MtoM #256: Internist Pays Off $300,000 of Student Loans in 7 Years and Financial Boot Camp: High Deductible Health Plans vs PPO

Summary

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Episode Overview

Podcast: White Coat Investor Podcast – Milestones to Millionaire
Host: Dr. Jim Dahle
Episode: #256: Internist Pays Off $300,000 of Student Loans in 7 Years & Financial Boot Camp: High Deductible Health Plans vs PPO
Date: January 5, 2026

In this episode, Dr. Jim Dahle interviews Dr. Rose Ngishu, an internist who paid off nearly $300,000 in student loans within seven years, despite being a non-traditional student, raising four children, and enduring financial setbacks. Rose candidly shares her journey of immigrating, switching careers, and making tough financial choices, offering practical lessons for physicians and high-income professionals. Following the interview, Dr. Dahle delivers a concise breakdown of High Deductible Health Plans (HDHPs) versus PPOs for the “Financial Boot Camp” segment.

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Key Discussion Points & Insights

1. Dr. Rose Ngishu’s Backstory & Financial Milestone

• Background & Immigration:
  • Rose immigrated to the US in 1998, determined to become a doctor after missing entry to medical school in her home country by one point (03:11).
  • Initially trained and worked as a nurse for 10 years; started a family with four children and nearly gave up on medical school dreams.
• Crisis & Reboot:
  • After healthcare changes increased nursing workloads, Rose, with her husband’s support (“He decided, okay, we have four children. I’ll stay home, you go to school.”—05:06), went to medical school as a non-traditional, mid-career mom.
• Financing Medical School:
  • Both Rose and her husband were out of the workforce, supporting six people on loans and limited prior savings.
  • Tuition was modest due to Texas state rates, but living expenses made up the bulk of nearly $300k debt (06:47).

2. Financial Mistakes and Lessons Learned

• 401(k) Loss:
  • Rose liquidated a $70,000 401(k) to partner in a business that failed (“Bad idea. Don’t do that.”—05:47; “I did. I did.”—06:14).
• Frugal Living:
  • Lived in campus housing, crammed six people into a three-bedroom apartment, and stretched every dollar.

3. Loan Repayment & Early Career Choices

• Loan Strategy in Residency:
  • Used deferment for most federal loans, paid interest where possible, but debt grew from ~$225k to ~$290k by end of residency (08:03).
• Post-Residency Approach:
  • Took a rural job in Oklahoma that offered ~$40k/year (pre-tax) in loan repayment aid for five years (09:22).
• Family Situations:
  • Continued modest living, with husband taking on flexible small jobs (“ride share type things”—09:34).

4. Balancing Priorities: Home, Family, & Investing

• Income & Lifestyle:
  • Rose earned over $300k/year plus loan assistance (“I made over 300k a year, so it was a good income.”—10:20).
• Financial Priorities:
  • Chose to buy a large home post-residency for family stability, despite financial planners often recommending doctors wait (“It’s the one thing I probably would say isn’t ideal...for me, I did. I had to honor that.”—12:01).
• Investments & Retirement:
  • Maintained contributions to retirement accounts throughout.
  • Maxed out 401(k) first four years after training, did backdoor Roth IRAs; her Roth grew from $27k to $115k (“There’s a good move right there, right?”—15:36).
  • Dabbed in real estate investments using CARES Act COVID-19 hardship withdrawals from retirement accounts; this move did better than the earlier business attempt (“Please tell me this worked out better than the other business opportunity.” / “It did.”—14:42–14:45).

5. Emotional Resilience & Mindset

• Dealing With Setbacks:
  • Encourages not letting volatility or setbacks dispirit you; shares the importance of faith, mindset, planning, and not reacting on emotion (“Emotions are good. They’re like an alarm, but they are not the firefighter.”—19:23).
• Balanced Approach:
  • Advocates moderation, consistency, and thoughtful adjustments as life circumstances evolve (“You can tweak it along the way...be cautious. Don’t make decisions on emotion like I did.”—19:59).

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Notable Quotes & Memorable Moments

• On Starting Over:
  “My husband, who obviously cared...he's like, what do you really want to do? I said, really? I would want to pursue my dream. And he looked at everything...how do we make this happen?” —Dr. Rose Ngishu (04:50)
• On Early Financial Mistakes:
  “I had about $70,000 in my 401k...pulled it out with the intention of doing some business...Bad idea. Don’t do that.”—Dr. Rose Ngishu (05:47)
• On Living Simply:
  “We crammed all of us in a three bedroom, two bath apartment and just made life work.”—Dr. Rose Ngishu (06:36)
• On Rural Job Loan Repayment:
  “I looked for a job that would offer me some payback...you get about half of that because the taxes come out...it helped.”—Dr. Rose Ngishu (08:25)
• On Family Sacrifice:
  “My sons always talk...the boys shared a room. They still talk about it today. They’re like, I hated that.”—Dr. Rose Ngishu (13:13)
• On Financial Priorities:
  “We have a home, we have food, we have insurance. Now it’s the loans and kind of kept it to that up until about 2020.”—Dr. Rose Ngishu (13:45)
• On Pandemic & Investing Out of Caution:
  “That was more of an emotional thing. And you always get tripped up on emotional things. So it wasn’t a well thought plan, but nonetheless, we survived.”—Dr. Rose Ngishu (15:13)
• On Mindset & Advice:
  “A part of that is your mindset. Like, train your mind, get it out here straight...Don’t let them [emotions] be the ones trying to fight that fire because then they mess it up.”—Dr. Rose Ngishu (19:16–19:23)

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Timestamps for Important Segments

| Timestamp | Segment Description | |-----------|--------------------| | 02:21–06:12 | Rose’s immigration, nursing, and decision to pursue medical school | | 05:47–06:15 | The $70,000 401(k) mistake | | 08:09–09:22 | Rose’s loan balance after residency; rural loan repayment job | | 10:20–10:34 | Rose’s income and loan repayment benefit details | | 12:01–13:13 | Balancing home purchase with other financial priorities | | 15:24–16:25 | Retirement account growth and investment strategy | | 18:24–20:02 | Rose’s advice: faith, mindset, planning, and caution with emotions | | 21:20–25:37 | Dr. Dahle’s Financial Boot Camp: PPO vs. HDHP Plan Explainer |

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Financial Boot Camp: High Deductible Health Plans vs PPOs

Main Concepts:

• PPO (Preferred Provider Organization):
  Managed care, contracted providers at discounts, greater flexibility; higher cost, lower deductible (21:20–22:43).
• EPO (Exclusive Provider Organization):
  Like PPO but only covers care from network providers (22:09–22:43).
• HMO (Health Maintenance Organization):
  Must choose a primary care doctor, referrals needed for specialists, more restrictions but lower costs (22:43–23:30).
• High Deductible Health Plan (HDHP):
  Any plan (PPO/EPO/HMO) can be an HDHP if it meets government deductible thresholds (≧$2,500 single); lower premiums, higher out-of-pocket max, HSA eligibility (23:30–24:48).

Dr. Dahle’s Decision Framework:

“If you’re going to be a high consumer of health care…get the PPO plan…low deductible. If you’re a low consumer of healthcare, get the high deductible health plan…lower premiums…and usually you come out ahead unless something catastrophic happens.” —Dr. Jim Dahle (23:51)

• HSA Benefits:
  HDHPs allow for tax-advantaged Health Savings Accounts, which can be powerful long-term investment and healthcare planning tools.

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Advice & Takeaways

• Have a Grounding Principle: Faith, purpose, or discipline to weather setbacks.
• Plan, but Stay Adaptable: A flexible plan is better than none; tweak it, but avoid impulsive, emotion-driven financial decisions.
• Seek Balanced Progress: Simultaneously attack debt, invest for retirement, care for family, and enjoy life when possible.
• Leverage Benefits: Use employer loan repayment, state tuition discounts, and tax-advantaged accounts to maximize progress.

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Summary for Non-Listeners

This episode offers a raw, practical glimpse into the life of a physician who succeeded not by being perfect, but by being persistent, honest, and adaptable. Dr. Rose Ngishu’s story proves that major financial milestones, like paying off massive student loan debt, are possible even in less-than-ideal circumstances. Dr. Dahle follows Rose’s interview with actionable advice for physicians and professionals choosing health insurance, succinctly clarifying the tradeoffs between PPOs and HDHPs, empowering listeners to make informed choices for the year ahead.

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Transcript

[Jesse Mecham]

This is the White Coat Investor Podcast Milestones to Millionaire Celebrating stories of success along the journey to financial freedom.

[Jim Dahle]

This is Milestones to Millionaire podcast number 256. Internist pays off $300,000 in student loans in seven years. Are you ready to take control of your financial future through investments that you can personalize to your specific goals? Black Swan Real Estate specializes in helping high income professionals, including physicians, achieve financial freedom through private multifamily real estate investments. With over 13 years of experience, a $375 million portfolio and 1,600 plus units under management, Black Swan offers unique opportunities that put investors first. They operate with no GP level fees ever, a structure virtually unheard of in the industry. Led by physician Dr. Elaine Stageberg and supported by a vertically integrated team, Black Swan ensures hands on management and a proven track record of strong, stable returns. Learn more about their investor aligned [e-mail] BlackSwan all right, champions program ends earlier this year than most years. The last day to apply is February 15th. This is our book giveaway program. We're trying to give a copy of the White Coat Investors Guide for students to every first year medical, dental, et cetera student in the country. But you got to sign upWhite Coat Investor.com champion. What you're signing up for is to be your class champion to pass the books out. So if you sign up, we send you a couple of boxes of books, one for everybody in your class and you pass them out. That's it. And we give you some swag. That's the whole program. But we need you to apply by February 15. If nobody has handed you a book yet, your class probably doesn't have a champion. So please sign up to do it. And if you know somebody that's a first year student, make sure they've been handed one of these books. If not, encourage them to apply themselves. Whitecoatinvestor.com Champion all right, we got a great interview today. A lot of times we get requests, people who want people with lower income or not highly paid specialties or somebody that's made some mistakes or somebody that's a non traditional student. Well, today we've got all those things, so. So I hope you enjoy the interview. My guest today on the Milestones podcast is Rose. Rose, welcome to the podcast.

[Dr. Rose Ngishu]

Thank you.

[Jim Dahle]

Dr. Rose, why don't you introduce yourself to the audience, tell everybody what part of the country you're in, what you do for a living, how far you are out of training.

[Dr. Rose Ngishu]

So my name is Rose Ngishu. I'm a physician in town of medicine, subspecialty, or rather specialty. And I currently am practicing in the Dallas Fort Worth area. I am seven years out of training.

[Jim Dahle]

Okay, and what did you accomplish?

[Dr. Rose Ngishu]

I just paid off my almost $300,000 student debt.

[Jim Dahle]

Wow. Okay, take us back, take us back to med school here and you know, maybe even pre med school. And you're looking at it going, oh boy, I'm going to borrow how much a year? I'm going to be borrowing, you know, $75,000 a year or whatever.

[Dr. Rose Ngishu]

Yeah.

[Jim Dahle]

And, and tell us about how that felt.

[Dr. Rose Ngishu]

So I'll, I'll go back to undergrad. So I came to this country around 1998 with the full intention of going to medical school. So I always wanted to go to med school. I always wanted to be a physician since about age 7, that I can remember. And back in my country of origin, I missed it by one point and I was devastated. And so talking to friends and family and realizing I may never get to this in this part of the world, I need to try it elsewhere, I made a determination to come to either Europe or the Americas to try it. And so I came here thinking, okay, I'll just go and apply to med school and go to school. And then lo and behold, I get to this country and I begin to learn the system and they tell me you have to have an undergrad before you can consider med school. And. And so back in my country I had started studying nursing and so I thought, okay, I'll just go back to nursing. So I did my nursing training. I worked for about 10 years actually and started a family. We have four children, my husband and I, and med school was beginning to become a non reachable goal. In fact, I had thought, okay, maybe I just won't pursue that. Maybe I'll go to PA school or NP school or something like that. And unfortunately, as the healthcare landscape started to change, right around 2006 is when I started to feel it. We were short staffed. You were running like a chicken with the head cut off and just couldn't get through all the tasks that you needed to do as a nurse in your shift. And I thought to myself, I can't see myself doing this at 50. I had to be honest. And just physically and emotionally I was so drained and I actually became depressed. And my husband, who obviously cared about how things were going, he's like, what do you really want to do? I said, really? I would want to pursue my dream. And he looked at everything and we looked at each other and it was like, how do we make this happen? And so he decided, okay, we have four children. I'll stay home, you go to school. And that meant loans.

[Jim Dahle]

He didn't work at all while you were in med school?

[Dr. Rose Ngishu]

No, not with four children. They need to go to school. The younger was still.

[Jim Dahle]

And you didn't work. And you didn't work at all either?

[Dr. Rose Ngishu]

No.

[Jim Dahle]

So you guys borrowed living expenses for six people.

[Dr. Rose Ngishu]

Yes.

[Jim Dahle]

Plus tuition, fees, books, everything.

[Dr. Rose Ngishu]

Yes.

[Jim Dahle]

And somehow, miraculously, you kept this under $300,000.

[Dr. Rose Ngishu]

So I made a mistake, which I will gladly share with the others so they don't make the same mistake. I had about $70000 in my 401k at the time from my nursing job, and I pulled that out with the intention of doing some business with some folks. Bad idea. Don't do that. So that was my way of trying to supplement loans. But it didn't work out.

[Jim Dahle]

So did you end up losing the 401?

[Dr. Rose Ngishu]

I did. I did.

[Jim Dahle]

Oh, gosh, what a disaster.

[Dr. Rose Ngishu]

I did. And so then we tried to just live the most frugal way you can. And with four children, thankfully, our cars were paid off at the time. We had two cars and we lived on campus. They had student housing, so we crammed all of us in a three bedroom, two bath apartment and just made life work.

[Jim Dahle]

Right. But this still doesn't work. Well, I guess maybe it works if you went to school in Texas and tuition was really cheap. That was the key. How much was tuition?

[Dr. Rose Ngishu]

Tuition. You paid it back in.06k a year.

[Jim Dahle]

Okay, so it was not the lion's share. Lion's share was your. Your living expenses for the same.

[Dr. Rose Ngishu]

It was my living expenses, yeah.

[Jim Dahle]

Okay, so you get out of med school, you owe $300,000. What. What year was that?

[Dr. Rose Ngishu]

It was actually more like 223. 226. Yeah. And then you add on the interest and whatnot, it came to about 290.

[Jim Dahle]

By the time residency was over.

[Dr. Rose Ngishu]

Yes.

[Jim Dahle]

Yeah. Okay, so what did you do with the loans in residency? Did you make income driven repayment payments? This wasn't the student loan holiday if you've been paying on them for seven years.

[Dr. Rose Ngishu]

Correct.

[Jim Dahle]

Or did you just go in deferment?

[Dr. Rose Ngishu]

I went into deferment. So I had multiple different kinds of loans. There was, of course, the Fed, Stafford and Direct and all that. And then I had some Texas college access loans that were fair on their interest, which I think Texas does a good job of trying to supplement some of this. And then I had some private loans on Top of this. So I had like just borrowed from here and there, and I paid interest on, during residency on some of the Texas loans, which wasn't bad. It was like $300 here and there. And then the others I kind of just deferred.

[Jim Dahle]

Yeah, but basically your loans went from 225 to 290.

[Dr. Rose Ngishu]

Correct.

[Jim Dahle]

While you're in your medicine residency.

[Dr. Rose Ngishu]

Correct.

[Jim Dahle]

Okay. So then you come out seven years ago and you're like, what. I mean, you're looking at this debt and what do you guys. I mean, did you have any sort of a plan or were you ignoring it at that point or at what point did you say, we're going to pay this off in seven years?

[Dr. Rose Ngishu]

My goal was to get rid of the thing as quickly as I could because I knew I don't have a chance if I dragged this around. It's just going to hound me. I'm dataverse generally, but also I recognize that it was my only avenue to get to where I needed to go, at least for my situation. And so from the get go, I knew we had to pay this off. And I was not going to wait for people who say you could probably defer more and longer and da, da, da. But what I did was I looked for a job that would offer me some payback, some loan payback assistance. And so that's how I ended up in Oklahoma, a rural place. They offered, you know, reasonable figure that helped. You know, they say this much a year, but then at the end of the day you get about half of that because the taxes come out of that too. And I was like, you trapped me for like five years, but it helped.

[Jim Dahle]

So you worked in Oklahoma at a job that gave you some help paying off some of the loans that, that made a difference. Give us a sense of the living situation. Okay, you, you go into residency, your husband's still stay at home, dad with the four kids.

[Dr. Rose Ngishu]

So he tried to work something flexible, but it didn't really pay a whole lot. So he kind of did ride share type things. Lift and work.

[Jim Dahle]

Okay. A little bit of stuff here and there.

[Dr. Rose Ngishu]

Yeah. Just so we'd get salt for today, sugar for tomorrow.

[Jim Dahle]

How old are those kids now?

[Dr. Rose Ngishu]

22, 21, 18 and 16.

[Jim Dahle]

Okay, so you're getting closer to being empty nester now.

[Dr. Rose Ngishu]

Oh, yeah.

[Jim Dahle]

Okay, so this is all 13 years you're paying off this student debt with. And so you took the job in Oklahoma and that helped, obviously. But it sounds like mostly, even during the last seven years, it was all your income as an internal medicine Doctor, so give us a sense of what your income looked like.

[Dr. Rose Ngishu]

I mean, overall, I made over 300k a year, so it was a good income.

[Jim Dahle]

Does that include the loan payback amount, too?

[Dr. Rose Ngishu]

The loan payback on top of that.

[Jim Dahle]

Which was how much per year?

[Dr. Rose Ngishu]

For five years, about 40.

[Jim Dahle]

Okay, so, yeah, that added up to a couple hundred thousand dollars.

[Dr. Rose Ngishu]

Yeah. Yeah.

[Jim Dahle]

Okay. So you actually made pretty good money for an internist. Were you working really hard? Were you taking a lot of call? Were you doing hospitalist shifts? What were you doing?

[Dr. Rose Ngishu]

I did a little bit of everything, so I did a little hospital work, mostly clinic, this particular part of the town. You know, I was the specialist in town, and so I had enough volume. Although at the same time, you know, the hospital was generous. They. They offered me a guaranteed salary and I could take time off. And they were very supportive, I guess, because of the need. And so I didn't feel like I was working overly hard. I did a few locum shifts, you know, border town type hospitals on the border of Texas there in Wichita Falls, for a few months right before COVID hit. And so I made a few extra thousand dollars there just to keep us going.

[Jim Dahle]

Okay, but. But between supporting, you know, four teenagers now and your husband and yourself and some moves and so forth, you still had to send some money into the lenders. You know, this $40,000 a year wasn't going to wipe out your student loans completely. So tell us how you balanced your financial priorities for the last seven years, how you decided how much to save for retirement, how much to spend, how much to send toward the debts, et cetera.

[Dr. Rose Ngishu]

So we had some financial counseling sessions in my school right before graduation, end of residency. And so I knew the priorities being, you know, I need to secure my income with insurance and also, you know, just have a plan for handling my biggest liability right now, which was the student loans. And because of my family. And in part, it was a compromise when we moved around. You know, it's like, okay, once we move, we'll. We'll kind of settle down, buy a house. And so I had to honor that. And so it's the one thing that I probably would say isn't ideal for a typical person coming out of residency. Don't buy a home just yet. But for me, I did. And so this particular part of the country, we were. There wasn't enough big homes for a family of six. And so we just had to go all in and buy something substantial, which wasn't cheap, but I promised my family I was gonna keep them Comfortable?

[Jim Dahle]

Yeah. At this point they're teenagers. You're not talking about it. A two year old and a four year old and a five year old. Oh, you guys can all share the same room, you know.

[Dr. Rose Ngishu]

No, my sons always talk. I have to. We have two daughters and then two sons. When we were in residency, the boys, well, when we were in med school, they all shared rooms. You know, the girls had one room and then the boys. And then we went to residency and the boys shared a room. And they still talk about it today. They're like, I hated that. And I'm like, okay, I understand. And so after residency, that was not going to be a compromise. I had to get them all their own.

[Jim Dahle]

That's not going to work when you're making 300k. No, that's not going to fly anymore. They've been sacrificing right along with you the whole time.

[Dr. Rose Ngishu]

Yeah. And so I kind of followed the plan for the most part. I deviated a few times, which not good. But you know, I kind of stuck it to. We have a home, we have food, we have insurance. Now it's the loans and kind of kept it to that up until about 20, 20, 20. So that was what, two years into, three years into. And during the pandemic, everybody was scared and I, you know, I got into this also feel of unknown. What if I got sick and you know, what would happen to me and the family and da, da, da. And so we decided at the time to dabble into real estate a little bit, especially since you could borrow up to 100k and invested in something at the time, like hardship money out of the retirement account. I guess I didn't learn this the first time.

[Jim Dahle]

Please tell me this worked out better than the other business opportunity.

[Dr. Rose Ngishu]

It did, it did. So we got a couple of homes and kind of like 50% equity into them. So they're not bad. And so I told my husband, you know, this is at least if I die, you have something to start on besides my life insurance. You have a place for the kids and then you figure the rest of it out. And so that wasn't, that was, I would just be honest. That was more of an emotional thing. And you always get tripped up on emotional things. And so it wasn't a well thought plan, but nonetheless, we, we survived.

[Jim Dahle]

You got something, you got some investments. Were you also funding retirement accounts too, or was that it? That was your only investments?

[Dr. Rose Ngishu]

So I did in residency I actually put away like almost $27,000 in my Roth in my 401, not 401 gate, which I converted at the end of residency to a rock.

[Jim Dahle]

There's a good move right there, right?

[Dr. Rose Ngishu]

Oh yeah. So. And that has grown over the time I was looking at that recently. It's about 115k, which that's untaxed. So it's grown. I had a few other, you know, little monies in during my nursing years that different. So I just kind of pulled it all together. And it's about, you know, 115 right now. And then at the time also did 401k, maxed those initial four years and I've had a challenge this year, so we'll get into that later. But I maxed the first four years and then I also did extra, you know, just doing a backdoor Roth for myself and my husband. And so that has helped. His account is doing better as well. It's about 88 right now.

[Jim Dahle]

Yeah. So you take a balanced approach, paying off these loans. Yeah, you got the house, you paid off the loans, you invested some for retirement. You, you know, started a real estate portfolio. Nice work. I mean that's a good balanced approach. And yeah, it took seven years to get rid of those loans, but you also got five years of payments from an employer. So I mean, it's probably pretty smart to maximize the benefit of those as well. Well, as a non traditional student, I mean, you're starting your career now, you know, your financial career and a little later than most docs do. Do you feel like pressure to save more now for retirement to get to the same place or do you just think moderation? All things, this is where we're at.

[Dr. Rose Ngishu]

So right now, really, now that the loans are behind me, I think to myself, these are going to be my legacy years. So I need to really build that nest egg, is that what we call it? To really maximize that to the best that I can. And I try not to deprive myself because I know myself. If I do, I'll become very depressed and I'm worth not. So I try to splurge here and there between my husband and I am the spender. And so that's fine. He's okay with that. And so a few trips here and there, some generous work with church and ministries and all that. So that also goes. It's budget, well budgeted into every month. So it's either we have it in priority or we don't. But moving forward, I really want to do the best I can to, to secure the legacy years.

[Jim Dahle]

What advice do you have somebody out there that can Relate to your story. They're like, oh, I'm a non traditional student, or I went to medical school with kids, or I lost money in a bad investment or a scam or something. What advice do you have for them so they can become successful like you have?

[Dr. Rose Ngishu]

Thank you. That's a very, very good question. Because a lot of times you watch one thing go down and think, oh, my gosh, can I ever make a right decision? You know, you begin second guessing yourself. But I think one is to really be grounded in, you know, what is your source of strength. For me, it's my faith. And so I always look at everything through the lens of faith. The sparrows don't sow, they don't store, and God takes care of them somehow. God has a way of taking care of me. That doesn't mean I'll become lazy and sleep all 12 hours, but I can go to him for wisdom to navigate the challenge. And so what grounds you? I think we need to start there. And a part of that is your mindset. Like, train your mind, like, get it out here straight. And once you have that, then along with that comes the planning aspect of it. There is nothing that you can achieve without a plan. Somebody once said, you know, you fail to plan, you plan to fail. And so it is very true that you have to have a plan. Can you tweak it along the way? Yes. But even in that, be cautious. Don't make decisions on emotion like I did and got in trouble a couple of times. And so emotions are good. They're like an alarm, but they are not the firefighter. They just need to alarm you. Okay, there is this concern here, but don't let them be the ones trying to fight that fire because then they mess it up. So, A, ground yourself. B, have a plan. C, don't work on your emotions or run off of with your emotions.

[Jim Dahle]

Good advice, Rose. Well, congratulations to you on what you've accomplished. You should be very proud of it. We're proud of you and we thank you for coming on the podcast and sharing your story to inspire others to do the same.

[Dr. Rose Ngishu]

I appreciate it. Thank you so much and keep up the good work. I would have never gotten here, or at least initially. I didn't know any financial information. I didn't grow up with this financial information. And so I'm still trying to indulge a little bit on your podcast and other resources out there.

[Jim Dahle]

It's our pleasure.

[Dr. Rose Ngishu]

Thank you.

[Jim Dahle]

All right. That was a fun interview. And the resiliency is what I love to see Right. You find yourself in a career you don't like and you're like, I'm going to medical school. And you do what you can to keep the loans down. You do what you can to pay them off. You, you roll with the punches. You take a job that helps pay them back, you send some money to the lender to pay them back. You balance your life raising teenagers and saving for retirement and getting into a home. You balance it all with paying off those student loans and bam, seven years out of training, they're gone. You're free. You paid for medical school, and now you can concentrate on your other financial goals. I love it. Good stuff. And I hope a lot of you out there can take some inspiration from what Rose has done.

[Dr. Jim Dahle]

There are a number of different types of health insurance, and it's important for doctors to understand all of them. Not just because they're doctors and getting paid by these health insurance plans, but because they're also consumers and they have to make decisions about their health care plans. A common question I get these days is, should I use this PPO plan or should I use this high deductible health plan? And I think it's important to understand the differences between the various kinds of health insurance plans and organizations. PPO stands for preferred provider organization, sometimes called a participating provider organization or preferred provider option, all to keep the acronym the same. But it's a managed care organization of doctors, hospitals and other healthcare providers who.

[Jim Dahle]

Have agreed with an insurer or a.

[Dr. Jim Dahle]

Third party administrator, provide healthcare at reduced rates to the insured or administrator's clients. That's what a PPO is. And sometimes that's contrasted with an epo. An EPO is an exclusive provider organization, right? Very similar to a ppo. But unlike EPO members, PPO members are reimbursed for using medical care providers outside of their network of designated doctors and hospitals. Okay, so epo, you can only use.

[Jim Dahle]

The ones on the health plan.

[Dr. Jim Dahle]

A ppo, you just pay less if you use the ones that the insurance company has chosen. It's also often contrasted with a health maintenance organization or an HMO. You know, these really came around in the 1990s when they were talking about making pretty significant changes to our health care system. Unlike PPOs, HMOs often require members to select a primary care physician and that doctor then acts as a gatekeeper to direct access to any sort of non emergency medical services. And they often have to get a referral from the PCP before they can go see any sort of a specialist. And so the idea is to lower the cost. And HMOs often do have a lower cost than a PPO, but they're a little bit more of a pain for you as a consumer to work with because you got to go get these referrals and maybe you're discouraged from seeing as many specialists, specialists, et cetera, but the cost might be lower overall. You notice I have not yet talked about a high deductible health plan option because technically all of these could be a high deductible health plan option, right? It's the government that designates what a high deductible health plan is. If the government says you're an hdhp, you are. If the government says you aren't, you aren't. Typically what that means though, these days is that you have a deductible of at least $2,500. As for a single person, it's sometimes higher if you're a family. And the idea behind that is that you have more skin in the game and maybe you'll be a little bit more judicious with how much healthcare you consume. So often when people are comparing a PPO to a high deductible health plan, whether the high deductible health plan is a ppo, an EPO, or an hmo, they're looking at, okay, am I going to be a high consumer of healthcare, in which case I'll be on this PPO plan and I'll have a relatively low deductible, or am I going to be a low consumer of health care, in which case, well, I'll get the high deductible health plan, right? And have lower premiums and usually you come out ahead unless something catastrophic happens and maybe that year you end up paying your out of pocket max, which is usually higher on a high deductible health plan option. The other benefit, of course, of a high deductible health plan is it allows you to make HSA contributions, your health savings account. And those dollars, of course, grow in a tax protected way and can come out of the account tax free to pay for health care. So while you don't necessarily want to choose a high deductible health plan just so you can use an hsa, it does help defray the additional cost because you're getting those tax and investing benefits as you go along with the high deductible health plan. I hope that summary of how these various health plans works will help you to understand and make the important decision of what kind of health insurance plan you're going to use for the coming year.

[Jim Dahle]

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[Jesse Mecham]

The White Coat Investor Podcast is for your entertainment and information only and should not be considered financial, legal, tax or investment advice. Investing involves risk, including the possible loss of principal. You should consult the appropriate professional for specific advice relating to your situation.