rent that comes in and you make money above the mortgage you're paying, etcetera. You also build equity as your tenants pay off the mortgage. There are significant tax advantages, especially if you achieve something called real estate professional tax status in the US, which allows you to use these paper losses that exist in real estate to offset your active doctor income. Dr. Dimitre Ranev: [00:31:07] Interesting. Interesting. Dr. Jordan Frey: [00:31:09] That's a really powerful thing. And we do that because my wife is a real estate professional from a tax standpoint, and that's just based on the number of hours you put into participating in your property. But the real beautiful thing about real estate is, you know, our clinical work as doctors, when you really break it down, we're in the service industry. Our income is tied to the work that we put in in a 1 to 1 fashion. Real estate, you know, doing active real estate like I do, buying properties, renting them out, managing them, there is active work that goes into it, a lot on the front end. But then that 1 to 1 ratio starts to get broken. All of a sudden it becomes that there's not a lot of work, especially as you start to automate your processes and get more experience, etcetera, to where you're not really working a lot. And that money keeps coming in, so it becomes more passive income and that's really powerful. You know, we started two years ago. We bought our first place, just a small duplex, and now we've built it up to where we own seven places, which is 16 units, and that brings in $10,000 a month in net income for us. And a lot of that is tax protected. So that's income after mortgages, after maintenance, after things like that. So that's really powerful. And now we just, the way we've been able to scale so quickly is we just take that income and we use it to invest in more real estate. But eventually what it'll do is just become extra income that we can use for, you know, fun stuff. For vacations, for our kids' education, and for our retirement. So that is really powerful and that's like a whole podcast episode in itself. Dr. Dimitre Ranev: [00:33:07] I'd love to. I'd love to, just thinking, I want to talk to you again. Dr. Jordan Frey: [00:33:11] We can definitely, definitely we can do that. And there's tons of resources on my site about it and I'm very open. You know, it's not all, it's not all biscuits and gravy. You know, there's hiccups and there's stuff along the way. It's ultimately very worth it. But I try to be even, I'm obviously very open about our successes, but I am equally open about our mistakes and about the tough parts because I think not enough people do that. But it's really, really a powerful thing and that's what has accelerated our wealth building or our path to financial freedom, kind of more than anything else. And I'll say there are much more passive ways to do it. You can, you can do what we do, but also use a property management company to manage the day-to-day workings for you. You can invest in things like syndications, which is basically you are, you're just a money person, you just contribute the money. Someone else does all the investment aspects for you and there's pros and cons to all of this, but there's lots of ways that doctors can be involved in real estate investing very successfully. Dr. Dimitre Ranev: [00:34:21] Yeah, I have to have you back. This is so fascinating, Jordan. Dr. Jordan Frey: [00:34:26] And I'm happy to do it. Dr. Dimitre Ranev: [00:34:28] Listen, thank you so much for your time. I suggest the listeners take a look at the website. It's really good. Take a look at the course. And Jordan, thank you again. We have to talk about real estate because you have so much knowledge, I have so many questions. But this is, it's about time to stop. So all the best, Jordan. Hopefully we speak in the future. Dr. Jordan Frey: [00:34:47] Absolutely. Thanks so much for having me again, Dimitre. Dr. Dimitre Ranev: [00:34:49] Take care. Bye. Dr. Kevin Mailo: [00:34:50] Thank you so much for listening to the Physician Empowerment Podcast. If you're ready to take those next steps in transforming your practice, finances or personal well-being, then come and join us at PhysEmpowerment.ca - P H Y S Empowerment dot ca - to learn more about how we can help. If today's episode resonated with you I'd really appreciate it if you would share our podcast with a colleague or friend. And head over to Apple Podcasts to give us a five-star rating and review. If you've got feedback, questions or suggestions for future episode topics, we'd love to hear from you. If you want to join us and be interviewed and share some of your story, we'd absolutely love that as well. Please send me an email at KMailo@PhysEmpowerment.ca. Thank you again for listening. Bye.
	30 Oct 2022	06 - Leadership as an Antidote for Burnout with Dr. Katharine Smart	00:34:18
Dr. Kevin Mailo welcomes Past President of the Canadian Medical Association (CMA), Dr. Katharine Smart, to the podcast. Dr. Smart shares how leadership roles can enhance the success of wellbeing within our careers. Dr. Smart details how the child health program she spearheaded in the Yukon came to be, and explains how wellbeing for patients and physicians alike is balanced in her program. She carries a lot of passion for the work and is a passionate person by nature. This passion helped Dr. Smart when she became the President of the CMA just as the pandemic was getting extremely difficult. Her authenticity is what she carried into that role, and as she advocated for colleagues she worked to state clear facts and distill where things were truly at. In this episode, Dr. Kevin Mailo and guest Dr. Katharine Smart really dive into what wellness looks like for physicians in the dark time healthcare is currently experiencing. Dr. Smart believes that having a voice and connection to work through leadership opportunities is a vital part of avoiding burnout. She explains the variety of ways leadership can take shape. She also addresses releasing the fear of failure to realize that what we call ‘failure’ is really a necessary part of growth. Drs. Kevin Mailo and Katharine Smart have an enlightening conversation about burnout, mentorship, and the power of letting go of perfectionism in this must-hear episode. About Dr. Katharine Smart: Dr. Katharine Smart is a pediatrician in Whitehorse, Yukon and Past President of the CMA. Her work is centred on developing collaborative partnerships with community and government services to serve marginalized children using a model of social pediatrics. She works primarily with children who have experienced trauma and adverse childhood events, and she witnesses the broad and lasting impact these events have on children and their development daily. She is passionate about improving services for marginalized children in an effort to change their life trajectory. In addition to her community-based work, Dr. Smart enjoys acute care and provides on-call services to the hospital. Before moving to the Yukon, she was a pediatric emergency medicine physician at the Alberta Children’s Hospital in Calgary. Dr. Smart is the past president of the Yukon Medical Association. Resources discussed in this episode: Canadian Medical Assocation (CMA) — Physician Empowerment: website \| facebook \| linkedin Dr. Katharine Smart, Pediatrician and Past President of CMA: website \| instagram \| twitter __ Transcript: Kevin Mailo: [00:00:00] Hi, I'm Dr. Kevin Mailo, and you're listening to the Physician Empowerment Podcast. At Physician Empowerment we're focused on transforming the lives of Canadian physicians through education in finance, practice transformation, wellness and leadership. After you've listened to today's episode, I encourage you to visit us at PhysEmpowerment.ca. That's P H Y S empowerment dot ca to learn more about the many resources we have to help you make that change in your own life, practice and personal finances. Now onto today's episode. Kevin Mailo: [00:00:35] Hi there. I'm Dr. Kevin Mailo, one of the hosts of the Physician Empowerment Podcast. And today I am extremely, extremely excited to introduce everyone to Dr. Katharine Smart. And Dr. Smart is the past president of the Canadian Medical Association, and her term is recently expired as president of the Canadian Medical Association. She is kind of a super doctor. She is a pediatrician based in the Yukon with a practice centered on the emergency department, as well as community based clinic. And I'm honored and excited to be joined today by Katharine. Katharine, why don't you tell us a little bit about yourself and your work. Dr. Katharine Smart: [00:01:17] Sure. Thanks, Kevin. Excited to be here as well. And thank you for all your work. So, yeah, I've been in pediatrics now for over 20 years. I started my career as a pediatric emergency medicine physician at the Alberta Children's Hospital in Calgary, but I've always done work in northern Canada, time in northern Manitoba, I had the opportunity to work in Nunavut as a pediatric resident, so I've always had a passion for rural and remote medicine as well. And an interest in First Nations health and Indigenous health. So I had the opportunity to move to the Yukon five years ago to create a child health program there. At that point in time, they had an amazing group of six pediatricians who were coming up twice a year for four days a month and providing services to kids in the territory. But as you can imagine, four days a month of pediatric coverage, no call coverage, nothing to support acute care was probably not really enough. And and in talking with those colleagues, they definitely saw the role for for more supports for children. So I moved there with my husband, who's an orthopedic surgeon, and the two of us built two new programs, me in pediatrics in him and orthopedic surgery. And that's what I've been doing clinically for the last five years. So now we've got four pediatricians, child psychiatrist, a social worker, a neonatal and pediatric medevac program, outreach to all our Indigenous communities, lots of partnerships with schools, mental health and our First Nations communities. And I'm really proud of our program and the work that we do to serve kids and families in the Territory. Kevin Mailo: [00:02:40] That sounds absolutely outstanding. Now, I'll always just kind of pitch, but are you guys recruiting? Dr. Katharine Smart: [00:02:46] Not currently. We're actually fully, fully staffed at the moment. Yeah, I think it's a testament to our program. Kevin Mailo: [00:02:53] I would absolutely agree. Dr. Katharine Smart: [00:02:54] Yeah. Kevin Mailo: [00:02:55] I would absolutely agree. Dr. Katharine Smart: [00:02:57] So, you know, Kevin, I know one of your passions is wellness. And when we designed the program and just the way we operate our clinic, that was one of the foundational principles for me. And I think one of the advantages of creating a program we've already been working for a long time is you kind of see the pitfalls. So I thought a lot about that and the way we structured the way we work. And we work as a team, the four of us, we support each other. The person who's on covers all the patients, they cover the inbox, the EMR, any emergency. Kevin Mailo: [00:03:24] So when you're off, you're actually off. Dr. Katharine Smart: [00:03:26] You're off. Yeah. And we still schedule in such a way that there's a lot of continuity. You know, most patients are follow ups. It'll be the same pediatrician, but they're always covered. So if something comes up, something's unexpected. There's no holes in care. But exactly for us workers, when we're off, we're off. And we have that total confidence in our colleagues, they're covering. So that structure, I think, has made it quite desirable. Another... Kevin Mailo: [00:03:49] Isn't that amazing. It's rare. It's rarer than it should be. Dr. Katharine Smart: [00:03:53] The other key piece I think to our success is, you know, I knew that we'd be dealing with a variety of challenges and a lot of our patients have a lot of social challenges. So I was able to negotiate with the government an alternative payment model. So we get paid a combination of a daily rate plus fee for service for after hours coverage. So I think we're well remunerated. It covers our time. It allows us to work in different ways, right, being very patient centered. Kevin Mailo: [00:04:20] Creative. If it needs a phone call... Dr. Katharine Smart: [00:04:22] It needs a phone call, a video call, an email, doesn't matter, right? Because we're just being paid to look after patients. And we do it in the right way that works for patients. Kevin Mailo: [00:04:30] What a great example of how when the economics of health care align with well being and best patient outcomes. Isn't that wonderful? I love it. It's so important. Dr. Katharine Smart: [00:04:39] Yeah, it's so important and it's made it possible for us to recruit and retain, but it's also made us desirable for locums because they know they're coming into a well run clinic. Kevin Mailo: [00:04:47] Oh yeah. Dr. Katharine Smart: [00:04:48] With a clear plan, clear ways things are covered. They're going to be well paid for their time. So it, and like you said, the win of that is now it's sustainable. We have great people. We're all aligned. We know what we're doing. We know our purpose and those things have come together. And that really links to me to one of my principles, which is I think solutions have to work for patients and physicians. And when they do, that's when you get the best wins. And I think our program is an example of that. Kevin Mailo: [00:05:11] I absolutely love it. Let's talk briefly about your work as president of the Canadian Medical Association, because what really caught my attention was listening to you speak so boldly and courageously about the crisis facing our health care system. And I think we're all feeling that. I know we certainly get word through Physician Empowerment about physicians coast to coast struggling to deliver care under a health care system that's, frankly, under-resourced. So first off, I want to sincerely thank you for that advocacy because, you know, it's there, but we need to start talking about it. And you have done such a powerful job. And I would encourage anybody to look up Katharine's media interviews at CBC and some of the others that have been just remarkable in terms of crystallizing some of the issues that we're faced with. Do you want to just talk a little bit about that briefly, because the crisis isn't about to go away. We always try to create evergreen content, know things that are going to be relevant ten years from now. I worry this podcast is going to be just as relevant in ten years. If I can be blunt. So tell us about what's going on in Canadian health care. Dr. Katharine Smart: [00:06:14] Yeah, for sure. I worry about that too, Kevin, and thank you for your kind words. Yeah, it was a really interesting journey into this role and it's quite a long landing kind of launchpad into becoming the CMA president. You know, there's the election, it's few years before then, you're the election year present, etc. So, you know, when I put my name in for this, it was pre-pandemic, when I found out I won the election, it was just like the month before the pandemic was declared. And then I came into the role of president-elect sort of a few months into the pandemic and then became the actual president kind of a year into the pandemic when things were really starting to get difficult, I think we were starting to see a lot of less social cohesiveness around how we were approaching the pandemic. There was, you know, vaccines were out, vaccine passports that was controversial, mandatory vaccines for health care workers. We were starting to see that narrative shift from health care as heroes to a lot more harassment and intimidation of health care workers, protesters outside a hospital. So things were really heating up. And of course, at that point, we were deep into the ICU crises with hospitals being overwhelmed, people not being able to receive care. And it was a really tense time. So I would say that the role I ended up being in was certainly not what I thought I was going to be doing when I when I took this on. But I felt an immense sense of privilege to be able to speak for my colleagues, because what I would say is, you know, whenever as a physician, I felt so proud of my colleagues because of the tremendous work they've done over these past two years. I mean, always people are doing tremendous work, but people have really had to rise to this challenge in a way that we haven't seen. And to be the person out there representing this profession to the public and publicly, I took that very seriously. And it's really meaningful for me to hear feedback from colleagues who felt that I did it justice. And that was my goal. And my personality is, I'm a straight shooter. If you ask my opinion, you're going to get it. I'm not always right, but I'm going to tell you what I think. And I tried to carry that authenticity into my role as CMA president because I felt my job was to state the facts and to state what I was hearing from colleagues and to put it out there, really distill for people this is where we are. And I, your question, what's the state of Canadian health care? I mean, I don't think it is an overexaggeration to say we are at, I think the low point that we've probably ever been at in our system. And it's not in one place, right? We are now seeing this across the system. It doesn't matter what you're talking about, from community clinics to emergency departments to inpatient wards to long term care to home care, it doesn't matter. There's no part of the system that's working well. There's no group of physicians who would say to you right now, I can deliver the care I want for my patients, Everyone is struggling. And the problem is fundamentally about access and being able to deliver care to patients in a timely way. And in none of those settings is that happening. And I think that's leading to the burnout and moral injury that we're seeing amongst not only physicians but across health professions. And that's now leading, I think, to the staffing challenges we're seeing as people are starting to walk away because they just can't compromise themselves any further, you know, both professionally, ethically, physically, mentally. The toll has been massive. And I always say the health care system, to me, it's the people. A hospital bed means nothing without the expert care of the staff. And it's not only doctors, as you and I know, it's the nurses and other parts, pharmacists and cleaners and everyone who comes in and supports that patient. And the fact that we have a system now that is eating those people alive and spitting them out is deeply worrisome because that is the most precious resource. And right now we have not invested adequately in the people to make them feel valued, and we're paying that price. And these are not resources that are easily recaptured. Kevin Mailo: [00:09:58] Like when I think about my incredible nursing colleagues, for instance, that have decades of experience and I rely on them in the emergency department for their intuition and their experience and their knowledge. I mean, when somebody like that walks, there isn't going to be suddenly a replacement. There's no money for that. Do you know what I mean? And we're faced with this across the health care system. And, you know, the term that's getting thrown around in the Western world, kind of in terms of people being dissatisfied with their jobs are struggling, is that quiet quitting, right? You know, it's that person that decides to retire. It's that family physician who decides to retire this year instead of three years from now because she's burnt out. Do you know what I mean? Dr. Katharine Smart: [00:10:42] Oh, absolutely. Absolutely. Kevin Mailo: [00:10:43] It's, you know, a nurse that doesn't want to pick up that overtime shift because she or he is burnt out. Right? These are the things that are happening quietly and leaving fewer and fewer of us to work in a system that's putting more and more pressure on frontline staff. Dr. Katharine Smart: [00:11:02] 100%. And that's the vicious cycle, right? Because now the people showing up are showing up to a system that's struggling more and more and more. So it just keeps building. And I agree. I think the other thing that people don't understand enough I mean, you and I understand it as providers, but the public doesn't understand is just what you said. You know that nurse who's been there 15, 20, 30 years in an ICU or an emergency department, that the skill of that person. Kevin Mailo: [00:11:26] Goodness. Dr. Katharine Smart: [00:11:26] The knowledge, you cannot replicate that. And then the mentorship that they provide. Kevin Mailo: [00:11:31] Oh, my goodness. Dr. Katharine Smart: [00:11:31] Not only to junior nurses, but junior doctors. Right. How many times did you have your butt saved as a junior doctor by - and even as a senior experienced doctor - by experienced nurses-- Kevin Mailo: [00:11:41] -- how about as a staff -- Dr. Katharine Smart: [00:11:42] -- like all the time, even today, right. Like Kevin hey, I think you missed this or that dose was wrong or actually this. Like, the reality is we all need each other. And when we lose those people, experienced anyone in any of the health professions, with them walks wealth of experience, insight, compassion, ability to mentor others. And that's what creates resiliency and safety in our system. And it's intangible, right, because we don't have a way to really track it. Kevin Mailo: [00:12:07] It's our culture, it's our folklore, it's our essence. It's in the health care system. Dr. Katharine Smart: [00:12:13] And it's irreplaceable. And those are the people we're losing. Kevin Mailo: [00:12:16] It is, right? And also, you know, another thing that we've noticed is physicians that are exiting the public health care system and working more privately because they're burnt out and they're struggling with working conditions in the public health care system. So these are huge challenges that we're faced with. Huge challenges. Dr. Katharine Smart: [00:12:35] Absolutely. And I think the real, at the heart of this is that providers are tired of having these systems failures downloaded onto them as individuals, both to be held to feel responsible for trying to prop up a broken system, to feel responsible for the bad outcomes that are coming from this broken system and at times being held liable and medically responsible for outcomes, which are nothing to do with them and not their fault. Kevin Mailo: [00:12:59] Yeah, these are system-based issues, you know. Dr. Katharine Smart: [00:13:02] 100%. So there's huge risk right now for people as well. I think both emotionally but also legally, all of these things. So it's, I think it's a really challenging, challenging time. Kevin Mailo: [00:13:14] So you mentioned, you and I have talked about burnout and clearly we're both very passionate about it. Today's topic is fascinating, that you brought forward is leadership as an antidote to burnout. I'm fascinated. I want to hear it, about this. What does this mean? How is leadership an antidote to burnout? Dr. Katharine Smart: [00:13:33] Well, what I've been thinking a lot about, right, is just what you and I have been saying. Like here we are, things are dire, but what we know is the people in the system are amazing. They're resilient, they're highly competent, they bring really an incredible skill set. Anybody in health care to me is the type of person I want to be friends with and have over for a beer, right? They're just my people. So what I've thought a lot about is so many of these things are out of our control, right? The systems pieces. In some ways we can't make it totally different tomorrow. SSo what can we do and where can we be putting our efforts or framing up our roles and our moments in the system to feel like we can regain some control and choose things and pass forward that make us feel like we're still contributing to making things better when it can feel so hopeless. And for me, and that's part of been, part of my experience in my journey as a leader, as president of the CMA and now as past president, has been through leadership. And I think what I would like younger doctors to consider is, is developing your leadership skills a way that you can feel you can start to position yourself to harness some control over what happens next. So maybe that's in a small way, in the way you design your clinic, the way you run your department, the way you show up in your staff meetings, in your hospital, in your community. Maybe it's more broadly as a representative in your PTMA, maybe it's getting involved with the CMA. There's all different things people can be doing, but I really believe that having those leadership skills, starting to see yourself as a leader, so that you start to feel you're someone who could be part of that change, however small. I think those are those steps to regaining sort of our power and feeling like we can be part of the solution. And I think to me it can be that antidote to hopelessness or burnout is that sense of, okay, it's not perfect, but I'm part of the conversation and I feel like I've got the skills to show up that way. And I think developing those leadership skills is really important so that you feel you can be at the table. Kevin Mailo: [00:15:27] I think that's incredibly powerful because it is a source of burnout when people feel disconnected from their workplace. And that's not just specific to health care, that's across multiple industries, right? People don't feel like they have input, feel like they have a voice. And so giving yourself a voice by becoming a leader can be very, very powerful. What are some practical ways that people can do that? Right, like you mentioned, getting involved, but people say, Well, I've never been in a leadership position before, and I'm a big believer in at some point everyone has to jump, right? You know, at some point we have to deal with the uncertainties that life throws at us. We do it in medicine all the time, but we don't think about it in other aspects of our life, whether it's finance or leadership or practice management. But, you know, talk to us about, like, practical, small steps that we can take to get involved without feeling we're in over our heads and without that fear of failure, which I think is another thing we struggle with in the profession. Dr. Katharine Smart: [00:16:22] Yeah, absolutely. I think those are all great questions. And I think the first thing is, you know, be flexible with yourself about what being a leader means, right? It doesn't always have to mean being the top person or having a really prominent role or even a role with a title. Being a leader might just be how you show up with your colleagues that day. You may just decide I'm going to show up and I'm going to make a point of really checking in with people authentically and leading that way within my cohort of friends and colleagues. That may be how you show leadership. I think find a mentor, right? Look around you, look at people who you admire or just show up in a way at work or in a leadership role in a way that you think, Yeah, I respect that, I'd like to be like that, and talk to them about their journey, what they've learned. I think people have a lot of wisdom to share that have been doing this longer that can tell you These were some of the pitfalls, these are things I wish I would have known, these are things that helped me. So don't be afraid to create that network. I think we're getting better at that as physicians, we're finding each other in these different informal and sometimes formal groups, like minded people, and we're trying to build each other up. Right? And I think that's really, really important. So lean into those opportunities, look for them. I think there's also some more formal opportunities. You know, the physician leadership courses that are available can be really helpful. And I've taken some of those myself over time that I found really valuable in terms of crystallizing my skills. I think we all come with a variety of skill sets, some things to help us, sometimes things hinder us. But the more you have insight into yourself and your own personality, what your strengths and weaknesses are, and can start to kind of put a framework around some of the challenges that we encounter as physicians and as leaders. I think that can build your skills and you show up feeling more confident and it gives you, just like you show up to a code with a plan, being able to show up to difficult communication situations, difficult, you know, organizational situations. If you come there with a framework of how you're going to deal with it, I think you feel less afraid, less intimidated, less afraid of failure because you actually kind of have a plan about what you're going to do. So I think building all those things can really put you in a position where you feel more empowered to take those leaps of faith and take things on. And then I think it starts to build from there, right? Once you see how you do, then you can start to build the confidence to take on more and more roles, and eventually you'll probably find yourself mentoring other people. And there's a lot of learning in those opportunities too. Kevin Mailo: [00:18:43] Absolutely love it. Talk to us about the importance of passion when it comes to leadership roles, and I'll mention that I could really sense passion behind your vision of setting up the pediatrics program in the Yukon and serving those communities and serving your patients. So passion fuels leadership. But talk to us a little bit about what that means in our lives. Right? It's not just about sitting on a hospital committee so we can say we sat on a hospital committee. Dr. Katharine Smart: [00:19:10] Yeah. So important. And it's funny you ask me about that because I've self-diagnosed myself with excessive passion syndrome. I call it hashtag EPS. So other people are welcome to join me in that diagnosis. Kevin Mailo: [00:19:22] I love it. Yeah, I love it. That's why I spend all my time in Physician Empowerment. Dr. Katharine Smart: [00:19:27] Yeah, No, totally. So, you know, in terms of passion, I think for me that's been something that I've really recognized I need to lean into in my career because it's really, I think, what makes me me, right? So again, I think part of figuring out how you want to show up as a leader, as a physician, is understanding yourself and what really drives you. So what I know about myself, that's why I've created my own DSM criteria for myself, is that I am a very passionate person. Now sometimes that gets me into trouble. Passion is not, doesn't always play out well, right? Because sometimes you're so passionate about what's going on that it can be overwhelming for people. Kevin Mailo: [00:20:00] That was my question? Yeah, how do you navigate that when other people are like kind of lukewarm? Dr. Katharine Smart: [00:20:05] Yeah, it could be a lot, right? And I know that I can be sometimes a lot and sometimes it can make you very emotional and sometimes, you know, tempering that so that it's not overwhelming or that it's appropriate, right? Because we don't always get what we want by being super emotional. Not that that's always good or bad. But again, it's just realizing, right? It's good and it's bad. It's got pros and cons. But for me, when I'm doing things I'm passionate about, that's when I hit my flow, right? That's when I know I'm doing the right things because that's where I feel excited, I feel that meaning, I can see myself being successful. I can see myself achieving things because I think often that passion is contagious. It gets people on board with you. You feel people find you authentic because they can tell you're really committed to it. And I think things I've been able to do where I've had success have been because I've fueled that with the passion that I feel. And for me, passion directly relates to purpose, right? Because I think that's the other value that really matters is you have to know your why and what your purpose is. And again, the beautiful thing about health care is there can be a whole variety of purposes for people. For me, I like building things. I really enjoy finding problems, trying to solve them, looking for solutions, and feeling like I'm creating something. So for me, that's kind of my why and it gets fueled by my passion. So that's why the Yukon opportunity was sort of perfect for me. I think I was at a point in my career where I had enough wisdom, having seen the health system for a long time, I knew kind of things I thought would work and not work. It was an environment that I felt passionate about. It was a patient population I felt passionate about, and I could see the ways to bring the various components of the system together in a way that could really serve patients. And I could feel like we were making an impact, but also doing it in a way that allowed me to feel like I could create a job that I felt I had some reasonable life balance in. I was, it was meaningful. I was able to create a group of colleagues that shared my vision and passion, and we have shared our values and view of how we wanted to deliver care, and then create that. And so that, for me, really kind of ticked all those boxes. But I think when you bring passion to your purpose, that's kind of the magical thing. And that's where I think things really start happening. And I think those are, again, why, in my view, leaning into leadership for people who are interested in that can really create those opportunities. Because once people start seeing you as a leader, you're able to make more things happen because people come to you and you have more opportunity to share your ideas and solutions and then you start to be part of seeing things change. And I think once we start to feel things changing and getting better, even if it's small, that fuels a lot of hope. And I think that's what people need right now in the system, is hope that it could actually be different. Kevin Mailo: [00:22:38] Talk to us about failure and setbacks, and I'll frame it a little bit in terms of the broader medical culture. And one of the things we struggle with in medicine is failure, right? I mean, we're highly selected against it and we're not used to having setbacks. We're not used to failing. And we often try to fail privately. But leadership roles mean public failures. Right? And it can be as much as you get shot down at a committee meeting, it can be a giant flop with your clinic, it could be a major dysfunction at a hospital level, right? I mean, there are scales of failure, but failing. How do you approach failure or what wisdom do you have in this space, Katharine? Dr. Katharine Smart: [00:23:20] I think that's so critically important. And I think our fear of acknowledging failure as an unavoidable part of career development, personal development, growth across the spectrum is actually a real problem, right? Because we all are going to fail. No one's perfect. The perfectionism in medicine, I think, is part of the weird hidden curriculum that drives all sorts of strange behaviors and interactions and ultimately, I think often doesn't create the best patient care because we're doing things that are performative just because we want other people to think we're good, not necessarily because it's the right thing to do. So I think that that fear of failure is really behind a lot of problems. You know, and I've absolutely had failures. I've had failures with relationships with colleagues, I've had clinical failures where I've made the wrong decision or the wrong diagnosis. I've had personal failures, where I've let down people that I care about in my life, or haven't shown up maybe the way I wanted to. I think like everyone I've had all those things happen. But how I try to approach it, and I think partly why I am where I am today is because of some major challenges I had at one point in my career professionally, with colleagues, where I was just in a clinical situation that I really didn't feel comfortable in and I had to make some major decisions about what I was going to do with my career at that point. But I really leaned into that as an opportunity for self improvement, right? I really reflected on that moment in time in my career and thought, you know, why did this turn out the way it turned out? What do you feel proud of in terms of how you handled it? What do you wish you'd done differently? How could you have made this more positive? What could you have done that would have been better and gotten a better outcome? And I took that as an opportunity to really develop some additional skills. I thought, okay, I don't think I communicated as well as I could have. So I took a course on communication. Right? I thought, you know, I don't want things to be like that again. So I took a course about getting to understand yourself better and how you show up as a leader. So I really tried to take that as not an opportunity for the blame and shame for anyone involved -- Kevin Mailo: [00:25:23] -- or to retreat -- Dr. Katharine Smart: [00:25:24] -- including myself -- Kevin Mailo: [00:25:25] -- or to retreat -- Dr. Katharine Smart: [00:25:25] -- or to retreat. But I really leaned into it, right? I was like, You've got to lean into this failure. Like, what could this mean for you and what can you take from this? And how do you leverage this moment to improve yourself? Because I think everything in life has a lesson in it, and you can either choose to be made smaller by it, you can choose to let it defeat you, or you can choose to not own your part in it, right? Because no matter what happens, you always have a role. And I thought, I've got, I'm either going to let this sort of destroy me or I'm going to lean into it and I'm going to come out better. And I think I did come out better. And I suspect I probably never would have became the president of the Medical Association had that not happened to me. So I think that we shouldn't be afraid of our failures. I think we shouldn't be afraid of knowing that we're never always going to be perfect. And that's okay. But we've got to stay open to what's the lesson here for us and how can I emerge from this a better version of who I was? And be okay with the fact that it took a failure to get there. Kevin Mailo: [00:26:22] Wow, absolutely love that. And even just celebrating the journey and the process. And that's another thing in medicine, we're very goal oriented, like, okay, I just want to set this up or establish this or have this new process of doing things. But the reality is, is that we may not get there. Right? But in the process we've learned something about the system we work in or we've learned something about ourselves that allows us to become more powerful as leaders and more effective in communicating that vision and that passion. Dr. Katharine Smart: [00:26:53] I totally agree. Kevin Mailo: [00:26:54] It isn't just a saying that failure is an ingredient of success. Failure truly is key to success. You haven't tried if you haven't failed. Dr. Katharine Smart: [00:27:03] I agree, and I don't think you're going to find any successful person in any walk of life who hasn't failed multiple times across spectrums of their life. That's just the journey, right? It's not a straight line from A to B, it's up and down. And again, I think the most interesting people are often the people that have been through some really hard things. And that's where we find ourselves, often, and find who we really are. And I think we have to be open to that. And again, I think this is why community is so important, right? Being able to talk honestly about this with each other, normalize, normalize failure, right? Be like, hey, man, this is part of it. Like, you know, one of the most powerful things that happened to me - I'll never forget this - I was a new attending, so I was a peds emerg doc in Calgary. I'd done my fellowship there. So on June 30th I was a resident, a fellow, and then July 1st I was attending physician. We've all had that transition. But, you know, in my case, like a pretty straightforward transition, right? The department I trained in, worked in, I'd had a lot of independence as a fellow, so it wasn't really all that different. But all of a sudden my anxiety around what I was doing was like ten times what it had been the day before. And I was just like perseverating about all the patients I was seeing, potentially making mistakes, and it was getting overwhelming, like it was like anxiety that was like I couldn't sleep, like it was a problem. And I talked to a colleague, a good friend of mine who's still a close friend, a more experienced emerg physician, and she said something to me that was really helpful. She said, Katharine, if you imagine the best doctor you know, like someone you really respect clinically, you think they're excellent. I was like, okay. She's like, Do you think they're right 100% of the time? And I was like, No, that's impossible. She's like, Right, so say you're amazing and you're right 98% of the time, which no one's even that good, you know that, right? That still means every month you're seeing thousands of patients, there's going to be several like 20, 30 or more patients where you were wrong. Now, most of the time we're lucky that the natural history of things is nothing untoward happens or people come back and there's this second go and it's fine. But other times, sometimes, bad things are going to happen and you're going to wish you'd done something different. She's like, What you have to understand is it doesn't matter if you're the very best of the very best, that is part of this work. It's always going to happen. It happens to all of us. And you have to let go of this pursuit of being perfect because it's impossible. And that was so powerful for me. It really allowed me to step back and go, You're right, I'm going to have, and even mistakes I don't know if that's even the right word, right? Kevin Mailo: [00:29:23] I mean, it's a process of self forgiveness and learning to forgive ourselves before the event happens. Dr. Katharine Smart: [00:29:30] That's right. And that really helped me. And then what I realized and what I tried to really march forward with from that in my career was, Okay, instead of seeing this as as bad and blaming, let's see this as learning, right? So when I had a case that bounced back or something went differently, really, honestly, look at what happened and ask yourself, could I have done something differently? And sometimes the answer is no, right? Sometimes you look at the care you gave and you're like, Given what I knew in that moment, I wouldn't have done anything differently. Other times you're like, You know what? The patient told me X and Y and I didn't really listen or I didn't pay enough attention -- Kevin Mailo: [00:30:03] -- I was distracted -- Dr. Katharine Smart: [00:30:04] -- and I should have done something else. Right? But I committed in that moment to really look at these, if you want to call them failures or misses or even going to term them, as opportunities to become better. And so that really shifted the way I felt about it from blaming and shaming myself to being like, No, I'm a continuous learner. I'm going to lean in to these moments. I'm going to make sure it makes me a better doctor, and I'm going to talk to my learners about this, right? I'm going to be overt with them about how I think, how I approach the things I do. And hopefully give them a framework too that allows them to be kinder to themselves. Because some of this is about kindness to yourself. Kevin Mailo: [00:30:40] Absolutely. And just creating a culture of humanity within our health care system. We are not a bunch of metrics. Right? And it is not just about tracking a bunch of bounce back rates or whatever, a bunch of statistics. It's about creating a human health care system that ultimately is there to support the frontline workers and it benefits patients, right, when you're not paralyzed with fear going in to work. Dr. Katharine Smart: [00:31:08] 100%. And I think the problem is operating from a place of fear iin medicine actually can cause a lot of harm. Because doing unnecessary things to people because you're anxious or fearful is actually harmful. Right? So we need to acknowledge that as well. Kevin Mailo: [00:31:22] Yeah, without question. Without question. So I think we should probably begin to wrap it up. But we'd love to have you back on again because there was just so much here. Katharine, do you want to share any kind of closing thoughts or reflections or just something for physicians to take away with them today? Dr. Katharine Smart: [00:31:40] Well, I think if I could say anything to physicians right now, it would be a resounding thank you. I mean, people have just shown up incredibly in this time. They've shown up in the system. They've shown up for their colleagues. They've shown up as leaders in the media and social media for their communities, for the country. I mean, I think it's really been incredible just to see how people have stepped up in this unprecedented time of a global pandemic and just tried to look for any way they could make a contribution. And people have done it in so many different ways and all of it's been needed and necessary. And I've felt so proud to be a physician. I've felt so proud and privileged to represent all of you as my colleagues. And I just really want to say thank you to people for the work that all of you are doing and continue to do, and that I hope that we can continue to support each other, even though it feels like dark times. I know the only thing that's going to get us out of this is the people in the system. So make sure you're looking after yourself. Don't sacrifice yourself on the altar of medicine. That is not the solution here. But continue to show up the way that works for you. Lean into your passion and purpose and most importantly, lean into your colleagues, who I know will be there to to support you when you need it. Kevin Mailo: [00:32:49] Wow. Absolutely amazing. Again, I really want to thank you for being here today and speaking to us, Katharine. And again, I think on behalf of many, many physicians across the country and patients as well, thank you for your advocacy in getting us through the pandemic. But afterwards as well, and everything you do to improve this, the public health care system that we all love and cherish. And so, again, thank you so much,Katharine. Dr. Katharine Smart: [00:33:17] Thanks for having me. Kevin Mailo: [00:33:19] Thank you so much for listening to the Physician Empowerment Podcast. If you're ready to take those next steps in transforming your practice, finances or personal well-being, then come and join us at Phys Empowerment.ca P H Y S empowerment dot ca to learn more about how we can help. If today's episode resonated with you, I'd really appreciate it if you would share our podcast with a colleague or friend and head over to Apple Podcasts to give us a five star rating and review. If you've got feedback, questions, or suggestions for future episode topics, we'd love to hear from you. If you want to join us and be interviewed and share some of your story, we'd absolutely love that as well. Please send me an email at KMailo@PhysEmpowerment.ca. Thank you again for listening. Bye.
	30 Sep 2022	04 - Banking and Portfolio Management with Rob Burylo	00:50:39
Dr. Dimitre Ranev, one of the co-founders of Physician Empowerment, hosts the show this episode to talk with guest Rod Burylo about financial advice, banking, and fiduciary duty. Rod Burylo is an expert in the industry, Chief Financial Officer of the Empowerment Office, and the author of “The Wealthy Buddhist”, and shares a wealth of insight with listeners. Rod Burylo defines some of the roles that exist within the financial industry, helping to clear up confusion surrounding the types and quality of advice available to consumers. He breaks down exactly what it is that differentiates a personal banker from an investment advisor from a portfolio manager. In this episode, Dr. Dimitre Ranev and guest Rod Burylo explore the advisor options that exist in the financial industry for professionals like physicians. Rod defines and explains what fiduciary duty means and who in the industry actually has it. He demystifies the role of portfolio managers and explains how a portfolio manager is empowered to work with finances and investments on behalf of their client through fiduciary duty. The conversation Dimitre and Rod have shines light on how accessible portfolio managers are, and provides important clarity on how roles within the financial industry apply directly to specific services listeners may want. About Rod Burylo: Rod Burylo is the Manager of IFM & EMD Services at Axcess Capital, providing governance and risk mitigation support to capital raisers and investment managers. Rod has worked within the financial services industry for over 30 years in a wide range of roles including Director, Chief Compliance Officer, and Director of Marketing. He has extensive experience in the exempt market sector as past CCO and owner of Canada’s largest Exempt Market Dealer. Rod is a Canadian Advisor of the Year Award winner, 2019 Champion of Financial Literacy Award Finalist, international speaker, and author of three books. Resources discussed in this episode: Axcess Capital Advisors Empowerment Office “The Wealthy Buddhist: Buddhist Ethics, Right Livelihood, and the Value of Money” by Rod Burylo — Physician Empowerment: website \| facebook \| linkedin Rod Burylo, CIM FCSI: Chief Financial Officer at Empowerment Office: linkedin \| book __ Transcript: Kevin Mailo Hi, I'm Dr. Kevin Mailo, and you're listening to the Physician Empowerment Podcast. At Physician Empowerment, we're focused on transforming the lives of Canadian physicians through education and finance, practice transformation, wellness, and leadership. After you've listened to today's episode, I encourage you to visit us at physempowerment.ca - that's P H Y S empowerment.ca - to learn more about the many resources we have to help you make that change in your own life, practice, and personal finances. Now on to today's episode. Dimitre Ranev Welcome everyone to the Physician Empowerment Podcast. I'm really honored to have Mr. Rod Burylo today as guest. Rod is a renaissance man in the financial industry. He wears many hats and has many roles, but currently his projects are that he's the manager of Investment Fund Services for Axcess Capital. He's also a consultant to portfolio managers, accountants and professional associations. And, importantly to us, he's the Chief Financial Officer of the Empowerment Office. He's an Advisor of the Year award winner, media contributor for over 30 years including for the CBC Radio and other leading newspapers. He's also an excellent teacher, which I can attest to because when I first met Rod a couple weeks ago actually, he explained a concept to me that I could not understand and it just clicked. And that's how I know that somebody is a good teacher when they can simplify something that's hard to understand. It's not surprising, because you've had over 20 years of international teaching experience, right? In many topics. I think currently, you mostly talk about professional ethics in alternative investment strategies. And finally, I do want to mention that Rod has published a book in 2019 that I find very interesting and I hope we can talk about it in the future. It's called the "Wealthy Buddhist: Buddhist Ethics, Right Livelihood, and the Value of Money". So again, Rod, thank you for joining us. What I do want to talk about today is an issue that I've noticed talking to other professionals, doctors, is there seems to be quite a bit of confusion about the actors who are involved in the financial advice industry. And specifically three things. We don't necessarily understand what the different roles are, what the different skill sets are, but also what is the duty to the client, to us, because I mean, we're seeking their help. For example, to give an analogy with medicine, obviously when you go to a doctor, you can make a couple of assumptions, not always true, unfortunately, but most of the time should be true. First of all, that they have a license to practice medicine in Canada. And secondly, they have a duty of care to their patients. But that's not as clear to me or to other professional, to other people I talk to, when it comes to financial advisors, or people doing financial advice. So Rod, I guess, do you find that that confusion does exist? And what are some reasons you think it does exist within us, within people that are looking for financial advice? Rod Burylo Yeah, that's a wonderful question and very important. Definitely confusion exists around that, not only amongst consumers, people that would seek out financial services persons, but honestly, there's confusion amongst the people within the financial services industry, as well. So there are some people that are in different roles that think that they have a greater responsibility than they in fact have. And then there's others that, unfortunately, might miscommunicate to consumers about that level of responsibility, perhaps setting false expectations around that. Why is that confusion there? Well, you know, I think there's a few reasons. One of them certainly is that there's a very, very wide range of participants in the financial services industry, and depending upon their level of licensing, or registration, or the types of organizations they're working for, their responsibility could vary greatly. Another reason for the confusion is that the people participating in the industry might misunderstand what their registration category requires of them under certain circumstances. And the final place that some confusion might come in is around notions of fiduciary duty, for example, where it's generally accepted that it would be up to a court to decide or judge to decide if, in a particular circumstance, a particular financial services person had a fiduciary relationship at that time. So there's a lot of questions that can arise from this. Dimitre Ranev Right. And we'll talk about the fiduciary duty a bit later, because that sort of blew my mind. I made some assumptions about what that meant and I think it's important everybody understands what it actually means and that it's not as common as you think it is. So I feel like when there's this risk confusion, it's really important to go back to first principles and just definitions, like defining who does what, that's a good place to start. I've looked at some of the actions that I've encountered in my financial journey and perhaps, Rod, you can discuss about what the role is and what their skills are and how they can be useful to professionals. And the first one that a lot of us encounter, not all of us, are personal bankers. Can you comment on on how they fit in in just the financial team of somebody like a doctor? Rod Burylo Yeah, a personal banker - I actually had a role of a personal banking representative with Royal Bank back in about 1990, and so I can speak to that, you know, from actually doing that job - so one of the ways that we categorize responsibility in the financial services industry is one category is often referred to as a guidance role. And as a rule of thumb, people that we typically find in the historical banking type roles, the personal banking representative roles, would have what we call a guidance role, which means that their responsibility is to help guide a consumer make a choice, which is a long way away from more more onerous obligations they might have. And often the people in those basic branch roles have, what I would say in my opinion, very minimal education or licensing requirements around that, often they have something as basic as a mutual fund registration category, which really is just one course. This might surprise a lot of consumers out there, but historically a mutual fund registration category did not even require a structured continuing education requirement, where almost every other category license or registration in the industry required that. Where it didn't not even require that, there was not even a requirement to take ethics classes for most of these people going forward. So it'd be a very basic, introductory, you know, grade one level of education that's required. And they're typically dealing with proprietary products from that institution. And their obligation is to help someone choose amongst a fairly limited range of products and services. And again, this is stereotypes, but this is a very useful way of looking at it for most consumers most of the time. Dimitre Ranev So if you do want to get, and correct me if I'm wrong, but if you want to get a line of credit from that bank, you would go to them, or if you want to get a loan, is that where you'd go to, is the personal banker? But specifically to that bank? Or am I misunderstanding this? Rod Burylo Well historically, like when I was a personal banker with Royal Bank, there was a mandate to develop relationships with certain market segments. And we used to call them, you know, at Royal Bank, VIP clients, for example. And there was a requirement to build relationships with those people, understand their needs, and present to them a range of possible bank services, including lending services, credit services, but it might also include savings accounts, you know, basic investment accounts, through mutual funds, and those kinds of things. But, you know, I've been a VIP client of Royal Bank for a very long time. And I don't mind saying that, I'm not critical of them, but nobody has reached out and contacted me to build a relationship with me in a very, very, very, very long time. You know, so what I was taught back in the 1990s about trying to have a relation, this know your client philosophy that's a critical part of the financial services obligation, I don't know how that's showing up in the relationships that I have. So I wouldn't, if I was a consumer, I wouldn't expect very much in terms of obligation from these people. And I wouldn't expect very much in terms of true advice and guidance. And I want to say something that might be considered a little off color, and I have to tell you I've never been sued yet, even though I've been a critic of the industry for a very long time, but I don't intend to do it anytime soon. But, you know, here's the one of the ways that we would often look at many of the people in the banking industry is - and this has been really candid for your audience - there's no money in being a personal banker. And I never saw anyone that I thought was excellent at that stay in those roles, because there's not money being made. So they do one of two things. Either they, and again, this is a gross generalization, but they tend to want to work up the bank ladder, so increasingly stepping away from the consumer. So I would see really good people in the banking system not dealing with consumers anymore, because they went a different direction, or they left the banking environment entirely and went on to a different situation where they had a wider range of products and services, or they were in control of their business or their practice. So for example, there was a time in the 1990s, where myself and some of my friends at Royal Bank went to Investors Group. And at Investor's Group we felt we had a wider range of products and services and a different business model. Our compensation was more greatly tied to the successful outcomes of the consumer than they were previous to that. So that would not be the place that I would go to for sophisticated financial advice. You don't tend to have entrepreneurs with multimillion dollar businesses working at the bank. And so as a consumer, if that's you as a physician, you've got to find, in my opinion, you've got to find people who are living a life more like yours in the sense that they are entrepreneurial. They're buying buildings, they have staff, you know, they're creating personal wealth from their efforts, they have advanced education, and so on. They're far more likely to get you and get the kinds of services that you might need in my opinion. Dimitre Ranev That makes sense. I laugh because I'm also a VIP client for RBC and I don't remember ever getting a call from anybody there. It's interesting, I guess back in the day they used to do that. Alright, so there's a limited role for personal bankers, in that case, for our audience. So let's move up the ladder, maybe it's not even a ladder here, but what about investment advisors? What's... this is where I started getting confused. What are investment advisors? What is their role? And what is their duty? Rod Burylo Yeah, so that's a really good question. And this actually is interesting you should be asking about this now, because we've just come out of a year of some fairly significant developments in that regard. So when we use the word advisor in Canada, historically, one of the reasons there's confusion is there was not what we now call title protection. So - Quebec had title protection, but most of Canada did not - and so there were people out there using the word advisor without it being regulated, you know. So a consumer would go 'Well he's calling himself a financial adviser, or she's calling herself a financial advisor', and I'm not sure at all what that means, and you can understand why the confusion would be there. But historically, a lot of those people would have beyond a basic licensing or registration, and would start to more often see a designation. So when I say the word licensing or registration, I'm referring to someone that is registered to sell mutual funds or licensed to sell life insurance, where a designation in financial services industry tends to refer to some kind of more sophisticated financial planning education. These people tend to be more holistic. And you'll see letters after their names in Canada, like CFP, for example, which is probably the most common in that category. There were some really cool things that happened last year, two of them actually that are really worth noting. One is we had something called Title Protection for the rest of Canada confirmed last year. And what that means going forward, if you find - this is how it's supposed to work - if you find an a financial services person that's referring to themselves as a financial advisor or a title very similar to that, they are supposed to have a recognized credential from an approved credentialing body. And the last we heard in Canada is there was some expectation there would be single digit number of these credentialing bodies approved. So there used to be a whole bunch of them, anybody could open up a business saying 'I'm going to provide a credential to financial services people, charge them a fee to get the credentials, and then charge them an annual fee to keep these things up' and make a business out of it. And sometimes consumers weren't really getting, you know, a sophisticated quality. So there was a movement in Canada that said no, if you're going to call yourself an advisor, you have to have one of a short list of credentials, and the bodies that are providing those credentials have to be approved. So historically, there would be more confusion than I think there will be kind of starting from now. So that was the first thing that happened last year. The second thing that happened last year was something called client focused reforms, or CFR is often the acronym. And there was two stages of the introduction of client focused reforms but the crux of it was last year is that it was supposed to oblige people in the financial services industry, both individuals and the companies in that industry, to have to put the needs of the clients first. And this should be shocking to a lot of people that - and I think you and I talked about this a couple of weeks ago - it's only last year that there was even a nationally recognized requirement to put clients first and manage conflicts of interest around product distribution and those kinds of things that never existed before. So theoretically, for everybody, we should start to see as of this year, some improvement, some clarification, but I do want to stress, nothing and anything that we saw about these client focused reforms uses the word fiduciary duty. And I do want to comment, and I want to say to your audience out there, in the introduction you talked about me consulting to professional associations, one of the roles that I've had in Canada is helping these professional associations draft policies and procedures, as well as codes of ethics and mechanisms for enforcing codes of ethics and those kinds of things. So I'm a weird guy, I actually have a binder in the room behind me, it's got all these codes of ethics from different professional associations like CFAs, and I study them. Because - you didn't mention this - but my specialty in university in the 1980s was applied ethics, my postgraduate research was actually in Biomedical Ethics at the Foothills Hospital here because I thought I was going to go to law school with that and have my kids early and I ended up in this industry. So, you know, the study of ethics as a practical study, but also kind of more academically, is something that means a lot to me. So when I've looked at these codes of ethics for these credential people, they're very careful in there not to say that anybody has a fiduciary duty. And in fact some of them will say things like, you may have, in certain circumstances based upon the relationship with the client, blah, blah, blah, a judge will decide, but there is no confirmation in any of that stuff that someone has a fiduciary duty, even with these client focused reforms. Putting the client first is not the same thing as having a fiduciary duty. Because let's say that I have a very limited range of products and services, because I work for a big company, in everybody's mind is that as long as I'm helping them choose from my products and services with their interests in mind, I'm okay. But it's not obligating me to go out and find the best solutions, just solutions that are okay for the client but not necessarily the best solutions. So that's kind of where we're at today from all of that, so improving, but probably still quite a bit different than most people thought that they were getting from these relationships. Dimitre Ranev So a couple of things that surprise me. So the whole title protection... so what you're saying is - this is a metaphor using, again, the medical industry - is last year, a doctor could just say he's a doctor, and then wouldn't have to prove they were a doctor, no licensing would be required, or a dentist would just say 'I'm a dentist', and that the financial industry was doing that until last year. Now there's an - oh I guess Quebec wasn't but Ontario and all the other provinces - that's very surprising to me. But I'm glad it's changed, it's great it's changed. And the other thing you mentioned, and I think maybe we'll move on to fiduciary duty here, but you talked about how if they - what did you say that they have as opposed to fiduciary duty, you have to do the best for the for the client? Well, what is that phrase that they use? Rod Burylo Putting the clients first before all other needs. Dimitre Ranev But if they can only sell you a specific product, they won't go above and beyond to find other products. So, for example, it's a doctor just giving one pill for depression, because they work for that company. Okay, got it. Rod Burylo Yeah, it would be more like that. So we have a standard that applies to most people in the financial services industry, which is one of the standards is called the standard of suitability assessment. And so if you came to me and said, 'Hey, I'm looking at an investment, is this suitable?' It's like saying it's either okay or not okay. And the suitability assessment is based upon things like your risk tolerance and your personal objectives. But nowhere in there is the obligation to ensure that it's the best solution to your problem. It's just an acceptable solution. So if you say, I want a cash flowing investment, and I find a cash flowing investment, we know everybody might say that suitable, but it's not necessarily the best. Dimitre Ranev I understand. So maybe we can go back to to the actors, but I think it's a good time to actually talk about fiduciary duty. Talk about that specifically, because that's where.... it's funny that the way I met you, right, is I was talking about fiduciary duty and obviously I didn't know what I was talking about so ou were typing furiously, I need to talk to Dimitri, to Kevin, and then you gave me a twenty minute lecture. And I'm like, okay, now I understand. So thank you very much. No, don't apologize. I really thank you. And I actually, when I did the presentation later on, I talked about that. So I thank you, but can you educate the rest of the audience about what fiduciary duty means? And I guess what percentage of people actually have that in financial industry? Rod Burylo Yeah, so the concept of fiduciary duty is, as we've been talking about, is a requirement to put the client's interests ahead of all other interests. It's an interesting principle, but it's sometimes hard to see how that actually plays out in a very specific role or a specific client relationship. So one of the ways I like to talk about this is let's go back to that banker role, when I talked about a traditional role of a banker type investment person as being about guidance. That's often how that category is referred to. The next category up is often what has been referred to as an advisory category, which is not - so guidance is helping someone make a choice, advice is more telling them what their choice should be. The practical application of fiduciary duty now, which is the highest standard, is really the advisor just making the choice for the client. And so let me explain to you how that plays out. In all the various registration categories in Canada in the investment space, one of the ones that is considered to be the highest is what we call a Portfolio Manager Registration Category. And that is a category that's granted by two types of entities in Canada. One is a provincial securities regulator. The other is IROQ, which is where you would find your stockbroker type people as well, because their responsibilities overlap a little bit depending upon where the advisor is actually working. But the concept of the portfolio manager in that space is similar in the following way: a portfolio manager has a discretionary ability to manage money. So let's say I'm your portfolio manager, and I've worked with several of these in Canada, by the way, and these roles, and you decide that you want me to be your portfolio manager. And you're going to allow me to look after $100,000 of your money. Once I determine your risk tolerance and your objectives, and we have that conversation, and I come up with kind of a sample approach to helping you based upon your parameters, I am now just empowered to go ahead and do that. So let's say I'm your portfolio manager, and we decided we're going to allocate some of your funds to buying a publicly traded bank, Royal Bank, I just go buy Royal Bank. I don't ask you. That's the difference. And one of the reasons you have to have a fiduciary duty there is because you are not participating in the process, I'm just going and making the purchase. And if I don't like Royal Bank anymore, in that category, let's say I want to switch you to TD for whatever reason, I don't call and ask you, I just switched you to TD. So you can imagine if I didn't have your best interests at heart, I might be funding some private equity deal that my brother is managing and I've got a back end piece of and, you know, I'm clearly not objective in these matters, I clearly have conflicts of interest that are not being disclosed. So a regulator would come along and say, 'Wow, you're just basically doing whatever you want to do with Dimitre's money.' Of course, you have a fiduciary duty there. Because in that case, it's the nature of the power you have in the relationship. It's hard to say a banker has a fiduciary duty if I say to you, 'Hey, do you want to have the Canadian Equity Fund or a Canadian Balanced Fund?', and you go, 'Well, I'm kind of conservative, blah, blah, blah', you're Balanced Fund, you know, we only got so many of them, and it's huge. And nobody gets too anxious about that, because you're kind of making the decision with my guidance. Where on the other end, I'm just doing it. And so the number of people that that have that registration category in Canada is actually fairly limited. It's surprising. And this is one of the reasons I talk to you about that. So the people that actually have a fiduciary duty, what I would say, as a matter of fact, as a matter of merely having that registration category, it's understood you have one, those numbers of people are fairly small in the grand scheme of things. And to get there, by the way, you have to have advanced education, you have to have certain number of years in training, being supervised by people in that role, you can't just show up and say I want to be a portfolio manager. It is a process. You know, where mutual fund licensing categories and stuff like that are pretty straightforward. You spend a month studying a class, you pass a course, you're up and running. These other things take possibly years and require advanced designations to get there. So I have some advanced designations that were required of me to be in these kinds of supporting roles in that environment. But you can't just automatically do that. So the other way that a person could have a fiduciary duty is if the nature of the relationship is such that you are really reliant upon me, I have a lot of power and influence over you, perhaps a senior or - and I don't mean to say that all seniors are vulnerable, I'm not gonna do that - but there's a concept in Canada that was established as part of those CFR reforms, called the vulnerable client. So a client that's particularly perhaps reliant upon a person's opinion and so on. If there was a problem in that relationship, and this person was not a portfolio manager, they're just a regular advisor, and they went to court, a judge might decide that in that particular circumstance, that person did have a fiduciary duty. But I gotta tell you, I've been at this a long time, and I don't think those kinds of court cases are all that common. You know, we don't hear about that. And there's one more thing I want to say about the portfolio manager stuff that sometimes blows consumers away. And because a lot of this stuff, you might say, well, what does that mean for me, what do I really care if, you know, if they have this duty towards me, or if I'm not going to sue them, what difference does it make? But there's some real practical problems. So I'm going to give you one for example. And I wrote a paper in 2007 called Move It or Lose It, and it was a discussion of why I thought the market was going to drop. I got a little lucky with that topic, because in 2008 the correction started. I got lucky. And the last time I did this speech I was actually in Las Vegas, I was speaking to a conference of advisors, Canadian advisors in Las Vegas, and a lot of the advisors used to push back when I would say things like, I think the markets going to correct and so on. And the very next day after that last speech, Lehman Brothers announced their bankruptcy and the market started to freefall. But here's one of the reasons why advisors get upset about that. If I tell a bunch of mutual fund advisors, for example, or stockbrokers even, that the stock market is going to drop, we think it is, what do they do with that information? Consumers might think their job is to help people buy low and sell high. And if the market is going to drop, maybe suggest that they sell and wait for the market to drop and buy back, and we have these fantasies that this is going to happen or maybe we saw TV shows and stuff like that, but here's the reality of it. If you're a person that's not a portfolio manager, it means you have to talk to every single client about a trade. They have to approve every single trade. I don't get paid to do trades, to move people from one product to another, you're not - that could be churning, right - so most of the time people are moving money from one portfolio of mutual funds to another, trying to change the market, I'm not getting paid. But the mere fact that I'm reaching out to possibly hundreds of clients, which could take months - that's assuming they're in Canada and they're not snowbirds and any other thing that could complicate it, they're not in the hospital - I've got to somehow get to all of these people while the market is doing this, and get signatures and confirmations from everybody. It's a nightmare. The thought that most of the people in the industry could actually effectively help people sell high and buy low in these environments, it's not realistic even in the slightest. So who do they call? They might call their mom and dad, they might do their own account. You know, if Dimitre's their buddy and Dimitre's got a bunch of money sitting over there with the bank, we're trying to get over, Dimitre I got some news, we got to act now, man, because I'm trying to get.... but the reality is most of the clients never get the call. And so what do they teach these people? They teach those types of advisors to tell their clients, don't worry, these are not your numbers, you're gonna retire in 20 years. And they coach them to be complacent, or calm, depending on, these are politically charged expressions, I acknowledge. They encourage them to be calm and try to get them to reframe how they think about this, but it's in part because they can't actually help them buy low and sell high as a scalable activity. It can't be done. And so let me connect the dots for everybody out there. This is one of the reasons why the concept of a portfolio manager is so important. Because if I'm a portfolio manager, I don't have to call everybody. I can trade $10 million worth of Royal Bank in seconds on the computer for hundreds of clients. It's very fast, it's very effective, it's very cheap for the client, because I'm doing it all now. But to do that, I need to have full responsibility for everything that I'm doing, and therefore a fiduciary duty. So here's the takeaway, most of the people can't be an environment where they can have a fiduciary duty, most consumers will not benefit from that environment, we should want those people that are portfolio management have fiduciary duty, not just because they have that duty. But because since they have that duty, they're in an environment where they can do things very quickly and effectively. And that's one of the reasons why I try to teach consumers about what these different categories look like, so that they can not only manage your expectations, but hopefully get better relationships that are more effective for them. Does that make sense? I know that's a lot of information. Dimitre Ranev No, it makes sense. And two things I want to sort of expand on. It's funny, because when I used to have a, I guess a portfolio - I didn't have, I never had a portfolio manager - but had an investment advisor, I used to get those emails when the market went down saying oh, you shouldn't shouldn't worry, you're in for the long haul. So that's interesting that it's almost automatic, I guess, because they can't do much. But second, you had a great analogy that I seriously stole, thinking about a surgeon, right? If a surgeon has to call about every cut he makes and ask the family 'Can I cut here?' Okay, sure. 'Can I cut there?' Okay, sure. That's the difference between a portfolio manager and an investment advisor. An actual portfolio manager does not have to call for every single trade. So my question to you then, is how accessible are portfolio managers for, again, for professionals such as doctors? What are the fees like? Does it make sense for people to, I mean, is it accessible? How about this, let's just start with the accessibility question. Rod Burylo And actually, there's some irony around this as well. And I'm here not to speak in favor of any particular portfolio manager. I want your audience know I'm not marketing or promoting anybody. But as a general concept, here's one of the cool ironies about the portfolio manager concept, is you might think that because these tend to be the most sophisticated, the most educated, the ones with the greatest responsibility, that that means they're also the hardest to find or the most expensive, right? But here's part of the irony. If I can effectively trade 10s of millions of dollars just by doing this, then that means I can actually scale my service to a wide range of audiences. So most of the portfolio managers that I've dealt with in Canada have minimums, some of them had quite low minimums, and sometimes $50,000 minimums. Which shocks people to think that I can actually get the best, in my mind, the superior category of management for a relatively small account size, in part because of the scalability of it. Now as a practical sense, I tend to see most portfolio managers starting with 100,000 minimum, and then you get up to bigger shops that will do million dollar minimums, but mostly because they can. They just say we're not going to look after retail consumers, we're going to do a hard line at a million dollars. So within this category of Portfolio Manager, what you might find for those that are providing services on what we might call a smaller account, let's call it 100,000, they probably have what we call a very systematized or pooled approach. So you and I, with our 100,000 and a portfolio manager are participating in pools that they've created. They're not buying and selling for you and I specifically, they're buying and selling within the pool. And so we happen to be participating in the pool with small dollars. It's not a unique range of investments for us, it's not a unique portfolio, but it's very effective. As you have more money, some of these portfolio managers will provide what's called a Separately Managed Account or an SMA. An SMA account would be me saying to Dimitre, oh Dimitre, you're gonna give me a million dollars? I'm going to create something especially for you. Now, it might look a lot like the pool funds. They're portfolio managers, they're just human, they can only analyze so many stocks, they can only be good at so many strategies. But there could be some tailoring to the client. So let's say a doctor has a corporate account, the taxation of investments in a corporate account are going to be different than in an RRSP. And so it would make sense that if you're talking to a portfolio manager, you could say, 'Hey, this is corporate money so we should have a slightly different strategy', which makes sense. If it's in an RRSP, it might not matter. But I typically see separately managed accounts starting at around a million dollars. But I've also seen some 800,000, half a million dollars, and it kind of depends upon the portfolio manager. You know, so they can make a choice, if Dimitre says, you know, I've got $5 million but I'm gonna give you half a million dollars to start, I might be inclined to say I'm going to treat you, you know, because I want to get the rest of it, I'm going to really pay attention to your half a million dollars, not my normal minimum, but I'm going to do it for you, because I'm looking at a bigger picture. You know, or Empowerment Office, for example, one of the groups that I'm working with, representing doctors as a collective has some negotiating and bargaining power with portfolio managers to begin to reduce the price or reduce the level that they'll do these tailored approaches. So what's the price of that, that's one of the things you asked. I would say you typically would be looking - and depends upon the services provided by the portfolio manager - if the portfolio manager is just providing security selection, so buying stocks, bonds, private offerings, trading those for you, and they're not doing anything else, they're not doing estate planning or tax planning, you have other resources for those, you might be looking at a price, let's say 1%, 1.5% of assets under management in that range. If they start adding on other pieces like financial planning pieces, then you can start seeing the price go up, and usually I see it start maxing out around 2%. But I gotta say there's a wide range of possibilities in there, because if the portfolio manager is picking other products, those products could have prices in them as well. So I might be charging a fee to help, you know, to buy a fund, a third party fund that's been created, but there could be fees embedded in that fund. And that's one of the things consumers have to be very, very careful of, is sometimes a manager of investments might say, 'Hey, I'm only charging you 1%'. So they walk around thinking that the cost of management is 1% because that manager only has to talk about what they are actually charging themselves, where the other products could also have fees associated with them. But let's say as a walking around concept, somewhere between 1% and 2% would be normal. And again, depending upon the level of other services being provided within that relationship. Dimitre Ranev So a couple of points, it already seemed to me, but first of all, it does sound like it's accessible to most professionals. So I think there's a misconception that for a portfolio manager to be actually wanting to take your business we're talking about a million dollars or half a million dollars, but I think that's more coming from the idea of hedge fund managers, which can go up to 25 million, right? So that's good to know it's accessible. Secondly, it's interesting that the fees can start at 1%. Because that's actually lower than a lot of mutual funds. That's surprising to me. Rod Burylo Well and isn't it ironic that I'm making a case that buying a bunch of mutual funds, where the mutual fund advisor can't readily buy and sell on their own volition, they have to come to you for everything, meanwhile the portfolio manager is buying and selling and trading, I typically see the performance better, I typically see a lower cost, it makes a bunch of people like us go, why in the world would you not go to a portfolio manager? Why would you not go? And the only reason that I can come up with typically is - well, there's two reasons - is I don't quite have enough money to get started with the portfolio manager, or the person wants to do a lot of the stuff on their own and try to bring down that 1% to, you know, let's say ETF type prices of .1 or .2 or or .3, that kind of thing. But I don't mind telling you that I have the top designation with the Canadian Securities Institute, but I don't buy all my stocks on my own. I buy all my own private offerings through my own analysis and my own contacts. But I have relationships out there that helped me understand public markets. And there's nothing wrong with that, some of the best people I know in our industry still go to other people for help. And I don't mind paying a little bit if it shows up in the performance overall. Dimitre Ranev I have so many questions. But you know, we're running out of time. A couple of more here. So, for example, would a portfolio manager have access to alternative investments, such as limited partnerships or things that, for example, as a DIY investor would never be able to invest in? Rod Burylo Yes, yeah. In fact, the portfolio managers I've worked with in the past have tended to have a strategy or a skill set, that's not common. And the reason why I've looked for that, not only for employment opportunities as a consultant in that space, but as a consumer of investment services, is I subscribe to a variation of what we call the efficient market hypothesis. Which basically states that information is so available to everybody out there all the time, you know, everybody's sitting there on Bloomberg access and on terminals, that everybody has the same information. And if you don't have information that's available, that means you have insider information. So you're likely in the realm of possibly committing a crime. So if we all have the same information and the same analysis at the same time, why would you think that the prices of securities are not the right prices? That's what we say about being efficient. So what portfolio managers will often do is, because of that efficiency, is they'll apply strategies or approaches that help bring value to the process. So I'll give you an example. You said it already, limited partnerships and private securities, offerings that consumers can't get in on their own, you know, if I got a billion dollars as a portfolio manager, and I'm allocating, you know, 1%, to different offerings, I have millions of dollars to go buy an apartment building. And I can buy it like that, and allocate funds there, and so get these clients participating in something they wouldn't have participated in. So a portfolio manager, in my mind, the best ones, for the best price, given the best value, are doing more than just buying stocks and ETFs. They're doing those things. And I'll give you one more example. And this now sounds more hedge fund-ish. But one of the portfolio managers I worked for in Canada for several years, was an option strategy specialist. And options strategies are hard to scale up for an individual, but they had hundreds of millions of dollars under management, very effective team, so if somebody was interested in the hedging power of option strategies, if they were interested in it, I always said it makes more sense to go to a big group where there's a whole team doing it for hundreds of people in the order of hundreds of millions of dollars, then you trying to figure it out on your own. You know, so they're trying what I would call the secret sauce, what's the secret sauce with that portfolio manager? What are they bringing to the table in terms of value? Can they articulate it? If they can't, that might be a warning sign, you know. Doesn't mean they're bad, but it might not necessarily mean you're getting a special value out of it. Dimitre Ranev The robinhood, the trading app, was pushing option strategies for people for $10. But that's not a good idea. Two follow-up questions then. So number one is, you know when you look at the whole active versus passive debate - which is very cloudy and confused, and quite frankly, on both sides, I think dishonest - because when you look at the passive debate, they always compare returns to just a slew of different things like mutual funds. Is there any actual studies, and I know studies are hard to get in financial industry, looking at specific portfolio managers and how well they do compared to the market? Is there actually anything out there, and I'm talking about portfolio managers, forget about mutual funds or the other definition of active investments. Rod Burylo I'd say there's a lot of portfolio managers that don't outperform the market and that have their fees. And fees go up, the more active they are, or they're more they're trying to do unusual things, that generally means that the price is going up. And yeah, as a rule of thumb, they don't tend to outperform the market. And even if they did in one year, you know, there's a lot of studies that suggest that that's not a replicable thing. You know, they had a good year, and maybe, and so one of the things about taking risks with securities, a risk is, by definition, a risk. It could pay off. And it might not. To have an unusual performance relative to a benchmark, it means you've got to take on some unusual level of risk to do that. And by definition, that means sometimes that risk will pay off, and sometimes it won't. What's bad for consumers is to try to follow performance of a portfolio manager and, you know, say oh, they had a really good year, and I didn't like my current portfolio, I'm going to move over there, you know. And there's often really good reasons to move, don't get me wrong, but moving because you're chasing someone's really good year last year, is probably not the way to go. You know, so yeah, I think some of this comes back to that concept of the efficient market hypothesis. If we all have the same information, you know, I don't mind telling you, sometimes I've done my best by just buying a bunch of big blue chips with dividends and sitting on them for, like, 5, 6, 7 years. And then I go back, and I go, you know, Google, you want to have some fun, go out there and Google, 'if I bought Royal Bank 10 years ago and sat on it', you know. Now remember, you paid one fee to buy it, you probably have no ongoing fees, what your return would be... but the thing is, so here's one of the reasons I invite you guys to continue to follow Dimitre's podcast, because you get someone like me, an industry person who calls out the industry, for, you know, it's, I won't call it deception, but let's say some lack of clarity over value proposition. And there's a chapter in my book called Is The Financial Services Industry Trustworthy? And, you know, I generally argue that it's not trustworthy, but I have a very specific meaning when I say that, you'll have to read it to get it. But yeah, I would just be really super careful of a bunch of people who are just saying, I'm going to go buy some stocks for you, and I'm going to be better than the market. This is one of the reasons I focused on portfolio managers that have a secret sauce. Are they doing something that I can't do on my own, because if I can do it on my own, I might as well do it on my own. You know, and this is where I look for private securities or something else in there. I'm a fan of private securities myself, but I don't often get those from portfolio managers, I find that I can source them on my own. But I'm in the industry, I've been at this a long time, so I know that people. If you don't know that people, it might be hard. You got to know the people that know the people and you'll have the best opportunities. Dimitre Ranev So to summarize for an investor, the advantages of a portfolio manager is, first of all, there's fiduciary duty. Rod Burylo Correct. Dimitre Ranev Which is the thing that you really want. Secondly, you have access to different investment vehicles, which most people don't have access to. Thirdly, you save a lot of time, you don't have to worry about rebalancing your portfolio or buying or selling stocks, that's done by the manager. Fourthly, the fees are - and again, obviously, you have to look at different managers - but 1% fee, I'll tell you, it's very reasonable to me. And I'm saying this as a person who does DIY investing, but that's a very reasonable fee. And it's much better than the average of mutual funds in Canada, which is about, say about 2%, I believe. Rod Burylo Last I heard. Dimitre Ranev The disadvantage is that there is an entry fee. So there's a bit of a barrier, but I guess for professionals, like doctors, it's $50,000. So even, I would say 100,000 isn't necessarily a barrier. Might be a barrier for, unfortunately, some people who are not professionals. Is that a fair summary of what you said, Rod? Rod Burylo Yeah, I think you've captured that very, very well. Dimitre Ranev So my last question to you - and again, I have actually have a thousand questions, but we have to we have to wrap it up - is if somebody is interested in having a portfolio manager, is there a resource, for example, I know psychologists have a website where you can find a list of psychologists, is there a resource for portfolio managers or do you just have to do it by word of mouth? How does it usually work? Rod Burylo Yeah, you could look at a record of registration categories for people. So for example, in the past I've pulled out entire lists, say from a brokerage firm, like a stock brokerage firm, a list of all the dealing representatives there, and which ones have the portfolio manager registration or not. But doing that I don't think is the most useful of exercises, because just because you found a registrant like that, it doesn't mean that they're doing anything special or, you know, have a compelling offering. It'd be like finding a hamburger place. I found one, there's a million of them, is it a good hamburger place or not? So I would go back to, you know, word of mouth is a useful thing. One of the things that we try to do with physicians through Empowerment Office, is provide vetted portfolio managers, ones that we have identified and vetted, either they already have an attractive price or we've worked on the price a little bit, so that it's more attractive to our audience, to physicians, for example. But I would always go with a referral or word of mouth in that space. And, you know, asking your buddies, if they've got some - one of the challenges is that you could go ask your friend who's a physician if you've got a portfolio manager, and they might not know that that has a very technical meaning, they might just think it's managing their investments. But one of the things, let's say you had a short list of these types of people, you can look on regulatory websites to see if they have any complaints against them, any sanctions, that would be a useful thing. But that might just tell you that they haven't gotten themselves into trouble, that doesn't necessarily mean that they're excellent, that's a different thing, right? So I would go with word of mouth. And then there's one other thing that you might contemplate. There are certain associations in Canada where, let's say they have a designation of a particular kind, like a CFP designation, where they'll have lists of these advisors and will also say what registration category they have, like, possibly Portfolio Manager. And I like those kinds of resources, because that starts telling me a little bit more about the overall character quality of the person. And another thing you could do is, if you've got a topic that you're excited, I know, we're going to talk about ESG at some time in the future, but there are associations in Canada where they look, for example, a Responsible Investment Association in Canada, that tends to attract advisors that are interested in ESG topics within this overall realm of responsible investing, that will list off all the advisors in there. And then if they're portfolio managers or not. And so if you've got a topic that you're really interested in, and want to try to find a portfolio manager that specializes in that space, there might be lists out there to do that. I had a company in 2004, you referenced for the audience that I won an Advisor of the Year Award, that Advisor of the Year Award was for a business we created called Canadians Retiring Abroad. And so if you're interested in retiring abroad, you would find us. But it was because not necessarily that we were excellent - I thought we were good - but because we had made sure that that we could clearly communicate what our differentiator, what our special topic was. So if you wanted a special topic, call us, if that's not your topic, you know, go talk to somebody else. So sometimes there's associations out there. But, you know, if you've got friends out there that are really interested and they want to talk one on one, you know, the two of us together on how to select an investment advisor, we could do a whole discussion on that at one point, the things that I would look for. But it's not necessarily as easy as it sounds. Dimitre Ranev That was, I had one. I had a question about that, but I feel like that's a whole topic for podcasts. It's not a five minute question. Listen Rod, I really appreciate your time and your wisdom. And I'd love to have you back. There's so many more things I want to ask, but thank you again for coming and for talking about this. And hopefully we'll talk soon. And I have to get that book and give it a read. Rod Burylo And very good to talk to you and you provide an excellent, important service to your audience. I really mean that. So thanks a lot for having me on. Dimitre Ranev Thank you. Kevin Mailo Thank you so much for listening to the Physician Empowerment Podcast. If you're ready to take those next steps in transforming your practice, finances, or personal well being, then come and join us at physempowerment.ca - P H Y S empowerment.ca - to learn more about how we can help. If today's episode resonated with you, I'd really appreciate it if you would share our podcast with a colleague or friend and head over to Apple podcasts to give us a five star rating and review. If you've got feedback, questions, or suggestions for future episode topics, we'd love to hear from you. If you want to join us and be interviewed and share some of your story, we'd absolutely love that as well. Please send me an email at KMailo@physempowerment.ca. Thank you again for listening. Bye.
	30 Jul 2023	24 - Tax Hacks for Busy Medical Professionals with KPMG Tax Lawyer Jason Pisesky (PHE Masterclass Faculty)	00:44:57
Drs. Kevin Mailo and Wing Lim host a webinar with guest Jason Pisesky, a tax lawyer with KPMG Law. Dr. Lim takes the lead in interviewing Jason on an overview of tax hacks and advice that will form the contents of deeper focus in future Masterclass events. Jason Pisesky starts the conversation by discussing the financial incentive of tax deferral in having a PC. He highlights when a PC is most useful in a professional’s career journey along with when it is an advantage and when it may not be. But Jason’s biggest piece of advice is to be surrounded by, and work with, trusted professionals who can guide decisions correctly. In this episode, Dr. Wing Lim and Jason Pisesky wade into the shallow end of tax hack topics that will be covered in depth in the upcoming Masterclass. They discuss the benefits of having a PC, what to put in a PC and what to keep out of it, when a hold co or sister corporation is beneficial to form, the change in TOSI rules, how salary can work where split income no longer does, and many other insights and advice from Jason’s wealth of knowledge on all things tax-related. This is vital information to digest and will whet appetites for even deeper conversations in the Masterclass. About Jason Pisesky: Jason’s practice covers a broad spectrum of taxation law matters including corporate, personal, farm and estate tax planning as well as representation in dispute resolution and litigation matters Jason joined KPMG in January 2021. Prior to starting at KPMG, he spent over six years working at a leading western Canadian boutique tax law firm. Jason has experience in both the tax dispute and tax planning for both personal and corporate taxpayers. Jason has worked with small and medium-sized owner managed operations to reorganize structures in a tax efficient manner, acting as counsel for vendors and purchasers in arm’s length deals as well as families in the midst of related party estate and succession planning. He has argued on behalf of taxpayers in many contexts and obtained favourable results for taxpayers from auditors, appeals officers and lawyers at the Department of Justice. Jason has appeared before the Alberta Court of Queen’s Bench. Resources Discussed in this Episode: TOSI Physician Empowerment Masterclass — Contact Information: Physician Empowerment: website \| facebook \| linkedin Jason Pisesky: website \| linkedin __ Transcript Dr. Kevin Mailo: [00:00:01] Hi, I'm Dr. Kevin Mailo, one of the co-hosts of the Physician Empowerment podcast. At Physician Empowerment we're dedicated to improving the lives of Canadian physicians personally, professionally, and financially. If you're loving what you're listening to, let us know. We always want to hear your feedback. Connect with us. If you want to go further, we've got outstanding programming both in-person and online so look us up. But regardless, we hope you really enjoy this episode. Dr. Kevin Mailo: [00:00:35] Hi, everyone. I'm Kevin Mailo, one of the co-founders of Physician Empowerment, and we're bringing another great webinar podcast episode to you. Today it's going to feature Wing interviewing outstanding tax lawyer Jason Pisesky, and Jason is an associate with KPMG, one of the world's preeminent accounting firms, one of the biggest in the country. And they're going to be talking about tax hacks for busy medical professionals. And this is just the start of how much there is to know. And we are following this up with our master class where we dive into these topics in a lot of depth. And I think it's important for Canadian physicians to be reminded of the fact that it is not just good enough to play offense, right? We're all out there, we're all learning and we're all working hard to, you know, make those returns in our investment portfolios. But a key part that's often neglected is long-term tax planning. And so this is our introduction to that because it can be worth hundreds of thousands of dollars over the course of your career, if not millions, depending on where you're at and how you invest. So with that being said, Wing, I'm going to hand it over to you and let you go at it. Dr. Wing Lim: [00:01:54] Sure. Thank you, Kevin. So Wing, I'm Wing Lim. I'm a family physician based out of Edmonton and I'm a co-founder of Physician Empowerment. And a lot of you know me. Some of you don't. And yeah, so so we're launching a new tax series at our Masterclass. And then today it's kind of like a content page, we'll run over a lot of concepts and it's meant to be an overview. So if there's something that kind of goes over your head, don't worry about it. It probably goes over other people's heads. But then instead of lecturing, we thought, it's better to do interview, right? And so Jason and I went back quite a bit and of all places, we met on a dance floor. And so my wife Katie and I and Jason and his wife, Amy, we were kind of dance classmates. And so it's been a number of years, right, that we knew each other as friends, I liked him right away. He was one of the dance teacher's pet, teacher's pet. The teacher actually said that. And then we became friends. And then a few years later I got stuck with a tax planning issue. I got like a dozen companies and the whole thing looked like a spider web. And it went to a tax accounting firm that was ready to skin me alive in fees. So I was unhappy. And I said, Jason, you're a tax lawyer, aren't you? And that's how we started, right? And he got me out in a pinch and we dove into a lot of really, really neat tax strategies. And then so we like to have a chit-chat, another fireside chat with Jason. So Jason is not just a nice guy on a dance floor. He is also a prominent tax lawyer. So he, I think he started at a prominent tax firm in Edmonton and he jumped into one of the largest tax firm in Canada and he's heading the tax division. He told me that, but Jason, you said you got 98% colleagues, accountants, and you're the 2% that are lawyers? Jason Pisesky: [00:03:46] Yeah. No, that's that's about right. Yeah. It's technically two firms. There's KPMG LLP, which is the accounting side and then KPMG Law, which is where I am. And we are the little brother. But we are becoming more and more important as we kind of stay in the firm longer. Dr. Wing Lim: [00:04:01] Right, so you deal with accountants all day long, right? They present you cases after cases after cases. And most of them are professionals, business owners and including medical doctors, right? Jason Pisesky: [00:04:13] Absolutely. Yeah. Yeah. And that's one of the reasons I'm at KPMG is for, as you said, one of the biggest shops in Canada, if not the biggest. And yeah, the variety, the depth, the, you know, working with people across the country is fascinating and gets you out of bed in the morning kind of thing. So. Dr. Wing Lim: [00:04:28] Right. So I may have to put some put the brake on if you go on a little bit fast on the professional track, I may need to slow down and have you hey, dumb it down, dumb it down to the MD level, right? Where I heard one thing that we are idiots outside of our own fields, right? So, you know, we're ignorant outside. So we're here to learn. We're here to learn and have some fun. So. Hey, so we're going to talk about some tax hacks, right? So busy professionals. Meaning that we're busy. We're busy. We're making money, right? We're on a treadmill or trading time for money or trading or trading life energy for money. And at the end of the day, we're in a progressive tax system, unlike where I came from, Hong Kong, which is regressive. And so I think we did the math the whole lifetime after overhead and tax, maybe we only take one-third if we're lucky. Right? So that's substantial, right? So let's have some tax hacks for busy medical professionals. And we're not going to be able to cover everything. But as I said, we had a quick chit-chat before today. So let's talk about some easy ones. I know a lot of people have PCs, a lot of people don't have PCs. Right? And so when does it make sense to have a PC? Jason Pisesky: [00:05:41] So the tipping point for medical professionals in particular, for everyone who's kind of entitled to a PC, that's lawyers, accountants, dentists, doctors, normally when you have a corporation, a lot of people do it for the liability shield, right? Limited liability. I can't be sued if the corporation gets in trouble. You know, generally speaking. Professionals don't get that kind of protection. And so for them, really, it is kind of a purely financial decision of when do I need a PC? And that determinant is when you're no longer spending all of your income. The financial incentive for having a PC is called tax deferral, where you get to keep the money in the company paying corporate tax at a lower rate and you take out less and spend it. But there's some left behind. If you are early in your stage in your career or maybe just in a in a field or a stage of your life where you're not earning excess amounts and you're just spending all your earning, then having a PC won't provide much of an advantage for the professional. Dr. Wing Lim: [00:06:40] Yeah, so I'm surprised to hear that one of my neighbors, who's a specialist, and some colleagues, husband and wife, both medical doctors and I'm ten years later, 40 years later, their accountants still said that you don't need a PC, right? That's shocking the money that you left on the table. Right? So then. Yeah. So then how do we do this? Like, should we, once we earn more than we spend, or we budget as such in such a way? What do you do? What's the advantage? What's the advantage of the tax deferral? Jason Pisesky: [00:07:14] So actually, I'm going to tag on to what you just said there first about talking to their other advisor. And you actually said in your opening comments, too, about, you know, we're all only experts in the things that we, of course, spend years studying. We can't know everything. And actually, one of the first tax acts I'd like to highlight is like, surround yourself with the right people, with people to take these tasks off your hands. I'm sure you can allude to it as well. I know tons of professionals of all those stripes, engineers, dentists, doctors, lawyers who, you know, every year come June, they're struggling through TurboTax, trying to figure out their own taxes, collecting receipts, pulling their hair out, just praying they don't get audited by the CRA. And same thing on the legal side of looking after their own minute books and trying to record things and keep everything up to date. And that's not a good use of your time, I would argue. You work hard. You've reached a high level of competency in a very specific set of skills. And what is money but the stored value of time and labor that you can spend to get yourself more time. Jason Pisesky: [00:08:17] And so, yeah, one of the easiest tax acts is hire people to kind of take some of that off your shoulders to do it correctly. Because as I always tell people, you kind of, you pay for it eventually one way or another, you either pay for it a little bit every year or you wait until you're audited by the CRA, or you start to do a transaction and someone's going to buy your PC and you know, they want to see good minute books and financial records and you have to go pay someone probably a lot more than what that would have been annually to catch you up and kind of do almost a forensic audit to figure out what have you been doing for the last 20 years? I have no idea. But they want to see good journal entries and general ledgers for all the money that's come and gone from the corporation. And so for many reasons, the simplest tax hack is kind of offload a good portion of the tax work onto someone else who does deal with it on a daily basis. Dr. Wing Lim: [00:09:04] Yeah, but with that, there's always this XYZ accounting that doesn't change the lesson plan. I liken it to Mrs. Jones, a fictitious Mrs. Jones, that taught Macbeth for 30 years and never changed her lesson plan. Right? You know, like a lot of have one that accountant that I fired because ten years later found that I could have done something ten years for the last past ten years, I could have saved a ton of money. He never mentioned it, right? Jason Pisesky: [00:09:29] Absolutely. And there's no right answer to how do I know if my professional is doing the right thing? And again, hopefully the audience appreciates there's, in medical field, there's differences of opinions of diagnoses and prescriptions and all these things. So I think the answer there is, you know, get someone who you do believe in and kind of comes with perhaps good referrals. But there's nothing wrong with getting second opinions, you know. Maybe every five years or ten years or when you reach a certain milestone, you get married or you have your first kid. I don't think a professional should be offended if you go out and speak to another one just to pick their brain and see what's out there, especially if - and a lot of people don't know or don't like to think about it - but accounting is very much like the medical field in that you have general practitioners, then you have expertise in certain areas. So not every accountant is a tax accountant. And so if you have a more of a general, call it a GP accountant, then there's nothing wrong with going out and speaking to a tax accountant or a tax lawyer to pick their brains. But yes, you had asked me about corporations and the benefits of them. Jason Pisesky: [00:10:33] So say, yeah, you've reached the point where you're earning a certain amount and you're not spending it all. So keeping it in the corporation leads to what I call tax deferral, where you pay a low level of corporate tax, lower than you would pay if you just earned it all personally. So for the first generally call it $500,000, it depends which province you're in, but generally, for the first $500,000, you'll pay a tax rate, again, province dependent, kind of in the range of 12 to 13% or 11, maybe 11 to 15% on that first $500,000 in the company that's left behind after you take salary and dividends. And then after that, it kind of goes up to about, you know, the 23 to 25% range. So, and it doesn't take very much as an individual taxpayer to kind of get up, definitely to get above 13% basically, once you're past your personal credit limit, you're kind of into the 25% range. And then, of course, even comparing to the 23%, it doesn't take much to get above that as an individual for every marginal dollar you earn. So that's the benefit there. You build up that pool of income, lower-taxed income. Of course, if you take it all out, you pay a tax rate that is meant to approximate had all of the money been earned by the individual. Jason Pisesky: [00:11:52] So don't be afraid of, well, what if I am going to yeah, I'm going to be banking an extra 1 or $200,000 in my PC. But what if I need it? Then I'm going to take it out and I'm going to pay personal tax and I'm going to be behind the eight ball? No, generally the system is set up, we call it integration in Canada, where the idea is on the flow through of money, you should end up at the same place as if you'd earned it personally. So all that is to say is when you take the dividends out to recoup the money left behind, you pay a lower rate of tax than you would have if you would just earned a salary on that amount. So the net amount, it's not always perfect, but generally you end up at the same spot if you just kind of flow the money out of the corporation. So you're not, certainly not penalized for having a corporation, but I do hear stories of professionals that have just take all the money out. And so really, you're just paying professional fees and accounting bills and these things to keep the corporation running, but you're not getting the benefit of it. Dr. Wing Lim: [00:12:46] Right. So I guess the conventional wisdom is stuff as much in the PC as possible and then pay you as yourself the least amount. And then just invest, invest, invest, right, within the corp and then you pay the tax when you take it out, when you retire, so to speak. Right? So but is there a reason not to just put all the money, all the investments inside the PC? That it may not be wise? Jason Pisesky: [00:13:13] Definitely. And so PCs are like any corporation. If the PC gets sued, its assets are subject to potential creditors of the PC. So definitely it depends, of course, what field you're in and what you feel your risk of, you know, getting sued, malpractice suit are. Obviously higher in some fields than others. And so in a perfect world, you'd kind of move those investments from the PC earning it into a sister corporation, one that's kind of beside it or a Holdco. It's above it, again, that's province dependent which structure will work best for you. The idea is, is you want to kind of strip those assets out to the side. You can do that in a way generally that you shouldn't be paying income tax on it. Then you set it up in a side corporation and then if the PC gets sued, what does it have? It has its medical license and maybe a couple pieces of equipment and a laptop. That's kind of all you really want exposed in the PC. That said, again, without the shield, the individual, the professional is usually the same thing as the PC. So that's why a lot of professionals, they will like to set up an investment company under their spouse's name, shuffle everything over there to the best you can, and have kind of the growth in the investments grow in the spouse's name who of course should not be sued if you as the professional are. Dr. Wing Lim: [00:14:30] Now so that itself when we cover this thing at the Toronto live conference, a lot of people said, really, I've never heard of it. So lots of people stock everything, real estate, stocks, everything portfolio, everything under the PC. And they never heard of a whole course of how they do that. Can you move money over there tax-free, like you know, it's so confusing for a lot of people. So at what stage should a physician or a professional, right, that say, hey, okay, I'm building up some assets, at what time is it wise to set up a Holdco system under the spouse's name? Jason Pisesky: [00:15:06] Yeah, I'd say once you kind of reach, maybe that - I mean there's no magic number, of course - but once you reach that kind of autopilot moment where, you know, you're married, you've got the house, the kids, are kind of looked after, you've got some college funds set up and you just know like, yeah, every year I've got a certain amount that's going to kind of go there. You know, there's no big renovation bills that we expect to come. We've got new cars. Um, you have to wait till all those things. But it's that point in time where you're just you're starting to every year accumulate a material amount of extra things in the PC, things being investments. Don't collect other things in the PC. Dr. Wing Lim: [00:15:41] For example, don't collect, what, cabins? Jason Pisesky: [00:15:44] Yeah. Cabins in the woods and, you know, a little hobby plane. And generally I would say don't collect those personal use items in the PC. It just kind of leads to a headache. And then if you're using it, you have to charge yourself for its use and without having shareholder benefits and it kind of becomes a mess. So that's definitely a tax hack. Don't have personal items in your corporation's, general advice, even like, Oh, but I'm saving the tax because don't have to take it out personally. But again you have to charge yourself, they're huge audit red flags, CRA loves to go after those things. You know, the company owns a plane and it's not running an airline. And so, you know, have you been charging yourself for the use of that plane every year and all of a sudden you find yourself with penalties and interest. So, generally there are more tax efficient ways to get money out of the corporation, buy the plane, do it outside than to keep it in there and maybe keep it simple. But setting yourself up for a headache down the line. Yeah. The idea is, you know, once you're kind of you're starting to accumulate, you know, into the six figures, maybe approaching seven figures - and again, it depends what field you're in. If you're in a field where maybe you feel, hey, one slip of the scalpel and I'm going to be sued for everything I own, then maybe it's more prudent to be more aggressive on stripping things out of the PC early on. If you feel you're in a relatively peaceful practice where the odds of something going horrifically wrong are lower, then again, maybe you can let it build up a little longer because then you don't have to, you know, incur the professional fees to set up the structure and peel things off to the side. Dr. Wing Lim: [00:17:12] Well, for most practicing professionals in Canada, we have this thing called CMPA, the Canadian Medical Protective Association. So I don't know the ceiling, but most of the malpractice suits are covered by them. But other liabilities, if you have a clinic, somebody slip outside that is not, your CMPA ain't going to cover that. Right? Especially for those who stuff all the real estate condos and all that inside the PC. They definitely can sue your PC, right? And that's when you say that it's better to strip those assets outside of your PC and into a sister court, right? Jason Pisesky: [00:17:48] Yeah. And without the risk of maybe getting into too much detail, it probably never hurts to really early on set up a side sister corporation to do the investment, again under a spouse's name, because you can always move some assets over without doing more complex steps. Because the professional will probably generally always be exposed to the initial earnings. You know, you earn an extra 100 grand. There's kind of a sort of gifting it to your spouse, which can lead to other problems, that hundred grand is always in your head. What you want to move is the growth. Over a 30 year career, that 100 grand is going to turn into, what, a multiple of 16 or 20? I don't know what, you know, your standard investment advisor will tell you that'll turn into over a career, but what you want to move over is that growth over to the spouse. So yeah, you can just have the PC loan it over to that sister corp. Sister corps invests it and the benefit goes to the spouse and then that initial $100,000 is at risk. And then again, there's a way to kind of clean that up down the line with some tax planning. Dr. Wing Lim: [00:18:46] Right now, let me just dovetail on that. So there are people who advise that, oh, for some provinces at least, the spouse can be inside a PC. So should the spouse be, if the spouse has a Holdco on the outside, should the spouse be still part of the PC? Jason Pisesky: [00:19:01] I would say generally, yes. If there's always a personal element to it, you never want the tax to, uh, to put the tax cart before the wagon for the horse. Sorry. But all else being equal, it definitely doesn't hurt to have the spouse in there. Yes, there are income splitting rules, which can mean maybe there's no immediate benefit to it, but if there's ever a sale of the company, then certainly there can be benefits to having that spouse be a shareholder. There may be ways, some tax planning available to, you know, get the spouse some income and some benefits without falling afoul of those income splitting rules. And kind of a third reason is, oh it's jumped out of my head. Sorry. Dr. Wing Lim: [00:19:46] Well while you are thinking... Jason Pisesky: [00:19:49] Future sale annual. Oh, and once - sorry - once you reach the retirement age, 64 or 65, then you can income split with that spouse out of the company. So, playing the long game and they kind of need to have to accrued value. You can't just add them as a shareholder when you're 64 or 65, you know, they have to build up value and you only do that by having them be a shareholder for a long period of time. Dr. Wing Lim: [00:20:11] Right. So while you're on that topic, I think we should spend a couple, maybe a minute on tax on split income, but as of 2017, CRA has a much stricter definition and a lot of people fall in traps to that. So can you highlight a few of those things for us so that we get a good reminder slap on the upside of the head? Jason Pisesky: [00:20:31] Yeah. And it's probably just, I'll give kind of a broad overview of the rules and that's maybe as far as we'll go because they're, yeah, I mean they could... I've given whole day, you know, eight-hour courses on TOSI before. Dr. Wing Lim: [00:20:42] No not that, not that. Jason Pisesky: [00:20:44] Yeah. They are a thing on their own. So the idea of TOSI is, is that again what was happening in the market was people were adding, you know, their spouses, kids, nieces, nephews to corporations and paying them dividends. And then over the age of majority, there used to be rules blocking it for minors, and then basically just expanded those rules. So the idea is, is that they don't want people who are related to the main business person driving the business in the company, to get kind of, to pull out money from the company as dividends if they aren't also involved in the business. That's kind of the most simple explanation of the TOSI rules. We call it tax on split income, with split income being the bad type of income that's being split. So yeah, what will happen is people will, well what was happening is you'd have your spouse and your university-age kids as shareholders of the PC and then, you know, you're paying out dividends to them, you know, to a spouse who was probably a little bit more maybe, you know, 2, 300 grand to use up all of their lower brackets. But, you know, I think that would save you about $40,000 in tax if that all went to the professional spouse earning income at the highest bracket, probably a little lower, maybe just tuition fees plus some living expenses for the university kid. Jason Pisesky: [00:21:56] But that's kind of all been cut off now. So you'd have to either have them be kind of getting capital gains or kind of wait for a sale to get the advantage, although that's kind of a good dovetail into sometimes you actually don't want your spouse to be a shareholder. If your spouse is a professional doing their own thing or they have their own company, you may not want them to be a shareholder because that may, if you both have your own corporation doing your own thing, you'll both get your own small business deduction. That first 500,000 that's taxable at that relatively low rate, low teens. But if you start to have each person being a shareholder in the other one's company, then you can, you'll have to share that 500,000 limit. And so again, very personal decision, not just are you comfortable with your spouse being a shareholder, the non-voting shareholder in your PC? Dr. Wing Lim: [00:22:51] So let me highlight this thing. The tax hacks is not just what to do, but what not to do. Right? So I think the takeaway is don't pay your spouse a dividend that is not commensurate with what they actually working, their actual contribution. Right? And my accountant says he has seen a lot of the clients, like you say, pay the spouse a few hundred thousand dollars without even showing up at the clinic at all. And those would be dinged. Right? It just pays tons of money to the kids under the age 25, and that's why it cuts off at 25, right below 25. You should not do the dividend to your kids, right? Jason Pisesky: [00:23:31] Yeah. And then, but again, hack tax, salary. You should be able to pay a reasonable salary to your spouse as long as there's some justification for it. If they're doing the bookkeeping, if they're helping doing some of the admin side of the practice, usually accountants will feel comfortable kind of 40, 60,000. And honestly, that soaks up most of the benefit for the income splitting. You don't, again going up to the I think it's like 340, 350,000 to get to the top bracket. Yeah, 80% of that benefit comes from paying someone you know under a hundred grand kind of thing is where all that income splitting benefit comes from, getting their personal tax credit and using the 25% tax bracket instead of the up into the high 40s or low 50s. So yeah, salary, it's just subject to a reasonableness test as opposed to the TOSI rules which are much more explicit and bright-line tests that are much easier for them to attack. You also have to, again, you have to kind of have really good records to feel, for your accountant to feel comfortable wading into the TOSI realm of dividends and are they justified, whereas salary, it's a reasonableness test. Your downside is just denial of the deduction in the company, whereas for TOSI your downside is kind of high rate income for the individual and you've already paid the tax in the company because dividends are paid by after-tax money. So you've already given up that. Dr. Wing Lim: [00:24:50] So to recap, so this hack is if you want an income split with your spouse and your kids, then pay them a salary instead of a dividend. But does it, is it...? Jason Pisesky: [00:25:01] Basically find a way to feel like you can fit into the salary rules which are generally more lenient and well-established. The problem is also TOSI is, you said 2017, there's no court cases on it. There's a million conflicting CRA opinions on it. Whereas you know, the reasonability of deductions for salary and things, tons of cases, really well-established rules. They've been around for decades and decades. So yeah, we kind of, we know how to guide you through those rules a lot better, right? You don't want to be the first person in Canada to go to court on the TOSI rules. Dr. Wing Lim: [00:25:33] Don't want to be the famous one. Jason Pisesky: [00:25:34] That's the tax act. Try to not be the first person in court on a specific issue. Dr. Wing Lim: [00:25:38] Right. Have your name on this, the state versus you. Okay. Jason Pisesky: [00:25:42] Yeah, be referenced as that case going forward forever. Yeah. It's great if it works, it's great if it works, then you're known as, you know, that case becomes your calling card. But. Dr. Wing Lim: [00:25:53] Right. Let's pivot a little bit to talk about, since we're on the topic of salary versus dividend, T4 versus T5. Right? So there are a lot of strategies, right? Some are conflicting. Some say, okay, do nothing but T5 to draw dividend. But then there's some strategies like RSP and IPPs, you need a T4 to build a route. So can you highlight T4 versus T5 salary versus dividends? What's the pros and cons? Jason Pisesky: [00:26:19] Yeah. And so this is a great one where, kind of circling back to that hack about, again, having someone to help explain this to you every year, because it will be an annual decision, especially if you're sending some T4 salary income to a spouse. Again, figuring out what the right mix is for your family. So as I said at one point, kind of that concept of integration in Canada where we, you know, the government wants you to be indifferent for earning that dollar through the corporation or personally. So if you earn $100,000 in the PC and you pay $100,000 salary, well, you get a deduction in the company for $100,000, and then the person pays the personal tax. Dividend, if you earn $100,000, the company pays corporate tax on it and then it uses the residual and pays a dividend and you kind of end up at the same spot. So the big one is, is for T4 income, you're going to be subject to CPP. There's a related party exception for EI, there's not for CPP, so you're going to have to pay the employer and personal half of the CPP. So that's just a kind of a little bit of leakage, tax leakage. Jason Pisesky: [00:27:25] At the same time, you do gain access to the RSP, the individual pension plan, IPP. I believe that's going to be talked about in a later webinar, Wing, so I won't dive into that. Plus, it's very, again, you get a whole day course on IPPs if you so wish and all the modelling and that goes into those. So it's a personal decision. It's an annual decision. There's no right answer to, you know, I can't tell you oh, you always take this. I think it depends on what you value. Some people really value RRSPs and IPPs and building up those kind of after-tax pools that they'll take out later in retirement. Some people will say, you know what, I want all my money tax paid. I want to know I can access it at any point in time. And that's what they value. And so, but there are definitely things to consider, and it's not just a well, just I'll just do this one because someone told me to do that one. It's, it warrants consideration every year. Yeah. Dr. Wing Lim: [00:28:21] Right on. Okay. So let's move over to a couple more topics or strategies. So what about this trust, family trust and whatnot? We're thinking of a retirement or upon death or the corporate assets would be deemed disposed. Right? So and it may not be free from liabilities. So what about trust, family trust? Is there still a place in it because the government was trying to castrate it? Up to 2017. Jason Pisesky: [00:28:50] Absolutely. Trusts were definitely one of the things targeted in those 2017 new anti-income splitting rules. That said, I still think there's a strong place for them in kind of a well-rounded, high-net-worth family plan. I am in the process of settling a handful of them and I do tens of them every year, I help people set them up because they absolutely do. As with a lot of things you don't always want, again, tax to drive the conversation. So trusts are great, they do offer again another layer of creditor protection. They allow you to introduce people to the ownership structure without actually giving them direct legal rights over shares, which may lead to oppression remedies in court and, you know, entitlement to financial statements and rights to vote on certain things, even if they're non-voting shares. You kind of cut all that out with the trust. And you also don't have to, they're kind of maybe shareholders when they're through the trust, right? Maybe they'll get a dividend, maybe they won't. Maybe you'll transfer shares out of the trust to them, maybe you won't. So that flexibility is what a lot of people are interested in the trust. The two big ones for tax are again, flowing dividends out, generally not going to lead to much tax advantage in a trust. The big ones are a potential sale. What might we be able to sell in the future? Then the capital gains deduction, that's the tax-sheltered, you know, almost $1 million right now. Jason Pisesky: [00:30:13] You might be able to access the beneficiaries of the trusts' capital gains deductions and shelter several millions of dollars using those. You may also be able to do some planning with the trust to flow out some type of income. Generally involves more steps, a lot of prep work involved, but there can be advantages to that. And then you also have the advantage to, in the future, transfer shares to the individuals. We talk about this a lot in some other industries. Farming is a big one where, okay, you now know who the farming kids are. You can transfer shares to them. Probably not as pertinent that one for medical professionals. But at the same time, a family trust can help you avoid some estate tax, depending on when the family trust is put in your life. Of course, when an individual dies, they're deemed to dispose of all their capital property, which can result in a capital gain. The family trust outlives the creator's death. And so that can be avoided depending on when the family trust is put into place. So there's lots of advantages, many of them non-tax, many of them tax. So, and again, it depends which province you're in too, and who is allowed to be a beneficiary of a trust. So very personalized decision. Dr. Wing Lim: [00:31:23] Right. So trusts are definitely a very valid tool. It has to be customized to your needs. But then I think most are only what, 21 years, the lifespan of a trust? Jason Pisesky: [00:31:35] So a trust can live, they can they can outlive 21 years. And so like, I think BC has a hard 80-year rule maximum. Many of the other provinces again it's 21 years past everyone who's kind of involved in the trust be them the creator, the trustee or the beneficiary. So that can be your longest-lived person, is one years old and they live to 90. You get another 111 years, kind of, it's how long a trust. For tax purposes, so I said that rule of, hey, when you die, you're deemed to dispose of all your property. Parliament wised up pretty quickly to the fact that trusts they could live for 100 years. We don't like that. And so they decided on 21 years, which is, you know, about the span of a generation, maybe not so much when families are getting created a little bit later in life now, but the idea that trusts live for 21 years and then they also go through a deemed death, dispose of all their property, and then they can continue on for another 21 years, do the same thing. So in tax conversations we generally say trusts, yes, they live for 21 years because at that point you're going to have to decide should we do a tax-deferred rollout of the property to the people? Should we eat the tax bill and keep it in there? Should we do some other planning to manage this event that happens in 21 years? So I'd say rule of thumb, I don't see many trusts outliving 21 years. So yeah, 21 years is kind of your starting point for looking at a trust. Dr. Wing Lim: [00:32:57] Right. And then at what point, like would a practicing professional contemplate, Wow, this is I've got a PC, I've got my sister Holdco, at what point should they contemplate on family trust? Jason Pisesky: [00:33:10] So the benefit of the family trust is accruing value into other people's hands. So I'd say for a medical professional, you don't want to start it too early, I guess is the thing. You don't want to, you know, get out of med school in your late 20s or early 30s and then settle it and then your 21 years happens kind of around 50 when maybe you're still practicing. And so probably maybe five, ten years into your career, maybe even 15. Once you're established, you know what field you're working in. You have your clinic or, you know, your kind of day-to-day routines and where your money's coming from. And that's when you, again, you'll have that growing investment pool and you can do more of the setting up the structure in the right spots. And just because yeah, the succession planning piece isn't as much, generally you're not going to have a kid take over your PC. Maybe it'll happen. Not impossible, but not the same way you have, you know, someone who's running the general store, you know, their kid may take over it, or a farm, where again, it's that succession planning piece and then maybe you where a sale is possible, you kind of want it in as early as possible. Jason Pisesky: [00:34:11] So if we have, you know, professionals here who are in a field where they think, hey, I may be able to sell this within 21 years, that's the other concern. So if you're just looking at building it up and trying to get into retirement with it, yeah, a little later in life. If you're in a field where you think I may be selling this corporation, earlier is better. Dentists in particular sell their practices quite a bit. We're seeing it more and more in other medical professions as they start to consolidate debt. People are buying medical PCs and dental PCs. And so if you feel that is a game plan for you, then earlier is better because you can then grow more value into the family trust. Which is the ultimate goal: to shift as much value out of your hands into the trust hands. Dr. Wing Lim: [00:34:59] Wow. Okay. So there's a lot there. So now I'm aware of the time. So one last thing I want to go back to a few times you mentioned this lifetime capital gains exemption, and I know a lot of my colleagues have never heard of this phrase. So can you expound on that a little bit? And how much, what close to a million, like, and how do we take advantage of it? Jason Pisesky: [00:35:17] Sure. So the lifetime capital gains exemption, the idea being parliament created this thing to incentivize people to start and grow businesses in Canada. If you do that, you can sell the shares and if certain conditions are met, you get shelter on the first portion of the capital gains. Currently, it's $971,000. It's indexed to inflation. So it kind of goes up call it 15, $20,000 a year. So it'll be over a million if not next year, the year after. And so that'll save you in the realm of $240,000 in tax for everybody who can claim it. So again, if you're the only shareholder of your company and you sell and there's a $5 million gain, you're going to have, you know, shelter on the first million, call it, and then 4 million subject to full rate capital gains tax of, you know, in the realm of 25%. Depending on your province. Whereas if you have a family, if you have a spouse who's a shareholder, that's great. You got two cracks at it. If you've got a family trust with some kids in it, maybe you've got 3, 4 or 5 cracks at the capital gains deduction. And so the conditions that need to be met for it, there's three. Again, without diving into too much detail, there's the you have to own the corporation for, no unrelated person can own the shares for a 2 year period 24 months before the sale. For the 24 months before the sale, more than 50% of the assets have to be used actively in the business carried on in Canada. And then at the time of sale, it has to be 90% pure. So 50% for the two years before, 90% at time of sale. Jason Pisesky: [00:36:55] And so that's another benefit of either having a side investment corp or a family trust. They can help you take money out of the PC to keep it pure is generally the word used in tax. Purification, removing these surplus extra assets, cash, investment portfolios. Again, if you don't listen to my advice, your cottage and your - what else did I say - your plane, putting them somewhere else so that when time of sale comes, you don't have to do a bunch of extra steps. You're already pure, you know you're good on that 50% test. I have seen people skating very close to the 50% test, and it kind of comes down to what was that investment worth on that date? Okay, we're good. We're good on the 50% test. You don't want that stress. So moving assets somewhere else helps you meet those tests. And then, yeah, you get that big benefit if you get the sale, which again, I think is becoming more and more common. So. Dr. Wing Lim: [00:37:46] Yeah. I think the take-home message is don't, you got to think of this ahead of time. Because I have friends who got caught or partners got caught, they want to retire this year, they have a sale. Somebody, be lucky enough somebody would buy them out, oh they didn't purify the 90/10 rule. Right? And they didn't do the 50/50 rule, T-24 months. Right? They didn't do it. So they kiss that money away, right? That tax exemption. Right? So yeah. Jason Pisesky: [00:38:12] Yeah. No. And again, circling back to that initial point that I said is one of the most key is, again surrounding yourself with people that you trust. And that's kind of the point of this whole group, right, is having that network of people who have your back so you can go do what you're good at to earn money. Because I've also had clients come to me and say, Hey, I've got a, you know, I've got a pharmacy, I've got someone's coming in and offering me, you know, 8 million bucks for my couple of pharmacies. And that's great. I've heard a lot about these family trusts. I've got young kids. Can I put a family trust in? It's like, well, no, it's too late, you have to put the family trust in earlier so value grows in the family trust. And so, like with many of these plans, the, you know, it's sowing seeds. The benefits come earlier sometimes, like the case with the trust there's quite literally nothing we can do. Passage of time, I can't go back in time and put it in place. Some of these, the purifications, there are steps that can be done. It's just more expensive and time-consuming if we're able to do it to kind of get you back on side to meet that 90% test. If you're floating around like 50%, then it's quite a bit of work to get you to 90. So if you're, if you've done a good job and you're at 85%, then boom, nice and easy to get you to 90, you know, one small dividend and you're on side and off you go and you sell and you get your big benefit. Dr. Wing Lim: [00:39:27] Right on. Okay. I think Kevin is bringing the big stick. We can go on for hours. But this... Dr. Kevin Mailo: [00:39:32] So a huge thanks to Jason for being here this evening. You know, every time we have you on, every time we, you know, have you speak to our group, there's just more and more information that shakes out. And we're learning very quickly that pretty much the only thing you cannot do, Jason, is travel back in time. But it seems like you're able to do a whole bunch else. So we're so glad to have you participating with Physician Empowerment because this is what Canadian physicians need. They need long-term tax planning that goes far more than just filling up your RSP. So there is one question, though, that I wanted to bring forward here while we, while we're still recording the episode, and then we'll open it up afterwards to the group because we got a big group tonight. The big one is, the question I've got is, what is the net worth level in which a family trust will make sense? Is there any kind of rule of thumb or general guidance? Jason Pisesky: [00:40:24] No, it is. It is, I think it depends. You've got your two streams of people. You've got your ones who think, hey, I'm going to be able to sell this business, I'm in one of the fields that's getting consolidated or think it's going to be ripe for consolidation or maybe, again, I'm running my own clinic and I've got buildings and these other things that, again, someone's going to want to buy. Then early, early is better as soon as you can kind of viably see like, yeah, I'm on a good trajectory here. Things are established. I've got my necessities looked after. That's when the family trust I think makes sense, when you're, as long as the sale is within 21 years is kind of what you're looking for. Beyond that, if you're looking for more of the kind of family management succession planning tool, again, the goal is to shift as much money into the trust as you can because you can always pull money out of the trust yourself too. Well, it depends which province you're in and yadda yadda. Some of them, the only beneficiary of the trust can be children. Jason Pisesky: [00:41:20] And so again, that needs to be something you're prepared for if you're in a province where the rule is only children, you have to make sure that you've left enough shares in your hand that you'll continue to be able to pull out dividends and accrue value. So unfortunately, no direct rule of thumb, it is how am I going to use this? Who are my beneficiaries? How many kids do I have? Do I have no kids? What are the rules in my province around who's allowed to be in this trust? Can I have companies be our beneficiaries? If you're in a, if you're in a province where corporations are allowed to be shareholders of a PC or of a trust, you're golden. That's awesome. Some of them are extremely restrictive. So I think would just draw a line for you. And if you think you're going to sell within 21 years, you're a great candidate almost no matter what your net worth is. Past that, it's quite a hodgepodge and you kind of have to sit down and really hash out what the next 21 years look like for you. Dr. Kevin Mailo: [00:42:13] Okay. So there's a lot there. There's a reason why you're working full time navigating the tax system and we're very grateful. Thank you for your time. For anybody that's struggling with this, because it felt like drinking from the fire hose for me tonight. By all means, reach out to us because this is what we're doing in the master class. We are breaking down all of these topics and we're starting our next hack series coming up next month. But everything's recorded and you have access to our faculty, you have access to Wing for sort of one on one discussions. So with that being said, I think we're going to wrap it up. Wing, do you have any closing comments? Dr. Wing Lim: [00:42:50] Well, I'm going to say that there's certainly things you should not do with DIY. If you do DIY, you do DYI - you do yourself in. So tax is just one of those. I have people take time off work and do their own books. Like how smart is that, right? You know, but then yeah, so, we're here to empower you, right? It's peer-to-peer empowerment. Empower you to ask smarter questions, to ask your advisors smarter questions, and get smarter advisors for some people. Right? If you have outgrown your advisors and like Jason says, it doesn't hurt to have a second opinion. Right? And so yeah, so little plug is in a couple of weeks time we start a masterclass series. For those of you enrolled, so we'll have faculty members teach this third year of Masterclass. So first year Kevin taught, second year I taught, third year I teach co-teach with the faculty member like Jason, all the other high-level professionals that came and worked with us. Yeah. So and I would love to see all of you at Masterclass if we can. Right? And then we'll break down in different topics and then we'll spend a few months doing that and then we'll do some case studies. Dr. Kevin Mailo: [00:43:55] Awesome. Thank you again. Dr. Kevin Mailo: [00:43:58] Thank you so much for listening to the Physician Empowerment podcast. If you're ready to take those next steps in transforming your practice, finances or personal well-being, then come and join us at PhysEmpowerment.ca - P H Y S Empowerment dot ca - to learn more about how we can help. If today's episode resonated with you, I'd really appreciate it if you would share our podcast with a colleague or friend and head over to Apple Podcasts to give us a five-star rating and review. If you've got feedback, questions or suggestions for future episode topics, we'd love to hear from you. If you want to join us and be interviewed and share some of your story, we'd absolutely love that as well. Please send me an email at KMailo@PhysEmpowerment.ca. Thank you again for listening. Bye.
	30 Sep 2022	01 - The Three Dynamic T's of Success with Dr. Wing Lim	00:28:17
Kevin Mailo, one of the co-founders of Physician Empowerment, talks with fellow co-founder Dr. Wing Lim about wealth mindsets. They explore not just financial health, but personal and practice-oriented wealth habits that lead to greater well-being and sustainable growth. Dr. Wing Lim, founder of Synergy Wellness, references a wakeup call he received from his mentor, Dr. George, in the form of the question “How would you like to make 100% of one person versus 1% of 100 people?”. This led Dr. Lim to what he calls a “brain decompression” that has informed the wealth mindset journey he’s been on ever since. In this episode, Kevin Mailo and Wing Lim discuss a 100 year old concept called The Three Dynamic T's of Success, which they currently host a masterclass on. The three T’s are time, talent, and treasure, and Wing Lim breaks down how each T is key to success. If you can learn to manage time, talent - people, teams, other people’s talent - and treasure/money, you will have tapped into an endless source of wealth from which your success can be fuelled. Dr. Lim shares his personal insights on exactly how the three T’s have made the difference for him. About Dr. Wing Lim Dr. Wing Lim completed his Medical Degree at the University of Alberta in 1991 & Family Medicine Residency in 1993. Later he qualified for the FCFP designation in 2005 & 2019. His practice is focused on preventive health & Geriatric Home Visits, for which he received the Alberta Centennial Medal in 2005. Apart from his clinical & teaching roles, Dr. Lim has extensive experience in Practice Management and Business Development. He co-launched the Sherwood Park Primary Care Network in 2007 (currently 90+ physician members). In 2009, he founded the Synergy Medical Clinic, which grew from 12 to 37 physicians over the following ten years, serving a panel of 50,000+ patients. He also co-developed the Synergy Wellness Centre, a 75,000 sq ft integrated medical-professional destination providing 55+ medical modalities by various specialties & allied health professionals, with over 500,000 patient encounters annually. He is currently co-developing a 165-bed Senior retirement facility with the provision of comprehensive care from independent, active living to secured Dementia care. Dr. Lim is passionate in sharing his extensive knowledge & experience (both clinical & business) with others in various settings, from his clinic mentoring younger colleagues, to churches, senior groups, ethnic functions, radio broadcasts, retreats, seminars and national conferences. Resources discussed in this episode: Synergy Wellness Centre Synergy Medical Plus Confucius quote — Physician Empowerment: website \| facebook \| linkedin Wing Lim, BMSc, MD, CCFP, FCFP: website \| linkedin __ Transcript Kevin Mailo Hi, I'm Dr. Kevin Mailo, and you're listening to the Physician Empowerment Podcast. At Physician Empowerment, we're focused on transforming the lives of Canadian physicians through education and finance, practice transformation, wellness, and leadership. After you've listened to today's episode, I encourage you to visit us at physempowerment.ca - that's P H Y S empowerment.ca - to learn more about the many resources we have to help you make that change in your own life, practice, and personal finances. Now on to today's episode. Kevin Mailo Hi, I'm Kevin Mailo, one of the co-founders of Physician Empowerment. Tonight we're hosting a webinar. It's a beautiful summer evening out there. And I'm not going to keep this too long, because I'm headed off for some water skiing for the first time this year, yeah, so I'm really happy about that. And I'm very happy to have my fellow co-founder here as well, Dr. Wing Lim. And tonight what we're going to be talking about, Wing and I are going to be discussing wealth mindsets. I think this is such an important topic for physicians, because many of us have access to knowledge, many of us have access to credit, we have high incomes to invest, but one of the things that, you know, I found over this journey of educating physicians in finance is that there's a lot of facts, knowledge, and information out there in the world - we can go on the internet and find that very easily - but wisdom and experience are in short supply. And so we try to hit to some of these deeper notes by covering some of these more profound topics. And one of the ones that we want to discuss, and only in brief, because there are entire books written about this, is the notion of wealth mentalities. And I'm interviewing Wing today, because it's really exciting to hear his journey. And if you want, you can go back to one of our founding episodes to hear Wing's entire origin story. But in brief, you know, Wing, you started out as a family doctor in general practice in the early 90s, kind of doing it all - hospital-based, clinic-based, psychotherapy, delivering babies, you did it all. Why don't you tell us just the start, the first question I got for you is just tell us a little bit about your journey. Wing Lim Yeah. So I'm a U of A grad, graduated a long time ago, early 90s. Yes, that was a time when practices were given away because people were leaving the province, there was a guy called Ralph Klein - those who called it the Ralphonomic Days for those who knew about Alberta - and I lost 98% of my classmates to US, so I was the two percent who stayed behind. Anyways, practices were given away, but I was crazy enough to have actually bought a practice with money that haven't got. So it was a solo practice and there is a built in lab. Those days, you can still have a lab in your clinic, believe it or not. And I have an X-Ray clinic next to me, so I'm running like a mini emergency department. I loved it, so bought it, ran it, 100 percent ownership, and my wife gave up her career. And so we built a clinic together at 100 hours per week. So that was the starting point. Kevin Mailo Yeah, so that's a lot. So you're working these long hours, you're struggling to balance tax payments, overhead, your time, you've got a young family, you're in the thick of it. And let's flash forward to where you're at now, you know, as a family physician with a great practice still, but you also are a real estate developer, having originated over $100 million in new developments. And, you know, take us through the couple of the highlights on that journey. And obviously, that's not going to be the whole journey. But take us through some of the points where your mind changed, right. There's something about you along that journey that changed. Wing Lim Yeah, I think point number one is going to the school of hard knocks. You got hit by the upside of the head really fast. At least at my med school at U of A, there was one hour of teaching on health economics that is not about your personal health economics, it was about the hospital budget, provincial budget, bored to death, that kind of stuff. So personal finance budget, how you bill, we didn't even know we have to save money for tax. So that was first smack on the head. And then very soon we got evicted. The landlord took over and doubled our rent, we went to court, lost. So we spend my firstborn child - he's 25 now - so anyway, so we spent the first Christmas at a construction site because we get evicted right around Christmas. So that was another smack on the head. So we're running as hard as we could and then we're stuck and kids were coming. We got three kids within each 18-19 months apart, right? So my wife cannot work as hard. I cannot work as hard. So how are we going to do that when we keep trading time for money, and feel like I'm on a treadmill and running faster and faster like a stress test, the way booze protocol, I'm ready to fall off. So that was a wake up call, rude awakening, and then a critical mentor. They say when the student's ready the teacher shows up. So my mentor, Dr. George - you know, he's still a friend of mine, now he's in his 80s - and Dr. George asked me a critical question that decompressed my mind. And he said that he asked me 'Wing, how would you like to make 100% of one person versus 1% of 100 people?' I said can you repeat the question, George? I'd done very well at 100% of one person at 100 hours per week, and I'm going nowhere, right? Everything I went to school for I was doing, and I thought I should be actualized, I should be happy. But I got stuck. And the just trading time for money thing is not working out. So when he asked 1% of 100 people, that decompressed my brain and that is like an airbag in the car when this deployed. You cannot push it back. So I have been decompressed since I've been thinking about 1% 100 since, and it's a 20-some year journey. Kevin Mailo So again, one of the learnings in your journey as you develop this wealth mentality, and I should share with everybody that when you have been a personal mentor to me in this space, that I was on that hamster wheel over five years ago when we met - six years ago, now, when we met - trading time for money, exhausted, working long hours, and asking myself, 'Where am I really headed in life?'. And, you know, I was a bold dreamer, you know, and that's partly why I founded Physician Empowerment, but struggling with the concrete, the ingredients that I needed to get where I was going. So you talk about taking 1% from people, but that sounds like team building to me. Tell me about a little bit of the team building journey that you've gone on, because you started out in solo practice, now you're part of a large group practice, that's practice transformation. We teach that in our small groups, but just give us a little bit of a teaser as to what that means for you. Wing Lim Solo practice means you do everything by yourself. If you got to do it, do it yourself, right? So we always have that mentality that we do it ourselves. And that's got to change, right? Everyone learns to leverage, learn to exceed yourself, that you got to decompress and learn how to work with other people. So then I worked at create a multidisciplinary clinic, we ended with six physicians, and then I was ready to give up my practice, I was so burned out with the provincial health care, yada, yada. And then I went to a conference, came out, I dug my residency dream, I said 'I want to build a wellness Wellness Center', and fast forward about 10 years, 11 years ago we build this giant clinic, 75,000 square foot Wellness Center at the clinic. My family medicine clinic as the anchor tenant. So right now I have 30-some colleagues. It is one of the largest clinics in the province and we do a panel size about 50-60,000 patients, which is half of the county. And the building serves about 2000 clients a day, like with all the paramedical and medical services. Kevin Mailo Yeah. Because you have a whole bunch of specialists there, as well as, you know, pharmacists, chiropractic, physio, all of that. Wing Lim Yeah, exactly. Yeah. Kevin Mailo Yeah. So very comprehensive. So this is living a dream for you. Wing Lim It is living a dream. Yes. And it's not just my dream, people embrace it. Now it's a lot of people's dream come true. Lots of people's dream practice come true. Kevin Mailo It's a shared dream. Yeah. And I remember you talking about how important it's been for you to ensure that every physician within your group feels cared for and valued, right? That the strength of the clinic depends on the well-being of every individual physician. Wing Lim Correct. Yeah, exactly. You would only win if everybody wins, right? That's the big win. And that's one of the transformation of the thinking. Right? Kevin Mailo Let me just segue into what that is. That's a wealth mentality. That's the idea that the more generous we are with the people in our lives, with our communities, in terms of our time, our expertise, and even our money, the more that comes back to us, right? Because people want to join with someone who radiates that, and so it's that prosperity mentality, right? Like, because we're in a group practice doesn't mean that we're taking from one another here, that we're reducing one another's billings or increasing one another's overhead, that we can actually come together, and in more practical terms, boost revenue, and reduce relative overhead, in addition to delivering better practice, or better medicine in our practices, and delivering better care for our communities. And I'll just put a little plug there because Synergy Medical sees both. I work in the hospital as an ER doctor, you know, a few blocks away from Synergy, and it sees 10 times more patients per day than my entire hospital. You know, so it really speaks to what you've built, Wing. Wing Lim Well thank you. And part of the learning is to learn to think outside of the box. I think we went to school to be the best we could be professionally. Since pre-med days, we study for ourselves, we get a good GPA, get a good MCAT score, get in, and then you learn and you always for yourself is just one off, right? But when you go into the real world, you got to drop that thinking and do team play. In fact, I came across a concept that is 100 years old. And in a masterclass we're actually diving into this, and this is called The Three Dynamic T's. The Three Dynamic T's of Success. So in the real world to have professional success, it's not just your GPA or how smart you are, how special you are, it's about three dynamic T's and the first T is time, the second T is talent, and the third T is treasure. So when you manage these three T's, then you and your team will be unstoppable. So a masterclass is going to go through a lot of this in depth thing, so we invite everybody to check us out on masterclass which is a 12 month program. You start the one on time. So if you can manage time, manage talents - which is people and teams, other people's talents - and you can manage treasure - which is money - then you would truly be successful. In fact even when you work for fee for service, calculation model, or a fixed budget, or you work for public health, each enterprise, whether it's public or private, to be successful, these three dynamic t's need to be worked on. Kevin Mailo Yeah. And this really speaks to another core physician empowerment concept called 'you is the most important investment'. And really what that is, is the idea that, you know, your practice, your financial stability, your personal well-being, depends on constantly investing in yourself as an individual, right? That it is not about just endless personal sacrifice, but that we are, you know, focusing on our well-being in terms of, you know, sleep, exercise, eating right, and maintaining healthy relationships. And this is something that, you know, we pay a lot of lip service to within the profession, but be mindful that as fee-for-service earners, the vast majority of us, or at least al of us trade time for money in our clinical work, the importance of being able to stay in this not as a sprint, but as a marathon. And so time is a key component to that. And even being able to outsource, being able to trust professionals in our financial and practice lives, so that we are focusing on the most important tasks, I have found to be personally transformative along that journey. When you talk about that T. Do you want to talk about talent as it relates to delegation and outsourcing, Wing, because I think that's another important topic. And if I can be blunt - and, you know, we try to be straight here on Physician Empowerment - let me be blunt, many physicians struggle with micromanaging. I certainly have done it over the years, right? So we have this mentality of, well, if I want it done, I gotta do it myself. And I'm gonna do it properly. And that means it's going to be me. And let me be the first to say, that is exactly what I want out of my surgeon. If somebody is cutting me open, I want to make sure that my bowels are getting sewn up extremely meticulously, right. And same goes with, you know, when I'm caring for critically ill patients and these sorts of things. But as we zoom the lens out a little bit, and look at how our clinics function, how our hospitals function, how our financial lives function in terms of, you know, whether it's real estate, or investing in the markets, that micromanaging can really trip us up. And it's not only in terms of not reaching our financial goals, or our practice goals, but even in terms of our well-being. That there is a limit to how much any one person can micromanage before they start to really hit the wall and become exhausted. So tell me a little bit about that, then, Wing. Talk to me about that second T, talent, as it relates to delegation and outsourcing. Wing Lim The micromanagement, I think, it's our trademark. If you looked up the dictionary, you see our pictures in there. And the micromanagement thing, other than just being super focused on success, and no error, no mistake, we are a very mistake-adverse culture because if we make mistakes people die, people suffer, and we lose our license, potentially, we get complaints, blah, blah, blah. So we're very mistake-oriented culture, so we don't trust people. But it's a micromanagement issue. It's an issue, like you need to see a therapist, right, and it's a mistrust. The lack of ability to trust others. And I think the many more years we stay in tertiary care, the more we do that. So the first thing is to undo some thinking deep down, you give yourself permissions, right, I've learned a long time ago, if you give yourself some permissions, you can actually learn to decompress and learn and grow. And first thing was, I'm not the smartest guy, right? And I think as a family physician, as a primary care provider, it's easy for me to do because I always refer. But even specialists, they specialized and when people would always refer out they would say, 'this is not my field', right? So I'm not, I don't need to be the smartest guy, I'm not the smartest guy. So there are lots of talents out there. There's an ancient Chinese saying, "Three people walking, two of them are my teachers". Okay, this is actually a saying from Confucius. And he's not confused. Right? And so that is social, we can learn from everyone, every member on the team. So thinking change number one for talent, is 'I'm not it', right? I need other people that grows, if I'm not the smartest one, I need other people that grows to the next phase, which is called interdependence, right? We've become from dependence to independence, and then now interdependence. And I think that is a breakthrough. It's easier said than done, but we got to lean on it. And healthcare is morphing, man. Right? If you look at how we do things in hospital, we have robotic arms now, I mean, the people from third world with a surgeon here working with a surgeon there, right? Like, we're changing. We've been expected to work with a paramedical professionals, you know their MPs writing orders right next to you. Kevin Mailo Our MPs at the hospital are phenomenal. Phenomenal. I feel very privileged to be working with our MPs, because I feel like they helped create one of the best emergency departments in the country. And again, that was a process of learning to work, you know, in an interdisciplinary mindset, and learning to let go a little bit. And it's been just great. Wing Lim Yeah, exactly. And once you respect people for what they are contributing, even down to the most, quote, junior person.... I think we have this elitism that's another one we need to fight against. These are cocooning off the shelf, one of which, that leads to pride and arrogance, honestly, is that elitism, right? Like I'm holier than thou and smarter than thou, I belong to the smartest group, I think the sooner we break away from that, and we say, hey, we need each other, the sooner you respect the talent. And the talent is in things that you might not think is important clinically, but it's very, very important. And one example was there was a study going around with complication rates in ICU. They found that the ICU, the highest performing ICUs across the country with the lowest complication rate, come from one single parameter, how easy it is for the lowest ranking person with these knowledge, how easy it is for that person to say, 'Hey, I think we got a problem'. And the ICU group that had even the janitor or anybody, right, supportive staff, will say, 'Hey, I think we got a problem'. If the team listens to that angle, they have the best safety and the least amount of complication. Kevin Mailo You have that parallel in the airline industry, where everyone is empowered to speak up and errors, when they are caught, are actually celebrated. And I think that's very powerful. So let's just shift a little bit here, staying on this second T talent. Talk to us about our financial lives, like another one that I see physicians do, I mean, I see physicians not wanting to pay an accountant, they do their own accounting. I see physicians who do their own bookkeeping, which is just, I feel like, overwhelming for me. I see physicians trying to manage their portfolios, talk to us about that, right? Because I see the whole spread. And it's not just about making gains financially, and managing that other T treasury. But it's about, like, our well-being. I mean, for myself personally, working, you know, a 10 hour shift in the emerg, coming home and trying to stare at my books, trying to pick stocks, feels absolutely overwhelming. And I'm certain I would screw that up a whole bunch. And then the couple of times that I've tried it, I have screwed up massively and learned my lesson. So I outsource, right, I have professionals that manage real estate for me, bookkeeping, accounting, and my equities. So talk to us about that in our financial lives, that micromanaging, because I think that's another big one. Wing Lim So the T that's talent in the personal finance and corporate finance world is even more pertinent, because you cannot do it all. Right, so the DIY mentality, it goes right back to the mentality that I made, I'm the smartest one I can't trust anyone. Right? And if you want to be that special, you are guaranteed to be small. The S is not Superman, it's like you are super small. So you got to trust me when, if you become a specialist and okay I DIY and do all those do stocks or do crypto, good for you, it becomes a habit, a hobby, good for you. And we're not knocking anybody. But it's a team sport, right? We went to school to play solitaire, but then when we graduate, this is a team sport, right? And so you need to learn how to do a team. And so in finance, more importantly, it's a team sport. You need team members, each with their strength. They don't have to be perfect, right? You have the accountant, you have the lawyer, you have a bean counter, you have a guy who... it's just like Dorothy going to see the Wizard of Oz. She's got all these characters that each have their defects, one has no courage, one has no heart, one has no brain, right? And so these actually, I have been taught, that puts it into all your consultants. Kevin Mailo To come back to your point, when this bit on an element of humility, I'll just share one personal story that actually came from today. And you helped me with this. I have a property that I can't sell, I can't rent, and so I'm putting it on AirBNB and I've hired a company to do that. I outsourced. And it's eye-watering, they need a $45,000 check to get the house ready, you know, to stage it, to furnish it, everything. And, you know, I'm so tempted to just like move funds from my PC, pay myself that $45,000, and then write the check off to this company. And I paused and I phoned my accountant. I rarely rarely have any answers in this space, I only have questions. But I'm thankfully very fortunate in that I'm ready to ask questions, even the so called dumb ones, and I just go ahead and ask him, I said, 'Is that smart?' Or should I be loaning money from my PC, or should I be using a line of credit? And he said based on, you know, the nature of the purchases and the property and everything else, line of credit. Wow, wow, right? Huge saving 1000s of dollars right there, huge pressure off me, I'm so happy I did that, maybe, you know, 100 bucks for that phone call, worth every penny of it, right? And so that's a growth for me, right? That's, you know, learning to be humble enough to ask questions. Understanding that I don't have the answers. And we actually do this in practice. When I'm in the emergency department, I feel like I'm in over my head, I pick up the phone and call a consultant. You know, we've got a patient in front of us in clinic, we refer on to a consultant. I mean, you mentioned that earlier, Wing, but it's important to think about that in terms of our financial lives as well, which I think is so powerful. So that was, like, actually today, off went the check. Wing Lim You shared and you demonstrated that you actually picked a team member that is valuable. Right? So, but if you didn't pick the right team member, you won't have got that answer. So part of this talent thing is you become a talent agent. Right? People ask me, 'How do you do such big projects?' I said, 'Oh, it's easy. I chum around people who are smarter than me.' Right? If your why is big enough, the house will come to you. I'm not good at engineering at all, right? One day I found myself in a room with 18 engineers around me and 2 architects building this big senior project that is today worth $52 million that we just launched last year, right? So here's the brightest engineering minds in the city, and they're circling around me asking me questions. Well, I chum around with people who are way smarter than me. So when you put the right team together, so it's a talent show where you hunt for the talent, and you hunt for the right talent for the right thing. And then you're going to win, you're going to win because you got the best team, you got the A Team. I'm dating myself with The A Team, Mr. T. Kevin Mailo Yeah, but it's true. And, you know, like, certainly this AirBNB thing that I'm doing, it is not cheap. I am paying a lot upfront, and I'm paying a lot for management fees, but I am so much happier. Number one, I know it's going to work far better than if I did it myself. And number two, more importantly, I am happier. Because I do not want to be going and trying to turn over a space and micromanage cleaners and everything else, right? It's about our personal well-being along this financial journey that is not simply about getting to a certain number, a certain net worth, a certain cash flow. It's really about building a financial plan that works in our personal lives. That works with our practice lives. I think that's so important. So important. Wing Lim Exactly. The other example is, tying the three T's together, is if you DIY everything yourself, you're gonna miss some advice, and tax is single handedly the biggest expense in our life. And if you don't get the right tax advice or, worse, get the wrong advice, you could be wasting a lot of money. I spent the time, sought out a smart guy in insurance and in tax, and I went home and ran it by my team and I saved about $350,000 in tax based on that one piece of advice. Kevin Mailo Yeah, that is exactly it. And you know what, we have seen that on our Physician Empowerment conferences, people come up and they go, 'Oh, my goodness, I wish I knew this 20 years ago'. And it's never too late. Right? Like that's the most amazing thing about anything in life - any stage, anything in life, is that nothing is ever too late. So if you have those kinds of questions, start asking them, start going to people, start building that team, begin now. It can be so powerfully transformative. And I have missed out on far more deals than I had been part of. And that's okay, because guess what, Warren Buffett didn't buy Walmart, didn't buy Amazon, and he's doing just fine, right? So it is never too late to be okay. And better than okay, it is never too late to thrive in our financial lives and in our practice lives. Tomorrow is always a new day. Wing Lim So more important than the actual talent that we thought we need to possess, is to ask the question why? And ask the right questions. What questions are we supposed to ask? Now interestingly, the word knowledge, which is a Greek word, but in Chinese the word knowledge is actually two characters: learn, ask. So knowledge in Chinese thinking is 'learn to ask questions'. So that the more knowledge you got, that means that the more questions you learn to ask, you just ask smarter questions. So what we hope to empower people at Physician Empowerment, it's a peer to peer empowerment process, is to empower you to ask better questions to your own team. How do we assemble the right team, keep asking questions, and in doing that you have an enlightened path. Right? And then you can reach your own goal, which is different than mine or yours, right? Kevin Mailo I love that. I absolutely love that, Wing. So I think we're going to actually start winding it down. We don't want to make these too heavy. We don't make these too long. And I'll just share a little bit of my own wellness with those that might be a little bit late joining, is that I'm about to go waterskiing, and it's a beautiful summer night, and I'm not going to miss that. Anyhow, being out on the lake, on the boat, it's going to be great. So we are going to wind it down here. I've really, really, really loved this. I'm always inspired when we talk like this, because it's these bigger questions, right? It's learning to take risk. It's learning to ask the big questions, why. It's learning to be humble enough to reach out to people in our practice lives, in our financial lives, that are going to help us soar. That it doesn't have to be a one person show. So we have quite a few people who've joined us in the webinar. And I'll just put it out there briefly for anyone that wants to ask questions, go ahead and type them into the chat. But otherwise, I'm also just happy to wind it down. Because this was great. And this is only a start of what we're going to be covering in this area because there's so much... you know what, when I reflect on practice success or financial success, it's about grit. And this is some of the process of building grit, just that inner toughness, that inner resiliency to keep going when you feel like giving up. And so I'd invite anyone who's interested, just reach out to us, go on the website or sign up for emails, but like we are super accessible, you reach out to us over email, phone. And if you want to know more about our masterclass or conferences, we're always happy to talk about them. But at any rate, I think I'm gonna wrap it up there. And I really want to thank everyone for joining tonight. And Wing, I really want to thank you, again, for just sharing so much wisdom. Wing Lim Well, thank you. It's always fun and we hope to see more of everyone. Thanks. Kevin Mailo Thank you so much for listening to the Physician Empowerment Podcast. If you're ready to take those next steps in transforming your practice, finances, or personal well being, then come and join us at physempowerment.ca - P H Y S empowerment.ca - to learn more about how we can help. If today's episode resonated with you, I'd really appreciate it if you would share our podcast with a colleague or friend and head over to Apple podcasts to give us a five star rating and review. If you've got feedback, questions, or suggestions for future episode topics, we'd love to hear from you. If you want to join us and be interviewed and share some of your story, we'd absolutely love that as well. Please send me an email at KMailo@physempowerment.ca. Thank you again for listening. Bye.
	15 Aug 2023	25 - You Are More Than an Empty Vessel with Dr. Kevin Mailo	00:27:28
Dr. Wing Lim interviews Physician Empowerment co-founder and frequent co-host Dr. Kevin Mailo on the subject of burnout. Kevin addresses how the language we use for recovering from burnout makes us sound like a drained battery and reminds us we are not simply vessels that are either full or empty. He discusses building daily wellness and resiliency. Dr. Mailo resists the language that makes us sound like fuel tanks and instead shares his vision of each of us being a great oak tree that can withstand storms, drought, and pesticides without breaking. That is the image he uses when he teaches wellness: the notion of us as growing living beings, needing daily nourishment, not just a refuel when we are empty. In this episode, Dr. Wing Lim and Dr. Kevin Mailo talk about the very real stresses of physician’s careers and how frequent burnout truly is. They address the need to be honest about our needs, about needing time off, or cutting back on hours. Kevin reveals the three selves that need to be nourished in balance: the personal, professional, and financial selves. He has some ideas on how to both do more to achieve constant growth and self-care, and also how to do less in order to rest. This episode is vital for understanding the importance of cultivating resiliency and healthy boundaries. About Dr. Kevin Mailo: Kevin is an emergency physician based out of Edmonton, Alberta. He is known for his highly engaging teaching style that breaks down complex topics into memorable experiences. Kevin cares deeply about the long-term wellness of the medical profession and wants to see physicians and their families succeed personally and financially. Resources Discussed in this Episode: “YOU as the most important investment” mini-course by Dr. Kevin Mailo — Contact Information: Physician Empowerment: website \| facebook \| linkedin __ Transcript Dr. Kevin Mailo: [00:00:01] Hi, I'm Dr. Kevin Mailo, one of the co-hosts of the Physician Empowerment podcast. At Physician Empowerment, we're dedicated to improving the lives of Canadian physicians personally, professionally, and financially. If you're loving what you're listening to, let us know. We always want to hear your feedback. Connect with us. If you want to go further, we've got outstanding programming both in-person and online. So look us up. But regardless, we hope you really enjoy this episode. Dr. Wing Lim: [00:00:34] Okay. Welcome everyone, to our episode of Physician Empowerment. I am Dr. Wing Lim. I'm a family physician, one of the co-founders of Physician Empowerment, and we're really glad to interview my partner and co-founder, Dr. Kevin Mailo, emerged out of Sherwood Park as well. And today we're going to talk about a topic that he presented in Mexico. This is back in 2021, 22. We brought in the New Year at that time, Kevin, right? So we had a lot of fun. And this topic that you presented was very well received and there was a lot of echoing from the depth of people's souls. So we'd like to bring this up. And the topic is you're more than an empty vessel. So Kevin, tell us why you had that name as a topic. Dr. Kevin Mailo: [00:01:19] So if you want to get down to sort of what we're going to be covering in brief today, this is not by any means the comprehensive discussion that I had during our time in Mexico. Thankfully, we're not going to spend that much time. But it's the notion of burnout. Right? And one of the first things that I came to realize in the current model of physician wellness, and occupational wellness in general, is this idea of burnout being that you are some kind of empty vessel, right? Like how many times do we hear that imagery kicked around in wellness circles of you are some kind of fuel tank that runs out of fuel or you are a battery that runs out of power. And somehow in the current model, when we get close to empty, we're supposed to do something dramatic or not so dramatic to refuel the tank to get better. Dr. Wing Lim: [00:02:18] Of course, that was not just our phone, even our car. It's got to be plugged in overnight. A zoom, two, three, four, five, six hours later, you're good as new. Dr. Kevin Mailo: [00:02:25] Exactly, right? But like, we're people. We're not electric cars. I'm not a Tesla. Okay? And frankly, that model is exhausted because when we think about the length of our careers, it has to be better than a pendulum or a yo-yo where you oscillate between being okay, you know, relatively full and empty. So that's why I titled the talk 'You are more than an empty vessel'. And so this is a Physician Empowerment concept in the notion of personal growth and resiliency. And in my opinion, it's a far more optimistic model of looking at physician wellness because burnout is only half the discussion. Yes. Is it a very real fact of life? You bet it is. We work extremely stressful jobs. We have one of the most stressful jobs in society. We deal with people's lives. And more than that, we make decisions that are, frankly, life and death. And it doesn't matter what kind of specialty you're in. As a psychiatrist, you're constantly assessing your patients for risk of self-harm or suicidality. As a pathologist, how good are the margins on that sample you looked at? As a radiologist, is it a benign nodule or is it cancer that needs to be followed up aggressively with a repeat CT. Right? So we're constantly faced with this and we're very highly trained. So we don't necessarily consciously have an awareness of this. But the burnout is a very, very real fact. Dr. Kevin Mailo: [00:03:50] And the other thing that I came across is the CMA data. And if you have not looked at this data, I would strongly encourage you to look at this data. It was published in 2017, 2018, somewhere around there. And I know the post-pandemic data is even worse. But to summarize in very broad strokes, I'm not going to get into the numbers or the figures, is that at any given point, six out of ten physicians are experiencing some kind of burnout. And at any given point, three out of ten of us are screening positive for depression. So, and that doesn't mean that we're not performing well in our jobs. It doesn't mean that we aren't great doctors, but it means that we're barely treading water. For many of us, we are just surviving in our careers and our personal lives. And frankly, life has to be better than that. We need to be thriving. And that's really my mission. One of the reasons why I started Physician Empowerment is to see physicians truly thriving, truly happy in their lives, happy in their careers, healthy, doing the things we should be doing to be our best selves. Dr. Wing Lim: [00:04:57] So let's yes, let me just have a point of reflection. Right? So I think we know, I've been around 30 years, so we went from hush-hush with ten feet tall, bulletproof. Nobody's stupid. Nobody's weak. Everybody's Superman. Right? There's no Kryptonite, right? Everybody's strong. To a point that now we realize that, oh, gosh, people are burning out, but we still hiding. Right? But then suddenly I've heard some colleagues, the department now have these forcible sessions of wellness. Dr. Kevin Mailo: [00:05:25] Oh, forced wellness modules. Dr. Wing Lim: [00:05:27] Yeah. Forced modules. Suddenly you're supposed to be well, now. Okay. Dr. Kevin Mailo: [00:05:31] You're supposed to be well, you did a module, Wing, and the organization got to check the box. Dr. Wing Lim: [00:05:37] So how do you manufacture wellness? Dr. Kevin Mailo: [00:05:41] Yeah. So let's agree that, you know, you're probably not a battery. I'm not a battery. I'm not a fuel tank. You're not a fuel tank. Um, the image that I have, and this is actually the image that I teach with, so I had one slide in Mexico when I taught this. There was only one slide. And that was a picture of a big, beautiful tree standing on a hilltop with the sun. And that, you know, when you think about a plant, it's a living thing like us. And you don't wait until the plant withers and begins to shrivel before you water it, sun it or weed it. But at the same time, the plant itself has an intrinsic resilience, an intrinsic drive to grow and to become stronger. To reach greater heights. And that's the way I look at it when we talk about ourselves and our lives personally, professionally and financially. So when it comes to wellness, I have this vision of a tree, a great big oak or something along the lines of that, a tree that withstands droughts, hail, attempts to cut it down, pesticides, storms, lightning and the tree lives for hundreds of years and encounters those things. And it does not break. It continues to grow. And that's the vision that I try to have for myself as I go through the ups and downs of life and career. Where despite whatever struggles I face, I continually invest in myself, continually grow. And that's really how I've been teaching it for a few years now. This notion that we are growing living beings, very three dimensional, that we need to nourish ourselves every day, physically, emotionally, and spiritually. The other thing that I would challenge you on, and again, I brought this forward to our attendees in Mexico, challenge you on if you were your own patient, what would you say to yourself? You'd probably say work less, sleep more, strengthen your personal relationships, strengthen your relationship with yourself. Set boundaries. You would do all of those things, or at least you would tell your patient to do all of those things. Dr. Wing Lim: [00:08:00] Isn't that ironic? It is ironic, right? We tell people this and there's a very high degree of hypocrisy about ourselves. Dr. Kevin Mailo: [00:08:08] Yeah. Dr. Wing Lim: [00:08:09] Right? Do we exercise enough when you go to these pharmaceutically sponsored meals, people just gorge themselves, but then, you know, they prescribe it. Do they actually exercise and eat well? Right? Dr. Kevin Mailo: [00:08:21] And it's not about being a model of perfection because that itself can actually be a source of burnout. Right? I am not saying, you know, we all have to be, you know, exemplary. I'm hardly that when you watch me hit the McDonald's drive-through. If I'm having a busy day with the kids or whatever and work, right? There has to be lots of room for self-forgiveness. There has to be lots of room for, you know, being the humans that we are, not robots but imperfect beings. But we should be striving not to be someone else, but to be the best version of ourselves, right? And so again, it comes back to that challenge of if you were your own patient, what would you be telling you to do? And we rarely take time to reflect on that. So I want to, you know, share two sides of the coin here. Number one is the notion that there's burnout and that's the negative aspect of high-stress jobs like health care. And then there's resiliency, which is the beauty, you know, within. Right? It's our ability to overcome. It's our ability to grow despite challenges and setbacks. And so let's explore burnout first, very briefly. And again, this isn't going to be a definitive exploration. This, actually we do have this full talk on the website, so we'll show you how to, how to link to it, or if you have questions, just reach out to me because I think it's worth, I really think it's worth watching. Honestly. It's one of my best. It's one of the things I'm most proud of in this journey. Dr. Kevin Mailo: [00:09:57] But number one is burnout. These so-called lows, they can be prevented. They're not all preventable. But over the course of a 30-year career, maybe you have fewer of them. And maybe the lows aren't so low, right? So maybe the lows don't have to be as low as they get. Again, when you consider this kind of yo-yo back and forth between, you know, struggle and success is one of the first things they want to highlight. Okay. And I've got a few strategies that I'll go over, but only very briefly, because again, we don't have a lot of time for that. Okay. Dr. Wing Lim: [00:10:35] Okay. Sure. Dr. Kevin Mailo: [00:10:36] So again, it starts with self-care and the notion that suffering in our professional and personal and financial lives is inevitable. You know, it's like saying I'm going to be a diagnostician, so I'm going to be a physician, you know, who works on the front lines and primary care, internal medicine, emerge, whatever, you're going to have a certain miss rate. Or being a surgeon and saying, well, I'm never going to have surgical complications. Of course you are going to have surgical complications. This is an inevitability, right? So accepting some of those inevitabilities in our practice lives can be very powerful because when they arise, we can put them in context. And rather than flogging ourselves, we can look at them as a point of deep reflection and improvement in our practices. And I'm not just talking about technical improvement, but saying what is the context? How much was I working? How much call was I doing that week? Whatever it is-- Dr. Wing Lim: [00:11:31] Can we just stop right there, please? Because I think this is huge, right? So we don't even allow ourselves to park there because a) is there's a lot of shame. Dr. Kevin Mailo: [00:11:41] Yes. Dr. Wing Lim: [00:11:42] And b) there is a lot of consequence. Right? So there will be a lot of cover-up and denial. And actually people ended up with malpractice complaints and lawsuits are the ones that either a) denied or b) over embracing and apologize when it's not their fault. Right? Because we are our own worst enemies, right? Dr. Kevin Mailo: [00:11:59] Oh, without question. Without question, Wing. And that can become a kind of a, you know, a negative, self-feeding cycle where we get down on ourselves and it begins to rock our confidence. And so it's really important that we address that. And there's lots of formal supports and informal supports. There's lots of reading that can be done around it. But even spending time with, you know, in counselling or some other formal support like that can be extremely, extremely powerful. But just recognizing the inevitability of complications and setbacks in our career can be a very powerful source of resiliency for us because we're not alone. We're not the first and we're not the worst, to borrow the words of one of my mentors, when we go through our struggles. The other thing that I try to highlight is that there are three selves, and this is another Physician Empowerment concept. And one day I'll go on a big deep exploration on the podcast or something like that. But there's a personal self, a professional self - so the MD - and there's a financial self, and those all have to be in harmony. Right? And they all affect one another differently. So if you are struggling in your personal life immensely, it will inevitably at some point bubble up in your professional life. Likewise, if you have financial struggles, they will at some point impact you professionally or personally. Right? So these things are all tied to one another. But resiliency. Resiliency is about having margin. So resiliency is when the system is putting pressure on us and the work environment becomes too stressful, having the ability to set boundaries and step back and work fewer hours when we need to, is a huge source of personal professional renewal. Right? And the way we do that is by having that constant awareness of self in our professional lives going, Wow, you know what? Call has been really busy on the wards these days, and I think I'm getting a little tapped out. Maybe I should be working less. Dr. Wing Lim: [00:14:07] Yeah, that's a really good patch there, Kevin. So let's dwell a little bit on it. Number one in response to that, a) we're taught and we bred and we're still expected to be so professional that we don't let anything come through, right? And when we do, we fail, right? But, you're right, the personal and financial side does affect the professional side. So. And then when you say, okay, let's just cut back some calls. Well, I think you and I lived through it, the shame, the guilt, the hate that we get from our colleagues, you know? Dr. Kevin Mailo: [00:14:43] But in my opinion, that's not a marker of weakness. That's a marker of strength. Strength says I'm aware of my limitations. Strength says I'm powerful enough to be vulnerable with my colleagues and say I need to work less. And financial strength says I can afford to do it. Right? But again, we struggle with that culture in medicine of like being the quiet warrior and you just go in, no matter how much it negatively impacts your personal health or your relationships, and just work more and more. But resiliency in our personal lives also affects our professional life, right? So when we have lots of, you know, margin in terms of sleep, exercise, diet, you know, healthy relationships with people that build us up and support us, healthy time for self where we're not consumed with work, those things, again, can be an enormous strength of resiliency and an enormous strength of happiness in our lives that let us keep going and go back to that stressful ward where we're struggling with high volumes and patients laying in stretchers in the hallway, which, let's be honest, we're increasingly facing. Dr. Kevin Mailo: [00:16:01] The other thing that I want to talk about, and this underpins wellness both personally and professionally, is money. Financial resiliency. A lot of people, you know, will ask, you know, why at Physician Empowerment do you guys talk about money or teach financial literacy like you do? I'm not here as an educator in finance to help, if I can be blunt, to help doctors buy nicer cars, homes, boats, vacation properties or whatever. That's not my goal. That's not my dream at all. And I'll be very blunt about it. The power of financial security and why I teach it is that it allows us to step back from the stresses of the profession when we need to. Right? That we're not worried about paying the bills. That we have a, that we work in an efficient practice where if we need to take a week off for a personal or family matter or a health issue, that we can do it. And we're not worried. We're not dragging ourselves in. So we're doing better medicine when we are financially secure. Dr. Wing Lim: [00:17:08] Or, may I add too, the guts to stand up and speak against authorities that could affect your livelihood. Dr. Kevin Mailo: [00:17:14] Exactly. So one of my mentors who spoke up very boldly at a lot of meetings, one time I sort of walked up to him and said, like, how do you do that? And he goes, I have money. I don't care. They can fire me. And I thought that was very powerful. Like, if you want to change the system, you need to be able to do it from a place of personal, but also financial strength. So you're not worried about any retributive behavior. The other other side to this is, you know, when we talk about financial resiliency is, you know, being able to do those wellness things that matter. Right? Like so when your wellness module is online, take you to you should do more yoga and meditate and exercise and go on a nice vacation. Well, all of that costs money, whether it's a direct expenditure, or whether you're giving up clinic time to do it. So again, when I teach this to residents - and I do a lot of teaching to residents about money, not through Physician Empowerment, but as, you know, an academic doctor that I am - I say that money is not the cake, but it's one of the ingredients. And so, you know, again, financial resiliency is so key. It's about financial security. It's about peace of mind. It's about when things are getting rough in the hospital or you start having physical ailments or there's a loved one that needs you, you can cut back on your clinical hours without worrying about money, because in those situations, that's the last thing you should be worrying about. Dr. Wing Lim: [00:18:44] Well, let's face it, wellness has a price tag, right? A colleague of mine just had a minor surgery, and they said that, well, I can't afford not to come back within two weeks. Right? So just saying. It's so real. It's so real. Dr. Kevin Mailo: [00:18:58] It is so real. We all face it. And it's not necessarily that it's going to go away, but we can do a lot to make it better. And so let me talk about resiliency more practically. And then we're going to wrap up here because I know this is already going on and I can keep going on and on. So resiliency, when I think about it, this constant investment, growing the tree of our lives, is a daily activity. That it's something we set out daily to do. It should be consciously and mindfully undertaken and shared with those closest with us, like so our colleagues, our spouse or our partner, even our children. Setting a positive example. Resiliency should go across the three selves - personal, professional, and financial - and it should occur regardless of our mood. So the people that are, you know, training, let's say for a marathon, that person gets out there and runs, whether it's a good day or a bad day, whether they feel like it or not, good weather or bad weather, they're out there training. Okay. And resiliency can be big things like saying, okay, you know what, I've got a very powerful goal to be retired within ten years and I'm going to take the steps to get there. Or it can be something small, which is like, I'm going to go for a walk every single day. Right? And, you know, resiliency needs to be built into our dreams, our aspirations, and our goals, and not just our own personal individual dreams, but the shared ones with our spouse, family, or even our colleagues. Dr. Kevin Mailo: [00:20:28] Okay. So let me just go with a brief overview of what we call quick wins and what we call long-term strategies. So when it comes to like quick, easy things you can do to feel better and to be more resilient rather than running out of the tank, try just some of these sorts of things. So the first category I have on quick wins is doing less. Actually let me go with doing more. I like doing more better to start with because doing less is funnier. So doing more. Spend a day laying in bed and sleeping. Watch a favorite movie. Go and exercise. Walk or go for a drive. Have a wonderful meal, like cook one, you know, go buy the ingredients, go real slow, take your time. Have some comfort food. Phone a mentor or a friend that you can confide in. Hug your spouse or partner, tell them how much you love them. Hug your kids or your pets, tell them how much you love them. Spend time with the people who aren't medical. Like get out of the health care space, you know, and hang out with non-medical friends or family, people in your, you know, religious or cultural community if you're affiliated with one. And again, those are just examples. I don't want to be prescriptive here. That's the whole point of this is not to give you a bunch of modules or a checklist, right? But to do, you know, but to share just some ideas of what you can do to invest in yourself on a day-to-day basis. Dr. Kevin Mailo: [00:22:04] So when it comes to quick wins, though, there's actually a lot in the doing less space. And this is where I kind of have a little more fun with these. So draw up a clinic day. We already alluded to that. If you are feeling burnt out, then start cutting back, right? It's not only better for you, it is better for your patients, it is better for the system in the long term. Our patients deserve to have happy, healthy, resilient doctors who are taking their own advice. Here's another good one. Turn off the notifications on your phone. Or better yet, put it away for the day and just unplug. Don't check your email or your EMR. Stop. Set some boundaries. Don't go and spend more money that you don't have. Buying more consumer items that you know deep down are not going to make you happy. Right? Like, truthfully, and again, that's not why we started Physician Empowerment when we started talking about financial education. And then here's my favorite, skip another useless meeting. Honestly, do that for yourself. Do that for yourself. Another big one that I rely on is practicing gratitude, really trying to sit down and be thankful for what I have in my life and not just focusing on the problems. Dr. Kevin Mailo: [00:23:25] Obviously, we can't be avoidant towards problems or try to distract ourselves. You know, we have to face our problems because that's the only way that life gets better. But at the same time that we face them, keep looking ahead at the beautiful things in our lives and remind ourselves of what's really important. And then in the long run, it's about like having very clear, personal, professional, and financial goals that you are working towards every day because those things keep you on your path. They help you set your priorities. More importantly, they help you set boundaries. They help you say no when you need to say no. Because there are system-level issues that are never going away. Health care is inherently stressful and it will only get more stressful and more complex. So you as one person in this giant, giant machine, need to care for yourself. Okay. And so I regularly check-in. I regularly write my dreams down. I regularly write down my goals. And I'll talk in another episode about the difference between dreams and goals. I think maybe last Zoom meeting we had, Wing, I was accidentally screen-sharing my dream panel. I had them written down. Maybe you didn't see it all, which is probably just fine. Um, but I've got a, it's probably my biggest note on my computer. Dr. Wing Lim: [00:24:50] There's a name for that. It's called the power page. Dr. Kevin Mailo: [00:24:52] Yeah. Ooh, I like that. Ooh, I like that a lot. Dr. Wing Lim: [00:24:55] Yeah. The power page. Dr. Kevin Mailo: [00:24:56] Okay. So again, at a future point, I'm going to talk about dreams. And I really want you to hold on to that concept because that's something that's very near and dear to me. And I really, really love talking about it because it's so important. So with that being said, I think we're going to wrap up and, again, check us out on the website. And if this resonated with you and you want to talk further, hear some of the things that I've done over the years to become more resilient. I'd love to connect. I am so, so passionate about this, so just reach out to us over email or you can text me. Thanks so much. Dr. Wing Lim: [00:25:31] Yeah, thanks Kevin, for sharing. And yes, to recap, everybody knows about burnout. Everybody talks about it. Everybody knows seven out of ten of us and maybe us was just denying it. And we look around, nobody is owning it up and saying, I'm the one that burned out. Right? So this is a very toxic environment. And as you know, in Alberta and any other places, the working environment is getting so stressful post-pandemic. Well, we're not even post-pandemic yet. And then we cannot just manufacture wellness just based on a few wellness modules. And it's not something to plug a USB in the brain and then you download a wellness app and you're better, right? This is a lot of hands-on stuff and I hope we just creating an awareness and we're ready to walk through with our colleagues, east to west coast, right? Dr. Kevin Mailo: [00:26:19] Absolutely. Absolutely. Dr. Wing Lim: [00:26:20] Wonderful. Good. Well, so thank you, everyone, for joining us today, and we'll look forward to seeing you at the next event. Check our website. All right. Dr. Kevin Mailo: [00:26:29] Thank you so much for listening to the Physician Empowerment podcast. If you're ready to take those next steps in transforming your practice, finances, or personal well-being, then come and join us at PhysEmpowerment.ca - P H Y S Empowerment dot ca - to learn more about how we can help. If today's episode resonated with you, I'd really appreciate it if you would share our podcast with a colleague or friend. And head over to Apple Podcasts to give us a five-star rating and review. If you've got feedback, questions, or suggestions for future episode topics, we'd love to hear from you. If you want to join us and be interviewed and share some of your story, we'd absolutely love that as well. Please send me an email at KMailo@PhysEmpowerment.ca. Thank you again for listening. Bye.
	30 Nov 2022	08 - Human Centered Design and Tools for Change with Marlies van Dijk	00:33:43
Dr. Kevin Mailo welcomes Marlies van Dijk, founder of Alberta Health Services Design Lab and Lead of The Pivot Group, to the podcast to talk about human centered design and how to truly innovate for change in health care. Marlies felt a restlessness in her nursing career that became the realization that she couldn’t influence the change she wanted in the places she was working. She moved jobs a lot, constantly innovating, and then came up on human centered design thinking and started the Alberta Health Services Design Lab. Marlies truly desires innovation that affects change in real ways. In this episode, Dr. Kevin Mailo and guest Marlies van Dijk discuss what the three box solution to effective innovation looks like, why true change must prepare to bump up against organizational inertia, and how Marlies balances delivering results in her day job while pushing for new change on the side. She addresses how to safeguard time, why not joining committees that are the same old bureaucratic process is better for her, and shares very practical ways to communicate with immediacy between the members of your team. About Marlies van Dijk: Marlies van Dijk currently leads The Pivot Group. Marlies is a registered nurse and has worked as an innovator and change agent in the health and care system. Her most recent experience was as founder and leader of the Alberta Health Services Design Lab. She led this to design new service models across all corners of the health care system. Prior to that she worked in British Columbia to improve care across 25 hospitals in 7 health authorities. She has worked with many national healthcare organizations to improve health care and services. Her passion is co-design as a way of working and hopes to apply her skills to the creation of a world class eating disorder treatment facility with clinicians, patients, community, and government. She loves the outdoors and feels most alive when she is on her bike (yes, she is Dutch too!) — Physician Empowerment: website \| facebook \| linkedin Marlies van Dijk, RN and Lead of The Pivot Group: the pivot group \| the design lab \| linkedin Transcript: Dr. Kevin Mailo: [00:00:00] Hi, I'm Dr. Kevin Mailo and you're listening to the Physician Empowerment Podcast. At Physician Empowerment, we're focused on transforming the lives of Canadian physicians through education in finance, practice transformation, wellness, and leadership. After you've listened to today's episode, I encourage you to visit us at PhysEmpowerment.ca - that's P H Y S empowerment dot ca - to learn more about the many resources we have to help you make that change in your own life, practice, and personal finances. Now on to today's episode. Dr. Kevin Mailo: [00:00:34] Hi, I'm Dr. Kevin Mailo, one of the co hosts of the Physician Empowerment Podcast, and today I'm very excited to introduce to you Marlies van Dijk. And Marlies is... you know, Marlies, before I talk about you a little bit, I'm going to say it's a little hard to kind of describe what you do because you do so much and you've had such an incredible career and you've built so much. But Marlies is the founder of Alberta Health Services Design Lab, which is kind of an in-house console consultancy for the Alberta Health Services health care system, essentially for Alberta to help on leadership and direction. But then, as Marlies has grown as a leader in health care, she's now stepped out and formed the Pivot Group, which is nationwide. Super exciting. And every time I talk to Marlies, I'm learning something, I'm inspired, and I am so, so glad Marlies, to have you here today. So can I get you to just start with a little bit about yourself and your journey and how you got here? Marlies van Dijk: [00:01:39] Yeah, for sure. Thanks for having me. So I started out in nursing and I realized very quickly that I was a cog in a wheel and that I could not influence the change that I wanted to make. And I started working in the nonprofit sector, working grassroots with marginalized communities. And I absolutely loved it. But I quickly felt that I wasn't growing there either. So I went back to the health system and I started leading large scale change initiatives with national organizations, things like, say, for health care now, etc.. And then I went to British Columbia for a while. So I change, you know, quote/unquote, jobs every five or six years. I'm not one of those lifers, which I'm very proud of. Dr. Kevin Mailo: [00:02:24] I am inspired by the way. Inspired by the way. Keep going. Marlies van Dijk: [00:02:29] Yeah. No, no pension is going to hold me down for life. There's no way. Dr. Kevin Mailo: [00:02:32] Good. I love it. Marlies van Dijk: [00:02:34] And I ended up in British Columbia working with surgeons across the entire province in 25 hospitals. And once I was finished that I came to Alberta and I was given a job because I was creative and I was like, What creative? I kind of know I'm creative, but not like in the traditional sense, like compared to really creative people, I'm pretty straight. But in the health care environment, I think I do stand out a bit that way. So I came to Alberta Health Services and I thought, Well, what am I going to do here? And then I realized there was a gap in the market inside the organization. There was a lot of improving best practice or implementing best practice, closing the gaps. But innovation was, per se, was no methodology for innovating. They talked about it, like I mean, thousands of people have the word innovation in their title, but actually doing it and how do you do it? So I stumbled upon a human centered design, design thinking, and I studied labs across the world and I said, Yeah, this is what we need to do. We need to create a design lab. So yeah, go ahead Kevin. Dr. Kevin Mailo: [00:03:45] Tell us what human centered design is. Because, you know, the first place I kind of go is patient centered, But we realize that we're ignoring another part of that equation, which is health care providers and frontline staff. So tell us what human centered design means within our health care systems and talk to us at everything from the clinic level in private practice all the way up to large subnational health care organizations. Marlies van Dijk: [00:04:12] Yeah, I can give you some examples that makes it more tangible. Human centered design is essentially a methodology that's pretty high level that looks at collaboratively making decisions about a product or service that would meet the need of the user. And usually it's out of the box. It is something that hasn't been thought about. We use a lot of analogies from other industries to gain inspiration, but the method is really that walks you through testing, building prototypes, and creating something that which you can feel fast with. So that's human centered design. Examples of, for example, I just came from Vancouver and we led a two day skunkworks project and we called it Hacking Wounds - the year before, Hacking Pain - where we essentially take 75 to 100 people, clinicians, diverse teams who tackle a problem from a different angle and try to come up with unique solutions and test them right then and there. You know, failing in health care is difficult to do because of the stakes, but we also put way too much time into our work six months, 18 months before we actually test it with our users or patients. And so failing is not an option because we've put this much money and time into things, like it's cost us. Dr. Kevin Mailo: [00:05:36] The cycle is so long. Marlies van Dijk: [00:05:39] It's so long. Yeah. Dr. Kevin Mailo: [00:05:40] When I think about starting my companies, it's like, Oh, try something. And if it doesn't work, try something else. But that happens very quickly and at low cost, right? Because as you said, the stakes are high in health care because we deal with patient care. Marlies van Dijk: [00:05:54] Yeah. And I think human centered design is a method that that is a - well, it's well known to be the innovation method - but we haven't created a lot of space for people to work in that way, in part because we're all about evidence based practice, return on investment, you know, show me the impact. Dr. Kevin Mailo: [00:06:12] Productivity, output, volume, measurable. Quantifiable. Marlies van Dijk: [00:06:17] Yeah. Dr. Kevin Mailo: [00:06:19] Values. Marlies van Dijk: [00:06:21] Exactly. And I mean, if you look at the three box solution, which I'm a big fan of, which tells you that future customer base is future models or delivering service, you have weak signals telling you something might be doable, but you're not 100% sure. Like, you know, virtual care. Before COVID, we were like trying to ignore it at all costs, right? The US had embraced it long before us, but now we're actually finding that, oh wow, we can actually provide the care virtually in many circumstances. But why did we not look at that sooner? We know it's more cost effective. People don't have to travel. But it's, in essence, we haven't cultivated the space for us to innovate because it's a different skill set than implementing, you know, evidence based practice where you know, what needs to be done. You have a list, right? It's proven and future work and delivery models are not proven yet. Dr. Kevin Mailo: [00:07:21] And talk to us about the three box approach just in brief. I mean, I just love new ideas out there and get people to look at the world differently. Not in any great depth. Tell us, give us an overview. Marlies van Dijk: [00:07:34] So three box solution, which I'm in love with, is incredibly simple. So if you Google it, you'll find some great videos. The author talks about we have box one, that's day to day operations. It's what, you know how to operate a hospital. You know how to deliver services at scale. You know your business. We're very good at that. Box two is what is it that you can let go of to create the space to actually look at new service models and new potential future customers? So that's the letting go of phase. You know how we have trouble letting go of things? Everyone does. So you actually have to take some time to figure out what you can scrap so you can create space. And that third box is really about - and he says it should be between 10 to 20% of any organization - should have dedicated resources and people that look at weak signals. There is no recipe, there is no proven methods for how we're going to move forward, because most of our problems are very complex, right? We're not dealing with just taking out an appendix for most of our health issues. We're talking about chronic disease management, delivering care to rural communities. Those are complex problems that it all depends on the local resources to know how you're going to navigate that. So that's a quick summary of the three box solution. Dr. Kevin Mailo: [00:08:56] I love that. And let's shift gears a little bit. And one of the things, so Physician Empowerment, we host a lot of educational events. We've got monthly small groups with a small group of physicians where we tackle aspects of practice or health care or finance. We also have our national conferences and other events like that. And, you know, whether it's in the formal discussions or a hallway conversation, you know, somebody next to the coffee urn is talking about the culture of large organizations. And specifically what I'm getting at is the struggle to overcome organizational inertia. Right. Like an object at rest wants to stay at rest. And so, you know, and it's a source of burnout. It is because I've heard many physicians, especially kind of mid-career, you know, 10 to 20 years in where they came into the profession, they came into health care - and this applies across the board, it's not specific to physicians - they've come in with a certain energy, a certain zeal, a desire to go beyond patient care, to build better systems, to improve delivery, and being people centered is part of it. And they come up against organizational inertia. And I've heard this from doctors coast to coast. I hear it from American physicians as well. And so what does a physician in that position do when she or he is in a leadership role and they're trying to say, okay, how do we break past this organizational resistance to change? Even thinking about new ideas, it's not, you know, it's not even a case of like getting to change and taking steps and trying something new. It's like even having the discussion of could we do things differently? It's like we're going to shut that down. Marlies van Dijk: [00:10:54] Yeah, well, I've lived it my whole life up until very recently. I've survived in the health authorities across Canada until now, and I decided to leave on my own fruition, believe it or not. But a couple of things. And I of course, I'm super passionate about this, but the first thing to know is you need to find some others who are like you, which sounds easy, but it's not, right? You need to find some fellow, and I call them rebels. I know for some people that might be too much, but you need some people who are innately dissatisfied with the status quo. But they are hopeful because if you're dissatisfied with the status quo and you are miserable and don't see any hope, then you know that's not fun to work with. So you need people who have not given up the spirit. I also have learned over time that you have to avoid the formal structure of a health organization. You have to do it on the edge. This is not something that's going to be in an operational plan. This is not going to be approved by the CEO with the multi year implementation plan. Real change happens on the edge where you start small with a group of people and see if it has some legs before you start talking about it. And that is hard to get your head around in the way that you feel like you're manipulating the system, which is exactly what you're trying to do. You also need to really embrace the fact that you're not going to be super popular. I knew from day one that people thought I was a loose cannon, wildcat, tornado. You know. Dr. Kevin Mailo: [00:12:34] All compliments, by the way, as far as I'm concerned. All compliments. I love it. Just keep rolling them off. Marlies van Dijk: [00:12:39] I remember talking to a leader and I said, hey, I want to do this. And she said, Walk to the elevator. She goes, Marlies, two suggestions for you. Watch your back, first of all. And second, you need to learn how to walk before you fly. She opens the elevator, steps in, and goes up. And, you know, I stood there and I said, No way in hell am I not going to fly. So you have to really believe in yourself in the sense that you can, that you're not going to back down to keep the job, to keep the pay. Although I have to say, I have really focused and I've told you this earlier, people said, how come you haven't gotten fired? Like, how is this possible? Dr. Kevin Mailo: [00:13:19] Love that. Love you. Marlies van Dijk: [00:13:20] And it's an interesting question. I, I think I really, the reason I've survived is I'm quite a doer. I'm action oriented, so I deliver. So I've always made sure that I'm focusing on something that people know, Oh, Marlies does that. Oh, she delivered that. Yet on the side, I do my innovative stuff and I change stuff. So I make sure that I'm not just all about innovation and trying new things. I actually have a day job. And on the side is where you try these new things. And then the very last thing that is really worth mentioning is accepting this fact that people might not like you, they might think you're likable, like I think people think I'm friendly and they can laugh with me, but they know it's, you know, they're not quite sure what to make of me. Dr. Kevin Mailo: [00:14:09] It's coming. Marlies van Dijk: [00:14:10] Right. They're like, Oh, God, what's she going to say? Yeah, but managing the discomfort and being really, like, comfortable with getting the answer no. Like, I didn't care. Like, I would get ten no's, I didn't care. I'm like, Yeah, okay, I knew that was coming. All right, go around this person. Go talk to so-and-so. I'm going to manipulate so-and-so and I'm going to talk to so-and-so. And I was continually navigating. Dr. Kevin Mailo: [00:14:35] It's a hustle, It's a hustle. I love it. It's a hustle. Marlies van Dijk: [00:14:41] Right. It's a huge hustle. And some people aren't hustlers. I am a natural hustler, like I am an extrovert. Dr. Kevin Mailo: [00:14:50] I am totally a hustler. Love it. Yeah. You and I are very much on the same wavelength. Marlies van Dijk: [00:14:56] Yeah. Dr. Kevin Mailo: [00:14:56] Yeah. Marlies van Dijk: [00:14:58] And so, I mean, I think I also knew that I would get down, like there was times where I was completely deflated, demoralized, burnt out. But I took those those times to recharge and to forgive myself for not succeeding and to lay low for a little while. And then I knew my energy would always come back. And it did again and again. So I just was sort of watching my cadences. And I also knew with my supervisors, because I did have them, believe it or not, that I would need to make them happy too, and make them look good. And I, I focus on that quite a bit. But then, you know, I would time my jabs or time my challenges so that I wasn't burning out my supervisors with me as a nutbar employee. But actually, you know, she's delivering. Oh, and it's worth listening to her at times when the message isn't what they wanted to hear. Dr. Kevin Mailo: [00:15:55] I love that. And I think it's also important, as we're trying to invoke change, is to focus on core values. Right? Like this is about making things better for patients and frontline staff. I feel like that's always a centering, that's always a great centering point. It's like, listen, I know we're disagreeing here and I know you didn't want to hear it, but I'm just trying to tell you that this, from my perspective, is a step forward in patient care or a step forward in caring for our burnt out frontline staff. Marlies van Dijk: [00:16:30] Right. And just even to build on that, doing a 'Yes and', is people quickly realized I wasn't a climber. They knew, once they realized that I was not there to try to climb the the bureaucracy which is what most people are into, let's just be honest. Dr. Kevin Mailo: [00:16:46] I'm not. But yes I get that. Marlies van Dijk: [00:16:53] Yeah. Yeah. Yeah, exactly. So once people realized I wasn't in that game, that's a whole other game, you know, that's a Game of thrones. Like, you know that, like it's like, it's cutthroat, killer. I wasn't part of that. So, for example, if I did a project and I wasn't acknowledged or I wasn't thanked, I didn't care and I honestly didn't care. Dr. Kevin Mailo: [00:17:18] You know what, though? Clearly you're making waves because here you are on the podcast, right? Right. But I mean that, I mean that, right? Because actions speak louder than the words of an email or some little placard or whatever have you. Marlies van Dijk: [00:17:33] Well, and I think too, I started to realize you could influence without being high up in the hierarchy, even more influential potentially. And they talk about the 3% influences 80% of the organization. You can be an influencer without that position. And so I when I first came to Alberta Health Services, I started tweeting, and I was like, Why is no one talking outside of the formal email process? And that was fairly new in 2015 and comms just talking about we can do better. And health care suffers from X, Y, Z. I have been told by the communications team that I walk the line just right, just a fine line. I say enough about generally speaking and health care. I don't point fingers. But I learned how to be critical yet hopeful and not pointing fingers. So just that wasn't a role navigator. And so my voice mostly came to me through social media. I didn't wait for a committee meeting or something, you know. Dr. Kevin Mailo: [00:18:42] Oh, exactly. Right? And I think the other thing is, is focusing on actions, not individuals when we're directing criticism. Right? Or focusing on the process, not on the individuals that set it up or run it, because that gets very emotional when we personalize like that. And there really isn't any role for that. Do you know what I mean? Like. Marlies van Dijk: [00:19:03] No. Absolutely. Dr. Kevin Mailo: [00:19:04] I don't think it moves anywhere when we start getting into finger pointing. Marlies van Dijk: [00:19:09] Exactly. And I also think, to build on that, is I was invited to many committees and I actually have a rule that I don't join committees on a regular basis, like I'm not a member. Dr. Kevin Mailo: [00:19:22] You'll come in, you'll speak. Marlies van Dijk: [00:19:23] A committee land for me is like, no, no. But I got invited to an innovation committee and I was like, Oh geez, I'm innovation. I guess that makes a lot of sense. And oh, there's a there's some VP's there. Oh my God, VP's this is Whoa. I went to the first meeting and I realized this is nothing about innovation. This is just another bureaucratic process of committee meetings. And I knew that the end game, there was nothing there. I could sense it. And so I actually resigned from the committee after the first meeting. I wrote a nice note. I apologized, but I'm -- Dr. Kevin Mailo: [00:19:59] Yeah, powerful. You know, you're your most important resource. Marlies van Dijk: [00:20:02] Yes. My time is really important. Dr. Kevin Mailo: [00:20:03] Where are you gonna spend your time? Marlies van Dijk: [00:20:04] Yeah, yeah. Dr. Kevin Mailo: [00:20:06] I love it. I mean, it's wisdom for all of us in health care. We're the rate limiting step. If I'm busy translating the Bible into Klingon, I'm probably not doing something else more important. Marlies van Dijk: [00:20:20] Yeah, it's easy to get sucked into the way things, the way they design change. And I, somebody in the hallway saw me shortly after that, and they said, How did you get out of that committee? I want to do that too, but I can't. And I said, well-- Dr. Kevin Mailo: [00:20:36] You run a course on that. Marlies van Dijk: [00:20:38] -- why can't you? Like, let's get real here. It's all a figment of our imagination. What's happening there? Like, it's just fluff. And I just made really careful calls on that without, you know, offending anyone. Dr. Kevin Mailo: [00:20:52] I just say I think I'm more effective not being on the committee. Right. Like, politely declining. I like that. Marlies van Dijk: [00:20:59] Yeah. And call me, call me when you need me. I'm here. Dr. Kevin Mailo: [00:21:02] So talk to us about practical ways to communicate. And let me just send my big gripe. I hate email. I think it's a giant step backwards in human communication. Like I feel like spoken language, written language, the printing press, really great developments in human evolution. Email was like a step back because how do you address a complex issue going back and forth over an email string with like five other people on it? Right? So for those of you that email me personally, you'll find that I have on my signature line a little thing that says, I never check this, I'm real hard to get a hold of. And so I'm old fashioned. I want to pick up the phone or go meet with somebody because if it's something complex, it's probably best addressed that way. But that's just one example, and that's my own personal perspective on it. I mean, in the end, yes, emails have to go back and forth and in the end there has to be some kind of formal written summary of what was said, what was decided at meetings or whatnot. But in the end, I think we're just so much more effective when we communicate verbally or face to face. Marlies van Dijk: [00:22:08] Right. Dr. Kevin Mailo: [00:22:08] So talk to us about some very practical approaches. I mean, we covered some of them, but I want to hear more because this is, these are the things that that courageous health care leader listening to this podcast who wants to do more, wants to get out there, wants to begin hustling to improve their health care system, but what does she or he need to really hear on the how? You know. What do they need for tools? Marlies van Dijk: [00:22:31] Well, I always, you know, made it my mission to get, to have a relationship with the highest person in the organization. And you can imagine that wasn't going to happen through email. So I would use Twitter or LinkedIn. So DM people directly. And ultimately texting is of course, my love. But I, you know, my teammates at Pivot, we communicate through Discord. You're probably wondering why, we just picked Discord because some people are on it. And actually I love it. It's instant. But of course I'm not in a health organization. But when we were in a health organization we used, of course, Slack, and methods to communicate quicker about logistics. Like you don't want to email logistics. That's just painful. Right? But I did have one of my teammates say, You know what? I got a text from you, I got a tweet, I got a... Dr. Kevin Mailo: [00:23:26] There we go. Marlies van Dijk: [00:23:27] And I was like, Yeah, this is yeah, I am a little bit intense at times. Answer me, no. So I think just also what I've learned is just having fun with your teammates like at the design lab, we were like family, like it was crazy. We fought like cats and dogs and and still loved each other. So being able to create a relationship in your team where you actually really like each other and appreciate each other for who you are allows you to work much faster because you can say, Oh my God, I'm sorry, but this PowerPoint needs some help. People don't want to give negative feedback very easily. And we talked about radical candor on my team and we would have to detox people when they joined the lab because they were, the bureaucratic detox, right. Like, and the first time someone, you need to be able to challenge the boss. If you're not challenging the boss and your team, you do not have a psychologically safe team and your products are probably crap. Because no one wants to say, Hmm, I want to-- Dr. Kevin Mailo: [00:24:34] -- throw this one in the trash. Let's start over. Marlies van Dijk: [00:24:36] Yeah, Yeah. And so I have, I think people, I've been told have never worked for someone who gives this kind of feedback, like, ever. And I'm like, Wow. Like, do we just go along and say, good job? Good job, employees, you're awesome. And yet the work is shit and you know it. So intervening early to create that iterative feedback about what about this and what about this and how can we make this better? I think it's a culture of where you can, everyone can improve the products you produce because I've seen in formal systems people can work for eight months on something and it's not good, but it's too late to comment because you've spent that much time. Dr. Kevin Mailo: [00:25:19] Yeah. It's like a rocket that's never going to launch. I'm never going to launch properly. Marlies van Dijk: [00:25:25] Right. And I think the Gantt chart and the project management planning for complex problems is an absolute joke. It's like it's a human system. You think you're going to map out for six months what you're going to do? Like what planet are you from? Like, that's never going to happen. So I have a joke on my team, like if a leader is really into Gantt charts and project management, go to Google. There's tons of templates. I want you to spend half hour on a Gantt chart, make it look good with colors. They love red, blue and yellow for some reason. Do a dashboard, put it in front of their faces and they'll come right down, like they see order. They see a plan. Because that's what we're trained, we're trained to think, you know, and good business etiquette is a plan. And so, I mean, I'm sounding horribly manipulative, but that's how we kind of work. We feed the the top, you know, a really canned project management plan. And then underneath you work more in an agile way where you're not living to that Gantt chart because you know you're going to get information within two weeks that's going to throw your whole plan into the garbage. So we play the game. You have to play the game on the outside and have another game on the side. Dr. Kevin Mailo: [00:26:41] Love it. Now, here's one more one that I'm going to put you. And I think we can just keep going because I absolutely love this. Absolutely love it because I'm passionate about seeing health care done better. You know what I mean? Marlies van Dijk: [00:26:54] No, I get it. Yeah. Dr. Kevin Mailo: [00:26:56] Let me be blunt. Let me let me follow your path. When we talk about closing down beds because we don't have adequate staff, that's kind of like the airliner that you're about to board, that you're boarding, it's about to go for a transatlantic flight, and they're like, oh, by the way, three out of four engines are working and we're down a few crew members, but we're pretty confident we're going to get through our transatlantic flight, you know? So I'm passionate about seeing things done better. And yet the issue is that I feel like health care is always in crisis. I mean, you know, there's no margin within the system. And I hear this coast to coast from Canadian physicians who are like, yeah, I want to do change, but as a leader, I'm putting out fires all the time, right? As an organization, we're putting out fires all the time. Marlies van Dijk: [00:27:47] We're designed. Yeah, we're designed to not be in the news. That's what we're, that's how we operate. How can we not have a headline that makes us look bad? Dr. Kevin Mailo: [00:27:56] Yeah. So how do you get past that? That crisis in front of us a week, a month ahead from now, and really make space mentally, emotionally and in our calendars for real change? Do you have any ideas? Marlies van Dijk: [00:28:14] Yeah, it's a really tough one. If you are a full time clinician, it's going to be hard to carve out space because the mountain of work and the mountain of people is just growing of who needs to see you. So maybe going back to that three box solution, finding out what you can let go of and actually creating time and space to be, to bring bring people together to look at different ways of skinning this cat. We're holding on to old models, right? Old models of delivering service. It's clear we cannot ensure that every Canadian has a family physician. I know that might be like a gas for some people listening, but with chronic disease rise the age, the cost of the system-- Dr. Kevin Mailo: [00:28:59] Oh if you've seen what I've seen in the ten years that I've been in practice or so, I say, Wow, it really, really changes. I mean, sorry, I'm just going to interrupt because-- Marlies van Dijk: [00:29:08] Yeah, yeah. Dr. Kevin Mailo: [00:29:09] Like you get a young person, like in the emergency department where I work, you know, a young person, 25 years old, has a fall. I mean, you may, they may dust themselves off and you may examine them, they may not require an x ray. Right? And yet, if that same person was an 85 year old on a blood thinner that has a fall, like they're getting a lot done in the emergency room. Yeah, a lot of time there. And then they're getting admitted. Right? And so, you are absolutely right when you talk about like, how are we going to, how are we going to service an aging population with a growing list of chronic diseases? Marlies van Dijk: [00:29:46] Yeah, it's going to like, you know, I'm from Europe myself. I grew up there and I go there a lot. And, you know, when we're spending 85% in the last year of life, we need to start asking ourselves is, is that what we should be doing? And what about, what could we not potentially do and how do we navigate that? Why are people dying in the ICU? I've heard numbers up to 84, 85% of non reversible deaths are happening in the ICU of acute care facility. And it's like, that's $4 / $5,000 a day when it was not reversible. We know these things, right? So, I mean, there's, this is a huge conversation, but... Dr. Kevin Mailo: [00:30:28] These are big conversations. But it starts by having the conversation for change. Marlies van Dijk: [00:30:35] And to challenge people. But I think in the end, making sure that you don't burn out is number one. Tackling something that you can make your project that you get some satisfaction from because you say to me, oh, you've done so many great things and I feel like I've barely done anything. Like I'm hard on myself. And most innovators and entrepreneurs and change agents are. They're like this is pathetic. What have I done? And that is the part about being a change agent. Like, I remember seeing one of my VP's in the cafeteria one day and I was talking to him and I was like, on fire. I was in a great mood and all of a sudden he goes, Wow, are you not happy in your job? And I said, What? What are you talking about? And then I realized, Oh, no, this is, I'm wired this way. I'm dissatisfied with the status quo, but I'm willing to tackle it. But he wasn't used to it, like he he thought, you know, he was surprised that I sounded the way I did. So that is, that is definitely a criteria for being a change agent, that you're not happy. Dr. Kevin Mailo: [00:31:47] I love it. I absolutely love it. Marlies, I want to just keep going. But I know we have to wrap this up, which just means we'll have to get you on again to talk about these issues because there is such a hunger out there with physicians who, you know, physicians and other health care providers who are passionate about what they do and the system they work in. And they want change. They want tools. And you often feel alone in this, but you realize you're not. And the wisdom that I'm going to, I'm going to take away is, find those allies, find those people that are like minded as yourself, and begin to connect with them and see what you can do to start the conversation. Marlies van Dijk: [00:32:28] Yeah. Find your wolfpack. Dr. Kevin Mailo: [00:32:30] Yeah, I love that. Love it. So again, Marlies, I really want to thank you. And for those of you that are interested, again, it's The Pivot Group that Marlies founded, which is her national consultancy, and it's really incredible. Marlies van Dijk: [00:32:44] Thanks for having me, Kevin. Dr. Kevin Mailo: [00:32:45] Thank you so much. Marlies van Dijk: [00:32:46] Bye. Dr. Kevin Mailo: [00:32:47] Thank you so much for listening to the Physician Empowerment Podcast. If you're ready to take those next steps in transforming your practice, finances, or personal wellbeing, then come and join us at PhysEmpowerment.ca - P H Y S Empowerment dot ca - to learn more about how we can help. If today's episode resonated with you, I'd really appreciate it if you would share our podcast with a colleague or friend and head over to Apple Podcasts to give us a five star rating and review. If you've got feedback, questions or suggestions for future episode topics, we'd love to hear from you. If you want to join us and be interviewed and share some of your story, we'd absolutely love that as well. Please send me an email at KMailo at PhysEmpowerment dot ca. Thank you again for listening. Bye.
	30 Sep 2024	52 - Real Change in Our Healthcare System with Jayna Amadasun, MD, LLM	00:43:53
In this episode, Dr. Kevin Mailo and Jayna Amadasun, an M.D. and ethical strategist, confront one of the most pressing issues in healthcare today: the burnout epidemic among our frontline professionals and why systemic change is no longer optional. They discuss the ethical and systemic issues that have led to a strained healthcare system, where overworked doctors and nurses struggle to provide optimal patient care. The episode highlights the importance of addressing the healthcare workers’ environment to improve outcomes for both professionals and patients. Key topics include the lack of resources, the need for policy reform, and how burnout impacts the quality of care. This conversation is a must-listen for anyone concerned about the future of healthcare in Canada and beyond. Jayna also discusses how healthcare systems can become more sustainable by focusing on the well-being of frontline staff. By addressing burnout, healthcare providers can improve patient outcomes, foster a healthier work environment, and prevent the silent withdrawal of professionals who feel disengaged. Dr. Milo and Jayna provide practical insights into how healthcare leaders can begin making changes to support their teams. About Jayna Amadasun Jayna Amadasun is a dynamic ethical strategist and consultant who coaches Black medical professionals. With an M.D. from the Dominican Republic, Jayna brings a wealth of experience, having worked as an R.N. in the Bahamas and trained in the U.S. healthcare system. She holds a Master’s in Law and Medical Ethics from the University of Edinburgh and is committed to creating equitable healthcare environments. Her unique perspective, shaped by years in emergency and flight medicine, allows her to address the complex issues facing healthcare systems today. -- Physician Empowerment: Attend an upcoming Empowerment Retreat Join the Physician Empowerment Masterclass now Website: PhysEmpowerment.ca Jayna Amadasun Website: Ember Impact Global LinkedIn: Jayna Amadasun Instagram: EmberImpact Calendly: Jayna Amadasun
	15 Feb 2023	13 - The Finance Industry for Physicians with Dr. Yatin Chadha	00:33:35
Dr. Kevin Mailo welcomes physician and beyond MD podcast host Dr. Yatin Chadha to Physician Empowerment to talk about finance for physicians. Yatin Chada’s podcast is well-known and he has interviewed a wide and notable range of physicians and finance industry professionals since beyond MD launched in 2020. Kevin Mailo shares the news that Yatin Chadha’s podcast reached the Top 50 of finance podcasts on the Apple Canadian Business podcast. He asks Yatin about some of his more memorable episodes and Yatin shares several, including one with Kevin himself, and other episodes featuring Jamie Golombek and Joe Bakish. He highlights what he learned from each of them. In this episode, Kevin Mailo and guest Yatin Chadha discuss the finance industry through the lens of topics Yatin has explored with his podcast guests. They talk about how to build financial security, real estate as a great investment, diversifying portfolios, generating passive income, and dividend stocks. Kevin and Yatin break down what is important for physicians to consider when pondering their financial futures. About Dr. Yatin Chadha Dr. Yatin Chadha, MD is a Diagnostic Radiology Specialist in San Diego, CA and has over 13 years of experience in the medical field. He graduated from UNIVERSITY OF BRITISH COLUMBIA / FACULTY OF EDUCATION in 2010. Dr. Chadha launched the beyond MD podcast in 2020, which focuses on financial literacy. The content is provided by subject experts, but is steered by him to ensure relevance to healthcare professionals in Canada. There is a frequent focus on professional corporations. He believes that stress related to personal finance can lead to physician burnout. Dr. Chadha’s mission is to change this. He has learned a lot along the way and wants others to be more prepared than he was. His aim is to help other healthcare professionals navigate personal finance such that this area becomes enjoyable, rewarding, and eventually automatic such that physicians are able to dedicate more time to the things that matter most to them. Resources Discussed in this Episode: Save the Date for May 6-7, 2023 in Toronto Dr. Yatin Chadha on LinkedIn “beyond MD” podcast “Real Estate Investing - a Physician’s perspective” beyond MD episode with Kevin Mailo “RRSPs for incorporated small business owners with Tim Cestnick” beyond MD episode “Holding Companies with Ali Spinner” beyond MD episode “Corporate investments - optimization and taxation with Jamie Golombek” beyond MD episode “Alternative Investments with Joe Bakish” beyond MD episode — Physician Empowerment: website \| facebook \| linkedin __ Transcript Kevin Mailo: [00:00:00] Hi, I'm Dr. Kevin Mailo and you're listening to the Physician Empowerment Podcast. At Physician Empowerment, we're focused on transforming the lives of Canadian physicians through education in finance, practice transformation, wellness and leadership. After you've listened to today's episode, I encourage you to visit us at PhysEmpowerment.ca, that's PHYS empowerment.ca, to learn more about the many resources we have to help you make that change in your own life, practice and personal finances. Now on to today's episode. Kevin Mailo: [00:00:35] Hi, everyone. It's Kevin Mailo here, one of the co-hosts of the Physician Empowerment Podcast. And today I am joined by the one and only truly amazing Dr. Yatin Chadha. And for those of you that haven't heard Yatin speak or listen to his podcast, you can find him online at the Beyond MD podcast. And it's truly amazing. And Yatin, you had a big milestone. I'm going to talk about you for a couple of minutes and then I'll let you talk about yourself. But let me do some bragging for you. But you broke the top, you broke the top 50 finance podcast. That's not medical podcasts. You broke the top 50. And was it...? Yatin Chadha: [00:01:12] You know, yeah, it was the, I think it was the Apple Canadian Business podcast. But Kevin, I can tell you what, you're so kind to mention that, but it gave me, it gave me newfound respect, though, for the people who just continue at this and are actually able to stay there. Because I tell you what, I do rely a lot of my guests for the content. Now I am producing a few more solo episodes, but it is really hard once you get there, it's really hard to stay there. Kevin Mailo: [00:01:42] Yeah, trust me, I've done it for years, not just this podcast, but obviously the other one as well. Yeah, there is a lot there. Yatin Chadha: [00:01:49] Yeah. Yeah. It just takes, and I have a lot of respect for people who have been doing this for years and like with anything in life, it's a journey, not a marathon, right? Just takes a lot of time and effort. Kevin Mailo: [00:02:00] Make sure, make sure you're doing what you love, right? I think that rule applies to all of us in our lives. Like, if we're not loving it, why are we doing it? Life's got to be more than just a trudge. It truly does, you know? So, you know, you got this incredible podcast. Do you have guests now coming to you? Like, are you still having to source guests or are you big enough now where everybody sort of says, Oh, can I be on the show? Yatin Chadha: [00:02:25] It's definitely getting to that now. And I can tell you, I think this was around episode seven or eight - I'm trying to think, episode seven - it was Tim Cestnick who agreed to come on, and I can tell you at that point in the early days, I remember that specific episode. Kevin, I was scrambling to find a guest because I told myself, I have to put something out there every four weeks, stay consistent, and then thank goodness Tim Cestnik messaged me back the same day and he was just like, Yeah, I'd love to come on. And I was just like, Thank you. Because without him I would have been struggling. But now times have changed. I mean, now I've probably recorded episodes to, all the way out through January, February, and a lot of requests, a lot of requests now to come on. But it's a mix, right? Because for me, my goal is to find who I think are going to be the right people to come on and present information in an articulate way and hopefully less biased way. So it's a bit of a mix, but certainly a lot of demand from guests now. Kevin Mailo: [00:03:23] And where do you see your audience now? I mean, we talk about this being Canadian physicians, but I can see you being so much bigger than that. Do you have some sense of your audience beyond Canadian physicians? I know lots of us talk about you and hold you in enormous esteem, but I have a feeling this is now expanded beyond that. Yatin Chadha: [00:03:43] Well, thank you. That's very kind of you. Canadian physicians are certainly the top audience, other health care professionals, so dentists, pharmacists, I do get messages from time to time. But then there are a lot of people in the in the finance industry as well, because one goal that I've had is I want to be touching on topics that are not only relevant or maybe are a little bit beyond what people may be talking to from day to day, like tax free savings accounts and RRSPs. I'm trying to just take it one level further - and not, this is not to say that more complicated is sexy or better, but I think there are a lot of things that we need to be better versed in and more aware of. And so that's my goal. And I think because of that focus, it naturally gravitates to people in the financial industry as well. I think they find the content interesting. So I do have a lot of people reaching out from from that part as well. Kevin Mailo: [00:04:38] You know, one of the central teachings that we do at Physician Empowerment is talking about the notion of your why. Right? And getting down to what motivates you to build financial security and create wealth. The other side to this is learning to ask your own questions. Like, you know, we sit there, you know, always talking about looking for the answers, but how do you know what answer you need if you don't even know the question to be asking? And these are questions of, questions of ourselves, of our lives, of our loved ones, but even within our careers. And then taking that further is, you know, sitting down with an insurance specialist, you know, a tax lawyer, sitting down with an investment advisor, looking at the markets, you don't even know what questions to be asking. Like, you know, I struggled with that with my accountant in the early years of my practice, like just not knowing enough about the Canadian tax system at a corporate or personal level in order to ask educated questions of my accountant. Do you know what I mean? Yatin Chadha: [00:05:37] 100%. Kevin Mailo: [00:05:38] You know, it's up to us, I think, with sophisticated tax or financial picture, to have enough base knowledge in order to step into these conversations with trained professionals, our consultants, if you want to call them that, and ask them relevant questions. Right? Because if it's poor data in, it's going to be poor data out, is been my own personal experience. Yatin Chadha: [00:06:02] Yeah, and I think with that summary, Kevin, I think you have encapsulated the main goal of the podcast, and that is to make people feel comfortable enough on a broad range of topics so that they feel comfortable asking the right questions. And, and the truth is, I've always had in the back of my mind that maybe we should have more of this material in our medical training. But then after thinking about that again, I think with the information people have to learn now in medical school and residency, it is really hard to incorporate it. And so I do think the onus is on us as a community to continue to talk openly about these topics and hopefully motivate our colleagues to just be avid learners and really curious about this content. And I think that's the right step forward. Kevin Mailo: [00:06:45] And the other big, big side to this is practice management, right? I mean, we started teaching practice management at Physician Empowerment because we realized like nobody was getting educated on this stuff. And again, like, you know, going back to your point, like rightly so, in a sense, like there's already so much medicine to learn in that 5 to 10 years of training that that someone goes through like to learn their craft. Do we really, honestly have time to be taking deep dives into finance and practice management and tax planning and all these sorts of things? But I think it speaks to the need for lifelong learning in these areas, and... Yatin Chadha: [00:07:25] Absolutely. Kevin Mailo: [00:07:26] ... realizing that our finances affect our practice, our finances affect our personal well-being. Right? And so having a handle on those, not a perfect handle, but a good approach and a solid financial base, allows us to practice our best medicine, allows us to live our best personal lives, which I think is so important for Canadian physicians. In my opinion, that's what we deserve across the profession. I see doctors constantly working extra hours to serve their patients and serve the community, but we should be able to do that knowing that our financial futures are secure. Yatin Chadha: [00:08:01] Yeah, I totally agree. Kevin Mailo: [00:08:02] So talk to us about some of your memorable moments along the Beyond MD podcast journey. What was it like in the early days? What is it like now and how long have you been at it now? Is it two years now, Yatin? Yatin Chadha: [00:08:15] Yeah. So it started September 2020. So just over two years now. Kevin Mailo: [00:08:19] Wow, it went by so quickly I felt like we talked for the first time yesterday, but it's been two years that we've been talking because I was on one of your earliest episodes, right? Yatin Chadha: [00:08:28] Yeah. Yeah. Kevin, so you were on my season one finale. We did an introduction to real estate, and I know you wanted to pick my brain on some of the most popular episodes ever. So in fact, your episode, that was episode number 16, that that is one that did help the podcast jump to the next level. So thank you for that because that was a great-- Kevin Mailo: [00:08:50] -- Oh, lumbar puncture night -- Yatin Chadha: [00:08:51] -- talking about real estate-- Kevin Mailo: [00:08:51] -- if anybody wants to know that one, you can just listen to Yatin's podcast. Lumbar puncture night. That was a lot of fun. Yatin Chadha: [00:08:58] Yeah. Yeah. So, your your episode is quite memorable. And I have to say, it wouldn't have been possible without my first guest, Ali Spinner, who was an accountant at Crowe Soberman. She's based in Toronto, and she helped me produce two incredible episodes, one on basics of corporations and the other one on holding companies. Her episode on holding companies, I mean, up until recently, that was the most popular episode in terms of like the one week and one month metrics. And then and then early on, just to have a name like Jamie Golombek. Kevin Mailo: [00:09:28] Oh, wow. I know. I remember when I saw that, I was like, Wow, Jamie Golombek went on the show. Yatin Chadha: [00:09:33] To have Jamie Golombek on the show, that was huge because I was literally, you know, I had a few downloads up until that point. And then that week when I released his episode, it was like every two days I was getting, I was hitting new milestones. Just because he was on, he was blasting it around. And so I'm very, very grateful to that, to him for doing that. Kevin Mailo: [00:09:53] Wow. Isn't that awesome? Isn't that absolutely awesome? And then what sort of things have you learned along the way? Right? Like, what have you learned about the finance industry that Canadian physicians who are listening to today's episode should hear about? Because I certainly have found this process to be eye opening through Physician Empowerment because we engage with, we get a lot of outreach from the finance industry, and by and large keep them at arm's length. But tell us what have you learned about the finance industry? Yatin Chadha: [00:10:23] Yeah, I think some of the notions that our community had about the finance industry in terms of maybe doctors at times due to our income and our relative lack of knowledge in this area, we become a bit of a target. I will say that there are people out there who do get very interested in seeing a product based on finance. So the podcast that's being put out by a physician. And so I will get a lot of people reaching out and, and you know what? Now that I'm becoming more comfortable with the content, I think I do know the questions to ask, and I do know when to maybe challenge somebody on a point. And so yes, I think that that notion that people have, for sure, it's correct and you have to, I think that's point one is that's all the more reason to be well versed in this material so that you know the right questions to ask and you know how to protect yourself and make sure you're getting the right product and served in the right way. So that's one thing I've learned. The other thing, though, is I've learned how much there is to learn about about finance. When I first started, the talk was really just about investing in a TFSA, investing in an RRSP, maybe buying an ETF. But when we look at what's happened, Kevin, especially since February, it's really just been kind of all downhill this year in the markets, right? Kevin Mailo: [00:11:43] Yeah, that was eye opening. Yatin Chadha: [00:11:45] Yeah, it's just been, it's been crazy. And you look at the history, you know, most bear markets are, are fairly long, but I think we're kind of hitting the average length of what historically most bear markets have been, and you know just to to endure something like this. It's also taught me, well if you have the right knowledge base, you can invest in different instruments and different ways such that those investments will not totally correlate and move the same direction as the stock market, right? So this is a notion that I had no idea about, but it's the concept of uncorrelated returns. And that's why-- Kevin Mailo: [00:12:21] -- I like that. Wow, goodness-- Yatin Chadha: [00:12:23] --I think I encourage everybody to read about this a little bit. And so just for people who may not be as familiar with the concept, it's if two types of investments have a correlation of one, that means they generally tend to move in the same direction at the same time and often by a similar magnitude. But you want to make sure that, I think most people would feel comfortable if their portfolios were truly diversified. And so you want to be investing in things that are not always correlated with stocks. And traditionally, that's why a mix of stocks and bonds has worked well. But this year, with inflation, the stock bond 60/40 mix has not worked well at all. It's just been brutal for bonds. So I think that's why it begs the question, do you go beyond that? And I think it's at least worth learning beyond that. And so one of my more recent episodes, I hosted a very knowledgeable, savvy financial planner. His name is Joe Bakish, and he talked about alternative assets. And so I know this is an area that some people may see. They may raise an eyebrow and be like, well, there's a lot of costs. But I always tell people, at least learn about it and then you kind of know. Kevin Mailo: [00:13:33] Oh be aware. Yatin Chadha: [00:13:34] Yeah. Be aware. Kevin Mailo: [00:13:35] Be aware. You've got nothing to lose by being aware of a different opportunity or different asset class. Yatin Chadha: [00:13:41] Yeah. And one thing I'll say is I never like to give advice because to each their own. Personal finance is personal. And, but now what I've started to do is small parts of my portfolio, now that I've been investing for 4 to 5 years, small parts, I am starting to incorporate some of these alternatives that are truly uncorrelated from the markets. And this can be more an offline discussion if people want to reach out. I never give advice. I'm not certified, I'm not a planner, but I encourage people to learn and enjoy learning. Kevin Mailo: [00:14:11] Yeah, yeah. At Physician Empowerment, we call it CBE, continuous business education, right? Like knowing what money does in our lives and the different ways that we can use it. One thing that we always kind of harp on at our finance events - and we've got another finance conference coming up May 6 and 7, 2023 in Toronto, of course you're invited, Yatin. Yatin Chadha: [00:14:36] I'll be there. Kevin Mailo: [00:14:37] Yeah, I know. It means a lot when you come out. Yatin Chadha: [00:14:40] I wouldn't miss it. Kevin Mailo: [00:14:41] But one of the challenges that we try to encourage people to face is the notion of an income based retirement. Right? Because in my opinion, real wealth is income coming in regardless of whether you are going into work, regardless of whether you're picking up that call, that clinic, you know, doing those ORs, is money coming in through passive investments or near passive investments, right? Because nothing, you know, it's very, like unless you've got a trust fund that's churning out money, like most of the time, you're going to have to at least learn to manage your managers, whether that's a property manager or a portfolio manager. But talk to us about an income based, a truly income based existence where we are not dependent on hours worked and ideally one in which we retire and our net worth continues to climb because the income not only handles our day to day expenses, but continues to grow in value or continue to grow our asset column in value. Do you want to talk to us about what that means or what your reflections are on that? Yatin Chadha: [00:15:47] It's such a wonderful question, Kevin, and so I'm happy to talk about my perspective on this. And first off, I think we'll hear a lot of stats out there. But I think generally speaking, most people who end up in a very good financial position in life and people have different definitions for that, whether it's a millionaire - but now when the cost of living is getting so expensive to have $1,000,000 at point X may not mean that much - but generally speaking, people who do well have multiple sources of income, and those sources of income are not necessarily tied to their day to day grind. So I was reflecting on this, and I'm a radiologist day to day. And one thing I realized was, well, wow, I have a lot of income tied to radiology. It may not all be tied to the hospital, but it's tied to extra clinic shifts that I'm doing and locums that I'm doing. And you and I have talked about this. This is a very, you know, the tendency of a lot of physicians to just start doing these extra shifts. But what I notice is that if-- Kevin Mailo: [00:16:51] -- it's easy and we know it right, and you go, Well, exactly how am I going to make that kind of money? Well, just exactly a shift. But but that's not a recipe for health and wellbeing and it's not sustainable-- Yatin Chadha: [00:17:03] -- exactly. That's my point. I realized that if I was doing this same thing all day, every day wasn't necessarily making me happy inside. And in fact, I had a few people reach out to me. These were friends who were listening to the podcast and they said, Yatin, why, some of us are asking, why are you doing this? Because you could just go and read radiology cases all day and ramp up your income. I was like, Yeah, I could do that. But deep down that would be almost stalling my personal development. That would be, that would be, in a way stalling my ability to network and and meet with people. And at the end of the day, I want, you know, and I'm not saying I'm going to monetize the podcast, but at the end of the day, you know, I want to grow and-- Kevin Mailo: [00:17:49] -- you're doing something you love-- Yatin Chadha: [00:17:50] -- exactly, but I think-- Kevin Mailo: [00:17:54] -- keep going. Keep going. Yatin Chadha: [00:17:56] No, no, no, no, no, no, no. I keep interrupting you there. But I was going to say, I think most successful people have sources of income that are truly diversified coming from different areas. So that's one of the reasons that I started to get into real estate, for example, in the last several years. So starting in 2020, up until now, each year I have invested in one property and now, now as I'm learning more about real estate and I'm learning about the different ways you generate income in real estate, I can say that each year I think the investment that I made is probably a more sound investment. And my most recent one was in fact a triplex in my hometown of Kingston because I wanted to make sure that the next property that I acquire results in some positive cash flow each month. Kevin Mailo: [00:18:42] I love it. Yatin Chadha: [00:18:42] And so, and so this is my goal. So the reason I'm doing real estate and first of all, listeners don't have to invest in real estate because I can tell you - and as you know, Kevin, you know more than me about this - but when you're starting early on in real estate, it certainly is a bit more active until you have your team on the ground and you understand the processes, then it can become truly more passive. But I'm still in that kind of more active phase. But what I want is that I want, let's say, a handful of rental properties so that by the time I am, let's say, 60, you know, most of that stuff is paid off. And then it's just, it's cash flow every month, it's gravy every month. And I don't have to work for that. Right? You're providing a necessary need for society, you're providing shelter. And that's something that at the end of the day, that would make me feel good, and I won't have to be grinding to earn that money. So that's why I'm investing in real estate. I want a certain number of dollars each month that are just flowing in at a certain point in time. Kevin Mailo: [00:19:40] I couldn't agree more. Just on the real estate point. I mean, when we talk about an income based existence, very few things beat real estate, right? I mean, if you have a big stock portfolio or a whole bunch of bonds or whatever, you're going to have to liquidate that at a certain rate in order to fund your lifestyle and hope that the market continues to grow. But, you know, this year was a nice reminder that the markets don't always grow. So how much do you want to liquidate? But again, what's powerful about real estate, there's different ways to own it, but what's powerful about real estate is I've been through one, two, I think three cycles now, three downturns in Alberta's real estate market. But the money just keeps coming in. The income just keeps coming in, it's like, as long as I'm not under pressure to sell in a down market, real estate allows me to enjoy an income, you know. And that's what's so powerful. So, you know, people ask, does real estate mean that much to you? I say, Yes, real estate transformed my life. I used to worry about my future. I used to worry about money. And now I don't. Not that real estate is perfect. Not that it's all the answers, but it's a big part of my own financial picture because it's that very powerful income based existence that is so hard to get elsewhere. I mean, I know people that have made money in crypto and then watch them lose it all this year when crypto crashed, you know, and it's something about owning a hard asset. Yeah, I know. I know somebody who who got a little bit woken up with the crypto crash. Right? And all it took was rising interest rates. Do you know what I mean? And so there's all these swings, but real estate, again, it's not perfect, but it holds on nicely. Yatin Chadha: [00:21:19] Absolutely. And I can tell you that when I acquired this latest property, I felt almost like a small weight was being lifted off my shoulders because I knew that my future became slightly better. And I actually bought the property when my wife was out of town. I told her I was serious about it. She didn't know I was going to buy it. She kind of freaked out. But we're all good. Kevin Mailo: [00:21:37] You know what? That's okay. Sometimes you just have to jump on things. But, you know... Yatin Chadha: [00:21:42] 100%, 100%, you keep keep going. Kevin Mailo: [00:21:44] You converted your hard, hard working labor. You doing call, you doing extra clinics, you're doing those locums, you converted that labor into a lifetime of income through that triplex. Do you know what I mean? And you do that a few more times over the course of your career, and then you replaced your clinical income. And I know doctors who do it all the time and don't have to own the doors directly. You can invest in private equity. There are different ways to get involved in the real estate markets without having to manage your own doors, because I think that's a big downside for a lot of people that are in this space or thinking about this space, is like, am I going to be getting calls in the middle of the night for, yeah. Yatin Chadha: [00:22:28] Well, Kevin, I'll speak to that. Absolutely. I will speak to that quickly. And I can tell you the one thing that I've learned over the last few years, and this is also from talking to you, is that how we spend our time is critical. Kevin Mailo: [00:22:39] Oh, yeah. Yatin Chadha: [00:22:40] And we have to be spending our time that is in line with how we want to live our our life and in touch with our core values. And so for me, I don't want to be getting calls in the middle of the night. So for this triplex, what I've done is I have this week, in fact, Thursday I'm handing the keys over to a property manager and that's incorporated into the the expenses of the property. And so the other thing that I'll kind of just say your comment about private equity, so, and I won't mention specific companies or what I invest in, but I did do my first private equity investment this year as well. And that was-- Kevin Mailo: [00:23:11] -- so did I. And it was amazing. Yatin Chadha: [00:23:13] Good for you. Good for you. You know what? And I know that the two reasons I did it was it's a passive way of investing in real estate development. And then the other way, the other reason is, it's often, not always, but it can be uncorrelated from the market. So I wanted to just kind of diversify things and I wanted it to be totally passive. And so I did that. And so more for an offline discussion, people can obviously reach out to me. I won't mention specifics here, but yeah, just to comment on private equity there. And the other thing is, Kevin, in terms of having different sources of income over time, I have, I have become more interested in things like dividend stocks. You know, Canada is very rich with dividend stocks. And I know that Dimitre did a wonderful presentation at the Physician Empowerment Conference, so he did a great presentation. And the thing is, like, I know emergency physicians, I'm about to interview one in a month or so who basically reached his definition of financial independence. And a core component of his strategy was investing in dividend stocks that continue to raise their dividends year after year after year. There are so many in Canada. And when you look at this last downturn, Kevin, you kind of look at what's happened to stocks, what's happened to bonds, what's happened to crypto, the asset class among these more liquid asset classes that has actually fared the best, are dividend stocks. And so I think having that as a chunk of my portfolio, personally, it gives me an added layer of confidence and to get those dividends either monthly or quarterly, it just, it feels good when you see that. Kevin Mailo: [00:24:49] I couldn't agree more. Yatin Chadha: [00:24:51] I'm a fan. I'm a fan, it's not for everybody, but. Kevin Mailo: [00:24:53] A big part of this is how well are you sleeping at night? I mean, you alluded to that earlier. And I consider that to actually be an investment criteria. Wing calls it the pillow test, you put your head on the pillow at night, are you sleeping better or sleeping worse? Because if you're sleeping worse, don't invest in it. Right? You know, if it's Tesla stock or whatever, don't invest in it. You know what I mean? Like so, you know, find things that are going to bring you peace of mind because that's one of the reasons to have money is to simply be happier and less stressed out about your day to day. Right? So if you're investing in a certain dividend paying stock allows you to feel better and go to bed at night feeling a little more secure in your future, then go and do it. Yatin Chadha: [00:25:32] Yeah, it does for me. And there's a lot of wisdom coming from Wing. I mean, he's lived, he's lived a very experienced life, one with varied experiences. And so there's a lot of wisdom there. Kevin Mailo: [00:25:43] Yeah, I respect it a lot, you know, and it's, it's about just getting to that point where you don't have to stress about your future and then at some point you don't have to stress about your monthly bills. That's the dream. It's hard to get there, requires a lot of discipline, a lot of savings and a lot of retained corporate earnings. But I know that Canadian physicians have tons of opportunities in front of them. You know, even though I just want to send a message of hope because I think a lot of Canadians that I've talked, Canadian doctors that I've talked to coast to coast, and I don't know about you Yatin, are really struggling. Right? I mean, inflation's going through the roof, cost of living, interest rates. But then it's our overhead is going up. And yeah, codes aren't keeping up. I mean, in Alberta, we just I think we just voted to ratify our agreement. But it's not, it's not going to keep up with inflation, you know, and so physicians feel squeezed and they start saying, well, now I'm going to work more hours. But there are actually strategies so that we are not working more hours to catch up or keep up. There are ways that we can utilize advance tax planning, learn to invest and really learn to grow without feeling pressure to simply pick up more hours, because I think most of us are probably tapped out. Yatin Chadha: [00:27:00] You know, 100%. I'm going to comment on a few things there and interrupt me at any time. Kevin Mailo: [00:27:05] No, no. Go, go. Yatin Chadha: [00:27:06] We talked about kind of an income based existence. So we touched on dividends. We've touched on real estate. And for me, I'll talk about my experience. But for me, it's still kind of early stages for the podcast. And right now I'm beginning to have some conversations about, well, what's kind of the next step? But what I want to relay to the listeners here is, sometimes don't think that the path you are on is going to be your only path or the final path. You have to be very open minded and open to new experiences. And so I can tell you, when I decided to start the podcast, it was April 2020, that entire month, not by choice, because our volumes really slowed down, I was only able to work four days that month and I don't do well in that kind of setting, Kevin, and so I just thought to myself, there's got to be some other way for me to bring something useful to the world. And so I told my wife, Sima, I said, Hey, I'm getting more and more interested in finance. I mean, I drive my accountant crazy with all these questions. I'm always talking to you about it at home. But I told her, I think that there's a way to create something so that I'm bringing on subject experts and that through this maybe we can kind of enhance the financial literacy of the medical community. I think it'd be really worth trying. And so I didn't even do any research, Kevin, I did a quick Google search on, financial podcasts for physicians. I saw nothing and I was like, okay, good enough for me. Kevin Mailo: [00:28:28] There you go. Yatin Chadha: [00:28:29] I'm going to start it. Just do it. Pull the trigger. And to be honest, even though I'm not making anything off it right now, Kevin, just because I took a chance, because I made a decision in the moment and I acted on it, the pod is one of my, I guess it's one of my proudest accomplishments today. Kevin Mailo: [00:28:46] Well, I'll tell you, I treat my companies like children. Like my companies are like babies to me. So you can just call it a baby. I don't know how your real kids are going to feel about that, but. Yatin Chadha: [00:28:56] Yeah, yeah. No, I honestly, it's one of my proudest accomplishments to date today for those reasons. Kevin Mailo: [00:29:01] You should be proud, it's incredible. Yatin Chadha: [00:29:02] Thank you, Kevin. But you know what? And the real message I want to get across to people is that sometimes in life, whether you're thinking about starting a podcast, whether you're thinking about starting a business or you have an idea, just sometimes you have to act, sometimes you have to take a little bit of risk, and sometimes you have to just kind of throw that Hail Mary and hope for the best. And if you make a mistake, you'll be better for it in the long run. Kevin Mailo: [00:29:27] And don't be hard on yourself for mistakes. I've made many mistakes in my financial life. Don't be hard on yourself. Accept it is a cost of learning. Yatin Chadha: [00:29:35] 100%. I mean, make sure that you're sleeping well at night, but you have to take chances sometimes. And honestly, part of the reason that I continue to do the pod, it takes up a lot of my time right now. I mean, I'm not really making much off it at all. But, you know, at the end of the day, my kids see me do this and they ask me questions about it. And there's a lot of messages and lessons I want to teach my kids. And one of those is, Boys, I want you to pursue things that you're passionate about in life. I want you to learn how to work hard in life. And I hope that the things they see in our household, I hope that those lessons will be passed on to them and that they'll be better for it. You know, it's a multi layered process, Kevin. There's so much to this, and I think it's taken me a long time to realize this, but I think the pod has shown me where one of my key interests lie, is just in online education and there's so many ways to do it. And so that's the path that I want to kind of keep pushing towards. And it may not become apparent to you right away what your path is, but if you stick with it, if you do things with full intent and with passion, you will discover that path. So that's what I want to articulate for the listeners. Kevin Mailo: [00:30:44] I absolutely love that. And you know what? With that, I can't believe we blew through over 30 minutes. We should probably wrap up, but I loved it. As you can tell, we could probably just keep talking and talking and talking, you and I, because every time we do this, we just go and go. But it was truly incredible. And Yatin, like, you just, you're so gifted in this space, you really just got to keep going and I know you will, and I know you're going to continue to succeed. And again, for our listeners, if you haven't listened to Yatin's podcast, I really encourage you to do so. It's the Beyond MD podcast and it's all over the Internet tubes. And so with that, I'm going to start wrapping up, say a final word, and then we'll get to some questions in our webinar here. Yatin Chadha: [00:31:22] Yeah, Kevin, thank you for that. And the one thing I will also say is that the fact that you and your team have been at these webinars have been at these conferences year and year over and over again, it speaks to your passion and I've had many conversations with you offline, and in fact I've learned so much from you. One of the topics being real estate. You really lit a fire under me when it came to real estate. So I have to thank you for that. And honestly, you've, you know how to encourage people to pursue the areas that are most tied to their skill sets. Kevin Mailo: [00:31:55] Find their why, find their why. Yatin Chadha: [00:31:56] I know, I know people are going to get listen to you on many podcasts, but you're a great host, you're great at what you do, and I hope you and your team keep it up. Kevin Mailo: [00:32:03] Yeah, you know what? We're going to keep working. And like I said, we've got the conference coming up this May 6 and 7, 2023. And it is going to be wonderful. That's something, I'm not the best at everything, but I'm very confident in what we do at our conferences, in our ability to transform physician's lives. And you've been there Yatin, you know. Yatin Chadha: [00:32:20] Yeah, I'll be there next year too, as a guest. But I look forward to it. Kevin Mailo: [00:32:24] Very much looking forward to having you there. So we're going to wrap it up because like I said, we can keep going and going. Thank you again Yatin for being on the show. Yatin Chadha: [00:32:30] Thank you for this, Kevin. Oh, pleasure. Anytime. Kevin Mailo: [00:32:32] Thank you. Bye. Kevin Mailo: [00:32:33] Thank you so much for listening to the Physician Empowerment Podcast. If you're ready to take those next steps in transforming your practice, finances or personal wellbeing, then come and join us at PhysEmpowerment.ca - P H Y S Empowerment dot ca - to learn more about how we can help. If today's episode resonated with you, I'd really appreciate it if you would share our podcast with a colleague or friend and head over to Apple Podcasts to give us a five star rating and review. If you've got feedback, questions, or suggestions for future episode topics, we'd love to hear from you. If you want to join us and be interviewed and share some of your story, we'd absolutely love that as well. Please send me an email at KMailo@PhysEmpowerment.ca. Thank you again for listening. Bye.
	31 Oct 2023	30 - Why Your Dreams Matter	00:27:39
Dr. Kevin Mailo is interviewed by Physician Empowerment co-founder and co-host, Dr. Wing Lim, on the topic of dreams. Kevin once gave a talk on this subject at an accredited CME event in Mexico; about what dreams really are and why it’s so important to have them. And in this episode, he shares a bit of that talk. Wing asks Kevin to first define dreams and differentiate them from goals, which are not the same thing. Something Kevin says in giving his definition is that “dreams are what help us keep going forward in our lives despite the struggles”. That is part of why dreaming is such an intrinsically vital part of wellness and forward motion. In this episode, Dr. Wing Lim and Dr. Kevin Mailo explore dreams, dreaming, why we have dreams, why they matter, what dreams give to us, and what dreams offer the world at large. Dreams not only give meaning to our lives but give us the ability to enjoy the pursuit of them and to flourish in the journey toward them. This episode will shake you out of going through the motions, which is a source of burnout, and leave you inspired to dig deep to reconnect with your own dreams. — Contact Information: Physician Empowerment: website \| facebook \| linkedin __ Transcript Dr. Kevin Mailo: [00:00:01] Hi, I'm Dr. Kevin Mailo, one of the co-hosts of the Physician Empowerment podcast. At Physician Empowerment we're dedicated to improving the lives of Canadian physicians personally, professionally, and financially. If you're loving what you're listening to, let us know! We always want to hear your feedback. Connect with us. If you want to go further, we've got outstanding programing both in person and online. So look us up, but regardless, we hope you really enjoy this episode. Dr. Wing Lim: [00:00:34] Well, welcome everyone to our next episode of podcast in Physician Empowerment. So I'm Dr. Wing Lim, I'm one of the co-founders of Physician Empowerment, and today I'm really glad to interview my co-host and co-founder, Dr. Kevin Mailo, who is an emerging physician out of Sherwood Park. And we're going to talk about a topic that he delivered in an accredited CME event in Mexico a couple of years ago. And it's about dreams, why dreams matter in your life, and how it ties into your wellness. So welcome everyone and welcome, Kevin. So why do you pick a topic like that? Strange topic, dreamy weamy stuff. Dr. Kevin Mailo: [00:01:16] Yeah, so this one actually, this was actually an accredited talk that I delivered when we, when we got invited to Mexico. And at first I was actually overwhelmed with this one. And today on the episode, I'm not going to go into it in its complete depth. There's a lot, a lot there. But boy, at first it was, like I said, overwhelmed. And I'm like, where do I start? And then I started and I just kept going and it was incredible. And this topic specifically represents really, I would say, my falling in love with Physician Empowerment, because in many respects, Physician Empowerment represents a dream for me to help transform the lives of Canadian physicians. But what was so powerful is that in this journey of teaching, I was forced to learn the material myself. I was supposed to take it. I was forced to take a very hard look at my personal life, my professional life, my financial life and making a lot of incredible change, and I'm just so much happier for it. And so this topic of dreams became very powerful for me because it brought a lot of focus into my life. And so, yeah, again, I could go on and on about about this, but yes, this was an accredited talk. You could claim main Pro Plus credits for it. Really far from blood pressure management. Really far. Dr. Wing Lim: [00:02:41] Manage your own blood pressure. Dr. Kevin Mailo: [00:02:42] Manage your own blood pressure. Exactly. By being better. Dr. Wing Lim: [00:02:45] So tell us. Tell us, Kevin, how does, why do our dreams matter to our wellness? Dr. Kevin Mailo: [00:02:50] Yeah. So. So dreams matter in our lives. And I'm not talking about goals, okay? Goals I'll get to later, that's a much narrower thing. Dreams are those things that we truly want that are part of our self actualization. Okay? Dreams are. When I think about a dream, I think about our life as a landscape. So I look at my life like it's a landscape. It's got hills, it's got paths, it's got fields, it's got forests, it's got mountains. It's got whatever in front of it. And on the horizon is a destination. That is a dream to me. That's the visual imagery I use to describe dreams, and that you can have multiple dreams in your life's journey, that you can walk across the landscape of your life, and you can go to all these vistas, all these points. All these locations, and each one represents a dream, right? So it's not one thing on the horizon. It's many things on the horizon. So dreams are what help us keep going forward in our lives despite the struggles, despite the setbacks, despite the monotony, despite the burn out, dreams end up being the thing that we can focus on so that when we're walking life's path and it's muddy, it's rainy, there's quicksand, there's no clear path ahead. Somehow we make it when we follow our dreams. Dr. Wing Lim: [00:04:20] Right? So yeah. So you said the dreams and goals are not the same. And most people, they just lump them up, dreams and goals. Right? Dr. Kevin Mailo: [00:04:27] Exactly. Dr. Wing Lim: [00:04:27] So how do you distinguish between them two? Dr. Kevin Mailo: [00:04:29] So for me a dream is a representation of a better future for myself, for my loved ones, and for society as a whole. The other thing is that dreams can be very small. You might have a dream to run a half marathon. Okay? Or a dream can be huge. We actually had somebody come to the Physician Empowerment conference one year - do you remember, Wing? I think you do - He is very successful physician entrepreneur, and we talked about physician entrepreneurs before, but his goal was to build his business and create a $50 million endowment for children with autism and autism awareness. And that was his big dream, right? So dreams can be huge. Dr. Wing Lim: [00:05:15] Mhm. Dr. Kevin Mailo: [00:05:16] Dreams can also be private. So they can be, you know, things that are very personal that we don't share. It can be something, you know, like a special trip. You know, you want to go to a great location and just experience a certain festival let's say. But dreams can also be shared. Right? You know, that you share with your loved ones that you share with colleagues. Like let's say, you know, you talk about your dream, Wing, of Synergy Medical. That was a shared dream to bring comprehensive health care to a county of, well, probably getting close to 100,000 people now, that was underserved. So dreams are a lot more than goals, you know. A goal might be to say, I want to have X amount of dollars in the bank when I retire, but a dream is really I want to have this money to do this great thing for myself or my family, have a sense of purpose. And the truth is, and you know, I don't want to sound too romantic here, but the truth is, our world is built on dreams. Every invention, innovation or discovery was a product of dreams. And the people who make the headlines, they're not particularly intelligent, not even necessarily particularly hard working, but they're dreamers. And they kept going despite the failures and the setbacks. Dr. Wing Lim: [00:06:41] Mhm. Yeah, I once heard one definition of dreaming is an attack on status quo. Dr. Kevin Mailo: [00:06:48] Ooh I love that. Looking at the world and saying I'm not happy with what I see, or looking in our lives and saying, I'm not happy with what I see. How can I do better? Dr. Wing Lim: [00:06:59] Mhm. Dr. Kevin Mailo: [00:06:59] For me, and I would say, you know, some of the most important people in my life are immigrants, including you, ing. But immigrants inspire me because their lives are, are an embodiment of a dream of a better existence for them and their descendants. When you think about the immense sacrifices somebody makes, you know, to travel to another country, leave everything behind that they know, and start working at a lowly job and start working up the ladder, is incredible. Right? Again, not happy with the status quo. Dr. Wing Lim: [00:07:37] Mhm. Dr. Kevin Mailo: [00:07:38] And somewhere along the line as we become adults, and it's funny because one of my kids had a birthday and I told him like, don't ever grow up. And it's not that I don't want my children to become highly responsible, industrious, hardworking, self-reliant young people that will have careers and families of their own. But the message behind that was, don't grow up. Don't give up on your dreams and become some stuffy adult that is focused on day to day tasks and has no meaning in the broader arc of their life, that loses track of the landscape. Because when you think about dreams, probably your best way to connect with your own dreams is to look at the ones that you had when you were a kid. You know, when you were a teenager. And it's like, what would I do in my career? Where would I live? Who would I marry? What would my kids be like? Where would I travel? What would I experience in life? What would make me happy? Somehow, as adults, we have lost that. Somehow, as adults, through career, life struggles, institutional level sort of functioning, being put into a system, whether it's an education system or the health care system or a business system or whatever, our dreams get ground down. We're told it's unrealistic to think like that. And yet, as I said before, some of the most powerful innovations in our world, inventions, new systems of government, whatever, are the result of dreams. Dr. Wing Lim: [00:09:19] I read some stats. I don't know who put it up. I can't quote your source, but somebody says that in North America by age about 25, we stopped. We just stopped dreaming. And for us, that takes us through med school and residency. You know what? It was a dream that that put us in to where we are as clinicians. It was our dream. Dr. Kevin Mailo: [00:09:40] Yeah, I had a dream of being a doctor. Dr. Wing Lim: [00:09:42] Exactly. And then what happened? Right. We stopped dreaming. And they also heard somewhere else that dream is like a kid, right? When we grew up, my family was really broke so we have school uniforms - I grew up in the British system and we have school uniforms - and my parents would buy me 1 to 2 sizes bigger so I can grow into it. And they say, dream is just like that. It's 1 to 2 sizes bigger than you right now so that you can grow into it. And once you fit it, now you need a new set of clothes. You need a new dream to grow bigger. Dr. Kevin Mailo: [00:10:12] And the thing is, is that dreams give us meaning in our lives. When I think of one of the biggest tragedies in modern human existence, I think of the loss of people's dreams, and I see so many people within our profession or patients, people you meet on the street who are unhappy because their lives lack meaning. Did they just go through the motions, check the boxes? But they're not aspiring to anything bigger in their life anymore. And so watching somebody lose their dreams by about the age of 25 and never recover them is, in my opinion, one of the greatest tragedies in modern life. Dr. Wing Lim: [00:10:54] Right. And when I look at how, reflecting upon when we went through med school, we were they say people were so broke they eat dog food and cat food. I couldn't even afford it. It was too high of a price item for me and my spouse at that time. Right? And then how do we go through 100, 120 hours of work without burning out? How do we go through work and study at the same time and doing the lowest, lowest job, menial job? How do we survive? Because we had a dream, right? So somebody also said that if there's power, if there's hope in the future, there's power in the present. So the dream helps us to become more resilient because we know that the stuff that we work through is only temporary, right? There's a brighter future. There's a brighter tomorrow. Dr. Kevin Mailo: [00:11:41] Well, it's walking to that destination on the horizon that you deal with what you face in the landscape of life, even when it's hard, even when you feel lost, even when you feel stuck or you're going in circles. It's that notion that it's somewhere on the horizon where you're headed to. Dr. Wing Lim: [00:12:01] Mhm. Dr. Kevin Mailo: [00:12:01] And there are a lot of ways, and I did research on this in preparation for, you know teaching it, and I'm not going to go into all the reasons why dreams are destroyed, but there are a lot of external factors. People are, some of us are scared of being successful, we're overwhelmed with consumer spending. To the point that we don't have any margin to pursue dreams, which is very true. Dr. Wing Lim: [00:12:24] Oh, what a sore spot. Dr. Kevin Mailo: [00:12:26] You can count how many hours you have to work clinically to pay your mortgage every month, and those are hours that you are not able to pursue a dream, potentially. There are lots of societal factors. Some people are, you know, will be jealous of you or want to hold you back. You told me this one, Wing, is a lot of well-meaning people think that they're watching out for you by telling you not to dream. Dr. Wing Lim: [00:12:51] Exactly. Yeah. Dr. Kevin Mailo: [00:12:52] And I actually, I can recall many conversations from friends and family who would caution me on my dreaming. Dr. Wing Lim: [00:12:58] We just don't want you to be hurt, honey. Dr. Kevin Mailo: [00:13:00] Exactly. We don't want to see you fail. We don't want to see you struggle. And, Wing, I really want it, that's my first big thank you on this topic. That's my first big thank you to you on this topic because you told me about that. Dr. Wing Lim: [00:13:15] Oh you're welcome. Dr. Kevin Mailo: [00:13:16] But the second and more profound part to that is you said it wasn't about the external voices that were hard to ignore when it came to your dreams. It was that inner voice saying, I can't do it. It's too hard. Why try? And I remember that conversation. It's that inner voice saying, I don't deserve it or I can't do it, why bother? That's the hard voice we have to learn to shut down and ignore from within that holds us back from pursuing our dreams. Dr. Wing Lim: [00:13:53] So some people astutely put it as the imposter syndrome. Dr. Kevin Mailo: [00:13:57] Yes. Dr. Wing Lim: [00:13:57] Who do you think you are? Dr. Kevin Mailo: [00:13:59] Who do you think you are to dream? To think you can change the world or change your life? Dreams are important because that better vision of the future of ourselves, of our world, of our family, it creates optimism and optimism drives positive action. When you are optimistic, you feel like you can take chances. You feel like you can step out of your comfort zone. You feel like you can do things. Pessimism and a lack of dreaming is the opposite. It leads to fear and inaction. Would I ever attempt that airway if I thought I wasn't going to make it? Would you do surgery if you thought your patient was going to die? Right. Would you do counseling, Wing, and clinic and say, Oh, why am I bothering my patient's not going to follow through on it anyhow? No. No. We take, we have an optimistic view of our interventions in the world, in our practices, and it leads to action. Right? So dreams provide enormous meaning in our lives. And they help unify our lives as well. So at Physician Empowerment we teach that there are three different types of people within. Dr. Kevin Mailo: [00:15:16] There's our physician self, the MD, the professional self. There is the personal self which includes our inner child, the one who used to dream. And there's the financial self. When you're a dreamer and you know your dreams, you've written them down, you have a clear sense of who you are and where you want to go in life, it allows you to unify the three selves. And in doing that, you make life and career and financial decisions that reflect your dreams. Right? Because your three selves can't be walking in opposite directions across the landscape. You can't say, I've got a dream of setting, of traveling around the world, but you've got a consumer spending problem that keeps you working endlessly. And you're not able to train and get fit to do it. Right? And, you know, I wish I had more time to explore the example that I used in Mexico because it was really beautiful. But it is on the website and I encourage you to to watch the talk. The other part to dreams, and I don't know if you want to share on this, Wing, because I know you've taken some big leaps over the years, is dreams give us courage. Dr. Wing Lim: [00:16:26] Mhm. Yeah, actually, let me relate to this. The first time I got exposed to this dreaming stuff was at my CCFP confo. This is at Banff, right, for us in Western Canada I went to bang for my CCFP confo. And so 8:00 in the morning this big conference started at Banff Spring Hotel. And then this lady, she was a Mount Everest climber, she was one of the first female Mount Everest climbers. And she talked about her journey, and I thought, why are we woken up at 8:00 in the morning to listen to somebody climbing the mountain? And she almost died, some of her teammates died. And then at the end of that talk, she had a five minute standing ovation and she ended her talk, she said, That was my Mount Everest, what's yours? Right? And it was, wow. It just woke me up from the depth of my soul. Right? And what's your Mount Everest? What is that impossible dream? What is that thing you want to achieve that is bigger than you, bigger than all you can muster together, right? And when that things, when thoughts like this got turned on, I think it unleashes a lot of power. And they also say that when the student is ready, the mentors will show up, right, the magical mentors, the resources, people that you need to make connections with show up. And that's how things got turned around in the world. How big things got changed in the world. Dr. Kevin Mailo: [00:17:55] Absolutely. Absolutely. Dreams also, and you alluded to this earlier on today's episode, Wing, is that dreams make sacrifice meaningful in our lives, right? Like we, don't focus, when we talk about dreams don't focus on the destination. Focus on what it does to you over the journey. But as you're walking life's landscape, inevitably you are going to encounter struggle, setback, and failure. But when we actively pursue our dreams, they make those sacrifices and those hardships meaningful. You know, I always think about my dream of being a father. I'd wanted to have kids since I was a teenager, and it was such a joy to have them. And we had the twins first, and I remember countless sleepy nights that I'd be up feeding babies, thousands of diapers changed, countless days spent chasing around toddlers that didn't want to get dressed while we were going through medical school and residency, you know, exhausted. And yet when you look at it in the frame of I'm living my dream, those things aren't relevant. Those things aren't struggles. Those things are a joy. Right? You know the long hours that we spend on the wards of hospitals as med students and residents represents us living a dream. And it makes the sacrifice bearable. It makes the sleep deprivation and the hardship bearable. Right? Because we're living a dream. And so being explicit about it can be very powerful in our lives. When we say, no, this isn't a chor, this isn't, I'm not working towards a goal, I'm working towards a dream. Dr. Wing Lim: [00:19:34] Mhm. Yes. Now so we're almost out of time. So Kevin, maybe give us some takeaway, a couple takeaway points. Dr. Kevin Mailo: [00:19:46] Yeah, okay. There was a lot here, and I wish I had time. And maybe I should come back to it later, because, I write down my dreams. Dr. Wing Lim: [00:19:54] Yeah, another episode. Dr. Kevin Mailo: [00:19:54] Big, big dreamer. Okay, so let me let me wrap this up here with this wisdom that I came to when I was reflecting on my own life's journey. The destination is less important than we think. Whether we get to our dream or not is far less important than the fact that we actively pursued it, that we gave ourselves meaning along the way, that we grew as people, that we challenged ourselves and in the process, we connected with those in our lives more meaningfully. So here I'll leave you with with one example. And imagine a young woman that's training in a marathon, and she spends five years training to become a top tier marathoner, and she wants to win that race, she wants to come in first. Which means that she sacrificed every day. She trained, she ate right. And let's say a month before the marathon, she suffers an injury. Is she a failure, Wing? Absolutely not. Let's say that she's running the marathon and she's in first place after five years of training and 100m from the finish line, she trips, falls, wipes out, and doesn't even place. Is she a failure? Dr. Kevin Mailo: [00:21:25] Absolutely not. Let's say that after five years of training and working towards her dream, she runs that race and somebody just happens to be faster than her and beats her. Is she a failure? Absolutely not. It's the personal growth along the way that makes us, that makes it so meaningful when we pursue dreams. That is what helps us grow as individuals. That's what takes us from being static, going through the motions of life, checking the boxes, to being this dynamic individual who's growing, who's changing, who's optimistic about their future. And so for me, I constantly try to reconnect with my dreams and I constantly remind myself that success or failure is irrelevant. It's the fact that I get up every day and I feel like in some capacity, I'm living one of my dreams. Whether it's as a doctor, as a father, as an entrepreneur in Physician Empowerment, whatever it is, I feel like I'm living my dreams and that's what gives me an enormous sense of meaning. Not whether, not whether a certain thing happens. That's a goal. It's are you living your reality? Are you living your best version of you? Dreams are intrinsic to that. Dreams are intrinsic to that. So I'll leave you with, you know, sort of, practically speaking, is to take some time, like real time, like many, many hours, to just think back to your childhood. To that younger version of yourself. Be vulnerable with who you are and ask yourself what you really wanted when you were much younger, when you were a teenager or a child. And then look back on the times when you sort of slowly let those dreams fall to the wayside. And you so-called, grew up. Dr. Wing Lim: [00:23:36] Mm hmm. Dr. Kevin Mailo: [00:23:36] And then begin to write them down. You don't have to share them with anybody. But just write them down and be bold. That's the, that's the third big thank you I have for you, Wing, is I remember in one of our earliest meetings at that little breakfast restaurant - I think it's called Tutti Frutti, remember, it was super loud and super crowded - and I remember you telling me I'm not dreaming big enough, and I still hold on to that. So again, that's what I'd encourage listeners to do, is, is to just connect with yourself and begin to dream unapologetically and stop worrying about what anyone will think, and stop worrying about whether you actually reach your destination or not. The real gift of a dream is in living it now and pursuing it now. Not whether you get there or not. Dr. Wing Lim: [00:24:31] Exactly. So I got lots of patients, who are hunters, right, at the end of the day they said the hunt or they said the kill isn't the hunt, right? It's a journey, right? It's a journey that counts. So that, those those are lots of really good points, Kevin. So thanks for sharing with us. And we hope, at Physician Empowerment, we hope we'll rock your boat a little bit. I know you're busy. We're busy. We're going 100mph. But we hope we stop you down, smack you a little bit on the side and disrupt you a little bit so you can dig deep and go deep down, deep down. Dr. Kevin Mailo: [00:25:04] Just get out of the everyday. Get out of the everyday. Because so many physicians are just going through the motions. And it's an enormous source of burnout. Because you feel like that hamster wheel never stops turning over. But when you get out of that comfort zone and you just, you just ask yourself some hard questions and begin to take steps along that road, it can be so profound. And, that's you know, that's one of the things that we try to achieve on Physician Empowerment is like helping you connect with with your inner self and to transform your life, like, really transform your life. Dr. Wing Lim: [00:25:46] So I'll just end this episode with a comment. So this, from my mentor that unlocked my potential, Dr. George is his name. Most of you don't know him, he's 88 years old already, and he asked me way back 30 years ago, or not quite, 20 some years ago, What if time and money were no object? What if success is assured? What would you do? What would you see? What would you become? What would you not do? Right? So he was the guy that changed my whole entire life by that little question. So we pass you along with this question, and for those of you are already in the journey that you're chasing your dream, you're living your dream, maybe you can be the dream giver, right? That's the next step, right? And ask people around you, empower them so that they can embark on the journey of reliving their dreams. So we hope this episode is meaningful for you, and we look forward to seeing a lot of you. Dr. Kevin Mailo: [00:26:37] All right. Thank you so much. Dr. Wing Lim: [00:26:38] Okay. Thank you. Dr. Kevin Mailo: [00:26:41] Thank you so much for listening to the Physician Empowerment podcast. If you're ready to take those next steps in transforming your practice, finances, or personal well-being, then come and join us at PhysEmpowerment.ca - P H Y S Empowerment dot ca - to learn more about how we can help. If today's episode resonated with you, I'd really appreciate it if you would share our podcast with a colleague or friend and head over to Apple Podcasts to give us a five star rating and review. If you've got feedback, questions or suggestions for future episode topics, we'd love to hear from you. If you want to join us and be interviewed and share some of your story, we'd absolutely love that as well. Please send me an email at KMailo@PhysEmpowerment.ca. Thank you again for listening. Bye.
	15 Apr 2024	41 - Staying inspired through community and shared experience	00:26:59
Physician Empowerment co-founders Dr. Kevin Mailo and Dr. Wing Lim address why the events and masterclasses they hold are key to the foundations of Physician Empowerment overall. The promotion of wellness, health, and transformation in all areas of a physician’s life - mental, financial, leadership, practice - is the impetus behind everything they do. This translates into how they approach events and the focus of masterclasses. As Wing Lim reminds listeners in this episode, Physician Empowerment was created to form a community and network for peer-to-peer empowerment. He reiterates the four foundational pillars of its existence: 1. Physician wellness, 2. Financial health, 3. Leadership development, and 4. Practice transformation. Those pillars factor into how they present learning in a conversational and community-friendly way. Kevin Mailo stresses that it isn’t just about being better in the future but having that better life now. Wing and Kevin address what they’ve learned from mentors, what they hope to impart to the community, how the masterclasses are designed not just to impart facts but shape a different way of thinking, and their hopes that everyone can share their journeys together. __ Interested in going further in your financial journey? Join our national conference and meet the PhE team live in Toronto this May 25 and 26th: https://www.physempowerment.ca/live __ Physician Empowerment: Register for the Physician Empowerment Live Conference in Toronto on May 25 - 26, 2024 Join the Physician Empowerment Masterclass now
	30 Dec 2024	58 - Revisiting Capital Gain Investments with Jason Pisesky	00:34:51
PhE is headed to Cancun this February 23 to March 2 for our Health and Wealth Summit! We'd love to have you join: https://www.physempowerment.ca/cancun — Dr. Kevin Mailo and Dr. Wing Lim welcome Masterclass faculty member Jason Pisesky back to the show to talk about the recent capital gains changes in Canadian tax policy. Jason is a tax expert with KPMG and he breaks down for Wing why the changes sparked widespread concern among professionals, small business owners, and investors. He and Wing examine the actual impacts, where they were felt most, and what the practical implications of the changes are. The conversation focuses on the government’s decision to increase the capital gains inclusion rate from 50% to two-thirds for amounts exceeding $250,000 annually, meant only to affect the top 0.13% of Canadians. Jason explains that the policy affects those with significant investments, corporations, and trusts, while individuals have some exemptions. The nine-week notice period left people rushing for solutions, leading to a variety of overreactions, like liquidating assets too early, and responses such as corporate stripping. Jason advises caution against unnecessary asset liquidations that could trigger large, immediate tax bills. Despite the initial panic, Jason reassures listeners that the tax increases are manageable for most with proper planning, emphasizing the importance of consulting experts to avoid unnecessary financial losses. About Jason Pisesky: Jason is a tax lawyer with an international accounting firm, KPMG. His practice background is extensive and includes personal and corporate tax planning as well as litigation and dispute resolution. Whether you are scaling up your practice or winding it down, proper coordination between a tax lawyer and your accountant can ensure you're doing it right. __ Jason Pisesky: Jason Pisesky at KPMG Jason Pisesky on LinkedIn Physician Empowerment: Attend an upcoming Empowerment Retreat Join the Physician Empowerment Masterclass now Website: PhysEmpowerment.ca
	15 Dec 2022	09 - Outside Perspectives of Financial Planning with Galen Nuttall	00:41:04
Dr. Dimitre Ranev welcomes Galen Nuttall, Certified Financial Planner (CFP), to the podcast to discuss some of the ins and outs of financial planning. Galen answers questions about what financial planners do and explains the differences between a financial planner and a certified financial planner. Galen Nuttall has a background in teaching and a Masters in Education, but his father was a physician (a nephrologist) and he estimates half of his current clients are also physicians. The combination of his ability to teach financial concepts with ease to any audience and his familiarity with physician financial needs gives him great insight to share with listeners. In this episode, Dr. Dimitre Ranev and guest Galen Nuttall break down some misconceptions surrounding CFPs and the value of financial planners. Galen discusses the value of incorporation for physicians, retirement planning, riding out economic slowdowns, and some advice about taxes. His knowledge is vast and makes for valuable listening. About Galen Nuttall: Galen Nuttall grew up watching his dad (a now-retired nephrologist) struggle to make good decisions around his money. It felt like everyone wanted time with him to pitch the latest and greatest financial product. Now that he’s a planner, he sees why so many Canadians are unsure how to invest their money. There are so many options and even the experts seem to disagree. No wonder most Canadians are confused and don't know where to start. As a planner, Galen is changing this. With a background and a Masters in Education, Galen is able to explain financial concepts with ease and enjoys imparting financial literacy to people. He says a fee-based financial plan answers the biggest questions around investing with cold, hard facts. Plans should be evidence-based, not based on opinions or preferences. — Physician Empowerment: website \| facebook \| linkedin Galen Nuttall, M.Ed, CFP: podcast __ Transcript: Dr. Kevin Mailo: [00:00:00] Hi, I'm Dr. Kevin Mailo and you're listening to the Physician Empowerment Podcast. At Physician Empowerment, we're focused on transforming the lives of Canadian physicians through education in finance, practice transformation, wellness, and leadership. After you've listened to today's episode, I encourage you to visit us at PhysEmpowerment.ca - that's P H Y S Empowerment dot ca - to learn more about the many resources we have to help you make that change in your own life, practice and personal finances. Now on to today's episode. Dimitre Ranev: [00:00:34] Welcome back, everyone, to the Physician Empowerment podcast. I'm very honored to have Galen Nuttall as a guest today. I actually met Galen at the Physician Department Conference in June. Galen is a financial planner, he's an investment advisor, and he's a certified, he has a CFP Certified Financial Planning certificate, as well as a Masters in Education, which I find really interesting and actually really important because financial products can be extremely hard to understand, especially when we talk about insurance. I mean, any product and it's so important to be able to explain things, simplify things. And just reading some of the comments on Galen's website, it seems like it's something you do very well and having spoken to you, it's something you do very well. I can say that again. You also have your own podcast, I think it's called a Clean Bill of Wealth. Is that correct? I think you post twice, twice a month? Galen Nuttall: [00:01:27] About two, yeah, I do about two episodes a month. Dimitre Ranev: [00:01:29] And you have guests and then you have sort of solo things and you're really good at explaining concepts. Today I just, one of the reasons I have you on is I think people need to realize that investing is a journey and it's a very personal one. There is no one size fits all, even though a lot of people will tell you this is the best thing to do. For example, now the current rage - and I'm not saying it's bad - but the current rage is to do your own investing, low fees, put all your money in an ETF and forget about it. But just like I'm giving an example of medical conditions, so for example, if somebody wants to lose weight, your job as a doctor is to show them all the tools available to them so they can find what's best for them, whether it's exercise or diet or even an emotional thing. Just like that's investing as well. There's different tools and you need to be aware of them because if you're not aware, then you won't find what's best for you. Today I want to talk about the tool of having a financial planner on your side. So I always like to start off with definitions because there's so many definitions in the financial world and it's so confusing. So, Galen, do you mind if we start by I want to ask you, because you do two things. You're a financial planner and an investment advisor. Can you tell me what is, when you put your financial planning hat on, what is it that you do? What is your role? Galen Nuttall: [00:02:53] Yeah, Yeah, very good question. Yeah. And first off, thank you so much for having me. I definitely enjoyed attending the conference and meeting and we probably could have talked a really long time about financial stuff when we were hanging out after the conference. So I really appreciate being here. Completely. Yeah. And, I mean, and I love what you said about I do have a Masters in Education, I bring that to the table. If anyone checks out any of my videos, I'm usually using a whiteboard. I'm a very big believer in visual learning. Most people resonate with that. So yeah, when it comes to definitions and certified financial planners, so I mean, I guess the easiest way to look at it is certified financial planner is the international designation for financial planners. So the way that you get this designation is you have to have a certain number of years working as a financial advisor and then you take exams. I had to read about 1200 pages worth of textbooks, take multiple module quizzes, and then one three hour exam, then one six hour exam, and then a three month long case study. And then you're part of the certified financial planning body. And every year you vow to uphold the code of ethics of the certified financial planners. And as all good things, you pay an annual fee to stay on their list. And at the end of the day, really, I mean, I'll say why I got my financial my certified financial planner, I was already an advisor for many years and I felt like I was doing a really good job, but I was not able to offer fee based planning, which is that someone... I was coming up against giving people advice and the only way I could get paid before I got my certified financial planner was if they bought something from me. So like, I would, sometimes I'd give people, I would take people through a very lengthy process of discovery, of recommendations, of portfolio construction, of insurance recommendations. And they would say, Galen, I actually am not ready to do any of these things, but I would love to pay you for your time because I realize you've spent a lot of time on this. And I kept having to say no because I was not allowed to take money like the way that a lawyer may bill you by the hour or the way that an accountant may bill you by the hour, I couldn't do those things. So I got my certified financial planner so I could start doing that, which is hourly fee based and planning based, which is someone can pay me for a plan that they can implement wherever they want for themselves or with me. So that was the main reason I got it. So I think that's probably one of the best ways to quote/unquote define it, is that some people say, Oh, you should only work with someone who's a certified financial planner. I'm like, Well, I was in this business for like seven or eight years before I became a certified financial planner and I stand by all the recommendations I gave before I got it. But like, if you meet someone who has their CFP, they're taking it pretty seriously. Like someone doesn't go to all these lengths to to get this designation without being pretty serious about the career. So I would say it's a sign of that. So yeah, that's, that's kind of my journey with the CFP. Dimitre Ranev: [00:05:40] And when did you get your Masters in Education? When did that happen in sort of your journey as an advisor? Galen Nuttall: [00:05:48] For sure, yes. I mean, so I started, I taught overseas, actually, I moved to Venezuela when I was 22 and worked for a grassroots development organization. And I was only going to stay there for a year and I loved it so much, I decided to stay longer. And then I got married and I ended up staying ten years and I started working for an international school. And while I was working for that school, they said, Galen, you know, there's like a rule where I could work for a year or so, but then I had to start working towards my teaching degree. So I said - and I never wanted to be a teacher, it was never my thing - but I am, I would say that my superpower is making complex concepts simple, usually through whiteboards. Like that's, I love making financial concepts simple. Almost every meeting I have with people is a shared screen whiteboard meeting, because that's what most people enjoy. So I started teaching, I had to get my teaching degree, and then I went ahead and got my Masters. So I finished my Masters back in like 2010 and I had every intention of continuing to teach. But my wife and I left Venezuela because it was getting too dangerous. We were worried about either me or my son getting kidnapped, so we said, We better leave. We looked all over for other international jobs, but it was around 2008, 2009, economic downturn. So a lot of international schools weren't hiring as much. So we ended up in Canada and there were no teaching jobs to be found. So I made a transition to financial advice. My advisor said, Galen, I think you'd make a good advisor. And initially I said, I am not interested at all. I was like, I don't want to be, I don't want people calling me when the markets are crashing. I don't want to be the guy at the party that's trying to sell you life insurance. And they said, Well, you don't have to work that way. Like you can find your own way of working that works for you. Because I was like, I can't do anything sleazy or salesy or knocking on doors, I don't want to do any of that stuff. So they said, No, you can figure out how to do it without doing those things. So when I started, it took me a little while to embrace it, but I realized that one of my differentiators - because there's like, I don't know, like 20,000 CFP in Canada or something like that - I was like, What's going to make me different? And it's like, I have a Masters in Education. Like I know how to explain things and I know how to tell if someone's understanding something or not. So I went guns blazing into like drawing and educating and like really heavy on that side of things. And so yeah, so I got the CFP in 2010, sorry, my Masters in 2010, I became an advisor in 2013, and then I got my CFP I think in like 2018 or 19, something like that. Dimitre Ranev: [00:08:08] What kind of education were you doing in Venezuela? What were you, what subjects were you teaching? I'm just curious. Galen Nuttall: [00:08:13] I was teaching, I was the core teacher for grade five at the International School in Caracas, Colegio International de Caracas. I was the grade five teacher, so I taught basically the core subjects, everything but P.E., everything but Phys Ed and Art, basically. And music, I didn't do music. Dimitre Ranev: [00:08:28] I'm certainly curious. Did they have any like sort of financial teaching as part of the curriculum? No, because if you didn't have it in Ontario, like when I was growing up, there was no such thing. Right. Galen Nuttall: [00:08:40] Not really. They've got, I think they've got some pretty good now because I know my son has come home and talked to me about interest rates and borrowing and all these things, and I'm like, All right, all right. Like, I like this. Like if they're at least teaching kids not to take on lots of credit, like bad credit, then I'm pretty happy. So I think they're doing a pretty good, my son was getting pretty into it. But no, we didn't, I didn't teach any financial literacy. I taught grade five. And really, like, one of the things I say is one of the hardest things I've ever had to do was teach fractions to grade five. So I know how to teach anything to anyone. And I really do take it, like I typically start with people and I say, Look, I'm going to take it to a grade five level. If you need me to go more complex, I can, but that's where I'm going to start. And then I let people decide whether they want to go more complex or not. Dimitre Ranev: [00:09:21] And I'm so, you know, I teach from, I teach myself from McGill. And I think it's so important to have that visual element because to me, I'm a visual person. Not everybody is, right? Not everybody is. But I love the whiteboard. I love drawing things and talking things through. It just, I remember somebody was trying to explain me something about pensions two days ago, and I didn't get it until they drew it and like, Oh, that clicks. So yeah. So I'm glad that you do that because I think it's quite important. My question is, because you told me when I talked to you at the conference that you have a pretty sizable medical clientele. Is that correct? Galen Nuttall: [00:09:58] Yeah, I'd say like of the last ten clients I brought on, I pretty much, half. Half the clients I bring on are incorporated business owners and the other half are incorporated medical professionals like physicians. Dimitre Ranev: [00:10:09] How did that happen? Is it just sort of randomly or what? Galen Nuttall: [00:10:13] Yeah, it's a good question. So when I started as an advisor, again, I was looking at ways of differentiating myself because I thought, What can I bring to the table that will be a value add for my clients? And so I started as an advisor and everyone was talking about, I started hearing about the corporate structure, right? And I was like, How does this thing work? And so I just started studying. Actually, I'll back up one more minute. So my dad's a doctor. So my dad's a physician, he's retired, he's a retired nephrologist, and I grew up watching my dad struggle to make good decisions with his money. Like I grew up in the heyday of cold calling. So he'd get cold calls from, like, stockbrokers and they knew he was a doctor, they'd find his phone number and they'd say, You've got to get in on this penny stock. You know, all this stuff. I remember as a kid going to meet with his stock broker, playing with like, toy trains while he was meeting with his stockbroker, and his stockbroker is telling him how much money he lost in gold that month or whatever. And I remember thinking, like, and I was confused about what my dad did when I was little. Someone asked me, What does your dad do? And I said, My dad's in construction. And my dad's like, What are you talking about? I'm a doctor. And I was like, Well, Dad, every day after school you take us to this old smelly building, we have to put on hard hats, you're telling people what to do. Like, I thought you were in construction. And he's like, No. He's like, my friends and I bought a building and we're renovating it, and we're renting it. And like, so basically what I didn't know as a six year old was that my dad was trying to create a retirement plan through real estate investing. Right? And so when I became an advisor, I started to think, Man, if I could really help people like my dad, like physicians who - I'll generalize a bit - but most physicians I meet, they do enjoy what they do. Obviously, there's high levels of burnout and there's a system that is not functioning very well. But most physicians are very, they really want to serve their patients. They really want to make a difference. They usually enjoy what they do, even though there's good days and bad. And a lot of them don't necessarily want to take on another thing in their life that's going to distract them from their family or their health or their sleep. So a lot of them want to say, Hey, Galen, you know, I trust you. Tell me what you're doing and why, and I'm going to let you manage my stuff and I'm not going to worry about it anymore. So I started studying the corporate structure very heavily. I started meeting with corporate accountants, corporate lawyers. I started meeting with different investment companies that worked with corporate preferred investments. So I just worked really hard to get really good at saying, okay, you're a doctor, you have no pension, What's the best, like, what's the best route that we can figure out for you such that one day you get to flip a switch and you don't have to work anymore if you don't want to. Because you've done all the right things to now be able to retire. Dimitre Ranev: [00:12:49] Yeah, exactly. And just before we started the podcast, we talked a bit about investing in index funds and just putting money in there. But you were saying a lot of people don't know, Okay, so I'm doing this, but what happens when I retire? Do I have enough to retire if I do this? And how long after that is to be able to do it? So that's that's where you can come in and help figure things out. I was talking to one of my friends who was like, trying to figure out how much he needs to retire to keep his current income. And what he didn't take into account is inflation, right? Like your current income, you have to inflate every year. So it's those little things where somebody who knows what they're doing is really helpful. And I guess my question to you is, so you're saying that about 50% of clientele are incorporated professionals, right? About half? Galen Nuttall: [00:13:37] Well, almost all my clients are incorporated. Half of them are medical professionals. Dimitre Ranev: [00:13:43] And, you know, I'm not saying doctors are special, but have you found any differences between sort of your medical incorporated clients and your other professionals? Like do they have anything, any specific interesting quirks or needs that are a bit different, maybe, from accountants or lawyers or dentists? Galen Nuttall: [00:14:01] Yeah. Yeah. It's a good, it's a good question. So of the last ten clients I've brought on, half of them were incorporated business owners. So, you know, someone who owns a factory or someone who owns some sort of saleable business and then the other half are physicians or osteopath. Brought an osteopath as a client recently, I'd say the biggest, there's not, I mean, the biggest difference from a mechanic's situation is that a business owner can sell their business, and not very many physicians can sell their business, right? Their corporation is basically them, right? Like your corporation is, you know, Dimitre Ranev medicine professional corporation, right? That's, it is you, you are the corporation. So every once in awhile you'll have someone with maybe a clinic or something that they can actually sell, but almost all of my clients are not going to, at the end of the day, sell their business for all this money and then suddenly be able to live off of that. The business owner clients, some of them will sell their business for a lot of money and that's their retirement plan is I'm going to sell my business. The physician, on the other hand, is almost exclusively, you know, what are they going to be able to create an income on their own, whether it be through investing, whether it be through real estate, whether it be through whatever they end up coming up with. So I'd say that's the biggest mechanical difference between the physician and the business owner. Like the straight, like, true blue business owner. From the other side of things, I mean, the biggest thing that physicians have in common is that they typically get a very late start in life due to going from residency where you're not really making a ton of money. You finally start your practice, but you've got $200,000 plus of debt you have to figure out how to pay off. You know, so a lot of physicians I meet aren't really starting to save money until about ten years after a lot of other people might be able to start saving money. So that's the other thing, is there's a very short runway for physicians in general. And a lot of, depending on the specialties, some physicians really don't plan on working long. I have friends who are ER docs who are like Galen, I really don't think my body is going to be able to take work past 55/56. I have clients who are maybe cardiologists or radiologists who say I could probably work to 68, you know, and I mean I'm not picking on them, but it's just the reality, the nature of their specialty. So all that being said, I think that it's so important for physicians to maximize the corporate structure, for physicians to make smart decisions around what they can make, how they can make the most of the corporate structure. Because as we were saying, a lot of people think financial planning, or they think success is paying as little as possible for their investments and they don't know a whole lot else. Like this happens. I meet people and they say, again, I'm really happy with what I'm doing because I know that I'm getting low cost investments, I'm doing index funds, I'm not paying a lot of money, it's really great. And then I'm like, Cool. Do you have, do you know when you'll be able to retire? Do you know if you're doing, are you owning the right kinds of ETFs in your corporation? Because there are some that you should not own inside your corporation, like even at the conference you were showing, Well, don't pick the one that's not a Canadian one because that's going to cause tax problems. And then the whole other conversation is, you know, I'm a big believer, so I think that financial planning for me takes the shape of a tree. So when I talk to people about where they want to be in the future, it's kind of like the leaves at the tips of the branches of the tree and all the work we do for saving money, investing money, saving taxes is growing towards that goal. And, much like a tree needs strong roots, I think a financial plan needs strong roots. And those roots are the protection side of things, like what will happen if you get sick, what will happen if you get injured, what will happen if you pass away prematurely? Like will your tree still stand if that were to happen? Or would your tree fall over? And so, even above and beyond the investment conversation, which is far more complex than just getting the lowest cost investment, there's the whole other side of the coin, which is protecting against what can go wrong. Dimitre Ranev: [00:17:43] Yeah, exactly. And so my question to you then is with your clients, like, we'll talk about fee structure maybe at the end, but is it sort of like, do you keep them on for long? Like do you see them yearly? What's the usual way you follow up with them? Galen Nuttall: [00:18:00] Yeah, absolutely. So with my clients, obviously there's a lot of meetings in the beginning, because in the beginning it's very much discovering if like, the first, my first meeting with people is a half hour phone call, and the whole purpose of that phone call is to find out if we're a good fit. Because people have to, I have to be a good fit for them and they have to be a good fit for me. Like I say, I'd say of all the people who call, most people I end up in conversations with, they call me, because they book a time. They hear my podcast, they hear me on someone else's podcast, they book a time and we have a conversation as to whether we're a good fit or not. And I'd say about half of the people I talked to aren't a good fit either. I'm not a good fit for them or they're not a good fit for me. And I'm very picky about, I'm not picky, but like there's a very specific person I want to work with, and other advisors say things like, Well, just bring them on as a client and then if you have to get rid of them later, it's okay. And I don't like that at all. I'm like, I want clients for life. I don't want people that I'm just going to bring on and see if it works. I don't like that at all. So, that's the first step is to make sure that we're philosophically aligned. Like if someone thinks that my job is to beat the market and I can't get them to see what my real job is, then we're probably not going to be a good fit. If someone is, like, a very heavy DIYer who's trying to like get me to join in on their philosophy of market timing, that's not going to work either. There's just certain things that aren't going to work. So, I mean, just since I'm talking about it, like the person that's the best fit for me is the person who is looking for someone to trust. They don't want to do it themselves. They want to understand what they're doing and why. And they want an advisor that's going to patiently explain everything, and an advisor who intimately understands all their options when it comes to corporate investing and understands all their options when it comes to insurance. And someone who's going to be okay with like, yeah, like, I'm not going to try to time to market. I'm not with, with a few exceptions, which I can talk about in a minute. So yeah, so that's the first meeting is to figure out if we're a good fit. Then if we decide we are a good fit, we decide whether we're going to go the fee based planning route or the portfolio management insurance review route, and just depends on the complexity of questions that someone has. So, if someone sends me just a ton of questions like should I be using my spousal RSP, should I be using TSFSAs, how much should I have on side of my corporation? What's an estate freeze? You know, like if someone's got all that going on and they've got quite a bit of assets already accumulated, they're probably going to go for the planning route because if I, if I don't feel confident that I'm going to be able to give them some good solutions without first doing a deep dive into all their structures and everything, then I'm going to say we need to go the fee based route. If someone is maybe less complex and it's a simple retirement plan or they're just starting out, like I have a lot of clients who are just coming out of residency and they're in that year of, Oh, I'm going to incorporate, I'm going to start practice. Like for those people, it's probably, they're not yet a good fit for a plan. So I will take them on and help them in that phase of incorporating, what do I need to do? Like what are some smart things to do with my money? So that's kind of... and then after they become a client, we meet every year at a minimum. We meet any time there's a major life change, like if they buy a house, if they sell a house, have kids. And then I reach out to everyone whenever there's a market downturn--. Dimitre Ranev: [00:21:13] --I was going to ask. Galen Nuttall: [00:21:14] So in 2020, I sent, I think in 2020 I called every single one of my investment clients and I said, Hey, you're probably watching the news, you know, or if you are watching the news, we're going to stay the course. And I didn't call everyone this year because when I called everyone in 2020, most of my clients were like, Why are you calling me? Are you going to tell me to, like, sell or buy or anything? And I was like, No, no, no, we're going to stay the course. And they're like, Oh, well, you didn't need to call me. You could just send me an email. I was like, Okay. So then this year I sent an email to all of my investment clients and basically said, We're going to stay the course and why. Or, the one quote/unquote market timing thing is if someone has some tax loss harvesting we can do, which that's another value add a good advisor brings to the table. If you have corporate investments that are in a taxable account and you've actually lost value, let's harvest those losses to offset future gains. Or I said to my clients, if you've got a pile of cash sitting somewhere, I don't know if we're at the bottom yet, but let's start putting some of that money into the market while it's on sale because we're in this, the beginning of this year was one of the five worst beginnings of the year we've ever had. So it's like one of the best five sales we've ever had. Like if you went to buy a car and they said, Oh, in the last hundred years, this is the fifth cheapest this car has been, you'd probably buy the car. So I say to people, like, just put money in and I have a few clients who did have some money kicking around, and they're really happy that they have been putting money in regularly over the last couple of months because they've gotten pretty good returns. And my clients who did it in 2020 got really great returns. I mean, I don't know, as I said, I never know when where the bottom is going to be, and I don't even try to pretend. But when things are on sale, I encourage my clients to buy more. And it's, they've always thanked me for that. So that's things look like when someone becomes my client. And the other thing I'll say is if there is something out there that I think they should know about, like if I've had a client that I think, you know, some private equity stuff makes sense or some market exempt stuff makes sense, we'll look at it. I think there's a product out there that we haven't talked about yet, and I'll kind of, I'll go for a run or a bike or a swim and I'll think about this client and say, Huh, they might be a really good fit for this. Then I'll call them up and say, I was kind of thinking about this, but I'm not moving stuff around a lot. Like that's not not really my style. It's more of a Let's figure out where you need to be, how much you need to put away, and mostly stick to that. Dimitre Ranev: [00:23:26] So, like, the family doctor of your financial health, you get the annual checkups and and when there is the flu, so the market crashes, you're there to calm things down. So I wonder if it's the process you go through to select your clients that do you have a lot of people sort of calling and freaking out when the market collapses? Galen Nuttall: [00:23:47] Zero. Dimitre Ranev: [00:23:48] Interesting. Interesting. Galen Nuttall: [00:23:50] Zero. Yeah. Nope. Well, part of it is I'm proactive, right? I mean, this year I'm actually mad at myself because I did wait a little bit. I don't really watch the news so I don't always know, I mean, I know enough to know that people are freaking out, right. And like, the news is talking, I call it the apocalypse du jour. And I don't mean to minimize. Like I sent out a newsletter and I posted I think, I don't know I couldn't post on LinkedIn because it was a little too long, but I posted it pretty much anywhere I could post. I sent it to my clients and I personalized it, like each client, you know, the first paragraph was very specific to their situation and the rest of it was the market. People are reacting to world events like the invasion of Ukraine, economic slowdown in China, inflation, all these things. And I don't mean to minimize the impact that those real world events are having on people, and I said the exact same thing in 2020 when I said COVID is having a real life impact on people. Like my dad was one of the first people to get COVID. So, and it was in the early days and we didn't really know what this thing was so it was very scary. So I don't mean to minimize the real world things that are happening, but the people who are reacting to the markets are the ones who are most likely to lose money and the people who are staying the course, as long as the caveat to all that is as long as they started in a good portfolio, they're going to be okay. But if they've got all their eggs in one basket, who knows, right? Or if they've got all their eggs in crypto or one private equity firm, which I saw recently, which kind of blew my mind. I had, I met someone who we did a plan for them and they have every last penny of their investments in one private equity holding. And I was like, This is so insanely risky. Like, and they claim that they're conservative investors. And I'm like, that's another thing I help people do, is they say they're one thing, but they're doing this instead. And so I help them match like what they think they are and what they're actually doing. So, yeah, accurately speaking, I did lose one investment client in 2020. First investment client I ever lost. I wrote everyone and I said, Stay the course. And this person couldn't stay the course. And I said, Fine. So they didn't stay the course. And then in this year, one more client left during the market downturn. But it's a pretty small percentage of my clients. So I shouldn't say no one or zero. There was one each time. So I don't know if that's going to be my average from now on, every time there's a market crash, I lose one client. But I'm pretty proud. I've only lost two in the last three years to that panic because I, you're right. Like it's partially selection and I just help people understand a little bit better. Like one of my first physician clients, I sat down with him and he said, Galen, I am terrified of losing everything in the market, I only want to keep pace with inflation. And this was back in 2013 and he wanted to do like all GICs and stuff. And GICs were like less than a percent or something. And I was like, Why do you feel this way? And he's like, Well, my dad lost all his money with Nortel. Dimitre Ranev: [00:26:25] Right. Right. Galen Nuttall: [00:26:25] And I was like, okay. I was like, That is not the only way to invest in the market. And so I showed him a 20 year time lapse of the kinds of portfolios that we're using. And in 08/09, one of the biggest downturns in recent history, I mean, you can find portfolios that only dropped 8% and still did pretty good annual average rates of return since then. So people think, a lot of people think, like I have to be exposed to extreme amounts of risk to be in the markets. And historically, that's just not the truth. Obviously, you typically, like generically, get rewarded for more risk, but that's another big part of what I do with people is I help frame that because sometimes I'll meet people who have sort of a mis, they don't completely understand the markets because they have these horror stories of like an uncle or a dad or whoever. And I'm picking on guys, because guys typically make very brash decisions in investments. They've lost everything in one thing that they did. And they think, yeah, there's research that women make better investors than men. Dimitre Ranev: [00:27:24] I read that. Galen Nuttall: [00:27:26] Yeah, it's totally true. Which kind of blows my mind because when you look at all the major investment firms, like the major fund companies and all that, there's not a ton of women on them. And so I'm like, how come if statistically speaking, women make better investors, why aren't there more of them in these boards of like investment fund managers and things like that? So anyways, yeah. Dimitre Ranev: [00:27:46] Yeah, you're so right because I started my investment journey right after 2008, right? So I was very lucky. Really lucky. Galen Nuttall: [00:27:53] Yeah. You thought you were a genius. Dimitre Ranev: [00:27:55] I thought I was a genius. Everything was going up. But I remember talking to people who were, a good 10, 5 to 10 years after they had lost a lot of money, did not go back into the stock market because they're just so afraid. And sure, there is a possibility you lose everything, but that means Armageddon, like apocalypse, like you're not going to be worrying about your retirement plan if the stock market goes to zero. There will be other things happening in the world. So that's great. It's really... Because I think people you know, when I looked at the research for financial planning, the value of financial planning - I talked about this in my presentation - so surprisingly, it was done by Vanguard and Morningstar, which their deal was they sell index funds or mutual funds. So they didn't really necessarily like having financial planners involved, but they found that you guys, if I can say you guys, add some value. And part of it is the psychological thing. So you're there to make sure people realize this is the plan. You're going to retire in ten years. So a drop of 20% right now isn't affecting you. So don't sell everything. That's very valuable. That's probably worth the fee that people are paying if you prevent them from selling all their stocks and never going to stock market for the next ten years. And that's why I want to talk to you today, because I wanted people to know that this existed. Studies in finance are not like medical studies, not rigorous, but there is value to having somebody like you on the team especially, forget about the investments, but the incorporation part, which is complicated. Like I've been incorporated for ten years and I'm still like surprised by some things I learn, right? And having somebody navigate that is really important. So I do have a follow up question because you're very knowledgeable in corporation, but... Is there some?, I've heard about the clichés about why you shouldn't incorporate, but do you practically have clients where you should tell them not to incorporate? Do you have that or do you have clients who have incorporated and you think it was a bad decision for them? And what would make that a bad decision? I'm really curious if you have that experience. Galen Nuttall: [00:30:12] Yeah, Yeah, for sure. Yeah. And I do want to just echo one thing that you said about the value add of an advisor. The one, the thing that I think that people, sort of the character, the sort of generalization is, okay, I could get 6% with an advisor, but if I cut that fee out, I'm going to get 7% with an index fund. Like because I think the general, like you see these charts all the time where it's like, oh, over the lifetime of your investments, you could save tens or hundreds of thousands of dollars by saving on fees. But that's not the only variable. Like, if that were the only variable, I would totally hang up my hat and say, forget about it. Like you guys go pick your index funds. I just don't even need to be here. That's not the only variable. And then the study that you sent me showed that advisors on average add 3% net of fees value to their client's portfolio. And you say what? Like they, a good advisor will admit that they can't time the market. So it's like, well then how are you making more money? And that's what I say to people is my job is not to beat the market, it's that you would have significantly more money in the future than if you didn't work with me. And if you're like, okay, how does that work? Well, so, it is partially fee, but it's more like you said, like the behavioral side of things. And that 3%, I would venture that if that, if the study they had done were with people with with corporations that had good corporate planning, I think that would be much higher than 3%, especially in Canada, where taxes is such a consideration, either while you're alive or when you're gone. So that's just one thing I wanted to add with that value add is corporate planning, just as one, when you gave your talk that I was there for in Toronto, you were talking about portfolio construction and someone asked a really great question. They said, Are you talking about non-registered or RRSPs? And then you're kind of like, Well, that's a whole nother ball of wax, you know, like a whole nother, like registered versus non-registered is a whole nother thing to know how to invest properly. Anyways I couldn't help but add that to the to the conversation about value added. Dimitre Ranev: [00:32:05] That's that's the thing, people talk about management fees but your biggest, taxes are the biggest fee you're going to be paying on investments by a lot, by a lot. So if you can get to be tax efficient and I'm not saying like, taxes are important, we all get why we pay them, but if you can be more efficient with the way you pay your taxes, you compound a lot more than if you save an extra 1% fee by not talking to somebody who knows what they're doing. Galen Nuttall: [00:32:32] Exactly. Dimitre Ranev: [00:32:34] So that's very important. Galen Nuttall: [00:32:35] And another thing is debt reduction. That's another big thing that we help people with. Like we oftentimes meet doctors that are very aggressively paying down their debt. They're incorporated, so every dollar they take out of their corporation, they lose $0.30 to taxes, and then they're going to pay off a debt that currently might be at around 4%, I don't know. But it's like you're going to spend $0.30 off taxes to then pay down something that you're accumulating $0.04 per year. We start looking at those things, and I did a plan for some clients who we looked at, they wanted to accelerate their mortgage, they wanted to pay it off in two years instead of five, I think. And we showed them by leaving that money inside of their corporation to compound tax efficiently pre-personal tax, so slowing down their mortgage just by a few years, they were going to have an extra $2 .illion in retirement. And that $2 million means extra trips, bigger legacy, you know whatever that looks like for them just by that one thing of like being really smart with how they take their money out of their corporation. So I can now, I think, answer the corporation question. Dimitre Ranev: [00:33:35] Yes. And I'll get back to that issue you're talking about. Go ahead. Galen Nuttall: [00:33:38] Yeah. So I was on another podcast recently and they said, like, I'm not in the financial planning group for physicians because I'm not a physician. But one of my clients did say, like, there seems to be a hot topic in there. I mean, there's a couple of hot topics in there. One would be should you own occupation disability insurance or not? Like I've heard that that's kind of a big thing. Whole life insurance obviously is a huge, divisive, polarizing topic. And the other one was whether you should incorporate or not. And I was like, this is really like, or even if if you should incorporate or not. And I was like, I mean, all my clients are incorporated. The times when I would say that someone doesn't need to incorporate or doesn't need to rush to incorporate, at least from a financial planning standpoint, like incorporation has a legal and an accounting standpoint, I'm going to talk about the financial planning standpoint. So if there's a legal or an accounting reason, that's not what I'm talking about. But from a financial planning, investing, savings standpoint, typically if someone is spending every last penny they make, it doesn't make sense for them to incorporate because you're not really, like the government a few years back there's a thing called integration where basically what they said was they didn't want people to be able to earn money into a corporation, then bring it out personally and be better off than if they didn't have a corporation. Right? They didn't want to penalize people who couldn't incorporate. So they got really, you know, certain things like you used to be able to pay yourself a dividend that you'd save a little bit or you'd sprinkle money to your kids and split income with your spouse, like there are all these things that are really quite diminished now. So like if I meet a physician and I haven't met, I mean, I don't, I mean if I meet a physician who's very early on and they say to me, Galen, I do want to pay down some debt aggressively, I need to buy a house, I need to buy a car, you know, it's my first year in practice, I might say, You know, don't be in necessarily a rush to incorporate if you think you're going to spend everything you make. Because basically you're paying a fee to incorporate from a legal standpoint, you're paying a fee to file your corporate taxes and your personal taxes. So it's like, do you really need that extra cost, which isn't a ton of money, but it is money and it's like, is it worth it? But the vast majority of physicians, I mean, it makes complete sense for them to be incorporated. Although I will say, like I give a talk about incorporation and I say a corporation can either act as a sale that you add to your financial ship that speeds you forward to your destination or an anchor that slows you down from getting to your destination. And the anchor comes into play when people save money inside of their corporation and they don't do anything with it, or they put it into something like a GIC where they're going to lose half of the growth to taxes or they put their money in something like US dividend bearing stuff where they're going to get, the growth is going to get penalized and all these other things. So like the caveat to the generic rule of thumb that I, the accountants that I know say, if you don't need the money, leave it in your corporation. But far too often I meet people who leave it in the corporation and they don't do anything with it. And it's like, okay, you save taxes, which is nice. But there's also this thing called inflation that is eating away at the power of your money if you're not doing anything with it or if you're just invested in very conservative things, you're losing half the growth of taxes and you're not even keeping up with inflation. So that's the caveat to it all. Like you want that corporation to act as a sail. Tax efficient things that are going to push you towards your goal, not like these inefficient things that are going to be an anchor. Dimitre Ranev: [00:36:43] I mean, how much do we lose in inflation, what, eight, 8%, -8%, just keeping it? More than that. Galen Nuttall: [00:36:49] Yeah. Inflation, like, yeah, depending on how you calculate it, there's a lot of obviously a lot of talk out there as to how we calculate it and whether we should calculate it. But I mean, at the end of the day, there's ways to achieve tax efficient compounded growth inside of your corporation where it's pre-personal tax. And we've already talked about this, but I mean I'm going to hammer it into the ground, is that every dollar you take out of your corporation like you're losing quite a bit to taxes. And I get why we pay taxes, I'm not saying we shouldn't pay taxes, but if you have, the beauty of the corporate structure is the flexibility on how you pay yourself. Because if someone's just an employee, like if I were, if I'm an executive, well, I'll just say this, if I'm an executive at IBM and I'm not incorporated and the government pays me 350,000 a year salary, I'm going to lose so much of that to taxes. If I'm a physician with a corporation that bills 350,000 a year and I only need to live off of 90, I get to keep a whole bunch of money pre-personal tax to compound for me for the future. So it's really a, I mean if you use it effectively, it's it's an incredible bonus. Dimitre Ranev: [00:37:52] It's a gift. It's a gift. I mean, I keep saying this, it's a gift to physicians. And I would add the GICs are doing slightly better this year because interest rates. Galen Nuttall: [00:38:01] Yeah, GICs, they're looking great. I mean when GICs go up, mortgages go up. So you'd have to see. Like I have a client that got a mortgage yesterday for 3.6%. And the mortgage that I got five years ago is like 0.95. But that's back when GICs were doing like 0.85 and now GICs are doing 4.5. So, I mean, actually, yeah, I won't go much into the mechanics, but we are going to see a huge shift in how returns are achieved in the markets because for the longest time, none of our, next to none of our return came from fixed income, for like a very long time. Because things like GICs and treasury bills and all these things that used to sort of prop up a portfolio, were doing nothing. So you had to get all your money from, or most of your returns from higher risk stuff. So it is going to shift a lot of how we get our returns, at least for a little while. Dimitre Ranev: [00:38:49] I think that's what's so, yeah, that's what's so exciting. Galen Nuttall: [00:38:51] Yeah, it's all a spiderweb. Like one thing moves, another thing moves, like it all, it all kind of moves together. Dimitre Ranev: [00:38:56] That's what I love about the market. It keeps shifting and going around. I just want to finish off by saying the whole debt thing, because so I come from Eastern Europe, right? And communist country, right? So that was like a sin. Like it's, you don't go in debt, credit cards. I remember when I when I came to Canada, credit cards were like the devil, right? Galen Nuttall: [00:39:20] No. Dimitre Ranev: [00:39:21] And the thing about it, and that's why it helps to have somebody talk to you through things about your belief systems, is there's some bad debt, but there's some good debt. And that's where talking to somebody like you, where you can actually show the math of what bad debt is and good debt is, and and change that belief system, which is untrue, is very valuable. So I want to thank you for taking the time to talk today. I hope I can have you again. I think you're very knowledgeable and you explain things very well. And I have so many questions for you. Is there anything you want to add before we end the podcast? I have so many questions, but we we have to keep the time. Galen Nuttall: [00:39:58] Yeah, yeah. Dimitre Ranev: [00:39:59] So I know that you might be training to run a triathlon. So if that's still the case, I wish you all the best, I wish you good luck and thank you for your time today. Galen Nuttall: [00:40:08] No, thank you so much. This was great. Dr. Kevin Mailo: [00:40:11] Thank you so much for listening to the Physician Empowerment Podcast. If you're ready to take those next steps in transforming your practice, finances, or personal well-being, then come and join us at PhysEmpowerment.ca - P H Y S Empowerment.ca - to learn more about how we can help. If today's episode resonated with you, I'd really appreciate it if you would share our podcast with a colleague or friend and head over to Apple Podcasts to give us a five star rating and review. If you've got feedback, questions, or suggestions for future episode topics, we'd love to hear from you. If you want to join us and be interviewed and share some of your story, we'd absolutely love that as well. Please send me an email at KMailo@PhysEmpowerment.ca. Thank you again for listening. Bye.
	30 Jun 2023	22 - Lessons in Personal Finance and Happiness with Nour Khatib	00:32:32
Dr. Kevin Mailo welcomes Dr. Nour Khatib back to the show to share her insight into personal finance and finding happiness. Dr. Khatib has an MBA and worked in the finance sector before returning to medicine as an emergency physician, which has given her educational and practical knowledge on physicians and finance. Nour Khatib talks to physicians about burnout and wellness because, she said, digging into those topics made an impact on her and she wants to share that learning with her colleagues. Part of happiness is finance and she has some key pieces of advice to share. Advice for those just getting started, because it’s never too late to caretake your personal finances, but also advice for those already on their financial journey. In this episode, Dr. Kevin Mailo and guest Dr. Nour Khatib talk all about personal finance, from what incorporation means to compounding to diversification. Nour explains the time value of money, why everyone needs a team of experts to assist their financial aspirations, and how diversification can reach beyond the public markets into the public sector. The conversation is full of book recommendations, practical tips, and also real questions around what makes us happy and how finance is only one part of that equation. About Dr. Nour Khatib: Dr. Nour Khatib MD CM, MBA is an enthusiastic and dynamic emergency physician and financial professional with keen interest in Quality Improvement, Patient Education and Global Health. She completed her family medicine training at Sunnybrook Health Sciences Center and did further training in emergency medicine at the University of Ottawa (CCFP-EM). With extensive experience and a professional record as a financial and business analyst, Dr. Khatib has excelled in both international and local firms with determination, hard work, and resourcefulness. Utilizing a broad acumen in healthcare, finance and business practices, she aims to solve issues regarding the quality of healthcare and the patient experience. Resources Discussed in this Episode: Physician Empowerment “Episode 5: Med School Dropout with Dr. Nour Khatib” “Millionaire Teacher” by Andrew Hallam “The Wealthy Barber Returns” by David Chilton “Beat the Bank” by Larry Bates “The Value of Simple” John Robertson, PhD “The Millionaire Next Door” by Thomas J Stanley, PhD and William D Danko PhD “The Millionaire Mind” by Thomas J Stanley The Happiness Lab with Dr. Laurie Santos podcast — Physician Empowerment: website \| facebook \| linkedin Nour Khatib, MD CM, MBA: linkedin __ Transcript Dr. Kevin Mailo: [00:00:01] Hi, I'm Dr. Kevin Mailo and you're listening to the Physician Empowerment podcast. At Physician Empowerment, we're focused on transforming the lives of Canadian physicians through education in finance, practice transformation, wellness and leadership. After you've listened to today's episode, I encourage you to visit us at PhysEmpowerment.ca - that's P H Y S Empowerment dot ca - to learn more about the many resources we have to help you make that change in your own life, practice and personal finances. Now on to today's episode. Dr. Kevin Mailo: [00:00:35] Hi everyone. I'm Dr. Kevin Mailo, one of the co-hosts of the Physician Empowerment podcast. And today I am absolutely honored and excited to have Dr. Khatib, Dr. Nour Khatib, joining us again for another great episode. And today Nour is going to be talking a little bit more about her financial journey and some of the fundamental aspects of finance that every physician, regardless of their stage of practice, needs to understand. And for those of you that do not know Dr. Khatib, she wears a lot of different hats. But the big thing is that she is a physician like us. She's an emergency physician, but she had a career before medicine. She practices not only in the GTA, but also northern Ontario in remote, and she does do some international work as well. Dr. Khatib also has.... well, maybe you want to describe it for us, Nour? Why don't I just, why don't we just break there and I'll let you just talk and share what you do, where you're at. Dr. Nour Khatib: [00:01:35] Thanks so much, Kevin. I really appreciate the introduction. And thanks for having me tonight. Dr. Kevin Mailo: [00:01:39] I'm not very good at these. Not when they get this long. Dr. Nour Khatib: [00:01:43] No. No. I thought you did great. Dr. Kevin Mailo: [00:01:44] Such highly accomplished guests on the show, so I'm just going to have to let you do it yourself. Dr. Nour Khatib: [00:01:48] You're too kind. You're too kind. So over the last couple of years, I also started speaking to physicians like myself about burnout and wellness. And I know you're all rolling your eyes because I did, too. But I really feel that it's something that's affecting all of us. And I decided just a few years ago to stop rolling my eyes at things that are labelled wellness or labelled well-being and really start to dig deep and try to learn what that means. And it really made an impact on me and I wanted to share with my colleagues. So I've been invited to give talks about wellness and burnout in physicians. And so if you need to reach me to help out with your group, I'm happy to as well. Dr. Kevin Mailo: [00:02:28] Awesome. Okay, let's start. Tell us a little bit about your journey, Nour. How did you get from here? And for those of you that don't know the earlier episode, I think it's episode number five on the Physician Empowerment podcast, was a deeper introduction to Nour's background, but it's entitled Med School Dropout, so a really great story and by all means go back and listen to it. But for now, just tell us how you got to where you are. Dr. Nour Khatib: [00:02:54] Absolutely. It's entitled Med School Dropout for a reason, because actually, I was a med school dropout. So basically what happened is, I had gotten into med school at a very, very young age, wasn't sure that it was for me, and ended up two months in quitting and going into business. So I in fact, did a finance degree. I worked in finance for Pratt and Whitney Canada, which is an engine airplane engine manufacturer. And there, that's where did my MBA at the same time. All in all, at the same time, always thinking what if, what if, what if, what if I had continued? What if I had not left? What if I had a different path? And at that point I thought to myself, If I don't try now, I never will. And I'll always be second-guessing and I'll always be wondering. So decided to risk it and quit the business life that I was working in and ended up going into medicine and absolutely love the fact that I left the first time. And I'm very, very grateful for being able to come back the second time. And in that career, though, in that path, I learned quite a few things about finance that I actually was never taught in my finance degrees. So there's a lot of things that real life teaches you and not your degree, not your piece of paper, not the textbooks. Dr. Kevin Mailo: [00:04:11] Good. Love it. One theme that's already popping out is the notion of the lifelong learner. I mean, we talk about continuing medical education throughout our careers, but it sounds like, you know, this has been a, you know, a big personal journey for you. Dr. Nour Khatib: [00:04:27] Absolutely. And I would say the first ten years, I didn't not learn personal finance. But then once you start making money and wanting to know what do I do with it, that's when you start learning personal finance. And it's not really taught well in business school. It truly isn't. I believe it was an elective and one elective in the entire four years of the bachelors. So it wasn't even mandatory when truly it should be something mandatory for everyone in every field. Dr. Kevin Mailo: [00:04:56] Awesome. Awesome. Okay, continue. Share. Share your journey with us. Dr. Nour Khatib: [00:05:01] I remember graduating and thinking, okay, great. It's June 30th. I'm ready to take on the world. I, you know, no longer does anyone have to sign the bottom of those charts. And, you know, these patients are now mine and these decisions are now mine. And I felt great about it until I realized, Oh, damn, these patients are now mine. These decisions are now mine. And I have no, there's very little hand-holding, especially when it comes to outside of medicine in terms of what do we do next? Who do we talk to next? So July 1st really felt overwhelming, especially the month after July 1st when you start actually making some income and realizing, okay, when do I incorporate? How do I invest, who invests my money and how much do I save and how much do I even invest? And what do I even mean by investing? So I spent the first two years after graduating, doing a lot of learning on my own. And honestly, it taught me more about finance and personal finance than I ever learned in business school. Dr. Kevin Mailo: [00:05:59] Wow. Wow. Dr. Nour Khatib: [00:06:01] So exactly what you said, the lifelong learning thing. And I'm still learning. I still got a few books that I want to get through to learn more about it. And I'm telling you, a finance degree and an MBA did not teach me any of these personal finance pearls that you need, in fact, anytime. Dr. Kevin Mailo: [00:06:17] Let's stop there and I'll just share one reflection that I'm having is the fact that you don't have to have an MBA to be great at personal finance. You don't have to have a background in real estate to be a real estate investor. You don't need these things necessarily to be successful in this space. I'm not, I don't believe in do-it-yourself, not one bit, but you need to have at least the tools to be able to interact in the world of finance, and those can be acquired through self-learning. Dr. Nour Khatib: [00:06:49] Absolutely. The tools, the drive and the curiosity. And I would say curiosity is the big one. You have your best self-interest in mind. And so if you're, you know, if you're not putting pen to paper and trying to learn on your own, and I know we all lead busy lives, but we're leading them for a purpose, right? We're leading them not just to work the 12 hour days that some of us do. It's because we want a better life for our families, because we want to retire eventually, we want to have a better life or enjoy what we're doing or earning. Right? And who better to try to sort that out than yourself through learning about how to do that? And so the first things I asked myself after is, okay, so what about this debt that I have, and when do I incorporate, when do I not? The first thing is get your tribe in order. And who's your tribe? It's going to be your accountant, your lawyer, your financial planner or advisor, and get the right people in your circle to advise you appropriately. I'm not saying become an accountant. I'm saying you need people around you that know things, more than you do, not everything can be DIY. I completely agree, Kevin. There are some things that can and some things that can't. And accounting is definitely one of them. Dr. Kevin Mailo: [00:07:59] Wealth creation is a team sport. Wealth creation is a team sport, in my opinion. Dr. Nour Khatib: [00:08:04] Absolutely. Absolutely. And so when it came to debt and incorporating, I spoke to my accountant and we literally ran the numbers together. He was very, very patient with me and went through, okay, this is what happens if we incorporate now, this is what happens if we incorporate later. This is how much you need to save a month in order for it to make sense that you incorporate. So just keep listening to them, keep learning, keep looking that up, and just be curious about it. And whether you're two years in, six months in or 15 years in, don't think of the years that are lost. That's what we call in finance sunk cost. That's not going to help if you think that way because there's still the many, many years ahead that you can help renavigate yourself in the right direction. Dr. Kevin Mailo: [00:08:48] What an optimistic message, right? Because I think there's a lot of us out there who look back and go, woulda, coulda, shoulda. And I think that's all of us in some aspect of our financial lives. But the truth is, it's irrelevant to worry about past financial mistakes or I shouldn't have bought so much house or, you know, I missed out on this investment opportunity, or I wish I learned about real estate sooner in my career. You know, you can go endlessly with those kinds of questions, but I don't think it's helpful. I think what's helpful is looking at the here and now saying what's the best decision I can make for my life, for my family and for my future? Dr. Nour Khatib: [00:09:19] Absolutely. And I mentor a couple of students from U of T, and what I've told them is here is here's what I wish I knew. And one of them was learn about what it means to incorporate. Even if you're a few years in it's good to know, it's good to know what you can expense, what you can't expense and what it means to incorporate. We all think that it's just a way to save us some taxes. No, there's a lot more to it than that. And there's a lot of things that we can learn at any stage really about incorporation. Dr. Kevin Mailo: [00:10:12] Love it. Love it. Okay, keep going. Dr. Nour Khatib: [00:10:14] The next question I asked myself was, okay, so who invests my money? I mean, with a finance degree and an MBA, shouldn't I be investing my money? But I felt like I wasn't sure, wasn't capable, wasn't, wasn't sure if I wanted to, to do that on my own. So what happened is I ended up actually interviewing six financial advisors. It was a period of like three months where I met six different financial advisors, met with them, talked to them, and learned what they can offer me, what they can help me with. And in the end, what was right for me personally was I ended up doing the DIY investing route, but I hired a financial planner who helped me make some decisions that made sense for me. Okay, so I still, even though I had and I can tell you my job title at Pratt and Whitney Canada was financial planner. So, but I was a corporate financial planner. But regardless, I still needed that hand-holding, that guidance to help me decide what I need to do and look at like retirement planning and all that. So I still hired someone to help. So again, the degrees don't really help you with this stuff? It's you. It's your curiosity. And trust me, this information is not beyond our intelligence whatsoever. You as physicians, you're very intelligent people. You're very curious people. You will be able to understand these concepts with just a little bit of curiosity and a little bit of time, you'd be able to understand these concepts. Dr. Kevin Mailo: [00:11:44] My own reflection on this as well, when we're talking about wealth creation is a team sport, is make sure that as you build your team, the people you know, your accountants, lawyers, real estate professionals, financial advisors, portfolio managers, whoever it is you're working with, make sure they're accessible for you. Because in the end, you pay them and you should feel comfortable asking questions, including the so-called stupid questions, the really basic ones, where you're like, Actually, can we roll this back? I don't understand what you're saying, but I feel like it's important. Can you explain it to me? And I've learned over the years it took me a while to just go ahead and ask the questions that are popping into my head because these folks, they want to help. Right? And they can't help if they don't know what the issue is. So, again, you know, it sounds like you found somebody, Nour, that you can work with who meets you exactly where you're at. Dr. Nour Khatib: [00:12:39] Absolutely. And so how did I decide on this person? First off, for me, I was looking at someone who was accessible, someone who would answer my stupid questions, because I had some, and someone who, of course, their costs were low. And for me, the fee-based financial planner was perfect for me. I was comfortable doing some investments on my own, but I just needed help, guidance, help with guidance on retirement planning, budgeting and things that really I never really looked into before. So that was in the end what did it for me in terms of how I picked the person that I picked. So it was the financial planner, the accountant, the lawyer, and I made sure that all three of these were people who were accessible and responsive and would answer any question that I had, right? And for me, the accountant was ideal for me to make sure that I have someone that I trust and that I can and that other people have vouched for. So I found him through word of mouth because I actually spoke to other accountants who I felt were more interested in how much business they were making themselves. And you can get that if you meet them face to face or whether it's virtual, you can get that sense and, you know, really go with your gut when that happens and you realize it's not a long-term relationship, you can always change if anything, if anything happens or you don't feel comfortable with them again. Dr. Kevin Mailo: [00:14:03] Absolutely. Absolutely. So, you know, you have all this background in business, years and years of training and you worked in finance. Tell us the big lessons you learned about money and personal finance. Dr. Nour Khatib: [00:14:17] Sure thing. Absolutely. Here are some things that in seven years of business school, what I've learned mainly about personal finance and there are three concepts I think everybody should know in any field. Okay, so we'll start with the idea of compounding. So compounding, it's basically the process in which an asset's earnings are reinvested to generate additional earnings over time. So for example, if you are investing, if you are making, if you're investing $10 and then you make an extra dollar above that, the compounding is what that $1 will make in the future. It will be compounded for more and more. So it's really an exponential growth. Investments will generate earnings from both your principal, so your $10, and the accumulated earnings from the interest part, which is the $1. And so that, over time, is an incredible exponential growth. And the power of that idea of compounding is so significant that if I give you an example of like there's, here's an example of one investor who starts at the age of 25. She sets aside $5,000 a year for ten years. And that's it. At age 34, she stops. Then you've got a second investor who starts at 35, so starts ten years later than her, and he puts in $5,000 each year for 30 years and he stops age 65. Believe it or not, the first investor that only invested for ten years does better in the end at age 65 than the second investor, and that is because of the power of compounding. That's not because investor one was smarter than investor two or invested their money better, with someone better than investor two, it's literally about the amount of time. So when do you start? Now or yesterday. And don't feel bad that you haven't started yet or that you, um, or that you haven't looked into this yet. Just start is my biggest take, my biggest learning lesson. Dr. Kevin Mailo: [00:16:18] Wow. I love it. So. So what's this related concept of time value of money? Dr. Nour Khatib: [00:16:23] Yeah. So the other concept that they teach you and they hound you in business school is the time value of money. Basically saying that the value of a dollar today is worth more than the value of a dollar in the future, mainly because the money you have today, the money that you get today can be invested and therefore can make more money in the future. So I'd rather have $100 now than $100 a year from now because in that one year, I can invest it and make more money. So that's the time value of money. Money today can be invested and therefore has potential to grow. And so it's worth more. And it's used to make some strategic long-term financial decisions, such as whether you invest in a project with certain cash flow versus another cash flow. So, you know, like when they tell you, well, if you win the lottery, would you like the lump sum now or would you like it over a few years? So people use time value of money calculations to try to make that decision. And it really it's compounding and the time value of money together are very, very similar concepts. Dr. Kevin Mailo: [00:17:25] I love that. Absolutely love that. And I mean, this also even just is, you know, a reflection of our personal spending. Right? Like spending on consumer goods or what have you, I mean, it's out the door, right? And that, it's not just the value of that dollar that was spent now on consumer spending. It's what it could have bought you 10, 20, 30 years down the road when it's been compounded. And that's always the calculation that runs in my head when I consider like, do I really want this like widget? Dr. Nour Khatib: [00:17:55] Absolutely. And you have to think to yourself, like how much, when I start thinking like that, I go through a rabbit hole and then I don't want to pay for anything. But then you think to yourself what marginal benefit or marginal happiness is this going to get me? Dr. Kevin Mailo: [00:18:08] Yeah, right. Love it. Dr. Nour Khatib: [00:18:10] Is this widget going to bring me more joy in the future or is it going to give me immediate joy for the next ten minutes and then once I get used to it, the joy is gone? Dr. Kevin Mailo: [00:18:17] Yeah, totally, totally. Love it. Keep going. Tell us what else you learned. Dr. Nour Khatib: [00:18:22] So the third aspect that they teach you in business school is diversification. So diversification basically means it's a strategy where you're not going to put all your eggs in one basket. Okay? So what that means is you mix a variety of investments or a variety of different things in your basket so that if one does poorly, you're not at a huge loss because when one does poorly, sometimes one does better or one stays the same. And so it's a strategy that mixes a wide variety of investments within a portfolio in an attempt to reduce the portfolio's risk. So diversification is most often done by investing in different asset classes, like, for example, in stocks and bonds and real estate. And so when you mix that up, then the risk of that portfolio is actually reduced. So buying investments in different countries also is a type of diversification, industries, sizes of companies, and so that's also a concept that business school really hounds. And in fact, in a lot of classes in business school, they make us go through the calculation of trying to figure out how many stocks do you need in order to have a diversified portfolio. And if you look at some of these indices nowadays, there's like 12,000 stocks in them and whatnot. Right? But in fact, it's only a handful. It's about 30 stocks that you need in different industries and different companies and different types of companies that will help mitigate risk. And so you can mitigate that diversifiable risk. Dr. Kevin Mailo: [00:19:56] And what about diversifying outside of the public markets? Because I mean, we've seen we've seen a big market correction this year or last, beginning last year. And a lot of physicians, you know, come to us asking about private equity and whether that's startups or real estate projects, people are looking to diversify. It actually, if you look at the numbers, there's a lot more money being made outside of the public markets in the private markets than there is in the public, than there is, you know, on the stock market, if you want to call it that in its simplest term. So how do physicians diversify there? Right? Because there are pitfalls associated with it. Dr. Nour Khatib: [00:20:36] Absolutely. So there's many types of diversification. You can diversify within the stock market, whether it's bonds or stocks or, you can diversify within that. But then what you're saying is go externally and that's another level of diversification. So absolutely, if you have the luxury of being able to access markets that are outside of, you know, the public domain, then that is a different, that's a type of diversification. As long as you're not putting all of your eggs in that one thing. Dr. Kevin Mailo: [00:21:02] Exactly. Dr. Nour Khatib: [00:21:03] That's a type of diversification. Dr. Kevin Mailo: [00:21:05] Yeah. I mean, I often deal with physicians who are very keen to join in certain real estate projects, and I will often tell them to exercise some caution about like, don't put so much money into this, you know, if it's really going to hurt to lose it or if you're not, even if you're not going to lose it, but you're just not going to sleep well at night, you really haven't added to your well-being by making such a big gamble. And the other thing that, you know, I'll reflect on in the private markets is that physicians are very, very privileged because of our high incomes. We are almost all of us are accredited investors. And an accredited investor means, is a category that allows you to join in the private markets in a way that the general public cannot access because their income is not high enough. And those rules were set up to protect essentially middle and working-class folks from getting swindled in private equity deals. And so there is risk. But at the same time, there's a lot of upside because there's a lot more money that's made in the private equity sphere than the public markets potentially. But there has to be a lot of due diligence and caution exercised there as well. Dr. Kevin Mailo: [00:22:14] So again, it's just, it's that notion of diversity can be a lot bigger and a lot more three-dimensional than just picking a wide spread of stocks. The other reflection, and this is something that, you know, I kind of learned from Wing was, you can diversify within an asset class that you're comfortable with, right? So if you love real estate, you can own reits which are publicly traded. You can own reits that are privately traded. You can own your own doors and manage them yourself. You can invest in private equity deals and real estate projects where you are a limited partner and you're hands-off. You can even consider your personal residence to be a part of that diversification as well. Right? So again, it's kind of wrapping our heads around the idea of diversification being more than just, you know, a spread. And to allude to what Nour said earlier is like, you know, we sit there and you look at the staggering array of different stocks you can buy in the market, but there aren't necessarily a lot that are wildly different from one another when you're trying to diversify. Dr. Nour Khatib: [00:23:15] Absolutely. Agree with everything you've said. And then the fourth concept, though, is with increased risk, increased return rate. When you have got a lot of risk, you might have a lot of return. Low risk, low return. That's another concept to think about. But as long as you're diversifying, whether it's public, private or a mix of both, as long as you have that in mind and you're comfortable with it, and keep in mind, you have to be very honest with yourself. Are you more of a conservative investor, more of an aggressive investor? And there is a ton of surveys out there that will help you decide that because you might not know yourself, right? Dr. Kevin Mailo: [00:23:53] Oh, I love that, actually. That's great. Dr. Nour Khatib: [00:23:55] These will help you decide what kind of investor are you. There are certain questions and behavioral questions that they can take you through and they'll help you decide. Yeah. And whenever you sit with a financial planner or you sit with a financial advisor, they'll go through something like that with you. But if you don't have one right now, that's it's fine to try to understand what kind of risk are you? Dr. Kevin Mailo: [00:24:15] Developing our own notion. I love that. Developing our own notion of risk tolerance and what we can live with. Right. Because, and I've said this again, I kind of rant on it, is like no matter how much money you're making, you really want to be sleeping better at night. That's one of the whole purposes behind money is not just to buy you things, but to buy you a sense of security and peace of mind. So if you're not enjoying your process of investing, then maybe you should reconsider something that fits more along the lines of you as a conservative investor or you as a, you know, an investor with a higher risk tolerance. Right? Because there's upsides and downsides to both. The other aspect to diversification and appreciating risk is the notion that, you know, when we are diversified, that means that not everybody's a winner, right? Like if you look at your basket of investments, if you are truly, truly diversified, it's rare that they're all going up. And it's great when things are going down in certain categories because others will go up. But psychologically, you have to internalize the fact that, yeah, well, if I really spread myself geographically or across different asset classes, then it's, you know, there are going to be times when, you know, certain asset classes underperform relative to others and be willing to accept that as part of the discipline of diversifying. Dr. Nour Khatib: [00:25:33] And you're constantly learning, you're going to learn about yourself. You're going to learn what your risk, your, you know, when it comes to real life, it might be very different from the survey you took to see what your risk level is. But that's the beauty of it, is that you're going to constantly learn and constantly adjust and just stay the course, stay, adjust, but stay the course, if that makes any sense. So it just is, navigate slowly but surely, as long as you've started. And I think that's the biggest thing I learned over the years, is that I just need to keep learning about it. I just need to keep going, keep learning about new asset classes or things, ways for me to diversify, ways I'll be comfortable with. And the learning never stops. And I hope that this kind of instilled a sense of curiosity in you, because I, I do have a couple of books that I would love to recommend to you and might recommend to your listeners. And they're books you may have heard of. And I've always had thought of reading, but I highly would recommend books like The Millionaire Teacher, The Wealthy Barber Returns, Beat the Bank or the Value of Simple. So those are the four books that I'm looking at and it talks a lot about investing. Any books, Kevin, that you highly suggest to the listeners? Dr. Kevin Mailo: [00:26:47] You know, like the ones written by Stanley Thomas in the 90s were foundational for me. They were called The Millionaire Next Door and The Millionaire Mind. He kind of wrote this millionaire series and he was a researcher, a PhD, and he did a lot of like quantitative, but also a lot of qualitative research. But really, I found those books to be so powerfully centering because society's concept of wealth, like what's projected on the media, social media advertisements, is very different from what real wealth looks like and that most people that enjoy an extremely high net worth, let's say, you know, people that are in the eight-figure range and up, they live a lot further below what you would think they do. And it's because fundamentally they haven't changed as a person. Right? And he summarizes his books by saying a millionaire is a cheap date, which means a millionaire can have fun, can enjoy life doing basic things. And not that you can't travel, not that you can't have nice vehicles, nice homes, all those sorts of things. But it's a centering and this grounding exercise. And so those books were very beautiful for me. It's something I teach my children, but it's being happy with what is now rather than always I want, I want, I want. Because that force, when we're in that position, we're spending today's dollars. And as you said earlier, Nour, the time value of money is so precious. Right? So I'd rather that money was compounding than a very transient joy or little dopamine hit from whatever little experience or widget I purchased. So it's funny, those books are, they don't teach investing, they don't teach anything about like making money. They're not even that relevant for the 2020s now. But there's a lot of wisdom there and a lot of universal truths. So, so those are the ones that I really, I really center on. Dr. Nour Khatib: [00:28:45] That's a great add. That's a great one. Dr. Kevin Mailo: [00:28:47] And there are lots of others I recommend whenever I teach but those are the first ones that come to mind. Dr. Nour Khatib: [00:28:53] You made me think of one of my favorite podcasts, actually. It's called The Happiness Lab. So the Happiness Lab by Dr. Laurie Santos. She's a psychologist at Yale. Oh, you're going to love it. You're absolutely going to love it. So every episode she talks about the science of well-being, the science of what makes us happy, and all these evidence-based studies that talk about what makes people truly happy. And the biggest thing that she mentions is something called the hedonic treadmill, the hedonic adaptation, basically the tendency of us mere humans to quickly return to a relatively stable level of happiness despite a recent positive or negative event that has happened. So buying that boat, eventually you'll go back to your stable level of happiness that you had before buying that boat. So just things to consider and things that I learned on that podcast were phenomenal. And adding to my, I would call it wellness wealth, I would say, because it's really helped. It's really helped. Dr. Kevin Mailo: [00:29:56] Your happiness bank. Dr. Nour Khatib: [00:29:57] My happiness bank. Yeah. And it's something that definitely I would add to your financial literacy because it really does help in making us decide on what's important and what's not important. Dr. Kevin Mailo: [00:30:07] And even just the bigger question of the pursuit of money because I think it is important. Money matters. That's why I teach it. That's why I try to live by some of these principles. But in the end, it's like, how much do you need? How much? How much is enough for you? Not looking at what society thinks we should have, not looking at our neighbors, our colleagues, you know, but really, it's that bigger question of what do I need right now to be secure and enjoy peace of mind and have the most amount of happiness? And when I teach it, I've got this little cute slide saying that money isn't the cake, it's one of the ingredients. And that's all it is. That's all it is. And another million probably isn't going to have a meaningful impact in most people's happiness. Dr. Nour Khatib: [00:30:55] Completely agree. Completely agree. When I teach my wellness talks, I tell them wellness wealth, one of the prongs is your financial goals. Dr. Kevin Mailo: [00:31:05] Love it. Dr. Nour Khatib: [00:31:05] One of the prongs of the wellness wealth is your financial stuff. But otherwise it's many different things. Dr. Kevin Mailo: [00:31:11] Nour, this has been absolutely phenomenal. I know we've got more, but I think we've got to wrap up. So that means we just have to get you back on the show again at some point in the future. Dr. Nour Khatib: [00:31:22] It would be my pleasure. Thanks so much, Kevin. Dr. Kevin Mailo: [00:31:24] You know what? It was just amazing. Every time we talk, I always love it, I always feel like I'm learning and not just like concepts, but the wisdom that you share. And for those of you that don't know, look Nour up. She does this incredible work in the space of workplace wellness, which I feel our profession needs now more than ever, because obviously things aren't getting better post-pandemic. So again, I encourage you to reach out to Nour for your group or your event. And with that being said, I want to wrap up and sincerely thank you, Nour, for joining us. Dr. Nour Khatib: [00:31:58] Thanks for having me, Kevin. Have a wonderful evening, everyone, and thanks for joining us. Dr. Kevin Mailo: [00:32:03] Thank you so much for listening to the Physician Empowerment podcast. If you're ready to take those next steps in transforming your practice, finances or personal well-being, then come and join us at PhysEmpowerment.ca - P H Y S Empowerment dot ca - to learn more about how we can help. If today's episode resonated with you, I'd really appreciate it if you would share our podcast with a colleague or friend and head over to Apple Podcasts to give us a five-star rating and review. If you've got feedback, questions or suggestions for future episode topics, we'd love to hear from you. If you want to join us and be interviewed and share some of your story, we'd absolutely love that as well. Please send me an email at KMailo @ PhysEmpowerment.ca. Thank you again for listening. Bye.
	30 May 2023	20 - Creating a Canadian Locum Network with Dr. Jordan Vollrath	00:24:29
Dr. Kevin Mailo returns as host and welcomes Dr. Jordan Vollrath, physician and co-founder of Cherry Health, to the show to talk about how he created an innovative physician network. It started with just locums but Dr. Vollrath describes how far Cherry Health has expanded and how it helps physicians. Jordan Vollrath had only worked in clinical medicine for a brief time after graduating from his residency when contacts and ideas fell together in serendipity to create Cherry Health. He enjoys his clinical work, which he currently does very part-time at the Alberta Obesity Clinic, but saw a real opportunity to create a job connection network for Canadian physicians where one was currently lacking. In this episode, Dr. Kevin Mailo and Dr. Jordan Vollrath talk about how Jordan’s start in locum work led to the first iteration of Cherry Health as a locum network, how it quickly expanded to all manner of medical employment, Jordan’s vision for the future information hub that Cherry Health will be, and why such a network will transform physician’s lives for the better. This episode will pique your interest in Cherry Health and the connection opportunities available. About Dr. Jordan Vollrath Dr. Vollrath completed his medical school at the University of Alberta in Edmonton before going on to finish his Family Medicine residency at the University of Calgary. He has worked in a wide variety of both urban and rural clinical settings including ER and hospital based medicine. He is a co-founder of Cherry Health, a Canadian technologies company. In 2020, he was awarded the Joule Physician Innovation prize by the Canadian Medical Association. He has a passion for mental health and its relationship with weight outcomes. In his spare time, he enjoys being active and outdoors - skiing, camping, mountain biking and spending time with his French bulldog. Resources Discussed in this Episode: Jordan Vollrath, MD on LinkedIn Cherry Health Doximity in the USA M3, Inc in Japan Doctors.net.uk in the UK — Physician Empowerment: website \| facebook \| linkedin __ Transcript Dr. Kevin Mailo: [00:00:01] Hi, I'm Dr. Kevin Mailo and you're listening to the Physician Empowerment Podcast. At Physician Empowerment, we're focused on transforming the lives of Canadian physicians through education in finance, practice transformation, wellness, and leadership. After you've listened to today's episode, I encourage you to visit us at PhysEmpowerment.ca - that's P H Y S Empowerment dot ca - to learn more about the many resources we have to help you make that change in your own life, practice, and personal finances. Now on to today's episode. Dr. Kevin Mailo: [00:00:35] Hi, I'm Dr. Kevin Mailo, one of the co-founders of Physician Empowerment and one of our podcast hosts. And today I am very excited to introduce to you Dr. Jordan Vollrath. Jordan is a family physician based out of Calgary who has developed, if you haven't heard of it yet you will, Cherry Health, Which is an online platform, online app, that allows physicians to connect with different locum services. So, Jordan, why don't you tell us a little bit about yourself, where you are in your career, what you do right now clinically, and then share a little bit about your journey? Dr. Jordan Vollrath: [00:01:12] Yeah, for sure. So thanks for having me, Kevin. Glad to be here. It's an honor. But yeah, basically like right now I'm working at the Alberta Obesity Center, so I'm mental health specialist and really I'm only part-time there. So I'm doing about like one day a week on average of actual clinical practice. And then the rest of the week is working at Cherry Health. Dr. Kevin Mailo: [00:01:31] Awesome. Awesome. How many years have you been in practice? Dr. Jordan Vollrath: [00:01:34] I've been an adult since 2019, so we're coming up on like four here. Dr. Kevin Mailo: [00:01:38] You've been a grown-up for a few years now. Dr. Jordan Vollrath: [00:01:40] Yeah, yeah. We're getting older. Dr. Kevin Mailo: [00:01:41] You're like, you're like a pandemic baby. Dr. Jordan Vollrath: [00:01:44] Pretty much, yeah. Just before that I actually had like, a real job for about seven months, and that's when things started to shift. Dr. Kevin Mailo: [00:01:51] Yeah, there was a time when we didn't wear masks for every patient encounter. There was a time, Jordan. Dr. Jordan Vollrath: [00:01:57] I recall that briefly from residency. Yeah. Dr. Kevin Mailo: [00:02:00] Okay. Yeah, yeah, yeah. I suppose it would have been some residency in med school before then. Okay, so tell me a little bit about, okay, where did you come up with this idea and then what were the early steps that you took to build Cherry Health? Right? Because I mean, clearly I mean, you had an idea. How did you take those first steps? Dr. Jordan Vollrath: [00:02:18] So it evolved just out of solving selfishly, like a problem that I had for myself. So after graduating, I was working as a locum physician, so I was doing locums, you know, all around Calgary, Southern Alberta, rural/urban stuff. And then so I really liked just the flexibility of booking my shifts on short notice. So I would do short notice coverage. I'd do like short-term coverage for a day, a week, a month, you know, anything in that kind of ballpark. And it was really fun. It was a really rewarding way to actually practice, like covering for people when they got sick. If somebody needed like last-minute time off, it was very appreciated by like all the doctors in the clinic. So I'd actually be, because that was like a very sorely needed thing. They didn't really have very many people that were willing to practice like that, but it had its pitfalls practicing that way, right? So it was kind of if you want to cover short-notice things, you have to leave your schedule open until short notice. So that resulted in lots of downtime, lots of like days where I actually didn't have anything arranged. Not that I really hated having a day off here and there, but like in terms of efficiency of... Dr. Kevin Mailo: [00:03:17] Yeah, quit bragging, Jordan. Keep going, keep going. Dr. Jordan Vollrath: [00:03:23] You know what I mean? Dr. Kevin Mailo: [00:03:24] No, no. I know what you mean. Dr. Jordan Vollrath: [00:03:25] It got to the point where there'd be like down days, down weeks. I'd be picking up a shift at a time, at some walk-in clinics, things like that. But anyways, like then the pandemic kicked in. Like I had only been working for six, seven months because I had graduated the previous summer and then took a month off. And then March came around and suddenly, like nobody needed vacation coverage anymore, you know, nobody was going anywhere. Nothing was happening. People weren't actually even leaving their houses. So zero people were showing up to the walk in center. And so now suddenly it got like even more of a stress, an actual like issue to try and book things back to back on this short notice. And so the whole inspiration for Cherry Health kind of was a bit of a serendipity. Like I was actually just like hanging out with some friends at one at somebody's house one day. And then I met a guy who worked at a local, it's called a venture studio, so basically, like what they do, instead of investing in startup companies, they invest their time and then they get a return of like a stake in the company. And so this guy, Maximilian Kurz, yeah, so I met up with this guy, Max Kurz, and he's a genius. So this is like what he does for a living at this venture studio. And we were kind of just like talking. He was telling me what he does, and I was like, That's super cool. Like, just like the whole process of innovating and coming up with new things and like, you have an idea how do you actually get it off the ground. And it's basically like consulting, but for startups and implementing all these different strategies for growth and building like operations and things like that. Dr. Jordan Vollrath: [00:04:56] And so I was like, That sounds super cool. Like, you know, the creative outlet and the actual ability to, like, think outside the box. You know, I found that, like a lot of the times in medicine, thinking outside the box seemed like a good avenue to malpractice suits and losing your license. You're very much expected to think inside the box for a lot of things. So anyways, this just sounded very foreign to me, like this whole premise of like, how he operated. You show up to work one day on a Monday and you'd have really not necessarily an idea of what you'd actually do that week because you kind of got to figure it out as you go. So we're kind of just talking and I was like, Hey, if anything medical comes across your desk, drop me a line anytime. I'd love to weigh in or hear what you guys have planned. And then the next week he just called me up on the phone and he's like, Do you have anything in health care, like problems that you yourself have or anything else? Any ideas? We kind of just started spitballing ideas and it started out with, Hey, I do all these locums and it's a pain to organize sequential work and high-quality opportunities. And then next week he called me back again and he'd put together the most impressive, gigantic spreadsheet I'd ever seen. And he's like, I think we can do something with this. I think this is, I think this idea has got legs. That's really how it all started. Dr. Kevin Mailo: [00:06:08] Wow. Wow. Excellent, Excellent. Dr. Jordan Vollrath: [00:06:12] Serendipity, hey. Dr. Kevin Mailo: [00:06:13] Love that. Okay, so. Okay, so we kind of know what, you know, what it started as. But tell us what Cherry Health is right now for Canadian physicians. Dr. Jordan Vollrath: [00:06:23] Okay. So it started out with the locum perspective on it, right? So we initially launched it just to tailor it to like connecting these temporary jobs. It's since expanded. So now it's all across the country, it's no longer just family doctors, and it's no longer just locums. So now it's full-time long-term jobs, part-time jobs, telehealth jobs, contracting jobs, any physician specialty, really all the provinces in Canada. So it's kind of like the one-stop employment shop now. Dr. Kevin Mailo: [00:06:51] Love that. Love that. And then talk to us about where you're headed with Cherry Health. Like what's your dream or what do you want for Canadian physicians with Cherry Health? Dr. Jordan Vollrath: [00:07:04] So, okay, this is where the really interesting opportunity, I think, lies is we're building this network essentially, right? And so the backbone of this network currently is predicated on employment, on jobs. And so the goal is to like start strengthening those connections between people. So right now, they're looking for work opportunities. In the future, we want to start expanding it more into sharing research articles, into sharing medical news. Dr. Kevin Mailo: [00:07:29] Oh, wow. Dr. Jordan Vollrath: [00:07:30] Kind of becoming the one-stop, you know, kind of platform for digital physician networking in Canada. Like right now, there's not a whole lot of like infrastructure, like digital infrastructure for physicians in Canada. Like other countries, the US has Doximity, you know, the UK has physicians dot net, you know, Japan has M3. It's essentially like LinkedIn for doctors, all these companies I'm describing. So that really is kind of the goal, right? So you could, you take this network, kind of this core foundation that we're building that's, you know, founded around the employment thing, and then you start adding more tools, more widgets, more things on there to actually like help physicians make their lives easier, their jobs throughout the day. Right? So that really is the value of the whole thing is you've got this collection of people and you can start putting on new tools, new utilities, all kinds of different stuff, you know, resources, different articles like how to optimize your billing, how to optimize your clinic workflow, connecting you with all the other innovations, all the other exciting things that are popping up in Canada. Dr. Kevin Mailo: [00:08:34] So as you grow, how do you maintain the quality of what's on the platform? Because I think it's one thing, it's like, okay, I'm a clinic, I'm advertising a locum opportunity, I'm a locum physician, I'll sign up, you know, Airbnb it, I get it, right? But how do you maintain, you know, quality? Is there a chat platform? Like what do you do in terms of that? Because I think one of the issues that we face in medicine, and I'm guilty of being part of that, is that we just throw so much information out there that it can be a little bit overwhelming for physicians. Like I kind of don't know what to do with the latest podcast episode on all of the different podcasts that I'm subscribed to, right? And so, you know, so talk to us about that, right? Like intentionality and finding some balance. Dr. Jordan Vollrath: [00:09:24] So one of the things we did initially, we actually had ratings and reviews on there. So for the different clinics now that was a bit of a hot-button topic. Yeah, like there was a lot of physicians who were like, Wow, this is a sorely needed thing. Like, how many digital marketplaces do you interact with lately that don't have that on there? Right? Like Uber, Airbnb. Dr. Kevin Mailo: [00:09:44] Yeah. Well, and you know, you step into like that clinic and you're like, blow the dust off the paper charts and you look in and you see like, it's going to be a little bit of a long week for me. Dr. Jordan Vollrath: [00:09:55] So anyways, that feature did not get ported over to the new platform that we just updated. It released. It may come back at some point in this next little while, I don't know yet. But in terms of that quality otherwise, like that really is a big thing that I'm dealing with right now is like we've got this very sophisticated tool and how do you engage everybody to use it properly? Like so we've been doing some webinars for some of the local health associations recently just on like how to recruit. And this included a big focus on how to create a job posting that was actually appealing. Yeah. So that's a lot on us, right? Dr. Kevin Mailo: [00:10:33] Yeah, yeah. I'll be honest. Like when you flip the pages of most medical publications, it sounds a little dry, you know? Dr. Jordan Vollrath: [00:10:42] Okay, part of preparing for those webinars is actually one of the funnest things I saw was just looking through some of the job ads on the CMAJ and the CFP and like those things are very expensive. It's like, I can't remember, but you get so many. Dr. Kevin Mailo: [00:10:56] I've advertised on some of those. Yeah, not cheap. Dr. Jordan Vollrath: [00:10:59] Right? And so some of these job ads, like even though they paid all that money, they didn't even use up like the 80 words or whatever they were allowed to. It was like one sentence on like, Hey, we have a clinic and we use this EMR. Dr. Kevin Mailo: [00:11:12] Yeah, think I was skipping spaces between words just to, you know, get my money's worth. Dr. Jordan Vollrath: [00:11:19] So a lot of it is like, you know, it's on us to like really educate people and provide them resources on like how to actually successfully recruit. Recruitment is a very complex, difficult thing. That's why there's these professionals that actually do this for a living. And so physicians and most of us medical people, you know, never had exposure to that. And then you have a clinic and you need to like, how do you choose office staff? How do you hire more physicians? It's just very foreign to a lot of people. So in terms of ensuring that quality, that's definitely a big part of it is like teaching people actually like what needs to be done, and there is a messaging platform in there as well. To answer your other question, that's like coming out next week, I think. That will be updated finally. So we're super excited for that. Dr. Kevin Mailo: [00:12:00] Very cool. So okay, so going back to the core offering. So how does it work if you've got questions about the locum, do you just like is there a messaging way back and forth between you and the clinic or do you just pick up the phone and call the clinic manager or the physician you're seeking to replace and just, you know, sort out the finer details there? Dr. Jordan Vollrath: [00:12:21] So it would just show you right away the contact details. You got one outgoing message if you were interested, you got to put some text in there and then it would send a thing and show you the contact details. But again, as of like literally any day now, finally we will have the messaging system implemented in there. So they'll be like peer-to-peer chat now, if you have questions you can reach out. Very low pressure, low committal. You know, our generation of millennials and most of the people doing the locuming right now are a little, you know, afraid to pick up the phone and talk to a human. So text-based interface, it'll be nice. Dr. Kevin Mailo: [00:12:52] Yeah, I got. What is the fee model for the core offering? Dr. Jordan Vollrath: [00:12:58] So we got three things. Two of them haven't been released yet. The one that is on there so far, the partnerships model. So we actually have sponsorship deals with other companies that are doing really cool, innovative stuff in health care, clinical tools, things that will update your EMR workflow, things that will help you engage with your patients, all kinds of different like actual things. It's all these things that you've never heard of, right? Because advertising in medicine is incredibly expensive, right? Like there's tons of big conglomerates out there with large budgets that will send reps to your office. Dr. Kevin Mailo: [00:13:32] Well, we compete with Big Pharma. Big Pharma writes the biggest checks. Dr. Jordan Vollrath: [00:13:37] Yeah, exactly. And so there's so much cool stuff out there that's happening that you've never heard of because these companies can't afford to have you hear of them in a lot of cases. So forming partnerships with them like stuff that actually like adds value to the physician's lives. And so that's like one of the fee models. And then just like any other LinkedIn, indeed, you can upgrade your post. So that'll be coming very soon if you want it to be seen at the top of the pile, you can pay to play and get some more exposure, which, you know, kind of the whole premise of the platform is that we really want to democratize recruiting, right? That's the thing right now is that most clinics, most organizations, they cannot afford to pay to play. And so that's why we have this very sophisticated freemium model where there's like a ton of value and ability to, like, get your jobs in your locums out there based on meritocracy as opposed to just purely like the relative size of your budget. Dr. Kevin Mailo: [00:14:30] Wow, isn't that great? Dr. Jordan Vollrath: [00:14:32] And then number three is the recruiter seat. So actually, if you want to like take that advanced functionality and really start doing the outreach, the active outreach, to other people on the network, that's a paid feature. So those are kind of like the three things that fuel the network. Dr. Kevin Mailo: [00:14:46] So listen, I'm not going to sit there and poke and prod you too much longer about it. I would encourage everybody who's listening to this to download the app. I did, and I love looking at it. I mean, I got, I'm very much busy enough as it is in my existing position, but I can see how much better this is than trying to track, track it down through, through traditional publications, trying to track down a locum through traditional publications or word of mouth or whatever. Right? And I think my big reflection on Cherry Health is that this is a massive productivity boost to the profession, right? Because at the beginning of this, Jordan, what you shared with us is your downtime, right? You know, here you are as a, you know, a young physician wanting to be in practice, but, you know, wanting to take your time to find out what you really like and what you want to be doing rather than just jumping and joining a practice. And so this locum app, you know, really allows you, Cherry Health really allows you to, as a physician, find, you know, maybe the thing that fits the best for you. But as across the profession, you can see that this offers a ton of value. Right? And it's not just, and I hate using the word productivity like at Physician Empowerment, we're always ranting about like it is not about churning more output in a given day. It is about living better, practicing your best medicine. Dr. Jordan Vollrath: [00:16:11] But that work-life balance and like... Dr. Kevin Mailo: [00:16:12] Exactly, exactly, right? Like it is, it's huge. Dr. Jordan Vollrath: [00:16:16] So there's a couple problems in medicine right now, right? Like there's the absolute lack of physicians. Dr. Kevin Mailo: [00:16:23] Only growing. Dr. Jordan Vollrath: [00:16:23] Which is just a mess across everywhere. Yeah, only getting worse. And then there's the second thing, which is the actual like relative fraction of locums that are going around right now, right? So if you talk to anybody, there's just an absolute paucity of locums out there. Like it's a struggle to recruit anybody. So I think by making it easier actually, like making a big giant digital shiny pipeline of locum work, a lot of the new grads are going to be, you know, kind of drawn to actually practicing in that manner. And then we're going to have less burnt-out physicians, right? So once we start actually balancing and making that match a little better of the established physicians versus the temporary relief coverage like that's going to be huge to actually just cutting back all the doctors that are retiring early, cutting back their practice, moving away, taking time off, reducing their clinical hours, doing things that are non-medical. Right? So that's going to be one of the biggest benefits of like, obviously not today, but like as the months and years roll on. Yeah. Dr. Kevin Mailo: [00:17:20] Oh long-term, right? I mean, this is the next step, right, in the labour shortage that we have across this country. Right? Because, you know, we're not about to suddenly get more doctors to address the shortage, but having them deployed in a better, more efficient way really matters. And I think, you know, again, reflecting on the other end of the spectrum, physicians that are late career and contemplating retirement, well, maybe they'll push that back if they can reliably get locums, right? Because if you can't get a locum and you know, you're 60, I mean, you know, 70-year-old doctor, which they're out there, you know, I work with one and you want to start slowing down, you want to start taking those vacations and you realize like, well, if I can't get a locum, well, then I'm just going to shut down my practice and retire, you know? So again, like there's just so many advantages here and it's truly inspiring to see what you're doing because I think it's a lot more than just a service, right? It's the opportunity to transform the profession and create better work-life balance for everybody, which we all need. That is a crisis within the profession. Absolutely a crisis within the profession. Dr. Jordan Vollrath: [00:18:24] 100%. Dr. Kevin Mailo: [00:18:25] Okay. So, of course, like, what did I tell you? 20, 25 minutes and we keep going on and on. But tell me, Jordan, share some reflections about your journey thus far. Tell us a little bit about how you went from being a family medicine graduate to here you are as a physician entrepreneur because we constantly, at Physician Empowerment, we always have the, you know, physicians that are reaching out to us, that they're developing something on their own, whether it's clinic based or outside of medicine entirely, or health tech or whatever. But talk to us a little bit about your journey, some of your reflections, maybe a bit of wisdom along the way. Dr. Jordan Vollrath: [00:19:02] Well it's kind of funny looking back in the rearview mirror, right? Like when we got started, like the company is almost three years old now, getting pretty close, like, did I think I would be here today? You know, like almost not doing hardly any clinical medicine four years after graduating my residency. Like, was that my intention from the get-go? Like, no, absolutely not. Right? Like I really enjoy like, actually, my Monday is where I see my patients most of the time. It's one of my favourite days of the week. I actually really like health care. But it's just that it kind of evolved, right? And there was this window of opportunity to like really enact some significant systems change and it just kept getting bigger. So we've kept following it and I've kind of been just tapering back my clinical practice like as needed by the company. Right? It all started out like we won The Joule Physician Innovation Prize, in January 21 for physician or was it Physician Health and Wellness was the category, right, just for this creating a tool to actually cut back on burnout and that work-life balance. And so that really catapulted things, like that opened so many doors like as a for-profit company, right? Like as a registered incorporation, like a lot of the time in health care, it's very difficult to actually like get meetings and get things done because it's like, oh, it's one of those evil corporations, right? But like having that actual endorsement coming from the top down of the regulatory body opened so many doors. So that immediately, like obviously the money was a huge boost to just productivity and being able to like build more stuff and more technology. Dr. Jordan Vollrath: [00:20:36] But that opened so many doors, and so leveraging that, like talking to more people, getting in with some of the like health care organizations actually getting like more reach and more awareness of the system. Got that going. We turned that into then some funding. So actually like we closed some private investor funding last year. So that really like really, you know, things just kept kind of skyrocketing past that point. Then we had more staff, more team members. Everything just kept getting more sophisticated. Now we're up to, I think, like seven full-time people. We've got a few interns and apprentices. We've got a job description posted right now hiring for another marketing person. So we just continue to grow and kind of that window of opportunity to like really do some good for Canadian health care system just keeps getting bigger. And so we keep just following it. But it's been a fun journey. Dr. Jordan Vollrath: [00:21:25] It's definitely very different from like all the normal doctory things we're used to doing. But it's been a really enjoyable journey. The people you meet, like going to the, you know, networking events and business minglers, meeting other people that are in the health care space. There actually is a fairly well-developed like innovation space in health tech, right? And actually, as of yesterday, we just found out that we've been accepted to a health accelerator program. Like as the startup, I'm not allowed to name it or embargo on. I don't know when this is coming out, when this will actually be published, but so we're super excited that we'll be working with some of the biggest basically agencies in health care in Alberta for the next few months on some of these things. So you just meet tons of interesting people that are doing all sorts of really fascinating things. And it's very cool. Like I hadn't really seen any of that previously. Right? You're kind of just, you got your blinders on of clinical operations and patient care and, you know, whatever the thing du jour is. But now that you take a step back and actually look at what's going on around us in the innovation system, there's so many interesting things happening. Dr. Kevin Mailo: [00:22:33] Awesome. Absolutely awesome. Okay, we're going to wrap it up. Dr. Jordan Vollrath: [00:22:37] Yourself included, of course, like obviously like all your projects your company has on the go, all the stuff you guys are doing for physicians. Like that's how we match, right? It's just kind of like... Dr. Kevin Mailo: [00:22:47] Yeah, honestly, I mean, a year and a half ago, somewhere around there, a little less than a year and a half ago, we were in Mexico teaching, doing our course. And like, if you'd asked me five years ago that I'd be lecturing in Mexico, I, you know, at a beautiful resort, I wouldn't have believed it. And knock on wood, we're off to the Galapagos in early 2023 for a big tour. So we'll see how that goes. Dr. Jordan Vollrath: [00:23:10] That'll be a fun spot. Dr. Kevin Mailo: [00:23:11] You'll get an invitation. I'll come shake you down. Dr. Jordan Vollrath: [00:23:13] Oh, perfect. Awesome. Dr. Kevin Mailo: [00:23:15] All right, good stuff. Let's wrap it up. Thank you so much again, everyone, this was Doctor Jordan Vollrath, founder of Cherry Health. Thank you. Dr. Jordan Vollrath: [00:23:24] Awesome. Thank you so much, Kevin. Dr. Kevin Mailo: [00:23:26] Thank you so much for listening to the Physician Empowerment Podcast. If you're ready to take those next steps in transforming your practice, finances, or personal well-being, then come and join us at PhysEmpowerment.ca - P H Y S Empowerment dot ca - to learn more about how we can help. If today's episode resonated with you, I'd really appreciate it if you would share our podcast with a colleague or friend and head over to Apple Podcasts to give us a five-star rating and review. If you've got feedback, questions or suggestions for future episode topics, we'd love to hear from you. If you want to join us and be interviewed and share some of your story, we'd absolutely love that as well. Please send me an email at KMailo@PhysEmpowerment.ca. Thank you again for listening. Bye.
	15 Jan 2025	59 - Long-Term Investments and Tariffs with Diana Choi	00:37:41
PhE is headed to Cancun this February 23 to March 2 for our Health and Wealth Summit! We'd love to have you join: https://www.physempowerment.ca/cancun — In this episode, Dr. Wing Lim introduces a discussion with Diana Choi, team lead to a group of portfolio managers, about professional investment strategies. Diana Choi explains her investment philosophy; looking at the unpredictability of the future and the importance of focusing on quality businesses. She tells Wing that successful companies are ones that can perform well in various market conditions, thriving in good times and surviving in downturns. Through this approach, refined over 25 years, risk-adjusted returns can be delivered by identifying strong businesses that are resilient to market fluctuations. Dr. Lim and Diana Choi also explore the idea that investment decisions should not hinge on short-term events or political cycles, such as presidential elections. Quality companies transcend political changes and Diana points to the example of CCL Industries, a label-making firm with strong cash flow and growth potential. This strategy makes robust fundamentals a priority and not trends, fads, or short-term gains. The conversation highlights the disciplined effort that is needed to assess and maintain investments, with a focus on the value of patience, diligence, and durable business models. Physician Empowerment: Attend an upcoming Empowerment Retreat Join the Physician Empowerment Masterclass now Website: PhysEmpowerment.ca
	15 Feb 2024	37 - Tax Benefits of Family Trusts, with Masterclass Faculty Member Jason Pisesky	00:36:33
Dr. Wing Lim welcomes Physician Empowerment Masterclass Faculty Member and tax lawyer Jason Pisesky back to the show. Jason talks all about trusts from a tax perspective. He explains not only the history of how trusts came to be but also how they are defined today and how they work, offering knowledgeable insights into the complex topic. Jason explores the tax and non-tax benefits of family trusts, detailing the tax advantage of the multiplication of the capital gains deduction. He also explains the lifespan of a trust, the beneficiaries, how income splitting factors into a trust, and how family trusts are useful in facilitating the movement of assets from one company to another in a tax-deferred way. The topic of family trusts is a dense and layered one but the information Jason provides here works as a good base of knowledge. This information can then be further explored in a Masterclass. – About Jason Pisesky: Jason is a tax lawyer with an international accounting firm, KPMG. His practice background is extensive and includes personal and corporate tax planning as well as litigation and dispute resolution. Whether you are scaling up your practice or winding it down, proper coordination between a tax lawyer and your accountant can ensure you're doing it right. Jason is one of Physician Empowerment’s professional Masterclass Faculty members. __ Physician Empowerment: Register for the Physician Empowerment Live Conference in Toronto on May 25 - 26, 2024 Early Bird pricing ends March 15 Join the Physician Empowerment Masterclass now
	15 Mar 2025	63 - Indentured Servitude: The Wrong Way to Fix a Broken System. Featuring Jayna Amadasun, MD	00:42:46
Want to dive deeper into topics like this? Master your journey with Physician Empowerment’s Masterclass Membership—your gateway to exclusive content, expert-led sessions, and actionable strategies to elevate your personal and financial well-being. Learn more and join us today! https://www.physempowerment.ca/masterclass — In this episode, Dr. Kevin Mailo welcomes returning guest Jayna Amadasun, MD - ethicist and founder of Ember Impact Global - to the show to discuss Bill 83. Bill 83 is a legislative measure in Quebec that mandates that doctors who receive their training in the province must work in the public healthcare system for five years; if they don’t, they face substantial fines of up to $200,000 per day. Jayna and Kevin critique this policy, calling it coercive and relating it to indentured servitude. They discuss the impacts the bill could have on the healthcare system. Dr. Mailo and Dr. Amadasun highlight certain systemic problems in the medical profession, including the exploitation of residents, student debt burdens, and a lack of respect for physicians' contributions. Rather than imposing restrictive measures, they believe policymakers should improve working conditions by collaborating with doctors. Jayna explains why physicians, like other professionals, deserve fair treatment, and ultimately concludes that governments should prioritize physician well-being to ensure quality patient care. The conversation around Bill 83 focuses on the need for physician empowerment, collective advocacy, and a system reform to regain a more sustainable and equitable healthcare system. About Jayna Amadasun, MD: Jayna Amadasun is a dynamic ethical strategist and consultant who coaches Black medical professionals. With an M.D. from the Dominican Republic, Jayna brings a wealth of experience, having worked as an R.N. in the Bahamas and trained in the U.S. healthcare system. She holds a Master’s in Law and Medical Ethics from the University of Edinburgh and is committed to creating equitable healthcare environments. Her unique perspective, shaped by years in emergency and flight medicine, allows her to address the complex issues facing healthcare systems today. __ Resources discussed in this episode: Episode 52: Real Change in Our Healthcare System with Jayna Amadasun, MD, LLM __ Physician Empowerment: Attend an upcoming Empowerment Retreat Join the Physician Empowerment Masterclass now Website: PhysEmpowerment.ca Jayna Amadasun, MD: Website: Ember Impact Global LinkedIn: Jayna Amadasun Instagram: EmberImpact Calendly: Jayna Amadasun
	15 Jan 2024	35 - Be the Dumbest Person in the Room	00:25:17
Doctors Kevin Mailo and Wing Lim join forces to talk about the “d word” that isn’t talked about enough: delegation. They lead a discussion explaining why we need to move away from assuming we know everything there is to know and instead embrace the expertise of others to achieve the best results. And how delegation is the key. Dr. Mailo and Dr. Lim break down what can and can’t be delegated out. There are crucial tasks that only we can do and must continue doing, but there are plenty of other tasks we don’t need to be spending our personal resources on tending to. They talk about the difference between delegation and abdication because very different results emerge from adhering to the wrong one. Dr. Wing Lim shares a checklist on how to do delegation the best way, with clear instructions and expectations keeping everyone informed on their part of the equation. This is an episode that’s key to freeing up our time by ensuring that we do only those tasks which require us and that we responsibly delegate the tasks that don’t need our direct involvement. – About Dr. Kevin Mailo: Kevin is an emergency physician based out of Edmonton, Alberta. He is known for his highly engaging teaching style that breaks down complex topics into memorable experiences. Kevin cares deeply about the long-term wellness of the medical profession and wants to see physicians and their families succeed personally and financially. About Dr. Wing Lim: Apart from his clinical & teaching roles, Wing has extensive experience in Practice Management and Business Development. He is passionate about sharing his extensive knowledge & experience (both clinical & business) with others in various settings, from his clinic mentoring younger colleagues, to churches, senior groups, ethnic functions, radio broadcasts, retreats, seminars, and national conferences. – Physician Empowerment: website \| facebook \| linkedin -- Transcript Dr. Kevin Mailo: Hi, I'm Doctor Kevin Mailo, one of the co-hosts of the Physician Empowerment podcast. At Physician Empowerment we're dedicated to improving the lives of Canadian physicians personally, professionally, and financially. If you're loving what you're listening to, let us know! We always want to hear your feedback. Connect with us. If you want to go further, we've got outstanding programing both in person and online so look us up. But regardless, we hope you really enjoy this episode. Dr. Kevin Mailo: Hi. Uh, it's Kevin again on the Physician Empowerment podcast. And, of course, we've got Wing here joining us. And today's topic is very near and dear to my heart because it has taken me a long time. To develop this skill because I was very much in the micromanaging, do it yourself space. And it's been not only, I think for myself, you know, in terms of life being less stressful, but it's also been really a lot of fun because as you expand your network, you begin to broaden your horizons, see things through other people's eyes, and grow as a person. And what I'm getting at here, and I didn't use the D word yet, is delegation. And that's what's so powerful in improving our lives. So in an earlier episode on the podcast, we talked about time management. And one of the keys to time management is being able to either automate a task and streamline its process, or hand off to somebody that you trust, who maybe you've even invested some time in training up, let's say if it's a medical office assistant. So today, Wing is going to be exploring the power of delegation in our lives. Because again, you know, Wing, you've achieved so much in the space of real estate practice building while maintaining a robust and happy family life. And I would venture to guess a big part of that success has been through delegation. Dr. Wing Lim: Yeah. Delegation doesn't come easy. So let's go deeper. And this one is not going to be a talk, Kevin and I, we're just going to chat on this. The delegation, I think we all talk about the D word, right, but deep down we don't want to. We really don't want to because we trust ourselves. Right? And this is a recurring theme at Physician Empowerment. The biggest enemy of freedom may be the guy in the mirror. Because we have so many years of education and processes and because lives are at stake. Mistakes are costly to other people and to yourself. So we tend to just do it, right, and they say, if you want to do it right, do it yourself. And so years after years, post-graduate training, residency, one fellowship and all that, teaching you that you are it, you're the expert. And so you have to do it right. And because of that, we have this intrinsic trust in ourselves. And some of us become very egotistical, giant ego, and even the God-like syndrome. Right? And we don't trust anyone. So as a result, it's very difficult for medical professionals to actually delegate. I'll give you an example. There are people who would rather take the, I have colleagues that would take the blood pressure themselves, like on a patient, rather than trusting a medical staff to do it. Why do you have to do that? Right? Because even blood pressure, you know, there's a good way and bad way to do it. Okay, I understand there's some procedures you cannot delegate out, but more and more we're team based. So I think the first thing to fight is this intrinsic bend towards just trusting yourself and not trusting others because I'm smart, therefore everybody else is dumb. So therefore I don't want to water down my quality. So I don't want to delegate to you. Dr. Kevin Mailo: And let me just interrupt there and say like, this is not about delegating the crucial tasks, right? You know, like if you're a surgeon, you know, and you're elbow deep in somebody's abdomen, you really want to make sure that it's done right. That's where you want to focus your energy is on those crucial, crucial tasks, right? I mean, I do the same thing in the ER in the trauma bay, right? Like sitting at the airway, making sure it's done properly. Because that's the crucial task. But realize that delegation, and I'm just going to go on a little bit of a rant here, delegation is a resource saving measure for us, right? Because we only have so much concentration and intensity and focus. So do you want to dissipate that by like measuring every single one of your patients blood pressure, because you don't trust that somebody will put the automatic blood pressure cuff on properly on the arm? Dr. Wing Lim: Exactly. Dr. Kevin Mailo: Right? Like there has to be some limits here because if you're so focused on that, are you really hearing the history? Do you know what I mean? Or if you are doing your own taxes because you don't want to pay an accountant, or you're doing your own bookkeeping, are you missing the big picture on high level tax planning that could mean hundreds of thousands of dollars to you. Right? So there is a limit to how much attention and focus we can bring in, right? Like I can't sit there and, you know, make sure every IV that, you know, my nursing staff in the department are doing it, doing it perfectly right. Like, no, I have to sit there and be able to focus on the things that no one else can do but me and then, and be comfortable delegating and trusting my team. So that's a personal growth thing, but don't feel bad about the parts that you need to micromanage in your life. By all means do it. You can't outsource personal relationships and friendships, but you want to be present for those. Dr. Wing Lim: Exactly. So you hit it right on the nose there, Kevin. So the paradigm here is this: only do what only you can do. That's the whole thing about delegation. Only do what only you can do. You're the only one that could be your significant other's significant other, spouse, or whatever you want to call it. You're the only dad or mom your kids have, right? You cannot delegate that out, right? When you have the chief surgeon, you have to do stuff that you have to do. But then everything else you should not do, right? It's like a flashlight versus a laser pen. Right? We all understand that, right? The point of focus is to just put everything out and just do only what you can, only you can do. And then, you know what? If you're a team lead in the department and your practice and your division, you know, what's the most scarce resource is a thing called thinking. Thinking--. Dr. Kevin Mailo: -- but it's true-- Dr. Wing Lim: -- is a hard thing. Otherwise everybody will be doing it. Dr. Kevin Mailo: It's very easy to do. And I think this segues nicely backwards to our earlier talk about time. I think it's very easy. Our minds like to get into that rut of, well, I want to focus on this one detail or task because it requires less mental energy. Dr. Wing Lim: Mhm. Dr. Kevin Mailo: When really, thinking, as Henry Ford said it, is the hardest job of all. And that requires some mental space. And to get that mental space, we need to delegate. Dr. Wing Lim: Exactly. So you cannot rely on your allied professional that you delegate down to do that for you. Right? Otherwise they should be sitting in your chair. Then you need to be delegated the task and they need to do the thinking. So if you're a clinic owner, you need to absolutely do the thinking. If a department head, the list goes on and on, right? And so, yeah, so do only what you can do. And if we can chew on that and then just plan your life accordingly, your life would absolutely change and everybody around you would absolutely change. But for that to happen, to only do what you want to do, only you can do, that means you have to have the intrinsic trust in other people. And I tell people that I love to work with people smarter than me. I love to be the dumbest person in the room. I love to because then I gain a lot, right? So I have no background in architecture construction. When we built this 156 unit senior home, state of the art building that won an award, second in the world, I didn't even know that until we got the award. And who won the award? What we did collectively. But the designers did, and I found myself and my partners, this was my dream, right? And I sat in a room downtown Edmonton, top architect, or biggest architect firm in the nation, in the Edmonton branch and in there is like 15 engineers. And I look around. These guys are all very, very smart. I didn't even know there could be 15 engineers, different disciplines. They kept looking at me and my partners. What do you want? Right? So if the why is big enough, the how comes. And so once you delegate the people who are smart and I said I'm the dumbest person in this room. And time and time again and once you do the delegation, things get done despite of you. I love that, not because of me, but things got done in spite of me, right? And then big things could happen. So that's delegation. Okay. Let's talk about what delegation is not. Delegation is not abdication. Okay, let me repeat. Delegation is not abdication. And why would you say that? Because that's the common mistake we have. And the top, top, top example is in finance. Okay, I just had a chat with one of our Physician Empowerment Masterclass attendees and this professional, we're talking about this application that we give our money to these transaction based, commission based people that set their financial advisors. And meanwhile, he's selling us products, right? Sorry. They are selling us products and they're going to help you be financially free. Maybe, maybe, maybe maybe not. Dr. Kevin Mailo: I don't know, I don't know. Dr. Wing Lim: What's assured is their commission, not your future. Right? And so this abdication just because oh, because you said you're good. I just give it to you. Give my whole life hard earned money to you. That's your abdication, right? Dr. Kevin Mailo: I mean, but I mean, you can also go the other way. I mean, you can blindly buy the market on a broad spread ETF and not pay attention to what, not that you want to time the market, but you want to time your life around the market like, you know, and ask yourself, am I ready to fall off the cliff 12 months before retirement if the market crashes, you know? And again, you can't just blindly trust a person or a process and say, well, that's good enough. You do have to, you have to manage your managers. I think that's what we teach at the course. Dr. Wing Lim: Another example. There's lots of horror story examples. We're just looking at a building in our city that was owned by a physician that went into receivership. Right.? And this dude trust to somebody else who is the expert who's going to run the whole thing. And I drove by that plaza, that plaza is full. It's hard to find parking. How does somebody run it down to the ground? Right? And now it's in judicial sale. And this, unfortunately, this guy's in deep trouble now. And so if you think, oh, real estate is going to, or whatever, you know, you pick a asset class, it's going to make me rich. No it doesn't. And unless you have a good management team, if you just blindly trust somebody, just abdicated your future, they're going to bite you back in the butt. Right? So that's a sobering example. Dr. Kevin Mailo: And I think the other reflection here is like a lot of the time when we've done something ourselves for many years, we unconsciously know all the ins and outs of it. We unconsciously know all the ins and outs of it, and so there has to be some patience when we're working with somebody and teaching them and some humility. Right? And put yourself in their shoes and remember when you were learning that process and that thing. And so just pause, put the time in and and make sure that they understand and make sure you understand their position as somebody new to this task. And so check your assumptions before you begin to sit down and have that instructions conversation with the person that you're about to delegate to. Dr. Wing Lim: Right. And then they don't perform well and you give them heck. You know what? You should give yourself heck, right? I'm just training a new staff, a highly reliable staff just left for a higher-paid position in the hospital. Right. We do that, lose staff all the time, right? We start with new and there's a lot of assumptions. So I got angry that why is this not done? Because they're new. I didn't teach them. Right? Next thing is you need to give a clear time frame. The song I love you tomorrow, you're just a day away. It keeps postponing tomorrow. If there's no clear time frame, don't expect to get it done. And relationships get tarnished, work relationships, even personal relationships get tarnished because you always say that I'm going to do it when. Right? So if you don't have a time frame, don't expect it to be done in a hurried manner. And then there has to be measurable outcomes. If there are no measurable outcomes, it's just a bunch of warm fuzzies. Sorry. It has to be measured. If you cannot measure it, it cannot be done. There has to be accountability. So you give the task to somebody. Is that accountable? Okay, let's jump from clinical practice to finance again. I have a colleague that was told by his wealth manager, doctor in the last 20 years, in the stock portfolio, you earn 20% a year for the last ten years. Is that even possible? Right. And the only reason, if you take that up... Dr. Kevin Mailo: Of course, I know where this is going. Dr. Wing Lim: It's the annual contribution. Then you had this was making money every year. Right? Dr. Kevin Mailo: Yeah. Dr. Wing Lim: Right. And there's no accountability because you just believe them, right? Whatever they say. And same, we delegate a task to the accountant. Like I do, I trust my accountant, but I don't run business decisions with my accountant. My accountant is not the guy who makes that business decision. He makes accounting decision. Right? So the accountability structure has to be well defined, and they have to be accountable to you or somebody else on something that is measurable. That's true. Dr. Kevin Mailo: Absolutely. Absolutely. Dr. Wing Lim: Final thing is consequence. If you let people do something where whether they do or not, there's no consequence, you have endorsed the non-performance. So somebody says if you, if your staff or whoever you trust in your team, they can get away with XYZ. And they keep getting, they will continue to get away, because you blessed it. You condone it. There has to be consequences. Yay or nay, right? Good or bad. So these are some of the guardrails that is supposed to be intrinsic. But you know what, I don't think it's really common knowledge. And while talking about it, I reminded myself 3 or 4 things that, oh shoot, I didn't follow what I preached. Right? This is just reminder for all of us that to be effective, you need team. And to have effective team, you need to have this delegation process. Dr. Kevin Mailo: I love it. I love it. Dr. Wing Lim: Right. And then to have a systematic thing. If you do this together as a systematic process that's at different level, right. Delegation was just talking about this act of delegating. But then you still, somebody still need to create the architecture, the whole conveyor belt, the whole, what do you call that, assembly line. Right? And A on B fold on C glue on D and you achieve E. Like so this has to be processed, and that's called systemization which is a different talk altogether. But this is really important for us to understand that to achieve more than what you can achieve by yourself, you got to let go of this ego thing, trust somebody. But with criteria. Dr. Kevin Mailo: And again this is people skills. This is absolutely people skills and I think that's so important. Right? Not only the words you choose, the time frames you give the person you're delegating to, how you provide feedback, how you discuss consequences or outcomes, all of this is people skills, right. And again this is the barrier to delegating because you go oh I'm not looking forward to this conversation. Maybe I'll just do it myself. But again, that's not how we grow as individuals. When we grow as individuals personally, professionally, financially, it's because we're able to have those tough conversations, but just have it with yourself in the mirror before you go in there. And again, emphasize to yourself that this is a people skill. This isn't about the given task or your process or anything more than, it is a people skill. Dr. Wing Lim: Right. And it's to empower your team up to their capacity. So we have, I've joined a practice management course a long time ago and that's a different talk as well. But basically what we learned is a doctor should never do a nurse's job, RN should not do LPNs job, LPNs should not do MAs job, MAs should not do a receptionist job, receptionist shouldn't do a janitorial job. But you can see all this in every clinic, every department, right? It's all screwed up. I was a patient once a few years ago, and I found a Sunday morning there's a RN changing bed sheets. I thought, why do you need to do that? Right? That's an absolute waste of public resource. And so if we understand that process we would be a lot more effective. Dr. Kevin Mailo: I'll just chime in with a few high level practical points about delegation. And this applies, because delegation can be done in our personal life and professional life. You know, do you change the oil on your vehicle or you take it into the shop to get it done? Do you mow your own lawn or do you hire it out? And so the first sort of matrix that I get people to look through, the first lens actually, is probably a better description, the first lens I get when I teach this topic at our conference or in the Masterclasses, is the first thing you want to look through is your hourly rate. Know how much per hour you make gross. And then net after overhead. And remember, when you're calculating your hourly rate, it is not just time in front of patients. It is administrative work, CME, emails, charting, whatever have you. It could even include your commute. Right? So understand what your hourly rate is. And I think unfortunately when you add up all of the unpaid things you do as a doctor, your hourly rate plummets and it's pretty depressing. Nonetheless, go through the exercise. I encourage everybody to do it. I know my hourly rate. And so number one is know your hourly rate because it allows you to make decisions on how much you're going to pay somebody to do something, right? And remember there are tax consequences. So if it's a corporate expense then it's a corporate expense. And you're more tolerant of, you know, that higher hourly rate to bring in a great professional, for instance, a great accountant or a great bookkeeper. Dr. Wing Lim: Exactly. Dr. Kevin Mailo: These people that help you build wealth. And then in your personal life, remember, it's after tax dollars, so you probably don't want to hold, you don't want to delegate to Skip the Dishes every night. Put it that way. You really don't. And or, you know, Uber Eats or whoever else is out there, right? Like you actually have to be very mindful of the after tax cost to yourself before you delegate. The other lens that I get people to look through, you know, we talk about this in an earlier episode, is what is crucial and cannot be delegated. That list is actually very short in our personal and professional lives. But don't delegate away the things that are actually going to matter in your life, whether it's driving your kids to soccer, spending time with your spouse or partner, even if it means taking him or her to the airport, right? Yeah, could you delegate a cab? But what about that moment that you could have shared together? Be mindful in delegation. This is, I hate the word efficiency in our lives, especially in our personal lives. I remember coming across, I remember I met an ophthalmologist once who was outstanding, said be efficient with things, not with people. Dr. Wing Lim: Mhm. Wow. Dr. Kevin Mailo: Like ideally if you have done time management and delegation properly, you should have lots of like free moments where you don't have to be anywhere else but enjoying that moment, right? Whether it's reading a book, spending time with family or friends, going for a walk, whatever, like or even just be free to like have like a day that just goes all over the place. But you didn't have to do anything else in your life because it was all properly delegated and you created that space. That's a gift to you. That is so powerful. And so that again is the next criteria that I ask people to use as a lens is, is this making my life happier? Like for instance I changed the oil on my truck with my kids because I like that time with my son and at times it's been three generations of us doing it just to teach and bond. I would never delegate that out. Right? That's just an example from my personal life. So try to be mindful and reflective of where you are delegating and delegate the things but don't delegate people. Don't be efficient with the people that matter in your life. And don't even be efficient with yourself. Like, you know, create downtime for yourself. Dr. Wing Lim: Mhm. Dr. Kevin Mailo: So that you can invest in yourself. So those are, those are again my reflections, you know having maybe learned the hard way about either under delegating or over delegating, frankly. There is a balance. Dr. Wing Lim: Exactly. Dr. Kevin Mailo: Okay. Maybe we'll wrap it up. Again that was another great one. I love, I love these topics because these are the things again that we all struggle with but don't even have a framework to talk about it or think about it. But if you can effectively delegate in your personal and professional life, you can go anywhere and build anything you want. That's a key. Dr. Wing Lim: And to earn back the freedom. Dr. Kevin Mailo: Oh goodness. The freedom's everything, honestly. Dr. Wing Lim: Mhm. Yeah. Dr. Kevin Mailo: Honestly I look at my, I look at my own teenagers living that free life and I'm deeply envious of their time richness. Dr. Wing Lim: Exactly. Dr. Kevin Mailo: You know? Dr. Wing Lim: No kidding. Dr. Kevin Mailo: Not all the drama of being a teenager. Not all the drama of being a teenager, but certainly envious of that, the wealth of time that they have compared to the rest of us who are so busy and overscheduled. Dr. Wing Lim: Mhm. Yeah. Dr. Kevin Mailo: All right. All right. Let's wrap this one up. Thank you. Dr. Wing Lim: Yeah okay. Thank you everyone. Dr. Kevin Mailo: Thank you so much for listening to the Physician Empowerment podcast. If you're ready to take those next steps in transforming your practice, finances, or personal well-being, then come and join us at PhysEmpowerment.ca - P H Y S Empowerment dot ca - to learn more about how we can help. If today's episode resonated with you, I'd really appreciate it if you would share our podcast with a colleague or friend and head over to Apple Podcasts to give us a five star rating and review. If you've got feedback, questions or suggestions for future episode topics, we'd love to hear from you. If you want to join us and be interviewed and share some of your story, we'd absolutely love that as well. Please send me an email at KMailo@PhysEmpowerment.ca. Thank you again for listening. Bye.
	15 Dec 2024	57 - Medical Entrepreneurship Series with Dr. Adenike (Nike) Olowu and her husband, Daniel Ashaolu	00:45:43
PhE is headed to Cancun this February 23 to March 2 for our Health and Wealth Summit! We'd love to have you join: https://www.physempowerment.ca/cancun — Dr. Kevin Mailo introduces another episode in the Medical Entrepreneurship Series. Dr. Wing Lim interviews guests Dr. Adenike (Nike) Olowu and her husband, Daniel Ashaolu, masterclass members and entrepreneurs. Dr. Olowu is a full-time family physician and her husband Daniel manages their growing real estate portfolio. They tell Wing about their journey of coming to Canada, setting up practice, and how they are not just thriving but soaring. Dr. Adenike Olowu went to medical school in Nigeria, where she did her residency at University College Hospital before coming to Canada in 2017. She practiced for six years prior to immigrating and she describes the process of getting certified to practice in Canada. By January of 2020 she was practicing here. Daniels explains why they chose Canada and then Alberta, how the move worked for their children, and how they decided to start their real estate investing journey. Wing explores the fascinating process of how the pair dove into entrepreneurship and investing and what steps they took to ensure success. About Dr. Adenike (Nike) Olowu: Dr. Ashaolu Adenike Oluwatoyin Mulikat, also known as Dr. Ashaolu [Ash-a-loo], is a family medicine physician working out of the Elk Point Healthcare Centre and the Ayobami Oyebode Medical Clinic. She became the third family physician to practice in town. Dr. Ashaolu comes to Elk Point from Winnipeg. She arrived in Canada in September 2017 after completing her medical training and residency in Nigeria. With plans to specialize in geriatric medicine, Dr. Ashaolu enjoys cooking and hiking as well as spending time with her husband Daniel Ashaolu and their three children: Joshua, Jemimah and Joy. — Physician Empowerment: Join the Physician Empowerment Masterclass now Website: PhysEmpowerment.ca
	30 Nov 2023	32 - Setting Boundaries and dealing with internalized shame with Dr. Megan Melo	00:29:17
Dr. Kevin Mailo welcomes board-certified family physician and obesity medicine specialist Dr. Megan Melo to the show. Megan has a coaching business, Healthier For Good, focused on transforming the lives of physicians through one-on-one or group coaching. Megan and Kevin talk about burnout, shame, and how physicians can learn to set boundaries and overcome perfectionism. Dr. Melo explains how perfectionism sounds benign and hardworking but is actually often shame avoidance. If we are perfect enough, we can avoid being shamed or called out. She talks about how that plays out in affecting the day-to-day lives of physicians. Megan and Dr. Mailo share stories from their own experiences and discuss what steps physicians can take to start pulling out of perfectionism and shame cycles. They address setting boundaries for self-care and why taking care of ourselves is such a vital aspect of being a physician. Megan offers coaching for physicians to help them achieve these goals, and this episode highlights some of the insights she has that can change lives for the better. About Dr. Megan Melo Megan Melo is a physician, board-certified in Family Medicine and Obesity Medicine, as well as a Certified Life Coach for physicians. She helps physicians struggling with burnout and overwhelm to feel better, including those who have been labelled "toxic" or "difficult" by their employers. Megan is on a mission to help physicians and other healthcare professionals heal from burnout and change their lives for the better. She does this through one-on-one and group coaching, as well as podcasting, blogging, and speaking to groups. Resources discussed in this episode: Ending Physician Overwhelm podcast -- Physician Empowerment: website \| facebook \| linkedin Dr. Megan Melo: website: HealthierForGood.com \| linkedin \| instagram -- Transcript Dr. Kevin Mailo: [00:00:01] Hi, I'm Dr. Kevin Mailo, one of the co-hosts of the Physician Empowerment podcast. At Physician Empowerment we're dedicated to improving the lives of Canadian physicians personally, professionally, and financially. If you're loving what you're listening to, let us know! We always want to hear your feedback. Connect with us. If you want to go further, we've got outstanding programming both in-person and online. So look us up, but regardless, we hope you really enjoy this episode. Dr. Kevin Mailo: [00:00:34] Hi, everybody. I'm Dr. Kevin Mailo with Physician Empowerment, and I am very, very pleased to introduce you to Dr. Megan Melo. Megan is a board-certified family physician and obesity medicine specialist based out of Seattle, Washington, and she has an incredible coaching business focused on group as well as individual sessions called Healthier For Good. And the goal here is to transform the lives of physician clients who are coming through. And I think you've kind of got a focus, if I can describe it as that, Megan, on perfectionism. So why don't you tell us a little bit about your career journey to start with and how you got to this place, and then we'll get into today's topic? Dr. Megan Melo: [00:01:20] Yeah. So I grew up in a household of two nurses, and from a very young age I was like, I'm going to go be a doctor, right? And when you grow up that way, you get a lot of positive reinforcement. Oh, a doctor is a great thing to be. And oh, you sort of learn a lot of sort of people pleasing things along the way. And of course, socialized as a woman, we can throw that in there as well. Went straight from college to medical school and then into family medicine residency and did well, but was always kind of looking for gosh, like I wonder when things are going to feel better. And I remember my residency advisor would always be like, oh, second year is easier than first year, and third year is easier than second. And I was like, that doesn't seem to be true. I'm not sure why you keep telling me that over and over, because it seems like things are getting harder, more responsibilities, more people asking me to do things. But regardless, I graduated and went into practice doing pretty broad scope of family medicine for the United States. So I was delivering babies, doing clinical practice, occasional hospital medicine as part of teaching residents, and started a family at that point as well, pretty early in my career, and again, just had this experience of constantly looking for, When am I going to feel better? When is it going to get easier? When have I done enough that people will sort of start to ease off on all the things they're asking me to do? Along the way I picked up teaching in our family medicine residency, joined the faculty there, two kids by that point and life just kept feeling harder and harder, and I didn't know why and I thought it was me. I thought there was something wrong with me, that I don't feel happy. I feel like I'm constantly working harder and harder. And it never feels like enough. Dr. Kevin Mailo: [00:03:22] Wow. I think we can all relate to that. I'll share my own reflections. I mean, it's, you know, you sort of touched on this. This starts long before we even enter medical school. I mean, medical schools select for conscientiousness and a sense of duty and obligation, which is not a bad thing. I mean, that's how you want your doctors, but it is a perfect recipe for this perfectionism burnout cycle. And we're all surrounded by each other on top of it. Dr. Megan Melo: [00:03:56] Right? And we're all hiding how we feel from each other. Dr. Kevin Mailo: [00:03:59] We're hiding how we feel. Right? Dr. Megan Melo: [00:04:03] Absolutely. Dr. Kevin Mailo: [00:04:04] But you just, you don't want to raise your hand and say, I'm not happy, right? Or I don't feel like doing it. Dr. Megan Melo: [00:04:10] Like this isn't enough for me. Dr. Kevin Mailo: [00:04:12] This isn't enough for me. So then talk about, talk about perfectionism. Talk about how this impacts us in a very real sense. I'd love to dig down on this and hear more. Dr. Megan Melo: [00:04:28] Yeah. So you probably grew up with this same idea that perfectionism sounds great, right? It sounds like, oh, I'm just a perfectionist, right? It sounds like this very benign, hardworking sort of process. But a lot of the way that it's defined, especially by Brené Brown, who I follow closely, is that perfectionism is really shame avoidance. Right? So if I act perfect enough, if I know enough, if I, you know, look right and sort of perform excellently, then no one can shame me, right? No one can cast me out. No one, you know, I'll have to be a part of the group. And no one will see any flaws in me. And there is a huge difference between that perfectionism, right, that desire that I have to do everything just right, and excellence, right? Wanting to do a good job, wanting to learn more. If you've got a knowledge gap, you know, wanting to do the right thing. Those two things are not the same. But often, you know, again, our medical training has really reinforced this notion that I need to avoid shame at all costs. I mean, that's literally, you know, when we're on rounds, right? And we're being pimped by our attendings, you know, they're trying to find out all the things we don't know. And we are humiliated. Dr. Kevin Mailo: [00:05:53] Yeah, it's a shame-based learning system. Dr. Megan Melo: [00:05:56] So we're all steeped in that. Right? And it often, for many of us, just keeps going. But the stakes get harder. You know the responsibilities get more. We throw families and other, you know, kind of outside responsibilities in there. And then we're trying to keep up on those planes too. Have that perfect Christmas card or whatever the keeping up with the Joneses is. It's an unwinnable game and it's so toxic inside. Dr. Kevin Mailo: [00:06:24] And you know, I'll share my own reflection. I mean, you know, we talk about those external voices, right? Whether it's, you know, family or friends that have expectations of us, our broader community, of how we should behave or look, what colleagues say, superiors say. But the hardest one, the hardest voice, is that voice inside saying I'm not good enough. Or not worthy to be here or shouldn't be here. Dr. Megan Melo: [00:06:51] Yeah. And often that person that you may see, you know, and may be working alongside who is someone who seems really harsh, really judgmental, really, you know, kind of always unhappy with other, your performance, other people's performance. If we could listen inside of them, we would often find that that negativity, that judgment, that shame is even more intensely turned towards themselves because we can't shame and blame others without having a high degree of it within ourselves. Dr. Kevin Mailo: [00:07:26] Wow, wow. So. How does this play out in terms of our day-to-day practice as physicians who have now, you know, settled into our careers? Talk about how it impacts our scheduling, our patient interactions. Our, you know, vacations. Talk about how this, you know, bleeds boundaries, if you will. Dr. Megan Melo: [00:07:56] Yeah. And I often talk about this, you know, looking at perfectionism and people-pleasing and lack of boundaries together. Because there's a lot of overlap between them. But, you know, it shows up as us being unwilling and afraid to say no. Unwilling and afraid to set boundaries on our schedule, or whether we can throw in an extra patient or, you know, whether we'll set an agenda with the patient and say, I'm sorry, we don't have time to continue today. I know that you'd like to discuss these other things, but we're out of time for today. Right? So much of the time, too, we're operating in very broken healthcare systems, which are strapped and under-resourced. You know, there can be things like, you know, lack of beds, as we've discussed earlier or, you know, we don't have nursing staff or things like that. So everybody's responsibilities seem to have gone up, right, while our bandwidth has gone down. But if I'm internalizing that I'm not doing enough for my patients, and I'm bearing the weight of all of the shortages and the brokenness of health care, then that is a recipe for disaster, because I will not take the time to take care of myself. Make sure that I'm eating, sleeping, peeing, you know, feeling connected with my family, having some fun, God forbid. Right? Dr. Kevin Mailo: [00:09:18] And let me interrupt there and just say that this notion of shame in our careers and perfectionism bleeds into our inability to be present during family and personal time, because you feel this nagging inadequacy eating away at you in the back of your mind that you should be doing more, or that you could have done more. Maybe I should have. Dr. Megan Melo: [00:09:39] Or maybe I didn't do that right. Or maybe... Dr. Kevin Mailo: [00:09:42] Maybe I should have squeezed this other patient in. Dr. Megan Melo: [00:09:44] Absolutely, absolutely. And we often interpret, if we're used to sort of people pleasing and lack of boundaries, we often interpret other people's disappointment as proof that we're wrong or, you know, proof that we can't do that. Right? If I'm uncomfortable with saying no to you and you get upset with me, right? If my default is just to roll over and do it anyway, right? Like, oh, okay. You know, I guess so, I guess I'll do that. I guess I'll join that committee. I'll do these extra things for you today. Then I'm interpreting my own discomfort with their disappointment as proof that I shouldn't be trying to set boundaries, right? And that's where we often really hit a struggle because we can talk about boundaries, but we need to talk about us not controlling other people's expectations as well. Dr. Kevin Mailo: [00:10:34] That's theirs. Dr. Megan Melo: [00:10:35] That's theirs. Dr. Kevin Mailo: [00:10:36] You don't have to own that. You don't have to internalize that. That's an iss-them, not an iss-you. Dr. Megan Melo: [00:10:43] Right? I love that: iss-you. Yeah. Because, you know, I don't control, you know, how sick my patients are when they show up. I don't control that they've got a list of 17 items. What I'm working in, though, is, you know, a health care system that has, you know, time constraints and constraints on what is available to me to solve that day. Similarly, you know, sometimes in primary care or in the emergency room, right, we might get pushed to do things that, you know, are really, you know, at a specialist level. We want to help. We want to do more and provide the care that the patient needs. But that's not always the best solution. And the difficulty with finding, you know, finding specialists, if we continue to sort of suck it up and take on more than is reasonable for us to take on, then we're enabling the health care system to not make any changes. And as long as we do that, there's no pressure on the system to hire the appropriate amount of staff or resources, you know, get the appropriate amount of resources because they'll just continue to push us. Well, you care about people. Just take one extra person. Just do more. Dr. Kevin Mailo: [00:12:01] One year at our conference, we had an incredible speaker come who cares for physicians primarily in her practice as a psychiatrist. And she stood up and told the whole room, don't tell us to be more resilient. Don't give us another online module to do telling us to be more resilient. Dr. Megan Melo: [00:12:22] Yoga at lunch. Dr. Kevin Mailo: [00:12:23] Yeah, yoga at lunch. Dr. Megan Melo: [00:12:25] Or yoga before work. Dr. Kevin Mailo: [00:12:27] Yeah, like goodness, it is not about doing more and adding more to our to-do list. It's actually about doing less and doing it happily. But yeah, don't tell the profession to be more resilient. We are already highly selected for this resiliency. And we are trained in it and we practice in it. It's what is the limits of human capacity? Dr. Megan Melo: [00:12:51] Yeah, we need to learn how to turn it off. Dr. Kevin Mailo: [00:12:53] And most physicians who are burnt out are working beyond what is a reasonable limit for human capacity. Dr. Megan Melo: [00:13:00] Yes, yes, we need to learn how to turn it off. To say yep, even though I see it's very busy here and technically speaking, I could stay longer and do more, but it's ultimately better for me and every other person that I go home and rest, that I go home and take care of myself so that I show up again tomorrow. Dr. Kevin Mailo: [00:13:23] Yeah, yeah. Dr. Megan Melo: [00:13:25] But that's not something that often comes to us from the outside. People don't sit us down, our managers and clinical leadership and hospital... Dr. Kevin Mailo: [00:13:33] Nobody is going to sit you down say you know what -- Dr. Megan Melo: [00:13:36] -- they do not share that with you -- Dr. Kevin Mailo: [00:13:37] -- don't worry. Things are rough right now, but it's important you get home. But we actually need to start having those conversations in the workplace. Saying like, listen, you know, I know it's really busy today, but none of us is going to fix this. Let's just go home and, you know, we'll have to just hit it again tomorrow, right? So then okay, so talk to us about like some concrete steps to make this better. I mean love on your website it says I am a recovering perfectionist. Right? And in recovery, always in recovery. Dr. Megan Melo: [00:14:13] Right. Always in recovery. Dr. Kevin Mailo: [00:14:15] Because we always have those tendencies. I know for myself I've made a lot of progress in this space, but I always feel this backslide to take another sip of perfectionism. You know what I mean? And so talk to us about like, what we can do in a concrete sense. Because if I can be honest, I think a lot of this goes back to even early developmental stages in our childhood. Dr. Megan Melo: [00:14:37] Absolutely. Dr. Kevin Mailo: [00:14:37] Right. So how do you begin to rewire? What does that look like, Megan? Dr. Megan Melo: [00:14:45] Yeah, I mean, I think, you know, one really important step, right, is really tuning into our emotions. We've been taught to ignore our emotions often, the same way we've been taught to ignore our bladders, right. Or our stomachs. And this can be hard to do at first. Because if we're tuning into our emotions more, we'll often notice more negative emotions. We'll notice that we're feeling frustrated or resentful or overwhelmed or angry. But if we can start to understand what the thoughts are that are creating that, and often that's really where we see that perfectionism or that people pleasing, because the thoughts that are connected to those things are, I can't believe someone is asking me to do one more thing. Or don't they see how hard I'm working? Or how on earth could I possibly do more? Or I have to do this all right. You know, when we can start to really understand those negative emotions and those negative thoughts, we can start to unravel them and start to say, you know, it doesn't actually serve me to think that I'm the one who has to do all of this, that I can't ask for help. It doesn't serve me to continue to use other people's disappointment as a reason why I can't set boundaries for myself. Dr. Kevin Mailo: [00:15:57] Wow, that's a wrong fuel. Dr. Megan Melo: [00:16:02] So really sort of tuning in to understanding that dynamic. And it's hard work at first. Right? Because the well-worn ruts that are, you know, kind of that we're used to are saying yes, doing more, you know, not disappointing other people. And when we're doing this work, when we're tuning into who we are and what we need, we have to get out of those ruts. Right? And that's uncomfortable. One of my group members was saying, yeah, not only is it uncomfortable to, like, bump ourselves out of those ruts, but we're exposed. It's cold. You know, we're up at the elements. And I'm like, yeah, that's a perfect way to think about it because it's different. Right? Change is something that we have to put more energy into than following the well-worn ruts. But we also have to. You know, tune into ourselves and realize that I don't actually control other people's experience, right? I don't control whether my patients are happy, I don't control what their expectations are. But if I want to take care of myself and continue to serve patients in this model, in this place that I work, or however I take care of patients, then I'm going to have to set some limits on what I do for me. Because ultimately taking care of me is my job. No one's going to do that for me. And I think for such a long time, I wrestled with wanting and expecting that the healthcare system would somehow take care of me, right? That they would somehow, you know, tap me on the shoulder and say, hey, you need a break. Like, you know, here's a week's vacation. Or they would lighten my load somehow or pay me more or something. Dr. Kevin Mailo: [00:17:35] Or even just the reward and joy of practice. Dr. Megan Melo: [00:17:39] Right? Right. Dr. Kevin Mailo: [00:17:40] It doesn't... Dr. Megan Melo: [00:17:42] It's not enough. Dr. Kevin Mailo: [00:17:43] That's not, that shouldn't be the fuel. And it certainly isn't the antidote to burnout and perfectionism. Right? You have to be able to go in and love your job even when it's hard, right? And even when you struggle or, you know, you have complex patients or whatever it is, you have to be able to love your job, right? But that can't be the, that can't be the crux of, you know, oh, I'm really exhausted at work at 70 hours this week, but had some great cases. Yeah, that's not sustainable. That's not healthy. That's not the right reference point or goalpost that we should be using. Dr. Megan Melo: [00:18:22] Well in so much of, you know, kind of what we, what we think of, you know, in health care, so much of it seems tied to the physician. Patients do this, hospitals do that, like so much of a patient's outcome seems to be tied to the quality of the physician care. Right? That's what metrics are driven by. And we believe it too. So we are often carrying around this burden: I've got all these sick people, it's my job to make them better. Meanwhile, we're ignoring the fact that most of a person's health outcomes are related to their socioeconomic status, their genetics, how they've been living their life for the last 70 years, whether they got a vaccine, you know, and all of these other components that have much more of an impact than me taking care of them right now and trying to reverse things that are going on that are already pretty deep in the process. But again, when we go back to our training, right, treatment failures, bad outcomes are so often blamed on us, right? I must not have the knowledge, skills or experience to have properly taken care of this. Ignoring the fact that this patient came in septic with chronic kidney disease, poorly controlled type two diabetes, right? A really sick body. And I'm meeting it very late in the process. My ability to actually make impact is quite small, right? Something like 20% of our healthcare outcomes is related to the care provided by the physician and the healthcare team. The majority of it, generally speaking, is so many other factors that are outside of us. Dr. Kevin Mailo: [00:20:04] Much of the story is told before we ever arrive in the plot. Dr. Megan Melo: [00:20:09] Right. But if I'm carrying around this idea that most of the responsibility is mine, yeah, there's this little lifestyle and, you know, yeah, they inherited bad genetics, but most of the burden is mine, right? I'm going to keep in that perfectionism model. Because I'm going to feel like I'm never going to be able to do enough for that patient. We have to let go of that responsibility. Not to say that we're going to provide poor care, but let's be realistic about what is possible and what's not. Dr. Kevin Mailo: [00:20:39] Even just accepting the complications, misses inevitably happen. Dr. Megan Melo: [00:20:47] They do. Dr. Kevin Mailo: [00:20:47] I mean you're setting yourself up for failure if you become a surgeon and you say, I'm never going to have surgical complications. Well, that's, you know, that's just completely unrealistic. And yet when those complications occur, we feel horrible about ourselves. Well, I could have done this differently or that differently, or I missed this, or I missed that. And we, you know, we can tear ourselves to pieces, but without accepting the fact that every surgeon has complications. Dr. Megan Melo: [00:21:15] Right. And every body is a little different. Dr. Kevin Mailo: [00:21:17] And everybody's a little different. Dr. Megan Melo: [00:21:18] We learn where most of the organs are supposed to be, right, and how they're supposed to operate, but they don't always follow those instructions. Dr. Kevin Mailo: [00:21:24] So it's this notion of struggle is inevitable in a career like this. Right? I mean, you know, you're a professional athlete and you're going to have bad games. And so it's okay, well, how do I overcome that? And how do I keep going and not just limp along. But truly thrive. Say, okay, something happened. I'm, I've learned, I'm wiser. I put it into context and I can continue to confidently move forward in my career. That takes a lot of work, but it can be done and it should be done because like we said, like we discussed on your podcast, Megan, is if not now, when? If I'm not happy and thriving in my day-to-day clinical practice now, when am I going to? Because it isn't going to be sometime in the future, like you said. Dr. Megan Melo: [00:22:21] Right. We won't get to retirement and magically be a different person. Right? We won't have the capacity, honestly, to feel joy and gratitude because it's been, if we haven't been practicing it, we won't spontaneously experience it. Dr. Kevin Mailo: [00:22:37] And it's a skill. You have to work at it, but it does get better. So speak, you know, I don't want to keep going on and on and on, although I could. Trust me, we should just get you back on the show and dive deeper into these topics. But talk to me about, like, how coaching in this space can be so helpful for physicians. Dr. Megan Melo: [00:22:58] Yeah, I think a lot of the work that I end up doing with physicians is really about dialing down that messaging that I have to do perfect, I have to do everything perfectly. I have to say yes to everybody. I have to hold all of this. Because so often the messaging and the pressure on that physician is that they should just say yes with a smile. They should, you know, see more patients, make it to all the meetings, they should bring cookies. That's that's often, you know, for us, socialized as women. Right? Like we should contribute to the potluck and be just fine with, you know, being called that lady doctor or being mistaken for the nurse. Right? Dr. Kevin Mailo: [00:23:43] Yeah. I've got daughters myself, and it boils me over, and I'm working so darn hard to raise them without that, you know, socializing, as you call it. Because it is, it's horrifying. Dr. Megan Melo: [00:23:56] And it's quite pervasive. And it's, you know, we'd like to think, oh, we should be done with that, you know, in medicine. But no, of course, it's still just like racism persists, right? Like we're working on it, but we're not done with any of that. But really sort of trying to figure out like, what is that internal dialog that is going on for that physician about what they owe to others? You know, what's getting in the way of them taking care of themselves? Where are they struggling? A lot of times people come to me and they're really struggling with charting, or they're thinking they want to leave that job, you know? And we really sort of use that as a jumping-off point to really untangle this internal dialogue and figure out, okay, you're not broken, and you do have agency and choice, and you can start to say no. And here's how we, you know, start working on this. And through that process, really learn to, you know, be with our emotions, to see that connection between our thoughts and our emotions, and see that we are not responsible for fixing the broken health care system. But if we're going to continue to work in it, or if we're going to choose to leave, right, we need to learn how to take care of ourselves. Dr. Kevin Mailo: [00:25:07] Mhm. Dr. Megan Melo: [00:25:07] Because so many of my clients, you know, have been working 80-hour weeks and always putting others first and they, don't know how to do self care and they don't know how to answer the question what is it that I want. Like that question just stops them. Dr. Kevin Mailo: [00:25:23] Yeah. A lot of us don't actually know what we want. We maybe have a sense of what we don't want. Dr. Megan Melo: [00:25:31] I wanted to be a doctor. Okay, well, I am, but now what? What else? Dr. Kevin Mailo: [00:25:38] Yeah, yeah. Dr. Megan Melo: [00:25:40] Yeah, yeah. Dr. Kevin Mailo: [00:25:41] So powerful. Dr. Megan Melo: [00:25:42] It really does a lot to kind of offload the mind. Right? The mind that is telling them you're the only one who's like this. You should be happy just with the joy of taking care of patients and serving others, you know, and the guilt and the resentment and frustration that are kind of all tied into that. So really sort of understanding that internal dialogue and where that came from, and how do we start to undo it so that no matter what you decide to do, you will feel better, you will have better boundaries. You will see that you are not responsible for fixing the broken healthcare system, and you're not responsible for other people's emotions. Dr. Kevin Mailo: [00:26:21] I love that. Love that. So how do we reach you, Megan? For anyone that's listening. Dr. Megan Melo: [00:26:29] Yeah. So I've got a podcast called Ending Physician Overwhelm, and that's available on all the major podcast players. And then you can also find me at my website which is www.HealthierForGood.com. And I have a blog there. You can link to my podcast from there and you can find out about working with me either one-on-one or in my group coaching program. Dr. Kevin Mailo: [00:26:49] Wonderful. I love it. Thank you again so much for your time today and your insights, because I think this is the the unspoken... Dr. Megan Melo: [00:26:58] It's what we needed to learn. Dr. Kevin Mailo: [00:26:59] ... issue that we have pervasive within the medical culture. Right? And even when you just talked about like how others may be externalizing their internal shame was just eye opening for me. So again, I really want to thank you for, you know, highlighting such a big issue. And it's difficult to, I think I'll just share my own reflections before we wrap up, but it's difficult to, you know, except on the outside, you could say, well, this has been since my childhood. This is the way the profession is. But the truth is, it's highly empowering because it just, it's a matter of turning the cameras inward and doing the self-work. And we are highly resilient. We are highly intelligent and we're hard workers. So if we direct those energies towards self-improvement, it can get better. And it's independent of what hospital you work in, who your colleagues are, you know, what happened to you years ago in your life. The truth is, you can make it better now with that self-work. So I think that's so, so powerful. And again, it was wonderful having you on the podcast, Megan. Dr. Megan Melo: [00:28:11] Yeah, thank you so much for having me. It's been a real pleasure. Dr. Kevin Mailo: [00:28:14] Thank you for all your work supporting the profession. Dr. Megan Melo: [00:28:17] And for you. Dr. Kevin Mailo: [00:28:20] Thank you so much for listening to the Physician Empowerment podcast. If you're ready to take those next steps in transforming your practice, finances, or personal well-being, then come and join us at PhysEmpowerment.ca - P H Y S Empowerment dot ca - to learn more about how we can help. If today's episode resonated with you, I'd really appreciate it if you would share our podcast with a colleague or friend and head over to Apple Podcasts to give us a five-star rating and review. If you've got feedback, questions or suggestions for future episode topics, we'd love to hear from you. If you want to join us and be interviewed and share some of your story, we'd absolutely love that as well. Please send me an email at KMailo@PhysEmpowerment.ca. Thank you again for listening. Bye.
	14 May 2024	Bonus Episode - 2024 Federal Tax Budget & Changes - what you must know with Cherry Chan, CPA	00:35:27
Dr. Kevin Mailo introduces Cherry Chan, a renowned author and expert in real estate taxation, who discusses the implications of the 2024 federal budget alongside Dr. Wing Lim. They delve into how the budget targets the wealthy but inadvertently affects the middle class, particularly through the increase in capital gains inclusion rates. Their discussion explores how the changes penalize not just the ultra-rich but also ordinary Canadians who have invested in properties or stocks for long-term financial security. Cherry Chan and Dr. Wing Lim dissect the budget's effects on both unincorporated individuals and incorporated professionals. They explain how the changes disproportionately affect those who have incorporated their businesses to benefit from lower tax rates, as now, even the first dollar of capital gain within a corporation is subject to the elevated inclusion rate. This shift undermines the previous tax advantages of incorporation, significantly impacting investment strategies and financial planning for professionals like themselves. Cherry’s insights help unpack the changes being instituted and how to approach them. – About Cherry Chan, CPA: As a real estate tax expert, Cherry provides specialized advice to a wide spectrum of clients in the real estate sector, from investors to agents, ensuring tailored solutions for their unique needs. Concurrently, at OTUS Group, she contributes to revolutionizing financial management for non-profits and associations, offering strategic oversight akin to a CFO's role. Cherry’s dual involvement reflects a deep commitment to delivering expert financial guidance across diverse sectors. Cherry Chan on LinkedIn __ Interested in going further in your financial journey? Join our national conference and meet the PhE team live in Toronto this May 25 and 26th: https://www.physempowerment.ca/live __ Physician Empowerment: Register for the Physician Empowerment Live Conference in Toronto on May 25 - 26, 2024 Join the Physician Empowerment Masterclass now
	15 Jul 2024	47 - Implementing AI in the Medical Practice	00:25:45
Dr. Kevin Mailo is joined by physician and entrepreneur Dr. Amjed (AJ) Kadhim-Saleh. AJ has a remarkable story to share because he is not only a family physician in Toronto who built his own clinic in his second year of residency, but an AI entrepreneur as well. He and his wife are the founders of Pippen, an AI technology specifically designed to ease the administrative notes burden of physicians. He tells Kevin all about how it works and why it will revolutionize physician lives. Dr. Kadhim-Saleh describes how building and managing his own clinic from the ground up was a big challenge that added an extra administrative burden to his days. He says that one of the largest unpaid administrative burdens is one that faces all physicians: taking patient notes. The extra time drain from that pushed him towards burnout. So he and his wife created an AI that works in the background of patient conversations, transcribes, and takes notes. It frees physicians from being stuck to a screen taking notes instead of facing patients and conversing and eases the burden. AJ describes the potential of AI for physicians to Kevin, explaining all the ways in which it is already making their lives easier and the ways it will be incorporated into practices and clinics in the future. – About Dr. AJ (Amjed) Kadhim-Saleh: AJ is a community family physician and clinic owner in Toronto. AJ has a deep understanding of the joys and pains of practicing family medicine, building an efficient practice, and creating workflows that work for family physicians. AJ developed Pippen [AI] so that family physicians could claim back their time, feel supported, and have a great day at work. AJ also wants to help physicians discover the wonder of AI, which is poised to revolutionize how physicians deliver care. __ Dr. AJ (Amjed) Kadhim-Saleh: LinkedIn Website: Pippen.ai Physician Empowerment: Attend an upcoming Empowerment Retreat Join the Physician Empowerment Masterclass now Website: PhysEmpowerment.ca
	15 Dec 2023	33 - Critical Mineral Investment with Graham Koehler	00:33:04
Dr. Wing Lim invites Graham Koehler, an expert in flow-through shares and VP of Business Development focused on flow-through since 2010, to the show to explain what flow-through is. Not only does Graham define flow-through shares, but he also explains their amazing tax benefits, potential risks, and who they work best for. The flow-through program was developed by the Canadian government to help resource companies raise capital to explore for minerals to mine. The original program was developed with a main credit called the Canadian Exploration Expenses credit (CEE). Graham goes into detail about how the CEE differs from an RSP or TFSA and then explains the additional tax credits available to investors on top of the original CEE. He shares a partial list of the critical minerals that qualify, how flow-through shares work, potential tax deduction numbers, and the inherent risks worth considering. This is a fireside chat introduction to the opportunities of flow-through shares so we can all ask informed questions of our tax accountants and advisors. -- Physician Empowerment: website \| facebook \| linkedin -- Transcript Dr. Kevin Mailo: [00:00:01] Hi, I'm Dr. Kevin Mailo, one of the co-hosts of the Physician Empowerment podcast. At Physician Empowerment, we're dedicated to improving the lives of Canadian physicians personally, professionally, and financially. If you're loving what you're listening to, let us know! We always want to hear your feedback. Connect with us. If you want to go further, we've got outstanding programing both in person and online. So look us up. But regardless, we hope you really enjoy this episode. Dr. Wing Lim: [00:00:35] Okay, so welcome everyone to another exciting episode of Physician Empowerment, a live webinar series, and we talk about highly relevant topics. We interview interesting people on interesting topics that will help our physicians and medical colleagues live better lives. So we're not just physicians, we're physicians and other health professionals like dentists. And so we're really excited to have you join us tonight. And this, of course, becomes an evergreen podcast. So you can go back on. So let me introduce tonight our guest. Our guest is Graham. And Graham has been in the space of flow-through shares since 2010. So he's a Canadian living in Kelowna. But he's now talking to us from Huatulco, Mexico. And so we want to cover this topic, I've done three shares actually since 2012, and full disclosure, I actually bought it from from this company. And I really trusted them to have really, really good track record. So Graham's role is the VP of Business Development of the excellent capital in one of their flagship flow-through shares. So tonight it's a fireside chat to warm everybody up. What is flow-through, right, the history. What is about and how does it impact us as medical professionals? So without further ado, Graham, thank you for joining us from Huatulco in the midst of your holiday. Graham: [00:02:07] No problem. I'm really happy. I mean, quite frankly, Wing, I would always come on board when you ask. And I'm always thrilled to talk about this program because I've seen how it can help people save significantly on taxes in Canada, especially professionals. So I'm always happy to participate. Dr. Wing Lim: [00:02:27] Right now. So why don't you first walk us through? Because a lot of people have heard of it or haven't heard of it, but the knowledge base is almost zero. So walk us through what is flow-through share and why does the government creates such huge incentive like 100% plus tax write off? Graham: [00:02:45] I know, and, yeah, absolutely. When people get exposed to the flow-through, the government flow-through program in Canada for the first time, it's almost too good to be true scenario. But it is a, first off, it is a federal government program that's been around for a long, decades, quite frankly. And we'll talk about that and maybe why people haven't heard of it. But essentially the program was developed back in the 70s in its current form. So decades ago, because Canada, as we all know, is a resource rich country. We do rely heavily on our natural resources and always have in Canada. But the idea of companies going out to explore, what I call poke holes in the ground, to go out and poke holes looking for, you know, whether it's oil or gas or minerals of any kind, precious metals, gold, whatever the case may be, is risky business. These explorers, these Canadian wonderful explorers, go out there, typically on their own dime, looking for these resources and and hope they find them. Well, the truth is they sometimes don't and they're not successful. So it's risky. Exploration is risky business. So what the government, the federal government did back in the day was created a program to help these resource companies go out and explore, to raise capital, to raise money to do their business. So to help them raise capital from investors, which is typically where capital comes from for most things, they offered significant tax benefits for the investors to put their money up so that significantly reduces the risk involved, obviously, when you get tax benefits or tax refunds. So the original program was developed and still continues today with a main, a main credit, if you will, called the Canadian Exploration Expenses credit. CEE. So it's just simply, that credit is simply a 100% deduction from income for every dollar invested in the flow-through program. So for every dollar that you give to these companies that are out exploring and needing capital, you get 100% reduction of income. That part would be similar to an RRSP. Dr. Wing Lim: [00:05:13] Right. So then okay. Very good. So thanks for the intro. It's like gold rush. Right? So the government is incentivizing people to do gold rush equivalent. And then so there's, like RSP, there's some advantage. So can you tell us it's like RSP but it's not like RSP. In the sense it's better than RSP. Graham: [00:05:33] It is. It actually gives quite frankly far more deductions now than RSP does. A typical RSP platform, as we all know an RSP is simply an account, things have to go in it. The flow-through is an actual program. So really in Canada there's some different programs out there, but as far as federal government programs spanning the country, there's really three on the tax side. There's RSPs, which we pretty much all know about. There's the somewhat newer TFSA program, which doesn't save you taxes up front, but it builds tax free within the program. So it is a tax program. So we have RSPs, TFSAs, and flow-through. The main difference between RSPs and flow-through are that, well, number one RSPs can only be purchased by an individual, not a corporation. Correct. Whereas flow-through can be purchased by an individual, a corporation or a trust. There's also a maximum contribution limit every year on an RSP. Whereas with flow-through there is no upper limit. The only the would be on the investor's, you know, suitability for the program and their risk tolerance. But there is no mandated upper limit on the program. And then really the main significant differentiator is, as I mentioned a few minutes ago, the first credit with the flow-through program is 100% reduction of your income by the amount you invest. Graham: [00:07:15] That's exactly the way RSPs work. But in the flow-through case, there's two more federal tax credits involved on top of that. And these are for everybody that invests in flow-through individually. And they are what's called the mineral exploration tax credit. And that's a 15% additional ITC or investment tax credit on top of the 100% you get with the exploration expenses. And as of last year, 2022, there's now a third tax credit involved with flow-through. The federal government announced in 2022 that they were adding in a 30% tax credit, ITC, investment tax credit, on the flow-through program for any part of a fund that is invested in critical minerals. So it's called the Critical Minerals Investment Tax Credit. So you have the original 100% reduction of income for every dollar invested, which is somewhat similar to an RSP. You have the additional federal 15% mineral tax credit. And now the potential for a 30% tax credit on anything in a fund, in a flow-through fund, that's considered critical minerals. And the government gave a list of critical minerals. Dr. Wing Lim: [00:08:40] Can you give us, I just know the list is big. Give us some common ones. A common one, is it lithium or is it... What is it? Graham: [00:08:46] Yeah. There's a number of them, and some of them will make a lot of sense. Mainly they're minerals that are critical to the electrification of the world, to elect batteries, electric vehicles etcetera. So that's really what the government is promoting right now because we have a lot of those minerals, or most of them in Canada, and we can explore for them and bring them out of the ground. Examples, lithium of course, magnesium, cobalt, copper, the rare earth elements, none of which I can pronounce the names of, those elements as well. And interestingly, uranium, as of last year, the government has considered or has actually called now, classified, uranium as green. Dr. Wing Lim: [00:09:35] Wow. Graham: [00:09:36] Yeah. Yeah. Very interesting. Dr. Wing Lim: [00:09:37] When you think about it, it is very green. Graham: [00:09:40] Yeah. It is. And, you know, obviously this isn't the place or time to get into the pros and cons and things like that. But yeah, what happened a year ago was in this decades-old program, the federal government actually pulled oil and gas out of the flow-through program. So we can't buy oil and gas flow-through shares or, you know, shares of oil and gas companies now. They took that out. But they added in this critical minerals 30% tax credit. In other words, they're really trying to build, to help explorers and developers in Canada, Canadian companies, to go out and find more critical minerals. So that's the difference between RFP and flow-through right now. Dr. Wing Lim: [00:10:27] Now, can you educate us, Graham, that I've heard about tax credit and tax deduction. What's the difference? Graham: [00:10:35] Yeah yeah just... Dr. Wing Lim: [00:10:37] Briefly. Graham: [00:10:38] Yeah I will, I'll try and be brief there. And I'm glad you picked up on that, because I did use the two different terminologies here. I've mentioned the three different credits available. And the first one that I said has been around forever, for decades is the CEE, and that stands for Canadian Exploration Expenses. That is the main, that part is again, it's federal, everybody gets it. It's a 100% reduction in income. So for every dollar you invest, you get your tax slip from a flow-through company, you know, in the spring for the year, for the past year. And it'll show that CEE, your accountant simply reduces your income by that amount. So you save taxes, you know, to be simple, to simplify, if you're in a 50% marginal tax rate, a high income earner, and you invest in a flow-through, 50% of the money you invest is going to come back to you immediately in a tax refund. That's the CEE. In addition then, that second and third credit are called investment tax credits. They operate slightly differently than that first one. They don't reduce income by the amount, they actually, you multiply the first case 15%. It's called the mineral tax credit exploration, it's 15 - one five - percent. So you multiply your investment times 15%. That number comes directly off remaining taxes that you owe. So it's very powerful. And then the third credit is an investment tax credit as well of 30%. So you multiply, or you know, effectively, the auditors do this. You don't do any of this. We just in the industry give you a tax slip. But the critical minerals at 30%, any part of a fund that's critical, gets multiplied by 30%. And that number comes directly again off taxes you still owe. So very powerful. So there's a little difference in how the two... Dr. Wing Lim: [00:12:44] So can I just, just give some numbers? So and you can tell me if I'm right or wrong. Right? So if let's say doctor XYZ makes 100,000 this year, taxable income, and invest $10,000 in there. So just based on the first, the CEE, then the income taxable income becomes 90,000. Graham: [00:13:04] Right off the top. Dr. Wing Lim: [00:13:05] Yeah. So and if doctor XYZ owes the government $50,000 in tax right then hey 15% of that, whatever they invest in, comes right off the tax. So potentially 40, so if they do $10,000 investment, so what 45% of that? Which is 40... Graham: [00:13:26] But the only thing to keep in mind is the 100% everybody gets, the 15%, you get either the 15% on part of a fund or the 30. They don't stack on top of each other. Dr. Wing Lim: [00:13:40] Got it. Potentially, let's say we buy the critical mineral. Then 30% of 10,000, that's 3000. Graham: [00:13:47] That's right. Dr. Wing Lim: [00:13:47] 3000 comes off your 50,000. And you owe that year for tax. Graham: [00:13:51] Yeah, the way it works out for most funds, the way it works out, and again there's multiple, there's many many, you know, there's a number of flow-through funds in Canada. I would say on average an investor is going to get somewhere between 120 to 125% in deductions for every dollar they invest. So if they invest $10,000, they're going to get the equivalent of about $12,500 in deductions. Dr. Wing Lim: [00:14:23] That's absolutely amazing. Graham: [00:14:25] It is. And what it's done, especially with this added, when the government in 2022 added in this extra critical minerals tax credit, what it means again, and this is for an average fund, it depends how much a fund has in critical minerals or not critical or things like that, so it's hard to give exact numbers here, and every individual it will be different as well with their tax rates, but again, on average it'll be 120, 125% in tax benefits for every dollar invested. And what that does is it reduces, when you calculate it out, it reduces the at risk money, that $10,000 that you've invested, it typically reduces that down to $3 or 4000 out of the $10,000. That's the money you actually now have at risk because you've received all the rest back in tax refunds. Dr. Wing Lim: [00:15:13] So there's so much refund that you're only about 30% of this is really at risk capital. Graham: [00:15:18] And that's directly why the government's doing it. Is to, and by the way, there's no exact number on the benefit to the government. But I've heard in the industry many times over the years that the federal government, the CRA, basically, recoups, recovers anywhere from 3 to $4 in basically income generated for the government for every dollar they give back in tax credits to investors. And the reason for that is because these companies that explore, many of them are very successful and eventually pay a lot of tax. So it's been a very beneficial program for decades for both investors and the government, quite frankly. Dr. Wing Lim: [00:16:04] Right on. So I think we touched on this is such a good program. And the next question is, well, how comes my accountant didn't just jump at my throat on that? Graham: [00:16:15] It's you know, I've mentioned it's been around for a long time. The actual original, the very, very origination of the program in an older form was mid 1950s. This program's been around since before the RSP program. It came into its current life in the early 70s. Why isn't it more well known? One of the main reasons it's not is, and I think this is from the accounting side of it perhaps, is there is risk, of course. And a lot of times, quite frankly, I think accountants don't want to, you know, be responsible for talking about a product that has risk. You know, it's very, very difficult sometimes, even though it's been de-risked so much. The other reason, and I think this is far more, will answer the question I think far better, is the big institutions in Canada, the big banks, the big financial institutions, the big investment sellers, they're not really interested in the flow-through program. And the reason that they're not is it's just for them, not big enough, quite frankly. On average, over the years, the Canadian Federal flow-through program has raised, on average, about a half a billion a year in capital. So about 500 million a year gets raised every year in flow-through. And I'm sure that's, you know, in a niche market that's a pretty good number. But to the Royal Bank of Canada, it's just not look. They look at that and go, no, we're not interested in that kind of niche small market. They're far more interested in doing mutual funds and RSPs, which are, you know, continuous. That's really why it's been mostly, up until about ten years ago, it's been mostly the purview of certain accountants and certain tax lawyers that paid attention to it. Now there's more and more funds. So it's getting a lot more attention. There's more people like yourself looking at it. Dr. Wing Lim: [00:18:11] Yeah. So if you had 50% tax bracket, right, if you added 25% tax bracket, it doesn't make as much impact as 50 plus percent. Graham: [00:18:19] Yeah. And we get, you know, people ask me oftentimes like what would, who should buy this? Who should invest? Who should invest in flow-through? And there's two answers. One, anybody that's got a tax problem. If people have a tax problem, they should look at flow-through. If their tax problem is five grand in a year, maybe not. They're, really in my mind to get the biggest bang for your buck out of this, you really should be in the, I'd say the 35 to 50% marginal tax rate, right? Dr. Wing Lim: [00:18:58] The bigger the tax problem, the bigger the solution, right? Graham: [00:19:01] That's exactly it. Dr. Wing Lim: [00:19:03] Yeah. Right. So maybe tell us, okay, so this is the good side. Tell us the worst. What's the worst scenario that could happen? Graham: [00:19:11] People can lose money. And and I'm not being flippant. It just, it can happen. This is, there is risk involved with this program. And you know, that's why it's imperative too that the individuals look at, know a few good questions to ask a flow-through fund. And we can talk about that if we have time. But yeah, the ups and downs of it. This is, for the most part, junior, what they would call junior resource companies in Canada, which are smaller companies, their share prices are smaller, their, I guess they would be what's termed as penny stocks out there, even though some of them have been around doing this for decades. They've been around a long time. There are still smaller companies. They go explore, they find something, they move on. Or quite frankly, they get bought out and they start it again. They get, when they find something, they get bought out by a bigger developer and they start exploring again. So they're back to being small. So that's where the real risk is, is when a fund is put together, quite frankly, if the fund manager, the research team involved, aren't that great at picking the stocks, these funds can go down dramatically. I've seen funds, they don't go to zero these funds because they have many different companies in them, many different shares, but have seen a, from certain companies out there, I've seen a $10,000 investment get paid back at $1,000, let's say. A few, you know, 18 months or 24 months later. Well, you need to get back about $4, quite frankly, 3 to $4 to break even. Unattend, I'm talking $10 purchase prices. You know, so you would need to get back 3 or $4. I've seen returns of a dollar, $1.50. So those are actual real losses. Dr. Wing Lim: [00:21:07] And those is not right away. Right? It's over time. Right? Graham: [00:21:11] Yeah. Most flow-through funds in Canada operate on anywhere from a 8 to a 24 month kind of window. There are a select few out there that have done a great job by being a little bit longer term for their investors, maybe 3 to 5 years. I've found that those companies have done a little bit better, quite frankly, because what they've done is they've given the resource companies more time. So hopefully make a profit. So there are a few companies like that out there. Dr. Wing Lim: [00:21:47] But it's also dependent on cycles. Graham: [00:21:50] It is. And when I mentioned that these are junior resource companies, a lot of them are, most of them, in fact, of this variety, are traded on the TSX Venture Exchange, out of Calgary, not the general TSX, but they're traded on the TSX Venture. And so you've got to look at that exchange to see how it's gone up and down over the years. And it doesn't track the same as the TSX. Okay. It is a totally different market. Now the TSX Venture isn't just resource companies. There's tech companies and all kinds of small firms there, but it seems to have its own path. And yeah, it went through a long bare market, quite frankly, the TSX Venture went through a bare or a down market from 2010 to about 2017. So it's kind of on a downward rate, but it also goes up. And right now, by the way, the market in general for this in Canada is somewhat, is low, like it's been here. So there's, you know, who knows. But it may be an opportune time to get into natural resources in Canada because they are somewhat suppressed right now. Dr. Wing Lim: [00:23:07] Right. Tell us something about this super cycle. Graham: [00:23:10] Well, that's kind of where that, you know, we're in that, there are a lot of us believe that we're kind of in the first or second inning of a super cycle right now, and all that means is a bull market or a potential up market on steroids. Meaning that it's going to go high and it'll last, this bull market in commodities, if it truly is a super cycle - and there's been three super cycles in history before, this would be the fourth - it would last for maybe as long as 6, 8, 10 years. The super cycle. A lot of the very experienced portfolio managers, the commodity people out there in Canada, the, you know, commodity trading managers and the guys like Sprott and, you know, they've been calling this now for 2 or 3 years. And they all feel that we're in the beginning of that super cycle. And really it's because there was such a depression for those years I talked about. Nothing got done. And it takes, once things get rolling again - and precious metals, for example, like gold, and I think we're all pretty familiar that, you know, gold is on a, you know, should be and has been on a bit of a trend - people are looking for ways to buy precious metals right now, but it takes, and now critical minerals like lithium and stuff and uranium, by the way, uranium has started to go up dramatically now. Lithium went up dramatically 2 or 3 years ago. So that's, now just keep in mind that these super cycles, if that's what we're in, and a lot of us think we are, they don't go up in a straight line. Nothing goes up in a straight line. So it'll be a bit of a bumpy road right now, I think. Some years we'll be down a little bit, some will be up. But the general trend, I believe, for the next 8 to 10 years is going to be an upswing. So I look at the flow-through program, which was developed by the government to help this type of a cycle, really, as a significantly de-risked way for investors to get involved in commodities. Right? They don't have, yeah, they don't have to pick their own. They can get, you can get involved in gold and silver and lithium and a whole basket of these in the flow-through program now for your portfolio. Dr. Wing Lim: [00:25:36] Right. So I listen to a lot of podcasts. That's how I do my pastime. And we're truly in a global village situation. A war in Ukraine. Boom. It affects Canada. It affects the African food supply because the wheat basket, but also minerals and resources. Right? When Russia and Ukraine have big war and now we have Middle East war, and so it impacts and of course, like you say, we're electrifying everything. Right? Electric vehicles. A patient of mine just, he's in a developing business of different kind of battery that is going to make the regular battery that we see now obsolete. There's so much advanced, technological advance, but the limiting factor is still the resources. Man, you got to find those nickel, cadmium, lithiums of the world. Right? Graham: [00:26:27] And you do. And not only do you need to find them, once they're found, once once a resource is found, it doesn't relate to a producing mine next week. These take, these can take a few years to develop once that mineral is found. You know, there's obviously a lot of hoops and mountains to jump over literally with regulation before this gets off the ground and that mine gets running to produce what it needs to produce. That's why when I talk about the potential, if we're in a super cycle, I mean, we're in a bull market, but, you know, potentially a super cycle, that's why these can go for years because it takes time to ramp up reproduction. Dr. Wing Lim: [00:27:12] And then is it true that the world is now coming to us because we are the Canadian Shield, right? Other places they have, but there's political instability. They don't have infrastructure. Right? They're coming to us. Graham: [00:27:27] Yeah. The world does come to us. I mean, you know, we hear sometimes reasons why certain places don't come to us or they wish we were doing things differently here and there, regulation-wise in Canada. But the fact of the matter is, you know, for years, and I think it's true, I've been, to me, I like to keep things really simple, kind of dumbed down for myself. The world needs these minerals more than ever. We have them. So they're going to come and we're a stable country to deal with. And quite frankly, our environmental record is pretty good too, compared to a lot of other countries. Dr. Wing Lim: [00:28:06] Right. So because it's uncertain and we possibly could be going into a super cycle, so is it wise to do dollar averaging thing, buy some every year? Graham: [00:28:16] Well, yeah. Dr. Wing Lim: [00:28:16] Or just buy a big lump sum? Graham: [00:28:19] No, I would actually recommend that people don't buy a big lump sum necessarily, whatever big means to an individual. Um, I would say no, you're far better off once you understand the program and the merits of it, to cycle this, to buy some every year. Because there is going, even with the best fund in Canada out there, there's going to be the odd down year. One of the things to look at with any fund, quite frankly, is what I call an asymmetric return. How many, if a company has had 20 funds or 30 funds over the years, how many have been positive? How many have been negative? And if there's significantly more that have been positive than negative, that's a great asymmetric return for clients. Dr. Wing Lim: [00:29:08] Got it. Graham: [00:29:09] Right? It means that company kind of knows what they're doing. Dr. Wing Lim: [00:29:12] Good. Graham: [00:29:15] I recommend cycling. Dr. Wing Lim: [00:29:18] Good. So you're walking into the last question I'm going to ask is, the funds are not created the same, equal, right? So our program is not to flag a fund, but to empower our listeners to ask smarter questions to their advisors. So what are a few questions, maybe three questions, they should ask these funds? Like what are the key separating, what differentiating questions? One of which is probably the asymmetric return, right? They need to have good track record that. Graham: [00:29:47] That would be one, that wouldn't be the first question, or place to look, but that's absolutely one. How is the company done? You know, asymmetric? Have they had good asymmetric returns? To me, number one with anything in life, especially in the investment world, is management. Absolutely look at management. Look at their experience, their background, their credentials, how long they've been doing flow-through funds in Canada, what their relationships are with the mining groups, with the big investors in the mining community. I would also ask what that company's thesis is, what their investment thesis is. Because that can be critical, especially in flow-through. When you look at something like real estate, for example, buying a building, well, the thesis is pretty standard. Buy it and rent it and make money and hopefully it goes up. The thesis can be a little more, slightly more complicated in flow-through, but I would ask what the portfolio managers' thesis is. And they should be able to send you a 2 or 3 or 4 page only report on how they put, what their thoughts are, and how they put together the fund. And the reason you want that is, in my experience, I've seen a lot of flow-through funds out there that have focused on one thing only. Tax refunds for investors. That's great. But if you lose money, why bother? You really want to look for a fund whose investment thesis is to number one, try and put together a resource fund that's going to make people a profit and it comes, and just happens to come with flow-through shares. But in companies, their thesis is just to get you, is number one, to try and make a profit for their investors and give the significant benefits that down period in Canada were suppressed for about, they were poorly managed and just disappeared during the bare market. So I would look for companies that have just been consistent for many years, coming out with a product every year and doing their job. Dr. Wing Lim: [00:31:50] Okay, good. Graham: [00:31:51] Those are a few of the things that that you should look at. Dr. Wing Lim: [00:31:54] Right. Right on. Okay. So that's really good. So I want to thank Graham for his pile of wisdom. Pearls of wisdom. He's been in there the good days and bad days. Seen a few cycles. Dr. Kevin Mailo: [00:32:07] Thank you so much for listening to the Physician Empowerment podcast. If you're ready to take those next steps in transforming your practice, finances, or personal well-being, then come and join us at PhysEmpowerment.ca - P H Y S Empowerment dot ca - to learn more about how we can help. If today's episode resonated with you, I'd really appreciate it if you would share our podcast with a colleague or friend and head over to Apple Podcasts to give us a five-star rating and review. If you've got feedback, questions or suggestions for future episode topics, we'd love to hear from you. If you want to join us and be interviewed and share some of your story, we'd absolutely love that as well. Please send me an email at KMailo@PhysEmpowerment.ca. Thank you again for listening. Bye.
	15 Nov 2022	07 - Hospital Conflict Resolution with Dr. Mandy Brisebois	00:27:29
Dr. Kevin Mailo welcomes Dr. Mandy Brisebois, physician and Certified Health and Wellness Coach, to the show to address the reality of interpersonal conflict and how to resolve it. Dr. Brisebois specializes in helping practitioners work through conflict and shares her experience with listeners. Dr. Brisebois clarifies that conflict is the end result of missing the boat on necessary steps that come beforehand. She identifies that communication, collaboration, aligned expectations, and knowing each other’s goals are all conversations that should be happening amongst colleagues in order to avoid clashes. However, knowing how to resolve conflict when it does arise is vital, especially in pandemic times of stress and overwork. In this episode, Dr. Kevin Mailo and guest Dr. Mandy Brisebois discuss how to address conflict or tense exchanges in the moment, with Dr. Brisebois offering ways to change how we think about the exchange and how to open conversation before walking away. Dr. Brisebois shares what process she has learned to identify conflict, how she takes people through conflict resolution, and the necessity of psychological safety in the workplace in order to foster the communication required. About Dr. Mandy Brisebois: Dr. Mandy Brisebois uses her influence in high level leadership positions to advocate for physician integration into our health systems. Ultimately a deeper understanding of our complex systems will enable physicians to maximize their impact and promote patient care in the most effective capacity. Ultimately this strategy contributes to less conflict in the work environment, and fewer practitioners modifying their practice due to burnout. Dr. Brisebois is a certified Wellness and Executive Coach (with specialization in healthcare in process), a General Internal Medicine and Palliative Medicine Specialist, as well as having extensive training in conflict, negotiation, mediation, equity, diversity and inclusion. She has served as the Medical Director for a large 290 bed hospital, the Medical Director of the Covenant Palliative Care Institute, as well as an Associate Chief Medical Officer of Covenant Health. She is completing her Masters of International Health Leadership through McGill University and has trained at multiple world renowned organizations including the Mayo Clinic, Berkeley, Oxford, UBC, and the Justice Institute of British Columbia. Her leadership specialty is helping practitioners and teams find success through conflict, and learn from these successes to create happier, more efficient and more effective healthcare teams. She has spoken at many international events, and she is a published author in her fields of expertise. Resources discussed in this episode: Canadian Medical Association statistics on physician wellness Crucial Conversations Edmonton Zone Medical Staff Association — Physician Empowerment: website \| facebook \| linkedin Dr. Mandy Brisebois, MSc, MD, FRCPC, AoDI, CEC: website \| linkedin __ Transcript: Dr. Kevin Mailo: [00:00:00] Hi, I'm Dr. Kevin Mailo and you're listening to the Physician Empowerment Podcast. At Physician Empowerment we're focused on transforming the lives of Canadian physicians through education in finance, practice transformation, wellness and leadership. After you've listened to today's episode, I encourage you to visit us at Phys Empowerment.ca, that's P H Y S empowerment.ca, to learn more about the many resources we have to help you make that change in your own life, practice and personal finances. Now on to today's episode. Dr. Kevin Mailo: [00:00:35] As I've mentioned before, for those of you that have joined us on our webinars or podcasts, you know who I am. I'm Dr. Kevin Mailo, one of the co-hosts of the Physician Empowerment Podcast and one of the co-founders of Physician Empowerment, and who I have with me today is a colleague and a friend whom I really admire, not only for her clinical work, but for her incredible leadership. So joining me today is Dr. Mandy Brisebois, and Mandy is a general internist with a hospital based practice. She specializes primarily in palliative care and chronic disease management, but she's also held numerous leadership roles, including Associate Chief Medical Officer and Medical Director at a major community hospital. And Mandy, over the course of her career, has really taken leadership to another level. And one of her areas of focus as a medical leader is conflict resolution. And so that's what we're going to be talking about. And it's going to be interesting because we get a lot of training in medical school and residency on how to navigate a difficult patient encounter. But what we're going to focus down on today is interpersonal conflict between physicians. And I don't need to go to any great length about how common this is, but we certainly know what occurs. And with that being said, Mandy, why don't I let you take it from here as far as introductions and where you want to want to go with our talk today. Dr. Mandy Brisebois: [00:01:58] Sounds great. Thank you so much, Kevin, for having me here. And it's just been such a pleasure to talk to you. I wanted to be on this show and also really specialize in this conflict work because I think we're in a really bad spot and physicians have been through a really tough time through the pandemic. We've been bogged down and a lot of us don't have much capacity to really be on our best behavior all the time. And I don't think in medical school we get taught how to manage conflict. In fact, I know we don't because in my role as medical director and the ACMO role, I had to manage so much conflict with colleagues and I had no idea what I was doing. And it wasn't my fault. And I thought for a long time that it was my fault. And so I went and got training and this is why I've got so interested in it, because I've got extensive training now in conflict negotiation and mediation. And I realized that there's a process and that we actually can learn how to take care of conflict. Dr. Kevin Mailo: [00:02:58] Awesome. So what are some of the contributing factors then to conflict? Like talk about the ingredients for interpersonal conflict. I mean, one of the big ones coming out to me is like limited resources, right? For physicians as we try to deliver the standard of care to our patients. But tell me a little bit more about what do you think contributes to a conflict prone environment for health care providers? Dr. Mandy Brisebois: [00:03:23] That's an excellent question, and I love that you bring up the resources because it's typically what we go to is what's limiting me. And the conflict, usually I say if we have conflict, we've kind of missed the boat. Conflict is the end result. The beginning is the communication, the collaboration, the expectations that are aligned, actually knowing what each other's goals are and having those conversations. And because we haven't really been taught how to do that, we end up just going, I don't have enough resource or I can't take care of my patient. And we shrug our shoulders and then we say to somebody, Give me more resources. And we don't actually know how to talk to them about what is the problem. And we don't know in the moment to say to someone, let's say a physician colleague talks to you in a very terse way, how do you manage that rather than walking away kind of thinking, Well, my day is really bad. I'm just going to, it's going to get worse now. Instead of talking to them in the moment and solving it and then it's over and you know your colleague better and your day is actually better when you learn how to solve those in the moments and you learn how to actually go through the problems and see what they are. It's not just about a resource thing. You have to actually nail it down to a solvable, neutral problem that you can solve. And it takes a lot of work and skill to figure out how to do that. And so I think we need to practice on it and learn how to do it. Dr. Kevin Mailo: [00:04:47] So finding shared interests then is a key part of this. Dr. Mandy Brisebois: [00:04:51] Yeah, and especially with big organizations, I keep saying that we are part of these massive organizations now. They have multiple strategic plans. Most of the time we're not really aware of what the strategic plans are, and so we want a resource. We don't know where it fits in our organization's strategic plan because we haven't, well, maybe we haven't looked at the Internet. The expectation that we're supposed to look on the Internet hasn't really been connected to us either. And even our leaders aren't really sure, like, what am I supposed to give to my colleagues? What do they care about? How do I connect the organizational goals with our goals as physicians? And when we don't connect, then we don't communicate. We don't know how to move forward and to really action on our knowledge, which is clinical care. And so I'm really trying to promote if we get these conflict situations under control and learn how to talk to each other about hard things that we actually learn about each other, we learn more about our jobs and we want to come to work instead of just sort of putting our heads down and walking in the door and going home. Dr. Kevin Mailo: [00:05:55] Yeah, I think that's it. You know, as far as like when morale falls, I think a lot of people do just honestly just want to get in, get out and get through it. But that means people aren't invested in health care systems in which they work in, right. Because people sort of, I think, throw up their hands and feel disempowered. So how do you go about that process of learning to say those initial, start that conversation? I think that's probably one of the hardest steps is to say, I'm identifying a conflict here. How do we, how do we get to that point ourselves personally as individuals working within the health care system? And then what practically do we say when you talk about sharing in the moment or notifying a medical leader? How does that look? How should that look? Dr. Mandy Brisebois: [00:06:42] It's so hard because we're not really used to it. We're not really used to responding to behavior that we're not comfortable with. And it is important to remember there's so many cultural differences between people that sometimes someone maybe seems very terse or no expression, and that just might be the way they are. So one of the things they say that if you notice something at work and somebody says something to you, let's say it seems quite aggressive because this happens a lot, someone's like, they were really aggressive and demeaning. And I'll ask them, Well, what did they say? And only 7% of what we understand are the words. So the rest of it is the tone of voice, the mannerisms. And often when they tell me the words, what they remember the words being, it didn't seem like it should be something that you would be so upset about because I wasn't there. And often when these people get feedback after the fact, they don't know what they did either. So what I tend to do is if someone, and you have to develop your own little things, but if someone says something to me in quite an aggressive tone, often I'll just do a little tear. I'm like, Oh no. Or I'll say, Ouch. Or I'll say to them, Are you okay? Dr. Kevin Mailo: [00:07:50] Right. Dr. Mandy Brisebois: [00:07:51] And they'll be like, What are you talking about? And I'll say, Well, this just wasn't the reaction I was expecting from you. I really thought we were on the same team. I'm worried I said something wrong. Can you tell me where you're at? And when you flip it around like that, people sort of go, Yeah, I'm having a terrible day. I've got 15 people in the Emerge, you know, what did you interpret? And I'm like, I just thought you were really upset with me. And most of the time they say, No, actually I'm not. I'm just really stressed. Thanks for saying something. Now, if they don't say that, I was talking to someone else and someone else said, What if they say screw you? And you start to think, Well, that would really feel bad. But you know what? I say the same thing because if someone says that I don't like it, that you're talking to me about this, I'll just say, But I really want to work with you. And when I got on this team, I was excited to hear what you had to contribute to the team. And for me, I can't be a part of that if I don't really understand what you're saying or I feel you're yelling at me and I want to be part here. And how do you think we can move forward? Or I'll say to them, what kind of tone of voice do you think you're using? And they'll sort of look at me and go, What are you talking about? And I had one person say, Well, I'm in the military, so I don't know. That's just how I talk. And I said, Oh, that's good to know. Like, you start to know each other. Dr. Kevin Mailo: [00:09:11] Yeah, well. Dr. Mandy Brisebois: [00:09:12] It's fun. Dr. Kevin Mailo: [00:09:13] Yeah, well, that's that's what I sort of discovered as I get a little bit older and a little bit wiser. I saw personalizing things that I came across, whether that's a patient that might be irritable or an allied health colleague or a physician colleague, it's just peeling back that layer. Peeling back that layer just a little bit to find out what's going on. Because very often it's that old iceberg theory that comes up, which is we don't know 1/10 of what someone's really dealing with beneath the surface. Right? And I'll never forget watching one of the most egregious outbursts from a physician towards another staff physician when I was a medical student. And it was later in the week that he just sat down and described how his whole life was falling apart on a personal level. And that's when I realized, like hurt people hurt. And I don't think that's an excuse and to say, okay, well, we're just not going to deal with it. That's that's not right either. But it's about saying, okay, now there's another issue here, right? We're not talking about beds or discharges. We're actually talking about something else. So now we are going to deal with it. It's an opening. Dr. Mandy Brisebois: [00:10:20] Yeah, exactly like you said, it's an opening and that person may go home and kill themselves. And I'm not trying to be depressing. Dr. Kevin Mailo: [00:10:27] Oh, God, I completely agree. I have looked at the stats - for anyone that's listening to this podcast that I'd encourage you to look at the Canadian Medical Association statistics on physician wellness. There was a great publication that came out in 2017, 2018, and I think there is now post pandemic data that's coming out and it's staggering. And I think we all need to give one another some compassion and some space because the job is incredibly stressful, but so are many of our personal lives. Dr. Mandy Brisebois: [00:10:54] Yeah, and don't give up on people. And I always say, just take a pause if something seems off, because after the fact, it is so hard to go over who did what and who said what. And especially if you go to a supervisor or something, we really try, it's called the Vanderbilt model, where you really start with this coffee chat and you just sit down with someone. I say, don't wait for coffee, do it right then, but talk to someone, look at them in the eyes and say, I actually care about you. I mean, you may not think I do and we're not, maybe we're not perfect friends. Dr. Kevin Mailo: [00:11:28] Yeah, Maybe we're never going to get together -- Dr. Mandy Brisebois: [00:11:30] Yeah. Dr. Kevin Mailo: [00:11:31] -- and go hang out outside of work. But I do care. Dr. Mandy Brisebois: [00:11:34] Yeah. And I'm invested in health providers, whether it be a nurse, a physiotherapist or a physician. And I really do want to be here. And if you don't want to talk, just recognize. I recognize something. And if you ever have a chance to talk, I want to talk to you about it, but I'm just letting you know how I feel so you know that those things impact me at work too. And they sort of make me wonder whether I want to be here too. And when you say it that way, people start going, Oh, I'm impacting other people's work as well. Dr. Kevin Mailo: [00:12:02] And I think physicians, we're all by and large, very conscientious. So that I think is a very powerful statement when you say you're impacting me because that that is kind of a a cue for us to evaluate our behavior. Dr. Mandy Brisebois: [00:12:17] Yeah. And I try to make things, it's really important... I was just talking to somebody else and I said, it's so important to not tell people what to do or what they should do differently because we all want to be different, but no one wants to be told to be different, but really putting it on how it's making us feel and that it's their behavior, it's not them. That it just isn't that you think they're a bad person, it's just that moment that made you feel that way and then really focusing on the positives and you're talking about what to do about it. Well, you do that in the moment. And you know, if it doesn't work and something happens again and you do it again and it doesn't work and you have to get an adviser or a supervisor or whoever is above you involved, if you've said something in the moment, that person will not be surprised. Because you'll have twice said something and you'll say, How do we resolve this? And I'm like, Well, we're not resolving this. Well, I'm going to have to then get some help because I don't have the tools I need. And if you say it like that, like I don't have the tools I need to resolve this instead of someone getting called out of the blue with some complaint they didn't know it was coming because then they're coming into the conversation already unhappy. Dr. Kevin Mailo: [00:13:26] Right. So, Mandy, you alluded earlier to a process. You said there are steps to go through conflict resolution. Can you give us an overview of that? I mean, obviously, we don't have the time to go into this in a whole bunch of depth, but I would absolutely love to hear this because, I mean, it's probably not that much different when it comes to care. There's a history, there's a physical, there's a lot of tests. I mean, we just we go through a process. So take us through an overview of that process of conflict resolution. Dr. Mandy Brisebois: [00:13:55] I love this because I always say internal medicine is easy and everyone goes what are you talking about? Well, it's just you categorize things and stepwise, stepwise, stepwise. So this is exactly the thing. So I say, look, we have emotion. So we got, I call it the rant, but whatever it is, you've got to package that somehow, like deal with it. Some people have written me 15 page letters. They're like, This is great, let's send it off. Nope, this is just for you to think about. But you have to get that out and you have to be okay with it and recognize that emotions are normal and it's really hard. So give yourself that. That's the first thing. The second thing, though, is knowing where the place for that is and where the place is not for that. You take care of that and then you go through the process of conflict. I call it conciliation because conflict's never resolved. It's still there. Dr. Kevin Mailo: [00:14:39] Yeah. Dr. Mandy Brisebois: [00:14:40] So the first thing is what is the issue, as we say in conflict teaching. And the issue is the problem and the problem isn't He yelled at me. The problem has to be solvable and it has to be very clearly neutral. So it has to be something like if someone's yelling at you, I want to know how we communicate in the workplace to effectively get work done. And what's the process, so another problem would be what would the process be if you feel somebody is behaving in an unprofessional way in the workplace? Those both things are solvable. Both of them are very neutral. You're not using this, Crucial Conversations is a great program and it talks about victim, villain, and helplessness. And when you hear people talking about being a victim or you're a villain or I'm helpless, conversations will not occur, So it's very good to recognize that and keep everything neutral. So I spend an hour with people, actually, and outline the problems. It takes a lot of practice to learn how to do that. So you actually look through the problems, map them all out. People always come with to me with one, and there's actually 18 solvable problems. And when they look at them, they go, Wow, that's really an easy one. Like, I easily can come up with a solution to that. It's just like internal medicine. And so we do that. Then I send them home and I say, I want you to think about these problems and you tell me why you care. And this is really digging deep. It's very reflective. The why do you care if you communicate well with your partners? And it's all about I want to enjoy my work. You know, I want to be able to effectively work. I actually want to have a job. I need my job for for my livelihood. I don't want to take shifts. I'm not taking shifts now. So I'm losing money because I don't want to be there. So there's all these different things. Or it comes in it is infiltrating my family. So really, what do they care about? So then they come back. The next step is we talk about the stakeholders. So who's involved? You know, sometimes it's one person, but sometimes you have a whole team and there's multiple different people. And we go through that. And then I have the person think about what those stakeholders, they care about. And we're just guessing. But it's putting you in that position that you really think about them. And as you said before, what are they going through? They may collapse in tears when they turn the corner. You know, they may be getting separated, their child may be sick. They may be taking care of an elderly person. You don't know. So I always say, guess. Just go through it and think. And we create a, I call it a conflict roadmap, and we create this roadmap. And then I let the person decide, What do you want to do with that? And most people want to meet with the person that they had this thing with. And I usually offer to go sit with them while they're doing that, or I'll coach them through how to actually take that meeting in a really, again, really neutral, neutral language, positive way and just collaborating. And we send the person that we want to meet with, this roadmap beforehand. And it's amazing. The meetings are amazing. Dr. Kevin Mailo: [00:17:33] Wow. Dr. Mandy Brisebois: [00:17:34] Because physicians see that you worked so hard. I really want to be better. I really want to be your colleague and look at all the work I put into it. I want to hear your perspective. I guessed but now you tell me and then you can have a conversation about those things. I had one person come back and say, This was so amazing and someone who would never really share, they went back to their team, they shared everything and they're like, We got to get the team to do this. Because it bonds you. It bonds you together. That you both have some common goals. You see common things together. And it seems so easy when you've done it once. But it takes, it takes practice and courage and the ability and being in a safe place. And this, I keep encouraging organizations let people in your organization be in a safe place where if someone comes back at them and doesn't respond well multiple times, that you have a place to go and someone takes you seriously, that you're trying to do this. So this is the whole thing about psychological safety in our workplaces that we have to take it seriously so we can communicate in the moment. Dr. Kevin Mailo: [00:18:38] So how do we create psychological safety? I hear that term so much, and I think it's amazing because I didn't hear that term 10, 15 years ago. Right. Or it wasn't that common. But how do we create robust organizations where we feel, number one, that we can share, number two, that we're heard, and number three, that it's safe as we do so. Right. We're not worried about retributive behavior or being silenced. Talk to, talk to us about that. I think that's so powerful. Dr. Mandy Brisebois: [00:19:11] We need some brave people because it takes vulnerability and it takes bravery in the workplace. And I've sat in situations with my team talking about my son when he was suicidal or drug addiction with family members, really vulnerable, having chronic illness. And it's amazing when you start being vulnerable, people are vulnerable back and you start to develop these dialogs. And so if one person sees somebody model this behavior, so if someone talks to me in a really offensive way from my perspective and I say in front of all the residents and the nurses there, you know, oh, ouch. I'm, I'm really trying hard. You're modeling for all those people. And if it turns out well, which usually it does, honestly, it flips the behavior immediately when you say something like that. I've had patients laugh because they say, what is this emotion? Like I'm yelling, I'm angry. But it really gives people that ability to open up. So I think we need brave people that can model this, that can mentor it. And once you're actually on the ground doing it, it's not something you read on the Internet. Like we can write for our organizations all we want, that we have psychologically safe environments. You have to see it in action to feel safe enough to come forward, because many people have had experiences where they do try to come forward and they don't have that experience. And that's where we need to jump in. And that's some of the work I'm doing where people are stuck in those situations and I'm helping them work through it in that regimented way so we can take that road map to the stakeholders and say, we're really trying to help fix this problem and the organizations do care right now. We have to just come in a regimented way and really show them how we can do it better. Dr. Kevin Mailo: [00:21:00] And what should medical leaders, like high level medical leaders, be looking to do, practically speaking, to begin to implement this? You know, we talk about modeling it in an encounter or a one on one or in meetings, but at an organizational level, what do we need to be doing? Dr. Mandy Brisebois: [00:21:18] I think people are afraid in a lot of organizations to say anything. They don't want to jeopardize their relationships. They're working with people and just coming to work and going home is good enough. And I think that organizations and high level leaders need to find strategies for people to report things in safety, whether it be a click of the button that they can just click. And hey, if you have eight complaints about someone, it is, you know, in a lot of regions in bylaws that you can actually move forward without having to put your name forward. I think that people need to know that it's not just the concern that will go forward, but something will occur and they may not know what occurred, but they'll know that that behavior is stopping. And if they don't see it stopping, that they can go back. Because if we don't have those methods for people to move forward and really take it seriously, like really trust the people that we're-- Dr. Kevin Mailo: [00:22:18] We're talking credibility. We're talking credibility. Dr. Mandy Brisebois: [00:22:20] Yeah. If someone says that this was very hurtful, it doesn't mean that the words were hurtful, but something about the interaction made it hard for them to work. And so instead of just sort of, sometimes they go to the person and say, well, what happened? And they're like, nothing. I didn't do anything. And they're like, okay, they didn't do anything. And that ends. Instead of that, they can say, What could it have been that this person felt so impacted? And you can actually work through it with the person who felt so impacted and say, What do you think it was? And really dig, it's called appreciative inquiry. You just keep asking these questions to find out what it was. And sometimes you get to an issue that actually didn't have anything to do this situation, or maybe it did, and the person who was talking to them had no idea about what they were getting into or what they were saying, or they didn't realize that something at home was impacting them, even. The person who is being a little aggressive or whatever it may be. So I think it takes conversations, it takes time. And so this means that organizations and physicians need to invest the time and say this is important, that we actually get to know each other, because we can have really great workplaces. And this is the message I'm trying to send that please don't give up hope, because if we do stick together, if you have trouble, we reach out to each other and try to work through this process and get some help. But it's solvable. Dr. Kevin Mailo: [00:23:43] Wow. Wow. Mandy, this was absolutely amazing. And I hate to wrap it up. Dr. Mandy Brisebois: [00:23:53] I know we have to go. Dr. Kevin Mailo: [00:23:54] I know. I know. I don't want to. We are absolutely, absolutely going to talk again because I'll tell you why I think this is so relevant for Canadian physicians is to echo past CMA President, Dr. Smart, we are looking at crisis in our health care system. And crisis in our health care system means fewer and fewer resources for a sicker and sicker population that is aging. And this is going to bring more and more physicians in conflict with one another and in conflict with medical leadership and allied health. And we need the tools to navigate this. And obviously, this isn't the solution. The solution is more resources, which we have to advocate for separately. But the big one is that inevitably things are going to get worse before they get better. That is my own opinion. So how can we weather this storm and how can we come out as a profession, not only having gotten through it, but thriving and growing as a profession? Because I think there's a lot to be learned and I think things got, we learned a lot through the pandemic. And I think there's more to be learned and that the profession is an ongoing effort to modernize and improve. Dr. Mandy Brisebois: [00:25:03] And we need to stick together, as you said. Dr. Kevin Mailo: [00:25:05] Absolutely, care for one another, care for one another. You know, I try to treat my colleagues like patients, not, you know, not in a paternalistic way here, but in a notion of compassion. Right. Like just have some compassion for your colleague who might be exhausted, working long hours or dealing with a health issue or mental health issue or whatever. A little bit of compassion goes so far. So far. Dr. Mandy Brisebois: [00:25:31] Absolutely. Dr. Kevin Mailo: [00:25:32] So with that being said, we'll open it up to the chat if anybody has got any questions. But otherwise, I am so, so grateful to have had you on here, Mandy. It was just amazing and I cannot wait to interview you again on the podcast and have you do another webinar because I think people need this. I think we all need this. Dr. Mandy Brisebois: [00:25:55] I need it. I coach, I can't coach myself, but I do, I get coaches to coach me through my own thing, so... Dr. Kevin Mailo: [00:26:00] It's wonderful. Dr. Mandy Brisebois: [00:26:01] Yeah, you've got to do it and I will put a plug if you're in the Edmonton zone, I am doing this work through the Medical Zone Staff Association, so go to their website if you need any help, like as a leader or someone in your organization and you want some advice or you want to learn how to do this, I'll help you through it. Dr. Kevin Mailo: [00:26:18] Absolutely. Absolutely. Thank you again, Mandy. Dr. Kevin Mailo: [00:26:22] Thank you so much for listening to the Physician Empowerment Podcast. If you're ready to take those next steps in transforming your practice, finances or personal well-being, then come and join us at Phys Empowerment.ca, P H Y S Empowerment.ca, to learn more about how we can help. If today's episode resonated with you, I'd really appreciate it if you would share our podcast with a colleague or friend and head over to Apple Podcasts to give us a five star rating and review. If you've got feedback, questions, or suggestions for future episode topics, we'd love to hear from you. If you want to join us and be interviewed and share some of your story, we'd absolutely love that as well. Please send me an email at KMailo@PhysEmpowerment.ca. Thank you again for listening. Bye.
	15 Feb 2025	61 - Self-Acceptance and Changing the Culture of Medicine	00:31:24
Want to dive deeper into topics like this? Master your journey with Physician Empowerment’s Masterclass Membership—your gateway to exclusive content, expert-led sessions, and actionable strategies to elevate your personal and financial well-being. Learn more and join us today! https://www.physempowerment.ca/masterclass — In this episode, Dr. Kevin Mailo welcomes Dr. Susannah Ward to the show to talk about self-acceptance and her work in changing the culture of medicine. Dr. Ward is a fellow with the College of Physicians, a specialist in rehabilitation medicine, and the Founder of Ataraxia Collective which promotes the well-being of doctors. Susannah and Kevin discuss the pressures and demands of medicine and how awareness around taking care of ourselves first should become a priority. Dr. Susannah shares some of her stories and reflects on the stress, lack of autonomy, sexism, and constant pressures of her journey through training and work. She points out that doctors face the reality of burnout around the world and it helps to understand they’re not alone. Susannah and Kevin talk about what can be done when someone identifies their burnout: everything from seeing their own GP to avoiding numbing coping mechanisms like alcohol and taking care of personal nutrition and sleep. Susannah and her work shine a spotlight on the importance of identifying our need for self-care, allowing ourselves to be human and prioritizing our own well-being. About Dr. Susannah Ward: Dr Susannah Ward qualified as a rehabilitation physician in 2018 with the Basmajian Award for best fellowship clinical exam performance. She has over 15 years of experience working in public and private hospitals across Australia. She has diverse clinical experience including general medical and surgical care, palliative care, geriatrics and rehabilitation. She has rehabilitation experience working in brain injury, spinal cord injury, chronic pain, geriatrics, palliative care, orthopaedic rehabilitation, stroke, amputation and general rehabilitation. She has private clinics at The Wellness Place Blacksmiths. She also offers telehealth appointments and home visits. She has a special interest in acquired brain injury. She has an expert understanding of the behavioural, psychological and social challenges faced by people & the impact of environment, upbringing & social determinants of health. Dr Ward is passionate about holistic health and lifestyle, behavioural and psychological rehabilitation. She likes to incorporate evidence-based wellness tools like mindfulness, healthy eating, exercise and social/lifestyle prescription into her goal-directed and patient-centred care. She promotes the key message that living with illness or injury need not be a barrier to feeling well or living life to the full. Dr Ward’s therapeutic emphasis is to support a client to self-compassionately accept themselves and acquire self-mastery skills to maximise their functional ability and quality of life. She aims to help empower clients to independently self-care and optimally manage their circumstance using wellness tools and adopting a healthy lifestyle. Dr Ward has always been an advocate of health professional wellbeing & promoting a more supportive & nurturing medical culture that facilitates wellbeing & sustainable careers. She founded Ataraxia Collective in 2018 as a creative adjunct to her clinical practice hosting retreats & workshops show casing powerful holistic tools like mindfulness & yoga. She currently runs doctor wellbeing & CPD retreats. She is the Chair of the Royal Australasian College of Physicians Member Health & Wellbeing Committee & director for the not for profit charity Mood Active. She enjoys professional writing on topics related to doctor wellbeing & is publishing her first self-care book Mastering Real Wellness this year. Website: AtaraxiaCollective.com.au Book: “Mastering Real Wellness” by Dr. Susannah Ward __ Physician Empowerment: Attend an upcoming Empowerment Retreat Join the Physician Empowerment Masterclass now Website: PhysEmpowerment.ca
	30 Dec 2022	10 - The Intersection of Space and Medicine with. Dr. Shawna Pandya	00:22:25
Dr. Kevin Mailo welcomes Dr. Shawna Pandya - Physician, Aquanaut, Explorer, Director of IIAS Space Medicine Group, Space Medicine and Austere Environment Researcher - to the show to talk about her amazing career. But more than that, Shawna speaks about dreams and how to make them reality. Shawna Pandya is an explorer, an aquanaut, she’s lived in a Mars simulation in the Utah desert, and she’s lived in an underwater habitat for five days. She works for a company focussed on immersive technologies and a company trying to put the world’s first rotating partial gravity artificial gravity space station into orbit. She’s also a martial artist, skydiver, and pilot-in-training. She has an amazing career. And she knows more than a little bit about having lofty dreams and not sacrificing them to reality but pursuing them with determination. In this episode, Kevin Mailo and guest Dr. Shawna Pandya talk about the varied paths of Shawna’s career. And they dive deeply into how Shawna’s childhood dreams propelled her into the journey she’s on today. She addresses self acceptance, having a plan of action, positive visualization, preparing for setbacks, and the mentors who invested in her along the way. Her story and advice on dreams are deeply inspiring. About Dr. Shawna Pandya: Dr. Shawna Pandya is a scientist-astronaut candidate with Project PoSSUM, physician, aquanaut, speaker, martial artist, advanced diver, skydiver, pilot-in-training, VP Immersive Medicine with Luxsonic Technologies and Fellow of the Explorers' Club. She is also Director of the PosSUM Space Medicine Group and Chief Instructor of the PoSSUM Operational Space Medicine Group. She holds degrees in neuroscience (BSc Hons. Neuroscience, University of Alberta), space (MSc Space Studies, International Space University), entrepreneurship (Graduate Studies Program, Singularity University) and medicine (MD, University of Alberta), and is currently completing a fellowship in Wilderness Medicine (Academy of Wilderness Medicine). Resources Discussed in this Episode: International Space University Nasa Johnson Space Center Chris Hadfield “An Astronaut’s Guide to Life on Earth” by Chris Hadfield — Physician Empowerment: website \| facebook \| linkedin Shawna Pandya, MD - Physician, Aquanaut, Explorer, Director - IIAS Space Medicine Group: linkedin \| twitter \| iias \| luxsonic \| zenith canada pathways __ Transcript: Dr. Kevin Mailo: [00:00:00] Hi, I'm Dr. Kevin Mailo and you're listening to the Physician Empowerment Podcast. At Physician Empowerment, we're focused on transforming the lives of Canadian physicians through education in finance, practice transformation, wellness and leadership. After you've listened to today's episode, I encourage you to visit us at PhysEmpowerment.ca - that's P H Y S empowerment.ca - to learn more about the many resources we have to help you make that change in your own life, practice, and personal finances. Now on to today's episode. Dr. Kevin Mailo: [00:00:35] Hi, I'm Dr. Kevin Mailo, one of the hosts of the Physician Empowerment Podcast. And today I'm very, very excited to be joined by Dr. Shawna Pandya. And before we get started in the interview, let me say a little bit about Shawna, and she is a primary care physician who practices mostly emergency medicine. And for years now, even before her career in medicine, Shawna has been pursuing space medicine with a focus as well in extreme medicine and hostile environments. And so I would love to hear from you, Shawna, and that probably isn't the full introduction. Why don't you tell us a little bit more about yourself? Dr. Shawna Pandya: [00:01:15] Yeah, sure. So first of all, thanks so much for having me on the podcast. I think this will be really fun. So for those who don't know me, here's a little bit about my background. I'm an explorer, I'm an aquanaut, I've been on expeditions in what we call analog environments. So that is environments that are analogous in some way to the spaceflight environments. I've been to the Mars Desert, or I've been to the Utah desert on a Mars simulation. I've lived underwater for five days, yeah, in a water underwater habitat. There's lots to talk about. I work with a lot of space companies with applications for Earth. I work with Luxsonic Technologies, which focuses on immersive technologies. So virtual reality, augmented reality, 360 video for medical education, for health care workers, physicians, paramedics and more. And I also advise a company trying to put the world's first rotating partial gravity artificial gravity space station in orbit by the end of the decade, as well as a space food company. So that's Orbital Assembly Corporation and IIAS, respectively. There's a lot we could talk about. So I think this is going to be fun. Dr. Kevin Mailo: [00:02:23] Yeah. So there is a lot we could talk about. And it's funny because at first I was tempted to interview you about space medicine specifically, right? Because I think that's extremely exciting. I myself am a big fan or I don't want to say fan, but I constantly follow space exploration and all the remarkable progress we've been making throughout the world in terms of space technologies. But I really want to hear about your dreams and the meaning of dreams in our lives, because what struck me, following you on social media, Shawna, is the fact that what appears to be your dreams are very much a part of your daily reality. And that your dreams have been integrated into your career. In fact, your career is your dream. You live and work your dream, and that is so incredibly rare. And in Physician Empowerment, actually, in December 2021, we were actually in Mexico talking about wellness practice transformation. But one of the topics that we covered is dreams and how dreams provide not only goals in our lives, it's bigger than that. Dreams provide focus and meaning in our lives. They give us a sense of the arc of our life, and it can be a source of immense personal comfort and wellness as we pursue them. So talk to us about what dreams mean in your life. Tell us about your dream journey. Like, how old were you when you decided you wanted to go on this path? Dr. Shawna Pandya: [00:03:47] Yeah. So my childhood journey is actually, I think, where this all starts. And I think that's where this idea of, Hey, I want to go to space comes from. Before that, it came with actually even bigger ambitions. So this is me as a nine or ten year old settling down, quote/unquote, decide to pursue astronautics. And so I think this is really a good example of what it means to be limitless and not-- Dr. Kevin Mailo: [00:04:13] -- I love that-- Dr. Shawna Pandya: [00:04:14] -- bound by what is possible in reality. And so to make that more concrete, so when I was four, I was like, I want to save the world. I want to do good. And I'm going to do that by being a Transformer, like I was going to be Optimus Prime crime fighter. We do good. And then I matured a little bit. I became seven and I realized, Oh, you can't actually be a Transformer. That's just ridiculous. So I thought, okay, well, I will be a billionaire superhero like in this Batman, Bruce Wayne kind of context. Dr. Kevin Mailo: [00:04:46] Also very reasonable. Dr. Shawna Pandya: [00:04:48] Very reasonable. You know, I matured. I'd put on some years since the age four. And I thought, okay, well, clearly I need to do good in the world. I need to pursue this Batman persona, you know, get lots of money and also fight crime. And then I realized that's not something you go to school for. You don't get your degree in billionaire-ology. So then by the time I was nine, this is also during the nineties when Canada had sent its first ever female astronaut to space - and that was, of course, Dr. Roberta Bonder - and I looked at her and I said, okay, she's Canadian, I'm Canadian, she's female, I'm female. So now all I need to do is be a neuroscientist, physician, astronaut, boom, done. That's my path towards astronautics. And so if you look at all of my homework from junior high, it was all about astronautics and how to get to space and just everything obsessed with human spaceflight and exploration. And then in high school, again, focusing down more, I said, okay, I'm going to go be a neurosurgeon. I'm going to medical school. That's what I'm focusing on. So my first degree was neuroscience. And then somewhere along the way, that space dream kind of crept back in. And so by the time I was applying for medical school, I realized how insanely competitive it was. And I said, okay, I'm not guaranteed to even get an interview. I need to pick a backup plan, a contingency that even if I don't get into med school, will make me happy that I could spend the entire year, you know, saying, this is amazing, like not wishing I was somewhere else, like medical school. And I'd heard of someplace called the International Space University, which is in Strasbourg, France, offers a master's program, and in reality is like Starfleet Academy, where you meet amazing students from all across the world. It's very, they abide by this international, interdisciplinary, intercultural perspective. We had 50 students, 31 countries represented. We had lawyers, engineers, future physicians and myself. Everything we did was collaborative. And that's when I realized maybe I didn't have to choose between space or medicine. Maybe there was an intersection. That's where I really learned about what space medicine was. And so kind of tying back to your initial question, this is kind of where realizing that, hey, having these big dreams as a kid, you can actually forge a path towards them. And that's really kind of taking what seems pie in the sky limitless, but also maybe not necessarily attainable, becomes attainable. Dr. Kevin Mailo: [00:07:14] So talk to us about self acceptance of dreams and living them boldly. Because I'll be honest, I'm a big dreamer. I have lots of my own dreams about what I want to do with my life, where I want to go, where I want to see Physician Empowerment go. And, you know, it took me years to live that boldly. It took me years to even speak about my dreams. And for those of you that come to our conferences, you'll hear all about it. But tell me about like learning to live that boldly, learning to speak it, share it, and overcome the people that might have something negative to say or who who aren't necessarily there to support you. Because that's hard when we work in highly collaborative environments or even just with friends and family. So talk to us about overcoming doubt. Dr. Shawna Pandya: [00:08:05] Yeah. So I mean, I'm a big believer in having a plan of action, having multiple contingency plans, and also taking concrete steps to put yourself on the way. And I think Chris Hadfield actually captures this in his book perfectly when he says when he was a kid and decided to be an astronaut, he didn't just go into his kitchen and declare it to his family because he would have been laughed out of the kitchen. He said, okay, I'm just going to be the best student possible. I'm going to do this. I'm going to pursue a career as a fighter pilot. And so it comes down to creating an action plan of how is this going to move me forward towards my goals and my ambitions, and then also realizing that you can prepare yourself and that also just because you're not eligible for something today doesn't mean you shouldn't keep it on your radar. And so to give you a concrete example, I knew about the Canadian Space Agency sponsored Aerospace Medicine elective to go down to NASA for a month and perform research related to space medicine. I knew about that since I was in Grade 11 and I would, like, compulsively check the CSA website, but you weren't eligible to even apply for it until you were final year medical school or until you were a first year resident. So, I mean, that was at least a decade off. But the nice thing about keeping an eye for these opportunities is it gives you something to reach for. Then you start putting together that ladder that gets you there. You start making yourself a competitive candidate. And so that was always in the back of my mind. And by the time it came to apply, you know, I had publications under my name, I had a book chapter under my name. I was very involved in Canadian space activities. And so I became one of two Canadians sponsored for that term to go down to NASA. So part of it is being aware of the opportunities and then working towards them as a matter of attaining your goals. And then the other part of it is rehearsal and for the hard things. And so to give you an example of, like, how rehearsed I've been for what I've deemed the most important things in my life, I will practice it before the real thing ever comes. And so when I was writing my MCAT, my medical college admissions test, which I'm sure the entire audience is familiar with us, they've all we've all had to write it. My family was out of town. It was to a new part of the city I'd never been to. So as a dress rehearsal, I drove all the way to the test site, found my parking spot, figured out how long it would take me to get to the test hall, make sure I knew where it was. I did all of that the day before, just to make sure I knew that part of the the concrete part. I applied to medical school a year before I was qualified to even apply, just so I could go through the essays, know what they asked for, have them all written. So when it came time to actually apply, I had something to draw off of. Same thing for Canadian Space Agency astronaut selection. Even the years I wasn't eligible, I went through their 50 page, literally, 50 page submission process, so I knew what they were asking for, so I knew what they were looking for. So the qualifications I didn't have, I would just go out and get them. And so there's an element of preparation and planning and action that really comes along with realizing our dreams. Dr. Kevin Mailo: [00:11:15] I love that. Tell us about positive visualization. Right? Because it's one thing to say, oh, I have this dream on the horizon, but like positive visualization goes further in that we start to have specific stepping stones imagined or seen or written down. Talk to us about the role of positive visualization in your mind, as well as negative visualization of setbacks. Dr. Shawna Pandya: [00:11:43] Yeah. So I think we need to talk about, we can't talk about positive visualization without negative visualization. And I call it the what if game. Anyone who practices emergency medicine will be doing this at all times because we're constantly asking, What is the most likely diagnosis? What is the worst case scenario? Best case scenario? What else could this be? And in everything we do in life, we should be asking the same, like, what is most likely to happen? How would this work? What would this look like if this is was a best case scenario versus what could go wrong and the reason that we do this, so when we talk specifically about positive visualization and we go through, for example, the exact steps to do a procedure in medicine, we're building that muscle memory by activating our supplementary motor areas. So we're kind of priming our brains to say, I'm ready to perform. But the value of going through the worst case scenarios, playing that what if game is also saying, how am I going to react, I don't want to be caught unawares if something bad happens because I didn't plan for it. So I call it the What if game. Chris Hadfield calls it the power of negative thinking, but it's also preparing ourselves for the reality of what life is and saying that I have a plan for that as well. Dr. Kevin Mailo: [00:12:56] I love that. I love that. Talk to us about failure or setbacks. Because I think that is inevitable. Any time we are pursuing a higher goal or a dream, trying to get somewhere, we encounter failure. And again, that's another thing it took me years to embrace was failure as a stepping stone to success. Talk to us about failure. You don't have to share any specific stories, but how you overcome failure, how you approach it, how you learn from it, and then how you move ahead and try again. Dr. Shawna Pandya: [00:13:33] Yeah. One of my friends, she's amazing. She's Canada's seventh female fighter pilot and she said, If you've never failed, you're either lucky, lying, or Jesus himself. So I love that. And I, for me, I say, if you're always winning, you're probably in the wrong league. So you have to fail because you're not really pushing your own limits if you haven't failed. And the other part of it is to realize that success and failure are two sides of the same coin. And what I mean by that is even when we succeed, our successes aren't always pretty and perfect, that there's something that can always be improved upon. And when things, when we fail, it's not final. There's a quote that says Success is not final. Success, or failure is not final, failure's not fatal. It's the courage to go on that counts. And that's basically saying, well, if you fail, you've only failed if you refuse to do something about it. Why not take that situation, analyze what went wrong, figure out what went right so you can reinforce that part, and then come up with a plan to address the part that didn't go so well. And in the operational world, in aviation and space, we call that the art of the debrief. Any time we fly a zero gravity campaign, we are debriefing after every flight because we want to know what went well so we can reinforce that pattern of performance. What didn't go so well, so we can share those lessons learned with the rest of the team, and also so we can change our own actions and performance patterns in what didn't go so well. And so that's why I say success and failure are two sides of the same coin, because there's always actions to be optimized. Dr. Kevin Mailo: [00:15:02] Absolutely love that. What else do you want to share with us about your journey or about what you've learned along the way in terms of pursuing your dreams? Dr. Shawna Pandya: [00:15:11] Yeah, I definitely feel like I'm just getting started. I think there's so much else I want to do. So many other places I want to go. Dr. Kevin Mailo: [00:15:20] I love that because you've been at it, like, dreaming for over 20 years, right? Dr. Shawna Pandya: [00:15:24] Yeah I've been doing it my whole life. Dr. Kevin Mailo: [00:15:25] But it still feels fresh. It still feels new. I really love that. Dr. Shawna Pandya: [00:15:28] Absolutely. Every single day is like, Wow, I can't believe that someone would think of me for this. That's amazing. And part of it is you can't acknowledge success without acknowledging the imposter syndrome. We all feel it. Dr. Kevin Mailo: [00:15:41] Right. Right. Dr. Shawna Pandya: [00:15:42] And what I've learned is it's an opportunity. It's a growth opportunity. Right? Because someone even if I don't feel ready to be in, whatever, in medical school or to be in this position within a company or an organization, someone somewhere saw something in me that they believed I could do this. And so it's an opportunity to become better, smarter, more educated, and then also execute. So that's how I deal with the imposter syndrome. And then just realizing that you have to love every bit of the journey. And there's people who say, I want to be an astronaut, I'm going to study engineering, even though I hate it. I'm to go get my operational certifications in skydiving, whatever, even though I hate it. And when they're hating every step of it and then maybe ultimately they are medically disqualified forever from astronaut candidacy and they feel like they've wasted their life. And for me, it's the exact opposite. I love every aspect of what I do and every part of the journey. That's how I work seven days a week. That's how I live out of a suitcase. And I'm home for maybe three days a month because everything I do is absolutely fun to me. And I think that's key when realizing, you know, if this is the path I want to pursue, is it actually the path I want to pursue, get those data points, live it, and then figure out, is this how I envisioned it to be? Dr. Kevin Mailo: [00:17:02] Amazing. Talk to us about the importance of mentors and surrounding yourself with people that build you up, because I know I've certainly, over the years, become much more mindful of who I spend my time with in terms of sharing my dreams, working towards my dreams. Because there are people that build us up in life. There are people who bring us down. Talk to us about how you seek out mentors. I would love to hear that because I bet you, well already, from what you've mentioned, it sounds like you met some incredible people on the journey. Dr. Shawna Pandya: [00:17:28] Yeah. So for mentors, I think mentorship, I have this view of it doesn't have to be this very formal relationship. It doesn't have to be, hey, will you be my mentor? Because I think there's this unrealistic expectation that this person is going to transform you into the person you want to be. And that comes from within. And I think we don't do a good job with with any type of mentorship relationship setting those expectations that, no, it's you. You're the one who has to set your goals and pursue them and come armed with questions. And that's the approach I've always taken. And then the other part of it is just feeling, realizing the social contract to pay it forward, because I wouldn't be where I am if incredibly busy people hadn't taken time during their careers to invest in me, even though they didn't have to. And the best example I can give of that is someone I've mentioned a lot through this podcast because the first day I ever interned at NASA's Johnson Space Center, the phone rang in my office. It was off campus. I'd lost my passport, I was frazzled. So I picked up the phone and I said, I'm sorry I have to put you on hold. And then I realized that the person on the other end of the line said that was Lieutenant Colonel Chris Hadfield, who is training to be commander of the International Space Station. And I just put him on hold. And so the man was busy. This was 2012. He was training to command an entire space station, but he still found time to take myself and the other Canadian medical student out for coffee, answer questions about space. Why? He has no impetus to do that. All of this, all of the Canadian astronauts, Jeremy Hansen, David Saint-Jacques, they took time to invest in us. That's amazing. Dr. Kevin Mailo: [00:19:10] That's incredible. That's so inspiring. Dr. Shawna Pandya: [00:19:13] Right? Dr. Kevin Mailo: [00:19:13] Yeah, like, what a Canadian hero. Dr. Shawna Pandya: [00:19:16] He was amazing. I can't say enough good things about him. And so, to me, that really is a lesson in pay it forward. Like, you know, as busy as I get, I also feel a duty to help others, to help answer the questions. I'm involved with [00:19:31] Gosh as a mentor. [00:19:32] Space Prize Fellowships, [00:19:34] sets Canada [00:19:35], Zenith Pathways, Women in Aerospace Medicine. Like there is a very long list that I'm sure I'm forgetting more because once upon a time I was at that stage and I definitely wouldn't be where I am if folks hadn't taken the time from their schedules to invest in me. Dr. Kevin Mailo: [00:19:52] Wow, wow, wow. What a great story. And so beautiful to talk about paying it forward. Right? Because I think that enriches us immensely when we can take the time and help somebody who's on a similar journey or somewhere further down the path or coming up the path like we are. So powerful. I think that also helps renew our interest in our dreams and energize us and focus us. Wow. Shawna, I'm not going to, I'm not going to keep you longer because I know you're busy. Do you want to share like a book that you love that might be related to this? But that's always hard because I'm putting you on the spot. I didn't give you any prep about that ahead of time. Dr. Shawna Pandya: [00:20:30] It's very on brand. It's the same book I've been quoting this whole. Dr. Kevin Mailo: [00:20:33] Go for it. Dr. Shawna Pandya: [00:20:34] Chris Hadfield's 'An Astronaut's Guide to Earth'. It's very resonated very much with me. A lot of the lessons I've shared this hour have been from that book and also through my own lessons, so totally recommend it. Dr. Kevin Mailo: [00:20:46] Was that the guy that you put on hold when you... Oh, that guy okay. Yeah. Yeah. Amazing. Amazing. That's truly incredible. Love it. Okay, Shawna, thank you so much for coming on and just sharing your story, sharing your journey. It is so inspiring. As I said earlier, it is rare to meet people that live their dreams so boldly and so fully. And yet dreams are maybe one of the most important things in our lives because they give us so much meaning and joy. And like you said, it's the journey that has to be savored, not just the destination. Dr. Shawna Pandya: [00:21:20] Absolutely. Dr. Kevin Mailo: [00:21:21] I love that. Thank you so much, Shawna. Dr. Shawna Pandya: [00:21:24] Yeah, my pleasure. Dr. Kevin Mailo: [00:21:25] Thank you so much for listening to your Physician Empowerment podcast. If you're ready to take those next steps in transforming your practice, finances or personal well-being, then come and join us at PhysEmpowerment.ca - P H Y S Empowerment.ca - to learn more about how we can help. If today's episode resonated with you, I'd really appreciate it if you would share our podcast with a colleague or friend and head over to Apple Podcasts to give us a five star rating and review. If you've got feedback, questions, or suggestions for future episode topics, we'd love to hear from you. If you want to join us and be interviewed and share some of your story, we'd absolutely love that as well. Please send me an email at KMailo@PhysEmpowerment.ca. Thank you again for listening. Bye.
	15 Nov 2024	55 - Behind the Curtains: Common Threads amongst the Ultra-wealthy	00:42:45
PhE is headed to Cancun this February 23 to March 2 for our Health and Wealth Summit! We'd love to have you join: https://www.physempowerment.ca/cancun — Dr. Wing Lim introduces Physician Empowerment Masterclass faculty members Jason and Simon in a feature called “Behind the Curtain”. Jason Pisesky is a tax lawyer and Simon Wong is a wealth planner and they’ll both be discussing what the ultra wealthy do, a topic which is also a focus in the upcoming Mexico Health and Wealth Summit. Simon and Jason talk with Wing about how the wealthy deal with their finances and what the current mindsets are. Some things they address are the shift from wealth accumulation to wealth preservation, mitigating risk, investment strategy and remaining level-headed, and how to select the right financial advisors for a team designed to manage assets for us. They detail who should be on the wealth building and planning team and why, and they discuss how to align wealth intentions to planning an end goal. This episode is full of sound advice and serves as an example of the in-depth topics covered in the Mexico summit. About Jason Pisesky: Jason is a tax lawyer with an international accounting firm, KPMG. His practice background is extensive and includes personal and corporate tax-planning as well as litigation and dispute resolution. Whether you are scaling up your practice or winding it down, proper coordination between a tax lawyer and your accountant can ensure you're doing it right. About Simon Wong: As an Integrated Wealth Planner, Simon's expertise lies in simplifying complex financial concepts into clear, actionable insights, forming the cornerstone of his Financial Plans. Simon specializes in navigating individuals and businesses through the intricate landscape of tax planning and investing, utilizing his extensive knowledge and experience to foster their financial success and stability. — Physician Empowerment: Join the Physician Empowerment Masterclass now Website: PhysEmpowerment.ca
	28 Feb 2025	62 - Optimizing Your Office-Based Practice with Kate Post	00:28:40
Want to dive deeper into topics like this? Master your journey with Physician Empowerment’s Masterclass Membership—your gateway to exclusive content, expert-led sessions, and actionable strategies to elevate your personal and financial well-being. Learn more and join us today! https://www.physempowerment.ca/masterclass — In this episode, Dr. Kevin Mailo welcomes Kate Post to the show to discuss her dental practice consultancy firm and how she works with hundreds of Canadian dentists to assist them in optimizing their practices. Kate has 25 years of experience working in dental practices and dental management, and she shares her insights on what it takes to instate systems that improve efficiency and the patient experience. Optimizing medical practices is not something that doctors and dentists are given a lot of instruction on but it’s key to creating better patient outcomes and making for a happier, healthier practice overall. Kate details her process for Kevin, explaining how she assesses the practice needs through observation, discussion, and evaluating newly instated processes. Kate touches on revenue streams, tax strategies, employee contracts, delegation, and the human dynamic intrinsic to any successful practice. Kevin explores the challenges Kate faces in coming into practice as an outside voice and how she works with the medical practitioner to inform and support what is ultimately their decision. About Kate Post: Kate Post is highly skilled at streamlining operations, increasing revenue and reducing costs to maximize business profits. A decisive and strategic leader with demonstrated track records of success in single-owner multiple dental practice environments, Kate has successfully worked in a variety of dental practices throughout Ontario over the past 22 years with over 1500 team members. Kate has the ability to adapt to the varying needs of entrepreneurs and a variety of business types with previous experience in retail start-ups, the service industry and the dental business. With the compliment of recently completed Project Management courses, she has the skills to work with entrepreneurs in planning out their future goals, guiding teams towards the future and achieving quantifiable results. Kate Post on LinkedIn __ Physician Empowerment: Attend an upcoming Empowerment Retreat Join the Physician Empowerment Masterclass now Website: PhysEmpowerment.ca
	30 Sep 2023	28 - The Physician Entreprenuer	00:28:17
Dr. Kevin Mailo interviews fellow Physician Empowerment co-founder and co-host, Dr. Wing Lim about entrepreneurship. Wing is an accomplished businessman, entrepreneur, and real estate investor in addition to being an excellent doctor, and he talks with Kevin about what it took to make his journey from Med School to where he is now. Wing recalls how risk averse he was when he initially graduated from Med School thirty years ago. He looks back and see how dramatically he has grown and changed and a lot of it had to do with mindset and learning how to develop the entrepreneurial side of being a physician. What physicians aren’t taught is how to manage the clinical side, the business, the “dark suit” side of their careers outside of patient treatment, often to the detriment of personal fulfillment and smooth-running clinics. In this episode, Dr. Kevin Mailo and Dr. Wing Lim address how physicians can encourage their entrepreneurial sides to grow. They talk about not being the know-it-all and becoming comfortable with being “the dumbest guy in the room” in new situations because it offers a chance to learn. Failure is part of growth as much as embracing dormant dreams and learning to feed other aspects of smarts besides simply intelligence. Kevin and Wing share their ambition to help all physicians realize their entrepreneurial sides through mentorship and Masterclass advice of the sort Wing offers in this episode. Resources Discussed in this Episode: Physician Empowerment Masterclass — Contact Information: Physician Empowerment: website \| facebook \| linkedin __ Transcript Dr. Kevin Mailo: [00:00:01] Hi, I'm Dr. Kevin Mailo, one of the co-hosts of the Physician Empowerment podcast. At Physician Empowerment we're dedicated to improving the lives of Canadian physicians personally, professionally and financially. If you're loving what you're listening to, let us know. We always want to hear your feedback. Connect with us. If you want to go further, we've got outstanding programming both in person and online so look us up. But regardless, we hope you really enjoy this episode. Dr. Kevin Mailo: [00:00:34] Hi, I'm Dr. Kevin Mailo, one of the co-founders and co-hosts of the Physician Empowerment podcast. And on today's episode, I'm going to be interviewing my fellow co-founder and host Dr. Wing Lim. Wing is, as many of us know, is a very, very busy, ambitious dreamer within our profession. And it's truly admirable what you've done, Wing, over the years. And I thought that today we should explore a little bit about your journey, because when we look at you as, you know, an entrepreneur and a real estate developer and a highly successful clinician, there is a lot there. But I have the feeling that it hasn't always been the case, that you were something else when you started 30 some years ago. So with that being said, Wing, why don't you tell us about how you journeyed from being, you know, a physician to becoming a physician entrepreneur because we see that a lot in our Masterclass attendees. So a lot of our attendees in the Masterclass with Physician Empowerment are entrepreneurial. They're trying to build something, whether it's something they're building in real estate, building in their practice, we even have some that are kind of working more in a tech space. So it's really, really interesting to see how physicians come to this point of moving from being strictly a professional to being a professional who's also an entrepreneur. So tell us a little bit about your journey, Wing. Dr. Wing Lim: [00:02:02] Yeah, sure. So yeah, so I go to a local med school, went to U of A like 30 some years ago. And I just finished my 30th year of practice in family practice. So the journey is torturous. There are ups and downs and if you have a time machine and just bring me back to the me 30 years ago and just the present Wing and the Wing that is just out of practice, I think if you say this is going to be you in 30 years, I say that it's a lie. I couldn't even believe that, the metamorphosis is like unbelievable. Right? I was at a larval stage. Dr. Kevin Mailo: [00:02:41] You were just a little grub. Dr. Wing Lim: [00:02:44] I was just crawling on the space. Right? It's like the primordial soup. So where I was was I was risk adverse. I was diligent, hardworking, medical graduate, just like anybody else. But then life, life has its twists and turns. Right? Yeah. So to recap one of the stories is my preceptor had a really good faith in me more than I had faith in myself. He actually spent the money. He wanted to build a clinic. He spent all the money to put me in a clinic to start one, and I was just finishing my R2, right? And so he says, okay, Wing, I'll set you up. And then I told my wife, my newlywed, said, No, this is too, too scary, too risky. Starting a clinic from scratch, what if there is nobody coming in? Then we don't even have money to pay rent. And my very astute and pragmatic wife, some of you know her, Kitty, said that look your boss gave you - oh, there's a Chinese dish, famous Chinese dish called the soy sauce chicken - she said your boss gave you the chicken and asked you to cough up some soy sauce, and you said that's too risky. So that was how risky, how risk adverse, and I actually said no, believe it or not, I said no. And then went and find a locum instead. So that's where I was. Right? And then so fast forward 30 years, yeah some of you heard my story, right? We developed one of the largest clinics in Alberta and we developed a wellness center that processes 2000 patients a day, more than half a million visits a year. And we just launched a senior home that is six storey high, 156 units, and it's 90% full. So there's a lot of other stuff that I do and I look at, Wow, how did we end up here? So is this nature? Is it nurture? And I would say somewhere there are some pivotal people. We call them mentors. They disrupted my world. How dare they, right? Dr. Kevin Mailo: [00:04:48] So yeah, the first thing I'll just highlight here that's resonating with me is the notion of mentors, right? Those people that come into our lives and carry enormous meaning and kind of push us to the next level, help us grow. I mean, you know, you're one of my mentors and I can certainly recall a lot of those kinds of moments. So continue, continue on with your story. Dr. Wing Lim: [00:05:10] And the mentors are not didactic. Like we went to med school eight hours per day for four years, right? Or three years. And then 100 hours of rotations. But mentors are the ones that open doors for you and they open doors by disrupting your status quo, by asking you some pivotal questions or give you like a light bulb. And one of my mentors, we just spent an evening with him, Dr. George we call him. He's in his late 80s and he asked me a question. He says, Wing, what if time and money were no object? What if success is assured? What would you like to do? And that's when we started this dreaming session, writing it down, and we called it The Power Page. You write down first 20 items and you think, Oh, I want to have this car, this boat, you know, this trip, you know, all these bucket lists. But then very soon you run out of steam. And then and then they say, don't stop. Keep going. Don't question it. Don't, don't disqualify. Keep writing. And if you last 20 minutes later, there's some more notable stuff that are coming out if you don't stop your pen, some of these bigger, more noble dreams come out. Right? And some of that would be your life calling, your life's destiny. First time emerging and calling your name. Dr. Kevin Mailo: [00:06:25] Wow. Dr. Wing Lim: [00:06:26] And all of those you need to break out of your shell. And that is where entrepreneurialism comes. Dr. Kevin Mailo: [00:06:33] Yeah. And and it is about that personal growth. And we see that so commonly in the physician community where, you know, it's this brilliant mind of a physician. And, you know, I'm not going to try to toot our horn too much, but truly, the selection pressure within the profession is so high. You know, we have this collection of brilliant minds who are incredibly hard working and industrious, but at the same time, the profession can be somewhat constrictive in that it's not necessarily a creative space or a space for our dreams. Dr. Wing Lim: [00:07:05] It's not. In fact, it's the opposite of creativity. It's called conformity. We are bred in extremely purebred, incestual kind of purebred environment that we don't question whatever has been agreed upon, right? The clinical practice guideline or whatever the college says, right? Whatever your profession says. And then you're locked into there and you're supposed to be better and better and better. So there's a concept called white coat versus dark suit. So I came across this a number of years ago. We went to school to become white coat. But then as soon as we got our billing number, our practice license, we started work in the department, got the first paycheck, first billing, depending on fee for service or your stipend, wuddenly your first year's income is bigger than your last many years. No, sorry. Your tax bill this year is better than your income last year and then you start to become dark suit, right? Suddenly you have to adopt the business side, especially those of us who are in private practice. Or you are noncommissioned too, you have a research grant or you have the whole department funding. You suddenly have to manage it like the dark suit. And of course, we didn't go to business school, right? So this is where we fumble. We struggle. Dr. Wing Lim: [00:08:15] For me, my journey, I bought my practice right off the bat after I said no to the preceptor. And then we borrow money that we haven't got. We got evicted by the landlord within two years. Our son was just one year old, barely in the car seat. Right? And there are a lot of hard lessons to learn. And so a lot of this dark suit side, we never went to school, right now I went to school a long time ago, but I heard my recent colleagues that there is hardly any business education, any entrepreneurial side of the business, about the medical practice, the practice side of the medicine, right? The nitty gritty detail of it. We don't, how do you run a clinic, right? I have some great clinician, some of my own doctors. I love them, but every time it's a solid two hours wait at the office and just looking at their workflow, it just aches my heart. And hospitals be waiting for 12 hours, 14, 26 hours, right? There's so much wrong in the practice of medicine because we are clinicians, we're white coats, we're not black coats, black suits. And so it is a journey and a half to evolve. Dr. Kevin Mailo: [00:09:27] And I would say that that journey can be deeply meaningful in our lives. I mean, we talk about dreams quite a lot at Physician Empowerment because they bring focus to what we're doing. And a lot of physicians, you know, that we've encountered over the years find it so meaningful to have that entrepreneurial outlet, that place where you can pour your energy and your passion and your creativity with the dream of making things better, whether it's within your practice or within education or other areas strictly outside of that face to face encounter with the patient. I think that's so important. Dr. Wing Lim: [00:10:06] Yeah. So this is nature versus nurture, right? Are these medical entrepreneurs, are they born with it? Is this a nature or is it nurture? Are they, did they go to school and become a business person? I'm going to say it's more a concept like epigenetics, right? You know, the genes and you get the environment can turn on and turn off the genes like uncle genes and other genes. So I'm going to say that we yes, of course, we deal with the brightest of minds, the highest GPAs, the high achievers. Those become our colleagues. Right? But we only breed them in their scholastic intelligence. Right? When people nowadays look at intelligence, they're like nine kinds of intelligence. IQ is only one of them. There's Adversity Quotient, there is a Relation Quotient. There's Emotional Quotient. Right? And if you have high IQ and low three of those, you become one of those department's delight. Everybody is scared of you, right? In my days, some grumpy surgeon would throw scalpels at the nurses. That's before the days of AIDS. Yeah. And so there's just these people with personality of doorknobs that run the department. Dr. Wing Lim: [00:11:10] But now things have changed. Everybody is more civil. But then I'm going to say that these brightest of minds, they got turned on one gene. The gene is the scholastic education. But now that they're thrown in a different environment, now the brain is saying, what else? Right now, with the money, with the influence, what am I going to do? What can I do? And we're fumbling because we haven't turned on those genes. Right? As we move on, as we allow people to talk about these things, their genes will be turned on. And so that's why when we do these Physician Empowerment encounters masterminds, we're like magnets. We're attracting people that either come out and say, Hey, I've got that gene, or people say, Hey, I think I might have that gene turned on. So when, let's say for you and I, Kevin, right, when we met, we thought we were X-Men. We're the Mutants, right? And now we find that there are more and more X-Men, X-Women out there. Dr. Kevin Mailo: [00:12:04] Yeah, there are just so, so many of us that are, yeah, are interested in doing something, you know, along the lines of an entrepreneurial pursuit. And it's really wonderful because although the thrust of the activity where specific projects someone is working on may be radically different, there's a lot to be said for sort of the cross-pollination that occurs when you get people together where they share their experiences, they share their perspectives, they share their advice with each other. And that's that's a very, very powerful part of the community experience that I've noticed over the course of doing our master classes. Dr. Wing Lim: [00:12:44] So this thing about entrepreneurship, so one time I was invited to speak at a religious context, right? These are congregants and we're talking about entrepreneurship. So compare what the the religious world would see as, let's say, a clergyman or somebody who is really good at running, let's say a charity or NGO. The list of attributes and skills versus a successful multi-billion dollar international enterprise, the skill set or the build - borrowing from people who are gamers - this character's build, it's identical. Whether you are a money driven, money hungry entrepreneur or you're an altruistic NGO builder, right? The skills are identical. So if you have a dream to run your department different, to run a new idea, new medical idea that could change the world, it all takes the same skill set, right? Same resources. So we just came back from Iceland at a CME trip and we met this dermatologist who discovered that he grew up in Iceland and it's a fishery country and they throw away the fish skin since he was a kid, and he discovered fish skin is the best for human skin regrowth. And so he created a product, right, that is selling everywhere and haven't got in Canada. And fish skin has the least amount of rejection compared to, you know, any other animals. Dr. Kevin Mailo: [00:14:09] Wow. Dr. Wing Lim: [00:14:09] This thing is going gangbusters. And you know what? I look at them, this is now, this thing is going public, they have like 20 plus million dollars of investors money. Right? And now this becomes, his dream became true because somebody kicked in with that entrepreneurial side. Right? Get together with him and make this dream come true. And now it's benefitting people all over the world. Dr. Kevin Mailo: [00:14:32] I love that. Dr. Wing Lim: [00:14:33] That's a good story, right? Dr. Kevin Mailo: [00:14:35] Yeah. And you know, again, one of the things that that's so important as well is this notion of margin, right? That there has to be some balance in our personal and professional lives to create space to come up with these ideas and to develop them and then to actively work towards them. Right? Like, you know, if you're working 80 hours a week and you've got a big dream, it's going to be frankly, hard to achieve. I don't know. What are your thoughts on that, Wing? Dr. Wing Lim: [00:15:02] Yeah, exactly. So people say, where do you find time? But I think we always find time to think, do things we want, because time management is never rational. It's emotional based. Dr. Kevin Mailo: [00:15:12] Ooh, I like that. Dr. Wing Lim: [00:15:14] Were we supposed to do this, and supposed to do dictation, do charts, and you ended up watching six hours of Netflix, right? Because you're so, so dry, so burnt out that you got to pacify yourself with something, right? So I think what is more costly than time is headspace, right? So I tell people that I'm a serial entrepreneur. I build multi-million dollar corporate entities, so I'm a profit driven, some are for profit, some are not for profit. But it all takes time and effort. So persistent quality, part time effort, right? We could carve out from our calendar say, I want to, let's say you name a number, two hours, three hours, five hours, ten hours, whatever. Right? We just met a new person that we met through our Physician Encounter Endeavor. This guy now cuts out 15% of his week to do something entrepreneurial. Right? So as long as you can do that, well, it's no different than if you need to take a master's degree like MBA, MPH or whatever through your residency or through your clinical hours, you carve out the time to do it, right? So if you do that and nurture the entrepreneurial side and with the bright mind that you already got - you won't be a successful physician if you're not being bright - we just need to give ourselves permission that, okay, I'm learning a new thing, I'm starting from zero, right? From being like a pre-med student stage, right? And we just own that up and say, Hey, I'm an idiot outside of my own field. I'm going to start in the field and the time. Dr. Kevin Mailo: [00:16:44] I love that that, that powerful humility, that vulnerability. Dr. Wing Lim: [00:16:49] And the permission for us to say, okay, I'm learning a new thing, like learning a new language, go to yoga class, and knowing nothing like me learning dance, right? When could not even dance like Pinocchio, like my kid said, right? Start something new. You learn something new and that's about personal growth. Dr. Kevin Mailo: [00:17:05] And I was just going to add, you know, before when we started our journey together, and we've been at this for well over the better part of a decade now, but I remember being the type that used to be terrified of being the dumbest one in the room. And now I feel honored to be the dumbest one in the room because I feel like I'm learning. But that was a mindset shift for me, to realize that I'm being immersed in a field or a topic or an area of expertise that I have no background in, that someone else is going to know a lot more than me and this is my time to to quietly learn or not so quietly learn and ask my questions. But that takes a lot of personal work and personal growth that's very far from that medical student or resident on the wards who's getting ready to get thrown a doozy of a question by the senior resident or the staff or the fellow, and you're expected to know it. And God forbid you're not the smartest one or one of the smarter ones in the circle at the patient's bedside. So it's a big mindset shift. Dr. Wing Lim: [00:18:10] Yes, because contrary to our paradigm, the know-it-all does not own the world, right? And here's a paradigm that I've learned, that I embrace now, if you get the why big enough, the why, then the whats would come to you. The whats and the hows would come to you. Just like Mr. Ford, when he started this motor vehicle revolution. And he actually started with a dream. His dream is not to be the number one seller of cars, his dream was when he grew up he saw the countryside, he lived in the countryside, his dream was to have every American have a chance to have an affordable way to travel to see the countryside. And because of that dream, right, and he's not an engineer, he's not a technical person, and one time at a press conference, they say, Mr. Ford, how do you become so smart? Do you actually know how to fix this part of the engine? And then he picked up the phone and they said, wait a minute, what are you doing? He says, I'm going to call my engineer. They said, That's cheating. He says, No, that's not cheating. In real life, if the why is picking up, the hows would come to you. Right? So I think that is important, right? People ask me, how do you learn so much about so many things? You have your hands in so many different things. I said because I hang out with people smarter than me. Right? Always look to be the dumbest. And one day when we were building this senior home, I found myself downtown in one of the top architect firms. So there are a few of us surrounded by 3 architects and 15 engineers from different disciplines. Dr. Kevin Mailo: [00:19:38] Oh, wow. Dr. Wing Lim: [00:19:39] These are top notch engineers. And they were grilling us and saying, What do you want? What do you want us to build? Right? And I'm just not qualified. I'm just the dumbest person in the room. But I had a dream. But I had a dream. Dr. Kevin Mailo: [00:19:54] Exactly. Exactly. So I think we could go on and on in this area. But tell us, like, what practically have you done in terms of personal development to get where you are as an entrepreneur? Going from that very narrow technician to being this expansive entrepreneur who dabbles in so many fields. Tell us. Dr. Wing Lim: [00:20:23] Sure. So I think we already talked about some ABCs, maybe we just put them down more formally. A is to give yourself permission, right? That I don't know anything. I'm learning a new discipline. The second part is to carve out your head space, right? You got to dedicate some head space together as time and also quietness. The mindfulness that I'm going to learn this and then you got to feed it. You got to feed that part of the brain. You got to turn the genes on. You got to keep feeding it. And that's why listen to podcasts. And well, 30 years ago there were no podcasts, right? You can read books, you can listen to tapes. I grew up with tapes, right? And so for now, you can listen to our podcast. And actually, Kevin, you and I were just talking about we're going to start a new series, right, called the Medical Entrepreneurship. And let this be our kickoff, right? This kickoff session. We're going to interview a lot of our colleagues who have that mutation, that mutant gene of entrepreneurialism. And when you interview our colleagues, how do they do it? What started it? We're going to interview people's journey. And somewhere there is like a tuning fork where you go binnnngg and the guitar box, the rest of this box is going to resonate, right? So we put different tuning forks and then we're going to turn people on. We're going to turn on your gene, right? And those of you who have that gene, it's going to echo. And those of you who don't think you have one, maybe you would echo too. Dr. Kevin Mailo: [00:21:45] Take time to explore it. You know, and the other thing I'll reflect on is the goal is less important than you think. The journey is far more meaningful. Dr. Wing Lim: [00:21:56] That's right. Yeah. Dr. Kevin Mailo: [00:21:57] You know, because for me, just reflecting on my own journey as an entrepreneur, there's just been so much growth and it's been so much fun and so exciting and I think that's a real source of personal renewal is like doing more than just the 9 to 5 grind. And we know it's not the 9 to 5 grind, it's the 8 to 8 grind for doctors. Dr. Wing Lim: [00:22:20] Yeah, exactly. Dr. Kevin Mailo: [00:22:22] It has to be more than that. Dr. Wing Lim: [00:22:23] It's very hard for us. It comes with a price tag, right? It comes with a price tag. So it's an investment. It's an investment in your future and for unknown number of people's lives. Right? Because when I go to the wellness center that we built, there are patients who say, Wow, we're so thankful that somebody built this. They from two hours away, rural, they could come to Sherwood Park and downtown Edmonton. And I'm glad that when I want to go to this center, I'm not known. People don't know me. I have a very healthy ego. I don't need to be thanked. But it scares me sometimes to think about what if I did not activate on my dream? That reality today that everybody took for granted would not be there. We would be struggling. Our medical delivery would be a mess in our county. Right. So exposure. Exposure, right? And then learn the lingo, learn the mentality, talk to people. Allow yourself to dream. Allow yourself to take more risks. It's a metamorphosis. Dr. Kevin Mailo: [00:23:22] And allow yourself to fail. Dr. Wing Lim: [00:23:25] Exactly. Dr. Kevin Mailo: [00:23:26] This is a lot less stress than you think it is. If you can get past the ego component where you're worried about what people think or what you'll see in the mirror when you look. You know, when it comes to, you know, especially like, you know, sort of business and real estate and things like that, you know, there's money at stake, right? But it's not the same pressure as medical errors. And so, like, be comfortable failing, be comfortable having setbacks and frustrations and be comfortable learning from those. That was the other thing that I took from that is that it sounds so cliche to say that, you know, failure is the path to success, but it is. Every single highly successful entrepreneur, highly successful, not just entrepreneur, you know, whether it's a political leader, an athlete, a musical performer, an actor, an actress, that person has had innumerable failures on their path to success. And we don't know them, right? Dr. Wing Lim: [00:24:24] We only meet them when they're successful. Right? So I have kids who are musicians, right? So I understand that mentality. And then in our in our profession, there is zero margin of error. Right? So therefore, it's very one of the toughest thing is not A) every time you're successful, the first time you try, you got to fail. B) I'm not the know-it-all. Right? I need to be the dumb guy, right? And don't DIY, don't do it yourself, do it your way. If there's one way to do it, do it yourself. So I find it very difficult for us to delegate. If you want to be huge in this entrepreneurial world, you gotta learn to let go of yourself. Dr. Kevin Mailo: [00:25:02] Oh, yeah. Oh, yeah. Dr. Wing Lim: [00:25:04] And we teach this concept of leverage. I have a talk on that in Mexico that we did about leverage. Right? It's leverage is the way to to build success. The time, money and talents, the three essential T's for success. All of those lessons are learned and you learn from your own mistakes or other people's mistakes. So it's better to learn from other people's mistakes. Right? And that's why it's good to join us. Join us on our podcast, webinar, Masterclass, fun conferences and our destiny trips. That's where we share our ups and downs. Dr. Kevin Mailo: [00:25:38] Yeah, and there are a lot of downs. Dr. Wing Lim: [00:25:42] Lots of downs. It was shameless. We share our failure stories, right? Dr. Kevin Mailo: [00:25:46] It was no fun having a business built around live events during the pandemic. Yeah, that was a real struggle. Nobody seemed to want to come to our conferences while a pandemic was ravaging the globe. Dr. Wing Lim: [00:26:00] Or at a Mexico conference. The spouse showed up, but the doctor could not because of pandemic, the hospital would not let him go. Dr. Kevin Mailo: [00:26:08] Yeah. So lots of ups and downs, but still so wonderful. And so with that being said, why don't we wrap it up? Because we'll be coming back to this topic over and over again. Dr. Wing Lim: [00:26:21] Yeah, so Kevin, so we're going to interview people. So we already have a list of people. And for people who are our audience, if you have a good story to share about your journey of medical entrepreneurship, let us know. We would love to hear your story. Dr. Kevin Mailo: [00:26:36] Oh yeah, yeah. I was just going to say please and I forgot to plug this many episodes ago and I got to start remembering to do it now. If you are hearing this and you want to share something on a topic of wellness, practice transformation, leadership, finance, entrepreneurship, talk to us because we want more guests on the podcast. We want this to be a community of physicians who are sharing their story, sharing their journey. We don't want it to be the Wing and Kevin Show. So if you have something great, let us know and we'd love to have you on the show. Okay. That's it. That's it. Thank you. Dr. Wing Lim: [00:27:13] Okay. Thanks, everyone. Dr. Kevin Mailo: [00:27:16] Thank you so much for listening to the Physician Empowerment podcast. If you're ready to take those next steps in transforming your practice, finances or personal well-being, then come and join us at PhysEmpowerment.ca - P H Y S Empowerment dot ca - to learn more about how we can help. If today's episode resonated with you, I'd really appreciate it if you would share our podcast with a colleague or friend and head over to Apple Podcasts to give us a five star rating and review. If you've got feedback, questions or suggestions for future episode topics, we'd love to hear from you. If you want to join us and be interviewed and share some of your story, we'd absolutely love that as well. Please send me an email at KMailo@PhysEmpowerment.ca. Thank you again for listening. Bye.
	15 Jun 2024	45 - Connecting Through Our Vulnerability Transforming Our Personal and Financial Lives	00:21:57
Dr. Kevin Mailo and Dr. Wing Lim, co-hosts of Physician Empowerment, join together for this episode to talk about the recent Physician Empowerment Live Conference. They recount the success of the conference and attribute much of it to the vulnerability of the panellists and the willing feedback from the attendees. Addressing some of the topics broached, Kevin and Wing highlight lessons learned and stories shared that contributed to the atmosphere of positive connection. One of the things Wing revealed was that the conference was designed with the intent of the first day covering more ‘brainy’ subjects and the second day reaching more into the heart of physicians. Attendees were pleasantly surprised by that revelation and equally enjoyed another highlight of the second day which featured a non-medical spousal panel. Topics like burnout, experiences being the spouse of a physician, wealth creation, leadership, and technology were all addressed at the conference by Masterclass leaders and students alike. Acknowledging the real heart-felt success of the conference, Wing and Kevin then moved on to announce the upcoming more relaxed destination conference weekend in Canmore. Physician Empowerment continues to grow through the inclusion and involvement of all members and through the success of events like these where attendees allow themselves to learn and share. __ Physician Empowerment: Attend an upcoming Empowerment Retreat Join the Physician Empowerment Masterclass now Website: PhysEmpowerment.ca
	30 Sep 2022	02 - Growth Mindset	00:28:54
Kevin Mailo, co-founder of Physician Empowerment, talks with fellow co-founder Dr. Wing Lim about having a growth mindset and allowing yourself to not be an expert in everything. Dr. Lim shares how CBE - Continuous Business Education - is a cornerstone to his success and to what Physician Empowerment seeks to share with others. Dr. Lim discusses how a conference he attended was the first place where he was challenged to step outside the need to know it all. At that conference, attendees were challenged to tell themselves “I’m an idiot outside of my own field” as a way to open themselves to learning from others who are experts in different fields. That ability to access humility is necessary for a growth mindset and personal empowerment. In this episode, Kevin Mailo and Wing Lim explore how Continuous Business Education includes surrounding yourself with professionals in other areas who can build on expertise in fields that are not your strength. This ability to allow others to take tasks from you allows you to focus on what your specialty is and contributes to growth in many areas and contributes to not just financial wealth but wealth in terms of time and wellness. They discuss the necessity of “decompressing perspective changes” and paradigm shifts in the service of finding your own dream instead of following the path of someone else’s. About Dr. Wing Lim: Dr. Wing Lim completed his Medical Degree at the University of Alberta in 1991 & Family Medicine Residency in 1993. Later he qualified for the FCFP designation in 2005 & 2019. His practice is focused on preventive health & Geriatric Home Visits, for which he received the Alberta Centennial Medal in 2005. Apart from his clinical & teaching roles, Dr. Lim has extensive experience in Practice Management and Business Development. He co-launched the Sherwood Park Primary Care Network in 2007 (currently 90+ physician members). In 2009, he founded the Synergy Medical Clinic, which grew from 12 to 37 physicians over the following ten years, serving a panel of 50,000+ patients. He also co-developed the Synergy Wellness Centre, a 75,000 sq ft integrated medical-professional destination providing 55+ medical modalities by various specialties & allied health professionals, with over 500,000 patient encounters annually. He is currently co-developing a 165-bed Senior retirement facility with the provision of comprehensive care from independent, active living to secured Dementia care. Dr. Lim is passionate in sharing his extensive knowledge & experience (both clinical & business) with others in various settings, from his clinic mentoring younger colleagues, to churches, senior groups, ethnic functions, radio broadcasts, retreats, seminars and national conferences. Resources discussed in this episode: Synergy Wellness Centre Synergy Medical Plus — Physician Empowerment: website \| facebook \| linkedin Wing Lim, BMSc, MD, CCFP, FCFP: website \| linkedin __ Transcript: Kevin Mailo Hi, I'm Dr. Kevin Mailo, and you're listening to the Physician Empowerment Podcast. At Physician Empowerment, we're focused on transforming the lives of Canadian physicians through education and finance, practice transformation, wellness, and leadership. After you've listened to today's episode, I encourage you to visit us at physempowerment.ca - that's P H Y S empowerment.ca - to learn more about the many resources we have to help you make that change in your own life, practice, and personal finances. Now on to today's episode. Kevin Mailo Hi there. I'm Dr. Kevin Mailo, one of the cohosts of the Physician Empowerment podcast and one of the cofounders of Physician Empowerment. And on today's episode, I'm very excited to bring to you my fellow cohost/cofounder, Dr. Wing Lim, and Wing is a very close friend of mine, a mentor, like a father figure to me. You're a lot to me, Wing, and we've had an incredible journey together. We met years ago. And we've done so, so, so much together, but let me introduce you to our audience. Wing is a family physician based out of Sherwood Park, Alberta, just east of Edmonton, and practice focused mostly on the care of the elderly. But I think saying that you're a family doctor really does not describe you in any anywhere close to its fullest sense. Because you are so much more than your medical practice. You are a real estate developer, a business person, an educator. So why don't you go ahead and share today a little bit about your journey, because I'm inspired by your journey of going from a struggling family doctor in the early 90s to what you are now and how you got there. So just go ahead and share with us what that was like. And I'll interrupt from time to time with my questions. Wing Lim Sure. Thank you so much for the kind introduction. And yes, Kevin and I, we met half a dozen years ago, maybe? And we instantly clicked and I caught his stream about this Physician Empowerment thing. And I thought, you know, I was actually a speaker, right? But honestly I didn't know I was actually a guest speaker in the Toronto conference. Humble beginning. Kevin Mailo That's one of the most exciting things, is we have somebody that comes to our conferences, and then the next year they're like, but now I want to speak and share and I love it. Absolutely love it. Wing Lim Exactly. They say vision is not taught it's caught. So I caught the vision and here we are doing podcasts and webinars and seminars and masterclasses together, right, and so my humble beginning... I was U of A graduate, a family med grad. In those days, we have about one hour of health economics education. So I graduated with nothing, zero how-to-- Kevin Mailo -- Wing, I'll be happy to share with you that it is 100% more now. Wing Lim Two hours? Kevin Mailo A whopping two hours. Wing Lim So I was so risk averse. But you know what, I was offered practices for free at that time. That's in the early 90s. And practices were given away, nobody was buying practice. And a lot of people left to the US, I suppose you can go to anywhere and they'll give you a Green Card, match your spouse, match your kids work/school. But I didn't go, I was so risk averse, and I stayed right in Edmonton. Right? And so as I walked into this dream practice, and it cost me more money than I could afford. So we borrowed this big amount of money to us at that time. And my wife actually gave up her profession, and joined me to chase my dream building a clinic. I thought I got my own x-ray and my own lab. This is my mini emergency department. So at that time, I actually wanted to be like the emergency department. So we ran 100 hours per week - that was 20 hours work cut from 120 hours a week of residency. And off we went: 16 months, not a day break, 16 to 24 hour days. We went home at 11pm, my wife and I, you know, and mow the lawn and at the next year's Block Party, 'Oh, you're the guy that mow the lawn at 11 pm'. And then the first year, I was thrown in this painful story, first year we found that oh, we didn't save money for tax. And then we have to pay tax, oh my goodness. And then the first Christmas, actually, Alberta Health does not pay for two weeks. So we didn't have money to pay ourselves. We cough up some money to pay our staff. And then the following year at Christmas, we faced an eviction. The previous landlord died, an old physician died in Spain, the new landlord came and doubled the rent and we went to court and we lost. And I remember that we got 30 day notice November 30th. So the next 30 days is to move a clinic pronto. And we have a newborn baby and we spend the first kid's Christmas in the construction site. It was just... I wonder if I still have PTSD from that. And then just like we got three kids, three kids in four years, something like that, five years, right? It's just like you - and you understand right Kevin, you got four kids right, we got three kids all close - so life just happened. And you just got hit by the upside of the of the head. And I told people that I didn't go to business school, I went to the school of hard knocks. Right? Everything that we bump into, the mistake that we make, was so very costly. And then we pay high tuition in terms of money and disappointment and distress. And so fast forward. This is my 30th year of practice. And so now I'm in a group practice, 30+ physicians, it turns out to be one of the largest practice in Alberta. We actually, I think, officially we're the biggest client for Telus Health in Alberta. I've read the EMR. And our panel size is about 50 to 60,000 patients which is half of the county. And we built a building, a medical professional building, that is 75,000 square feet with five acres of parking. And we handled collectively in the building, not just our clinic, 2000 patients a day, and that's about half a million visits a year. And so when you look at that, wow, how did I arrive here, right? Today I wake up sometimes I pinch myself. If I met some of these movie things, you meet your future self, like you say, 'Are you kidding me?' I was so risk averse that when before I even bought my practice, my preceptor in my family residency program, was willing to cough up money and risk and start a brand new clinic just to have me show up to work. And I was so scared. I said, what if nobody comes to see me? From zero, I can't even pay rent. And my wife laughed at me. She says you're such a scaredy cat. And there's a Chinese dish called the soy sauce chicken. She says somebody's giving you a chicken, you just skip the soy sauce and you're too scared. I was that risk averse. And we just finished building a senior home that we launched a year ago: 156 units, six stories high, award winning building that is filling up pretty good. And we signed collectively a $43.5 million loan. So from a guy who's afraid of putting on soy sauce, for soy sauce chicken, to that. It's a journey. It's a journey. Kevin Mailo It's an incredible journey. And so you touched on one important thing that a lot of physicians, I think, struggle with, and we've talked about that before, is the ability to tolerate risk. And I think some of it comes from our training, that we are inherently risk averse. But also the fact that I think we deal with a lot of risk fatigue by, you know, you go to work, and you honestly if you really look at it, you make life and death calls all the time, whether you're a radiologist or a psychiatrist, an ER doctor, a family doctor, whatever your practice background, you're dealing people's lives. But I think it doesn't leave a lot of space for us to be risk takers in our financial lives. Or - I don't want to say risk takers, I don't even like that word - risk managers. Because there is no reward without risk in finance, right? Wing, you to date - that's how I describe it now - to date have executed $100 million in new developments, of which you've been the principal. And there's more coming, right, but somewhere along the line, your mindset changed. And you learned to manage risk from being the fraidy-cat new grad to a real estate developer that, like you said, signed $43 million in loans. So talk to us a little bit about how you got there. And this is the term that we use at Physician Empowerment - that came from you, Wing - CBE. Like medicine, we have CME, which is Continuing Medical Education. In order to develop ourselves financially and build wealth and create financial security and to build efficient, effective medical practices, we need to have CBE, Continuous Business Education. So why don't you share with us a little bit about your your journey in this space? Wing Lim Sure. So what is underneath the CBE is a growth mindset. Right? If you don't have a growth mindset, they say if you don't have a goal in life maybe you have arrived if you don't know where you're going. Right? So I think first step to the growth mentality is to give ourselves permissions, give ourself permission to acknowledge where we're at, right? I like this idea - I went to a big conference and they say, go to the mirror and look at your image and say, I'm an idiot, outside of my own field. And when the first time looked at this, I laughed and was deep down was mad. I'm not an idiot, I'm a doctor. But if we are truthful to ourselves, we are all idiots outside of our own field, that's why I have friends who said, that's why I want to be a specialist. I don't want to be a general practitioner that needs to know everything about everything, but I will know this and this might feel right. So outside of our field, which we spent so many years, how many years do we spend in school? Oh my goodness, right, a few decades. And so we have missed out learning a lot of stuff. So by the time we finished medicine, we've finally hit the real world, and all these book knowledge, all these stuff, clinical trials, and all that, suddenly doesn't apply, the evidence based science paradigm doesn't apply. So we need to have the mindset, and the first step is to acknowledge that, okay, I'm starting something brand new, right? Give myself permission that I know nothing. I'm going to start from scratch, and then learn something new, every day, do something new, every day. And so I went to another conference, leadership conference, a global leadership conference, and to be up there, you got to be somebody, like this conference where they interviewed 23 year olds, why 23 who actually happens to have, like, 13 million followers, he made it. And one of the speakers, he said, I'll give you an assignment, I'd like you to get a bunch of friends together, fine, not your regular medical, professional friends, other friends, that you need to have a two hour discussion that you have nothing to contribute, that you know nothing about, and just take it in and let them talk on things that you don't understand. So that you don't say, let me teach you on this. Right? And he says, I challenge you. This is your homework after this leadership conference, go and find somebody that you can have a two hour conversation and you just got nothing to contribute. You just open your ears and learn. And for me, that's not hard. My kids are young adults, they talk in language I don't understand. My son is a musician, him and his friends are into all these high tech stuff, web stuff, and music stuff, anime stuff that I understand every English word, there is nothing I can contribute. So how often, when's the last time you learned something new with something that you haven't done and something you didn't go to school for? Once we give ourselves that permission to learn, the license to learn, we suddenly become humble again. We climb a mountain, we thought we're at the peak and we're the big fish, now we start all over again, as a new new discipline, just like a new language. Right? And to me personal finance was one of those. Right? I was at a crossroad. Like I went to school. And when I graduated, finished my residency, I was doing literally everything I went to school for. Deliveries, hospital admission, psych stuff, psychotherapy, home visits, you know, mentoring kids, mentoring youngsters, young interns and residents. I did everything, but 100 hours per week. Do I feel really actualized? Professionally, I probably was. But I felt so stuck in life. So that's why I thought I knew nothing about this real life thing, especially personal finance and corporate finance. The business side, I need to start and learn something I haven't got. And so step number one is permission to learn something. Second is to prioritize. So when I got my CCFP - sorry, the first FCFP, right, you know, for those of us in a family med, we belong to the College of Family Physicians, but you need a 10 year thing, right now it's a lot more to get your FCFP. So I was invited to go for convocation right and I have a very pragmatic wife who used to be a financial planner. And she said that there hadn't been kids, right. Nice that you could go to a convo, but can you put this new title on the table and we eat it as dinner? No, no, it was joke, it was a joke. We didn't want to put down any any title or degrees, right, for some of us we got more degrees than a thermometer. Kudos to all of you. But the pragmatic side, does it change us financially? I also have colleagues after 16 years of family practice, went back and did a residency - one become a dermatologist, one became ortho, you name it, right. So at the end of the day, do we change this training time for money trap? Right? I was saying to myself, if I trade my day job to a night job, I go back to school, keep this up and is still trading time for money. Or one of the speakers in Toronto is trading live energy for money. I'm no better off. So I want to learn differently. o and then some mentors popped up. One mentor - he's a physician who's now in the 80s, Dr. George Wickham - and George says, 'Wing, how would you like to earn 1% of 100 people, or 1% of one person?' I said what kind of question is that, George? He says let me repeat right and said, I actually understood your question. I just find it shocking. I knew how to do 100% of one person there was 100 hours a week. And if I don't perform, there's nothing coming in. When we take a holiday you got a double loss. I'm sick and tired of it and kids are coming, everybody needs a piece of me, I was just burning out. And the government is getting more more hostile on us and I'm sure everybody relate on that. My patient demands, government the regulations, to college, you name it, right. And so I began to think okay, what is life like in the real world? How can we learn to be better and different? So the big number two step for me was actually the prioritization of investing time and money for an education. Right? Instead of taking a residency, a second residency, I'm taking, quote, a residency in mastery of wealth. So that was my residency. So my mentor says, 'How would you like to do, prioritize 8 to 12 hours a week and create a different future?' Life is either by design or by default. Right? If we don't design it, it's by default, somebody else's default? Not our default. Right? Some health economists trying to do design your and my life on our pay structure, and that's our default. That's why we're stuck. Right? The tax system is fixing us, especially recently, more and more hostile to us physicians, were incorporated or even non incorporated, right? The ERP structure, right? Like everything, it's somebody's default. So how do I, how do we design a life to have a different future for us and our family to enjoy life, enjoy our profession, and have some life? Right? And so the key is to prioritize time, effort, brain space, and money to put aside and say, this is my ongoing CBE Continuous Business Education. Kevin Mailo Wow. Wow. Absolutely love that, Wing. It's, this isn't, you know, we talk about this at Physician Empowerment all the time. This is so much more than dollars and cents and money. We teach a lot of money. We teach a lot of finance, we can get into a lot of details. But the bigger question all of us needs to be asking is our why. And what Wing is touching on I think is so important here, is this notion of living our lives by design, not getting tossed around in the ocean of government regulation, fee structures, taxes, overhead, the cost of living, but being able to take control. And it's not only about making money and creating that financial security, but it's also about practicing better medicine. That we just aren't beholden to these forces that drive our practice decisions as well. So I think it's just so important, what you're sharing, Wing. And like you said, it's not necessarily an easy journey, I think for a lot of us, I'll reflect on my own life, it's very easy to just go back into our clinical work, and just do it because we're so highly trained. And we're good at it. Do you know what I mean? Like, it took me a long time to really step out and learn to invest in real estate, and do it well, you know, learn to start another company, and do it well. Like for you, Wing, to become a real estate developer, that took time, right? But it's also, it's not just the time, it's that mental effort and that vulnerability, to step out and say, okay, I'm about to do something I have no clue about. And I'm about to sit in a room full of people that I know a fraction of what they do in the area we're about to discuss. And it's hard, for us as physicians, because it's very easy to say, well, yeah, I'll just go back into the clinic and you know, bill that X amount of dollars, or I'll go back to the hospital and bill that X amount of dollars, and not think about it. But we're ultimately trading our time and our energy for money. And as we get older, that trade becomes less and less beneficial if I can be frank. Wing Lim Right. So I learned from lots of great masters and I've got a lot of these one liners that became an internal monologue right now. So one of which is: the enemy of good is not bad, I'm sorry, the enemy or best is not worst, the enemy of best is good. Because we are good at what we do. Right? What we thought we're good in this bubble, which is called the healthcare system. Right? Opportunity costs is the best. But what else is better for us and our family, for our future, for our profession as a body together? And if we don't leave our comfort zones, get a little bit risky, get a little vulnerable, eat a few humble pies, we'll never ever change our future. Kevin Mailo Absolutely, absolutely. Wing Lim They say, 'What's your five year plan?' Look at the last five years. Kevin Mailo But it's true. Wing Lim Nothing changes. Kevin Mailo It's true. Right? It's absolutely true. And it really is about, like, you know, being willing to put ourselves out there, being willing to grow personally. And it's not just about like, you know, CBE for me and I think for most of us isn't just about reading more. Or, you know, dedicated teaching. Obviously, there's a role for that. I mean, come to our conferences, grab great books, there are great podcasts out there. There's so much, right. But it's more than knowledge, it's experience. And it's about actually getting out and stepping foot into some of the spaces that maybe we're not as comfortable with anymore. Meeting some of these people. What do you want to say to that, Wing? Wing Lim I'm going to say one thing, what is more important than knowledge that you could buy, is perspective that you may or may not be able to buy. If you get a different perspective it'll let you change everything. Right. That's how movers and shakers, how they disrupt the world. Create needs that is not even fathomed by humankind. So these decompressing perspective changes, paradigm shifts, happen in my life a few times. And all you need is one glimpse, you bring it, decompresses, like the what do you call it, when you drive when you call that the airbag can be deployed, you can't put it back. My brain got decompressed. Right? I could not put it back. And I start to morph, this is a metamorphosis, is an evolution. You evolved to be somebody else. So right now, umpteen years later, I say, okay, now I can tell you I do double major now. My double major is health and wealth. Kevin Mailo No, it's absolutely true. Right? It is, it is. And I mean, one of those things is just creating time in our schedule to have those moments. And it doesn't have to be anything big and dramatic. I mean, it doesn't mean, you know, going and doing hallucinogens on some beach, some abandoned tropical beach, right? Like you don't have to go out and have those moments, like create space to go for a walk, you know, a long walk a few times a month. And just think your thoughts, don't have any distractions, don't have a podcast, don't even have this podcast in your ears. Like, just go out there and think your thoughts and think about what you want in life, and how you're gonna go out and get it. Right. But yeah, just stepping out of that narrow lens that we look at in our daily lives. Wing Lim Yeah. And we're all busy, right? Nobody's not busy, right? So I'm going to give a personal model I'm going to share here. It's called consistent quality, part time effort. And we have that consistency is like cruise control, right? Set it at 110. Right. I'm amazed at a lot of miles that I drove, I'm sure a lot of you, right, when you get on cruise control, I found that I pass more cars. If I don't remember, like, I pass people but they pass me, right. So consistency, quality, part time effort. And all these real estate deals that I have done, I haven't quit my profession yet. I still have a practice to run. Right? I didn't, I can't drop shifts. I have no shifts. I have a panel of agents, but to drop shifts, they're still on my panel. I'm still on call from my-- Kevin Mailo I know, in the emergency department, a big long letter about things you got to deal with, you know, Wing Lim Exactly, yes. So, and all these stuff that I created - and thank thank God everyday for that and it's always a team effort, you learn to leverage, but that's not the name of the talk today. It was all part time. Right? And you can do this part time guys. Right? So I challenge everyone to really find, dig deep and look at yourself, look at your future, look at your family future. What are you worth? Are you worth what the healthcare system tells you? Are you worth? What the structure that cooked up by some health economists? Are you worth that? Are you worth it? What's your future, family future, if you want to design it, if time and money were no object? If success is guaranteed? Dream a little bit! What if, what if, what if... right? And see what comes out. Kevin Mailo And I think that's one more thing that we're going to touch base on is, like, you know, this path to wealth, or success, or whatever you want to call it, this isn't someone else's path. This is about finding your own. This is finding your own passions, right? So you gotta dream to build some massive, efficient clinic, you know, that transforms healthcare in your area, I mean, maybe that's where you want to go, right? Or if there's a research interest, or, you know, an academic interest that you've got, but you need to create space in your schedule, which means you got to, you know, sort of your finances to do it, then go, right? Like, it's about finding your path, not about following somebody else's. And, you know, at Physician Empowerment we always laugh that we don't have a lot of answers, we got a lot of questions, right? And it's those internal questions you ask yourself, your own why, that helps you light that fire and helps you inspire yourself to go out there and chase your dreams. Because life is short and it is flying by. And, you know, I think it's so important to use that CBE, that Continuous Business Education to go out there and really develop your passions, right? Don't turn, you know, don't live them. You know, don't look at them as some dream on the horizon, but live them every day, which I think is so powerful. Wing Lim Yeah, so I think the CBE is basically part of the personal growth program. Kevin Mailo Yeah, it's bigger than CBE. Wing Lim Actually when you dig deep, a lot of this lesson, that's when I speak on and teach on practice transformation, we don't call it practice management. It's a transformation that you transform yourself. And even in the wealth strategy course we teach at a masterclass which is the next week-- Kevin Mailo -- yeah, that's every month if anyone's interested, just let us know. We run a monthly class on wealth creation and CBE. Wing Lim Yeah, exactly. And part of that is really not just about money, right? And we're going to touch about the three dynamic teams and the talent management, right. So we talk about a lot of things - how to manage your time, your talent, other people's talents, and the treasure, right? So it's so poly dimensional, and you would change deep in to be a bigger person, right? And wealth is exactly that, it's not just money, right? So look forward to empowering a bunch of people. That's why we started Physician Empowerment together. We want to ignite you, inspire you. Right? And our story is not your story, right? Of course not. And my success is not, may not be your definition of success, but we want you to share your story of success. We want to inspire people to achieve their dreams, and together with a better profession and better society. Kevin Mailo Yeah. That is the dream, right? Is to see physicians not only financially secure, but truthfully, living their best life, being their healthiest, being their happiest, but also doing their best medicine. Because when we answer those big questions about finances, and we create, you know, that balance in our lives, then we are doing our best medicine, and we are serving our patients and we are serving our communities. And that is the dream. And that is what is so exciting about Physician Empowerment. So with that being said, Wing, I think we're gonna wrap it up. This was amazing. I'm just so glad that we're launching the podcast finally. It's an exciting step forward. I really love it. Wing Lim Yes, I look forward to, yeah, we have a whole host of people we want to interview, interesting people, colleagues and otherwise, that I look forward to all these podcasts coming up. Kevin Mailo Awesome. Thank you so much. Wing Lim Thank you. Kevin Mailo Take care, everyone. Kevin Mailo Thank you so much for listening to the Physician Empowerment Podcast. If you're ready to take those next steps in transforming your practice, finances, or personal well being, then come and join us at physempowerment.ca - P H Y S empowerment.ca - to learn more about how we can help. If today's episode resonated with you, I'd really appreciate it if you would share our podcast with a colleague or friend and head over to Apple podcasts to give us a five star rating and review. If you've got feedback, questions, or suggestions for future episode topics, we'd love to hear from you. If you want to join us and be interviewed and share some of your story, we'd absolutely love that as well. Please send me an email at KMailo@physempowerment.ca. Thank you again for listening. Bye.
	15 Oct 2023	29 - Dr. Sarah Smith, founder of the Charting Coach	00:47:57
Dr. Kevin Mailo welcomes back Dr. Sarah Smith as his guest to discuss the topic of sustainable clinical practice, what it means, and how to achieve it. In this episode, they discuss the struggles physicians face to organize their day, combat burnout, and take time off. Dr. Smith shares tactics she learned through her struggles as a physician in Australia and Canada and how she overcame them. Dr. Smith shares her best practices for physicians to manage their days, shift their mindsets, and set goals at a sustainable and manageable pace. You’ll hear the impact of small decisions, and little shifts can lead to big changes both in your personal and professional life. They also discuss ways physicians can feel more empowered and make proactive decisions to provide quality care and balance their own mental and physical health. About Dr. Sarah Smith Dr. Sarah Smith is the Charting Coach for Physicians. She is a Rural Family Physician and Certified Life Coach through The Life Coach School. She helps physicians get their admin and paperwork done more efficiently to create time for the things they love. Dr. Smith has spent the last three years coaching hundreds of Physicians, over 1000 hours of coaching, in the specific area of “getting home with today's work done”. Resources discussed in this episode: Slim’s Cabins - Saskatchewan ChartingCoach.ca Dr. Sarah Smith on LinkedIn — Physician Empowerment: website \| facebook \| linkedin — Transcript: Kevin 00:01 Hi, I'm Dr. Kevin Mailo, one of the co-hosts of the Physician Empowerment Podcast. At Physician Empowerment. We're dedicated to improving the lives of Canadian physicians, personally, professionally, and financially. If you're loving what you're listening to let us know we always want to hear your feedback. Connect with us. If you want to go further, we've got outstanding programming, both in person and online. So look us up. But regardless, we hope you really enjoy this episode. Kevin 00:36 Hi, I'm Dr. Kevin Mailo, one of the co-hosts of the Physician Empowerment Podcast. And I am very, very glad to have a returning guest, Dr. Sarah Smith joining us again. So for those of you that have been following the podcast, we had Sarah on in one of our earlier earlier episodes, talking about charting and boundary setting. And Dr. Smith is known as the founder of the Charting Coach. And, yeah, and it's an outstanding program where she helps Canadian Family Physicians truly manage their practice, and more importantly, get to a better place personally and professionally. So that we are not feeling overwhelmed, that we feel like we can manage our work and our lives and your episode, the last time was just so powerful. It really connected with a lot of people, I got a lot of positive feedback about it. And so I'm very, very glad to have you back again, Sarah, and why don't you tell us a little bit about what you do. And I'll just introduce the topic today, which is sustainable clinical practice. And I'll let you tell us what that means to you and what that should mean to the profession. Sarah 01:49 Sounds good. Thank you so much for having me back. Yes, last time I was on, I did promise to come back and talk about sustainable clinical medicine. So I'm back. I am a family physician, rural in Alberta right now and originally from Australia. And you'll find out how I got to Canada if you have listened to the last episode. But this time, we're talking from a slightly different perspective. So I went and did the hard work to become a different doctor. So originally, I was in that pain of hours and hours after work evenings, weekends, charting, inbox paperwork as a busy family doctor, and this particular painful experience had followed me from an Australian practice to a Canadian practice. So it wasn't the country at fault. Kevin 02:41 We’re looking at a global phenomenon. Sarah 02:43 It wasn't the EMR. And it wasn't the government. It was a me problem. Kevin 02:47 You're kind of an interesting test case, in that sense, Sarah, right, because I think we always view our issues as hyperlocal. But I do I myself do look at some of this data in health care across the western world. And you can see it, it's actually a global phenomena. That's there are many factors driving it. And I don't want to get into all of them. But you are the interesting test case, I don't know that anyone else has moved across the world, only to discover the problems… Sarah 03:17 Followed me. Know, no, this was impossible, right? I thought this was the way right, sign up for family medicine, sign up for inboxes, sign up for never having a life, sign up for giving away my weekends. Like this is just what I expected. I asked every mentor along the way. How do I do this? And their answer was come in on Sunday, like that was the unanimous answer to my question that I'd had since residency. So the answers were not out there. And it was simply the listening to a general life coach at the time about, I can do impossible things, I can have a different experience in medicine right now with nothing changing. And I just thought that was completely ridiculous. And she had no idea what I was facing as a family doctor. So off, I went into the world to find the coach who could help me figure out this impossible puzzle because I was done with giving away my life to medicine. And I didn't want to leave medicine because I had no other skill set. I literally had no other way to support my family as the single-income earner in our family. Right. So for me, the skill set was medicine. I had to figure this out. So I went out into the world. At that time, the only physicians who were coaching, were helping me leave medicine and I wasn't ready because I had no other thing to do to earn money. Now, It's a lot of things like what you do to help me figure out how else I could have kind of approached that at the time. But in this moment in time, I'm like I'm gonna have to figure this out where I am right now, with the staff that I have the EMR that I have the patient panel that I have the way I'm being paid. And now what? So went back to the original general life coach and said, Okay, I'm in, I'm ready to do impossible things, you said it's possible, let's go. And it took me a full 18 months of changing everything about how I showed up within exactly the same clinic, EMR patient load, and going home, with everything done. Bucket loads of time, right bucket loads of time, sit on the couch at the end of the day, feeling accomplished, but also guilt free. Like, done. I’m done. And that was such a incredible experience. So proud of myself, and I had all this time and I'm like, I have to share this. So I originally started with the family doctors, yeah. Kevin 05:55 Without question. And, you know, I'll just share my own reflections. So this year, I retrained in family practice, like I had originally, you know, done family medicine residency, and then done emerged and worked, you know, nearly 10 years in the ER, as a community emergency physician, but I decided I wanted to expand my skill set, and just have more potentially more flexibility down the road. But I was overwhelmed by how much a family doctor has to manage. And, frankly, if I, if I can be blind, until I go through your program, Sir, I don't know that I'm gonna feel super confident, taking on a panel myself. Again, just being very, very honest. Because until you learn that workflow, until you learn those boundary setting strategies, it's, you know, it's quite, it's daunting, honestly, it's daunting, and there is so much in that, that we just didn't get, we got, of course, a rigorous academic training in medicine, you know, the disease, diagnosis and management, and, you know, all of those core clinical skills, but nothing in practice management, nothing really in charting. So, so talk to us about what sustainable clinical practice truly means. Tell us. Define it Sarah 07:15 Yeah. So just before I step in there, one of my very early mentors said, don't take on a practice owner, position until you've done five years of the medicine just to get used to the medicine because the decision-making around patient care, looking after a panel of patients, takes you about five years of getting used to the whole, just medicine and fast decision making required before you even think about taking on the whole hire and fire half. Like when we think about the business of medicine, those hats, you're right. Nobody's taught us that unless you had a mentor showing you in that apprentice style, how to do the business of medicine. And I was lucky growing up in the Australian system, I was one resident in one practice. So, I had the whole cohort of mentors to show me and they were very transparent, they would show me the earnings, how much it costs to hire and fire, but they didn't expect me to do any of those pieces. And, in addition, I was asked to see patients on my own panel, and I would earn 55% of the fee for service for those patients. So that was in my favor to learn how to do medicine as if I was graduate already. Right. So it's given me that it had a baseline so I could always, you know, fall under the number of people who need to be seen and still have a certainty about what I would be earning. But yeah, what does sustainable clinical medicine mean? So, in the world, there are lots of carrots and sticks to make physicians stay because it's very expensive to replace a physician. So, if you look at some of the US big organizations that estimate about a million dollars to replace a physician, so for physician says: “I'm done, had enough, burned out, you've done it, I'm out.” It's about a million dollars to turn over a new physician. That's it. That's pretty incredible. So of course they want retention. But when the physicians turning up and saying, it's too much, you're asking too much, I can't. I can't even go on vacation. Because I could check my inbox or iPad or whatever. It had to come from the physician. So me the physician in my clinic, and I watched this little video from the primary care network. It was about Evolution 2.0 And they were going to bring us team players to help us. I’m like great, sounds amazing. And in this little promotional video, they had this tiny little sentence that said, physicians get today's work done today. And I'm like wow. I’m in! I looked at through all of their resources, zero backup for that statement, so annoyed at that whole thing. So I'm like, okay, back to me figuring out on my own, here we go. So, um, sustainable clinical medicine means you have, wherever you are right now, physician, no matter what sort of physician you are, you have some things about your practice that you cannot change. For instance, your EMR, your location, how many staff you have the role that those staff play potentially, your hours of work, the number of patients, you have to see whether that's you choosing that number of patients, or an RVU, with those US physicians who are required to do a certain number of productivity encounters per week. And there's bonuses potentially attached to that, or because of the fee structure and your other expenses in life. So there are concrete things about your day that you can't necessarily change or can't change easily, right? So hiring a new person could be an amazing idea. But your organization will say no, for whatever reason, maybe they're unionized, maybe, you know, that's just you're just a salaried physician who has zero control over who's hired and fired. So there's concrete parts of your day. But a sustainable practice means, now that we know your concrete parts of your day. Now, what? What are you able to do differently about what you're doing in your day that can create a clinical day that is confined to what you're given? So whether you’re ER, hospitalist psychiatrist, family doctor, what is it that you are being asked to do? And then how can we start to do it in a way that you can contain it to what you're given? And we're not looking for an answer immediately and an immediate change for tomorrow? Don't burden yourself with that. We're looking at what do you want to create? What does successful, sustainable look like for you? And then what are the steps we take to get there? What are the things we need to change about your practice? To get you closer and closer until you either get there or get at least closer to the mark? Sustainable means? Kevin 12:20 I’ll just share one reflection, and like already, what's, you know, what I'm hearing is the power of reflection and goal setting, right? Because we all say, well, I just want to be less busy. I just want to be less burned out. I just want to be but what does that mean, in clear, concrete terms? And that's a unique question we're all going to be answering for ourselves. Sarah 12:42 That's right. So if you look at my example, I wanted to be home at five o'clock. Right? reliably, I was getting a text almost every day from husband saying when are you home? I wanted to just be able to be home at five. Right? But that's easy. All you have to do is hop in the car at ten to five you might have to,, Kevin 13:01 So you're not from Toronto Sarah 13:05 I didn't actually mean that I would be done. Yeah. Wait a minute. Okay, so I want to be home at five with everything done is a completely different sentence and a completely different goal-set than I want to be home at five. Right? Kevin 13:24 Exactly. Exactly. But that's powerful. Right. It's about having that clarity. You know, yeah, I mean, when we coach physicians in this, not quite the charting and practice management space, but we talked, we talked about the power of like, clear goal setting in terms of actually write it down. Like if you have an ideal practice of what you want, write it down. Okay, continue. Sarah 13:52 Alright, so I wanted to be home a five, and what had everything done. So now we have to step back from the busyness of the day, this is the big step back. And we have to really think about what's inside the day. And I like to use the phrase “we’re mathematicians, we're not magicians”, okay. So there's going to be X number of phone calls, X number of inbox / Portal messages, number of results that come in and we’ll have ebbs and flows. So as I come back from an emergency, if there's going to be a lot more in my inbox, or I might be covering a colleague, but for the most part, what is in the day, like how many patients, how many charts, how many interruptions am I getting? What is the expectation, like what is the rest of today's work? So we have to consider that when we're thinking about what do I need to have get done? Because I'm not just going to magic 200 results in 10 minutes. Not going to happen? Yeah. So that's part of the consideration of now that I know what my goal is. And now I have to think about what's involved in my clinical day. And then I have to think about why would I want to make a change? Because the way I turn up and do something is so easy and familiar, I've been doing it for years this way. Any change is putting another burden on you. So you have to have a reason why you’d want to do that. Kevin 15:15 So how do you go about beginning to implement some of this? Sarah 15:19 Yeah. Even before we start making changes, and there’s foundational steps, which we kind of covered last time, they're getting your chatting done as you go, and the finding that protected time to get the inbox done. So you're not doing work twice. But it's the noticing what you're saying to yourself about your day, makes a huge difference. So you can get tired before you even walk out the door in the morning. So when you wake up, and your brain says “Here we go again. I hate clinic. Nothing ever goes right? Oh, no, I have to see Mr. So and so today. Ugh, this is so hard. I'm so tired.” We are defeating ourselves. We're not the inner cheerleader. We don't have to be all lovey, lovey. But we can also be adding suffering. So you have 13 patients today, for instance, and if you say, that's such a lot, that is already hard to overcome, because if you can say 13 patients, this is my day, let's go. Gives us a different fierceness about ourselves. That helps us in the moment, it's that part of I'm choosing it because I'm staying. So if I choose to come into work tomorrow, and there's 13 patients. That's what we're gonna do. We're gonna do 13 patients, we can do 13 patients. And that, that little bit of reasoning to ourselves. Kevin 16:52 Well, I think you know, another part to this is that notion of acceptance of the things that we cannot control, you alluded to this earlier, right, is one source of burnout. And we know this across different, you know, different professions and fields in occupations is the fact that people feel burnt out when they feel powerless, right? People who work in large organizations that don't care about their feedback, feel disconnected from them, they feel burnt out, they feel irrelevant, right? And there are those aspects to being in even private practice, like you said, the EMR is potentially fixed, right? Or your workspace, you know, where you practice is fixed until the lease is up or until you sell, right? I mean, all of these things are fixed. But the things that are not, we should be seeking to exercise control. But that also includes the patients that we have, right, and acceptance that inevitably there are going to be those difficult cases that we have to navigate through. And in knowing that everyone deals with this, this is part of the job. Yeah, but you know, only people that are professional, like Netflix watchers get to really choose what they do all day. But for the rest of us, there's this notion of, there's going to be a certain struggle. But accepting that can be a very powerful source of wellbeing for us. Because then we say, Okay, where does my energy go? It goes into these things that I can control. Sarah 18:21 Yeah. Now, there's the difference between ideal and what we've got. So ideally, for instance, a new patient, you might like to spend two hours with them to get to know who they are, and deal with today's issues, right, ideally, and you've been given X number of minutes to see them. Kevin 18:40 Yea, not counted in hours counted in minutes. Sarah 18:44 And excellent is the best you can do with the resources you're given. So when we come up against this and say, I can't do a good job, because I don't have two hours with this patient that really adds that suffering, right? You really feel shitty about you being a doctor, when you're saying, I can't do good medicine in 30 minutes, and then saying, Okay, I have 30 minutes or an hour, whatever your new patient is, how can I best spend the time? What is the objective of today's visit that would give my patient what they are most requiring? That's a huge question, not at them question. Remember, you're the boss in the room. This is another part of the work we do is we save the physician is the executive decision maker in the room. So when you're in the room and you're hearing the questions or requests in the room, you're really navigating what is of most importance here, whether that be because the patient is requesting that because I'm noticing that this is very important for us to achieve today. And then the dissonance of and I've got 30 minutes and now I have to make some decisions and negotiation and have all this tied up in a little neat bow with my documentation done in the minutes given, right? This is not going to look like an ideal medical history taking that you were taught in medical school. It’s not going to look like a comprehensive physical exam, like you were taught in medical school. And the documentation is not going to look like something a professor would write. Right? And all of that is the puzzle of medicine. This is the part where physicians start questioning themselves and saying, Is this okay? And only you can answer? Does this you, know, did it cover the most important things for the patient? Did they get enough information to give me pertinent important information about this encounter? Can I kind of back up my decision-making with pertinent positive negatives? And is it good enough in my documentation for the next person or myself to follow what was going on next time I look at this chart? What else do I need in here? Or insurance and billing? Done? So we don't get two hours. We don't get to squish two hours into 30 minutes. We're not magicians. It’s this now what? About my entire day. I have 30 minutes, now what? Kevin 21:17 Yes. Yes. So, keep going. Tell us about like workflow during the day. Talk to us about, you know, boundary setting, you know… Sarah 21:31 So some physicians will get a knock on the door, every single patient encounter. Okay? So it's the noticing is just being curious about what happens in my day. So you're in a room doing your highest level work with a patient, you're listening to their story, your physical exam, your illness, script, medical reasoning, decision making is all happening in the room, you're focused on them. And hopefully, we've dumped everything else out because we've completed our work because we work behind us. Knock, knock, knock. You open the door. Mr. Jones is 10 minutes late, will you still see him? Now, your brain says, what's happening this afternoon? Is it my day for kid pick-up? What time does daycare close? How far behind am I running? What's Mr. Jones got going on for him? I don't have a choice anyway. Because my, you know, my employer says I must patients, like literally, I've the amusement of there was no question, I had to see them anyway, because of the rules of what I engage with in my workplace. So it was a yes or no, and we close the door. We turn around and we're like, Where was I? that is very expensive. Oh, goodness, it’s contributing to your decision fatigue, it’s contributing to interruption of your highest level work? This is a very sacred space, it could look like a pop up, a knock on the door, an alarm going off? Whatever, you may have calls you have to take. And even then I would say do you have somebody who can intersect to say this is one that has to be taken and I will take it to the door and knock on her door and interrupt her? Versus that's, you know, this call and that call that didn't really need to be taken. And the one I was actually waiting for that came through? Right? So just protecting ourselves. What was the rule this morning at eight o'clock? You knew if you could run late this afternoon? And who did you need to tell as you tell that person, hey, I have kid pick up today? It's a no for anyone late this afternoon. You have my blessing to go rebook them. That will stop X number of interruptions this afternoon, this is handled for you. Kevin 23:37 Well, just treating things not like one-offs, because I think that tends to be how we look at it. I mean, you know, you're always putting out fires in clinic-based practice, but you realize that there can actually be a pattern to this. Right, where you can exercise a lot of control in those interruptions, because you have clinic staff and Wing’s talked about this extensively, as well as the importance of delegation, right? Because if you have rules or guidance, well now, and now we don't need to worry, but it even improves the working conditions for your staff. Right? So if you have somebody that's late, and you cannot and you know, you can't accommodate somebody who is 30 minutes late, then it's easy for your clinic staff to say, I'm so sorry. No, they don't have to run down the hall. They don't have to send you a message. They don't have to jumble like it, actually, you think it's improving just for you, but it's also improving for your clinic staff. Right? It reduces their burnout because now we have some guidance, right. And that's just one small example. Sarah 24:43 Yeah. Let's say you have to see late patients and you still have kid pick up right now how do we engage in that next visit with that person who was late, who used up their entire appointment getting here? How are we showing up to run that consultation differently? If you have choice, you don't have to spend that X number of minutes you were given in its entirety. You have autonomy, about what is the focus for today, we're going to be super fast. Okay, that language with patients just learning new language with patients so important, even opening sentences, How are you? Versus what are we doing today will cost you three to five less minutes in an encounter. Anything else? At the end? catch yourself doing that, versus It was great seeing you today. Kevin 25:39 Wow. Wow. But you're right. Back to your earlier point about? We have these ingrained habits, right? And there's so much automatic wiring. Sarah 26:00 Yeah. Kevin 26:01 But if we're, if we're mindful of it, and we're intentional, we can slowly make change. Where the sign off is different. The opener is different. And it dramatically improves your workflow. I love that. Wow. Sarah 26:15 I get them to write it on their hand for the first week you're practicing it. It was good to see you today. Kevin 26:22 Exactly. Not tell me the next five things that are worrying you. Sarah 26:27 That’s right, yes. Knowing that bringing a list into the room is expected. We talked a little bit about that last time. Right and not going and thinking you have to handle the whole list. Right? You're still the boss in the room. You still get to say this one and this one. Oh, I've just got a quick question about my 20 years worth of headaches. You know, that's not a quick question. You know, that's at least a five-minute deep dive to make sure. So you get to do things that are safe for you, such as triage the problem, but then I would love to spend the time understanding and working on this puzzle of your headaches, let's rebook that. So we have a good space to do that. Kevin 27:11 Exactly. Exactly. Sarah 27:15 It is part of the learning, the nuancing of us as the executive decision-makers in the room. Kevin 27:23 And even for myself, you know, just reflecting on my own, you know, training time in family practice, you realize that every complaint, or presenting issue generates X number of minutes or hours of paperwork to follow. Sarah 27:40 Potentially, yeah. Kevin 27:41 And so, you know, you think it's that 20-minute encounter, but it's an hour of paperwork, referrals, results to order, or tests to order the results to review, communications to be made and follow up. So you have to be mindful of this, like fanning or this you know ripple effect on your workflow, when you would just agreed to see multiple complaints. And, you know, to go back to your point, how good a medicine are you doing, when you're doing that? And this is a lot of this is unique to family practice, in the sense that, you know, as a specialist, you can, you're kind of there to focus on a narrow problem, although some, you know, a specialist to be fair, like do deal with a lot of the psychosocial or, you know, complex interacting issues. But I think certainly family medicine is defined by a lot of this holistic care. Sarah 28:31 But even in our specialty areas, when a surgeon is seeing your patient, and the surgeon is in the room singer new patient that you sent with, you know, a good letter, and we're not going to say we're doing a donkey letter at the, within this process, I think it's important that we say, here's a question I want answered, is this patient suitable for surgery? And the patient arrives and the surgeon has no CT or ultrasound report, or no history of their previous surgeries. And that surgeon has that happen five times a day, and they go looking for the CT. That there is a system problem. That there is a oh, now what? I noticed that I have to go looking for CT scans with every new patient and I wonder why? And we go back down to the corridor, we say, hey, Mary, when we get new patient encounters, what do we tell patients to bring with them? What do we ask to be found for this encounter? Well nothing. Oh, I wonder why. Or now what? I wonder, could we think about before this patient arrives, this checklist, tick, tick, tick. And then I can do my job in a much more efficient way and have an answer for this patient within this first encounter. It's these stepping back and saying what is really happening in my day that's costing me frustrating me. I whine about it all the time. That can be a good way to find these things. Kevin 29:54 It's listening to that inner voice. You know, it's done in psychotherapy. Where is it coming? From dig deep, right? It can be highly informing. When you go, gosh, that annoys me and annoys me every day. And every time that happens, we let me stop. And can I fix this? Sarah 30:13 Can I just have a conversation with someone? And who would I have to have a conversation with? And then I'll watch and monitor how that conversation went? Did I get it right? Do I need to edit it a little bit to get the results that I was looking for? Like, we have this ability. These are tradable skills, as part of our leadership role. We are all leaders as the executive decision maker, you are already a leader, even if you don't have a hat that says that. Kevin 30:36 I like that, that is so powerful, and so empowering, as well. Because we forget, we feel like we're just, you know, pulled a million different directions responding to somebody else's request, whether it's the consultant, the patient support, or admin staff, colleagues in the clinic, like we're feel like we're always pulled. Sarah 30:57 Yes. Oh, always, I had that experience multiple times. But we just want you to record it, if they're a smoker or not. And I would just be devastated. I'm like, You don't understand what I have to do in my day, I have so much to do already. I don't want to do that, too. I just don't have the time, mindspace, my bandwidth to do anything else. Stop it. Stop asking me to do things. Kevin 31:16 Well, and again, it is, you are the most important resource in your practice. We teach that over and over again at Physician Empowerment. You are the rate-limiting step. For Success. Everything else is peripheral. Everything else is peripheral. It goes back to your comment about what does what does an interruption at the door for five seconds really mean? It means that you have disrupted the most important part of that patient's care at that time. Right. And you know, you've interrupted your own workflow. Sarah 31:51 Yeah. Even the way we talk to our patients matters. So when we talk to dermatologists who are trying to improve the flow, they want to see high volume, that is what they choose to do. But the patient's appointment is at 3:40. Right? So when a patient's appointment is at 3:40, but there was absolutely no way the physician was going to be entering the room at 3:40. Because the patient is registered, goes upstairs, hops in the waiting room, goes into a room sees the MA, who does this. And then the doctor comes in, and then the nurse comes in to do education. But we've not explained any of that to our patient. If we step back and say, Okay, well, how do we help the patient understand, this is a team process, the physician is the three-minute part in the middle. But at 3:40, you're going to be meeting Mary, who's an excellent MA, and she's going to be taking the story. And then the physician will come in and go this, this and this needs to be taken off. And the rest of them are this and so it's this particular thing, doing their highest level work. Nurse Jane comes behind. Here's your nurse, this is Jane, she helps explain this better than I do. And she spends the time helping them understand where to put this. How to take off that. How to manage this wound after we take it off. And that is their experience rather than it's my job as the doctor to be in that room at 3:40. Like no, the way you set your clinic up was amazing. You just didn't give that gift to your patients to help them understand. Kevin 33:25 Delegate right? Sarah 33:26 Yeah, using our team wisely. Kevin 33:27 Use your team. I mean it we see it in surgery. I mean, the surgeon doesn't set up the O.R. Sarah 33:34 You wouldn’t want them to. Kevin 33:36 You wouldn't want them to right. I mean, it's everybody does it. But you know, for us, I think it's family doctors we get we feel, but it is okay to step away. Right. And, and yeah, your office staff when they're trained well, and they're supported in the day. The work can be more rewarding for them as well. For sure. Sarah 34:00 There we found Family Medicine in Canada, we know we have a crisis right now. So we have somewhat about 18% of new family grads, saying that they want to take a panel of patients. Right? We have a lot of Canadians without a family doctor. And the education of family practice residents often happens within family medicine context where the family doctors are saying there's too much I need a break. I can't. So when we, when we're looking at these systems, structures, patient medical homes, whatever they look like, it's the stepping back and looking at it broadly, to help understand how do we interact with it as family physicians. This is just one again, another example within medicine. So academic practice. The family doctors have their own panel, they'll see patients on a 15-minute schedule, they work these hours and they have this break in the middle than another set of hours or they're seeing patients with residence at the same time, or this overseeing a resident or two or three or four, who are working and then not taking on patients that day. And then we look at how are they paid? How many staff do they have? How many rooms do they use? And we're starting to help them understand what is possible within this day? How can you show up in a way that's going to help you be successful? When you're ticking off those charts with your residents? That's now a new work list for your week, or your day that you're creating. When will you do this work? Because I'm sure you don't want to be doing it Friday night or Saturday morning. Kevin 35:42 Exactly. Sarah 35:43 And this resident might not even get the feedback then because they're not getting that at all if that you might be editing their notes. So it's this really interesting piece of how would I do it if I was going to be stepping into that role? Like, if you weren't working in this situation, you're just having a look at it from the outside saying, Okay, if I went and signed up for that, even if you're already there, just if I was to go and sign up for that. But and I wanted my evenings and weekends. What do you think I'd start doing differently about my day, in order to survive that environment? What would I have to say to my residents? How would I do my teaching? How would I see my patients? What would I be able to physically achieve in a consultation with a patient? Yeah. Yeah, big step back. This big eagle eye of our clinical days. Kevin 36:41 Yeah. How do doctors manage? Give us some insights? This is just a question because I think so many of us are not static, right? We think about maternity leave, we think about paternity leave, we think about maybe, oh, God, wouldn't it be wonderful if we could take sabbaticals like truly as community-based physicians take sabbaticals? Like a month, three month, not a month, that doesn't count three months, a year? Something truly incredible, right? Like there's this ebb and flow, right, like, many of us are forced to work at this very steady concrete pace, you know, in practice, but is there ways to sort of say, okay, well, you don't want there was something going on, you know, in my personal life, and I'd like to work less, right, or a loved one needs me, I need to work more, or, you know, what I'm loving what my kids are doing in their activities. I don't want to miss things. Right? You know, or I want to be there in volunteering, kindergarten, or whatever have you right, like, so how do we adjust to that? Because this is a major issue with younger generations who were like, no, no, I'm not signing up for a 60-hour workweek for 40 years, no interruptions two weeks of vacation a year not happening, right? Because this is one of the reasons why younger generations of doctors are not interested in it because there's this lack of flexibility. Sarah 38:09 Yeah, well, they feel like they're trapped. I even hear constantly. I haven't had a true day off for 12 year, or well, 10 years. Kevin 38:13 I hear that from physicians so often. Sarah 38:14 You hear that from physicians, okay. This is possible, you guys it is possible. And it's it's really important to protect you because you will, like all the humans, need rest and water and a break and holiday to make you a nicer human. Good for your physiology. You have physiology even when you're a doctor. Okay? You still need rest and water and food. Okay downtime. Kevin 38:41 Sad that we have to veg that, but we do. Sarah 38:44 You do, you have physiology, your afternoon, your brain is tired, even when you're looking after your brain during the day and not allowing interruptions and those sneaky peeks at the worklist in between patients and all the things that you're doing to add decisions to your day, even when you tidy all of that up. You're still human afternoons, brain sluggish, normal. Okay. So now we need to know that about you and figure out how do we look after you in the afternoon, that type of thing really important. So let's talk about holidays. So in part of my career, I got modeled this very well. So my first general practice, and one of my colleagues went on a month holiday to go fishing. He would not be on internet and this was way before we had access to EMR. Outside of the clinic right, before internet. We had an electronic EMR, but there was paper charts, but it was before you could just you know be 24/7 accessible. He went away from it. I saw his people for him. What was fascinating, I actually learned something from that experience. His patients would come in and about eight minutes in they'd stand up to leave. I was a brand new resident, year one or two. And I'd be like sit down I'm not done. My decision-making is not anywhere near I haven't got enough information yet. And I realized patients are trainable. Ha! Who knew? Even if you've had the same patient panel for 10 years, you can still train them. Kevin 40:09 Wow. Sarah 40:10 Because I've done it multiple times. Don't tell them. So they'd come in, sit down about eight minutes later, they'd be starting to get up to leave. I feel like what's going on? So, but he was completely off, inboxes handled, patients handled, gone for the month. Came back much better human. We can tell when he needed a holiday. You need a holiday, you do. So I love to find a destination that has zero internet access. We have this amazing little place in northern Saskatchewan it’s called Slim's Cabins. They have cabins on the river. We go fishing, big pike, very little internet access. Okay, I give away my patients and my inboxes to my colleague. Okay, they have full autonomy. But there's rules, we talk about it. And we all have different rules. I could say if I wanted to, I want to read the consultation letters when I get back anything about them that you think is important, but leave them for me to read when I get back. Or, hey, I have these appointments set apart. So if you're seeing something and you need them seen by me on my return, put them in there just tell reception, put them in her calendar, where she's assigned these time for these patients to be coming back to talk to her. So they're not necessarily burdened by taking on and trying to manage these things that aren't very urgent while I'm away. So I like to have a full month off. It's amazing. And it's possible. Kevin 41:48 Wow. Sarah 41:49 Even if you're in micro practice or a single practitioner. Find a buddy. You know a locum may or may not be available. Find a buddy who's also similar practice to you. Figure out how to get in the EMR confidentiality contracts. And away you go. Like, manage it. Kevin 42:07 Help one another. Sarah 42:09 I have a buddy. I have, we normally have buddies in our like one doctor who will go away and you're their buddy, and then you'll reciprocate for them. But it doesn't have to be. We've got quite a few physicians in our environment. And we'll pick kind of maybe like practice, or just who's not had a break or who has had a break recently who could take on this. Can we just make it an easy yes. Then there's you away on holidays with internet access. And you can still beacon network this because you don't want to have to bother your colleagues about your patients. So you do it for them. And you think you're doing a good thing. You're not. You need a break. You need an actual rest. You are replaceable. This was a lesson learned when I took a sabbatical. Remember that 18 month going around Australia. I said enough full-time family medicine, I want to go see the world I want to be a mum, I want to create some amazing memories with my kids. It's highly, highly satisfying. Kevin 43:14 I love that. I love that. It's such a hopeful message, Sarah, when so many of us are just like you said, we're hoping for a day off, let alone a month or a year. Yeah, I think the other thing too is we don't acknowledge how stressful this job is. We deal in people's lives. We deal with serious things. We deal with a lot of sad stories, but on top of it is enormous stress in managing the practice. Right? I mean, think about think about your colleagues that, or your patients that will come to you talking about burnout, and you know, they're their workplaces when they have these rules of responsibility as executives or managers burnt out, but they don't necessarily deal with the level of stress that we have in dealing with patients lives. And so you're right, invest in yourself to be happier, healthier, and a better, better physician for it. I'm already thinking that we should get you back on and talk about, I know I gotta like a million ideas to get you back on which means when we get you back on not if we get you back on but I'm just exploring how to begin to have conversations colleague to colleague within the clinic about like, Okay, I'm making change, but how do we make change and not just fighting over the EMR? Or whether to hire another MA? But it's like, okay, what can we do to support one another? I would love to go in that direction. And hear your thoughts on it, and I know it's not just your own experience. It's you talking to hundreds of doctors. Sarah 44:50 Yeah. Yeah. You'd asked me to explain my program it was Charting Champions is our physician program and Smarter Charting is the program I have for clinicians who are not physicians, and it's just the place like you said, you will have a season that's happening for you right now, maybe you coming back from that leave, maybe you have small children, maybe you have children who are graduating, maybe you're in the phase where you want to work like a workaholic. And then you kind of have this realization one day, I'm so exhausted, I don't want this version of me anymore. How do I get the other one, that's not a workaholic anymore? Like working hard and working? A lot is okay, you are the boss of you, if that's where you're at, and you want to work hard, do it! And when you're at that point of pivot, you can. You have pivoted, so many times already, you have already become a doctor, you weren't one before. Like you've done impossible things already, you are capable of change, and you're not trapped. And you can redesign this within the system you're working or even if you're choosing to move somewhere else. That whole pivoting learning, like through a pandemic, we added portals, we added emails, things that we never had with patients before. Yeah, we pivot all the time. We just tell ourselves, we don't know how well we can't or it's too hard. Just notice that. Kevin 46:13 And take the time to invest in doing things differently. Sarah 46:19 Yeah, if you want something different, go for it. Honestly, just figure out what's my lowest hanging fruit? What do I actually want? Where am I going? I don't know. It's just an obstacle course. Let's go. Kevin 46:29 Write it on your hand. I love it. I love it. What a beautiful, beautiful and uplifting message about making things better. Right, controlling what we can control. So with that being said, we went of course we went over. But this was incredible. I loved it. Again, thank you so much for being with us today, Sarah, and we can't wait to get you back on the show again. Sarah 46:52 Sounds good. Thank you. Kevin 46:55 Thank you so much for listening to the Physician Empowerment Podcast. If you're ready to take those next steps in transforming your practice, finances, or personal wellbeing. Then come and join us at physempowerment.ca p-h-y-s empowerment.ca To learn more about how we can help. If today's episode resonated with you, I'd really appreciate it if you would share our podcast with a colleague or friend and head over to Apple Podcasts to give us a five-star rating and review. If you've got feedback, questions or suggestions for future episode topics, we'd love to hear from you. If you want to join us and be interviewed and share some of your story. We'd absolutely love that as well. Please send me an email at KMailo@physempowerment.ca. Thank you again for listening. Bye.
	15 Jun 2023	21 - Private Equity and Real Estate with Gaurav Sobti	00:33:53
Dr. Wing Lim hosts guest Gaurav Sobti, Vice President at Create Commerical Mortgage Services, in a discussion about private versus public equity and real estate investing. Gaurav holds designations as CPA, CA, and CFA, and has a wealth of knowledge to draw from in shedding light on equity and what the average investor needs to know. Gaurav Sobti is the husband of a physician - he likes to joke that his parents wanted him to be a doctor so he did the next best thing and married one. He understands investments both from the financial point of view, his career, and from a physician standpoint as well. Gaurav defines a lot of terminology for Dr. Lim and offers insight into the markets and asset classes. In this episode, Dr. Kevin Wing explores the world of private versus public equities with guest Gaurav Sobti. They talk about the differences between public and private, the pros and cons of each, the differences in leverage and liquidity, and who to buy such funds from. Gaurav shares some important advice on what to investigate and what questions to ask when approaching an EMD (Exempt Market Dealer) or fund manager. This episode is a solid groundwork guide into the world of private and public equity and real estate as an investment from a financial expert. About Gaurav Sobti, CPA, CA, CFA Gaurav Sobti has 10+ years of financial services experience across real estate, investments, finance and accounting. Gaurav’s most recent formal role was with a national real estate finance firm where he was responsible for originating and underwriting commercial mortgage transactions with a specialty on CMHC insured (multi-family) financing. Prior to that, he spent 4+ years at a private investment fund which had a mortgage investment fund. Prior to that, Gaurav worked at Alberta Teacher’s Retirement Fund Board on the private investments team focused on private equity transactions. Gaurav was part of a top performing team that managed a $3Bn institutional grade portfolio. Gaurav started his career at Deloitte, one of largest accounting/advisory firms in Canada and worldwide. By training, Gaurav is a designated CPA, CA and CFA Charter holder. Gaurav is a licensed mortgage associate. Resources Discussed in this Episode: Gaurav Sobti on LinkedIn Create Commercial Mortgage Services — Physician Empowerment: website \| facebook \| linkedin __ Transcript Dr. Kevin Mailo: [00:00:01] Hi, I'm Dr. Kevin Mailo and you're listening to the Physician Empowerment podcast. At Physician Empowerment we're focused on transforming the lives of Canadian physicians through education in finance, practice transformation, wellness and leadership. After you've listened to today's episode, I encourage you to visit us at PhysEmpowerment.ca - that's P H Y S Empowerment dot ca - to learn more about the many resources we have to help you make that change in your own life, practice and personal finances. Now on to today's episode. Dr. Wing Lim: [00:00:34] Well, welcome, everyone, on a Monday night, and it's always good to see you guys. And yeah, so Kevin there, me and Gaurav. So I'm Wing Lim, Dr. Wing Lim and this is Dr. Kevin Mailo and there's Gaurav, our guest. So welcome, everyone. There are other people who might pop in later. Yeah, so we're super excited to be hosting this one, this webinar, live webinar and etiquette as we record the show and so that you guys know it's being recorded. So yeah, I'm one of the co-founders of Physician Empowerment and what we do with the live webinar and the podcast is we interview interesting people on interesting topics that might help physicians live better lives. So we're here to do all that. And so tonight I'm super pumped to have Gaurav to be our guest. And Gaurav is interesting for many, many reasons and we'll dive right into it. But Gaurav is a physician's husband, so this is one of the spouses, but he's got a very diverse background. So maybe tell me or tell us a little bit about your immediate family or extended family, how you link into the physician community. Gaurav Sobti: [00:01:45] Sure. So thanks, Wing So I like to joke that, you know, I come from an East Indian background, lots of medical doctors in that from that background. And so my parents wanted me to be a doctor. So I did the next best thing and married one. And so, yeah, my wife, she's a family physician. She's been a family physician, I think since probably 2015 when she finished her residency. She works as she works out of a clinic. We don't run the clinic. She just works out of a clinic. And yeah, her family has a few, there's a few doctors and her mom's a doctor and so is, I think her, her cousins as well. Dr. Wing Lim: [00:02:23] Right. And then you got some on your side, right? Gaurav Sobti: [00:02:26] Do I? I'd have to think actually, I don't, I'm not sure actually if I have too many on my side. Dr. Wing Lim: [00:02:31] Right, yeah. But it doesn't matter, right? We're all regular people anyways, right? It doesn't matter what profession we are. So now professionally, you have a very interesting background. You're a CA, CPA, CFA, that's quite a designation. You have institutional background and you're not, I guess you don't want to be stuck behind a desk doing people's tax returns. So you do a whole diverse a lot of things and you're into financing as well. So tell us more about what your journey is like. Gaurav Sobti: [00:03:01] Yeah, so I went to school in Waterloo. I actually studied biotechnology and chartered accountancy. So, you know, I was kind of hedging my bets, thinking maybe I'd go into medicine. Um, but yeah, so I, I worked for Deloitte, which is an international accounting firm there. It was good, I liked it, gave me a good investigative background, but kind of always knew I wanted to do finance. Decided to move out to Edmonton to join a sort of mid-size and growing pension fund, our teacher's retirement fund, and didn't really know much about finance really until I got into there and we were doing private investments. The program was, you know, I would say the book was, you know, it was a $3 billion book where that's what we were building. Dr. Wing Lim: [00:03:46] Wow, Wow. Gaurav Sobti: [00:03:47] Half was private equity, half was infrastructure. And I worked primarily on the private equity side. Yeah, we were investing in funds and co-investments. And it was fun. It was, I could have had a very cushy job, but decided that I wanted to kind of do more entrepreneurial things. So I, you know, long story short, I joined a private lender. That's where I kind of got my experience in real estate, I was there for about four years, kind of originating deals, mortgage deals. Right? Again, probably prior to that really didn't think of mortgages as investments. And then decided I wanted to get some CMHC experience, which is related to multifamily. So I joined a national real estate finance firm, learned multifamily financing, CMHC, and then now I've kind of become, you know, independent, you know, I am technically a mortgage broker, right? I like to think of myself as more of a sort of consultant, like I put together my own deals as well, equity deals for real estate as well because I think that's where my passion lies. Dr. Wing Lim: [00:04:52] Right? So that's a really interesting background. And so of course you're more qualified than anyone, but what you just said just caught my attention. You said you learned about private equity and real estate quite a few years after you became a CA, right? So that tells me that the CAs that we use, if they're the general practice kind of CA, they might not know a lot about this stuff, do they? Gaurav Sobti: [00:05:16] Yeah, no, you're totally right. Like I, when I was a CA and doing audits, right, you know, I would say my Excel skills were pretty limited as well. Right? Think now, you know, with new CAs that's improved. You know CAs, you know, they know numbers. Some of them, even within CAs, some of them know taxes, some of them don't. There were some CAs who were auditors who didn't even do their own personal tax returns. Right? So I think obviously, just like physicians, CAs come from different kind of backgrounds and experiences. Just as finance advisors do as well, right? Dr. Wing Lim: [00:05:55] It never ceases to amaze me how my colleagues and I made a lot of decisions, East, West Coast. They always run business ideas by the accountants. Gaurav Sobti: [00:06:02] Usually they'll tell, you know, then if it's your accountant because they're generally pretty risk-averse, right? Dr. Wing Lim: [00:06:08] They're very risk averse. They'll shoot down your idea even if it's a good one. Right? So anyways, that's just for what it's worth, right? Do not go to your accountant for business advice. Go there for your tax return advice. Right? So, yeah. Okay, so let's move on. So when we talk about private equity, let's talk about public markets, right? There's public, private and most people just give their money to their advisors. And most people, most physicians I know of have thrown their money into the public markets. And it's a mess out there. So do you want to make some comment about the reason that bank runs stocks, bond reversal, crypto upheaval can just give me, get a broad brush. What's the weather like? What's the temperature like out there in the public markets? Gaurav Sobti: [00:06:53] Yeah, no, I mean, so obviously there's a lot of volatility, right? You know, after Covid. Well, when Covid hit, you know, the markets took a big dive. And then there was a big run-up related to all the printing of money. Right? Now, they're kind of out of favor again. The markets have taken a hit with just interest rates rising. Right. Tech has definitely taken a huge hit. And, you know, now there's definitely recession fears coming. So, you know, the yield curve is kind of changing, you know, by the month. Right? And especially with these banking failures with ICB and now Credit Suisse like people are worried like is this another 2008? Dr. Wing Lim: [00:07:34] Very much so. Gaurav Sobti: [00:07:35] So there's definitely a lot of volatility. You're seeing that in the bond market for sure. Dr. Wing Lim: [00:07:39] Yes, exactly. So historically, people say, well, 80/20 rule, 60/40 rule 60% stocks 20/40% bonds. Oh, you're set. Well, gee, if both of them tank, what do we do if that's our retirement? Gaurav Sobti: [00:07:53] Yeah, me personally, like, I think capital should be, you know, flexible. I'm not saying, you know, public markets are bad, but sometimes, you know, there's sometimes a time to invest in them. And so there's sometimes there's better times and sometimes there's worse times. That being said, I think you look at the Canadian pension plan model, right? And Canadian pension plans are really pioneers globally when it comes to investing, right? They tend to put a lot of money into alternatives. And I would say the three big asset classes are private equity, infrastructure, and real estate. So definitely that has a place in someone's portfolio. And you know, there is a trend towards, you know, making this more widely accessible. But yeah, you definitely have to understand sort of what the risks are and, you know, private equity, again, very broad term. Right? Dr. Wing Lim: [00:08:42] So before you go further, because treat us like grade eight in finance language. Right? So what is private versus public? Why do they call it public versus private? What distinguishes them apart? Gaurav Sobti: [00:08:57] Yeah, so private, private and public, I mean, the simple difference is that, you know, public is on a, you know, it's openly traded on an exchange. There's generally more regulation there. Right? Like, you know, to go public, like there's a lot of securities documentation that have to be filled out. Whereas private can be, although there is securities regulation associated with private, it's not as regulated, right? And yeah, it's, you know, just it's privately owned. Dr. Wing Lim: [00:09:27] Right. So why do people consider, why people go into private equity versus public? What's the advantage there? Gaurav Sobti: [00:09:35] Well, I think there's a few things. So one is control, right? When you invest in a public security. Well, especially if you invest, let's say, through an EFT or a mutual fund manager, well, that manager does not have really any say or control over that over that company. Whereas, you know, if you invest in private securities, whether you're doing your own or you're investing with the manager, they're generally going to have more control, right? That's one reason. The second reason is, you know, there's diversification. There's the universe of public companies, like there's lots of public companies out there, but there's way more private companies out there. So, you know, if all you do is invest in public, then you're missing out on a segment of the market. And then I would say generally private investments they tend to, I mean they have outperformed. Right? That's another reason. There is potential for more alpha because of the fact that there is control and also because you might be investing in different, you know, smaller mid-sized companies or projects and that could eventually go public right through consolidation. Right? Dr. Wing Lim: [00:10:56] So let's go back a little bit because we are afraid of jargon. So when you say more alpha, do you mean that there's more profit? Gaurav Sobti: [00:11:02] There is potential for more profit. There is potential. Dr. Wing Lim: [00:11:04] And then that means that potentially there's more rate of return because people go to private, I know, at least I know people, myself included, go there because all the rate of return is more attractive. Gaurav Sobti: [00:11:14] There could be, yeah. Now, you know, I will caution that part of that return comes from leverage as well. Like the public markets hate leverage, right? So like if you look at like a public REIT, for example. They're definitely not going to put as much leverage on the asset. Now they'll say it's because of risk and, you know, there's probably some truth to that. But part of it is just if they put too much leverage on it, they're punished by the public markets. You don't have that issue in the private markets. Dr. Wing Lim: [00:11:45] Let's backtrack. By leverage you mean they actually borrow some money? Gaurav Sobti: [00:11:48] Yeah, they borrow. Yeah. Typically private investments, there's more leverage in loan. Right. Which, you know, leverage, you know, it can be in, you know, in the right instances, it can be a good thing for returns. Dr. Wing Lim: [00:11:58] Right. So so what other things should we consider like, say, the downside or the cons of private investment that we need to watch out for? Gaurav Sobti: [00:12:07] Yeah, I would say a con, one con is that it's not as liquid, right? So, you know, when you invest in a stock, if you need to sell, you can sell immediately. Now that can be a bad thing too, because sometimes you're your worst enemy, right? Dr. Wing Lim: [00:12:23] Chicken Little. Gaurav Sobti: [00:12:25] So yeah, like, you know, I would say if you're investing in private, you have to have a longer-term horizon, right? You shouldn't be investing funds that you're going to need anytime soon. Dr. Wing Lim: [00:12:35] So what kind of horizon, What months, years, decades? What are we talking about? Gaurav Sobti: [00:12:40] Well, definitely years for sure. Like, you know, obviously it depends on what you're investing in. But, you know, the thing is like public, you can literally buy something today, can sell it tomorrow, I might sell it for a loss, but I can sell it tomorrow. Right? Private securities, you don't necessarily have that liquidity. There are, there's I mean, we can probably for another conversation, there is a whole area called secondaries in the private markets, which does provide liquidity. But that's, again, that's probably too much for this conversation at this point in time. In general, private securities are less liquid. The other thing is transparency. Now, depending on the group you're investing in, right, like, you know, it's less regulated. So there's going to be, there can be less transparency around it. With public you have to file your statements quarterly. You're dealing with the regulator. Private overall is just less regulated and there can be less transparency. Like you could, you could just get into a deal with like, for example, a local developer. There could be, you know, very limited transparency around it. Dr. Wing Lim: [00:13:46] So in your experience, what's the split that, like most people, do they do like 80% of their money in public, 20% in private? What's your feel, like an average professional. Gaurav Sobti: [00:14:01] That's a tough question, but I would say it really depends on your own personal circumstances. And your need for liquidity. You know, that being said, I don't think you should be 100% in private, right? I think the public markets do, there is a role for them. Dr. Wing Lim: [00:14:20] Right. Gaurav Sobti: [00:14:22] And so it's, I would say, what I can tell you is that like, for example, the pension fund that I worked for, we had 35% in privates, right? So 10% was in private equity. 10% was in public equity, not public equity sorry, infrastructure, and 15% was in real estate. So I think if you look at a lot of the pension funds, you can pull up their reports, right, for Canada. Like I would say, they're anywhere between, you know, 30 to 50% in privates. Dr. Wing Lim: [00:14:55] Right. I think for most physicians, we don't, like we don't do day trading. We don't have time to do that. We're long-term. We're building up the nest egg for retirement for us and in intergenerational wealth. So for long-termers, you think it's a good idea, right, to... Because these are longer horizon, like you said. Gaurav Sobti: [00:15:16] Well, I think physicians, like the advantage they have is, you know, especially in Canada they're, generally if you're a physician, you're a physician for a very long time period. Right? You have very predictable earnings. And it's almost like a bond, right, in itself. Like that cash flow stream. So because of that, you can probably rely on that more than, let's say, other professions. Right? You know there definitely is a case to be made to invest more in private securities. Dr. Wing Lim: [00:15:49] Sure. So let's dive into it. So how can an average Joe get involved in private securities and where do they find them or what kinds are there? Gaurav Sobti: [00:15:59] So I mean, you know, some of the private wealth managers or investment managers, they may have a private offering. I will caution you that, you know, sometimes these guys are just trying to sell private securities for the sake of almost as - well I'm not sure what the right, I don't want to use the word gimmick - but they're just like, okay, we know private securities is hot. Let's get someone into, let's get these guys into private securities, but they don't necessarily know how to do actually, honestly, the proper due diligence is one. And frankly, they probably overly diversify. So when I was at the pension fund, for example, we actually ran a very concentrated private equity book where we invested inside fund managers. And then we also did direct deals alongside the fund managers. And the reason we were concentrated is because if you have like, let's say, 40 managers that you're investing in, well, they're going to have multiple funds that invest in, you know, 8 to 15 companies each, right? So that's just, like you're just overly diversified. You're probably going to end up, after all the fees are said and done, you're just going to end up getting like an ETF type return. Dr. Wing Lim: [00:17:21] Well that's exactly - I totally agree with that. And actually, it's not just me. So last time we interviewed Brandon Carlson. He's a portfolio manager and the podcast just got released. And so we asked him, I actually interviewed him in December and say, what's 2023 going, right? Where's the public markets going? And he's just saying exactly that because it's a zoo out there. So he says, if I were to predict where Fortune 500, half of this is going this way, half of that going that way. And if you just do a very broad-based diversification like index fund, you end up with the very mediocre thing, which is, you know, not much different, right? But then if you become more selective and you're not just picking average Joe, you actually need to understand what they do. And become more select, more focused. Then you probably win, right? So I guess that applies to private equities then? Gaurav Sobti: [00:18:17] No, definitely. Yeah. Like, so that's one thing to consider. You don't want to be overly diversified either because if you're trying to, you know, the whole one of the reasons to invest in private is to get that additional return. And if you just end up overly diversifying there, it kind of defeats the purpose. Right? And honestly, you have to just, depending on who you're investing with, like you might be able to find like a manager that you can invest directly who invests in companies. Right? Or you can invest through what is known as a fund of funds. So the fund, they create a fund like a feeder fund, which invests in a variety of managers. And honestly selecting the right manager to invest in, there is a skill to that. And there is a process. But if that manager is investing in, if your fund a fund is investing in too many managers and then they're laying on too many fees, then again, you're just going to end up with a ETF return, right? Dr. Wing Lim: [00:19:18] Right, exactly. Now let's pivot and move into that space, into more day-to-day. Who would end up buying these funds from. And there's a, one of the hot, hot, at least in my experience and in my space, but one of the hot, hot things is real estate, right? Real estate funds is part of this private equity. And they're a big chunk of real estate. And so I think you and I are both passionate in this space. And there's a lot of capital raised. There's a lot of good returns. So how would you describe the space right now, this real estate fund space. Is it expanding? Is it hot? Is it worth getting into it? Gaurav Sobti: [00:19:55] Definitely expanding. The whole alternatives is expanding and real estate is probably, you know, I haven't looked at the statistics, but it's probably one of the largest private asset classes. Right? And there are more private funds kind of showing up. Yeah, so you could find a manager to invest with. You could find a sponsor to invest in. You could go through an EMD as well, right? EMDs have different products on their shelves. But again... Dr. Wing Lim: [00:20:30] Let's talk about EMDs, that's a good catch phrase. Right? So what does EMD mean and what are they? What do they do? Gaurav Sobti: [00:20:40] Yeah. So Exempt Market Dealer - I was actually formally registered as an Exempt Market Dealer back in 2015 and I'll be honest, I didn't fully understand it at that point. I was maybe 25, 26. I just had the right credentials and someone got me registered. I got to learn about this space a lot later on, right? And think I have a better appreciation for it. So yeah, so an EMD is an exempt market dealer. From my understanding these are groups that are essentially allowed to raise capital in the exempt market space. Dr. Wing Lim: [00:21:12] So why, exempt from what? Gaurav Sobti: [00:21:14] From a prospectus. So when you're raising capital, there's, if you raise capital in the public markets, you have to prepare what is known as prospectus. Which is essentially a legal/marketing document to go public. When you raise money in the in the private markets, there's various exemptions that you can rely on to raise that capital. And, you know, one is, you know, friends and family, another is the accredited investor exemption. Right? And so if you're, I would say EMDS, one) from a from an issuer point of view, from like a sponsor point of view, if they're raising capital on a very frequent basis, then I believe they need to use an EMD right, to stay on with regulation. But EMDs also provide products to potential investors, right? So they have products on their shelves that they essentially sell. So you know, we've done our due diligence. We've approved them. And here you can invest in this product. That being said, I would say, I would caution you coming from a pension background and coming from learning from a mentor who really taught me how to do diligence and having an audit background, I personally would be skeptical of an EMD's, like how much diligence have they truly done? Right? There's probably some out there that are great, but there's some out there that are just pure salespeople who don't really understand the risk, haven't really done significant amount of diligence. Right? And frankly, they're probably not even investing their own capital in the opportunity. Dr. Wing Lim: [00:22:53] So basically, to recap, EMD in my mind, is more like a brokerage house that they have a product shelf and then the different products and these are all private equity products. Gaurav Sobti: [00:23:06] Yeah, that's a... Dr. Wing Lim: [00:23:07] So to speak. Gaurav Sobti: [00:23:08] That's a good way to sum that up. Dr. Wing Lim: [00:23:09] Good way to sum that up, right? So versus you go to mutual funds manager or advisor mutual funds. So that's all the public equities. Most average financial planners will sell you public equities, right? And the private equity salespeople are the... DRs. Right? So, and I don't know how everybody's exposure is, there more and more DRs because there are more and more projects. So other than EMDs, would there be some funds that people can buy directly or like, say, from this what you call sponsor, like the developer, the issuer they call them? Or what about a REIT? Can people just directly buy from these people? Gaurav Sobti: [00:23:48] Well, even if you invest in a private REIT, for example, most likely that private REIT is raising capital on a frequent basis. There will be an EMD involved. Like for example, I was just more curious, I won't name the shop, but, you know, I was just very curious about a certain apartment sort of issuer. Right? Private issuer. So I just, you know, I reached out to them. They immediately, you know, directed me to a third party EMD who I had a chat with about the suitability, first of all, about the opportunity. But whether it's suitable for me. Right. So chances are, if you're dealing with somebody who's raising capital on a very frequent basis, you will get in touch with an EMD. You can invest in projects directly without an EMD, right? But then the issuer has certain responsibilities. Dr. Wing Lim: [00:24:41] So you talk about accredited investors, right? So think a lot of EMDs, they look for doctors because we are mostly high net worth, right? So can you briefly just tell the audience what's the space about accredited versus non accreditors, the eligible to like, where do they make the cut-off? But do we fit? Gaurav Sobti: [00:25:01] So accredited investors, I mean... You know I think it's you have to have $1 million in net financial assets that can include your house or you have to make, you know, $200,000 individually or $300,000 with a spouse. And I believe it's like a two-year cut-off. And you have to believe that it's going to persist, right? So that's kind of the definition of accredited. So most doctors, you know, even if they don't meet the financial, the net financial asset test, they'll generally make it on the income test. Right? And then, you know, there's obviously a path forward to get to that net financial asset test as long as they, you know, continue to save money and invest properly. Dr. Wing Lim: [00:25:41] Right. And then for those of us who are a little bit more exposed, I don't know about the audience, but certainly I'm very familiar with this space. So they promise a lot of returns, double-digit, like 8, 9% prep and then back end. So we end up with 15, 20, 20+ percent. So do you think those are realistic? Are these real? Are they true or are they poo? Gaurav Sobti: [00:26:05] Yeah, I mean, I think I think they can be realistic, but, you know, definitely there can be a game to it as well, right? Like you can, you know, you can put together a model, right? And, you know, you can make whatever assumptions you want and you can create that 20% potential return. But I think you have to, like I think there's a few things you got to look at. What I look at, for example, is like definitely I want to have alignment of interest with whoever I'm investing with. I want to make sure that they have skin in the game, you know, whether it's through investing cash, hard cash in the deal, plus, you know, potentially putting up their guarantee. Right? They don't always have to have everything, but there's got to be some level of alignment of interest. And then you want to see what kind of, do they only talk about the potential gains, do they even mention any of the risk? What's their track record? Have they done it before? Right? And so those are kind of some of the critical pieces. Do they understand financing? I think that's pretty, especially in real estate that's very important. So I've met with Bob Dylan, for example, from Main Street, right, which is the company. He's very successful. Dr. Wing Lim: [00:27:22] Big guy Gaurav Sobti: [00:27:24] Big personality type. And you know, he said like, you know, in this business, you know, you make money on the buy - and again he's more value-add apartments - you make money on the buy, you make money on the financing. You'd be surprised how few sponsors, like how little finance knowledge they actually have and how little knowledge they have related to like even financing. Like I was, people send me opportunities to look at from time to time and, you know, I kind of give my input, right? Like I try to give my unbiased opinion. And someone showed me an opportunity in Winnipeg and it was $100 million project and they were using an interest rate that was like 2% below the current market, right? And so it's like, do you not understand? Like, you know what I mean? Like, you should have this basic understanding. And the other thing I would say is you have to see like, listen, you're going to pay fees, right? Whether you invest in the public markets, if you invest your manager or you invest in private, there are going to be fees. And sometimes the fees in privates are going to be higher. It is more work to put a deal together versus just investing in a stock. But is there an alignment of interest? Like is there a preferred return, for example? Right. I was just looking at another opportunity the other day for somebody and, you know, these guys were taking 40% sweat equity, no preferred return. And they didn't, it didn't seem like they were really putting any cash in the deal. So these are some of the things you should look for, right, when you're kind of evaluating somebody. Dr. Wing Lim: [00:29:01] Right. So to recap what you say, well, they give you very attractive return while some of those are actually true. But there's a lot of stuff hidden behind that is all by assumption. And we have to do some sort of a due diligence. Gaurav Sobti: [00:29:16] Or you have to get somebody who knows how to do it. Like, you know, like-- Dr. Wing Lim: [00:29:19] Because they-- Gaurav Sobti: [00:29:19] -- who can do it for you. Dr. Wing Lim: [00:29:21] Or you have to find somebody who could do the due diligence, short for DD, right, a proper DD. So of course with your background being an accountant, auditor and with your CFA, of course you would know how to crunch numbers. How would average Joe Doctor know whether the salesman across the table knows what they're talking about? Gaurav Sobti: [00:29:43] I mean, I would say you got to educate yourself, right? So if you want to take the path where you're going to do it on your own, then you definitely have to educate yourself. And it's not that it can't be taught, but you have to invest in that process. You know, despite being relatively educated, right, on the financial side, you know, I think anybody is capable of learning something. But they have to they have to have the time. And they have to commit to it. Dr. Wing Lim: [00:30:11] Right, exactly. Now, so we have actually gone over time, but I want to switch over and spend a little bit of time about institutional-grade real estate investment. So that's part of our topic. So what would you say is the institutional-grade real estate investment project? Well, you can. Gaurav Sobti: [00:30:29] Think of institutional grade as generally, I mean typically they are larger assets, but I mean I think you can do it on a small scale too. You just have to have some of the same structures, right? So when, let's say when you're valuing an opportunity, is there a preferred return built in? That's one, that's probably, you know, that's typically a sign of, that's like an institutional concept, right? If they don't have that, then it's definitely not meeting that test, right? Dr. Wing Lim: [00:31:00] So to me, institutional grade is what institutional funds would buy, right? So that or they would sell, right? And so if somebody builds a project and they would the institution would smell you and say, I want to buy you out, then, you know, you got institutional grade real estate, right? Because you're worth pursuing. But it's different, right? Because we, most doctors have one, two, three, 20 doors of condos or houses. And so these are moms and pops, right? And there's a different level, which is the bigger, more sophisticated real estate. Gaurav Sobti: [00:31:34] So yeah, generally larger assets for sure are considered more institutional grade for sure. Yeah. Dr. Wing Lim: [00:31:39] And the returns are different. The effort is different, right. And so that would be a discussion for a different day. Okay, so, one final question. So yeah, you already answered some of that for us, what's the next step if we're interested in this or - our audience is diverse, I know some of the audience already talked to you one on one - some already have a huge portfolio and they're actually walking into institutional-grade already. So what's next for people like that or for the average doctor if they want to expand? Gaurav Sobti: [00:32:14] Yeah, I mean you can consider investing in, like these GPLB structures, right? Just kind of keep kind of some of the things that I said in mind, right, when you're kind of evaluating these opportunities. And, you know, there are, you could talk to an EMD. But just again, if you're talking to an EMD I would say make sure that they're investing their own capital in those same opportunities. That's probably one of the first questions to ask them. And really understand their due diligence process and who's doing their due diligence. Dr. Wing Lim: [00:32:46] Yeah. Okay, good. Thank you, Gaurav. It's a lot of questions. It's a lot for people who haven't heard about this quite a bit. Dr. Kevin Mailo: [00:32:54] Thank you so much for listening to the Physician Empowerment podcast. If you're ready to take those next steps in transforming your practice, finances, or personal well-being, then come and join us at PhysEmpowerment.ca - P H Y S Empowerment dot ca - to learn more about how we can help. If today's episode resonated with you, I'd really appreciate it if you would share our podcast with a colleague or friend and head over to Apple Podcasts to give us a five-star rating and review. If you've got feedback, questions or suggestions for future episode topics, we'd love to hear from you. If you want to join us and be interviewed and share some of your story, we'd absolutely love that as well. Please send me an email at KMailo@PhysEmpowerment.ca. Thank you again for listening. Bye.
	28 Feb 2024	38 - The Transformative Power of Coaching with Dr. Angie Hong	00:28:50
Dr. Kevin Mailo welcomes Toronto-based family physician and obesity medicine practitioner Dr. Angie Hong to the podcast. Dr. Hong has been involved in coaching for a few years now and joins Dr. Mailo to talk about the differences between coaching, mentoring and therapy and the specific value of coaching. Dr. Angie Hong stumbled into coaching when she accidentally joined the wrong course at the University of Toronto and found herself in Solution Focused Coaching instead of Solution Focused Therapy. She stayed in the course and “fell in love with coaching”. Angie describes the enjoyment she gets out of helping a client reach a goal that sometimes isn’t even their original goal but something born out of self-discovery. Dr. Mailo and Dr. Hong discuss how physicians specifically find Angie and the challenges that drive them to seek guidance. Angie describes the feelings of emotional burnout and exhaustion that coaching can be effective in assisting and preventing. The journey of a physician drives towards burnout in many cases and Angie believes that engaging with coaching earlier, in medical school even, can help combat the issues that compound later. Dr. Angie Hong will be at the Physician Empowerment Live conference in Toronto on May 25 and 26. – About Dr. Angie Hong: Dr. Hong has been a family doctor for over 20 years and has focused on metabolic health and disease for almost a decade. She is a fellow of the CCFP and a diplomate of the American Board of Obesity Medicine, one of the first family doctors in Ontario to earn this credential. Dr. Hong is also an International Coaching Federation Coach, a body recognized globally as the gold standard of professional coaching. In addition, she is a graduate of the University of Toronto Brief Coaching program and was mentored by world-renowned researcher and coach Dr. Haesun Moon. For the past seven years, Dr. Hong has had the privilege of teaching coaches and healthcare providers throughout North America at various schools and organizations, including Obesity Canada, CBT Canada, the University of Alberta, and the University of Toronto, among others. Dr. Hong lives in Toronto with her husband, three teenage daughters, and her dog Hugo. Her downtime is spent with family and friends and laughing at dog memes. However, she can usually be found taking another course to increase her skills and knowledge. Dr. Hong’s passion for lifelong learning is driven by her commitment to providing the highest level of care and service to her patients and clients. Learn more about Dr. Hong's services and contact her via her website at AngieHongMD.com __ Physician Empowerment: Register for the Physician Empowerment Live Conference in Toronto on May 25 - 26, 2024 Early Bird pricing ends March 15 Join the Physician Empowerment Masterclass now
	30 Jan 2023	12 - Real Estate for Incorporated Physicians with Dr. Kevin Mailo	00:30:46
Dr. Wing Lim, co-founder of Physician Empowerment, turns the tables and interviews Dr. Kevin Mailo for a change. Kevin talks about real estate investment for physicians and shares insights and advice from his own personal real estate journey. With a family history of investing or buying in real estate, Kevin acknowledges that he came to real estate naturally. He sees real estate as a very powerful wealth creation tools and he names three main reasons for that: appreciation, positive cash flow generation, and mortgage paydown. Kevin gets into detail with Wing about how each of those three work. In this episode, Dr. Wing Lim and Dr. Kevin Mailo discuss how an incorporated physician can start in real estate investing, why Kevin feels real estate gives him more peace of mind than stocks or other portfolios, how to start if someone is not incorporated, and why eventually it’s advisable to bring experts in to help with property management. They shed light on real estate as a powerful tool for physicians to use to their benefit. About Dr. Wing Lim Apart from his clinical & teaching roles, Wing has extensive experience in Practice Management and Business Development. He is passionate about sharing his extensive knowledge & experience (both clinical & business) with others in various settings, from his clinic mentoring younger colleagues, to churches, senior groups, ethnic functions, radio broadcasts, retreats, seminars, and national conferences. About Dr. Kevin Mailo Kevin is an emergency physician based out of Edmonton, Alberta. He is known for his highly engaging teaching style that breaks down complex topics into memorable experiences. Kevin cares deeply about the long-term wellness of the medical profession and wants to see physicians and their families succeed personally and financially. Resources Discussed in this Episode: Save the Date for May 6-7, 2023 in Toronto Robert Kiyosaki “The Growth Mindset with Dr. Wing Lim” episode on beyond MD with Dr. Yatin Chadha “How Finance Relates to Personal Wellness with Dr. Kevin Mailo” episode on beyond MD with Dr. Yatin Chadha — Isn’t it enough to have a personal CPA & a regular lawyer for annual tax & corporate returns? What does a Tax Lawyer offer & when would we need one? Come & learn from a “fire side” chat between Wing & Jason the Tax Lawyer on February 2nd at 6pm. — Physician Empowerment: website \| facebook \| linkedin __ Transcript Dr. Kevin Mailo: [00:00:00] Hi, I'm Dr. Kevin Mailo and you are listening to the Physician Empowerment Podcast. At Physician Empowerment, we're focused on transforming the lives of Canadian physicians through education in finance, practice transformation, wellness and leadership. After you've listened to today's episode, I encourage you to visit us at PhysEmpowerment.ca - that's P H Y S Empowerment.ca - to learn more about the many resources we have to help you make that change in your own life, practice and personal finances. Now on to today's episode. Dr. Wing Lim: [00:00:34] Well, welcome everyone. So good to have a few people show up on Wednesday evening. Alberta time 6, I guess it's 8 p.m. in Ontario. And so yeah, so I'm really delighted to have this webinar and so we hold this on a regular basis once a month. And so we're going to talk about real estate for incorporated physicians. All right. So this is not for the faint of heart, I guess, and I'm very delighted to welcome everyone and actually I'll be turned the table around. Usually I got interviewed by Kevin, but I'm going to interview Kevin. So I'm Wing. I'm Wing Lim, one of the co-founders of Physician Empowerment. And so I'm turning the table around to interview Kevin about this, this interesting topic. So of course, people have different backgrounds and people invest in different things, and there's a wide spectrum across all of four asset classes. And so let's start off by saying that why real estate, right? There are people who do nothing but index funds and people do nothing but mutual funds, some do stocks, bonds, some do exclusively crypto, bless their heart right now. And then there are also people, even within real estate, they flip and there are a lot of things they do. So let's just have a bird's eye view over why real estate compared to other asset classes. So, Kevin, what's your take? Dr. Kevin Mailo: [00:02:03] Yeah, let me talk a little bit about my my story about real estate and why it came to me and fairly naturally. But I come from a family where, for a few generations, has always been somebody on either my mom's side or my dad's side who has invested and bought in real estate. And I saw a lot of wealth created in real estate. So real estate started with me at a very early age. I kind of got into it by accident. Initially, having bought our first property as our personal residence years ago in medical school, and eventually didn't get rid of the place but rented it out. And so that was years and years ago that I started. And since then it's been a really, really great journey. But real estate, it's a very powerful, very, very powerful wealth creation tool for a number of reasons. The classic three are the following benefits of real estate. Number one is appreciation. So if you look historically across all different types of real estate in buoyant markets in North America, right? So I'm not going to talk about other parts of the world that are depopulating or aging or, you know, stagnant economies like the Rust Belt in United States or things like that, where real estate can be stagnant or drop. What I'm really referring to is a buoyant market and it doesn't have to be red hot like the GTA or the Lower Mainland in Vancouver. But real estate appreciates. That's the first pillar of why I love real estate and why I invest in it. Number two is real estate, if done properly, generates positive cash flow. So if you were in a buy and hold model where - and it depends on the ownership structure and we'll get into this in a little bit - but if you're in a buy and hold model and there is a tenant, whether it's a commercial tenant, whether you own your own clinic, whether you have residential tenants, ideally you're generating positive cash flow every month, which is income that comes into either your your own pocket personally or corporately. And then lastly, this is the most powerful of the three, is mortgage paydown, right? So when you acquire that property in year one and this is a very simple example, when you acquire that property in year one, you're using a down payment of 20% or less, typically on residential real estate. And then you flash forward to year 26 when the when the property is paid off and the mortgage is cleared. That property has appreciated in value three times, maybe four times what you paid for, but what you didn't you didn't pay with all of your own money. You used a loan from the bank, use the mortgage to acquire 80% of that property in year one. Dr. Kevin Mailo: [00:04:52] So somebody else, the whole 25 years that you held the property, paid that mortgage, and that is your tenant, whether it's a commercial tenant or practice colleagues or a residential tenant. And this is incredibly powerful and we've got our conference coming up, so for anybody that's listening to this or joining us on the webinar tonight, our conference is coming up May 6th and 7th in Toronto. We do it every year. It's an outstanding event where we talk about wealth creation for Canadian physicians, and we're going to be focusing on real estate this year because we keep getting more and more interest. But we're going to break this down in a lot more detail in May, but just put that in the back of your head that the wealth creation through real estate very passively is this mortgage pay down and appreciation. And it's stunning what the annualized returns are on that on very, very basic entry level real estate investing. Right? Like you don't need to be out there as some aggressive high level investor who's buying up, you know, shiny office towers. You can make a lot of money in real estate in lower class properties for sure. So Wing, do you want to take us to the next question, then? Sorry, you can tell I just keep going and going because I love it. Dr. Wing Lim: [00:06:04] Yeah, you're right. Yeah. So, there are advantages of the real estate. So while there are advantage of others, how does that compare to stocks, bonds, all those others? Dr. Kevin Mailo: [00:06:17] Yeah. I mean, you know, we teach at our events, we talk about investing in the markets. And for those of you that have listened to our speaker, Dimitri, he's phenomenal, right? Dimitri has been very active in the stock markets, very active in crypto. And I always say there are many, many ways to make to create wealth as a position. We have many advantages and many opportunities. It's really about finding what works for us. One of the things I love about real estate is, number one, to allude to my point earlier, is you get access to credit for it, right? So you can't walk into the bank and say, Listen, I'm really good at buying stocks and bonds. I'm really good at investing in crypto. Give me a mortgage for $1,000,000 and watch me grow it at 15% annualized return. The banks are just going to laugh you out the door, right? They don't do that. But if you say I found a property, I want to acquire it, I need a mortgage, the bank goes Sure, right? Because the banks inherently recognize the stability and the long term growth that real estate offers. They do not offer the same for the markets, and I think we're in a great year to prove that point. And not that you can't make money in a down market, there are going to be many people that make a lot of money in a down stock market, but it's tricky. Real estate for me at least, I love because it's relatively simple. You put your money in as that down payment. You put a tenant in and over the course of years that mortgage is rapidly paid down. The property accrues in value and you get cash flow. Dr. Kevin Mailo: [00:07:50] And what I'm really getting at is peace of mind. One of the central things we teach at Physician Empowerment is that when it comes to investing, your investment portfolio, your strategy should reflect your life. So we have stressful jobs, we work long hours. So I really don't want to be up at night wondering what the markets are doing, wondering what crypto is doing. I wonder if my Tesla stock is sinking, not that I own no Tesla stock, not one bit of it. But just to give you a sense of like what's going on in the markets and appreciating that that can take a mental toll, whereas real estate, there's a lot more stability there, right? Like, you know it's trending upward. You know that every month, even in a down market, those mortgages are getting paid down. And so it offers a lot of peace of mind. And again, at the conference, I'll show you the math on this, where you can sit down and say, well, if I invest X amount in real estate and if it grows at a certain very conservative rate, then I'm going to be worth millions of dollars in 20 years time. And it's as simple as that, right? So it really brings a lot of peace of mind. So that's personally why I love real estate is and it's a very tangible asset, right? It's not an electronic signal on the internet like crypto. You can drive, I can go look at the properties I've invested in or the properties I own directly. So I hope that kind of answers the questions. I mean, there's a lot here, Wing. Dr. Wing Lim: [00:09:15] Yeah, so maybe let's go one step further, right? Because the topic is for INC positions. So does it matter whether we INC, let's talk about INC and let's talk about those that are not INC. Dr. Kevin Mailo: [00:09:30] Yeah. So yeah, real estate as an INC position there are a few advantages and one of the big ones is you can retain earnings within your professional corporation. You pay corporate tax on that right, like we all do. But then you have that extra $100,000, let's say sitting in your professional corporation, you can then transfer to a holding corporation and invest in real estate. And whether that's direct ownership or a limited partnership or syndicated deal or something like along those lines is it's a very flexible, relatively easy thing to do. Setting up a holding corporation is very straightforward. Your accountant and any average kind of lawyer can easily set one up and then it can be funded with shareholder loans from your professional corporation. So in that regards, there's a huge tax advantage, at least to start out with when you're acquiring real estate because you're not forced to take the money out of the corporation. Because in Ontario, as an example, the top marginal tax rate I believe is 53.53%. So if you had that extra $100,000 retained in your corporation and you wanted to take it out and buy a rental property, let's say, well, you're going to be paying that, most of that is probably going to be in the top marginal tax bracket, which is going to leave you with only 43,000. 47,000, pardon me, I'm very bad at math, especially public math, 47,000 ish to invest. Right? Whereas if you held that corporately, you'd be probably sitting closer to 90,000. So that's a big spread. So you can see, like if you're trying to build that portfolio, it can grow quite rapidly using retained corporate earnings. And again, we're going to be diving into this a lot more at our conference. Dr. Wing Lim: [00:11:13] Yeah, exactly. So, yes. So I like the big gurus, like the Robert Kiyosaki of the world saying that I love real estate because I borrow the money for free. Everything I leverage. And he brags about owing $1,000,000,000 in debt, leveraging, getting higher on other people's money. Dr. Kevin Mailo: [00:11:33] I put some caution there. I put some caution there because there are risks to that, to overleveraging in real estate. And, you know, the truth is and again, we can show you this at June just as a side dig, but in some cases, you can actually create an infinite return for yourself on real estate by using totally other people's money. I again, I caution because there is there is some risk associated with that and we can explain what that looks like. Can I step back and just talk about personal real estate personally, because I own a little bit personally and that was also an interesting journey. So, you know, converting one of my personal homes that I previously lived in into a rental property because I couldn't sell it in a down market with rising interest rates. So I kept it. And that was kind of an interesting journey and it works out all right in terms of the same things apply. You have annual appreciation, you have mortgage paydown. But the issue is, is that whatever cash flow you're making, whatever profit you're making on that place, you're paying top marginal income tax rates. So that's one of the, that's one of the big ones that I struggle with, is that whatever money you're going to make off of your personal holdings, you're paying, you're probably going to be paying at the top marginal income tax rate. So that's a bit of a struggle. And then the other downside is, is whatever you own personally is because it's not your personal residence, you don't get the capital gains exemption. So if you go to sell the property and let's say a gain 500,000 in value over the 20 years that you owned it, you're going to pay capital gains on that. So again, it's sort of, it's not that great. And then there are some questions as to whether you're exposed to more liability. But this is all direct ownership of real estate when you probably want to get to other types of real estate investing. Dr. Wing Lim: [00:13:30] Yeah, but maybe we just pause. So what about those who are not incorporated? They don't have a PC. What do they do? Should they give up? Dr. Kevin Mailo: [00:13:40] No, no, no. There are many ways to invest. I mean, you can run it as a proprietorship. Absolutely. Again, I would recommend very robust insurance on that and definitely sit down and talk with your accountant and talk to your lawyer before doing anything in real estate in general, but especially, you know, as operating as a proprietorship. But you can still invest in real estate deals, you know, as an individual. So most physicians are what we call an accredited investor, which allows them to step into private equity deals in real estate that the average person can't access. And you want to just explain what an accredited investor is for a minute, Wing? Dr. Wing Lim: [00:14:16] Sure. Accredited Investor, well, there's a very technical definition, but basically, from what I can gather as a layman, is you need to own $1,000,000 worth of free property, have $5 million of cash, sorry $1 million cash, $5 million of of properties, in everything you hold liquid and illiquid, but also for most people is $200,000 a year of income for the last two years. Well, $300,000 a year of income counnting the spouse. So most physicians qualify. Dr. Kevin Mailo: [00:14:48] Yeah. Yeah. So again, there are ways to invest personally as well, even if you are not incorporated. But again, sorry continue Wing. Dr. Wing Lim: [00:14:59] So we step into it already, so we're ahead of ourselves. So yeah. So then what are the different ways to own real estate? Dr. Kevin Mailo: [00:15:06] Yeah. Yeah. So let me talk about my journey a little bit and why I'm changing growing maturity as as a real estate investor. And for anybody that follows Yatin Chadha's podcast, I was on there talking about my own real estate adventures and lumbar puncture night, which was pretty memorable. People still mention that when I bump into them and I won't go through that war story again. But the bottom line is I started out investing real estate, buying doors. Right? And that's sort of the the colloquial term we use for acquiring small single family dwellings, whether it's an individual condo unit or apartment unit or an individual home or a duplex or fourplex. But what I'm getting at is something small scale that I own myself as an incorporated position, and then go and effectively manage it myself. And even with a property manager, it ends up being work. It's always work, right? And I think this is one of the things that turns people off of real estate, right? And so I bought enough doors that I got to a point where I had quite a few doors, if I can be honest with you, that was keeping me really busy, you know, in terms of phone calls about some small issue, big issues, vacancies, paperwork, bookkeeping, accounting, there was a lot there that added up. And, you know, I've got property management on most of my doors and it's excellent. But in the end, somebody's still going to phone you about things, even if it's not you in the middle of the night dealing with that broken toilet, which after a while when you realize, like if I keep going down this journey and keep just buying more doors, I'm just going to get busier and busier until I bought myself another job, right? And I'm busy enough with emergency medicine and raising my kids that I really don't want to take away from my personal time. And to go back to echo that point earlier, this is about building a better life, right? Whatever we invest in, whether it's the markets, crypto - crypto, right, this is not the year - you know, whatever it is, it should be buying us peace of mind, right? So there comes this kind of tipping point, and every physician's different, I mean, some people, you know, I'm sure there are physicians out there with like 50 doors and love it. Right? I'm nowhere close to that and already feel busy enough with what I've got, you know, realizing that as somebody who is initially very hands on, like, you know, I go paint walls with my kids because I want to teach them a little bit about the business. You know, I can swap out appliances like nobody's business. You know, maybe it's all that practice on central lines and airway equipment. It just gives me handy skills, you know, swapping out appliances. I don't mind it, but I realize that as time consuming as I get busier, I'm going to struggle with this. And even if you have to find a contractor for a lot of this, it becomes difficult. So now this year for the first time is I finally stepped into private equity, right? I realized that I didn't want to keep scaling up, getting more and more doors, more and more mortgages and more and more phone calls. Even if I am making money and loving that part of it, there comes this kind of tipping point where, as a busy physician, I say to myself, you know, how much of my time, even personal time can I deploy here? And so that's where I stepped into private equity. And that's where I really think most physicians are going to be happiest, right? Because I come from a background where I grew up enough around this stuff to understand it. I'm pretty handy. But at some point, if you're busy, you may just be, as a physician, you may be much more interested in private equity. And so physicians make a lot of money in this space when it's done properly. And what private equity is, is you're not on the hook for mortgages or personal guarantees in many cases, what you're really doing is you're lending money into a project where somebody else carries the credit risk and somebody else is in charge of developing the property and managing the property. And I did that for the first time this year, and I'm very excited and very happy about that, that new phase in my real estate journey as I mature from being kind of the hustler that's doing it all myself to now stepping away and investing at a higher level with people who are professionals in this space, right? People who are experts, because that's what we do in practice, right? When we're in over our head, it's time to consult. The same sort of thing goes in our financial journey, whether that's finding an excellent portfolio manager, whether that's finding a great accountant, whether that's finding a great tax lawyer or somebody to help us with insurance or again, property management or deals, at some point we have to let go. And that's one of the things I struggled with as a physician was that instinct, that impulse to micromanage. But as you can step away from that, you could make a lot of money and be happier and enjoy more peace of mind, which I think that's the the triple win there. So keep going. Dr. Wing Lim: [00:19:53] So. Yeah. So there are different things you talk about: actively managing, change your own toilet all the way to private equity, you're totally hands off. So for those of us who are brand new at this, how does a busy physician start? Dr. Kevin Mailo: [00:20:10] Yeah, I mean, this is always the thing. And so we talked about this earlier in this month's small group. So we lead a master class and Wing actually took us through a great one called Navigating the Asset Jungle. And one of the key pieces of wisdom that I'm going to say before you even get started is actually start. Right? I encounter physicians all the time who talk year after year about investing in real estate and never pull the trigger. Some of whom I followed for years. I have physicians that say, I'm going to get into the market, right, whether it's the public markets, stocks and bonds year after year, and you find out that they have six, even seven figures worth of cash stacked in their professional corporation because they are too scared to finally step out and put it someplace. And knowing that your cash is dropping. In our current inflationary environment by 10% a year. So if you have $800,000 in cash stacked up in your professional corp and you're too scared to invest it in real estate or the markets or whatever, you just lost 80,000 this year in purchasing power. Right? So the first piece of wisdom in this space is having the courage to actually do it, right? Dr. Kevin Mailo: [00:21:24] So saying to yourself, I'm never going to know everything, but at some point I have to step out there and do that. And you know what? That's not that different than our clinical careers, right? I mean, I remember my first few weeks in practice being like, Oh my goodness, there is a lot here, but it's on me because I'm now an independent physician. And we have to carry that same mindset of being able to step out knowing that we don't have all of the answers, knowing that there's always going to be some risk. So the first piece of wisdom is do something, number one. The next piece is realize that you cannot fully eliminate risk, and that goes across any asset, be it crypto, the markets, real estate, whatever you want to buy, there is no zero risk here. So be willing to accept some risk in real estate. Create that wealth mindset which is optimistic, informed ability to manage risk. Right? We're not talking about blind gambling and we're not talking about blind trust of the professionals you're working with. We're talking about understanding risk and being able to accept and put a little bit of money on the line. The next big one-- Dr. Wing Lim: [00:22:28] -- Sorry, let me interject to plug in. So the masterclass that we're doing next month, December, we're going to do the risk jungle, navigating risk jungle. Dr. Kevin Mailo: [00:22:39] Good, good, good, good. That one took me years to learn, and I'm still learning it for anybody that's on this webinar. Drop us a line. Email us because we would love to have you join us just to drop in and see what a single, what a single webinar or masterclass with Wing looks like because they're outstanding. But yeah, we're going to talk about risk. So let me move to the next thing here in what I recommend as first steps, and this is start reading, start learning about real estate so that you understand how it works, so you understand the terminology and you can begin to talk the language a little bit. And again, you don't have to be the expert here. You don't have to be the most knowledgeable person in the room. But just having some awareness goes a long way. The other thing that I anchored to, through the good times and the bad with real estate, is those three truths - cash flow, why would we call them 3 truths, 3 powers of real estate - cash flow, appreciation and mortgage paydown. The reason why is because there are ups and downs in real estate. I've been through Alberta's real estate market with some downs over the years and you have to just open up those numbers and go, Well, I'm not gaining through appreciation this year, but I'm still making cash flow and my mortgages are still getting paid down, right? Because when you get to those core realizations about real estate, it allows you to hold the road, right? You know, when people with the stock market plummeting like it is, we'll say Historically the stock market goes up, I'll ride out this rough patch, even though it's an eye watering loss in a given year, which is why I have very little in the public markets. And I have no answer for crypto. None whatsoever. Don't. How about that? Sorry to be so blunt. Yeah, crypto keeps coming up, but it's just, this is the month that went under. So anyhow, just going on about educating yourself in risk, educating yourself in the basic terminology of real estate, and having a commitment to say, Okay, I'm not going to freak out here, I am going to put some money into a project and you can start small, right? You don't have, do not go throw a million bucks into a deal. Right? As your first deal. Like, don't do that. There's no rush. There's always new real estate deals coming up, always new opportunities coming up. So go cautiously, go slowly, and get comfortable with what you're doing. And then once you see those returns coming in, you can start saying, Okay, now I get it. I'm okay with this. And you can gradually put more and more in and that's how I did it. And 15 years on, I couldn't be happier. Dr. Wing Lim: [00:25:16] Right. Cool. So maybe Kevin can share with us some pitfalls and lessons learned that you wish knew earlier. Dr. Kevin Mailo: [00:25:25] Absolutely. Yeah. So, number one, I wish I hadn't worried so much. I spent so many years investing in real estate over the years, and I worried. It's kind of like raising kids. You know, you sit there and you worry about them day to day, and then you look back and you're like, What did I worry about? They're actually all right. And so number one is, I wish I hadn't worried so much over the last ten years when I've really been much more active in real estate. I wish I had scaled up sooner and gone into private equity sooner. I spent far too many years in my life managing my own doors and chasing smaller returns because I wanted to be able to micromanage it. And I wish I had stepped into private equity five years ago and gotten involved in bigger projects. The other big one is don't overleverage, really don't overleverage. The banks are going to give you a lot of money if you go out and ask for it. But that doesn't mean you take all of it because you're on the hook for that. And in the end, like real estate is, like, you make a lot of money leveraging. I'm not saying not to, but I'm just saying to be mindful that in the end you've signed personal guarantees on all of those mortgages. And so don't overdo it. Go cautiously. Go slowly. And build within your risk tolerance. Right? But don't be scared. Like I got, there are physicians out there that have $2 million worth of personal mortgage and it's on them to show up every month with a with a mortgage payment. Whereas if you had $2 million in rental properties, somebody else is coming up with those mortgage payments every month. And whatever you have to subsidize, if it's a slow patch or a slow month, it's a tax write off, right? So it's a huge, huge advantage to being in debt corporately with rental properties versus personally. And so I would say compare those two. What does $1,000,000 in mortgage, personal mortgage debt look like versus $1,000,000 in rental property debt, and realize that personal mortgage debt is far riskier than rental property debt. And then the other big one that I would encourage people to do is not get too caught up in faddish returns or all the glitz and glamor because there's a lot out there. Right? As an accredited investor, you're going to have a lot of people potentially approaching you, looking to invest with you, but you have to be mindful who you invest with and when you can speak to that because you've had more experience in private equity as a real estate developer. Right? But there's a lot of caution, right? The people in the finance and real estate industries do not hold the same fiduciary responsibilities that we hold towards our patients. So don't go into it with rose colored glasses. Be very aware of who you're working with and who you're investing alongside. I would say it is very important if you're looking at going into private equity. Dr. Wing Lim: [00:28:19] Right on. So those are really good pieces of gem that you offer, Kevin. So while we're going to wrap up, so we intentionally don't want to make this a long, drawn out thing, because if you want to do more technicality, come join our master class. We'll do the deep dive. We're doing a whole year's worth of, well building strategies and real estate, and June would be a big, big event in Toronto face to face. And we're going to have a lot of fun and we're going to plan for some some nice trips down the road. This is a further down the road project. Dr. Kevin Mailo: [00:28:50] Yeah, Yeah, exactly. Lots of great, lots of great opportunities to come together. But yeah, we're going to be talking about this in a lot more depth in May in Toronto at our national conference. So again, that's May 6th and 7th. We're going to be covering this. We are just in the process of moving to new email. So this is my personal email that I just send out to our webinar participants. But reach me personally if you have questions or you want to learn more because this is, there are a lot of great opportunities in real estate, and in my opinion, every physician should be invested in real estate, not all of it, right? Like you can be diversified if you want, but I'd say every physician should be looking at real estate because there are just so many advantages as an incorporated professional to invest in this space and so much return to be had and peace of mind. Like I said, real estate's been such a positive thing in my life. Dr. Wing Lim: [00:29:38] Yeah. All right. Good. Super. So thank you. I want to thank Kevin for sharing your wisdom. And thanks. I want to thank everybody for joining. Dr. Kevin Mailo: [00:29:47] Thank you so much for listening to the Physician Empowerment Podcast. If you're ready to take those next steps in transforming your practice, finances or personal well-being, then come and join us at PhysEmpowerment.ca - P H Y S Empowerment dot ca - to learn more about how we can help. If today's episode resonated with you, I'd really appreciate it if you would share our podcast with a colleague or friend and head over to Apple Podcasts to give us a five star rating and review. If you've got feedback, questions or suggestions for future episode topics, we'd love to hear from you. If you want to join us and be interviewed and share some of your story, we'd absolutely love that as well. Please send me an email at KMailo@PhysEmpowerment.ca. Thank you again for listening. Bye.
	30 Nov 2024	56 - You As The Most Important Investment: Mindfulness	00:32:08
PhE is headed to Cancun this February 23 to March 2 for our Health and Wealth Summit! We'd love to have you join: https://www.physempowerment.ca/cancun — Dr. Kevin Mailo welcomes lifetime Masterclass member Dr. Iuliaa Povieriena as his guest in this episode to talk about mindfulness. This episode is part of a new podcast segment called “You As the Most Important Investment”. Iuliaa introduces mindfulness with the definition of “observing what’s present in the moment without judgment or expectation”. She and Kevin discuss the importance of mindfulness to overall health and emotional wellness. Dr. Povieriena describes the “most important investment” that mindfulness is and how to approach mindfulness as being a more objective perspective. Instead of saying “I’m angry”, we could say “I’m experiencing anger”. Being mindful of the present moment not only aligns with personal wellness but also improves patient relations. Kevin and Iuliaa explore the practices of mindfulness such as meditation, body scans, and breathing exercises, how a even short mindfulness practice can be extremely helpful, and why investing in mindfulness supports our personal health and improves daily life. About Dr. Iuliia Povieriena: Dr. Povieriena is a Hospitalist at Georgetown Hospital and has been a physician since 2020. She is a primary care physician with a strong interest in inpatient care, and palliative and geriatric medicine. Iuliia finds her work very meaningful and enjoys spending time with patients. She also has experience in GP psychotherapy, which she says was one of the best jobs she ever had. Dr. Povieriena is a firm believer that everyone deserves an equal opportunity to pursue their passion in medicine and would like to express gratitude to all women who have paved the path for the female physicians of today. __ Resources discussed in this episode: Mindfulness Meditation 3 Minute Breathing Space Insight Timer app Tara Brach “The Mind Illuminated: A Complete Meditation Guide Integrating Buddhist Wisdom and Brain Science for Greater Mindfulness” by John Yates PhD, Matthew Immergut PhD, and Jeremy Graves “Attending: Medicine, Mindfulness, and Humanity” by Ronald Epstein, MD __ Dr. Iuliia Povieriena: Iuliia Povieriena, MD on LinkedIn Calming Chamomile on YouTube Physician Empowerment: Attend an upcoming Empowerment Retreat Join the Physician Empowerment Masterclass now Website: PhysEmpowerment.ca
	30 Oct 2024	54 - Medical Entrepreneurship Series with Drs. Renee Jacques and Sam Peters	00:35:28
PhE is headed to Cancun this February 23 to March 2 for our Health and Wealth Summit! We'd love to have you join: https://www.physempowerment.ca/cancun — Dr. Kevin Mailo introduces guests Dr. Sam Peters and Dr. Renee Jacques, a husband and wife team of doctors in Ontario who run a family clinic and an entrepreneurial medical site together. Dr. Wing Lim interviews Drs Peters and Jacques, both of whom are Physician Empowerment Lifetime Masterclass members, about how they met, what it’s like to work together, and the drive they share for entrepreneurial endeavours. Dr. Sam Peters and Dr. Renee Jacques attended and graduated from the Northern Ontario School of Medicine in Sudbury together and had their first son at the end of their family medicine residency. They both enjoy the independence that family medicine offers in terms of freedom in practice and not being tied to a particular hospital. Sam and Renee talk with Wing about the hectic demands of balancing family and several entrepreneurial efforts. They elaborate on what they like about entrepreneurship, the new medical technologies they’ve been able to provide in their clinics, why being able to work with family inspires them, and the day-to-day office management platform they developed to help physician workloads. About Dr. Renee Jacques and Dr. Sam Peters: Sparrow Health was developed by a husband-and-wife team committed to serving the Northern Ontario region. As healthcare professionals themselves, Dr. Sam Peters and Dr. Renee Jacques know first-hand the post-pandemic burden the healthcare system faces, experienced by providers and patients alike. Sparrow Health was developed by a husband-and-wife team of family doctors who envisioned a way to help patients and physicians access quicker, easier care. We designed Sparrow Health specifically for helping physicians improve workflow, while ensuring that patients have simplified access to their doctor. __ Dr. Renee Jacques / Dr. Sam Peters: Website: BorealMedicine.com Website: SparrowHealth.ca Physician Empowerment: Join the Physician Empowerment Masterclass now Website: PhysEmpowerment.ca
	30 Jun 2024	46 - Journey to Financial Freedom	00:39:14
Physician Empowerment Masterclass Faculty Member Simon Wong joins Dr. Wing Lim for a conversation about financial freedom. Simon dissects how the interchangeable terms of financial freedom, financial independence, and financial security actually hold rather different meanings and how there are philosophical mindset factors that affect where people see themselves as finally achieving freedom or security. What are the quality of living goals, retirement goals, and wealth ambitions? Simon walks Wing through how all of these affect financial freedom. Dr. Wing Lim asks the question “When are we free?” which leads Simon to explain that financial freedom is almost impossible to 100% achieve because life will always contain risk. Even a passive income real estate portfolio carries the innate risk of rising interest rates or damage to a property due to fire. But Simon also points out that feeling 100% secure in whatever the projected “freedom” rate is for each individual isn’t necessary because one can experience a sense of financial freedom at 70% certainty or 90% certainty. Simon and Wing discuss all the factors that affect financial freedom, how to think about it, what to set up to make it a future reality, and why a financial planner can assist in setting the right goalposts for hitting that freedom. – About Simon Wong: As an Integrated Wealth Planner, Simon’s expertise lies in simplifying complex financial concepts into clear, actionable insights, forming the cornerstone of his Financial Plans. He specializes in navigating individuals and businesses through the intricate landscape of finance, utilizing his extensive knowledge and experience to foster their financial success and stability. Simon’s academic and professional credentials, including an MBA in Accounting and a prestigious trio of designations - Certified Financial Planner, Chartered Investment Manager, and Chartered Life Underwriter - empower him to provide holistic and strategic financial advice. His career spans beyond traditional wealth planning, enriched by collaborations with elite asset management firms and a notable tenure at a leading accounting firm. __ Physician Empowerment: Attend an upcoming Empowerment Retreat Join the Physician Empowerment Masterclass now Website: PhysEmpowerment.ca
	30 Jan 2025	60 - Tax Benefits on Charitable Giving and In Kind Donations	00:34:12
Want to dive deeper into topics like this? Master your journey with Physician Empowerment’s Masterclass Membership—your gateway to exclusive content, expert-led sessions, and actionable strategies to elevate your personal and financial well-being. Learn more and join us today! https://www.physempowerment.ca/masterclass — In this episode, Dr. Wing Lim hosts the first webinar of 2025 with Masterclass faculty member Simon Wong. Wing and Simon discuss legacy donation and tax efficiency. Wing will get Simon’s professional advice on decisions around the specifics of donating to a charity organization, gifting, legacy, and foundations including in-kind and insurance. They talk about the philosophical and philanthropic aspects of charitable donations in addition to the tax benefits. Simon Wong says that people often don’t spend time planning charitable donations in the ways they plan vacations or research buying a car and that planning donations at the end of the tax year is an important thing to do. Simon explains the federal tax credits and provincial tax credits available, what’s available to physicians in a high marginal tax rate, and lays out numbers to illustrate what’s on offer. Wing asks about donating insurance plans which Simon breaks down for listeners and they also touch on how to set up donor advised funds (DAFs) as well as ensuring donations are made to a qualified charity that ensures the donation gets tax credits. This episode is a good map for starting to plan now for 2025 donations. About Simon Wong: As an Integrated Wealth Planner, Simon's expertise lies in simplifying complex financial concepts into clear, actionable insights, forming the cornerstone of his Financial Plans. Simon specializes in navigating individuals and businesses through the intricate landscape of tax planning and investing, utilizing his extensive knowledge and experience to foster their financial success and stability. __ Physician Empowerment: Attend an upcoming Empowerment Retreat Join the Physician Empowerment Masterclass now Website: PhysEmpowerment.ca

Améliorez votre compréhension de Physician Empowerment avec My Podcast Data

Chez My Podcast Data, nous nous efforçons de fournir des analyses approfondies et basées sur des données tangibles. Que vous soyez auditeur passionné, créateur de podcast ou un annonceur, les statistiques et analyses détaillées que nous proposons peuvent vous aider à mieux comprendre les performances et les tendances de Physician Empowerment. De la fréquence des épisodes aux liens partagés en passant par la santé des flux RSS, notre objectif est de vous fournir les connaissances dont vous avez besoin pour vous tenir à jour. Explorez plus d'émissions et découvrez les données qui font avancer l'industrie du podcast.

About us Privacy Policy