Carolyn McRae 

Hello and welcome to JoyMed. I am your guest host for today's episode. My name is Carolyn McRae, and we are going to be talking about prescribing prosperity, financial wellness and physician burnout. I have two wonderful guests with me today, a financial wellness power couple, if you will. Dr. Taylor Tolliver and her husband Tim Tolliver. 

Dr. Tolliver is finishing up her residency in obstetrics and gynecology at VCU Health. Six days and counting. Wonderful. And Tim is Vice President of Strategy for Aero Communications, and he's been working with the Medical Society of Virginia on a lot of work around programs to expand and enhance financial wellness for a really career physician. So thank you both so much for joining me today. 

Dr. Taylor Taliaferro 

We're thrilled to be here. 

Tim Taliaferro 

It's a privilege. 

Carolyn McRae 

Such a pleasure. So, my first question for both of you is, can you talk to me a little bit about your experience in the financial wellness space? Why is this a passion of yours? 

Dr. Taylor Taliaferro 

Well, I'll start in by saying that I came into medical school as a very non-traditional, non-linear student. So I graduated from undergrad, I went out into the workforce, I worked in sales and marketing, and I got to be an adult, I got to explore what that meant to be on my own with my finances, have a mortgage, get married, do all of those things, and then later went back to school. And when I found that, going back to school, I met with a lot of my peers that had gone straight through. 

They went straight undergrad into medical school and into residency and never really had a, that kind of life education that I was able to have in my early 20s. And I found that people were either, they had two things. They were either like an ostrich with their head in the sand and just wanted to completely ignore it, or they were just overrun with anxiety about it. And I thought, this cannot be like this for everyone. 

Why is this such a big, you know, problem with all the brilliant doctors that I'm seeing? And I found that I just, I couldn't not let them get some sort of help and have some sort of guiding, you know, help in the world to get them through those anxiety-producing feelings that they were having about their finances. So that's how I really started to get excited about this topic and really see the great need for something like this in all of medicine. 

Tim Taliaferro 

I mean, I kind of came to it late, relatively late. You know, like I didn't get exposed to some of the real basics of financial wellness until I was into my career. And once you learn about like the time value of money, for example, or, you know, some of these basic things where the actual, the later you get to this, the more costly it is, or the more you sort of lead on the table. I just thought it was crazy that, how can I be this old before I'm starting to understand some of these things? So that's, I don't want other people to have to get to later in their career before they figure out some of these basic things. 

Carolyn McRae 

And a really interesting point too, when you were thinking about early career physicians and how much more education and school they have to go through by the time they get to the part where they are a full-time professional physician, they might be 5, 10 years behind where some of their peers from undergraduate study perhaps have been as far as saving for retirement or building wealth? 

Dr. Taylor Taliaferro 

100%. And then you start giving them this big paycheck that they have no idea what to do with, and you expect them to just know suddenly what to do with all of that. It just seems like we're really missing a big piece of their education. 

Carolyn McRae 

Yeah, let's talk about that, big paycheck and not knowing what to do with it. Why is it that you think that financial wellness, there is a gap in financial wellness when it comes to medical education? And what are the consequences of that gap? 

Dr. Taylor Taliaferro 

Well, if you imagine that, you know, getting into medical school is already a really kind of competitive, challenging, experience and then you get into medical school and you're constantly being evaluated against your peers and having to take challenging tests and these test scores and evaluations are all going to then. get you into residency. It seems like an impossible task to add one more thing to their to-do list, right? Some medical schools even give out a copy of White Coat Investor to their first year medical students, which is a great book. But unless you have the time to go read it in your spare time on top of all of your clinical duties and your studying and your step exams, then I don't think we're really preparing them for those kind of financial skills that they need. 

They're expected to then learn everything about the body and the pathophysiology of every disease. And then, oh, in your spare time, when you are also supposed to be exercising, maintaining all of your relationships and doing extracurricular activities, go ahead and read this book. I think it's just not part of that innate curriculum that they are already doing on the day-to-day. And you can't expect them to then go out and say, let me just go read up on tax codes and figure that out because there's just not enough time. And if it's not in their kind of forced curriculum where they have to meet with someone or they have to kind of go through these sessions, then I think they're not going to go get it themselves. 

And so I think the whole point is that we have to weave it into their undergraduate education, their medical school education, and their residency as well. And then hopefully we're catching them up that at least gets them to be halfway to where their peers are out in the workforce. 

Carolyn McRae 

A great point. Medical students and residents are not known for having the most free time out of our young professionals. 

Dr. Taylor Taliaferro 

Right, and then, you know, we talk about wellness, and they're like, okay, don't forget to exercise and keep up with all of your other things, extracurriculars. And so, there's not a lot of time to go out and do your own self-study on all the things finance that you need to know. 

Carolyn McRae 

On top of being an expert in the field in what you're trying to enter as a working professional. 

Dr. Taylor Taliaferro 

Exactly. 

Carolyn McRae 

Of course. Well said, Dr. Toliver. Thank you. Tim, I wonder if you could give us a little bit of the perspective of Coming from the outside and seeing the stresses in the financial space for residents and medical students? 

You and I have talked a little bit about how spouses have kind of gotten together and said, here are some of the things that we're seeing when it comes to financial wellness and stress. And I wonder if you could kind of give us that outside looking in perspective there too? 

Tim Taliaferro 

Yeah, I'm happy to. It's not obvious for people who haven't gone through this. I've never known someone in my family who's been a doctor, so I didn't know what the process was like. But when you're in med school and then when you're in residency, it's basically all-consuming. So even that idea, well-intentioned though it was, of here's a book, read it. That's just so unrealistic for so many of the people that I've seen that, you know, Taylor has gone through this process with. because all their incentives are on the clinical, right? That's what they're graded on. That's what they're going to focus on. And it is so all consuming that there's just not a lot of time. And when you do have time, you kind of want to just relax, I think, rather than, you know, something like read a dense book about investing. That just doesn't seem right. 

So what I what I do think, though, is much more realistic is partners and spouses who are in many cases on this journey with a resident or a young doctor can be important allies in practically getting these types of things in front of them, either, with information they have or doing, a joint, meeting with a financial planner, whatever that looks like, but involving spouses or partners it's just realistically a better way to actually get it done. 

Carolyn McRae 

Absolutely, and you two have shared with me previously that because you came in from that non-traditional background, that you two kind of became the de facto financial counselors for the other residents in your program. 

Dr. Taylor Taliaferro 

Yes, they lovingly refer to us as the mom and dad of residency. And I started just forcing people to log into their Fidelity accounts in front of me and proving to me that they actually knew their login. And then we would go in and I would force them to press the up arrow to how much they were contributing to their 401k. So call it bullying, call it peer powering, you can call it what you will. But I realized that I alone cannot force every resident. 

There's over 900 residents and fellows at VCU to do that. And so, I needed a little help and a little support in a way that could make this sustainable and make it so I wasn't just, my whole job was going around and making sure people could retire before they were 100 years old. 

Carolyn McRae 

I love that term, peer powering. 

Dr. Taylor Taliaferro 

You know, it's dealer's choice, what you'd like to call it. 

Tim Taliaferro 

She's an expert in peer powering. I guess partly I'm a little bit older than Taylor, and Taylor's generally a little bit older than most of the residents, so that makes me nearly ancient. And so a lot of them kind of were willing to hear me talk about it, partly because they were just like, oh, he's got kids, he's married, he's got a house. He probably knows something about that, which is a little bit telling. But yeah, that was my, that's partly my role, has been my role in the program, be the old guy. Don't see what to do with money. 

Carolyn McRae 

Ancient wisdom. 

Dr. Taylor Taliaferro 

Ancient wisdom, exactly. 

Carolyn McRae 

The 2 of you have also been really helpful with the Medical Society of Virginia and starting to develop some more formal education and resources around financial wellness. 

 Something that you helped to do early on was to hold some focus groups around financial stress. I wonder if you could talk a little bit about how you saw in those focus groups that we held what financial stress looks like for these early career physicians, the folks in these residency programs, and how do you think that is contributing to their overall well-being? 

Dr. Taylor Taliaferro 

I think a big thing we saw in those focus groups was that, you know, thankfully, we have a lot of first-generation students coming through that were their parents were immigrants or their parents were just working really hard to get them that next level of education. And so, they didn't come in with that kind of familial assistance saying, hey, this is what you need

to do and here's how you set yourself up because they're now going to be the main providers for their families. And so I think they just felt a little lost and didn't know where to turn. 

And I think there are a lot of predatory people out in the world that they just felt they couldn't trust either, because we get thousands of emails, all of these people reaching out saying, well, let me be the one to help you with all of your money problems. And it sounds kind of sketchy, to be honest. And so, they didn't know who to turn to. They didn't have other people in their life that they were turning to, and they just felt a little lost. And like, if I just keep pushing, and pushing it down the line, I'll get to it at some point. And I think kind of forcing people to face it head on, you have to get through that initial anxiety and then they have a bit of a breakthrough where they can say, okay, I know this, I didn't want to talk about it, I didn't want to think about buying a house, but now I've pushed through, I've gotten to that point where I know how much I need to save for a house. I've now bought a house. made the down payment, we're closing next month. And then you get to that point where you get to see them kind of have those initial successes and you see, okay, it was worth it to go through a little bit of that pain to get to where we are now. 

Tim Taliaferro 

What I remember vividly from the focus group that we did over dinner was it seemed everybody there understood sort of intuitively how important it was, but they weren't necessarily sure really what to do, right? 

And they were just kind of like, I can, I know this is really important, but I don't actually know what to do. That was one thing, which is an initial interesting finding, right? Like there's interest and there's, you know, a very solvable problem, right? You just got to give them the right information. They were wary, and like Taylor says, they are, you know, they get zillions of emails from people inviting them to steak dinners and, you know, promising the best return ever if they just buy this annuity. So, there's a lot, there's a trust issue there. 

 

What most stood out to me was one of our attendees, for her, it was about, she was super capable, super smart, super conscientious, she just didn't want to be talked down to. And she was very sensitive about, you know, don't condescend me, right? Don't bury me with abbreviations and acronyms. And, you know, the approach was really going to be important to her, not just the information. 

Carolyn McRae 

Yeah, approach is an interesting concept there of making it accessible and delivering it in not a condescending way, right? These are incredibly smart individuals who are coming in who just aren't experts in financial wellness, in the financial, personal finance field. Do you think that there are myths or misconceptions that might drive them to make decisions that don't align with financial wellness early on in their career? Do you think it's lack of knowledge or what do you think is happening there? 

Tim Taliaferro 

Well, you know, the one thing I'll say about that is you'd think doctor, you'd think make a lot of money. And so I suspect there are people that just are willing to not worry about it for a long time. Just say, I'll sort that out when I get a job and I have a lot of money. I don't know if you agree with that. 

Dr. Taylor Taliaferro 

Oh, yeah, I think you're right. I think they just say, I'm gonna… ignore this and put my blinders on for the next 10 years of my career. And then I think, there's a lot of well-intended people that are trying to sell you a mortgage, trying to sell you a house, trying to sell you a car, trying to sell you anything. And that's their job, to sell you something. And they do a good job of it, a lot of them. 

But there's not a lot of people out there that are willing to give good advice and say, do you think you need to buy a new house right now? Or could you rent for a year and wait and see where you're going to be? And I think having that kind of trusted advisor to help people make big decisions is really what's missing and not letting people get set up for success to make those big decisions, but make them in an informed way. 

Carolyn McRae 

Yeah, it sounds like some of these financial pitfalls for some of these early career physicians are, that's a tomorrow problem, so I don't have to worry about it right now. And there's a lifestyle creep piece as well, right? We know I'm going to make a good amount of money soon, soon being a relative term. And so I can buy the house or I can buy the car because I'll be able to pay for it later. 

And then a third pitfall of being almost a victim of maybe some predatory practices in the financial space of people coming and saying, look at this great product and kind of identifying these early career physicians as that's someone who's going to make a lot of money. And if I can get them on the line now, whatever their intentions may be, this could be a really great client for me to have long-term. So maybe providing them with some opportunities that don't necessarily align with their financial goals early on, like those annuities that you mentioned, for example. 

Dr. Taylor Taliaferro 

Then they miss the really, the gems out there, like the disability insurance that you can get as a VCU resident that gets you, know, this sort of locked in rate without, you know, there's some really good things, products out there that I actually really try to encourage people to explore, but they can be hidden amongst all of the trash. 

Carolyn McRae 

I think that's that kind of drives to my next question. What advice would you give to a medical student or a first-year resident? What would you tell them as far as here are ways that you can kind of build your own financial wellness and your financial capability? 

Dr. Taylor Taliaferro 

I think the first thing is you can't ignore it. So, you have to open your account. You have to know your login. You have to know what your goals are. And you have to look at where you are in terms of those goals. So, knowledge is power. You can't ignore it and you can't ignore that, you know, I'm just not even going to look at my bank account, not even going to look at my spending. So actually, looking at the problem. 

And then I think finding a trusted person that's going to give you good, solid advice is key. And now whether that is a, you know, kind of a pro bono financial advisor that you can find through MSV, great. If that's somebody that you can find outside of that, great too, but make sure it's a well-vetted person and make a plan and then execute that plan. Don't just kind of go all over the place. You know, actually have some goals and work towards those goals. 

Carolyn McRae 

Yeah, there's a phrase about best laid plans in there, right? So, making the plan and sticking to it. Absolutely. 

Dr. Taylor Taliaferro 

You can adjust and change over time, but you have no plan, then where are you going? Just kind of floundering. 

Tim Taliaferro 

Right. Yeah. I mean, I think there's a weird thing, maybe this isn't unique to doctors, but they're typically really high-achieving people who are very confident that they can solve problems and are generally very intellectually capable. But I suspect they may also be willing to be their own patients or their own doctors in this financial health thing. And I think that's a bad idea. For almost everybody who's, whether you're, if your undergrad is in finance and you're just a, you're away on that spectrum, okay, maybe, but you don't, you don't behave like this when you're, when you're ill, you go to an expert, right, in whatever's healing you. That's why you, know, obviously you believe that you're becoming a doctor for that reason. 

Similarly, you should go to experts for this because there's just so many rules between the products, the, law, the tax implications, that go find who's doing that, right, and hire them. And there's ways to hire them where the structure of the agreement is, as they grow your money, they get paid. And so, your incentives are aligned. And so, you're not like shelling out to them in a fee way. It's as they care for your money, and it grows, that's how they get paid. That's a very sensible way to, just not be your own patient. 

Carolyn McRae 

I love that. And I think it ties back to what Dr. Tolliver was saying as well around this idea of knowing what products to actually invest in and use and so that you're not missing out on opportunities. So, relying on those experts who have your best interests in mind. And of course, doing your homework and making sure that they are aligned with what you want to do financially to set yourself up for success long term. 100%. 

Dr. Taylor Taliaferro 

100% 

Carolyn McRae 

100 %. So, Tim, Dr. Taliaferro, to you, what does financial empowerment look like for an early career physician? 

Dr. Taylor Taliaferro 

Gosh, what an amazing question, because I had an attending one time ask me, how old do you want to be when you retire? And I thought, I have no idea. I don't know how old I want to be. And then it made me think, okay, well, actually, what do I see for myself and my future? And what are my goals for my children and their education? And I think going back to knowing kind of where you want to go, you can always adjust a little bit along the way, but kind of finding out where that is and how you're going to get there is really half the battle. 

Tim Taliaferro 

I kind of think it's just like what Taylor said, it's like having a plan. Like that is pretty empowering because it presupposes that you've confronted, you know, your challenges, you're aware of them, you know, your debt situation, and you have an actual sensible plan. And that should be empowering to most people in this context, I think. 

Carolyn McRae 

Right. Going back to that initial advice that you gave of knowing your login, knowing what your balances are. 

Dr. Taylor Taliaferro 

Yes, it's amazing to me when you ask people, you know, what is your, you know, how much debt do you have? How much do you have in your bank? And people don't even know. And they don't even know what's coming in and what's going out. And I think that's incredible power and knowledge that you need to just kind of start at square one. 

Tim Taliaferro 

That's another thing I think a lot of people in this space don't really understand is debt specifically. We didn't talk about that earlier, but there's this sort of free, I'll just borrow, it's fine, you know, whatever it costs, whatever med school costs, whatever I need to get through residency, I'll just borrow, borrow, borrow, because I'm going to make $1,000,000, or I'm going to make a ton of money. But the differences can be quite vast. 

The implications of that on the back end, even though you are making a lot of money, it won't feel that way if you've really buried yourself in debt. So even the most highly paid doctors can feel financial stress if their debt burden is as high as sometimes, they get. 

I think you showed me once some survey data of physicians that showed a kind of a shockingly high percentage that feels financial stress. And that's counterintuitive when you think about what, doctors feeling financial stress? Don't they make a ton of money? Yeah, I mean, there's what comes in and what goes out, and the relationship between those two, you have to look at both of those. 

Carolyn McRae 

Absolutely. I think particularly in the early years as well, when you're, when we're thinking about these debt levels that physicians are taking on to get through school and get through residency, The average right now is over $200,000 in medical student debt alone. So then when you're talking about entering residency and thinking about buying a house or buying a car or moving or getting married or whatever the case may be, that debt can compound and compound and compound, particularly when you're not at full attending level and necessarily able to service all of that right there. 

And it's interesting because I think we've seen and we've talked about that some individuals feel really stressed by that amount of debt. And then some others will also think, well, I could just borrow a little bit more because at this point, it's a drop in the bucket. 

Dr. Taylor Taliaferro 

I absolutely have seen that. And it is shocking the difference because you couldn't, you can't spot it from the outside. You have to kind of dig a little bit to get to that point where, you know, a lot of people aren't paying their loans in residency or they're just deferring, deferring, deferring. And it's like, at some point, you got to rip that band-aid off and you got to face it head on. And I think the sooner you can get people into that mentality, the better it will be for them long term. And again, I'm like, don't you want to retire ever? Or do you want to just keep working and paying this mountain of debt for the rest of your life? 

Tim Taliaferro 

Yeah, I would actually revise my earlier thing about financial empowerment. I think maybe the first step is a clear grasp of your debt as it relates to most young med students, if they are clear-eyed about their debt, how much they have, what it means, and what it means to take on more, that's very empowering, very financially empowering right there. 

Carolyn McRae 

So knowing cash flow, knowing net worth, and I used to work with undergraduate students on this issue, and we would do a net worth statement, and I would have to tell them, you have made no money at this point, most of you, and you have probably taken out loans to be here. So, your net worth is probably going to say red. And that's okay. That's okay. It's still important to know what it is so that we can start building towards financial future. 

Dr. Taylor Taliaferro 

Right, and I think financial empowerment does not mean you're driving a brand-new car and living in the biggest house and, you know, belonging to the fanciest country club. It's about knowing that you can achieve the things you want in your life, whether that's travel, whether that's time with your kids, or whether that's a fulfilling job that may pay less than another job you could take. I think that feels really empowering to people when they have choices. 

Carolyn McRae 

Yes, choice can be so very empowering. 

Final question for you, what can we be doing to make sure that our medical students and residents and early career physicians are have access to those feelings of empowerment. 

Dr. Taylor Taliaferro 

I think the medical society is doing a great job of really getting in early. And I think by being in front of the medical students and the residents before they go out and maybe make bad

decisions is huge because you guys have the opportunity to say, here's the resource, here's how we can help. Let's be in front of you and get you those feelings of empowerment earlier rather than later. And I think just getting in front of all those, kind of future physicians and early training physicians is huge. 

Tim Taliaferro 

I agree with that. was pretty well said. I mean, maybe it's emphasizing that you're not really selling them anything, you know, that that's a, that's like a practical way of just reminding, you know, whether you're talking to a residency coordinator or a director or whatever, like this isn't a sales call. You know, I'm not, I'm not trying to get money from them. I'm actually here to help them, address their financial health. And that's part of our mission. And so I think that's a powerful message. 

I think being up front with it, being forward with it, being confident in it, you know, I'm biased, but I think the MSV is just doing a great job and taking on this challenge because it's urgent and it's important to the whole field. And the better you succeed, the better ultimately, care people are going to get. Because doctors are happier and better and not as stressed. And that's what we want out of health care. We want better outcomes. And if that in some small way helps it, carry on. 

Carolyn McRae 

Dr. Tolliver and Tim, first, I want to thank you so much for being here today and talking with us about financial wellness, how that contributes to overall physician well-being and mitigates physician burnout and stress. It's such an important piece to really make sure that we're doing right and bringing this type of education resources in front of our physicians throughout their career. So, I want to say thank you for sharing your expertise and also for helping us to start developing resources in the financial wellness space for our early career physicians. It's been so wonderful to work with you both today and over the past year. 

Dr. Taylor Taliaferro 

It's been a pleasure. It's exciting for me. I'm excited to continue this work. And for any medical students and residents that might meet me in the future, just be ready to log into all your accounts. So be prepared. 

Tim Taliaferro 

You're serious about that? 

Carolyn McRae 

I love it. All right, everybody, make sure you know what your logins are, or Dr. Tolliver might come and find you. Thank you again for being here today. 

Tim Taliaferro 

Thanks so much.