I Got Rejected for Loans in Residency — So I Started My Own Bank For Doctors!

Dr. Michael Jerkins is a med-peds physician and the co-founder of Panacea Financial, a financial services company for doctors. After being rejected for multiple loans during residency, Michael realized that traditional banks were failing doctors as customers. So, he created a bank that understands the unique financial struggles and goals of the medical community.

In this episode of How I Doctor, Offcall co-founder Dr. Graham Walker talks with Michael about why doctors need their own bank, and how Panacea has evolved since its launch to continue meeting the needs of physicians (and eventually other clinician groups too). They also explore why more doctors are looking for ways to practice on their own terms, and discuss numerous other aspects of doctors' financial lives.

Here are four highlights from an episode filled with incisive insights about physician financial well-being, entrepreneurship, and our broken consumer banking system.

Traditional banks have treated doctors poorly because of their “weird financial life cycles.”

“You could actually be taking care of a banker's family. They're like, "This person, I'm going to trust with literally my life," but when I get back to work, "Sorry, dude, you can't have this couple thousand dollars."’

While physicians have high earning potential, they also face a unique set of financial challenges driven by the cost and length of medical education and training: Doctors start making money later, and many begin their careers with considerable debt and no savings or credit history to speak of. And it’s not only student debt; it’s common for early-career, cash-strapped doctors to take on high-interest credit card debt too. These aren’t the attributes banks typically look for in customers, so doctors frequently get rejected for loans — even for just a few thousand dollars.

During residency, Michael learned first hand about the pain points of dealing with banks as a doctor. Despite budgeting as best he could, Michael had a growing family to support and found it hard to make ends meet. Any unplanned expense became a source of stress and sunk him further into debt. Multiple banks denied his personal loan applications, saying he either needed to make more money or get a cosigner.

Other residents had similar stories. Michael realized the situation didn’t make sense — doctors were treated like responsible, trustworthy adults in every way, except when they needed money (for perfectly understandable reasons). The roughly 4,000 banks in the country didn’t understand doctors as financial customers and they weren’t trying to. The solution, Michael decided, was to create a bank that catered specifically to doctors. So that’s what he did. Along with another resident, and eventually a partner with a background in investment banking, Michael launched Panacea Financial. They started by offering personal loans and have built out their services over time.

Physicians shouldn’t underestimate the value of their “secret sauce.”

“As doctors, we have a lot of skills and flexibility, and can learn new things very quickly. That's our secret sauce. I just think we don't give ourselves enough credit for how much we actually can do outside of your standard academic or private practice clinical track and being willing to learn and listen, just like we did every single month in residency in med school, learning a new thing. We can do that same thing and find really creative ways to help our community.”

In launching and building Panacea, Michael has learned how important it is to seek out other types of experts, beyond just doctors. But he’s also come to realize that his own expertise is broader than clinical knowledge. Physicians aren’t just experts in their specialties; they’re also experts at being fast, nimble learners. This ability shouldn't be overlooked.

When it comes to financial planning, Michael says doctors just need to find the right balance between humility and confidence. He’s seen doctors default to one extreme or the other: Some “get in front of their skis,” assuming they can manage their money without an advisor, since nothing is harder to master than medicine. Others underestimate their ability to become fluent in financial concepts. Michael believes the best mentality is the same one he recommends to medical interns: “I don’t know, but I can find out.”

Physicians aren’t the only clinicians who haven't been well-served by traditional banks.

“We started with physicians, and that's the community we knew best, but we started to get a lot of demand from our dentist and the veterinary colleagues like, "Hey, we're having the same issues over here."’

When Michael’s own negative banking experiences inspired him to start a bank for physicians, other clinical communities weren’t on his radar. But demand from dentists and veterinarians eventually led Panacea to expand their customer base. Their financial concerns and priorities aren’t identical to those of physicians, but there’s a lot of overlap. And they similarly don’t feel understood or properly served by traditional banks.

The biggest distinction between physicians, and dentists and vets, Michael has found, is the percentage of clinicians who are practice owners. About 80% of dentists are owners in some capacity, compared to 30% or less of physicians. That’s because owning a small business isn’t as big a wealth-builder in medicine. A physician’s primary asset is still delivering clinical services.

However, Michael has noticed the tides turning, somewhat. Locum tenens work used to be something pursued primarily by later-career doctors, but it’s becoming more popular across the board. This reflects a broader trend he’s noticed: Doctors are increasingly looking for ways to practice on their own terms.

Michael sees big benefits to staying in clinical practice part time.

“When I'm leading a financial institution for doctors, I need to know what's going on, right?”

Whenever Michael speaks about Panacea to a physician audience, the first question he gets is: “Do you still practice?”

He does, and he doesn’t plan to stop. He currently does three half-days of practice each week at a family medicine clinic. For one thing, he likes patient care. Like most doctors, that’s why he went into medicine. What’s more, Michael believes being in the clinic is like field research for his job leading Panacea. Doctors’ specific financial struggles and priorities evolve, and he wants to keep his insider knowledge up to date.

Connect further with Michael on LinkedIn here.

To make sure you don’t miss an episode of How I Doctor, subscribe to the show wherever you listen to podcasts. You can also read the full transcript of the episode below.

Offcall exists to help restore balance in medicine and improve the wealth and wellbeing of physicians. Sign up for Offcall here to bring about more physician compensation transparency and join our physician movement.

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Transcript

Michael Jerkins:

It was 4,000 banks or so in the country, and they all pretty much do the exact same thing. And the reason they do that is because they've made money for a very long time, so why have to change the model? And for us, it was, "Well, we don't want to go wide. We want to go deep with a very narrow segment that we feel very passionate about." And that allows us the ability to go deep on, especially, like you mentioned, understanding what an outpatient cardiologist needs versus a rheumatology startup.

Graham Walker:

Welcome to How I Doctor, where we're bringing joy back to medicine. Today, we're bringing you a physician who recognize the unique challenges faced by physicians during their education and training specifically around our financial health and futures. Dr. Michael Jerkins is the president and co-founder of Panacea Financial, and is also a practicing physician in Little Rock, Arkansas. Panacea Financial is a financial services company for doctors created by doctors, and I'm really excited to talk to Michael today because I think he illustrates both the problem-solving and the entrepreneurial spirit of doctors. We see a problem, and we want to fix it.

Welcome to the show, Dr. Michael Jerkins. Thank you for being here.

MJ:

Awesome. Thanks for having me. Very excited to get to chat today.

GW:

We don't normally dive into people's pedigrees on the show, but Med-Peds has a special place in my heart. I was actually thinking about doing Med-Peds, but I don't think it's very well known as far as residencies go. So do you want to give me just a two-minute spiel on why you picked Med-Peds, and what's special about it?

Med-peds: a small but growing specialty with its own flavor

MJ:

I actually never have gotten this question in a podcast, so I love I get to talk about it. But yeah, Med-Peds was very appealing to me because I knew that I wanted to be able to take care of patients of all ages. I just knew I wasn't planning on using IOB training and wanted a little bit more pediatrics focus. So essentially, I have two board certifications, internal medicine and pediatrics, which means I have the honor of taking two board exams and paying two fees-

GW:

And paying the fees, yeah. That's what I was going to guess. Yeah.

MJ:

Exactly. But basically, you fit the core rotations of an internal medicine residency and a pediatrics residency in four years, and that's the nuts and bolts, but it's relatively young compared to some other residency programs and training programs, but I really loved my time, and it's an interesting thing. I think you probably talked about this, of personality types that drift towards certain specialties, and Med-Peds certainly has its own flavor.

GW:

Yeah. Yeah. Do you have a stereotype that you want to accuse yourself and your colleagues of?

MJ:

Med-Peds is sarcasm with hugs. Essentially you go on the ... You're on wards on the adult hospital, and then you rotate back to the pediatric hospital, and it's a lot brighter, it's a lot more food, a lot more smiling, so you feel a little bit different there, and then in the internal medicine hospital, the adult hospital, you're smiling a lot more than others. You might've forgotten to take the duck off of your stethoscope when seeing an adult patient with COPD, so it's a fun little specialty.

GW:

That's great. I feel like emergency medicine maybe is just the sarcasm.

MJ:

That sounds about right.

GW:

Well, Michael, let me ask you about Panacea. You've written and spoken a lot publicly about your own challenges with access to financial support during and after residency. Is there one particularly issue that stands out in your mind as the one that you always come back to when you decided to create Panacea Financial?

How financial institutions fail physicians

MJ:

Yeah, lots of things, I think are wrong with how doctors are treated by financial institutions. We had very weird financial life cycles. We don't start making money until later. We have nothing saved up. We might have no credit history at all.

So the standard customer that a financial institution wants to see, we just don't have those attributes. In med school you can live off student loans. Hopefully you don't have to take out too many, but if you need some money, you can, in theory, get that. But as soon as you match and need to move, which I did, I moved from Tennessee, where I went to med school to Ohio, so I'm moving on no money. I'm living a whole month of residency on no money.

So most of us, really, going into our first month of residency have tons of debt, not just student debt, but actual consumer high-interest debt like credit cards. That's what I lived off of. And then, you're playing from behind, right? If you look at my month-to-month cash flow during residency, I was losing money every month. I would budget, but I couldn't always plan for these expenses, especially having a young child.

So then, I'm trying to pay off a high-interest credit card bill, I'm losing money every month, gets us really stressed out in a very stressful time. My third year of residency, in particular, was a stressful one. We had had a second child my second year, so more expenses. That was great. My program was very supportive, but our house flooded, our basement flooded.

They got four feet of water a night before going into my CVICU shift, and we actually had a car accident within that 30-day window too. So it was a lot of stress. I called multiple banks, and I applied for multiple personal loans online, and the answer I got was I didn't make enough money, or I was rejected, or I needed to go get a cosigner, like a real adult, because I guess I wasn't an adult enough that could be trusted with five grand or something. You talk a lot in the residency workrooms, you hear these same stories over and over and over, and it just seemed obvious to me that there's a problem that no one was really looking to solve. And once we figured out, I think that, with what we call our peer and personal loan, that's really what we started with, we saw other problems.

We saw problems with how practices get funded. All of these types of things, being in the space, identifying problems and seeing where other people just don't have the flexibility or really care to cater to a very specific group, we saw as a really good service to our community.

GW:

The first thing I, really resonated with me was just trust. I remember the difference between going into a shift, where if I order the wrong medicine, I can literally kill somebody, but then, like you said, but I'm not trusted with a couple thousand dollars?

MJ:

And it's crazy, right? You could actually be taking care of a banker's family. They're like, "This person, I'm going to trust with literally my life," but when I get back to work, "Sorry, dude, you can't have this couple thousand dollars."

GW:

The other things, Michael, you mentioned were family, and I think there's way more focus on professionals and starting families, and understanding the challenges of starting families later, and then a lot of people forget because they maybe don't rent anymore, but you probably had to pay last and first month's rent, and a security deposit when you're moving and starting residency, and you've got a gap of time. Where is that money supposed to come from? So those all come to mind as kind of unique challenges that we all jump through in our mid to late 20's that seem kind of silly that everybody's reinventing their own wheel for this every single time.

MJ:

Exactly. We actually did a survey. We did, it's like 600, almost 700 residents and fellows across the country and asked them these questions about financial stress, and I think panaceafinancial.com/report. Hopefully that's still the URL, but we asked a lot of questions on this, and it's very common. All the stuff I just described to you is a very, I would say, average financial profile of a resident, someone who has no credit history.

Most of us have lots of student debt, and then consumer debt, especially credit card and auto, but people don't realize how that dictates where we practice and who we see as patients, and ultimately, I think leads to a poor healthcare system because we're putting all these other stressors on our physician workforce that start really, really early.

GW:

Michael, take me back. How do you go from, "Wow, this system really sucks," to, "Somebody should fix this," to, "I'm going to fix it." Where does that will or that idea to change the system and start Panacea come from?

MJ:

One was I was just very angry that there was the system, and I think especially in the academic medical world, there's a lot of hurdles to problem solving that are outside of the academic space. It takes a lot to do much of anything, and so I think it's opening people's eyes to possibilities outside of the academic track, and it's opening people's eyes to outside of the clinical track, and you can still do both. I think most of us love patient care. That's why we did all this. We don't want to give that up.

The other thing too, for us, if I could go back is Ned and I, in residency, we identified this, we had the idea, it's so funny to think about what we thought we needed to do at first. We just didn't know anything, and we literally went to banks, like bank branches, and we had this business plan, and we would sit down and talk with just a bank branch manager, explaining this thing. They had no clue what we were talking about. And where we really hit, I think our stride was when Ned and I partnered up with Tyler Stafford, who, as happens to be a person, a friend of mine since the ninth grade, but other than that, he also is an investment banker for a decade plus covering banks, and knew a ton of bank CEOs and CFOs across the country. And those are the people that know how to do it, and they're looking for ideas, and that's the lesson.

I think the second part is being willing to partner with people in the industry that are experts, and they aren't experts in doctors, they aren't experts in the doctor problems or how to reach doctors, but they're experts on how to get some of this other stuff done, and that's really where the magic, I think happens.

GW:

Whenever I talk to people outside of medicine, it is very clear that the rest of the world has kind of no idea what we do. They don't really have a great understanding of the challenges kind of on our side of the exam room or the table or whatever. It also is respecting the fact that your investment banker colleague has something to bring to the table too. You're not building just a doctor bank, you're building the bank part too, which is not your guy's particular expertise.

MJ:

Exactly, yeah. You don't want me making a credit decision on a million-dollar practice loan. That's not my expertise, just like I'm not going to do your heart cath. You don't want me doing that, but I'll get you the expert who can. As doctors, we have a lot of skills and flexibility, and can learn new things very quickly.

That's our secret sauce. We had to. We had to be able to do that. And you might not know anything about a topic, you might have an idea, you might partner with someone who knows a lot, but honestly, you'll very quickly learn a lot about that. So I just think we don't give ourselves enough credit as a group of how much we actually can do outside of your standard academic or private practice clinical track and being willing to learn and listen, just like we did every single month in residency in med school, learning a new thing. We can do that same thing and find really creative ways to help our community.

Doctors are experts at learning new things

GW:

We recently talked with a financial advisor who said that, "No financial services or financial concepts are really any more complex than anything we learn in medicine." And so physicians should feel empowered that we can figure this out. Like you said, we might have to do a little bit of background research, but if we invest a little bit of time, you can figure it out.

MJ:

Yeah, and I think there's a balance there. I think doctors can maybe get in front of their skis, and it's almost too extreme of like, "I can figure out the most complex medical thing, so I can make all my financial planning choices." And it's the same thing I say to new interns, I'm sure you do too, is being okay with the phrase, "I don't know, but I can find out." We should, as doctors, be very comfortable with that, and finances as well, but if we commit the time, then we can learn just about anything. We might not have the time to do it or the time to manage it, but we certainly can understand it and be better informed to avoid really big mistakes.

GW:

Tell the listeners all the products you offer, and then which one you chose to start with. I think it was personal loan, and why there? Why'd you start with that one?

MJ:

I think easiest to spin up was the personal loan. Now, we did and still do, have a personal checking and high-yield savings account. It's all on a digital banking app and mobile banking platform. To be honest, we started with physicians, and that's the community we knew best, but we started to get a lot of demand from our dentist and the veterinary colleagues like, "Hey, we're having the same issues over here." And so we opened it up to dentists and veterinarians.

Then we started to get ... At that time, student loan refinance was a big deal, interest rates were low, and so we got a lot of interest, "Hey, can you help me with my student loans?" And so we built out a student loan refi arm. That since slowed down as things have, interest rates have gone up and all the problems with the government repayment plans I started, but then we got those demand for practice support, so financing for an acquisition, financing a buy-in to a surgery center, or starting my own practice. What I learned was that your average bank might have a banker that can write a loan to a car lot or a restaurant, but really, none of them understand medical, dental, and vet.

That's totally different business, especially medical, right? We do this every month, where we'll have a dermatology acquisition right next to a deal that banker's working on, vascular surgery expansion. Two totally different businesses. There's some commonalities, but you have to have the expertise to be able to do it right, and so we built that out, and that's a very large part of what we do, and I'm very proud of that because I think all of us in medicine, especially the last few years have identified the beauty of maintaining independence as much as possible, and so where our group comes in is really allowing doctors the ability to practice independently through a setting of their own choosing, a set of if they don't want an employed setting, that there are actual avenues to this. So we do a lot of that too.

GW:

It does feel like the pendulum is starting to swing and more people are more interested in, going back to what we used to call private practice. The other thing you mentioned that's really interesting is everybody talks about, "We don't know what doctors do." You just gave a perfect example of a pathologist or a vascular surgeon or a dermatologist. They have vastly different days. I probably could kind of guess what you do, and you could probably guess what I do in the ER, but I have no idea what a pathologist does all day. And so understanding the nuance of what equipment a pathology office needs versus a vascular surgery clinic, or an ambulatory surgery center are all extremely different.

MJ:

It was 4,000 banks or so in the country, and they all pretty much do the exact same thing. And the reason they do that is because they've made money for a very long time, so why have to change the model? And for us, it was, "Well, we don't want to go wide. We want to go deep with a very narrow segment that we feel very passionate about." And that allows us the ability to go deep on, especially, like you mentioned, understanding what an outpatient cardiologist needs versus a rheumatology startup, or a orthodontics acquisition. I mean, we helped a clinic that has 200 different sites.

GW:

Wow. That's massive.

MJ:

Right. So that's a huge deal, or we can help someone with a $50,000 ASC buy-in for a GI doc that's going to do their procedures there. And I think the other lesson here is where you started and where we started really was just with this personal loan thing, and it's evolved into something much bigger, and we've addressed a lot more problems because once you start showing competency and the ability to execute, people are like, "Oh, yeah. Hey, we actually need help on this too."

Financial challenges for early-career physicians today

GW:

Michael, have you thought about kind of generational financial challenges? Are there different financial patterns that you're seeing with different groups of physicians?

MJ:

The fact of the matter is most med students come from the top quintile of household incomes. So that's an interesting fact to consider, because even despite that, a lot of them are still running up a high consumer debt bill. The biggest financial hurdle is, "Can I match?" That's really it, because if you can't match and you have the student debt, then that is an extremely difficult spot you're in. But then, once you get into residency, the data is something like 99% of people who start residency finish a residency to some degree.

And so then, it's, "How do I limit my consumer credit? How do I properly manage my student loans?," which most of us ... I did this. Most of us do, is some sort of income-driven plan to limit my payments per month, get some months under my belt for public service loan forgiveness, which is a great program, and then once you graduate, it's the biggest thing there is, "How do I not mess up?" And then, really, after that, we see a lot of people ...

It's trying to navigate the, "How much do I need to retire? What can I do with excess savings if I paid off my debts and not messing up that?," because certainly, we've seen a lot of doctors who are very successful, but they maybe don't need to be the ones making all the decisions by themselves with what to do with retirement, or investments, or things like that. And that's kind of the pattern we see now. It's a little different in dental, a little different in veterinary, but some of those trends carry through. The biggest difference in dental and vet is the amount of practice owners.

80% of dentists are going to be a practice owner to some degree. It's more like 20 to 30% at most of physicians. For dentists and vets, that's a big wealth builder. They're a small business owner, and they have an asset that that's building value. We don't have that opportunity. Our biggest asset is our ability to actually deliver clinical services.

GW:

Michael, one of the other trends that I'm seeing and hearing about a lot with my colleagues are people trying to leave the bedside, or maybe they're just reducing their clinical practice, to some degree, to pick up a side job. Are you seeing trends of people trying to find a way to get some 1099 income to kind of diversify?

MJ:

I see that same trend. I think people, especially since COVID, are very stressed, and they feel a little sense of hopelessness in some way. A lot of that is back to the student loans thing. If you had $0 of student loans, your decisions on what you do with your time is a lot different than if you have $400,000, $200,000 of student loans. So I think people feel really burdened by the student loan thing, and once they pay those off, then what they decide to do, we're seeing lots of different avenues. Most commonly is, "How do I practice clinically on my own terms?"

And a lot of people are as self-employed or they incorporate, but locums is becoming a little bit more popular. I think classically locums was you had later career doctors doing that, but now, I think you're having more earlier career doctors doing that because they want the freedom. You can make pretty good money. It's a little bit more complicated financially and clinically in some way.

Physicians are looking to practice on their own terms

GW:

I've been saying people want to have more control of their practice, but it really is people just want to practice on their own terms. They don't want someone else telling them what they can or can't or should or shouldn't do. Part of it is just that we've gone through so much training to then have someone with less or no medical training, dictating how things should work.

MJ:

You're right. So you think about dentistry. Again, I'll go back to it because I think it's a good comparison. People who are highly trained, they treat patients, but most of them are small business owners, or they might be employed, but generally are more able to dictate how they treat patients. But I think what you'll actually see is over the next decade is that Medicare will see dentistry as an essential service.

I mean, how many Medicare patients have you seen can't get hearing aids, can't see a dentist? And when you see that happen, it's going to be very similar, I think to what happened to medical, and you'll potentially have ...

GW:

Interesting.

MJ:

And that's great for patients. I think the opportunity that dentistry has then is to say, "Okay. How do we learn from what happened to our medical colleagues and still maintain control over how we practice, while also balancing greater access to patients?"

GW:

How much are you working clinically these days?

MJ:

I practice around three sessions a week. So those are half days. So a day and a half generally at a family medicine clinic in the Little Rock area. It is great. I love the clinic.

I really do like outpatient, and I love my colleagues at the clinic, so it's been great to collaborate. I've learned a lot too. It's my first time working in a family medicine office, instead of Med-Peds or internal medicine, and they just have different training and different expertise, things I don't know a lot about, or don't know how to do, and I've really enjoyed that aspect of my clinical practice as well.

Balancing the clinic and a business

GW:

So you're working essentially like quarter time clinically, and then your other time is on Panacea?

MJ:

That's right. It's kind of funny to me. Maybe you can agree or disagree. To me, in academics, it's like the less FTE you can dedicate to clinical and you've been able to have research and these things, it's like an honor. Like, "That's so cool. You can do that."

But if you're not in academics and you say, "I only practice whatever a quarter of the time," people are like, "Ooh, what happened? Why are you doing that?" Isn't that so funny?

GW:

Yeah.

MJ:

It's a different standard, but at the same time, it goes back to what we said, we want control over our time. I don't know if you agree with that.

GW:

Yeah.

MJ:

That seems to me like the differences there, how they view time.

GW:

I remember some of my attendings would, in medical school, would say, "Oh, I'm on service one week a year or two weeks a year," and then I'd be like, "Wow, that's incredible." But thinking back, I'm like, "God, I wonder how much the fellow just runs the service."

MJ:

Yes. Yes. I'll say once I cut down, it was hard, right? Our identity really is in being a physician, and I wasn't doing it full-time, and that was hard from when I, like, "Who am I? I just did all this, and now I'm not practicing full-time?"

But I took some advice from one of my academic colleagues of like, "Hey, if I could do that and balance my clinical with all of the research I want to do, I would be praised at my academic institution and you should feel the same instead of being ashamed," which sometimes, I think we can feel when we're not in academic setting.

GW:

Why do you still see patients a quarter of your time? You probably could fill up your days very easily, those three half days. You could probably fill up with other meetings and talk to customers and clients, but what's the drive there for you?

MJ:

The very basic, and this is going to sound too simple, I like to, and I genuinely like sitting with patients. I like to think there's no cost fallacy involved of my thinking, but the more and more I've thought about it, I'm energized on those clinic sessions. I think the other side benefit is when I'm leading a financial institution for doctors, I need to know what's going on, right?

GW:

Yeah, absolutely.

MJ:

I want to stay in touch with, "What is it like?" And if I go and speak to an audience of doctors and they find out I'm a doctor, well, their first question, "Do you still practice?"

GW:

Yeah. Absolutely.

MJ:

First question. And if you don't, the questions, they're not going to say out loud, they're going to start thinking in their head of like, "Oh, what did he do? Why can't he practice anymore?" But ultimately, even regardless of Panacea, anything like that, I will always see patients. I really enjoy it.

Financial advice to follow and mistakes to avoid

GW:

I think the other trend is they might not be asking you, "Oh, what did he do wrong?," but, "Wow, how did he get out?" It's bad if all of our doctors want to get out of medicine. I'm similar. I think the tech and AI stuff I do informs my clinical practice and vice versa. I have better and worse shifts in the ER for sure, good days and bad days, but it's still honestly just an incredible privilege that somebody trusts me to walk in the room and try to figure out how I can help them.

Michael, in our last few minutes, I've got just some kind of rapid fire questions. Best piece of financial advice for a physician?

MJ:

Be comfortable with saying, "I don't know."

GW:

Worst money mistake a doctor can make?

MJ:

Living above their means, right out of practice.

GW:

What is the best and worst parts of your specialty?

MJ:

Best part is the variety. I love the variety. The worst part, I wouldn't say it's worst. The most challenging is the variety. It's fun. It's a little bit of a tricky answer.

Anything can walk through. Any type of issue, or chronic disease, or acute illness can walk through the door. And honestly, a lot of times they've seen a couple of other people that are in primary care, and then they come to you. That's a challenge, but that's also the appeal, I think, to a lot of us that chose the field.

GW:

If you could instantly cure one disease forever, what would it be and why?

MJ:

Probably heart disease. Now, obviously, there's lots of things that feed into that. My initial thought was diabetes. Man, that's a really tough question, and I feel guilty answering it, because then I feel like I'm ignoring another chronic illness.

GW:

I like it. I like it because it also forces ... It helps people understand the way you think about the problem, like, "Is it the most people? Is it the most suffering?" Michael, if you could send one message to yourself on the first day of residency, what would it be?

MJ:

It's okay to not know everything.

GW:

Absolutely. I fully agree with that. I would much rather have a resident or a medical student just say, "I don't know," than lie or make it up.

MJ:

Yes.

GW:

That will always get you shunned. That's a bad mistake to make as an intern, but it's absolutely okay to not know the answer to something. That's literally why you're in training. What's the most ridiculous thing you've gotten dinged for?

MJ:

One time, I didn't do my duty hours in residency for five months. I'm not going to say they didn't remind me. They reminded me.

GW:

Yeah, yeah.

MJ:

I just was busy, and it wasn't my priority. And by that time, it's five months later. I don't know what I did four months ago, so I just went in and put 8:00 to 5:00 Monday through Friday.

GW:

And look, you're an attending. You made it.

MJ:

That's true. I'm not encouraging other people to do that, but that is the answer to my question.

GW:

No. Of course not. Okay. The most ridiculous thing you've had to argue about with prior auth?

MJ:

It was an imaging study on a patient who had a previous mass, and the radiologist, even in their report, advised them to follow up with a specific imaging study at a specific interval that I order, and then I had to do a peer-to-peer and talk to a not radiologist. I think it was like ... I don't even know what this person did. And they were like, "Yeah, it makes sense." And I had to take time out of my day, check a box, explain to someone who already knew the answer.

GW:

Michael, if you could design a new medical specialty, what would it focus on and why?

MJ:

Transition. So from pediatric to adult, we see so much drop off, and especially people who have chronic diseases. They might've been seeing their pediatric specialist till they were 30, and then finally, the person's like, "You know what? You need to see an adult," and then they can't find anybody. Greater focus on training on the transition of care of pediatric adult, folks with chronic disease amongst subspecialties, so like a actual required rotation and specified training for those individuals, I think would help our system a heck of a lot.

GW:

A lesson from a mentor in medicine that still shapes how you practice today.

MJ:

So this was a very esteemed dermatologist that I rotated with in residency, widely known towards the end of their career, and their comment to me was, "Institutional memory is short, but patient's memory is long." So essentially, focusing on those individual patient care relationships, instead of more and more kind of academic rat race amongst a large institution that ultimately, that memory is short, they're going to move on as soon as you retire. That sounds very cynical, but I think it does orient us in a more healthy way.

GW:

Yeah, and to having the control or practicing medicine our way because it feels better to us.

MJ:

Exactly.

GW:

Michael, where can listeners find you and Panacea Financial, and how can they support the work that you're doing?

MJ:

Yeah. So you can find us at panaceafinancial.com. We're on all the major social media channels. We have a really, I think, vibrant blog, a lot of financial topics from experts on our website, panaceafinancial.com. We also have a podcast called The Podcast For Doctors (By Doctors).

GW:

Michael, thank you so much for taking the time today. It's been a pleasure to talk.

MJ:

This is great. Thank you for having me.

GW:

Thanks for joining me today. For insights into how doctors can better manage their money, head to offcall.com/podcast. Make an account on Ofcall to confidentially share your details about your work, and sign up for our newsletter, where you can hear more about the latest trends we're seeing in physician pay. You can find How I Doctor on Apple, Spotify, or wherever you listen to podcasts. We'll have new episodes weekly.

This has been and continues to be dr. Graham Walker. Stay well, stay inspired, and practice with purpose.