David Burd and Jim Hemphill – triage-md.com

Listen as Jim Hemphill and David Burd let you in on what they’ve discovered about working with physicians:

  • Why deferred gratification plays such an important role in how physicians spend and why having both spouses or partners buy into the financial plan is crucial
  • How the habit of competition can influence money decisions and how changing the game you decide to play can really impact your bottom line and outcome
  • What is the inflection point and why choosing your lifestyle at that point is so important
  • What are the 7 strategies and how can you use them to retire wealthy

Josh Mettle: Hello and welcome to the Physician Financial Success Podcast. My name is Josh Mettle, and this is the podcast dedicated to advising physicians how to avoid financial landmines. Today, we’ll be talking with Jim Hemphill and David Burd, authors of Changing Outcomes: A Financial Recovery Strategy for Peak Career Physicians, as well as Pay Yourself First: A Financial Guide for Doctors Entering Practice. Jim and David also are the principals and founders of TGS Financial Advisors, an independent advisory firm focused on helping high net worth clients make the most out of wealth by simplifying the process of becoming wealthy. Jim, David, I’m excited to have you. How are you this morning?

Jim Hemphill: Great! Happy to be here.

David Burd: Well, let me regress a little bit. Both Jim and I use our hobby of bicycling to support various charities. We support the American Cancer Society, the upcoming ride to support Abramson Cancer Center and also the Multiple Sclerosis Society. And they had a ride this weekend, and both Jim and I participated in. I can truly say I peddled 100 miles on Saturday, and as yet, I am still just a little tired from that.

Josh Mettle: We’re not‑

David Burd: Two old guys with sore muscles, but otherwise in great shape.

Josh Mettle: Well, I appreciate you saving your brains for us. That’s all we need of you today. All right, so I understand you both spend a considerable amount of time working for one of the world’s largest financial service firms before starting TGS Advisors. Would you mind just giving us a little background? Tell our listeners a little bit about your history and how you got started down the path to serving physicians.

Jim Hemphill: We both started working for Wall Street firms in the late ‘70s. Dave was first. He actually brought me into the business, and by the late ‘80s, we have kind of had it. Without mentioning specific firms, a lot of water under the dam since then, the firms were not client centered, and we just felt an increasing tension. We worked at the end for the two largest firms, Dave for one and me for the other. We had just come to the conclusion that we needed to find some way to do what we thought was right and put the clients first. We founded TGS at that time. I actually worked with my first physician client starting in 1979, but it was really David who made physicians the center of his practice and has been very successful with that. He won’t say it so I will, he’s been on the Medical Economics list of 150 Best Financial Advisors for Doctors for the last four or five years running. Dave, perhaps you could talk a little bit about just the focus on docs.

David Burd: Right. And I would add that we truly, both Jim and I, wanted to be independent and be able to chart our own course. When I think about how and why I ended up dealing with more and more physicians, I think it started in my interest on how they make decisions. Now obviously, most people in the financial services business, you have a few physicians in your client list, but what was intriguing to me about dealing with physicians is how they made decisions. Their process is part training, it’s part logic and their intellect, and it’s part intuition, and I guess that’s why they call it not only medical science but the medical arts.

Anyway, I found their process of making decisions interesting, and I just started to parse out the dynamics of how they make those decisions. As I became more comfortable with that decision process, I started to utilize it in my interactions with my clients. I think that many people in our industry approach them simply because they are high net worth individuals, and they really didn’t take the time to understand the circumstances under which they live their lives.

Josh Mettle: Yeah, it’s interesting, and I found the same thing in our practice, which has driven us farther and search out and serve more physicians. I definitely identify with what you’re talking about there. Let me move on to the next question that I have. While on your website, triage-md, which is excellent by the way, I found an interesting post called Why Docs Fall Behind. It identifies physician specialists as having lifetime incomes in the top 2 percent of all income earners and asks the question “Why don’t all docs get rich?” I think it’s a great starting place. Would you help us maybe better understand that dichotomy?

David Burd: Well, let me just preface it, and then I’ll let Jim riff for a while, but one of the things you have to understand about physicians is, in elementary school, they did well, high school, they did extremely well to get into the best colleges, and college, they did very well, of course in order to place into medical school. And then of course a lot of them want a particular specialty, so they even succeeded against a very successful group in medical school. As a result of that, there is a competitiveness in their psychology that’s not only self-competition but they’re used to competing against their peer groups. I think there is something important in that competition in the way that they deal with that competition that can lead them down both good and bad decision trees.

Jim Hemphill: There is something that David has talked about when we started working on the book, something David pointed out is that you really need to understand where a young doctor or a young physician is when she comes out of fellowship or residency. Late 20s, early 30s, sometimes mid 30s, intensively schooled for years, hardworking, undercompensated, and for the first time in her life and his life, that young doctor is going to get a real paycheck. It’s a group that has deferred gratification like no other cohort of high-achieving people. There are two implications of that.

The one is, it’s time for them to get the stuff they’ve denied themselves for years. The second issue is simply a time value of money issue, that they are starting to accumulate wealth 10 years later or 15 years later than many of their college peers ‑ that engineer who got out, the lawyer who took the three years of law school immediately after undergraduate. They’re also starting out typically today with $175,000 or more medical school debt.

Josh Mettle: Right.

Jim Hemphill: I think they’re finally earning money, and I think they’ve gotten into the “proverbial train station” when in fact it’s just another step in their voyage and they still have important decisions to make.

Josh Mettle: It’s very interesting. So, Dave going back to something that you said a minute ago, you mentioned that physicians are relatively high performers since childhood and are used to competition. I think that brings about a sense of confidence in many of them, which is very, very important for what they need to accomplish in practicing good medicine on a day-to-day basis. But I’ve noticed in our practice that we notice that that confidence sometimes can be an overconfidence in an area where they may not have had the time and the energy to go in and really fully research or to dig deep enough. In our world, what that translates to is almost an overconfidence in being qualified for a mortgage, and then it’s very surprising sometimes when we bring to the surface a challenge that they’re going to have. Were you sort of alluding to that same sort of confidence and that same sort of caution in the financial service world?

David Burd: Yeah, but I don’t think that’s necessarily true of only doctors. I think that’s true of a lot of people who are relatively successful. There is a false sense of confidence, and I think that ‑ I want to use the right words here.

Josh Mettle: Sure.

David Burd: They think about what’s been presented to them and they make conclusions that can be problematic. For instance, their peers were earning, I don’t know, $50,000, or $100,000, $125,000, and they come out and they’re making $250,000 to $350,000 say if they come out as a surgeon. The first thing they think of is, “Well, jeez, I’m earning $300,000. I’m earning $25,000 a month. I can afford this.” They make sort of very cursory judgments about what that actually means. A more sophisticated approach, a more reasoned approach, a more experienced approach is, well obviously you might be earning $250,000, but the reality is you have about half of that in order to spend. You don’t have the $250,000. You have the $125,000. You can make very quick judgments.

We rely on physicians to be somewhat intuitive because they don’t always have all the information before they make a diagnosis because they’re under time stress or emergency stress from the patient so they have to be able to quickly make decisions, and they create rubrics in their mind. Once that rubric is created, it’s very difficult to change, and it’s something we pay a lot of attention to because doctors they’re smart enough to convince themselves, and it’s our job to convince them of what we see to be the truth.

Josh Mettle: I think that’s going to parlay just perfectly into my next question and the next topic, so you both collaborated to write a couple of books, and one that I reviewed and took a liking to was Pay Yourself First. That’s just the principle that I’ve applied in my own life that I know is true. Thanks for sending me a copy of the book by the way.

David Burd: Yeah. Happy to.

Josh Mettle: In reviewing that, the first thing that jumped out of me was that you referred to the inflection report point, which is the moment where the resident or fellow becomes an attending and their income jumps hundreds of percent just like you were jus speaking about. You go on to tell the tale of Mary and Edward, a physician couple who might have done things differently if they had their inflection point to do over. I love that analysis. It was so very clear for me when reading that real-life story. Maybe help us better understand the significance of the inflection point and the Mary and Edward’s story.

David Burd: Yeah. So what we tried to do in the book is we tried to essentially tell the story of actual physician lives, but it’s important to say that none of the stories are exactly the story of any one individual, so we’ve combined individuals. We’ve married people to other people, we’ve changed all of their names, we’ve changed subspecialties so that nobody can look at any of the stories and say, “Hey, wait a minute! They’re violating confidentiality, they’re talking about my individual story.” We contrasted two physician couples to real-life based but fictionalized couples – if that makes sense ‑

Josh Mettle: Yeah.

Jim Hemphill: And Mary and Edward were the couple who got married, bought a reasonable nice, used house sort of halfway between their two practices, where one of them could take public transport into the city, that had two children, good neighborhood, good public schools. Kids went to public schools. They always maximized their savings, but they always saved beyond that. By the time they got to their late 50s, their kids were out of school, their net worth was such that they could, first Edward semi-retire and got and rehabbed a historic house, and then by their early 60s, fully retire with net worth in the high seven figures, with $8 million or $9 million in net worth.

We contrast that with John and Anne where he was a very highly compensated specialist, started practice in the ‘80s, lots of money, big trophy house, kids in the best private schools, luxury automobiles, and everything going along, vacation house at the shore. Everything going along, going just great; then in his late 50s, he had a health issue, which made him unable to operate, transitioned from subspecialty to more general medicine, took a 70 percent pay cut, and came to us and said, “How can we sort this out?” We had a number of conversations and were not ultimately able to get those folks to make the lifestyle change they needed to catch up.

The issue there is that once you choose that lifestyle, it becomes very nonnegotiable later on. The psychology of wealth and status is very powerful even if you don’t consciously understand it. The point at which you can change your trajectory without pain is really that point when you exit fellowship or residency and start practicing as an attending. That’s the point where your income goes, as Dave said, say your income goes from $60,000 as a resident or as a fellow to $250,000. You can dramatically increase your lifestyle and also dramatically increase your savings. But the tendency is to say, when they get caught up first, and they they’ll push savings. “Yeah, I’ll do the 401(k). I’ll do enough to get the match. But let me buy the house. Let me buy the cars. Let’s start taking some nice vacations. We denied that to ourselves. And then 5 years or 10 years from now, then we’ll start pushing savings to get caught up financially.”

David Burd: They deny themselves and then the next step is they say “I’m owed this.” More problematically, all of the other physicians, well not all, many of the physicians in their practice, they own things. They’ve been around a while, they’ve done those things, and they’re looking at that, and that is being reinforced. It does not mean that there’s a lot of equity in those other investments – historic property, vacation property – but that’s what they see from the outside. And it’s a very powerful dynamic when other doctors reinforce your decision process.

Jim Hemphill: What we found dealing with doctors at the peak career is that there’s that 1 out of 10 doctors and it’s about that number, who never bought into the high-speed lifestyle, who bought a nice house but not a trophy house. The ultimate example is the doctor who’s in his late 50s worth millions and millions of dollars, who’s literally driving a 10-year-old Honda Civic. The surgical subspecialist with plenty of income, and the younger docs look up to that person and say, “Gosh, I would like to be positioned like he is.” But they’re not driving a Civic.

David Burd: It’s interesting. One of the things we’ve had the benefit of doing is we’ve dealt with physicians in all of their different phases ‑ newly-minted physicians or physicians who have been in practice for a while, and not only just physicians on our client rolls, but that we’ll meet potential clients. It’s not uncommon for us to meet a physician who has been in practice for many, many years. There isn’t a lot that we can do for them because at that inflection point many years ago, they didn’t make the right decision, and out of that came Jim’s book Changing Outcomes. Of course, we might want to discuss a little bit about the sort of Pay Yourself First book and maybe where that came from, the genesis of that.

Josh Mettle: Please.

Jim Hemphill: Yeah. So just to talk about that briefly. It’s kind of an interesting story. We have a very talented woman who is our director of outreach to the physician community. Her brother, her father, grandfather all physicians, and she’d worked for the American Heart Association before she came to us. She was making the rounds of the medical schools and just talking about what we do, and one of the directors of a medical school program said, “You know, look! Everybody wants to work with a doctor who’s 55 years old and has $2 million, but we need somebody to help our attendings, our residents, our fellows because they don’t have a clue. They’re just starting off as attendings. When they start off as attendings, they don’t have a clue, and nobody is really helping them who’s not trying to sell them something specific. I need a solution for those people.”

And so, we really took that as a challenge and that was the genesis of the idea and ultimately of the book Pay Yourself First.

Josh Mettle: Great, I love it. Really, what you’re describing is a chapter out of, or really the whole theme of the Millionaire Next Door.

Jim Hemphill: Boy! Are you ever right? Yeah.

Josh Mettle: I mean we’re talking about it in context of physicians, but it really holds true to anyone who has an above-average income. I love the comment about breaking the psychological chains to kind of living that affluent lifestyle. Once you’ve done that for a series of years, it’s unbelievably hard to come back compared to that inflection point where you’re just getting a taste for a little bit nicer lifestyle and a little bit nicer and still significantly nicer than residency or fellowship, so you don’t have to go all the way to caviar. You can just meet somewhere in the middle, get set up correctly in terms of your savings, and I think that’s going to take us to the next question. But you can improve life and still get set on the right path. I love the way you frame that so clearly.

Jim Hemphill: Thank you.

Josh Mettle: You have a three-year program for new physicians and their families. It’s called Triage, and I’m assuming this is all part of the getting off the ground the right way. Would you mind telling us a little bit about the Triage program and maybe its primary objectives?

Jim Hemphill: Triage is our attempt to reframe the decision matrix in those first three years for young physicians. As Dave can tell you, you cannot go into a successful physician and say, “I’m going to tell you what to do.” That’s not our role and that’s not psychologically something that is productive, but what we can do, we think, is provide information in an accessible and dense way, because we don’t have a lot of time, that will give them a frame or a context within which to make decisions. To give them tools so that they can essentially figure out what their trajectory is going to look like and understand how powerful that three year decision point is.

If you imagine coming out of, you go into a box with income of $60,000, and then the moment you’re in the box, all of a sudden your income is $300,000. Three years later, you’re going to come out of the box, you’re going to have a house. You’re probably going to be married. You may have kids. You have automobiles. You have all that stuff, and you’re going to come out with a certain trajectory. It may be very flat; in other words, you’re accumulating wealth very slowly if you bought the larger house and the better cars. Or you can come out of that box with a very steep trajectory that is really going to get you toward financial independence by the end of a normal career in your late 50s, early 60s, mid 60s.

We want to give young physicians that frame so that they can make those decisions mindfully and understand that really the parties to that negotiation about what their lifestyle looks like are themselves today and themselves in 25 years

David Burd: And just as importantly their spouses. Because in many instances, the spouses have been there with them through medical school and thereafter, and are just as important -they supported their spouse through all of those years, and they had many of the same sort of psychological issues as the physician.

Josh Mettle: It’s all about buy-in with your spouse.

Jim Hemphill: It really is. It’s about getting on the same page, right?

Josh Mettle: Yeah.

David Burd: As two old married guys, we understand that. That’s from personal experience.

Josh Mettle: And so how do you guys do that? Is this a program in which you bring obviously both in and you frame the different potential paths and let them come to a joint conclusion? Do you really bring them together in that decision-making process?

David Burd: A meeting without both of the parties, both of the spouses is in my opinion, not very useful.

Josh Mettle: Yeah.

David Burd: You could introduce yourself, but in terms of understanding their psychology and understanding what makes them run, what makes them tick, you really need both parties. We often make it a practice of going to, in some cases, their apartment or their house if they own it because you need to be able to see what’s on the walls, you need to be able to see what kind of neighborhood they’re in. You need to see how they decorate their house and what’s important to them. And so, there’s a lot more to it and there’s more information in the meeting with both of them in a more personal setting.

Josh Mettle: I couldn’t agree with you guys more in regards to those first three years. I think you really hit the nail on the head there, and I love the way that you’ve made it so clear in that decision-making process, not requiring the client to do something or as you say making the decision for them, but just revealing the facts so that they can make their own decision. I love that.

David Burd: Well, and‑

Josh Mettle: Go ahead please.

David Burd: One of the things that I think that is just as important I mean, while we are talking about the build up of wealth, there is so many other things that we find are often neglected, whether it be the decision to purchase a particular type of insurance, negotiating with the employee group or the hospital in terms of disability, making sure that the wills, legal documents – if they have young children, it is vital that powers, and trustees, and guardians are selected. One of the things we try to do is work with a network of professionals and have those professionals work with the physician and her spouse. Because there are a lot of things that you never have to worry about until you have to worry about it. When something dramatic happens, trust me, we have seen this many times, they’re happy that we have the beneficiary designations correct. They’re happy they have the legal documents. Unfortunately, the life insurance becomes a critical issue. There’s so many other things other than just the build-up of wealth that protects them.

Josh Mettle: But David, do you think it’s almost anti-intuitive. I mean I’m trying to picture myself as a young resident or fellow coming into practice, and I could feel myself thinking that I could probably delay these decisions for a few years and get away with it. I could probably take the vacation, spend a little more, get into the house, and a couple of years down the road, I’ll confront all this kind of financial stuff. But then, the reality is, you start traveling that path, and it gets further and further away from the path that I should have been on, and it’s hard to retake that ground. But I don’t think it’s intuitive. I don’t think that somebody gets there and says, “This is the inflection point that I’ve got to make all these decisions correctly, and then once I’m on the right path, I can just, to some degree coast because I’m headed in the right direction.

David Burd: Well, yeah, you’re right. It’s not intuitive. Now there are conversations you can have, but there are also ways that we have developed to make them think about it in different ways. Here’s a very simple and not the only example: I just turn it around and I say to them, “Well, I’m your patient and I have high blood pressure and maybe an emergent heart condition. Should I wait a few years? Or maybe I should take your advice and exercise a little bit and it’s not fun to do, but you should. Maybe I should eat better, and maybe you should take that beta-blocker.”

When you put them in a different position and because they’re so used to negotiating with clients and one of the number one problems that physicians have is compliance. They prescribe and there is a scrip out and they want them to exercise more, and I come back and they never fill the prescription and they never did the exercise. Doctors have a hard time with compliance. One of the things that we have done and what we continue to do is, not only do we render advice, but we come back to them later and we – the word we use is nudge or be a nudge ‑ because we want them to get this done, remind them that it should be done because it’s not natural. You’re right. Counter intuitive is a strong word, but you’re right. Inertia is so powerful you have to change it as early as possible.

Josh Mettle: Yeah.

Jim Hemphill: It’s something that I tend to be kind of a nuts-and-bolts person behind the scenes while David is more of the public face, so one of the things that we’re really aware of is the need to have measurables, but also the need to have the right relationship. Josh, as you know, traditionally the group that has serviced young physicians is life insurance agents. You go in, you get that big take out of in one case, a doctor told me an $80,000 per year premium cash value life insurance premium. That’s a big, big payday for an insurance agent. What we’ve done is we’ve structured things where it’s entirely fee-based. We don’t take commissions for anything. All of our compensation is fee-based. We structured a flat fee program, and we will refer to the insurance agent. We will make darn sure that that physician is getting a 20 year level term policy whose cost is in the hundreds, not in the tens of thousands. And so hopefully, we can be the advocate for that physician family and help them to get all of the things that they need but not to tie up a large part of their capital in something that they don’t need, and that is not a good use of their resources.

Josh Mettle: It makes total sense. Let’s jump into the next question, which is in regards to chapter 11 in your book, I want to touch on the 7 strategies. In the time we have left, I always know we’re doing a good job with an interview when the time goes quick, but I’d love to just quickly run through the 7 strategies and just tell us a little bit about their importance and the trajectory of retiring wealthy.

Jim Hemphill: Just in terms of, again just the specifics, the nuts-and-bolts, the first thing is you have to understand your cash flow, and it is not as much as you think. In an early edition of the book, we said, “Well, your cash flow is 30 percent less than you think.” I had the director of a specialty program at a large Midwestern teaching hospital and he was kind of annoyed with me. He said no. He said, “Thirty percent is not right. Try 40 percent. Try 50 percent.” You have to understand what your actual cash flow is after all the deductions and after the taxes. The second thing is you do need the basic protections. You do need the disability insurance, the life insurance. You need to protect yourself with liability, obviously malpractice insurance.

And then the next thing is you need to pay yourself first. You need to create a scenario where you’re going to be able to walk away at your normal retirement age. You need to understand how many dollars that’s going to take and to make all of that automatic, just so that everything happens before a single dollar gets to the account from which you write your checks and pay your Visa bill.

We have really good resources to do that. It’s an easy thing to set up. It’s something that rarely happens.

David Burd: What traditionally happens as you know is people pay all of their bills and they say we save what’s left over. But of course your bills grow to fill up your entire income, so if you don’t make to saving one of the bills, you’re in trouble, and perhaps most importantly about the savings issue is you have to establish the habit. If we get an adamant “No. We can’t possibly save this amount,” we come back to them and say, well then it’s $200 a week. It doesn’t matter. You have to get into the habit. There’s an old saying if you do something 21 times, it’s ingrained. If we can get someone to send in checks 21 times, then we’ve helped establish the habit, and then after that, it’s only a matter of moving the lever. They’ve already decided they’re playing with the lever. Later on, we can move the lever, so the habit to us is widely important.

Jim Hemphill: Then after the savings, you need to build up that emergency cash reserve, but we think you really have to start the savings strategies, begin to put that in place first and then your early savings can be to create that reserve. You need to have a will, and one of the things that we say all the time is whatever you think may happen, reflect that in your estate planning from the beginning. If you’re engaged, assume you’re married, if you’re married, assume you’re going to have kids if you’re planning on kids. Even if you’re just starting out, assume you have $1 million or more of assets and make proper provisions for that when you do the first estate plan because we’ve seen many cases where you do your estate plan, you’re 33. The next time you think about it, you’re 60.

Josh Mettle: Right.

Jim Hemphill: In the meantime, you may have accumulated $4 million but you didn’t contemplate that when you made that first will, so make that first will while looking ahead.

Josh Mettle: That’s wise.

Jim Hemphill: The two final of the seven are buy less house in a good school district, buy a used house instead of a trendy new construction house, and go in with an understanding of what your budget is because there’s always a nicer house out there.

And then, the final thing is and again this seems like something way out of left field in terms of financial advice is choose your friends wisely. When we think about our physicians, who are in their 50s, in their 60s, financially very successful, those tend to be the individuals who have the most eclectic group of friends. One friend is a linguistic professor at a small liberal arts college, another friend is a professional photographer, another friend, you know, works overseas in construction in Dubai, but it’s not a uniform group, and most important is, it’s not a high-spending group or universally high-spending group. It’s very, very easy for a physician, given that they’re working 50 hours a week plus, to only hang out with other physicians in the same specialty, and then you really get into a process of social comparison of wealth and status that turns into a game that you can’t win.

Josh Mettle: Wow, that one is important, and I have not heard that before, very wise. I’m thinking of a particular dentist client that I’ve known for quite a while. I think that the pattern of friends that he got in just as you have described here were not the eclectic type – the opposite were of very high-income earning physicians in different specialties, and there was a long lifetime journey of trying to keep the physical gratification items on par with those friends.

Jim Hemphill: Yeah.

Josh Mettle: And‑

Jim Hemphill: Absolutely.

Josh Mettle: And that is a tough one for someone young in their life to think through. Great bit of wisdom especially with this book, which is intended for younger physicians, so well done on that.

Jim Hemphill: Thank you, thank you.

Josh Mettle: I’ll just say one more thing on the pay yourself first, because I think this is something that is difficult for folks to get started in and the B word comes out, budget, and nobody wants to feel confined or constricted with that. But once you get into it for a little while, as you said, I like how you put that in order where you’ve got pay yourself first before the emergency cash reserves, because it’s like putting on the bridle before you get on the horse. That is the correct sequence so that you can build up the cash reserves, and then once your reserves are there, you just parlay that into what other investments that you have. But what tends to happen is that once you have that successful action going for a while, you start to have some pride in that. You start to get excited‑

Jim Hemphill: Yeah, absolutely.

Josh Mettle: What that investment plan looks like.

Jim Hemphill: Yeah.

Josh Mettle: And then, it becomes very easy to make the decision ‑ $300 to $400 more a month on a car or $300 to $400 more a month into this investment asset that’s growing, that I’m already having excitement over that I’m building.

Jim Hemphill: Yeah. So Josh, what you’re describing and that really is let’s get to the core of it, it’s a positive feedback loop.

Josh Mettle: Yes.

Jim Hemphill: So you now have another metric for comparison to other people that gives you an opportunity to build your wealth and to take pride in it, and to reinforce the behavior. If you start that early, you have so much more opportunity to get your head into that mode because we’re primates. We’re not squirrels. We’re structured to pay attention to our relative status within a group. You’re going to do that. That’s baked in a cake. What is it that you’re going to pay attention to? The automobile you’re driving or your net worth? If you give yourself the chance, as you described, to see the numbers on the statement, understand the benefit to have a metric that allows you to praise yourself and feel a competitive success at saving the money. Boy, that’s half the battle won right there.

Josh Mettle: That’s probably the clearest I’ve ever heard that stated, and that is so wise in that you’ve given yourself a different way to compete. The game that we’re given, we don’t walk around with our retirement account statements. We go around with our cars and our clothes, and so the game, the psychological game, there is an element of competition there, and I love the idea of just saying I’m going to play a different game. I’m going to compete on the long term, “how are we doing with net worth” versus “what are we driving”. Beautifully said.

Jim Hemphill: Right, yeah. Thank you.

Josh Mettle: Well, guys, I appreciate both of your time, and I know you’ve got a whole other book that we didn’t even get into. The reality was there’s just so much good stuff that you have out there. I think we did a great job getting through the beginning portion of Pay Yourself First, but I’m certain that our listeners will want to learn more about you and more about the services that you offer. Where would you like them to go to find out more information about you?

Jim Hemphill: I think two good places to go, the first is the website, which is triage – T-R-I-A-G-E ‑ md.com, triage-md.com, so that will get to essentially the center of a lot of our frequently updated content for physicians and also a description of the Triage program for young physicians in their first years of practice. And the book is also available, both books, Pay Yourself First and Changing Outcomes, are available on Amazon and they’re both available on Kindle. If you’re an Amazon Prime member, you can actually download the Kindle version for free.

Josh Mettle: Wow.

Jim Hemphill: Otherwise it’s either $2.99 or $9.99 and hopefully the best $2.99 or $9.99 that you’ve ever spent.

Josh Mettle: Guys, thank you again. I appreciate your time and your generosity with sharing new ideas, and we look forward to connecting with you again soon.

Jim Hemphill: Great pleasure. Great. Thank you, Josh.

David Burd: Thank you for the opportunity. Bye-bye.