Wealth Planning for the Modern Physician

In this first episode of a two-episode interview, host David Mandell speaks with Cory Kleinschmidt, an industry veteran in the locum tenens space. Cory shares his journey into the field, which began unexpectedly in the late 1990s when he helped develop LocumTenens.com, a job board that played a significant role in the industry’s growth. He later founded Locumpedia, a digital platform dedicated to locum tenens professionals, offering resources, job listings, and insights into the industry.

Cory explains the concept of locum tenens, which allows physicians to work as temporary providers in various healthcare settings, providing them with flexibility, higher earnings, and work-life balance. He highlights how the industry has evolved from a necessary staffing solution to a strategic workforce model, driven by growing physician shortages and changing work preferences. 

This first part of a two-episode interview also covers trends in locum tenens, including the increasing interest from younger physicians, the rising demand for specific specialties like neurology, cardiology, and psychiatry, and the impact of AI. Cory emphasizes that locum tenens is becoming an essential part of healthcare staffing, allowing doctors to explore different practice environments while mitigating burnout and financial stress.
 
Key Insights:

1. Locum tenens, meaning "to hold the place," originated in the Catholic Church before transitioning into healthcare staffing.
   
   
2. The industry has grown significantly, with more physicians, especially younger ones, choosing it for career flexibility and income potential.
   
   
3. Locumpedia is a digital platform that provides a free, centralized resource for physicians and healthcare organizations.
   
   
4. The No-BS Guide to Locum Tenens was created to offer straightforward, unbiased insights into locum work. See https://www.locumpedia.com/.
   
   
5. Locum tenens physicians work as 1099 independent contractors, allowing them to take advantage of tax benefits and business deductions.
   
   
6. The demand for locum tenens is increasing due to physician shortages, burnout, and changing work preferences.
   
   
7. Specialties such as hospital medicine, neurology, cardiology, psychiatry, anesthesiology, and radiology are currently in high demand.
   
   
8. AI is expected to impact radiology, but the combination of AI with skilled radiologists is seen as the future rather than full automation.
   
   
9. More doctors are using locum tenens as a way to test different work environments before committing to full-time positions.
   
   
10. Locum tenens is becoming an essential part of modern healthcare staffing, allowing hospitals to adapt to patient demand and financial constraints efficiently.

Learn more, including additional show notes, links, and detailed key takeaways, by visiting physicianswealthpodcast.com.

Click here to get your FREE copy of our latest book, Wealth Strategies for Today's Physician!

Host David Mandell welcomes Dr. Jude Pierre back to the podcast for an engaging discussion on physician entrepreneurship, financial pitfalls, and operational best practices. They begin by revisiting common mistakes doctors make when purchasing their first or second home, such as relying on 100% financing and overspending on a house before their career stabilizes. Dr. Pierre emphasizes the importance of financial prudence and warns about the risks associated with early-career real estate decisions.

The conversation then shifts to the benefits of hiring a medical scribe, a strategy that transformed Dr. Pierre’s practice. He explains how scribes improve efficiency by documenting patient interactions in real time, allowing physicians to focus more on patient care. His transition from an in-house scribe to a virtual scribe further optimized workflow while reducing costs. He also discusses the financial benefits of Medicare Advantage, outlining how physicians can maximize revenue while ensuring high-quality patient care.

Lastly, the discussion covers physician burnout and the importance of self-care, social connection, and financial planning. Dr. Pierre stresses to David that doctors should recognize their worth, invest in their practices wisely, and plan their personal finances strategically. He highlights the advantages of owning medical real estate and encourages physicians to take control of their financial future by being proactive in wealth management. The episode closes with a reminder that strategic decision-making, both professionally and personally, can lead to long-term success.

KEY INSIGHTS:

• Many physicians fall into the trap of buying a large home too early, only to face financial strain when their career trajectory changes.
  
  
• 100% financing often leads to a lack of equity, which can create problems during economic downturns.
  
  
• Physicians should be mindful of lifestyle creep, resisting the temptation to upgrade their homes or cars just because they can afford them.
  
  
• Hiring a medical scribe can free up significant time, improving work-life balance and patient interactions.
  
  
• Virtual scribes offer a cost-effective and efficient alternative to in-house scribes, reducing administrative burdens.
  
  
• Medicare Advantage provides an opportunity for physicians to earn steady income through capitation, but it requires proper patient management.
  
  
• Owning the building where a physician practices can be a smart long-term financial decision, adding equity and stability to their business.
  
  
• Physicians should be aware of their worth and avoid undervaluing their services, ensuring they receive fair compensation.
  
  
• Small personal care habits, like regular haircuts, contribute to mental well-being and help combat burnout.
  
  
• A structured financial plan, including strategic investments and savings, is essential for long-term financial success.
  
  

Learn more, including additional show notes, links, and detailed key takeaways, by visiting physicianswealthpodcast.com.

Click here to get your FREE copy of our latest book, Wealth Strategies for Today's Physician!

Listen in as host David Mandell welcomes back to the Podcast healthcare attorneys Michael Byrd and Brad Adatto, both of whom joined David back in Season 1.

Brad and Michael begin the discussion laying out the legal issues around the weight loss drugs that have become so popular today and what physicians prescribing such drugs need to be aware of – from patient consent issues, to compounding challenges and state-specific dispensing regulations, to marketing rules and more.

The conversation then shifts to mergers and acquisitions concerning medical practices. Michael and Brad relate the shift they have seen in the last year from “wall street” deals to “main street” deals and what this shift means for physicians who may consider exiting their practice.

David then asks the attorneys about the proposed rules out of the federal government regarding non-competes, where those rules stand and what physicians need to know about non-competes in the medical context.

The podcast concludes with Brad and Michael leading a discussion around how physicians can best work with healthcare attorneys and the value of legal subscription models.

KEY POINTS:

• Healthcare Law Expertise
• Weight Loss Drugs in Medical Practices
• Compounding Issues and Compliance
• Patient Consent and Risk Mitigation
• Business and Revenue Risks with Weight Loss Drugs
• Mergers and Acquisitions Trends
• Valuation Challenges in Practice Sales
• Non-Compete Clauses
• Importance of Healthcare-Specific Legal Counsel
• Compliance as a Dynamic Process
• Legal Subscription Models
• Proactive Legal Strategies
• Broader Regulatory Trends
• Entrepreneurial Approach to Law

Learn more, including additional show notes, links, and detailed key takeaways, by visiting physicianswealthpodcast.com.

Click here to get your FREE copy of our latest book, Wealth Strategies for Today's Physician!

Listen in as host David Mandell welcomes orthopedic surgeon Dr. Patrick St. Pierre. Pat begins by sharing his background in the military, where he served in the infantry and as an airborne ranger pathfinder and eventually transitioned to medical school and a path in orthopedics. He then tells David about his decisions around the first job he took outside of the military on the east coast and his eventual move to Palm Desert, CA to a growing orthopedic practice there.

The conversation then shifts to Pat’s involvement with industry, including work on a Mako orthopedic robot for shoulder surgeries. He comments on the importance of physicians working with industry and gives advice to those thinking about doing so.

David and Pat then discuss Pat’s plan for retirement, which he has given a lot of thought to over the last decade after seeing colleagues struggle with life post-medical career. Pat is passionate about retiring TO something, not just FROM medicine. Pat explains his TO – is wine – and give insights on what he has been doing for some years to train and become certified as a master sommelier.

The episode concludes with Pat giving some specific advice for colleagues on approaching retirement beyond medicine.

KEY POINTS

Dr. Pat St. Pierre's Background: A West Point graduate, he also completed his medical education at the Uniformed Services University of Health Sciences and has an extensive military medical career, including residencies and fellowships in orthopedic surgery and sports medicine.

Military Experience: Dr. St. Pierre initially served in the infantry, where he undertook demanding roles such as airborne ranger and pathfinder, before transitioning to medicine in the military.

Motivation for Medicine: Inspired by personal experiences, including his mother's battle with heart disease, Dr. St. Pierre initially considered cardiology before shifting to orthopedics.

Choosing Orthopedic Surgery: He found his passion for orthopedics and sports medicine through impactful rotations and mentorship during medical school.

Transition to Civilian Practice: After 24 years of military service, his first civilian role in Virginia was driven by family considerations and proximity to his wife’s ailing parents.

Palm Desert Practice: Dr. St. Pierre joined Eisenhower Desert Orthopedic Center and has been practicing there for 17 years, playing a pivotal role in the growth of the practice.

Sports Medicine Leadership: He became the lead physician for major sports events, including the BNP Paribas Tennis Open, and worked with junior colleges, high schools, and a professional hockey team.

Financial Lessons for Young Physicians: He emphasized the importance of mentors, contract review, and considering regional factors like managed care and ancillary revenue streams when choosing a practice.

Overhead Management: Dr. St. Pierre’s group reduced their overhead by transitioning into a hospital-affiliated model, which improved financial efficiency.

Industry Collaboration: He values physician involvement in medical device development and has contributed to innovations like the BioWick rotator cuff anchor and the Mako robotic shoulder replacement.

Mako Robotic Shoulder Surgery: Dr. St. Pierre is part of a global team developing this cutting-edge technology, with FDA approval recently granted, signaling a transformative advance in shoulder surgery.

Planning for Retirement: He advocates for retiring to something meaningful rather than simply retiring from medicine, sharing his personal journey of preparing for life after surgery.

Passion for Wine: Dr. St. Pierre pursued a Master of Wine certification, a rigorous program blending science, viticulture, and business, becoming one of a select few in the world to achieve this level.

Future Endeavors: He plans to continue contributing to wine education and management while staying engaged with the medical industry, ensuring a fulfilling post-retirement phase.

Lifelong Learning: Dr. St. Pierre underscores the importance of challenging oneself with new pursuits, such as studying wine or learning an instrument, to keep the mind active and engaged.

Learn more, including additional show notes, links, and more, by visiting physicianswealthpodcast.com.

Click here to get your FREE copy of our latest book, Wealth Strategies for Today's Physician!

Listen in or watch as host David Mandell sits down with medical marketing consultant Kristy LaGourgue and aesthetic nurse Rachel Varga to discuss branding and marketing lessons that all doctors can benefit from, whether they own their own practice or not.

David begins the discussion by asking Kristy and Rachel the most common mistakes medical practices make with marketing and how to avoid them.  They then chat about the importance of marketing when offering new services or equipment or even bringing on new doctors.

The discussion then turns to branding – how an individual doctor can brand him/herself in the marketplace- which not only can be patient-focused, but also to other doctors, who are key referral sources –and even industry for further business opportunities.

Finally, Kristy and Rachel speak to the use of social media and how doctors should approach getting started in marketing efforts.

KEY TAKEAWAYS

Takeaway #1: Having a Clear Marketing Strategy is More Effective Than Piecemeal Efforts.

Piecing together different marketing tactics without a clear strategy can lead to poor results. Kristy points out that one common mistake practitioners make is trying “a little bit of this, a little bit of that, hoping something's going to stick.” Instead, she suggests that it's crucial to understand how different marketing activities work together to drive steady patient flow.

Rachel supports this point, noting that practitioners often give up too soon or get in their own way due to imposter syndrome or feeling out of their comfort zone. She encourages practitioners to stick with their marketing efforts and to recognize the long-term benefits. “It's really getting also that validation and accolade from your colleagues in the space too, to then position you even further, which might open up the gates for different opportunities on boards and business development deals as well”.

In essence, being strategic and consistent about marketing activities, rather than trying different tactics in a piecemeal manner, can lead to better results and open up new opportunities for practitioners.

Takeaway #2: Diversifying Practice Offerings Can Lead to New Opportunities.

With the rapidly evolving field of medical technology and treatments, diversifying practice offerings can open up new opportunities for physicians. For instance, adding new technologies or treatments to a practice can attract different types of patients, or even create new revenue streams.

Rachel explains how one of her colleagues transformed his practice by incorporating group coaching and video training, thus creating a seven-figure business. She says, “So you just don't know what's possible until you start to go down this path.” She also mentions the increasing popularity of concierge medicine and biohacking, suggesting that practices that incorporate these elements are very appealing to buyers.

Diversifying practice offerings can, therefore, not only bring in new patients and revenue streams but also increase the practice's value in case of a potential buyout. This diversification, coupled with a strong online presence and marketing strategy, can significantly enhance a practice's success and growth.

Learn more, including additional show notes, links, and more, by visiting physicianswealthpodcast.com.

Click here to get your FREE copy of our latest book, Wealth Strategies for Today's Physician!

Listen in as host David Mandell sits down with Carole Foos, CPA from OJM Group and Greg Heimkreiter, JD, CPA from Howard, Nunn & Bloom, Inc. 

David asks both Carole and Greg to give their key insights on the tax landscape as we enter 2025 with a new party in control of both the White House and Congress.  Carole begins with a discussion of potential changes to individual tax rates and Greg mentions the SALT limitations and dives into estate tax issues as well.

David then chats with Carole about retirement plan changes due to the Secure Act, new planning opportunities coming online in 2025, and the continued importance of tax diversification. 

Greg then shifts the discussion to corporate taxation, including the possibility that C corporations may come back into more utility for medical practices and other small businesses. 

Carole and David then discuss Qualified Opportunity Zone investments and how the deferred tax is going to be coming up for payment soon and what that means for 2025 tax planning.

David concludes asking both Carole and Greg for their input on the changes in the accounting industry and why so many physicians and practices are having difficulty finding good firms who want to provide tax return preparation services.  

KEY POINTS

Tax Uncertainty in 2025: With potential changes to tax laws due to a new administration, tax planning remains a "wait and see" process, especially for individuals and businesses. 

Expiring Tax Cuts: Key provisions of the 2017 tax reforms, including lower individual income tax rates and increased standard deductions, are set to expire at the end of 2025 unless extended. 

Estate Tax Exemptions: Current estate tax exemptions of $13 million+/- per individual ($27 million for married couples) could be halved if laws revert in 2026, raising planning concerns. 

SALT Deduction Limit: The $10,000 cap on state and local tax (SALT) deductions is a significant pain point, particularly for taxpayers in high-tax states like California and New York. 

Retirement Plan Changes: The Secure Act 2.0 introduces supersized catch-up contributions for ages 60-63 in 2025 and expands options for Roth contributions, encouraging tax diversification. 

Opportunity Zones: Taxes deferred through qualified opportunity zone investments will become due in 2026, requiring proactive liquidity planning for investors. 

Inherited IRA Rules: New rules require most beneficiaries to withdraw inherited IRA funds within 10 years, potentially accelerating tax liability. 

Business Tax Considerations: Proposed reductions in C corporation tax rates from 21% to 15% and changes in bonus depreciation rules could shift entity structuring decisions. 

Qualified Business Income (QBI): The QBI deduction benefits pass-through entities but is not available to most high-income professionals, particularly medical practices. 

Industry Shifts in Tax Preparation: A shortage of accountants and outsourcing trends have made finding quality tax preparation services more challenging for individuals and small businesses. 

Roth IRAs and RMDs: Funding Roth accounts now can reduce future required minimum distributions (RMDs), offering long-term tax benefits. 

Accelerated Depreciation: Businesses, including medical practices, may benefit from restored 100% bonus depreciation for assets like equipment. 

Tax Diversification for Retirement: Balancing assets in different tax treatment "buckets" (e.g., Roth, traditional accounts) enhances flexibility and minimizes tax burdens in retirement. 

Future of C Corporations: Lower corporate tax rates could make C corporations more attractive, but double taxation remains a potential downside. 

Challenges in Accounting Industry: Many firms are shifting away from individual tax returns, emphasizing the importance of finding specialized services that align with clients' needs.

Learn more, including additional show notes, links, and more, by visiting physicianswealthpodcast.com.

Click here to get your FREE copy of our latest book, Wealth Strategies for Today's Physician!

Listen in to episode 5.10 as host David Mandell interviews Dr. Jude Pierre, internist, doctorpreneur, fellow podcaster and coach to young physicians.

Jude begins by sharing his background, including a brief description of his family's immigrant story as immigrants from Haiti who moved back to Haiti from New York City when Jude was eight years old, for a business opportunity for his father—beginning his entrepreneurship interests. This entrepreneurship continued in his residency, as he began moonlighting and early real estate investing.

The conversation shifts to the challenges Jude had starting a practice in Miami and why he chose to move to a more rural area outside of Tampa. He explains his success in “getting busy” but also gives some advice around getting too busy and work-life balance for physicians.

David and Jude then discuss Jude’s work as a content creator, through books and videos, as well as his work coaching young physicians. They discuss the type of help he provides other physicians through this content, as well as his "Independent Physicians Blueprint" podcast.

The podcast concludes with Jude giving some specific advice for young physicians.

Key Points

Dr. Jude Pierre's Background: Trained in internal medicine, he has been providing primary care since 2000 in South Florida and Tampa Bay metro area. Dr. Pierre actively mentors new physician graduates, helping them navigate the challenges of a rapidly changing healthcare environment. Apart from practicing medicine, Dr. Pierre is a podcast host and coach for physicians, sharing strategies to succeed both in medicine and entrepreneurship.

Diverse Upbringing: Raised in Haiti after being born in New York, Dr. Pierre attributes his entrepreneurial spirit to early exposure to his parents’ business ventures in Haiti. Residency and

Financial Challenges: During his residency, Dr. Pierre faced significant financial pressures, prompting him to moonlight and prioritize early debt repayment.

Real Estate Ventures: Dr. Pierre began investing in real estate during residency, starting with a condominium and later flipping properties, which sparked his interest in entrepreneurship.

Physician Practice Challenges: Early in his career, Dr. Pierre faced challenges establishing a private practice in Miami due to oversaturation of primary care providers.

Strategic Career Moves: Dr. Pierre moved to Spring Hill, near Tampa, for greater professional opportunities, noting that smaller markets can offer significant practice growth potential compared to larger urban areas.

Burnout Awareness: Dr. Pierre emphasizes the importance of work-life balance, sharing his experiences with burnout and the personal impact on relationships.

Coaching and Education: He launched a course, "Learn About Medicare Advantage (LAMA)," to educate physicians on managing patient populations and insurance dynamics effectively.

Independent Practice Advocacy: Dr. Pierre promotes independent practice models like concierge medicine and direct primary care as alternatives to corporate healthcare.

Risk Management in Rural Practice: He highlights the risks of being overwhelmed in underserved areas, urging physicians to set boundaries and prioritize manageable workloads.

Efficient Practice Management: Dr. Pierre coaches physicians on balancing patient care with payer relationships to optimize practice sustainability.

Podcast Rebranding: His podcast, initially "Practice Impossible," was rebranded to "Independent Physicians Blueprint" to align with his mission of empowering independent practitioners.

Advice to Physicians: Dr. Pierre advises doctors pursuing entrepreneurship to seek wise counsel and avoid taking on ventures alone, emphasizing the value of collaboration and specialized guidance.

Learn more, including additional show notes, links, and more, by visiting physicianswealthpodcast.com.

Click here to get your FREE copy of our latest book, Wealth Strategies for Today's Physician!

Listen in as host David Mandell interviews financial advisor Jay Zigmont PhD, MFA, CFP®, the CEO of Childfree Wealth.

David begins that he had read’s Jay first book and was extremely interested in the topic—as he and his wife Sheila do not have children. He and Jay then discuss Jay’s background and how he came to direct his career around helping child-free clients.

Jay then shares some statistics from various studies about the prevalence of childfree people and how this demographic is growing rapidly. David and then dig into the various ways traditional financial planning misses the mark for childfree people—working backwards from estate planning to present day financial decisions. David makes the point that even folks with kids or grandkids can learn from tactics that childfree people use often.

Jay then provides to David and the audience a few resources that childfree people can utilize if they are interested and concludes with Jay emphasizing the importance of community.

Key Points:

• Childfree Wealth Defined: Childfree Wealth caters to individuals who do not have children by choice or circumstance, representing a significant and underserved demographic in financial planning.
  
  
• 25% of the U.S. Population is Child-Free: Research indicates that 25% of Americans are child-free or permanently childless, highlighting a large, often overlooked segment of the population.
  
  
• Lack of Representation in Financial Planning: Traditional financial planning is geared towards families with children, leaving child-free individuals with advice that doesn't align with their unique needs.
  
  
• Financial Impacts for Child-Free Individuals: Child-free people often focus less on wealth transfer to future generations and more on living fulfilling lives, with different priorities such as disability insurance, long-term care, and lifestyle investments.
  
  
• Higher Net Worth Among Child-Free People: Research from Pew shows that child-free individuals tend to have higher net worth, and gender pay gaps are significantly reduced within this group.

Learn more, including additional show notes, links, and more, by visiting physicianswealthpodcast.com.

Click here to get your FREE copy of our latest book, Wealth Strategies for Today's Physician!

Listen as host David Mandell continues his conversation with dentist and coach Dr. Sue Keller.

Picking up where they left off at the end of Part I, David and Sue discuss the ongoing financial challenges of her specialty dental practice.  Here, they tackle Sue’s difficult decision to file bankruptcy for the practice after more than 20 years -- and the legal, practical and emotional processes involved.

The discussion then turns to Sue’s transition after closing her practice – from working part-time for another dentist, serving patients as part of a non-profit and her eventual interest in, and transition to, coaching.

David and Sue conclude the conversation chatting about Sue’s role as a coach and how physicians and dentists could benefit from this type of advisor.

Key Points

• David discusses the stigma around bankruptcy in the medical and dental fields and how it can be a difficult but necessary decision.
  
  
• Dr. Sue opens up about the emotional attachment she had to her practice, likening it to one of her children, which made it hard to let go despite financial struggles.
  
  
• By 2018, Sue realized she was losing $7,000 per month despite working with coaches, accountants, and business consultants.
  
  
• She shares that her staff turnover and the irregular income of her practice contributed to her financial distress, comparing the ups and downs to a "gambling addiction."
  
  
• A business coach encouraged Dr. Sue to explore bankruptcy, which led her to interview multiple lawyers to understand her options.
  
  
• Sue highlights the emotional weight of separating her identity from the practice, realizing she wouldn't "die" if the practice failed.
  
  
• Once she accepted the need for bankruptcy, Dr. Sue moved quickly, closing the practice within a month and transitioning into part-time work at another practice.
  
  
• Working part-time at another dental practice, Sue found she earned more with less stress and more time for herself than she ever did in her own practice.
  
  
• The bankruptcy process took several years to resolve, but Dr. Sue managed to repay part of her debt and eventually moved on from the practice.
  
  
• During the COVID-19 pandemic, Sue worked with the Medical Reserve Corps, vaccinating as part of a team, which she found rewarding and different from the solo nature of running a practice.
  
  
• Dr. Sue transitioned into life coaching after discovering her love for helping people make positive life changes, drawing on her own experiences of resilience.
  
  
• She explains the distinction between coaching and therapy, emphasizing that coaching focuses on helping clients take steps toward future goals, rather than revisiting past traumas.
  
  
• Sue advocates for the importance of balance in life, urging professionals to reflect on whether their careers are enhancing or detracting from their overall well-being.
  
  
• She notes the value of mastermind groups and communities where professionals can openly share challenges and vulnerabilities without competition.
  
  
• The episode ends with Dr. Sue encouraging listeners to seek support, whether through coaching, therapy, or peer groups, as no one is truly alone in their struggles.

Learn more, including additional show notes, links, and more, by visiting physicianswealthpodcast.com.

Click here to get your FREE copy of our latest book, Wealth Strategies for Today's Physician!