FS_Darwinian_Dr
00:00:00.000 | Hello, everybody.
00:00:01.000 | It's Sam from the Financial Samurai Podcast.
00:00:04.400 | In this episode, I have with me a special guest, Dr. Daniel Shin from the Darwinian
00:00:09.760 | Doctor.
00:00:10.760 | Say hello.
00:00:11.760 | Hey, Sam.
00:00:12.760 | Really happy to be here.
00:00:13.760 | Thanks for having me.
00:00:14.760 | So, Daniel, you started your site a couple years ago or no, maybe four or five years
00:00:20.320 | ago after you became a doctor.
00:00:23.800 | It's interesting to me that I've seen a proliferation of doctors who are writing about personal
00:00:29.120 | finance when I was thinking to myself, "Why not just focus on being a doctor and make
00:00:34.480 | a lot of good doctor money, save, invest, and then you'll be set, good to go for the
00:00:40.160 | next -- for the rest of your life after, let's say, 20 years?"
00:00:43.720 | What inspired you to start your site as well as start a TikTok site and all this other
00:00:50.800 | stuff?
00:00:51.800 | Yeah, absolutely.
00:00:52.800 | I mean, there's a lot of credit that I think we have to give to Jim Dolley, who is the
00:01:01.000 | founder of the White Coat Investor blog.
00:01:04.840 | He's, I would say, considered by many to be sort of the progenitor of a lot of the physician
00:01:10.240 | finance blogs.
00:01:11.320 | But I think for me, it was more than just wanting to sort of copy that model.
00:01:17.360 | A couple of years into becoming a surgeon, it was really interesting for me because you
00:01:23.880 | have to understand that for doctors, you go for literally over a decade trying to achieve
00:01:28.840 | this goal of becoming a physician.
00:01:32.360 | It goes through college, through medical school, and through residency training, which for
00:01:36.960 | some people is as short as three years, but for most people can be four or five.
00:01:41.200 | In my case, it was six years of residency training.
00:01:43.080 | So you're talking about like a 14-year journey to become an attending.
00:01:47.120 | Then you get there, and all of a sudden, that's something that you're supposed to do for the
00:01:52.080 | next 30 or 40 or maybe even 50 years in some cases.
00:01:56.000 | So that was my experience.
00:01:58.200 | And then the first year or two was this incredible period of learning new skills and getting
00:02:04.040 | comfortable with being sort of in charge of my own medical direction.
00:02:09.240 | But then just a couple of years in, I went through this interesting period where I felt
00:02:14.100 | very secure in being a surgeon.
00:02:16.760 | I was good at my job.
00:02:18.680 | My patients loved me.
00:02:19.760 | I had a low complication rate.
00:02:21.640 | I felt that I was very good.
00:02:23.000 | And then I was looking and thinking about my life, and I didn't see any obvious goals
00:02:28.920 | or outlets for all the energy that I still had.
00:02:33.520 | And I think a lot of physicians kind of go through this, where you kind of reach the
00:02:36.520 | top of the hill, and then you look around, and then you just stay there.
00:02:40.840 | You're supposed to stay there for decades.
00:02:42.600 | And in my case, I sort of wanted a creative outlet.
00:02:45.680 | I thought that would be a good way of keeping life interesting.
00:02:51.760 | So I started the blog as sort of a creative outlet.
00:02:54.200 | I've always loved writing.
00:02:56.080 | And in terms of goals, I fixated on the goal of financial independence as a new goal, because
00:03:02.800 | I thought that was one that would be very interesting.
00:03:04.800 | And I thought it would be interesting writing about the ways that I was trying to achieve
00:03:09.800 | that.
00:03:10.800 | So that was really the start of my blog.
00:03:12.400 | It was a number of reasons, but it was for a creative outlet, and it was also to have
00:03:16.560 | sort of a new vehicle to express my goals.
00:03:19.960 | Got it.
00:03:20.960 | Yeah, I remember working in finance.
00:03:24.120 | And the only reason why I started Financial Samurai in 2009 was because I thought I was
00:03:28.200 | going to get laid off, and I needed something else to do, because it was pretty dicey times
00:03:34.240 | then.
00:03:35.240 | How many years were you as a attending-- not attending, or what's it called?
00:03:39.640 | Just a-- Attending, yeah.
00:03:40.640 | Just a practicing doctor before you started.
00:03:44.240 | And you hear all these stories about long hours during residency, and then a stressful
00:03:49.480 | job being a surgeon.
00:03:51.520 | Did you do surgery?
00:03:52.520 | Yeah, yeah, urologic surgery.
00:03:55.080 | So I treat sort of surgical conditions of the urinary tract.
00:03:58.240 | So if you get a kidney stone, you'll call someone like me to come take care of it, and
00:04:02.240 | you'll be-- we'll both be very happy once you're through that experience, because it's
00:04:05.040 | very painful.
00:04:06.040 | Got it.
00:04:07.040 | And isn't that a long and stressful day, usually?
00:04:11.040 | Yeah, absolutely.
00:04:13.720 | At this time, there was a lot of things about my job that were great, but a number of things
00:04:17.840 | that were not so great.
00:04:18.840 | I was working 50 to 60 hours a week baseline, just doing my job.
00:04:23.600 | And then at the time, I lived in Southern California.
00:04:26.160 | I lived in Los Angeles and practiced down in Orange County near Disneyland.
00:04:32.600 | So I was driving literally 2 to 2 and 1/2 hours every day just in the Southern California
00:04:38.600 | traffic.
00:04:39.600 | So I was feeling burnt out.
00:04:42.600 | And it was interesting, because burnout, traditionally, you would think of someone in their 50s working
00:04:48.840 | really hard.
00:04:49.840 | And they've been doing it for decades as a physician.
00:04:53.640 | And in my case-- and I think, actually, a lot of physicians nowadays, we're finding
00:04:58.420 | burnout earlier than we used to.
00:05:01.360 | And that was the case for me.
00:05:03.160 | Interesting, because I think part of becoming a physician or getting to the top of any type
00:05:09.440 | of well-paying field is to have the endurance to keep on going no matter what.
00:05:16.960 | And do you think there's some kind of disconnect in terms of the people who are in medical
00:05:21.280 | school thinking about what life will be like as a physician versus what happens and what
00:05:26.640 | life is like after they get there?
00:05:28.760 | Yeah, absolutely.
00:05:30.120 | And I think this has always been the case, except that now people feel more empowered
00:05:34.800 | to talk about it.
00:05:35.800 | We're in this world of social media where there's a lot more openness and transparency.
00:05:40.440 | But I think the term that we're looking for is arrival fallacy.
00:05:45.000 | And a lot of people work towards a goal, and they expect that once they achieve that goal,
00:05:50.040 | their life's going to be incredible.
00:05:51.320 | And it's going to stay that way.
00:05:53.200 | But I think we're very adaptable creatures.
00:05:55.620 | So once we reach a goal, it's great for a little bit of time.
00:05:58.240 | And then all of a sudden, you're saying, "Oh, this is just life now."
00:06:01.520 | So you're sort of searching for that next thing all the time.
00:06:06.340 | Did you have some pressure to become a doctor?
00:06:09.000 | Because I remember in high school, I knew there were some of the kids who wanted to
00:06:12.640 | be doctors very early on.
00:06:14.120 | Our salutatorian became a doctor, and he was always very smart.
00:06:17.480 | And I was like, "No, I can't get those trade As.
00:06:19.920 | Nope, not me."
00:06:20.920 | But he also went to William & Mary, and then he went to medical school.
00:06:24.480 | I just knew I couldn't do it.
00:06:25.880 | So did you have some kind of predetermined view of being a doctor?
00:06:30.140 | How did you decide to be a doctor?
00:06:31.960 | Yeah, absolutely.
00:06:32.960 | I mean, I'm Korean.
00:06:34.240 | So when I was growing up, there were sort of a few professions that seemed to be an
00:06:41.240 | option for me.
00:06:43.120 | And it's not like my mom sat me down and said, "Okay, Dan, you can become a doctor, a lawyer,
00:06:48.640 | or an engineer."
00:06:49.640 | But in church, that was sort of what the other Korean moms would brag about.
00:06:55.800 | And after a time, becoming a physician actually did seem something like I was really interested
00:07:01.880 | in because I didn't have a very good understanding of what people did in "finance."
00:07:08.760 | And I think that's something that you can talk about and how you ended up going into
00:07:14.760 | there.
00:07:15.760 | But for me, I sort of understood what doctors did.
00:07:17.920 | It's like doctors help people get better, and doctors are respected, and doctors make
00:07:22.440 | a good living.
00:07:23.440 | And all of these things sort of seem to make sense.
00:07:25.280 | And when I started college, yeah, I basically started out with the goal of becoming a physician.
00:07:33.760 | And I sort of meandered a little bit.
00:07:36.920 | I took some time off in college.
00:07:39.160 | I did other things and eventually did come back to pre-med and eventually went to med
00:07:46.740 | school, and that sort of became the goal.
00:07:49.560 | Got it.
00:07:50.560 | Where did you go to undergrad and medical school?
00:07:55.360 | So I went to undergrad at Yale University.
00:07:58.560 | And then afterwards, I was a philosophy major there, so I had a couple of pre-med requirements
00:08:04.720 | that I still had when I graduated.
00:08:06.480 | So after that, I did a year at Penn, just kind of finishing up med requirements.
00:08:11.920 | And then I went to the University of Pittsburgh for medical school.
00:08:15.200 | And then I did six years of urology residency at USC in LA.
00:08:19.320 | Oh, wow.
00:08:20.600 | So that's interesting.
00:08:21.600 | So getting into Yale is kind of impossible nowadays.
00:08:25.560 | What do you think enabled you to get into Yale?
00:08:28.960 | And then how did you feel going from Yale to Pittsburgh Medical School?
00:08:35.800 | So I think about this, and it's one of my favorite conversations these days, talking
00:08:42.000 | about other--
00:08:45.000 | So I went to Yale, my wife went to Yale, her sisters went to Yale.
00:08:47.800 | So when we get together on family vacations, we kind of sit around and say, oh, are kids
00:08:52.960 | ever going to get into Yale?
00:08:53.960 | It's so much harder now.
00:08:55.160 | We talk about these things, right?
00:08:56.680 | And then there's been recent things in the news about affirmative action and legacy and
00:08:59.680 | all that stuff.
00:09:00.680 | But I think the thing, when I look back, I did work really hard in high school.
00:09:07.080 | I was valedictorian.
00:09:08.320 | I got straight As.
00:09:09.320 | I got a 1540 on the SATs.
00:09:13.400 | I was drum major.
00:09:14.600 | I did track.
00:09:15.600 | I was in student government.
00:09:18.000 | I did all sorts of stuff.
00:09:20.320 | And I went to governor's school.
00:09:22.120 | So I mean, I did work really hard early on.
00:09:26.000 | And when I got into Yale, I was incredibly happy and grateful.
00:09:31.560 | And I think that even when you do all those things, even when you check off the boxes,
00:09:35.080 | it's still a crapshoot.
00:09:36.240 | Because acceptance rates are low now, but they were low back then as well.
00:09:40.320 | And I think a lot of things kind of have to go right.
00:09:43.140 | And I just got lucky.
00:09:45.200 | I don't know if you got lucky.
00:09:46.560 | Because if you did all those things like governor's school, I didn't even know what governor's
00:09:50.200 | school was in high school.
00:09:53.160 | They seem like you did a lot of things.
00:09:54.840 | So did your parents say, "Hey, you need to get into one of these schools when you're
00:09:59.240 | at a young age," or were you self-motivated?
00:10:03.560 | I think it was both, honestly.
00:10:05.760 | And I've talked about this and written about this on the blog a lot.
00:10:10.440 | But my family struggled financially for a significant part of my childhood.
00:10:16.120 | I mean, when I was very young, in the '80s, my dad was working in real estate in Manhattan
00:10:22.900 | and as kind of a commercial broker.
00:10:25.800 | And things were quite good.
00:10:26.800 | But then there was a recession.
00:10:29.600 | And then his entire sort of livelihood dried up.
00:10:32.680 | And pretty much from middle school onwards, we really struggled financially to a point
00:10:38.720 | where at times my mom was worried about just buying us food for dinner.
00:10:43.560 | And it coincided with a time when I was starting to realize what was going on as I was getting
00:10:51.200 | older.
00:10:52.200 | And I could tell that one ticket to financial stability was to go to a good college and
00:10:59.160 | get a good job.
00:11:01.280 | So that did motivate me.
00:11:04.720 | I think that also my parents, I have to give them a lot of credit because I think one thing
00:11:12.400 | that they did convince me of, and I don't know how much was internal versus external,
00:11:16.800 | but they said, "Look, you're smart.
00:11:19.200 | You have a lot of potential and you should try to fulfill that potential."
00:11:22.520 | And it's something that sort of I still believe in.
00:11:25.840 | And I believe for all people that if you have abilities and if you have talents, you should
00:11:30.160 | share them with the world.
00:11:31.160 | You should try to achieve to the limits of your potential.
00:11:33.300 | And I think that did sort of instill that self-motivation that helped me to achieve
00:11:38.880 | both in high school, college, med school, et cetera.
00:11:42.760 | What do you think the percentage split is between genetics, smarts, natural ability,
00:11:48.680 | and work ethic?
00:11:49.680 | And just two variables in terms of getting into college and having a successful career.
00:11:58.480 | So this is a really loaded conversation, right?
00:12:00.200 | Because I think that getting into college is, there's so many factors that have to go
00:12:05.180 | right.
00:12:06.180 | I do think that even though my family struggled with money, they from a very early age invested
00:12:12.500 | in my education.
00:12:13.700 | So when we were choosing between buying new shoes and getting cumon, like math lessons,
00:12:22.360 | my mom and my dad would choose lessons and all these things that they felt that were
00:12:29.460 | going to be important in getting ahead.
00:12:31.860 | So I think a lot of it is sort of the environment in which you were raised, which is related
00:12:37.420 | to privilege and sort of education and all that.
00:12:42.340 | Genetics I think do have a correlation with IQ, right?
00:12:45.420 | But something that I am realizing more in my 30s and 40s is that pure intelligence only
00:12:52.560 | gets you so far in life.
00:12:53.560 | And I do think that at the extremes it can kind of work against you, but so many of the
00:12:58.740 | really successful people that I see nowadays and the people that I admire, they didn't
00:13:03.060 | go to the best colleges.
00:13:04.540 | And if they did the SATs, maybe they wouldn't get what I got, but they have other skills
00:13:10.300 | that are in life that are even more useful.
00:13:12.380 | Like they're incredible with people, they can relate to people, they can motivate people,
00:13:16.140 | they can communicate.
00:13:17.180 | And all these things I think can be even more important than pure intelligence.
00:13:23.200 | So I got to lock you down on an exact percentage here because this is like a quiz here.
00:13:27.580 | So that would be, I guess, nurture what you're talking about.
00:13:31.740 | So give me a percentage because there's only two variables and then we figure out one variable,
00:13:35.980 | we know the other.
00:13:36.980 | So in terms of genetics and nature, what do you think that percentage is?
00:13:42.240 | In terms of your success, determining your success in life, getting ahead.
00:13:47.700 | Genetics versus nurture, so nature versus nurture?
00:13:52.940 | Correct.
00:13:55.960 | I'm going to go 50/50.
00:13:57.960 | 50/50, that's the safe bet.
00:14:02.260 | It's a safe bet, but it's so true because you see these people who are clearly, clearly
00:14:07.700 | smart, right?
00:14:12.440 | Some people are too smart.
00:14:14.800 | I was talking to someone's father, an incredibly smart guy, and he said that from the age of
00:14:27.480 | five he looked around and realized he was smarter than everyone, including adults, that
00:14:34.140 | he was encountering, right?
00:14:36.680 | And to him, I think that obviously in certain aspects of his career, that was a luxury because
00:14:42.980 | he could do computations, he could have insight into various problems.
00:14:47.660 | But in a lot of ways, I think that worked against him because he was very bored and
00:14:51.900 | very isolated as a child because he saw himself as just different, right?
00:14:57.460 | It wasn't necessarily that he was better.
00:14:59.300 | I think it just kind of isolated him.
00:15:00.860 | So on the other hand, a lot of people who maybe aren't the smartest, but they have those
00:15:11.940 | skills that we talked about, they're definitely going to go farther and have gone farther
00:15:15.880 | in life than people like that.
00:15:20.820 | And it's definitely a mix.
00:15:23.140 | And you see the success of very, very wealthy kids, right?
00:15:28.220 | And maybe they're not the smartest, but they were supported and continue to be supported
00:15:33.140 | by their family who might have a lot of resources, and I would consider that nurture, right?
00:15:37.720 | So I think that more and more I'm realizing pure smarts will only get you so far.
00:15:42.480 | You have to have that support if you want to succeed in life as well.
00:15:46.560 | And one can make up for the other.
00:15:48.480 | >>No, you're absolutely right.
00:15:51.960 | It's always interesting because as a parent, I'm thinking to myself, how much effort should
00:15:54.880 | I put into parenting and how much are they just going to figure it out on their own?
00:16:00.380 | So you have kids, right, Daniel?
00:16:02.200 | >>Yeah.
00:16:03.200 | I've got a five-year-old and a nine-year-old.
00:16:05.200 | They're two boys.
00:16:07.920 | >>And when you think about them going to college, how do you see that?
00:16:13.520 | What if they don't get into Yale?
00:16:17.400 | >>So they're young, and who knows how the next 10 years are going to go.
00:16:25.460 | But I would love for them to go to Yale.
00:16:27.080 | It's like I had an incredible experience, and when I got there, I realized that I wasn't
00:16:32.240 | the smartest person in the room.
00:16:33.720 | I was surrounded by all these people who were incredibly accomplished and interesting and
00:16:39.640 | much, much better than me in a lot of ways.
00:16:43.120 | I think in a lot of ways, I focused so much on academics in high school that I stunted
00:16:48.280 | my social growth.
00:16:49.280 | So it wasn't until literally first or second year of med school that I was like, I think
00:16:54.000 | I kind of get this whole social thing now.
00:16:55.920 | So I was like president of my med school class and things like that because finally, I felt
00:17:00.920 | like I sort of got it, how everyone relates and everything like that.
00:17:04.200 | But in college, when I first started out, I was behind, absolutely, in terms of social
00:17:10.720 | interaction and all that stuff.
00:17:14.240 | When I think about that for my kids, I think there's so many factors that go into it.
00:17:18.880 | I would love for them to go to Yale.
00:17:20.640 | And when I think about them objectively right now, I think they're both very smart.
00:17:27.800 | But again, that only gets you so far.
00:17:30.820 | So smart plus lazy will not get you as far as smart plus very determined.
00:17:36.240 | So I'd love for them to go to Yale, but I think that they're going to be successful
00:17:40.520 | regardless.
00:17:41.520 | >> Okay.
00:17:42.520 | I guess I asked this question because you decided to go to medical school and be a doctor
00:17:49.440 | and do that route.
00:17:52.040 | And there seemed to have been a dissatisfaction that fell upon you just not too long after
00:17:58.080 | you started working, despite the income, despite the status and all that.
00:18:03.400 | So would you want them to go through that same path?
00:18:07.280 | And how do you think you would have done things differently if you knew then what you know
00:18:11.680 | now?
00:18:12.680 | >> So I would start out by saying that I'm incredibly grateful to the medical path that
00:18:19.960 | I did.
00:18:20.960 | Because even now, I'm spending about a quarter to a third of my time in medicine still.
00:18:28.200 | I do locum tendens urology, which is I kind of visit places and help them fill a specific
00:18:34.440 | need.
00:18:35.440 | And I travel around and do that.
00:18:37.980 | And I spend the rest of my time in business like real estate and the blog and content
00:18:43.920 | creation and all that.
00:18:45.600 | And I am incredibly grateful because I never would have had the freedom to do this if I
00:18:50.720 | hadn't gone through medical training and had that very high income to sort of give me the
00:18:56.720 | freedom to do all this stuff.
00:19:00.000 | But you're right.
00:19:01.000 | I mean, if I had to think about it for my kids, I would not recommend them to go into
00:19:05.880 | medicine, certainly not surgery.
00:19:08.600 | Because the six years of training that I had to do to become a surgeon, I came out very
00:19:14.000 | well trained.
00:19:15.000 | But it was torture.
00:19:16.120 | It was 80-hour plus weeks.
00:19:20.480 | One week I hit, I think, 120 hours or something like that.
00:19:24.360 | It was ridiculous, right?
00:19:26.040 | And there's so much life that you give up along the way in medical training.
00:19:34.040 | And honestly, the equation of medicine for physicians today is very different from what
00:19:39.440 | it was 20 years ago.
00:19:41.860 | There's much less autonomy.
00:19:43.540 | Most physicians now are employed.
00:19:46.320 | Most physicians now are burnt out.
00:19:49.080 | And these are well documented in surveys that have been done throughout the pandemic.
00:19:57.120 | And certainly things are worse now than they were just three or four years ago because
00:20:01.360 | of the pandemic.
00:20:03.680 | But this is well documented.
00:20:05.080 | So you're talking about a physician workforce now that is in more debt than they used to
00:20:09.880 | be.
00:20:10.880 | They're more burnt out than they used to be.
00:20:13.120 | And they have a lot less control over their lives.
00:20:15.200 | So if I were to recommend to my kids what I would want them to do with their lives,
00:20:19.920 | I would want them to do something where they have complete control over their schedule.
00:20:23.200 | So entrepreneurship and business, I think, offer that.
00:20:28.480 | And they're a lot of the reason why I chose in 2018, 2019, as I was going through this
00:20:36.240 | creative process with the blog and figuring out how to get to financial independence,
00:20:39.920 | I decided to shift towards investing and real estate because I felt like that was the path.
00:20:46.760 | And to get that life of autonomy where you can decide exactly what to do with your week,
00:20:52.680 | that's how you get there.
00:20:53.680 | You don't do it by having a traditional job where you beholden to an employer.
00:20:56.840 | Well, it definitely helps, though, to have that foundation of income and your learning
00:21:02.240 | so you can have those savings to invest.
00:21:05.800 | It's an interesting journey that I think many people wonder from the outside looking in.
00:21:11.720 | Doctors, they make good money.
00:21:13.360 | So let's talk about money because you were open about that with TikTok and how much you
00:21:16.800 | made.
00:21:17.800 | So can you give listeners an idea of how much you made as a resident and then how much you
00:21:22.200 | made your path over the next five years and then why you shifted from moving from Southern
00:21:27.840 | California to Tennessee?
00:21:30.200 | Sure.
00:21:31.520 | So I think people know this now because a lot of people like on TikTok and are very
00:21:39.040 | transparent about resident salaries.
00:21:40.880 | But residents and these are training doctors, they are physicians, they have an MD, they
00:21:45.360 | finish medical school, but they're kind of learning their specialty.
00:21:50.920 | You can make anywhere from like $45,000 a year to $70,000 a year.
00:21:56.080 | I think that's really typical as a resident.
00:21:58.640 | And you do that for three years.
00:22:01.040 | You do that for six years or seven years in some cases.
00:22:04.720 | And you're working, remember, probably about 80 hours a week, depending on your specialty.
00:22:11.280 | Doesn't seem safe working eight hours a week if you're actually doing some surgery.
00:22:14.720 | What do you think?
00:22:19.120 | I think that it is not ideal, but it's the way that medical training is created.
00:22:26.320 | And is it safe?
00:22:28.520 | So we kind of had a rule in residency.
00:22:33.040 | And if you're safe to drive, you're safe to operate, to do surgery.
00:22:42.520 | I think the problem is that now they've shown that being sleep deprived is equivalent to
00:22:46.880 | like drinking X number of beers.
00:22:51.040 | And certainly after being on call for 36 hours, which we did routinely, I would drive home
00:22:58.040 | and I crashed.
00:22:59.040 | I actually crashed once in residency.
00:23:01.400 | It was a fender bender, but I crashed.
00:23:04.000 | And there were probably a hundred close calls where I almost crashed.
00:23:10.960 | And this is because you're driving home and people say, "Oh, you should just like take
00:23:15.360 | a nap before you go home."
00:23:16.520 | And you don't understand.
00:23:18.000 | After 36 hours in the hospital, you'll do anything to get out of there.
00:23:21.680 | You just want to go home.
00:23:22.800 | So you're not going to go to the call room and nap for 20 minutes because you just want
00:23:27.520 | to go home.
00:23:28.520 | So anyway, so it's not a deal.
00:23:30.840 | So on the 36 hours, is that straight being awake or do you get an hour or two hours of
00:23:36.120 | sleep?
00:23:37.120 | It depends.
00:23:38.840 | So many times it was being awake straight.
00:23:42.800 | And this was in...
00:23:45.440 | So first year of general surgery, I was in-house call.
00:23:48.480 | And that means that when you're on call, you're there because you have to be able to respond
00:23:52.640 | at a moment's notice to a car crash coming in.
00:23:56.160 | And someone needing emergency surgery.
00:23:59.920 | And I think in a lot of cases, it was so busy that you were awake the entire time.
00:24:08.160 | And maybe you would sleep for like 15 minutes and your pager goes off and then you have
00:24:12.120 | to like call the nurse and say, "Yes, it's okay to give this guy Tylenol."
00:24:16.960 | Or, "Okay, thank you for telling me that he's constipated."
00:24:19.320 | You know, all these things.
00:24:22.800 | So it depends on your specialty, but then after intern year, I was at home call.
00:24:28.120 | So you can actually go home in some cases if you're not needed in the hospital.
00:24:32.720 | But in residency, I was at the county hospital.
00:24:35.320 | And when you're covering the county hospital, there's so many emergencies.
00:24:38.840 | A lot of the times you're at the hospital still 80% of the time.
00:24:42.840 | And the trick about home call is that since you're not technically in-house, you work
00:24:48.200 | a normal day the next day.
00:24:50.440 | So in a way, after intern year, things were better because if you got super lucky, maybe
00:24:57.680 | you didn't get called that much.
00:24:58.800 | But in a way, it was harder because you were on call overnight, maybe spending the entire
00:25:04.160 | night in the emergency room or in the operating room, and then you work a full normal next
00:25:08.040 | day.
00:25:09.040 | So you're just exhausted the entire day.
00:25:10.040 | So pluses and minuses.
00:25:11.440 | >> Dr. Kim: Yeah.
00:25:12.440 | I would say for listeners, I wouldn't want a resident to do any kind of big surgery on
00:25:17.800 | me.
00:25:18.800 | I'll ask them straight up, "How long have you been here?"
00:25:21.080 | Because I know for myself, after working, let's say, 10 hours, I'm dead and I'm done.
00:25:26.280 | I miss things.
00:25:27.280 | I get in accidents, all that stuff.
00:25:29.740 | So this seems like a problematic system.
00:25:32.280 | But go on.
00:25:33.280 | So you're talking about 40,000 to 70,000 as a resident.
00:25:35.560 | And then afterwards, what can you make or what are you making then?
00:25:40.400 | >> Dr. Keltner: Right.
00:25:42.200 | So urology is one of the better paid surgical specialties.
00:25:46.720 | It's consistently in the top 10.
00:25:49.360 | And as an attending level urologist, after a few years, you're probably going to be making
00:25:56.360 | between $400,000 to $600,000 a year.
00:26:00.080 | And when you start out for the first few years, depending if you're employed or if you're
00:26:03.160 | going into private practice, it might be significantly less.
00:26:05.920 | Might be about $300,000.
00:26:08.400 | But you can usually plan on making at least $400,000 as a urologist in our nation today.
00:26:16.700 | And then some urologists on the upper ends of the earning spectrum may earn a million
00:26:22.160 | dollars.
00:26:23.160 | That's rare, but it can happen.
00:26:24.560 | >> Dr. Insane: Okay.
00:26:25.560 | So that's pretty good money, $400,000 to $600,000.
00:26:28.200 | And I'm assuming there's a correlation with age and experience?
00:26:32.040 | >> Dr. Keltner: Yeah.
00:26:33.400 | Generally, you earn more.
00:26:36.400 | You sort of increase in income as you're building your skill set, your salary, and/or your practice
00:26:42.320 | if you're in private practice.
00:26:43.320 | I would say for the first 10 years and then things kind of stabilize and plateau.
00:26:49.020 | What I've learned as being out in the real world, there's a very big difference as an
00:26:54.280 | employed physician and someone in private practice because employed physicians generally
00:26:59.700 | have a very hard cap on how much they can make.
00:27:03.280 | There's a salary and there can be a revenue bonus, whereas if you're incredibly productive,
00:27:08.540 | they'll sort of give you a certain bump, but it's tough to make a significant amount more
00:27:13.340 | as an employed physician.
00:27:15.300 | In private practice, they're actually sort of like a hybrid between a doctor and a businessman,
00:27:20.500 | business people, because they have these ancillary income sources where they can make money from
00:27:25.940 | their lab.
00:27:26.940 | They can make money from the surgical center.
00:27:28.580 | This is all things that can help surgeons and other specialists sort of get to those
00:27:34.940 | upper income levels, but you have to be a savvy business person.
00:27:38.100 | Right.
00:27:39.100 | So, as a surgeon yourself, if you're not doing surgery, are you just not getting paid as
00:27:44.060 | much?
00:27:45.060 | You can be a consultant doctor and still make money?
00:27:48.140 | Yeah.
00:27:49.140 | So, it really depends on your specialty.
00:27:51.740 | Orthopedic surgery, if you're not doing surgery, you're not making money.
00:27:54.660 | They try to spend all their time in the operating room because that's, first of all, a lot of
00:27:59.180 | people break bones, so that's where they're needed.
00:28:01.720 | That's where the need is, but also that's where they make money.
00:28:05.020 | In urology, it's a little different actually.
00:28:06.900 | So, a lot of the ways urologic surgeons actually make the most money generally in the clinic
00:28:14.900 | doing diagnostic scopes and things that are outside of the operating room because they're
00:28:20.900 | much more time efficient.
00:28:21.900 | So, you could do a lot more quick procedures in the clinic or in the surgery center than
00:28:26.140 | you can in the main operating room with full anesthesia and all these other costs.
00:28:30.740 | So, it's very dependent on the specialty.
00:28:33.540 | So, when you were in residency, when was your light bulb moment to say, "I want to be a
00:28:38.660 | urologist who helps mostly men maybe get their kidney stones out of their bodies?"
00:28:45.100 | What was that epiphany moment like?
00:28:47.620 | It was actually, I remember it well.
00:28:49.620 | It was third year of … Actually, no.
00:28:54.060 | So, third year was when I did my first rotation, but the epiphany moment was in second year
00:28:58.860 | when a urologist came and gave us a lecture.
00:29:03.300 | When you're in medical school, you get a lot of specialists who come in and say, "This
00:29:06.260 | is what I do and you can do this too."
00:29:08.860 | He showed a video of laser lithotripsy, which is one of the ways that we treat kidney stones.
00:29:15.220 | You put a tiny little camera up the bladder to the kidney and the patients usually sleep
00:29:22.340 | almost all the time.
00:29:23.340 | Okay.
00:29:24.340 | Thank God.
00:29:25.340 | So, you use a fiber optic fiber to deliver laser energy to break kidney stones.
00:29:34.940 | When you see videos of this, it looks like a video game.
00:29:38.500 | When I saw that, I was like, "That looks awesome."
00:29:41.540 | Still, it's one of the most fun things you can do as a urologist, break kidney stones.
00:29:47.460 | I thought that I would be very good at it and that I would like doing it and that was
00:29:52.500 | true.
00:29:53.500 | I had this rotation spot open in the beginning of third year.
00:29:57.060 | I just filled it with urology.
00:29:58.060 | It was my first third year rotation and I loved it because I learned that urology is
00:30:03.460 | not only kidney stones.
00:30:04.580 | You also cure cancer.
00:30:06.660 | You can cure kidney cancer.
00:30:08.060 | You can cure bladder cancer.
00:30:10.620 | You could help people urinate better and you could help men have better sex and things
00:30:15.500 | like this.
00:30:16.500 | A lot of these things are great because you're curing cancer, but a lot of the satisfaction
00:30:21.280 | that you get as a urologist is helping people with these very basic things because you don't
00:30:26.780 | understand how good you have it if you're urinating normally and so you can't pee normally.
00:30:32.100 | Then you'll do anything to get back to normal urination.
00:30:35.860 | A lot of these things, you're helping people get back to themselves and they're very thankful.
00:30:40.540 | That was what brought me to urology.
00:30:42.860 | I know as men, as we get older, we need to start peeing more at night.
00:30:51.040 | What percentage of your patients are older?
00:30:53.840 | It seems like AGE is a huge variable for having these problems.
00:31:00.480 | Yeah, absolutely.
00:31:01.480 | I would say the majority of your typical urology patient is probably 60 to 70 years old and
00:31:08.880 | male.
00:31:09.880 | We do treat a lot of females too because men and women get kidney cancer and kidney stones
00:31:14.600 | and bladder cancer, but the majority of our patients are men for sure.
00:31:20.000 | Do you have any advice for those of us who are not 60 or 70 or 60 or 70 to try to be
00:31:26.680 | more preventative so we don't see you?
00:31:29.400 | Sure.
00:31:30.760 | The number one thing that you can do, you can't really do much about getting an enlarged
00:31:34.360 | prostate.
00:31:35.360 | It's genetic.
00:31:36.360 | It's autosomal dominant, usually passed down through your father, et cetera.
00:31:41.320 | But you can drink plenty of water and stay hydrated because that's going to stop you
00:31:47.680 | from getting kidney stones.
00:31:50.440 | If you have any predisposition towards it, like your parents have kidney stones or anything
00:31:54.520 | like that, you should probably be drinking between two and three liters of water a day
00:31:58.400 | and that's going to dilute your urine.
00:32:01.140 | You remember science, right?
00:32:02.140 | If you have something that's diluted, you're not going to form as many crystals.
00:32:04.880 | You're not going to crystallize.
00:32:06.360 | So that's how it works in the kidneys as well.
00:32:09.280 | Okay.
00:32:10.280 | So let's say I'm a 78-year-old man who has to go to the bathroom every two hours.
00:32:15.840 | Is it kind of too late for me and am I trying to just drink a lot of water during the day
00:32:22.480 | and have a certain cutoff point before I go to bed?
00:32:24.560 | I'm just trying to think about one person in particular to try to help him out.
00:32:28.840 | Yeah, absolutely.
00:32:29.840 | So you're talking about lifestyle modification and that's always the first step.
00:32:34.320 | So cut off fluids two or three hours before you go to bed.
00:32:37.480 | That way your body has time to process it and that helps to a certain extent.
00:32:47.320 | Once you sort of get beyond those things though, there's medication.
00:32:50.880 | There's a very common medication that sort of relaxes the prostate and it helps you pee
00:32:56.400 | better and can kind of reduce those nighttime bladder overactivity issues.
00:33:02.680 | And then there's surgery.
00:33:03.680 | There's medication.
00:33:04.680 | What is that medication called?
00:33:05.680 | Yeah.
00:33:06.680 | So they're called alpha blockers and there's medications like Tamsulosin which is one of
00:33:12.840 | the most common ones and there are a variety of them but Flomax is the most common one
00:33:18.400 | you might hear of.
00:33:19.400 | Flomax.
00:33:20.400 | Yeah.
00:33:21.400 | And have you ever encountered a situation where you would prescribe to your patient
00:33:24.400 | Flomax or whatever these alpha blockers are and then they would encounter a rejection
00:33:31.360 | from the insurance company saying we are not going to cover that?
00:33:35.360 | You know, they're very effective.
00:33:38.080 | They've been around forever.
00:33:39.640 | So generally your generic alpha blockers are going to be covered.
00:33:44.520 | They're super cheap.
00:33:45.520 | They're super cheap.
00:33:46.520 | If the doc's prescribing an alpha blocker that's not covered, just tell him to stop
00:33:52.280 | prescribing the flashiest thing and just prescribe one that is generic and cheap because there
00:33:57.280 | are plenty to choose from.
00:33:58.760 | Okay.
00:33:59.760 | Good to know.
00:34:00.760 | So we know one of the problems or issues that doctors face is declining insurance reimbursement
00:34:07.600 | rates that has hurt the income generating power of doctors.
00:34:13.240 | Do you see that in your field?
00:34:15.320 | Yeah, absolutely.
00:34:16.560 | So this would be sort of an hour's long talk all to itself but the industry of medicine
00:34:27.800 | and healthcare in the United States is so messed up and it has gotten this way because
00:34:34.560 | of many different things.
00:34:36.960 | But you could argue that, I think very convincingly, that the major reason is the for-profit insurance
00:34:42.800 | companies that basically control healthcare in the United States.
00:34:46.760 | And anyone who wants to change it just gets drowned out by millions of dollars of lobbying.
00:34:55.160 | So it would be much, much better for us to be in a single payer system, Medicare for
00:35:01.040 | all.
00:35:02.040 | It would totally be better.
00:35:03.040 | There'd be so many less people uncovered.
00:35:05.400 | The baseline level of medical care in this country would go up.
00:35:09.160 | I don't know if doctors would be happier but they might be.
00:35:15.840 | It may limit the ability of some doctors to make stratospheric levels of income but it's
00:35:20.980 | no doubt in my mind that from a public health perspective, there shouldn't be single payer
00:35:26.200 | or universal healthcare.
00:35:28.520 | We're the only developed nation at our level that doesn't have it.
00:35:32.960 | And everything from infant mortality to just like diabetes care and all these things would
00:35:38.880 | be so much better if we changed our system.
00:35:42.000 | Got it.
00:35:43.000 | Got it.
00:35:44.000 | Yeah.
00:35:45.000 | It is interesting.
00:35:46.000 | I remember when I left my day job in 2012 and then I no longer had health insurance
00:35:49.960 | provided because my wife left in 2015 when she was 35 as well.
00:35:53.280 | So we were stuck and we had to buy our own health care insurance and at the time for
00:35:56.480 | two people, it was around $1,650 a month.
00:35:58.920 | And I was thinking to myself, "Wow, this is like so expensive."
00:36:02.480 | And we had trouble getting reimbursements and coverage.
00:36:06.360 | And so I said, "I'm just going to buy UnitedHealthcare stock and all these healthcare
00:36:10.440 | providers because they're just crushing us.
00:36:12.840 | So if you're going to crush me, I'm going to at least invest in you guys."
00:36:15.720 | And these guys have been great investments.
00:36:17.640 | Yeah, that was very smart of you to do because they're making tons of money.
00:36:23.480 | And it's one of my...
00:36:27.080 | So I'm on TikTok as the Darwinian doctor and one of my favorite other doctors that I follow
00:36:31.320 | is Dr. Glockum Flecken.
00:36:35.720 | It's a tough mouthful, but basically it's this ophthalmologist who produces these incredibly
00:36:41.040 | funny skits and he acts out all the characters.
00:36:46.000 | But over the last few years, as he's grown in fame, he's found a voice criticizing for-profit
00:36:53.640 | health insurance.
00:36:54.840 | And he goes into a lot of things.
00:36:56.600 | It's like the pharmaceutical industry is messed up, for-profit health insurance is messed
00:37:00.640 | up and he summarizes it incredibly well.
00:37:03.440 | But basically one of his recent skits basically highlights that insurance companies see you
00:37:10.080 | as a dollar sign.
00:37:11.320 | And they want you to give them the most amount of money possible and then die.
00:37:18.040 | Okay, that makes sense.
00:37:22.320 | To make way for other well-paying people.
00:37:26.000 | And they don't actually want to cover stuff.
00:37:27.480 | So a lot of times it's been well proven that a lot of times they'll automatically just
00:37:31.760 | deny coverage for various things just as a cost-saving measure.
00:37:34.800 | And then it's just messed up.
00:37:37.640 | It's tough.
00:37:38.640 | It's tough.
00:37:39.640 | We had an issue when our daughter ate too many eggs and we didn't know that she was
00:37:43.840 | allergic to eggs.
00:37:45.080 | So she started swelling up and then the whole ambulance debacle was crazy.
00:37:49.440 | I'm so thankful that they came in time of need.
00:37:52.360 | But then the 20-minute ride was $3,800.
00:37:54.360 | And we're like, "What?
00:37:56.080 | Come on.
00:37:57.080 | $3,800."
00:37:58.080 | So it's almost like the consumers are afraid, afraid to get medical coverage because they
00:38:03.880 | don't know exactly how much coverage the insurance company is going to pay or how much is going
00:38:08.800 | to come out of their pocket.
00:38:10.400 | So there's a lot of fear in terms of I'm sure there's a lot of undiagnosed people who are
00:38:13.920 | suffering because of the cost of health insurance.
00:38:17.120 | That is so true.
00:38:18.960 | And I think there's a lot of attention now to it.
00:38:22.480 | And it's so entrenched that you've got this entrenched healthcare, pharmaceutical industry,
00:38:29.760 | insurance complex.
00:38:32.240 | And it's hard to know how that's ever going to change.
00:38:34.960 | But you have this growing discontent among all the citizens of this country that are
00:38:39.320 | like, "This is messed up.
00:38:41.080 | We should have better healthcare."
00:38:42.920 | And it's almost like going to come to a head in some way.
00:38:45.080 | Who knows how doctors end up on that.
00:38:46.940 | So a lot of me diversifying my income by investing has been sort of hedging my bets because who
00:38:53.280 | knows what's going to happen to healthcare in this country.
00:38:55.400 | You might as well have other sources of income, other investments, other than just working
00:38:59.900 | as a physician.
00:39:01.400 | Right.
00:39:02.920 | Tell us about your move to Tennessee because it seems unconventional.
00:39:06.840 | I know from a doctor's perspective you can make more in lower population cities around
00:39:12.520 | the country, but I don't think you moved for that reason.
00:39:15.520 | Why did you move from Southern California, which is sunny and nice and glamorous, to
00:39:20.720 | what part of Tennessee are you in now?
00:39:22.280 | I'm in Memphis, Memphis, Tennessee.
00:39:25.240 | Okay.
00:39:27.640 | So basically my move from Southern California to Memphis, it was a number of things coming
00:39:33.480 | to a head.
00:39:35.460 | After six years with my medical group in Southern California, I basically made it, or I tried
00:39:44.280 | to optimize it as much as possible.
00:39:46.160 | I had a Tesla, so the commute was much better.
00:39:49.040 | I was chief of my department, so I felt a lot more sort of ownership and autonomy in
00:39:52.960 | my day to day.
00:39:54.400 | But again, I've been disillusioned with healthcare to a lot of extent, and I love practicing
00:40:01.720 | medicine, but there are a lot of downsides of being a doctor, right?
00:40:04.800 | You know, covering a call and all these things.
00:40:07.000 | And I also, by that point, had a large and growing business of real estate, right?
00:40:15.340 | So I had a portfolio that I was managing in my spare time on the weekends, and I was additionally
00:40:20.320 | writing the blog and creating short form video content and all these things, and I loved
00:40:25.920 | that stuff.
00:40:26.920 | That was fun for me and also interesting, and I wanted more time for that.
00:40:29.880 | And I didn't really see an ideal way out, right?
00:40:33.840 | So a lot of my time was spent kind of wondering about this and wondering where I was going
00:40:37.720 | to go.
00:40:38.720 | But then my wife, who is in the museum field, basically was recruited to lead the museum
00:40:47.520 | in Memphis, and this was sort of at a crossroads for her, where either she could continue doing
00:40:54.880 | her museum job in LA, which she was very good at and they loved her, or she could take a
00:40:59.280 | leap and try to make this big career step and it could potentially go great.
00:41:07.440 | So we basically decided that for both of us, we were about 40 at the time, it was about
00:41:11.000 | a year ago, and we're like, "This is the time to make a leap like this," right?
00:41:17.020 | We had thankfully saved a lot of money, invested well, so financially we're stable, and we
00:41:24.240 | were at a point where even if we made this move and everything went horribly, we could
00:41:28.640 | start over.
00:41:29.640 | We're young enough.
00:41:30.640 | But we figured our kids were young enough, we're at a point in our careers where it was
00:41:34.600 | time to do something like this.
00:41:35.920 | And I think most people sort of don't want to do that.
00:41:40.360 | They want to just keep the status quo, and they'll just grit it out, and they'll do it
00:41:43.520 | for 20 years, 30 years, and then retire, and then live for 14 years and then die because
00:41:48.160 | that's what happens.
00:41:49.160 | But for us, we're like, the trajectory of our lives, I have this goal of where I want
00:41:55.240 | us to be, and it's this vision of freedom and growth and contribution to society.
00:42:03.240 | And I thought that we had a much better chance of getting there if we took a leap like this.
00:42:07.220 | So she took the job.
00:42:09.360 | I told my medical group that I was quitting.
00:42:12.400 | And then since then, we've relocated here.
00:42:14.400 | And it's been incredibly challenging, but we're making it work.
00:42:17.480 | And I think overall, we're much happier.
00:42:19.680 | Well, if you're much happier, that's a win to me.
00:42:23.920 | I know from your, I think your TikTok videos or something that, so she got a pay increase,
00:42:32.160 | but you did not, no?
00:42:34.600 | What are you doing in Memphis?
00:42:36.000 | Yeah, so her pay is equivalent, I would say.
00:42:41.400 | That was one of the stipulations of her coming across and taking this larger role.
00:42:46.000 | She wanted to at least make the same amount of money.
00:42:48.280 | And so that was part of her contract.
00:42:49.960 | But for me, I knew that I would be in the short term taking a huge loss because they
00:42:57.520 | wanted her to start right away.
00:42:58.760 | And I published this post where I basically calculated that I lost about half a million
00:43:04.720 | dollars moving to Memphis because I wasn't working for about five months because I was
00:43:10.640 | working on my medical license.
00:43:11.760 | I hadn't lined up a job, but they wanted her to start right away.
00:43:14.960 | So a lot of people criticized this.
00:43:16.480 | They were like, "You idiot.
00:43:17.480 | Why did you move without lining up a new job?"
00:43:20.160 | And I don't think they realized that my wife actually makes a very good living and that
00:43:24.240 | they wanted her to start immediately, right?
00:43:26.720 | So we, in the course of just four to eight weeks, moved across the country, you know,
00:43:32.040 | and we had to buy a new house.
00:43:33.800 | We hadn't sold our LA house.
00:43:35.440 | So we had to come up with the cash for that.
00:43:37.760 | And then in the five months that it took me to start practicing medicine again, I lost
00:43:41.760 | about 250K or 300K in opportunity costs of not working.
00:43:46.680 | But for us, we knew that would happen.
00:43:50.320 | And we were okay with that because we had savings, et cetera.
00:43:53.720 | And again, we were taking a calculated risk.
00:43:56.680 | Since then, I did talk to traditional practices out here, and they were not really cool with
00:44:03.320 | the level of sort of autonomy and freedom that I wanted over my week.
00:44:06.320 | So instead of joining a private practice, I'm doing what's called locum tendens medicine,
00:44:12.280 | where you sort of are a for-hire physician that you'll come in and say, you know, a hospital
00:44:20.680 | suddenly has someone quit or retire or get disabled.
00:44:24.120 | They need to cover and get help with those patients.
00:44:26.120 | So you come in and you help them.
00:44:27.480 | And it is very efficient in terms of time and income, and you have complete control
00:44:33.800 | of your schedule.
00:44:34.800 | So that's what I have been doing for the past few months.
00:44:37.040 | And we're working on the finer details in terms of all of it, but it's working out pretty
00:44:43.440 | well so far.
00:44:45.120 | Okay.
00:44:46.480 | Going to a new city, new state with family seems to be tough for me.
00:44:53.480 | I don't think I can convince my wife to move at all.
00:44:56.280 | I mean, it's hard enough to convince her to move houses in the same city, let alone a
00:45:01.360 | new state and city.
00:45:03.360 | I know Memphis is a booming city in terms of at least real estate, but the diversity
00:45:10.560 | in Memphis is different from the diversity in Southern California.
00:45:14.360 | Can you talk about how adjusting to a different type of city culture has affected you guys
00:45:21.200 | as an Asian-American family?
00:45:23.480 | Sure.
00:45:24.640 | And I think it's a very pertinent thing to talk about because diversity is important.
00:45:31.240 | So Memphis is actually a majority black city, and it has about 2% or 3% Asians.
00:45:38.440 | Wow.
00:45:39.440 | Really low.
00:45:40.440 | Yeah.
00:45:41.440 | I mean, coming from San Francisco where, I don't know the Asian percentage, but it's
00:45:44.120 | got to be at least- It's like 50%.
00:45:45.680 | Yeah.
00:45:46.680 | It's huge, right?
00:45:47.680 | So when you look around and when you walk around, you see many fewer Asians.
00:45:52.600 | And my kids, they're half-E's.
00:45:57.920 | They're half Korean, half Caucasian.
00:46:00.040 | But the Korean identity is important to us.
00:46:03.880 | But even in a place where there's only 3% Asian community, there's still Asians.
00:46:10.920 | And so my kids still go to Korean school.
00:46:15.040 | My parents came with us to Memphis, and they go to a Korean church on the weekends.
00:46:19.080 | Interesting.
00:46:20.080 | So you can still find community.
00:46:21.480 | But I'd be lying if I said that restarting in terms of your social life and forming friends
00:46:27.560 | and all that is not challenging.
00:46:29.040 | That's one thing that we're working on.
00:46:30.720 | But we're willing to put in the time and make it work.
00:46:34.520 | Okay.
00:46:35.520 | So it's hard, but it's maybe not as hard as you thought.
00:46:40.120 | It's like an adventure?
00:46:41.120 | Yeah.
00:46:42.120 | I mean, I think that's what we're seeing it because we know that professionally, my wife
00:46:45.600 | and I are much, much happier.
00:46:48.520 | The schooling options were actually much better here.
00:46:52.040 | So in LA, we couldn't even get a call back from the admissions director at the top private
00:46:57.040 | schools in LA.
00:46:58.560 | It's like-- You don't want to go to Harvard, Westlake, or
00:47:01.240 | whatever?
00:47:02.240 | It's like Hunger Games.
00:47:03.240 | It's like Hunger Games out there.
00:47:04.240 | It's like you're going to be fighting against the entertainment industry like Progeny, who
00:47:10.560 | are like billionaires.
00:47:11.720 | So it's hard to get attention at the good private schools.
00:47:16.540 | But they were incredibly welcoming here in Memphis.
00:47:20.120 | So the nation is kind of sleeping on Memphis.
00:47:22.760 | It gets a bad rap because of crime.
00:47:24.600 | And those are the things that make the news.
00:47:25.920 | But there is an incredibly passionate philanthropy sort of community here that is investing into
00:47:32.640 | the city.
00:47:33.640 | And they saw bringing in my wife and bringing my family to the city as like a big win.
00:47:39.200 | So they were like, "Okay, so we're going to help you get into private school.
00:47:42.400 | We're going to help you get set up here and there."
00:47:44.520 | And it has been an incredibly welcoming experience.
00:47:47.960 | And in that regard, I think it's been a lot more seamless than we expected.
00:47:54.840 | That's good to hear.
00:47:56.120 | I think it actually sounds like it helps being a Korean American where the population is
00:48:01.520 | only 2% to 3% because you're more unique.
00:48:05.240 | And so you bring different viewpoints, culture, profession, all that good stuff.
00:48:10.720 | So that's pretty good.
00:48:11.720 | I know I talked to my wife about whether we should move to Virginia or Hawaii.
00:48:17.840 | And the reason why I say Virginia or Hawaii is because I grew up in Virginia for high
00:48:20.920 | school and college.
00:48:22.520 | And the Asian American community, there was something like 5% or 6%.
00:48:26.680 | And I encountered some occasional racism, some fights, public schools.
00:48:32.460 | But in retrospect, I think it really toughened me up and it has made me more resilient in
00:48:38.720 | terms of the ills of the world and combating and standing up for yourself.
00:48:43.880 | And I was saying to myself, "Well, why don't we go back to Virginia and just kind of rough
00:48:47.040 | and tumble it a little bit more?"
00:48:48.160 | It's not like Virginia is that rough and tumble but like versus going to Hawaii where it's
00:48:52.280 | majority Asian, it's good lifestyle, peace, awesome love, great weather.
00:48:58.720 | And she said, "Absolutely, we're not going to Virginia."
00:49:01.320 | So I'm trying to think about the parallel of you going to Memphis, Tennessee versus
00:49:04.840 | staying in Southern California and we go to Honolulu, Hawaii.
00:49:08.000 | Because I like the grit.
00:49:11.560 | I like that.
00:49:12.960 | It's just real.
00:49:13.960 | It's the real world.
00:49:15.640 | How much do you think we're sheltering our children in developing?
00:49:23.200 | Because if we send them to private schools and they grow up in a nice house and their
00:49:27.600 | parents earn money, are you afraid that you're going to make them soft?
00:49:33.280 | And how are they going to function in life?
00:49:35.360 | Yeah, I mean, I think it is no doubt that our success means that our children are going
00:49:42.760 | to have less challenges in terms of things in their childhood.
00:49:48.240 | I think that's – it's funny.
00:49:50.240 | It's almost like a double-edged sword, right?
00:49:52.120 | You want to do well so that you can provide for your kids.
00:49:54.760 | But a lot of the experiences that shaped me and made me who I am and make me sort of this
00:49:58.760 | like determined striver who always wants to improve myself, a lot of that came from the
00:50:03.920 | challenges that I saw when I was growing up.
00:50:06.600 | We were poor for a certain part of my childhood.
00:50:09.120 | And that made me want to achieve so that I can provide for my family in a very good way.
00:50:16.680 | But we talked about this.
00:50:17.720 | So in LA, it's like perfect weather, right?
00:50:20.360 | And I always joked that everyone I encountered from Southern California in life always went
00:50:28.040 | back to Southern California for their professional lives.
00:50:31.360 | It's almost like they couldn't hack it with the weather that exists outside of Southern
00:50:34.960 | California.
00:50:35.960 | So my kids, when it's hot here because it's very hot in Memphis, they wilt.
00:50:42.200 | I wilt too.
00:50:43.200 | We're not used to it.
00:50:44.440 | But yeah, I think that there is a risk that if you provide too much, you can make your
00:50:49.920 | kids "soft" or whatever.
00:50:52.280 | But I think that doesn't mean that you don't want to provide a good education.
00:50:56.560 | That doesn't mean that you don't want to buy them clothes and things like that.
00:50:59.320 | I think you have to provide them with challenges in other ways.
00:51:03.360 | So challenging situations and challenging programs, there are other ways to do it.
00:51:09.680 | And we haven't figured it out.
00:51:10.920 | My kids are young still.
00:51:11.960 | But we'll both have to do that, I guess.
00:51:15.080 | Yeah.
00:51:16.080 | So tell me about your net worth goals and your financial goals.
00:51:19.680 | Because you left, I'm assuming, a $400,000 to $600,000 job as a urologist in Southern
00:51:24.880 | California.
00:51:25.880 | I'm assuming you're making less than that band in Memphis, but the cost of living is
00:51:30.320 | much lower.
00:51:33.120 | What is financial independence to you?
00:51:35.760 | And do you have specific net worth targets?
00:51:37.600 | And how do you come up with those targets?
00:51:40.320 | So I was very calculated about this.
00:51:43.920 | So two years into Tendinghood, when I was making a certain amount of money and it was
00:51:49.920 | a reliable paycheck and I knew what things were going to be like, I used that to project
00:51:55.560 | out a 15-year plan to financial independence.
00:51:58.580 | And I knew exactly how much we were spending in Southern California and how much we're
00:52:02.480 | likely to save and an 8% return in the stock market.
00:52:07.480 | And I calculated that we would need about $6.5 to $7 million of investments.
00:52:12.400 | And by the 4% rule, that would provide everything we needed, including inflation and all that,
00:52:18.320 | and we'd be good, right?
00:52:21.400 | Things are a little bit different now because after a while, I decided that actually the
00:52:25.860 | fastest way to financial independence is through residential real estate because so much of
00:52:31.040 | your return is in cash, in rent payments, and you could use that to just directly offset
00:52:36.320 | your living costs.
00:52:37.320 | So you don't have to abide by the 4% rule anymore because you can just pay for things
00:52:41.400 | out of the income from the rental property.
00:52:43.680 | So over the last four or five years, I've increasingly shifted our investments to real
00:52:51.440 | estate.
00:52:52.440 | So that has shifted my goal of a certain sort of investment number in the stock market to
00:52:59.960 | a cash flow number from real estate.
00:53:07.480 | So about a year or so ago, I calculated that the cash flow that we've created already with
00:53:12.760 | our portfolio, which is 28 units currently and worth about $9 million of real estate,
00:53:23.000 | the cash flow we generate has cut off about five years from that financial independence
00:53:26.640 | goal.
00:53:27.640 | So we're probably going to get there, this was one or two years ago, I was like, "We're
00:53:31.440 | going to get there probably in about 10 years or less."
00:53:34.200 | And then I didn't publish it, but I secretly feel that we're going to be there in five
00:53:38.540 | years or less, right?
00:53:41.080 | So in terms of income, by the way, in terms of transparency, by working seven to 10 days
00:53:50.200 | a month in urology as a traveling urologist, I'll still be making 400K plus a year.
00:53:57.240 | Oh, wow.
00:53:58.240 | Seven to 10 days a month, that's it?
00:53:59.560 | Seven to 10 days a month.
00:54:00.920 | And how many hours a day is that?
00:54:04.160 | About 10 hours a day.
00:54:06.280 | So it's a long day and I'm covering call, I'm doing procedures, I'm doing surgery, it's
00:54:13.160 | busy.
00:54:14.160 | But the rest of the time I'm home, I'm talking to you, I'm working on business and it's an
00:54:20.080 | incredible amount of freedom outside of that.
00:54:21.960 | So for me, that's actually much more satisfying in terms of a balance.
00:54:26.240 | And so my income has not, it's gone down because I was making, when I left Southern California,
00:54:31.880 | about 600K a year.
00:54:34.000 | So it's gone down from there quite significantly, but it's allowing me freedom to grow areas
00:54:39.780 | of business that have much higher potential.
00:54:44.600 | So I was never going to make more than 600K as a urologist in Southern California.
00:54:48.920 | I was very lucky to make that and I'm very grateful for that, but I knew that it's unlimited
00:54:53.920 | what you can make in business.
00:54:55.000 | So for me, making 300 or 400K a year as a locum tendens urologist and having all that
00:55:02.280 | extra time to work on the blog, work on social media and real estate investing, it has, I
00:55:09.080 | have no doubt that it's going to be much more lucrative in the long term.
00:55:12.680 | Okay.
00:55:13.680 | So that's interesting.
00:55:16.280 | So six to seven million was the target, but it's, it sounds, so when you said 9 million
00:55:20.960 | in real estate, is that just total real estate exposure excluding the debt you have on the
00:55:25.320 | real estate?
00:55:27.440 | Excluding the debt, correct.
00:55:28.440 | Yeah.
00:55:29.440 | So if I were to sell it, that's how much you would get, but then I wouldn't end up with
00:55:32.600 | that because I have to pay back all the mortgages and stuff like that.
00:55:35.800 | Right, right.
00:55:36.800 | Yeah.
00:55:37.800 | Got it.
00:55:38.800 | Well, it sounds like you have a lot on your plate, but then, you know, knowing that you
00:55:41.920 | only do seven to 10 days out of a 30 to 31 day month, that, that sounds pretty great.
00:55:48.240 | It leaves you a lot of time.
00:55:49.760 | I mean, how long do you think you can do?
00:55:51.800 | What's your ideal duration to do this kind of hybrid day job work and entrepreneurial
00:55:56.840 | work for?
00:55:58.380 | So I, I would love over the next year or so to get to a point where I am status quo, where
00:56:04.120 | I'm, I'm happy in all aspects, all, you know, I see it as the triad, right?
00:56:08.120 | So there's like traditional medicine, there's my family and there's business.
00:56:13.520 | And over the next year I would like to get to a point where I can sustainably do that
00:56:19.600 | balance forever because I've sort of like find the balance that works for me.
00:56:24.120 | And I think I'm pretty close actually.
00:56:27.840 | So doing medicine seven to 10 days a month I think is satisfying that, that itch for
00:56:33.400 | medicine and I love practicing.
00:56:34.840 | I love surgery still.
00:56:37.920 | And if I can do that and just be gone one weekend, one week a month, including the weekend
00:56:44.240 | and having the rest of my time to just be present for my family, I think that's pretty
00:56:48.080 | good.
00:56:49.080 | And I am hoping to scale up pretty rapidly in multifamily real estate, which takes a
00:56:55.520 | lot of investment in terms of making contacts and like finding investors and things like
00:57:00.040 | that.
00:57:01.040 | So I think I can do that with the time that I have outside of medicine very, very easily.
00:57:05.840 | So I think I'm pretty close to sort of a permanent sustainable thing.
00:57:11.280 | You know, ideally I wouldn't have to travel to do the medicine part, but if I do, I think
00:57:16.320 | I'm okay with that, at least for now.
00:57:19.320 | Got it.
00:57:20.320 | Got it.
00:57:21.320 | So in conclusion, any departing advice for listeners in terms of medicine, entrepreneurship,
00:57:29.280 | going on the path, what would you say to them who are actively looking to achieve financial
00:57:34.400 | independence?
00:57:35.400 | Yeah, I would speak to it sort of more globally, like in terms of life trajectories, right?
00:57:39.860 | So I think everyone should be going towards financial independence.
00:57:43.600 | Absolutely.
00:57:44.600 | But I think for a lot of people it is going to take a long time just depending on your
00:57:48.320 | circumstances of your income and things like that.
00:57:51.200 | I think it's a worthy goal for everyone.
00:57:52.720 | I would say more globally though, like what I say is that we have this one life, right?
00:57:59.080 | And before you know it, if you don't do anything active to move towards your goals, you'll
00:58:03.640 | look up and you'll be 65 and retired and just be kind of tired, right?
00:58:10.640 | Because you've spent your life doing something that maybe you're not satisfied with.
00:58:15.600 | So I think you don't want to be that frog that is in the pot of boiling water that just
00:58:21.280 | gets boiled, right?
00:58:22.280 | If you notice things in your life that are not to your liking, start thinking about them
00:58:26.400 | and being active in terms of changing your circumstances.
00:58:29.780 | So maybe it means a change in what you're doing in your spare time.
00:58:32.880 | Maybe it means a change in your job and your employment.
00:58:36.080 | But make those changes, start moving every single day slowly towards your goals and those
00:58:42.760 | changes and your effort will compound.
00:58:45.040 | And five years from now, you could be living the life that you dream.
00:58:49.280 | So that's what I would say.
00:58:50.280 | Dr. Iyer Well, great.
00:58:52.280 | Thanks, Doc.
00:58:53.280 | If listeners want to get in touch with you, learn more, where can they find you?
00:58:56.800 | Dr. Kahn I think the easiest is for most of us is going
00:59:00.040 | to be my blog, which is thedarwiniandoctor.com.
00:59:04.680 | It's where I have sort of chronicled my journey so far and where a lot of the big events gets
00:59:11.600 | chronicled.
00:59:12.600 | I've actually surprisingly gotten kind of a following on TikTok.
00:59:17.560 | So I have like 110,000 followers on TikTok at The Darwinian Doctor.
00:59:24.080 | And it's the same thing for YouTube.
00:59:27.040 | And I think I could get into a little bit more detail in sort of like video format because
00:59:31.400 | you can just communicate a lot more rapidly.
00:59:33.800 | So it's sort of a very good corollary to the blog.
00:59:37.200 | But those are the two places where people can easily find me.
00:59:40.200 | Dr. Iyer All right.
00:59:41.480 | Well, thanks so much.
00:59:42.480 | And listeners, if you enjoyed this episode, please rate, review and share.
00:59:47.520 | And if you want to stay in touch with Financial Samurai, I'm at financialsamurai.com/news.
00:59:52.680 | All right, take care and thank you so much, Doc.
00:59:54.640 | Dr. Kahn Thank you so much.
00:59:55.840 | This was really fun, Sam.
00:59:57.200 | Bye.
00:59:58.200 | Dr. Iyer Bye.
00:59:58.360 | (sips)
00:59:59.280 | you