Career Opportunities in Physical Medicine and Rehabilitation: Financial Issues Affecting Trainees

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1 Page 1 Hello, and welcome to the Association of Academic Physiatrists podcast, featuring financial issues affecting physical medicine and rehabilitation trainees. Today s podcast will include a Q&A with Dr. Mallow, Assistant Professor in the Department of Rehabilitation Medicine at the Sidney Kimmel College of Medicine at Thomas Jefferson University. I am Dr. Alice Hon, a Spinal Cord Injury Fellow at Kessler Institute for Rehabilitation, and a member of the Association of Academic Physiatrists Residents and Fellows Council. I will be hosting this podcast. Welcome to the program, Dr. Mallow. Let s get started. Dr. Michael Mallow: Thank you very much, (sounds like: Al). Dr. Mallow, could you describe your background? Dr. Michael Mallow: Yes. Sure. First of all, it s important that everybody listening to this realizes that I have no financial authority or training. I m trying to say this with some humor. I m 36 am I I m 36 years old, and I have a tendency to be fairly obsessive; learned as much as I can about some minutiae about things. So, I feel like I m at a decent place to give some general advice, or really just transmit some general advice about planning your future when you re in your late 20s, mid 20s, early 30s, and leaving residency. What are the financial issues that affect trainees?

2 Dr. Michael Mallow: Association of Academic Physiatrists Page 2 I think and I base what I m saying on my experience of being a trainee and going through the process, and I think you re at an interesting place in life. You really haven t had any money, usually, as a trainee, to invest to focus on that. You ve likely have some debt, and are perhaps comfortable with having that debt. Residents have also delayed some gratification. And so, they might go and make quick decisions that maybe are built up from some kind of time that they ve spent during training, during medical school, going without; and friends of theirs, peers of theirs in other fields, might be higher along down the path of life. And that can be really challenging, and an interesting thing for residency graduates. The other thing that I think is really an important thing, is that residents are very ripe targets for financial advice. And I see that. I saw that with me, and I see that with my residents now. Who should be part of the financial team for a physician? Dr. Michael Mallow: I think it s really your loved ones and the Internet. I don t think anybody needs a financial advisor, unless you re at a very, very high income level. Now, for some people listening to this, might that might apply to; and it might apply down the line to more people. And that s fine. But really having investment advice you know, a person in a Merrill Lynch person, or something like that just throwing that name out there they re really for higher-income people, and they re really investing cash that you might have in excess of retirement accounts. And so, that s probably not the audience of this podcast, and it s really for an only a small percent very, very small percentage of the population.

3 Page 3 There are a lot of resources available online. And that s where I think, if you you know, don t take my word for anything I say; go look me up. There s a great online wealth management sites that are coming more and more being more and more of a thing, where they will help manage your money. And this is retirement money, primarily. And you can search for online wealth management, and you ll see a lot of different options there. And they have things to read, and resources. Other things that are really useful, and I would two places I would guide people to is, read about John Bogle. B-O-G-L-E. He founded The Vanguard Group and speaks very eloquently about investments and about stocks versus mutual funds. And another thing that I think could be Googled very quickly is index card financial advice, that was by University of Chicago professor Harold Pollack. And hopefully I m pronouncing his name right has very, very nice advice on there, that can be helpful. Regarding financial issues, Dr. Mallow, what would you recommend to trainees? Dr. Michael Mallow: So, I think there s sort of a stepwise way you can approach this, at any point in your life as a young person, and build this financial picture that will be helpful to you. And I think the first step there is life insurance. And I think anybody should consider purchasing life insurance. And when I say life insurance, I mean term life insurance. Term life insurance the policy exists for only a set number of years and expires. And it s very, very, very cheap obnoxiously cheap. $1 million of term life insurance could cost less than $1,000 a year; likely does cost less than $1,000 a year. Which seems like a lot now, but in the grand scheme is a good thing to protect you and your loved ones.

4 Page 4 I have personal reasons for feeling strongly about this. It can t be said enough, how important this is, to protect your loved ones and your dependents if something might happen to you. There s a quick way, and you can look up calculators for term life insurance. A quick way to decide how much you should have is the using the acronym DIME. Debt you want to pay off your debts. Income you want to replace the income that your loved ones might need. You want to pay off your mortgage, is the M. And you want to provide potentially for your children s education, is the E. And so, you could add up those things to be quite a sum. But thankfully, even $1 million, $2 million of 30-year term life insurance, assuming good health and no tobacco, of course, is very affordable. I want to stipulate here that I m very passionate about not ever buying whole life insurance, or universal life insurance, or they call it some other things sometimes too. Now, these are life insurance products that stay with you your whole life. And they re very expensive. They cost a lot more than a term policy would. And you might imagine why. They stay with you forever. But not only are they life insurance products; they re going to be sold to you. And every one of you listening to this will be sold whole life insurance. You can t buy term life insurance without saying no to whole life insurance. Whole life insurance is a life insurance plus an investment, rolled into the same package. Unfortunately, the investment is very, very poor. You can read about this online. You can look up whole life insurance articles. You can see what folks will say about it. I think it s only useful for a small, small number of individuals. It s useful for people that have dependents that will last a long time past their 60s or 70s.

5 Page 5 So, the general for most of us will buy term life insurance, and it will provide for our dependents if something were to happen to us, up until a certain point, at which we no longer have dependents, or we ve saved enough money to then cover these issues that would occur if we were to pass. At 60, 70 years old, a 30-year term will get you about there. Hopefully you don t need life insurance any more. Whole life insurance sounds good, but it s very expensive. There s an opportunity cost associated with it, because you couldn t possibly buy enough whole life insurance to cover everything. And you would, I think, invariably miss out on another aspect of your finances that you should be focusing on. Another thing that I think it s important to think about is disability insurance. You can buy that privately. I don t feel as strongly that everybody does that. I feel strongly that you should have term life insurance. I feel strongly that you should avoid whole life insurance. Disability insurance is fairly expensive sometimes. It s something to look into; read about; decide for yourself. I will say here that most people will go get jobs, perhaps in institutions, that will provide life insurance for you and provide disability insurance for you. And now, that s fine. I don t think you should decline that. But I think that and often you can t decline it. But I think you should keep in mind that you might leave that job. Things might change. And if you develop a health issue while you re at that first job, you might not then be able to buy any more life insurance at the next. So, I think from a life insurance standpoint, I think it s very important to get private term life insurance as soon as you feasibly can. What recommendations would you give to trainees with loans?

6 Page 6 Dr. Michael Mallow: So, that s a fantastic question. And if it was ten years ago, I could talk for 45 minutes, or 45 hours, about this. I don t know enough these days about the new repayment options and the new forgiveness options that I understand are out there. I don t know that I asked around here at the medical school, and I don t know that anybody is really completely understanding of all the options that are out there now. I would advise you to go to the AAMC website, for one place. I m sure there s lots of other places. If someone searches for AAMC loan repayment options, they get what I think is a nice website and has nice descriptions about the different areas. The one caveat I would say is that I ve had friends and colleagues that are very focused on paying off their student loans as soon as humanly possible. I would not necessarily advise that at the expense of other important things: having term life insurance; feeling secure in your retirement planning; potentially buying a home. I think you have to keep the student loans as just one piece in the big picture of your financial situation. What financial investments do you recommend to trainees? Dr. Michael Mallow: Read John Bogle. His advice is really to avoid individual stocks, and to avoid managed mutual funds. The idea being that there s little data to support any human being s ability to predict the market to say that I m going to buy this stock, and this is the best thing for you right now; I m sure this is going to go up. Or even someone s ability to pick a sector and say, you know, energy investments are good in the next five years. Apparently now, I didn t do the research, but read about it. Apparently that s fraught with fallacy.

7 Page 7 And so, the recommendation I use, and I ve read a lot about this and feel good about it, is to be in mutual funds that are not managed. And you can read about what that means specifically. But it means that the fund itself is a compilation of stocks that are a broad section of the market. So, you own basically the whole market. Which is confusing, of course; but, becomes more clear when you read. They also have funds that are target retirement funds that, you know, set you up when you re going to retire, and how old you are. That can be easier. Now, this is complicated, and I would encourage people to read about it. But what I would caution is being focused on any one individual thing. And I would caution anybody about playing the stock market, because I think that can be very difficult. I would recommend that everybody, when you re looking at your retirement and that s really what I m thinking about, when I saw financial investments. I m really focusing right now on retirement. So, this is the investments in your retirement accounts. I think you want to look at 401(k)s, which are the generic sort of retirement package that most of us are familiar with, in which case your employer puts money in that is not taxed, and at some point in time when you take that money out, it will be taxed. Now, there are limits pretty high limits to that, in the high teens of thousands of dollars a year, that you re allowed to put into a 401(k). The other options are Roth IRA that are very nice, and you pay the taxes today. The money grows tax-free, and then you can reap the benefits of that money. It seems to be that if you qualify for the Roth IRA, that s the better place for your money initially. Now, this might not be the case. You can do the math. You can go online. But it seems to be that, because when you re

8 Page 8 young you have so much time for that money to grow tax-free, that the Roth IRA is a nice choice. And beyond that, I think that s a lot. Once you ve maxed out your 401(k); once you ve purchased the insurance products that you need; you re focusing on your home; you re paying down your loans, you re probably doing very well. Another thing to consider is to have try to accumulate some emergency fund. Most advisors recommend six months of income in an emergency fund, in case something were to happen. Beyond that, once all those things are taken care of, which is saying a whole lot, then perhaps you re at a point where you have money to do other things with, and talking to an advisor would be reasonable. And there s one thing I think I would also like to add, is saving for education, and that people should know that there s the availability of a vehicle called a 529, which is for their children s education, or any person s education. You can change the person that is the recipient of this money. And the money put into that plan grows tax-free, and then needs to be used for secondary education of some sort. And you can learn about those online. They re a nice option as well, for investment, once you ve maximized your retirement investment options. And that s an important caveat. Most people seem to say, and understandably so, that you should focus first on your retirement, and make sure that s secure and that you re not a burden on dependents later in life, and then after that think about saving for college and things like that. Thank you, Dr. Mallow, for this insightful discussion on financial issues affecting physical medicine rehabilitation trainees. On behalf of the Association of Academic Physiatrists, we would like to thank you for listening

9 Page 9 to this podcast. More information on podcasts and the American Journal of PM&R, including the journal ipad app, can be found on the AAP website at This concludes today s program. Thank you. THE END

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