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.

Dr. Jim Dahle:
This is White Coat Investor podcast number 334 – How you're being ripped off by incompetent and corrupt CMS bureaucrats.

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All right, welcome back to the podcast. I'm flying solo here in Utah. Not only am I holding down the fort here at the White Coat Investor while about a third of our staff is out of town, I'm holding down the fort at home as well.

As I record this in mid-September, Katie is high on Kilimanjaro. I think she's in camp four today and will soon be headed to the summit. So I've got to send her a weather forecast via satellite text device so that she'll know what to expect as she heads for the summit. But that means for two or three weeks here, I'm holding down the fort at home. So it's been a very interesting experience. This is the longest Katie's been away from our family for 24 years. A three week trip.

I've been away this long, three times two deployments with the military and a trip to the Grand Canyon. But this is kind of an interesting experience for me to kind of be taking care of everything. Hold down a job because I still have shifts while she's gone. I got to make sure the kids are taken care of while I'm working those shifts, as well as making sure everybody's fed and happy and school's progressing and teams are coached and all those kinds of things. So, if you've never had the opportunity to do this, it's a good one and it sure will make you appreciate your spouse a lot.

QUOTE OF THE DAY

All right, what else can I tell you before we get into our interview today? We should do our quote of the day. This one comes from a relatively famous politician, Barack Obama. He said “A budget is more than just a series of numbers on a page. It is an embodiment of our values.” I suspect he was talking about the federal budget when he made that statement, but it certainly applies to our personal budgets.

All right, we've been registering people now for WCICON24 in sunny Orlando. Early bird registration goes for a couple more weeks here, and unless the thing fills, then of course we're going to stop registering. But that saves you $300 off. $300 off until October 12th. That's when the price goes up.

So, I highly recommend you register ASAP number one to make sure you get to come to the conference. Number two, because you can't book a room until you've registered for the conference. And you definitely want to get in on our room block. Not only is it cheaper, but you get to stay on site, which is that much better at the conference. But you do have until October 12th if we don't sell out to get the early bird pricing.

But this conference is going to be awesome, and this is going to be our best one yet. There's a reason people rave about this conference. It truly is a wonderful life changing, career changing, finance changing, burnout changing four or five days. And that includes the travel time. The conference itself is only three, plus the opening reception the night before.

So, come join us in sunny Orlando. It's in February, February 5th through 8th. You can register at wcievents.com. We'd love to see you there. I love to hear about your challenges. I love to hear about your successes, and it's even better when I get to do that in person at WCICON.

INTERVIEW

All right, we have an interview today with somebody that has been out working on a problem that you probably didn't even know existed. Some things that have been annoying you maybe. Dealing with insurance companies. Statistics suggest that a huge percentage of our healthcare dollar is being wasted, wasted somewhere in between the providers of healthcare, hospitals, doctors, et cetera.

And these third party paying organizations, insurance companies, these third parties that are sitting there between you and the patient. And they hire yet more companies to enter the bureaucracy to make it so money is wasted so you're not paid so patients are frustrated.

At any rate, our guest today has been working on this problem and aspects of it that I wasn't even aware of. And I suspect that most of you are not either. So, I want you to listen to this podcast so you're at least aware of the problems, and so that we can start talking about solutions for it and banding together and getting these problems solved, because they're not only affecting your pocketbook, which makes it very important for this podcast and its mission and this audience, but it's affecting patient care. It's making for worse patient care. And that's a real problem.

Not all of us, but many of us, 75% of those listening to the podcast, have dedicated our lives to healing the sick and injured. And today we're going to be talking about a problem that is preventing that. And the worst part about it is it's kind of a self-imposed problem, not by us, but self-imposed by government bureaucrats and lobbyists and this organization out there that exists and shouldn't. So, let’s get our guest on the line and talk about it.

My guest today on the White Coat Investor podcast is Dr. Alex Shteynshlyuger, who is somebody you may not have ever heard of, but he has been doing incredible work on your behalf behind the scenes now for quite a long time. And the work he's been doing is the subject of our podcast today. Welcome to the podcast, Dr. Shteynshlyuger.

Dr. Alex Shteynshlyuger:
Thank you.

Dr. Jim Dahle:
Before we get into the subject matter today, I think it would be interesting for our audience to hear a little bit about your upbringing, maybe what it taught you about money and the way you view it.

Dr. Alex Shteynshlyuger:
Oh, surely. My accent tells you about myself quite a bit, I guess. The accent is Russian. I was born in the former Soviet Union when the former Soviet Union still existed. The communist rule. I was raised in the Soviet Union. I came to the US as a teenager when I was 13 years old. And I went to high school in New York City. And I went to college in Massachusetts and came back to Brooklyn for medical school. And then I went to St. Louis, Washington University for my fellowship.

Dr. Jim Dahle:
Okay. So, a little bit of Brooklyn accent, a little bit of Russian accent, but I think you're pretty understandable. So, I don't think anybody's going to have any trouble understanding what you're saying.

Dr. Alex Shteynshlyuger:
And certainly when we talk about money, money is important. It is a way to exchange value and to allow the society to function, a modern society to function. Certainly, as you know money is what we work for, but it also allows us to pay our employees, which is very important, to stay in business if you're in private practice. A lot of hospitals are closing down the doors as well, because if the amount of money going out is greater than what you are bringing in, you can't really stay open for too long.

Money is important. And one thing that I was taught about money is that you can't really leverage too much. Whatever comes in, needs to be balanced by what whatever comes out. Otherwise, you are out of business pretty shortly.

As someone who is in private practice, my cash flow, so to speak, is very important. At the end of the month, I need to pay my rent. I need to pay my employees’ salaries, and I need to take home a paycheck as well. If I can't do that, I can stay in business.

Dr. Jim Dahle:
So, tell us a little bit about your practice. What do you do? What kind of patients do you see?

Dr. Alex Shteynshlyuger:
I'm a urologist. I'm in private practice. I finished the fellowship in urological oncology. I have a pretty broad practice. Most of my patients, middle class, lower middle class. So not necessarily, even though I practice in Manhattan, not all of my patients are billionaires. I practice general urology, ED, BPH, urinary incontinence. I also see patients with prostate cancer, bladder cancer, for example. So, it's a broad range of urology.

Dr. Jim Dahle:
That's very different from urologic practice out here in the desert. I feel like 80% of what the guys out here and the ladies out here are doing is all stones. They do stones all day long.

Dr. Alex Shteynshlyuger:
Well, I don't cover the ER call as much now, so as a result, I don't see as many stones, but I do treat patients with kidney stones as well.

Dr. Jim Dahle:
Yeah. So, you're taking care of people that are middle class, that are lower middle class. You have employees, you have to make salary, you got to make payroll. Obviously, you're not doing this out of the goodness of your heart. You also want to get paid as well. But you've noticed something in the relatively recent past that has affected your ability to do all that. And a recent article in ProPublica described you as being on a crusade against payment processor fees. Can you tell us what a payment processor fee is and why we should care?

Dr. Alex Shteynshlyuger:
Right. Back in 1990, a federal law called HIPAA law was passed. It's called HIPAA, Administrative Simplification Requirements. The law was designed to lower the administrative cost of healthcare and administrative burdens in healthcare. In fact, the law allowed only those practices that lower the cost of healthcare and lower administrative costs to be implemented.

The law sought to transition healthcare to the electronic era. It mandated that all the paper transactions go away and be replaced by electronic transactions. Instead of sending paper claims by USPS, the claims are going out electronically. As a matter of fact, right now, 97% of claims for payment go out electronically in the United States, which is a great accomplishment, certainly saving a lot of trees and money.

In the same vein, the explanation of benefits should be coming in electronically, and they should have correct information on them. That's a federal law. Payments should not be coming through the USPS by mail. Instead, they should be coming electronically through electronic funds transfer, EFD, which is less expensive, faster, saves a lot of money to insurance companies and physician practices and it's safer. There is no risk of checks being stolen or disappearing in the mail.

The law was adopted in the 1990s. The regulations were issued, and they went into effect in 2004. Starting in 2004, every health plan should be compliant with these regulations, which mandated that insurance companies send payments upon request as long as the physician asks for it to be sent electronically, that insurance companies send it at no cost to the physicians and other healthcare providers electronically, directly to their bank account.

That actually saves a lot of money to insurance companies, and it certainly saves money to practices. In the end, that allows lower cost provision of healthcare, because every dollar that I spend on administration has to be paid by someone.

In this situation, some health plans decided to hire a third party providers that would instead of sending payments at no cost as the law requires, impose tremendous costs on payments.

For example, Zealous charges 2% to 3%. 2.5% most recently for sending electronic transaction EFT to providers. 2.5% is actually a tremendous amount of money if you think about it.

MedPAC reports that hospitals operate on 8% of profit margin. So, if they have to pay 2.5%, that's 30% of their annual profit, just paying to receive the payment for the care they provided.

It costs at least $5 billion, but more likely $10 billion a year to medical practices in these fees. There are also virtual credit cards that health plans and these contractors, third party contractors send to medical practices, which create tremendous burden in terms of administration processing these payments entering them into EMRs and medical record systems.

And the processing of credit cards can cost as much as 16% according to a Zealous representative. So, this costs a lot of money. Now, the interesting part is that when you run a credit card and you pay your merchant fee, that fee is actually split between the bank and Zealous. Then Zealous takes apart a certain amount of it and split it with the insurance company. Insurance company and Zealous get a kickback from the banks for processing credit cards for which medical practices are paying through the nose.

Dr. Jim Dahle:
Between the credit card fees and the payment processor fee, what percentage of a practice's revenue is going to these third party companies that are doing nothing more than facilitating the payment?

Dr. Alex Shteynshlyuger:
More than you think. More than you think. The merchant processing fees cost at least 3% of revenue. I'm not even talking about profitability or profit. 3% of overall revenue. So, if you buy a cancer medication for $10,000 and you get $60 from Medicare for it, for administration and processing, you're paying 3% of the amount you paid for in these fees. It adds up probably overall to more than $10 billion a year.

Dr. Alex Shteynshlyuger:
In terms of how much of the total amount of payments are processed, my best estimate is Zealous alone processed about 3% of payments in the United States. At least 3% affected through Zealous alone.

But Zealous is not the only company that does that. UnitedHealthcare, VPay is another company that engages in exactly the same practices. It's probably even bigger than Zealous.

Echo Health is another one that does exactly the same thing. It imposes fees on EFTs and sends virtual credit cards. The numbers are difficult to come by. My belief is that they are actually bigger than Zealous as well. So, potentially 7 to 10% of healthcare payments are affected by these fees and costs.

Dr. Jim Dahle:
Yeah. I had never heard of Zealous before I started reading of your work, and I suspect that's the case for a lot of our audience. What is Zealous exactly, and why are they so powerful?

Dr. Alex Shteynshlyuger:
Zealous is a multi-billion dollar private equity company that is operating on the edges of flawlessness in healthcare. What they do is that they provide a solution to health plans to comply with the federal law called HIPAA Administrative Simplification Requirements. They format the data into a compliant form, which is a good service to health plan. It's a legally mandated service.

The problem is that they're doing something underhanded. Instead of charging health plans for the services they provide to health plans, they impose these costs on healthcare providers.

In addition, because we have no option, I cannot select another merchant to deliver the payments because the merchant is selected by the health plan. Basically, this is a vertical antitrust issue at hand, where they basically bend you over and extort you for these fees. Otherwise, you're not getting your payment electronically.

While Zealous provides valuable service to health plans, it provides zero value to healthcare practices. It does nothing for us. There is no reason for us to pay for something where we derive no value. Health plans are legally obligated to deliver the payments to our bank accounts at no cost. That's what the law says. And we're actually being extorted by companies such as Zealous, UnitedHealthcare, VPay and Echo Health for something that we are legally entitled to.

Dr. Jim Dahle:
Let's pause for a minute and I want to talk about one individual by the name of Matthew Albright. Can you explain who he is and what he has done to doctors?

Dr. Alex Shteynshlyuger:
Matthew Albright is a bright guy, apparently. I've never met him in person, but he was the interim director of the Division of National Standards at CMS where according to his bio on Zealous website, he actually wrote the regulations that applied to every electronic transaction between physicians and health insurance companies, including electronic transaction, electronic payments via EFT and electronic remittance advice.

He wrote the rules, and the rules clearly state that the transactions should be delivered to healthcare provider at no cost. As a matter of fact, the regulations are written in such a way that the entire owners on compliance is on health plans. The providers have a right, physicians have a right, but health plans have obligations.

The reason this happened is that health insurance lobby clamored for these regulations. They wanted things to flow electronically because they're saving millions or billions of dollars by not sending paper statements, by not sending paper checks.

They really wanted physician practices and hospitals to adopt these transactions, and they made a deal that they will pay for implementation and for delivering these payments as long as physician practices and hospitals agree to adopt them.

And that's actually written in the federal regulations. It describes the process of what happened. It's very clear that there was a consensus between the health plans and the provider community that providers would agree to assume the cost of implementing this. This is also not free, we need to build our system to accept these formatted data files. And the insurance companies will pay for transmittal to the bank account, payments to the bank account.

Unfortunately, once the ink dried up, health plans turned around and started singing a different song. With the help of Zealous, they started imposing billions of dollars in costs on healthcare providers. Worse, they are actually profiting from this by splitting these fees with Zealous, VPay and Echo Health.

Now, Matthew Albright, after he worked at CMS and wrote the regulations that govern these transactions, a few years later, he went and started working for Zealous, interacting with his past underlings as well as colleagues at CMS arguing that the regulations he wrote and enforced are actually not what they are, and that they allow Zealous to charge these illegal fees.

Dr. Jim Dahle:
He was an administrator, a government employee. Subsequently became a lobbyist for the company that he was in charge of regulating, essentially, at his prior job.

Dr. Alex Shteynshlyuger:
Correct.

Dr. Jim Dahle:
And it sounds like he's been a very effective lobbyist.

Dr. Alex Shteynshlyuger:
More than that. Tens of billions of dollars in value transferred from physicians to the likes of Zealous, UnitedHealthcare, VPay and Echo Health. Stolen. Money essentially stolen from physicians. Earned, but stolen.

Dr. Jim Dahle:
Now, there are some organizations, some people out there who aren't paying these processing fees. For example, the VA is refusing to pay these processing fees. Why can't we all do what the VA has done?

Dr. Alex Shteynshlyuger:
Well, what happened is that the VA, which is the Veterans Affairs. It's a government run system of hospitals in the United States. They provide healthcare to veterans. But if a veteran comes there for treatment of diabetes, and it's not a covered benefit under the VA benefits, and it's usually paid by the employer plan.

VA gets paid by insurance companies employer plans for the care they provide to veterans. So, that's how they come into this play. They are basically doing the same thing I'm doing in my urology practice.

Now, the VA wanted to get payments electronically through EFT because it would save VA, which is I think the largest hospital system in the United States, millions of dollars in costs instead of processing a paper. Getting electronic payments is much less costly and as assumes less risk of fraud, stolen checks, et cetera, et cetera.

The VA actually filed a complaint with CMS against companies such as Zealous and their ilk. However, CMS did nothing to enforce the law and told the VA that it's completely on its own. So, VA started sending hundreds of letters over the past eight, nine years to health plans asking them to comply with the federal law and send them payments electronically.

However, as far as I can tell, based on the freedom of Information Act documents that I obtained from the Veterans Affairs, they have not been very successful with that. So, the only thing that VA resorted to doing is it stopped accepting virtual credit cards. It'll not accept virtual credit cards that costed 3% of revenue. And instead, it calls the companies like Zealous, Echo Health, UnitedHealthcare, VPay subsidiary, and ask them to send checks.

I think instead of incurring these fees, the VA is actually processing paper checks, which are more costly and involves more administrative waste, instead of actually getting what it's legally entitled to electronic ERA and EFT.

My understanding is that VA is still not getting electronic transactions, and instead of paying these fees, it simply incurs a different type of cost by processing paper checks instead of getting EFT.

Dr. Jim Dahle:
Are you doing this in your practice? Are you refusing to pay the fees and just taking paper checks?

Dr. Alex Shteynshlyuger:
Correct. That's exactly what I'm doing. And it may be actually more cost to me to do that because processing paper checks and electronic remittance paper explanation of benefits is not cheap as well. It also exposes me to the risk of check theft or payment theft. But more or less, I'm doing it out of spite to companies such as UnitedHealthcare, VPay, Echo Health, and Zealous.

Now, I should note that after my complaints Echo Health, actually without my knowledge, it marked my account as no cost. So, it sends me EFT at no cost, but I think I'm the only person in the United States who's getting that. They never told me that.

The only reason I found out is because the reporter for the ProPublic article asked me some questions, and I started digging. He asked me what am I paying to Echo Health? And I realized that most recently in the past year, I have not been getting virtual credit cards from them or paper checks. So, we would've been getting EFT, but I never signed up or agreed to pay them. So, it turns out they enrolled me in a paid product without asking me to pay for it just to muzzle me so that I don't complain to CMS.

Dr. Jim Dahle:
I wonder if it's cheaper for them too. It can't be super cheap to send the paper checks either.

Dr. Alex Shteynshlyuger:
Oh, no, it's not. It's more expensive to send than sending electronic transactions, but they use them as an extortion tool, like a good mafia tactic. That we'll make it as difficult as possible for you, even if it costs us money to extort you into paying us for EFT or getting virtual credit cards.

Dr. Jim Dahle:
Yeah. So, that's not really the solution to just take paper checks. What do you think the solution to this problem is?

Dr. Alex Shteynshlyuger:
Well, legally speaking, the federal law already forbids these practices. The HIPAA law clearly states that anything that raises the cost of healthcare or raises administrative burden is illegal.

The problem here is that CMS issued regulations with some vague language. Zealous latched onto this somewhat vague language. Now, if you take Zealous interpretation of regulations, that interpretation is illegal per se, because it raises the cost of healthcare. So, the government law would not allow that interpretation.

But my impression is that CMS is afraid of being sued by Zealous, but also you have to understand that Matthew Albright is not the only person working and massaging CMS and HHS. This is a much broader effort.

What I found out is that Visa and MasterCard spend a lot of money lobbying on this issue. You'd be surprised. What would Visa and MasterCard, what business do they have being at HHS and CMS lobbying? Well, you'll be surprised. It turns out the lobbyists for MasterCard actually met with the attorneys at HHS and apparently gave them a nice presentation. I don't know if there was a lunch involved or a MasterCard or pencils, I don't know, a razor maybe as well.

But they gave them a presentation apparently arguing that HHS should not be banning these virtual credit cards. I filed the Freedom of Information requests to HHS about that meeting, but they have not released any information so far.

Dr. Jim Dahle:
So, it sounds like you feel like the solution is for CMS and HHS to just enforce the law as it is.

Dr. Alex Shteynshlyuger:
Yeah. The bottom line is that CMS needs to enforce the law. The problem is that there is a question whether or not the adopted regulations have some vague language that prevents them from enforcing them the way they should be enforced. So, at this point, I think the only solution is to sue CMS for violation of the federal law called the Administrative Procedure Act.

Dr. Jim Dahle:
So, how do you envision this lawsuit happening? Is this one doctor suing CMS? Is this a class action suit? How do you anticipate this happening?

Dr. Alex Shteynshlyuger:
Well, I don't think you can sue CMS as a class action. You can't really get money from CMS. The only thing you can get from CMS is from them to withdraw illegal regulations and issue something that complies with the governing law.

I filed more than a hundred complaints to CMS about these issues. CMS has not given straight answers, and it actually violated federal law called the Administrative Procedure Act when it failed to resolve my complaints the way they should be resolved.

The only way to solve this problem is really to sue CMS to force it to comply with the Administrative Procedure Act. The problem is that the cost of a lawsuit like this is more than $500,000. Now, you have to remember, at least $10 billion a year is stolen from us by companies like VPay, United Healthcare, Echo Health, and Zealous. So, we are losing an order of magnitude more money on this.

Personally, I can't afford spending $500,000 to defeat Zealous and United Healthcare. And the American Medical Association will not do anything to help, unfortunately. Worse than that, the American Medical Association actually states on its website that these virtual credit cards are not illegal. I have been fighting with the AMA for the past few years asking them to remove this unhelpful language. And the AMA apparently prefers to side with Zealous, UnitedHealthcare and Echo Health.

Dr. Jim Dahle:
What can doctors do to help?

Dr. Alex Shteynshlyuger:
Well, I think that doctors needs to raise hell with the AMA. AMA is the only organization that can afford to sponsor a lawsuit like this and overturn this unhelpful regulations.

The physicians should also complain and ask their state medical associations, as well as their medical societies such as American Urological Society, for me, for example, to help with a lawsuit like that. If we have 20 associations pinching you $25,000, we can do that.

Now, the big issue is that this issue does not affect simply these electronic transactions and payments. The law is much greater than that. There are many, many issues, including prior authorization, electronic attachments that are involved with this. So, if we don't force CMS to fix the regulations and enforce them, we are going to suffer much greater on this, including with prior authorizations and electronic attachments.

Right now, UnitedHealthcare division called Change Healthcare is trying to charge for transmitting electronic attachments. So, it's coming up soon. CMS is writing regulations about electronic attachments, and UnitedHealthcare is already trying to charge us fees for that. If we don't fix it, it's not going to be $10 billion a year. It'll be a $20 or $30 billion a year problem.

Now, this is the same law. The Administrative Procedure Law, act law is the same law that a course in Texas recently found that CMS and HSS violated this law at least three times in a row when it implemented the No Surprises Act. So, as you might have heard, the federal court in Texas declared that CMS violated administrative procedure acts three times in the past year and forced CMS to reissue No Surprises Act regulations.

A lawsuit like this can work, and there is proof, so to speak, that it does work. It can work fast. Within a year, CMS was forced to rewrite their regulations three times, and that I think is the only way to solve the problem at hand.

Dr. Jim Dahle:
All right. Well, I sure appreciate you coming on and letting us know about this problem. I think step one is just letting people know about it. I didn't know about this, and I'm guessing 99% of doctors didn't know about it. And so, it's not just the doctors. It's the practice managers and the billing managers and everybody else like you mentioned.

I think step one is just getting the word out. So I hope today we've helped a lot with that, getting the word out about this problem. And then it sounds like step two is raising some money to pay some lawyers to go do lawyer work. So, maybe there's even some lawyers listening to this podcast that are interested in helping with this problem because it certainly is a huge problem. Our healthcare system has enough problems as it is, it doesn't need self-imposed ones. So, I sure appreciate you coming on to let us know about this.

What else do you think doctors need to know that we haven't yet talked about?

Dr. Alex Shteynshlyuger:
Well, I think it's important to know what's happening with prior authorization. It's the greatest problem in healthcare today affecting patients, our staff, and ourselves. The reality is prior authorization is not going away anytime soon.

As a matter of fact, the policy makers in Washington DC, the people at CMS, they see prior authorization as the ultimate Mecca in terms of controlling the healthcare expenditures and delivering what they call cost effective evidence-based care.

The problem is that go-carting is not really a viable solution. Go-carting is easy to overcome. Today they will go-cart you, tomorrow they will deny it. You need to do the same service many, many times to get go-carted. The reality is that every practice does a lot of one thing, but 80% of prior authorizations involve one-off medications of procedures. So, even if you get go-carted for some procedures or tests or medications, you'll not get go-carted for others.

The real problem with prior authorization is not that it exists, but it's that we don't get compensated for doing it. So, every time we do a prior authorization, actually, we are just pulling money out of pocket. There is a great disincentive for physician practices and hospitals to do prior authorization or to appeal prior authorization denials.

As a result, patients are suffering. Patients are not getting the care they need because physicians don't have the right incentive to appeal wrongfully denied prior authorizations.

The only viable solution to prior authorization reform is a fear compensation for doing prior authorization and a fear compensation for appealing improper denials of prior authorization. That has been proposed to the AAMA, however, nothing has been done.

The AAMA needs to issue CPT codes for prior authorization and for prior authorization denial appeals. And Washington DC, the Congress and CMS need to mandate that if a health plan wants to require a physician to do prior authorization, it has to compensate adequately and fairly for prior authorization.

That is the only way the problem can be fixed properly, fairly, and long term. Any other solution will not be viable. Even if you get denial, the real problem is that patients are harmed by prior authorization denials that are wrongfully denied and not appealed.

Physicians cannot afford to appeal every wrongfully denied pre authorization unless they are compensated for that. That's the basic economics behind it. And health plans are writing this as much as they can. They know that we cannot appeal wrongfully denial prior authorizations, and that's why they are denying right and left and taking money to the bank. That's very appropriate for your podcast as a matter of fact, the economics that works.

Dr. Jim Dahle:
Absolutely. I talk a lot on this podcast about people maximizing their income. And this is a great way to do it. We're talking about a boost of your income that is not insignificant here to solve these problems. So, imagine a day in which you're doing a quarter as many prior authorizations. Once they start paying for them, they're not going to make you do them nearly as often number one. And number two, actually you are getting paid for your time when you do that. It's ridiculous how much donated time docs are doing out there.

Dr. Alex Shteynshlyuger:
Absolutely. It's not even a question of making a profit. It's actually a question of recovering the costs. When the costs are not recovered, the patients are harmed because prior authorizations are not happening, improper denials are not appealed. It's well documented in published literature, so I'm not making it up. It's all documented. Patients are harmed by improper denials, especially patients who are least able to afford. Patients on Medicaid are particularly denied, affected, especially those who have significant medical problems.

Dr. Jim Dahle:
Yeah, it's not just a financial issue, it's also a patient care issue. Thank you for pointing that out.

Dr. Alex Shteynshlyuger:
Absolutely.

Dr. Jim Dahle:
All right. Well, Dr. Alex Shteynshlyuger, thank you so much for coming on the White Coat Investor podcast to make us aware of these problems as well as the potential solutions for them. We appreciate your time. We appreciate all the work you've been putting in over the years.

Dr. Alex Shteynshlyuger:
Jim, I really appreciate your podcast and giving me an opportunity to inform the community about these issues.

Dr. Jim Dahle:
It's our pleasure.

Dr. Alex Shteynshlyuger:
Thank you. Have a good day.

Dr. Jim Dahle:
Okay. I hope you enjoyed that podcast. He throws out this number half a million dollars for a lawsuit like it's some insurmountable sum. We're talking about 50 cents a doctor. I guess we got a million doctors in the country and we need $500,000. Yeah, it's 50 cents a doctor. That's what we need is 50 cents a doctor to sue these guys and make them actually enforce the law the way it is. That is not a lot of money. This should have already been done. What is taking so long?

Those of you involved in organized medicine, those of you who aren't, write your medical societies, write the AMA, send these complaints to CMS. Let's get this problem solved. This shouldn't exist. It's affecting patient care, it's affecting your pocketbook. It's affecting physician burnout. This is a problem. Let's solve this problem. We can do this.

All right, what else can I tell you as we wrap up this podcast? Don't forget about WCICON. You sign up at wcievents.com. It'll be links in the show notes. There's a link on the main whitecoatinvestor.com webpage. This is not hard to register. We want you to come register and come to this conference. It’s $300 off until October 12th.

So, please register, come to the conference. It's going to be great. Bring your family. It's in Orlando. Did I mention that? Come with your family a few days early. Go to Disney World, go to Universal Studios, go to SeaWorld or stay a few days late. Spend the weekend afterward. This is a wonderful time of the year to be in Florida and tons of fun stuff to do, and it's a life-changing conference. So, please come.

Thanks for those of you who've been leaving five star reviews on this podcast and telling your friends about it. This really does help us to spread the word. One of our reviews that came in very recently is from Jonland who said, “Not just for docs. This is a down to earth, easy to understand podcast. The blog and the podcast both give extremely useful investment and life advice. Thank you for working so hard to bring this invaluable advice for free.” Five stars. Thanks, John. I appreciate that kind review.

For the rest of you, keep your head up, your shoulders back. You've got this and we can help. We'll see you next time on the White Coat Investor podcast.

DISCLAIMER
The hosts of the White Coat Investor are not licensed accountants, attorneys, or financial advisors. This podcast is for your entertainment and information only. It should not be considered professional or personalized financial advice. You should consult the appropriate professional for specific advice relating to your situation.

Dr. Jim Dahle:
This is Milestones to Millionaire podcast number 137 – Roadie becomes a millionaire.

At some point in our financial lives, it'll be time to buy a home. A physician mortgage can be a good vehicle for a young doctor who's just out of school and has a more effective place to use their money than on a big down payment.

These loans allow doctors to secure a mortgage with fewer restrictions, a smaller down payment than a conventional mortgage, all without paying for private mortgage insurance.

But if you're further advanced in your career, or deeper into your journey to financial freedom, buying a home with a conventional mortgage and then later on potentially refinancing that loan to a better rate with a shorter time frame could be a great move.

Wherever you are in your financial journey, make sure you use the mortgage that will be most financially beneficial for you. Hop over to our recommended tab to learn more about all of your mortgage and refinancing options at whitecoatinvestor.com/mortgage.
You can do this and the White Coat Investor can help.

Welcome back to this podcast. If it's new to you, welcome. You can come on this podcast, by the way. When you accomplish a financial milestone, we want to feature you. We want to use your experience, congratulate you, but most importantly, use your experience to inspire others to accomplish the same or similar goals.

We're all working together here on our individual goals. It's a single player game, but we can still take inspiration from other people. If you'd like to apply to come on the show, it's whitecoatinvestor.com/milestones.

Okay. We've got a pretty special guest today that we haven't had anybody of this profession previously on our podcast. So, let's get him on the line. Stay tuned afterward, we're going to talk a little bit about retirement accounts for the self-employed.

INTERVIEW

Our guest today on the Milestones to Millionaire podcast is Miles. Welcome to the podcast, Miles.

Miles:
Thanks.

Dr. Jim Dahle:
Congratulations on your recent accomplishment. You have become a millionaire.

Miles:
Yes.

Dr. Jim Dahle:
Congratulations.

Miles:
Thank you very much.

Dr. Jim Dahle:
Was this a big goal for you? Something you've wanted to do for a long time?

Miles:
Yeah. I've been intentional about it. There's certainly goals beyond a million bucks, but it was like you said, a milestone to hit.

Dr. Jim Dahle:
Well, we've had lots of millionaires on this podcast. This is episode 139. We've been doing this for quite a while. What we have never had, however, is somebody of your profession come on the podcast and share any milestone, much less becoming a millionaire. Can you explain to people what you do for a living?

Miles:
I'm a concert roadie nowadays. I used to do a circus roading. Just like you see in the movies, this is Spinal Tap or whatever. I travel the world, putting up concerts and taking them down.

Dr. Jim Dahle:
So, when did you start doing that?

Miles:
Shortly out of college, or I guess even in college to pay for it. I was a local stagehand and wanted to travel after I graduated and thought this would be a nice way for someone else to pay for me to travel.

Dr. Jim Dahle:
Huh. What was your college degree in?

Miles:
Civil and mechanical engineering.

Dr. Jim Dahle:
Mechanical engineer. And you walk out and go, “I'm going to be a roadie.” Tell me about that decision.

Miles:
Yeah. I graduated in the financial crisis and there weren't a ton of jobs. I was applying to some, but wasn't very eager to do it. I was still doing, like I said, local stagehand rigging work where I lived, and when the circus came through town, it looked like a nice lifestyle and had the travel that I desired and an okay income. And that was it. I thought I would do it for a few years and then I would scratch that itch. And then I've still been doing it more than a decade later.

Dr. Jim Dahle:
Huh. So you're how far out of college now?

Miles:
13 or 14 years.

Dr. Jim Dahle:
13, 14 years out. So mid-thirties-ish.

Miles:
Yes.

Dr. Jim Dahle:
Okay. And what does it pay to be a roadie?

Miles:
It's a broad range and there's lots of different avenues like anything freelancing or working for a company. Low six figures, like mid six figures is like my mid profession, and I don't see a whole lot of upward mobility from there, but that's about where it is.

Dr. Jim Dahle:
So, did that surprise you when you found out how much roadies made?

Miles:
A little bit. It's a bit like the military I imagined. I've not served, however, when I hear your stories and others. There's a lot that's baked in. The salary is one component. So, you make $100,000, but you get a per diem of maybe $10,000 a year. And then you don't have to pay for your travel costs, your lodging, your food. All of this is provided for us by the tourist.

So, we can keep our expenses super low if we desire to. Just like anything, there's lifestyle creep or try to scratch other itches. Lots of people develop funny habits that can be quite expensive, but I've managed to keep mine pretty low.

Dr. Jim Dahle:
Yeah. The average household income in America is something like $60,000. And I play hockey with a truck driver. He's a truck driver. He told me he made $111,000 last year. He worked pretty hard, but he made $111,000 as a truck driver in our local area. There are a lot of jobs out there that make six figures that people never think about.

Miles:
Truly.

Dr. Jim Dahle:
And it sounds like roadie can be one of those.

Miles:
Absolutely.

Dr. Jim Dahle:
Are you generally an employee or a contractor, or do you own the company? How's it work?

Miles:
I've always been an employee. In the mid-2000s, I was diagnosed with Crohn's disease and it was kind of like pre-Obamacare. I don't know, I guess I trained myself or told myself that I was going to be an employee just for health insurance from now on, because the treatment is so expensive. I don't know that that's necessarily the case anymore. I think you can buy health insurance that would cover the drugs, but I've always been an employee and been pretty happy doing that.

Dr. Jim Dahle:
Well, you're a millionaire. What's that made up of? If you had to divide your net worth into categories, what do you have?

Miles:
Sure. We're kind of looking into two buckets. The US assets as well as Brazil. I live in Brazil and I’m calling from Rio de Janeiro. My taxable brokerage is $650,000. Roth, 401(k) and IRAs are $300,000. $25,000 in I bonds. $25,000 in money market emergency fund. $15,000 in HSA, and $5,000 in checking. That's just over a million, I guess. And then in Brazil we've got probably $25,000 in the banking system in US dollars, and another $125,000 in an apartment.

Dr. Jim Dahle:
So, where'd all this money come from? Was there an inheritance? Is there some family money you came into?

Miles:
Not at all. Maybe about a few thousand from a UTMA right after I graduated college, my parents gifted me, but other than that, it's surely earned income and capital gains.

Dr. Jim Dahle:
Okay. So, rough numbers here. You make $100,000-ish a year. For 13 years, that's $1.3 million and you've got a million dollars of it left. How did you do that?

Miles:
Honestly, keeping expenses low. Much of it is provided for us. All of the things that the travel budget most of us have, has been mostly subsidized by my employers, which has been great. It's led to really fantastic trips and once in a lifetime experiences. I think developing good habits and lifestyle as well as saving.

Dr. Jim Dahle:
How did you treat debt during your life?

Miles:
I ran from it. I definitely took out student loans in college, and it wasn't very much, it was maybe $35,000 in 2010, I think. And my first year working full-time in a grownup job, I was able to pay that off before I went on tour.

Dr. Jim Dahle:
Crohn's disease has a lot of treatments, but most of the best ones aren't very cheap.

Miles:
They're not.

Dr. Jim Dahle:
How have you dealt with that particular expense in your life?

Miles:
A funny little story. While I was in college, I don't exactly remember what my insurance situation was, but it was a little bit precarious. And I got the Remicade infusion at the local healthcare facility, and a few months later I got a bill for something like $30,000 or $40,000. And I had no money. I was washing windows the summer after college, just kind of potting around and that was an inconceivable amount of money. And I later found out, as I'm sure you and your listeners already know, the drug manufacturer subsidizes the cost of the copay or deductible or whatever, and they ended up paying for all of that.

Now, I've totally figured out the system, at least I think I have, to where I have a high deductible healthcare plan. My premium is almost nothing. And each year the drug manufacturer pays for the deductible and copay. So, my healthcare cost is something like $5 a year. It's bonkers.

Dr. Jim Dahle:
Wow. It's pretty awesome.

Miles:
Yeah. It has its downsides too, right? You have Crohn's disease.

Dr. Jim Dahle:
Well, yeah. Yeah. I'm not saying Crohn's is awesome, I'm just saying it's awesome that it hasn't bankrupt you, that you've been able to build wealth despite it.

Miles:
Yeah.

Dr. Jim Dahle:
We've all met lots of patients for whom their medical issues have really held them back in being financially successful. Whether it's kept them from working or whether it's caused them to spend all their money on healthcare or whatever, it's a big problem for a lot of people. So, it's impressive that you've found a way to overcome that.

Miles:
Thank you. Yeah. And otherwise I'm very healthy. I think I'm at least reasonably healthy, but, yeah, that was tough to figure out the first year or two, and then I’ve been smooth sailing after that.

Dr. Jim Dahle:
Yeah. Most docs in their mid-thirties are not millionaires. I was not a millionaire when I was your age. And there's very much a delay to the career. And we talk about this a lot at the White Coat Investor because we have lots of upsides as doctors, like that high income, but a lot of downsides too, like the big debt at the beginning and a big delay in the start of our career. Talk to us a little bit about the advantage you kind of feel or felt from being able to start early with your investing process.

Miles:
Sure. It was nice to start with… I think my first job paid $70,000 or $80,000 in 2011, and I kept my expenses very low. As though I was still living in college, I had roommates, I didn't eat out a whole ton. I didn't go on a bunch of trips. So, I was able to save a lot of cash, pay off my student loans very quickly and aggressively. However, I didn't super understand or understand the value of tax advantaged accounts at the time, so I saved up a bunch in taxable brokerage.

And nowadays I'm able to, I think I've figured it out enough, where I save in my 401(k) and IRA and HSA and I've achieved reasonable growth in my taxable brokerage. But I feel like I missed out a bit on those early years of stacking paper in 401(k)s and IRAs that I didn't fully understand in my early and mid-twenties.

Dr. Jim Dahle:
What's next for you? What are your financial goals? Do you plan to try to become financially independent relatively soon? Or do you plan to go become a mechanical engineer? Or what are your plans going forward?

Miles:
Couple things. I say this half in jest, one of the motivating little scenes that I remember was a movie called The Gambler in 2014 with Mark Wahlberg. There's a monologue with John Goodman where he is talking about having FU money. You got a boss you don't like, FU you. Someone asks you to do something you don't want to do, FU. You've got your house, your car, your fortress of solitude. And I took that to heart in the fun way. The job that I do is very physical and I don't think there's a lot of long-term longevity. There aren't people in their mid-60s and late into their 70s working in my industry. So, there's a shelf life to it, and it's hard. So, I would like to have an out to not do that job if I choose to, or get pushed in a tough way.

The pandemic taught us a lot so far as the industry didn't exist when in February, March of 2020, there was no entertainment work. A few people went to the film industry, but live entertainment didn't exist at all. So, the first year I was posted up in our apartment in Brazil and my wife and I learned that we can live on her income comfortably. And I don't necessarily have to work, but I do enjoy it, find fulfillment in the work.

The second year of pandemic, I took a job at Tesla and in Fremont, and we moved to Fremont for the year. And right like that taught me that I have transferable skills outside of live entertainment. I wasn't an engineer there. I did other types of work, but it was super fun. I met really neat people, really smart people that taught me great additional skills. So, that's nice to know that there's an avenue outside of live entertainment that isn't going back to school to get a master's or trying to remember the stuff that I learned 15 years ago.

Dr. Jim Dahle:
But when you got a chance, you went back to being a roadie.

Miles:
Yes, I did. Yeah. I do love the work.

Dr. Jim Dahle:
What does your wife do for a living?

Miles:
She's a graphic designer and a product designer at a science museum in Brazil.

Dr. Jim Dahle:
Okay. So, Brazilian wages down there, I presume?

Miles:
Yes, sir.

Dr. Jim Dahle:
Yeah. Okay. But these numbers are all combined numbers that you gave us earlier?

Miles:
Yes.

Dr. Jim Dahle:
Okay. Very cool. Well, congratulations to both of you. That's pretty awesome. So, what advice do you have for somebody that's coming up on the end of college, maybe doesn't really like their major anymore and maybe doesn't want to go to law school, doesn't want to be a doctor, but still wants to be financially successful? What advice do you have for them?

Miles:
Sure. Right. There are plenty of jobs and in the trades and otherwise that don't require a lot of education or with non-applicable education, just like the truck driver you mentioned earlier. There are plenty of jobs with totally reasonable salaries that the things we talk about every day, and Dave Ramsey stuff like living below your means, being disciplined, being intentional, that can totally lead to a fulfilling career, a comfortable lifestyle, and be able to save money for retirement or fun or retiring early. These are all very possible.

Dr. Jim Dahle:
Awesome. Great advice Miles, and thanks so much for being willing to come on the Milestones to Millionaire podcast and share your experience and inspire others to do the same.

Miles:
No, thank you so much. I really appreciate everything you do and love listening to your stuff. I listen to either you or Dave Ramsey while I wash the dishes every day. And I super enjoy it.

Dr. Jim Dahle:
The dishes or listening?

Miles:
The listening more. I really don't like washing dishes, but it's a compulsive thing that I do.

Dr. Jim Dahle:
Well, I'm glad we can make your chore a little bit more enjoyable.

Miles:
Truly. Thank you so much.

Dr. Jim Dahle:
All right, I hope that was an enjoyable interview. It's certainly different. When we do surveys of our audience, it's probably 75-80% doctors, but that's not everybody. The other 20% of you are other stuff and sometimes it's other stuff that's really interesting. I don't know anybody that works as a roadie prior to doing this recording. And so, it's pretty cool to glimpse into the lives of other people and realize that guess what? There are other ways to have a good income that don't involve practicing medicine.

And I think that's an important lesson for us to take as doctors. If you hate what you're doing, go do something else. There's plenty of other great stuff out there. Yes, it might not be quite the income you're used to, but if you have your financial ducks in a row, you can do something else and be happy.

The other thing is we get a lot of criticism on this podcast that we only bring on people with these super high incomes. Well, here's another example of somebody without a high income. Yes, he got to start in his twenties. Yes, he got to start without a huge student loan. He still had student loans but without a huge student loan and he was still able to build wealth.

Given how quickly his wife and he had been saving and putting money away and building wealth, they're not very far away from financial independence. They're not spending that much money. So, given five more years maybe, they'll be financially independent.

I think there's also a lesson there. He lives in Brazil. Guess what? It costs less to live in Brazil than it costs to live here. And so, that's the classic financial arbitrage. You can go live someplace cheaper. You do not have to live in Manhattan. You don't even have to live in the United States. If you want to practice medicine, there's a good chance you might have to live in the United States for a while.

But there are other options out there and there are plenty of retirees that have chosen to go to Guatemala or Costa Rica or Belize or some Caribbean island or lots of other places in the world. Thailand I think is pretty big for expats where it is not quite as expensive to live and your money will go a lot further. So, don't be afraid to look into some other options, particularly if you love to travel and aren't particularly wedded to one geographic location.

FINANCE 101: RETIREMENT ACCOUNTS FOR THE SELF-EMPLOYED

All right, I promised you at the beginning we were going to talk about retirement accounts for the self-employed. So, let's start at the very beginning of this. When you're self-employed, you are the employer. You're the employer, and you are the employee. And so, you are responsible for all the benefits. You got to line up the health insurance, you got to line up the retirement accounts, you got to line up the insurance, you got to line up everything.

Yes, all that can be paid for with pre-tax dollars, which is nice but you got to do the work. The benefit though is you also get to choose the benefits. You don't have to buy benefits you don't care about. If you don't need life insurance, don't buy life insurance. If you need a really great retirement plan, you can go out and get a really great retirement plan. Same with high deductible health plan and HSA and that sort of stuff. You can go do that when you're self-employed. It's in your control. And that's one of the best things about being self-employed.

As a general rule, when you become self-employed you need to be paid a little bit more than you were as an employee because your employer is no longer paying for anything. They're not paying for the other half of social security taxes. They're not paying for any of the benefits.

For a typical doctor, if you're going to go 1099 and be self-employed, an independent contractor, you should expect to be paid about 10% more to make up for all that stuff. You got to run the numbers individually, but that's a rule of thumb, about 10% more. So, if you were getting paid $250,000 to be an employee, maybe you ought to be getting $275,000 to be self-employed to be equivalent. So, keep that in mind. You generally got to be paid a little bit more.

But at any rate, when you go to get your retirement account, the mainstay for a self-employed physician, and this is whether you have an employee gig on the side or not, is the individual 401(k). And if you have an employee gig, you can have two 401(k)s and don't let that stop you.

Yes, you got to understand that all the contribution rules, but you can have two 401(k)s. And generally with two 415(c) limits, which for those under 50 this year is a $66,000 limit that can be put in there. That's the total between you and the employer put in the account. So, this is the mainstay of your retirement savings when you are self-employed as an individual 401(k).

And this year, if you're under 50, you can put in $22,500 as an employee contribution. But you can make up the rest of that $66,000 as an employer tax deferred contribution or you can make it up as an employee after tax contribution. And if you set up the plan right, if the plan's set up for this, you can make those after tax contributions and you can immediately convert them to Roth if you want.

So, lots of options there, both on the Roth side, the tax deferred side, whichever one makes more sense for you, which is generally tax deferred if you're in your peak earnings years but that rule of thumb is plenty of exceptions. So, that's the mainstay. Your first $66,000 in savings for retirement is probably going into an individual 401(k).

Your other options, everybody that has earned income or whose spouse has earned income can do an IRA contribution. Now for most of us docs, most of us high income professionals, we're doing this via the backdoor Roth IRA process for ourselves and for our spouse. $6,500 this year if you're under 50. $7,500, if you're 50 plus. For each of you, even if one spouse isn't working, you can still do one of these for each of you.

That gives you another $13,000. So, we're up to $79,000 that you can save for retirement. And that covers most people. Even most doctors. If you're saving $79,000 for retirement, awesome, good on you. You're probably done. A lot of people can't even max both of those out.

But if you want to save more, there are other options. An HSA. If the right healthcare plan for you is a high deductible health plan, you should definitely use an HSA. This triple tax free account, maybe the best investing account out there. It's the first thing I fund every year. And the exact contribution amount for 2023 eludes me for a family it's around $7,000 something. For an individual it's about half that. That goes up each year with inflation. So you can get a few thousand dollars more into your HSA and use that for healthcare either now or in retirement or even after age 65 you can take the money out, pay taxes on it, but without penalty, spend it on non-healthcare stuff.

Okay. Let's say you're just absolutely killing it. You're making tons of money and you want to save even more for retirement. Well, there's another good option called the defined benefit cash balance plan. And you can have a personal defined benefit plan or personal cash balance plan, even if you're it, you're an independent contractor.

Schwab, for example, offers these. You can go to the people we recommend under our recommended retirement account provider page and they can set up custom plans for you. Both customized solo 401(k) or individual 401(k), that allows you to do after tax contributions and conversions or a personalized defined benefit cash balance plan.

But depending on your age, you might be able to put a ton each year into cash balance plans. I've seen contributions as low as $5,000. I've seen contributions well over $100,000 per year. It's actuarially determined because this thing has to masquerade as a pension. So the older you are, the more that can actually be put in there.

All right. Even if you've maxed all of that out, you can always save more in a regular old non-qualified taxable brokerage account. And you can buy stocks, bonds, mutual funds, whatever. You can go buy an investment property, anything you want. There's no limit in how much you can invest in a given year. There's only limits in how much you can put into a retirement account.

Now the big question a lot of people have is “What about a SEP IRA? My accountant says I should use a SEP IRA.” Well, SEP IRAs are pretty good. They're better than nothing. They're almost always going to be better than a simple IRA, which occasionally a small practice with a few employees will use.

But the downside of a SEP IRA is the balance in there counts against you when you go to do the backdoor Roth IRA process. Essentially your conversion gets prorated. And that's not a great thing. And so, that's why most docs, other high income professionals that are self-employed should be using an individual 401(k) instead of a SEP IRA.

At some income levels, you can contribute more to an individual 401(k) than you would be able to with a SEP IRA because you have that employee contribution that you can use. You also have this option if the plan set up for it to do after-tax contributions.

Now, starting this year, SEP IRAs are supposed to be accepting Roth contributions, which would obviously keep you from being prorated, and might solve that issue. In practice, I'm not sure I've run into one yet that's taking Roth contributions, but hopefully by the end of the year you'll see that at Vanguard, Fidelity, Schwab, those sorts of places.

But as a general rule, SEP IRA is the wrong choice for a doc. Solo 401(k) or also known as an individual 401(k) is the right option. Once you have employees, this is no longer a do-it-yourself game. You need professional help. You ought to get your practice studied. We got that list of retirement account providers on our recommended list. You ought to talk to those people and help them decide what the right plan is for you and your practice or your small business.

It might be a 401(k), it won't be a solo 401(k), not once you have employees that aren't your spouse. It might be a SEP IRA, it might be a simple IRA, it might be no plan at all. But you got to kind of have your practice and employees and how much you want to save studied to figure out what the right plan is for you. I hope that's helpful in understanding self-employed retirement accounts and how they fit into your life.

SPONSOR

At some point in our financial lives, it's going to be time to buy a home and a physician mortgage can be a good vehicle for a young doctor who's just out of school and has a more effective place to use their money than on a big down payment.

Those loans allow doctors without having to pay private mortgage insurance or PMI to secure a mortgage with fewer restrictions and a lower down payment than a conventional mortgage.

But if you're further along in your career and you can get a conventional mortgage, you don't have a better use for your money at this point than down payment or if you just need to refinance, we've also got great resources for you and people that can help you to do that. So, wherever you are in your financial journey, make sure you use the mortgage that will be most financially beneficial for you.

Hop over to our recommended tab to learn more about all of your mortgage and refinancing options at whitecoatinvestor.com/mortgage. You can do this and the White Coat Investor can help.

All right, we've come to the end of another great podcast episode. I hope you're enjoying the podcast. Send us feedback if you'd like to see something different. If you'd like to be on it, whitecoatinvestor.com/milestones. We'd love to celebrate your milestone with you. Keep your head up and shoulders back. You can do this. We'll see you next time on the podcast.

DISCLAIMER
The hosts of the White Coat Investor podcast are not licensed accountants, attorneys, or financial advisors. This podcast is for your entertainment and information only. It should not be considered professional or personalized financial advice. You should consult the appropriate professional for specific advice relating to your situation.