Seth Harrison 0:03

Welcome to Becoming an Attending, a guide for future ER physicians. Each episode delivers financial insights into navigating undergrad, medical school, residency, fellowship, and becoming an attending physician. Your host, behavioral financial advisor Johans is here to ensure you're surviving and thriving through your transitions. Now let's get started.

Yohance Harrison 0:31

Welcome to Become Coming and Attending. I'm your host, Yohance Harrison, financial advisor, specialist to those in the ER field. When you come to me, though, it can't be an emergency. We're not supposed to have financial emergencies. We're just not. I mean, things happen financially, but I'm not an emergency financial advisor. I'm here to help you prepare so that the emergencies aren't that emergent. But with me today, I have my good friend, my brother, Dr. Fred Kencey Jr. Maryland. And lots of other letters behind his name. This man, he is. He is everywhere. He's at asap, he's at aa, he's at SAEM, he's at NMA. Right. You'll be anime. I'll see you in a couple weeks. Not this year. Oh, anime. I'm sorry.

Dr. Fred Kency 1:13

Not this year. Not this year.

Yohance Harrison 1:19

I invited him. You heard me invite him.

Dr. Fred Kency 1:21

It's true. I've gotten all the invites, but. Okay, schedule is, you know, the schedule is the schedule, so we're gonna make it work.

Yohance Harrison 1:27

Hey, just the schedule. I get it. I get it. The schedule is the schedule. I get it. Okay. But Fred. Can I call you Fred?

Dr. Fred Kency 1:35

Oh, yeah.

Dr. Fred Kency 1:38

Okay.

Yohance Harrison 1:38

Either one. Or I can call you Earl. Can I call you Earl?

Yohance Harrison 1:44

He gave me his whole government name in his. In his bio. Okay. All right. Dr. Kinsey, as an established physician, I wanted to bring you on to becoming an attending today to talk about something that is unfortunately what I'm seeing. And this is maybe just with the clientele that I'm working with. That's why I was speaking to these emergencies as almost, to use a medical term, almost an epidemic at this point, with ER doctors facing the psychological, emotional, and physical burnout. And when I start to dig into it with some of these docs, I find out that it. A lot of it has to do with their lifestyle creep where, you know, their lifestyle, they're. They're, you know, working the extra shift just to afford the BMW payment or working the two extra shifts just to go get a rental property. And they just kind of get caught up in that. Next thing you know, they're. They're burnt out and they, you know, they're taking weeks off at a time. And, you know, if they're 1099, there's no income coming in at that point. And it's just. And I just. So I was hoping that you and I could have a conversation about it. Let's talk about what the burnout is. And forgive me if I laid it on too thick by calling it a epidemic. I just feel like I'm dealing with it a lot in my circle. It's becoming a bit of an epidemic. But, yeah, talk to us. Well, let's start with qualifying yourself. We all know you're Dr. Kinsey, but. But tell us a little about your journey from. To becoming an attending. So from medical school to, well, residency or

Yohance Harrison 3:24

fellowship and to attending. How did you get here?

Dr. Fred Kency 3:27

No fellowship for me in emergency medicine, we're one of those few doctors where doing a fellowship doesn't really add anything to the bank financially. So I didn't really take the fellowship road, even though fellowship is a great thing, especially in academics, whether it's ultrasound or sports medicine or toxicology, obviously, all those are amazing roads. And all of those, in my opinion, are ways to help relieve burnout, because you're not in the emergency room with some of those fellowships all the time. So it actually is a good helper. We'll piggyback on that a little bit later. But I went to medical school at the University of South Alabama down in Mobile after graduating college at Alcorn State University. When I got into medical school, we had to figure out a way to pay for this thing. Medical school is not cheap, as you all know who it is.

Yohance Harrison 4:16

It is not. It is not getting cheaper either.

Dr. Fred Kency 4:20

It's not getting cheaper, and we're losing some benefits to payback stuff, which I'm pretty sure you talked about. The podcast

Dr. Fred Kency 4:28

had a recruiter from the Navy come down to All Corn State University, told me about all these beautiful places that I could potentially end up after residency. We could put you in Hawaii. We have places in Italy and talked about all these amazing locations of, you know, working in the Navy, wearing these amazing uniforms, serving our country. And as soon as I graduated, graduated medical school from South Alabama, they shipped me right down to Gulfport, Mississippi. So did not go to all the.

Yohance Harrison 4:57

Extravagant locations, none of the amazing places.

Yohance Harrison 5:02

But at least you were at the beach, though. I mean, the Navy. So you're at least on the water.

Dr. Fred Kency 5:06

When the beach and the water the same color, it's just not as exciting as it could be, you know, it's not.

Yohance Harrison 5:11

I'm in Texas, so I know what you're talking about.

Dr. Fred Kency 5:14

So, you know, I took my talents down to Gulfport, Mississippi. For three years I served as a general medical officer. I was responsible for the health and welfare of about 700 sailors. We did some deployments to Africa, took care of guys in eastern and western Africa, over in Abu Dhabi, so in Middle east, down in.

Yohance Harrison 5:36

Oh, so you did get to see some places you got to.

Dr. Fred Kency 5:38

Oh God, I didn't get to see him. I got to take care of the guys who were already there, so I can see them through some video chats and we did some dead hops. But the majority of the time I was in, I was stationed in Djibouti, Africa, took care of some folks in Rota, Spain. We had a detachment out there. So I kind of was managing all of these different medical assets and all these different personnel from my little cubby hole and 130 degree Africa. But it was an amazing experience, both from a leadership standpoint, both from a medical education standpoint, because you learn a lot when you're the only person taking care of a whole bunch of people who are not the healthiest people. You learn a lot, you grow up fast. It makes you a leader really quickly. And I learned leadership from some pretty amazing sailors. And I pride a lot of my growth at being a part of that organization and being a part of that unit and being some of the leaders that I looked up to. Finished my GMO tour, general medical officer tour with the CBs and came back to Mississippi to do residency at the University of Mississippi Medical Center. So it was a program very excitingly that was going from a four year program to a three year program. So I was a part of the first three year cohort, which was good for me, which I was excited to come back to residency whether it was a three or four year. My wife was here, she was completely.

Yohance Harrison 6:59

Time out, time out. I'm sorry, I gotta interrupt you. Wait. It was a four that went to a three. But now everybody's talking about going from.

Dr. Fred Kency 7:05

Three back to four back to fours. Yeah, yeah. That conversation is deep, right?

Yohance Harrison 7:08

More, more things change, the more they stay the same.

Dr. Fred Kency 7:11

Yeah. Ten years later, we're looking direction.

Yohance Harrison 7:15

Sorry, I got hung up on that for a minute. As someone, you know, and I'm in finance, I'm there, but I hear the conversations.

Dr. Fred Kency 7:20

Everybody's talking about it. It's the talk of the town. So, yeah. So the program was originally a 1 through 4. I'm sorry. Yeah, it was originally a 1 through 4, then it became I think a 2, 3, 4. So people did their second. I'm sorry, the program was initially a 2, 3, 4. So you did your, you did a first year and whatever you want to do it in, you could do it in pediatrics, internal medicine, surgery, whatever. And then you would get there in your second year, do 2, 3, 4, kind of like what anesthesiology does and some other residencies, dermatology, ophthalmology, I think. And then it changed to a 1, 2, 3, 4, and then it changed to a 1, 2, 3. And so in 2015, 18, I was a part of the first cohort that did a 1, 2, 3. And which was good for me because I'd already done an internship year in the Navy. I did a transitional medicine year in San Diego at Balboa, which is the Navy's hospital in California. And so I, you know, if I had come back to do four years, I'd been technically doing five years of rescue, which I didn't really care. I wanted to come back to Mississippi. I knew I wanted to do my training here. So I was fine, kind of whatever, whichever route we went.

Dr. Fred Kency 8:28

And so luckily, you know, God's grace, it became a three year program. And, you know, I knocked those three years out. And then I was lucky enough to get a job at one of the community sites that was not very far down the street. Has an amazing staff, has an amazing group of people that I work with every day, amazing nurses, ancillary staff, everybody. And so I've been blessed to be able to stay in that position as well as have a title of assistant professor

Dr. Fred Kency 8:57

at the University of Michigan Medical Center. And so, you know, being able to have both positions, I don't work as many clinical shifts as I did before COVID And now it's kind of mainly kind of more the educational stuff. So I do some interviews with the medical school, different things like that, which, you know, all these things are kind of things that I feel help me with burnout because I'm not always just in the emergency room. There are so many other facets of my life that are not, you know, 12 hour shifts in the ER. I'm able to do other things, you know, mentor young medical students who want to go into, you know, every branch of medicine. We have just kind of, you know, I had a meeting yesterday with a young kid, not young kid, he's an adult. I had a meeting yesterday with an adult gentleman who wants to go into family medicine and, you know, you know, discussing the positives and negatives of choosing residency, you know, locations, you know, should we have children during this year versus this year, you know, being able to Mentor those minds and give them some, you know, positive feedback for what they're already thinking and choosing has been a really good feeling for me and something I feel I need because it takes my mind off of those 12 hour shifts when I'm in the emergency room and where it's kind of just pound, pound, pound. I get to actually use my brain to do other things still in medicine, but not as in distressful, you know, gunshot, stab wound, heart attack, you know, call five consultants type of life.

Yohance Harrison 10:28

So let's get into that, that 12 hour shift mentality a bit because, I mean, most people, if they don't go directly into academics in the fellowship, even those that do, they're going to experience some of that. I mean, did you ever have a period where you felt burnt out, where you felt, okay, I can't do this anymore, something has to change.

Dr. Fred Kency 10:50

Oh, yeah, yeah, definitely. You know, a couple times. You know, one during the military time when I was doing my GMO tour. I mean, you have so many requirements. I mean, like, so many requirements. I have to, you know, for 700 people, they're moving in and out, they out, they all have four different bosses that tell them where to be, when to do this, what to do this, what to do about this. And I have to have my readiness at 95%. So I mean, I need 95% of my entire battalion to be ready at the moment's notice to go. So that means vaccinations, influenza, yellow fever, typhoid, that means all of your phas, your periodic health assessments. That means everything medically that can be done. Your teeth, you know, make sure that you don't need any fillings in any of your teeth. And you have to be medically ready to go 95% all the time. And so, you know, that's, that's a lot of stress for, to me, a kid who just got into the military and, you know, sitting down with your CEO every week and saying, my readiness this week is 72%, not even close to 90.

Dr. Fred Kency 11:52

And so what is your plan to get this to 95, Doc? Well, if I can get these sailors to come to the clinic, you know, we can make it shake pretty quickly. But you know, I, I, my, my chief calls his chief and his chief gives me four different reasons why he can't come down to the clinic until next Tuesday. And I'm doing this for 700 sailors. It was not an easy task to do. So, I mean, you know, you get to the point where you're like, every day you're telling Your boss, you know, I'm not meeting the metric that you set, and I would love to, but it's just not happening. And then you kind of, you get your, you get under, you get the ropes, you learn how to not manipulate, but you learn, you learn how to fix the numbers. Because sometimes a patient has gotten a typhoid shot, but the computer didn't register it. And so now the system that does our tracking is not there. So learning how. And so, you know, eventually get to the point where you're like, okay, I have to like manually go in here and look these things up, teach my staff how to go in there and look these things up. Because I feel like we're meeting all these metrics, but it's not reflecting in the reports that are being given to my commanding officer. And so once we learn how to really, you know, kind of let the data work for us, instead of trying to work too hard to make the data look the way it should look, the numbers started kind of just, you know, doing their thing. Everything looked a lot better. I had more hours at home where I could sleep. And so, you know, the burnout kind of, you know, lessened a lot. And then a lot of it is getting ready for deployment, right? So the deployment is where your readiness has to be at a certain percentage. And so once you get to deployment, it's about maintaining the readiness, so making sure that. So most of the things that we do there on a two, two year schedule, two or three year schedule, your vaccinations,

Dr. Fred Kency 13:36

your health assessments, all these different things are on a kind of one, two, three year schedule. So the biggest thing is just keeping that schedule up to date, knowing, letting your, having great communication with the people who are in charge and other departments, making sure that things happen the way they're supposed to happen. But once I got that swing, it helped me tremendously, tremendously. You know, same thing when I came back to college. I'm not, I'm sorry, college. When I came back to residency,

Dr. Fred Kency 14:00

you're going to have some burnout there too. Because in our residency in Mississippi, when I was a first year, we work 12 hour shifts, which in a lot of places, people don't work 12 hour shifts. A lot of people like to work tens, nines, eights, kind of mixture of. But we work 12 hour shifts. And as first years, we were working sometimes 18, 19 days a month. And so that's. Yeah, now you're talking about somebody that's already been out of medical school for four years coming back into medical school. I Already have a child. My oldest child is 10. So I already got a child, I got a wife. I mean, I'm not just somebody that just goes home with all this free time. Like I got to get home and, you know, play with the baby and I gotta do this and I gotta be a loving husband. I gotta be, you know, so it was, it was very, very stressful that first year. I made it very easy to get burnt out with the amount of knowledge you're trying to ingest, learning these different procedures. Learning because you think you know something when you leave medical school, but when you get the residency, man, the water hose is still open. I mean, it's, it's, the water hose is still wide open. There's a lot of information that you have to ingest. Especially now with that three year program. They've taken a year away, but they still got to dump all that education into you in that, in that shorter period of time. The toxicology, the procedures, taking your pediatric rotations, all these different things. So with that.

Yohance Harrison 15:20

So how did you. In residence. Let's stay on the resident residency for a moment because I know one of the stressful parts of residency is again, the time commitment, the mental commitment. Like you said, that fire hose is still open.

Yohance Harrison 15:36

Your other family and personal commitments.

Yohance Harrison 15:40

But then there's the lack of finance there because, you know, if you, if you, if you, if you weren't fortunate enough to spend some time traveling the world with the Navy, you know, you may have a few hundred thousand dollars worth of student loans out there hanging out, and you're only making what, five, six thousand dollars a month.

Dr. Fred Kency 15:59

That's pretty, pretty low. I was fortunate when it comes to the money side because I had done my military time. I got my GI bill while I was in residency. So my entire three years of residency, I was getting an extra tax free

Dr. Fred Kency 16:17

$2300 a month. So I was a little bit more comfortable than the average resident when it came to a paycheck. And I'm also, my wife had started her chief year, so she was getting paid like an attending, so that was a little bit of a buffer, but aside. But you know, the other nine of my cohorts didn't have that. And so now they're, they're stressed with the financial portions of residency, so working crazy, crazy, crazy hours and the compensation being almost, you know, less than minimum wage, you know. So during that time, kind of what helped me with, I would say burnout is my extracurriculars. I'm a huge, I'm from Mississippi and so we have a lot of outdoor stuff to do.

Yohance Harrison 17:04

There's nothing to do outdoors in Mississippi. Y' all catch. Y' all catch fireflies.

Dr. Fred Kency 17:10

With our hands. What are you talking about?

Yohance Harrison 17:11

Exactly. That's what y' all do. Y' all. Y' all catch some catfish or y' all. Y' all wrestle boars. What y' all doing? What y' all doing?

Dr. Fred Kency 17:17

Mississippi have to. I'll tell you some stories one day about something like that, but. Yeah, so my. You know, so my time outside of the hospital, how did I kind of decompress? I would. You know, I go fishing. I go fishing a lot. I got fishing poles in the back of my truck right now with a bucket ready to go at the moment's notice. We know we ride four wheelers. We. We go hunting, you know, in the right seasons, deer hunting and rabbit hunting. So I had a lot of things for me that were my decompression that would, you know, take my brain completely away from that emergency room room or anything medicine related. And I can get out there on that water, and it's just, like, my brain just becomes completely clear, and I am in my own zone. Right? So those were kind of things in residency that were kind of like my, you know, let me get out of this emergency room and go do something besides medicine. Let me decompress. Let me not. Let me not, you know, do this burnout thing again, which I'd already experienced in the military time. Like, I didn't want to get back there, where I kind of literally just hated coming to work. There were some days in the military, like, literally that alarm would go off, and I would just be like, what happens if I don't show up today? You think they're gonna send me cars out there to come get me? How many days can I go before they come and pick me up at this bed and, like, force me to come back to work? I mean, literally, there were some days where it was. It was tough those first couple of years, that first year, at least.

Yohance Harrison 17:29

Okay.

Dr. Fred Kency 18:44

But, you know, once I learned to kind of learn how to decompress, learn how to use other methods to, you know, bring in my aura to a point where I was good and I was back excited to do the thing that I loved, life was very different, and I knew I didn't want to go back to that place. And so I knew that, you know, when. When my mentally started getting a little stressed at work or, you know, short at home, that I needed to decompress, you know, and my decompression is outdoors, getting outside. Regardless of how many pages I have to read, those pages are going to be there. That they going to be there. They're not going nowhere. But what's going on in my brain, if I don't fix it now, I'm not. I'm not. I'm not going to get those pages done. And other bad things could happen too. So luckily enough, I had some. Some coping skills already made for my time in the military, and I was able to utilize those skills and put them to work and get some fun things into my life and move that direction.

Yohance Harrison 19:52

So, so how does, how, how does this burnout, how does it show? How does it manifest in. Well, let's talk about residency. So did you see other residents that did experience burnout? I mean, did you see people not make it through residency due to the burnout and the stresses that they were under?

Dr. Fred Kency 20:11

Luckily, in my program, we had some. A lot of help, a lot of advocates. So we did not personally, in my program have anyone that did not make it through because of burnout.

Yohance Harrison 20:24

Okay, good.

Dr. Fred Kency 20:26

So we were lucky though, you know, there. And you know, in the different programs, you know, general surgery, some of the more, I guess you would say, programs where the compression doesn't happen as easily, you may not. That probably doesn't happen. But in our program, it was, it was very loving, rewarding. They would, even when we verbalized to our program that the 12 hour shifts were kind of tough because we were having to do sometimes, you know, four days in a row, seven days in a row. And so they took that information and said, well, what we're going to do is create a hybrid schedule and we're going to do it for one month and we're going to see how y' all like it. And so we would work 12 hours from Monday, Tuesday, Wednesday, Thursday, and then Friday, Saturday, Sunday, it would transition. The Friday would become 10 hour shifts, and then the weekends, Saturday, Sunday would be eight hour shifts. It mirrored the attending schedule. And so we were lucky that we had people that listened, people that cared. And so it actually, you know, there were changes made based on the things that we discussed that actually, I think helped a lot of our classmates, resident mates, not experience a burnout as much as it could have been had they not had someone who was as responsive that didn't listen, actually took that information and utilized it and actually made the program better.

Yohance Harrison 21:54

So I just want to recap a bit here because you were dropping gems here and I again, I want to appreciate you for pouring yourself your selflessness here into the next generation of physicians, or if you're already attending right now, this is still good information for you, especially if you have other residents around you, which I'm sure you do. But one thing I heard you say is that because of the demands that are required, the education, the physical demands, the taking away from the personal life, the time constraints, you got to recognize that. That if you're not careful, burnout is coming. Like, it's just. It's kind of baked into the system itself. However, if you're able to recognize your methods of decompression. So that's something I want. Anyone that's a medical student, resident, your physician, you're listening. Think about what are your methods of decompression? What do you have that you can, for lack of a better term, escape to? Whether it is fishing or it is wrestling boars. I mean. I mean, be careful if you're wrestling a boar. But whatever it is that you can do that can help take you out of the emergency room, out of a place where you're constantly pouring all of your energy into saving the lives of others. How can you take the time to pour back into you? And I encourage you to, if you can't find something, start trying some things, okay? Try cooking, try photography, try taking hikes. But don't just say, oh, I'm just going to walk around the block. You can get bored with that real quick. Or maybe that might be your thing. Or is it reading books? Is it painting? Is it back to wrestling boars? Whatever it is, you got to find that thing that helps you decompress. So that's one. The second thing that I heard that's, I think, as important is your community of leadership. Are you in a community of leadership that is willing to listen and implement change for the safety and viability of the program itself? So you want to know that you've got mentors you can talk to, that you have leaders that you can talk to and make sure you're talking to them, make sure you're speaking to them and saying out loud what's going on so that that change can be implemented to make a more supportive environment. Did I pick up what you put down there?

Dr. Fred Kency 24:09

Oh, yeah, exactly. And then also to your outlets will change over time, right?

Yohance Harrison 24:15

Yeah, because, yeah, we can't afford to just add the bucket in the back of our truck, you know.

Dr. Fred Kency 24:22

So, you know, the outlets I had when I was in the military, change from the outlets I had when I was in residency. And now, you know, I don't Hunt as much as I used to. I still fish as much as I can. But now I have another business. I have Kansas Medical Services, which we specialize in doing. If you. If you're a part of a church, he wants to come and teach your church cpr. If you want us to come teach some students in your Sunday school cpr, I contract with some EMS and nurses throughout the city, and we will come teach CPR your classes. We sometimes get grants from people to pay for those classes. Sometimes those are paid directly to us from the organization that we're teaching. We also do medical marijuana certification for the state of Mississippi. We've been doing it for about three years now. We do expert witness, documentation, review of things. And so now I've been able to go from working 15 days a month in an emergency room to working 10 days a month in the emergency room. And so how has that helped me on burnout? Tremendously. You know, instead of working seven days in a row at any hospital, you know, at maximum now, I try not to work more than five, and sometimes even four if I can, because now I actually have other things I do outside of emergency medicine. So now I'm not doing the same monotonous thing. I don't. You know, I haven't been to work now, and like, today I work tonight, but I haven't been to work before tonight in like. Like nine days. And so I'm hoping I remember passwords when I get to work, but because I have so many other things I do. You know, whether it be organizational medicine, my clinic, whether it be teaching CPR to kids, whether it be teaching atls, it's. You don't get burned out as quickly because now you got. So the variety is there, you know, so one day I'm doing cannabis certifications. One day I'm at a lawyer's office reviewing a case and telling them how that doctor was an amazing doctor, and there's no way that this guy should be sued for what he did. The next day, you know, in my cannabis clinic, the next day I'm teaching cpr. The next day I'm at work in the er. So because I have so much variety in what I do, the burnout is less likely to happen. I don't. I don't get tired of going to work anymore. I actually enjoy it because, you know, I get back to work and I'm like, doc, where you been? I'm like, yeah, I've been, you know, in Malta. I've been in Greece, and I've been in, you know Miami,

Dr. Fred Kency 26:46

because now these things. I know, right? These things allow me to travel. They allow me to do more things that actually bring me joy, which my job does bring me joy. And I'm very grateful that I have a job that brings me joy. And I want my job to continue to bring me joy for many more years because I don't plan on retiring anytime soon. But in order for it to bring me joy for many more years, it cannot be the sole basis of my life. I have to have other things that bring me joy as well. And by doing this, by allowing myself to be these different little pockets or packets throughout my life, it allows me to keep the joy I have for the emergency room going. Because when I go back tonight, I'm excited to be there. I'm excited about who I'm going to be working with. I haven't been looking at the same person for the past 12 days, 12 hours a day. I haven't seen them in two weeks. So it's just like a family reunion. When I go back to work, you know, people are excited to see me. I'm excited to see them. I'm excited to get back to the work. And to me, that's what's going to keep me in this job much, much, much longer.

Yohance Harrison 27:52

Indeed. Indeed. Well, thank. Thank you for that education session on burnout. And congrats to you, of course, for being able to navigate that some organically, some from, you know, like you said, the mentors that you had. But knowing. Knowing thyself and knowing what you need in order to. To be your best, to show up for all of the people in your life. I want to transition a bit because I wanted to talk about lifestyle creep a little bit, so I mentioned that earlier where I'll see doctors that will commit their shifts based on the lifestyle that they're trying to live. You know, they'll get offered that first job and. And, you know, they go from making 5, $6,000 a month to 30, $40,000 a month, and immediately they buy the BMW, they buy the house and the rental house, and they get married and they start having some kids, if they haven't done that already, and then they want more. And so I was like, oh, I can just go pick up a shift over here. I can do this over here. And so, I mean, first, did you. I know with the military background, you may have been a little bit more disciplined, but did you. Did you ever find. Did you and your wife ever find yourselves in a position where that lifestyle creep was starting to take over and if so, how did you make those adjustments?

Dr. Fred Kency 29:15

So. So kind of a. I guess it's kind of a yes and no answer. So there are certain things in our lifestyle that we did jump the gun. Maybe there's other things that I was very disappointed and I was like, no, we ain't doing that. So the jumping in the gun. We. When I finished residency, we were on our third child. So in those three years of residency, we came 1, 2, and 3. So we finished residency in 2018. The third child is born, and we're in a three bedroom house that's kind of small and they all have a lot of stuff. And so my wife wants a bigger house. What's the first thing I tell people when I'm educating them about graduation. Don't buy a house after graduation. Don't buy a house after graduation. Give it a year. You know, live in the same home you've been in for the first year, Stack some money, you know, maximize those retirement plans, pay off as much debt as you can, and then look into getting a, A more comfortable home. But we didn't do that. I didn't take any of my own advice. I went straight to my realtor and was like, my wife is saying that we got to move about this house and I'm not gonna get no sleep until she gets another house. And so one of the things that I did that I, I did not advocate for at all is that we did buy a house as soon as we graduated from medical school, which wasn't terrible for us because, you know, having gone through my military time, having. Getting extra money during residency, my wife wasn't attending at the time for the, the next two years.

Yohance Harrison 30:45

And you got a VA and you got a VA loan.

Dr. Fred Kency 30:47

And I had the. And I had a VA loan. So we were in a position where I still didn't want to do it, but, you know, I wasn't sleeping good at night because it hadn't happened yet. So we were gonna have to make it work. And so we did buy what I consider my very long home. I'm gonna be here for quite some time. Things that I did not give up on is that I wasn't gonna buy expensive car. I had a. Right now I drive a Dodge Ring. It's a very, you know, basic truck for me.

Dr. Fred Kency 31:20

So certain things that I warrant, I was not going to get crazy with. We don't. We don't.

Yohance Harrison 31:25

A Dodge Ram is a very basic truck.

Dr. Fred Kency 31:28

Yeah, that's very basic. Yeah. And so we don't do trips on credit and so, okay, if we can't afford to pay that trip ahead of time. So plane tickets, we don't put those on. Credit cards have to be paid over time. We don't finance cruises, we don't finance trips. If we can't afford to pay for the trip at the time of decision to do it, we just don't do it. And so that was one of my sticklers. I don't believe in, you know, paying for a trip when I've gotten home. You know, I'm not paying for Greece, you know, five months after I get back from Greece. That ain't that just.

Yohance Harrison 32:03

Hey, say it again for the people in the back. You don't. What?

Dr. Fred Kency 32:07

That's just one of my things. I'm just.

Yohance Harrison 32:09

No, no, no, no. I need you to repeat that. I'm not going to pay for a.

Dr. Fred Kency 32:12

Trip five months after I get back from Greece.

Yohance Harrison 32:16

I'm paying for a trip at home. Man. That is.

Dr. Fred Kency 32:19

Ain't gonna happen. So that trip will be fully funded. I'm using that stuff. But yeah, that trip's gonna be fully funded before we ever get on a plane. And so that's one of my kind of. This is one of my things when it comes to traveling. I love to travel, but that's one of the things that I don't, I don't give up on. Like, I don't. There's no give on that. If we can't afford to pay for everything. I would love to go to Bora Bora. Love. It's my wife's kind of bucket list trip. She wants to go to Bora Bora. Bora Bora is $10,000 for the week for where she wants to stay.

Yohance Harrison 32:49

And that's just the way. That's just where you stay. You have, you haven't got plane yet.

Dr. Fred Kency 32:53

That's not the plane to get there. So until we got that $17,000 just sitting in an account that doesn't, you know, after the, after retirement accounts fully funded that year, blah, blah, blah, blah, blah, we gonna be holding off on board. Board.

Yohance Harrison 33:07

I held off on Europe for five years. It took us five years to do Europe the way we wanted to do it. And I leave next Friday. That's what I'm talking about. Five years worth of. So we didn't, we didn't use any of our American Express points for five years. And I'm taking family of four first class. I said, I just got the last little hotel we needed to get. I had enough points left over for that hotel too. I was like, oh, look at that now. It did take some money out of pocket, of course, but. But still, no, we refused to finance. So the way I used to say it is that I don't want to. I don't want to pay for something that I already pooped out. So that's how I think about the credit card. Like, I'm financing food and I'm paying for it and flush it down the toilet weeks ago. But the way you said it, I don't want to pay for a vacation after I get home. Amen.

Dr. Fred Kency 33:28

Oh, yeah.

Dr. Fred Kency 33:45

Yeah.

Dr. Fred Kency 33:58

Can't do it. Can't do it. So, and. And so that's one of the things that I don't give on. Right. And so a couple of small things, too, like that, where we don't give. You know, these are things, boom, we're gonna do. These are things that, boom, we're not. We're gonna, you know, our retirement accounts. My wife works for the state, so her retirement account is taken out of her check before she even gets paid. Mine, I do at the end of the year, but I say we're going to put in this percentage that's going to happen every year. That means that we can't go to a Cowboys game, but, you know, I love them Cowboys, but can't go to a Cowboys.

Yohance Harrison 34:32

You would mention them on this podcast, man.

Dr. Fred Kency 34:35

Always got to have a Cowboys in there. So if I can't make it to a certain football game or a certain basketball game or a certain cruise, I'm okay with that. Certain things are gonna get done every single year unless there are some dire circumstances happening that prevent us from. From doing it.

Yohance Harrison 34:50

Well, if you want to find yourself. I'm sorry. If you want to find yourself, if you can fit it into the budget. I am planning to attend one Cowboys game this year, but it'll be in Charlotte, North Carolina, when they play my Carolina Panthers.

Dr. Fred Kency 35:05

I'll be there, all right?

Yohance Harrison 35:07

You'll be there, all right. I'm counting on you being there.

Dr. Fred Kency 35:09

One of my classmates from residency is. Lives in Carolina. Lives in North Carolina on the Virginia North Carolina border. And we went to the one not last year, but the year before last. So this is the third in a row. Third year.

Yohance Harrison 35:22

Is it?

Dr. Fred Kency 35:24

And we won it both times.

Yohance Harrison 35:27

That. That wasn't part of this interview. That. That. That wasn't one of the questions that I had here. You just be offering up extra information.

Dr. Fred Kency 35:39

The way that worked last time is that I literally flew up that morning and then flew back that night. Like, we were like, we're gonna make this.

Yohance Harrison 35:45

Oh yeah, yeah. That's how I go to Carolina games. Yeah. No, I, I fly to Charlotte at, at best depending on time in the game. But you know, if it's a one o' clock game, maybe I'll fly in the night before or I'll red eye, get to Charlotte, get my car. I go the same place for breakfast every time, go to the game, have fun at the game, maybe go to a bar or two with a friend and I'm back at the airport by 9, 10 o' clock at night back home.

Dr. Fred Kency 36:09

And this helps my brain out because these are the things that I enjoy doing. I mean this is, this is one of my things. This is a decompression thing for me. It's already in the budget every year.

Yohance Harrison 36:12

Yeah.

Yohance Harrison 36:20

My wife, that she don't even argue it. She don't, she, I say, hey, this is the games I'm going to. She's like, bye, see you later. Because you know that that's me. That's if I don't get that time then as I was saying earlier, I don't have the emotional capacity to talk to my clients about their financials. Like I got, I have to refill my own cup before I pour into theirs. That's what it comes out to. I, I've got it in that part. Got that part. All right, so any closing thoughts on this lifestyle creep? And I want to speak specifically because this is going to air in the next few weeks. We've got dozens upon dozens of residents that are graduating or about to graduate now. You know, they're all signing their contracts for that job that's not going to start until August. They're going to have, it's so, it's so cold blooded how they do y' all, man, you graduate in June, your job didn't start to August. Like what am I supposed to do for money in July? Figure it out. Yeah, like there's no, there's no other profession that treats people this way. It's like I figured summer out. I mean know I have residents right now that I'm in conversations with and they're trying to figure out, okay, how do I pay for my apartment for the next three months? And they got, you know, they're taking private loans and stuff like that just to, to pay for their apartment and it's like this is crazy, crazy, crazy interest rates. So, so for those that are about to go through this transition, if you could give them your top three on just from, from a financial literacy Financial advice standpoint, what would be the top three things you would say to a resident that's graduating this month?

Dr. Fred Kency 37:19

It's crazy.

Dr. Fred Kency 37:56

Prepare financially for the next three, four months? Obviously, when those checks stop, look at the things that you spent money on for the past three or four months that were not necessities and just cut them out. You can turn them back on later.

Yohance Harrison 38:12

You know, you don't need Netflix for three months. You'll be fine.

Dr. Fred Kency 38:14

You need Netflix. Do you need Netflix plus, Hulu Plus, Amazon prime plus, you know, your cable?

Yohance Harrison 38:21

No. What is it? Your subscriptions combined? I am cable.

Dr. Fred Kency 38:26

Oh, yeah. I mean, it's crazy. It's crazy. The financials you spend on that is crazy. Decrease the amount of money you're spending outside the home. You know, it is crazy. In my house, we will go and make 300 in groceries, and then I will see DoorDash pull up two hours later, and I'm like, what was the reason for buying that grocery if we're gonna order doordash? So, you know, decrease the number of times that you're spending money on things that you don't need to spend money on. This is a great time to. To pull out that old hello fresh thing at the corner that you use for, you know, four months, two years ago and then whip those recipes back up to save some money on just expenditures in restaurants and such. That helped us tremendously during that kind of transition period. We huge drawback on how much money we spent on takeout

Dr. Fred Kency 39:23

and things like that. And that saved us hundreds of dollars. I mean, you will be. You will not be surprised. It'll be very clear about how much money people spend on restaurants, dining out, dining in. In just, you know, two or three weeks, you will save so much money and that you can use that money to actually pay the bills that you need to have paid, which is the most important thing. Also, look into once you graduate. That means those loans are getting turned back on for repayment. So know when those dates are, because when you graduate, they know the date. You don't have to tell them.

Dr. Fred Kency 40:03

They already know when you're graduating.

Yohance Harrison 40:06

They get an alert. They're like, fred graduated. He's done. He's done. Does he have a job? Who cares? Send him a bill.

Dr. Fred Kency 40:13

With the new. With the things that are happening in a new administration, we no longer have some of the. The loan forgiveness and the loan reduction programs that we once had that were abundant. And so now when it's time to pay the piper, it's time to pay the piper. And so you want to make sure that you're financially ready when those loans get turned back on, because they're going to give you a grace period, but it's not going to be 12 months. Pretty quickly, they're going to want their money to start getting repaid. So be very aware of what those dates are. You don't want them to surprise you where you've been kind of tailoring back. You've got this little piggy bank of storage. You're ready for the next three months, and then you get a bill from Sallie Mae for, you know, $6,000. You don't let that be.

Yohance Harrison 41:05

Let me tell you a funny story. Dealing with this right now. Right now. Have a client

Yohance Harrison 41:11

that. And she's, I guess, nine months into being an attending now. So this happened last summer. So her student loans were going to her mom's house, and she wasn't aware of her repayment period, but in her head, she was thinking, oh, you know, because of the COVID and deferral, everything's gonna be all right. She forgot that one of her loans was private.

Yohance Harrison 41:35

Didn't make the payments on that private. And it wasn't until they were like, oh, credit got crushed.

Dr. Fred Kency 41:44

What's.

Yohance Harrison 41:44

What's going with the mail? It's like, oh, yeah, you got a stack over here. Be getting all these bills from student loans. I just been setting them aside.

Dr. Fred Kency 41:50

Huh. The credit killer.

Yohance Harrison 41:53

Okay, so we're fighting it. We're saying wrong address, what have you. We're trying, but she doesn't really have a leg to stand on. And her can. Her credit score dropped like 200 points.

Dr. Fred Kency 42:03

Oh, it's. And it is. It drops quickly.

Yohance Harrison 42:05

It is real quick and takes so long to return. Yes, sir.

Dr. Fred Kency 42:10

And when you're talking about. Even they don't care about. I mean, they care about how much money you're making in the future. But if your credit score is horrible, they don't even get to the amount of money you make part because you've already shown that even with some money, you're not responsible at paying your bills.

Yohance Harrison 42:22

They're like, we don't believe you.

Dr. Fred Kency 42:24

Yeah. So when it comes time to buy that home, to buy that car, it is exponential the difference in monthly payment and total payments of things. When your interest rate is 2% versus interest rate being 9%, it is a

Dr. Fred Kency 42:39

huge difference. And the total cost of those products. And so what I can tell you is that, you know, go to fafsa, look at all the loans that you have that are out there before you graduate, because they're going to get activated shortly after. Know who services those loans and then contact them so that you know that when those loans are going to start into repayment so that you're not tricked and you're not fooled about what's going to be due and when it's going to be due. Because I've seen a lot of people get in trouble. And if you get hurt badly from a credit standpoint, early in residency is going to cost you hundreds of thousand dollars in the long run when you go buy that first home instead of getting a 4% interest rate. If your interest rate is 8 or 9% because your credit score, that, that 4% difference in credit percentage will. It is tough.

Yohance Harrison 43:30

Hundreds of thousands of dollars. Hundreds of thousands of dollars.

Dr. Fred Kency 43:35

And that, that money that you could have saved could have been rental properties, could have been a second business, could have been investments into this. I mean, so we don't want to throw away any money that we've earned because you, you work too hard to get here. Way too hard.

Yohance Harrison 43:47

Way too hard.

Yohance Harrison 43:49

All right, so we said. So we had three. So one, One was look at your expenses over the last three months, four months. Plan for the next three months. Cut out everything that's discretionary. If you can cook at home, go to those. Hello. Fresh recipes. I'm still laughing about that. I'm thinking we have a little drawer that has the old.

Dr. Fred Kency 44:06

Hello.

Yohance Harrison 44:07

We do got some recipes down there. You know, you got, you got half of the stuff in your pantry already because you know, you bought the whole thing of oregano and only used it one time. So. Exactly. And then number two is, is. And, and I, I like how. I like what you said, Dr. Kinsey. I like. Because you said log into FAFSA, not Mohila, not nelnet, not it. Go to the source. Go to Sally, who used to be Sally. It's not Sally anymore, but go to fafsa. FAFSA will tell you who your loan services are. But also remember, if you borrow directly from your school, that's not going to show up on fafsa. So if you got a loan directly from your school, you have to go to the school to negotiate that. And usually they don't negotiate. They're like, now you don't go here. No more payments due.

Dr. Fred Kency 44:54

Yeah. So 8.9. Bring it.

Yohance Harrison 44:56

Yeah, bring it. All right, so number three, what would be the number three financial tip for those graduating residency this month?

Dr. Fred Kency 45:05

The checks are going to change. Don't let it go to your head. Stay responsible how you spend it.

Yohance Harrison 45:14

Well said. Don't let it go to your head. You earned it. Yes.

Dr. Fred Kency 45:18

Yeah. You didn't earn it. But it leaves.

Yohance Harrison 45:20

Don't let it make you.

Dr. Fred Kency 45:22

The amount of money they take out of your check today, it's gonna be very different than the amount of money to take out of your check in four months.

Yohance Harrison 45:29

So you, you made the money. Don't let it make you. Don't let it make you. So. Indeed. All right, if anybody wants to find you, tell us where they can find you.

Dr. Fred Kency 45:32

Exactly.

Dr. Fred Kency 45:40

Sir, I'm on all the social medias. Fred Earl Kinsey Jr. Is my name on Facebook. It's doctor.freddy f r e d d I e dot earl e a r.

Yohance Harrison 45:52

E. Oh, it's been there this whole time and I never recognized it. Okay. I didn't even know the Earl was there. All right.

Dr. Fred Kency 45:57

Oh, yeah. And then from an email standpoint is kinseymedicalservices.com I mean, I'm sorry, Kinsey MedicalServices gmail.com so always happy to talk. You know, after we did this last time, I had people reach out about different financial tips. I'm like, well, I'm not a advisor finances, but I can tell you what I did and the things that worked and that didn't. But then, but Johannes is the guy that teaches you how to start fresh and, and keep it growing.

Yohance Harrison 46:24

And full disclosure, I am not his advisor. He has an advisor already. It's not me. He has one. I'm like, great, glad you got one. So last tip. Tip number four coming from me or my one tip, get some help. Find a qualified professional that can help you. I can't help everyone. Feel free to reach out to me if, you know, if we can make our schedules align. Great. I want to help you, but it doesn't have to be. Find a qualified professional. Someone that's, that's a fee based financial planner preferably, because then they're not just going to sell you products. And I'm not saying products are bad, it's just that at this stage you probably need some planning. But yeah, get some help. Don't just rely on chat gbt. Get some help from a professional. So with that, thank you, Dr. Fred Freddie Earl Kinsey Jr. For joining me again. For those of you that picked up on that, he was on the Money script podcast a few years ago. So if you want to, we'll put a link to that episode if you want to go back to that. But thank you for spending some time on becoming an attending and helping those in medical school transition to residency and residency transition to being, attending and from attending transition to a successful ER career. We'll see you next time.

Seth Harrison 47:38

That's it for today's episode of Becoming and Attending. Did you pick up something valuable to carry into your next step? I hope so. Remember, the journey is a marathon, not a sprint, so take one step at a time and give yourself grace along the way. Also, this isn't intended to be specific tax or legal advice. Please talk to an attorney or CPA before taking any action. Before you go, please like comment and subscribe. If you're on YouTube, click the bell for notifications. Share this episode with one of your colleagues who is also on the path to becoming an ER physician. Share this episode with one of your colleagues who is also on the path to becoming an attending ER physician. The show notes also contain more.