MtoM #229: Intensivist Goes into the ICU and Comes Out a Millionaire and Finance 101: How to Know Where You Stand Financially

Summary

White Coat Investor Podcast Summary
Episode: MtoM #229: Intensivist Goes into the ICU and Comes Out a Millionaire and Finance 101: How to Know Where You Stand Financially
Release Date: June 30, 2025
Host: Dr. Jim Dahle

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Introduction

In episode number 229 of the White Coat Investor Podcast, Dr. Jim Dahle welcomes back Ian, an academic pulmonary critical care physician from the Midwest. This episode delves into Ian's impressive financial journey to becoming a millionaire and his recent personal experience of being hospitalized in the ICU. Dr. Dahle intertwines financial wisdom with real-life experiences to provide listeners with both inspiration and practical advice.

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Financial Milestones: From Half a Million to a Million

Net Worth Growth

Ian shares his remarkable progress in building his net worth from half a million to just over one million dollars in under a decade. This growth is attributed to disciplined saving, strategic investing, achieving Public Service Loan Forgiveness (PSLF), and benefiting from real estate appreciation.

• Saving and Investing: A combination of personal savings and employer contributions played a significant role.
• PSLF Success: Ian managed to have approximately $40,000 of his student loans forgiven through PSLF, highlighting the program's benefits for medical professionals.
• Real Estate Appreciation: Incremental gains from his primary residence contributed to his net worth increase.

Notable Quote:
"Through a combination of saving and investing, PSLF forgiving the last few, maybe $40,000 of my student loans and a little bit of real estate appreciation in our home."
— Ian [03:44]

Income and Savings Rate

Ian's annual income ranges between $300,000 to $350,000, augmented by moonlighting opportunities. Despite this high income, his disciplined approach ensured a consistent savings rate of around 20%, combining personal savings and employer-sponsored accounts.

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Student Loan Journey

Ian outlines his path with student loans, starting with an initial debt of approximately $200,000 upon graduation. During residency, his debt increased but was gradually reduced through various strategies:

• Paying Down Debt: Regular payments and additional contributions helped lower the principal.
• NIH Clinical Research Loan Repayment: Participation in loan repayment programs provided significant relief.
• COVID-19 Measures: The pandemic-induced PSLF pause further reduced his loan burden, eventually leading to a full forgiveness of his remaining debt by the end of 2024.

Notable Quote:
"I came out of school with probably around $200,000. That number went up during residency and through a combination of pay down, some NIH, clinical research, loan repayment, and then the COVID pause in PSLF eventually went to zero."
— Ian [04:16]

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Becoming a Millionaire: Reflections and Advice

Upon reaching a net worth of one million dollars, Ian reflects on the emotional significance of this milestone. While it's a notable achievement compared to the average 401(k) balances, he finds the feeling somewhat anticlimactic due to other pressing life priorities, such as family and health.

Notable Quote:
"Honestly, it's a little bit anticlimactic. I'm still a dad to four young children and a working doc... Other things seemed more important."
— Ian [06:09]

Advice for Aspiring Millionaires

Ian emphasizes simplicity and consistency over perfection. He advises others to focus on the fundamental financial principles without becoming overwhelmed by complexity.

Notable Quote:
"You don't have to do everything right. We certainly didn't do everything right. But you have to do the basic things well and just keeping it simple and not overcomplicating it."
— Ian [06:54]

He shares a personal lesson on financial missteps, such as purchasing multiple new cars. While these decisions did not severely impact his net worth due to the choice of reliable, resalable vehicles, he acknowledges that minimizing unnecessary expenses could have accelerated his financial growth.

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Personal Health Challenge: ICU Experience

Ian recounts his recent hospitalization during a severe influenza season, detailing his experience in the Intensive Care Unit (ICU). Despite being a critical care physician, he faced significant health challenges, including bronchospasm and the need for high-flow oxygen therapy.

Notable Quote:
"I developed some myalgias and a low grade fever... I was admitted and made a pit stop on a step-down unit, but was admitted to the ICU pretty quickly."
— Ian [07:48]

After ten days in the hospital and six weeks of physical recovery at home, Ian returned to full health but not without contemplating the financial implications of his illness.

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Financial Impact of the ICU Stay

Emergency Fund and Financial Planning

Prior to his hospitalization, Ian had initiated a "Ian gets hit by a bus" financial plan with a fee-only planner. This proactive approach led to building a more substantial emergency fund, which played a crucial role during his medical crisis.

• Emergency Fund: Before his ICU stay, Ian had approximately one month’s cash reserves. Post-incident, he ramped up his emergency savings to an anticipated $50,000 to $60,000.
• Income Protection: His physician group’s salary continuation and long-term disability policy ensured his income remained stable, minimizing the need to dip into his emergency fund.

Notable Quote:
"Having no debt outside the mortgage, a modest mortgage and some cash in the bank really alleviated a lot of my anxiety so that I could focus just on getting well."
— Ian [10:31]

Insurance and Financial Security

Ian highlights the importance of disability insurance and adequate emergency savings, especially for high-income professionals who might otherwise feel invincible.

Notable Quote:
"My first piece of advice is to make sure that you get disability insurance as soon as you can... You're not invincible. And so there's no substitute for cash in the bank."
— Ian [14:20]

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Financial Advice and Planning Steps

Dr. Dahle and Ian discuss essential steps for financial planning, applicable to both medical professionals and high-income individuals.

Creating Financial Statements

1. Balance Sheet (Net Worth Calculation):

   • Assets: Include investment accounts, bank accounts, and home equity.
   • Liabilities: Account for all debts such as student loans, mortgages, and credit card balances.
   • Net Worth: Subtract total liabilities from total assets to determine net worth.

2. Income Statement (Budgeting):

   • Income: List all sources, including salaries, side hustles, dividends, and rental income.
   • Expenses: Itemize all expenditures, preferably using bank and credit card statements for accuracy.
   • Savings Rate: Aim for saving at least 20% of gross income, primarily for retirement, with additional savings for other goals.

Notable Quote:
"This is the way you keep score. And this is the way you keep score."
— Dr. Jim Dahle [18:XX]

Regular Review and Adjustment

Both speakers emphasize the importance of annual reviews of these financial statements to ensure progress towards financial independence.

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Conclusion

Episode #229 of the White Coat Investor Podcast masterfully blends Ian’s personal and financial milestones with practical financial advice. From achieving millionaire status to navigating a critical health crisis, the episode underscores the importance of disciplined saving, strategic planning, and having robust financial safeguards. Dr. Dahle reinforces the message that financial independence and security are attainable through simplicity, consistency, and proactive planning.

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Disclaimer:
The hosts of the White Coat Investor are not licensed accountants, attorneys, or financial advisors. This podcast is for entertainment and informational purposes only and should not be considered professional or personalized financial advice. Consult appropriate professionals for specific advice related to your situation.

Transcript

[Ian]

This is the White Coat Investor podcast, Milestones to Millionaire celebrating stories of success along the journey to financial freedom.

[Jim]

This is Milestones to Millionaire episode number 229. Intensivist goes into the ICU and comes out a millionaire. Are you using multifamily to build long term wealth? If not, I strongly encourage you to take a look at 37 parallel properties. They are multifamily specialists with 100% profitable track record across over $1 billion in transaction volume since 2008. Investing with them like partnering with a highly tax advantaged family office building an income producing long term wealth development platform. With 37th Parallel you get access to institutional quality assets conservatively managed with proven results. Raising educational content on passive multifamily investing is also very good. Visit 37th parallel.com WCIToday for more information. All right, we got a great episode for you today. Not only a great interview, but afterward we're going to talk a little bit about figuring out where you stand this episode. We're only recording this on June 24th, so this thing drops like next Monday, but it drops the day before the start of the new year in the medical world, which is July 1st. So it's a great time to be talking about just figuring out where you stand. So we're going to talk about that after this interview, so stick around afterwards. In the meantime, I want to make sure you know about Financial Boot Camp. If you go to whitecoatinvestor.com Bootcamp you can sign up for something that's totally free. You catch the price on that, it's free. It's a free email course. It's a fast track to being debt free within five years of residency and to becoming a millionaire. It is a series of 12 emails we will send you to help you catch up to other White Coat investors. We put this together years ago. Thousands and thousands of doctors have been through the White Coat Investor Financial Boot Camp. And some of the emails you'll look at and you'll go, oh, I've already got this taken care of. And some of them you won't. But you need to pay attention to all of them because all of them talk about an important topic, an important task, for lack of a better term, that you need to take care of to get your financial ducks in a row. So that'[e-mail] Bootcamp all right, let's get our guest on the show and get going with this. Our guest today on the Milestones Millionaire podcast is Ian. And Ian is significant because he is a Repeat offender here on the Milestones podcast. He was also on podcast number 139. Ian, welcome back to the show.

[Ian]

Thanks so much for having me.

[Jim]

Remind people what you do for a living and how far you are out of training and what part of the country you're in.

[Ian]

Yeah, so I live in the Midwest. I am an academic pulmonary critical care doc. I work mostly in the intensive care unit, and goodness gracious, now I'm nine years out of training.

[Jim]

Okay, nine years out of training. Very cool. And we're going to kind of do two milestones on this episode. Last time we had you on a couple of years ago, we celebrated you reaching half a million dollar net worth. Tell us now where your net worth is at.

[Ian]

Yeah, it's just north of $1 million.

[Jim]

Very cool. Very cool. Congratulations on becoming a millionaire. So we're going to talk about that one first and then we're going to get to a bit of a non traditional milestone that I can really relate to. As podcast listeners will realize, Ian has dealt with some time as a patient in the ICU recently. So let's first. Let's do the financial stuff first. Obviously, going from half million dollars to a million dollars, you gained half a million dollars in net worth in the last couple of years. Tell us how you did that.

[Ian]

Through a combination of saving and investing, PSLF forgiving the last few, maybe $40,000 of my student loans and a little bit of real estate appreciation in our home.

[Jim]

Holy smokes. You got all kinds of milestones. You got PSLF recently too. Yeah, that.

[Ian]

Well, I'm trying to think. It took a while for the paperwork to process, but it came through, I think, at the end of 2024.

[Jim]

Okay, so tell us a little bit about your student loan journey. Just give us like four lines or so of what happened with your student loans.

[Ian]

Yeah, so I came out of school with probably around $200,000. That number went up during residency and through a combination of pay down, some nih, clinical research, loan repayment, and then the COVID pause in PSLF through a number of those mechanisms, eventually went to zero.

[Jim]

Okay, very cool. So PSLF works even if you don't owe that much money still, bottom line. So $40,000. Basically, the taxpayer wrote you a check for 40 grand to say thank you for how you've chosen to work, the employer you've chosen to work for.

[Ian]

Yes.

[Jim]

So wonderful. Okay, give us a sense of what your income's looked like the last couple of years as you've gone from half a million to a million.

[Ian]

It's probably between 3 and 350,000. It varies based on moonlighting and things like that.

[Jim]

Okay, so certainly this wasn't just a crazy high income story. You saved a whole bunch of that income. So what do you think your savings rate's been the last couple of years?

[Ian]

I think it's probably been right around 20% between our savings and the employer savings.

[Jim]

Okay, so a millionaire. When you were a kid, did you ever think you'd be a millionaire?

[Ian]

I don't think I had any concept of what that even meant Now.

[Jim]

Obviously, a millionaire now doesn't mean the same thing as a millionaire in 1980, much less a millionaire in 1930, which I think is the image we all have in our head from the Monopoly game. It's still a lot of money, though, and it represents a pretty significant achievement. Especially when you look around at the average 401k balance for people in their 60s, which is like 100 or 150 or $200,000, something like that. I mean, it's substantial sum of money compared to the average person, even in America. So it's a nice big fat round number that I think a lot of people get excited about getting to and becoming millionaires. What's your sense of how you feel from when you were before you were a millionaire to now that you are a millionaire?

[Ian]

Honestly, it's a little bit anticlimactic. I'm still a dad to four young children and a working doc, and my wife also had some health issues in the fall. So other things seemed more important, which is fine. That's sort of, I think, normal.

[Jim]

Yeah, I mean, absolutely. Other things are more important and. And it's wonderful that you have recognized that money, while important in life, an important tool, is not necessarily the most important thing. Okay, any financial advice for people that want to be millionaires? Seven years out of residency, nine years out of residency, like you were. Anything you'd tell them if they're coming out of residency now going, man, I'd like to be a millionaire in less than a decade.

[Ian]

Well, I would say you don't have to do everything right. We certainly didn't do everything right. But you have to do the basic things well and just keeping it simple and not overcomplicating it.

[Jim]

Very cool. Tell us some of the things you didn't do right.

[Ian]

Yeah. We bought a bunch of new cars as our family grew. The only good thing is that they were all Hondas and Toyotas, so they held their resale value well and we didn't lose tons of Money to depreciation. That's probably the biggest sort of thing that I would probably have done differently.

[Jim]

Still paying off any of them?

[Ian]

No, they're both paid off.

[Jim]

Okay. All right, well, let's move on to this other. You know, I don't know if milestone is the right word to use for it, but experience, something you've had to overcome recently, which is not terribly dissimilar from my experience, you've spent some time in the hospital yourself. Tell us about that. And then a little bit about the financial impact of it.

[Ian]

Yeah. So like I said, I'm a pulmonary critical care dyke. I work in the medical ICU of a large hospital. And this was a really terrible year for influenza. For anyone who works in the hospital, they know that. And the Monday after a week in the icu, I developed some myalgias and a low grade fever. I have asthma. I did okay. But after about a week at home, I got worse. I drove myself to the hospital, which was, I think, in retrospect, a questionable decision.

[Jim]

What were your stats when you walked into the er?

[Ian]

Well, my oxygen saturation was okay, but my heart rate was about 103, 30.

[Jim]

Wow. All right.

[Ian]

And yeah, so I got admitted and made a pit stop on a step down unit, but was admitted to the intensive care unit pretty quickly, where I was not intubated, but spent basically a week on high flow. I felt what heliox was like. I had to use that once or twice for bronchospasm, so it was pretty scary.

[Jim]

And these are your partners taking care of you?

[Ian]

Yeah, I drove to a sort of like a sister hospital where I knew people, but it wasn't my icu, because that would have been sort of even more strange.

[Jim]

A little too weird. Yeah.

[Ian]

So, yeah. And then after. After 10 days in the hospital, I went home. I had to use a cane to get up the stairs. So I took about six weeks of physical recovery at home until I went back to work. And now I feel normal.

[Jim]

Fine, back to normal. Wonderful, 100% recovery.

[Ian]

Yeah. For which I'm very grateful.

[Jim]

Okay, let's talk about the financial impact of this experience.

[Ian]

Yeah. So ironically enough, earlier in the year we had reached out to a fee only planner, like a fixed fee planner, to go over together our plan. I sort of called it the Ian gets hit by a bus plan. And part of what she identified was that we sort of had a relatively lean emergency fund, a bit of an optimizer, I think. And so we started building up some more cash in the emergency fund. And you Know, I was really fortunate as an employed physician. My income was protected. But I was starting to think about, you know, all these things related to our financial plan. What would happen if I couldn't go back to work or was out of work for a long time. And having no debt outside the mortgage, a modest mortgage and some cash in the bank really alleviated a lot of my anxiety so that I could focus just on getting well. And I was really aware during that whole process how uncommon that is actually for people who are critically ill and their families and that most people are not in that position of privilege. So I'm even more grateful for that as well.

[Jim]

Do you have very many financial discussions with your patients and their families?

[Ian]

Honestly, no. I talk a lot with patients as they are more awake about the psychological recovery from critical illness and that was something I was experiencing myself, which is really different. But I, I don't really talk about finances. I think I could imagine it's, I don't know, it's an interesting question and there's some interesting literature on the financial consequences of critical illness.

[Jim]

Yeah, I occasionally do have these conversations. Most recently I had one with a 26 year old that just come off his parents plan and was now, you know, uninsured. And of course he has an ER visit which is not, you know, it's not like being in the ICU for sure, but it wasn't trivial either. And so we talked about his options, you know, getting on the ACA and getting a plan off the exchange, you know, maybe trying to cobra his parents plan. I didn't know if that was a possibility or not, you know, and negotiating with the hospital to get a cash payment break on his ER visit. But I have these conversations occasionally and it's pretty illuminating to me just that nobody has any idea how to interact financially with the healthcare system. Yeah, it can be pretty overwhelming. Have you seen your bills yet?

[Ian]

Yes, I have a great HMO plan and my out of pocket costs were pretty limited, but I saw the itemized bill and it would have been a multi three figure or multi six figure.

[Jim]

Bill for my stay, my ICU stay was $108,000. That's what the insurance company paid. That's not the Chargemaster price. It was $108,000. My main treatment was morphine and sitting up in bed in three or four days and that added up to $108,000. The flight to the hospital. The actual price paid by the insurance company, $44,000. You know, it's. Health insurance is pretty important. Yes, you can go broke real fast from, you know, spending some time with critical illness or a cancer diagnosis or a big bad trauma, something like that. It doesn't take that much for sure. Okay, so how much of the emergency fund did you burn through?

[Ian]

Not much.

[Jim]

Because you still had your regular income, Correct?

[Ian]

We would have used it probably if my disability had extended for longer, but we were really fortunate.

[Jim]

So what was providing the income? Were you just between shifts or were you on a short term disability policy provided by the employer or what exactly provided it?

[Ian]

Actually our physician group has sort of like a salary continuation in our contract and then it would have, you know, if I'd been out for a long time, it would have converted to our employer long term disability policy.

[Jim]

Okay, so that is kind of a built in employer funded short term disability, it sounds like.

[Ian]

Yes.

[Jim]

Okay, very cool. So I'm curious, what did you end up settling on for an emergency fund? How much money did you decide to put into the emergency fund?

[Ian]

Yeah, we were partway building back up to sort of like north of three months. I probably had closer to a month of cash. But we're going to probably when we're done, we'll probably have between 50 and 60 grand in cash.

[Jim]

Now you said you were a bit of an optimizer, so I'm assuming you were taking that money and putting it into Roth IRAs and putting it into 403s and that sort of thing. Is that what you were doing with it rather than keeping more in cash?

[Ian]

Yes, and I have also a government 457, so there's a lot of space in my employer for tax advantaged accounts.

[Jim]

Yeah, very cool. Okay, what advice do you have for other docs, other high earners out there that may think they're a little bit invincible and will never end up, you know, being out of work and in an icu. And what advice do you have for them?

[Ian]

Well, my first piece of advice is to make sure that you get disability insurance as soon as you can. My policy now has an exclusion for asthma because in the time between when I got a policy that was not the right policy and I sort of discovered I needed a different policy. I had a bunch of kids and their respiratory viruses cause asthma trouble and I was on prednisone intermittently and things like that. So that's number one and number two, you're not invincible. And so there's no substitute for cash in the bank and making sure that your spouse knows where things are and can deal with them. If suddenly you're unable to do that.

[Jim]

Cool. Well, Ian, congratulations on becoming a millionaire. Congratulations on surviving an ICU stay, both physically and financially. And thank you so much for being willing to come on the Milestones podcast to share your experience with others and inspire them to do the same.

[Ian]

Yeah, thanks so much to you and everything that you and your team have done. And I also just want to say thanks to everybody that took care of me to whom I'm really grateful.

[Jim]

Yeah, I know how that gratitude feels. I didn't realize it was possible to feel as grateful for my rescuers as I feel. So I'm sure it's pretty incredible when you've been the recipient of those sorts of things. Yep.

[Ian]

Thanks, Jim.

[Jim]

Okay. I hope you enjoyed that. It's always fun to have repeat customers on the Milestones podcast. I love tracking you guys progress throughout your financial investing career, which runs parallel to your real career. It's pretty awesome to see you guys go from getting back to broke to building $100,000 in net worth and 500,000,000 and becoming financially independent. All these things as you go along. And the fun thing about doing this white coat investor stuff for the last 15, almost 15 years is that we keep, you know, running into people that found us many, many years ago and hearing the rest of the story. And so it's a lot of fun to have somebody like Ian back on. Obviously, I can relate very well to somebody who spent some time in the ICU in the last year. It is a sobering shot across the bow as far as your health goes. And you realize, you know what? I'm not going to live forever. You know, I watch my parents get older. They turned 80 this year. I turned 50. In between the time I record this and when you hear it, happy birthday to me. That's right. Just turned 50 and I realized my parents are not going to live forever. They're not in awesome health, and my health is not what it was 20 years ago either. None of us get out of this live, and so we definitely need to be paying attention to how we're living our lives and making sure we're getting the most bang for our buck that we can. That includes both out of our money, but also out of our time. So find a balance between present you and future you. Right. Don't leave future you impoverished, but don't save so much money, don't spend so much time on finances that you're forgetting to live your life now. Okay, start of the medical new year I mentioned at the beginning of this podcast. So let's figure out where you stand. This can be pretty sobering in the beginning, so you might have to pour yourself a stiff drink to do this exercise. But I want you to sit down. I want you to create two documents. This is the same thing a business would have. A business would call this a balance sheet and an income statement. So a balance sheet essentially calculates your net worth. On the left hand in a column, you put down everything you have. Now, you don't need to get too crazy. You don't need to put down your car, not put down your clothes and your furniture and your TV and that sort of stuff, but everything you have, right? Investment accounts, your bank accounts, maybe your home equity, you know, these sorts of things that are big chunks of your money in your life. Now, on the right side, I want you to tally up all your debts, all your student loans, your car loans, your credit cards, your mortgage, whatever, you know, investment property mortgages, whatever you've got, okay? Total it all up, okay? Add up your assets, add up your liabilities. Total them together. That is your net worth. And you should calculate that, I don't know, once a year or so. It's important that you track it to make sure it's moving in the right direction. Right? For most white coat investors, if you're doing this right, your net worth goes up every year. Now, it might go up because you paid down debt and reduced your liabilities. It might go up because you added to your investments and have more money saved. It might go up because your investments earned money on their own and went up in value. Occasionally, you might have a year where your net worth goes down. We've certainly had that. Typically, it's when something happens to the value of the white coat investor. If it makes less money in one year, well, we value it lower, and that's how our net worth can go down. But you should do that every year and track it along and make sure that at least in the long run, it's moving in the right direction. The other statement I want you to create is an income statement. And the best way to think of this is like a budget. On the left side, you put all your income, all your sources of income, whether it is payment for your job, whether it's money you get profit from, whatever business you might own. Maybe it's some side hustle you're doing, maybe it's dividends from your investments, maybe it's some rent you receive from investment property, whatever. All your sources of income list on the left side. Then on the right side, I want you to List all your expenses. If you've never done this before, it's a really enlightening activity. You can do it just by going to your credit card statements, to your bank account statements and literally just total up everything that you spent in the last month or the last three months or whatever and then put the total at the bottom. Now what I'd like to see is I would like to see the income outpace the outgo by about 20% of the income. And that's your savings rate and that's an important number. I'd calculate that once a year as well. How much of your total income you ended up saving for retirement. And you might want to do a secondary savings rate that includes college savings and saving for short term stuff and paying off debt and those sorts of things. But the main one is how much went toward retirement divided by your gross income. And the number I recommend for that is 20%. You might need to be higher if you want to retire early. 20% should be enough for most white coat investors that have a typical length career to retire financially independent and not have to have a decrease in your lifestyle spending once you retire. So figure out where you stand. Right? That's the first thing to do when you're trying to sort out a written investing plan. Then calculate it again periodically. You don't need to do this every week or every month, right? Do it once a year, that's plenty. But make sure you're moving in the right direction. If you're not keeping score in this game, it's gonna be hard to figure out if you're winning it or not. And this is the way you keep score. Okay, As I mentioned at the top of the episode, Our sponsor is 37th Parallel. This is a company I've invested with myself. They ask, are you using multifamily to build long term wealth? If not, we strongly encourage you to take a look at 37 parallel properties. They're multifamily specialists with 100% profitable track record across over 1 billion in transaction volume since 2008. Investing with them is like partnering with a highly tax advantaged family. Office building an income producing long term wealth development platform. The 37th parallel. You get access to institutional quality assets conservatively managed with proven results. Their educational content on passive multifamily investing is also very good. Visit 37Parallel.com WCIToday for more information. All right. Don't forget that if you want to do boot camp, it's totally free, right? This is the same thing you get when you sign up for the White Coat Investor newsletters, but you can go to whitecoatinvestor.combootcamp to sign up. Don't forget, this podcast is driven by you. We need you and your milestones to continue to have the Milestones to Millionaire podcast. You can sign [e-mail] Milestones till next time, Keep your head up, your shoulders back. You've got that, You've got that. You've got this, and we're here to help. We'll see you next time.

[Ian]

The hosts of the White Coat Investor are not licensed accountants, attorneys or financial advisors. This podcast is for your entertainment and information only. It should not be considered professional or personalized financial advice. You should consult the appropriate professional for specific advice relating to your situation.