Work Life Balance with Tired Super Heroine – Podcast #152 – The White Coat Investor – Investing & Personal Finance for Doctors

Intro:
This is the White Coat Investor podcast where we help those who wear the white coat get a fair shake on Wall Street. We’ve been helping doctors and other high-income professionals stop doing dumb things with their money since 2011. Here’s your host, Dr. Jim Dahle.
Jim Dahle:

This is White Coat Investor podcast number 152, a discussion with the Tired Superheroine. This podcast is sponsored by ERE Healthcare Real Estate Advisors. Colin Hart, CEO of ERE, has been a guest on my show and specializes in representing leading physician groups and structuring sale and leaseback transactions on their clinical and surgical center real estate. Here, he is a real estate broker, but takes an advisory approach, expertly positioning their clients for real estate sale as part of succession planning surrounding their practice in real estate investment.

Jim Dahle:
If you own your practice or ASC real estate and are interested in maximizing its value, or are considering partnering with private equity, retaining expert guidance on lease structuring may be a prudent financial move. You can learn more about ERE on their website, ereadv.com, or you can reach Collin directly at collin.hart. That’s H-A-R-T @ereadv.com, or call them at 702-839-8737. Our quote of the day today comes from Warren Buffett, “Investors should remember that excitement and expenses are their enemies.

Jim Dahle:
And if they insist on trying to time their participation in equities, they should try to be fearful when others are greedy, and greedy only when others are fearful.” I like that quote from Warren Buffett. It’s certainly appropriate in a time like this. I want to thank you for what you’re doing out there. We’re recording this on March 17th. You will listen to it for two and a half more weeks, I suspect. I just got back from my first shift since all of this really hit the fan. We’re in PPE and to see every patient with a cough or a fever, walking around with an N95 mask all the time and wondering what I’m going to bring home to my family.

Jim Dahle:
We’re out there on the frontlines, all of us, and I think society is starting to appreciate it, maybe a little bit more than they usually do. But if they haven’t told you lately, let me tell you that I appreciate what you’re doing, and I appreciate you putting yourself in harm’s way. And in some ways, increasing the risk for your family by doing what you do. So, I’ve always told you this in the past, but more so now, thank you for what you’re doing. You’re probably on the way home.

Jim Dahle:
Maybe you’re on the way into work. It feels like going to battle these days and being deployed to the hospital, doesn’t it? In China, when the healthcare workers walk past the apartment buildings, they’re applauded by all the people who are in quarantine or self-isolation. And maybe we’ll get to the point where people are doing that in our country as well. I know right now as I record this, there’s a couple of emergency physicians who are in critical care, one in Washington and one in New Jersey.

Jim Dahle:
And we don’t know yet how they’re going to do with this. And I’m sure by the time you hear this, there will be a number of other ill doctors with this pandemic. So, thank you for the difficulties that you are going through. We’re going to have a great interview today with a fine doctor. But before we get into that, a few words about an opportunity we have coming up. We have put together a package that you may find useful while you’re doing social distancing this spring.

Jim Dahle:
If you are interested in becoming more financially literate or just needed a distraction from the 24-hour news cycle about coronavirus, you may want to check out Continuing Financial Education 2020. This is an online course that we’ve subtitled, The Latest in Physician Wellness and Financial Literacy. It has over 30 hours of presentations from physicians and others relevant to your wellness and your finances that you will find absolutely spectacular. It’s super helpful.
Jim Dahle:
And the best part about it is it qualifies for CME. That means you can use your CME fund to buy it. You can write it off if you’re a business owner and pay for it with pre-taxed dollars. So, really, a spectacular opportunity. A lot of the recordings came from the recent WCICON conference. But as you know, that week was crazy for all of us. And so, we actually have added some additional content to it from people who weren’t even there. So, it’s even more than that conference contained.
Jim Dahle:
The price on it is $649. But from now through April 20th, we are offering a discount price, $100 off from now through April 20th at midnight, Mountain Time. So, it’s now just $549 for over 30 hours of content, which also provides CME. So, take the opportunity. There will be a link in the show notes. Also, it will be linked prominently on the White Coat Investor website. Look for that and check it out today.

Jim Dahle:
All right, let’s get into our interview here. Let me introduce Dr. Hamilton. Barbara Hamilton, MD is an interventional radiologist, a wife, a mother and the founder of the appropriately titled, Tired Superheroine blog, which can be found at tiredsuperheroine.com. Started in November 2018, it’s subtitled on being a professional and mother right now. It’s about the challenges of balancing a busy professional life and a busy home life while thrown in some financial content from time to time.
Jim Dahle:
Dr. Hamilton, welcome to the White Coat Investor podcast.
Barbara Hamilton:
Thank you so much for having me, Jim.
Jim Dahle:
Tell us a bit about yourself. Where did you grow up? What was your family like? And how did that influence your financial philosophy?
Barbara Hamilton:
So, I’m an interventional and diagnostic radiologist in Southern California, but I’m originally from Northern New Jersey. And I’m actually a daughter of immigrants. And so, like some of your other guests have been, and I think that’s affected my financial life. My father came to this country by escaping communism in the former Czechoslovakia, and he wanted to play the stock market, I think as he used to say. Some would take issue with that terminology.

Barbara Hamilton:
So, growing up, he spoke a lot about the market and what stocks were worth and their price to earnings ratios. And he will try to introduce me to some of these concepts. We would go through the paper together. And I think he handed me my first copy of The Millionaire Next Door before I was probably 10 or 12. So, that was really influential.
Jim Dahle:
So, you’ve been in school for a long time. Tell us about your education and training.
Barbara Hamilton:
So, in New Jersey, I was able to go through in state schooling. That was a huge benefit. So, I’m a huge proponent of that on my blog. I write a little bit about what it looks like to go through a combined BS or BA/MD program. And so, I went to Rutgers, The State University of New Jersey, and they had a great program you could apply to as a sophomore. Not only did going into that program save me a year of tuition, but it saved a year of time with some double counting of credits.

Barbara Hamilton:
So, I was happy to get out with my MD and just in the lower six figures of student debt. And then, from there, headed out of New Jersey for internship, residency and beyond.
Jim Dahle:
And where did you do those?
Barbara Hamilton:
I did my intern year, I couldn’t wait to get out of New Jersey. So, after 27 years of being in my home state to get that in-state tuition, I couldn’t wait to leave. I went to Washington State, which is a gorgeous place called Spokane, on the eastern side of the state. I was there for a year doing a transitional year. I did my residency at Brown in Rhode Island, and I did my interventional radiology fellowship at UCLA.

Jim Dahle:
Long path, huh?
Barbara Hamilton:
Yeah. So, I started bouncing back and forth.
Jim Dahle:
It sounds like you’ve always been smart about money. You grew up smart about money. You were smart. When you went to school, you’re smart. When you came out, you’re smart now. Do you ever remember a time when you felt financially illiterate?
Barbara Hamilton:
Well, I think some of the lessons that my super uber-frugal dad instilled in me were helpful from the get-go. But on the other side, my mom was more of the spender in the family. So, I think that was informative as well to see how that affected their relationship and the different ways that people can deal with money. Certainly, I consider a financial education to be like medicine. It’s lifelong. I know there are still so many things that I don’t know. So, that’s why I’m laughing as you’re saying I was always smart about money.
Barbara Hamilton:
I mean, I’m still an early career attending, so I’m just doing my best and trying to spread the word on what I’ve learned so far.
Jim Dahle:
So, how did your parents deal with that issue where one was a spender and one was a hyper frugal?
Barbara Hamilton:
Yeah. So, both of my parents were fiercely independent people, not very well-matched. They actually ended up getting divorced, which is part of my financial backstory.
Jim Dahle:
I’m sorry to hear that.
Barbara Hamilton:
Thank you. So, I think that that really informs a young child in financial instability and what that can look like, how taking one household and breaking it into two, is hard. Even if you’re in middle class, both parents had solidly decent incomes, not six figures, no doctors in the family, not anything like that. But just splitting up the house and what that means and it’s extra gas money, and now, we’re just a very different dynamic of having to pay for two households instead of one.

Jim Dahle:
Tell us about your career so far. You said you’re a few years out of training. How’s it gone so far?
Barbara Hamilton:
Yeah. So far, it’s been really great, of course with its ups and downs, as is to be expected when you have such any medical career, I guess. But I’m six years out of training, and I guess because of where I practice, I’ve been able to ascend into some leadership positions. So, I found a really gratifying community practice where I practice private practice in the community in the Southern California desert outside of Los Angeles. We’re about two hours from LA.
Barbara Hamilton:
And in this community, I live in Palm Springs, and we have lots of travelers coming here throughout the year. So, it’s a population influx, but definitely lots of retirees, lots of people who need help and who need my minimally invasive procedure. So, that’s what I specialize in about two-thirds of my time. I do image-guided therapies like cancer treatments, vascular procedures, lots of trauma interventions for a trauma center. And then, the other about third of my time, I spend doing diagnostic imaging.
Jim Dahle:
Yeah. You mentioned before we got on the call that you’re actually between cases and having the nurses not bother you for a little bit. So, clearly a busy practice at this point.
Barbara Hamilton:
Yeah, I just got out of a microwave ablation. So, it’s like I love to spread the word about what we can do for local regional therapies. That’s a person with metastatic colorectal cancer. So, just microwaving part of the liver to do metastasectomy basically.
Jim Dahle:
Awesome. It’s really cool. So, a lot of the most impressive advances in medicine the last few years have all been in interventional radiology it seems like sometimes.
Barbara Hamilton:
Yeah. I think a lot of other people are advancing too, but it’s definitely at the forefront of technology, and the microwave technology is something that I’ve seen advanced just out of fellowship. Even the last couple of years, it’s improved.
Jim Dahle:
So, your blog is Tired Superheroine, and at a certain point, every blogger has to come to a decision to go, “I’m going to start a blog. I’m going to do it.” What caused you to do that? Why did you start blog?
Barbara Hamilton:
Yeah. I was inspired because there are a few things. I’m in a specialty that’s very male-dominated. So, less than 10% of IRs across the country are female. And so, part of starting the blog was basically my personal mission to change that. I want to be an example of what it can look like to have work and life outside of work in my field, because there’s a common misconception that you can’t when you attend to emergencies that that precludes having any life outside of work.
Barbara Hamilton:
And I feel like when I was growing up in medicine, this was just a black box. You hear little snippets of attending saying that maybe they parented on the weekend, like it was a hobby, but they didn’t talk a lot about the mechanics of what it was like to be a parent in a demanding field. And so, I just felt after I had my child and I was learning about these various things like negotiation or breastfeeding on my job, I just felt like I had a ton to share, and specifically for my audience, which I consider not just interventional radiologists, but women in male-dominated fields like surgery too, because I feel like we share a lot in common.
Jim Dahle:
Other than inspiring other women to go into interventional radiology, what else do you hope to accomplish with your blog?
Barbara Hamilton:
So, apart from the male-dominated specialty aspect, I wanted to empower other physicians with a message of financial empowerment. So, it’s not just about the mechanics, which are super important about which tax advantaged accounts you should be saving in and so forth. But it’s also about a mind, and since there’s so much disempowering language around being a physician these days, I wanted to be a positive voice out there for someone who is learning and taking steps to empower herself financially. So, just putting that out there as well.

Jim Dahle:
One of my favorite parts of a blog is the tagline, the bit you put underneath the name of the blog that often sets the tone for it or tells you what it’s about. Yours is on being a professional and mother right now. What do you mean by right now? Do you mean you didn’t put off your having your family? Or what do you mean by that? What does right now mean?
Barbara Hamilton:
What I mean is, right now in 2019 and 2020, women are still being discouraged in different ways from going into certain fields, and I think that’s putting them at an economic disadvantage a lot of times. And so, that’s part of my financial empowerment message, is you may not think that it’s the nicest environment if it feels like walking into a locker room or you feel like on the surface, you don’t belong. But that has real financial implications if you choose a different field just for that reason, and it’s something to consider.
Barbara Hamilton:
I’m not advocating that people should choose their specialty based on income, certainly not. But that if they’re getting frightened away from certain fields, they should consider the economic implications of choosing say a procedural field in pediatrics over something like what I do.
Jim Dahle:
It’s interesting you mentioned that. A lot of people put a lot of emphasis on what the average income especially is, but I’ve been much more impressed over the years with the range of incomes within a given specialty. Sometimes, it seems like the range in any specialty is greater than the range between the averages of orthopedics and preventive medicine. And I’ve just been constantly impressed at how different people with the same specialty, how different their incomes are.
Jim Dahle:
Have you found that in interventional radiology as well that some people are paid dramatically more than others?
Barbara Hamilton:
I think that there is a bit more equality within IR as far as what I’ve heard. There are some IRs which are becoming more entrepreneurial, striking out on their own, and maybe finding a partner like an equity partner to start an outpatient-based lab. That’s a totally different animal. But as far as the interventional radiologists that are hospital-based, which is still most of us, I think it still varies by region.
Barbara Hamilton:
And then of course, what tax bite is coming out of that also causes even more variation. So, say where I am in California, we have quite a big tax bite.
Jim Dahle:
Yeah. I think I’ve probably read it about California more often than my readers and listeners are interested in hearing, but yeah. I’m certainly well aware of the tax bite in California. But it’s really not all that different from what you get in the northeast where it can also be pretty brutal. And the weather is a lot nicer in California.
Barbara Hamilton:
Yeah. There are definitely multiple components to the geographic arbitrage.

Jim Dahle:
Now, lots of financial bloggers seem to be wanting to cut back on their medicine lives or even leave them completely. But you seem to be full speed ahead. How come?
Barbara Hamilton:
I am really biased, but I think I found the coolest job within medicine where I basically get to play videogames at work. I wouldn’t put it so lightly to a patient or their family member. But basically, image-guided procedures are a really wonderful way to provide minimally invasive therapy. So, I feel passionate about that, and then sharing that with other women who otherwise may not find the field. Aside from that, I mean, I did experience burnout early in my career.
Barbara Hamilton:
So, I also had a reality check early on that it was going to be important to financially empower myself so that I would live beneath my means and make sure that I had some escape hatch needed, because I just know that we don’t have a lot of control with a lot of these things that are happening in medicine around us.
Jim Dahle:
What if your side gig started making a lot of money? Let’s say I made a quarter-million dollars a year. Would you change how much you practice?
Barbara Hamilton:
I’m not close to that number yet. So, I became an independent contractor so I could control how much I worked. Unfortunately, I just… or fortunately, either way, it’s depending on how you look at it, I became an employee recently. So, a little bit of that freedom has been taken away. And now, I have a set number of vacation weeks, but yeah, maybe a harder bifurcation to actually step away from work.
Barbara Hamilton:
And I’m also chief of IR at my institution and vice chair of the department. So, it’s not easy for me to just go part-time. I would probably be giving up more than just the work hours. But at the same time, yeah, that seems to be quite a ways away. So, I haven’t really considered that in detail.
Jim Dahle:
No problem. I don’t think most people who start a blog actually ever expect to be in that situation. You’ve often written and you mentioned earlier that interventional radiology is about 90% men. Why do you think that is? And now that medical schools are greater than 50% of women, do you expect that to change?
Barbara Hamilton:
Yeah, this is a really interesting topic to talk about, and it’s something we’re discussing in our society. Medical schools have been approaching 50% for a long time now. So, just because we took the balance recently, it’s not necessarily a new thing that women are flooding into medicine. And yet, they’re not flooding into our field. So, if we look at other fields like surgery, they’ve had a greater influx of women. And then of course, we all know, OB over the past couple decades, has had a huge influx of women.
Barbara Hamilton:
But IR is not seeing that. So, we’re trying to figure out why so we can pull from the full talent pool and not just half of it, so we’re not losing half of our talented qualified candidates, so that we can have the brightest future for our specialty. I think some of the reasons that are cited are the emergencies, the on-call lifestyle which I addressed on my blog, the radiation concerns, which we’ve addressed in the society with a pregnancy toolkit, and just informing people because there’s a lot of misinformation about that.
Barbara Hamilton:
And then, apart from those logistical and safety issues that drive some people away, I think it’s the locker room, the boy’s club reputation, and I think that just repels some people.
Jim Dahle:
A little bit orthopedics, where all they care about is your board scores and your bench press, that environment?
Barbara Hamilton:
Yeah, we’re a little scrawnier in IR than the orthopods I think, if you go by stereotypes, so that’s hilarious. But yes, definitely before we went pass/fail, board scores were a huge part of getting in, and that I think may have repelled some women who didn’t want to be judged by their board score. And then, the other thing is just walking into a room and you’re the only female there, and some people don’t want to deal with that.
Barbara Hamilton:
But at this point in my career, I’m trying to address that and just talk about it, because if we don’t talk about it, it can’t change. One of the things, sign of hope, actually, is that in 2017, IR became its own dedicated specialty, a primary specialty, along with medicine and surgery. So, that has allowed an IR training pathway which is drawing more women in. It’s still not 50%, but it’s higher.
Jim Dahle:
Yeah. You mentioned something in passing that I don’t think we’ve touched on yet on this podcast that came out in the news a few weeks ago, that board scores, and we’re only talking really about step one of the USMLE here, has always been a pass-fail test. It’s always been pass-fail, and the idea was you had to pass in order to become licensed. But they also used to report a score, which we shared with potential residency programs.
Jim Dahle:
And so, it started getting used as a residency selection factor. What do you think about this change that now they don’t actually tell you or the residency programs what your score was on the test? Do you think that’s a good thing, a bad thing? How do you see it as changing the residency application process?
Barbara Hamilton:
Yeah. I think I personally feel like it’s not a good thing. I also have learned in medicine, it’s not always up to me. So, clearly, it’s a learned helplessness that I think a lot of us are feeling sometimes these days. But basically, I think coming from a state school myself, I feel like that would have put me at a disadvantage in some ways, because I think people who have a higher score are going to be biased towards thinking the score should be kept, because it helped them and I’m in that category.
Barbara Hamilton:
I had a pretty good board score, which gave me confidence to go into my interviews, which say my interview skills weren’t as great, or my institution wasn’t Harvard. So, the board score helped me, but I think it’s hard. And I know just looking at the conversation around this on social media, some people have expressed that lacking that feedback is as it is, we don’t know what questions we get right and what questions we get wrong when we take the boards.
Barbara Hamilton:
But just having that feedback that, yes, you’ve assimilated, or no, you haven’t assimilated as much information as you think you have, that that can make it a little more disquieting for people to not get that feedback.
Jim Dahle:
Yeah, I’ve got mixed feelings as well. I mean, I really liked the first couple of years of medical school that were… at our school, were pass-fail. I guess we had honors pass-fail, the top 20% got honors, but we all knew nobody cared about our grades from the first two years. Maybe if you’re going to interventional radiology, orthopedics or dermatology, somebody cared, but most of the class knew that nobody cared.
Jim Dahle:
And we’d all get a couple honors a year, and then the rest, you’d get passes. And it was really nice. It made for an environment where you’re just trying to learn the medicine, was very collegial. You’re trying to help your fellow classmates. It wasn’t nearly as much gunning as I think there probably is in a lot of schools, certainly as the premed institutions we all came from. But at the same time, it makes it really hard to compare apples to apples as far as that preclinical knowledge goes without that score.
Jim Dahle:
And I feel particularly bad for people coming from weaker schools, and I’m not even necessarily talking about a state MD school. I’m talking about people trying to break in from second chance U, basically something out of the Caribbean or perhaps even some of the DO schools, where you’re trying to match in the MD match and show that you’re just as smart as those going to a top notch MD school. That’s a lot harder for them now I think and a lot more difficult for the residency programs.
Jim Dahle:
What I fear is going to happen is that they all just look at step two, right? And now, we put even more pressure on, what is a step two, CK? I didn’t take it. I wasn’t in med school when they put that one in. But are they just going to look at that score now and treat it like step one with a cutoff? And I’m not sure that’s necessarily a better thing from all the things I’ve heard about that test. So, I empathize with the program directors trying to make these decisions without an information.
Jim Dahle:
Certainly, it will make it easier if you suck at taking standardized tests to get into a good residency program. But at the same time, it’s going to make it harder for those who are particularly good at those tests and who really have a good handle on that information to match into a residency program, but a lot of philosophical information there.
Barbara Hamilton:
I’m not sure what the benefit was supposed to be by taking away the score.
Jim Dahle:
I think the idea was to deemphasize the preclinical stuff. I think that was the idea, because they didn’t take away step two. You’re still going to get the step two scores.
Barbara Hamilton:
Just go to the other score?
Jim Dahle:
Yeah. I’m assuming that was the reasoning behind it. But it would have been fun to be a fly on the wall in that room when the decision was made.
Barbara Hamilton:
Oh, yeah.
Jim Dahle:
Yeah. But anyway, let’s turn now to your blog. Now, you’ve got a few ads on your blog, but you’ve primarily chosen to monetize it by selling your time, essentially a coaching or a mentoring service. How do you possibly have time to do this in addition to your practice in your family?
Barbara Hamilton:
Well, I don’t watch a lot of Netflix outside of the faster scenarios like pandemics. I don’t have any TV shows I’m dedicated to. I think that really contributes to my free time. And then, I don’t want to make it sound like I’m just better at time management than other people, but I’m just intentional about spending lots of time with my baby who’s two and having lots of time where I can just write. And frankly, part of it is when you’re in a procedural specialty between cases, I used to waste a lot of time just going on glamour.com or something and just trying to kill the time as the room was being turned over.
Barbara Hamilton:
And now, sometimes I just write. I can just bang out a blog post like a rough draft very quickly between patients because an idea strikes me. But as far as selling my time, the monetizing of the blog has been very experimental so far. So, that ad revenue that you see, that ad plan is the first I’ve gotten, and that’s really helped me to improve things on the back end that I can’t do myself. And with that extra money coming in, I just hope to be able to expand my reach and reach more people.
Jim Dahle:
Yeah, I understand how it is when you’re starting out a blog, you throw a bunch of crap at the wall and see what sticks. And it’s a fun process, very, very different from medicine that can be tricky to navigate your way through there. It’s interesting, I looked up your coaching service, and your hourly rates for coaching are much lower than I would expect an interventional radiologist to make at their regular gig. Why are you willing to do this work for that amount of money when you have a full-time IR gig?
Barbara Hamilton:
So, it’s a labor of love. I’ve done a lot of this in different ways for free for a very long time. So, through the Society of Interventional Radiology, I’m part of the mentor match. So, I mentor people without any money changing hands, and this was my way to offer my time in a more dedicated deep dive way where I could get compensated for my time but just dedicate my time to someone without them feeling like I was always getting the feedback like, “Oh, thank you for your time. Oh, sorry to take up your time.”
Barbara Hamilton:
And I feel like I had this to offer and this was another part of my career I can develop. So, for me, if I take a hit, obviously I could make more just working more as an interventional radiologist, but this means more to me.
Jim Dahle:
What are you going to do when that practice fills up?
Barbara Hamilton:
So far, it hasn’t happened. I think it’s still enough of a barrier for people that who are in training, I think there’s probably a market for it, but it’s just there’s a way that we limit the number of mentoring relationships in IR. And so, in the same way, if I’m finding myself saturated, I could just tap it.
Jim Dahle:
I mean, I imagine it’s a tiny niche, women interested in IR, but you own it, right? I mean, I’m not seeing anybody else out there trying to do a bunch of mentoring in that field. So, I presume at some point, it may just fill up.
Barbara Hamilton:
So no, make no mistake, there are a ton of mentors in IR, and they’re fabulous. But this is a way for me to drill down specifically for the woman who’s wondering, “Should I choose this or a lifestyle field? Can I be the mom on-call? How does this work?” Someone who wants to talk about the mechanics or the heart behind all of this, and I’m willing to take a deep dive with them on that. So, whether you want to go, it’s not just IR, if you want to be a surgeon and you’re asking… because I feel like we share a lot in common.
Barbara Hamilton:
I’m going in at 2:00 in the morning for a bleeding pelvis, so are they. I’m not going to say that my lifestyle is the same as theirs, but I feel like we share a lot in common. So, I feel like by banding together, we can help each other out.
Jim Dahle:
Recently, it’s important to find your tribe in medicine. What’s your tribe and how has it helped you?
Barbara Hamilton:
Yeah. So, the tribe… This idea came to me recently, and I think it’s something I’ve felt for a long time since I realized that I wanted to be an IR. And so, below the surface, there’s a male-dominated field. But yet, we feel like you could work with your hands. You could help these patients. You want to be doing image-guided procedures. So, that’s your tribe. It’s looking past the superficial aspects of what may be stereotypical or what may be scary that there’s radiation involved.
Barbara Hamilton:
And looking past that to see what’s really going to be fulfilling for you in a career, because we all want to have I think some career longevity. We don’t want to go through all this training just to turn around and say, “That’s enough.” We want to care for patients in ways that feel gratifying on a personal level. And that’s what finding the tribe is for me professionally, is being able to find the people that you gel with. If I go to a conference, I can have an instant connection with those people.
Barbara Hamilton:
And I think we start to realize this when we go on our third and fourth-year rotations, you gel on certain rotations and you don’t gel on others. And so, I think that’s finding your tribe, and I think it’s so important. So, I wanted to write about that.
Jim Dahle:
Now, your blog isn’t all about personal finance, but you describe yourself personally as a personal finance nerd. How come?
Barbara Hamilton:
Yeah. So, I see a nerd as someone who studies a particular subject out of a combination of interest and passion but almost to the point where it becomes socially unacceptable. So, nerd has this just mildly negative connotation. So, I would characterize myself in that way because I’m just more likely to read about it than my friends. And I’m the one who’s thinking about money more than my friends. And when I find people who are thinking and talking about money, I gravitate toward them.
Barbara Hamilton:
And those are super interesting conversations to me. So, that to me, is what embracing your money nerd is all about. And then, in turn, I think learning about these money concepts is super empowering. And so, that’s part of my message that I want to spread.
Jim Dahle:
Now, I went back to the first few posts on your blog. I think this is always an interesting thing to do for a blogger when you’re checking out a blogger, because it tells you what’s really on their mind at that time when they start the blog. And the first financial post you wrote for your blog was about knowing your value and negotiating to get it. How come?
Barbara Hamilton:
Yes, amen. So, I think most of us know… for some people, this is still controversial to say, but women make less in medicine. And even when you control for outside factors like years of experience and academic rank, they’re still making less. There was recently an academic paper, I forget the journal, of women chairs who were making less even at the top of their careers, these women who knew how to negotiate and had interpersonal skills, and had business skills, that they’re still making less than their male colleagues.
Barbara Hamilton:
And that’s why I think this message is particularly important for women in medicine.
Jim Dahle:
Do you make less than your male colleagues?
Barbara Hamilton:
No, I’ve aggressively negotiated to the point where I think I was making more. And so, transparency is one of the things that I extol in that post. One of the things I think is really important to get women and minorities on a similar playing field is to get rid of this lack of transparency that we see in a lot of places. And so, that’s one of the key points I pointed out in that post. Other things are just I negotiated. I would mark my calendar year after year to negotiate, because I knew they were hiring me at a bargain rate as a post-fellowship grad.
Barbara Hamilton:
And I knew that to get where I wanted, I would need to be strategic and keep asking. Otherwise, they would allow me to keep working for less. And so, I was just… I would say pretty, almost aggressive about it and persistent.
Jim Dahle:
Now, you wrote that there was a little bit of blowback from being aggressive and negotiating, and being persistent. Can you tell the listeners about what you experienced? Because I think a lot of them fear that, that they’ll be viewed differently for being aggressive.
Barbara Hamilton:
Oh, yes. I actually come out on the other side. I’ve been called money hungry. So, that was what I shared it in that post. That is my worst fears realized over the phone. It was a phone conversation at the time, and my practice manager was just making me feel like I was doing the wrong thing by negotiating for myself. And thankfully, after a couple of years, I think over time, you prove your worth and people will do anything to keep you around. I’m in a place where it’s not really easy to recruit. And for me, that’s leverage.
Barbara Hamilton:
So, these are the things that I’ve learned over time. They want to keep me around and I’m at every conference. I’m asking my colleagues, like we’re talking about this. We’re not only talking about great cases and techniques. We’re talking also about the business of medicine as it pertains to us as employees and sometimes as independent contractors.
Jim Dahle:
Tell us a little bit about your financial life. Now, you’re not anonymous. So, as much as you feel comfortable with, you’re six years out of residency, where are you at with your student loans and building net worth, and et cetera? Where are you at in your financial life?
Barbara Hamilton:
Sure. I’m pretty transparent about this because it’s my ethos. So, on the blog, and I feel like I’m doing this to show how we can be more transparent, just to push back against the societal secrecy around money. And so, I probably border on oversharing, but I share my financial goals for the year in a couple different posts, and that tells a lot about my income, my net worth, stuff like that. So, just before the bear market hit, I was solidly over a million net worth and that was my big first milestone. So, I’m very proud of-
Jim Dahle:
Congratulations, six years out of residency, no small feat.
Barbara Hamilton:
Thank you. Yes, six years out of fellowship. So, a little bit less credit than you’re giving me.
Jim Dahle:
Student loans still or gone now?
Barbara Hamilton:
No. So, I wrote a post about how I minimized and then obliterated my loans. So, I attack them aggressively. So, if you’re talking about that spectrum of pay down your loans or invest, I was definitely on the debt averse side. I wanted to get rid of those loans.
Jim Dahle:
So, what do you invest in? What does your portfolio look like?
Barbara Hamilton:
So, I do a combination of index funds, some individual stocks, ala Warren Buffett. I do believe in a little bit of value investing. And I have a long time horizon, so I’m okay with that. I recently became a real estate investor too. So, in the past year, I bought a duplex in my neighborhood.
Jim Dahle:
Exciting, blogger, mother, wife, interventional radiologist, landlady.
Barbara Hamilton:
Yeah.
Jim Dahle:
All right, I got it.
Barbara Hamilton:
It’s a super exciting life.
Jim Dahle:
So, you’ve had a chance to interact with a lot of docs now that you’ve been blogging for well over a year. What financial aspect of their lives do you think doctors screw up most often?
Barbara Hamilton:
So, I’ve certainly made some financial mistakes along the way. I don’t put myself out there as a symbol of perfection in any way. But I think that some people didn’t have the same influences I did where they had paper frugal parents or maybe they had family in medicine. So, my theory is that, as a group, doctors can be conformist. And because we’re selected in that way and then if we stand out from the pack in a bad way, we’re punished for it in training. So, my feeling is that we conform as a group.
Barbara Hamilton:
So, for me, that translates into having a certain car or having a certain house that you’re expected to have at a certain income level. Whereas I’m okay with being a nonconformist, and if somebody makes fun of my car, I’m okay with it. I’m even proud of my car which is 10 years old, same car from residency.
Jim Dahle:
Ten years old. What is it?
Barbara Hamilton:
It’s a Mazda 3, very reliable.
Jim Dahle:
Mazda 3. I drove a Mazda 6 for four years at a residency, so totally get it.
Barbara Hamilton:
Nice. And I know you talk about the car thing as well. So, just I think, sometimes living paycheck to paycheck, I think that’s a big mistake.
Jim Dahle:
Yeah. Certainly, a lot of docs are doing it. I’d estimate about 25%, unfortunately. Now, you met a lot of docs that don’t do that. Last year, you attended FinCon conference for financial bloggers, podcasters and YouTubers. What did it mean to you to meet other docs in the personal finance space in person?
Barbara Hamilton:
It was fabulous. So, it felt like meeting your family outside of your nuclear or institutional family. Like I mentioned before, it’s not common to find people who are comfortable discussing money and who actually like to talk about money. So, it’s very inspiring environment to be in where other people are okay talking about it and are excited to talk about that. Also, this is a group of people who have taken part of their free time to learn how to live more intentionally to make intentional spending decisions.
Barbara Hamilton:
So, I felt like I had a lot to learn from everyone. And then, beyond that, just the overall sharing tips on how to blog better, how to create better so we’re all creatives. And just when creatives come together, that’s really fun as well.
Jim Dahle:
Now, your clinical work is three quarter time, which I actually think is just about perfect. I’m often telling people if they’re feeling a little burnt out, they ought to first cut back to full-time, and then maybe even a little more to three quarter time. But how did you decide on three quarters time as your clinical workload?
Barbara Hamilton:
Yeah. So, when you reach the physician income brackets, I think there is a sweet spot where you can just keep going with the momentum that’s there. People that’s either always patients to be taken care of, people always want you to work more. But if you work more, you’re just paying more taxes. So, I think there was a sweet spot between living your life and making less where you are not… it’s not diminishing returns. I think Physician on FIRE speaks to this in his blog.
Jim Dahle:
Yeah, and he’s not practicing at all now. So, you can certainly take it to the extreme.
Barbara Hamilton:
Yeah. And the other aspect was having interests outside of medicine basically. So, having a two-year-old and wanting to do, like actually hunker down with him and for enough time where I was like, “Okay, going back to work is a little bit of a break.” And just working on other aspects of life, like the blog and just being at home, and having a full life outside of the hospital.
Jim Dahle:
Yeah. And you and your husband both have a full life outside of your home as well. So, let’s talk about a subject you’ve addressed several times on your blog, childcare. What did doctors not understand about childcare costs before they have kids? How much does it cost? What tax firms do you have to file? How do you find somebody good? What do you do about your call shifts, et cetera? Can you talk a little bit about your expertise with childcare?
Barbara Hamilton:
Yeah. So, I consider myself a bit of a novice with this, because I just have a two-year-old, and I’ve done it my way, and other people have multiple kids and they’ve tried different things. But I think what people don’t realize is that across the board, people are told it’s really expensive, but at a doctor salary, you can afford it. So, I think what maybe what they don’t understand that strikes me the most is that people don’t realize how many options they have.
Barbara Hamilton:
Because when you’re not working with a $60,000 income, you’re working with more than that. So, that gives you more flexible options and just more options. And then, as far as the tax implications, part of the learning curve for us was having a part-time nanny. So, when you pay a household employee enough, then you have to actually do dedicated household payroll. So, you have a dedicated household employer ID number. You need to go through formal payroll, which contributes to disability fund and things like that, so that you are covered as high income professional if your nanny gets disabled on the job.
Barbara Hamilton:
So, this is something that not everybody is doing. And I think some people skirt and they just pay cash, but they just need to understand that they’re putting themselves at risk for that, basically for tax evasion, and then the disability implications. I mean, if somebody becomes disabled in your home.
Jim Dahle:
And what do you do about call when you’re maybe there you may not be there. What’s your solution to when you’re on-call, what you do for childcare?
Barbara Hamilton:
Yeah. I think a lot of parents on-call cobble it together. And so, it doesn’t make life seem any easier for the trainees that are considering this. But I have an OB colleague who used to take his daughter in for every delivery, whether it was 7:00 p.m. or 2:00 a.m. And I’m fortunate to have somebody else at home. My husband is home most of the time. So, I can leave the house at 2:00 in the morning to do an embolization and he’s there, and I don’t need to call anyone.
Barbara Hamilton:
It just gets more complicated if you’re on a 24-hour call and your spouse is not there. Or sometimes my spouse, he’s a freelance musician, so he works. Sometimes, I’ll work through the evening and I’m on-call. So, there’s always that chance. So, I think having a battery of options, basically, a list of people to call in case of an emergency like that is helpful, and having those people on board of course, but we have neighbors across the street who have filled in for us an hour here, an hour there and they enjoy doing that.
Barbara Hamilton:
I had a postpartum doula who also fills in for childcare. She has been on-call for me before. I’ll give her a rate to hold the pager in quotes. And then, a minimum callback rate, like she’s a physician on-call for me. So, that has worked really well when the other parent isn’t home.
Jim Dahle:
Now, my last few questions talk about childcare. I don’t think I’ve discussed that subject with a single male that I’ve had on the podcast. Is it fair that this is a subject that’s widely covered by blogs written by women but almost never on blogs written by men? Why aren’t their blogs written by women that just covered general finances for everyone? And why don’t blogs written by men cover these subjects that drive women to start their own blogs just to cover them?
Barbara Hamilton:
Yeah. I mean, I don’t see… Maybe I’m looking at different blogs than you are, but I see parenting blogs, and I see financial blogs, and I consider mine to be focused mostly on career and self-empowerment, but also what the balance looks like, and that includes parenting. So, it becomes at times like a mommy blog, or I affectionately call it that. I think that there are men talking about childcare. They may not be in the financial independence blogosphere. I think that some men are talking about it in that they’re talking about world schooling their kids or intentional decisions.
Barbara Hamilton:
Maybe they’re not talking about just the nitty-gritty childcare articles like I wrote. But like it or not, women are still, in our society, often responsible for some of the mental load. And it can be more than 50%, even if I’m not the spouse who’s home more or my husband’s home more, but there are still some times where I showed her more of the mental load than he does. There are other times where he’s scheduling and taking the child to the doctor’s appointments, for example.
Barbara Hamilton:
So, he does do a good job in being a partner in the mental load of running a household and being a parent. But I think that’s not always the case, and women in our society don’t assume that’s going to be the case. And so, some of these aspects of the mechanics of parenthood I think are important to cover for women who want to decide whether this is feasible for them or not.
Jim Dahle:
Now, our next couple of subjects may not age well, just as a note to the podcast listeners, we’re recording this on March 17th. It’s going to run on April 2nd. Given our current environment, a lot is probably going to change between those two dates. But I’m going to talk about these subjects anyway. What are your thoughts on the current market meltdown? Are you doing anything differently with your investments right now because of it?
Barbara Hamilton:
Yeah. So, I am trying to look at my statements less often. As the downturn started, I actually purchased a lump sum of some money I had in savings to just put toward my solo 401(k). So, I was able to get in, edit some of the dip pricing. Some of this stuff was starting to go on sale. Now, I’m just trying not to look at my accounts too often because I know I have a long time horizon, and these are unrealized gains. So, I was thinking of writing a post about this actually, the way I think about unrealized gains or unrealized losses, rather.
Barbara Hamilton:
Because I intend to continue… I’m not going to touch that money for at least 10 years or more, probably longer than the 401(k) specifically, so it’s just irrelevant right now, unless the entire market collapses, in which case we’re all going to need, as we said, like canned goods and water more than our Mint app.
Jim Dahle:
And lots of firearms to protect it, I suppose.
Barbara Hamilton:
God forbid.
Jim Dahle:
All right, second subject that is not going to age well, coronavirus. What are your thoughts right now by going to the hospital and potentially bringing home the virus to your family and friends? How do you balance those two duties to your family and to your work?
Barbara Hamilton:
That’s so interesting, because as physicians, we are trained to just march into battle. I started work this week, I really felt like I was going to war. After reading all the social media posts and the information shared by the Italian physicians, it’s really unsettling, and I think all of us feel really vulnerable right now. So, beyond just being in the hospital, the hospital is on lockdown, no visitors right now, that makes me feel a bit safer. And apart from that, I had a two-year-old in Montessori up until a few days ago.
Barbara Hamilton:
So, that was when we thought this is being called into question by some of the children’s hospital, but having a two-year-old who touches his face constantly and touches everything in his environment, like the biggest risk to us on certain days. So, it’s a blessing and a curse in a way. I’m not the only one exposing the family to risk. But that being said, I’m taking as many precautions as I can.
Jim Dahle:
We better wrap this up soon so you can get on to your next case, but you have the year of something like 30,000 high income professionals that will listen to this podcast in the next month or two. Is there anything else that we haven’t covered today that you would like to say to them?
Barbara Hamilton:
I think just as a final thought, I want to encourage everyone to seize their big, beautiful brains. We all got into medicine by being really smart and resourceful. And even though there’s this cloud of negativity, there’s a lot of negative press about physicians and our system failures, and I think a lot of us are internalizing this. So, I’m just trying to be a positive voice while I can be to counterbalance that. I want people to empower themselves in their careers and in their finances.
Jim Dahle:
This has been a discussion with Dr. Barbara Hamilton, an interventional radiologist and the brains behind the tiredsuperheroine.com blog. Be sure to check that out. Dr. Hamilton, thank you for being on the White Coat Investor podcast.
Barbara Hamilton:
Thank you so much for having me.
Jim Dahle:
That was great having her on. I’m in awe at all that she has accomplished and all that she’s doing. Certainly, be sure to check out her stuff. And if you’re interested in that mentoring relationship, obviously, she’s very interested in it too, and so you can check her out at the blog. Hey, if you find yourself with some extra time while you’re social distancing during this trying time, you might want to check out Continuing Financial Education 2020, the Latest in Physician Wellness and Financial Literacy.
Jim Dahle:
This is an online course that we put together including talks from WCICON as well as talks that were not presented at WCICON, all packaged up together. The course sells for $649, but from now through April 15th, you can get it just for $549. That’s a promotional price. I’m sorry, not April 15th, April 20th at midnight Mountain Time. Through April 20th, you’ll be able to get the promotional price, which is just $549, $100 off, so be sure to check that out if you’re interested. There will be a link in the show notes as well as a prominent one at whitecoatinvestor.com.
Jim Dahle:
Thank you for leaving us a five-star review and for telling your friends about the podcast. It really does help it to grow. And if you see ways in which we can improve it, be sure to send those to me by email at [email protected] If you want to get your questions answered on the podcast, go to whitecoatinvestor.com/speakpipe and record them there, and we’ll get them on the podcast and get them answered. This episode was sponsored by Collin Hart of ERE Healthcare Real Estate Advisors.
Jim Dahle:
ERE works across the country with many physician real estate owners who appreciate it and have benefited from the expertise of Collin’s team. ERE is a real estate brokerage but takes an advisory approach, expertly positioning their clients for a real estate sale as part of the succession planning surrounding the practice of real estate investment. Contact Collin directly at collin.hart at ereadv.com, or call him at 702-839-8737. Keep your head up your shoulders back. You’ve got this, and we can help. Stay safe out there.
Disclaimer:
My dad, your host, Dr. Dahle, is a practicing emergency physician, blogger, author and podcaster. He is not licensed accountant, attorney or financial advisor. So, this podcast is for your entertainment and information only and should not be considered official personalized financial advice.