Physician Empowerment

Kevin Mailo, Wing Lim, Dimitre Ranev

Physician Empowerment is an organization dedicated to transforming the lives of Canadian physicians through education in finance, practice management, wellness, and leadership. read less
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Episodes

41 - Staying inspired through community and shared experience
1w ago
41 - Staying inspired through community and shared experience
Physician Empowerment co-founders Dr. Kevin Mailo and Dr. Wing Lim address why the events and masterclasses they hold are key to the foundations of Physician Empowerment overall. The promotion of wellness, health, and transformation in all areas of a physician’s life - mental, financial, leadership, practice - is the impetus behind everything they do. This translates into how they approach events and the focus of masterclasses.  As Wing Lim reminds listeners in this episode, Physician Empowerment was created to form a community and network for peer-to-peer empowerment. He reiterates the four foundational pillars of its existence: 1. Physician wellness, 2. Financial health, 3. Leadership development, and 4. Practice transformation. Those pillars factor into how they present learning in a conversational and community-friendly way. Kevin Mailo stresses that it isn’t just about being better in the future but having that better life now. Wing and Kevin address what they’ve learned from mentors, what they hope to impart to the community, how the masterclasses are designed not just to impart facts but shape a different way of thinking, and their hopes that everyone can share their journeys together.__Interested in going further in your financial journey? Join our national conference and meet the PhE team live in Toronto this May 25 and 26th: https://www.physempowerment.ca/live __Physician Empowerment: Register for the Physician Empowerment Live Conference in Toronto on May 25 - 26, 2024Join the Physician Empowerment Masterclass now
40 - Capital Gains in Real Estate Investments with Jason Pisesky
Mar 30 2024
40 - Capital Gains in Real Estate Investments with Jason Pisesky
Physician Empowerment Masterclass Faculty Member and tax lawyer Jason Pisesky returns to the show to talk with Dr. Wing Lim about capital gains in real estate investments. Jason and Wing explore everything to do with real estate from tax to property depreciation and personal versus corporate real estate purchases.Jason addresses how the Income Tax Act applies to real estate and the nuances involved with the PRE or Personal Residence Exemption. He explains some of the insights that apply to buying and flipping houses, up markets and down markets, and depreciable capital property. Personal versus corporate purchases, income versus capital gain, and active versus passive axis are discussed in broad terms, enough to give a clearer understanding of what Jason will be addressing in greater detail in future episodes and at the Physician Empowerment Live Conference in Toronto in May. The knowledge Jason shares is foundational and directly applicable to anyone with an investment mindset.–About Jason Pisesky:Jason is a tax lawyer with an international accounting firm, KPMG. His practice background is extensive and includes personal and corporate tax planning as well as litigation and dispute resolution. Whether you are scaling up your practice or winding it down, proper coordination between a tax lawyer and your accountant can ensure you're doing it right.Jason is one of Physician Empowerment’s professional Masterclass Faculty members.__ Interested in going further in your financial journey? Join our national conference and meet the PhE team live in Toronto this May 25 and 26th: https://www.physempowerment.ca/live __Physician Empowerment: Register for the Physician Empowerment Live Conference in Toronto on May 25 - 26, 2024Join the Physician Empowerment Masterclass now
39 - You as the Most Important Investment with Dr. Michelle Jackman
Mar 15 2024
39 - You as the Most Important Investment with Dr. Michelle Jackman
Dr. Kevin Mailo welcomes physician coach, Physician Empowerment masterclass student, and 2024 Physician Empowerment conference speaker Dr. Michelle Jackman to the show today. Physician Empowerment not only focuses on financial health but on the mental and emotional health of physicians as well. Dr. Jackman’s coaching aims at that need for emotional well-being and improves the mental health of physicians throughout their careers.Dr. Michelle Jackman came to physician coaching during Covid, by asking questions about her own career path and satisfaction. She worked with Dr. April Elliott, an executive coach, and Dr. Nadeem Lalani, a physician coach, and the self-awareness she gained guided her into leaving the career path that wasn’t satisfying her and into coaching instead. She describes coaching as allowing us to prioritize ourselves and allowing us to make a commitment to ourselves and not just to our jobs and demands.Dr. Mailo and Dr. Jackman discuss all aspects of physician coaching from acknowledging strengths and learning from accomplishments to evidence-based neuroscience and how our brains can be rewired to change our thought patterns. Michelle offers small group and one-on-one coaching and she describes the benefits of both to Kevin. She affirms that asking for help is not a sign of weakness but of strength and encourages physicians to seek out coaching if they need support.Dr. Michelle Jackman will be at the Physician Empowerment Live conference in Toronto on May 25 and 26. –About Dr. Michelle Jackman | physician coach, PhE masterclass student, 2024 PhE conference speaker:Dr. Michelle Jackman is a practicing pediatrician, born and raised in Ontario. She grew up in the City of Kawartha Lakes and is a University of Toronto Alumni OT1. She completed three years of surgical residency at Queen’s University in Kingston and earned her FRCPC in pediatrics in 2008. Dr. Jackman has been clinical lead at the Pediatric Centre for Wellness & Health at Alberta Children’s Hospital since it was established in 2012. Her clinical passion focuses on supporting children and youth at risk for obesity through this multi-disciplinary program. Her clinical expertise is in supporting children and youth with mental health and metabolic and mechanical co-morbidities of obesity to achieve their best health. She recently completed her executive coaching certification and coaching mastery program through Erickson International and is passionate about bringing coaching into the medical field to help her colleagues navigate challenges, excel in their professions and increase their fulfillment in all aspects of their lives.Michelle lives in Calgary with her husband and daughter. She enjoys making her daughter laugh and being out in nature and mountains on bikes, skis and horses.__Physician Empowerment: Register for the Physician Empowerment Live Conference in Toronto on May 25 - 26, 2024*Early Bird pricing ends March 15*Join the Physician Empowerment Masterclass now
38 - The Transformative Power of Coaching with Dr. Angie Hong
Feb 28 2024
38 - The Transformative Power of Coaching with Dr. Angie Hong
Dr. Kevin Mailo welcomes Toronto-based family physician and obesity medicine practitioner Dr. Angie Hong to the podcast. Dr. Hong has been involved in coaching for a few years now and joins Dr. Mailo to talk about the differences between coaching, mentoring and therapy and the specific value of coaching. Dr. Angie Hong stumbled into coaching when she accidentally joined the wrong course at the University of Toronto and found herself in Solution Focused Coaching instead of Solution Focused Therapy. She stayed in the course and “fell in love with coaching”. Angie describes the enjoyment she gets out of helping a client reach a goal that sometimes isn’t even their original goal but something born out of self-discovery. Dr. Mailo and Dr. Hong discuss how physicians specifically find Angie and the challenges that drive them to seek guidance. Angie describes the feelings of emotional burnout and exhaustion that coaching can be effective in assisting and preventing. The journey of a physician drives towards burnout in many cases and Angie believes that engaging with coaching earlier, in medical school even, can help combat the issues that compound later. Dr. Angie Hong will be at the Physician Empowerment Live conference in Toronto on May 25 and 26. –About Dr. Angie Hong:Dr. Hong has been a family doctor for over 20 years and has focused on metabolic health and disease for almost a decade. She is a fellow of the CCFP and a diplomate of the American Board of Obesity Medicine, one of the first family doctors in Ontario to earn this credential.Dr. Hong is also an International Coaching Federation Coach, a body recognized globally as the gold standard of professional coaching. In addition, she is a graduate of the University of Toronto Brief Coaching program and was mentored by world-renowned researcher and coach Dr. Haesun Moon.For the past seven years, Dr. Hong has had the privilege of teaching coaches and healthcare providers throughout North America at various schools and organizations, including Obesity Canada, CBT Canada, the University of Alberta, and the University of Toronto, among others.Dr. Hong lives in Toronto with her husband, three teenage daughters, and her dog Hugo. Her downtime is spent with family and friends and laughing at dog memes. However, she can usually be found taking another course to increase her skills and knowledge.Dr. Hong’s passion for lifelong learning is driven by her commitment to providing the highest level of care and service to her patients and clients.Learn more about Dr. Hong's services and contact her via her website at AngieHongMD.com__Physician Empowerment: Register for the Physician Empowerment Live Conference in Toronto on May 25 - 26, 2024*Early Bird pricing ends March 15*Join the Physician Empowerment Masterclass now
37 - Tax Benefits of Family Trusts, with Masterclass Faculty Member Jason Pisesky
Feb 15 2024
37 - Tax Benefits of Family Trusts, with Masterclass Faculty Member Jason Pisesky
Dr. Wing Lim welcomes Physician Empowerment Masterclass Faculty Member and tax lawyer Jason Pisesky back to the show. Jason talks all about trusts from a tax perspective. He explains not only the history of how trusts came to be but also how they are defined today and how they work, offering knowledgeable insights into the complex topic.Jason explores the tax and non-tax benefits of family trusts, detailing the tax advantage of the multiplication of the capital gains deduction. He also explains the lifespan of a trust, the beneficiaries, how income splitting factors into a trust, and how family trusts are useful in facilitating the movement of assets from one company to another in a tax-deferred way. The topic of family trusts is a dense and layered one but the information Jason provides here works as a good base of knowledge. This information can then be further explored in a Masterclass.–About Jason Pisesky:Jason is a tax lawyer with an international accounting firm, KPMG. His practice background is extensive and includes personal and corporate tax planning as well as litigation and dispute resolution. Whether you are scaling up your practice or winding it down, proper coordination between a tax lawyer and your accountant can ensure you're doing it right.Jason is one of Physician Empowerment’s professional Masterclass Faculty members.__Physician Empowerment: Register for the Physician Empowerment Live Conference in Toronto on May 25 - 26, 2024*Early Bird pricing ends March 15*Join the Physician Empowerment Masterclass now
36 - Individual Pension Plans with Nick Giovannetti
Jan 30 2024
36 - Individual Pension Plans with Nick Giovannetti
Dr. Wing Lim hosts Physician Empowerment Masterclass Faculty Member and Certified Financial Planner Nick Giovannetti on the show today. Wing and Nick talk about Individual Pension Plans, or IPPs, breaking down how they work, who qualifies, and what sorts of benefits they provide for physicians. Nick has a wealth of knowledge about CPPs, RRSPs, and IPPs that he shares in this episode.Nick Giovannetti explains that IPPs are not a new financial tool, they’ve been around for over thirty years in Canada. But RRSPs have been around longer and are less complicated than IPPs to administer. There are more complex forms and filings to fill out for the CRA where IPPs are concerned and Nick says the lack of awareness about IPPs and the fear associated with the complexity prevents some accountants and planners from informing their clients about the IPP benefits. So Wing and Nick dive into exactly what an IPP is and how you can best benefit from it. They cover everything from contribution limits and family member beneficiaries to buyback and defined contribution versus defined benefit pension plans. This episode gives an overview of why Individual Pension Plans are worth exploring.–About Nick Giovannetti:Nick is a Certified Financial Planner® with a fully Integrated Wealth Planning Team. His approach to financial planning centers around a deep understanding of clients' goals and objectives, fostering long-term relationships built on trust and transparency.Nick is one of Physician Empowerment’s professional Masterclass Faculty members.__Resources mentioned in this episode: “Kentucky Fried Pensions” by Christopher B Tobe and Kenneth C Tobe--Physician Empowerment: Physician Empowerment MasterclassLive Conference 2024--TranscriptDr. Kevin Mailo: [00:00:01] Hi, I'm Doctor Kevin Mailo, one of the co-hosts of the Physician Empowerment podcast. At Physician Empowerment we're dedicated to improving the lives of Canadian physicians personally, professionally, and financially. If you're loving what you're listening to, let us know! We always want to hear your feedback. Connect with us. If you want to go further, we've got outstanding programing both in person and online so look us up. But regardless, we hope you really enjoy this episode. Dr. Kevin Mailo: [00:00:35] Hi everyone, so glad to have you out tonight for another webinar featuring the topic of IPPs, Individualized Pension Plans, which were in fact established by the federal government back in the 90s. They were not very well known until last 5 or 10 years when they've started to take off. But there are a lot of ins and outs to using these properly, and they have certain advantages over RRSPs that incorporated professionals really need to be taking a close look at. So to go on this deep dive, well, I shouldn't say it's that deep a dive, the deep dive is going to come with the masterclass. So if anybody's interested in that, do reach out to me and we'd be happy to talk further about having you join the masterclass, because this topic is dense. So Wing is going to take us through it tonight, and he's going to do it with one of our masterclass faculty, Nick Giovannetti. And Nick is an Integrated Wealth Planning Specialist, holds a lot of designations, and he and our other masterclass faculty member, Simon Wong, have done a ton of outstanding teaching on topics like this. Because you want to know what it is you're you're using when it comes to wealth creation and advanced tax planning. That's where these topics are so, so powerful to cover, like we're going to do. So again, if you have questions, you're interested, reach out to us. But let me take it from there, Wing, and hand it off to you. If you want to go ahead and introduce Nick to everybody. Dr. Wing Lim: [00:02:08] Sure. So good to see everybody and hear everybody's voices later. And yeah, this is very exciting episode in December this year. And we thought we'll wrap up the year by something that is really important. And that's about the RRSP, IPP, and the pension world. And like we said in the intro on social media, we're going to unpack this mystery box. So our guest today for our fireside chat is Nick. And Nick has a lot of designations. And he's actually also a multi-talented Renaissance man, I guess, he was previously an international recording artist. You might want to explore that on the different dimension of him. And we just talked about one of his designation is about cash flow personalities. Right? And we'll probably do an episode on that, definitely will be a lot of fun. But today we're going to talk about this project, sorry, this platform. There's RRSP that everybody probably heard about and some people do RRSP, some people don't believe in RRSP. Right. But then there's IPP pension world. So Nick, maybe you should walk us through, when we talk about this, you said you got to bring in CPP too, so may as well bring in CPP, RRSP, IPP. So walk us through a little bit of a history lesson and how it's pertaining to incorporated professionals. Nick Giovannetti: [00:03:33] For sure, yeah, thanks for having me, everyone. Like Kevin had mentioned, you know, the Individual Pension Plan, it's not a new financial tool. It's actually been around for over 30 years here in Canada. And as we know, the RRSP or the Registered Retirement Savings Plan has has been around even longer than that. It's been around since the 50s, and it was actually something introduced by the Canadian Medical Association because physicians even back then, yeah, physicians even back then were saying-- Dr. Wing Lim: [00:04:02] -- one for us-- Nick Giovannetti: [00:04:04] -- hey, we need a retirement vehicle. We need something tax sheltered. They'd done a lot of research back then, and to them it made sense to say, hey, where can I put money now, get some tax relief today, invest and grow that pot of money in a tax sheltered environment? And then I can strategically, you know, pull it out in the future and give myself predictable and secure income, something that I can count on in the future. So that's really what happened in the early 90s, was that small/medium business owners, they wanted pension plans. You know, a lot of people look at especially medical professionals around the hospital, how many of your coworkers and colleagues in the hospital have pension plans? And that's something that I think a lot of physicians look at and say, what if I could have that? What if I could even just contact the Healthcare of Ontario or OMERS or Teachers Pension and say, hey, can I just contribute to this? Can I become a plan member? And then I can also have a defined benefit pension in the future. Nick Giovannetti: [00:05:07] So physicians are not alone. Business owners have been wanting that, self-employed people have been wanting that. So in the early 90s, the first ever one of one, so one person to one company pension plan was allowed by the Income Tax Act. And it's called an Individual Pension Plan. So you could be one business owner, have one pension plan, and you're the only plan member, but you can take advantage of all of the rules that all the other pension plans in Canada follow. So everything that everyone is very fond of, federal government workers, teachers, firefighters, police, you can benefit from those same retirement savings rules. So from contribution limits to tax deductions to predictable guaranteed income in the future, you can create your own. And it's been around a long time. So if you're a physician that is incorporated, you should really look at this as part of your overall planning. Dr. Wing Lim: [00:06:05] So how does it compare to RRSP that everybody knows? Nick Giovannetti: [00:06:09] So there's a few key takeaways or few key differences and one would be that the RRSP happens on a personal level, and the Individual Pension Plan happens on a corporate level. So what I mean by that is if you want to participate in an RRSP, you're going to have to pull money out of your corporation, pay some tax, and then you're going to have to then contribute to an RRSP with your after tax personal income, and then hopefully get a tax refund on the personal side. Now the RRSP is also limited to a certain amount of contribution room, so I'll touch on that in a second. The Individual Pension Plan side, it works a little bit differently. So you can actually earn money to your corporation and if you have a pension plan, the corporation can right away save that money into a pension before any tax has ever happened on those dollars. Okay, so that's one of the big key advantages. So then the second one I touched on was contribution room. So Registered Retirement Savings Plans are capped to 18% of your salary that you pay yourself or bonus, so it's got to be salary or bonus, on the personal level, defined benefit pension plans can get as high as 30% of salary, which is a big difference. We get into, you know, a difference of 30 grand a year to 50 grand a year when it comes to maximum savings room. And on the pension side, because the government really treats pension plans favorably, you have a lot of additional ways you can put money in a pension plan. So I'll touch on a few of those. Nick Giovannetti: [00:07:46] First one is, the government cares about what the rate of return in an Individual Pension Plan is, and what they want to see is a minimum 7.5% rate of return and a maximum ceiling of it's about 9.375. They want to see pension plans grow in that window, averaging every three years. And if your pension is not growing at that rate, you're actually allowed to put in more money. When we look at the RRSP, nobody cares if your RRSP grows at 7.5%. You care, but the Government of Canada is not going to let you put more money in if your investments are not performing well enough. So you got a fail safe there. And you can also do strategies like dry powder hedging, where you purposely underperform your investments so that you can put in more money. So there's some unique strategies there. I would say another one is, defined benefit pension plans your income is based on a formula. So you know, very predictably, what are you going to have as an income stream in retirement, whereas your RRSP, it's totally up to you how you want to pull the money out. Some people pull out a lot quickly, some people don't pull out enough, some people just do the minimum that the government wants to see you pull out. So there's a lot of room for error on the RRSP side, where the Individual Pension Plan can be more predictable and easier to plan around because it's been created for you by a formula. Now there's a few different, Wing, that we could dive into. But I'll punt it back to you and we'll see where we go. Dr. Wing Lim: [00:09:28] So I guess it's a good time to talk about these formulas. Who writes these formulas? Who dictates these formulas? Nick Giovannetti: [00:09:36] It's a great question. So it's a legal framework that goes back to when the first Income Tax Act was created. Your pension plan could be structured in a way so that you're going to have, you know, a flat benefit. So it might be I paid myself this much salary, I worked for my company this many years, I'm this certain age, so I get a flat benefit based on a formula of a couple factors like that. There's also another factor which could be career average earnings. So it doesn't matter if you paid yourself lower salary in the beginning and then you upped it later on, you know your pension could be calculated on an average. You could also do it so that it's a final or best average earnings. Or a percentage of contributions. So these formulas, when you set up and register your Individual Pension Plan, the CRA actually has a registration form. And on the form you're going to check off these boxes of how do you want that formula to be identified. And it's in the Income Tax Act as to how that calculation will be made. Dr. Wing Lim: [00:10:41] Right. So this is way more complicated than RRSP. Right? So maybe we could just maybe help, maybe I will use a layman's way to bring everybody on the same page. So basically if you work for a big firm you have a nice pension plan. Right? And the employer and the employee are different people. But now with this IPP platform, they allow professionals or business owners to actually be the same person, that the employer/employee is the same entity, well same person, right, different entities. But to ensure that the benefactor of the pension plan gets so much dollar sometimes guaranteed and so that's why they have these elaborate formula. Right? But then who is funding it, well in our case it's the PC. So if you come to our masterclass, the whole series is called Fat PC Skinny, right? So you want to have a fat PC but you want a skinny me, but not a starving me, right? So you definitely want the money to come out, especially in the golden years, right? That you've done your hard work. And so you want the pension to come. And now is a way to efficiently fund this piggy bank called IPP. Right? And so that's why there's a lot more calculation than RRSP. So let's look at, yeah there's some difference. What about some similarity? At age, what, 71 both plans have to kind of be put an end to it. Can you elaborate on that, Nick? Nick Giovannetti: [00:12:11] For sure, yeah. So the similarity there is that the government of Canada, so the Income Tax Act wants you to have to start pulling money out of either an RRSP or your pension plan by age 71. You can, in an RRSP, decide to pull it out earlier, and you can do so with a pension plan as well. Some pensioners I've seen start an IPP and actually turn on their pension income as early as their mid 40s. So you have a lot of flexibility there as to when you want to start drawing the money out of these accounts. But traditional retirement age in Canada is 65, and you can delay that to 71 if you want to push it off as far as possible. Dr. Wing Lim: [00:12:55] So with IPP, you still have to do the like the RIFF and all that, right? Like there's to pull the money out there's no difference whether you have RRSP, IPP. Is there a difference the way that you pull the money out past 71? Nick Giovannetti: [00:13:07] Yeah, that's a great question. So with an RRSP it gets converted to, you mentioned it, it's called a RIFF. It turns into a Registered Retirement Income Fund. And the government will have a calculation as to how much you have to pull out each year as you age. And you're going to be doing that through wherever it is, your money managers, your trading, what have you. You have to pull out that minimum, but you could ultimately pull out whatever you want. With an Individual Pension Plan, you actually have three different options to how you want to pull the money out. So the first option is whoever's managing your Individual Pension Plan, you're going to just instruct them and sign the form that I'm retiring from my corporation and they will ask you, how do you want to pull out the money? Do you want monthly installments based on your defined benefit formula, or do you want a one year, once a year, lump sum, boom here's my payment? So that's the first way you could. So the money manager continues managing your money. Same with a RIFF and you're just getting your distributions. Okay? The second way, if you don't want any market risk, you can actually take your defined benefit pension that you save for yourself and you could go to a life insurance company and you could actually buy something called a copycat annuity. Nick Giovannetti: [00:14:24] So these are available even now for teachers, firefighters, police officers, doesn't matter. If you have a defined benefit pension, you can go to an insurance company and buy something called a copycat annuity. Now the word copycat means whatever your income you are guaranteed to have, so the distribution let's just say it was 200 grand a year of pension income, the annuity will guarantee you that paycheck every year for a certain chunk of whatever your investments were in that defined benefit plan. And then depending on interest rates and annuity rates, you might actually have a little extra so you'll get paid a bit of cash and you'll have this guaranteed income the rest of your life. Now, the third way is you could shut your Individual Pension Plan down entirely and go right back to RRSPs. So we call that a wind up. So you could shut it all down back to RRSPs or into a RIFF, and you're going to have a certain amount of your pension that's allowed to transfer. So it's a tax free transfer back to the old way. But generally speaking, you will have a chunk of money that is extra that can't transfer back to an RRSP. So you'd have to take that as an income the year you decided to do a wind up. But you actually have three different ways that you could collect. Dr. Wing Lim: [00:15:47] Right. Okay. So you got more choices, more diversity, right? More versatility. That's great. Let's talk about defined benefit versus defined contribution: DB versus DC. Because as physicians we haven't heard a lot about it, we just know that most people nowadays have a defined contribution plan meaning that the company would match you. Right.? Some of you may, listeners, may be working for a big hospital. You might be in a pension plan already. So defined contribution meaning that they define how much you contribute. They did not define how much you get, which is the benefit. And way back, there's every plan is a DB plan and now who's left with these juicy DB plans indexed with inflation? Well, our Premier, our Prime Minister, a lot of politicians do, but most corporate owners they only define a contribution not define benefit. So let's talk about DB and DC in the IPP world. Nick Giovannetti: [00:16:46] For sure, yeah. So a defined contribution pension, I think you already touched on it, Wing, the only thing defined is the amount you can contribute. And it's actually the same contribution amount to that of an RRSP which is 18% of your salary up to the maximum allowable each year. So you can put in 18% of your salary. And then when you retire, it generally just turns into a RIFF. So same as RRSPs, right? So you're going to have the choice of taking out the minimum that RIFF allows or as much as you want, but whatever you pull out of that is going to be taxable income when you pull it out. So there's nothing really more predictable about a defined contribution pension than that of an RRSP. It's just that defined contribution pensions you can contribute through your corporation, whereas an RRSP you contribute personally. Now defined benefit pension, what's defined is your benefit, the predictable guaranteed income that you're going to receive for the rest of your life. And Wing touched on it, it could be indexed to inflation, meaning that if the cost of living goes up 3%, then your pension distributions next year will go up 3%, right? That just happened with Canada Pension Plan. Everybody got a 6.5% bump to their income because inflation changed in Canada. It was a big bump to the cost of living. So everybody collecting those defined benefit Canada pension plan cheques got a nice bump. So defined benefits are formula based on what you're going to receive in the future. Defined contributions are really a corporate version of an RRSP. Dr. Wing Lim: [00:18:30] I guess some people have a fear that if they're stuck in a DB thing, that they, if they don't have a good year, they can't contribute. Right? But you say that it's just like the RRSP, right? And if there's a year, let's say you fallen sick or you had a bad year, you took a sabbatical, and you cannot contribute that much into the IPP, would it collapse? Nick Giovannetti: [00:18:52] That's a really great question. So it was, I believe it was the end of 2020 where if you're a connected person to your IPP, meaning I own 10% or more of the shares of the company that is sponsoring the IPP, so in most cases for a physician, it'll be your MPC sponsoring the company, you own all the shares, or hopefully you own at least more than 10%. You're what's called a connected person. You don't actually have to contribute to your IPP at all because you're a connected person to that pension. You own majority share of the company sponsoring it, or at least 10% of it. Your family members are also connected. So if you added a spouse or children, you don't have to contribute for them either. So a lot of the fear, Wing, of having to contribute to an IPP to top it up or boost it up, if you go on sabbatical you're behind, maybe you don't have the cash flow that year, a lot of those fears are now gone. If you were to have an IPP set up and you didn't own the company and somebody set that up for you, they would be liable to fund it the same way that if you worked for the hospital, teacher, firefighter, whatever, they have to top it up, right, General Motors, big union companies, they have to top up their pensions. So you have some flexibility as the owner. Dr. Wing Lim: [00:20:08] Right. And for the years that you didn't contribute full amount, then there is buyback or catch up. Right? There's this feature? Nick Giovannetti: [00:20:16] There is, yeah. So even if you've been incorporated let's say for 15 years and you've never had an IPP and you decide to open an IPP right now, they can do a calculation and they look at pension adjustments, your RRSP room, your your current RRSP balance, how much you paid yourself in the past and they can go back in time and say, okay, Doctor Lim, you have a catch up of 300,000 just for setting up a pension and never paying yourself salary again, but you just have, you still currently have 300 grand of room. And then you could pay yourself a salary that year, have a percentage of salary and carry forward. So you do have the ability to buy back, but it will be offset if you took care of some, if you were contributing to RRSPs. because they're going to do a pension adjustment to offset what did you put in RRSPs? What were your unused room? How well did the RRSP perform? And then that will work into the calculation of the buyback. Dr. Wing Lim: [00:21:17] So if you have had an RRSP and you're contemplating starting IPP, so what happens to the RRSP once you start the IPP? Nick Giovannetti: [00:21:25] So if you want to participate in the buyback, then they're going to use your RRSP balance as part of the calculation. And what will happen is, high level example, when you have 500 grand to buy back but based on the pension adjustment calculation, you have to take 250 grand from your RRSP, and it's called a qualifying transfer, it's tax free, you have to move 250 grand from your RRSP over to your pension, and then it would allow you 250 grand room to contribute. The rest of your RRSP, whatever's over and above that minimum transfer, you could leave it external, leave it as an RRSP, or you could bring it into your pension under a secondary account known as an additional voluntary contribution account. Dr. Wing Lim: [00:22:15] Right. So there's a lot of flexibility. And then there are certain age related benefits, right? With the room, contribution room versus RRSP. So when does the gap start to widen big enough to be meaningful? Nick Giovannetti: [00:22:30] Yeah. So, defined benefit pension plans, the formula of the matching of the salary is about 12.5% of your salary when you're 18 years old for a defined benefit plan. And RRSPs are 18%, and defined contribution plans are 18%. But by the time you're 38, the defined benefit matching curve has caught up to the 18% already. It's a little over 18% by the time you're 38. And then from the age of 38 all the way to 71, it gets as high as almost 30% of salary. So really, you'll see a lot of people heavily look at Individual Pension Plans if they're going to do the defined benefit schedule. A lot of people will heavily look at it when they reach 40. Dr. Wing Lim: [00:23:18] Right? So 40 is kind of the turning point. Nick Giovannetti: [00:23:21] The turning point for most, unless they have one of the combination registrations, so their pension has both types. You can have it where you have both types, a defined contribution and defined benefit. So if you registered it that way, a lot of those professionals will just start whenever they start, because you don't lose contribution room and you can just convert it over whenever it makes sense. Dr. Wing Lim: [00:23:43] Right. So you talk about a lot of these calculations that have to be done right. And if it is not, I heard that there's very stiff penalty from CRA. Right? And so who does all this, all these calculations? Nick Giovannetti: [00:23:59] Yeah. So when you have a pension plan it's really important to have a good team. So as part of that team you need actuaries. There's got to be an actuary or a team of actuaries that's calculating all the math behind these complex pension calculations. And there's a lot of them out there, lots of different companies doing that. So it's important that's kind of step one. You could go a step further and make sure on that team you have pension lawyers. And it's good to have pension lawyers because they can also help with a lot more of the compliance factor of your pension plan, because you will be registering it with CRA as Doctor Wing Lim pension plan, registered pension plan. So it's important to have a team that is familiar with pensions, they're able to help you manage the non-investment related factors, and then you'll have an investment team that takes care of the money. And hopefully you have an accountant and a planner that help you with the distribution and the planning side. Dr. Wing Lim: [00:24:56] So the beneficiary of these plans, so it could be me, the doctor, the spouse. What about kids? Nick Giovannetti: [00:25:02] Yeah. So you you can, you can absolutely name your children as beneficiaries, and you can even add children to an Individual Pension Plan if they work at all or have any level of employment with your corporation. Dr. Wing Lim: [00:25:17] So if they're employed, not a dividend, not T5, but they have to be T4 as well, right? Nick Giovannetti: [00:25:23] That's right, yeah. Dr. Wing Lim: [00:25:24] Right. Then they could be part of the IPP itself. But for the beneficiary let's say after you turn 71, right, you want to take money out. So kids probably well grown up by then, so they don't, do they have to be employed by to get the benefit, they don't have to be, right? Nick Giovannetti: [00:25:40] So if they, if you wanted to make them a beneficiary so if you passed away where would all these assets go, no, they don't have to work for your company to be a beneficiary. But if they wanted to be a plan member because you're looking for some different intergenerational wealth benefits, then at some point they would have to have an employee relationship with your company. I've seen the employment income as low as $3,500. I've seen some people hire their kids to do admin and social media work. Maybe they pay them 10, 15 grand for that. Whatever you do, they just have to be paid at least minimum wage for whatever job it is that they're doing. And they could be added with just one year of service. Dr. Wing Lim: [00:26:23] One year of service. And this applies not just to kids, but to the spouse as well. Right? Nick Giovannetti: [00:26:28] 100%. Yeah. So a lot of professionals and business owners will find work for their spouse to do, and then they can add their spouse to their pension plan, and the company can contribute to that spouse's pension plan. Right? Because most likely a pension plan contribution room will be quite a bit higher than that of an RRSP. Dr. Wing Lim: [00:26:49] Right. Yeah. And so this, we talked about TOSI in other episodes. Right? Test on, Tax On Split Income. So it's pretty harsh, but IPP is just one really smart, astute and legal way that you can do the income splitting, especially in the latter days, when you're drawing money out. Nick Giovannetti: [00:27:06] Exactly. Yeah. It's a very black and white way to get money into your spouse's hands by paying them legitimate T4 income, so salary or bonus, and saving for their retirement. And in the future you mentioned pension plans you can do income splitting on the income that comes out of it. So these are very CRA-approved registered pension plans that there's a lot of peace of mind knowing that that part of your strategy is ironclad. Dr. Wing Lim: [00:27:37] Right. And so who are not eligible for IPPs? Nick Giovannetti: [00:27:41] So those that wouldn't be eligible are those that are paying themselves out of their corporation dividends or capital gains. So if you're doing pipelining, capital gains stripping, and that's your only source of income out of the company, or non-eligible dividend, then those would not qualify for pension contributions. Dr. Wing Lim: [00:28:02] So if you have done T5 all along, right, and then you have never given yourself T4, then there is no room. Is that true? Nick Giovannetti: [00:28:10] So that means you won't have any buyback room. That's correct. Now you could change today. So you could say, because pensions are based on current year, RRSP contributions are based on previous year income, so you could decide in the year I'm going to pay myself salary this year and open a pension that year and participate in the pension that year. Dr. Wing Lim: [00:28:31] What about if you're not incorporated? If you don't have a PC, you're sole proprietor. Can you do IPP? Nick Giovannetti: [00:28:37] No. So you do need to have a corporation. Now another corporation could do an IPP for you. So if you worked for another clinic and they were employing you, they could register one for you, but you would now be a non-connected person. So they would have to fund that pension plan. And a lot of employers wouldn't do that because of the risk. Dr. Wing Lim: [00:28:58] Right. Yeah. I want to point this out because there are always exceptions to the rule. Right? And so that's what because some of our listeners, they, the first five years of practice, they haven't even incorporated yet, or they say the accountants told them there's really no reason if you spend it all, then you don't need a PC. And I have a colleague, 30 years after they started the practice, the accountant still says no need for PCs, and all these benefits, these powerful strategies, don't apply to them. Right? Or my personal story, my accountant way back said, no, don't believe in T4, only give yourself T5. So the first 20 years of my practice I only got T5, zero T4. So by the time I knew about IPP, my buyback is really small amount, right? And I wish I knew, right, I wish I knew earlier. And so that's why for people who are in the early or mid part of your career, this is something to plan. Nick Giovannetti: [00:29:52] Yeah. And I've heard all kinds of stories. And you bring up a good point because your accountant didn't only talk you out of being able to participate in your own IPP, but your accountant also doing what they did for you there, they talked you out of participating in Canada Pension Plan, because when you make the decision not to pay T4 income to open an IPP or an RRSP, you're also shutting yourself down from getting any Canada Pension Plan. Dr. Wing Lim: [00:30:20] Now this is really interesting because a lot of accounting accountants of my vintage, right, 30 years ago, but even newer ones I'm shocked to hear as they now you invest better than CPP. Do you want to make a comment on CPP? Nick Giovannetti: [00:30:36] Yeah, I mean, I've heard all kinds of very competent investors think that they can outperform Canada Pension Plan. Um, Canada Pension Plan is probably one of the best run pension plans in the entire world. And in order for you to compete with that, we could dive into that maybe in the masterclass or in another session, but if we wanted to calculate what you would have to earn, consistently guaranteed every year from now all the way till you pass away, to be able to recreate what Canada Pension Plan created for 6 to 7 grand a year worth of savings, it would be a very, very difficult thing for anybody to do, even an astute investor. Dr. Wing Lim: [00:31:19] Right. So CPP is a good thing. Right? And so when you offer RRSP and IPP, you also offer CPP right? Nick Giovannetti: [00:31:26] You do by default, you get two pensions. Dr. Wing Lim: [00:31:28] Yeah. Now, so then let's go back further about this accountant thing. And I'm not trying to belittle or badmouth any accountants. But a lot of accountants and advisors are so against IPP or so ignorant about IPP. Why is that? Nick Giovannetti: [00:31:46] That's such a great question. And from what I've come across, a lot of it is lack of awareness and fear. Or they're looking for something easy because it's easier for an accountant to pay a dividend. Right? There's a little more work involved if you pay T4 and you got to remit tax at source, they got to make sure they account for Canada Pension Plan, they got to do your pension adjustments, like there's reasons why it simplifies their life. And I've actually heard an accountant one time say to a physician, I was on this joint call, I don't mind paying you salary but I'm going to have to download all that work to you, Mr. and Mrs. Physician. It was the most unbelievable comment I'd ever heard. And sure enough, they asked me after the call, can you help introduce me to an accountant that would do this work for me? So it's not that big of a deal. A lot of it is very simplified. They do it for a lot of other business owners, because a lot of other business owners do have IPPs, so they have to do the salary. Dr. Wing Lim: [00:32:48] I'm just saying that this is a few years ago, 2020 before Covid, right? I read some stats that of all the eligible people in Canada for IPP, which is like millions, only 2% were implemented, right? The market penetration is like 2%. That's abhorring right? Nick Giovannetti: [00:33:08] Yeah. And again, a lot of that is it's lack of awareness and fear. So I've seen, I've seen what kind of benefit an accountant that is forward thinking and stays on the top of their game with pension plans, how well their clients have done and they stand out from the rest. And that's probably some of the 2%, because why would a business owner know to ask for an Individual Pension Plan if it didn't come from their accountant or their planner? And a lot of financial planners know very little to nothing about Individual Pension Plans. And where I say the fear comes from is because there is filings with CRA that need to be done. It's either done by your administration team or your planner or your accountant. And if they screw up, I've seen people wait years to get their pensions off the ground, and there's all this compliance problems and they're just not doing it properly. So again, if you're working with a team that's familiar, this stuff is like cakewalk, right? They do these things in their sleep and you get a lot of benefit. Why so many are afraid is because it is complex. It's more advanced planning. And just not everybody's prepared for that. Dr. Wing Lim: [00:34:17] So don't just find somebody that would just wing it, just by my name. This is not a place for somebody to wing it. This is complicated stuff. It has to be done properly. Nick Giovannetti: [00:34:28] Yeah. I've seen the big banks steer away from things that are complicated because they can't scale. So why do they push RRSPs even? It's because it's easy. You just sit with them, you meet for five minutes, you sign a form, boom. You got an RRSP, right? That's scalable. That's easy for them to administer. So even the big banks have participated in why only 2% of the eligible population are doing it because a lot of people deal with the bank. Dr. Wing Lim: [00:34:59] Exactly. Now. So this is awesome, Nick. Final question topic is messy one. Pension world. So if we can now do our own pension plan, what about different badging together like MEPs of the world? Even our medical associations are tapping into this thing. Can you just give us a quick overview of what that is about? It's a very mysterious world. Nick Giovannetti: [00:35:23] Yeah. I mean, there's a lot of different pension types out there. There's Individual Pension Plans, there's Multi-Employer Pension Plans, there's Joint Employer Sponsored Pension Plans, there's Specified Multi-Employer Pension Plans. So pension plans are a complex world. They're actually an entirely different section of the Income Tax Act than that of the RRSP. It's got its own section because there's so much complexity of how you can put these together. And I'm sure you'll see if you dig into this world, there's so many different ones out there. And the biggest thing that I find is that a lot of pension plans have been rolled out, and they may claim to be something that sounds great and polished, but until you know the underlying way it was registered and all those little details of how much do I contribute, does my company sponsor it or do you sponsor it? Who has control? What if I don't like how you're managing it? Can I take it and go somewhere else? Can I add my kids to this plan? So there's so many things there. What about indexing, right? What happens if there's a market correction? So there's so many things out there that you do need to make sure you're aware of. And one thing I find that most business owners and professionals want is flexibility and control. And the IPP generally checks off both those boxes. Dr. Wing Lim: [00:36:52] Right. Because there are talks, right, because we're busy professionals just nose down, bum up, working to our bones. And so we don't have time to think about, oh, if some big brothers sisters come and create this plan, even our own association or a fragment of our administration, right, we thought then they must do a better job just because there's bigger group of people, more asset under management that the sexy term AUM. But like you say it may not be managed well. Right? So I listen to podcasts and there is a book called The Kentucky Fried Pension. And this is a guy who is a whistleblower, which is actually a paid job in the US, and he was investigating the Kentucky State Pension and how screwed up, this is like you say, the firefighters, nurses, policemen, that how not just mismanaged, but there is just hankie panky mismanaged, like funds got stolen, siphoned to Wall Street, some favorite pals, you know, who worked there and get whatever
35 - Be the Dumbest Person in the Room
Jan 15 2024
35 - Be the Dumbest Person in the Room
Doctors Kevin Mailo and Wing Lim join forces to talk about the “d word” that isn’t talked about enough: delegation. They lead a discussion explaining why we need to move away from assuming we know everything there is to know and instead embrace the expertise of others to achieve the best results. And how delegation is the key. Dr. Mailo and Dr. Lim break down what can and can’t be delegated out. There are crucial tasks that only we can do and must continue doing, but there are plenty of other tasks we don’t need to be spending our personal resources on tending to. They talk about the difference between delegation and abdication because very different results emerge from adhering to the wrong one. Dr. Wing Lim shares a checklist on how to do delegation the best way, with clear instructions and expectations keeping everyone informed on their part of the equation. This is an episode that’s key to freeing up our time by ensuring that we do only those tasks which require us and that we responsibly delegate the tasks that don’t need our direct involvement. –About Dr. Kevin Mailo:Kevin is an emergency physician based out of Edmonton, Alberta. He is known for his highly engaging teaching style that breaks down complex topics into memorable experiences. Kevin cares deeply about the long-term wellness of the medical profession and wants to see physicians and their families succeed personally and financially.About Dr. Wing Lim:Apart from his clinical & teaching roles, Wing has extensive experience in Practice Management and Business Development. He is passionate about sharing his extensive knowledge & experience (both clinical & business) with others in various settings, from his clinic mentoring younger colleagues, to churches, senior groups, ethnic functions, radio broadcasts, retreats, seminars, and national conferences.–Physician Empowerment: website | facebook | linkedin--TranscriptDr. Kevin Mailo: Hi, I'm Doctor Kevin Mailo, one of the co-hosts of the Physician Empowerment podcast. At Physician Empowerment we're dedicated to improving the lives of Canadian physicians personally, professionally, and financially. If you're loving what you're listening to, let us know! We always want to hear your feedback. Connect with us. If you want to go further, we've got outstanding programing both in person and online so look us up. But regardless, we hope you really enjoy this episode. Dr. Kevin Mailo: Hi. Uh, it's Kevin again on the Physician Empowerment podcast. And, of course, we've got Wing here joining us. And today's topic is very near and dear to my heart because it has taken me a long time. To develop this skill because I was very much in the micromanaging, do it yourself space. And it's been not only, I think for myself, you know, in terms of life being less stressful, but it's also been really a lot of fun because as you expand your network, you begin to broaden your horizons, see things through other people's eyes, and grow as a person. And what I'm getting at here, and I didn't use the D word yet, is delegation. And that's what's so powerful in improving our lives. So in an earlier episode on the podcast, we talked about time management. And one of the keys to time management is being able to either automate a task and streamline its process, or hand off to somebody that you trust, who maybe you've even invested some time in training up, let's say if it's a medical office assistant. So today, Wing is going to be exploring the power of delegation in our lives. Because again, you know, Wing, you've achieved so much in the space of real estate practice building while maintaining a robust and happy family life. And I would venture to guess a big part of that success has been through delegation. Dr. Wing Lim: Yeah. Delegation doesn't come easy. So let's go deeper. And this one is not going to be a talk, Kevin and I, we're just going to chat on this. The delegation, I think we all talk about the D word, right, but deep down we don't want to. We really don't want to because we trust ourselves. Right? And this is a recurring theme at Physician Empowerment. The biggest enemy of freedom may be the guy in the mirror. Because we have so many years of education and processes and because lives are at stake. Mistakes are costly to other people and to yourself. So we tend to just do it, right, and they say, if you want to do it right, do it yourself. And so years after years, post-graduate training, residency, one fellowship and all that, teaching you that you are it, you're the expert. And so you have to do it right. And because of that, we have this intrinsic trust in ourselves. And some of us become very egotistical, giant ego, and even the God-like syndrome. Right? And we don't trust anyone. So as a result, it's very difficult for medical professionals to actually delegate. I'll give you an example. There are people who would rather take the, I have colleagues that would take the blood pressure themselves, like on a patient, rather than trusting a medical staff to do it. Why do you have to do that? Right? Because even blood pressure, you know, there's a good way and bad way to do it. Okay, I understand there's some procedures you cannot delegate out, but more and more we're team based. So I think the first thing to fight is this intrinsic bend towards just trusting yourself and not trusting others because I'm smart, therefore everybody else is dumb. So therefore I don't want to water down my quality. So I don't want to delegate to you. Dr. Kevin Mailo: And let me just interrupt there and say like, this is not about delegating the crucial tasks, right? You know, like if you're a surgeon, you know, and you're elbow deep in somebody's abdomen, you really want to make sure that it's done right. That's where you want to focus your energy is on those crucial, crucial tasks, right? I mean, I do the same thing in the ER in the trauma bay, right? Like sitting at the airway, making sure it's done properly. Because that's the crucial task. But realize that delegation, and I'm just going to go on a little bit of a rant here, delegation is a resource saving measure for us, right? Because we only have so much concentration and intensity and focus. So do you want to dissipate that by like measuring every single one of your patients blood pressure, because you don't trust that somebody will put the automatic blood pressure cuff on properly on the arm? Dr. Wing Lim: Exactly. Dr. Kevin Mailo: Right? Like there has to be some limits here because if you're so focused on that, are you really hearing the history? Do you know what I mean? Or if you are doing your own taxes because you don't want to pay an accountant, or you're doing your own bookkeeping, are you missing the big picture on high level tax planning that could mean hundreds of thousands of dollars to you. Right? So there is a limit to how much attention and focus we can bring in, right? Like I can't sit there and, you know, make sure every IV that, you know, my nursing staff in the department are doing it, doing it perfectly right. Like, no, I have to sit there and be able to focus on the things that no one else can do but me and then, and be comfortable delegating and trusting my team. So that's a personal growth thing, but don't feel bad about the parts that you need to micromanage in your life. By all means do it. You can't outsource personal relationships and friendships, but you want to be present for those. Dr. Wing Lim: Exactly. So you hit it right on the nose there, Kevin. So the paradigm here is this: only do what only you can do. That's the whole thing about delegation. Only do what only you can do. You're the only one that could be your significant other's significant other, spouse, or whatever you want to call it. You're the only dad or mom your kids have, right? You cannot delegate that out, right? When you have the chief surgeon, you have to do stuff that you have to do. But then everything else you should not do, right? It's like a flashlight versus a laser pen. Right? We all understand that, right? The point of focus is to just put everything out and just do only what you can, only you can do. And then, you know what? If you're a team lead in the department and your practice and your division, you know, what's the most scarce resource is a thing called thinking. Thinking--. Dr. Kevin Mailo: -- but it's true-- Dr. Wing Lim: -- is a hard thing. Otherwise everybody will be doing it. Dr. Kevin Mailo: It's very easy to do. And I think this segues nicely backwards to our earlier talk about time. I think it's very easy. Our minds like to get into that rut of, well, I want to focus on this one detail or task because it requires less mental energy. Dr. Wing Lim: Mhm. Dr. Kevin Mailo: When really, thinking, as Henry Ford said it, is the hardest job of all. And that requires some mental space. And to get that mental space, we need to delegate. Dr. Wing Lim: Exactly. So you cannot rely on your allied professional that you delegate down to do that for you. Right? Otherwise they should be sitting in your chair. Then you need to be delegated the task and they need to do the thinking. So if you're a clinic owner, you need to absolutely do the thinking. If a department head, the list goes on and on, right? And so, yeah, so do only what you can do. And if we can chew on that and then just plan your life accordingly, your life would absolutely change and everybody around you would absolutely change. But for that to happen, to only do what you want to do, only you can do, that means you have to have the intrinsic trust in other people. And I tell people that I love to work with people smarter than me. I love to be the dumbest person in the room. I love to because then I gain a lot, right? So I have no background in architecture construction. When we built this 156 unit senior home, state of the art building that won an award, second in the world, I didn't even know that until we got the award. And who won the award? What we did collectively. But the designers did, and I found myself and my partners, this was my dream, right? And I sat in a room downtown Edmonton, top architect, or biggest architect firm in the nation, in the Edmonton branch and in there is like 15 engineers. And I look around. These guys are all very, very smart. I didn't even know there could be 15 engineers, different disciplines. They kept looking at me and my partners. What do you want? Right? So if the why is big enough, the how comes. And so once you delegate the people who are smart and I said I'm the dumbest person in this room. And time and time again and once you do the delegation, things get done despite of you. I love that, not because of me, but things got done in spite of me, right? And then big things could happen. So that's  delegation. Okay. Let's talk about what delegation is not. Delegation is not abdication. Okay, let me repeat. Delegation is not abdication. And why would you say that? Because that's the common mistake we have. And the top, top, top example is in finance. Okay, I just had a chat with one of our Physician Empowerment Masterclass attendees and this professional, we're talking about this application that we give our money to these transaction based, commission based people that set their financial advisors. And meanwhile, he's selling us products, right? Sorry. They are selling us products and they're going to help you be financially free. Maybe, maybe, maybe maybe not. Dr. Kevin Mailo: I don't know, I don't know. Dr. Wing Lim: What's assured is their commission, not your future. Right? And so this abdication just because oh, because you said you're good. I just give it to you. Give my whole life hard earned money to you. That's your abdication, right? Dr. Kevin Mailo: I mean, but I mean, you can also go the other way. I mean, you can blindly buy the market on a broad spread ETF and not pay attention to what, not that you want to time the market, but you want to time your life around the market like, you know, and ask yourself, am I ready to fall off the cliff 12 months before retirement if the market crashes, you know? And again, you can't just blindly trust a person or a process and say, well, that's good enough. You do have to, you have to manage your managers. I think that's what we teach at the course. Dr. Wing Lim: Another example. There's lots of horror story examples. We're just looking at a building in our city that was owned by a physician that went into receivership. Right.? And this dude trust to somebody else who is the expert who's going to run the whole thing. And I drove by that plaza, that plaza is full. It's hard to find parking. How does somebody run it down to the ground? Right? And now it's in judicial sale. And this, unfortunately, this guy's in deep trouble now. And so if you think, oh, real estate is going to, or whatever, you know, you pick a asset class, it's going to make me rich. No it doesn't. And unless you have a good management team, if you just blindly trust somebody, just abdicated your future, they're going to bite you back in the butt. Right? So that's a sobering example.  Dr. Kevin Mailo: And I think the other reflection here is like a lot of the time when we've done something ourselves for many years, we unconsciously know all the ins and outs of it. We unconsciously know all the ins and outs of it, and so there has to be some patience when we're working with somebody and teaching them and some humility. Right? And put yourself in their shoes and remember when you were learning that process and that thing. And so just pause, put the time in and and make sure that they understand and make sure you understand their position as somebody new to this task. And so check your assumptions before you begin to sit down and have that instructions conversation with the person that you're about to delegate to. Dr. Wing Lim: Right. And then they don't perform well and you give them heck. You know what? You should give yourself heck, right? I'm just training a new staff, a highly reliable staff just left for a higher-paid position in the hospital. Right. We do that, lose staff all the time, right? We start with new and there's a lot of assumptions. So I got angry that why is this not done? Because they're new. I didn't teach them. Right? Next thing is you need to give a clear time frame. The song I love you tomorrow, you're just a day away. It keeps postponing tomorrow. If there's no clear time frame, don't expect to get it done. And relationships get tarnished, work relationships, even personal relationships get tarnished because you always say that I'm going to do it when. Right? So if you don't have a time frame, don't expect it to be done in a hurried manner. And then there has to be measurable outcomes. If there are no measurable outcomes, it's just a bunch of warm fuzzies. Sorry. It has to be measured. If you cannot measure it, it cannot be done. There has to be accountability. So you give the task to somebody. Is that accountable? Okay, let's jump from clinical practice to finance again. I have a colleague that was told by his wealth manager, doctor in the last 20 years, in the stock portfolio, you earn 20% a year for the last ten years. Is that even possible? Right. And the only reason, if you take that up... Dr. Kevin Mailo: Of course, I know where this is going. Dr. Wing Lim: It's the annual contribution. Then you had this was making money every year. Right? Dr. Kevin Mailo: Yeah. Dr. Wing Lim: Right. And there's no accountability because you just believe them, right? Whatever they say. And same, we delegate a task to the accountant. Like I do, I trust my accountant, but I don't run business decisions with my accountant. My accountant is not the guy who makes that business decision. He makes accounting decision. Right? So the accountability structure has to be well defined, and they have to be accountable to you or somebody else on something that is measurable. That's true. Dr. Kevin Mailo: Absolutely. Absolutely. Dr. Wing Lim: Final thing is consequence. If you let people do something where whether they do or not, there's no consequence, you have endorsed the non-performance. So somebody says if you, if your staff or whoever you trust in your team, they can get away with XYZ. And they keep getting, they will continue to get away, because you blessed it. You condone it. There has to be consequences. Yay or nay, right? Good or bad. So these are some of the guardrails that is supposed to be intrinsic. But you know what, I don't think it's really common knowledge. And while talking about it, I reminded myself 3 or 4 things that, oh shoot, I didn't follow what I preached. Right? This is just reminder for all of us that to be effective, you need team. And to have effective team, you need to have this delegation process. Dr. Kevin Mailo: I love it. I love it. Dr. Wing Lim: Right. And then to have a systematic thing. If you do this together as a systematic process that's at different level, right. Delegation was just talking about this act of delegating. But then you still, somebody still need to create the architecture, the whole conveyor belt, the whole, what do you call that, assembly line. Right? And A on B fold on C glue on D and you achieve E. Like so this has to be processed, and that's called systemization which is a different talk altogether. But this is really important for us to understand that to achieve more than what you can achieve by yourself, you got to let go of this ego thing, trust somebody. But with criteria. Dr. Kevin Mailo: And again this is people skills. This is absolutely people skills and I think that's so important. Right? Not only the words you choose, the time frames you give the person you're delegating to, how you provide feedback, how you discuss consequences or outcomes, all of this is people skills, right. And again this is the barrier to delegating because you go oh I'm not looking forward to this conversation. Maybe I'll just do it myself. But again, that's not how we grow as individuals. When we grow as individuals personally, professionally, financially, it's because we're able to have those tough conversations, but just have it with yourself in the mirror before you go in there. And again, emphasize to yourself that this is a people skill. This isn't about the given task or your process or anything more than, it is a people skill. Dr. Wing Lim: Right. And it's to empower your team up to their capacity. So we have, I've joined a practice management course a long time ago and that's a different talk as well. But basically what we learned is a doctor should never do a nurse's job, RN should not do LPNs job, LPNs should not do MAs job, MAs should not do a receptionist job, receptionist shouldn't do a janitorial job. But you can see all this in every clinic, every department, right? It's all screwed up. I was a patient once a few years ago, and I found a Sunday morning there's a RN changing bed sheets. I thought, why do you need to do that? Right? That's an absolute waste of public resource. And so if we understand that process we would be a lot more effective. Dr. Kevin Mailo: I'll just chime in with a few high level practical points about delegation. And this applies, because delegation can be done in our personal life and professional life. You know, do you change the oil on your vehicle or you take it into the shop to get it done? Do you mow your own lawn or do you hire it out? And so the first sort of matrix that I get people to look through, the first lens actually, is probably a better description, the first lens I get when I teach this topic at our conference or in the Masterclasses, is the first thing you want to look through is your hourly rate. Know how much per hour you make gross. And then net after overhead. And remember, when you're calculating your hourly rate, it is not just time in front of patients. It is administrative work, CME, emails, charting, whatever have you. It could even include your commute. Right? So understand what your hourly rate is. And I think unfortunately when you add up all of the unpaid things you do as a doctor, your hourly rate plummets and it's pretty depressing. Nonetheless, go through the exercise. I encourage everybody to do it. I know my hourly rate. And so number one is know your hourly rate because it allows you to make decisions on how much you're going to pay somebody to do something, right? And remember there are tax consequences. So if it's a corporate expense then it's a corporate expense. And you're more tolerant of, you know, that higher hourly rate to bring in a great professional, for instance, a great accountant or a great bookkeeper. Dr. Wing Lim: Exactly. Dr. Kevin Mailo: These people that help you build wealth. And then in your personal life, remember, it's after tax dollars, so you probably don't want to hold, you don't want to delegate to Skip the Dishes every night. Put it that way. You really don't. And or, you know, Uber Eats or whoever else is out there, right? Like you actually have to be very mindful of the after tax cost to yourself before you delegate. The other lens that I get people to look through, you know, we talk about this in an earlier episode, is what is crucial and cannot be delegated. That list is actually very short in our personal and professional lives. But don't delegate away the things that are actually going to matter in your life, whether it's driving your kids to soccer, spending time with your spouse or partner, even if it means taking him or her to the airport, right? Yeah, could you delegate a cab? But what about that moment that you could have shared together? Be mindful in delegation. This is, I hate the word efficiency in our lives, especially in our personal lives. I remember coming across, I remember I met an ophthalmologist once who was outstanding, said be efficient with things, not with people. Dr. Wing Lim: Mhm. Wow. Dr. Kevin Mailo: Like ideally if you have done time management and delegation properly, you should have lots of like free moments where you don't have to be anywhere else but enjoying that moment, right? Whether it's reading a book, spending time with family or friends, going for a walk, whatever, like or even just be free to like have like a day that just goes all over the place. But you didn't have to do anything else in your life because it was all properly delegated and you created that space. That's a gift to you. That is so powerful. And so that again is the next criteria that I ask people to use as a lens is, is this making my life happier? Like for instance I changed the oil on my truck with my kids because I like that time with my son and at times it's been three generations of us doing it just to teach and bond. I would never delegate that out. Right? That's just an example from my personal life. So try to be mindful and reflective of where you are delegating and delegate the things but don't delegate people. Don't be efficient with the people that matter in your life. And don't even be efficient with yourself. Like, you know, create downtime for yourself. Dr. Wing Lim: Mhm. Dr. Kevin Mailo: So that you can invest in yourself. So those are, those are again my reflections, you know having maybe learned the hard way about either under delegating or over delegating, frankly. There is a balance. Dr. Wing Lim: Exactly. Dr. Kevin Mailo: Okay. Maybe we'll wrap it up. Again that was another great one. I love, I love these topics because these are the things again that we all struggle with but don't even have a framework to talk about it or think about it. But if you can effectively delegate in your personal and professional life, you can go anywhere and build anything you want. That's a key. Dr. Wing Lim: And to earn back the freedom. Dr. Kevin Mailo: Oh goodness. The freedom's everything, honestly. Dr. Wing Lim: Mhm. Yeah. Dr. Kevin Mailo: Honestly I look at my, I look at my own teenagers living that free life and I'm deeply envious of their time richness. Dr. Wing Lim: Exactly. Dr. Kevin Mailo: You know? Dr. Wing Lim: No kidding. Dr. Kevin Mailo: Not all the drama of being a teenager. Not all the drama of being a teenager, but certainly envious of that, the wealth of time that they have compared to the rest of us who are so busy and overscheduled. Dr. Wing Lim: Mhm. Yeah. Dr. Kevin Mailo: All right. All right. Let's wrap this one up. Thank you. Dr. Wing Lim: Yeah okay. Thank you everyone. Dr. Kevin Mailo: Thank you so much for listening to the Physician Empowerment podcast. If you're ready to take those next steps in transforming your practice, finances, or personal well-being, then come and join us at PhysEmpowerment.ca - P H Y S Empowerment dot ca - to learn more about how we can help. If today's episode resonated with you, I'd really appreciate it if you would share our podcast with a colleague or friend and head over to Apple Podcasts to give us a five star rating and review. If you've got feedback, questions or suggestions for future episode topics, we'd love to hear from you. If you want to join us and be interviewed and share some of your story, we'd absolutely love that as well. Please send me an email at KMailo@PhysEmpowerment.ca. Thank you again for listening. Bye.
34 - What Time Management Actually Is
Dec 30 2023
34 - What Time Management Actually Is
In this insightful episode, Dr. Kevin Mailo and Dr. Wing Lim engage in a profound conversation about self-control in time management. The discussion unfolds with a reflection on the evolution of time management concepts from one-dimensional to multi-dimensional approaches.Dr. Wing Lim introduces the audience to the Franklin Covey time management matrix, emphasizing the importance of not just handling urgent tasks but also allocating time to nonurgent yet crucial activities. He delves into the concept of significance, urging listeners to consider the long-term impact and purpose behind their actions.The episode further explores the notion of creating more time tomorrow by investing time today. Dr. Wing Lim introduces the concept of a "permission funnel," comprising permissions to eliminate, automate, delegate, procrastinate strategically, and concentrate on essential tasks. The episode concludes with a powerful reminder of the preciousness of time and a preview of future discussions, including an upcoming episode on delegation—a key component of effective time management. Overall, the conversation serves as a guiding light for physicians looking to regain control of their time and live a more purposeful and fulfilling life.About Dr. Wing LimIn 1993, Dr. Wing Lim embarked on his journey as a family physician, facing immense challenges in his first year. Despite putting in 100-hour workweeks, financial struggles, a receptionist issue, and the threat of eviction were formidable obstacles. Rather than retreating, Dr. Lim embraced these challenges, teaching himself Practice Management and transforming his approach.This resilience and newfound expertise turned his practice from that of a struggling "lone wolf" to the founder of one of Alberta's largest medical clinics. Dr. Wing Lim's story is a testament to overcoming adversity, highlighting the transformative power of learning and adaptation in the dynamic landscape of healthcare.Resources discussed in this episode:Stephen Covey: StephenRCovey7 Habits of Highly Effective People: franklincovey.comDragon Dictate: dragondictations.orgRory Vaden--Physician Empowerment: website | facebook | linkedinDr. Wing Lim/Synergy Wellness Centre: website | linkedin | Synergy Wellness Centre--Transcript:Dr. Kevin Mailo 00:01Hi, I'm Dr. Kevin Mailo, one of the CO hosts of the Physician Empowerment Podcast. At Physician Empowerment, we're dedicated to improving the lives of Canadian physicians, personally, professionally, and financially. If you're loving what you're listening to, let us know, we always want to hear your feedback, connect with us. If you want to go further, we've got outstanding programming, both in-person and online. So, look us up, but regardless, we hope you really enjoyed this episode. Dr. Kevin Mailo 00:35Hi, I'm Dr. Kevin Mailo, one of the CO hosts of the Physician Empowerment Podcast, and you guys probably already know that, because that's how I introduce myself every single time I'm on the show. And today, I've got my fellow co-host, Dr. Wing Lim, and again, I think most of you know who Wing is and what he does. And he's the one that leads our master class and does a phenomenal job teaching the ins and outs of high-level tax planning, wealth creation strategies, real estate investing. But there's a lot here with Wing. And that's why I look to you Wing like a mentor because I've learned so much from you, in so many facets of my personal and professional life. And one of the things in my personal life that I learned from you is the notion of time management. And so that's what we're going to cover today. And I'm very interested to hear your thoughts on how it is you've achieved so much in real estate development, full-time practice, a family, travel, you've done so much. And a lot of this comes down to not only goal setting but time management. So, why don't you talk and share some of your thoughts on this? Because I'm very interested to hear about it.  Dr. Wing Lim 01:49Yeah, thank you, Kevin, for a very kind introduction. And I say when people talk up on you, you wish you would live up to it. And so I love doing this because every time we share with our colleagues, we're more alike than different whatever your specialty, and now listenership is not just in with MDS, right, they're out of medical professionals that they're dialling in. So, we all dealt with this problem that we're time broke, right? And at first time I heard this term, this is like 25 years ago, maybe, what does time property mean? Well, because there are people who trade time for money, and that's us, right? We trade time for money. You don't have trade time, you have no money, right? So, you keep trading time for money. And then the problem is, then very soon, you run out of time, right? So, you and I went through gruesome training, we all did, right? 120 hours way back residency, when we did one in two calls, one in three calls, 36 hours straight. Right? And even when I started my practice, 100 hours a week, so you pretty soon run out of time. So, then we take these time management courses, we pay for it way back? And then what do you get? Right? So, I think all of us understand that we need to manage time. So, I think all of us would at least have a to-do list. You know, we have this to-do list every day you put down, right? And then I learned as I go and then I learned that that doesn't work. How many of you and I will look at the to-do list and we actually get better? In fact, what you're doing on a to-do list is just bumping, right? You're just doing it based on urgency. So then, some 10 years later, decades later, the thinking and time management's like medical journal, right, like medical thinking, it's changed. So, that's called a one-dimensional time management. And you've just bump things, in fact, nobody could control time, time is a commodity that you cannot control. Time goes on whether you do it or not. And the truth is, most of us can do the urgency, but time management or event control, let's call it better event control. It's a very emotional base thing. Right? You and I have said, Okay, I gotta get these charts done. I gotta do that stupid medical legal report or WCB report. And you were so stressed out, that you ended up clicking on a mini-series six episodes later of the Netflix. Right? Ya know. Dr. Kevin Mailo 04:12No, It's true. And a lot of it is we feel overwhelmed by how much we have on our plates. And so then it becomes very easy to procrastinate or distract ourselves. And it can even be distracting ourselves, not just with like idle leisure, but even distracting ourselves in work. Right, that rather than doing the hard stuff, you know, maybe we go do some errands around the house or, you know, get some shopping that's not urgently needed to be done. Even just going to work and doing more paperwork. Dr. Wing Lim 04:44Yep. And then we just keep being busy, right? But keeping busy doesn't mean keeping being productive. Right, so I'm the perfect Master of this. I have 15 things on my to-do list today and I only got four done, right and every day you just keep bumping it right? So, that's called the first dimension. There's actually different dimensions, polly dimensional. So, dimension one is the to-do list, and it's based on urgency. Okay, which one do you bump? And we know that that's not adequate. Now then comes the 80s and 90s. And then there's a guy, Franklin Covey. I don't know how many of you heard of Franklin Covey. I used to have a big binder, called Franklin Covey binder, but that's how you organize the life, and Covey “The Seven Habits of Highly Effective People”, right, he’s the guy.  Dr. Kevin Mailo 05:31Oh, Stephen Covey. Dr. Wing Lim 05:34Stephen Covey? Yes. Dr. Kevin Mailo 05:35No, I got you. No worries. Dr. Wing Lim 05:37Yeah, yeah. So, there are two companies that join, right? So, Frank. Anyways, the two companies and so that's called Franklin. I used to have these big Franklin folders. And they go into the urgency and importance, right? This is called a time management matrix, where some of you have heard it from The Seven Habits of Highly Effective People, right? So, you have the urgent, nonurgent, important, not important, then you got four possibilities, right? And most of us still deal with urgent/important things. This is actually people who, like you'd practice within ER, you're dealing with urgent, important things, right? But nonurgent, and not important things get ignored. Right? And that's why they say, why do people not read more? And the Maestro says because books don't ring? Right? You will always answer to the phone, to the urgent things, but they're important things that we don't deal with. So us physicians and medical practitioners, are no tourists dealing with more urgent stuff, and we push the important things away. And then it fights back, I have literally met colleagues that forgot to file taxes for seven years. And the CRA came to the door and garnish their wage. How do you do that? Right? Because you keep doing the urgent one, right? And you forgot about it? So, this Time Matrix thing helps people to do okay, I need to apportion the time, right? Dr. Kevin Mailo 07:00Well, I was just gonna say even if you don't internalize it, so rigidly and for anybody that has not read Stephen Covey's The Seven Habits of Highly Effective People, I strongly recommend reading it, but even just to be able to have that mental pause, when something comes in front of you, whether you hear about it, or you read about it, or somebody you know, you're reminded of it in your head, say, is this truly urgent? Is it distracting me from what's important that I have to get done to move ahead on this project with this goal? Sorry, please continue. Dr. Wing Lim 07:34So, it's absolutely important exercise. So, for those of us who are still stuck with this linear thing called the to-do list, you need a second now y-axis to create the importance. And so you and I need to apportion our days, that the toughest one, or the nonurgent, but important things. Buying tax return, doing your tax planning, right, you know, those things are super important. If you don't invest in these relationships then relationships blow out, right down the row. And so definitely, that is important. But then at the end of the day, you are still juggling different things. And the biggest thing and the motive here, the MO is to do more things, right? But there's still not enough time of the day, right? You still don't create time. So, then I attended a leadership conference, I think during COVID or pre-COVID. And the guy said there's a third dimension, oh, what is the third dimension? The third Dimension is called significance. Right? You don't just deal with what is there, you deal with what is the long-term significance. The longer significance is not just what is important, is way beyond that. I went to a leadership conference way back a big 20,000-people thing in the States and they talked about legacy, what you're left with, and after that, that conference, that's how I gave birth to, dug up my dream and gave birth to Synergy Wellness Center. But these things are life-changing. What is significant to you, what is the endgame? And so when you throw in the X, Y, and Z axis, it changes what you're going to do. It may change your priority and change what you do. You've been doing things for so many years for decades. Isn't why you're still doing it. Right? You need to ask why? Why am I doing this? You're running on a treadmill now for 10, 20, 30 years, trading time for money, right? We're talking a lot of colleagues and say, I'm like 40 some year old practitioner. I got X number of dollars in debt. I can't afford to retire. Why am I doing this? Right, and a lot of people have that midlife thing awoken and say this is getting nowhere and that's why there's so much attrition people walking out of the profession. Right, so until we find out why we don't know what we're doing. And then there's this guy call. I forgot his name. Now, Rory, somebody, Rory Haun there we go. Rory Haun, give him the credit for doing this. And he says there's this funnel that you can help create time. Right? You really you can create time? You mean like other than the Avenger Timestone? You can create time? And the question is what can you do today, to create more time tomorrow? Wow, that's absolutely amazing. How do you create more time tomorrow? Well, are there things that you can do today? So, that you don't have to do it tomorrow? Okay, give you an example. Right. And you and I do charts, do things every day, right? We have chart work to do. If you have a way to let's say, create a macro in electronic medical record system EMR, it does the template for you, or those of you dictate, Dragon Dictate. Kevin you’ve tried that, right? Things that could save you time, right, then you get this ROTI, return on time invested. So, what can you do today that invest a little bit more time so that you reap the benefit? And the equation that I got was 30 times 30. So, whatever tasks you want to give up to make it disappear, you invest 30 times the time you spent. So, for example, a five-minute task, you invest 150 minutes, okay, simple math. What is the five-minute task, something that your staff could do? And so the problem that we have is we are our top enemy. We’re the worst enemy because we want to do it. If you do want to do right, do it yourself. The more years we spend in tertiary care settings, the more we don't trust people, right, we just trust ourselves. I have, especially colleagues, if you refer them, they redo all the investigations all over because they don't trust anyone. So, this mistrust becomes difficult for us to delegate. And that's a different session we're going to talk about it's just delegation. But to delegate, you need a process, but the time we're talking about time management here, event control is a five-minute event you want it disappear in your daily life. It could be doing a chart, doing something that your clinic work. Invest 30 times 150 minutes to teach, delegate one of your staff to do the job for you. And then poof, you're earn five minutes per day. What if is an hour, 30 times, invest 30 hours. And that could be learning EMR. By learning EMR, what shortcuts can I do, so that I make these stupid things disappear? Right, prescription refills, you name it, and you invest 30 hours. I have colleagues who would not have 30 hours to get for anything. But you know what, if you invest the 30 hours, you earn one hour a day. And why don't we do it? Dr. Kevin Mailo 13:02It pays for itself in a month, and you still have your career to run.  Dr. Wing Lim 13:06You want to make more money and you might keep a relationship that you cherish or sports or some hobby that you don't have to kill. Dr. Kevin Mailo 13:14You know, I mean, even just reflect like in, you know, in our personal lives, the parallel is children. I mean, you can sit there and you can clean up after your children. But at some point, you just need to teach them how to scrub floors, and tidy up the house and do their laundry, even if it's like you said, 30 times that it takes you to just do this task yourself. But you realize that ultimately you're creating more time for yourself and less stress, Right? And so this dovetails with every aspect of our lives. It is just willingness to put in a little bit of front-end investment in time to make our lives easier and simpler. Moving forward. Dr. Wing Lim 13:58Right, exactly. So, let's just end this episode with a funnel, okay, this funnel is called the permission funnel. We need to give ourselves emotional permission, okay? I can give myself emotional permission but once you give yourself emotional permission, then you can move forth. So, the first question, the first permission you give yourself is to eliminate. Elimination that's one. Can I do without this? Okay, can I do with all these things? Say no. Say no, no, no no for people like me who was a yes man, mostly, it's a very difficult thing. But if we want to get on top of this time management thing or more control, event control thing. We have to say no, can I do without it? So, the first permission is the permission to say no and exit out. I don't want to do it. Permission number two is can we all automate. Right? We’re in an automation world. AI is gonna run the world. AI can read CT scans, better than we could, right? So can we automate? If you can automate, you're done. But the automation is not just AI, just technology. Automation means systemization. Can you have a system in your workplace, in your practice, in your finances, in your home life? Is that something that can be systemized? Right? And, of course, that's a different topic altogether. Can you systemize it? Or can you use technology to do it? Once you can automate, you’re done. The third permission is permission to delegate. Okay, and we're going to have a whole talk about delegation. Can we delegate that away? And the fourth permission is, can I procrastinate? So, you thought procrastination is a bad thing. Yes, it is. Procrastination is the assassination of motivation, as somebody once said that, but there are things that we should procrastinate because we have a finite amount of time, right now. So, things that don't fit that grid, X, Y, & Z grid. You need permission to procrastinate, to go back to the funnel, okay? So, you either procrastinate, or you number five, concentrate. And whatever goes into the concentrate is like the filtration. You put all your time, energy, effort, you and your team into the concentrate, and get it done. And that's how people move and shake the world. Right? Dr. Kevin Mailo 16:33It's very powerful. Dr. Wing Lim 16:33And it's never been to me, I've lost so many people right in this space. But this actually did it for me, this crystallizes everything.  Dr. Kevin Mailo 16:48Very powerful, very powerful. You know, I'm reflecting on when we were in Mexico in 2021, teaching with Physician Empowerment. And I remember coming across some wisdom that you shared as well, Wing because I think I actually had to deliver that talk. But I know that it was your wisdom and your knowledge in this space of time control. But one of the key elements here is that it's not actually time control. Because like you said, time is passing us by. It's truly self-control. It is self-control. It's knowing your priorities, setting them, and then sticking with them, even if that means saying no. And it's not just no to external requests on your time, your staff, your colleagues, your family, friends, whomever is asking for your time, but it's even that internal voice telling you, oh, but go do this, it's easier, right? Or this is important now. When it truly isn't, if you're honest with yourself, and that's about, again, self-control, not time control. And I think that's very powerful. Because when you look at people who have achieved enormous things, you know, heights in, you know, reached enormous heights, in business, politics, athletics, whatever. Fundamentally, they have the same number of hours in a day, as we do. Chosen, like you said Wing, to concentrate and focus. And it is fundamentally self-control, whether you're an athlete, a performer, you know, a business or political leader, or you know, even just a great dynamic physician, it comes down to self-control. And I think that is so, so powerful. And so key. That's certainly what I've taken away from listening and reflecting in this space. Dr. Wing Lim 18:40Mm-hmm, exactly. So, if we could apply these simple principles in every facet of our life, then we can have some freedom. But at the end of the day, we yeah, we only live one life, right? And we're getting older one day at a time, right? So, the sooner we get this in our brain, the sooner we reorganize our life and control our life. Then you get your life back and have more freedom. Dr. Kevin Mailo 19:10The only other reflection I really had was just how precious time is. And I did not appreciate this 20 years ago when I was a teenager. But I blink and a decade has gone by, I blink and another decade has gone by. And so the challenge is to ask yourself, what am I doing right now, with the time that I have, especially realizing that we don't know how much of it we actually have here. And I think that allows us to focus down and say, Okay, this actually isn't a priority. And I'm not going to worry about it. I'm not going to that meeting. Or I'm not doing that, you know, answering that email, because, frankly, it's not going to be something I'm going to remember a year from now, let alone a decade from now in my life, right? And so, again, just recognizing how precious these years in our lives are and that these years are comprised of a million small moments and countless hours that do drift by if we don't exercise that self-control. Dr. Wing Lim 20:13Mm-hmm, exactly. Exactly.  Dr. Kevin Mailo 20:16Yeah. No, it's It's a wonderful topic. I think we could go on and on about it. But we are going to do a future episode where we cover delegation, right, which I think is the key to effective time management. Is being able to hand tasks off, or as you said Wing, we automate a process. Yup. So, we'll cover that in a later episode. And I'm really looking forward to it. Because again, these are the things I think speak to all of us regardless of specialty, regardless of stage of career, I think we all feel too busy. And we want a way out, we want things to be better, and they can be unconfident in it. Dr. Wing Lim 20:58Exactly. So, imagine you could go home at five o'clock, six o'clock, whatever, and be done with work, wouldn’t that be a dream? Dr. Kevin Mailo 21:06True. Totally done. Yeah. Awesome. Thanks so much. Dr. Wing Lim 21:12Thank you, everyone.Dr. Kevin Mailo  21:15Thank you so much for listening to the Physician Empowerment podcast. If you're ready to take those next steps in transforming your practice, finances, or personal well-being, then come and join us at PhysEmpowerment.ca - P H Y S Empowerment dot ca - to learn more about how we can help. If today's episode resonated with you, I'd really appreciate it if you would share our podcast with a colleague or friend and head over to Apple Podcasts to give us a five-star rating and review. If you've got feedback, questions or suggestions for future episode topics, we'd love to hear from you. If you want to join us and be interviewed and share some of your story, we'd absolutely love that as well. Please send me an email at KMailo@PhysEmpowerment.ca. Thank you again for listening. Bye.
33 - Critical Mineral Investment with Graham Koehler
Dec 15 2023
33 - Critical Mineral Investment with Graham Koehler
Dr. Wing Lim invites Graham Koehler, an expert in flow-through shares and VP of Business Development focused on flow-through since 2010, to the show to explain what flow-through is. Not only does Graham define flow-through shares, but he also explains their amazing tax benefits, potential risks, and who they work best for.The flow-through program was developed by the Canadian government to help resource companies raise capital to explore for minerals to mine. The original program was developed with a main credit called the Canadian Exploration Expenses credit (CEE). Graham goes into detail about how the CEE differs from an RSP or TFSA and then explains the additional tax credits available to investors on top of the original CEE. He shares a partial list of the critical minerals that qualify, how flow-through shares work, potential tax deduction numbers, and the inherent risks worth considering. This is a fireside chat introduction to the opportunities of flow-through shares so we can all ask informed questions of our tax accountants and advisors.--Physician Empowerment: website | facebook | linkedin--TranscriptDr. Kevin Mailo: [00:00:01] Hi, I'm Dr. Kevin Mailo, one of the co-hosts of the Physician Empowerment podcast. At Physician Empowerment, we're dedicated to improving the lives of Canadian physicians personally, professionally, and financially. If you're loving what you're listening to, let us know! We always want to hear your feedback. Connect with us. If you want to go further, we've got outstanding programing both in person and online. So look us up. But regardless, we hope you really enjoy this episode. Dr. Wing Lim: [00:00:35] Okay, so welcome everyone to another exciting episode of Physician Empowerment, a live webinar series, and we talk about highly relevant topics. We interview interesting people on interesting topics that will help our physicians and medical colleagues live better lives. So we're not just physicians, we're physicians and other health professionals like dentists. And so we're really excited to have you join us tonight. And this, of course, becomes an evergreen podcast. So you can go back on. So let me introduce tonight our guest. Our guest is Graham. And Graham has been in the space of flow-through shares since 2010. So he's a Canadian living in Kelowna. But he's now talking to us from Huatulco, Mexico. And so we want to cover this topic, I've done three shares actually since 2012, and full disclosure, I actually bought it from from this company. And I really trusted them to have really, really good track record. So Graham's role is the VP of Business Development of the excellent capital in one of their flagship flow-through shares. So tonight it's a fireside chat to warm everybody up. What is flow-through, right, the history. What is about and how does it impact us as medical professionals? So without further ado, Graham, thank you for joining us from Huatulco in the midst of your holiday. Graham: [00:02:07] No problem. I'm really happy. I mean, quite frankly, Wing, I would always come on board when you ask. And I'm always thrilled to talk about this program because I've seen how it can help people save significantly on taxes in Canada, especially professionals. So I'm always happy to participate. Dr. Wing Lim: [00:02:27] Right now. So why don't you first walk us through? Because a lot of people have heard of it or haven't heard of it, but the knowledge base is almost zero. So walk us through what is flow-through share and why does the government creates such huge incentive like 100% plus tax write off? Graham: [00:02:45] I know, and, yeah, absolutely. When people get exposed to the flow-through, the government flow-through program in Canada for the first time, it's almost too good to be true scenario. But it is a, first off, it is a federal government program that's been around for a long, decades, quite frankly. And we'll talk about that and maybe why people haven't heard of it. But essentially the program was developed back in the 70s in its current form. So decades ago, because Canada, as we all know, is a resource rich country. We do rely heavily on our natural resources and always have in Canada. But the idea of companies going out to explore, what I call poke holes in the ground, to go out and poke holes looking for, you know, whether it's oil or gas or minerals of any kind, precious metals, gold, whatever the case may be, is risky business. These explorers, these Canadian wonderful explorers, go out there, typically on their own dime, looking for these resources and and hope they find them. Well, the truth is they sometimes don't and they're not successful. So it's risky. Exploration is risky business. So what the government, the federal government did back in the day was created a program to help these resource companies go out and explore, to raise capital, to raise money to do their business. So to help them raise capital from investors, which is typically where capital comes from for most things, they offered significant tax benefits for the investors to put their money up so that significantly reduces the risk involved, obviously, when you get tax benefits or tax refunds. So the original program was developed and still continues today with a main, a main credit, if you will, called the Canadian Exploration Expenses credit. CEE. So it's just simply, that credit is simply a 100% deduction from income for every dollar invested in the flow-through program. So for every dollar that you give to these companies that are out exploring and needing capital, you get 100% reduction of income. That part would be similar to an RRSP. Dr. Wing Lim: [00:05:13] Right. So then okay. Very good. So thanks for the intro. It's like gold rush. Right? So the government is incentivizing people to do gold rush equivalent. And then so there's, like RSP, there's some advantage. So can you tell us it's like RSP but it's not like RSP. In the sense it's better than RSP. Graham: [00:05:33] It is. It actually gives quite frankly far more deductions now than RSP does. A typical RSP platform, as we all know an RSP is simply an account, things have to go in it. The flow-through is an actual program. So really in Canada there's some different programs out there, but as far as federal government programs spanning the country, there's really three on the tax side. There's RSPs, which we pretty much all know about. There's the somewhat newer TFSA program, which doesn't save you taxes up front, but it builds tax free within the program. So it is a tax program. So we have RSPs, TFSAs, and flow-through. The main difference between RSPs and flow-through are that, well, number one RSPs can only be purchased by an individual, not a corporation. Correct. Whereas flow-through can be purchased by an individual, a corporation or a trust. There's also a maximum contribution limit every year on an RSP. Whereas with flow-through there is no upper limit. The only the would be on the investor's, you know, suitability for the program and their risk tolerance. But there is no mandated upper limit on the program. And then really the main significant differentiator is, as I mentioned a few minutes ago, the first credit with the flow-through program is 100% reduction of your income by the amount you invest. Graham: [00:07:15] That's exactly the way RSPs work. But in the flow-through case, there's two more federal tax credits involved on top of that. And these are for everybody that invests in flow-through individually. And they are what's called the mineral exploration tax credit. And that's a 15% additional ITC or investment tax credit on top of the 100% you get with the exploration expenses. And as of last year, 2022, there's now a third tax credit involved with flow-through. The federal government announced in 2022 that they were adding in a 30% tax credit, ITC, investment tax credit, on the flow-through program for any part of a fund that is invested in critical minerals. So it's called the Critical Minerals Investment Tax Credit. So you have the original 100% reduction of income for every dollar invested, which is somewhat similar to an RSP. You have the additional federal 15% mineral tax credit. And now the potential for a 30% tax credit on anything in a fund, in a flow-through fund, that's considered critical minerals. And the government gave a list of critical minerals. Dr. Wing Lim: [00:08:40] Can you give us, I just know the list is big. Give us some common ones. A common one, is it lithium or is it... What is it? Graham: [00:08:46] Yeah. There's a number of them, and some of them will make a lot of sense. Mainly they're minerals that are critical to the electrification of the world, to elect batteries, electric vehicles etcetera. So that's really what the government is promoting right now because we have a lot of those minerals, or most of them in Canada, and we can explore for them and bring them out of the ground. Examples, lithium of course, magnesium, cobalt, copper, the rare earth elements, none of which I can pronounce the names of, those elements as well. And interestingly, uranium, as of last year, the government has considered or has actually called now, classified, uranium as green. Dr. Wing Lim: [00:09:35] Wow. Graham: [00:09:36] Yeah. Yeah. Very interesting. Dr. Wing Lim: [00:09:37] When you think about it, it is very green. Graham: [00:09:40] Yeah. It is. And, you know, obviously this isn't the place or time to get into the pros and cons and things like that. But yeah, what happened a year ago was in this decades-old program, the federal government actually pulled oil and gas out of the flow-through program. So we can't buy oil and gas flow-through shares or, you know, shares of oil and gas companies now. They took that out. But they added in this critical minerals 30% tax credit. In other words, they're really trying to build, to help explorers and developers in Canada, Canadian companies, to go out and find more critical minerals. So that's the difference between RFP and flow-through right now. Dr. Wing Lim: [00:10:27] Now, can you educate us, Graham, that I've heard about tax credit and tax deduction. What's the difference? Graham: [00:10:35] Yeah yeah just... Dr. Wing Lim: [00:10:37] Briefly. Graham: [00:10:38] Yeah I will, I'll try and be brief there. And I'm glad you picked up on that, because I did use the two different terminologies here. I've mentioned the three different credits available. And the first one that I said has been around forever, for decades is the CEE, and that stands for Canadian Exploration Expenses. That is the main, that part is again, it's federal, everybody gets it. It's a 100% reduction in income. So for every dollar you invest, you get your tax slip from a flow-through company, you know, in the spring for the year, for the past year. And it'll show that CEE, your accountant simply reduces your income by that amount. So you save taxes, you know, to be simple, to simplify, if you're in a 50% marginal tax rate, a high income earner, and you invest in a flow-through, 50% of the money you invest is going to come back to you immediately in a tax refund. That's the CEE. In addition then, that second and third credit are called investment tax credits. They operate slightly differently than that first one. They don't reduce income by the amount, they actually, you multiply the first case 15%. It's called the mineral tax credit exploration, it's 15 - one five - percent. So you multiply your investment times 15%. That number comes directly off remaining taxes that you owe. So it's very powerful. And then the third credit is an investment tax credit as well of 30%. So you multiply, or you know, effectively, the auditors do this. You don't do any of this. We just in the industry give you a tax slip. But the critical minerals at 30%, any part of a fund that's critical, gets multiplied by 30%. And that number comes directly again off taxes you still owe. So very powerful. So there's a little difference in how the two... Dr. Wing Lim: [00:12:44] So can I just, just give some numbers? So and you can tell me if I'm right or wrong. Right? So if let's say doctor XYZ makes 100,000 this year, taxable income, and invest $10,000 in there. So just based on the first, the CEE, then the income taxable income becomes 90,000. Graham: [00:13:04] Right off the top. Dr. Wing Lim: [00:13:05] Yeah. So and if doctor XYZ owes the government $50,000 in tax right then hey 15% of that, whatever they invest in, comes right off the tax. So potentially 40, so if they do $10,000 investment, so what 45% of that? Which is 40... Graham: [00:13:26] But the only thing to keep in mind is the 100% everybody gets, the 15%, you get either the 15% on part of a fund or the 30. They don't stack on top of each other. Dr. Wing Lim: [00:13:40] Got it. Potentially, let's say we buy the critical mineral. Then 30% of 10,000, that's 3000. Graham: [00:13:47] That's right. Dr. Wing Lim: [00:13:47] 3000 comes off your 50,000. And you owe that year for tax. Graham: [00:13:51] Yeah, the way it works out for most funds, the way it works out, and again there's multiple, there's many many, you know, there's a number of flow-through funds in Canada. I would say on average an investor is going to get somewhere between 120 to 125% in deductions for every dollar they invest. So if they invest $10,000, they're going to get the equivalent of about $12,500 in deductions. Dr. Wing Lim: [00:14:23] That's absolutely amazing. Graham: [00:14:25] It is. And what it's done, especially with this added, when the government in 2022 added in this extra critical minerals tax credit, what it means again, and this is for an average fund, it depends how much a fund has in critical minerals or not critical or things like that, so it's hard to give exact numbers here, and every individual it will be different as well with their tax rates, but again, on average it'll be 120, 125% in tax benefits for every dollar invested. And what that does is it reduces, when you calculate it out, it reduces the at risk money, that $10,000 that you've invested, it typically reduces that down to $3 or 4000 out of the $10,000. That's the money you actually now have at risk because you've received all the rest back in tax refunds. Dr. Wing Lim: [00:15:13] So there's so much refund that you're only about 30% of this is really at risk capital. Graham: [00:15:18] And that's directly why the government's doing it. Is to, and by the way, there's no exact number on the benefit to the government. But I've heard in the industry many times over the years that the federal government, the CRA, basically, recoups, recovers anywhere from 3 to $4 in basically income generated for the government for every dollar they give back in tax credits to investors. And the reason for that is because these companies that explore, many of them are very successful and eventually pay a lot of tax. So it's been a very beneficial program for decades for both investors and the government, quite frankly. Dr. Wing Lim: [00:16:04] Right on. So I think we touched on this is such a good program. And the next question is, well, how comes my accountant didn't just jump at my throat on that? Graham: [00:16:15] It's you know, I've mentioned it's been around for a long time. The actual original, the very, very origination of the program in an older form was mid 1950s. This program's been around since before the RSP program. It came into its current life in the early 70s. Why isn't it more well known? One of the main reasons it's not is, and I think this is from the accounting side of it perhaps, is there is risk, of course. And a lot of times, quite frankly, I think accountants don't want to, you know, be responsible for talking about a product that has risk. You know, it's very, very difficult sometimes, even though it's been de-risked so much. The other reason, and I think this is far more, will answer the question I think far better, is the big institutions in Canada, the big banks, the big financial institutions, the big investment sellers, they're not really interested in the flow-through program. And the reason that they're not is it's just for them, not big enough, quite frankly. On average, over the years, the Canadian Federal flow-through program has raised, on average, about a half a billion a year in capital. So about 500 million a year gets raised every year in flow-through. And I'm sure that's, you know, in a niche market that's a pretty good number. But to the Royal Bank of Canada, it's just not look. They look at that and go, no, we're not interested in that kind of niche small market. They're far more interested in doing mutual funds and RSPs, which are, you know, continuous. That's really why it's been mostly, up until about ten years ago, it's been mostly the purview of certain accountants and certain tax lawyers that paid attention to it. Now there's more and more funds. So it's getting a lot more attention. There's more people like yourself looking at it. Dr. Wing Lim: [00:18:11] Yeah. So if you had 50% tax bracket, right, if you added 25% tax bracket, it doesn't make as much impact as 50 plus percent. Graham: [00:18:19] Yeah. And we get, you know, people ask me oftentimes like what would, who should buy this? Who should invest? Who should invest in flow-through? And there's two answers. One, anybody that's got a tax problem. If people have a tax problem, they should look at flow-through. If their tax problem is five grand in a year, maybe not. They're, really in my mind to get the biggest bang for your buck out of this, you really should be in the, I'd say the 35 to 50% marginal tax rate, right? Dr. Wing Lim: [00:18:58] The bigger the tax problem, the bigger the solution, right? Graham: [00:19:01] That's exactly it. Dr. Wing Lim: [00:19:03] Yeah. Right. So maybe tell us, okay, so this is the good side. Tell us the worst. What's the worst scenario that could happen? Graham: [00:19:11] People can lose money. And and I'm not being flippant. It just, it can happen. This is, there is risk involved with this program. And you know, that's why it's imperative too that the individuals look at, know a few good questions to ask a flow-through fund. And we can talk about that if we have time. But yeah, the ups and downs of it. This is, for the most part, junior, what they would call junior resource companies in Canada, which are smaller companies, their share prices are smaller, their, I guess they would be what's termed as penny stocks out there, even though some of them have been around doing this for decades. They've been around a long time. There are still smaller companies. They go explore, they find something, they move on. Or quite frankly, they get bought out and they start it again. They get, when they find something, they get bought out by a bigger developer and they start exploring again. So they're back to being small. So that's where the real risk is, is when a fund is put together, quite frankly, if the fund manager, the research team involved, aren't that great at picking the stocks, these funds can go down dramatically. I've seen funds, they don't go to zero these funds because they have many different companies in them, many different shares, but have seen a, from certain companies out there, I've seen a $10,000 investment get paid back at $1,000, let's say. A few, you know, 18 months or 24 months later. Well, you need to get back about $4, quite frankly, 3 to $4 to break even. Unattend, I'm talking $10 purchase prices. You know, so you would need to get back 3 or $4. I've seen returns of a dollar, $1.50. So those are actual real losses. Dr. Wing Lim: [00:21:07] And those is not right away. Right? It's over time. Right? Graham: [00:21:11] Yeah. Most flow-through funds in Canada operate on anywhere from a 8 to a 24 month kind of window. There are a select few out there that have done a great job by being a little bit longer term for their investors, maybe 3 to 5 years. I've found that those companies have done a little bit better, quite frankly, because what they've done is they've given the resource companies more time. So hopefully make a profit. So there are a few companies like that out there. Dr. Wing Lim: [00:21:47] But it's also dependent on cycles. Graham: [00:21:50] It is. And when I mentioned that these are junior resource companies, a lot of them are, most of them, in fact, of this variety, are traded on the TSX Venture Exchange, out of Calgary, not the general TSX, but they're traded on the TSX Venture. And so you've got to look at that exchange to see how it's gone up and down over the years. And it doesn't track the same as the TSX. Okay. It is a totally different market. Now the TSX Venture isn't just resource companies. There's tech companies and all kinds of small firms there, but it seems to have its own path. And yeah, it went through a long bare market, quite frankly, the TSX Venture went through a bare or a down market from 2010 to about 2017. So it's kind of on a downward rate, but it also goes up. And right now, by the way, the market in general for this in Canada is somewhat, is low, like it's been here. So there's, you know, who knows. But it may be an opportune time to get into natural resources in Canada because they are somewhat suppressed right now. Dr. Wing Lim: [00:23:07] Right. Tell us something about this super cycle. Graham: [00:23:10] Well, that's kind of where that, you know, we're in that, there are a lot of us believe that we're kind of in the first or second inning of a super cycle right now, and all that means is a bull market or a potential up market on steroids. Meaning that it's going to go high and it'll last, this bull market in commodities, if it truly is a super cycle - and there's been three super cycles in history before, this would be the fourth - it would last for maybe as long as 6, 8, 10 years. The super cycle. A lot of the very experienced portfolio managers, the commodity people out there in Canada, the, you know, commodity trading managers and the guys like Sprott and, you know, they've been calling this now for 2 or 3 years. And they all feel that we're in the beginning of that super cycle. And really it's because there was such a depression for those years I talked about. Nothing got done. And it takes, once things get rolling again - and precious metals, for example, like gold, and I think we're all pretty familiar that, you know, gold is on a, you know, should be and has been on a bit of a trend - people are looking for ways to buy precious metals right now, but it takes, and now critical minerals like lithium and stuff and uranium, by the way, uranium has started to go up dramatically now. Lithium went up dramatically 2 or 3 years ago. So that's, now just keep in mind that these super cycles, if that's what we're in, and a lot of us think we are, they don't go up in a straight line. Nothing goes up in a straight line. So it'll be a bit of a bumpy road right now, I think. Some years we'll be down a little bit, some will be up. But the general trend, I believe, for the next 8 to 10 years is going to be an upswing. So I look at the flow-through program, which was developed by the government to help this type of a cycle, really, as a significantly de-risked way for investors to get involved in commodities. Right? They don't have, yeah, they don't have to pick their own. They can get, you can get involved in gold and silver and lithium and a whole basket of these in the flow-through program now for your portfolio. Dr. Wing Lim: [00:25:36] Right. So I listen to a lot of podcasts. That's how I do my pastime. And we're truly in a global village situation. A war in Ukraine. Boom. It affects Canada. It affects the African food supply because the wheat basket, but also minerals and resources. Right? When Russia and Ukraine have big war and now we have Middle East war, and so it impacts and of course, like you say, we're electrifying everything. Right? Electric vehicles. A patient of mine just, he's in a developing business of different kind of battery that is going to make the regular battery that we see now obsolete. There's so much advanced, technological advance, but the limiting factor is still the resources. Man, you got to find those nickel, cadmium, lithiums of the world. Right? Graham: [00:26:27] And you do. And not only do you need to find them, once they're found, once once a resource is found, it doesn't relate to a producing mine next week. These take, these can take a few years to develop once that mineral is found. You know, there's obviously a lot of hoops and mountains to jump over literally with regulation before this gets off the ground and that mine gets running to produce what it needs to produce. That's why when I talk about the potential, if we're in a super cycle, I mean, we're in a bull market, but, you know, potentially a super cycle, that's why these can go for years because it takes time to ramp up reproduction. Dr. Wing Lim: [00:27:12] And then is it true that the world is now coming to us because we are the Canadian Shield, right? Other places they have, but there's political instability. They don't have infrastructure. Right? They're coming to us. Graham: [00:27:27] Yeah. The world does come to us. I mean, you know, we hear sometimes reasons why certain places don't come to us or they wish we were doing things differently here and there, regulation-wise in Canada. But the fact of the matter is, you know, for years, and I think it's true, I've been, to me, I like to keep things really simple, kind of dumbed down for myself. The world needs these minerals more than ever. We have them. So they're going to come and we're a stable country to deal with. And quite frankly, our environmental record is pretty good too, compared to a lot of other countries. Dr. Wing Lim: [00:28:06] Right. So because it's uncertain and we possibly could be going into a super cycle, so is it wise to do dollar averaging thing, buy some every year? Graham: [00:28:16] Well, yeah. Dr. Wing Lim: [00:28:16] Or just buy a big lump sum? Graham: [00:28:19] No, I would actually recommend that people don't buy a big lump sum necessarily, whatever big means to an individual. Um, I would say no, you're far better off once you understand the program and the merits of it, to cycle this, to buy some every year. Because there is going, even with the best fund in Canada out there, there's going to be the odd down year. One of the things to look at with any fund, quite frankly, is what I call an asymmetric return. How many, if a company has had 20 funds or 30 funds over the years, how many have been positive? How many have been negative? And if there's significantly more that have been positive than negative, that's a great asymmetric return for clients. Dr. Wing Lim: [00:29:08] Got it. Graham: [00:29:09] Right? It means that company kind of knows what they're doing. Dr. Wing Lim: [00:29:12] Good. Graham: [00:29:15] I recommend cycling. Dr. Wing Lim: [00:29:18] Good. So you're walking into the last question I'm going to ask is, the funds are not created the same, equal, right? So our program is not to flag a fund, but to empower our listeners to ask smarter questions to their advisors. So what are a few questions, maybe three questions, they should ask these funds? Like what are the key separating, what differentiating questions? One of which is probably the asymmetric return, right? They need to have good track record that. Graham: [00:29:47] That would be one, that wouldn't be the first question, or place to look, but that's absolutely one. How is the company done? You know, asymmetric? Have they had good asymmetric returns? To me, number one with anything in life, especially in the investment world, is management. Absolutely look at management. Look at their experience, their background, their credentials, how long they've been doing flow-through funds in Canada, what their relationships are with the mining groups, with the big investors in the mining community. I would also ask what that company's thesis is, what their investment thesis is. Because that can be critical, especially in flow-through. When you look at something like real estate, for example, buying a building, well, the thesis is pretty standard. Buy it and rent it and make money and hopefully it goes up. The thesis can be a little more, slightly more complicated in flow-through, but I would ask what the portfolio managers' thesis is. And they should be able to send you a 2 or 3 or 4 page only report on how they put, what their thoughts are, and how they put together the fund. And the reason you want that is, in my experience, I've seen a lot of flow-through funds out there that have focused on one thing only. Tax refunds for investors. That's great. But if you lose money, why bother? You really want to look for a fund whose investment thesis is to number one, try and put together a resource fund that's going to make people a profit and it comes, and just happens to come with flow-through shares. But in companies, their thesis is just to get you, is number one, to try and make a profit for their investors and give the significant benefits that down period in Canada were suppressed for about, they were poorly managed and just disappeared during the bare market. So I would look for companies that have just been consistent for many years, coming out with a product every year and doing their job. Dr. Wing Lim: [00:31:50] Okay, good. Graham: [00:31:51] Those are a few of the things that that you should look at. Dr. Wing Lim: [00:31:54] Right. Right on. Okay. So that's really good. So I want to thank Graham for his pile of wisdom. Pearls of wisdom. He's been in there the good days and bad days. Seen a few cycles. Dr. Kevin Mailo: [00:32:07] Thank you so much for listening to the Physician Empowerment podcast. If you're ready to take those next steps in transforming your practice, finances, or personal well-being, then come and join us at PhysEmpowerment.ca - P H Y S Empowerment dot ca - to learn more about how we can help. If today's episode resonated with you, I'd really appreciate it if you would share our podcast with a colleague or friend and head over to Apple Podcasts to give us a five-star rating and review. If you've got feedback, questions or suggestions for future episode topics, we'd love to hear from you. If you want to join us and be interviewed and share some of your story, we'd absolutely love that as well. Please send me an email at KMailo@PhysEmpowerment.ca. Thank you again for listening. Bye.
32 - Setting Boundaries and dealing with internalized shame with Dr. Megan Melo
Nov 30 2023
32 - Setting Boundaries and dealing with internalized shame with Dr. Megan Melo
Dr. Kevin Mailo welcomes board-certified family physician and obesity medicine specialist Dr. Megan Melo to the show. Megan has a coaching business, Healthier For Good, focused on transforming the lives of physicians through one-on-one or group coaching. Megan and Kevin talk about burnout, shame, and how physicians can learn to set boundaries and overcome perfectionism. Dr. Melo explains how perfectionism sounds benign and hardworking but is actually often shame avoidance. If we are perfect enough, we can avoid being shamed or called out. She talks about how that plays out in affecting the day-to-day lives of physicians. Megan and Dr. Mailo share stories from their own experiences and discuss what steps physicians can take to start pulling out of perfectionism and shame cycles. They address setting boundaries for self-care and why taking care of ourselves is such a vital aspect of being a physician. Megan offers coaching for physicians to help them achieve these goals, and this episode highlights some of the insights she has that can change lives for the better.  About Dr. Megan MeloMegan Melo is a physician, board-certified in Family Medicine and Obesity Medicine, as well as a Certified Life Coach for physicians. She helps physicians struggling with burnout and overwhelm to feel better, including those who have been labelled "toxic" or "difficult" by their employers.Megan is on a mission to help physicians and other healthcare professionals heal from burnout and change their lives for the better. She does this through one-on-one and group coaching, as well as podcasting, blogging, and speaking to groups.Resources discussed in this episode:Ending Physician Overwhelm podcast--Physician Empowerment: website | facebook | linkedinDr. Megan Melo: website: HealthierForGood.com | linkedin | instagram--TranscriptDr. Kevin Mailo: [00:00:01] Hi, I'm Dr. Kevin Mailo, one of the co-hosts of the Physician Empowerment podcast. At Physician Empowerment we're dedicated to improving the lives of Canadian physicians personally, professionally, and financially. If you're loving what you're listening to, let us know! We always want to hear your feedback. Connect with us. If you want to go further, we've got outstanding programming both in-person and online. So look us up, but regardless, we hope you really enjoy this episode. Dr. Kevin Mailo: [00:00:34] Hi, everybody. I'm Dr. Kevin Mailo with Physician Empowerment, and I am very, very pleased to introduce you to Dr. Megan Melo. Megan is a board-certified family physician and obesity medicine specialist based out of Seattle, Washington, and she has an incredible coaching business focused on group as well as individual sessions called Healthier For Good. And the goal here is to transform the lives of physician clients who are coming through. And I think you've kind of got a focus, if I can describe it as that, Megan, on perfectionism. So why don't you tell us a little bit about your career journey to start with and how you got to this place, and then we'll get into today's topic? Dr. Megan Melo: [00:01:20] Yeah. So I grew up in a household of two nurses, and from a very young age I was like, I'm going to go be a doctor, right? And when you grow up that way, you get a lot of positive reinforcement. Oh, a doctor is a great thing to be. And oh, you sort of learn a lot of sort of people pleasing things along the way. And of course, socialized as a woman, we can throw that in there as well. Went straight from college to medical school and then into family medicine residency and did well, but was always kind of looking for gosh, like I wonder when things are going to feel better. And I remember my residency advisor would always be like, oh, second year is easier than first year, and third year is easier than second. And I was like, that doesn't seem to be true. I'm not sure why you keep telling me that over and over, because it seems like things are getting harder, more responsibilities, more people asking me to do things. But regardless, I graduated and went into practice doing pretty broad scope of family medicine for the United States. So I was delivering babies, doing clinical practice, occasional hospital medicine as part of teaching residents, and started a family at that point as well, pretty early in my career, and again, just had this experience of constantly looking for, When am I going to feel better? When is it going to get easier? When have I done enough that people will sort of start to ease off on all the things they're asking me to do? Along the way I picked up teaching in our family medicine residency, joined the faculty there, two kids by that point and life just kept feeling harder and harder, and I didn't know why and I thought it was me. I thought there was something wrong with me, that I don't feel happy. I feel like I'm constantly working harder and harder. And it never feels like enough. Dr. Kevin Mailo: [00:03:22] Wow. I think we can all relate to that. I'll share my own reflections. I mean, it's, you know, you sort of touched on this. This starts long before we even enter medical school. I mean, medical schools select for conscientiousness and a sense of duty and obligation, which is not a bad thing. I mean, that's how you want your doctors, but it is a perfect recipe for this perfectionism burnout cycle. And we're all surrounded by each other on top of it. Dr. Megan Melo: [00:03:56] Right? And we're all hiding how we feel from each other. Dr. Kevin Mailo: [00:03:59] We're hiding how we feel. Right?  Dr. Megan Melo: [00:04:03] Absolutely. Dr. Kevin Mailo: [00:04:04] But you just, you don't want to raise your hand and say, I'm not happy, right? Or I don't feel like doing it. Dr. Megan Melo: [00:04:10] Like this isn't enough for me. Dr. Kevin Mailo: [00:04:12] This isn't enough for me. So then talk about, talk about perfectionism. Talk about how this impacts us in a very real sense. I'd love to dig down on this and hear more. Dr. Megan Melo: [00:04:28] Yeah. So you probably grew up with this same idea that perfectionism sounds great, right? It sounds like, oh, I'm just a perfectionist, right? It sounds like this very benign, hardworking sort of process. But a lot of the way that it's defined, especially by Brené Brown, who I follow closely, is that perfectionism is really shame avoidance. Right? So if I act perfect enough, if I know enough, if I, you know, look right and sort of perform excellently, then no one can shame me, right? No one can cast me out. No one, you know, I'll have to be a part of the group. And no one will see any flaws in me. And there is a huge difference between that perfectionism, right, that desire that I have to do everything just right, and excellence, right? Wanting to do a good job, wanting to learn more. If you've got a knowledge gap, you know, wanting to do the right thing. Those two things are not the same. But often, you know, again, our medical training has really reinforced this notion that I need to avoid shame at all costs. I mean, that's literally, you know, when we're on rounds, right? And we're being pimped by our attendings, you know, they're trying to find out all the things we don't know. And we are humiliated. Dr. Kevin Mailo: [00:05:53] Yeah, it's a shame-based learning system. Dr. Megan Melo: [00:05:56] So we're all steeped in that. Right? And it often, for many of us, just keeps going. But the stakes get harder. You know the responsibilities get more. We throw families and other, you know, kind of outside responsibilities in there. And then we're trying to keep up on those planes too. Have that perfect Christmas card or whatever the keeping up with the Joneses is. It's an unwinnable game and it's so toxic inside. Dr. Kevin Mailo: [00:06:24] And you know, I'll share my own reflection. I mean, you know, we talk about those external voices, right? Whether it's, you know, family or friends that have expectations of us, our broader community, of how we should behave or look, what colleagues say, superiors say. But the hardest one, the hardest voice, is that voice inside saying I'm not good enough. Or not worthy to be here or shouldn't be here. Dr. Megan Melo: [00:06:51] Yeah. And often that person that you may see, you know, and may be working alongside who is someone who seems really harsh, really judgmental, really, you know, kind of always unhappy with other, your performance, other people's performance. If we could listen inside of them, we would often find that that negativity, that judgment, that shame is even more intensely turned towards themselves because we can't shame and blame others without having a high degree of it within ourselves. Dr. Kevin Mailo: [00:07:26] Wow, wow. So. How does this play out in terms of our day-to-day practice as physicians who have now, you know, settled into our careers? Talk about how it impacts our scheduling, our patient interactions. Our, you know, vacations. Talk about how this, you know, bleeds boundaries, if you will. Dr. Megan Melo: [00:07:56] Yeah. And I often talk about this, you know, looking at perfectionism and people-pleasing and lack of boundaries together. Because there's a lot of overlap between them. But, you know, it shows up as us being unwilling and afraid to say no. Unwilling and afraid to set boundaries on our schedule, or whether we can throw in an extra patient or, you know, whether we'll set an agenda with the patient and say, I'm sorry, we don't have time to continue today. I know that you'd like to discuss these other things, but we're out of time for today. Right? So much of the time, too, we're operating in very broken healthcare systems, which are strapped and under-resourced. You know, there can be things like, you know, lack of beds, as we've discussed earlier or, you know, we don't have nursing staff or things like that. So everybody's responsibilities seem to have gone up, right, while our bandwidth has gone down. But if I'm internalizing that I'm not doing enough for my patients, and I'm bearing the weight of all of the shortages and the brokenness of health care, then that is a recipe for disaster, because I will not take the time to take care of myself. Make sure that I'm eating, sleeping, peeing, you know, feeling connected with my family, having some fun, God forbid. Right? Dr. Kevin Mailo: [00:09:18] And let me interrupt there and just say that this notion of shame in our careers and perfectionism bleeds into our inability to be present during family and personal time, because you feel this nagging inadequacy eating away at you in the back of your mind that you should be doing more, or that you could have done more. Maybe I should have. Dr. Megan Melo: [00:09:39] Or maybe I didn't do that right. Or maybe... Dr. Kevin Mailo: [00:09:42] Maybe I should have squeezed this other patient in. Dr. Megan Melo: [00:09:44] Absolutely, absolutely. And we often interpret, if we're used to sort of people pleasing and lack of boundaries, we often interpret other people's disappointment as proof that we're wrong or, you know, proof that we can't do that. Right? If I'm uncomfortable with saying no to you and you get upset with me, right? If my default is just to roll over and do it anyway, right? Like, oh, okay. You know, I guess so, I guess I'll do that. I guess I'll join that committee. I'll do these extra things for you today. Then I'm interpreting my own discomfort with their disappointment as proof that I shouldn't be trying to set boundaries, right? And that's where we often really hit a struggle because we can talk about boundaries, but we need to talk about us not controlling other people's expectations as well. Dr. Kevin Mailo: [00:10:34] That's theirs. Dr. Megan Melo: [00:10:35] That's theirs. Dr. Kevin Mailo: [00:10:36] You don't have to own that. You don't have to internalize that. That's an iss-them, not an iss-you. Dr. Megan Melo: [00:10:43] Right? I love that: iss-you. Yeah. Because, you know, I don't control, you know, how sick my patients are when they show up. I don't control that they've got a list of 17 items. What I'm working in, though, is, you know, a health care system that has, you know, time constraints and constraints on what is available to me to solve that day. Similarly, you know, sometimes in primary care or in the emergency room, right, we might get pushed to do things that, you know, are really, you know, at a specialist level. We want to help. We want to do more and provide the care that the patient needs. But that's not always the best solution. And the difficulty with finding, you know, finding specialists, if we continue to sort of suck it up and take on more than is reasonable for us to take on, then we're enabling the health care system to not make any changes. And as long as we do that, there's no pressure on the system to hire the appropriate amount of staff or resources, you know, get the appropriate amount of resources because they'll just continue to push us. Well, you care about people. Just take one extra person. Just do more. Dr. Kevin Mailo: [00:12:01] One year at our conference, we had an incredible speaker come who cares for physicians primarily in her practice as a psychiatrist. And she stood up and told the whole room, don't tell us to be more resilient. Don't give us another online module to do telling us to be more resilient. Dr. Megan Melo: [00:12:22] Yoga at lunch. Dr. Kevin Mailo: [00:12:23] Yeah, yoga at lunch. Dr. Megan Melo: [00:12:25] Or yoga before work. Dr. Kevin Mailo: [00:12:27] Yeah, like goodness, it is not about doing more and adding more to our to-do list. It's actually about doing less and doing it happily. But yeah, don't tell the profession to be more resilient. We are already highly selected for this resiliency. And we are trained in it and we practice in it. It's what is the limits of human capacity? Dr. Megan Melo: [00:12:51] Yeah, we need to learn how to turn it off. Dr. Kevin Mailo: [00:12:53] And most physicians who are burnt out are working beyond what is a reasonable limit for human capacity. Dr. Megan Melo: [00:13:00] Yes, yes, we need to learn how to turn it off. To say yep, even though I see it's very busy here and technically speaking, I could stay longer and do more, but it's ultimately better for me and every other person that I go home and rest, that I go home and take care of myself so that I show up again tomorrow. Dr. Kevin Mailo: [00:13:23] Yeah, yeah. Dr. Megan Melo: [00:13:25] But that's not something that often comes to us from the outside. People don't sit us down, our managers and clinical leadership and hospital... Dr. Kevin Mailo: [00:13:33] Nobody is going to sit you down say you know what -- Dr. Megan Melo: [00:13:36] -- they do not share that with you -- Dr. Kevin Mailo: [00:13:37] -- don't worry. Things are rough right now, but it's important you get home. But we actually need to start having those conversations in the workplace. Saying like, listen, you know, I know it's really busy today, but none of us is going to fix this. Let's just go home and, you know, we'll have to just hit it again tomorrow, right? So then okay, so talk to us about like some concrete steps to make this better. I mean love on your website it says I am a recovering perfectionist. Right? And in recovery, always in recovery. Dr. Megan Melo: [00:14:13] Right. Always in recovery. Dr. Kevin Mailo: [00:14:15] Because we always have those tendencies. I know for myself I've made a lot of progress in this space, but I always feel this backslide to take another sip of perfectionism. You know what I mean? And so talk to us about like, what we can do in a concrete sense. Because if I can be honest, I think a lot of this goes back to even early developmental stages in our childhood. Dr. Megan Melo: [00:14:37] Absolutely. Dr. Kevin Mailo: [00:14:37] Right. So how do you begin to rewire? What does that look like, Megan? Dr. Megan Melo: [00:14:45] Yeah, I mean, I think, you know, one really important step, right, is really tuning into our emotions. We've been taught to ignore our emotions often, the same way we've been taught to ignore our bladders, right. Or our stomachs. And this can be hard to do at first. Because if we're tuning into our emotions more, we'll often notice more negative emotions. We'll notice that we're feeling frustrated or resentful or overwhelmed or angry. But if we can start to understand what the thoughts are that are creating that, and often that's really where we see that perfectionism or that people pleasing, because the thoughts that are connected to those things are, I can't believe someone is asking me to do one more thing. Or don't they see how hard I'm working? Or how on earth could I possibly do more? Or I have to do this all right. You know, when we can start to really understand those negative emotions and those negative thoughts, we can start to unravel them and start to say, you know, it doesn't actually serve me to think that I'm the one who has to do all of this, that I can't ask for help. It doesn't serve me to continue to use other people's disappointment as a reason why I can't set boundaries for myself. Dr. Kevin Mailo: [00:15:57] Wow, that's a wrong fuel. Dr. Megan Melo: [00:16:02] So really sort of tuning in to understanding that dynamic. And it's hard work at first. Right? Because the well-worn ruts that are, you know, kind of that we're used to are saying yes, doing more, you know, not disappointing other people. And when we're doing this work, when we're tuning into who we are and what we need, we have to get out of those ruts. Right? And that's uncomfortable. One of my group members was saying, yeah, not only is it uncomfortable to, like, bump ourselves out of those ruts, but we're exposed. It's cold. You know, we're up at the elements. And I'm like, yeah, that's a perfect way to think about it because it's different. Right? Change is something that we have to put more energy into than following the well-worn ruts. But we also have to. You know, tune into ourselves and realize that I don't actually control other people's experience, right? I don't control whether my patients are happy, I don't control what their expectations are. But if I want to take care of myself and continue to serve patients in this model, in this place that I work, or however I take care of patients, then I'm going to have to set some limits on what I do for me. Because ultimately taking care of me is my job. No one's going to do that for me. And I think for such a long time, I wrestled with wanting and expecting that the healthcare system would somehow take care of me, right? That they would somehow, you know, tap me on the shoulder and say, hey, you need a break. Like, you know, here's a week's vacation. Or they would lighten my load somehow or pay me more or something. Dr. Kevin Mailo: [00:17:35] Or even just the reward and joy of practice. Dr. Megan Melo: [00:17:39] Right? Right. Dr. Kevin Mailo: [00:17:40] It doesn't... Dr. Megan Melo: [00:17:42] It's not enough. Dr. Kevin Mailo: [00:17:43] That's not, that shouldn't be the fuel. And it certainly isn't the antidote to burnout and perfectionism. Right? You have to be able to go in and love your job even when it's hard, right? And even when you struggle or, you know, you have complex patients or whatever it is, you have to be able to love your job, right? But that can't be the, that can't be the crux of, you know, oh, I'm really exhausted at work at 70 hours this week, but had some great cases. Yeah, that's not sustainable. That's not healthy. That's not the right reference point or goalpost that we should be using. Dr. Megan Melo: [00:18:22] Well in so much of, you know, kind of what we, what we think of, you know, in health care, so much of it seems tied to the physician. Patients do this, hospitals do that, like so much of a patient's outcome seems to be tied to the quality of the physician care. Right? That's what metrics are driven by. And we believe it too. So we are often carrying around this burden: I've got all these sick people, it's my job to make them better. Meanwhile, we're ignoring the fact that most of a person's health outcomes are related to their socioeconomic status, their genetics, how they've been living their life for the last 70 years, whether they got a vaccine, you know, and all of these other components that have much more of an impact than me taking care of them right now and trying to reverse things that are going on that are already pretty deep in the process. But again, when we go back to our training, right, treatment failures, bad outcomes are so often blamed on us, right? I must not have the knowledge, skills or experience to have properly taken care of this. Ignoring the fact that this patient came in septic with chronic kidney disease, poorly controlled type two diabetes, right? A really sick body. And I'm meeting it very late in the process. My ability to actually make impact is quite small, right? Something like 20% of our healthcare outcomes is related to the care provided by the physician and the healthcare team. The majority of it, generally speaking, is so many other factors that are outside of us. Dr. Kevin Mailo: [00:20:04] Much of the story is told before we ever arrive in the plot. Dr. Megan Melo: [00:20:09] Right. But if I'm carrying around this idea that most of the responsibility is mine, yeah, there's this little lifestyle and, you know, yeah, they inherited bad genetics, but most of the burden is mine, right? I'm going to keep in that perfectionism model. Because I'm going to feel like I'm never going to be able to do enough for that patient. We have to let go of that responsibility. Not to say that we're going to provide poor care, but let's be realistic about what is possible and what's not. Dr. Kevin Mailo: [00:20:39] Even just accepting the complications, misses inevitably happen. Dr. Megan Melo: [00:20:47] They do. Dr. Kevin Mailo: [00:20:47] I mean you're setting yourself up for failure if you become a surgeon and you say, I'm never going to have surgical complications. Well, that's, you know, that's just completely unrealistic. And yet when those complications occur, we feel horrible about ourselves. Well, I could have done this differently or that differently, or I missed this, or I missed that. And we, you know, we can tear ourselves to pieces, but without accepting the fact that every surgeon has complications. Dr. Megan Melo: [00:21:15] Right. And every body is a little different. Dr. Kevin Mailo: [00:21:17] And everybody's a little different. Dr. Megan Melo: [00:21:18] We learn where most of the organs are supposed to be, right, and how they're supposed to operate, but they don't always follow those instructions. Dr. Kevin Mailo: [00:21:24] So it's this notion of struggle is inevitable in a career like this. Right? I mean, you know, you're a professional athlete and you're going to have bad games. And so it's okay, well, how do I overcome that? And how do I keep going and not just limp along. But truly thrive. Say, okay, something happened. I'm, I've learned, I'm wiser. I put it into context and I can continue to confidently move forward in my career. That takes a lot of work, but it can be done and it should be done because like we said, like we discussed on your podcast, Megan, is if not now, when? If I'm not happy and thriving in my day-to-day clinical practice now, when am I going to? Because it isn't going to be sometime in the future, like you said. Dr. Megan Melo: [00:22:21] Right. We won't get to retirement and magically be a different person. Right? We won't have the capacity, honestly, to feel joy and gratitude because it's been, if we haven't been practicing it, we won't spontaneously experience it. Dr. Kevin Mailo: [00:22:37] And it's a skill. You have to work at it, but it does get better. So speak, you know, I don't want to keep going on and on and on, although I could. Trust me, we should just get you back on the show and dive deeper into these topics. But talk to me about, like, how coaching in this space can be so helpful for physicians. Dr. Megan Melo: [00:22:58] Yeah, I think a lot of the work that I end up doing with physicians is really about dialing down that messaging that I have to do perfect, I have to do everything perfectly. I have to say yes to everybody. I have to hold all of this. Because so often the messaging and the pressure on that physician is that they should just say yes with a smile. They should, you know, see more patients, make it to all the meetings, they should bring cookies. That's that's often, you know, for us, socialized as women. Right? Like we should contribute to the potluck and be just fine with, you know, being called that lady doctor or being mistaken for the nurse. Right? Dr. Kevin Mailo: [00:23:43] Yeah. I've got daughters myself, and it boils me over, and I'm working so darn hard to raise them without that, you know, socializing, as you call it. Because it is, it's horrifying. Dr. Megan Melo: [00:23:56] And it's quite pervasive. And it's, you know, we'd like to think, oh, we should be done with that, you know, in medicine. But no, of course, it's still just like racism persists, right? Like we're working on it, but we're not done with any of that. But really sort of trying to figure out like, what is that internal dialog that is going on for that physician about what they owe to others? You know, what's getting in the way of them taking care of themselves? Where are they struggling? A lot of times people come to me and they're really struggling with charting, or they're thinking they want to leave that job, you know? And we really sort of use that as a jumping-off point to really untangle this internal dialogue and figure out, okay, you're not broken, and you do have agency and choice, and you can start to say no. And here's how we, you know, start working on this. And through that process, really learn to, you know, be with our emotions, to see that connection between our thoughts and our emotions, and see that we are not responsible for fixing the broken health care system. But if we're going to continue to work in it, or if we're going to choose to leave, right, we need to learn how to take care of ourselves. Dr. Kevin Mailo: [00:25:07] Mhm. Dr. Megan Melo: [00:25:07] Because so many of my clients, you know, have been working 80-hour weeks and always putting others first and they, don't know how to do self care and they don't know how to answer the question what is it that I want. Like that question just stops them. Dr. Kevin Mailo: [00:25:23] Yeah. A lot of us don't actually know what we want. We maybe have a sense of what we don't want. Dr. Megan Melo: [00:25:31] I wanted to be a doctor. Okay, well, I am, but now what? What else? Dr. Kevin Mailo: [00:25:38] Yeah, yeah. Dr. Megan Melo: [00:25:40] Yeah, yeah. Dr. Kevin Mailo: [00:25:41] So powerful. Dr. Megan Melo: [00:25:42] It really does a lot to kind of offload the mind. Right? The mind that is telling them you're the only one who's like this. You should be happy just with the joy of taking care of patients and serving others, you know, and the guilt and the resentment and frustration that are kind of all tied into that. So really sort of understanding that internal dialogue and where that came from, and how do we start to undo it so that no matter what you decide to do, you will feel better, you will have better boundaries. You will see that you are not responsible for fixing the broken healthcare system, and you're not responsible for other people's emotions. Dr. Kevin Mailo: [00:26:21] I love that. Love that. So how do we reach you, Megan? For anyone that's listening. Dr. Megan Melo: [00:26:29] Yeah. So I've got a podcast called Ending Physician Overwhelm, and that's available on all the major podcast players. And then you can also find me at my website which is www.HealthierForGood.com. And I have a blog there. You can link to my podcast from there and you can find out about working with me either one-on-one or in my group coaching program. Dr. Kevin Mailo: [00:26:49] Wonderful. I love it. Thank you again so much for your time today and your insights, because I think this is the the unspoken... Dr. Megan Melo: [00:26:58] It's what we needed to learn. Dr. Kevin Mailo: [00:26:59] ... issue that we have pervasive within the medical culture. Right? And even when you just talked about like how others may be externalizing their internal shame was just eye opening for me. So again, I really want to thank you for, you know, highlighting such a big issue. And it's difficult to, I think I'll just share my own reflections before we wrap up, but it's difficult to, you know, except on the outside, you could say, well, this has been since my childhood. This is the way the profession is. But the truth is, it's highly empowering because it just, it's a matter of turning the cameras inward and doing the self-work. And we are highly resilient. We are highly intelligent and we're hard workers. So if we direct those energies towards self-improvement, it can get better. And it's independent of what hospital you work in, who your colleagues are, you know, what happened to you years ago in your life. The truth is, you can make it better now with that self-work. So I think that's so, so powerful. And again, it was wonderful having you on the podcast, Megan. Dr. Megan Melo: [00:28:11] Yeah, thank you so much for having me. It's been a real pleasure. Dr. Kevin Mailo: [00:28:14] Thank you for all your work supporting the profession. Dr. Megan Melo: [00:28:17] And for you. Dr. Kevin Mailo: [00:28:20] Thank you so much for listening to the Physician Empowerment podcast. If you're ready to take those next steps in transforming your practice, finances, or personal well-being, then come and join us at PhysEmpowerment.ca - P H Y S Empowerment dot ca - to learn more about how we can help. If today's episode resonated with you, I'd really appreciate it if you would share our podcast with a colleague or friend and head over to Apple Podcasts to give us a five-star rating and review. If you've got feedback, questions or suggestions for future episode topics, we'd love to hear from you. If you want to join us and be interviewed and share some of your story, we'd absolutely love that as well. Please send me an email at KMailo@PhysEmpowerment.ca. Thank you again for listening. Bye.
31 - Financial Education Awareness in Medical School with Christian Wigmore
Nov 15 2023
31 - Financial Education Awareness in Medical School with Christian Wigmore
In this episode of the Physician Empowerment Podcast, Dr. Kevin Mailo engages in an insightful conversation with Christian Wigmore, a medical student at UBC and the mastermind behind Budget Your MD. Together, they illuminate the critical role of financial literacy within the realm of medical education and practice. The discussion spans pivotal topics such as navigating student debt, management of lines of credit, and the influence of interest rates.Christian introduces his business, Budget Your MD, a debt projection tool and visual aid that empowers medical students to foresee their financial trajectory across various scenarios. The discourse places a strong emphasis on cultivating balanced financial habits that harmonize with professional ambitions, family life and personal dreams. Christian envisions a future where financial education seamlessly integrates into medical curricula, fostering a supportive community for open financial discourse within the medical community. Such an initiative, he believes, will play a pivotal role in alleviating burnout issues among physicians, ensuring a brighter, more empowered future for the medical profession as a whole. By melding financial wisdom with medical expertise, Christian and Dr. Kevin Mailo discuss how physicians can work toward a more prosperous and balanced lifestyle in the world of healthcare.About Christian Wigmore During Christian's first year at UBC Medical School, he noticed the lack of financial education integrated into the curriculum. Recently completing his double degree in Business and Biology, the importance of financial literacy heading into medical school was top of mind. He thought… we will be running small businesses and managing our personal finances in 6 years. Understanding the basics of finance is crucial to ensure we don’t A) get taken advantage of by financial institutions and B) don’t end up losing all the money we make in the process. All this, and much more, led Christian to start Budget Your MD. He tends to think of it as a passion project that he is slowly building as he progresses through medical school. Noticing the topics and problems his colleagues are interested in at each stage in the game. Christian hopes to one day play an integral role in changing how finance is discussed in the medical field. To not avoid these conversations, but rather dig deep to help one another live our best financial lives as physicians (because if we’re being honest, our finances play a role in our health and wellness).--Physician Empowerment: website | facebook | linkedinChristian Wigmore/Budget Your MD: website | instagram | email |--Transcript: Dr. Kevin Mailo 00:01Hi, I'm Dr. Kevin Mailo, one of the CO hosts of the Physician Empowerment Podcast. At physician empowerment, we're dedicated to improving the lives of Canadian physicians, personally, professionally, and financially. If you're loving what you're listening to, let us know we always want to hear your feedback. Connect with us. If you want to go further, we've got outstanding programming, both in-person and online. So, look us up. But regardless, we hope you really enjoyed this episode. Dr. Kevin Mailo 00:34Hi, I'm Dr. Kevin Mailo, one of the CO hosts of the Physician Empowerment Podcast. And I have today with me, our guest on the pod, Christian Wigmore. And I'm not introducing him yet as Dr. Christian Wigmore, because Christian is a medical student at UBC. And he founded a very interesting venture called Budget Your MD, and I wanted to share it because Christian connected with me over social media, we got talking, we had one of those great phone calls that I think was supposed to be probably five or 10 minutes. And it wound up being like an hour or two talking life, talking dreams, talking finance, talking career. And then of course, Christian joined us at our conference in 2023, and it was amazing to meet him in person. And we've stayed in touch ever since. So, I'm very glad to have you here, Christian. I love your passion. I love what you're trying to do for your fellow learners but I think there's a lot of wisdom here for us going through our careers, like I'm a mid-career physician, and I love your message. So, tell us a little bit about like your background. Tell us a little bit about what you were doing before medical school. And what you did you know, once you entered medical school? Christian Wigmore 01:41Okay, well, first off, super glad to be here. I can think back to when I messaged you first on, I think it was LinkedIn. And I think I might have messaged like six or seven other people, no answers, but you answered me right away, and then we get on that phone call. And then off we go to the conference in May. It's been cool to get to know you. It's so yeah, super glad to be here. So yeah, my name is Christian. I'm a fourth-year medical student at UBC. My journey has been pretty centred around medicine to start. I knew kind of in high school, I wanted to do medicine, you go to university, you do the sciences. But funny enough, like if you are UBC grad or you know how UBC medical school works, you get to drop your worst year. And I met my wife in second year and got like the worst grades.Dr. Kevin Mailo 02:27Was it worth it?Christian Wigmore 02:31Oh, well, I'm still married to her, right? So, I got the worst grades that year and I knew I needed to have a little bit extra time before that bad year can be dropped before getting into medical school. So I was like, What am I going to do? I grad with a science degree, that's going to leave me doing what? I know I don't really have an interest in something outside of medicine with a science degree. So, why not start taking some business courses, right? So I started doing business courses, and I realized, wow, I kind of liked this stuff. And you know, that wheel starts turning and I realized, okay, maybe if I start doing summer courses and push a little harder, I can grad with a science and a business degree. And so that ended up taking me five years. And after that, I found a small little internship in the midst of COVID with a financial advisor and kind of was able to be his associate and just watch the way he ran his business. And it wasn't only finance, but it was kind of more of like the operation side and entrepreneurship that really started to make me realize that there's that world out there. Like they don't teach any of that in science, you don't really learn any of it in high school. And so that got me excited. But that year I got into medical school, right? And that's the golden ticket everyone's waiting for is they think about medicine. And so after medical school, I went, but I guess over that time, the business mind was still kind of ticking at times. Dr. Kevin Mailo 03:46So, when calls that the white coat, black suit mentality, right? Do you wear the white coat when you're in your clinical work and the black business suit when you're managing your finances or your practice? So yeah, keep going, keep going. Christian Wigmore 04:01Totally. So like, I think originally, I was always believing that I would kind of wear that black coat, I guess like in my own personal finances, thinking about the ways that I'll eventually run a corporation through my medical practice or something like that. But what I started to notice is just the lack of any financial topics, discussion, or education at medical school. And then I realized I have friends around me that didn't necessarily have that same mind. And I said, Well, why don't we start talking about this stuff more? What? Why is this something that's never spoken of? The preceptors we work with don't really talk about it. And sure it maybe doesn't apply to us immediately as a first-year medical student, but eventually it will. So, when will this part of our education come into play? And I speak to people higher up than me, doesn't really seem like it's ever happening. And then I said well, you know, between studying and doing other things I kind of like finance and I probably know enough that I can make a few Instagram posts, so I start Budget Your MD is the name that I call it, right? And start to make little infographic posts and see how it goes. And at that time, it's still slow growing, and students are slowly finding out about it. But what I find is, as I go through each year of medical school, I'm able to see the questions, and topics and interests that students would have at that time. Like, I'll give an example in first year, it's the line of credit, like, what does that mean? I all of a sudden have been given sorry, $350,000 from a bank. What does that look like for me as a medical student? What is interest? How does interest even work? And you know, which bank offers the best package? And so that's kind of what I've used as an area to at least keep people interested on things that they're currently going through. And as now I go into fourth year, I realized disability insurance questions like that. Things that come up that are these decisions that require a little bit of financial savviness to understand, are being put on people's plates, right?Dr. Kevin Mailo 05:58I love that and so, you know, what are some of the big issues that and let's go a little bit beyond medical students to, you know, residents to fellows, people in early year practice. What are some of the struggles that people face in these early years? Because I think the big one for medical students is blowing through that line of credit, right? I remember, when I went through, it was low, ultra-low interest rates following the financial crisis, right? And so it was like how wasn't that bad, but interest rates have gone up massively, right? And so we have learners that are struggling with the thought of this interest piling up. But we also have a lot of physicians who have personal lines of credit used for consumer purchases, and it went from being tolerable to being very painful. If you think of it this way, and there's just little thing, and then we'll get back to the interview. But if you have a personal line of credit that you used for whatever home renovations or consumer purchases, whatever it is, and that line of credit is $1,000 a month of service, it's like $2,000, having earned because you have to pay personal tax on the money that you're going to use to service your line of credit. So, that's a really big hit. That's like working, you know, a whole long, busy clinic day, at a minimum, just to service that line of credit without even paying down the balance, right? So people are starting to feel the pinch of interest rates. But let's go back a little ways. And just talk me about what it is some of the issues that you see in you know, people that are now going through residency, although there's a little bit of income coming in, but there's a little bit of tax planning that has to start to begin. And also like in those early years of practice? Christian Wigmore 07:40Yeah. It actually reminds me of, I spoke with, I think it was the residence of doctors of BC when I think one of their whether it's the president or not, he showed me a presentation, at one point about the debt levels that residents have, when they start residency, this might just be BC specific, and when they end. And my thought had always been well, it would go down, right, like they finally started. Like you should be able to kind of work it down a little bit. 50% of it goes up, but of the students, 50% of residents will have more debt when they finish residency. And so things that mean, you have always talked about, but like, let's think it's got to be something rather than actually needing the fancy car or needing something. It's a mindset, potentially that's causing people to do this. Now, we always have to, like put in disclaimers, there's family circumstances, things that are out of–Dr. Kevin Mailo 08:33Yeah, I mean, when you're like in my household, when we were both going through medical school, we paid the nanny more than I made. Because we were both working like 80 hours a week and we had young kids and she was hitting overtime by Wednesday afternoons. So, yeah, you're right there, family circumstances, totally. And personal circumstances. Christian Wigmore 08:51There's potentially a mindset, right? And I have this funny little line that I heard from a physician at one point, and it goes, “If you spend like as a doctor, when you're a student, you'll live like a student when you're a doctor.” And that one hit me right away, right? Because it's that thought that if you blow up the line of credit through medical school, and you finally get into practice, and you think that pearly white income that you'll eventually earn will pay it all off, you start to realize that all that spending you did as a student, basically wrecks any of the beauty of having a higher income, I guess, as a doctor, eventually. Dr. Kevin Mailo 09:26And there's a huge tax penalty now, right? Like, that's the other reflection I have, you know, in your generation compared to mine, like, I mean, and it was even better years ago. But, you know, I graduated like 15 some years ago, it have been 10 years in practice. So, what am I, totally getting my numbers wrong. It'd been 10 years in practice, but like I was, you know, at a place where like, we could pay down the line of credit relatively easy with income splitting through the PC, and dividends to spouse. Personal Tax rates were lower and now it's different. And the cost of living has gone up, right? So, your base cost for food, clothing, shelter, transportation has gone up. So, there's less and less margin to pay off personal debt, right? Between taxes and the cost of living. And you're right, it's so critical to get this right in the early years of practice. Christian Wigmore 10:20Yeah, and I feel like what we're talking about here is just it's like, it's personal financial management. Like we're, there's kind of like, there's personal finance, and there's like your corporation management, all that fun, financial things that like we could all learn as doctors, but it's the personal side, the personal financial management that's so important. That could begin right as they get into medical school as they go through medical school, into residency, and then into practice. That is honestly the saving grace that appears like these days to save you from some of the hardships of feeling like you have to go to clinic every single day, or work that extra call shifts to pay for all the luxuries that have kind of built up over time, right? And so that's what I think of as like the end game in a sense when I see myself and I see the students around me of thinking about what do the decisions that we make right now as students and kind of the habits in a sense too that we make right now as students and the expectations that we make about what it'll be like when we start to make money. How that will actually impact our career, and how we can still be as healthy as possible as doctors in not only our lives as physicians serving our patients, but also in our financial lives, right? Dr. Kevin Mailo 11:35I couldn't agree more and it's so important to get that alignment right. Between what are your career goals and your personal goals, right? Because if you say, you know, I want to be healthy, I don't want to work in excessive number of hours, I want to minimize the number of call or night shifts I'm doing or whatever, or clinic days I'm doing in a month. Well, you have to have financial goals that align with that. Because if you don't, well, you know, I mean, your mortgage company doesn't care. You know, what, how many hours you want to work in a week that mortgage comes due every month, right, or the grocery bill or whatever else you're facing. And so it's again, it's being holistic in our lives, and looking across and seeing Okay, well, what do I really want? And then what financial decisions am I making that align with it? Especially the big ones, right, like mortgage and those kinds of things, like the big permanent purchases. Christian Wigmore 12:30Yep. Yeah. It's interesting and I think it like it ties in to, you know, we are offered this $350,000, when we've never had money before, there's like that aspect of like, quickly, your life-changing in the financial world. But then I assume, you know, I'm still like, early in the game, but I assume the moment I start making an income that is substantial enough, the bank's gonna come to me and say, Hey, here's this fancy mortgage, you can have it and but this million dollar house, and they make you feel like you can afford it. Because, in a sense, if you're willing to sell your life, you can, right? And it's those trip falls are like the traps that I think are just so important to be educated on as we're going through, to be aware and know the implications, right? Dr. Kevin Mailo 13:13And this is also another thing that we teach us at the conference. And I alluded to this, you know, when you were there as well Christian, is the notion of an hourly rate. Every one of us has an hourly rate, what we're worth per hour what we can bill. Remember that there's a tax penalty associated with that, right? So, if you're, you know, if you're billing $300 an hour, your after-tax income on that is actually going to be substantially less. So, when you say, how many 1000s of dollars do I have to pay on a mortgage every month and property taxes, and utilities, and maintenance, and repairs, and vehicle payments? Well, now you can actually calculate and, you know, I'm happy to show anyone that's interested, how many hours in a month you're gonna have to work just to maintain those big expenditures, right? And then how many hours are left for fun? And the bigger one is, how many hours are left to save for retirement? Which again, the sooner we start, the sooner we are better off. But if we if you know, we're struggling for 5 or 10 years to pay off a line of credit, then we've already really short in the compound growth curve, which is so vitally important not to do. Christian Wigmore 14:25Yeah, and something that like, is underrated and not maybe spoken about as much is student loans nowadays, like the government has announced that they're not charging interest on those. So, we already have it easier than the previous like, the generations before us, right? Like my student loans right now, if things don't change, I don't pay interest on it ever. Like I just have to make the minimum payment and it doesn't go up over time. Like that is a huge advantage. Dr. Kevin Mailo 14:50That’s a good deal. Christian Wigmore 14:51I know, yeah, pretty sweet. Yeah, almost say thanks to the guys over the line that did it first and then Canada felt like they had to follow suit, but like, yeah, the only interest-bearing debt that we're going to have coming out of is the line of credit. And you have to jump into that a little bit to pay tuition, the student loans never cover it fully. But it is still a variable cost in my mind of kind of your lifestyle and things like that, that really push that number up. Dr. Kevin Mailo 15:18It totally. And I mean, I'm sympathetic to it as well. I mean, you know, when you consider, you know, broader, you know, sort of North American or Canadian society, there are very few people that are forced to delay gratification the way doctors are. Like, some of us go a decade or longer in school. In fact, it's actually much longer some of us regularly go like 15 years from undergrad to practice. Like that is a very long road, right? And it's natural to want the nice things in life. Right? You actually do deserve them, right? The message here isn't, you know, that you've got to live this extremely austere existence, that it's craft dinner and ramen noodles every night. No, it's, there's just got to be some balance, right? Because there's a very real cost to that lifestyle creep and remembering that if we're 10 years behind the average adult in entering, practicing and earning in our prime, it's also 10 years that we've lost on the compound growth curve. Again, it's another big impact. Christian Wigmore 16:25Yeah, I've used the example sometimes with students, as we kind of talked about our debt of what would it look like if you just became a red seal electrician right off the bat, and you saved 15% of your income over time? The amount of time it would take us as physicians, who are thought to have made/make so much more money than a red seal electrician to catch up to that person is incredible. I don't know the math in my mind, I'm not that much of a whiz. But like, it would take so long to catch up to that person for the compounding that they would achieve over those years that we're studying. Yeah. It blows my mind sometimes. But that just only solidifies the point of just good, sound, basic financial knowledge, just for basic, like, you know, your own finances, things like that. Dr. Kevin Mailo 17:10And the other reflection is, you know, again, another observation about younger generations coming through, they don't want to work the 70-80 hour workweeks that older generations of physicians have worked. And I actually think that's a wonderful thing. I think that's an example to the entire profession, that we should all be working fewer hours. The job is stressful, we deal in people's lives, and more should be spread, more duty should be spread across a larger group of physicians. Absolutely, right? It shouldn't be two rural physicians holding up a town, you know, in a remote part of Canada. It should be four, do you know what I mean? And this applies everywhere across our healthcare system. But again, if we're going to cut back those hours, our finances have to align with that broader goal. And so it's about like being mindful and intentional. And reflecting on what do we really want our ideal work week to look like? Because yours was actually very interesting. I really liked yours. You don't have to share it. But it was great. It was really balanced. Christian Wigmore 18:14Yeah, I'm happy to share like my dream in the future. Like, I think, first and foremost, for myself, like this is getting a little bit more personal into how I feel. I'm like a family man first. I've always been that way. Like, my dream is to be able to go to my daughter's soccer–Dr. Kevin Mailo 18:27I love it. Trust me, do it all. Christian Wigmore 18:29–basketball game. Like that’s–Dr. Kevin Mailo 18:27That's wonderful. Don’t miss any of those moments. Sorry, I’m going on and on. Christian Wigmore 18:34–I want to be able to drive my son and his buddies to the basketball game and hear them get hyped up to some Eminem or something on the way to the game. Like I want to be there for those moments, right? And so I think like, if I could work clinic two-three days a week, and then have two or three days a week that are more flexible, that they could be, you know, those moments with my kids, or be moments where I'm getting to pursue Budget Your MD and kind of push those things forward.Dr. Kevin Mailo 18:58A passion.Christian Wigmore 19:00Yeah, exactly. That gives me the balance, right? That allows me to really be the doctor, I want to be on those two to three days. And then be the dad I want to be hopefully, be the husband I want to be, and then still kind of use that other part of my brain that sometimes has to be shut off at times. Right? Dr. Kevin Mailo 19:15I absolutely love it. What an inspiring message. So okay, let's tell us a little bit more about Budget MD. We touched on and then we went on on all these tangents. Tell me a little bit more like what what do you do right now with it?Christian Wigmore 19:31So, the thing that I would say we provide or I provide the most value on is something I call the debt projection tool and I know of honestly centers around everything we talked about today. And I made it originally for myself, I was just interested, okay, if I have this much debt currently, and say I want to go into family practice, which is what I want to go into, or what if I want to do internal med or ER. What would those differing incomes look like in terms of eventually being able to pay off my line of credits, my student loans? Like how long would it take me to get to financial independence and if I want to save a little bit along the way? And so I took some Excel courses through my business degree and know three or four formulas. So, it's not the cleanest Excel spreadsheet in the world, but it works. And what I allow myself to do is to plug in, okay, this is my age, this is the specialty I might think of doing. And I even have like the house I may want to buy it some age, the interest rate that approximately it could be at at that time, and the downpayment, I could approximately have, and I even have in there, how many kids I would want to have. I just do an average, I think it's like just under $14,000 a year for a kid from the age of like, zero to 18. I've never been a parent before, so, I have no idea. That's what I found on the internet, right? So, maybe it skews a little bit more expensive into the later years as you're paying for universities and stuff if that's something you want to do versus the beginning. But you can correct me if I'm wrong there. But basically, the goal of this tool is to help what I find to be two groups of students. And this is what I get passionate about, there's students that are, A. super worried about their finances, like I've met a few that like, I have so much debt, I'm never gonna be able to pay it off. Dr. Kevin Mailo 21:09That was me. Christian Wigmore 21:10It's hurting their ability to learn. And I'm like, you're gonna be fine. Like, you actually need to be told that, like you're doing a great job, and like be able to move on with just learning and know that things are going to be okay, that's one group. And then the other group is the, oh, I'm going to be a doctor one day, it's completely fine. Yeah, I do DoorDash every single night because like, you know, we'll make a good income at some point and pay it off. And so it's those two groups that fill up this debt projection that I have, and kind of give their example scenarios. And I can show them well, okay, person A, that's worried about their life, you're going to be okay. You're like this is kind of your projection, approximately, like none of this is exact, but it gives them an idea that the debt will eventually get paid off and kind of eases some of their worries. Group two sees on their projection that with their current debt and spending, the curve only just continues to go up, it's almost like, you're not going to be able to pay all this off. And coincidentally, they're the people that say they want to buy a $3 million house, and then that mortgage payment really causes the curve to continue up as well. But it, my goal with that is to just start the conversation, right, is to get that part of there, get the light switch moment to go and realize that, okay, the current habits and mindset I have, are maybe a little bit off from what I need to currently be doing to make sure I'm setting myself up to succeed, not only as a physician, but in my own independent financial life. Dr. Kevin Mailo 22:39I love it. Christian Wigmore 22:40So, that's my big like, that's the one I really have fun with because I kind of like Excel, and they send over the projection, I do it completely for free, and I send it to them. And then I offer them 30 minutes to chat about it too if they want to. And so, that's been super fun. It's kind of an extra thing I'll do in the mornings or the evenings, I'll fill those out for people. It's not AI-generated at all, at this point. So, I'm still collecting some things together on my own computer, but I'm one of those rare breeds that likes to see an Excel spreadsheet. So Dr. Kevin Mailo 23:10Yeah, I love it. So, where do you want to go with it? Right? Because obviously, we're gonna hear more about it. You're in the early stages. Where do you want to go with it? Like, what's your dream, in terms of the profession? Christian Wigmore 23:22Yeah. So, my dream, in terms of the profession would be to like, almost not solve but help in the world of, you're gonna get my mind going too fast here, Kevin, when you ask me what my dreams for this thing like, it's so like–Dr. Kevin Mailo 23:41No, no. Like, I just did a podcast episode on dreams. It'll come out before this one. I'm a very big believer in being open about our dreams. So, talk about your scope. Christian Wigmore 23:55So, like a broad dream would be to change the way that financial education is brought into the medical programs across Canada. Like let's start Canada first, we don't need to go worldwide. I don't need to dream that big. Like if we could somehow incorporate financial education into the undergraduate medical degree, and whether that just be evenings or a lunchtime money talk or something to not only help students become aware of the pitfalls as they transition into residency and practice. But also just to be aware of kind of the habits that we've been speaking to a lot over the past, I don't know how long we’ve been–Dr. Kevin Mailo 24:37I love it. Yeah.Christian Wigmore 24:40So I mean, that's the number one goal, right? And then after that, like, I hope that that could evolve into like a better community in medicine that is willing and I think Physician Empowerments already absolutely spearheading this, but a community where doctors feel more safe to talk about this stuff, right? Like, it's rare, like as a student, have I ever had a preceptor bring up, you know, billing or how they're like clinic rents and stuff like that? No, I haven't. And if there could be a community where students can ask about this stuff, where people further down the line can give advice about these are the some of the mistakes I made as a student. And that doesn't have to be like physician to student that can be, you know, 20 years experience position to first five years practicing physician, just the space like that would be awesome. Just to provide that advice and care almost for the future generation of physicians. And I think in general, the dream, like, macro of all of that, is that that could then some, in some way help aid like the issues that we see in medicine as a whole right now, like the burnout issues, like that's the big word. Dr. Kevin Mailo 25:48Oh, without question. Christian Wigmore 25:50And I think me and you align on this that, like if personal finance, can be focused on more and physicians understand how that binds them, I think we can, hopefully, turn the dial a little down on the burnout rates. And that's the goal, right? Like, that's the hot word these days. And in medicine, practicing physicians is burnout, right? Dr. Kevin Mailo 26:10Yeah, I'll just go on, I'll go climb on my, you know, pedestal on this one and go. I teach wellness, right, that's one of the things we teach at Physician Empowerment, and I've done CME events for it. And I'm going to be blunt. I mean, you can do all of the mandated wellness modules online, that the system tells you to do. You can do yoga, you can journal, you can meditate, I do all of those things, you can do all of that. But if you are unhealthy, working 70 hours a week, no amount of extra stuff you do is going to make that better. If you're healthy number of hours a week is 40, then you just have to come down, the only way to come down is to be financially secure. Financial Security underpins all wellness, in our profession, in my opinion. The other big one, and we sort of touched on this before we started recording, was leadership. When we want to transform the system and make it better for our patients, better for us, better for our allied health colleagues, we need to be involved. We need to be able to sit on those committees, we need to advocate, we need to be a voice, we need to be present, truly present. That will only happen when we're cutting down on 70-hour work weeks, and we have a little bit more balance to get involved. Again, truly believe that and again, that is underpinned by financial security. Christian Wigmore 27:37Yeah, and, you know, it almost feels odd as a student right now talking to a physician who's current practicing to like speak about this financial stuff, because it almost feels weird, to be honest. Like we're doctors. And I think at the conference, Wing spoke about this, about where there's this altruistic mindset that's kind of ingrained in us that we're supposed to just work like crazy and not think about the finances, because we're serving, and I 100%, like, have that heart to serve. But I think it's gotten to a point these days where like, you have to start to think about that weird financial pit in your stomach because it has all these implications we've been speaking to, right? Dr. Kevin Mailo 28:16You will do your best care when you are not burnt out, when you are not exhausted, and when you're not overbooked and worrying about the overhead. That is what your patients deserve. A rested physician who is in control of her/his schedule, that's what's so powerful. And that's what will lead to better patient care. So, to serve, it means to serve ourselves first or to be to be our healthiest first is in my opinion. Christian Wigmore 28:42Yeah. And like, honestly, Kevin, I appreciate you saying all that. Because I think that some of the mindsets I've come to I would never be able to come to just as a fourth-year medical student, you know, learning–Dr. Kevin Mailo 28:54It's hard to talk. Christian Wigmore 28:55Yeah, it is. And like, No, there's no medical student out there that's thinking about these things. We only hear of it from people like you and Wing and all these other physicians that are starting to talk about this stuff that we can begin to create some of these ideas of important topics and frameworks that it will matter later down the road. But what's so awesome about this conversation is that hearing them then allows you to have the advantage of applying them early. I think that's the key that I get excited about. Because talking about them, you know 10 years into practice is awesome and super important, has a role but there's such an advantage to thinking about it or like–Dr. Kevin Mailo 29:32I couldn't agree more. I couldn't agree more. Christian Wigmore 29:35Because you're making lifetime decisions. Even the specialty you go into like that's bigger than the house you end up buying, the house you end up buying it's high up there too, but the specialty end up choosing, like think about this stuff like it. That's your life like you're signing, we're all in medicine to–Dr. Kevin Mailo 29:50It's very hard to retrain.Christian Wigmore 29:51Think about your life to go do that, like be ready. You know what I mean? Dr. Kevin Mailo 29:52Very hard to retrain. I'm envious of our nursing colleagues who are able to cycle through different aspects of nursing over the course of their career in health care. Because we really struggle with that in medicine, it's very hard to retrain, and understandably so I mean that there has to be a lot of technical proficiency. So, I thought this is absolutely amazing. I would encourage listeners to check out Budget Your MD. I know more is coming from you, Christian. That's why we want to bring you on the show because this is going to be a lot more than just medical students and residents, right? I think all of us should be going through this exercise. So, get building those spreadsheets, no I’m just bugging you. No, we look forward to the other offerings that are coming. And you do so much education as well. I know over Instagram and other other places. So, I again, encourage people to check it out because it's the what you teach is so true. And it's been great connecting, and great having you on the show. So, we'll we'll definitely have you on again. Christian Wigmore 30:49I appreciate your mentorship. Thanks for having me on. It's been so good to chat about some of these things. Dr. Kevin Mailo 30:54Wonderful. Dr. Kevin Mailo  30:56Thank you so much for listening to the Physician Empowerment podcast. If you're ready to take those next steps in transforming your practice, finances, or personal well-being, then come and join us at PhysEmpowerment.ca - P H Y S Empowerment dot ca - to learn more about how we can help. If today's episode resonated with you, I'd really appreciate it if you would share our podcast with a colleague or friend and head over to Apple Podcasts to give us a five-star rating and review. If you've got feedback, questions or suggestions for future episode topics, we'd love to hear from you. If you want to join us and be interviewed and share some of your story, we'd absolutely love that as well. Please send me an email at KMailo@PhysEmpowerment.ca. Thank you again for listening. Bye.
30 - Why Your Dreams Matter
Oct 31 2023
30 - Why Your Dreams Matter
Dr. Kevin Mailo is interviewed by Physician Empowerment co-founder and co-host, Dr. Wing Lim, on the topic of dreams. Kevin once gave a talk on this subject at an accredited CME event in Mexico; about what dreams really are and why it’s so important to have them. And in this episode, he shares a bit of that talk.   Wing asks Kevin to first define dreams and differentiate them from goals, which are not the same thing. Something Kevin says in giving his definition is that “dreams are what help us keep going forward in our lives despite the struggles”. That is part of why dreaming is such an intrinsically vital part of wellness and forward motion.In this episode, Dr. Wing Lim and Dr. Kevin Mailo explore dreams, dreaming, why we have dreams, why they matter, what dreams give to us, and what dreams offer the world at large. Dreams not only give meaning to our lives but give us the ability to enjoy the pursuit of them and to flourish in the journey toward them. This episode will shake you out of going through the motions, which is a source of burnout, and leave you inspired to dig deep to reconnect with your own dreams.—Contact Information:Physician Empowerment: website | facebook | linkedin __TranscriptDr. Kevin Mailo: [00:00:01] Hi, I'm Dr. Kevin Mailo, one of the co-hosts of the Physician Empowerment podcast. At Physician Empowerment we're dedicated to improving the lives of Canadian physicians personally, professionally, and financially. If you're loving what you're listening to, let us know! We always want to hear your feedback. Connect with us. If you want to go further, we've got outstanding programing both in person and online. So look us up, but regardless, we hope you really enjoy this episode. Dr. Wing Lim: [00:00:34] Well, welcome everyone to our next episode of podcast in Physician Empowerment. So I'm Dr. Wing Lim, I'm one of the co-founders of Physician Empowerment, and today I'm really glad to interview my co-host and co-founder, Dr. Kevin Mailo, who is an emerging physician out of Sherwood Park. And we're going to talk about a topic that he delivered in an accredited CME event in Mexico a couple of years ago. And it's about dreams, why dreams matter in your life, and how it ties into your wellness. So welcome everyone and welcome, Kevin. So why do you pick a topic like that? Strange topic, dreamy weamy stuff. Dr. Kevin Mailo: [00:01:16] Yeah, so this one actually, this was actually an accredited talk that I delivered when we, when we got invited to Mexico. And at first I was actually overwhelmed with this one. And today on the episode, I'm not going to go into it in its complete depth. There's a lot, a lot there. But boy, at first it was, like I said, overwhelmed. And I'm like, where do I start? And then I started and I just kept going and it was incredible. And this topic specifically represents really, I would say, my falling in love with Physician Empowerment, because in many respects, Physician Empowerment represents a dream for me to help transform the lives of Canadian physicians. But what was so powerful is that in this journey of teaching, I was forced to learn the material myself. I was supposed to take it. I was forced to take a very hard look at my personal life, my professional life, my financial life and making a lot of incredible change, and I'm just so much happier for it. And so this topic of dreams became very powerful for me because it brought a lot of focus into my life. And so, yeah, again, I could go on and on about about this, but yes, this was an accredited talk. You could claim main Pro Plus credits for it. Really far from blood pressure management. Really far. Dr. Wing Lim: [00:02:41] Manage your own blood pressure. Dr. Kevin Mailo: [00:02:42] Manage your own blood pressure. Exactly. By being better. Dr. Wing Lim: [00:02:45] So tell us. Tell us, Kevin, how does, why do our dreams matter to our wellness? Dr. Kevin Mailo: [00:02:50] Yeah. So. So dreams matter in our lives. And I'm not talking about goals, okay? Goals I'll get to later, that's a much narrower thing. Dreams are those things that we truly want that are part of our self actualization. Okay? Dreams are. When I think about a dream, I think about our life as a landscape. So I look at my life like it's a landscape. It's got hills, it's got paths, it's got fields, it's got forests, it's got mountains. It's got whatever in front of it. And on the horizon is a destination. That is a dream to me. That's the visual imagery I use to describe dreams, and that you can have multiple dreams in your life's journey, that you can walk across the landscape of your life, and you can go to all these vistas, all these points. All these locations, and each one represents a dream, right? So it's not one thing on the horizon. It's many things on the horizon. So dreams are what help us keep going forward in our lives despite the struggles, despite the setbacks, despite the monotony, despite the burn out, dreams end up being the thing that we can focus on so that when we're walking life's path and it's muddy, it's rainy, there's quicksand, there's no clear path ahead. Somehow we make it when we follow our dreams. Dr. Wing Lim: [00:04:20] Right? So yeah. So you said the dreams and goals are not the same. And most people, they just lump them up, dreams and goals. Right? Dr. Kevin Mailo: [00:04:27] Exactly. Dr. Wing Lim: [00:04:27] So how do you distinguish between them two? Dr. Kevin Mailo: [00:04:29] So for me a dream is a representation of a better future for myself, for my loved ones, and for society as a whole. The other thing is that dreams can be very small. You might have a dream to run a half marathon. Okay? Or a dream can be huge. We actually had somebody come to the Physician Empowerment conference one year - do you remember, Wing? I think you do - He is very successful physician entrepreneur, and we talked about physician entrepreneurs before, but his goal was to build his business and create a $50 million endowment for children with autism and autism awareness. And that was his big dream, right? So dreams can be huge. Dr. Wing Lim: [00:05:15] Mhm. Dr. Kevin Mailo: [00:05:16] Dreams can also be private. So they can be, you know, things that are very personal that we don't share. It can be something, you know, like a special trip. You know, you want to go to a great location and just experience a certain festival let's say. But dreams can also be shared. Right? You know, that you share with your loved ones that you share with colleagues. Like let's say, you know, you talk about your dream, Wing, of Synergy Medical. That was a shared dream to bring comprehensive health care to a county of, well, probably getting close to 100,000 people now, that was underserved. So dreams are a lot more than goals, you know. A goal might be to say, I want to have X amount of dollars in the bank when I retire, but a dream is really I want to have this money to do this great thing for myself or my family, have a sense of purpose. And the truth is, and you know, I don't want to sound too romantic here, but the truth is, our world is built on dreams. Every invention, innovation or discovery was a product of dreams. And the people who make the headlines, they're not particularly intelligent, not even necessarily particularly hard working, but they're dreamers. And they kept going despite the failures and the setbacks. Dr. Wing Lim: [00:06:41] Mhm. Yeah, I once heard one definition of dreaming is an attack on status quo. Dr. Kevin Mailo: [00:06:48] Ooh I love that. Looking at the world and saying I'm not happy with what I see, or looking in our lives and saying, I'm not happy with what I see. How can I do better? Dr. Wing Lim: [00:06:59] Mhm. Dr. Kevin Mailo: [00:06:59] For me, and I would say, you know, some of the most important people in my life are immigrants, including you, ing. But immigrants inspire me because their lives are, are an embodiment of a dream of a better existence for them and their descendants. When you think about the immense sacrifices somebody makes, you know, to travel to another country, leave everything behind that they know, and start working at a lowly job and start working up the ladder, is incredible. Right? Again, not happy with the status quo. Dr. Wing Lim: [00:07:37] Mhm. Dr. Kevin Mailo: [00:07:38] And somewhere along the line as we become adults, and it's funny because one of my kids had a birthday and I told him like, don't ever grow up. And it's not that I don't want my children to become highly responsible, industrious, hardworking, self-reliant young people that will have careers and families of their own. But the message behind that was, don't grow up. Don't give up on your dreams and become some stuffy adult that is focused on day to day tasks and has no meaning in the broader arc of their life, that loses track of the landscape. Because when you think about dreams, probably your best way to connect with your own dreams is to look at the ones that you had when you were a kid. You know, when you were a teenager. And it's like, what would I do in my career? Where would I live? Who would I marry? What would my kids be like? Where would I travel? What would I experience in life? What would make me happy? Somehow, as adults, we have lost that. Somehow, as adults, through career, life struggles, institutional level sort of functioning, being put into a system, whether it's an education system or the health care system or a business system or whatever, our dreams get ground down. We're told it's unrealistic to think like that. And yet, as I said before, some of the most powerful innovations in our world, inventions, new systems of government, whatever, are the result of dreams. Dr. Wing Lim: [00:09:19] I read some stats. I don't know who put it up. I can't quote your source, but somebody says that in North America by age about 25, we stopped. We just stopped dreaming. And for us, that takes us through med school and residency. You know what? It was a dream that that put us in to where we are as clinicians. It was our dream. Dr. Kevin Mailo: [00:09:40] Yeah, I had a dream of being a doctor. Dr. Wing Lim: [00:09:42] Exactly. And then what happened? Right. We stopped dreaming. And they also heard somewhere else that dream is like a kid, right? When we grew up, my family was really broke so we have school uniforms - I grew up in the British system and we have school uniforms - and my parents would buy me 1 to 2 sizes bigger so I can grow into it. And they say, dream is just like that. It's 1 to 2 sizes bigger than you right now so that you can grow into it. And once you fit it, now you need a new set of clothes. You need a new dream to grow bigger. Dr. Kevin Mailo: [00:10:12] And the thing is, is that dreams give us meaning in our lives. When I think of one of the biggest tragedies in modern human existence, I think of the loss of people's dreams, and I see so many people within our profession or patients, people you meet on the street who are unhappy because their lives lack meaning. Did they just go through the motions, check the boxes? But they're not aspiring to anything bigger in their life anymore. And so watching somebody lose their dreams by about the age of 25 and never recover them is, in my opinion, one of the greatest tragedies in modern life. Dr. Wing Lim: [00:10:54] Right. And when I look at how, reflecting upon when we went through med school, we were they say people were so broke they eat dog food and cat food. I couldn't even afford it. It was too high of a price item for me and my spouse at that time. Right? And then how do we go through 100, 120 hours of work without burning out? How do we go through work and study at the same time and doing the lowest, lowest job, menial job? How do we survive? Because we had a dream, right? So somebody also said that if there's power, if there's hope in the future, there's power in the present. So the dream helps us to become more resilient because we know that the stuff that we work through is only temporary, right? There's a brighter future. There's a brighter tomorrow. Dr. Kevin Mailo: [00:11:41] Well, it's walking to that destination on the horizon that you deal with what you face in the landscape of life, even when it's hard, even when you feel lost, even when you feel stuck or you're going in circles. It's that notion that it's somewhere on the horizon where you're headed to. Dr. Wing Lim: [00:12:01] Mhm. Dr. Kevin Mailo: [00:12:01] And there are a lot of ways, and I did research on this in preparation for, you know teaching it, and I'm not going to go into all the reasons why dreams are destroyed, but there are a lot of external factors. People are, some of us are scared of being successful, we're overwhelmed with consumer spending. To the point that we don't have any margin to pursue dreams, which is very true. Dr. Wing Lim: [00:12:24] Oh, what a sore spot. Dr. Kevin Mailo: [00:12:26] You can count how many hours you have to work clinically to pay your mortgage every month, and those are hours that you are not able to pursue a dream, potentially. There are lots of societal factors. Some people are, you know, will be jealous of you or want to hold you back. You told me this one, Wing, is a lot of well-meaning people think that they're watching out for you by telling you not to dream. Dr. Wing Lim: [00:12:51] Exactly. Yeah. Dr. Kevin Mailo: [00:12:52] And I actually, I can recall many conversations from friends and family who would caution me on my dreaming. Dr. Wing Lim: [00:12:58] We just don't want you to be hurt, honey. Dr. Kevin Mailo: [00:13:00] Exactly. We don't want to see you fail. We don't want to see you struggle. And, Wing, I really want it, that's my first big thank you on this topic. That's my first big thank you to you on this topic because you told me about that. Dr. Wing Lim: [00:13:15] Oh you're welcome. Dr. Kevin Mailo: [00:13:16] But the second and more profound part to that is you said it wasn't about the external voices that were hard to ignore when it came to your dreams. It was that inner voice saying, I can't do it. It's too hard. Why try? And I remember that conversation. It's that inner voice saying, I don't deserve it or I can't do it, why bother? That's the hard voice we have to learn to shut down and ignore from within that holds us back from pursuing our dreams. Dr. Wing Lim: [00:13:53] So some people astutely put it as the imposter syndrome. Dr. Kevin Mailo: [00:13:57] Yes. Dr. Wing Lim: [00:13:57] Who do you think you are? Dr. Kevin Mailo: [00:13:59] Who do you think you are to dream? To think you can change the world or change your life? Dreams are important because that better vision of the future of ourselves, of our world, of our family, it creates optimism and optimism drives positive action. When you are optimistic, you feel like you can take chances. You feel like you can step out of your comfort zone. You feel like you can do things. Pessimism and a lack of dreaming is the opposite. It leads to fear and inaction. Would I ever attempt that airway if I thought I wasn't going to make it? Would you do surgery if you thought your patient was going to die? Right. Would you do counseling, Wing, and clinic and say, Oh, why am I bothering my patient's not going to follow through on it anyhow? No. No. We take, we have an optimistic view of our interventions in the world, in our practices, and it leads to action. Right? So dreams provide enormous meaning in our lives. And they help unify our lives as well. So at Physician Empowerment we teach that there are three different types of people within. Dr. Kevin Mailo: [00:15:16] There's our physician self, the MD, the professional self. There is the personal self which includes our inner child, the one who used to dream. And there's the financial self. When you're a dreamer and you know your dreams, you've written them down, you have a clear sense of who you are and where you want to go in life, it allows you to unify the three selves. And in doing that, you make life and career and financial decisions that reflect your dreams. Right? Because your three selves can't be walking in opposite directions across the landscape. You can't say, I've got a dream of setting, of traveling around the world, but you've got a consumer spending problem that keeps you working endlessly. And you're not able to train and get fit to do it. Right? And, you know, I wish I had more time to explore the example that I used in Mexico because it was really beautiful. But it is on the website and I encourage you to to watch the talk. The other part to dreams, and I don't know if you want to share on this, Wing, because I know you've taken some big leaps over the years, is dreams give us courage. Dr. Wing Lim: [00:16:26] Mhm. Yeah, actually, let me relate to this. The first time I got exposed to this dreaming stuff was at my CCFP confo. This is at Banff, right, for us in Western Canada I went to bang for my CCFP confo. And so 8:00 in the morning this big conference started at Banff Spring Hotel. And then this lady, she was a Mount Everest climber, she was one of the first female Mount Everest climbers. And she talked about her journey, and I thought, why are we woken up at 8:00 in the morning to listen to somebody climbing the mountain? And she almost died, some of her teammates died. And then at the end of that talk, she had a five minute standing ovation and she ended her talk, she said, That was my Mount Everest, what's yours? Right? And it was, wow. It just woke me up from the depth of my soul. Right? And what's your Mount Everest? What is that impossible dream? What is that thing you want to achieve that is bigger than you, bigger than all you can muster together, right? And when that things, when thoughts like this got turned on, I think it unleashes a lot of power. And they also say that when the student is ready, the mentors will show up, right, the magical mentors, the resources, people that you need to make connections with show up. And that's how things got turned around in the world. How big things got changed in the world. Dr. Kevin Mailo: [00:17:55] Absolutely. Absolutely. Dreams also, and you alluded to this earlier on today's episode, Wing, is that dreams make sacrifice meaningful in our lives, right? Like we, don't focus, when we talk about dreams don't focus on the destination. Focus on what it does to you over the journey. But as you're walking life's landscape, inevitably you are going to encounter struggle, setback, and failure. But when we actively pursue our dreams, they make those sacrifices and those hardships meaningful. You know, I always think about my dream of being a father. I'd wanted to have kids since I was a teenager, and it was such a joy to have them. And we had the twins first, and I remember countless sleepy nights that I'd be up feeding babies, thousands of diapers changed, countless days spent chasing around toddlers that didn't want to get dressed while we were going through medical school and residency, you know, exhausted. And yet when you look at it in the frame of I'm living my dream, those things aren't relevant. Those things aren't struggles. Those things are a joy. Right? You know the long hours that we spend on the wards of hospitals as med students and residents represents us living a dream. And it makes the sacrifice bearable. It makes the sleep deprivation and the hardship bearable. Right? Because we're living a dream. And so being explicit about it can be very powerful in our lives. When we say, no, this isn't a chor, this isn't, I'm not working towards a goal, I'm working towards a dream. Dr. Wing Lim: [00:19:34] Mhm. Yes. Now so we're almost out of time. So Kevin, maybe give us some takeaway, a couple takeaway points. Dr. Kevin Mailo: [00:19:46] Yeah, okay. There was a lot here, and I wish I had time. And maybe I should come back to it later, because, I write down my dreams. Dr. Wing Lim: [00:19:54] Yeah, another episode. Dr. Kevin Mailo: [00:19:54] Big, big dreamer. Okay, so let me let me wrap this up here with this wisdom that I came to when I was reflecting on my own life's journey. The destination is less important than we think. Whether we get to our dream or not is far less important than the fact that we actively pursued it, that we gave ourselves meaning along the way, that we grew as people, that we challenged ourselves and in the process, we connected with those in our lives more meaningfully. So here I'll leave you with with one example. And imagine a young woman that's training in a marathon, and she spends five years training to become a top tier marathoner, and she wants to win that race, she wants to come in first. Which means that she sacrificed every day. She trained, she ate right. And let's say a month before the marathon, she suffers an injury. Is she a failure, Wing? Absolutely not. Let's say that she's running the marathon and she's in first place after five years of training and 100m from the finish line, she trips, falls, wipes out, and doesn't even place. Is she a failure? Dr. Kevin Mailo: [00:21:25] Absolutely not. Let's say that after five years of training and working towards her dream, she runs that race and somebody just happens to be faster than her and beats her. Is she a failure? Absolutely not. It's the personal growth along the way that makes us, that makes it so meaningful when we pursue dreams. That is what helps us grow as individuals. That's what takes us from being static, going through the motions of life, checking the boxes, to being this dynamic individual who's growing, who's changing, who's optimistic about their future. And so for me, I constantly try to reconnect with my dreams and I constantly remind myself that success or failure is irrelevant. It's the fact that I get up every day and I feel like in some capacity, I'm living one of my dreams. Whether it's as a doctor, as a father, as an entrepreneur in Physician Empowerment, whatever it is, I feel like I'm living my dreams and that's what gives me an enormous sense of meaning. Not whether, not whether a certain thing happens. That's a goal. It's are you living your reality? Are you living your best version of you? Dreams are intrinsic to that. Dreams are intrinsic to that. So I'll leave you with, you know, sort of, practically speaking, is to take some time, like real time, like many, many hours, to just think back to your childhood. To that younger version of yourself. Be vulnerable with who you are and ask yourself what you really wanted when you were much younger, when you were a teenager or a child. And then look back on the times when you sort of slowly let those dreams fall to the wayside. And you so-called, grew up. Dr. Wing Lim: [00:23:36] Mm hmm. Dr. Kevin Mailo: [00:23:36] And then begin to write them down. You don't have to share them with anybody. But just write them down and be bold. That's the, that's the third big thank you I have for you, Wing, is I remember in one of our earliest meetings at that little breakfast restaurant - I think it's called Tutti Frutti, remember, it was super loud and super crowded - and I remember you telling me I'm not dreaming big enough, and I still hold on to that. So again, that's what I'd encourage listeners to do, is, is to just connect with yourself and begin to dream unapologetically and stop worrying about what anyone will think, and stop worrying about whether you actually reach your destination or not. The real gift of a dream is in living it now and pursuing it now. Not whether you get there or not. Dr. Wing Lim: [00:24:31] Exactly. So I got lots of patients, who are hunters, right, at the end of the day they said the hunt or they said the kill isn't the hunt, right? It's a journey, right? It's a journey that counts. So that, those those are lots of really good points, Kevin. So thanks for sharing with us. And we hope, at Physician Empowerment, we hope we'll rock your boat a little bit. I know you're busy. We're busy. We're going 100mph. But we hope we stop you down, smack you a little bit on the side and disrupt you a little bit so you can dig deep and go deep down, deep down. Dr. Kevin Mailo: [00:25:04] Just get out of the everyday. Get out of the everyday. Because so many physicians are just going through the motions. And it's an enormous source of burnout. Because you feel like that hamster wheel never stops turning over. But when you get out of that comfort zone and you just, you just ask yourself some hard questions and begin to take steps along that road, it can be so profound. And, that's you know, that's one of the things that we try to achieve on Physician Empowerment is like helping you connect with with your inner self and to transform your life, like, really transform your life. Dr. Wing Lim: [00:25:46] So I'll just end this episode with a comment. So this, from my mentor that unlocked my potential, Dr. George is his name. Most of you don't know him, he's 88 years old already, and he asked me way back 30 years ago, or not quite, 20 some years ago, What if time and money were no object? What if success is assured? What would you do? What would you see? What would you become? What would you not do? Right? So he was the guy that changed my whole entire life by that little question. So we pass you along with this question, and for those of you are already in the journey that you're chasing your dream, you're living your dream, maybe you can be the dream giver, right? That's the next step, right? And ask people around you, empower them so that they can embark on the journey of reliving their dreams. So we hope this episode is meaningful for you, and we look forward to seeing a lot of you. Dr. Kevin Mailo: [00:26:37] All right. Thank you so much. Dr. Wing Lim: [00:26:38] Okay. Thank you. Dr. Kevin Mailo: [00:26:41] Thank you so much for listening to the Physician Empowerment podcast. If you're ready to take those next steps in transforming your practice, finances, or personal well-being, then come and join us at PhysEmpowerment.ca - P H Y S Empowerment dot ca - to learn more about how we can help. If today's episode resonated with you, I'd really appreciate it if you would share our podcast with a colleague or friend and head over to Apple Podcasts to give us a five star rating and review. If you've got feedback, questions or suggestions for future episode topics, we'd love to hear from you. If you want to join us and be interviewed and share some of your story, we'd absolutely love that as well. Please send me an email at KMailo@PhysEmpowerment.ca. Thank you again for listening. Bye.
29 - Dr. Sarah Smith, founder of the Charting Coach
Oct 15 2023
29 - Dr. Sarah Smith, founder of the Charting Coach
Dr. Kevin Mailo welcomes back Dr. Sarah Smith as his guest to discuss the topic of sustainable clinical practice, what it means, and how to achieve it. In this episode, they discuss the struggles physicians face to organize their day, combat burnout, and take time off. Dr. Smith shares tactics she learned through her struggles as a physician in Australia and Canada and how she overcame them. Dr. Smith shares her best practices for physicians to manage their days, shift their mindsets, and set goals at a sustainable and manageable pace. You’ll hear the impact of small decisions, and little shifts can lead to big changes both in your personal and professional life. They also discuss ways physicians can feel more empowered and make proactive decisions to provide quality care and balance their own mental and physical health.  About Dr. Sarah SmithDr. Sarah Smith is the Charting Coach for Physicians. She is a Rural Family Physician and Certified Life Coach through The Life Coach School. She helps physicians get their admin and paperwork done more efficiently to create time for the things they love. Dr. Smith has spent the last three years coaching hundreds of Physicians, over 1000 hours of coaching, in the specific area of “getting home with today's work done”.Resources discussed in this episode:Slim’s Cabins - SaskatchewanChartingCoach.caDr. Sarah Smith on LinkedIn—Physician Empowerment: website | facebook | linkedin—Transcript:Kevin 00:01Hi, I'm Dr. Kevin Mailo, one of the co-hosts of the Physician Empowerment Podcast. At Physician Empowerment. We're dedicated to improving the lives of Canadian physicians, personally, professionally, and financially. If you're loving what you're listening to let us know we always want to hear your feedback. Connect with us. If you want to go further, we've got outstanding programming, both in person and online. So look us up. But regardless, we hope you really enjoy this episode. Kevin 00:36Hi, I'm Dr. Kevin Mailo, one of the co-hosts of the Physician Empowerment Podcast. And I am very, very glad to have a returning guest, Dr. Sarah Smith joining us again. So for those of you that have been following the podcast, we had Sarah on in one of our earlier earlier episodes, talking about charting and boundary setting. And Dr. Smith is known as the founder of the Charting Coach. And, yeah, and it's an outstanding program where she helps Canadian Family Physicians truly manage their practice, and more importantly, get to a better place personally and professionally. So that we are not feeling overwhelmed, that we feel like we can manage our work and our lives and your episode, the last time was just so powerful. It really connected with a lot of people, I got a lot of positive feedback about it. And so I'm very, very glad to have you back again, Sarah, and why don't you tell us a little bit about what you do. And I'll just introduce the topic today, which is sustainable clinical practice. And I'll let you tell us what that means to you and what that should mean to the profession. Sarah 01:49Sounds good. Thank you so much for having me back. Yes, last time I was on, I did promise to come back and talk about sustainable clinical medicine. So I'm back. I am a family physician, rural in Alberta right now and originally from Australia. And you'll find out how I got to Canada if you have listened to the last episode. But this time, we're talking from a slightly different perspective. So I went and did the hard work to become a different doctor. So originally, I was in that pain of hours and hours after work evenings, weekends, charting, inbox paperwork as a busy family doctor, and this particular painful experience had followed me from an Australian practice to a Canadian practice. So it wasn't the country at fault. Kevin 02:41We’re looking at a global phenomenon. Sarah 02:43It wasn't the EMR. And it wasn't the government. It was a me problem. Kevin 02:47You're kind of an interesting test case, in that sense, Sarah, right, because I think we always view our issues as hyperlocal. But I do I myself do look at some of this data in health care across the western world. And you can see it, it's actually a global phenomena. That's there are many factors driving it. And I don't want to get into all of them. But you are the interesting test case, I don't know that anyone else has moved across the world, only to discover the problems… Sarah 03:17Followed me. Know, no, this was impossible, right? I thought this was the way right, sign up for family medicine, sign up for inboxes, sign up for never having a life, sign up for giving away my weekends. Like this is just what I expected. I asked every mentor along the way. How do I do this? And their answer was come in on Sunday, like that was the unanimous answer to my question that I'd had since residency. So the answers were not out there. And it was simply the listening to a general life coach at the time about, I can do impossible things, I can have a different experience in medicine right now with nothing changing. And I just thought that was completely ridiculous. And she had no idea what I was facing as a family doctor. So off, I went into the world to find the coach who could help me figure out this impossible puzzle because I was done with giving away my life to medicine. And I didn't want to leave medicine because I had no other skill set. I literally had no other way to support my family as the single-income earner in our family. Right. So for me, the skill set was medicine. I had to figure this out. So I went out into the world. At that time, the only physicians who were coaching, were helping me leave medicine and I wasn't ready because I had no other thing to do to earn money. Now, It's a lot of things like what you do to help me figure out how else I could have kind of approached that at the time. But in this moment in time, I'm like I'm gonna have to figure this out where I am right now, with the staff that I have the EMR that I have the patient panel that I have the way I'm being paid. And now what? So went back to the original general life coach and said, Okay, I'm in, I'm ready to do impossible things, you said it's possible, let's go. And it took me a full 18 months of changing everything about how I showed up within exactly the same clinic, EMR patient load, and going home, with everything done. Bucket loads of time, right bucket loads of time, sit on the couch at the end of the day, feeling accomplished, but also guilt free. Like, done. I’m done. And that was such a incredible experience. So proud of myself, and I had all this time and I'm like, I have to share this. So I originally started with the family doctors, yeah. Kevin 05:55Without question. And, you know, I'll just share my own reflections. So this year, I retrained in family practice, like I had originally, you know, done family medicine residency, and then done emerged and worked, you know, nearly 10 years in the ER, as a community emergency physician, but I decided I wanted to expand my skill set, and just have more potentially more flexibility down the road. But I was overwhelmed by how much a family doctor has to manage. And, frankly, if I, if I can be blind, until I go through your program, Sir, I don't know that I'm gonna feel super confident, taking on a panel myself. Again, just being very, very honest. Because until you learn that workflow, until you learn those boundary setting strategies, it's, you know, it's quite, it's daunting, honestly, it's daunting, and there is so much in that, that we just didn't get, we got, of course, a rigorous academic training in medicine, you know, the disease, diagnosis and management, and, you know, all of those core clinical skills, but nothing in practice management, nothing really in charting. So, so talk to us about what sustainable clinical practice truly means. Tell us. Define it Sarah 07:15Yeah. So just before I step in there, one of my very early mentors said, don't take on a practice owner, position until you've done five years of the medicine just to get used to the medicine because the decision-making around patient care, looking after a panel of patients, takes you about five years of getting used to the whole, just medicine and fast decision making required before you even think about taking on the whole hire and fire half. Like when we think about the business of medicine, those hats, you're right. Nobody's taught us that unless you had a mentor showing you in that apprentice style, how to do the business of medicine. And I was lucky growing up in the Australian system, I was one resident in one practice. So, I had the whole cohort of mentors to show me and they were very transparent, they would show me the earnings, how much it costs to hire and fire, but they didn't expect me to do any of those pieces. And, in addition, I was asked to see patients on my own panel, and I would earn 55% of the fee for service for those patients. So that was in my favor to learn how to do medicine as if I was graduate already. Right. So it's given me that it had a baseline so I could always, you know, fall under the number of people who need to be seen and still have a certainty about what I would be earning. But yeah, what does sustainable clinical medicine mean? So, in the world, there are lots of carrots and sticks to make physicians stay because it's very expensive to replace a physician. So, if you look at some of the US big organizations that estimate about a million dollars to replace a physician, so for physician says: “I'm done, had enough, burned out, you've done it, I'm out.” It's about a million dollars to turn over a new physician. That's it. That's pretty incredible. So of course they want retention. But when the physicians turning up and saying, it's too much, you're asking too much, I can't. I can't even go on vacation. Because I could check my inbox or iPad or whatever. It had to come from the physician. So me the physician in my clinic, and I watched this little video from the primary care network. It was about Evolution 2.0 And they were going to bring us team players to help us. I’m like great, sounds amazing. And in this little promotional video, they had this tiny little sentence that said, physicians get today's work done today. And I'm like wow. I’m in! I looked at through all of their resources, zero backup for that statement, so annoyed at that whole thing. So I'm like, okay, back to me figuring out on my own, here we go. So, um, sustainable clinical medicine means you have, wherever you are right now, physician, no matter what sort of physician you are, you have some things about your practice that you cannot change. For instance, your EMR, your location, how many staff you have the role that those staff play potentially, your hours of work, the number of patients, you have to see whether that's you choosing that number of patients, or an RVU, with those US physicians who are required to do a certain number of productivity encounters per week. And there's bonuses potentially attached to that, or because of the fee structure and your other expenses in life. So there are concrete things about your day that you can't necessarily change or can't change easily, right? So hiring a new person could be an amazing idea. But your organization will say no, for whatever reason, maybe they're unionized, maybe, you know, that's just you're just a salaried physician who has zero control over who's hired and fired. So there's concrete parts of your day. But a sustainable practice means, now that we know your concrete parts of your day. Now, what? What are you able to do differently about what you're doing in your day that can create a clinical day that is confined to what you're given? So whether you’re ER, hospitalist psychiatrist, family doctor, what is it that you are being asked to do? And then how can we start to do it in a way that you can contain it to what you're given? And we're not looking for an answer immediately and an immediate change for tomorrow? Don't burden yourself with that. We're looking at what do you want to create? What does successful, sustainable look like for you? And then what are the steps we take to get there? What are the things we need to change about your practice? To get you closer and closer until you either get there or get at least closer to the mark? Sustainable means? Kevin 12:20I’ll just share one reflection, and like already, what's, you know, what I'm hearing is the power of reflection and goal setting, right? Because we all say, well, I just want to be less busy. I just want to be less burned out. I just want to be but what does that mean, in clear, concrete terms? And that's a unique question we're all going to be answering for ourselves. Sarah 12:42That's right. So if you look at my example, I wanted to be home at five o'clock. Right? reliably, I was getting a text almost every day from husband saying when are you home? I wanted to just be able to be home at five. Right? But that's easy. All you have to do is hop in the car at ten to five you might have to,, Kevin 13:01So you're not from Toronto Sarah 13:05I didn't actually mean that I would be done. Yeah. Wait a minute. Okay, so I want to be home at five with everything done is a completely different sentence and a completely different goal-set than I want to be home at five. Right? Kevin 13:24Exactly. Exactly. But that's powerful. Right. It's about having that clarity. You know, yeah, I mean, when we coach physicians in this, not quite the charting and practice management space, but we talked, we talked about the power of like, clear goal setting in terms of actually write it down. Like if you have an ideal practice of what you want, write it down. Okay, continue. Sarah 13:52Alright, so I wanted to be home a five, and what had everything done. So now we have to step back from the busyness of the day, this is the big step back. And we have to really think about what's inside the day. And I like to use the phrase “we’re mathematicians, we're not magicians”, okay. So there's going to be X number of phone calls, X number of inbox / Portal messages, number of results that come in and we’ll have ebbs and flows. So as I come back from an emergency, if there's going to be a lot more in my inbox, or I might be covering a colleague, but for the most part, what is in the day, like how many patients, how many charts, how many interruptions am I getting? What is the expectation, like what is the rest of today's work? So we have to consider that when we're thinking about what do I need to have get done? Because I'm not just going to magic 200 results in 10 minutes. Not going to happen? Yeah. So that's part of the consideration of now that I know what my goal is. And now I have to think about what's involved in my clinical day. And then I have to think about why would I want to make a change? Because the way I turn up and do something is so easy and familiar, I've been doing it for years this way. Any change is putting another burden on you. So you have to have a reason why you’d want to do that. Kevin 15:15So how do you go about beginning to implement some of this? Sarah 15:19Yeah. Even before we start making changes, and there’s foundational steps, which we kind of covered last time, they're getting your chatting done as you go, and the finding that protected time to get the inbox done. So you're not doing work twice. But it's the noticing what you're saying to yourself about your day, makes a huge difference. So you can get tired before you even walk out the door in the morning. So when you wake up, and your brain says “Here we go again. I hate clinic. Nothing ever goes right? Oh, no, I have to see Mr. So and so today. Ugh, this is so hard. I'm so tired.” We are defeating ourselves. We're not the inner cheerleader. We don't have to be all lovey, lovey. But we can also be adding suffering. So you have 13 patients today, for instance, and if you say, that's such a lot, that is already hard to overcome, because if you can say 13 patients, this is my day, let's go. Gives us a different fierceness about ourselves. That helps us in the moment, it's that part of I'm choosing it because I'm staying. So if I choose to come into work tomorrow, and there's 13 patients. That's what we're gonna do. We're gonna do 13 patients, we can do 13 patients. And that, that little bit of reasoning to ourselves. Kevin 16:52Well, I think you know, another part to this is that notion of acceptance of the things that we cannot control, you alluded to this earlier, right, is one source of burnout. And we know this across different, you know, different professions and fields in occupations is the fact that people feel burnt out when they feel powerless, right? People who work in large organizations that don't care about their feedback, feel disconnected from them, they feel burnt out, they feel irrelevant, right? And there are those aspects to being in even private practice, like you said, the EMR is potentially fixed, right? Or your workspace, you know, where you practice is fixed until the lease is up or until you sell, right? I mean, all of these things are fixed. But the things that are not, we should be seeking to exercise control. But that also includes the patients that we have, right, and acceptance that inevitably there are going to be those difficult cases that we have to navigate through. And in knowing that everyone deals with this, this is part of the job. Yeah, but you know, only people that are professional, like Netflix watchers get to really choose what they do all day. But for the rest of us, there's this notion of, there's going to be a certain struggle. But accepting that can be a very powerful source of wellbeing for us. Because then we say, Okay, where does my energy go? It goes into these things that I can control. Sarah 18:21Yeah. Now, there's the difference between ideal and what we've got. So ideally, for instance, a new patient, you might like to spend two hours with them to get to know who they are, and deal with today's issues, right, ideally, and you've been given X number of minutes to see them. Kevin 18:40Yea, not counted in hours counted in minutes. Sarah 18:44And excellent is the best you can do with the resources you're given. So when we come up against this and say, I can't do a good job, because I don't have two hours with this patient that really adds that suffering, right? You really feel shitty about you being a doctor, when you're saying, I can't do good medicine in 30 minutes, and then saying, Okay, I have 30 minutes or an hour, whatever your new patient is, how can I best spend the time? What is the objective of today's visit that would give my patient what they are most requiring? That's a huge question, not at them question. Remember, you're the boss in the room. This is another part of the work we do is we save the physician is the executive decision maker in the room. So when you're in the room and you're hearing the questions or requests in the room, you're really navigating what is of most importance here, whether that be because the patient is requesting that because I'm noticing that this is very important for us to achieve today. And then the dissonance of and I've got 30 minutes and now I have to make some decisions and negotiation and have all this tied up in a little neat bow with my documentation done in the minutes given, right? This is not going to look like an ideal medical history taking that you were taught in medical school. It’s not going to look like a comprehensive physical exam, like you were taught in medical school. And the documentation is not going to look like something a professor would write. Right? And all of that is the puzzle of medicine. This is the part where physicians start questioning themselves and saying, Is this okay? And only you can answer? Does this you, know, did it cover the most important things for the patient? Did they get enough information to give me pertinent important information about this encounter? Can I kind of back up my decision-making with pertinent positive negatives? And is it good enough in my documentation for the next person or myself to follow what was going on next time I look at this chart? What else do I need in here? Or insurance and billing? Done? So we don't get two hours. We don't get to squish two hours into 30 minutes. We're not magicians. It’s this now what? About my entire day. I have 30 minutes, now what? Kevin 21:17Yes. Yes. So, keep going. Tell us about like workflow during the day. Talk to us about, you know, boundary setting, you know… Sarah 21:31So some physicians will get a knock on the door, every single patient encounter. Okay? So it's the noticing is just being curious about what happens in my day. So you're in a room doing your highest level work with a patient, you're listening to their story, your physical exam, your illness, script, medical reasoning, decision making is all happening in the room, you're focused on them. And hopefully, we've dumped everything else out because we've completed our work because we work behind us. Knock, knock, knock. You open the door. Mr. Jones is 10 minutes late, will you still see him? Now, your brain says, what's happening this afternoon? Is it my day for kid pick-up? What time does daycare close? How far behind am I running? What's Mr. Jones got going on for him? I don't have a choice anyway. Because my, you know, my employer says I must patients, like literally, I've the amusement of there was no question, I had to see them anyway, because of the rules of what I engage with in my workplace. So it was a yes or no, and we close the door. We turn around and we're like, Where was I? that is very expensive. Oh, goodness, it’s contributing to your decision fatigue, it’s contributing to interruption of your highest level work? This is a very sacred space, it could look like a pop up, a knock on the door, an alarm going off? Whatever, you may have calls you have to take. And even then I would say do you have somebody who can intersect to say this is one that has to be taken and I will take it to the door and knock on her door and interrupt her? Versus that's, you know, this call and that call that didn't really need to be taken. And the one I was actually waiting for that came through? Right? So just protecting ourselves. What was the rule this morning at eight o'clock? You knew if you could run late this afternoon? And who did you need to tell as you tell that person, hey, I have kid pick up today? It's a no for anyone late this afternoon. You have my blessing to go rebook them. That will stop X number of interruptions this afternoon, this is handled for you. Kevin 23:37Well, just treating things not like one-offs, because I think that tends to be how we look at it. I mean, you know, you're always putting out fires in clinic-based practice, but you realize that there can actually be a pattern to this. Right, where you can exercise a lot of control in those interruptions, because you have clinic staff and Wing’s talked about this extensively, as well as the importance of delegation, right? Because if you have rules or guidance, well now, and now we don't need to worry, but it even improves the working conditions for your staff. Right? So if you have somebody that's late, and you cannot and you know, you can't accommodate somebody who is 30 minutes late, then it's easy for your clinic staff to say, I'm so sorry. No, they don't have to run down the hall. They don't have to send you a message. They don't have to jumble like it, actually, you think it's improving just for you, but it's also improving for your clinic staff. Right? It reduces their burnout because now we have some guidance, right. And that's just one small example. Sarah 24:43Yeah. Let's say you have to see late patients and you still have kid pick up right now how do we engage in that next visit with that person who was late, who used up their entire appointment getting here? How are we showing up to run that consultation differently? If you have choice, you don't have to spend that X number of minutes you were given in its entirety. You have autonomy, about what is the focus for today, we're going to be super fast. Okay, that language with patients just learning new language with patients so important, even opening sentences, How are you? Versus what are we doing today will cost you three to five less minutes in an encounter. Anything else? At the end? catch yourself doing that, versus It was great seeing you today. Kevin 25:39Wow. Wow. But you're right. Back to your earlier point about? We have these ingrained habits, right? And there's so much automatic wiring. Sarah 26:00Yeah. Kevin 26:01But if we're, if we're mindful of it, and we're intentional, we can slowly make change. Where the sign off is different. The opener is different. And it dramatically improves your workflow. I love that. Wow. Sarah 26:15I get them to write it on their hand for the first week you're practicing it. It was good to see you today. Kevin 26:22Exactly. Not tell me the next five things that are worrying you. Sarah 26:27That’s right, yes. Knowing that bringing a list into the room is expected. We talked a little bit about that last time. Right and not going and thinking you have to handle the whole list. Right? You're still the boss in the room. You still get to say this one and this one. Oh, I've just got a quick question about my 20 years worth of headaches. You know, that's not a quick question. You know, that's at least a five-minute deep dive to make sure. So you get to do things that are safe for you, such as triage the problem, but then I would love to spend the time understanding and working on this puzzle of your headaches, let's rebook that. So we have a good space to do that. Kevin 27:11Exactly. Exactly. Sarah 27:15It is part of the learning, the nuancing of us as the executive decision-makers in the room. Kevin 27:23And even for myself, you know, just reflecting on my own, you know, training time in family practice, you realize that every complaint, or presenting issue generates X number of minutes or hours of paperwork to follow. Sarah 27:40Potentially, yeah. Kevin 27:41And so, you know, you think it's that 20-minute encounter, but it's an hour of paperwork, referrals, results to order, or tests to order the results to review, communications to be made and follow up. So you have to be mindful of this, like fanning or this you know ripple effect on your workflow, when you would just agreed to see multiple complaints. And, you know, to go back to your point, how good a medicine are you doing, when you're doing that? And this is a lot of this is unique to family practice, in the sense that, you know, as a specialist, you can, you're kind of there to focus on a narrow problem, although some, you know, a specialist to be fair, like do deal with a lot of the psychosocial or, you know, complex interacting issues. But I think certainly family medicine is defined by a lot of this holistic care. Sarah 28:31But even in our specialty areas, when a surgeon is seeing your patient, and the surgeon is in the room singer new patient that you sent with, you know, a good letter, and we're not going to say we're doing a donkey letter at the, within this process, I think it's important that we say, here's a question I want answered, is this patient suitable for surgery? And the patient arrives and the surgeon has no CT or ultrasound report, or no history of their previous surgeries. And that surgeon has that happen five times a day, and they go looking for the CT. That there is a system problem. That there is a oh, now what? I noticed that I have to go looking for CT scans with every new patient and I wonder why? And we go back down to the corridor, we say, hey, Mary, when we get new patient encounters, what do we tell patients to bring with them? What do we ask to be found for this encounter? Well nothing. Oh, I wonder why. Or now what? I wonder, could we think about before this patient arrives, this checklist, tick, tick, tick. And then I can do my job in a much more efficient way and have an answer for this patient within this first encounter. It's these stepping back and saying what is really happening in my day that's costing me frustrating me. I whine about it all the time. That can be a good way to find these things. Kevin 29:54It's listening to that inner voice. You know, it's done in psychotherapy. Where is it coming? From dig deep, right? It can be highly informing. When you go, gosh, that annoys me and annoys me every day. And every time that happens, we let me stop. And can I fix this? Sarah 30:13Can I just have a conversation with someone? And who would I have to have a conversation with? And then I'll watch and monitor how that conversation went? Did I get it right? Do I need to edit it a little bit to get the results that I was looking for? Like, we have this ability. These are tradable skills, as part of our leadership role. We are all leaders as the executive decision maker, you are already a leader, even if you don't have a hat that says that. Kevin 30:36I like that, that is so powerful, and so empowering, as well. Because we forget, we feel like we're just, you know, pulled a million different directions responding to somebody else's request, whether it's the consultant, the patient support, or admin staff, colleagues in the clinic, like we're feel like we're always pulled. Sarah 30:57Yes. Oh, always, I had that experience multiple times. But we just want you to record it, if they're a smoker or not. And I would just be devastated. I'm like, You don't understand what I have to do in my day, I have so much to do already. I don't want to do that, too. I just don't have the time, mindspace, my bandwidth to do anything else. Stop it. Stop asking me to do things. Kevin 31:16Well, and again, it is, you are the most important resource in your practice. We teach that over and over again at Physician Empowerment. You are the rate-limiting step. For Success. Everything else is peripheral. Everything else is peripheral. It goes back to your comment about what does what does an interruption at the door for five seconds really mean? It means that you have disrupted the most important part of that patient's care at that time. Right. And you know, you've interrupted your own workflow. Sarah 31:51Yeah. Even the way we talk to our patients matters. So when we talk to dermatologists who are trying to improve the flow, they want to see high volume, that is what they choose to do. But the patient's appointment is at 3:40. Right? So when a patient's appointment is at 3:40, but there was absolutely no way the physician was going to be entering the room at 3:40. Because the patient is registered, goes upstairs, hops in the waiting room, goes into a room sees the MA, who does this. And then the doctor comes in, and then the nurse comes in to do education. But we've not explained any of that to our patient. If we step back and say, Okay, well, how do we help the patient understand, this is a team process, the physician is the three-minute part in the middle. But at 3:40, you're going to be meeting Mary, who's an excellent MA, and she's going to be taking the story. And then the physician will come in and go this, this and this needs to be taken off. And the rest of them are this and so it's this particular thing, doing their highest level work. Nurse Jane comes behind. Here's your nurse, this is Jane, she helps explain this better than I do. And she spends the time helping them understand where to put this. How to take off that. How to manage this wound after we take it off. And that is their experience rather than it's my job as the doctor to be in that room at 3:40. Like no, the way you set your clinic up was amazing. You just didn't give that gift to your patients to help them understand. Kevin 33:25Delegate right? Sarah 33:26Yeah, using our team wisely. Kevin 33:27Use your team. I mean it we see it in surgery. I mean, the surgeon doesn't set up the O.R. Sarah 33:34You wouldn’t want them to. Kevin 33:36You wouldn't want them to right. I mean, it's everybody does it. But you know, for us, I think it's family doctors we get we feel, but it is okay to step away. Right. And, and yeah, your office staff when they're trained well, and they're supported in the day. The work can be more rewarding for them as well. For sure. Sarah 34:00There we found Family Medicine in Canada, we know we have a crisis right now. So we have somewhat about 18% of new family grads, saying that they want to take a panel of patients. Right? We have a lot of Canadians without a family doctor. And the education of family practice residents often happens within family medicine context where the family doctors are saying there's too much I need a break. I can't. So when we, when we're looking at these systems, structures, patient medical homes, whatever they look like, it's the stepping back and looking at it broadly, to help understand how do we interact with it as family physicians. This is just one again, another example within medicine. So academic practice. The family doctors have their own panel, they'll see patients on a 15-minute schedule, they work these hours and they have this break in the middle than another set of hours or they're seeing patients with residence at the same time, or this overseeing a resident or two or three or four, who are working and then not taking on patients that day. And then we look at how are they paid? How many staff do they have? How many rooms do they use? And we're starting to help them understand what is possible within this day? How can you show up in a way that's going to help you be successful? When you're ticking off those charts with your residents? That's now a new work list for your week, or your day that you're creating. When will you do this work? Because I'm sure you don't want to be doing it Friday night or Saturday morning. Kevin 35:42Exactly. Sarah 35:43And this resident might not even get the feedback then because they're not getting that at all if that you might be editing their notes. So it's this really interesting piece of how would I do it if I was going to be stepping into that role? Like, if you weren't working in this situation, you're just having a look at it from the outside saying, Okay, if I went and signed up for that, even if you're already there, just if I was to go and sign up for that. But and I wanted my evenings and weekends. What do you think I'd start doing differently about my day, in order to survive that environment? What would I have to say to my residents? How would I do my teaching? How would I see my patients? What would I be able to physically achieve in a consultation with a patient? Yeah. Yeah, big step back. This big eagle eye of our clinical days. Kevin 36:41Yeah. How do doctors manage? Give us some insights? This is just a question because I think so many of us are not static, right? We think about maternity leave, we think about paternity leave, we think about maybe, oh, God, wouldn't it be wonderful if we could take sabbaticals like truly as community-based physicians take sabbaticals? Like a month, three month, not a month, that doesn't count three months, a year? Something truly incredible, right? Like there's this ebb and flow, right, like, many of us are forced to work at this very steady concrete pace, you know, in practice, but is there ways to sort of say, okay, well, you don't want there was something going on, you know, in my personal life, and I'd like to work less, right, or a loved one needs me, I need to work more, or, you know, what I'm loving what my kids are doing in their activities. I don't want to miss things. Right? You know, or I want to be there in volunteering, kindergarten, or whatever have you right, like, so how do we adjust to that? Because this is a major issue with younger generations who were like, no, no, I'm not signing up for a 60-hour workweek for 40 years, no interruptions two weeks of vacation a year not happening, right? Because this is one of the reasons why younger generations of doctors are not interested in it because there's this lack of flexibility. Sarah 38:09Yeah, well, they feel like they're trapped. I even hear constantly. I haven't had a true day off for 12 year, or well, 10 years. Kevin 38:13I hear that from physicians so often. Sarah 38:14You hear that from physicians, okay. This is possible, you guys it is possible. And it's it's really important to protect you because you will, like all the humans, need rest and water and a break and holiday to make you a nicer human. Good for your physiology. You have physiology even when you're a doctor. Okay? You still need rest and water and food. Okay downtime. Kevin 38:41Sad that we have to veg that, but we do. Sarah 38:44You do, you have physiology, your afternoon, your brain is tired, even when you're looking after your brain during the day and not allowing interruptions and those sneaky peeks at the worklist in between patients and all the things that you're doing to add decisions to your day, even when you tidy all of that up. You're still human afternoons, brain sluggish, normal. Okay. So now we need to know that about you and figure out how do we look after you in the afternoon, that type of thing really important. So let's talk about holidays. So in part of my career, I got modeled this very well. So my first general practice, and one of my colleagues went on a month holiday to go fishing. He would not be on internet and this was way before we had access to EMR. Outside of the clinic right, before internet. We had an electronic EMR, but there was paper charts, but it was before you could just you know be 24/7 accessible. He went away from it. I saw his people for him. What was fascinating, I actually learned something from that experience. His patients would come in and about eight minutes in they'd stand up to leave. I was a brand new resident, year one or two. And I'd be like sit down I'm not
28 - The Physician Entreprenuer
Sep 30 2023
28 - The Physician Entreprenuer
Dr. Kevin Mailo interviews fellow Physician Empowerment co-founder and co-host, Dr. Wing Lim about entrepreneurship. Wing is an accomplished businessman, entrepreneur, and real estate investor in addition to being an excellent doctor, and he talks with Kevin about what it took to make his journey from Med School to where he is now.  Wing recalls how risk averse he was when he initially graduated from Med School thirty years ago. He looks back and see how dramatically he has grown and changed and a lot of it had to do with mindset and learning how to develop the entrepreneurial side of being a physician. What physicians aren’t taught is how to manage the clinical side, the business, the “dark suit” side of their careers outside of patient treatment, often to the detriment of personal fulfillment and smooth-running clinics.In this episode, Dr. Kevin Mailo and Dr. Wing Lim address how physicians can encourage their entrepreneurial sides to grow. They talk about not being the know-it-all and becoming comfortable with being “the dumbest guy in the room” in new situations because it offers a chance to learn. Failure is part of growth as much as embracing dormant dreams and learning to feed other aspects of smarts besides simply intelligence. Kevin and Wing share their ambition to help all physicians realize their entrepreneurial sides through mentorship and Masterclass advice of the sort Wing offers in this episode. Resources Discussed in this Episode:Physician Empowerment Masterclass—Contact Information:Physician Empowerment: website | facebook | linkedin __TranscriptDr. Kevin Mailo: [00:00:01] Hi, I'm Dr. Kevin Mailo, one of the co-hosts of the Physician Empowerment podcast. At Physician Empowerment we're dedicated to improving the lives of Canadian physicians personally, professionally and financially. If you're loving what you're listening to, let us know. We always want to hear your feedback. Connect with us. If you want to go further, we've got outstanding programming both in person and online so look us up. But regardless, we hope you really enjoy this episode. Dr. Kevin Mailo: [00:00:34] Hi, I'm Dr. Kevin Mailo, one of the co-founders and co-hosts of the Physician Empowerment podcast. And on today's episode, I'm going to be interviewing my fellow co-founder and host Dr. Wing Lim. Wing is, as many of us know, is a very, very busy, ambitious dreamer within our profession. And it's truly admirable what you've done, Wing, over the years. And I thought that today we should explore a little bit about your journey, because when we look at you as, you know, an entrepreneur and a real estate developer and a highly successful clinician, there is a lot there. But I have the feeling that it hasn't always been the case, that you were something else when you started 30 some years ago. So with that being said, Wing, why don't you tell us about how you journeyed from being, you know, a physician to becoming a physician entrepreneur because we see that a lot in our Masterclass attendees. So a lot of our attendees in the Masterclass with Physician Empowerment are entrepreneurial. They're trying to build something, whether it's something they're building in real estate, building in their practice, we even have some that are kind of working more in a tech space. So it's really, really interesting to see how physicians come to this point of moving from being strictly a professional to being a professional who's also an entrepreneur. So tell us a little bit about your journey, Wing. Dr. Wing Lim: [00:02:02] Yeah, sure. So yeah, so I go to a local med school, went to U of A like 30 some years ago. And I just finished my 30th year of practice in family practice. So the journey is torturous. There are ups and downs and if you have a time machine and just bring me back to the me 30 years ago and just the present Wing and the Wing that is just out of practice, I think if you say this is going to be you in 30 years, I say that it's a lie. I couldn't even believe that, the metamorphosis is like unbelievable. Right? I was at a larval stage. Dr. Kevin Mailo: [00:02:41] You were just a little grub. Dr. Wing Lim: [00:02:44] I was just crawling on the space. Right? It's like the primordial soup. So where I was was I was risk adverse. I was diligent, hardworking, medical graduate, just like anybody else. But then life, life has its twists and turns. Right? Yeah. So to recap one of the stories is my preceptor had a really good faith in me more than I had faith in myself. He actually spent the money. He wanted to build a clinic. He spent all the money to put me in a clinic to start one, and I was just finishing my R2, right? And so he says, okay, Wing, I'll set you up. And then I told my wife, my newlywed, said, No, this is too, too scary, too risky. Starting a clinic from scratch, what if there is nobody coming in? Then we don't even have money to pay rent. And my very astute and pragmatic wife, some of you know her, Kitty, said that look your boss gave you - oh, there's a Chinese dish, famous Chinese dish called the soy sauce chicken - she said your boss gave you the chicken and asked you to cough up some soy sauce, and you said that's too risky. So that was how risky, how risk adverse, and I actually said no, believe it or not, I said no. And then went and find a locum instead. So that's where I was. Right? And then so fast forward 30 years, yeah some of you heard my story, right? We developed one of the largest clinics in Alberta and we developed a wellness center that processes 2000 patients a day, more than half a million visits a year. And we just launched a senior home that is six storey high, 156 units, and it's 90% full. So there's a lot of other stuff that I do and I look at, Wow, how did we end up here? So is this nature? Is it nurture? And I would say somewhere there are some pivotal people. We call them mentors. They disrupted my world. How dare they, right? Dr. Kevin Mailo: [00:04:48] So yeah, the first thing I'll just highlight here that's resonating with me is the notion of mentors, right? Those people that come into our lives and carry enormous meaning and kind of push us to the next level, help us grow. I mean, you know, you're one of my mentors and I can certainly recall a lot of those kinds of moments. So continue, continue on with your story. Dr. Wing Lim: [00:05:10] And the mentors are not didactic. Like we went to med school eight hours per day for four years, right? Or three years. And then 100 hours of rotations. But mentors are the ones that open doors for you and they open doors by disrupting your status quo, by asking you some pivotal questions or give you like a light bulb. And one of my mentors, we just spent an evening with him, Dr. George we call him. He's in his late 80s and he asked me a question. He says, Wing, what if time and money were no object? What if success is assured? What would you like to do? And that's when we started this dreaming session, writing it down, and we called it The Power Page. You write down first 20 items and you think, Oh, I want to have this car, this boat, you know, this trip, you know, all these bucket lists. But then very soon you run out of steam. And then and then they say, don't stop. Keep going. Don't question it. Don't, don't disqualify. Keep writing. And if you last 20 minutes later, there's some more notable stuff that are coming out if you don't stop your pen, some of these bigger, more noble dreams come out. Right? And some of that would be your life calling, your life's destiny. First time emerging and calling your name. Dr. Kevin Mailo: [00:06:25] Wow. Dr. Wing Lim: [00:06:26] And all of those you need to break out of your shell. And that is where entrepreneurialism comes. Dr. Kevin Mailo: [00:06:33] Yeah. And and it is about that personal growth. And we see that so commonly in the physician community where, you know, it's this brilliant mind of a physician. And, you know, I'm not going to try to toot our horn too much, but truly, the selection pressure within the profession is so high. You know, we have this collection of brilliant minds who are incredibly hard working and industrious, but at the same time, the profession can be somewhat constrictive in that it's not necessarily a creative space or a space for our dreams. Dr. Wing Lim: [00:07:05] It's not. In fact, it's the opposite of creativity. It's called conformity. We are bred in extremely purebred, incestual kind of purebred environment that we don't question whatever has been agreed upon, right? The clinical practice guideline or whatever the college says, right? Whatever your profession says. And then you're locked into there and you're supposed to be better and better and better. So there's a concept called white coat versus dark suit. So I came across this a number of years ago. We went to school to become white coat. But then as soon as we got our billing number, our practice license, we started work in the department, got the first paycheck, first billing, depending on fee for service or your stipend, wuddenly your first year's income is bigger than your last many years. No, sorry. Your tax bill this year is better than your income last year and then you start to become dark suit, right? Suddenly you have to adopt the business side, especially those of us who are in private practice. Or you are noncommissioned too, you have a research grant or you have the whole department funding. You suddenly have to manage it like the dark suit. And of course, we didn't go to business school, right? So this is where we fumble. We struggle. Dr. Wing Lim: [00:08:15] For me, my journey, I bought my practice right off the bat after I said no to the preceptor. And then we borrow money that we haven't got. We got evicted by the landlord within two years. Our son was just one year old, barely in the car seat. Right? And there are a lot of hard lessons to learn. And so a lot of this dark suit side, we never went to school, right now I went to school a long time ago, but I heard my recent colleagues that there is hardly any business education, any entrepreneurial side of the business, about the medical practice, the practice side of the medicine, right? The nitty gritty detail of it. We don't, how do you run a clinic, right? I have some great clinician, some of my own doctors. I love them, but every time it's a solid two hours wait at the office and just looking at their workflow, it just aches my heart. And hospitals be waiting for 12 hours, 14, 26 hours, right? There's so much wrong in the practice of medicine because we are clinicians, we're white coats, we're not black coats, black suits. And so it is a journey and a half to evolve. Dr. Kevin Mailo: [00:09:27] And I would say that that journey can be deeply meaningful in our lives. I mean, we talk about dreams quite a lot at Physician Empowerment because they bring focus to what we're doing. And a lot of physicians, you know, that we've encountered over the years find it so meaningful to have that entrepreneurial outlet, that place where you can pour your energy and your passion and your creativity with the dream of making things better, whether it's within your practice or within education or other areas strictly outside of that face to face encounter with the patient. I think that's so important. Dr. Wing Lim: [00:10:06] Yeah. So this is nature versus nurture, right? Are these medical entrepreneurs, are they born with it? Is this a nature or is it nurture? Are they, did they go to school and become a business person? I'm going to say it's more a concept like epigenetics, right? You know, the genes and you get the environment can turn on and turn off the genes like uncle genes and other genes. So I'm going to say that we yes, of course, we deal with the brightest of minds, the highest GPAs, the high achievers. Those become our colleagues. Right? But we only breed them in their scholastic intelligence. Right? When people nowadays look at intelligence, they're like nine kinds of intelligence. IQ is only one of them. There's Adversity Quotient, there is a Relation Quotient. There's Emotional Quotient. Right? And if you have high IQ and low three of those, you become one of those department's delight. Everybody is scared of you, right? In my days, some grumpy surgeon would throw scalpels at the nurses. That's before the days of AIDS. Yeah. And so there's just these people with personality of doorknobs that run the department. Dr. Wing Lim: [00:11:10] But now things have changed. Everybody is more civil. But then I'm going to say that these brightest of minds, they got turned on one gene. The gene is the scholastic education. But now that they're thrown in a different environment, now the brain is saying, what else? Right now, with the money, with the influence, what am I going to do? What can I do? And we're fumbling because we haven't turned on those genes. Right? As we move on, as we allow people to talk about these things, their genes will be turned on. And so that's why when we do these Physician Empowerment encounters masterminds, we're like magnets. We're attracting people that either come out and say, Hey, I've got that gene, or people say, Hey, I think I might have that gene turned on. So when, let's say for you and I, Kevin, right, when we met, we thought we were X-Men. We're the Mutants, right? And now we find that there are more and more X-Men, X-Women out there. Dr. Kevin Mailo: [00:12:04] Yeah, there are just so, so many of us that are, yeah, are interested in doing something, you know, along the lines of an entrepreneurial pursuit. And it's really wonderful because although the thrust of the activity where specific projects someone is working on may be radically different, there's a lot to be said for sort of the cross-pollination that occurs when you get people together where they share their experiences, they share their perspectives, they share their advice with each other. And that's that's a very, very powerful part of the community experience that I've noticed over the course of doing our master classes. Dr. Wing Lim: [00:12:44] So this thing about entrepreneurship, so one time I was invited to speak at a religious context, right? These are congregants and we're talking about entrepreneurship. So compare what the the religious world would see as, let's say, a clergyman or somebody who is really good at running, let's say a charity or NGO. The list of attributes and skills versus a successful multi-billion dollar international enterprise, the skill set or the build - borrowing from people who are gamers - this character's build, it's identical. Whether you are a money driven, money hungry entrepreneur or you're an altruistic NGO builder, right? The skills are identical. So if you have a dream to run your department different, to run a new idea, new medical idea that could change the world, it all takes the same skill set, right? Same resources. So we just came back from Iceland at a CME trip and we met this dermatologist who discovered that he grew up in Iceland and it's a fishery country and they throw away the fish skin since he was a kid, and he discovered fish skin is the best for human skin regrowth. And so he created a product, right, that is selling everywhere and haven't got in Canada. And fish skin has the least amount of rejection compared to, you know, any other animals. Dr. Kevin Mailo: [00:14:09] Wow. Dr. Wing Lim: [00:14:09] This thing is going gangbusters. And you know what? I look at them, this is now, this thing is going public, they have like 20 plus million dollars of investors money. Right? And now this becomes, his dream became true because somebody kicked in with that entrepreneurial side. Right? Get together with him and make this dream come true. And now it's benefitting people all over the world. Dr. Kevin Mailo: [00:14:32] I love that. Dr. Wing Lim: [00:14:33] That's a good story, right? Dr. Kevin Mailo: [00:14:35] Yeah. And you know, again, one of the things that that's so important as well is this notion of margin, right? That there has to be some balance in our personal and professional lives to create space to come up with these ideas and to develop them and then to actively work towards them. Right? Like, you know, if you're working 80 hours a week and you've got a big dream, it's going to be frankly, hard to achieve. I don't know. What are your thoughts on that, Wing? Dr. Wing Lim: [00:15:02] Yeah, exactly. So people say, where do you find time? But I think we always find time to think, do things we want, because time management is never rational. It's emotional based. Dr. Kevin Mailo: [00:15:12] Ooh, I like that. Dr. Wing Lim: [00:15:14] Were we supposed to do this, and supposed to do dictation, do charts, and you ended up watching six hours of Netflix, right? Because you're so, so dry, so burnt out that you got to pacify yourself with something, right? So I think what is more costly than time is headspace, right? So I tell people that I'm a serial entrepreneur. I build multi-million dollar corporate entities, so I'm a profit driven, some are for profit, some are not for profit. But it all takes time and effort. So persistent quality, part time effort, right? We could carve out from our calendar say, I want to, let's say you name a number, two hours, three hours, five hours, ten hours, whatever. Right? We just met a new person that we met through our Physician Encounter Endeavor. This guy now cuts out 15% of his week to do something entrepreneurial. Right? So as long as you can do that, well, it's no different than if you need to take a master's degree like MBA, MPH or whatever through your residency or through your clinical hours, you carve out the time to do it, right? So if you do that and nurture the entrepreneurial side and with the bright mind that you already got - you won't be a successful physician if you're not being bright - we just need to give ourselves permission that, okay, I'm learning a new thing, I'm starting from zero, right? From being like a pre-med student stage, right? And we just own that up and say, Hey, I'm an idiot outside of my own field. I'm going to start in the field and the time. Dr. Kevin Mailo: [00:16:44] I love that that, that powerful humility, that vulnerability. Dr. Wing Lim: [00:16:49] And the permission for us to say, okay, I'm learning a new thing, like learning a new language, go to yoga class, and knowing nothing like me learning dance, right? When could not even dance like Pinocchio, like my kid said, right? Start something new. You learn something new and that's about personal growth. Dr. Kevin Mailo: [00:17:05] And I was just going to add, you know, before when we started our journey together, and we've been at this for well over the better part of a decade now, but I remember being the type that used to be terrified of being the dumbest one in the room. And now I feel honored to be the dumbest one in the room because I feel like I'm learning. But that was a mindset shift for me, to realize that I'm being immersed in a field or a topic or an area of expertise that I have no background in, that someone else is going to know a lot more than me and this is my time to to quietly learn or not so quietly learn and ask my questions. But that takes a lot of personal work and personal growth that's very far from that medical student or resident on the wards who's getting ready to get thrown a doozy of a question by the senior resident or the staff or the fellow, and you're expected to know it. And God forbid you're not the smartest one or one of the smarter ones in the circle at the patient's bedside. So it's a big mindset shift. Dr. Wing Lim: [00:18:10] Yes, because contrary to our paradigm, the know-it-all does not own the world, right? And here's a paradigm that I've learned, that I embrace now, if you get the why big enough, the why, then the whats would come to you. The whats and the hows would come to you. Just like Mr. Ford, when he started this motor vehicle revolution. And he actually started with a dream. His dream is not to be the number one seller of cars, his dream was when he grew up he saw the countryside, he lived in the countryside, his dream was to have every American have a chance to have an affordable way to travel to see the countryside. And because of that dream, right, and he's not an engineer, he's not a technical person, and one time at a press conference, they say, Mr. Ford, how do you become so smart? Do you actually know how to fix this part of the engine? And then he picked up the phone and they said, wait a minute, what are you doing? He says, I'm going to call my engineer. They said, That's cheating. He says, No, that's not cheating. In real life, if the why is picking up, the hows would come to you. Right? So I think that is important, right? People ask me, how do you learn so much about so many things? You have your hands in so many different things. I said because I hang out with people smarter than me. Right? Always look to be the dumbest. And one day when we were building this senior home, I found myself downtown in one of the top architect firms. So there are a few of us surrounded by 3 architects and 15 engineers from different disciplines. Dr. Kevin Mailo: [00:19:38] Oh, wow. Dr. Wing Lim: [00:19:39] These are top notch engineers. And they were grilling us and saying, What do you want? What do you want us to build? Right? And I'm just not qualified. I'm just the dumbest person in the room. But I had a dream. But I had a dream. Dr. Kevin Mailo: [00:19:54] Exactly. Exactly. So I think we could go on and on in this area. But tell us, like, what practically have you done in terms of personal development to get where you are as an entrepreneur? Going from that very narrow technician to being this expansive entrepreneur who dabbles in so many fields. Tell us. Dr. Wing Lim: [00:20:23] Sure. So I think we already talked about some ABCs, maybe we just put them down more formally. A is to give yourself permission, right? That I don't know anything. I'm learning a new discipline. The second part is to carve out your head space, right? You got to dedicate some head space together as time and also quietness. The mindfulness that I'm going to learn this and then you got to feed it. You got to feed that part of the brain. You got to turn the genes on. You got to keep feeding it. And that's why listen to podcasts. And well, 30 years ago there were no podcasts, right? You can read books, you can listen to tapes. I grew up with tapes, right? And so for now, you can listen to our podcast. And actually, Kevin, you and I were just talking about we're going to start a new series, right, called the Medical Entrepreneurship. And let this be our kickoff, right? This kickoff session. We're going to interview a lot of our colleagues who have that mutation, that mutant gene of entrepreneurialism. And when you interview our colleagues, how do they do it? What started it? We're going to interview people's journey. And somewhere there is like a tuning fork where you go binnnngg and the guitar box, the rest of this box is going to resonate, right? So we put different tuning forks and then we're going to turn people on. We're going to turn on your gene, right? And those of you who have that gene, it's going to echo. And those of you who don't think you have one, maybe you would echo too. Dr. Kevin Mailo: [00:21:45] Take time to explore it. You know, and the other thing I'll reflect on is the goal is less important than you think. The journey is far more meaningful. Dr. Wing Lim: [00:21:56] That's right. Yeah. Dr. Kevin Mailo: [00:21:57] You know, because for me, just reflecting on my own journey as an entrepreneur, there's just been so much growth and it's been so much fun and so exciting and I think that's a real source of personal renewal is like doing more than just the 9 to 5 grind. And we know it's not the 9 to 5 grind, it's the 8 to 8 grind for doctors. Dr. Wing Lim: [00:22:20] Yeah, exactly. Dr. Kevin Mailo: [00:22:22] It has to be more than that. Dr. Wing Lim: [00:22:23] It's very hard for us. It comes with a price tag, right? It comes with a price tag. So it's an investment. It's an investment in your future and for unknown number of people's lives. Right? Because when I go to the wellness center that we built, there are patients who say, Wow, we're so thankful that somebody built this. They from two hours away, rural, they could come to Sherwood Park and downtown Edmonton. And I'm glad that when I want to go to this center, I'm not known. People don't know me. I have a very healthy ego. I don't need to be thanked. But it scares me sometimes to think about what if I did not activate on my dream? That reality today that everybody took for granted would not be there. We would be struggling. Our medical delivery would be a mess in our county. Right. So exposure. Exposure, right? And then learn the lingo, learn the mentality, talk to people. Allow yourself to dream. Allow yourself to take more risks. It's a metamorphosis. Dr. Kevin Mailo: [00:23:22] And allow yourself to fail. Dr. Wing Lim: [00:23:25] Exactly. Dr. Kevin Mailo: [00:23:26] This is a lot less stress than you think it is. If you can get past the ego component where you're worried about what people think or what you'll see in the mirror when you look. You know, when it comes to, you know, especially like, you know, sort of business and real estate and things like that, you know, there's money at stake, right? But it's not the same pressure as medical errors. And so, like, be comfortable failing, be comfortable having setbacks and frustrations and be comfortable learning from those. That was the other thing that I took from that is that it sounds so cliche to say that, you know, failure is the path to success, but it is. Every single highly successful entrepreneur, highly successful, not just entrepreneur, you know, whether it's a political leader, an athlete, a musical performer, an actor, an actress, that person has had innumerable failures on their path to success. And we don't know them, right? Dr. Wing Lim: [00:24:24] We only meet them when they're successful. Right? So I have kids who are musicians, right? So I understand that mentality. And then in our in our profession, there is zero margin of error. Right? So therefore, it's very one of the toughest thing is not A) every time you're successful, the first time you try, you got to fail. B) I'm not the know-it-all. Right? I need to be the dumb guy, right? And don't DIY, don't do it yourself, do it your way. If there's one way to do it, do it yourself. So I find it very difficult for us to delegate. If you want to be huge in this entrepreneurial world, you gotta learn to let go of yourself. Dr. Kevin Mailo: [00:25:02] Oh, yeah. Oh, yeah. Dr. Wing Lim: [00:25:04] And we teach this concept of leverage. I have a talk on that in Mexico that we did about leverage. Right? It's leverage is the way to to build success. The time, money and talents, the three essential T's for success. All of those lessons are learned and you learn from your own mistakes or other people's mistakes. So it's better to learn from other people's mistakes. Right? And that's why it's good to join us. Join us on our podcast, webinar, Masterclass, fun conferences and our destiny trips. That's where we share our ups and downs. Dr. Kevin Mailo: [00:25:38] Yeah, and there are a lot of downs. Dr. Wing Lim: [00:25:42] Lots of downs. It was shameless. We share our failure stories, right? Dr. Kevin Mailo: [00:25:46] It was no fun having a business built around live events during the pandemic. Yeah, that was a real struggle. Nobody seemed to want to come to our conferences while a pandemic was ravaging the globe. Dr. Wing Lim: [00:26:00] Or at a Mexico conference. The spouse showed up, but the doctor could not because of pandemic, the hospital would not let him go. Dr. Kevin Mailo: [00:26:08] Yeah. So lots of ups and downs, but still so wonderful. And so with that being said, why don't we wrap it up? Because we'll be coming back to this topic over and over again. Dr. Wing Lim: [00:26:21] Yeah, so Kevin, so we're going to interview people. So we already have a list of people. And for people who are our audience, if you have a good story to share about your journey of medical entrepreneurship, let us know. We would love to hear your story. Dr. Kevin Mailo: [00:26:36] Oh yeah, yeah. I was just going to say please and I forgot to plug this many episodes ago and I got to start remembering to do it now. If you are hearing this and you want to share something on a topic of wellness, practice transformation, leadership, finance, entrepreneurship, talk to us because we want more guests on the podcast. We want this to be a community of physicians who are sharing their story, sharing their journey. We don't want it to be the Wing and Kevin Show. So if you have something great, let us know and we'd love to have you on the show. Okay. That's it. That's it. Thank you. Dr. Wing Lim: [00:27:13] Okay. Thanks, everyone. Dr. Kevin Mailo: [00:27:16] Thank you so much for listening to the Physician Empowerment podcast. If you're ready to take those next steps in transforming your practice, finances or personal well-being, then come and join us at PhysEmpowerment.ca - P H Y S Empowerment dot ca - to learn more about how we can help. If today's episode resonated with you, I'd really appreciate it if you would share our podcast with a colleague or friend and head over to Apple Podcasts to give us a five star rating and review. If you've got feedback, questions or suggestions for future episode topics, we'd love to hear from you. If you want to join us and be interviewed and share some of your story, we'd absolutely love that as well. Please send me an email at KMailo@PhysEmpowerment.ca. Thank you again for listening. Bye.