Money
231: How to Break Free from Autopilot and Pursue the Life You Really Want
Do you ever feel like life is passing you by while you're stuck on autopilot? It's so easy to get caught up in the day-to-day grind and put off the things that truly matter. In this episode, I share a personal story about how I almost missed out on two incredibly special moments because they felt "inconvenient" at the time.
As busy professionals and moms, we often prioritize our never-ending to-do lists over the experiences and relationships that bring us genuine joy and fulfillment. But what is the cost of constantly saying "no" to the things we really want to do? Of waiting for the perfect time that never seems to come?
Join me as I explore the importance of living life with urgency and intention. Discover how to break free from the excuses holding you back so you can start creating the time and financial freedom you deserve. Because if you don't make a change, nothing changes. And you are worth so much more than a life of "what ifs" and "maybe laters."
We have just a few rooms left at our amazing group rate at the Four Seasons Oahu for the 2025 Live Wealthy Money and Wellness Conference For Women Physicians. Don't miss this chance to join us in luxurious Hawaii with incredible speakers to focus on money and living your best life. Virtual tickets are also available!
Ready to transform your life and finances? Join the Happy and Rich Club for Women Physicians — a 6-month, intimate program designed to help you thrive in both life and money. Click here to learn more, enroll, or schedule a quick call to see if it's the right fit for you!
What You'll Learn from this Episode:
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Why it's crucial to start saying "yes" to the things that truly matter, even when they feel inconvenient.
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How to recognize the excuses and limiting beliefs that keep you stuck in autopilot mode.
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The real cost of constantly putting off your dreams and desires for a later date.
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Why pursuing time and money freedom requires courage and intentionality.
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How to take actionable steps towards creating a life you genuinely love.
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Why investing in relationships and meaningful experiences is key to a fulfilling life.
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The power of deciding that you are worth the effort it takes to make positive changes.
Listen to the Full Episode:
Featured on the Show:
- Follow me on Instagram
Welcome to The Wealthy Mom MD Podcast, a podcast for women physicians who want to learn how to live a wealthy life. In this podcast you will learn how to make money work for you, how you can have more of it, and learn the tools to empower you to live a life on purpose. Get ready to up-level your money and your life. I’m your host, Dr. Bonnie Koo.
Hey everyone, welcome to another episode. I am recording this right after February 1st and I cannot believe it's already February. I don't know about you, but a part of me feels like the year's already over now. I know I'm being a little dramatic, but it's more that time is going so fast. So that actually ties in well with what I want to talk about today.
So I realized how easy it is to put off things that really matter. And I want to talk about how important it is to really start living life with urgency and intention. And so what really got me thinking about this is actually something that happened really recently a week ago actually, is I almost missed two really important and special moments. And that's where I was like, what is the point of all of this if I'm not actually doing the things that I say I want to do?
So here's what I mean. Here's the example. So I had two friends who were celebrating big milestone birthdays, and neither of them live near me physically. In fact, most of my friends, I would say, are kind of spread across the country and we try to meet up. A lot of us go to the same conferences or even vacation together.
And so, when I first got the invitation, you know, sometimes you get invited to something and you kind of like just ignore it. And they were dear friends of mine, so I don't want to say I just ignored it, but I kind of was like, well, you know, it would require me to book a flight and figure out a hotel, etc. So basically, you know, not the same as, you know, hiring a babysitter for the night and going to a party.
And so when I initially got the first invitation, I kind of was like, immediately, oh, basically, oh, it's too hard, like logistics of childcare. And then I got to travel and I travel so much already. And so I don't really want to travel more. Basically, it felt really inconvenient. And then the second dear friend also had the same milestone birthday. Not only that, but it was like the day after this trip. So I would have to fly to Washington, D.C. And then the day after, fly to California.
And not only that, a few days later, I had to be in Nashville for a two-day in-person mastermind retreat. And what I mean by that is I'm in a business mastermind with other female entrepreneurs, and they're ridiculously amazing. Like some of them are people you probably know. One of them is an author of books for, I think, tweens. And I don't have a tween, so I didn't know what the book was, but apparently everyone else there who does knew her books.
Anyway, all that to say is I was able to spend a few days with some incredible female entrepreneurs. So you can see that it would have been so easy for me to say, well, I can't because, you know, that's two flights I have to be on and I'm going to be, you know, out for two days for the mastermind. Like that's a long time to be away from my family. And there was even more, another excuse on top of that. Matt also had a business trip that overlapped, not the whole time, but for like 80% of that time.
So most people would agree that it just wouldn't work, that it's inconvenient, and that, you know, well, I can't really do that because… And again, it made me realize, obviously, a light bulb went off eventually because I did end up going to all of those things. And I was gone from like a Friday to a late Thursday night.
And again, I realized I have created a life where I have relative, almost 99% time freedom. And it's like, why did I create that time freedom? So that I can be present and available for these moments that really enrich our lives, that create memories, right? And yes, it took something to make all this happen, right? I had to arrange child care. I actually ended up flying my mom and my stepdad in and arranging for them to take Jack to school for a few days. And of course, in my head, I was like, well, that's really hard. And Jack's, you know, he's very high energy and, you know, my mom's not exactly a spring chicken. And so I felt bad to ask her to do that.
She said yes, obviously, but again, there were all these sort of competing thoughts and emotions and again, super justified as to why it was just not convenient. And I will tell you, I am so, so glad I went. It was so meaningful to be with two close friends of mine. In fact, the first one in DC, it was a true celebration of her life. It was actually quite moving and to also meet other people in her life that I haven't met before, mainly because I don't live near her, and just meeting new people. I already met one person there. I think we'll stay connected for a while, and so I am so glad.
Then going to California, I mean, I was basically walking on the beach every day, hanging out with a small group of girlfriends and again, and then had a very special dinner to celebrate her birthday. Again, an amazing experience that I know I'll remember for a long time. And I also know these two good friends will remember that as well.
And so how many of you, if you're listening, what things have you said no to that you really want to say yes to because it wasn't convenient? Now, I'm not saying you need to say yes to everything, but I know there are certain things that you would love to do that you know would be so meaningful for you and maybe a friend, but you're not doing because it's frankly inconvenient.
And so I wanted to ask you, what is the cost of you not saying yes what is the cost of you feeling sort of stuck and stagnant in your life what is the cost of not working towards time and financial freedom because the truth is and I know you know this if you don't make a change nothing changes and I see this too often with the women that I work with or before I work with them like another year goes by and they are not closer to what they want And everybody wants some version of time and money freedom. I don't know why you wouldn't do that. You probably wouldn't be listening to that if you weren't interested in that, right?
And so really, the takeaway message, I think this is going to be a pretty short and sweet episode, is that I really want you to think about this. If you feel like you're someone who keeps waiting for life to slow down, if you keep feeling like I'll do it later because now is not a good time, I'll do this later, I'll do this some other day, notice that that day hasn't come. How long have you been telling yourself this?
I understand and appreciate the courage and the boldness it requires to make this type of change where you are pursuing time and money freedom. And I'll be honest, this work isn't easy. It's simple in that there are predictable steps and actions you have to take, but it's not easy because it's so much easier to keep doing what you're doing even if you're not happy, even if you're struggling because you already know how to do whatever you're doing.
You know how to go to work even if you hate your work environment. You know how to show up and work many hours and take call even though you really don't want to. It's easy. You don't have to do anything different. It's like autopilot.
And so it does take something to basically kind of put a line in the sand and be like, this is not what I want. I want something more for myself. And honestly, I feel like that's basically what I do. This is why I have a podcast. This is why I'm in your ear every Thursday is because I want you to be living the life that you really want.
And even though I do this work and even though I'm speaking to you right now, it is so easy to kind of get into a pattern of autopilot. Like again, just the example I gave you earlier where I was presented with two invitations and my initial response was, oh, I can't.
In fact, actually, I agreed to the first invitation, and the second invitation actually didn't come that much later. I got a text saying, hey, we're going to California for so-and-so's birthday. Do you want to come? And immediately, I literally was a no and I was a no for a while. And even that birthday person reached out, you really can go. She's a former coach of mine. And I was like, oh, I really can't, childcare and blah, blah, blah. And then I feel bad. It's a lot to ask my mom to be by herself.
I have flown her down, but usually myself or Matt's around to kind of like, you know, help out. And I basically said, I can't, I can't, I can't. And then one day I said, I can. And again, I am so glad I did that. I'm still tired from that trip. I actually got back late last Thursday night and I'm still a little tired, but again, so glad I went. I have amazing memories and pictures and I'm just so glad that I rearranged my life, literally, to spend time with two people that are so so important to me.
So that's what I have for you this week. I really hope you make this year the life that you really lived intentionally, that you decide for yourself that you're worth it and that changes need to happen. Now, if this resonates with you, if this is something you want to work on, then you really need to consider joining my Happy and Rich Mastermind.
I think I talked about it last episode. I can't remember, but we are starting in March. And so now is the perfect opportunity to work with me to make this happen. And remember, it's not just about money. That's why I'm calling it Happy and Rich. It's really about creating a life that you love and putting time and attention on the areas of life you really want to elevate.
Now for the women who have joined so far, relationships are definitely a big focus. And again, relationships are everything. Your relationships, the experiences you have when you travel with your family, all of that, I think that's like 90% of what makes life so, so meaningful.
And so the mastermind is limited to 25 amazing women. It is like 60% full at the time of this recording. It is by application only. And so if you've been thinking about it or this is something that you really want to tackle this year, then I really encourage you to apply.
And so just go to my website, https://wealthymommd.com, and you'll see up top a link where you can find out more and submit your application. Once you apply, you'll hear from me probably within 24, usually within a day, and we'll go from there.
I hope you're having a wonderful week, and I'll talk to you soon.
Hey there, thanks so much for tuning in. If you loved what you heard, be sure to subscribe so you don’t miss an episode. And if you’re listening to this on Apple Podcasts, I’d love for you to leave a review. Reviews tell Apple that this podcast is, well, awesome. And it will help women find this podcast so that they too can live a wealthy life. And finally, you can learn more about me and what I do at wealthymommd.com. See you next week.
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230: PSLF, SAVE, and More: Your Guide to Student Loan Relief with Sim Terwilliger
Are you drowning in student loan debt and unsure of your options? With the ever-changing landscape of student loan forgiveness programs, it's easy to feel overwhelmed and confused. In this episode, we dive deep into the complex world of student loans to help you navigate the system and keep more money in your pocket.
I sit down with Sim Terwilliger, a Certified Financial Planner and student loan expert from Student Loan Planner. She breaks down the latest changes to student loan forgiveness programs, including the recent administration change and the ongoing legal battles surrounding the SAVE plan.
Whether you're pursuing Public Service Loan Forgiveness (PSLF) or exploring other forgiveness options, this episode is packed with valuable insights and actionable advice. Sim shares her expertise on how to lower your monthly payments, maximize forgiveness, and prepare for potential tax consequences. Don't miss this opportunity to get clarity on your student loan situation and take control of your financial future.
We have just a few rooms left at our amazing group rate at the Four Seasons Oahu for the 2025 Live Wealthy Money and Wellness Conference For Women Physicians. Don't miss this chance to join us in luxurious Hawaii with incredible speakers to focus on money and living your best life. Virtual tickets are also available!
Ready to transform your life and finances? Join the Happy and Rich Club for Women Physicians — a 6-month, intimate program designed to help you thrive in both life and money. Click here to learn more, enroll, or schedule a quick call to see if it's the right fit for you!
What You'll Learn from this Episode:
- How recent changes to student loan forgiveness programs impact borrowers.
- The current status of the SAVE plan and what it means for your loans.
- Strategies for maximizing PSLF and other forgiveness options.
- How to lower your monthly payments by filing taxes strategically.
- The importance of regularly certifying your employment for PSLF.
- What happens to your student loans if you die.
- How to prepare for potential tax consequences of loan forgiveness.
Listen to the Full Episode:
Featured on the Show:
- Follow me on Instagram
- Financially Free Physicians by Sim Terwilliger
- Travis Hornsby
- Student Loan Planner: Website | Instagram
- Book a call with SLP through my link here, and you'll get $100 off, plus extra email support for 3 months after your consultation.
- Text "LOANS" to 33777 for free student loan calculators.
Welcome to The Wealthy Mom MD Podcast, a podcast for women physicians who want to learn how to live a wealthy life. In this podcast you will learn how to make money work for you, how you can have more of it, and learn the tools to empower you to live a life on purpose. Get ready to up-level your money and your life. I’m your host, Dr. Bonnie Koo.
Hey, everyone. Welcome to another episode. So this episode is all about student loans. So if you don't have any, I guess you could skip this. Although we do have a bit of a non-student loan related discussion towards the end that you might find interesting. But if you do have federal student loans, which is what we're mostly talking about. As you know, the student loan world has been a crazy sort of thing since the pandemic. So many things were changing. There are all these what I call pandemic specials and a lot of things even just recently have changed and also with the new administration, we recorded this just a few days actually after the new administration started. And so a lot of things are still in flux, but I do think this is a topic that if you do have student loans, you need to keep abreast of and we give you some ways to do that without it feeling overwhelming.
So again, this is to inform you because I've definitely had clients who did not think they would be eligible for forgiveness and I've seen a lot of money forgiven. I've had quite a few clients get over $300,000 forgiven. So you know, I just want to make sure that you are keeping all the money that you can or not paying loans that you don't need to.
So this is my interview with Sim Terwilliger. I had her on the show before talking about financial advising. She is a CFP. She's a financial advisor. She's also a certified Student Loan Planner and so that's also her expertise and she works for Student Loan Planner. That is a company that I've been collaborating with for several years now. It was created through, Travis Hornsby created it. He's become a good friend and they do such great work. It's where I refer all my clients to if they really want to make sure that they're doing everything they should be or can regarding student loans. And even if you find out that there's nothing you can do, I do think that peace of mind is worth paying for because the last thing you want to be doing is wondering if you could have gotten loan forgiveness. And again, the laws are changing so rapidly. And so I think it's worth paying attention to. And there are forgiveness options for those not pursuing PSLF. I find that a lot of people don't know that exists. And so make sure you listen to this to find out more.
And so if you want to learn more about Student Loan Planner, it's studentloanplanner.com. And if you do want to book a call, when you use my link, wealthymommd.com/SLP, you will get, I think it's $100 off, maybe $200, but you do get a discount if you use my link and you do get some extra support after the call, because even though the call is about an hour, an hour and a half, I can't remember. You are able to follow up with emails and I believe you get an extra three or six months of email support when you use my link. So you definitely want to use that link if you are looking to have a consultation also at the time of this recording.
And I believe when the recording is coming out, we are taking applications for my Happy and Rich Mastermind. This is a brand new program that I'm starting this year. It is a six-month mastermind, and it's basically what it sounds like, happy and rich. How do we get your money working for you, and how do we work on the other parts of your life that are also important? Because at the end of the day, money is a tool. It is not the end all be all and you have to be intentional about your life, right? It's not going to just unfold the way you want to because that's what you want.
And so I think it's something that's always a good thing to do. And with all these changing times, uncertain times, I just can't think of a better time to really focus on this. And so it is application only. We're capping at 25 female physicians. And so when it's full, it's full. We are at the time of this recording, almost a third full already.
To learn more about it, go to wealthymommd.com and you'll see a link, the top banner that will say, learn more about the Happy and Rich Mastermind. And so you can get more information. And if it sounds like something you want to do and that's a good fit, then you can submit an application and we will get back to you usually within 24 hours and go from there. So I would love for you to apply if you think it's something that you want to work on this year.
Again, wealthymommd.com and you'll see a banner to find out more. All right, so here's my interview with Sim, all about student loans and more.
Welcome to the show, Sim, or welcome back, I should say.
Sim: So glad to be back. We have a lot to unpack today.
Bonnie: I know. So we had scheduled this a while ago, but it's timely because of what the administration changed. So we're recording this just a few days after Trump was inaugurated and even before then, there were some assumptions that had to be made about student loans after a bunch of the pandemic specials ended.
So I think this is very timely. I know we don't have all the "facts", but I think this podcast is great for anyone with federal student loans who just wants to kind of get, like, what is going on? What do I need to know? And what actions do I need to take, if any?
So I will kind of let you spearhead this conversation, since I don't really know what's going on. I don't keep up with it, because that's why I have friends like you and Travis.
Sim: Yes. And this is the thing, too, Bonnie. Even amongst us who work in student loans, we even argue about some of this stuff too, like what's gonna happen next and what this means. So I'll kind of just add a disclaimer that my opinions are my own, blah, blah, blah.
Bonnie: Right.
Sim: Yeah. Okay, so what's going on? Well, we had this wonderful new plan come out called SAVE. So what they did was they took an old income-driven repayment plan, repay, and they made some great changes to it, helped a lot of borrowers. It's called SAVE. It was eligible for PSLF, long-term forgiveness. And it became a political topic.
And my opinion has always been that student loans on the political spectrum are actually very small, right? And that our politicians on both sides of the aisle don't really care about it. And that's my opinion. And in an election year, you hear about student loans a lot because it's a carrot that they're dangling in front of people.
Well, so what happened? Well, the SAVE plan was challenged and now it's kind of stuck in limbo in the Eighth Circuit Court of Appeals, if I said that right. So it's frozen. Anybody who was on the SAVE plan who made that switch is in a forbearance. It's a SAVE forbearance. And unlike the forbearance that we had during COVID, this one does not count towards PSLF, and it does not count towards long-term forgiveness.
The silver lining, if you will, is that interest is paused, so there's no interest accrual, but it doesn't count for anything. So for someone who is going for PSLF, you're not totally screwed, right? So these last six or seven months that haven't been counting you will have an option to do something called PSLF buyback. And we don't think PSLF buyback is on the chopping block because I know people are going to ask that next. Can I do PSLF buyback? Can't promise it, but it's on the table for now.
The way PSLF buyback works is, let's say you get to 114 months out of the 120. You need 120 for PSLF.
And you're 6 months short because, hey, you got screwed with the safe forbearance. Well, now you can buy those 6 months back. So whatever your payment would have been over the 6 months, you'll just write a lump sum check, essentially, and you're buying those months.
If you had a $0 payment, because maybe you haven't had a payment in a long time, you came out of residency and you were in attending, but you didn't have to recertify your income, you had a $0 payment, you don't have to write a check. They're just going to give it to you. But you have to go through what's called PSLF reconsideration.
So essentially, you're appealing and saying, hey, I didn't have a payment, and I would have had these months count had I not been in the forbearance and then they should give it to you. You cannot do PSLF buyback unless it brings you to the 120.
So if you're like at 90 months and you're really itching, you want to see those 6 months on your file, I'm with you, I would probably want to get that right away. They won't give it to you. It has to bring you to the 120. So that's the deal with that. So a lot of people are gonna be kind of waiting so that they can do that.
Bonnie: What else do we need to know?
Bonnie: Okay, so that's the PSLF crowd. Non-PSLF crowd, they have the six months forbearance. I don't know that there's any kind of buyback option for them. Don't quote me on that. I just know for PSLF buyback.
So what's the deal with everybody who's stuck in this SAVE limbo? There are some options. We have different income-driven repayment plans. So if you wanna make sure all of your months are counting for something, you can switch out. Some people are not going to switch out, and there's maybe some rationale to not switching out either.
Some folks who have maybe like cashflow problems and they're not going for PSLF, maybe just ride out that 0% interest as long as you can. Or if you know, hey, I'm going for PSLF next year. This is actually a case that I had. Someone who's going to hit the 120 next year, she's kind of waiting to see what happens and then do the buyback and she's at a $0 payment. So for her, she may end up doing like a six to 12 month buyback of $0 payments.
That could be very strategic for her versus switching out. But for someone who has more time until they hit PSLF, might start being a good time to looking at different income-driven repayment plans, specifically IBR, ICR. I think repay might come back if SAVE is gone, and pay as you earn. Pay as you earn, by the way, went away when SAVE came about, and then they brought it back last month. So a lot of people are applying for it right now. Very slow processing with the paperwork. So someone who may be.
Bonnie: Isn't it always?
Sim: Yes. I mean, that's right. That's just the case with anything like this, but especially so with pay. Because a lot of people left pay to get on SAVE, and then they were screwed because pay was gone. And so they couldn't do anything.
They were like, okay, well, now what are my options? But now pay is back, so people are making the switch. So I would caution, you know, if you put an application like in December, give it at least 2 or 3 months, 2 or 3 billing cycles.
Bonnie: I kind of want to slow down and unpack because we said a lot of acronyms and
Sim: Yes.
Bonnie: So was everyone on a SAVE forbearance?
Sim: If you were able to get on the SAVE plan, then yeah, you're on the forbearance because they basically blocked the plan.
Bonnie: So I guess, you know, I'm just thinking of someone listening to this who has loans and is trying to learn what to do. So well, first, you probably have some more things to say, but maybe towards the end we can talk about, like, kind of give a rough algorithm, just so people can kind of at least figure out what they need to file, if anything. So I don't even know what questions to ask.
Sim: So maybe let's talk about a game plan then. What should someone do who's in this situation? So I'm kind of breaking this up into like the PSLF gang and the non-PSLF gang. PSLF gang, always get your employment certification form done. I tell people, let's do it every 12 months. Don't wait longer than that. Some people are, you know, we call them like spelling bee kids and I'm one of them, do it every six months if that makes you feel better. But we wanna make sure that you're getting the credit that you're owed on file. So that's part one.
Part two is figure out what income-driven plan is the best for you and if you should switch or not, right? If you're like really close to PSLF, like maybe like a year out, it could be strategic to wait if you have a low payment. Otherwise, if you're like, you know what? I don't like my job. I just wanna be done. I wanna go part-time, you know, then let's get every month on file and maybe that's the time to switch to a different plan.
One thing to note is that anytime you change plans, like if you're leaving SAVE and you're going to like a different income driven repayment plan, they will have you recalculate your payment. So if you were lucky enough to have a $0 payment, Now you're in attending, you have a higher salary, your payment will go up. And for some people that's worth it just to get all the months counting.
The next thing to figure out once you've figured out what payment plan you should be on is how do you file your taxes? Because our goal is always, let's get your payment as low as possible. They're calculating your payment using your family size that matches your tax return. And they're using your AGI, your adjusted gross income. That's line 11 on the 1040. So how do we legitimately lower your AGI?
Well, if you file your taxes separately and you totally ignore your spouse's income, that's a great way to lower your AGI. There's pros and cons to that approach. If you live in a common law state, sometimes filing separately can leave you with a much bigger tax bill than if you had filed jointly, and that stinks.
However, you have three years to amend your return from separate to joint. There's actually this really corny expression in tax world. You can make up, but you can't break up. So you can go from separate to joint, but you can't be like, you know what? I would have been better off just filing separately. You can't do that. So when in doubt, I would say for the flexibility, consider filing separately and then amending to joint later.
An exception to that approach is if you and your spouse both have similar levels of student loans, sometimes it's advantageous to actually file jointly. But the way they calculate your payment when like both people have student loans is they actually calculate like a household payment and then they prorate it for each person based on like their percentage of student loans.
So if you have two people, they have very similar balances, maybe like a dual physician couple, they're going to basically each have 50% of that payment. And sometimes that can be really advantageous versus filing separately. So it's a math question.
Bonnie: So people listening will be like, well, how do I know which one is best? Is this something that Student Loan Planner, the company you work for, is that something you help figure out? Who should they talk to figure out what would be the best for them?
Sim: Yeah, we offer consultations for an hour. We will look at your student loan data file. And if you have a partner spouse who also has federal student loans, we'll look at that as well. And we'll just kind of run everything through our calculator and we'll talk you through, you know, your tax situation.
And actually, if anyone wants to look at the calculator for free first before working with us, they can text loans, L-O-A-N-S to 33777.
I'll mention that at the end of our chat today as well. But then you can get a free calculator and kind of play with it if you want to. But we do that analysis all the time. We actually do talk people through their private loans as well. There's just less options with that.
Bonnie: Yeah, that's cool that you guys got that text thing.
Sim: Yeah, I just learned about it today.
Bonnie: Yeah. Okay, so there's still a lot of people who don't realize that there are forgiveness plans that are not PSLF. So basically these are people who are working for a for-profit versus a nonprofit, right? So can you just give us an overview of what that is, what's changing, if anything, and things to keep in mind?
Sim: Yeah, so people in that group have one of two options, which is either your income is so high you're going to end up paying off these loans anyway, or the math supports you're going to be able to get forgiveness. And so we're talking about forgiveness outside of PSLF.
So quick level overview, PSLF, Public Service Loan Forgiveness. You work in public service, essentially 501c3 nonprofit, government, military. You do that for 10 years, 120 payments. And then at the end, whatever balance is left is forgiven federally tax free.
Then you can get forgiveness outside of that. You're on one of those income-driven plans we talked about, and depending on which plan you're on, what you're eligible for, whatever balance is left after 20 or 25 years is also forgiven. However, there will be what we call the tax bomb. We call that lovingly because we hate the tax bill.
Now why is there a tax bomb? So whenever you get any kind of debt forgiven, whether it's student loans, credit cards, et cetera, you're going to get issued a form called a 1099-C, which is like a cancellation of debt notice. And so you're filing your taxes, you're getting all your forms together, your W-2s, your 1099s, you have this 1099-C. Whatever balance is on that 1099-C is going to be reported as income.
So if you got like $200,000 of debt forgiven, they tax you on it as if you just earned $200,000 that year, even though you didn't. It's like phantom money.
Now, I'm putting a big asterisk next to everything I said, because you have to do that in the student loan world. During COVID, they got rid of the tax bomb, and they got rid of it through the end of this year, through the end of 2025. So anyone who's getting their loans forgiven outside of PSLF on these like long-term plans is going to get that forgiveness federally tax-free. And most states don't tax it as well. I think there's like four or five that tax at a state level, but most people won't pay taxes on it. So this is a question we get a lot.
Well, I have to pay taxes on the end. And what happens if I can't? A lot of people who are going for long-term forgiveness don't have that much time towards the credit, right? Most of our borrowers, they're like maybe five or six years into it? Occasionally we'll get like people who are much closer, about 15 years. But if you're farther out, you have more time to prepare for this tax bomb. And that's actually something we can mathematically calculate.
We have to make some assumptions, right, about like, what will your tax bracket be? That's an assumption. Any president can come in and change it. Any administration can change that. We make some assumptions about rate of return on your investments, but at the end of the day, we get to a number and we're like, okay, this is your tax bill. And then we work backwards to say, okay, we have this many years left. This is what you're going to get on your investments. This is what you should save every month. This is what you should set aside every month, maybe in like a taxable brokerage account or something. And theoretically, right, if our estimates aren't too off, you'll have what you need by the 20 or 25 years.
If there is enough political will, and by that I mean people pick up the phone, call their congressperson, write letters. Because like I said, small fry issue for them. This is not something they care about. And the evidence, you know, I would say for that is we just had a new administration come in on day 1. Trump did a bunch of executive orders. Not one of them was student loan related.
So all of this talk about student loans in the election, not a single executive order about student loans. So to me, that's evidence that this is not something they care about. They'll probably get rid of SAVE and not look at student loans again. We have to advocate. So you can call our congressperson and say look you guys got rid of this tax thing through the end of 2025.
I would like for you to extend it, delay it whatever. But at the end of the day, it's something we prepare for. If they do get end up getting rid of it or modifying it somehow then look you just have this bucket of money you've been saving that you can do something else with. So it's a win-win.
Bonnie: Yeah. So obviously, I'm just thinking these are complex calculations because, as you said, it's like you want to make sure this forgiveness is advantageous. I'm assuming, and correct me if I'm wrong, because I don't do math very fast in my head. But is it possible for someone to actually owe more than if they paid it off quicker?
Sim: Potentially. So that's why it's always a math question, right? Is it worth it to go for forgiveness? Or are you going to end up paying so much more versus if you had just tried to pay it off over like 10 years. But that's always the question too, because if you're trying to pay it off over 10 years, you're probably going to have a very high monthly payment.
So like I said, it's always a math question, which one is saving you the most money overall? But part two would be what gives you the most flexibility. So some people maybe don't want to save the most money overall, they want to have the lowest monthly payment and then use the rest of their cash flow to like, invest or something.
Bonnie: My opinion is student loans are, they were already complex, and they've been in complex, it's not even more complex, just the rules have kept changing over the last you know since 2020 right.
Sim: Yeah.
Bonnie: And so honestly that's why I lean on you and Travis's group because you know that's your job to kind of keep up with what's going on and you know you know you've worked with some of my clients and definitely I've had clients who did not think they were eligible and then found out that they were. And this also includes non PSLF. I had one client who, an older client who just was like, I'm not eligible, but then got like $30,000 forgiven, right? So what would you say someone listening who has loans but thinks that they're not eligible? Do you think, well, I think the answer is yes.
Do you think it's worth it for them to kind of get a second look?
Sim: I think it's always worth it because the rules change constantly. And some of this just has to do with timing. I know, actually, I think I know you're talking about Bonnie. I think this is someone I worked with. And she was eligible for her loans being forgiven because of the timing of when we met.
If we had met like now, probably not. If we had met like a year earlier, probably not. It's just the timing of when we have certain programs available.
Bonnie: That's what's a moving target these days, right?
Sim: And it's so unfortunate because, you know, while these political battles are going on, it's real people who are getting affected. And people need to make decisions about their cash flow or even where they want to work. And so I have so much sympathy for people in that situation.
Bonnie: What's the Instagram handle that people should follow? Because I know Travis is really good about doing lives and telling people.
Sim: Yeah, it's just @StudentLoanPlanner.
And we also have our website, https://studentloanplanner.com.
Bonnie: Yeah, yeah, so it's @studentloanplanner, you're right, for the Instagram, yeah. So that's kind of how I get my updates is looking.
Sim: That's how I used to get my updates before I joined the team. I was with another financial planning firm, and I wanted to be the student loan gal. So I was like, who's this Travis guy? And I just started following his newsletters. I have a hope I can tell a quick, funny story, Bonnie.
But we were at FinCon just a couple of months ago in October, and that's when all of the court stuff was going on with SAVE and everything. We were at lunch and Travis has his headphones in, like I do now, and the rest of us are just talking. And every couple of minutes, he's like screaming something that they said. He's like, oh, they just said this. They just said this.
So like literally live while this stuff is happening, we're trying to keep on top of it.
Bonnie: I just love how much Travis cares and really takes the time. And he really does what he says. You know what I mean?
Sim: Yeah, we're doing our best, especially like you said, it's a moving target. So all we can do is just follow it and give our best advice as of today. And that's true with any kind of planning. All we can do is really plan with what we know.
Bonnie: Life situations change, marriages come and go.
Sim: I think it's always a good idea to revisit your plan. Like every few years, you know, some triggers might be, and I'm a financial planner, so I'm going a little off topic, but like if you move states, right, because you want your plan to conform with state law, so if you move states, relationship changes, either with you and your partner or like, this is an awkward one, but I went through this, guardianship for your children. If you're like, I want so-and-so to take my kids, and you're like, you know what, now I hate you, and you're gonna go nowhere, you're my kid, that is a great time to redo your statement. Ask me how I did.
Bonnie: That's actually something I recommend that you, that I recommend my clients to review those important people on an annual basis. Cause you forget who, you know, cause you know, if you're married, usually your spouse is the executor, but then, you know, usually you have backup. So it's like, are those people still alive, number one? Are you still friends with them?
Do you still trust them to do it? And then obviously the guardian is the same exact sort of thing. And it's easy to forget, you know, because you're not really actively thinking about your estate plan. So I kind of put it on the annual sort of checklist of things to kind of just briefly review.
Sim: Yeah. And I would also add to that, for your estate planning, if you have like a 401k or something, your beneficiary designations, those are actually going to override whatever's in your will. So even if you have a will and you're like, "I want everything to go to my honey," but you have your mom or somebody on your 401k, that's who's getting your 401k.
Bonnie: Yeah. I think that's really important, because when people get divorced, I think that's something you can easily forget to change, not give it to your. I actually heard of a case, and I don't know, I probably read it in the news. I don't remember where, where that actually happened. I think it was the man who died, but forgot to change the beneficiary, so it went to his ex-wife.
But that sounds like the ex-wife actually gave most of the money to his new wife or new family, or something like that. She actually was very gracious about it.
Sim: Surprisingly and refreshingly amicable.
Bonnie: Pretty amicable. They do exist. I don't know what percentage exists, but they do exist. But you don't really hear about them, because people aren't saying, "Everything's going so great, so easy," because people don't usually brag about that stuff.
Sim: Yeah, they're gonna take to social media when it's negative. "I hate my ex" or whatever.
Bonnie: Okay, so we digressed a bit about estate planning, but obviously extremely important. Well, since we're talking about that, can you remind people what happens to student loans when you die?
Sim: Yeah, great, great segue. So if you have federal student loans and they're in your name, no one is responsible for them. They die with you. Now what happens to the taxability of it? Through the end of 2025, there's no tax consequence.
After 2025, it's more like a we don't know unless they change things, but it could be taxable to your estate. But that does not mean that anyone outside of that is liable. There could be taxes coming from the estate. Private student loans are a different story. I would imagine, and I'm gonna put an asterisk next to that, depends if you're in a common law or community property state, most likely that there's going to be taxes owed by the estate as well.
I'm not an attorney, but I have heard that it depends on when you borrowed the loan. So if you're in a community property state, of which there are nine, and you borrowed private loans after you got married, the question is, are those loans considered to be property of the community or not? And I actually don't have a clear answer. I've tried to find out from an attorney if that's the case or not. I don't know what's gonna happen to those private loans in those nine states, but outside of that, my best guess is that no one is liable.
Because that's true for most types of debt that are in your name. Someone dies with a lot of medical debt, and the kids are like, do we have to pay it? No. So that's going to all come from the estate.
Bonnie: Because I did have a private loan that I did end up paying off early, but I remember reading specifically that it's not forgiven upon death.
Sim: The private loans probably are not. So they would be, the private loans would be owed from the estate, but the federal loans would be forgiven. The question is, is that forgiveness taxable or not?
Bonnie: Okay, so I don't know if you know the answer to this, but what happens if the debt isn't forgiven and there is no estate to pay for it, then who has to pay?
Sim: The custodian, the lender, is probably just gonna have to eat it and they'll write it off as a bad debt, but they can't go after someone else for it because they're not legally liable for it.
Bonnie: Well, that's the question, right? So...
Sim: They will try. They're going to try these shady tactics. They'll probably go after your spouse and say you have to pay it, but that's not true. Again, it's that weird specific situation of like a private loan borrowed after you got married in community property estate. I can't think of a situation where your spouse is gonna have to pay that.
Now, maybe the caveat would be if there's like a cosigner, the cosigner's gonna owe it. And actually, this is a really unfortunate situation with some lenders. Some private lenders, at the death of the cosigner, will have you owe the whole private loan in full up front. They just change the terms on you if there's a death of a cosigner. I don't know why they do it that way.
But that's why it's...
Bonnie: But assumes that they can do it, that they can pay it.
Sim: I mean, who has that kind of money sitting around? Most people can't do it. So if you have a cosigner, it's really important to read the terms of what you've signed.
Bonnie: Yeah. Basically read the fine print that most people don't read. You know what's nice about... I think ChatGPT is actually really good for this stuff. You feed it the contract and you ask it to kind of pull out, like, what are the things that I should keep in mind?
You know, that's something I need to watch for. Like, I forget the wording, but I find it really helpful to kind of like unpack things. So I don't have to read all this legalese. That doesn't make sense to me anyway.
Sim: Yeah, actually, I can nerd out about this. My husband works in AI. And so the new hot thing he really likes is Gemini, but they have a new Gemini. It's 1260. So it's like the new one that just came out.
And I think that one, in my opinion, is much better than ChatGPT. It's a lot more detailed. Whatever you decide to use, whatever AI you like, just make sure in your prompt, you say, using Google and cite your sources. Because sometimes they'll just make stuff up.
Bonnie: And sometimes the math calculations are wrong.
Sim: Yeah, and you can tell it. You can talk to it like a person, be like, that doesn't make sense. And they'll say, oh, I'm sorry, let me try again.
Bonnie: Again, this is off topic, but I'm sure people are curious. So I have the paid version of ChatGPT. I have Perplexity, I have the free version. What do you think is better about Gemini? Is that something you pay for?
Sim: Yeah, we have a paid version. And so I'll give you an example of what I used it for. I run a podcast called The Financially Free Physician. And sometimes I need help coming up with my outline for my podcast and so I'll tell them.
Yeah, so there you go. So try it out and see what you get, but I do it in ChatGPT, we have a paid version for that, and I'll do the same topic, same exact prompt in Gemini, the 1206 or 1260, and the Gemini one is so much more detailed. And it's part of Google, so it already has the sources. You can say search Google, and it's part of Google.
So the outline I get is so detailed and beautiful, and it lays out, talk about this for five minutes, talk about this for five minutes, or a ChatGPT kind of gives me a bunch of stuff. And it's like, here you go.
Bonnie: Okay, when I do it, it gives me timing.
Sim: Try out both and see what you get.
Bonnie: Curious, can you train Gemini like you can train chat? Because like, you know what a GPT isn't?
Sim: Yeah, you're like, it's doing like machine learning. I would assume so. I actually don't know the question to that.
Bonnie: Yeah, because I've trained it to know sort of like my brand, my voice. It's not perfect, but it's much better than if I just use plain ChatGPT.
Sim: I think that the new Gemini version doesn't remember what you said previously. I know ChatGPT will save what you've searched, if you have the paid version at least. I don't think Gemini does that, or the new Gemini.
Bonnie: Okay, well I'm gonna have to do some research and look into it. Not that I'm a ChatGPT genius, but I know more than the average person.
Sim: Just try it out and see what works for you.
Bonnie: So, you know, right now we're recording, I'm using Fathom. I'm sure you noticed. Do you use Fathom at all?
Sim: Okay, you're gonna hate me. So, our financial planning firm, I'm our chief compliance officer. I have interviewed a bunch of note-taking tools. We use Zox because they're more secure than Fathom. Now you're not using Fathom, I assume, for like client meetings or anything.
So for something like this, it's fine. But if you have like sensitive information, I wouldn't use Fathom because they actually store the data.
Bonnie: But what do you mean by store the data? Because obviously it lives on their, like I access the notes on their server. So like.
Sim: Zox will clear it out periodically. And then the other question I asked all of these providers is do you use this data to train your models? And so Zox does not, Fathom does, at least at the time that I interviewed them, this was like early 2020.
Bonnie: I think ChatGPT does that too. A lot of them do, right?
Sim: A lot of them do. So if you're going to use something that's like for sensitive purposes, you want to make sure it doesn't do that.
Bonnie: So I'm curious. I don't know if you know this, but does Fathom, can you delete things in Fathom? Or does it always keep it, even if you clear it out?
Sim: That I don't know. All I know is that a bunch of people on my team were very upset with me when I told them they can't use Fathom because they really liked it. But that's a good tip.
Bonnie: For like work?
Sim: Yeah.
Bonnie: Because, you know, for example, when I do my program, my group program calls, those are recorded. And obviously, it's put in a password-protected sort of site.
Sim: I think at the end of the day, we're all just kind of doing the best that we can because like we're in a, we're in an information age, which is wonderful. And it's always the question of like, well, what are you doing with my data and there can always be a data breach. So, you know, just do your best.
Bonnie: Yeah, I don't know if it was ChatGPT. But I remember reading that sounded scary that it was like, I think they were like redoing stuff and deleting parts of the software or whatever you want to call it. And then like it was doing things to prevent that to happen. It was something like that. And I was like, that can't be good.
Sim: The other issue with a lot of these AI tools is that they're going to reflect the biases of the people who build them. And unfortunately, this world, it's very white male dominated. And so whatever the biases that group has can be reflected in the outputs you get.
Bonnie: This is what I talk about a lot with finances, right? A lot of the rules or even the financial advisors, the vast majority of them are not women, right? And so things are different for women. And then especially if you're a mom and a breadwinner and just like different considerations. We live longer, right?
So yeah. That's not changing anytime soon, unfortunately. But.
Sim: Yeah. I did see a statistic as of 2019 that if you look at med school applications, who was getting into med school, it was now primarily women. Like, the percentages had changed. So the majority was women. So I'm hopeful for our future, because the statistics are starting to change a little bit.
But like you said, even in financial planning, those statistics haven't changed since 2020. These number of CFPs who are women is at 23%. That has not budged.
Bonnie: Yeah. Speaking of med schools, yeah, so my class was 50-50. Obviously, the physicians in the workforce are, it's still predominantly men. And the truth is women do tend to go part-time and quit medicine at higher rates than men. Actually, this is totally off topic, but this is something I've been thinking about and reading about how, again, what you just said about how AI predominantly created by men.
I mean, I don't know if there's any, are there any women who are involved in AI? Like, I haven't heard of any.
Sim: I'm actually meeting one next week from my alma mater, so I'm so excited to pick her brain.
Bonnie: Okay, well, definitely, you know, if you remember, shoot me an email and just tell me a little bit about it. So if you think about the workplace and just the things that we think are normal, all the working conditions were designed for a man versus a woman who tends to has kids, right?
And so I read, you know, there's a lot of complaints about how these accommodations need to be made for women. But the truth is, it's not that these are like accommodations, just that women are different than men. I read even something like the ideal temperature for women is higher than like that's why women are cold.
Sim: Yeah.
Bonnie: Because they actually do run colder than men. But you know, the workplace temperature is set to whatever the standard and it's all around men and like maternity leave and like, you know, pumping and these conditions are not good for women. And so people will say, oh, women can't cut or whatever. It's just that you can't do everything, you know, just it's like, I don't want to say it's physically impossible, but it's very different for a working mom.
Sim: It's a design flaw.
Bonnie: It's a design flaw, yeah. But I think there's a lot of people saying, well, they're not saying that, but they're saying, women aren't cut out for the workplaces. But the real problem is, and this was a very recent thing I realized is the workplace is designed for men, not for women.
Sim: Yeah. So. I have definitely experienced that. When I went on my maternity leave, I have a twin 19-month-old boys, and it was a very difficult transition. And I felt like I got left out of stuff.
There's a conference I wanted to go to. I had to pump for two. There was, you know, what am I gonna do? Disappear eight times a day? Like, could I sit in a different room and watch, you know, the speakers?
But they don't have stuff set up like that. And, you know, an example comes to mind, Bonnie. I heard about, this is starting to change this year, but like crash test dummies, they always use like the standard male, like five foot whatever, when they test like if their vehicles are safe enough for a crash, but women tend to be shorter. They're not using like five foot three, five foot four dummies. Now, more companies are starting to do that, but this is why.
Bonnie: It's just another example of. And even the, I'm sure you know, BMI's was based on white males.
Sim: Yeah, I didn't know that, that makes sense.
Bonnie: Okay, is there anything we have not said about student loans that you think people need to hear?
Sim: Get a plan, I know that that plan might change in a few months and that's okay.
Bonnie: So definitely follow Student Loan Planner, Instagram, and you guys have a blog, which you guys are really good about updating. And I always see the timestamp of when it was last updated. So probably the easiest thing is to follow Travis or Student Loan Planner on Instagram because you know people aren't necessarily remember to like look at a blog post right.
Sim: Yeah, we sent out a weekly newsletter. I'll just put another plug if you want those free calculators text loans to 33777 they are free and you can tinker with them and if you want some help you can book a call with us.
Bonnie: I will give out the link I have to book a call. I think it's just wealthymommd.com/SLP. It might even be /Travis. I think that was the original one. I'm like, OK, Travis is the only guy at SLP, so I should probably just make it SLP.
Sim: Yeah, we got, we have women on the team now.
Bonnie: Yeah, exactly. Okay, well, thank you so much for being here and giving out this very timely information. But I think the bottom line is if you have federal student loans, you're going to want to revisit it periodically and maybe even more frequently with the administration change.
Sim: Yeah, absolutely.
Bonnie: Okay, well thanks for being here.
Sim: Absolutely. Stay safe, everyone.
Hey there, thanks so much for tuning in. If you loved what you heard, be sure to subscribe so you don’t miss an episode. And if you’re listening to this on Apple Podcasts, I’d love for you to leave a review. Reviews tell Apple that this podcast is, well, awesome. And it will help women find this podcast so that they too can live a wealthy life. And finally, you can learn more about me and what I do at wealthymommd.com. See you next week.
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229: Maximize Your Income: Tax Strategies Every Physician Must Know with Doc Wealth
Are you a physician looking to keep more of your hard-earned money? Do you feel like you're paying too much in taxes and not sure what to do about it? If so, this episode is for you.
In this episode, I talk with Dr. Mark Applegate and Laxman Pichappan, the founders of Doc Wealth, a tax strategy and CPA firm tailored specifically for physicians. As a physician, you have unique challenges and opportunities when it comes to taxes, whether you're a W-2 employee or a business owner.
Mark and Laxman share their expertise on how physicians can reduce their tax burden using a variety of strategies. They discuss the difference between a CPA and a tax strategist, and why it's so important to work with professionals who understand the specific needs of physicians. If you're ready to take control of your taxes and keep more money in your pocket, you won't want to miss this valuable episode.
We have just a few rooms left at our amazing group rate at the Four Seasons Oahu for the 2025 Live Wealthy Money and Wellness Conference For Women Physicians. Don't miss this chance to join us in luxurious Hawaii with incredible speakers to focus on money and living your best life. Virtual tickets are also available!
Ready to transform your life and finances? Join the Happy and Rich Club for Women Physicians — a 6-month, intimate program designed to help you thrive in both life and money. Click here to learn more, enroll, or schedule a quick call to see if it's the right fit for you!
What You'll Learn from this Episode:
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Why most CPAs are not equipped to provide proactive tax strategy for physicians.
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The key differences between being taxed as a W-2 employee versus a business owner.
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How real estate investments, especially short-term rentals, can provide significant tax benefits.
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The power of setting up the proper business entity, such as an S Corp, to reduce self-employment taxes.
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Why defined benefit plans and cash balance plans can be a game changer for high-earning physicians.
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How to take advantage of the Augusta rule to write off personal home expenses.
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The importance of proper documentation when expensing business costs like vehicles and home offices.
Listen to the Full Episode:
Featured on the Show:
- Follow me on Instagram
- Doc Wealth Intro Call
Welcome to The Wealthy Mom MD Podcast, a podcast for women physicians who want to learn how to live a wealthy life. In this podcast you will learn how to make money work for you, how you can have more of it, and learn the tools to empower you to live a life on purpose. Get ready to up-level your money and your life. I’m your host, Dr. Bonnie Koo.
Hey, everyone. Welcome back. So today, I am interviewing the two founders of a company called Doc Wealth, and they're basically a tax strategy and CPA firm really tailored for physicians. And I was really excited to learn about them because one of the most common questions I get from doctors is how do I reduce my taxes? Whether you're a W-2 employee or a business owner, newsflash, if you're W-2, there are a lot less options for you, but there are options.
And so, as you know, my goal is to always educate you on what's available and what's possible. I do have a financial relationship with them. And what that means is if you use my specific link to schedule a call and you do end up working with them, I do get a small commission. In fact, if you don't know already, if you go to my website, wealthymommd.com, and if you go to /resources, that's with an S plural, you'll see a list of either companies or tools that I believe in and think they're great and a value add that you can basically peruse. I don't have financial relationships with all of them, but a lot of them I do.
You'll see that I have a list of what I mostly personally use for my own business. And so obviously, I like them if I'm using them myself. So do you definitely want to go and check out the resources I have available there? So again, you're going to learn so much. We give tax tips for W-2 employees, as well as business owners who do have a lot more things they can do.
My goal is for you to at least take one of these things, look into it, maybe even schedule a consult with them to learn more about their services. And to do that, using my link, it's wealthymommd.com/docwealth, that's D-O-C-W-E-A-L-T-H. Here's my conversation with the founders of Doc Wealth.
Bonnie: Welcome to the show, guys.
Dr. Mark: Thank you. Yeah. Happy to be here.
Bonnie: Yeah. So we've got two people on which we don't normally do. So hopefully we don't talk over too much, although it's bound to happen. So why don't you guys introduce yourself? Let's start with you, Dr. Applegate.
Dr. Mark: Yeah. So my name is Mark, Dr. Applegate. I am an emergency medicine physician, primarily work exclusively as a locum physician, kind of traveling more so in the local region. I'm also a founder of Doc Wealth, where we focus on positions as a tax firm.
Bonnie: Yeah, what about you?
Laxman: Yeah, so I'm Laxman Pichappan from Florida. My background is a CPA. Spent a lot of my time in Silicon Valley, over a decade working a lot of tech companies like Apple, Groupon and such. And then yeah, co-founder and CEO at DocWallet.
Bonnie: Awesome. So you guys have such an interesting origin story and I'm so glad we were able to connect. So I heard a little bit from Laxman before, but Mark, I'd love to just hear like how did this – because you guys are friends from college, is that right?
Dr. Mark: Yup. Basically, kind of kept in touch throughout the last decade. Kind of lost track in med school and the residency grind and no time for personal life. I started working exclusively as a locums doc 1099 and found that essentially, you know, you're a single member business owner and really struggled at that point finding, you know, a good reliable CPA that was comfortable working with a single member 1099 and maximizing and understanding the nuances of locums and travel in multiple states as a 1099 trying to maximize the strategy, understanding the differences.
If I'm in this state, this state, do I need a LLC? Do I need a PLLC? Do I need a PC? Do I need a foreign qualification? There's just a lot of nuances that come with being a 1099 or particularly a travel physician. That's when I reached back out to Laxman who I knew was in the CPA space and I said, hey, why don't we bring both our expertises together and kind of focus to serve the physicians in the space the best we can.
Bonnie: So did you have – I'm just curious, did you have this business idea right off the bat or was it more like, hey, Laxman, I need some help. Can you help me?
Dr. Mark: Yeah, so, no, I do a lot of like thinking, designing and first I identified the problem and said, hey, I'm struggling to find a solution. Why don't we just create it?
Bonnie: Yeah, I mean, it's very obviously, that's also you're a very entrepreneurial clearly. So I just love that because I think doctors are natural problem solvers. So I'm always talking about how I think every physician is an entrepreneur themselves, even if they don't think of themselves as one, because we are solving problems all day.
So I just love it because I work with a lot of clients in the money space, obviously, and that's like one of the top questions is how do I save on taxes? I think people get confused between the difference between a CPA and a tax strategist.
They're not necessarily the same person. And just because you have a, like CPAs come in all different shapes and sizes. So I educate on that. Because I think people do have a lot of bad experiences with CPAs like, oh, do I get charged every time I email them? They don't really help me with tax strategy.
And I think what I try to do is just kind of explain that you kind of have to find out what is the CPA actually do, like what are the services are going to provide? And some of them do have, you know, experience with tax strategy, but I think a lot don't. And Laxman, you can talk more about this. And then obviously knowing the specific doctor market, can you speak to that a little bit?
Laxman: So being a CPA for over 15 years, tax is not something we specialize in in grad school at all. It's something that you kind of really learn once you get into practice. And so actually most CPAs that you work with and what we realized is 95% of CPAs don't know tax strategy. It's very much a subspecialty. So that's why you see that most CPAs just file taxes.
Filing taxes happens after the tax year is done. To be able to deduct anything and get savings and lower your taxable income, you have to do it in the tax year.
Bonnie: Like doubt, right?
Laxman: You would think so. You would think so, but it's actually not as commonly known. And so, a lot of that, you know, we've had to kind of go through the education process with different positions on what that difference is really because not many know. But so, what we did was we spent about six months just researching what are all the CPA firms out there, what do they do, and as you mentioned there's not a lot of transparency on the costs, on every single time I get a call, do I get charged. So our focus was full transparency, everywhere we post we say hey we have one flat fee, it's just all inclusive of everything, You don't have to worry about getting on a call.
Am I getting charged? You can reach out to us however many times you want throughout the year and we're really here to help. So we spoke to about 700 physicians just to get a market search. And As Mark mentioned, Mark is always data oriented. The number one pain point was, hey, my CPA is not a tax strategist and whenever I reach out to them, I can't get a hold of them.
It takes a week.
Bonnie: So common.
Laxman: It takes two weeks. That was overwhelming. Over 90% mentioned that they can't reach your CPA. And being friends with Mark for so long and have a lot of physicians who are friends, I can never get a hold of them. So I know all of you are very busy.
And so when you need an answer, you want it pretty quickly. You don't have time to just wait around. If you forget about it and that's money that's on the table, right? And so we really prioritize that. And so staffing up correctly and we ensure like a 48-hour business response time.
Bonnie: It sounds like you guys really did your market research. It's very like well thought out. I love it. I didn't know this part of the, about the business. So like, cause I'm thinking I would love for you to explain what tax strategists do, what do you guys do specifically?
And then I'm curious how that goes along with your investments knowledge because obviously certain types of investments have different tax implications. So I'm just I'm curious on the breadth of knowledge. So let's talk about what is a tax strategist and why does every person, every physician need one?
Laxman: Whenever you're making money, you're going to have to pay taxes to uncle Sam. And that becomes very important because there's two ways of actually making money. Being a finance person. One is your income. The other is paying lower taxes.
And so as a tax strategist, we look at the 75,000 page tax code and evaluate, okay, what are the different strategies in the tax code that we can leverage legally and then be able to work with our single member or multi-member businesses to lower income. So that can be anywhere from setting up the right entity structure and LLC, S Corp, et cetera, to expensing meals on travel. Everything has to be following the certain tax rules related to the business. It can be all the way complex and to investments that you mentioned. Real estate investments are one of the biggest vehicles for minimizing taxes.
The tax code favors business owners. They don't favor W-2 because at the end of the day, we're a capitalistic society. And so the tax code, anyone who's building their own business is creating or furthering the economy. And so there's a lot of different tax strategies that are out there. But happy to go into any detail or...
Bonnie: Because the people listening who are W-2 are like, they're gonna be like, okay. So I think, you know, they hear time and again, there's not much for me. So why don't we speak to, because a lot of them, I don't know, you might know the percentage, but there's a, maybe it's half at this point of physicians are W-2. I think it's probably more than half. So like, what are, let's do some simple things.
I bet there are things that people aren't even doing that's like the simple stuff. So why don't we start there?
Laxman: Yeah, for sure. So let's talk about W-2. W-2, there are strategies. There's typically, I would say, 4 main strategies. The easiest one I would say is doing a mega backdoor Roth, right?
This is after tax, but instead of contributing only $23,000 to a 401k, you can contribute $69,000 that grows tax-free. Very simple to do, doesn't take a lot of time, you can talk to your financial institution, the bank that you work with, or your financial advisor, and they'll be able to do that.
Bonnie: But that's not available to most people, right?
Laxman: It is very much available to vast majority. You may have exceptions based on how your employer sets up the 401k, but most W-2 should have that availability. There are ways to have a loophole around it where you can contribute into an IRA and then have a conversion to a backdoor Roth and then do a mega backdoor.
Bonnie: Okay yeah because the backdoor Roth most people are familiar to exist although not everyone so what we mean by that I never want to assume someone listening understands all this so a backdoor Roth is basically the ability to contribute to a Roth IRA despite being above the income limits according to the IRS. But my understanding is maybe I'm wrong is that you need a 401k plan that allows in-service Distributions and a lot of plans don't allow that. I know that like Kaiser a lot of the Kaiser's on the West Coast do allow that. So a lot of people are able to do that. But because when I worked for a large hospital, two places that had foreign case, neither of them allowed it because isn't that a requirement?
Laxman: No, no, that is our climate has had in service. So you're correct. Not everyone is every 401k allows that. But you know, if it is, then you should definitely maximize it, especially if you have money laying around.
Bonnie: Okay, so what is it?
Laxman: Yeah, so mega backdoor Roth is essentially where you're able to contribute up to $69,000 into a traditional and then have it convert into a Roth IRA. So now this is all post-tax. So I want to make it clear, this is not going to lower your taxable income, but this is still important if you really value retirement planning and want it to grow tax-free. It alleviates that $23,000 threshold otherwise.
Bonnie: Do you still recommend that for people who live in like California or New York that are high state income tax?
Laxman: So what I would say is that if you have enough money left over after all your taxes, taking care of all your expenses and it's sitting on the sidelines and you have enough comfort, then it makes sense. You never want to overextend yourself. It's not worth it to overextend yourself.
The next item for W-2 is I would say real estate investment. When you're W-2, you can do basically a short-term rental and have it as a cost segregation, do a cost segregation study.
And What this actually means is when you're W-2, the short-term rental is the only real estate investment that enables you to have active participation. What that means is whenever you accelerate depreciation or lower your taxable income, you have to be putting a lot of time towards that. In a long-term rental, it requires you to have 750 hours of active participation in the year. As a W-2, it's just not possible because you're working a full-time job. That's why long-term rentals are out.
And for short-term rental, you need only 100 hours of active participation. And so this is usually kind of basically doable. And so most of the W-2 positions that we work with definitely go down this route.
And what cost segregation means is that once you have the short-term rental, say for example you buy a $500,000 property, based on the 2024 tax rules, there was 60% accelerated depreciation. So, at a high level, a $500,000 property, you can write off around $100,000 against your W-2 income.
If you're making $400,000, you're only paying taxes on $300,000 now.
Bonnie: Again, just making sure people understand. So real estate, we mentioned earlier, is a great vehicle for creating wealth. And it's a great way to create wealth, not just because of the income it can produce, but also because of the tax savings. It's almost like you're getting like two lovers right to create income. Long term rentals, like, as you said, it's much harder because they have just rules that basically if you're a full time position, you cannot take advantage of it.
It works if you have a spouse who basically doesn't work or works very part-time because there's stipulations on like, you know, you can't have a job. You have to work more hours as a real estate professional versus like your regular job. So it is harder, but there are situations where that works. And then also there's physicians who do decide to go part-time because they want to take advantage of it because they have the part-time physician income, but it's not hurting as much because they get to keep more of it, right? And so short-term rentals are more attractive because of what you just said, because they need a lot less hours.
It's very easy for physicians to get those hours and then have that ability to write off the depreciation. Because basically you can't really write off other expenses against your W-2 income. It's like there really isn't anything available to you. You can't write off your computer unless you're only – well, not unless, but unless your job reimburses you, you're kind of out of luck, right?
Laxman: Absolutely.
Bonnie: Is there anything else you want to say about short-term rentals?
Laxman: I mean, there's a couple more rules associated with that, but at a high level, the 100-hour after participation, short-term rentals are very popular as a tax strategy.
Bonnie: What else?
Laxman: Yeah, And then I would say oil and gas investments. I know the moment I mentioned this, people are like, okay, this sounds pretty risky and it's an investment. So there are risks associated with it. But for whatever reason in the tax code, oil and gas is considered an active investment. Unlike stocks, which where you’re passive, you don't control what's happening in the company.
If I invest in Apple stock, I don't control what happens. But in oil and gas, you're actually investing in a fund that is buying drills and procuring oil out. And so you get a K-1 with an oil and gas investment. And as a K-1, here, you're treated as a partnership and so an active. And so if you invest $100,000, typically, you can write off 90% of that.
So $90,000 is treated as a deduction against your W-2 income. Many different funds out there, some get oil, some don't. So there's definitely risk associated with that. So definitely do your due diligence with different funds. If they do well, they can average anywhere from 10% to 15% returns over five to seven-year period.
That's usually how long the drills and funds last to procure all the oil. But again, there, it is an investment and there are risks associated.
Bonnie: So yeah, it's important. Cause I think every doctor would love the easy button. Like what's a low risk investment that pays really well. I'm like, that doesn't really exist. But I think people want some kind of guarantee, unfortunately.
So I do invest in a mineral rights fund, but this particular one doesn't have any tax benefits. In fact, the income is considered ordinary income. So it's a very specific type because this company I work with, they also offer the type that you can write off against, but there's higher risk associated with. So again, it's all education. Okay, what's next?
Laxman: The last one is private foundations or charitable contributions. Typically with a private foundation, there is more administrative costs because you're basically creating your own charitable contribution company. But here, you can contribute up to like say about 30% of your total income and you can decide where you want to allocate that money. It could be to something that's very close to you, you know, boys and girls club or something that you create yourself. And instead of giving the money to the government, you're able to give this money to something that you're passionate about.
This is probably the least common overall, but it is an optionality.
Bonnie: So there's three ways to give that, you know, I'm broadly speaking here, right? You could outright donate it and as long as it's above the standard deduction threshold, you can write it off, right? And then there's donor advised funds. So what's, which is pretty easy, right? You just open an account on like Vanguard or Fidelity, Charitable, whatever.
So tell me what's the advantage of a foundation versus a donor advised fund.
Laxman: So the, through a foundation, you can do a combination of the foundation's limits. Plus you can do the charitable contributions through a 503c as well. So there's a little bit more you can contribute in aggregate. So there's a benefit on that side. The other benefit is that maybe there's these charities that you don't feel as close to and you can actually control exactly how these funds are being spent, right?
And so there's just a little bit more control at the end of the day.
Bonnie: But you can do that with a donor advice fund, right?
Laxman: We can do with a donor advice fund as well. I think it still has a little bit of limitations. The private foundations basically it's all controlled by you completely.
Bonnie: So the tax break in this case is more on the, you know, you're doing the money so it's no longer yours, but it does reduce your taxable income. And so, you know, I'm just trying to make sure people understand there's different ways to do that. So some of these aren't the easiest to implement and involves like risk with investments. But if you're listening, you know, you're someone who hopefully is wanting to invest your money. So it's like if you're going to invest your money, might as well maximize the return and also get to keep more of the active money that you, cause I think people forget that.
So now it's just what you make, it's what you keep, right?
Laxman: Exactly.
Bonnie: So, okay. And then obviously there's pre-tax retirement accounts. I think most people know that if you're going to do that, then you can maximize the employee side, which is kind of like your limit. And then if you're 50 or over, you have a little bit more. My partner just turned 50, so we're like, yeah, we can do a little bit more.
Okay. So let's switch over to on the business side. There's a lot of stuff, so we obviously can't cover everything, but what would you say, like, let's just give the top three or four things that are like the biggest tax savings?
Laxman: Yeah, absolutely. I think whenever you're a business owner, I think it's important, first you think about the entity structure. Is it an S Corp? Is it a C Corp? C Corp is usually for large corporations.
It gets a lot more complex, so I'll probably stick to the LLC or the S Corp. At a high level, when you're making over $60,000 to $80,000 in 1099 income, it typically makes sense to do an S Corp. An S Corp allows you to lower the self-employment taxes as well as FICA. This can be quite beneficial.
For example, if you're making about $200,000, in an S Corp, you have to treat yourself as an employee. You give yourself a reasonable income. So out of $200,000, I see the general rule is about 35% of that is what you should deem as a reasonable salary. So $70,000 is what you pay social security taxes and FICA on. The other $130,000 is a distribution. You still get the money, but you don't have to pay any of these self-employment or FICA taxes.
That equates to over $10,000 in cash back in your pocket. That's that structuring of the entity is pretty important and can be massively helpful.
Bonnie: Yeah. Yeah. Still paying income and state taxes, that applies obviously, but you are having a tax savings. I get asked a lot, what do they consider reasonable? So I'm a W-2 employee, so I use a payroll service.
I use Gusto, very popular among small businesses. I pay myself a salary of $70,000. People always ask – Actually, my friend just texted me. She's a coach. She asked me, like, what's reasonable?
It sounds like you have a bit of a rule of thumb, 30%, 35%. That's a net profit, right? Or gross revenue. I'm curious.
Laxman: That's gross. We look at the gross level. We've seen a lot of different S Corps and what gets audited, what doesn't. Obviously, that's a good rule of thumb. When you look at reasonable compensation, you want to see what is someone actually doing this job as a W-2 making?
As we typically look at anything from the VA, for example, what is the VA? VA is pretty low in terms of comp, but it at least gives a sounding board of, okay, this is what the range should be. And we look at, okay, what is the higher amount of 35% or someone doing this W-2 job, you know, full time and that gives us a little bit of comfort and protection.
Bonnie: I'm just curious now that we're talking, I'm learning so much from you by the way, so thank you. I'm curious why it's based on gross versus net because the gross could be 500,000, but if the net profit is like 100,000, you can't pay yourself the whole – you know what I mean? So I'm just curious why is it based on gross and not net?
Laxman: Because there's a lot of things you can do to start expensing and lowering that amount. When you run a company, for example, it's your gross income, you pay your staff, so that's an expense line, right? And then ultimately you get down to your net profit. So the way the IRS has it is that you need to expense this before the net profit. But that's also what we've seen with most artists and stuff is they evaluate, okay, is it meeting that 35% threshold against the growth?
Bonnie: Okay. I'm like, does that mean I have to pay myself more? Anywho.
Laxman: Yeah, property, the next is, it goes back to real estate, right? Short-term rental, long-term rental. And as you mentioned, it depends on if you're full-time, if your main job is being a physician, then you cannot get that active status to accelerate depreciation. If you have a spouse that does not work or they can say that their main job is managing this real estate, then you have the opportunity to do between short-term rental and long-term rental. Short-term rental, 100 hours active participation, long-term rental, 750.
If you can do that, now you have options on what type of property. Again, you can accelerate that appreciation and high-level rule of thumb, about 25% of that purchase price is what you can write off. So that's, I would say, number two. Next goes into retirement planning. There's cash contribution plans, cash balance plans, SEP IRAs and solo 401ks.
The latter two is probably the most common. And when you're a 1099, it's the SEP IRAs and solo 401ks, you can contribute up to $69,000 as well on the max side. On the solo 401k, it's 25% of your gross income or $69,000, whichever is lower. And the SEP IRA, it's 25% of your net profit or $69,000, whichever is lower. That's what I would say is the next strategy that's quite common.
Bonnie: I'm curious what your thoughts are, SEP versus Solo 401k. I'm curious what your opinion is.
Laxman: So when you have an S Corp and you're solely 1099, I think Solo 401k has the most opportunity for you to be able to contribute more because it's not off of net profit. But almost I would say 99% of the time, it yields a more favorable outcome.
SEP IRA, we have a lot of positions that we see that are trending from W-2 to 1099 or doing a combination of W-2 and consulting on the side as 1099. In those cases, when you already have a 401k plan, it's going to limit what you can do on the solo 401k side. So then you see a SEP IRA, because now we look at separately, the SEP IRA has no impact to what you contribute on the 401k side.
So look at your 1099 business separately, What is your net profit? And then let's see what makes sense.
Bonnie: Yeah. So obviously, again, all this tax strategy and personal finances, it's very, it really depends on your situation. So tell me, Does the SEP IRA interfere with your ability to do a backdoor Roth IRA?
Laxman: No, you can still do a backdoor Roth and I personally do that myself actually.
Bonnie: Yeah, because people have heard there's a pro-rata rule so that's mostly for the rollover traditional IRAs then.
Laxman: Yes, exactly. Okay.
Bonnie: Did you mention defined benefit plans?
Laxman: Defined benefit plans, cash balance plans, you know, you can contribute far more than the $69,000. There's a few nuances on that side, but ultimately the most important I would say is I talked to this position yesterday actually, they're contributing $200,000 pre-tax, so they're lowering their taxable income dramatically. But you want to make sure that there's consistency because it's really important. There's rules with this that you need to be able to maintain this level of contribution. And so, any times where you may dip or you may be out of work or you lower your gross income for the year, then it gets a little bit tricky.
There's also more administrative work. You need an actuary typically to be able to do this. So if you are in that lazy boat or you don't want to deal with any of this, this may not be the best plan, but if you're willing to put in the work and get an actuary and do all this, it can be quite, quite beneficial.
Bonnie: Yeah. I kind of think of it as a bit more advanced. Would you agree with that? It's kind of like start with the solo 401k or the SEP IRA. And then once you're making so much money, then you should visit the defined benefit plan.
Laxman: Yes. And yeah, we typically see this with our more mature attendings. We've been attending for a while. Anyone less than 10 years, it's not very common at all.
Bonnie: I'm curious, what's the penalty if you can't contribute the high level? Because I know my understanding is you have to be able to contribute a certain amount of money, like a high, you can't just do two under one year and be like, oh, they're sure I didn't You know make as much money. So what happens if that happens?
Laxman: I have to double-check that I'm not 100% Certain on that I have to do it.
Bonnie: It's not good.
Laxman: It's not good. It's not worth the risk.
Bonnie: Yes, you have to really believe that you'll have to maintain that level of contribution for a certain amount of time. Okay, was there another tip you want to give for business owners?
Laxman: I would say the other ones are more kind of general, like Augusta rule is where you can use your primary home, rent it out and pay back your LLC or your S Corp for 14 days out of the year versus renting a hotel space or Airbnb to conduct a business meeting. You know, instead of paying $1,000 to that, you can just pay yourself $1,000 for using your home, primary home as space. And I would say everything is pretty general. As 1099, you can expense a lot of things, your laptop, everything home office. Home office is huge.
We had many physicians renovate their entire home office space, you know, build cabinets, get desks, do paintings, walls, all of that was expense, right?
Bonnie: All the furniture in it too, right?
Laxman: All the furniture in it as well. Artwork. Artwork, yeah. We had a physician spend about $25,000 and that is one of the best home offices that I've ever seen.
Bonnie: I just want to say about the Augusta rule for people who don't know this. This is only if you're a homeowner. So I rent, so since I rent, I can't take advantage of it. But the just to make sure people understand why it's so valuable is it's an expense for your business. So let's say that use your example of $1,000.
So it's $1,000 off of your top line for your business. And then it flows to your personal income, but that's not taxed. And that's what the Augusta rule is all about is the 14 days, that income is tax free. So again, it's like you're keeping more money. And then obviously, hiring your kids for the tax break, but then also you get to fund like a Roth IRA or something.
I keep not getting my act together. Do that for my son. I didn't feel comfortable doing that for a while, but you know, he is in my social media, decent amount. So. All right. Is there anything else that you want to say tax strategy wise, whether it's a strategy or just some education around tax strategy?
Laxman: Yeah. I mean, I think we cover a lot of it. Paying kids is very popular. There's definitely some guidelines around it. You don't want to pay a two-year-old, right?
Because that can be a red flag. Has to be legit. That's very, very important. I would say the last thing is probably we see pretty common is everyone needs a car. If you're 1099 and you're using your car as your main source of going to work, then that can be expense as well.
If it's over 6,000 pounds, it's 179, you can basically accelerate all of the car, the entire expense of the car. If it's less than 6,000 pounds, you can typically do it over five years.
Bonnie: What are the rules though? Can you only use it for business or what's the percentage?
Laxman: Yeah, you'd have to track what is the percentage that is used for business, but it has to be more than 50% towards business.
Bonnie: Okay. Well, I think I'm so glad we connected because again, I think a lot, like we talked about in the beginning, being educated about tax strategy, again, most CPAs don't have this information. So it's a big pain point for doctors because they see all the taxes go out of their account. That is one advantage of moving to Florida is there's no state income tax. It's significant, you know, when you make a high income.
That's been a nice little bonus. It's like we got like a raise just by moving here. Plus our cost of living is lower than Northern New Jersey. So it's like we got like a double raise in many ways. So, so tell us more about your company, who you work with and what people can expect.
Laxman: Yeah, absolutely. So Doc Wealth, you know, founded by Dr. Applegate and myself, We work with about 150 physicians right now across the country, all specialties. And our focus is completely from the physician perspective. You know, we did a lot of market research and what we really prioritize is a one-stop shop where you can get help with structuring your entity and LLC escort.
We take care of all of that for you all the way to setting up payroll, then doing the tax strategy throughout the entire year. We have multiple check coins. Everyone gets their own custom plan. We sit with you when you get on boarded, understand all of your different revenue sources, your family situation, where your investments are, come up with a different plan of all these different strategies that I mentioned and say, okay, this is what we can do. This is the documentation that's required.
These are the next steps. Let's go execute it in the tax year. And come filing time, let's save all this money. And so we also file as well. So now you're not getting stuck between talking to a lawyer, talking to someone who does entities, someone who does payroll.
We try to be in one place to save our physicians as much time as possible.
Bonnie: We call that brain damage. So you guys offer a free consultation, right?
Laxman: Yes. Yes.
Bonnie: You guys are a good fit for them. So what can they expect on the consultation call?
Laxman: Yeah, the consultation call, you know, I love to just get to know the physician, what their income source is. There's a list of 9 questions where it's almost like an onboarding call. We go through different PACS questions they have themselves and even go through a strategy session where they get a feel for what, what we can do, how we can work and what we can probably save. So it's a pretty comprehensive call, I would say, but
Bonnie: People will get value regardless of whether they actually end up working with you.
Dr. Mark: Oh yeah. Absolutely.
Bonnie: Yeah. Okay. So the link is wealthymommd.com/docwealth. That's DOCWEALTH. And that link will take you to basically a way to schedule an appointment.
Is it with you or Mark?
Laxman: It's with me. Yeah.
Bonnie: Oh, it's with you. Okay. Well, Laxman, thank you so much for your time, and I just loved how thoughtful you and Mark were about seeing this problem, solving it. I just love that entrepreneurial engineer mindset, and so I know this is a problem that many of my listeners have, and, you know, I'm glad to be able to suggest a resource. People are always asking me for recommendations and it's hard.
Like I don't, you know, the tax people I use is specifically, they only work with online businesses, for example, it's not going to apply to most positions. All right, Well, thanks so much for your time again.
Laxman: Yeah. Thank you so much for having us. This was great.
Hey there, thanks so much for tuning in. If you loved what you heard, be sure to subscribe so you don’t miss an episode. And if you’re listening to this on Apple Podcasts, I’d love for you to leave a review. Reviews tell Apple that this podcast is, well, awesome. And it will help women find this podcast so that they too can live a wealthy life. And finally, you can learn more about me and what I do at wealthymommd.com. See you next week.
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228: Pivoting with Purpose: Aligning Your Money and Life Goals
Have you already given up on your New Year's resolutions? Don't let another year go by without making meaningful changes in your life. As a physician, it's easy to get stuck in the same career path, neglecting other important areas of your life like family, relationships, and personal growth.
In this episode, I share some exciting changes happening in my business and how they reflect the importance of evolving and living life intentionally. I'm retiring my main money program and launching a new six-month mastermind called the Happy and Rich Club for Women Physicians, as well as a business program for female physicians starting their own ventures.
Join me as I discuss the six key areas of life that money fuels and how to align your financial goals with your life goals. It's time to give yourself permission to pivot, make changes, and design the wealthy life you truly desire.
We have just a few rooms left at our amazing group rate at the Four Seasons Oahu for the 2025 Live Wealthy Money and Wellness Conference For Women Physicians. Don't miss this chance to join us in luxurious Hawaii with incredible speakers to focus on money and living your best life. Virtual tickets are also available!
Ready to transform your life and finances? Join the Happy and Rich Club for Women Physicians — a 6-month, intimate program designed to help you thrive in both life and money. Click here to learn more, enroll, or schedule a quick call to see if it's the right fit for you!
What You'll Learn from this Episode:
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Why it's normal and necessary to evolve in your career and life.
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The importance of living life intentionally and not neglecting key areas.
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How money is a tool to fuel six key areas of life: career, family, relationships, fun, vitality, and self.
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Details about my new six-month mastermind, the Happy and Rich Club for Women Physicians.
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Plans for a new business program for female physicians launching in the spring.
Don't forget to grab your Design 2025 & Beyond workbook I created just for you. You'll also get the deets to attend my upcoming live workshop Design Your Wealthy Life on Jan 15th or 18th, 2025.
Listen to the Full Episode:
Featured on the Show:
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Welcome to The Wealthy Mom MD Podcast, a podcast for women physicians who want to learn how to live a wealthy life. In this podcast you will learn how to make money work for you, how you can have more of it, and learn the tools to empower you to live a life on purpose. Get ready to up-level your money and your life. I’m your host, Dr. Bonnie Koo.
Hey, everyone. Welcome to another episode. So this episode should be coming out January 16th. And did you know that most people have already given up on their New Year's resolutions? I don't want that to be you. The year is so young and I know it's just early January or mid-January anyway, and you still have the rest of the year and so easy to let another year go by without making the meaningful changes that I know you want to make.
Also, it is not too late to attend one of my live classes, Design Your Wealthy Life. Again, this is coming out on January 16th, this episode, and I'll be going live again on Saturday, January 18th at 11 a.m. Eastern. And so you want to save your spot right now, go to my website, wealthymommd.com, and you will see a banner up top where you can save your spot for Saturday. And so I really encourage you to come if you haven't signed up already, because it is all about designing the life that you really want and how to align your money goals because money is not the end goal. It's a means to an end. It is a tool, a very powerful tool.
So what I want to talk about today actually is a bit more of an insider behind the scenes episode of what's going on in the business. I alluded on one of the episodes at the end of the year that I'll be making some big changes in my business. So that's what I want to talk about today.
So before I go into what the specific changes are, what I realized is this is such a beautiful example of how life changes, how people evolve, how businesses evolve, and how you can change your mind. You are never stuck to one thing, one career, and even what you're doing in your career. You could still be a doctor, but maybe change focuses, maybe start your own practice or go into pharma or whatever. There's so many choices available to you. I want to make sure you never forget that you do have choices and that it's normal to evolve.
What I found with a lot of physicians is that we think we should just stick to medicine and have the same job for the rest of our lives.
And that paradigm, and this is for everyone, whether you're a physician or not, that paradigm is simply outdated. So aside from attending my live webinar, it's actually not too late to attend our upcoming conference, the live wealthy money and wellness conference for female physicians. It's taking place February 20 to 23, 2025. So in a month in beautiful Hawaii at the Four Seasons, Oahu.
So I may have mentioned before, but this is the last time I'm doing this conference. I guess technically I shouldn't say last, but we're definitely not doing one in 2026. And as far as I know, with the way my business is going, it's probably not something we're going to do anytime soon.
A lot of people have expressed, "Oh no, how come?" Quite simply, two things, a conference requires a lot of work. I think you can probably appreciate how much work it takes to plan one, to curate it, organize all the things. It's like a three-day wedding, but a lot more work. And quite frankly, it loses money for the business. And I have to pay myself, I have to pay my employees, well, my contractors, I should say, and simply it is costing the business way too much money.
So from a financial perspective, it was – I am not saying this for you to feel sorry for me, but financially, it does not make sense for us to do one. I would have to charge a lot more money, which obviously I could do, but at this time, we've decided it is not a good use of company resources money-wise and time-wise. So that's the current decision anyway.
Plus, I have so many ideas for smaller intimate retreats, although the conference is pretty intimate size-wise. And so stay tuned for that. I'm thinking of doing something at Miraval this fall. I really want to do a Paris retreat. I already have the whole itinerary plan. It's just about choosing a date and making it happen and obviously making it available for some of you to join me.
So after teaching pretty much strictly money for since my business started, that's kind of how my business started as educating female physicians around money because I really saw the gap in education and just resources available. And also, it's so important to learn money and I've really enjoyed doing that. But again, as I said before, I've changed as I've learned and through my personal growth, sort of my desires about what I want to teach. And really, I don't even think of it as a major change in terms of what my business is going to be providing, but more of an evolution and my understanding of money is that, yes, it is so important to understand money, but I have seen too much of a disconnect between money and life goals.
And what I mean by that, and this is why that workshop is called Design Your Wealthy Life, because ultimately, when people ask me questions like, I don't know what to invest in, I don't know where to start. That question mainly tells me that you probably haven't really thought about what you want your life to actually look like.
And I have found, and I found this for myself, is we kind of stopped asking ourselves like not so much what do I want to be when I grow up, although truthfully, I still ask myself that question assuming I still have many years ahead of me, although I'm about halfway through I guess technically. But I don't believe that I should even be doing this for the rest of my life, right?
And so what are the areas of my life that are important to me? I know you all have areas of life that are important to you and that you would love to make some changes in. And it is so easy to not do something about it. It's so easy to neglect it to – I don't mean neglecting as if you're willfully doing that, but we're busy, busy physicians, busy taking care of our families.
If you have young kids, you're maxed out mentally, right? And it's so easy for things to kind of fall through their cracks. This could be your spouse, your boyfriend. This could be your health, right? And even parenting, right? Especially if you're working so much and you can barely see your kids. Like all these things are competing for your attention. They take up a lot of bandwidth and things will not change unless you purposefully put time and attention into it.
And again, I know how easy it is for another year to go by for even five or even 10 years to go by, and you're wondering what happened. This is not exactly what I want my life to look like.
And so if you're in this camp, first I want to say you are not alone. This is so common. It still happens to me because it's easy for me to kind of go autopilot in one direction and then realizing, you know, this area, well, it is parenting. It's my child, Jack. I actually really want to do this. And a lot of times I have to literally remind myself like, Hey, this is something I want to do. And this is a great example because just because you "forget" or don't spend time on it, it doesn't mean it's not important to you. It's just that we really have to live our life intentionally.
So I'm saying all this because I saw this for myself, I saw this with my clients, and so I actually have retired my main program, Money for Women Physicians. This was not a decision that I took lightly, but I really took time to think thoughtfully about what direction I want to go in and what I thought would be really valuable to the people that I work with. And what I decided is that I really think it's important to marry the two things together. Although, obviously, you can do a separate program on money, you can do a separate program on life, but the way I like to approach things is obviously, it's sort of my framework, if you will.
And so, I basically decided to combine the two, meaning the money part and also the life part. And what I mean by the life part, because that's such a big general topic obviously, is like, you know, I created this life wheel. Now, I didn't create it, life wheels exist, but I chose six specific areas. And then, so think of a wheel and think of the spokes and there's six spokes and money's at the center of it. It's not the only fuel to make those areas better, but money definitely is involved. Obviously there are things that aren't money related involved, But again, money is a fuel. It is a very important tool to help those areas of life thrive.
And so those six areas are career. Number two is family, and that includes your spouse, that includes your kids. Number three is relationships. So this is everything aside from that. So this could be relationships with people at work, your friends.
A lot of us have different communities like maybe your school community, maybe your local community. So that's number three. Number four is basically I call fun and that's kind of a catch all. So for hobbies, for you know, that could be travel, right? Things in that category.
Number five is health. I prefer the word vitality, and this is – When I say broad, it's mental health, it's physical health, right? It's not just health in the way we think of it as just physical fitness. So that's number five.
Number six, I called self. And this basically is your inner world, your inner voice. Most of us have a pretty inner critical, not so nice voice. It's about personal growth. It's really about yourself because so many of us neglect that, right? Like you are the person living your life. Let's not forget about you.
So common as a female physician mom to basically kind of stop taking care of yourself because you're so busy taking care of your patients and your family, kids, and maybe also aging parents. It's a lot, okay?
And so I've designed a program to work on both areas intentionally. When I say both, I mean life and money. So I'm really excited to let you all know that this program is going to be six months. It's called the Happy and Rich Club for Women Physicians or Happy and Rich for short. I love that name because it really encompasses what I want all of you to take away from it and that really focuses you on its life and its money.
And so it's going to be six months. It's going to be a relatively small, intimate group. We're all going to get to know each other and there will be an optional add-on to meet in person. And so to learn more about that program, you'll want to go to my website and you'll see the link to learn more about it and to either enroll or schedule a short call with me to see if it's a great fit for you.
So I'm really excited about this new program I'm doing. I'm really excited to get to know a small group of women really well to really work on those areas. Something else I'm also working on, this is something that's going to come out a little bit later, probably more like April ish is a business program for female physicians.
I had mentioned it before, but I wasn't quite ready to start it. I wanted to think a bit more about what I want to teach, how long all these logistics you have to think about when you're creating a new program. And so that's going to launch later in the spring. And that's kind of what it sounds like. It is a program for female physicians who are starting businesses. It's really geared for people in the beginning stages, but you don't have to be a beginner. Meaning like if you're making well over $100K as a coach, it is still for you because it's basically, I haven't figured out quite the name, but I really think of it as like a mini MBA.
And what I mean by that is I'm going to teach you literally everything you need to know to run your business because there's the marketing and selling and we are going to cover that by the way, but there's all the other things like what email program do you need? Should you be emailing your list frequently at least once a week? What do you say? How do you set that up? How do you set it up so that you're getting people into the right segments, you know? What's a funnel? How do you set it up? How do people work with me? What portal should I use? How do I hire my first assistant? What are SOP, standard operating procedures? How do I train a new person? How do I actually run the business? And how do I look at my business finances, right?
Business finances is a different topic than personal finances. Obviously, they're all related. So there will be some personal finance stuff sprinkled in just because, you know, a business is creating money for your personal finances as well. So it's really going to cover everything and you can come with me with for any questions you want. I love talking business. If any of you have interacted with me and we've talked about your business, you know that this is a topic that's near and dear to my heart. Whenever I talk to someone who has a business idea, like I just have so many ideas for you and I obviously have a lot of knowledge about what our best practices and so I'm really excited to share this with a small group of women as well. So stay tuned for that. So basically what's changing is I'm retiring my main money program.
I am starting this new six month, I guess you could call it a mastermind, the Happy and Rich Club, and I'll be starting a business program. It's probably going to be called Business for Women Physicians. I haven't quite decided if it'll be a four or six month thing because there is a lot of material I want to cover in addition to all the mindset coaching that's required around business. So that probably really should be a six-month program as well.
And then I'll be doing smaller retreats. Some will be related to those two programs I mentioned, but there also will be standalone retreats and some will just be fun like the Paris one. They'll be sort of we can really work on and talk about anything that you want to talk about in your life, money or life-wise, and to be in beautiful Paris. I know, the more I talk about it, I'm like, I really need to get this planned. This will probably, in my mind, is really more of a spring 2026 type thing, but this fall, I definitely want to do some kind of retreat.
It will probably be at Miraval, Austin. I think it's really central, easy to get to from both sides of the country. And I've been there many times. I know they can do a great job with accommodating us. And obviously if you have not been to Miraval, it is amazing. It's a high-end luxury, all-inclusive spa resort. And so all of your foods included, including snacks, alcohol is extra, but it's very reasonably priced. A bunch of activities. You get a credit every day to use their spa. Some of the activities are paid. There's a lot of free ones as well and just an amazing place to take care of yourself and relax and be away from the family. Kids are not allowed. It's adults only.
So I think it's a wonderful opportunity to really practice some amazing self-care. You will definitely not regret it. So I will let you know when we have dates for that. It'll probably be in the fall, October, November-ish type situation. So that's what's going on in my business and the reason why – Well, I want to share it with you to share and also just to give you permission to pivot and make changes.
I see a lot of women besides being afraid of change because change is always kind of scary. I think a lot of us feel that we should just be sticking to what we're already doing and that maybe changing is selfish or maybe it's weird, it's not normal. And I just want to give you permission to do that. If, you know, maybe you've been in clinical medicine for 20 years and you're like, you know, I think I'm ready to do something else, like do it. It's normal. You should do it. Life is too short. Our life is finite, but also it's long in many ways, right? Like we're going to live into well into our 80s or 90s. Like it doesn't make sense to do the same thing for the rest of your life. You know what I mean?
So not saying that if you love what you do and you could see it doing "forever", I'm not saying that's wrong. I'm just saying that if you have the desire or you're feeling some kind of pull to maybe pivot, by all means, do so. You have permission to do that. I am giving you your permission slip to do that.
And so if either of these programs sound great for you, reach out and let me know that you're interested, especially if you're a business person. I don't think it's set up on my website. We'll have some kind of thing you can fill out to let us know that you're interested in hearing about our business program when it comes out. And so I don't know if that will be set up by the time this episode comes out. So if it's not, just reach out to me and tell me you're interested and we'll make sure that you get on the list to learn more about it.
And actually, it will be set up. I'm deciding right now that we're going to have that set up because I want to start having a conversation about business and I'll send you sort of a separate business email here and there to just give you some tips until we actually start that program.
So just want to thank you if you've been following me from the beginning or even just the past year, just want to thank you for being here and listening to my podcast. I really appreciate you and I'm just so grateful. I'll talk to you next week.
Hey there, thanks so much for tuning in. If you loved what you heard, be sure to subscribe so you don’t miss an episode. And if you’re listening to this on Apple Podcasts, I’d love for you to leave a review. Reviews tell Apple that this podcast is, well, awesome. And it will help women find this podcast so that they too can live a wealthy life. And finally, you can learn more about me and what I do at wealthymommd.com. See you next week.
For media or speaking inquiries please click here.
For all other inquiries please click here.
227: Massive Action: The Key to Achieving Your Hopes and Dreams in 2025
Do you find yourself stuck in passive action mode, endlessly consuming information but never actually doing anything with it? You're not alone. As high-achieving, perfectionist women, we often fall into the trap of thinking we need to know everything before taking action. But here's the truth: all that passive action is really just a way to avoid failure.
In this episode, I'm diving deep into the difference between passive and massive action. I explain why we get stuck in passive mode and how it's actually a form of failure in itself. Plus, I share strategies for overcoming your fear of failure and taking the massive action required to achieve your goals.
If you're ready to stop letting perfectionism hold you back and start making real progress toward your hopes and dreams, this episode is a must-listen. I give you the mindset shifts and practical tools you need to get out of your own way and into action. Let's make 2025 the year you finally go after what you really want!
We have just a few rooms left at our amazing group rate at the Four Seasons Oahu for the 2025 Live Wealthy Money and Wellness Conference For Women Physicians. Don't miss this chance to join us in luxurious Hawaii with incredible speakers to focus on money and living your best life. Virtual tickets are also available!
What You'll Learn from this Episode:
- Why passive action feels safe but is actually a form of failure.
- How to radically change your relationship with failure.
- The importance of having compassion for yourself when you fail.
- How to shorten the time between failure and your next action.
- Why courses and communities make it easier to take massive action.
- How to track your progress and ensure you're taking enough massive action.
- The key mindset shifts required to overcome perfectionism and fear of failure.
Don't forget to grab your Design 2025 & Beyond workbook I created just for you. You'll also get the deets to attend my upcoming live workshop Design Your Wealthy Life on Jan 15th or 18th, 2025.
Listen to the Full Episode:
Featured on the Show:
Welcome to The Wealthy Mom MD Podcast, a podcast for women physicians who want to learn how to live a wealthy life. In this podcast you will learn how to make money work for you, how you can have more of it, and learn the tools to empower you to live a life on purpose. Get ready to up-level your money and your life. I’m your host, Dr. Bonnie Koo.
Hey everyone, welcome to 2025. I'm still signing things 2024. I always do that. I'm sure you do as well. I wonder when we'll all stop doing that, maybe within a few weeks.
So if you haven't heard, I am doing a workshop, Design Your Wealthy Life in 2025. I did something similar last year and it was a big hit. This is such a great time to think about this, like take advantage of the momentum of the new year to really think about what you want. Okay. And so if you're interested in coming, first of all, I'm going live on two dates, January 15th, which is a Wednesday at 8 p.m. Or Saturday, January 18th at 11 a.m. So I hope one of those times works for you. If it doesn't, no worries, we will send out a replay, okay? But be sure to sign up so that you get the replay. Now to sign up, go to wealthymommd.com/design, or just go to the main website and you'll see a link on the top banner to save your spot.
So today's episode is about massive action versus passive action. It's actually a replay of the episode I did last year. And honestly, there was really nothing I want to change. I want to do an episode talking about this topic. But when I listened to last year's episode, I was like, you know what? It's pretty good. And I really don't have anything to add. And so this is such a great episode for the new year because it's important to understand the difference of taking real action versus passive action. And I want to make sure you understand the distinction.
Also, if you haven't had a chance, make sure you listen to the previous episode, the first episode of 2025. I've created a workbook just for you, and it will make a big difference if you download it and take the time to do it. It's probably gonna take you between 30 minutes, maybe even an hour if you really get into it. We'll link that in the show notes, but it's episode 226, so just go to wealthymommd.com/226.
Oh, and I just wanna remind you, make sure you subscribe to this podcast so you don't miss an episode.
And I would really, really love it if you took the time to write a review either on Apple podcast or Spotify. It really helps other people find this podcast. And if you're listening, then it's making a difference for you and so pay it forward.
Okay, so let's talk about massive versus passive action.
Speaking of massive action, that's what today's episode is all about. Passive action and massive action and how I want you to think about it. Now, I said on the previous podcast that hopes and dreams without action remain hopes and dreams. Okay. And so I want to talk a bit more about the different types of action. Okay. You may have heard this concept before, but I think it's really important because too many of us get stuck in passive action. And there are some really good reasons why there's nothing wrong with you. You know, if this is you, but because I know you're a type A perfectionistic woman, passive action is really safe. We're also very good at it, right? Because passive action is mainly consumption. Learning about things, reading books, taking my course, yes, that's passive action.
And it's not that these things aren't necessary or useful, but they're only useful if you actually do something with what you're learning. And the main reason why it's so easy to just get stuck in it, because we're afraid we're going to take wrong actions, which might be detrimental in terms of reaching our goals, but ultimately comes down to avoiding failure.
So this is also an episode about failure because we don't want to fail because failure is bad. And I just want you to remember that all failure is, is that you didn't get the result that you wanted. It's a very neutral way of looking at failure. The reason why failure feels so bad is that we usually make it mean something about ourselves and we beat yourself up. Now this doesn't mean failure is not going to feel bad. It's not going to feel great, that's for sure. But it's what you make it mean that makes all the difference.
And so that's why it's so easy to stay in passive action because we have thoughts like, I need to know everything before I do something so that I don't make a mistake or do something wrong. But the thing is, you're never going to know enough. You know, the best analogy I can think of for this is, can you imagine if we became attendings but we never saw a patient because we had to make sure we knew everything. This is literally the same thing. We learned or we became physicians by learning things. We had to learn a lot, obviously lots of passive action.
But then we also had to do something with the knowledge. We had to see patients, we had to practice taking histories and physicals, knowing which questions to ask, knowing what information we needed to make a clinical decision and then carry it out. Obviously, we were under supervision during our training, of course, but that's how we learned.
And I'm just guessing you were pretty bad at it in the beginning, knowing at least I was, I definitely didn't know what questions to ask. I had an index card in my pocket to make sure I didn't miss anything and it was like very discombobulated. And now I'm at a point where I don't have to even think about what to ask, you know, based on what the person is seeing me for and whatever that I see as a dermatologist, most of its visual, I know exactly what questions to ask. I don't have to even think about it, but that's because not only did I learn, I also practiced it many, many times and made mistakes along the way.
And so it's not good news to know that making mistakes or having fails is part of the process. We want to avoid that as much as possible. I totally get it. But one thing I tell my clients that they hate hearing is that you have to make some money mistakes. Well, I don't know if I should quantify it as some, but money mistakes, money failures are part of growing your wealth.
I mean, do you think, think of like whatever person or persons come to mind when you think of someone who's super rich? Do you think they've never made a money mistake? Of course they have.
Another reason why we avoid doing things, again, everything I said really comes down to our perfectionistic nature, not wanting to fail because of what we make it mean. And what we make it mean ultimately is some kind of negative emotion, usually a group of negative emotions, and we don't want to feel those emotions.
But if you knew how to feel your emotions and have compassion for yourself, meaning you knew you could handle any emotion no matter how good or how bad because some of us are actually not good at feeling really good emotions or really good feeling emotions. Then failure wouldn't be so scary. You know what I mean?
And so you have to combine passive action with massive action and all massive action means is you actually doing something besides just consuming.
So it's something you do. So for example, if you're in my program and one of the things that I was going to say make you do, but I don't make you do anything. But you know, why would you take my course if you didn't want to do anything? Right? So one of the things you have to get clear on is where your money's going, right? You have to actually sit down, look at your money, look at your accounts, look at how you're spending money, etc.
So maybe an action is something like, what are bank accounts, picking a budgeting software program, and then buying it if it's, you know, something you have to pay for, connecting all the accounts, those are examples of concrete actions that are going to move you further along the path to getting your money in order and ultimately setting it up to grow it and help you reach your life goals.
So I mean, that makes sense. I think it's pretty obvious what massive action is versus passive action. And there needs to be a balance. And I don't know if it's 50-50, it's probably actually, I don't know, I'm not gonna even pretend to try to figure that out. But if you're noticing that you're not really taking massive action, or you're not taking action or nothing's changing, that's a signal, an obvious signal, but most of us just sometimes aren't aware of it, that you're spending too much time in passive action and it's an opportunity to examine why.
Now I want to go back to passive action a bit more. One of the things that one of my coach mentors taught me is that when you stay in passive action because you're afraid to fail, you're actually failing ahead of time. And when I heard this, it kind of blew my mind because a lot of us are thinking the opposite that as long as I don't take action, I can't fail. But not taking action when you have a hope and dream that you want to make true, not taking action is actually failure as well. So that actually kind of blew my mind, thinking of it that way sort of like helped me reframe that if I'm going to fail either way, I might as well fail by taking action. Because when I do fail, and notice I say when, not if, I'm taking action and not all those actions are going to be failures, right? But if I don't take action, then I am 100% failing.
What's that quote? You miss 100% of the shots you don't take. And so if you want to stay in massive action, then you have to radically change your relationship to failure and your relationship to yourself. And really that comes down to trusting yourself and having your own back.
You've heard all these phrases and they seem kind of trite, etc. But it's because it's true. If you know and have the capacity to have compassion for yourself. And if you know that you can handle any negative emotion, then it's just so much easier to take action.
This is one of the reasons why I'm such a big fan of courses and not because I have one. I'm also a consumer of many courses and masterminds, et cetera. It's because it's so much easier to take action when there's other people around you. Quite frankly, when you have a community, sometimes people have accountability partners, whatever you want to call them, and having someone who can guide you and having someone who can really help you out when you're stuck.
You obviously have to "raise your hand" and ask for help, but that's honestly one of the reasons why I take courses and put myself in groups of like-minded people because I am way more likely to take action. And I do take more action when I have something discreet to focus on, when other people around me are doing it, and frankly, when I'm spending money, right? Because when you pay, you pay attention.
And a lot of the stuff that I've learned as someone who's taken many, many courses is that I've really had to work on that muscle of not feeling like total crap when I fail. I still feel like crap when I fail, by the way. The difference now is that there's less and less time between feeling crappy about failure and taking action again.
You know, there was a time when, when I had a perceived failure in my business that like, it would really put me in a position or a place where I wouldn't do anything for, I don't know, let's say a month or two, I can't remember exactly.
And now that time period is so much shorter. It depends, right? It's not like it's like three hours and it's done, but it's a lot shorter. And that, again, is another thing you have to learn about failure is that, okay, you failed, process it, you know, maybe you have to vent to your friend, maybe you have to journal, maybe you have to just, you know, decide like, I'm going to feel crappy the rest of the day, and then it's time to move on.
So that's another skill to learn is to, in terms of changing your relationship to failure, is that you want to really shorten that time between failure and your next action. Otherwise, things can take forever. It's pretty obvious, right?
Okay, so that's really all I want to say about staying in action versus passive action. Because this, what I'm talking about today, this is what's required in order to really reach any of your goals, to make your hopes and dreams come true so that they don't stay hopes and dreams.
Again, be to listen to the previous podcast, make sure you do. I want you to think about the questions I asked in that podcast. You might even want to make a list of what's passive action and what's massive action or really think about when you're doing a week-to-week or whatever monthly progress tracker or whatever you want to call it. It's an opportunity to ask yourself was I mostly in passive action or was I mostly in massive action or did I have a good balance of both.
Hey there, thanks so much for tuning in. If you loved what you heard, be sure to subscribe so you don’t miss an episode. And if you’re listening to this on Apple Podcasts, I’d love for you to leave a review. Reviews tell Apple that this podcast is, well, awesome. And it will help women find this podcast so that they too can live a wealthy life. And finally, you can learn more about me and what I do at wealthymommd.com. See you next week.
For media or speaking inquiries please click here.
For all other inquiries please click here.
226: Rethinking Retirement: Are You Chasing the Wrong Goal?
I still can’t believe it’s 2025. Time seems to fly, especially when raising kids. My child is about to turn eight, and I can’t help but wonder how it happened so fast. It got me thinking about the stories I hear from clients - how childhood feels short. Many parents say they want to spend more time with their kids but feel money is the obstacle. The truth is, money isn’t the goal; it’s a tool to build a life you won’t regret.
This brings me to a question I hear often: Am I on track for retirement? Should I hire a financial advisor? But that’s not where I’d start. Too many people focus on hitting a “magic number” or following financial rules. The reality is, if you focus only on building net worth, you might reach financial success only to wonder why you didn’t enjoy it sooner. Life isn’t linear, and neither is money. So what are we really working toward, and are we living the life we want?
Tune in this week as I walk you through a mindset shift - thinking of life in seasons and aligning your finances with what matters now. I’ll share practical steps to create a vision of what you want, whether that’s traveling, prioritizing family, or feeling in control of your choices. By the end of this episode, you’ll feel ready to plan for a life that’s rich in every sense.
We have just a few rooms left at our amazing group rate at the Four Seasons Oahu for the 2025 Live Wealthy Money and Wellness Conference For Women Physicians. Don't miss this chance to join us in luxurious Hawaii with incredible speakers to focus on money and living your best life. Virtual tickets are also available!
What You'll Learn from this Episode:
- Why focusing on a “magic number” for retirement might be holding you back.
- How to shift your mindset and think of life - and money - in seasons.
- Ways to identify what truly matters to you and prioritize experiences now, not later.
- How to create a vision for your life and align your finances to support it.
- Why money is a tool, not the goal, and how to use it to build a life you love.
Don't forget to grab your Design 2025 & Beyond workbook I created just for you. You'll also get the deets to attend my upcoming live workshop Design Your Wealthy Life on Jan 15th or 18th, 2025.
Listen to the Full Episode:
Featured on the Show:
- Follow me on Instagram
- Peter Attia
Welcome to The Wealthy Mom MD Podcast, a podcast for women physicians who want to learn how to live a wealthy life. In this podcast you will learn how to make money work for you, how you can have more of it, and learn the tools to empower you to live a life on purpose. Get ready to up-level your money and your life. I’m your host, Dr. Bonnie Koo.
Happy New Year. Welcome to 2025. First, I can’t believe it’s 2025. And secondly, I actually recorded pretty much this whole podcast and realized I didn’t hit record. And I only noticed because I was looking at the program I use to record and I noticed there wasn’t a number which kind of tells me how long the recording is, and I realized I never pressed record.
This has happened one or two times before, and you can imagine it sucks, right? It’s like writing a paper and then realizing it didn’t save. But it’ll be even better because it’s the second time around.
So a question I get asked a lot is some form of this, am I on track for retirement? Should I hire a financial advisor to see if we are on track? And that is actually the wrong question. Many of us are sort of focused on, well, how much do we need in retirement, what is our magic number, like 5 million or 10 million dollars? And what this number means is it’s based on the 4% rule, which is also based on stock retirements, or rather usually it’s a combination of your brokerage accounts and your retirement accounts, like a 401K, 403B, and a Roth IRA.
And so you may have heard of the 4% rule where for every 1 million dollars you have invested in the stock market, you can safely take out $40 thousand a year. Now, the word safely is kind of in quotes because they’ve done these fancy calculations that if you do this, then you are highly, highly unlikely to run out of money. But most of you will have more than just stock investments, especially if you’ve been following me for a while you’re probably dabbling in other things like real estate et cetera.
So here’s what I want to say, you are going to die at your peak net worth. Did you know that? You are going to die at your peak net worth. So then it’s like, why did we work so hard? Why didn’t we enjoy the money that is ours when we were younger, right? That’s when you can enjoy it the most, when we’re younger and healthier. Not that being old means that you're not going to be healthy, but you know what I mean.
That being said, money isn’t the actual goal. Remember, it is a tool to help you live the life that you want. So the question is, what is that life that you want? Are you living it now? If not, what would you rather have? What would you want it to actually look like, like right now, in the future, and what I mean by future is that life comes in seasons. If you have young children, this is a season. If your kids are out of the house, that is a season.
And so I know it might seem overwhelming to sit down and think about this, but I really recommend that you do because this is how you're going to know if you are on track. And many of my clients think they need to have a certain amount of money before they can make changes like working less or starting a business, et cetera, but money isn’t linear. And it’s not really a problem to make less in the short term so you can enjoy, let’s say, your kids when they’re young.
Now, Jack is 7 right now, he’s turning 8 this year. He’s in first grade and will be starting second grade in the fall. And part of me is like, how did this happen? I mean everyone says the days are long but the years go fast. And so many parents I talk to with older kids, they’re always saying it goes so fast, it goes so fast. I remember being told this when I had a newborn, and it sure does.
And I saw this Instagram post that kind of really pierced through the heart, and it was something like you are going to know your children the longest time-wise as adults. Childhood is so short. So I’m not saying this to guilt trip you if you're a mom with young kids, but I really want you to think about that.
Pretty much all of my clients want to spend more time with their kids. And so the question is, do something about that. You can. And I think that’s the thing that I see a lot, is we feel like we don’t have a choice because of … money. I never want that to be the reason to not spend time with your kids and things that are valuable for you, experiences that really enrich your life.
Many of you love to travel and love to experience traveling to new places, and the truth of the matter is it’ll probably be harder when you're older. And growing older doesn’t mean that you're going to be frail and weak and unable to travel, especially if you follow Peter Attia’s principles and really be proactive about maintaining your health and your muscle and your bone density and your agility.
And so the question is, how do you enjoy the money that you’ve worked so hard for now and also make sure that you're planning for the future? It’s not either or. And so what you need to do is basically sit down and really, really think about this.
Now, this isn’t something you're going to figure out in one sitting. And I know many of you have thought about this, at least day dreamed about it, and how many of you have written it down?
Now, as I was planning this podcast episode I realized there are so many questions to facilitate this sort of vision, planning, or even brainstorming if you will. And so I actually created a worksheet for you and you can download it. The link will be in the podcast app for this episode. This is episode 226, and so if you go to wealthymommd.com/226, you can download the worksheet there.
And so this worksheet, really, you should approach piecemeal. Again, you’re not going to get it done in one go. It’s probably going to take several sittings. And so there’s going to be questions like, what does your life look like now? What would you rather have it look like? What experiences do you want to prioritize before retirement? And more.
So I’m not going to go through all the questions because they’re all on the worksheet. And again, go to wealthymommd.com/226 the numbers and you will be able to grab the worksheet there.
And so I think you can see that once you have a much better idea of that, then you can figure out what do my finances need to look like to actually have this life? Because that’s the only way you're going to know if you're on track, right?
And I know many of you will be thinking, well, how do I actually estimate? Now of course it’s going to be not super easy to do that, you really have to guesstimate, and guesstimate loosely. But that’s still worth doing because you're going to get a sense of what that’s going to take, right?
And so if you are attending my upcoming conference, which at this point will be in less than two months, the Live Wealthy Money and Wellness Conference February 20 to 23 in Hawaii. But if you are coming, I’m really excited for you. In fact I really want to make sure you download this worksheet because we are going to dive even deeper.
And if you come sort of having done at least a few passes, you're going to get so much more out of the conference because with the talks, with the people there and the masterminding you're really going to be able to get so much more clear on what that life will look like and be able to leave the conference with a pretty good plan of how to get there.
And hopefully it’s not too late, you're welcome to join us February 20 to 23 at the Four Seasons Oahu, and that’s wealthymommd.com/conference to learn more and to see if we have spots remaining.
Again, I encourage all of you to download the worksheet, it’s going to be so helpful, and honestly it’s going to inform you what you actually want to work on this year in all areas of your life. Remember, money is a tool, there’s so many aspects of your life that you may want to work on.
For example, if you have a goal of really optimizing your health, again, that’s kind of vague. Let’s say for example you really want to lift heavy weights, you really want to increase your muscle mass, and so obviously you're going to learn a bit about how to do that. It’s actually one of the topics at my upcoming conference, and so you can make a plan for how to do that this year, right?
It basically means making sure you get adequate protein, and most of us are severely undernourished when it comes to protein, and obviously that includes lifting heavy weights, not multiple reps of light weights. I don’t know what that was even a thing in the, I don’t know, was it a decade ago? But it’s actually about lifting heavy weights, that’s how you build muscle.
So I hope your year is off to a great start. I’m so excited for you, I’m excited for me because, again, this time of the year is such a great time to dream and figure out what to do next. I’ll talk to you next week.
Hey there, thanks so much for tuning in. If you loved what you heard, be sure to subscribe so you don’t miss an episode. And if you’re listening to this on Apple Podcasts, I’d love for you to leave a review. Reviews tell Apple that this podcast is, well, awesome. And it will help women find this podcast so that they too can live a wealthy life. And finally, you can learn more about me and what I do at wealthymommd.com. See you next week.
For media or speaking inquiries please click here.
For all other inquiries please click here.
225: Change Your Mindset, Change Your Life
What if the way you see the world isn’t about the circumstances around you, but the lens you’re looking through? Two people can go through the same experience yet describe it completely differently - one sees endless challenges, the other sees possibilities. The secret lies in something we all have but rarely think about: mindset. It’s not just who you are; it’s how you view and live your life.
Most of us think our thoughts are facts, but they’re not. They’re stories we’ve been telling ourselves for years - stories that shape how we feel, what we do, and ultimately, the lives we create. The good news? Those stories aren’t permanent. Changing them takes practice, but it’s absolutely possible. Once you start, it’s like flipping a switch on how you experience everything around you.
This episode is about getting that power back - learning to notice the thoughts that aren’t serving you and choosing ones that do. You’ll walk away with a better understanding of how your mindset shapes your world and simple steps to start shifting it today.
Learn more about Money for Women Physicians, an exclusive money coaching program to get your money and mindset working for you.
Hey! We have just a few rooms left at our amazing group rate at the Four Seasons Oahu for the 2025 Live Wealthy Money and Wellness Conference For Women Physicians. Don't miss this chance to join us in luxurious Hawaii with incredible speakers to focus on money and living your best life. Virtual tickets are also available!
What You'll Learn from this Episode:
- How your mindset shapes the way you experience life and why it’s not fixed.
- The connection between your thoughts, emotions, and actions - and how to take control of them.
- Why beliefs feel like facts and how to identify the ones holding you back.
- How to start rewiring your brain for a more empowering perspective.
- How to break free from autopilot thinking and create a mindset that supports your goals.
Listen to the Full Episode:
Featured on the Show:
- Follow me on Instagram
Welcome to The Wealthy Mom MD Podcast, a podcast for women physicians who want to learn how to live a wealthy life. In this podcast you will learn how to make money work for you, how you can have more of it, and learn the tools to empower you to live a life on purpose. Get ready to up-level your money and your life. I’m your host, Dr. Bonnie Koo.
So this episode is coming out the last week of December. And I know many of you are busy, maybe on vacation, maybe in a warm place. We used to get away every winter break because it was so cold in the Northeast. And this is the first year in a while where we are not leaving because the weather is relatively warm here in Tampa.
And so what I wanted to do today for today’s episode is actually do a replay of episode one. Many of you are probably newer to the podcast, and I’m just guessing it’s highly unlikely that you started from the very beginning. It’s a short and sweet episode, and it really lays the ground as to what my podcast is about and why I talk so much about mindset in addition to practical money strategies.
And so if this is relatively new to you, or you just want a refresh on what a mindset is, why examining and really looking at your money mindset is everything when it comes to reaching your money goals. And also, it’s a great episode to refresh your memory so that we can really start 2025 powerfully.
So this episode, coupled with episode 223, which is all about reflections, and then the following episode, the first episode in 2025, first of all, isn’t it crazy that we’re in the year 2025? That episode will be about how I think about making goals going forward, but obviously in the context of money, because what I’ve realized is most of us kind of get it wrong. And what I mean by that is we focus a lot on how much money we need to be stable, to feel secure, how much we need in retirement. And that is actually not the right question, or at least it’s not the first question.
And so that’s what we’re going to be talking about in the next episode. And I’ll also be doing my first workshop of 2025 that’s really going to tie in these three things all together. It’s called Design Your Wealthy Life. I’m going to be doing it twice because I want you to really have the opportunity to attend live. Obviously we will be recording it in case you truly can’t make it live.
And it’s going to be January 15th, a Wednesday at 8PM. And then we’re also doing it again on Saturday, January 18th at 11AM, both times are in Eastern time zone. And so I want to make sure you’re saving the date. And if you go to my website, wealthymommd.com/class, and there should be a little banner up top so you can just click it and save your spot and you’ll be able to add it to your calendar very easily.
And so I really encourage you to come not just live, but it’s really going to set you up for 2025 and, well, just your life in general. And so I really hope to see you. Again, go to wealthymommd.com/class to reserve your spot. Here’s episode one.
Welcome to the very first episode of Wealthy Mom MD. I’m Dr. Bonnie Koo. I’m a board certified dermatologist. I’m also a certified life coach with The Life Coach School. I’m also a mother to a toddler, Jack. He’s about two and a half years old, and I have a bonus son who’s 13, and I have a fiance.
I started the blog, miss Bonnie MD in 2017. And then last year I rebranded to Wealthy Mom MD. In terms of my career, I started out in academics in New York. I was the director of inpatient consult service for dermatology. What that meant was I actually did show up when you called the consult. I did.
Then I switched to private practice and then last year I switched to locums. I’ll talk about my switch to locums in another episode. Right now I work on my business, Wealthy Mom MD, and I see patients mainly via telemedicine.
So today we’re going to talk about the lens in which you view and live your life. This is called your mindset. So I went to medical school along with 150 other classmates at Columbia university. And if you asked each of us how medical school was, you’ll probably get 150 different answers, right? Some will say it was awful. Some would say it was hard. Others will say it was easy, a breeze, and they actually had fun.
But we all went to the same classes and learned the same material. So how can that be? It’s because of how we experienced it through our mindsets, the lens in which we live our lives. And we know this to be true. We all know people that always have a positive outlook on things, and we all know people that are negative Nellies who always seem to have a black cloud over them.
Now, I’m betting some of you, maybe most of you listening to this right now think your mindset is fixed and can’t be changed. Like I’m just the way I am and you’ve accepted it. Well, I have some great news, at least I hope it is, that you actually have the ability to change this. And once you learn this critical life skill that no one taught you, you no longer have to wait for X, Y, Z to happen to feel all the good feelings.
Many of us go through life thinking that we feel the way we feel because what happened or because something like seeing your checking account balance. So let’s say you had $10,000 in your checking account balance, different people will have different feelings about this number. So what is it that makes us different? The number is the same, right?
In fact, I’ll say the number itself is actually neutral. One person might feel anxious when seeing this number. Another person might be ecstatic. What differs between these two people is what they think about the number. You know, that little voice in your head that’s always talking and judging. Those are your thoughts. So newsflash, you are not your thoughts. You are the watcher of your thoughts and you actually have the ability to choose and think different things.
Now, here’s the thing, for us adults that are in our third or fourth or fifth decades of life the bad news is that we’ve been thinking certain thoughts over and over again, and they have become cemented into beliefs. They are ingrained. And in fact, they’re kind of like the truth to us, right? Not only that, but our brains like to be super efficient, so it’s just so much easier to think these automatic beliefs instead of entertaining new possibilities.
So basically you’ve got to retrain your brain. It’s kind of like lifting weights. It’s not very easy at first and somewhat painful as you’re building up new muscle or new neural pathways, but eventually it gets much easier. Well, the same holds true for rewiring your brain with new thoughts.
So then you might ask, well, why is it so important to be able to create and choose new thoughts and beliefs? Because it directly affects how you feel. And why is this important? Because your emotions affect what you do or don’t do.
So if you’re the one that sees $10,000 in your bank account and freaks out and feels anxious, well, you may just avoid dealing with money and making a plan. Now, we each respond differently to different emotions, so one person’s anxiety might actually be productive where another person’s anxiety is counterproductive.
So let’s summarize what we’ve gone over so far. I know it’s a lot, right? Your thoughts affect how you feel, which affects your behavior. And why is this so important? Because over time, over decades, these thoughts become beliefs and these behaviors produce outcomes. And these outcomes ultimately become your life, what you have or don’t have in life, right?
So I would hope it would behoove us to learn how to manage our thoughts, because the other way means we are completely powerless. It means our feelings, our emotions are totally out of our control and that we’re at the mercy of other people’s behavior and what happens to us in life, which is not a great way to live.
I promise you no one or no thing out there can jump inside your brain and make you feel an emotion. The emotions are under our control by our thinking. So I suppose the bad news in all this is that you are a hundred percent responsible for your thoughts and feelings. This might make some of you feel really great because now you have all the power back, but some of you are not going to feel great about this, but it’s okay. These are just your thoughts.
But I think it’s so freeing to know that no one can just jump inside my brain and cause a feeling and that no thing or circumstance, no event out there can force me to feel a certain way.
Now, this isn’t about choosing positive thoughts, by the way, it’s about understanding how your brain works and also having compassion for yourself and other people, because we all have the same human brain and it’s capable of amazing things. And it’ll always continue to offer up thoughts that aren’t necessarily helpful.
So throughout the next several episodes, you’ll learn how to work on your own lens, how to slowly rewire your brain. But for now, I want you to just become aware of your thoughts, become the watcher of your thoughts. And when you notice thoughts that aren’t really serving you, write them down. Thanks for listening and stay well.
Hey there, thanks so much for tuning in. If you loved what you heard, be sure to subscribe so you don’t miss an episode. And if you’re listening to this on Apple Podcasts, I’d love for you to leave a review. Reviews tell Apple that this podcast is, well, awesome. And it will help women find this podcast so that they too can live a wealthy life. And finally, you can learn more about me and what I do at wealthymommd.com. See you next week.
For media or speaking inquiries please click here.
For all other inquiries please click here.
224: From Medicine to Startups: Dr. Alison Curfman’s Leap Into Innovation
When I first met Dr. Alison Curfman in 2016, we were part of a Facebook group connecting women physicians who wanted to think differently about their lives and careers. At the time, Alison was deep in pediatric emergency medicine, never imagining she’d step outside the traditional healthcare system. Fast forward to today, and Alison has taken a bold leap - building startups, shaping new models of care, and proving the impact doctors can have beyond clinical work.
Alison’s story is about recognizing problems in the system and deciding to solve them. From co-founding Imagine Pediatrics, a company built to improve care for children with chronic conditions, to working with developers on tech-driven solutions, she’s learned what it takes to bring ideas to life in ways most physicians haven’t imagined. But it hasn’t been a straight path. Alison shares the risks, mindset shifts, and moments of growth that come with stepping into unfamiliar territory, like uprooting her family for a once-in-a-lifetime opportunity and scaling a team from a handful to hundreds.
Tune in to this inspiring conversation to learn how Alison leveraged her skills to break into consulting, advising, and healthcare innovation. Whether you’re a physician exploring new opportunities, curious about how AI and tech are reshaping the industry, or eager to hear how one doctor turned a gap in the system into a thriving business, this episode is packed with insights. Alison also gives a sneak peek into her latest venture, Start Up Physicians, where she’s helping doctors define their value, break into the startup space, and reimagine what’s possible for their careers.
Learn more about Money for Women Physicians, an exclusive money coaching program to get your money and mindset working for you.
Hey! We have just a few rooms left at our amazing group rate at the Four Seasons Oahu for the 2025 Live Wealthy Money and Wellness Conference For Women Physicians. Don't miss this chance to join us in luxurious Hawaii with incredible speakers to focus on money and living your best life. Virtual tickets are also available!
What You'll Learn from this Episode:
- How to transition from traditional clinical work to entrepreneurship and startups.
- The mindset shifts doctors need to embrace new opportunities outside the hospital.
- Why physicians are natural problem-solvers - and how to apply that skill to business and innovation.
- The role of AI, technology, and value-based care in shaping the future of healthcare.
- How to create and communicate your value when stepping into consulting or advising.
- Practical first steps for doctors interested in startups, including coaching, LinkedIn, and building a network.
Listen to the Full Episode:
Featured on the Show:
Welcome to The Wealthy Mom MD Podcast, a podcast for women physicians who want to learn how to live a wealthy life. In this podcast you will learn how to make money work for you, how you can have more of it, and learn the tools to empower you to live a life on purpose. Get ready to up-level your money and your life. I’m your host, Dr. Bonnie Koo.
Hey everyone, welcome to another episode. So, today I have a very special guest, Dr. Alison Curfman. We’re going to talk about in the episode how we met and long long we’ve known each other and how amazing it’s been to see each other’s journey over the years.
And the reason I wanted to have Alison on the podcast today is that, well, you’re going to hear her unique story and what she’s been up to, and it’s something that I think a lot of you don’t know about. Many of you know that I’ve talked about being an expert witness, which I think is an excellent way to have an additional source of income using your clinical knowledge.
And I always want to make sure that my clients know that there are so many ways to use your physician brain to create income besides just clinical work. And Dr. Alison is going to talk about how you can be involved in physician startups and do consulting, because these companies need physician input.
And I was looking at a post in one of the Facebook groups and it was talking about AI and tech and I saw massive amounts of comments where people really didn’t believe that the takeover was going to happen in our lifetime. And I think that’s a huge mistake, number one. Number two, is that if we’re not involved in the conversation, if we’re not involved in the evolution of this technology, that is also a big mistake.
They need us to do it, we want to make sure it’s done safely, and I think the more you deny that this is happening, like things will just pass on by you and I don’t want you to be in 10 years realizing that your job might not be as relevant as before. I’m not trying to scare you, but one of the things I think is so important in this day and age is to be agile, to be flexible, to be willing to learn new skills. And so Dr. Curfman is going to talk all about that and I’m super excited.
She’s also going to be one of our amazing speakers at the Live Wealthy Conference coming up in Hawaii February 20 to 23. And I just want to make sure that you all know that I am not doing this conference again. It’s the second one we’ve done and I’ve decided not to do it again, mainly because I’m taking my business in a new direction and I’m not ready to announce it just yet, but I will not too long from now.
And so it just doesn’t really fit in with where I’m taking my business. And so I don’t want to say sad, I don’t feel sad about it but I also am excited that this is happening because I know how important it is. It’s important to me that women physicians have a space where they can talk about money and other life topics because we need this information.
There is so much helpful information out there that I know can make a big difference for you. So if you’ve been thinking about it or on the fence, obviously, I highly recommend that you come. And I won’t be doing this again. So to find out more about that, you want to go to wealthymommd.com/conference.
Here is my conversation with Dr. Curfman.
Bonnie: Welcome to the show, Alison.
Alison: Hi, thanks for having me.
Bonnie: Yeah, I’m super excited about this. I’m always excited about the guests I have because they’re always so amazing and share so much wisdom. But you and I have known each other for a while and it’s been really amazing to kind of see how your trajectory has kind of changed.
And so I really want to not just share your story, but talk about the industry that you’re in and present it to my audience because people might kind of know it’s out there, but I just love how you’ve realized that this is something that physicians should know about and get involved because, well, we’ll talk about that.
So introduce yourself, talk about how we met, and then let’s hear your story of how this all happened.
Alison: Yeah, well, I’m Alison Curfman. I’m a pediatric emergency physician by training and initially started in academic medicine, kind of thought that was going to be the path for me. I didn’t think a whole lot outside of the box because I sort of thought that was the only opportunity for a pediatric sub specialist. But I realized throughout fellowship that I had a really deep interest in how healthcare systems work and solving problems that are really omnipresent in our day-to-day practice, but we all just kind of endure them.
And so being an emergency physician, one of the things that really impacted me was the inability to see my patients when a transferring hospital was calling about a really sick kid. And I remember this was back in like 2014 when telehealth was not common and I thought it seemed like such an obvious use case because other emergency department applications were using it like for stroke and TPA.
And I actually had a really tragic case where a child was seen in another emergency room and they called saying that he was really sick and they didn’t know what was wrong and they were putting him on a helicopter. But he had an unrecognized head injury and we didn’t have an exam or vitals or anything and he unfortunately herniated on the flight. And I remember being so devastated because this seemed like such a fixable problem that if I had been able to see and evaluate him before they sent him, his outcome may have been different.
So that was really a starting point for me as far as trying to think of ways that integrating technology and new technology into our day-to-day practices could actually have a massive impact on the patients that we serve.
I found along the way that there’s obviously a lot of resistance often to change and technology and new things. And I can talk a little bit about a few of the different phases I’ve gone through in my career. But now I work in the startup space and I found there’s a very, very different culture around change and change management and product development. It’s exciting, it’s creative, it’s fun and I see a massive need for physician input.
So I’m really excited that you brought me on here today and I’m excited to come to your conference in February, right?
Bonnie: Yeah, February in Hawaii.
Alison: Yes, yes. I think this is a really good topic for your audience because I hear from a lot of physicians that they’re very interested in alternative ways to generate revenue, and in particular interest in how they can use the clinical skills they already have to find other ways to contribute that aren’t just the typical inpatient/outpatient grind.
Bonnie: Yeah, that’s kind of what all of us are exposed to. It’s like you go to medical school, you finish residency and then you get a job, which is kind of not the way it was decades ago. Like most people, well, if they could, depending on specialty, would start their own practices. And now it’s, I forget the percentage, but like the percentage of people who become employed is way higher and a product of many different factors, including the way medicine is right now.
So Alison and I met online. It must’ve been around 2017. I think it was before I had Jack.
Alison: Yes.
Bonnie: Because that was 2017, so maybe it was 2016.
Alison: Yeah.
Bonnie: It sounds so long ago.
Alison: Almost a decade.
Bonnie: I mean, I guess it was eight years ago, right? And we met in a Facebook group. It was the PMG finance group. It had a few iterations. I think it was called Doc Mom’s Personal Finances and now it’s Women Physician Finances to be inclusive. And so what’s fun is I’ve sort of seen you grow and you’ve sort of seen me start my business, right? And neither of us were thinking about that at all when we first interacted.
Alison: Oh yeah, I don’t think either one of us could have planned the paths that we’re on.
Bonnie: In many ways, I don’t want to say random, but it’s like a series of, I was going to say decisions. But more like some parts serendipitous, right, and then just like being in the right room at the right time. There was a lot of that happening. And then obviously at some point we decided to kind of be more intentional about what we’re doing.
Okay, so when I met you, were you still in fellowship? I think you had just finished.
Alison: Yeah, I might’ve just finished. While I was in fellowship I actually did get my MBA because I had so many of these experiences where I felt like I really feel – And my thing at the time was telehealth, which now it just feels so common and run of the mill, but back then nobody wanted to do it.
So I ended up getting my MBA during fellowship. Although I don’t know how often I would tell doctors that they need an MBA to work in the startup world. But I ended up taking a role at a large health system in the Midwest as a medical director for pediatric virtual care. And I think that’s where I was in my career when we first started connecting.
Bonnie: And then you were doing something else, like some kind of research.
Alison: Yeah. Because of the barriers to implementing telehealth, I recognized that there was a need for more health policy around it because people aren’t going to do it if they don’t get paid for it. And so I actually started a national research network that was really a grassroots effort with a couple other co-founders on establishing best practices for pediatric telehealth. And we wrote the policy statement for the American Academy of Pediatrics.
And then I also took this role as medical director where I was designing and implementing a lot of different virtual care programs for children across a large hospital system. So we had a lot of different pilots, including in the emergency setting and the NICU and in several others.
But our core program was a program for children with medical complexity that was a population health program that was based on the premise that these children are a very, very small portion of the pediatric population that accounts for a massive amount of the cost. And a lot of their cost comes from inpatient stays and ICU stays and being sick. And we hypothesized that by providing more support for families and for parents, even if that support was virtual, that we could keep them healthier and out of the hospital.
So I ran that program for two years. I was, again, still practicing in the ER. I got my first experience and exposure working with a development team because we were building technology platforms to go along with this, you know, growing this program and trying to measure it at the same time. And we did get IRB approval to publish our results. And over a couple of years, we grew to about 200 children.
So it wasn’t a massive program, but it was enough to get statistical significance. And we reduced their hospitalizations by 35% and cut their ER visits in half, which led to a massive reduction in their cost of care. So it was very meaningful results, but we were in the wrong place because we weren’t actually getting paid anything for the care we were giving because it was meant to be a pilot and really prove the concept, but really needed to be implemented in a value-based system of care for it to even be sustainable.
And so we had a little bit of runway to prove the concept and we did, but then Covid hit and budgets changed and the program ended really abruptly in May of 2020. And they moved me into another leadership role that didn’t excite me. And I was in this transitional period where I felt like we had something really valuable that really was affecting children and families in a positive way and had real financial value, but it got shut down. It was not viable in that location or in that setting.
And I was working in the ER and I would just see these kids coming in every shift who we had previously kept out of the hospital for two years. And it was just, I really felt this call to do something different, but I had no idea what I wanted to do because I had never thought about – I lived in St. Louis. I’d never thought about leaving St. Louis. I’d never thought about leaving traditional healthcare.
And I think that’s when I reached out to you and said, I don’t know what to do. Do you know someone who’s a good coach? Because you seem to find that to be very valuable and I’m just in this transition period. So that’s when you recommended a coach for me.
Bonnie: Yeah. And then you, obviously, worked with her. So I just want to pull out so much stuff that you just talked about, because I think the common theme when people are making changes like this is basically you saw a problem or a gap and you wanted to help solve it in some way. In essence, that’s what entrepreneurship is, we’re problem solvers. And I think doctors are natural problem solvers. So that’s why I always see so much opportunity for the clients that I work with.
So I had a question. You said you were working with developers, was that something that the hospital provided? I was just curious about that part, because those people are not cheap.
Alison: Yeah. No, they’re not at all. It was an unusual setup because my hospital system was one of the front runners for virtual care nationally, like really piloting a lot of innovative programs. We had a really deeply developed population health program for chronically ill adults. And that was kind of our foot in the door as peds, they were like, well, I guess we could try it for kids too.
So to be quite honest, the investment in the development team was not dedicated to the pediatrics team. It was for this established program that was doing a lot of virtual care in home. And it was the adult teams that were really using that software and trying to build their own software because what we had been using from a vendor wasn’t working in some ways.
And so the hospital system did invest in a development team to build our own product. And I will talk about this in other settings, but product development is very, very different than the way we think as doctors. I mean, there’s a lot about using a minimum viable product. And I’ve seen other physicians work with development teams, like in this case where there was almost too rigid of thinking and it didn’t go well. Like the product never launched.
But what we got as the peds team was kind of the scrappy leftovers. It was like whatever software we had access to, we kind of had to make it work. And we didn’t have a whole lot of budget for that, but it was almost like we could use the leftovers of what other teams weren’t using. And we made it work. And we always had to stop and think, and this is a very startup way of thinking, like what’s the true core of what this person needs? And what’s the true definition of safety in this case? Because we will never, ever compromise on safety.
So I will never, ever design anything that has a risk of actually harming patients. If the risk is like, okay, well, if we put this out there and it’s actually not awesome, but the parent is going to have to click a bunch of buttons and they may not like that experience of getting lost in our menu screens, that’s not safety. That’s just an experience thing. And so we can overcome that with relationships and trust and they can understand that we’re launching our very first version of a software and they know that the people on the other end of the line care about them and their child, and they don’t mind clicking a bunch of buttons.
So we always want things to be really good or even perfect. As doctors, we’re trained to have standards of extremely high excellence. And that’s just not what you do in the software world. You get the smallest piece of something out there that can do a piece of what you want it to do. And then you iterate and grow and get feedback.
Bonnie: I mean, that’s business, right? That’s entrepreneurship. This is what I see a lot with physicians wanting to start a business, they feel like they have to get everything perfect first. And the problem with that is it never gets out there, right? I’m sure you’ve seen this.
And again, because we’re used to A plus work, not even A. And Brooke Castillo said B minus work changes the world. It could be even C work that changes the world.
Alison: Yeah, done is better than perfect.
Bonnie: Yeah, exactly. And so I do see a lot of people struggle around that. So I can see how, it’s not even like there’s something wrong with them, but they’re just not exposed to the type of thinking that you need in business and entrepreneurship. And so again, as you said, it doesn’t work.
I’m just curious, you didn’t mention it, but how did the parents and patients feel about the service?
Alison: Oh, they loved it. I mean, we knew these patients so deeply. We knew their siblings, we knew their birthdays, we knew their dogs, we knew their ventilator settings and what type of a trach they had and who their DME provider was. And we helped coordinate thousands of details for these kids.
And we didn’t replace their PCP or any of their specialists, but just added an extra layer of support. Like a one-stop shop of like, this is who I’m going to call if all of a sudden I’m getting an insurance denial. And it’s like people in traditional clinic settings often don’t have hours to spend on the phone with a mom in the middle of their workday.
And so we had all sorts of challenges. I mean, sometimes people didn’t like us messing with their patients. And even if we weren’t changing their treatment plans and we were just really trying to help improve the communication, there was some territorialism. And we had a lot of learnings, but overall the parents gave amazing feedback and just very, very deeply cared about their nurses and social workers and doctors that were on my team because we were really, really there for them.
And so when that ended, I felt like part of me was like I had invested so much into that. And so I did start coaching and I didn’t know what I was coaching for. It was like, am I trying to go get a job at a different healthcare system? I don’t really know, but it was a lot of mindset stuff about limiting beliefs about what I could do or what I should do.
And one of my limiting beliefs was that I could never leave St. Louis. I was like, no, no, this is where we live. And my husband has a medical practice and my mom lives close by and we are renovating our house. Like we’ve made the decision that we’re going to be here.
And I think that during coaching it kind of challenged me, like, well, if you want to design your life, can you consider any other options where there could be better opportunities for you? And it took me a long time to actually even – And I think that what it did was it primed me for opportunities that came a few months later.
And my closest friend, who’s named Megan, she’s our chief product officer at the company we started and she’s my co-founder. She has a background in technology development and product design. And she challenged me. I kept getting calls from recruiters about different jobs that were out of state and I just wouldn’t even think about it. And she’s like, you need to start interviewing. You need to start interviewing for all those jobs. The next one you get, you’re going to interview for. And she’s like, I don’t even care if you don’t want it because something will come along that you will want.
Bonnie: Was this for clinical jobs?
Alison: Yeah, like leadership jobs. Some of them were like Children’s Hospital even like chief innovation officer positions that I thought there was no way I was qualified for something like that, because that was like a jump from like a measly medical director to like a C-suite position. But one was in Fargo, North Dakota or something. And it was like North and South Dakota. And there was no way I was going to move to North Dakota.
But because Megan pushed me to, she was like, no, go. I did and I was probably a little choppy because I hadn’t gotten my thesis statement together of who I was and what I wanted to do. But it was a really good experience because, again, when the real opportunity came along, then I was ready for it.
And Megan approached me and said, you know what, neither one of us is happy with what we’re doing right now. We were so fulfilled and felt so motivated by the work we were previously doing. Why don’t we just do that on our own? And I thought she was crazy. And I was like, I don’t – She’s like, let’s just start our own company. And I was like, I don’t know how to do that. She’s like, you’re a doctor. You have an MBA. We have a model. I can build the tech. What’s the problem?
Bonnie: She’s like, what’s the problem?
Alison: Yeah. And I was like, well, you know, like I’m used to having an income and I don’t know how we could make money doing this off the bat. So she walked me through the whole process and we made a pitch deck of what it would look like if we were to build our own medical group for children with medical complexity.
We did go to a local startup accelerator who immediately accepted us into their coaching program.
Bonnie: Well, what is that? Let’s just pause and just define that because everyone listening, they might be like, what is that?
Alison: Yeah, so they all have different flavors, but they’re basically like an organization that helps to get really early stage concepts off the ground. It’s not even like incubating something, because incubating kind of indicates that there’s already somebody overseeing it and helping to grow it.
This is like, what they would provide, they had a facility. They did a lot of like biotech and pharma, so they would provide bench space for people that had an idea that needed to be designed or developed. They would provide coaching and network connections to investors.
And they had different kinds of organizational things to help early stage entrepreneurs really figure out how to get something to kind of develop into something that could launch or be interesting for an investor.
Bonnie: So do you pay these accelerators?
Alison: I think it was like an application program to be part of their coaching. And I think – I don’t remember paying them, but I think others do or others get grants. Like maybe you get a grant, but you don’t have a place to do the work. Or maybe you have someone who’s willing to invest in, like an angel investor to invest in like an early, early stage something, but you don’t have a place to build the thing or do the biotech research.
But we ended up not spending a whole lot of time at that startup accelerator because of what happened next. But it was an important mental step for us because we realized there was actually an appetite for what we were discussing. A lot of people were like, wow, that’s like a really good idea. And it sounds like you’ve done it before.
And so it really gave us a lot of confidence. And I had already done that work around challenging my mindset that like, could I uproot my life and go somewhere else? Well, yeah, the answer is always yeah. Like, of course, there’s like a million options in the world of what you could be doing. Nobody is trapped in their job. Even if you feel like you are, you’re not.
And so the day that I told Megan that I would actually quit my paying job as a doctor to go build a company with her was the day I got this random message on LinkedIn from a firm in Nashville that wanted to invest in complex pediatric care. So that’s one of the serendipity things that I think you mentioned.
Bonnie: Well let’s pause for a second. So that means you are on LinkedIn.
Alison: Yes, that’s important. And that’s another thing I really emphasize to physicians and work with people on, is how to brand or package yourself. I don’t think people need a website. I don’t think they need a lot of things, but you definitely need LinkedIn.
And I guess I skipped a spot in the story where after I worked with the coach, one of the things I realized was I really needed to be clear about what my skill set was and what my goals and vision were. And I actually hired someone to help write my LinkedIn profile.
Bonnie: Oh, really? I mean, that makes sense that you could hire people to do that.
Alison: Yeah, because I was like I don’t even – I tend to really under emphasize things that I’ve done. I don’t know, I minimize things that I’ve done. And I worked with someone whose entire job, she was like, well, how many dollars was that budget? And what was the percentage of this? And how many direct reports did you have? And it was like all these things, details that I would never include, but she wrote me an executive resume and my LinkedIn profile.
So yes, it was really important that I had this image out there of a competent physician entrepreneur, because frankly, the way this firm found me was they knew they wanted to invest in complex peds because they felt like nobody was addressing that in the market. And they found the paper that we had published, which is still bizarre to me because I literally got the data for the IRB study the week that the program shut down.
And I remember presenting it at a conference the following fall. And it was like, yeah, we had this great program. It had these great results and now it’s over. And I felt dumb presenting it, but that was actually the catalyst for connecting with this firm in Nashville.
And within a couple of days, we got on a call with them. And it was a very, very well-known healthcare entrepreneur who’s built multiple multi-billion dollar businesses. And 10 minutes into the call, we told him our story and he was like, do you want to move to Nashville? And we were like, whoa, I don’t know about that. And he was like, I’m sorry, that was too forward. Do you want to come to Nashville? Come in a couple of days.
So we flew to Nashville and we met everyone at the firm and all the things they were doing and all this unbelievable experience they had in value-based care and in building business and building tech. And it was just this incredible team. And we were like, oh, shoot, we’re moving to Nashville, aren’t we?
And it was interesting because we ended up incubating our company at this private equity firm in Nashville named Rubicon Founders. So we did uproot our family and my husband did have to end his medical group affiliation in St. Louis and start all over again.
Bonnie: How did that conversation go? I’m just so curious.
Alison: You know, Megan and I both have the most supportive husbands in the world. I think we just did a little group call and we were like, hey, can we all quit our jobs? And they were like, sure, whatever you guys want.
Bonnie: Was it really that easy?
Alison: You don’t know my husband, he is the most laid back.
Bonnie: I can’t wait to meet him. Maybe we could do something when I’m in Nashville next.
Alison: Yes, that’d be awesome. Yes, he is the polar opposite of me. Very, very laid back. I’m not a laid back person. But yeah, I think they recognized this was like a once in a lifetime opportunity. It’s not every day that someone says, hey, I have eight figures that I really want to invest in an idea that’s in your head. They knew this was what they wanted to do. And so we ended up moving to Nashville.
Bonnie: How quick was it?
Alison: The LinkedIn message was in August of 2021. And by November, we had signed contracts and were under contract for a house and had given our notice in St. Louis and whatnot. And we had another co-founder also who was coming from New Orleans, had a medically complex child himself, and he was our first COO.
And we launched the company, as in like seed funded and incubating within the firm on January 1st of 2022. And so all of that year I was basically hanging out at this private equity fund, like totally out of my element, but I really knew the clinical stuff. And I didn’t feel self-conscious at all about not knowing how a value-based contract worked or anything. I’d be like, I’ve never heard of that. I need someone to teach me that. And they did.
And it was like I learned more that year than I think any other year in my life. You know, it’s something about physicians, like if I was in the ICU and there was some patient case that was really complicated, I might feel embarrassed or something if I feel like, oh, I don’t want people to think I’m stupid that I don’t know that. But I was like a fish out of water and it didn’t even, I was like, I have to learn everything.
And so we built our selection algorithm for this risk-based population or contract, which I built with the healthcare economics team. I learned a ton about that. And we built our technology platform and I was doing a lot of pitching.
I was flying around the country with this team to try and figure out what exactly Medicaid plans needed or wanted from this sort of product. And it was amazing because like everyone thought it was a great idea. I mean, I don’t think that’s typical for entrepreneurs, but, you know, you find something that’s like so meaningful for children and families, and also could potentially make a lot of financial sense.
We had a lot of support, but we still had to get through the sales cycle contracting. And there was a point in August of 2022, you know, we’d been incubating the company for about seven months. We really were hoping to get a contract for – We needed at least a thousand patients to be able to launch. All of a sudden we got a contract for 10,000 patients in Texas from United Healthcare. And then very soon after that, another major plan gave us another 10,000 patients. So we were going to launch in January with 20,000 patients.
Bonnie: Were you guys prepared for that?
Alison: No, not at all. I mean, we only had three people at the company and I was the only clinician. So it was like, oh my God, we really need to hire some people. So we learned a ton about recruiting and hiring. We had this amazing team on our people team that like, you know, full speed ahead, brought on our first clinical teams and we recruited our whole executive team. We had to get a CTO. We had to recruit a CEO. I was the chief medical officer, and we really put together like this very amazing mission-driven team.
We launched in January. Everything went really well, except we forgot to order furniture. So that detail slipped through the cracks. So we were all sitting on the floor for the first month or so. It was very start up-y. But then we started caring for these patients again and it was so meaningful. And I just felt like the mission is what is so special about Imagine and all the people that work there.
It was really like a rocket ship, like totally insane growth. You know, we grew from three to almost 300 in less than two years and reached a nine figure valuation in that time. And so it was really an incredible experience, but it actually led to another transition point in my life where I realized I’m not an operator, which I never really knew what that meant until I was in it.
But it was kind of the way I felt when I went from envisioning and building the program previously, to more of like an administrative role. I was like, I don’t want to oversee all these people and hire and fire them and make sure that everyone’s following a Gantt chart or whatever. I was like, I’m like a visionary. I want to build things.
And I actually had recruited someone to run the medical group who was way more qualified than I was in that area. And I was able to move into more of a strategic advisory role and actually moved into this position and started another company.
So now I’m doing consulting and advising, and I’m working with a lot of early stage companies because I found that the really, really early stage where you’re really trying to get that zero to one growth and get that first contract and really get a model launched is where I really like to focus.
Bonnie: Okay, so everyone listening is going to be like, this sounds like, not crazy in a bad way, but just like, wow. Like maybe thinking like, good for her type of thing.
Alison: A once in a lifetime thing.
Bonnie: Yeah.
Alison: I will say, I doubt that someone’s going to reach out to you on LinkedIn and pluck you out of traditional healthcare and drop you into the startup world. But as I’ve done this work, I have seen this unbelievable need for strong clinical expertise. And I think healthcare is going to be changing at a pace that we can’t even imagine with all the AI that’s being developed and new clinical models and moving more care into the home.
And where I felt like my greatest value as a physician lies is not in the business planning, it’s in the clinical knowledge of how patients move through the system, what they need, what to do to keep them safe. What’s the worst thing that could happen, right? Like I’m an ER doctor, I’m always thinking about what’s the worst thing that could happen. And so I feel like my job was to put safeguards on the things we were developing and to determine –
And the things that I would advise on are things that many of you as doctors know these things. And so one of the most valuable things I created for my private equity firm was a patient journey of a complex kid, like how they move through the system and where all the barriers are along the way. I mean, this is just stuff we know from the work we do day to day. We’re going through a list of 10,000 ICD-10 codes and helping parse out which ones would fall into different cohorts because you know what those conditions are.
And so I would encourage physicians – That leads to kind of the other venture that I’m starting right now, which is a community for physicians to learn how to get into the startup space, because we need our voices here. I mean, if we aren’t involved, it’ll develop without us.
Bonnie: Yeah, and that’s what’s happening in medicine in general.
Alison: Yes, yes. And so I think that there’s some unbelievably easy first steps. You mentioned LinkedIn, you mentioned coaching, which I think really helped my mindset to be open to opportunities. But there’s a whole spectrum of opportunities.
You can be like me and quit your job and go found your own company. I don’t think many people want to do that out the gate. But you could also, on the other end, develop a side consulting or advisory work. And I have a lot of advice about pathways for that and how we can help train physicians to know what services they could offer, know how to find these opportunities, and really connect with networks that can help place them in these sorts of roles.
Bonnie: Well, that’s awesome. I mean, I think it’s such a great service because what I love is there are so many avenues that doctors can do without learning a whole thing. Because what I hear a lot of doctors say is like, oh, I don’t have any other skills. Well, that part’s not true. But it’s like if they want to still use their medical knowledge, there’s so many avenues, like there’s expert witness work, there’s telemedicine. But even under the telemedicine umbrella, there’s a lot of things under it. It’s not just being in front of a Zoom call with a patient, right?
So I know people are interested in this and I think people have heard of it. I think you being at my conference talking about it is really going to just spark a lot of interest because the type of women that work with me or come to my conference, they are sort of in that mindset of change, kind of like where you were. They might not know what that is, but they have this pull that they’re meant for more, I guess is the best way to describe it.
And I think entrepreneurship, and you said several times how meaningful it is, I think that is what makes entrepreneurship meaningful. There’s a mission and there’s a problem that you solve that’s really important to you, right? I think that’s kind of what you need in order to, I think, have a successful business or whether you’re consulting for a startup, because this world isn’t exactly easy.
And so I think really remembering the reasons why you’re doing this, it’s like you have to have that, because things can get rough, there’s snafus that happen, and it’s so easy to just quit, right?
Alison: Yeah, the energy is very different in startups, because it has to be fast. It’s like do or die, you know, and there’s so much energy. And people who are working in startups have already made some sort of a leap or a commitment that they’re really focused on getting it done. Like it just, sometimes in a traditional setting, it just feels kind of –
Bonnie: Well, medicine is slow.
Alison: – Lagging along and making these minuscule changes, if any, or spending all their energy arguing about changes that are going to have to happen. And it’s just annoying. But startups, even if it was something you wanted to do on the side, it’s exciting, it’s interesting.
And I think the coolest thing is to know that something that came out of my head is doing it on its own. There’s like 300 people that work over there that are doing this thing that I helped think up. And that there’s 25,000 kids being served. That’s way more impact than I could have had just seeing individual patients in the ER.
Bonnie: So let’s actually pause right there, because I think that’s such an important point, is the impact that you can have as an entrepreneur is way bigger than you can have – And I’m not saying you need to save the world, whatever that means to you. But I know that physicians, we became physicians for a reason, that we want to help people. And I think a lot of us don’t realize how much of a bigger impact we could have doing other things.
Obviously, we do need physicians doing direct patient care. But I have, for example, I have met with, I think it was pediatricians or family practice who feel like if they leave to start even something like DPC, for example, they feel like this population won’t be helped then, or they feel bad about that. And I always say, well, with DPC, and I don’t have a DPC practice, but I imagine because your patient panel is so much smaller and you can run so lean, you can decide to have patients on a sliding scale that wouldn’t normally be able to afford it.
And so Jack’s first DPC, he was telling me, and his fees were very reasonable. He told me that if a patient, you know, if they go through a financial hardship, he’s like, I never close the door on them. He’s like, once they’re a patient, they’re always my patient. So he’ll just reduce the fee until they’re able to pay again. And you can’t do that when you’re working for a big system, and you can do so much more.
And I think he has more resources. He can just like, for example, during Covid he just vaccinated the whole community, regardless of whether they had insurance or not. Like you can do things like that, that are meaningful.
And so I just think it’s, like this is the message I’m always telling physicians, like the impact they can have. I was just actually talking to someone today who is in sleep medicine and she has this idea for a business.
And again, this is like seeing a problem and not knowing that there’s a solution. And so you can imagine when patients are needing help with sleep, and maybe they do sleep studies, you have like 15 minutes with the doctor to kind of tell you, here are the results, and here’s what you should do. And again, these people need ongoing support.
And so she saw that gap and wants to provide some kind of coaching or education to help them so they can actually implement whatever help they need. And so, again, it’s actually helping them at a much higher level.
So I love this and I know people are going to be interested, and they’ll be like, well, how do you even get started? And obviously, this is something that you are trying to build as your business and service to kind of help physicians. Actually, why don’t you talk about it? But my guess is, obviously, they need some help with their mindset. And then learn the world, like what’s maybe some terms? Like some terms you mentioned.
Alison: Yeah, it’s like startup 101, the necessary points.
Bonnie: Exactly, startup 101.
Alison: And everyone at my company and in my private equity firm laughed at me because I had a picture of like right after we met the people at the firm I went to the library and I had like a stack of books that were like, startups for dummies. Like, I literally needed to start at the beginning.
So when I moved into consulting and advising and more strategic advising for my company, I was drawn to it because I felt like that’s where my skills lie. And I love working with founders, I love working with companies that are trying to solve a really important problem.
What I didn’t anticipate was how many physicians would come to me and ask how they could do it too. I was just getting flooded with requests from people saying like, well, okay, you had a cool path and now you’re doing something cool also that sounds like something I could do, but I don’t have any connections. I don’t have any idea of how to do that.
And so I met one on one with dozens of doctors who were asking me this. And I think I came to you and I was like, I feel like I need to do something with this. And so I decided to start this community that’s called Startup Physicians and I’m launching my podcast in January.
Bonnie: Oh, I don’t think I knew that you were doing that. Exciting.
Alison: Yeah. So there’s going to be three basic types of episodes. One is me basically going over startup 101 sort of stuff and kind of sharing some of the things that I’ve seen as needs for clinicians. Like things that I’ve actually seen doctors be paid to do for startups that you could do too.
Two would be interviewing other doctors who are already involved in some way with the startup scene, whether they’re founders or whether they’re just advising on the side. Or I have a couple of friends who just constantly have a couple of tech companies that are having them test something or review an algorithm or, you know, just different things. It’s creative and interesting. So I really want people to hear from other doctors who are doing cool things and what their journey was.
And then third, I’m going to be bringing on people from my network who are not physicians, who are more in venture capital and private equity and asking them, what do you need from physicians? Being the ones who fund these projects and the ones who build these companies, where is your need for physicians and where would you advise physicians to spend their time and focus?
And so one of the things that I’m also building is a training program because I feel like I also have doctors be like, well, if you hear of anything that could be good for me, let me know. And it’s like, okay, well, you have to have some services that you offer. So helping people figure out how to define their value proposition. And there’s a lot of ways to do it. I mean, I think there’s ways you could even reframe like QI work that you’ve done in more of a startup-y sort of way.
Bonnie: Basically, it sounds like a LinkedIn profile writer will be part of the service.
Alison: Yes. Yeah, for sure. And it’s about repackaging the skills you already have in a way that makes sense to the people that are looking for these, and also how you build services. How do you build a business development pipeline? How do you manage a sales cycle? I mean, even if you’re an advisor, you have to do that. How to work with development teams and product design and, again, going deeper into different things that you could include in your services that you may not even know exists as a need, but some of them actually require to have a physician.
And so it’s skills that you can learn or get involved in in early stage companies that you can get a lot of exposure. And it’s just like building anything, I mean, you’ve got to start with something accessible and maybe you’re not going to be charging a ton of money out the gate. But I do have a lot of guidance for physicians on how to build their pricing model and different ways of contracting and just really guiding people on what I’ve learned, which was really in a sink or swim trial by fire sort of environment.
It’s fun and it’s enthusiastic and creative and it’s another way to use the brain you already have. And so I will be putting a lot more development into that website and community, but it’s startupphysicians.com. And you’re on my list of my like pilot cohort.
Bonnie: Yeah. Yeah, I’m excited because, you know, it’s not that I’m bored with what I do, but just like you, I – How would I describe it? I also am like a visionary. I love just thinking of things. Like one of the things that I’m going to start doing, and I think I told her this, is work with physicians who want to have businesses kind of like yours, like consulting, coaching online.
Although I realized that I could even help physicians opening up their own practice, like cash-based. It wouldn’t be insurance-based. And even though I don’t know the nitty gritty of what space you need, but the business mindset and knowledge is exactly the same. And I find it so much fun.
Like I was again, coaching a client earlier today and she was telling me about her idea. And like literally in this session I basically was like, well, this is what I – Because I feel like I could see it so easily when someone kind of tells me what they’re interested in. And then we picked out her Instagram handle, her brand name. And I basically told her like, you need to reserve it on all the channels, reserve the domain name, you know, things like that. So it’s kind of like that service –
Alison: It’s like a million little steps, but all that inertia together, it starts to feel really meaningful.
Bonnie: Yeah. And it’s like, you know, because we started the conversation with, well, I think I want to do this. And she had taken some actually really great steps and then I was like, okay, well, this is what we need to do. And she just, you know, like in an hour just figured all this stuff out. We use ChatGPT to help us brainstorm names.
Alison: Oh yeah, I think there’s, there’s so many cool things to do with AI as an entrepreneur. Like just this week, I built a GPT for writing my proposals. So I have a standard kind of business sales cycle and a standard introductory consulting agreement, but I customize it to the customer. And so I now have built a GPT where I can input the transcript from my discovery call and it’ll spit out a proposal for the introductory services.
And I also, I don’t know if you’ve heard of having an AI coach. So you can actually train a GPT to have all the people that you listen to their podcasts or read their books or, I mean, and you can train it to like answer questions for you from that sort of –
Bonnie: And basically create a GPT, is that what you mean?
Alison: Yeah, like a coach. Yeah, like an AI coach that you can be like, I’m having this problem, I’m trying to figure it out. And it’ll talk back to you as if it’s like Brooke Castillo talking to you.
Bonnie: Yeah. So everyone is like, what are they talking about? I did an episode on ChatGPT, we’ll link it in the show notes. I don’t think I talked about GPT cause I feel like that’s, it’s not ChatGPT 101 type stuff, but basically you kind of – I describe it as like you’re creating like a brain.
Alison: It’s literally like you just train it by, I have a dictation app and I’ll just talk to it and I’ll tell it what I want and then it’ll like save those settings and then it’ll like learn over time.
Bonnie: Yeah, exactly. So I have one for my brand. It doesn’t write the best copy. Actually, someone told me today that Claude AI is better for copy. Like it’s really meant for writing. But yeah, I mean, it’s for my brand. I write my copy and I feel like it does like 80% of the work for me. Like it gives me ideas. It has my book. I uploaded my book. It has all the knowledge of my website. I’ve uploaded it. I probably should have my assistant upload the transcript for each podcast every week so that it just –
Alison: Yeah, because then it can draw from that and make connections. I find that I don’t do great with a blank sheet of paper or a Word document and I do way better just rambling. And so I often will go for a walk with my dogs and make a voice memo and just talk for like an hour to myself. And then I just drag that file into my transcription software and it spits out a project plan or a business plan or a proposal or something because I need to, like, I don’t know. Now I’m pretty reliant on it.
Bonnie: Yeah, we could talk about this all day. I love this stuff. We’re actually, the mastermind I’m in, we are actually having an AI training in January with, you know, Michael Hyatt?
Alison: Yeah.
Bonnie: He’s the Free To Focus guy, Full Focus Plan. Yeah, so he’s giving us an AI workshop, so I’m super excited.
Alison: In Nashville?
Bonnie: No, I think it’s going to be virtual.
Alison: Oh, okay. But you’re coming to Nashville again soon.
Bonnie: It’s like the week we’re going to be in Nashville in January.
Alison: Okay.
Bonnie: So I’ll send you those dates when I’m in town, but I think the AI workshop is before and then, but yeah, again, it’s changing business too.
Alison: It is. It is. And I mean, like any little tiny piece of the medical system, there is someone building an AI company for that tiny piece and all of them need doctors. All of them. I have no doubt.
Bonnie: Yes.
Alison: And I heard a quote at the health conference, which is like a big health IT conference, that the difference between an IT company and a healthcare company is whether there’s a physician at the table. It was someone from the AMA that said that, so of course they’re a little biased, but I think it’s a really good point. Like anyone can build technology. We’ve seen so many companies try and build tech for healthcare that just immediately fails because healthcare is so complicated and it’s so high stakes.
But all of these opportunities are out there. I would love to help connect more physicians to this work because there’s definitely more than I could do. And I think that I’ve had this really unique pathway and experience that just makes me really excited to share that with other people too.
Bonnie: Yeah. Okay, so how can people find you? Let’s just reiterate your website.
Alison: Yes, well, my name is Alison Curfman. So you can go to AlisonCurfmanmd.com, or you can go to startupphysicians.com, which is a little easier to spell.
Bonnie: Yeah. And then you have a Facebook group called Startup Physicians, right?
Alison: I do. Yeah, and that’s linked on the website. It is called Startup Physicians on Facebook. It’s not a hidden group or anything.
Bonnie: Okay. I love that it’s so clear and direct because that’s part of branding, it’s like you don’t want to just be all clever and stuff because you want people to know what it is right away too.
So, all right. Well, thank you so much for being here. I’m excited to learn from you because I’ve been sort of feeling the itch to expand into some other ventures myself.
Alison: Well I appreciate all your support over the years and, yeah, looking forward to seeing you in Nashville in January and in Hawaii in February.
Bonnie: Yeah. Super fun. Okay, bye.
Alison: Bye.
Hey there, thanks so much for tuning in. If you loved what you heard, be sure to subscribe so you don’t miss an episode. And if you’re listening to this on Apple Podcasts, I’d love for you to leave a review. Reviews tell Apple that this podcast is, well, awesome. And it will help women find this podcast so they too can live a wealthy life. And finally, you can learn more about me and what I do at wealthymommd.com. See you next week.
For media or speaking inquiries please click here.
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223: Reflect, Reset, and Step into 2025
Grab my End of Year Reflections Prompts that will help you make and stick to meaningful goals for the new year!
As we wrap up the year, I’ve been thinking about how time seems to speed up as we get older. Do you feel it too? Summers that once felt endless now seem to pass in the blink of an eye, especially with kids around. That’s why it’s important to pause and reflect on the year - on what went well, what we’ve learned, and the moments that truly mattered. For me, one of the highlights was spending a month in Greece with my family, enjoying a freedom and simplicity that’s hard to find in daily life.
Reflection doesn’t have to be overwhelming. It can be as simple as setting aside time to write about your favorite memories or jot down lessons from the challenges you’ve faced. I share some practical ways to reflect on the positives, the meaningful moments, and what you’d like to carry forward into the new year. Whether it’s creating a photo album or journaling, the key is to find tools that work for you and let them guide your thoughts as you close out 2024.
Join me today as we create space to reflect and plan with purpose. Together, we’ll celebrate what made this year special and start thinking about the next chapter. Whether you want to reconnect with your achievements or imagine what 2025 could bring, this episode will inspire you to look back with gratitude and ahead with intention.
Hey! We have just a few rooms left at our amazing group rate at the Four Seasons Oahu for the 2025 Live Wealthy Money and Wellness Conference For Women Physicians. Don't miss this chance to join us in luxurious Hawaii with incredible speakers to focus on money and living your best life. Virtual tickets are also available!
What You'll Learn from this Episode:
- Why reflecting on your year can help you move forward with clarity and purpose.
- Simple ways to pause and appreciate the positives from 2024.
- How to create a meaningful reflection through journaling, photo albums, or storytelling.
- How to identify the lessons in your challenges and turn them into growth opportunities.
- Why unstructured play and simplicity can bring joy to your family life.
- How to set the tone for 2025 with a clear vision and sense of direction.
Listen to the Full Episode:
Featured on the Show:
Hey, so before we start episode 223, which is all about reflecting your life in 2024, I wanted you to save the date. January 15th at 8pm or January 18th at 11am for my first workshop of 2025 called Design Your Wealthy Life. And so it’s basically what it sounds like, you're going to create your vision of what you want, and not just 2025 but like what do you really want your life to look like? Because if you don’t know where you're going, it’s really hard to reach your goals, even if they’re unspoken.
And so save the date, wealthymommd.com/223, you’ll see a button where you can sign up and save your spot for the workshop that way you can add it to your calendar very easily. And so make sure you do that. Okay, on with the show.
Welcome to The Wealthy Mom MD Podcast, a podcast for women physicians who want to learn how to live a wealthy life. In this podcast you will learn how to make money work for you, how you can have more of it, and learn the tools to empower you to live a life on purpose. Get ready to up-level your money and your life. I’m your host, Dr. Bonnie Koo.
Hey everyone, welcome to another episode. I don’t know about you, but I cannot believe the year is over. I mean, I kind of think this every year, but every year seems to go faster. And in fact, I was actually talking to someone about this. Now, this is obvious, but the realization, like you know how you hear something obvious, but you never really stopped to think about it? And so this was one of those things.
So remember when you were a kid and the summer seemed so long, like it almost felt like a whole school year in itself. And then as you get older, it just goes faster and faster and faster. I think it also seems to go faster when you have kids.
And basically we realize, well, this makes total sense because when you’re young, you literally haven’t had that many years of living your life. And as you get older, I’m 47 now, a year is literally shorter. Okay, not shorter, but I think you know what I mean. In terms of context, it’s shorter compared to the amount of life I’ve already lived.
Anyway, I think that’s why the year always seems to go by faster and faster.
Okay, so if you’ve been following me for a while, you know that in December I always like to encourage you all to do a year end reflection. And I do this for myself as well. And we provided a worksheet last year, but we’re providing an updated one because as I do these more and more, I always get sort of different or new perspectives on questions that I think will be useful for myself and for you.
And so what’s the purpose of doing one? I think it’s so easy for us to just keep moving forward. It’s like, okay, January is a clean slate and it’s almost like you want to forget whatever happened in 2024, right? At least that’s, I think, human nature.
And it’s also not a way to use it against yourself. It’s not just about reflecting on lessons learned and challenges you had, but also it’s a way to also think about what went really well. What gave you a lot of joy? Like what was amazing about the year? Because I don’t think we spend enough time doing that in our day-to-day life, let alone when a whole year goes by, right? So it’s an opportunity to pause and really reflect on that.
So a few things that I’m definitely reflecting on, I truly believe that every year my life gets better and better. And what I mean by better is I have more enriching experiences. I’m always meeting new people. So creating new relationships, deepening existing ones, and I just feel like I get to know myself every year on a deeper level. And I also, in general, like myself more as more time goes by.
And so the two things that really came up for me, or a few things in terms of reflection on my own life, is my family and I were able to spend a month in Greece with some really close friends. And that is an experience I’ve never had with my family. I’ve done the whole backpacking in Europe when I was younger, and I actually did one trip that was six weeks, maybe even a bit longer. But obviously I was much younger, single, and willing to stay in hostels, right? So that was an amazing experience for me, my family, and I would say especially for Jack.
Total side note, I recently followed Jonathan Haidt. I think it’s H-A-I-D-T or D-H-T. But many of you probably already know who he is. He’s a very outspoken person about the dangers of social media and how just the way childhood is so different now, and I know all of us already know that. And so he’s very outspoken about it, and so I think he’s a great social media account to follow.
So the reason why I bring him up is because one of the things that I really saw unfold in Greece is Jack having a lot of independence. And I never thought I’d be a helicopter mom, but what I realized is pretty much this whole generation of parents are helicopter-y. Like way more than our parents’ generation.
I’m sort of on the cusp of Gen X and Y, more X than Y, I would say. And we would just ride our bikes and roam around the neighborhood. No one knew where we were, right? There were no cell phones. And as long as you were back by sundown or dinnertime, no one cared where you were, right? We’d just roam, we explored, and did all sorts of things that kids do. And kids don’t have that anymore, like not really.
And so when I was in Greece, it was just so wonderful to kind of see or allow Jack to have the opportunity for lots of free play. And when we were on Syros, there was a big square that everyone would gather at night, and people clearly didn’t go to sleep till almost midnight. And the kids would just be running around in this square, and the parents would kind of just be on the edges chit-chatting with other parents, not super paying attention to the kids, but obviously they were there.
And it was the first time that I would leave Jack in a place like that and leave. I never left that long, because again, this was kind of new to me. But I would go across the street and maybe meet some friends for ice cream, and then I would come back, knowing that there were other parents in our cohort there loosely watching the kids, right? And so I was able to do that several times.
And the apartment we had in Syros, there were stairs that would go down to a playground, and he would run down to the playground by himself and play, and I would catch up with him later, but I wouldn’t feel the need to go with him, you know what I mean?
And now that we’ve settled in Tampa, we live in a pretty suburban neighborhood, and again, Jack loves to ride his bike. Well, he learned how to ride his bike here in Tampa. And we live in a townhome, and there’s rows of townhomes, and then regular homes, and obviously streets, et cetera. And so we have allowed him to ride his bike in an agreed-upon area where we don’t have to be walking behind him, you know what I mean?
And even then, there’s a part of me that wants to give him even more independence. And Jack has ADHD, and he can be quite impulsive, and so I do feel like there’s some safety concerns on that front. But that is something I’ve really been reflecting on, and also really thinking about how can I allow more free play that’s not structured, right? Because I think a lot of us have fallen into this scheduling with activities, and I was sort of against that. And then I realized, actually, I think I am sort of doing that, sort of like not on purpose, but anyway, that’s a whole other thing.
But Jonathan Haidt, great person to follow. He wrote the book The Anxious Generation, which many of you may have heard of, and so just a great, insightful book if you are a parent. But even if you’re not, I think it’ll be giving you a lot of insight on how different and challenging it is to raise humans in this day and age of technology and social media.
And so we do have a reflection worksheet for you, and so if you go to the show notes, you’ll see the link to click, and we’ll send it to you. Otherwise, you can go to wealthymommd.com/223, the numbers 2-2-3, that’s for episode 223. You can do these questions for yourself as well.
So I recommend doing the “positive” reflection first, and what I mean by that is really reminiscing about amazing moments, experiences like I just described, like really spending time thinking about them, you know? And also this might be an opportunity, as an aside, to go through the thousands of pictures you’ve probably taken in 2024 and to schedule like an hour or maybe two, depending how many you have, and create an album and take the best of.
I have an iPhone, I’m sure the same thing happens in Android where it can automatically create a movie about 2024. I don’t know if you can actually tell it to do that, but I’m guessing you probably could. And so I think that’s a really great thing to do for yourself.
So I recommend doing that first and then reflecting on sort of anything that you either wished things went differently, any challenges, you know, times or experiences that you could learn from, right? All of us have lots of those, including me.
So definitely one of the most challenging times this year was moving to Tampa. You can imagine why that was a challenging time. There’s just a lot of things to do, like besides moving us physically, all the things that we own, finding Jack a new school, feeling stressed about that, all that kind of good stuff.
And I’m really grateful for many aspects of the move because Matt is in a job that he loves and so it’s been really great to see him thrive professionally. I truly feel like we’ve hit the jackpot with the school that Jack now attends. Even though in the beginning I was actually mourning the school that he wouldn’t be able to continue back in New York. And so everything kind of has a bit of a mixed bag.
And moving was also hard, as you know, it’s one of the top three things that are stressful in life. And I had postpartum anxiety and I would say there were a few moments in my life where I had that level of anxiety where it did kind of interfere with my life in a negative way. And so I definitely experienced, I don’t know, is there a name for it? I know like clinically it’s called adjustment disorder, but really it’s post move anxiety. Or more like it was during, so whatever that word would be, right?
But it’s moving related anxiety. And it was really hard for me. And I think it was partially juggling all these things, the drawing experience of moving to a new place, not knowing anyone and just having to make so many decisions in a short amount of time. And so I had to get my medications adjusted, basically they all went up. And I knew that time and medications would help. And I will say, as of the time of this recording, I feel totally back to normal.
And I also truly believe that being in a sunny place is going to be so good for my mental health because it was hard, when you’re in the Northeast it’s cold and dark. And I actually got these glasses called Luminette, I think I’ve talked about them before. And so you may know that you can get a light box to help with seasonal affective disorder, but it’s also extremely inconvenient cause you have to sit there for, I don’t know, but probably at least 30 minutes.
And so these are glasses that you put on that are not exactly the equivalent of the number of lumens needed for effectiveness, but pretty close. And so I don’t have to use those anymore. And now what I use them for is actually for jet lag.
So as you can see, there’s been really great things about moving and also things that didn't go so well. And so I was talking mainly about professional things at this point, but I think this is also a time to reflect professionally as well. And so a question for you is what’s one accomplishment that made you feel really fulfilled this year or was very meaningful for you in terms of your business, your job, et cetera.
A few reflections I have about my business is I hosted the first ever Money and Wellness Conference for Female Physicians. We had the first one earlier this year in March at Miraval resort in Arizona. And I loved curating this conference. I loved curating the experience. I loved having it at Miraval. I loved that it was intimate and I loved all the speakers that I chose.
And before the actual conference, we had signed a contract to have the second one, February 20 to 23 in Hawaii at the Four Seasons. And so we still have spots remaining, and so I think this would be a wonderful way to really start the new year.
And actually right before I recorded this, I had an amazing idea, I think it’s amazing anyway, and I’m really excited to be able to share it with the attendees. So if you go to my website, wealthymommd.com, you’ll see a little button to learn more about the conference, or you can go directly to the website at wealthymommd.com/conference. And that’s February 20 to 23 at the Four Seasons, Oahu.
I mean, Hawaii is my happy place, but obviously Hawaii is gorgeous and the Four Seasons, like it’s going to be an amazing, luxurious experience. And it’s on the ocean and the ocean has been proven to be really calming for our nervous systems. And so I can’t think of a better place to be with other women physicians, to be with the amazing speakers that I have selected to really think about how you want to live your life with purpose going forward, money wise and also personally wise as well.
At the same time, I had mentioned most of the pros of hosting the conference, but then I also learned how difficult it is to create and host a conference. And so live events are definitely not for the weak of heart. And when I mean live events, I really mean larger scale events like a conference where you’re having like 50 plus attendees. I’ve done retreats. That was much less moving parts.
And I have decided I will not be doing this conference again, the way it is. I’m going to be focusing on smaller retreats. I’m not quite sure when, it could be as early as the fall of 2025, but I will not be hosting the Money and Wellness Conference going forward.
Of course I could change my mind, but I’m pretty sure that I won’t be doing that anytime soon just because the planning takes a lot of time and resources from myself and my team. And there are other things we really want to focus on in the business, providing lots of value for you, my listeners, really focusing on the programs that we offer and deliver.
And so just to give you a bit of a preview, in 2025, I will be offering a business program. And that’s something I’m really excited about. And it’s something that’s been on my mind for a few years and I finally decided I’m going to do it. And so I don’t have all the details as of this recording. It’s probably going to be starting in April. It’ll be open for enrollment probably in March, early March or end of February.
And so those are my sort of professional reflections on sort of what I’m up to and what I’d like to do moving forward. Again, I encourage you to do this for your professional life, whether you’re employed or not. And I mentioned the photo gallery. And in terms of spending time reflecting, it doesn’t have to take a lot of time, like we’re talking 30 minutes.
You can download the worksheet and spend some time journaling. I’m a huge fan of journaling, it has so many benefits and many of you probably journal already, but it’s also easy to kind of go off track and not journal as often as you’d like. It’s just very different, and I know you’ll agree, than just thinking about things, right?
It’s like, I know many of you will probably look at the questions and think about the answers, but writing them down, it does something different in the brain, right? It really helps you connect with what you’re thinking about and what you’re reflecting on. And that sort of deeper connection is fuel for moving forward in life.
Another fun thing I like to do when I’m reflecting is if 2024 was a chapter of a book, what would the chapter be called? Like what would the title be? I’m going to have to think about this one. So I haven’t figured out the title yet. I mean, it could be something just boring, like Tampa and Greece, or it could be like a phrase, like just have fun with it. I think it’s really fun to just give it a title.
And another thing is if 2024 was a movie, what would the title of the movie be and what actor or actress would play you? Now the problem is I’m Asian and there aren’t that many Asian actors. And so the actress or actor doesn’t need to look like you, okay?
I remember thinking like, well, I have a very limited choice here, but then someone’s like, but it doesn’t matter what they look like. Like who would you want to be you in terms of the acting? And so I thought that was a really great suggestion. So I think that would be pertinent to a lot of you because obviously not all of us are white.
And so when you do this, then it’s a great segue to think about 2025. And a lot of us tend to sort of be retroactive about things, but you can decide how the future will look. So for example, a fun question would be, what would the title of 2025 be? Like what would you want it to be called? What’s one area of your life that you really like to focus on in 2025?
So obviously in an upcoming episode, I believe it will be the first one in January, I’m going to talk more about how to think about the future. I’ll share the answer of what I call 2024. I’ll share what I’m calling 2025 and I’ll be sharing the area/areas that I want to focus on in 2025.
And so I truly hope that you are enjoying the rest of the year. I know it can be a bit of a crazy time with holidays and shopping and family and you know, there’s good and bad and ugly about all those things. And so wherever you are, whatever situation you are, always remember to be kind to yourself.
And again, please grab the 2024 year end reflections worksheet. It’s really an amazing opportunity to reflect and really honor yourself for who you are in 2024.
And in preparation for 2025, I’ll be hosting a workshop and I’ll be doing it twice. It’s going to be January 15th at 8pm Eastern and January 18th at 11am So January 15th is a Wednesday, January 18th is a Saturday. And so by doing it twice, I’m hoping that you will be able to make one of those times.
We will record it as well in case you truly cannot make it live. And so the theme is going to be designing your wealthy life. And it’s going to be an amazing opportunity to really start the year on the right foot and also really step into your future.
And again, we’ll be doing things like naming the chapter of 2025 and all that fun stuff. And obviously how you can then use that vision to help you create your money goals because, again, you can’t create your money goals without knowing where you want to go.
All right, so I will talk to you all next week.
Hey there, thanks so much for tuning in. If you loved what you heard, be sure to subscribe so you don’t miss an episode. And if you’re listening to this on Apple Podcasts, I’d love for you to leave a review. Reviews tell Apple that this podcast is, well, awesome. And it will help women find this podcast so that they too can live a wealthy life. And finally, you can learn more about me and what I do at wealthymommd.com. See you next week.
For media or speaking inquiries please click here.
For all other inquiries please click here.
222: Navigating Perimenopause and Beyond: A Guide to Women’s Health with Dr. Shieva Ghofrany
Being a woman can be challenging, especially when navigating life’s unspoken phases like perimenopause and menopause. I’m joined by Dr. Shieva Ghofrany, a board-certified OB/GYN with over 14 years of experience, to explore the often-overlooked aspects of women’s health. Dr. Shieva shares her personal experience of navigating postpartum life after having her third baby at 41, while also entering perimenopause. She sheds light on how unpredictable and transformative these phases can be, from hormone fluctuations to muscle loss.
In this episode, we dive into actionable advice for women of all ages. Dr. Shieva emphasizes the importance of building muscle and focusing on protein intake, especially after your 30s. She explains how small, realistic changes - like weightlifting and eating well - can have a big impact. Additionally, she discusses the gaps in medical education that leave both women and doctors uninformed about managing perimenopause and menopause, and offers simple, accessible solutions for taking charge of your health.
Tune in this week to gain expert insights on perimenopause, menopause, and postmenopause, as well as practical tips for navigating these life stages with confidence. From the surprising benefits of vaginal estrogen to breaking down the myths around hormone therapy and women’s libido, this episode is packed with empowering knowledge. No matter your age, this is an essential listen to help you take the reins on your health journey.
Learn more about Money for Women Physicians, an exclusive money coaching program to get your money and mindset working for you.
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What You'll Learn from this Episode:
- The key differences between perimenopause, menopause, and postmenopause.
- Why knowing these definitions is vital.
- How to manage hormone fluctuations with simple, accessible lifestyle changes.
- Why building muscle and prioritizing protein intake in your 30s can have long-term health benefits.
- The surprising connection between estrogen and vaginal health at different life stages.
- How gaps in medical education affect women’s access to comprehensive health knowledge.
- Myths and truths about hormone therapy, including the role of vaginal estrogen and testosterone.
- Insights into the limited options for addressing women’s libido compared to men’s health solutions.
Listen to the Full Episode:
Featured on the Show:
Welcome to The Wealthy Mom MD Podcast, a podcast for women physicians who want to learn how to live a wealthy life. In this podcast you will learn how to make money work for you, how you can have more of it, and learn the tools to empower you to live a life on purpose. Get ready to up-level your money and your life. I’m your host, Dr. Bonnie Koo.
Hey everyone, welcome to another episode. So over the next few or several podcast episodes, not necessarily in a row, I’m going to be featuring some of the amazing speakers that we’re going to have at the upcoming Money and Wellness Conference February 20 to 23rd at the beautiful Four Seasons resort in Oahu. That’s the main island where, well I shouldn’t say main, but that’s the island that has Honolulu and that’s the island that most people are familiar with.
And so I wanted to showcase some of the topics that I haven’t talked about on the podcast or haven’t had guests about. And obviously I hand-picked these speakers, so I find them wonderful and I think what they have to share is so, so valuable and might be topics that you may not have heard of.
And so today my guest is Dr. Shieva Ghofrany. I hope I pronounced her name right. And she and I met a few years ago and then recently reconnected because I was specifically looking for a speaker who could talk about women’s health. And as you know, nobody really talks about how we can take care of ourselves, optimize our health as we get older. And none of us were taught this in medical school.
Now, some of you may be aware that there’s a lot more awareness around perimenopause and menopause, and I’m so glad there is because all of us are going to go through it. And what does it even mean? Like the only thing I knew about menopause was that it happens in like your fifties and that your period stops and you get hot flashes and that sucks. And hormones are bad.
When I was in medical school, it was all about that WHI study that basically said, hormones are bad. Do not take it, you will get cancer. And that has been such a huge disservice to women. In fact, I would say a whole generation of women got gypped.
And so this education is so important, and not just that, just understanding how our bodies change and what we can do about it. And this topic just goes hand in hand with Peter Attia’s work, his book called Outlive about just being proactive with your health instead of being reactive.
We’re going to discuss what perimenopause is, what menopause is, when does this actually start? What does it mean? How are we going to feel and other things that we need to keep in mind. Like most of us kind of know, because we’ve sort of heard that as we get older, our bones get less dense and that we lose muscle or sarcopenia. And so that means we need to do something about it if we don’t want to have too much of that, which has its own consequences.
And so we’ll be talking about that, what you can do about it. And then also how hormone therapy is something you should really know about and then understand the risk and benefits.
Now, I want to share that I am in perimenopause. I started skipping my periods last year, and I was kind of surprised because prior to that I was clockwork every 28 days. And so I remember when I skipped my first period, I was like, oh, it’s not a big deal and whatever. Like I didn’t think much of it. But then like, obviously I knew that was a sign of perimenopause, but I didn’t really think much about it because I wasn’t having any symptoms.
But the more I dove into the topic, the more I realized that maybe I do have symptoms of perimenopause, namely the effects of declining estrogen. And one of the things that I noticed in my blood work is that my hemoglobin A1C has been creeping up despite not really having any diet changes. I had gestational diabetes, by the way.
And my lipids were creeping up. My lipids have always been really good. My LDL is generally 100 or less and my HDL has always been on the high side, I think close to 80. And the last panel I got, it was very different. And so I’ve learned that these are consequences of declining estrogen levels.
And then I thought about, or rather I just read about all the other symptoms that are kind of vague and can be attributed to a lot of things, but it could also be contributed to perimenopause, including mood, including brain fog. Now, I haven’t experienced brain fog, but I definitely have noticed that my brain isn’t the same. And it’s even hard for me to describe what I mean by that.
But taking that all together, when I saw a menopause expert, she’s a GYN who did some additional training, because many physicians, and namely many gynecologists, simply did not have this training. I heard that they got like one day or a week of anything about menopause. And so there is a society that does additional training. And so those GYNs do have the information to really explain things and offer treatment.
And so I met with one a few months ago and I started hormones. Namely I have an estrogen patch, it’s like a tiny little thing. And I take a progesterone pill at night. And so the hope is between that, between continuing lifting heavy, making good food choices, that things will move in the right direction.
I also got a continuous glucose monitor, or CGM, as of today, the day I’m recording this intro. Anyway, I just started my second, I don’t even know what you call it, my second patch. And each patch lasts for, I forget, around 10 days. And honestly, it’s been really eye-opening and frankly depressing to see how my blood sugar reacts to certain foods. As a Korean, I did hear that rice can be really bad for your blood glucose. And it was, I don’t even want to tell you what the number was, it was so high.
There are ways to decrease the blood sugar surge with rice. Apparently if you refrigerate it overnight or even freeze it, it changes the starches so they don’t get digested so quickly. And then I also saw this thing about cooking it with coconut oil. I’m not going to do that because I definitely don’t want rice that tastes like coconut oil.
And then people have said, just substitute cauliflower rice. If you’re Asian, that is just no. I mean, maybe I’ll mix some in, like a quarter to whatever, because obviously that provides some fiber and vegetables. But like the thought of having to replace cauliflower, like it’s just like, I don’t know, part of me is like, certain things you just got to enjoy.
And I don’t want diabetes. I never want to get on insulin. And so I am doing what I can to be proactive about it.
And these are things that all of you need to understand about our bodies. And so Shieva is going to be at the Live Wealthy Conference. I am so excited for the attendees to get this education that is so needed and just hard to come by. So here’s my interview with Shieva, I know you’ll enjoy it.
Bonnie: Welcome to the podcast, Shieva.
Shieva: Thank you, Bonnie, I’m so excited to be here.
Bonnie: Yeah, I’m so excited about this topic and we’ve had so many offline discussions, but why don’t you go ahead and introduce yourself?
Shieva: Well, I think you are younger than me, but I always joke at some of these podcasts that I am not only the hair club president, but I’m also a member. I don’t know if you’re old enough to know that club.
Bonnie: I do know what that is. Yes.
Shieva: I mean, I kind of joke like if you’re old enough to be perimenopausal or postmenopausal, then you might be old enough to know that. But I say that because as an OBGYN for 25 years, I understand things, of course, clinically and medically.
And then as the woman who went through six miscarriages and three babies and endometriosis and HPV and weight loss surgery, and then ovarian cancer with a smattering of perimenopause and then surgical menopause from my ovarian cancer surgery, I feel like I really have seen so much of this from the lens of what it’s like to be a patient and a woman, and a woman who, even though I have all the data and knowledge, you really don’t know some of these things until you’ve kind of adjacently experienced them.
And so it’s really helped me, I think, with the language and understanding how to get into the mindset of it. So I love talking about all these subjects, but especially perimenopause and menopause.
But yeah, essentially, I’m an OBGYN who still practices obstetrics. I am about to launch my telehealth menopause practice. And I have an online platform that right now is called Tribe Called V, but in the near future will be switched and will be called womaning.com, because our premise is giving people preemptive knowledge.
Bonnie: I love that word.
Shieva: And we say womaning is hard, but learning about perimenopause, for example, shouldn’t have to be. I can’t say perimenopause is not hard, but I can say learning about it and trying to manage it shouldn’t have to be as hard as it is.
Like you and I know, you’re a very educated doctor, and yet you as an educated female physician still had a little bit of struggles finding the right person, right, and getting through perimenopause. And it just belies the point that people don’t learn any preemptive knowledge about this, regardless of their education.
Bonnie: Yeah, it’s kind of important as a woman to know this.
Shieva: So important.
Bonnie: But people don’t talk about it.
Shieva: Yeah, exactly. Well, I like to talk about it, so I’m glad we’re doing this.
Bonnie: Yeah, because I think it’s something, you know, my audience is predominantly women. And it’s like I am so grateful that there is a heightened awareness around these topics because every woman will go through this. So this is not about perimenopause, but you know how all of us, our eyes change and we become more, you know what I’m talking about? Like starting to need reading glasses.
Shieva: Yeah, we get more farsighted. Yeah. Yeah, that is actually a little bit part of perimenopause, meaning it goes along at the same time and age typically.
Bonnie: Yeah. So I didn’t know that everyone went through it, I only thought some. And then when the ophthalmologist said, no, no, no, everyone goes through it, I was horrified.
Shieva: Well, it’s funny you say that, when I had my third baby I was 41. I was about to be 41. And I’m in the hospital holding her and I’m like, she’s so cute. And I was like, oh, oh, I joked, I have to put on readers to see my infant. And then that was when I realized like, oh, I’m all at once postpartum and probably on the brink of perimenopause or within it.
The good news is, as I keep saying, all this stuff is natural and normal. And we also get to say, sorry nature, screw you today. We’re not going to take it lying down. We’re going to try to help ourselves and make ourselves feel better.
Bonnie: Yeah, this is such an important topic because it’s not just – I think when women hear perimenopause and they’re younger, they might think it’s not relevant. But again, it’s going to happen. And the more information you have and to be proactive about things. And then there’s things that are recommended specifically for peri and meno, but some of those habits, like lifting heavy weights, should really occur when you’re younger.
Shieva: It really should, yeah. Protein intake.
Bonnie: Let’s talk about protein because actually today I was asking ChatGPT, and maybe you could help me figure out how much protein I actually need per day. Why is protein intake so important? Let’s talk about sarcopenia and how it’s coming for all of us.
Shieva: Well, because we naturally just start losing muscle. Like sometimes, I mean depending on the data you read, like in your thirties you start losing muscle. And then as you and I talked about before we started recording, as your hormones change, you also become more insulin resistant.
So you not only need muscle to strengthen your bones to decrease the risk of osteopenia and osteoporosis, which is where our bones are getting less dense and more prone to fracture as we get older, which is a big risk for women. But in addition, if you become insulin resistant, that’s also going to increase your weight. And as you get more insulin sensitive, you can build more muscle, and muscle helps the insulin resistance. So it’s a cycle.
So for all those reasons, you need to lift heavy weights, which is the polar opposite of what I learned in the seventies and eighties.
Bonnie: Oh my God. It was all about – Yeah.
Shieva: Aerobics and skinny, right? So we were restricting calories and making ourselves small. Now we really want to encourage women to lift weights, heavy weights, to strengthen your bones. And that also builds muscle, which becomes more insulin sensitive. And we want to eat protein because without protein, you won’t be able to build muscle because that’s the building block.
And so it’s hard to say how much, because that’s even controversial. Like a lot of things you and I are going to talk about, unfortunately, there’s data on both sides of the map, but I would say there’s very few definitive data points. Like I will listen to experts in the field who vary from like a person of mine in your frame should eat anywhere from 70 grams of protein a day, upwards of 120 grams of protein a day and anything in between.
So I tend to try to, like theoretically I try to hit 80 or 90 grams a day. And I will tell you that I hit that maybe two days a week, because it feels like a full-time job. So rather than do it exactly based on your kilos and whatever formula you decide, like 0.6 to 1.2, I think it’s easier to just say in general, like if a woman is hitting 70 plus grams of protein a day, that’s pretty good.
But then here’s the other part of this, I think that you and I as physicians can tell people exactly all the perfect things to do. Avoid alcohol, make sure you’re drinking enough water, make sure you’re taking your supplements, make sure you’re doing weight bearing, make sure you’re getting sleep, make sure. There’s a point at which it’s going to make us crazy to have to do all those things.
So I like to kind of generally know about these things and teach everyone about it, but also hold that loosely so that we’re not increasing our cortisol with the stress of like, I didn’t have enough protein, you know?
Bonnie: Yeah. Well, it’s also like our perfectionism can get in the way. It’s like, yeah, it’s like these are ideal, but very few people are actually going to do it. Yeah.
So I was asking ChatGPT, because someone actually told me today, like if I’m trying to build muscle, then I need 150 grams of protein. And that just sounded really, really high. I mean, maybe.
Shieva: I mean some will say that, but then other people would say, you know, yes, if your kidneys are really healthy, they can withstand it. But at the same time, can your kidneys really withstand it? And also like 150 grams of protein, I actually genuinely don’t know how you would actually have a life otherwise, because the amount of time it will take for the volume, unless you’re really intentionally putting extra protein powder in every single meal, for example, it just seems like a lot. But I’m not a fitness expert, I will say that.
Bonnie: Yeah, in fact when I asked ChatGPT for 150, it was a little insane what they wanted me to do. But 90 grams actually feels really doable because when I did ask ChatGPT and I basically fed it like, this is how much protein I want, here are the types of foods I eat. Like, I actually like a lot of different things. I’m pretty flexible. But it was very reasonable and it helped me get a visual of like, okay, this is the type of food I need to eat to get to that level.
And so I definitely have modified my diet. So for example, I was in Greece over the summer, so I really got into the Greek yogurt bowls and that’s a great source of protein.
Shieva: Amazing. So much, there is so much. And by the way, for those of you out there, I just discovered this because I am very lactose tolerant of cheese, but very lactose intolerant of milk and yogurt, but now that brand Fage, F-A-G-E –
Bonnie: Oh yeah, that’s what I use.
Shieva: They have a lactose-free Greek yogurt and it has 17 grams of protein in it. So I actually will put that in a protein shake if I can. Or you probably know this, cottage cheese, an amazing source of protein. Tuna, one can of tuna has like 37 grams of protein in it. So there are definitely ways to do it, you just have to be strategic. It’s hard.
Bonnie: You can’t just, like you have to kind of plan ahead for the protein. Yeah. So, okay. And question, like, why do we lose muscle?
Shieva: Oh my gosh, that’s such a good question. We don’t know exactly. I mean, again, partially it could be the hormone changes, the insulin changes, estrogen really helps support muscle, right? And just the idea that maybe it’s also lifestyle related. As we’re getting older, we’re just naturally getting less active, right?
Plus the stretch of time when you’re in your thirties now is when many women are actually getting pregnant. So getting pregnant, and if you nurse, ironically two things that are so good for our body, quote, unquote, and so natural, but they actually do deplete our body of a lot of the nutrients that we need. And so that can also increase the chance of sarcopenia and then osteoporosis and osteopenia. It’s a big challenge to be a woman, right?
Bonnie: Okay, so tip number one is get more protein and lift heavy weights. Okay.
Shieva: And lift heavy weights.
Bonnie: Yes. Okay. So speaking of like, obviously there’s so many effects of declining estrogen, but maybe I’ll just use myself as a case study. So I started, as you know, hormones. And the reason why my gynecologist who does have sort of additional meno, we should say that a lot of GYNs don’t actually have knowledge and training. And some of them will just say like, I don’t do hormones. I hear that a lot.
Shieva: Yeah. Well, and I think what’s good to know for the audience, who might largely be doctors, I don’t know. So OBGYN training, which is four years, gets very little. I mean, back when I did it 25 years ago, we started getting a lot of training in hormone replacement because I was pre WHI study, that big study that talked about hormones.
Bonnie: Yes, yes.
Shieva: And so I was lucky that I got training and that our residency director cared about it enough. But most residencies after that get like one to two hours of menopause exposure and training.
Bonnie: Isn’t that crazy?
Shieva: It is crazy. It is actually crazy, right? So there should be a separate kind of fellowship. And so nowadays, a lot of general OBGYNs, again, through no fault of their own don’t fully know it. Plus the data has really changed. Even in the last three to five years, the data has radically evolved and changed.
Plus, as you know, we’ve got 15 minutes per patient and you cannot do one and done with menopause, which is why now there is a big crop of doctors and nurse practitioners who are learning on their own through menopause society in different ways. And then they’re doing this either through telehealth privately, but without insurance, which is good and bad, right? Like I think I wish it was more democratized, but this is the world we’re in.
Bonnie: More accessible, yeah. The reason why I went to see her was like, yeah, I have been missing periods. Like I had like three in the past year. And I wasn’t having anything obvious, because like even in medical school all you learn is hot flashes, really. And so I wasn’t having that and my sleep was fine. But I did notice I feel like my brain doesn’t work as well, but then I’m like, well, is it peri or is it the fact that I’m an entrepreneur and I’ve become more ADHD because my days are just a little different and I’m spending a lot more time like being creative and imagining. And so my brain does feel different.
I got labs done after, but then a full cholesterol panel, hemoglobin A1C, I had gestational diabetes and like all that. My cholesterol has been creeping up, it’s always been very low. My hemoglobin A1C has been creeping up. And at first I was – And my diet hasn’t really changed significantly. And so I think these are things that are a result of declining estrogen.
And so I’m lifting heavy, taking walks and stuff like that. And so it’s like, I’m trying to optimize because I don’t want – Who wants diabetes? It’s like a horrible disease and wreaks havoc on the body in many ways. So we started it and it’s, you know, so I’m on the patch and then the progesterone pill at night, which looks like candy. I’m sure you know, it looks like little balls.
Shieva: Yeah. So it depends on which generic brand. I have two bottles in my cabinet. One looks like little balls and one looks like little footballs.
Bonnie: Yeah, why are they shaped like that? It’s just kind of funny.
Shieva: I don’t know. I know. It’s just the gel, it’s a gel cap. So that’s the way it is.
Bonnie: It is kind of fun-looking, like I wish all pills were kind of –
Shieva: Right. They look more like candy, I know. So how do you feel?
Bonnie: I don’t really know how to measure, you know, I don’t know how to measure, except the fact that I did get my period yesterday.
Shieva: Yeah. Which by the way, so this is where, I don’t know how much you want us to go through like the basics. In other words, the hallmark of perimenopause, as you and I know, is that your hormone levels are fluctuating, right?
So they’re not, it’s not like being post-menopausal, which is once you’ve had a year with no period. That means you hit menopause and everything after that is postmenopausal, that’s where you have no estrogen and progesterone. And actually your testosterone has already started to decline a decade ago.
When you’re perimenopausal, which is that time that leads up to menopause, which can last 10 plus years. So anyone listening, you could be in your mid to late thirties to early forties and already be perimenopausal and have very regular cycles, but subtle changes. Like you touched upon, sleep disturbances, maybe hot flashes, maybe mood changes, maybe brain fog, maybe ovulation pain.
Bonnie: Let’s talk about mood changes because I think people don’t talk about that. I’ve read about how depression and anxiety can get really bad when you’re peri and how getting on hormone replacement therapy is like getting on an SSRI.
Shieva: Yeah. Well, and this is where I think a lot of us in this space don’t want to say everyone should be on hormones, but we recognize that this period of time in our late thirties to mid fifties, especially nowadays, many of us are, like maybe we’re having children. So maybe we’re older and perimenopausal as well as being postpartum. We’re maybe taking care of our parents. We’re having careers. So it’s a stressful time.
Yes, we might truly have depression and anxiety, and maybe you really need an SSRI. But you might have exacerbated depression and anxiety because of your hormones. And maybe the hormones are going to help you just as much, if not more than the SSRI according to data, with the added benefit of protecting your bones, for example, in addition to maybe protecting your brain, maybe protecting cardiovascular health.
And I say maybe because as you probably know, the data on cardiovascular health and brain health, I would say is pretty definitive, but the menopause society has not yet endorsed estrogen as a way to prevent it because there’s data on both sides of the map.
But I think a lot of us feel like, why are we throwing SSRIs at people and all kinds of other medications when we could be using hormones, again, judiciously and not in every single woman, but safely and judiciously? Because the preponderance of data at the very least, if it doesn’t say it’s going to help your brain, cardiovascular health and all the other things, it at least says that it’s relatively healthy for almost all women.
Even if we can’t yet say a blanket statement, it’s going to decrease dementia and decrease cardiovascular health, because those are the two things that many people want to believe it is helping and many people want to say it’s not helping. So that’s where the controversy still lies. Whereas hot flashes and bone strength, we know definitively it will help those. So those are kind of the two broad camps.
We know that there’s definitive data it’ll help bones. It’ll help hot flashes and night sweats. I would say we don’t yet know definitive data on cardiovascular and dementia. Despite all that, we have definitive data that it is likely not harmful. And that’s really important, right? The safety of estrogen and progesterone when it is, nowadays most of us use bioidentical and not synthetic forms, there’s amazing safety data.
And that’s not what we had 25 years ago or 22 years ago when WHI study came out. That’s why we’re going to be talking about it more and people are going to hear about it more. And there’s still so much misinformation out there.
Bonnie: It’s so funny. I was like, aren’t I too young for this? So let’s talk about the age range for peri, because I think people think it’s something that happens after their fifties.
Shieva: Yeah.
Bonnie: Because I think people in their thirties might be like, oh, this isn’t relevant to me right now.
Shieva: Yes. And listen, I say this all the time, I never want to make it like, you know you could be perimenopausal. But the truth is if you’re 35 to 40 and you are all at once, very healthy, still able to get pregnant, getting your period, but again, maybe a little schvitzy at night, maybe a little sleep disturbance, again, all those little things we talked about, you might be perimenopausal.
Now here’s the good news, do you have to know it? You actually don’t. It’s not having any major health impact yet on you, other than it’s good to weight train, it’s good to eat protein, it’s good to be generally healthy. But isn’t it nice to know it so that when you start going through these things, you don’t wake up drenched in a pile of sweat thinking there’s something dreadfully wrong with me.
So the preemptive knowledge of understanding that menopause is defined by a year with no period on average to about age 51, but it is literally a minute, like a day that you’ve had a year with no period, that is menopause. Everything after you are postmenopausal.
Bonnie: What if a year goes by, but then you do get a period a few months later?
Shieva: At what age?
Bonnie: Oh, is that the – I don’t know.
Shieva: Well, and here’s where it matters because I wish we could be definitive about all of it. If you were 51, you had a year with no period and then you bled, you are definitively postmenopausal. It is likely nothing dangerous, but you have to be evaluated with an ultrasound.
I would personally say that at any age, but I’m more concerned of a 51 year old postmenopausal female bleeding after a year, than like let’s say you were 45, 46. Strictly speaking, you did not go through early menopause if you went through menopause at 45 or 46, because that’s within the normal age range of menopause, which is on average at 51, but it could be anywhere from 45 to 55.
Bonnie: That’s good to know, because I bet a lot of people who are 45 might be thinking they still – I mean, nothing wrong with being 51, it’s not that far after. But I think there’s a lot of people in their early forties and mid forties who are just thinking like, oh, I don’t have to worry about that.
Shieva: I don’t have to worry about it, right. And again, they don’t need to worry, but the problem is when they think they don’t need to worry and then they have symptoms, then they freak out and they do worry. That’s what I keep saying to everyone.
Like my sister and I, I always laugh, she’s two years older. I’m 55 almost, she’s 57 almost. And all those years in her forties when she would be like, I’m really hot. I’m really sweaty. I couldn’t sleep. My vulva hurts when I have sex, all those things. I would say to her, you know, I think it’s – And she was like, if you say perimenopause one more time. And I would joke like, oh, now I call it the other P word because it became this like dirty word where she –
Bonnie: P word, yeah.
Shieva: She was like, if you tell me perimenopause, like in her mind, I was telling her that she’s old. And I’m like, I’m not saying you’re old.
Bonnie: You know what?
Shieva: Yeah?
Bonnie: That’s really important because I think there is a stigma.
Shieva: Yes, and there shouldn’t be. We should all at once say, this does not mean you’re old. This objectively means there is a stretch of time leading to menopause where your hormones are predictably unpredictable. Meaning I can tell you when someone says to me, what could happen in perimenopause? My answer is anything could happen.
You might have normal periods and then suddenly stop your period altogether at 51. You might have months where it sucks. You might have months where you feel great, and anything in between. So as long as you know that, you can be less scared and less anxious and you can get help.
But I think so many people still shy away from the conversation because, you touched upon it, there’s that stigma that once you’re in perimenopause, you’re on the brink of menopause and you must be old. Or women mistakenly think that perimenopause, for example, at 42 implies that they’re going through early menopause, when they’re not.
You can be perimenopausal for that decade, still go through menopause at 51, which is again, normal and natural. But that doesn’t mean you have to take it lying down. You still get the opportunity to say normal, natural, and I’d like to treat it. We’re living into our nineties now, right? Like you and I were supposed to be dead at 52, 53 back in the day when we were hunters and gatherers.
So now we’re living longer, which is wonderful, but we’re living longer with chronic illnesses. So we have the opportunity to treat ourselves well, feel good, and make sure that we don’t develop those chronic illnesses. And that’s where I think it’s really valuable for people to be mature enough to listen to the data, listen to the history, listen to the knowledge so that they’re not blindsided by it.
Bonnie: I mean, it’s all about being proactive. I’m sure you know about Peter Attia.
Shieva: Yeah, very much.
Bonnie: And just it’s all about being proactive. And I think there’s, thankfully a greater awareness about like, yeah, it’s less about living longer, although that’s great. But it’s like, how do we live longer and feel great? Like he calls it health span.
Shieva: Right. Health span, yeah, exactly. And I think when you talk about that with people, even those people who might be listening who don’t know who Peter Attia is and don’t have access to that level of either knowledge, or I always joke, like I don’t have a grass fed bison farm in my backyard to be able to eat all the grass fed bison I want like Peter Attia does, but there’s so much that –
Bonnie: Wait, does he?
Shieva: Yeah, I think so. I think he has his own bison. I could be wrong. Someone should fact check, but I’m pretty sure he mentioned that in one of the things. God bless him, like if I could – Well, I don’t want to live on a farm, but if I could afford my own grass fed bison all the time, I would.
I think my most important nugget I would like to teach all women to really democratize this is learn the definitions of perimenopause, menopause, and what postmenopausal means. Learn what is normal and natural. Learn the simple ways you can fix it where you don’t have to spend millions of dollars, where you can literally get regular hormones from the pharmacy.
You don’t have to go to someone fancy. You don’t have to do all kinds of injections. You don’t have to buy the latest green juice. You literally have to eat good quality food, which means less processed food, less processed sugar, and move your body more and lift weights. So it could be that simplistic. And you could also do even more than that if you want.
I do think we’re starting to overcomplicate things a little bit in this space, because now we have access to all these other abilities to really –
Bonnie: Oh yeah.
Shieva: And that’s what I want to try not to do too often, right, for the people who can’t or don’t want to.
Bonnie: In many ways it’s like the simple things, again, are like adequate protein intake. And it’s something that women should do earlier in life because I think, you know, obviously you and I both have a lot of friends who are women. And so a lot of my friends are physicians, they’re highly educated, and a lot of them are – Well, you know a lot of physicians don’t take care of themselves. And what I mean by that is like exercise and stuff. We’re not lifting weights.
Shieva: Right, or sleep. We’re not getting adequate sleep. I mean, and our system is not cut out for it, right? Like many of us, you and I, I mean, at least for me, when I was 29 to 34, I was a resident. I was getting the worst sleep of my life. And then I was an early attending. So had you said to me at the time, lift weights, sleep more, I would have been like, when and how am I doing that? Like, who’s taking care of these patients?
Bonnie: But our friends are older and so like, I’ll just be like, are you lifting weights? Like one of them is an avid runner. I’m like, but you need to lift weights. And I think people just don’t understand how important it is.
Shieva: I know, yeah. I think that no matter how much, for example, you and I think everyone’s talking about menopause right now, right? It’s getting such a moment. Like you look every other day in the New York times there’s an article. And yet day after day, I see it on Instagram, women write to me and they’re like, but I thought hormones caused cancer, but I thought vaginal estrogen is really bad for you. Things that I’m like, again, what is everyone Googling? If they’re not Googling this, like, how are they not hearing it?
But I think that the truth is, no matter how much our silo is focusing on it, the average person out in the world, I mean, they are truly worried about other things, as we know, the price of eggs, right? Like they are not able to hear this information or digest it or know it.
So I’m hopeful that in the next couple of years, we’ll be able to get this basic stuff to be much more mainstream and get the doctors who are taking insurance. God bless them all, including my practice, we still take insurance. But I hope that we all find the time to be able to help women with it because they need it.
Bonnie: This is where I think just encouraging my friends, like following people like you, Kelly, Marie –
Shieva: Mary Claire Haver.
Bonnie: Yeah, because that’s how you can start getting educated and learn a bit, you know, read some books on it and stuff like that. So I think that’s a great start. And this is also why I’m so excited that you’re coming to our conference, because I know it’s going to be such a great value add and women are going to, I know they’re going to be so grateful to have learned about this now versus just being like having no idea what to do.
And again, it’s going to be doctors and most doctors don’t know anything about it. So I just wonder, like if doctors don’t know anything about this, how do we expect the public to even know, right?
Shieva: Bonnie, this is what I say, and you have a son, so I don’t know if you’ve thought about this yet. But this is what I say a lot, no matter the age, demographic, race, religion, socioeconomic status and education, right? Like the most educated physicians, who one would think knew their OB GYN health, they don’t get access to their OB GYN health knowledge, right?
Like you were a dermatologist, so you didn’t get access to the OBGYN health knowledge. And no matter how educated you are, you are of the highest education in our country, right? But you didn’t get to learn about it because your teachers didn’t know. When you were in medical school, they didn’t teach you about it. Dermatology residency didn’t teach you about it. And even your family members would not have necessarily known.
So it is, I always jokingly say, sadly, that it’s the great equalizer, OBGYN health knowledge, which is actually the most important thing in a way to us, right? We didn’t have access to as women. Like I was a daughter of a pediatrician. She was amazing. I didn’t know about my own HPV until I found out. I didn’t know about my own endometriosis until I had a massive ovarian cyst with it. I didn’t know about the number of pregnancy losses I was going to go through, my ovarian cancer, right?
So it is sad that education itself still hasn’t even seeped into OB GYN health. So I’m thrilled to be talking to all the doctors, for example, in February. But I still feel like, how is it possible that as women, we still haven’t gotten to learn about our own health? And this is really a fault of the system. Like we have to fix this somehow.
Bonnie: Unfortunately, I wish you and I could just say, hey, these are the three symptoms of perimenopause and then leave it at that. But it could be so many things and a lot of symptoms are vague. So actually when I was talking to a friend about, because I didn’t feel like I was having perimenopause symptoms except the fact that I was skipping periods. And I was like, yeah.
And then they’re like, well, what about brain fog? I was like, I don’t know about brain fog. But then I just said my cholesterol, like the labs were just showing, and I don’t necessarily feel that different. Like I still sleep great.
Shieva: Right. Right. Well, and that’s a good point. Yeah. I mean, so you – Okay, so I would say this, there’s so many points we could do. I’ll try to pick a couple of basics because this could be like five hours of us discussing it.
Bonnie: Yeah.
Shieva: I think that, like I said, first and foremost, I want women to know the definition of it. I want women to understand and not be angry at their doctors that their doctors don’t know it. So they might have to go to their doctor saying, hey, I’m 48 years old. I’m missing my period a little bit. I’m not having hot flashes and night sweats, but I know it could be perimenopause.
Or I’m missing my period and I am having hot flashes or night sweats or mood changes or brain fog or more weight around the middle or more hair on my chin or less hair on my head or decreased libido or more acne or more ovulation and breast pain. These are all like very common symptoms.
And then there’s less common symptoms, burning mouth, you know, people describe all kinds of skin changes. So there are a variety of symptoms, get to know what they are. I mean, if you overall are doing okay, then at least just knowledge of the basics is good.
There’s certain lab tests that you should have done. And I still think that women should see a primary care doctor every single year. And that means they would have their cholesterol checked, their thyroid checked, their blood count with their iron levels, ideally, because these things can all fluctuate once you get through perimenopause and being postmenopausal.
And as long as those are okay, then you get to decide, do I want to treat perimenopause or not? I don’t think we’re yet at the point where we can safely say every woman should be on hormone replacement for prevention of everything. Meaning I’d like to say that, but our societies don’t allow us to say that.
What we can say is hot flashes and night sweats and osteoporosis prevention are distinct reasons why people can be put on hormone replacement. And then there’s a variety of other things that many of us agree there’s enough data that it probably is worth it because it’s not unsafe.
The challenging part for women in perimenopause is that, like I said before, it’s predictably unpredictable. So trying to fix, like in your case, you’re on a patch of estrogen, which is bioidentical, meaning you got it from the pharmacy, but it is the type that mimics your own hormones. And you’re on a pill of progesterone, which is hopefully helping sleep, even though you don’t need it.
But trying to control your hormones when your hormones are fluctuating is hard because these hormone values are still lower than, for example, birth control doses. So one thing that is now coming out of this movement to teach people about menopause and perimenopause is I can’t believe some of these doctors are still putting perimenopause patients on birth control pills. You’ll hear people say this and they’ll kind of really malign doctors putting women on birth control pills to fix perimenopause.
Bonnie: Is that wrong?
Shieva: No, and that’s what I was going to say, I think that is an unfair statement, meaning perimenopause is more easily fixed by birth control doses because birth control doses are supra-physiologic. They’re higher than our normal doses, they shut down your ovaries. They make you not ovulate, which means all those fluctuations even out. So that’s a benefit.
Now, they’re not bioidentical. They are synthetic, at least in our country, and there are side effects and risks. So with the benefit of making life even, there come risks. So if instead I put someone on HRT doses, I’m using bioidentical, which is technically safer, and lower doses, which are technically safer, but it’s not as easy to control her symptoms.
You, for example, as an educated woman who has the time to think about it, might decide that that’s better for you. But there are a lot of other women who, regardless of their level of education, their means, whatever, they don’t have the time to kind of screw around with different doses of the patch and the pill and things like that. They don’t necessarily have a doctor they can call. They really might be served best by being on the birth control pill.
And so I really would personally kind of stand against all of my, I will say sisters, because it’s mostly females in our space, who are swinging the pendulum the other way and really maligning the birth control pill. Because again, the birth control pill, yes, has negative downsides, but also has some positives.
So I think what’s important for people to hear about and learn is, there’s no one way to fix this. There are multiple different ways, and it’s got to be a process and you have to, unfortunately, have some patience within the process, and listen to a few different sources to really understand all the different aspects of it, which sucks, right?
It would be so much easier if it could be one and done and I could just say, everyone go on the pill, it’s easier, or no one go on the pill, it’s easier. But the answer to all of this is, it depends, right?
Bonnie: Yeah. When do you think I would see improvement in blood glucose and cholesterol? I’m assuming that takes time.
Shieva: Yeah, but I would say, honestly, we know just in general with most of these types of hormonal things, which obviously cholesterol and blood glucose fluctuate with hormones. So I would say two to four months, I suspect you’re going to notice an improvement.
Now, here’s the truth. If someone said to me, if I only do the estrogen patch and progesterone at night and I don’t change my diet or exercise to increase insulin sensitivity, am I going to notice an improvement? The answer is, we don’t have great data. You might improve a little bit, but it’s not like, you still have to do the work, which you’re doing. So I would say two to four months, you’re going to notice some improvements.
Is it going to be dramatic enough where you don’t ever, for example, need a statin? Hard to say. Some people, yes. But we also, and you probably know this, some people synthesize cholesterol, and some people absorb cholesterol from their diet. And people fall into two different groups, and we don’t know which group you’re in just based on your cholesterol level. Like that’s kind of second level testing that people sometimes need to do.
But again, as soon as two to four months you might notice an improvement, especially in your A1C level, right?
Bonnie: Maybe I’ll just recheck it.
Shieva: Do it right before the conference. Yeah, do it in February before the conference and then we’ll see.
Bonnie: Yeah. Because my hemoglobin C went from, it was like 5.9 last January. And then it went down to 5.5 because I was doing some modifications. And then a month ago it was 6.0, and it’s never been that high. And the CGM, it’s like, again, it’s been depressed. Rice is just insane when I eat, right? I don’t want to tell you how high it got. I just was like, holy cow.
Shieva: Have you experimented with, and again, I think the data is like pro-con, about making the rice, freezing it?
Bonnie: Oh, maybe. I haven’t done freezing, but I did refrigerating.
Shieva: The resistant starch, yeah.
Bonnie: It still went up pretty high, but it was nowhere near it. It was a lot less.
Shieva: Less.
Bonnie: And honestly, I don’t even eat rice that often. I mean, I am Korean, but there’s weeks where I go by not having it. So, it’s not like, but I’m never going to cut it out. Everyone’s like, oh, you should switch to cauliflower rice. And I was like, no.
Shieva: Well, and here’s the thing, that’s what I mean. You know, I always joke that I literally had weight issues as far back as I can remember, since I was like six or seven years old. But I always say, I wonder is it all the food I was eating, or was it the self-flagellation over all the food I was eating, right?
I think of course you have to generally eat healthily. But if you’re so obsessed about how you’re eating and how you’re lifting and how you’re doing, again, that cortisol stress response is going to affect your glucose far more, probably, than enjoying the rice and eating the rice and giving good energy to that rice as it’s delicious and you eat it.
How was your fasting glucose with your CGM?
Bonnie: It’s in the, actually, let’s look. I have the aura ring, too. So, I just feel like I’m gathering all this data, which is fine. Let’s look at it. The CGM is wild. I’m like, this is crazy. So, is this like right when you wake up? Like, when do you actually?
Shieva: Well, I mean, it depends. Like, listen, because you have a CGM, you can say right when you wake up. If you didn’t, you probably would do it within a half an hour of waking up before you eat, right? So, give me both. What’s the difference? Tell me what it is.
Bonnie: It’s funny because at 6:16 it was 89. I think I got out of bed more like 6:30, which was 82. But then 6:26, it’s 102 and then it’s 90. But yeah, it’s under 100.
Shieva: Listen, I will tell you this, as OBGYNs, we’re a little bit more finicky, probably, than your primary care because we’re used to what we would have considered, like do you remember when you were pregnant?
Bonnie: I had gestational diabetes.
Shieva: Right, and so you would have been instructed that you needed your fastings to be below 90 to 95, and your two-hour postprandials under 120. I know. And so I will tell you that I do think that those numbers are actually what you should try to – I’m not an endocrinologist.
Bonnie: Oh, I was told 140. Like, I’m in trouble if it’s really, again, I think right now I’m just what I call the data collection. I’m not judging. But then I get to experiment. So again, today I had rice that was refrigerated. And then again, like being mindful of protein. Do you know what the seaweed wraps are that Koreans eat?
Shieva: Yeah.
Bonnie: The crispy seaweed. So I had that, just making little rice sushi rolls. So, I had avocado, I had canned salmon, and I had a hard-boiled egg for the morning. And I just was eating that as little rice rolls and just kind of experimenting.
So, it still went up high. It was like 180. But it was over 200 when I was eating fresh rice. And so I’ll just keep experimenting, like just different combinations.
Shieva: Do you like pasta?
Bonnie: I do. I don’t eat it super often.
Shieva: I know, because I have to say, pasta is like my – I’m Iranian, so I should love rice. I actually do not care. If I never have rice again, I’ll be fine. I love pasta. And I hate all these alternative pastas, except that I just found edamame pasta, which is just edamame. That’s the only ingredient. And I swear, it tastes like spinach fettuccine. And I put some butter and olive oil –
Bonnie: Is it in the refrigerated section?
Shieva: Nope. It is dry. And I order it from one of those big companies that sells us everything. It comes overnight. And it’s got 25 grams of carbs, but 25 grams of protein.
Bonnie: What?
Shieva: And it’s literally only edamame. That’s the only ingredient and it’s so good.
Bonnie: You know, it’s interesting, I’m not gluten intolerant and I’m not gluten-free, but I do try to reduce my gluten intake. So I buy the Jovial blend or this Andre. And I feel like it’s pretty good, but edamame, I’m going to –
Shieva: Oh, you’re going to like this better. I’m telling you, it’s so good. It is so good. And yeah, I think, listen, I do think it’s good to decrease our processed carbohydrates, right? Like red rice, pasta, and sugar that are processed. It’s always ideal to –
Bonnie: So what brand? I see Explore and the Only Bean.
Shieva: What is the one? It’s like a navy blue, I’ll look and see. There’s two different brands, I’ve ordered both and they taste the same.
Bonnie: The Only Bean is a green packaging. Explore is kind of like more neutral.
Shieva: Okay, the Only Bean, I’ve had that one. And then I like, I’ll tell you the one that I liked slightly better just because of the size of the noodle, that black one, yeah, the blue one, Seapoint. That was my favorite one.
And I’ll tell you another topic that unless you have other questions that we could talk about quickly. I mean, not really quickly. We’ll make it quick, but there’s a lot of stuff to discuss. It’s vaginal estrogen. Vaginal estrogen.
Bonnie: Let’s talk about that.
Shieva: So people with vulvas, so our vagina, our vulva and our urethra, which is the hole we pee out of, for those of you who don’t know, is very sensitive to estrogen and actually a little bit to testosterone, but very, very sensitive to estrogen. And so that means that three different times in our lives, we will be very estrogen deficient and we will be affected by it.
One is if you’re pregnant and then nursing. So during nursing, your estrogen levels are really low because your prolactin level suppresses ovulation, very low. This is why postpartum, if any of you have tried to have sex after your six-week visit, when your doctor was like, hey, you can have sex. It will hurt because your vagina and your vulva are less elastic because you’re essentially in an estrogen depletion state and vaginal estrogen will really help.
The second time is if you’re on combined hormone contraception, like on the pill.
Bonnie: Wait, question, can you do vaginal estrogen postpartum?
Shieva: Absolutely, I prescribe it.
Bonnie: Oh, I didn’t even know that was a thing.
Shieva: Oh yeah. See, this is why. And don’t even get me started because there’s a whole reason why I can tell you why you wouldn’t know it’s a thing, because your doctor didn’t have time at your six-week visit to talk about it.
And then the second time is during the birth control pill. If you’re on prolonged birth control pills, some women, because they’re on estrogen for the pill, but it’s a steady dose and it’s a synthetic dose and it antagonizes the estrogen in our vulva and vagina. And again, it can hurt. You can take vaginal estrogen then.
And then the most notorious time is perimenopause and most likely postmenopause. Perimenopause is potentially less for many women because they still have estrogen, but their estrogen levels are fluctuating. But postmenopausally, the data would say like 30 to 50% of us have symptoms. But really, if you actually asked women directly and asked them the symptoms, I guarantee it’s more like 70 to 90% of us. Because even for example, recurrent urinary tract infections, that is a symptom of estrogen deficiency.
And rather than taking antibiotics multiple times, especially if you’re getting recurrent urinary tract infections after sex, if you actually just use vaginal estrogen, you would enjoy sex more. It would hurt less, and you actually would not be getting urinary tract infections recurrently, for most women.
Bonnie: So how do you actually apply it? It’s like a gel? Let’s just talk like –
Shieva: Yeah, so there’s a cream. I know, I wish I knew we were just definitely going to talk about it because I have like my bag of tricks. But there’s a cream, there’s a ring, there’s a tablet, and there’s like a little gel cap torpedo. And that’s all estrogen. Then separately, there’s also vaginal DHEA, and that converts into estrogen and testosterone. And that’s a little suppository.
I personally actually think that while the cream is not the easiest, I think it’s the most impactful because, as you can imagine, remember I said it’s the vagina, the vulva, and the urethra. So if it’s just the tablet or –
Bonnie: You’re able to spread it around.
Shieva: Yeah, the cream, you can smear it all over the place. So what I tell my patients when I prescribe vaginal estrogen, I tell them three things. A, it might not be covered by your insurance because your insurance does not give a dang about your dry and inelastic vulva and vagina. So you might have to pay for it. But nowadays on like Cost Plus Pharmacy and all these other online pharmacies, you can get a big –
Bonnie: Are you talking about Premarin?
Shieva: Premarin is the brand, or Estrace is the other brand. Most of us use Estrace because it is the bioidentical form, but now Estrace is generic. So it’s estradiol cream. So I prescribe the tube. I tell them it might not be covered, but you can get it online for about $30 for a big tube.
Second, the package insert will tell you that it causes cancer, stroke, heart attack, blood clots.
Bonnie: Oh, great.
Shieva: They are misquoting actually the systemic hormone data, meaning the hormone data that they put on like the old Premarin boxes that are oral formulations. They’re putting it on the vaginal cream. It is absolutely safe, even for people who have had breast cancer. There’s multiple, multiple, I mean thousands of studies supporting this.
The third things that I tell them is when they say, well, how long do I have to use it? You got to use it as long as you want to use your vulva and vagina either for sex or just for comfort. Someone will say, well, I don’t even want to have sex, but when I’m like spinning on my Peloton, it’s irritating because their vulva and the vagina become less elastic and then it gets irritated.
Or again, nursing home women will get recurrent urinary tract infections. And as you probably know, this is a big source of concern. If they all had some vaginal estrogen that they put inside, it would help.
So you get the applicator. Most of us start with a half a gram or a gram twice a week. I tell patients start with the applicator because then you know how much you’re using, but after two or three times, because it’s usually twice a week, twice a week regularly, then you can toss the applicator because it’s annoying because you have to wash it, and eyeball half a gram to a gram.
A half a gram is about the size of a strip of toothpaste. And you put it literally, like if this is your vulva, you put it all around the outside, up into your vagina, smear it all around. You cannot mess it up. And it’s so valuable. Like if we gave that one intervention to all women, that alone truly would revolutionize so much. We would decrease UTIs. We would decrease pain, discomfort, all of it.
Bonnie: I mean, obviously I knew it existed, but I was just like, I don’t really feel like I need that right now.
Shieva: Yeah, and you might not. You might not need it now, but all of a sudden, let’s say in one, two, three, five years where you’re like, huh, I just got my second UTI, I want you to remember this conversation and be like, I’m not going to keep going on antibiotics to prevent the UTI. I’m going to actually use vaginal estrogen to restore my vagina and vulva to what it should have been.
Bonnie: Oh, let’s talk a little bit about testosterone.
Shieva: Okay, so here’s another nugget. And I think you know the answer to this, but if you don’t, don’t be embarrassed because most people don’t. Do we as women have more testosterone or more estrogen in our system?
Bonnie: I think I know the answer because I follow people, but I bet most people will say the wrong answer.
Shieva: Yes, so what answer do you think it is?
Bonnie: It’s testosterone, right?
Shieva: Yeah, women have more testosterone than estrogen. We still have less testosterone than men, but more testosterone than estrogen, but we have gendered hormones, right? Which we shouldn’t have. We’ve said testosterone is a male hormone and estrogen and progesterone are female hormones. But in fact, men also have estrogen, it’s just in different levels.
So because of that, estrogen and progesterone have gotten a lot of attention. Not enough, but a lot. Testosterone really has been ignored and only kind of looked at as like, oh, you only need that if you’re trying to build muscle like a bodybuilder or, oh, you people are trying to use it for libido.
So as of right now, the only indication that is kind of sanctioned by our governing societies, like menopause society and ACOG is hypoactive sexual desire disorder, which means if you have been diagnosed with that and you have less spontaneous desire and low libido, then your doctor can prescribe testosterone. Though in their defense, they might not know how, they might not have been taught. And it is technically a controlled substance because it’s off-label for women.
It is not an FDA approved indication for women. So even though we know scientifically it’s okay to use, we have to prescribe it to you, if we’re using a commercial pharmacy, off-label. So we end up having to do things like give you a one month male supply that will last 10 months for a female, because we use about a 10th of the dose of what a man would use every day because, you might know this, testosterone is frequently prescribed for men.
Like frequently FDA approved, multiple formulations, not even a question. For erectile dysfunction, I shouldn’t misspeak about erectile dysfunction because I don’t treat it, but it is up to 40% of people will have erectile dysfunction, which means it’s a pretty common thing.
Bonnie: Is it like their perimenopause?
Shieva: But they call it dysfunction, right? Whereas in our case, they’re like, oh, it’s natural. Perimenopause is natural. But in their case, we call it dysfunction.
Bonnie: That’s fascinating. It’s like, of course. Yeah.
Shieva: Of course, so they get treated. So testosterone, you will hear more about it, thankfully. Hopefully one day we will have a female formulation. Right now your options are get it from the regular pharmacy through your doctor or your menopause clinician. But again, they’re giving you what is technically a male dose in a one month supply, or they might prescribe it through a compounding pharmacy. There are people doing injections and pellets. I would personally say I don’t think there’s enough data yet to do that safely.
Bonnie: I thought aren’t pellets like not a good thing because you can’t really control the dose.
Shieva: Yeah, I think it depends who you ask. I would personally say that I don’t feel like I need to prescribe pellets for my patients or use pellets because so far I’ve been able to mostly help them and control them with these FDA approved like estrogen and progesterone doses and off-label uses of testosterone. So I would not use them myself or for my patients or my sister, for example.
Do I think there are some clinicians who are very judicious in using very, very low doses? I do. Like there’s some doctors in the space that I love and I trust and I believe that they are being judicious and using very low doses. And the reason why they use it is they say that it is more convenient because you get the pellet put in.
And just for everyone to know who’s listening, a pellet is this tiny, tiny little what it sounds like, a pellet, that’s being put right basically underneath your skin, like at the top of your buttocks. And it’s slowly releasing testosterone or estrogen. And our concern with it is, as Bonnie said, you don’t know exactly how much the person is absorbing. And once it’s in, you can’t take it out.
Bonnie: So that’s the part, you can’t adjust it.
Shieva: So to me, because it is not FDA approved and untitratable, and the majority of the data, even if it looks good, is by the companies who sell it. So I personally, unless they come out with really good –
Bonnie: It sounds kind of horrible. Can’t take it out. Can’t adjust the dose. You don’t know what you’re on. It’s like, why would you do that?
Shieva: Well, and again, I’ll be equitable and say this, I’ve seen some terrible, terrible side effects from it. I’ve also had patients who claim that they feel great on it and I believe them, but I still would personally say we can achieve you feeling good, yes, with a little bit more titration, but through more studies.
Bonnie: That just seems like it makes sense to do that. Sensible.
Have you heard the drug Addyi?
Shieva: Yeah, of course.
Bonnie: What are your thoughts on that? I had never heard about it until two weeks ago.
Shieva: Yeah, I will tell you this, here’s another nugget for y’all to know. Female libido, do you know how many drugs there are for female libido?
Bonnie: Is that the only one?
Shieva: There’s two.
Bonnie: Two.
Shieva: There’s Addyi and Vyleesi and then off-label testosterone, right? But there’s two FDA approved drugs. Do you know how many drugs there are for male erectile dysfunction?
Bonnie: A gazillion.
Shieva: 27 or 28. Multiples more, right?
Bonnie: Because people don’t care about women.
Shieva: Because people don’t care about women because we are taught – I mean, there’s so much we could talk about that. So yes, Addyi is a pill that you would take every day that theoretically can help with spontaneous desire. And I definitely have patients who think that it’s worked a lot. And I’ve had other patients who don’t think it works a lot. It actually might have a little bit of a beneficial effect on weight as well, so that’s good.
Bonnie: Oh, yeah. I’ve heard that too. Yeah.
Shieva: Yeah, because it works in the central nervous system. And so I think it’s great. And I think that the founder, Cindy Eckert is –
Bonnie: I heard her speak.
Shieva: Oh yeah, she was at your conference, right?
Bonnie: At the conference. Yeah, at Lead Her. Yeah, it was, I mean it was just amazing.
Shieva: She really cares. And she cares and she has done an amazing thing. You heard her story, how she sold the company and then bought it back. And then Vyleesi is an injectable that you could use twice a week, so eight times a month. And that’s right before you’re about to have sex. And it can help with, again, spontaneous desire, orgasm, things like that. So I do wish we would have more. I really do.
Bonnie: Yeah. Well, she started the talk with asking, how many know about this medication, like the pink pill? And I don’t think it was more than 50%. She’s like, how many of you know about the blue pill? Everyone.
Shieva: Right. Oh, everybody. God, how would you not know about the blue pill? Because it’s all over, there’s commercials all the time for erectile dysfunction. Like many women come to me saying, there’s something wrong, I don’t want to have sex, it must be menopause.
And here’s the honest answer I would say to all the people out there, menopause certainly can exacerbate it and perimenopause can exacerbate it because we’re tired, because we’re stressed, because we’re not getting sleep, because of all those things.
But also one of the biggest indicators of whether or not you have spontaneous desire, meaning walking around wanting to have sex, as opposed to when you’re in the act, once you start having sex, are you able to get lubricated and be excited and then have an orgasm? The answer is most of us, once we’re in it, are okay, but we don’t have spontaneous desire anymore.
And the biggest indicator is length of time in your relationship, which is why you and I have divorced friends who are our age, they are having rampant sex because they have spontaneous desire for their new partner.
And that doesn’t mean, I don’t say that to advocate for everyone cheating or getting a new partner. But I say it to audiences of women.
Bonnie: I mean, it makes sense.
Shieva: It makes sense. And that’s why I think, at least if we know that, then we can strategize. Now that I’ve said it, I want you to think of the people you know in your life who probably have the best relationships with their long-term partners, probably strategize things, whether or not they realize it.
They’re doing things to keep themselves excited. They’re maybe listening to erotica. They’re using vibrators. They’re talking about it with their partner. They’re keeping that feeling alive, not in a way that they needed to when they were younger, because when they were younger in a new relationship, that just happened.
They’re doing what people who exercise a lot do. I don’t love to exercise, but once I’m in it, I’m like, this is great, I’m going to do it again. And then tomorrow I’m like, I don’t want to do it again.
Bonnie: Oh yeah, I rarely feel like doing it.
Shieva: Right, but I could do better mindset work and decide that I want to be that kind of person who really loves exercise and work on it. And we could do the same thing for sex if we were taught that, but we’re not. So we end up just, as I joke, we just end up sucking it up and doing the labor of love or letting our sex life really dwindle.
And instead, we could help ourselves either with medication or mindset or both and with vaginal estrogen.
Bonnie: Do you feel that if partnered married people are not having sex, is that an indicator of something bad about their relationship?
Shieva: You know, I really, I will say this, I think it very much, like most things in medicine, very much depends. Right? I think that I have friends, patients, family members who have beautiful, really deep relationships that are very fulfilling and they have very little or no sex or they have not penetrative sex, but they have oral sex and they touch a lot and cuddle.
And I know other people who are having regular sex with their partners and they have very damaged relationships. So I really do think, I hate the term sexless marriage, you know there’s a term sexless marriage?
Bonnie: Yeah.
Shieva: And I think the truth is this, for many couples the lack of sex is because their marriage is damaged, right? And because they haven’t worked on it and because they’ve let all of that go by the wayside. But I don’t think it means every couple that doesn’t have sex has a bad marriage.
I think you two get to decide together. Like are we not having sex because we love each other, but we actually have decided we don’t want to, for whatever reason we don’t want to. But we otherwise are connecting emotionally and maybe even physically in other ways. Or are we not having sex because we’re avoiding each other and maybe it hurts and I didn’t go see my doctor and maybe you have erectile dysfunction and you’re too embarrassed and maybe I hate you because you snore too much.
I think anyone who says it is a sign of something wrong, I think men who are not having sex regularly probably have either a medical condition or maybe you’re seeking sex outside of the relationship because I think most men, their testosterone levels don’t tend to wane as much as ours do. So when I say medical condition, because we’ve determined that erectile dysfunction is a dysfunction and not natural, I would say those men could get help.
Bonnie: That’s fascinating. I never heard that.
Shieva: Right. Right, so I could look at it both ways. I could say, hey, it’s natural because 40% of men go through that. I think the data was, I think, we should check me on this, 40% by age 65, which means it’s somewhat natural. But since we’ve labeled it dysfunction, if a man goes through that and because there is shame attached to it for men, they really should seek help because they can get help pretty easily.
Bonnie: I’m assuming it’s also covered by insurance and cheap.
Shieva: Of course. I mean, it was covered by Medicare even.
Bonnie: What?
Shieva: Yes. But they should also make sure that their female partner is getting help because the last thing you want is him to be getting the blue pill when you haven’t gotten your vaginal estrogen and maybe your pink pill and your mindset, because then you’re just forced into a really incongruent relationship, which I do think is what happens for a lot of people.
Bonnie: I bet Addyi is not covered by Medicare.
Shieva: Oh God, it’s not covered by any commercial insurance. It’s like, I think it’s about $99 a month, which is very worth it for people who want to use it, absolutely. But not covered.
Bonnie: All right. Well, we could talk about so much more, but I think we covered a lot of topics. And for those listening, I hope this has been really informative and piqued your interest to, I was going to say it’s coming for you like it’s a bad way. But it’s going to happen, so be informed and be proactive.
Shieva: Yeah. And it’s not all bad, there’s many good aspects to it in many ways.
Bonnie: Okay. Well, thanks so much for being here. How can people find you?
Shieva: Thank you. I’m mostly on Instagram at Dr. Shiva G, which I like.
Bonnie: Can you spell that?
Shieva: D-R-S-H-I-E-V-A-G. So Dr. Shiva G, V-A-G is in the last part of it, so I love that. So that’s on Instagram. And then right now our website tribe called V, like Victor, like vulva, vagina, tribecalledv.com, which will be in the near future switching to womaning.com where we are going to help, I keep saying that we want to help decrease your anxiety by increasing your knowledge about your OBGYN health because womaning is hard.
Bonnie: Yeah. All right. Thank you so much for being here.
Shieva: Thank you, I appreciate it.
Bonnie: That was an amazing episode. I hope you enjoyed it and got so much value. And I hope this inspires you to maybe follow who I consider the thought leaders in this. So obviously there’s Dr. Shieva and then Kelly Casperson and Marie Claire Haver. And it also keeps that information fresh so that I know it reminds me to make sure that I’m doing what I can to stay on top of my health.
So if you love what you heard, then I encourage you to grab a spot at the Live Wealthy Conference, February 20 to 23rd in beautiful Hawaii at the luxurious Four Seasons. Spots are going fast and I don’t want you to miss this chance.
Now, and I’m not just seeing this, but I’m not sure I’m going to do this conference again. And people have asked me why not? If you know anybody who has planned a conference, it is a ton of work and the costs are so high. Like the AV, we got an updated quote and it was almost double, like $70,000. And that’s not even including our videographer.
And so between that and just all the time it takes for my team to plan this, I’m just honestly not sure I will do it again. I’m actually thinking I’m going to move to smaller retreats. There’s a Paris retreat that I’ve been wanting to do. And so that’s where I am right now. And so this is your chance to come to possibly the last Money and Wellness conference, and go to wealthymommd.com/conference to learn all about it and to save your spot.
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