Latest / Off the Chart: A Business of Medicine Podcast / S1 Ep155: What doctors don't know about their own finances, with Michael Jerkins, M.D., M.Ed., and Jillian Vestal, J.D., of Panacea Financial
Transcript
- Keith A. Reynolds 0:00 Our life's work is helping you protect yours. Copic medical liability insurance delivers more than just a standard policy. Our physician-led leadership team supports and protects physicians, APPs, and medical facilities with expertise developed from decades of experience, CME accredited education, and 20-four seven hotline support from a physician. copic.com We're Copic. Here for the humans of healthcare. Here for you. Speaker 1 0:26 To me, being a doctor is the coolest job you can have. Now, there will be, I think, a financial point where folks might reconsider or not pursue medicine. I don't know where that point Speaker 2 0:42 is, I Austin Littrell 0:42 welcome to Off the Chart, a business and medicine podcast featuring lively and informative conversations with healthcare experts, opinion leaders, and practicing physicians about the challenges facing doctors and medical practices. My name is Austin Luttrell. I'm the associate editor of Medical Economics. I'd like to thank you for joining us today. In today's episode, I sat down with Dr. Michael Jerkins, president and co-founder of Panacea Financial, and Jillian Vestal, head of legal services at Panacea Legal. We unpack the findings of Panacea's 2026 survey, The Financial Lives of Doctors, getting into why financial confidence barely moves across a physician's career, what physicians consistently miss in their own contracts. How student loan debt shapes nearly every major financial decision a doctor makes, and what the financial services industry keeps getting wrong about physicians as clients. Dr. Michael Jerkins, Jillian Vessel, thank you both for joining us. And with that, let's get into the episode, you I'm Jillian Vestal, Dr. Michael Zurkins. Thank you both so much for joining me today. Speaker 3 1:47 Absolutely, thank you. Speaker 1 1:49 Great to be here. Austin Littrell 1:50 Just before we begin, I guess, do you guys both want to tell the audience briefly a bit about yourselves and maybe a bit about Panacea? Speaker 1 1:57 Sure, so I am a MedPeds physician that struggled financially through training and earlier in my career, and through that frustration started a company many years ago called Panacea Financial to really empower doctors to have better financial lives and be able to take better care of patients, and through that we discovered lots of things that doctors also need help with, including employment contracts, which I have experienced personally are very confusing. So, we launched Panacy Legal, which is what Jillian runs. Speaker 3 2:31 Yes, I am a licensed attorney, and I have worked in-house at a health system, and so kind of been on the other end of Dr. Contracts, and have been reviewing contracts now for several years, have done roughly 2000 or so reviews, and came on board at Panacea Legal to help get this started, and have really, really enjoyed getting to work with doctors and kind of join with the mission of Panacea Financial and helping to make doctors' lives better and helping to kind of take, you know, a an industry like banking or like law that is certainly more traditional and tends to be a bit set in their ways, and kind of turn it on its ear and make it more tailored to to the doctor, more tailored to who it's trying to reach, and and making it work for our customers. Austin Littrell 3:41 Today we're going to be looking at panaceas 2026 customer survey, the financial lives of doctors. Dr. Durkins will start with you. The survey found that 53% of respondents said they wouldn't choose medicine, or they weren't sure if they would choose medicine again if federal student loans were capped at $200,000 which they will be as of July 1. They're both a physician and co-founder of Hanacea. When you saw that number, what's your reaction to that, and what does that tell you about where the profession is headed? Speaker 1 4:10 Yeah, I think it confirms that being a physician is tough. I think that also training is tough, not only mentally, physically, but also financially, and it's probably going to get a bit tougher, at least in the short term, with this change. I also think the good news here is that, despite what's happened with the federal student loans, despite what's happening with physician compensation and changes in demographics, that this last year we had a record number of medical students enter the match. I think 2024 was a record number of MD matriculants going into allopathic medical school, so to me, and this might be not the opinion everyone has in this call, but I think that being a doctor is the coolest job you can have, and obviously a lot of that has to do with the purpose and helping folks. In a time of need, I think there's a kind of a sacred aspect of being a doctor. There's also the financial aspect that is rewarding as well. Now, there will be, I think, a financial point where folks might reconsider or not pursue medicine. I don't know where that point is, but I think for a lot of people, despite some of the headwinds, it's still a very strong demand of folks who want to enter this profession. The other thing I would say is the loan cap, of course, only affects those who need a loan, so about 25% of medical students don't need lending at all, and so there's a lot of downstream effects if you think about it, because if there's 75% are further stressed with this loan cap. Perhaps we will have a greater representation in med school of those that are affluent or don't need loans, which, of course, has a lot of downstream effects on how people practice, where people practice, who can receive care. So, ultimately, I, of course, want things to be easier financially for doctors, and we're fighting for that, but I still think there's strong demand for folks who want to take care of patients. Austin Littrell 6:08 So, Jillian, on to you. Here, nearly half of the respondents, 49% said understanding whether their compensation is competitive is a top career challenge. From where you sit, reviewing physician contracts, how common is it for physicians to come to you without any real baseline what fair pay actually looks like, and whether that be their specialty or their region? Speaker 3 6:28 Extremely common, that's something that I see all the time. I would say, especially with folks who are coming right out of training who don't necessarily have a lot of experience. Their point of reference tends to be limited to what their peers are seeing in terms of offers, so there's not a lot of other information that they're getting. They don't necessarily know what data sources to look to, they don't even necessarily know how to read their contract and understand what the compensation actually is, and what I mean by that is they see a number, but they don't know what's behind it. Is that number guaranteed? How long is it guaranteed? Are there extra incentives that are available? You know, can they get a productivity bonus? Can they get a quality bonus? Are they being paid for call? Is there any call that is required, meaning they're not going to get paid for it? You know, if you have two contracts that have the exact same number, and one doctor is required to do 10 days of call without any additional pay, and the other is going to start being paid for call on day one. Those contracts aren't equal, and unless you're really digging into that contract, you're not going to find that, so even when they may be looking at the numbers, they're not doing sort of the deep dive on that contract, so it's extremely common for a doctor to come in and, and just really not know where to go with with what they're seeing, it's also really common for, and I hate to say this, but it's common for a doctor to come in and have kind of a number in their head that they've been told somewhere, or they've, you know, they've seen somewhere, and it's like, well, this is what I'm supposed to be getting, and that's almost more difficult for me to sort of work through, because we then sort of have to peel that back a little bit, and go, okay, well, Where did that come from, and what was that based on, and you're looking at something completely different, so it can be really, really challenging, and it's something that doctors just are not given a lot of information around, and that's something like I said, I've done this for years and years now, and it's something that I still am shocked by every single day, the lack of information that doctors have about their own compensation, about what they should be expecting, and what information is available to them, and what information is appropriate to ask for. It is, it is really, really shocking, and I actually, I think that the 49% is relatively low. My guess is that there are people who don't even know that they don't know who, who answered, yeah, it's fine. And the reality is they don't know that they are unaware of that. So, it is something I run into all the time. My, my job ends up being a lot. Of education, which I really, really love doing, but it's, it's a real shame to me that the folks who we rely on for such an important service are not really given what they need to make sure that they're protected within their own profession, Speaker 1 10:29 and what I would add too is residencies and fellowships are great at training you to be an amazing clinician, but they're not training you on how to make amazing employment decisions right out of training. It just isn't in their purview, and I don't think it's on purpose. And I didn't know that until I engaged with an attorney out of residency, and I, there was just so many basic things I had no understanding of. I think the other piece on information that Jillian brings such great experience, having worked on the hospital side, too, is it's not like the hospital necessarily is going to, on purpose, make things confusing for you, but when they try to lay out the methodology of how you get paid and how your productivity then equals compensation, it's not straightforward, especially when you're in a large system. I've heard some people call it funny money. It's like, okay, you can lay it out in a spreadsheet, but this doesn't really make sense to me. Health system, that's why it's really nice to have someone who's been on the other side really be able to walk you through it, because it's unfortunately not as straightforward as it looks. Austin Littrell 11:39 The data shows financial confidence barely moves across career stages. At a scale of five, it was 2.33 out of school or in school, and two point or 3.27 in practice. Why isn't earning more translating to feeling more financially secure? Speaker 1 11:56 Well, I think that our survey shows people are really busy with trying to practice and learn how to practice. I also think financial confidence is a little bit different than financial security. I think that if you're in practice, you know you're making four or 5x more than you made in residency or fellowship. Unfortunately, that means you can get by by making some financial mistakes, because you make enough money, so you might feel secure, but you actually aren't super confident on how to navigate long-term planning on things like tax planning, on retirement savings, because again, your bandwidth, both time and mental bandwidth, are really spent on clinical decision making, clinical care, administrative work, there, that it's really difficult to kind of take a step back, have room to breathe and learn, or have someone who can really teach you. Austin Littrell 12:50 The survey found that 46% of doctors don't fully understand their own repayment, forgiveness, or refinancing options. How does that knowledge gap bleed into contract negotiations? I mean, are physicians making employment decisions without fully accounting for their debt? Speaker 3 13:05 They are absolutely making employment decisions without accounting for that, and it is, it is all about contract negotiations. We, I see that all the time. First of all, I would say doctors are often leaving money on the table in terms of additional support that can be provided, so whether that's a signing bonus, whether that's student loan forgiveness, or support that could be offered by the employer, or even just within the community that the employer would support them through a program like that, I always encourage doctors to make sure that they are exploring every opportunity that exists, so I think that's the first step in the contract negotiation, the other piece of that is understanding what the contract says about when those types of things will be paid to them, how they're going to be paid to them, what the commitment is for the doctor, you know, or if they're getting student loan money, is that going to be paid directly to them? Is it going to be paid to the lender? Is it paid in a lump sum? Is it going to be paid monthly? Often they're going to have to show proof of that of that financial burden, you know, of their indebtedness, all of those types of things are typically in the contract, so they can have certainly financial impacts on on what that's going to look like, so you really want to, of course. Dig into that and understand, and it's again interesting, you know. A doctor will say, "Oh, I'm going to get $100,000 in student loan forgiveness. Okay, great. How long do you have to stay? Well, I don't know. Well, are they paying it to you? Are they paying it to the lender? I don't know. You know, they, they don't really have any more information than that. So that's really, of course, important to understand. We also then want to look at what happens upon termination if the contract were to end. Who's going to be responsible for that? And typically you're going to find, or what I hope to find is that that's going to look different if the employee, the doctor, decides to leave versus if the employer decides to end the agreement. I always want to see a situation where if the employer says, hey, you know, we're over staffed, we're closing down this line of service, or maybe, frankly, just, you know, you're not a great fit, that they're not going to try to recoup that money. We don't want to see a situation where the doctor has not chosen to leave, but now they're on the hook to repay $75,000 I also want to see it prorated, right, where you're not going to have to repay the full amount, but you're going to get sort of credit for what you've, the time you've time served, essentially. You know, all of those things can be negotiated in and can have a real financial impact, even if we can't get them into the contract again. I, you always want the doctor to know that, to understand. Hey, here's what you're looking at. Here's, here's the impact. So, if you choose to leave it two years, just understand you could be on the hook for 5075, $100,000 You can do that if you want to, but know what's potentially coming, so those types of things can certainly matter, and it's something that again we try to mitigate the impact during contract negotiations, even if we can't fully do that, awareness is really, really important, do Keith A. Reynolds 17:22 Hey there, Keith Reynolds here. And welcome to the p2 Management Minute. In just 60 seconds, we deliver proven real-world tactics you can plug into your practice today, whether that means speeding up check-in, lifting staff morale, or nudging patient satisfaction north. No theory, no fluff, just the kind of guidance that fits between appointments and moves the needle before lunch. But the best ideas don't all come from our newsroom, they come from you. Got a clever workflow hack, an employee engagement win, or a lesson learned the hard way? I want to feature it. Shoot me an email at K reynolds@mjlifesciences.com with your topic, quick outline, or even a smartphone clip. We'll handle the rest and get your insights in front of your peers nationwide. Let's make every minute count together. Thanks for watching, and I'll see you in the next p2 management minute. Austin Littrell 18:21 Dr darken back to you. Here, before we kind of open the floor with the last couple of questions. 70% of respondents struggle to balance loan repayment with other life goals, and 30-7% of those are already in practice. What does that mean practically for a physician trying to make major financial decisions, you know, buying a home, starting a family, you know, when they're trying to balance this, Speaker 1 18:42 I think it, the survey shows that student loans are the elephant in the room in any type of financial decision or planning. I think that when you graduate and have 234, we even see five, $600,000 of student debt, when then you think about, do I buy a house? How big is the house? Do I start a family now? Do I start saving extra for retirement? Any of those decisions should be influenced to a degree on your student loan plan, and I think psychologically it's really difficult for folks graduating from residency or fellowship because they've seen a lot of their peers that are their same age, they started college with, that were childhood friends with, have totally different lives for the last several years, they've actually gone weekends off, they have gotten to go on vacation, they've actually bought a house that is for a general, you know, a bigger size for a family, and so then once we engage with an amazing attorney like Jillian, who helps us negotiate our contract, we start our job. It's like we go back and I agree, and I understand it, that we deserve x, y, and z. We deserve the nice house, we deserve a nice vacation, we deserve to spend, and that's true. Through, but I think unfortunately that's also the highest risk time where doctors tend to make financial mistakes, and part of that has to go back to what we talked about, is the student loans. What's your plan, and that's why I think it's really worth it practically to, if you don't know what your plan is, to educate yourself, but also if you want to talk with someone, there are people called Certified Student Loan Planners, or CSLP, that's a specific professional designation for folks who are trained on student loan management. It's not easy, and it's only going to get more complex. So, I think that is a very practical recommendation to give to doctors. I mean, because there's questions that come up all the time, of what do I do with this extra dollar, meaning I have money left over after what I suppose I'm supposed to spend, or my obligations for the month. Do I pay more towards my student loans? Do I pay that more towards other debt? Do I invest that extra dollar? But it really goes back down to what's your strategy. Is your strategy loan forgiveness, because if so, you might not want to pay extra on that loan, so you can maximize forgiveness. If you're not sure, maybe you should be saving up that on the side in case you want to make a lump sum. Like all of those really shouldn't be short-term decisions you make month to month, but should be made in the context of a greater student loan strategy, Austin Littrell 21:24 tax complexity was the single most cited career challenge at 67% and it was nearly evenly split between trainees and physicians already in practice. That suggests more of a structural issue, I think. What specifically makes physician compensation so difficult to navigate from a tax standpoint? Speaker 3 21:40 I will just say I took a federal income law or federal income tax law class in law school, and it's still really complex, so this is not something that I think you know is limited to doctors or limited to any, I mean, I think the issue is just extremely complicated, and for high earners, I think it, it gets more complicated, so I think this is rightfully this is a really, really complex issue, specific to kind of marrying the last two questions, kind of the student loan, and and those kind of incentives, coupled with this, you know, something that I see a lot is when we're talking about signing bonuses or stipends or any of those sort of initial incentives, employers often structure those as loans, which is going to allow them to kind of give the money up front to the doctor, but allow them to recoup the money if the doctor were to leave, so what that may mean is the doctor is given the full amount pre tax when they're at one tax bracket living in a particular state, and then they're going to be taxed on it when it's forgiven, and they are in another tax bracket practicing in a totally different state, so just the complexity of that alone, and the doctor is often not aware of that, so that's something that I come through. Okay, well, don't forget you're going to be taxed on this, and they're like, wait, what are you talking about? So just the thought of that, that this is not money that you're going to be taxed on now, and they'll say to me, well, I don't want that, I want to be taxed today. Okay, well, that's not how this is set up. Relocation money, even when it's a reimbursement, the IRS counts that reimbursement as taxable income. It doesn't make a lot of sense. That's just the way it is, you know. So things like that do people just aren't expecting, and so there are a lot of things that can seem relatively small relative to the overall compensation, but when you start adding them up, all of these small pieces can really add to that tax burden, and so I think that's something that I see is that doctors are not aware of all of these things that are going to, you know, show up on their W-2 come that first year of practice. Michael, I'm sure you, you as a no, have some to add. Speaker 1 24:42 Yeah, no, I think a couple of things that come to mind. One is 1099 so folks who work 1099 they work locums or short term contracts. I know many people that are employed w2 they take a short term contract, they have no idea what. To do from a tax perspective with a 1099 and then they get a huge tax bill at the end of the year, and they learn the hard way how to navigate that. So that is a growing segment of doctors doing more short term 1099 work, and that is its own beast that you need to educate yourself on before you even take that first short term contract. That's only the thing I would add, Jillian, to your answer. Austin Littrell 25:23 The survey frames this as doctors being financially underserved rather than financially irresponsible. What does the financial services industry, whether that be traditional banks, advisors, or employers, consistently get wrong about physicians as a financial demographic? Speaker 1 25:39 So, I would say a couple things: one is that we are one thing they get wrong is that we're careless with our money. I don't think that's true. I think most of the time we're just busy and maybe uninformed, but we're not irresponsible. Unfortunately, there are people who take advantage of that in the financial services industry, see a doctor and see $1 sign and take advantage of the fact that we might be distracted with work and mismanage our money or give bad advice, that's unfortunate. The second thing I would say is they don't get right our schedule and accessing us. I mean, we're way more likely to be working at 6am than the general population, way more likely to be working at midnight than the general population, way more likely to be working on weekends and holidays, so when you have that type of schedule and you're trying to engage with the financial services industry, which is very much eight to five, it's very tough for a doctor to get anyone on the phone to answer any questions or have any real white glove service. So I think that's a big mistake and misunderstanding that they have, and lastly, as I think that financial services misunderstand risk of doctors. Think about that in two ways. One is early career and trainees, because on our spreadsheet, if you just listed out all of our assets and debts, it's going to look kind of fishy, because we have so much debt, so much student loans, maybe limited credit history, and so if they just look at that like they would any other customer or individual, they might over actually over basically think we're too risky. The other thing I would say is we have really weird, weird life cycle. I say that as an example of there's fairly fluid shifts I think doctors have between training and practice and different employers. So, there might be periods of time where there's income interruption, and especially when you're done with training and you go to apply for a mortgage or you go to apply for a loan, and they're like, cool, where's your money? You're like, well, I just graduated, and like, yeah, but do you have a job? Yes, I do. Here's my contract. When do you start? It's in a couple of months, because I'm gonna actually study for my board exams, and that just blows their mind, because you don't have money coming in the door. You might have, obviously, board certification or license, and a contract, and every indication that you're going to be joining one of the highest paid vocations with the lowest default rate in the United States, but because you don't fit in their rigid box that they want everyone to fit in, you are kind of kicked to the curb, and so that's really honestly why panacea exists, because we can kind of navigate the complexities. We don't have to worry about the rest of the population, we just have to worry about understanding one group, and that's doctors. Austin Littrell 28:31 If a physician in their first year of practice is listening, carrying significant debt, feeling behind, not sure where to start, what's the single most important thing that they can start with, and they can do right now, Speaker 1 28:41 one is I just want to say it's not too late to educate yourself, so don't feel like you're behind, you're not alone. There's plenty of us that are also have been in the same boat, and probably are still in the same boat. I think the second thing I would say is that appearances can be misleading, so you see a lot of your peers that are physicians that look like they have it all together, great house, great life. Their Instagram feed looks amazing, but they don't post their retirement savings balance, and they don't post what their average debt payments are on their boat and house and vacation home, and that goes back again to where doctors make enough money to look like they have it all together, but make lots of financial mistakes, and what that ends up doing is actually perpetually putting that doctor in a position where they're trading their time for money, and they're really never in control of their time because they're on this treadmill, this debt treadmill that they've turned up themselves, so all that to say is, like, don't believe everything you see, that everyone has it together. Understand, it's not too late to educate yourself. And then I think put yourself in a position where you can limit avoidable debt. Student debt is not avoidable for many of us, but limit avoidable debt until you have a strategic plan. Place long term financially, and why do you need a plan? It's because you want to be in control of your time, ultimately, and you don't want to have to just work to pay off the debt that you could have avoided years before. So, educate yourself, or if you don't have the time, find a financial advisor that's a fiduciary that has experience with doctors that has a CSLP, ask for references. I like, be really annoying about that. We can be very meticulous as doctors in our clinical decision making. We should be that way in financial decision making too. Speaker 3 30:34 I would add in there too. Part of that, even a year in can be having your contract reviewed, even if you've already signed it, even if you're in the middle of working at that job, and you have no intention of leaving. Make sure that you understand it. Make sure that you're making the most of it. Make sure that what's happening is what's supposed to happen. And you know, I've reviewed contracts for doctors who have been practicing and have realized, oh wait, I was supposed to get $40,000 that I didn't get, and they took the contract back, and then got those checks right. I mean, you never know sort of what's there that you're missing out on, so you always want to do your due diligence, like I said, even if you're already in the midst of that, so the contract can be part of of that education, and should be part of that education. Austin Littrell 31:29 Is there anything else, either from the report or just in general, that you think would have glossed over or miss? Our audience is mostly, you know, independent physicians, primary care physicians. So, anything else you want to share with them, one Speaker 1 31:42 thing I would say is, don't underestimate your worth as a physician, whether that means with the insurance companies and reimbursements, or with an employer. One of the things I see a lot is doctors, especially in the employment side, and Jillian can attest to this, thinking that the first offer is the best offer that they got from the employer, and not having more than one offer from multiple parties, and you really want to have at least two to three offers, so you can play them off each other and better keep them honest about paying you what you're worth. We unfortunately, I don't think, do the greatest job as physicians, understanding being educated on our worth, and then advocating on that. Speaker 3 32:26 Absolutely, Austin Littrell 32:27 Jillian Vessel, Dr. Michael Jerkins. Thank you both so much for taking the time today. Speaker 3 32:31 Thank you. Speaker 1 32:32 Thanks for having us Austin Littrell 32:40 once again. That was Dr. Michael Jerkins, president and co-founder of Panacea Financial, and Jillian Vestal, head of legal services at Panacea Legal. You can find a link to Panacea's 2026 survey, The Financial Lives of Doctors, in the show notes below. On behalf of the whole medical economics and physicians practice teams, I'd like to thank you for listening to the show and ask that you please subscribe, so you don't miss the next episode. As always, be sure to check back on Monday and Thursday mornings for the latest conversations with experts, sharing strategies, stories, and solutions for your practice. You can find us by searching Off the Chart wherever you get your podcasts, and if you'd like the best stories that Medical Economics and Physicians Practice published, delivered straight to your email six days of the week, subscribe to our newsletters at Medical economics.com and Physicians practice.com Off the chart business and medicine podcast is executive produced by Chris Mazzolini and Keith Reynolds and produced by Austin Latrell. Medical economics and physicians practice are both members of the MJH Life Sciences family. Thank you. Transcribed by https://otter.ai