Hello, everybody. It's Sam from the Financial Samurai Podcast. In this episode, I have with me a special guest, Dr. Daniel Shin from the Darwinian Doctor. Say hello. Hey, Sam. Really happy to be here. Thanks for having me. So, Daniel, you started your site a couple years ago or no, maybe four or five years ago after you became a doctor.

It's interesting to me that I've seen a proliferation of doctors who are writing about personal finance when I was thinking to myself, "Why not just focus on being a doctor and make a lot of good doctor money, save, invest, and then you'll be set, good to go for the next -- for the rest of your life after, let's say, 20 years?" What inspired you to start your site as well as start a TikTok site and all this other stuff?

Yeah, absolutely. I mean, there's a lot of credit that I think we have to give to Jim Dolley, who is the founder of the White Coat Investor blog. He's, I would say, considered by many to be sort of the progenitor of a lot of the physician finance blogs. But I think for me, it was more than just wanting to sort of copy that model.

A couple of years into becoming a surgeon, it was really interesting for me because you have to understand that for doctors, you go for literally over a decade trying to achieve this goal of becoming a physician. It goes through college, through medical school, and through residency training, which for some people is as short as three years, but for most people can be four or five.

In my case, it was six years of residency training. So you're talking about like a 14-year journey to become an attending. Then you get there, and all of a sudden, that's something that you're supposed to do for the next 30 or 40 or maybe even 50 years in some cases.

So that was my experience. And then the first year or two was this incredible period of learning new skills and getting comfortable with being sort of in charge of my own medical direction. But then just a couple of years in, I went through this interesting period where I felt very secure in being a surgeon.

I was good at my job. My patients loved me. I had a low complication rate. I felt that I was very good. And then I was looking and thinking about my life, and I didn't see any obvious goals or outlets for all the energy that I still had. And I think a lot of physicians kind of go through this, where you kind of reach the top of the hill, and then you look around, and then you just stay there.

You're supposed to stay there for decades. And in my case, I sort of wanted a creative outlet. I thought that would be a good way of keeping life interesting. So I started the blog as sort of a creative outlet. I've always loved writing. And in terms of goals, I fixated on the goal of financial independence as a new goal, because I thought that was one that would be very interesting.

And I thought it would be interesting writing about the ways that I was trying to achieve that. So that was really the start of my blog. It was a number of reasons, but it was for a creative outlet, and it was also to have sort of a new vehicle to express my goals.

Got it. Yeah, I remember working in finance. And the only reason why I started Financial Samurai in 2009 was because I thought I was going to get laid off, and I needed something else to do, because it was pretty dicey times then. How many years were you as a attending-- not attending, or what's it called?

Just a-- Attending, yeah. Just a practicing doctor before you started. And you hear all these stories about long hours during residency, and then a stressful job being a surgeon. Did you do surgery? Yeah, yeah, urologic surgery. So I treat sort of surgical conditions of the urinary tract. So if you get a kidney stone, you'll call someone like me to come take care of it, and you'll be-- we'll both be very happy once you're through that experience, because it's very painful.

Got it. And isn't that a long and stressful day, usually? Yeah, absolutely. At this time, there was a lot of things about my job that were great, but a number of things that were not so great. I was working 50 to 60 hours a week baseline, just doing my job.

And then at the time, I lived in Southern California. I lived in Los Angeles and practiced down in Orange County near Disneyland. So I was driving literally 2 to 2 and 1/2 hours every day just in the Southern California traffic. So I was feeling burnt out. And it was interesting, because burnout, traditionally, you would think of someone in their 50s working really hard.

And they've been doing it for decades as a physician. And in my case-- and I think, actually, a lot of physicians nowadays, we're finding burnout earlier than we used to. And that was the case for me. Interesting, because I think part of becoming a physician or getting to the top of any type of well-paying field is to have the endurance to keep on going no matter what.

And do you think there's some kind of disconnect in terms of the people who are in medical school thinking about what life will be like as a physician versus what happens and what life is like after they get there? Yeah, absolutely. And I think this has always been the case, except that now people feel more empowered to talk about it.

We're in this world of social media where there's a lot more openness and transparency. But I think the term that we're looking for is arrival fallacy. And a lot of people work towards a goal, and they expect that once they achieve that goal, their life's going to be incredible.

And it's going to stay that way. But I think we're very adaptable creatures. So once we reach a goal, it's great for a little bit of time. And then all of a sudden, you're saying, "Oh, this is just life now." So you're sort of searching for that next thing all the time.

Did you have some pressure to become a doctor? Because I remember in high school, I knew there were some of the kids who wanted to be doctors very early on. Our salutatorian became a doctor, and he was always very smart. And I was like, "No, I can't get those trade As.

Nope, not me." But he also went to William & Mary, and then he went to medical school. I just knew I couldn't do it. So did you have some kind of predetermined view of being a doctor? How did you decide to be a doctor? Yeah, absolutely. I mean, I'm Korean.

So when I was growing up, there were sort of a few professions that seemed to be an option for me. And it's not like my mom sat me down and said, "Okay, Dan, you can become a doctor, a lawyer, or an engineer." But in church, that was sort of what the other Korean moms would brag about.

And after a time, becoming a physician actually did seem something like I was really interested in because I didn't have a very good understanding of what people did in "finance." And I think that's something that you can talk about and how you ended up going into there. But for me, I sort of understood what doctors did.

It's like doctors help people get better, and doctors are respected, and doctors make a good living. And all of these things sort of seem to make sense. And when I started college, yeah, I basically started out with the goal of becoming a physician. And I sort of meandered a little bit.

I took some time off in college. I did other things and eventually did come back to pre-med and eventually went to med school, and that sort of became the goal. Got it. Where did you go to undergrad and medical school? So I went to undergrad at Yale University. And then afterwards, I was a philosophy major there, so I had a couple of pre-med requirements that I still had when I graduated.

So after that, I did a year at Penn, just kind of finishing up med requirements. And then I went to the University of Pittsburgh for medical school. And then I did six years of urology residency at USC in LA. Oh, wow. So that's interesting. So getting into Yale is kind of impossible nowadays.

What do you think enabled you to get into Yale? And then how did you feel going from Yale to Pittsburgh Medical School? So I think about this, and it's one of my favorite conversations these days, talking about other-- So I went to Yale, my wife went to Yale, her sisters went to Yale.

So when we get together on family vacations, we kind of sit around and say, oh, are kids ever going to get into Yale? It's so much harder now. We talk about these things, right? And then there's been recent things in the news about affirmative action and legacy and all that stuff.

But I think the thing, when I look back, I did work really hard in high school. I was valedictorian. I got straight As. I got a 1540 on the SATs. I was drum major. I did track. I was in student government. I did all sorts of stuff. And I went to governor's school.

So I mean, I did work really hard early on. And when I got into Yale, I was incredibly happy and grateful. And I think that even when you do all those things, even when you check off the boxes, it's still a crapshoot. Because acceptance rates are low now, but they were low back then as well.

And I think a lot of things kind of have to go right. And I just got lucky. I don't know if you got lucky. Because if you did all those things like governor's school, I didn't even know what governor's school was in high school. They seem like you did a lot of things.

So did your parents say, "Hey, you need to get into one of these schools when you're at a young age," or were you self-motivated? I think it was both, honestly. And I've talked about this and written about this on the blog a lot. But my family struggled financially for a significant part of my childhood.

I mean, when I was very young, in the '80s, my dad was working in real estate in Manhattan and as kind of a commercial broker. And things were quite good. But then there was a recession. And then his entire sort of livelihood dried up. And pretty much from middle school onwards, we really struggled financially to a point where at times my mom was worried about just buying us food for dinner.

And it coincided with a time when I was starting to realize what was going on as I was getting older. And I could tell that one ticket to financial stability was to go to a good college and get a good job. So that did motivate me. I think that also my parents, I have to give them a lot of credit because I think one thing that they did convince me of, and I don't know how much was internal versus external, but they said, "Look, you're smart.

You have a lot of potential and you should try to fulfill that potential." And it's something that sort of I still believe in. And I believe for all people that if you have abilities and if you have talents, you should share them with the world. You should try to achieve to the limits of your potential.

And I think that did sort of instill that self-motivation that helped me to achieve both in high school, college, med school, et cetera. What do you think the percentage split is between genetics, smarts, natural ability, and work ethic? And just two variables in terms of getting into college and having a successful career.

So this is a really loaded conversation, right? Because I think that getting into college is, there's so many factors that have to go right. I do think that even though my family struggled with money, they from a very early age invested in my education. So when we were choosing between buying new shoes and getting cumon, like math lessons, my mom and my dad would choose lessons and all these things that they felt that were going to be important in getting ahead.

So I think a lot of it is sort of the environment in which you were raised, which is related to privilege and sort of education and all that. Genetics I think do have a correlation with IQ, right? But something that I am realizing more in my 30s and 40s is that pure intelligence only gets you so far in life.

And I do think that at the extremes it can kind of work against you, but so many of the really successful people that I see nowadays and the people that I admire, they didn't go to the best colleges. And if they did the SATs, maybe they wouldn't get what I got, but they have other skills that are in life that are even more useful.

Like they're incredible with people, they can relate to people, they can motivate people, they can communicate. And all these things I think can be even more important than pure intelligence. So I got to lock you down on an exact percentage here because this is like a quiz here. So that would be, I guess, nurture what you're talking about.

So give me a percentage because there's only two variables and then we figure out one variable, we know the other. So in terms of genetics and nature, what do you think that percentage is? In terms of your success, determining your success in life, getting ahead. Genetics versus nurture, so nature versus nurture?

Correct. I'm going to go 50/50. 50/50, that's the safe bet. It's a safe bet, but it's so true because you see these people who are clearly, clearly smart, right? Some people are too smart. I was talking to someone's father, an incredibly smart guy, and he said that from the age of five he looked around and realized he was smarter than everyone, including adults, that he was encountering, right?

And to him, I think that obviously in certain aspects of his career, that was a luxury because he could do computations, he could have insight into various problems. But in a lot of ways, I think that worked against him because he was very bored and very isolated as a child because he saw himself as just different, right?

It wasn't necessarily that he was better. I think it just kind of isolated him. So on the other hand, a lot of people who maybe aren't the smartest, but they have those skills that we talked about, they're definitely going to go farther and have gone farther in life than people like that.

And it's definitely a mix. And you see the success of very, very wealthy kids, right? And maybe they're not the smartest, but they were supported and continue to be supported by their family who might have a lot of resources, and I would consider that nurture, right? So I think that more and more I'm realizing pure smarts will only get you so far.

You have to have that support if you want to succeed in life as well. And one can make up for the other. >>No, you're absolutely right. It's always interesting because as a parent, I'm thinking to myself, how much effort should I put into parenting and how much are they just going to figure it out on their own?

So you have kids, right, Daniel? >>Yeah. I've got a five-year-old and a nine-year-old. They're two boys. >>And when you think about them going to college, how do you see that? What if they don't get into Yale? >>So they're young, and who knows how the next 10 years are going to go.

But I would love for them to go to Yale. It's like I had an incredible experience, and when I got there, I realized that I wasn't the smartest person in the room. I was surrounded by all these people who were incredibly accomplished and interesting and much, much better than me in a lot of ways.

I think in a lot of ways, I focused so much on academics in high school that I stunted my social growth. So it wasn't until literally first or second year of med school that I was like, I think I kind of get this whole social thing now. So I was like president of my med school class and things like that because finally, I felt like I sort of got it, how everyone relates and everything like that.

But in college, when I first started out, I was behind, absolutely, in terms of social interaction and all that stuff. When I think about that for my kids, I think there's so many factors that go into it. I would love for them to go to Yale. And when I think about them objectively right now, I think they're both very smart.

But again, that only gets you so far. So smart plus lazy will not get you as far as smart plus very determined. So I'd love for them to go to Yale, but I think that they're going to be successful regardless. >> Okay. I guess I asked this question because you decided to go to medical school and be a doctor and do that route.

And there seemed to have been a dissatisfaction that fell upon you just not too long after you started working, despite the income, despite the status and all that. So would you want them to go through that same path? And how do you think you would have done things differently if you knew then what you know now?

>> So I would start out by saying that I'm incredibly grateful to the medical path that I did. Because even now, I'm spending about a quarter to a third of my time in medicine still. I do locum tendens urology, which is I kind of visit places and help them fill a specific need.

And I travel around and do that. And I spend the rest of my time in business like real estate and the blog and content creation and all that. And I am incredibly grateful because I never would have had the freedom to do this if I hadn't gone through medical training and had that very high income to sort of give me the freedom to do all this stuff.

But you're right. I mean, if I had to think about it for my kids, I would not recommend them to go into medicine, certainly not surgery. Because the six years of training that I had to do to become a surgeon, I came out very well trained. But it was torture.

It was 80-hour plus weeks. One week I hit, I think, 120 hours or something like that. It was ridiculous, right? And there's so much life that you give up along the way in medical training. And honestly, the equation of medicine for physicians today is very different from what it was 20 years ago.

There's much less autonomy. Most physicians now are employed. Most physicians now are burnt out. And these are well documented in surveys that have been done throughout the pandemic. And certainly things are worse now than they were just three or four years ago because of the pandemic. But this is well documented.

So you're talking about a physician workforce now that is in more debt than they used to be. They're more burnt out than they used to be. And they have a lot less control over their lives. So if I were to recommend to my kids what I would want them to do with their lives, I would want them to do something where they have complete control over their schedule.

So entrepreneurship and business, I think, offer that. And they're a lot of the reason why I chose in 2018, 2019, as I was going through this creative process with the blog and figuring out how to get to financial independence, I decided to shift towards investing and real estate because I felt like that was the path.

And to get that life of autonomy where you can decide exactly what to do with your week, that's how you get there. You don't do it by having a traditional job where you beholden to an employer. Well, it definitely helps, though, to have that foundation of income and your learning so you can have those savings to invest.

It's an interesting journey that I think many people wonder from the outside looking in. Doctors, they make good money. So let's talk about money because you were open about that with TikTok and how much you made. So can you give listeners an idea of how much you made as a resident and then how much you made your path over the next five years and then why you shifted from moving from Southern California to Tennessee?

Sure. So I think people know this now because a lot of people like on TikTok and are very transparent about resident salaries. But residents and these are training doctors, they are physicians, they have an MD, they finish medical school, but they're kind of learning their specialty. You can make anywhere from like $45,000 a year to $70,000 a year.

I think that's really typical as a resident. And you do that for three years. You do that for six years or seven years in some cases. And you're working, remember, probably about 80 hours a week, depending on your specialty. Doesn't seem safe working eight hours a week if you're actually doing some surgery.

What do you think? I think that it is not ideal, but it's the way that medical training is created. And is it safe? So we kind of had a rule in residency. And if you're safe to drive, you're safe to operate, to do surgery. I think the problem is that now they've shown that being sleep deprived is equivalent to like drinking X number of beers.

And certainly after being on call for 36 hours, which we did routinely, I would drive home and I crashed. I actually crashed once in residency. It was a fender bender, but I crashed. And there were probably a hundred close calls where I almost crashed. And this is because you're driving home and people say, "Oh, you should just like take a nap before you go home." And you don't understand.

After 36 hours in the hospital, you'll do anything to get out of there. You just want to go home. So you're not going to go to the call room and nap for 20 minutes because you just want to go home. So anyway, so it's not a deal. So on the 36 hours, is that straight being awake or do you get an hour or two hours of sleep?

It depends. So many times it was being awake straight. And this was in... So first year of general surgery, I was in-house call. And that means that when you're on call, you're there because you have to be able to respond at a moment's notice to a car crash coming in.

And someone needing emergency surgery. And I think in a lot of cases, it was so busy that you were awake the entire time. And maybe you would sleep for like 15 minutes and your pager goes off and then you have to like call the nurse and say, "Yes, it's okay to give this guy Tylenol." Or, "Okay, thank you for telling me that he's constipated." You know, all these things.

So it depends on your specialty, but then after intern year, I was at home call. So you can actually go home in some cases if you're not needed in the hospital. But in residency, I was at the county hospital. And when you're covering the county hospital, there's so many emergencies.

A lot of the times you're at the hospital still 80% of the time. And the trick about home call is that since you're not technically in-house, you work a normal day the next day. So in a way, after intern year, things were better because if you got super lucky, maybe you didn't get called that much.

But in a way, it was harder because you were on call overnight, maybe spending the entire night in the emergency room or in the operating room, and then you work a full normal next day. So you're just exhausted the entire day. So pluses and minuses. >> Dr. Kim: Yeah.

I would say for listeners, I wouldn't want a resident to do any kind of big surgery on me. I'll ask them straight up, "How long have you been here?" Because I know for myself, after working, let's say, 10 hours, I'm dead and I'm done. I miss things. I get in accidents, all that stuff.

So this seems like a problematic system. But go on. So you're talking about 40,000 to 70,000 as a resident. And then afterwards, what can you make or what are you making then? >> Dr. Keltner: Right. So urology is one of the better paid surgical specialties. It's consistently in the top 10.

And as an attending level urologist, after a few years, you're probably going to be making between $400,000 to $600,000 a year. And when you start out for the first few years, depending if you're employed or if you're going into private practice, it might be significantly less. Might be about $300,000.

But you can usually plan on making at least $400,000 as a urologist in our nation today. And then some urologists on the upper ends of the earning spectrum may earn a million dollars. That's rare, but it can happen. >> Dr. Insane: Okay. So that's pretty good money, $400,000 to $600,000.

And I'm assuming there's a correlation with age and experience? >> Dr. Keltner: Yeah. Generally, you earn more. You sort of increase in income as you're building your skill set, your salary, and/or your practice if you're in private practice. I would say for the first 10 years and then things kind of stabilize and plateau.

What I've learned as being out in the real world, there's a very big difference as an employed physician and someone in private practice because employed physicians generally have a very hard cap on how much they can make. There's a salary and there can be a revenue bonus, whereas if you're incredibly productive, they'll sort of give you a certain bump, but it's tough to make a significant amount more as an employed physician.

In private practice, they're actually sort of like a hybrid between a doctor and a businessman, business people, because they have these ancillary income sources where they can make money from their lab. They can make money from the surgical center. This is all things that can help surgeons and other specialists sort of get to those upper income levels, but you have to be a savvy business person.

Right. So, as a surgeon yourself, if you're not doing surgery, are you just not getting paid as much? You can be a consultant doctor and still make money? Yeah. So, it really depends on your specialty. Orthopedic surgery, if you're not doing surgery, you're not making money. They try to spend all their time in the operating room because that's, first of all, a lot of people break bones, so that's where they're needed.

That's where the need is, but also that's where they make money. In urology, it's a little different actually. So, a lot of the ways urologic surgeons actually make the most money generally in the clinic doing diagnostic scopes and things that are outside of the operating room because they're much more time efficient.

So, you could do a lot more quick procedures in the clinic or in the surgery center than you can in the main operating room with full anesthesia and all these other costs. So, it's very dependent on the specialty. So, when you were in residency, when was your light bulb moment to say, "I want to be a urologist who helps mostly men maybe get their kidney stones out of their bodies?" What was that epiphany moment like?

It was actually, I remember it well. It was third year of … Actually, no. So, third year was when I did my first rotation, but the epiphany moment was in second year when a urologist came and gave us a lecture. When you're in medical school, you get a lot of specialists who come in and say, "This is what I do and you can do this too." He showed a video of laser lithotripsy, which is one of the ways that we treat kidney stones.

You put a tiny little camera up the bladder to the kidney and the patients usually sleep almost all the time. Okay. Thank God. So, you use a fiber optic fiber to deliver laser energy to break kidney stones. When you see videos of this, it looks like a video game.

When I saw that, I was like, "That looks awesome." Still, it's one of the most fun things you can do as a urologist, break kidney stones. I thought that I would be very good at it and that I would like doing it and that was true. I had this rotation spot open in the beginning of third year.

I just filled it with urology. It was my first third year rotation and I loved it because I learned that urology is not only kidney stones. You also cure cancer. You can cure kidney cancer. You can cure bladder cancer. You could help people urinate better and you could help men have better sex and things like this.

A lot of these things are great because you're curing cancer, but a lot of the satisfaction that you get as a urologist is helping people with these very basic things because you don't understand how good you have it if you're urinating normally and so you can't pee normally. Then you'll do anything to get back to normal urination.

A lot of these things, you're helping people get back to themselves and they're very thankful. That was what brought me to urology. I know as men, as we get older, we need to start peeing more at night. What percentage of your patients are older? It seems like AGE is a huge variable for having these problems.

Yeah, absolutely. I would say the majority of your typical urology patient is probably 60 to 70 years old and male. We do treat a lot of females too because men and women get kidney cancer and kidney stones and bladder cancer, but the majority of our patients are men for sure.

Do you have any advice for those of us who are not 60 or 70 or 60 or 70 to try to be more preventative so we don't see you? Sure. The number one thing that you can do, you can't really do much about getting an enlarged prostate. It's genetic.

It's autosomal dominant, usually passed down through your father, et cetera. But you can drink plenty of water and stay hydrated because that's going to stop you from getting kidney stones. If you have any predisposition towards it, like your parents have kidney stones or anything like that, you should probably be drinking between two and three liters of water a day and that's going to dilute your urine.

You remember science, right? If you have something that's diluted, you're not going to form as many crystals. You're not going to crystallize. So that's how it works in the kidneys as well. Okay. So let's say I'm a 78-year-old man who has to go to the bathroom every two hours.

Is it kind of too late for me and am I trying to just drink a lot of water during the day and have a certain cutoff point before I go to bed? I'm just trying to think about one person in particular to try to help him out. Yeah, absolutely.

So you're talking about lifestyle modification and that's always the first step. So cut off fluids two or three hours before you go to bed. That way your body has time to process it and that helps to a certain extent. Once you sort of get beyond those things though, there's medication.

There's a very common medication that sort of relaxes the prostate and it helps you pee better and can kind of reduce those nighttime bladder overactivity issues. And then there's surgery. There's medication. What is that medication called? Yeah. So they're called alpha blockers and there's medications like Tamsulosin which is one of the most common ones and there are a variety of them but Flomax is the most common one you might hear of.

Flomax. Yeah. And have you ever encountered a situation where you would prescribe to your patient Flomax or whatever these alpha blockers are and then they would encounter a rejection from the insurance company saying we are not going to cover that? You know, they're very effective. They've been around forever.

So generally your generic alpha blockers are going to be covered. They're super cheap. They're super cheap. If the doc's prescribing an alpha blocker that's not covered, just tell him to stop prescribing the flashiest thing and just prescribe one that is generic and cheap because there are plenty to choose from.

Okay. Good to know. So we know one of the problems or issues that doctors face is declining insurance reimbursement rates that has hurt the income generating power of doctors. Do you see that in your field? Yeah, absolutely. So this would be sort of an hour's long talk all to itself but the industry of medicine and healthcare in the United States is so messed up and it has gotten this way because of many different things.

But you could argue that, I think very convincingly, that the major reason is the for-profit insurance companies that basically control healthcare in the United States. And anyone who wants to change it just gets drowned out by millions of dollars of lobbying. So it would be much, much better for us to be in a single payer system, Medicare for all.

It would totally be better. There'd be so many less people uncovered. The baseline level of medical care in this country would go up. I don't know if doctors would be happier but they might be. It may limit the ability of some doctors to make stratospheric levels of income but it's no doubt in my mind that from a public health perspective, there shouldn't be single payer or universal healthcare.

We're the only developed nation at our level that doesn't have it. And everything from infant mortality to just like diabetes care and all these things would be so much better if we changed our system. Got it. Got it. Yeah. It is interesting. I remember when I left my day job in 2012 and then I no longer had health insurance provided because my wife left in 2015 when she was 35 as well.

So we were stuck and we had to buy our own health care insurance and at the time for two people, it was around $1,650 a month. And I was thinking to myself, "Wow, this is like so expensive." And we had trouble getting reimbursements and coverage. And so I said, "I'm just going to buy UnitedHealthcare stock and all these healthcare providers because they're just crushing us.

So if you're going to crush me, I'm going to at least invest in you guys." And these guys have been great investments. Yeah, that was very smart of you to do because they're making tons of money. And it's one of my... So I'm on TikTok as the Darwinian doctor and one of my favorite other doctors that I follow is Dr.

Glockum Flecken. It's a tough mouthful, but basically it's this ophthalmologist who produces these incredibly funny skits and he acts out all the characters. But over the last few years, as he's grown in fame, he's found a voice criticizing for-profit health insurance. And he goes into a lot of things.

It's like the pharmaceutical industry is messed up, for-profit health insurance is messed up and he summarizes it incredibly well. But basically one of his recent skits basically highlights that insurance companies see you as a dollar sign. And they want you to give them the most amount of money possible and then die.

Okay, that makes sense. To make way for other well-paying people. And they don't actually want to cover stuff. So a lot of times it's been well proven that a lot of times they'll automatically just deny coverage for various things just as a cost-saving measure. And then it's just messed up.

It's tough. It's tough. We had an issue when our daughter ate too many eggs and we didn't know that she was allergic to eggs. So she started swelling up and then the whole ambulance debacle was crazy. I'm so thankful that they came in time of need. But then the 20-minute ride was $3,800.

And we're like, "What? Come on. $3,800." So it's almost like the consumers are afraid, afraid to get medical coverage because they don't know exactly how much coverage the insurance company is going to pay or how much is going to come out of their pocket. So there's a lot of fear in terms of I'm sure there's a lot of undiagnosed people who are suffering because of the cost of health insurance.

That is so true. And I think there's a lot of attention now to it. And it's so entrenched that you've got this entrenched healthcare, pharmaceutical industry, insurance complex. And it's hard to know how that's ever going to change. But you have this growing discontent among all the citizens of this country that are like, "This is messed up.

We should have better healthcare." And it's almost like going to come to a head in some way. Who knows how doctors end up on that. So a lot of me diversifying my income by investing has been sort of hedging my bets because who knows what's going to happen to healthcare in this country.

You might as well have other sources of income, other investments, other than just working as a physician. Right. Tell us about your move to Tennessee because it seems unconventional. I know from a doctor's perspective you can make more in lower population cities around the country, but I don't think you moved for that reason.

Why did you move from Southern California, which is sunny and nice and glamorous, to what part of Tennessee are you in now? I'm in Memphis, Memphis, Tennessee. Okay. So basically my move from Southern California to Memphis, it was a number of things coming to a head. After six years with my medical group in Southern California, I basically made it, or I tried to optimize it as much as possible.

I had a Tesla, so the commute was much better. I was chief of my department, so I felt a lot more sort of ownership and autonomy in my day to day. But again, I've been disillusioned with healthcare to a lot of extent, and I love practicing medicine, but there are a lot of downsides of being a doctor, right?

You know, covering a call and all these things. And I also, by that point, had a large and growing business of real estate, right? So I had a portfolio that I was managing in my spare time on the weekends, and I was additionally writing the blog and creating short form video content and all these things, and I loved that stuff.

That was fun for me and also interesting, and I wanted more time for that. And I didn't really see an ideal way out, right? So a lot of my time was spent kind of wondering about this and wondering where I was going to go. But then my wife, who is in the museum field, basically was recruited to lead the museum in Memphis, and this was sort of at a crossroads for her, where either she could continue doing her museum job in LA, which she was very good at and they loved her, or she could take a leap and try to make this big career step and it could potentially go great.

So we basically decided that for both of us, we were about 40 at the time, it was about a year ago, and we're like, "This is the time to make a leap like this," right? We had thankfully saved a lot of money, invested well, so financially we're stable, and we were at a point where even if we made this move and everything went horribly, we could start over.

We're young enough. But we figured our kids were young enough, we're at a point in our careers where it was time to do something like this. And I think most people sort of don't want to do that. They want to just keep the status quo, and they'll just grit it out, and they'll do it for 20 years, 30 years, and then retire, and then live for 14 years and then die because that's what happens.

But for us, we're like, the trajectory of our lives, I have this goal of where I want us to be, and it's this vision of freedom and growth and contribution to society. And I thought that we had a much better chance of getting there if we took a leap like this.

So she took the job. I told my medical group that I was quitting. And then since then, we've relocated here. And it's been incredibly challenging, but we're making it work. And I think overall, we're much happier. Well, if you're much happier, that's a win to me. I know from your, I think your TikTok videos or something that, so she got a pay increase, but you did not, no?

What are you doing in Memphis? Yeah, so her pay is equivalent, I would say. That was one of the stipulations of her coming across and taking this larger role. She wanted to at least make the same amount of money. And so that was part of her contract. But for me, I knew that I would be in the short term taking a huge loss because they wanted her to start right away.

And I published this post where I basically calculated that I lost about half a million dollars moving to Memphis because I wasn't working for about five months because I was working on my medical license. I hadn't lined up a job, but they wanted her to start right away. So a lot of people criticized this.

They were like, "You idiot. Why did you move without lining up a new job?" And I don't think they realized that my wife actually makes a very good living and that they wanted her to start immediately, right? So we, in the course of just four to eight weeks, moved across the country, you know, and we had to buy a new house.

We hadn't sold our LA house. So we had to come up with the cash for that. And then in the five months that it took me to start practicing medicine again, I lost about 250K or 300K in opportunity costs of not working. But for us, we knew that would happen.

And we were okay with that because we had savings, et cetera. And again, we were taking a calculated risk. Since then, I did talk to traditional practices out here, and they were not really cool with the level of sort of autonomy and freedom that I wanted over my week.

So instead of joining a private practice, I'm doing what's called locum tendens medicine, where you sort of are a for-hire physician that you'll come in and say, you know, a hospital suddenly has someone quit or retire or get disabled. They need to cover and get help with those patients.

So you come in and you help them. And it is very efficient in terms of time and income, and you have complete control of your schedule. So that's what I have been doing for the past few months. And we're working on the finer details in terms of all of it, but it's working out pretty well so far.

Okay. Going to a new city, new state with family seems to be tough for me. I don't think I can convince my wife to move at all. I mean, it's hard enough to convince her to move houses in the same city, let alone a new state and city. I know Memphis is a booming city in terms of at least real estate, but the diversity in Memphis is different from the diversity in Southern California.

Can you talk about how adjusting to a different type of city culture has affected you guys as an Asian-American family? Sure. And I think it's a very pertinent thing to talk about because diversity is important. So Memphis is actually a majority black city, and it has about 2% or 3% Asians.

Wow. Really low. Yeah. I mean, coming from San Francisco where, I don't know the Asian percentage, but it's got to be at least- It's like 50%. Yeah. It's huge, right? So when you look around and when you walk around, you see many fewer Asians. And my kids, they're half-E's.

They're half Korean, half Caucasian. But the Korean identity is important to us. But even in a place where there's only 3% Asian community, there's still Asians. And so my kids still go to Korean school. My parents came with us to Memphis, and they go to a Korean church on the weekends.

Interesting. So you can still find community. But I'd be lying if I said that restarting in terms of your social life and forming friends and all that is not challenging. That's one thing that we're working on. But we're willing to put in the time and make it work. Okay.

So it's hard, but it's maybe not as hard as you thought. It's like an adventure? Yeah. I mean, I think that's what we're seeing it because we know that professionally, my wife and I are much, much happier. The schooling options were actually much better here. So in LA, we couldn't even get a call back from the admissions director at the top private schools in LA.

It's like-- You don't want to go to Harvard, Westlake, or whatever? It's like Hunger Games. It's like Hunger Games out there. It's like you're going to be fighting against the entertainment industry like Progeny, who are like billionaires. So it's hard to get attention at the good private schools. But they were incredibly welcoming here in Memphis.

So the nation is kind of sleeping on Memphis. It gets a bad rap because of crime. And those are the things that make the news. But there is an incredibly passionate philanthropy sort of community here that is investing into the city. And they saw bringing in my wife and bringing my family to the city as like a big win.

So they were like, "Okay, so we're going to help you get into private school. We're going to help you get set up here and there." And it has been an incredibly welcoming experience. And in that regard, I think it's been a lot more seamless than we expected. That's good to hear.

I think it actually sounds like it helps being a Korean American where the population is only 2% to 3% because you're more unique. And so you bring different viewpoints, culture, profession, all that good stuff. So that's pretty good. I know I talked to my wife about whether we should move to Virginia or Hawaii.

And the reason why I say Virginia or Hawaii is because I grew up in Virginia for high school and college. And the Asian American community, there was something like 5% or 6%. And I encountered some occasional racism, some fights, public schools. But in retrospect, I think it really toughened me up and it has made me more resilient in terms of the ills of the world and combating and standing up for yourself.

And I was saying to myself, "Well, why don't we go back to Virginia and just kind of rough and tumble it a little bit more?" It's not like Virginia is that rough and tumble but like versus going to Hawaii where it's majority Asian, it's good lifestyle, peace, awesome love, great weather.

And she said, "Absolutely, we're not going to Virginia." So I'm trying to think about the parallel of you going to Memphis, Tennessee versus staying in Southern California and we go to Honolulu, Hawaii. Because I like the grit. I like that. It's just real. It's the real world. How much do you think we're sheltering our children in developing?

Because if we send them to private schools and they grow up in a nice house and their parents earn money, are you afraid that you're going to make them soft? And how are they going to function in life? Yeah, I mean, I think it is no doubt that our success means that our children are going to have less challenges in terms of things in their childhood.

I think that's – it's funny. It's almost like a double-edged sword, right? You want to do well so that you can provide for your kids. But a lot of the experiences that shaped me and made me who I am and make me sort of this like determined striver who always wants to improve myself, a lot of that came from the challenges that I saw when I was growing up.

We were poor for a certain part of my childhood. And that made me want to achieve so that I can provide for my family in a very good way. But we talked about this. So in LA, it's like perfect weather, right? And I always joked that everyone I encountered from Southern California in life always went back to Southern California for their professional lives.

It's almost like they couldn't hack it with the weather that exists outside of Southern California. So my kids, when it's hot here because it's very hot in Memphis, they wilt. I wilt too. We're not used to it. But yeah, I think that there is a risk that if you provide too much, you can make your kids "soft" or whatever.

But I think that doesn't mean that you don't want to provide a good education. That doesn't mean that you don't want to buy them clothes and things like that. I think you have to provide them with challenges in other ways. So challenging situations and challenging programs, there are other ways to do it.

And we haven't figured it out. My kids are young still. But we'll both have to do that, I guess. Yeah. So tell me about your net worth goals and your financial goals. Because you left, I'm assuming, a $400,000 to $600,000 job as a urologist in Southern California. I'm assuming you're making less than that band in Memphis, but the cost of living is much lower.

What is financial independence to you? And do you have specific net worth targets? And how do you come up with those targets? So I was very calculated about this. So two years into Tendinghood, when I was making a certain amount of money and it was a reliable paycheck and I knew what things were going to be like, I used that to project out a 15-year plan to financial independence.

And I knew exactly how much we were spending in Southern California and how much we're likely to save and an 8% return in the stock market. And I calculated that we would need about $6.5 to $7 million of investments. And by the 4% rule, that would provide everything we needed, including inflation and all that, and we'd be good, right?

Things are a little bit different now because after a while, I decided that actually the fastest way to financial independence is through residential real estate because so much of your return is in cash, in rent payments, and you could use that to just directly offset your living costs. So you don't have to abide by the 4% rule anymore because you can just pay for things out of the income from the rental property.

So over the last four or five years, I've increasingly shifted our investments to real estate. So that has shifted my goal of a certain sort of investment number in the stock market to a cash flow number from real estate. So about a year or so ago, I calculated that the cash flow that we've created already with our portfolio, which is 28 units currently and worth about $9 million of real estate, the cash flow we generate has cut off about five years from that financial independence goal.

So we're probably going to get there, this was one or two years ago, I was like, "We're going to get there probably in about 10 years or less." And then I didn't publish it, but I secretly feel that we're going to be there in five years or less, right?

So in terms of income, by the way, in terms of transparency, by working seven to 10 days a month in urology as a traveling urologist, I'll still be making 400K plus a year. Oh, wow. Seven to 10 days a month, that's it? Seven to 10 days a month. And how many hours a day is that?

About 10 hours a day. So it's a long day and I'm covering call, I'm doing procedures, I'm doing surgery, it's busy. But the rest of the time I'm home, I'm talking to you, I'm working on business and it's an incredible amount of freedom outside of that. So for me, that's actually much more satisfying in terms of a balance.

And so my income has not, it's gone down because I was making, when I left Southern California, about 600K a year. So it's gone down from there quite significantly, but it's allowing me freedom to grow areas of business that have much higher potential. So I was never going to make more than 600K as a urologist in Southern California.

I was very lucky to make that and I'm very grateful for that, but I knew that it's unlimited what you can make in business. So for me, making 300 or 400K a year as a locum tendens urologist and having all that extra time to work on the blog, work on social media and real estate investing, it has, I have no doubt that it's going to be much more lucrative in the long term.

Okay. So that's interesting. So six to seven million was the target, but it's, it sounds, so when you said 9 million in real estate, is that just total real estate exposure excluding the debt you have on the real estate? Excluding the debt, correct. Yeah. So if I were to sell it, that's how much you would get, but then I wouldn't end up with that because I have to pay back all the mortgages and stuff like that.

Right, right. Yeah. Got it. Well, it sounds like you have a lot on your plate, but then, you know, knowing that you only do seven to 10 days out of a 30 to 31 day month, that, that sounds pretty great. It leaves you a lot of time. I mean, how long do you think you can do?

What's your ideal duration to do this kind of hybrid day job work and entrepreneurial work for? So I, I would love over the next year or so to get to a point where I am status quo, where I'm, I'm happy in all aspects, all, you know, I see it as the triad, right?

So there's like traditional medicine, there's my family and there's business. And over the next year I would like to get to a point where I can sustainably do that balance forever because I've sort of like find the balance that works for me. And I think I'm pretty close actually.

So doing medicine seven to 10 days a month I think is satisfying that, that itch for medicine and I love practicing. I love surgery still. And if I can do that and just be gone one weekend, one week a month, including the weekend and having the rest of my time to just be present for my family, I think that's pretty good.

And I am hoping to scale up pretty rapidly in multifamily real estate, which takes a lot of investment in terms of making contacts and like finding investors and things like that. So I think I can do that with the time that I have outside of medicine very, very easily.

So I think I'm pretty close to sort of a permanent sustainable thing. You know, ideally I wouldn't have to travel to do the medicine part, but if I do, I think I'm okay with that, at least for now. Got it. Got it. So in conclusion, any departing advice for listeners in terms of medicine, entrepreneurship, going on the path, what would you say to them who are actively looking to achieve financial independence?

Yeah, I would speak to it sort of more globally, like in terms of life trajectories, right? So I think everyone should be going towards financial independence. Absolutely. But I think for a lot of people it is going to take a long time just depending on your circumstances of your income and things like that.

I think it's a worthy goal for everyone. I would say more globally though, like what I say is that we have this one life, right? And before you know it, if you don't do anything active to move towards your goals, you'll look up and you'll be 65 and retired and just be kind of tired, right?

Because you've spent your life doing something that maybe you're not satisfied with. So I think you don't want to be that frog that is in the pot of boiling water that just gets boiled, right? If you notice things in your life that are not to your liking, start thinking about them and being active in terms of changing your circumstances.

So maybe it means a change in what you're doing in your spare time. Maybe it means a change in your job and your employment. But make those changes, start moving every single day slowly towards your goals and those changes and your effort will compound. And five years from now, you could be living the life that you dream.

So that's what I would say. Dr. Iyer Well, great. Thanks, Doc. If listeners want to get in touch with you, learn more, where can they find you? Dr. Kahn I think the easiest is for most of us is going to be my blog, which is thedarwiniandoctor.com. It's where I have sort of chronicled my journey so far and where a lot of the big events gets chronicled.

I've actually surprisingly gotten kind of a following on TikTok. So I have like 110,000 followers on TikTok at The Darwinian Doctor. And it's the same thing for YouTube. And I think I could get into a little bit more detail in sort of like video format because you can just communicate a lot more rapidly.

So it's sort of a very good corollary to the blog. But those are the two places where people can easily find me. Dr. Iyer All right. Well, thanks so much. And listeners, if you enjoyed this episode, please rate, review and share. And if you want to stay in touch with Financial Samurai, I'm at financialsamurai.com/news.

All right, take care and thank you so much, Doc. Dr. Kahn Thank you so much. This was really fun, Sam. Bye. Dr. Iyer Bye. (sips) you