This podcast features an interview with Dr. Ramsey Tate, MD, FAAP.
Today, we are going to chat with Dr. Tate. She is a board-certified pediatrician and is wrapping up fellowship in pediatric emergency medicine. She is active in women in medicine professional groups and committed to helping other women build successful, rewarding careers in academic medicine. Frustrated by the lack of financial literacy among physicians and alarming rates of burnout in her colleagues, she started Call Me Dr. at CallMeDr.us to share finance, career, and productivity tips for young academic physicians. Dr. Tate believes that better balance is possible for physicians
This interview reveals the following:
– The financial secret to success that Dr. Tate learned at her college graduation (Hint: It doesn’t involve student debt)
– How to overcome the insidious disease of physician burnout
– Learn what inspired Dr. Tate to start her blog and how you can plan your exit strategy to step away from medicine
TRANSCRIPTION
Podcast Interview with Dr. Ramsey Tate, MD, FAAP
DAVE: My name is Dave Denniston. Welcome to my latest cast on The Freedom Formula for Physicians Podcast. Today, we are going to chat about three of my favorite subjects- money, women, and power. Although, not necessary in that order!
As I’ve gotten deeper and deeper into the medical community, I’ve found a number of blogs and bloggers who are doctors with some really unique perspectives and they write in an incredibly entertaining, but educational style. If you haven’t checked out CallMeDr.us, you definitely should today!
I have the distinct pleasure of hosting our guest today- Dr. Ramsey Tate, MD FAAP. She is a board-certified pediatrician and is wrapping up fellowship in pediatric emergency medicine. She is active in women in medicine professional groups and committed to helping other women build successful, rewarding careers in academic medicine.
Frustrated by the lack of financial literacy among physicians and alarming rates of burnout in her colleagues, she started Call Me Dr. at CallMeDr.us to share finance, career, and productivity tips for young academic physicians. Dr. Tate believes that better balance is possible for every physicians.
Welcome Ramsey!
DR. TATE: Great, thank you so much for having me Dave and for the warm welcome.
DAVE: It’s my pleasure. So, tell us a bit about yourself. What led you to be at this point? What inspired you to be a doctor? (then why pediatrician)
DR. TATE: Oh my gosh, we could talk a whole podcast just about how people end up pursuing their career in medicine. For myself I was a non-traditional applicant, I had worked in health services research for a few years before I even entertained the notion of going to medical school. I had the opportunity to work with some physicians who are also researches working on the issues that were important to me, issues around disparity in health care and social justice work and that’s really what led me to a career in medicine. I wanted to be like them and that’s how also how I pursued a career in pediatrics because I felt like that’s I where I had the best natural role as an advocate for children in this country and can do the best work over the course of a long career.
DAVE: Where you doing research specifically in pediatrics?
DR. TATE: I was not. I was actually doing research in lung cancer screening and in racial health care disparities.
DAVE: So you got a lot of exposure to a lot of different areas. What’s this journey has been like to you? You think about going to medical school, you went after working in the field for a little bit or what was that like?
DR. TATE: That’s correct, I went back to medical school after working for a few years. I actually trained in undergraduate to be a diplomat, I had no experience in medicine. I wasn’t someone who had ever set foot in a lab and I can proudly say I still haven’t, I didn’t have any background in science. For me it’s all about social justice and interacting with people one on one and it was a long slag for me to get through my medical education and training. It included going back to undergraduate education for a year to do a post-back program just to take things like organic chemistry and biology and apply it to medical school. So I think that my perspective has always been a little bit different from many physicians who kind of set out along that path in high school. I had more experience of the world, I had traveled internationally and worked in human rights work as well and I’ve sort of been both an insider to the process of medical training and the enculturation that comes with it and an outsider. I have tried really hard to maintain that perspective and to see what it does to us to train as young physicians, how it makes us better and how it makes us weaker.
DAVE: Well you go through all these stuff, your whole journey here and you get into residency and now your fellowship and you also happens to blog, so tell us about that? What inspired you to start blogging?
DR. TATE: It’s a relatively recent thing that I’ve started. I just started blogging last fall and partly it was the challenge of it. It’s something totally different than anything I have done before. I do a lot of public speaking and I really enjoy engaging with people when I can see them face to face and have great conversations and learn from one another but I have never tried blogging. It’s totally a different way of interacting with people. So i thought I’d give it a shot, I started CallmeDr.us as a form to share information that I’ve learned along my journey as well as through a systematic study of young female physicians and what makes them successful on their own terms.
DAVE: I’m sure many are listeners are wondering- how the heck do you find the time to blog while going through your fellowship? What do you enjoy about it?
DR. TATE: Great question. I think that finding time to do anything that we’re passionate about during our medical training is a real struggle and that’s a topic that I kind of addressed on CallmeDr as well. I think that having passions and remembering who we are outside of medicine is part of how we can make ourselves burn out proof. Burn out is absolutely epidemic among physicians whether you’re young or old whether you’re training or have been out practicing for twenty years, burn out affects all of us. Just the other day I was reading a newsletter from one of the state professional societies that I’m a member of and there was another obituary for a physician in my specialty who committed suicide and every time I see one of those it really drives me to look at how I can share better information about making ourselves more resilient with other physicians.
So to specifically answer your question about how I find time, there’s a technique that I write about on the blog called MM90 or My Morning Ninety and it’s how I carve out some time and space to pursue goals that are important to me.
DAVE: So it’s like finding that you time, it sounds like it’s kind of a release for you. It helps you work out whatever you’re going through. Is that fair?
DR. TATE: Yes and I think it’s also about career development too. It helps me in a lot of different dimensions. So My Morning Ninety is really my secret weapon for how I stay successful and how I feel balanced. It’s a technique that I use to create that time and space and what it actually looked like for me on a typical day is that I roll out of bed, I grab a cup of coffee before I check my phone or email. I think phone or email are the quickest roads to burn out for physicians and probably anybody. But before I check my phone and email, I sit down with the projects that’s important to me. I set a timer for forty five minutes and regardless of whether I feel like doing it, whether I am motivated, whenever what kind of mood I’m in I commit to sitting there until that timer goes off. After it goes off, after forty five minutes I’d let myself eat some breakfast, I still don’t check my phone or email and I sit down and I do it again.
DAVE: You’re strong. I have to look at that phone.
DR. TATE: So it’s a total of ninety minutes. Yes and it’s just one of the things that when I set out to interview other academic physicians who had been successful on their own terms and also looked at people from other fields and how they’re successful, a constant theme that I tell running through it was “building destruction fee zones and finding times to work that take motivation and behavioral cues out of the picture”. So many different productivity sort of gurus or people who study behavioral science recommend finding time that you are away from your phone, from any sort of technological distraction and creating a destruction free zone to work on something that is important to you. It may be blogging, sometimes you know I’m a researcher, sometimes it’s working on my research manuscripts, sometimes it’s doing exercise or yoga. It doesn’t matter what it is, what matters is having that time and preferably at the beginning of your day so that whatever happens the rest of your day you feel like you’ve accomplished something that’s important to you.
DAVE: One with kids and life that happens and husbands and wives and all these destructions, I mean some of these are great things but having time for ourselves I think, focus time on us can help keep us going.
DR. TATE: Yes absolutely and it doesn’t always even have to be just about ourselves. For other women physicians that I talk to, some of them try to use this time to do things like rad with their kids. So it’s less about how you use the time than that you carve out time and space to pursue something that is a personal goal for you. Something that is not told to you, a goal that is not set by your program director or by the faculty that you work with, it’s something that really keeps you whole and healthy.
DAVE: Let me just kind of redirect the subject here real quick.
DR. TATE: Yes absolutely.
DAVE: One of the ways that you and I got in touch and how I stumbled across your blog was on the subject of student debt. On your blog, I was happy to read a great post about IBR/PER and moonlighting, so I know this is a subject close to your heart. Tell us a bit about your experiences with student debt. What this journey that you’ve gone through? What have you been through in? What have you seen your colleagues go through?
DR. TATE: I think that financial planning is a vastly under addressed topic in medical education and certainly someone who had not planned a career in medicine before I embark on one, I really under appreciate it. The amount of stress and strain that medical education debt puts on on young physicians and also just how it’s ballooning over time. When I talk to physicians who trained a decade ago which really isn’t that long ago in our professional lives, they have a totally different order of magnitude of average debt than the current graduates do. So this is certainly something that I’ve not only felt but I continue to watch escalate among my colleagues and really determine a lot about how their lives are in the level of stress that they carry.
DAVE: So what do you think about this current system? What do you think the best advice that you’ve heard regarding student debt? Is the cost too high to become a doctor (If yes)? Does fault lie in the cost of colleges or elsewhere? What are other options- maybe should we have more diverse debt forgiveness programs?
DR. TATE: I’m not an economic expert, I won’t claim any expertise beyond my own expertise as a physician but I think that we have to address the system as if it’s broken. Another pediatric emergency medicine physician that runs a blog for academic pediatric emergency medicine physicians recently posted something where he calculated out his cost of training just in out subspecialty and it was well over a million dollars if you look at the income and the cost of licensing, examinations, maintaining certifications, it is overwhelming. I even trained in a system that’s very different from a lot of other house staff. Many people don’t realize that pediatric residency programs that are ran through free sending children’s hospitals are not funded through the same mechanisms as other residency programs are and require annual re-authorization through congress to keep going. So certainly I felt during as a trainee, during a period in which there were government shut downs how tenuous our funding system really is to support trainings as well as feeling the burden and stress of young physicians when we come out of it with an average of nearly two hundred thousand dollars in debt.
DAVE: So what do you think the options are? If this is the problem, what are some potential solutions?
DR. TATE: That is a question that is way over my pay grade. I do think that there have been some phenomenal expert opinion pieces published in New England Journal on Medicine last fall that looks at the pros and cons of the current payment structures to support health track training and there’s a lot of discussions as well about the ballooning medical education debt. I think that one sort of bright star on the horizon is student loan forgiveness programs. And that is really what we had in common when we come across this topic, public service loan forgiveness. Public service loan forgiveness will not kick in at the earliest until 2017.
DAVE: It’s getting close.
DR. TATE: So none of us really know what, I know, we’re getting there but we still you know, none of us know exactly what it’s going to look like or what it’s going to happen when the first round of debt forgiveness comes around and the amount of money that it presents to the government, it’s really processed. But I do think that that is a program that every training physician should be aware of and very few, shockingly few actually are aware of it.
DAVE: I’ve actually crunched the numbers on this which is actually kind of interesting, in terms of what the cost is to the government, when you have interest rate that almost seven percent on student debt, you know two hundred grand which is at least the average from most folks if not more, that’s fourteen thousand dollars a year in interest and so even if you’re paying over a thousand dollars a month, you are barely, you are actually negative in that particular case towards it, so the interest accrues and so even if someone applied in residency and goes into practice and maybe they’re getting paid a hundred and eighty, hundred and ninety, two hundred thousand dollars a year, my calculation was it was actually a break even proposition to the government over ten years because of that high cost of interest, so it’s kind of interesting to see what this is going to look like but at the end of the day it shouldn’t be a big deal because of how much docs end up paying once they are in practice.
DR. TATE: Yes what a great point and I do have from the perspective of the physicians on the CallMEDr site, I have a worksheet that is available that was specifically set up to show young physicians what the impact of moonlighting and generating income through moonlighting on that forgiveness, but can also be used just to look at how your interest accrues on your specific total value of loans over the cost of your training and into your young faculty years. It will give you a sense of what that forgiveness would look like for any individual physician.
DAVE: Some of the best advice I’ve heard, I’ll share in a second on student debt but I wonder what’s your perspective, what’s the best advice regarding these programs that you’ve heard for student debt?
DR. TATE: I think I was really fortunate to graduate from a medical school that values financial planning. I don’t think I appreciated that until I began residency and realized that most of my co-residents had to idea how much medical education debt they owed nor what to do about it. I was really astonished and I’m so grateful, I’ll give out a shout out to my alma matter University of Chicago for its school of medicine that before we graduated they had, I remember we had speakers from the AAMC come and talk about managing our student loans, we had a financial planner and help that sat down and reviewed all of our financial loans with each of us, talked about the different options, made sure that we understood what options we had because it was a time when the landscape of forbearance and the firm that we’re all changing. And so I remember making at the end of my fourth year of my medical school a spreadsheet and looking at t with the financial advisor in our admission’s office and coming up with a plan, a plan for how I was going to consolidate my loans overtime to keep he lowest possible interest rate but yet still qualify for public service loans forgiveness and income based payment programs and also how I was going to pay off my private loans within the first couple of years of residency and I have stuck to that spreadsheet. And now six years later I feel like I am in a dramatically different place financially than I ever would have been if I didn’t have access to those resources as a medical student.
DAVE: If only everyone could have those kind of resources right?
DR. TATE: Yes it’s been heartbreaking to me honestly to attend particularly women in medicine financial events and realize how little physicians have been educated about their loans and how much fear and avoidance and emotional stress and drain there is around them. Many people don’t know how much money they owe and until you know what you owe and sit with that number you really can’t even begin to make an educated plan about how to ideally have that debt forgiven or pay it all off.
DAVE: I was sitting with a couple late last year and early this year and they are two physician household and female transitioning to practice just last year and her husband going into primary care, finishing his residency a year from now and between the two of them is a three hundred and fifty thousand dollars debt. What we found as we crunched some numbers and this is a quick piece of advice, this is the best piece of advice I’ve recommended and had read about was if you are married, particularly for two physician household and you are looking to get your debt forgiven in PSLF look for married filing separately because your payments are extremely low.
DR. TATE: Yes absolutely.
DAVE: You can play with the calculators and I encourage people in addition to that, if you are going down that route look to do in another debt forgiveness program in top of that. One of the local ones or through a predicative primary care, there’s urban programs and world programs and all those different kinds of things, do the two combine together if you can.
DR. TATE: Yes and you know it’s funny, the best piece of financial advice I’ve ever got period was not specific to student loans or around medical education debt. It was when I graduated college, I don’t know what most people get as college graduation gifts but what I got from my father was a single sheet of paper and an envelope and it had typed a couple of lines, it has said “I am proud of you, pay yourself first start it with 1K tomorrow”. And I think that that was the single best advice that I’ve ever gotten because it normalized thinking about financial planning, it was something really important that I needed to be doing even before I have much of an income and pay yourself first is consistently the best advice I think anyone can get.
DAVE: Absolutely particularly that free money in the 401 case.
DR. TATE: I know like so many people have matches that they don’t realize exist particularly house staff. I don’t know why you have to be so resistant, I think its because we have such a low income to begin with than compared to our debt that it feels like giving up a penny of it is a real hardship and many of us who has families and are supporting our families are bubbling around in some state even than the food stamps line. And so the idea of contributing voluntarily into retirement accounts can be really overwhelming when you’re just trying to get by as a breadwinner for your family on a resident or fellow salary.
DAVE: Another topic that I know you are passionate about is women as physicians. I was reading an article last night that said World War II gave women for the first time the chance to work as doctors for the men who would return injured. So, women were given the opportunity to understand the field and as a result, some medical institutions were open to keeping them on staff. Others rid their staffs of the women who worked during the wartime and posted job offering signs stating “Doctors Wanted: No Women Need Apply.” Fast forward and few years and times were a changing- more and more medical schools began granting women admission. Apparently, today females account for around 23% of physicians in the United States. This number is pretty nuts and still quite low considering that 43% of medical school graduates are female.
Talk to me about how you see the gender gap of a physician changing.
DR. TATE: I think that one of the really difficult truth that we have to face and particularly academic medicine is that the gender gap is not changing very fast. Just like you mentioned medical school graduates now are about half women, women really has began to dominate a lot of different forms of higher education and medicine is no different. But we only represent about fifteen percent of leadership positions in academic medicine.
DAVE: Fifteen percent?
DR. TATE: Fifteen percent, there is still a tremendous gap in many institutions in pay and pay an academic institutions, although this is not true across the board it’s off to no peak where individual faculty members don’t know what other faculty members make which makes it harder to know if there is pay parity across gender. We know by looking at the numbers that women physicians are well represented as the entry level faculty rank, a system professorship and their numbers dwindle quickly when we hit associate professorship and then full professor unto dean. There was a recent article, I was just trying to think I can’t recall at the top of my head thee journal but I will email it to you separately and maybe you can append it to the podcast site, it was an article that just came out recently that was based on a survey of I believe that they were all associate or full professors at high level academic institutions all over the country and its specifically asked them how they felt like we were doing in different measures of gender and equality and the news was pretty discouraging, there was a lot of variability but there was not much accountability in higher level for institutions where women don’t have equal or parity pay or equal likelihood of promotion. There was still a lot of silence and a lot of fear around this topic. Something that is important to me is kind of breaking that sisterhood of silence. Acknowledging that this happens and that it exist, that there is still gender inequality in academic medicine and finding really important strategies for how we can support each other and get pass sort of the glass feeling around promotion.
DAVE: In one of your recent posts on the blog, you talk about how one of your female physician friends was crushed when a mentor that they admired said some incredibly hurtful things. What happened there?
DR. TATE: Yes, I’ll call her Rena, I change all the names on my blog posts but they are all true stories and Rena is a personal friend of mine, also a very successful female physician and had a mentor that was not only an important person in the entire department but also someone that she considered a family friend. She and her husband are both physicians, they’ve known this individual most of their lives having grown up locally and one day when Rena was a little bit tired from taking care of her sixth child at home overnight this particular mentor, an older male told her, essentially told her that she should be staying home with her children and that his wife never would have considered working when their children were young. This certainly was not feedback or comment that he ever made to Rena’s husband nor would he make it to him. You know it was clearly a gendered statement and this was heartbreaking to Rena. She was absolutely devastated because this is someone who she really trusted with her career, it was not only her mentor but is the person in charge of her career development in her department. So it’s been very difficult for her and how to process that relationship and how to move forward. I think that this is true for a lot of women although it may not be that blatant, I think that that sort of gendered statements are more of subtle, we do know that they occur, we know that if you study the language used in letters of recommendation for men versus women positions in trainees that the language used is different and gendered, we know that women are less likely to get promoted. So we know it exist, it’s just I think it’s a little more subtle usually that what happened with Rena and part of what I want women to hear a message is that there are relationships that we are going to encounter in our careers that are not productive. Many of them are going to be and it’s tough for anyone who spent, you know for some of us thirty years in educational system where grades matter, evaluations matter, getting people to like you matters, it’s really, really difficult for us to let go of seeking approval. Just recognizing and acknowledging that there are some people’s approval that we don’t need I think is an important stuff.
DAVE: What about on the other side? For the person that gave that comment, what would you say to them?
DR. TATE: I would lose some politic language here but I think that even more soothing that I would say is what should our institutions be saying, we know that there’s a lot of variability in how much gender equality is addressed in various institutions, some do a great job, some do a very poor job and even within a particular academic institutions it varies tremendously from department to department. I think that there needs to be a commitment at the highest levels of academic institutions to supporting gender equality, acknowledging that inequity exists and creating a safe space for women like Rena to come forward when that statements like that made. Because no matter what I would say to that individual you know that what matters is the impact on their behavior and their career and the simple truth is that there is no impact, no one hears about it beyond Rena and her friends.
DAVE: This is interesting, this is a problem I think that is in my industry too. Heck, in my opinion, women are much better with the empathy, the bedside manner than the fellas. I’m glad to see more women as docs! Frankly, I think we need more female financial advisors too!
DR. TATE: I’d like to bring it full circle and talk again about the blog. Many docs are burned out. They don’t think they can make it anymore doing what they are doing. Many may even be looking for the second career- as a matter of fact one of the best tax deductions that I talk about in my book is being a business owner. I think it’s really cool that you are working towards that.
DAVE: Here you are with a potential new business with a blog. You are doing it! Where do you envision the blog going another year or two or three from now?
What advice would you give to other doctors about having their own blog?
What kind of topics are most on your heart? What can we expect to see from your blog in the future?
DR. TATE: What a great question, I do in disclosure to our listeners here, I read your book The Financial Freedom for Physicians that I’m really looking forward to coming out, I’m going to feature it in my sight because I think it has some fantastic advice for young doctors in a way that is really accessible and I agree with you, I think that one of the realizations that I come around to is that when I look around, not just my specialty but academic medicine in general that there are few people with great career longevity, that there are many people who don’t have that and there’s a whole variety of reasons why people walk away from academic medicine or clinical practice in general but I think that you making that plan for exit strategy is an important step. That’s a piece of advice that I’ve heard when I’ve interviewed other academic physicians at different points in their career, to find out what lessons they’ve learned and what they would recommend. Many of them tell me I wish I’ve gone in thinking about how I would end my career. This blog is just one of many different things that I’m exploring and trying to see whether there are avenues for me beyond clinical medicine in the future when I get to the point where I’ just able to practice, ten, fifteen, twenty years down the line. I have no idea what the blog is going to look like and a year from now or five years from now I certainly have ideas on how I can share more concrete information with my readers as well as specific courses on how to help them get their financial lives in order and reduce the stress and help them feel like they are more balanced as they are going through their young faculty years.
DAVE: So what kind of topics are most on your heart that we can expect to see over the next couple of months.
DR. TATE: I’m really focused on three pillars that I think can help achieve better balance by maximizing our greatest assets, our earning potential as young physicians. These three pillars are financial planning, maximizing productivity and investing in our career development. So I’m committed to bringing you more the best information that I have on those three topics called from a variety of different experts and sources and I try to sort of digest them and present them in a way that I think is more accessible to female physicians than many of the sort of male dominated financial advice sites and productivity sites. Because for most women the goal is not about numbers, it’s not about our bank accounts, it’s not about the hours in the day, it’s about having success in our own terms and feeling like we are able to balance our professional life with our private life.
DAVE: Yes I totally see that, it’s a tough balance and I think I do tend to get too tied to the numbers and don’t see the forest beyond the tree when it comes to that stuff. I think it will be great for the fellas to read as well as the ladies.
DR. TATE: Yes and I respond to every single email that I get and I love hearing from readers and many of them are men and although I don’t always write with them as my specific readership in mind, I think that it’s the same information that is just as relevant to men versus women, it is just presented in a way that I’m trying to design it to be more accessible to women physicians but is equality applicable to men.
DAVE: Absolutely, when you take the story that you told there’s lessons for that from the male doctor and stuff that we ought to keep in mind and keep one another accountable for.
Thanks so much for being with us! If people have more questions, how can they get in contact with you? Where can they find your blog?
Thanks again for joining us Dr. Tate! I’ll look forward to reading your next post on your blog, do you have any closing thoughts you want to share with everybody?
DR. TATE: Thank you so much for inviting me to sit with you today like I said i would read every email that I get and I look forward to hearing from readers, so anyone who would like more information or who would like to drop me a line you can find me on my website CallMeDr.us or you can reach me by email at thedrisin@callmedr.us
DAVE: Well thanks again for joining us Dr. Tate, we look forward to chatting again. If you are a physician wanting to tell your story, grapple with these tough issues, and get on the soapbox for a few minutes, I’d love to share it too in the next Freedom Formula for Physicians Podcast. Make sure to contact me at dave@daviddenniston.com or on my website www.daviddenniston.com/physicians.
For the Freedom Formula for Physicians podcast, this is Dave Denniston. Thanks so much for joining us and make sure to subscribe and check in again soon! Have a good one.
