022: Why Physicians Who Live First Get Richer

This episode challenges the idea that wealth has to come before life. Dr. Kristine explains why waiting for retirement, a bigger portfolio, or a lighter schedule can delay both freedom and wealth, and how designing a life with time, location, and creative space can actually create better financial outcomes. She introduces her "Pay Yourself Twice" framework, showing how physicians can invest aggressively in both their future self and their present self at the same time without being reckless.

Key topics:

• Why this episode is for physicians who keep waiting for "someday"
• The flawed model of wealth first, life later
• Why time freedom, location freedom, and flexibility can be a precondition for innovation, energy, and wealth creation
• Introducing the "Pay Yourself Twice" framework – funding both your future self and your present self with equal intentionality
• The type of options that "Pay Yourself Twice" produces in real life
• A wealth-building approach of mastering one money-making formula at a time, then layering in the next
• Why outside income removes the ceiling that hospital employment creates 
• How to think about building remote income and geographic freedom

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Transcript

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Most of us believe we have to choose between the life that we really want to live in medicine or the wealth that we want to create. We grind now and live greater later. We sacrifice the present for the future. But what if that sequencing is completely backwards? And how would I know? Because I tested the opposite. I moved toward the life I wanted to live in medicine before I felt financially ready, before I felt every single financial duck was in a row. I worked less, I traveled more, and I ended up wealthier and with more options at 40 than I would have had at 65, staying in the hospital, waiting for the perfect moment. This episode is about why that happens to so many of us as physicians and what we can do about it, how we can choose to both live the life that we want now and build the wealth we deserve at the same damn time. If you want to build the remote income that makes this possible in your specialty for your desired lifestyle, book a one-to-one freedom call. The link is in the show notes. Let's get into it. You're listening to Doctors Abroad, the podcast for doctors who want to build remote income and create location independence. I'm Dr. Christine Goines, founder of Nomad MD. I've exceeded my hospital income while working part-time and living abroad. And on this show, we break down how to make hospital income optional. Let's get started. This episode is for two types of physicians. One with an idea for a business or creative project that you've just been sitting on. Something you keep coming back to, something you've told yourself you will build someday, when the loans are paid off, when the schedule lightens, when the time finally feels right. And the other one is the physician who keeps telling themselves they'll start living the life that they want in medicine after. Maybe it's after you've hit a specific portfolio number, after your children are a certain age, after retirement, after some future threshold that interestingly keeps moving just far enough ahead to stay out of reach. If either of those or both of those resonates, this is about why waiting is making both the life you want to live and the wealth that you want to build take longer than they need to. And what becomes possible when we flip the sequence of waiting to live the life we want to taking action and living it now. We were handed a model. Most of us accepted it without questioning it. And the model goes like this work hard, sacrifice now, delay gratification, accumulate wealth, and eventually arrive at a point of financial independence at some point in the future, maybe at retirement, maybe a little before. And at that point, we will have then earned the right to live the life we actually want. The wealth comes first, the life comes after. This is the sequential model. And I believe it has a fundamental flaw. And the flaw is not financial. The flaw is that it treats the life that you want as a reward when, in reality, the life of time freedom, location freedom, and flexibility is often what generates the wealth. It's the space for innovation, for thinking differently. The creative energy that comes from actually living freely that is not separate from wealth building. But for many of us, it is the precondition for wealth building. The physicians who grind the longest and hardest inside the hospital are not always the ones who end up with the most options. They are often the ones who arrive at retirement with a portfolio and a body that they cannot fully enjoy. Burnt out, health compromised, relationships strained, the wealth is there. The life it was supposed to fund has already passed. The sequential model assumes time is unlimited, but it is not. So just consider what are you currently deferring to some future version of your life? And what is the cost financially, creatively, physically of that deferral right now? The concept I want to introduce today is what I call pay yourself twice. Most of us know the principle of paying yourself first, directing money to savings and investments before expenses. That is essential. And it is the foundation. But pay yourself twice goes further. It means paying your future self aggressively. That can be maxing out your retirement accounts, investing consistently, building the portfolio that will compound over decades. And it means paying your present self fully, the life abroad or domestic, the freedom, the experiences, the space, the rest, the time, control over your calendar. Not as a luxury that's earned after the accumulation of wealth, but as a simultaneous investment in the conditions that make everything else possible. Both at the same time without robbing either one of their due. So this is not permission to be financially reckless. It is a different way of thinking about what counts as an investment. The life that you desire in medicine is not a cost, it is a condition. And when we treat it that way, when we invest in the present self with the same intentionality we invest in the future self, the return is not just financial. It is creative, energetic, physical, relational, and professional. So when you think about your life right now, are you paying your future self? And are you paying your present self? Which one are you robbing? If either, and what would it look like to invest in both your future self and your present self simultaneously? I want to be specific about what happens when we actually pay our present selves because I think it sounds abstract until we see some of the concrete outputs. So when I left hospital medicine and moved abroad, I started working two days a week on a remote contract that paid more than my full-time academic salary. And during that time, I gave myself five days a week that were not spoken for in terms of work. It was my leisure time. And that was not indulgence. I did use that time to sit on the beach and travel and meet new people and go to yoga classes and try new hobbies, but that was an investment in my present self. And in that space, that breathing room that the hospital had never allowed, something emerged that could not have been born inside the institution. And that was Nomad MD. Not because I had planned it, I never sat down and thought, you know what, I really want to start a physician coaching program. No, not at all. But I did know I wanted to create something, something meaningful, impactful. And I was willing to give myself space to determine what it would be. So what happened was physicians, friends of friends, kept finding me and reaching out to me and asking how was I doing what I was doing? And they wanted advice and guidance on how they could do the same in terms of live abroad or work remotely and travel, but in their specialty. And because of the space that I had given myself to have time to have conversations, it allowed me to notice the pattern of what was being asked of me, to provide that guidance and to let the idea of what I wanted to create build and form and grow. If I had waited until retirement to live differently, the conditions for Nomad MD would have never existed. The idea needed space. The business needed the version of me that only emerged when I wasn't running on empty. And this is not unique to me. The physicians that I work with who move toward and actually live the life that they want, even if in the beginning it's incrementally, before the financial picture is the perfect portfolio number, consistently they report the same thing that the creative, professional, and financial opportunities that emerge in that space are ones they could not have predicted or manufactured from only staying inside the hospital. Living first, choosing to live the life that you want to have in medicine first does not have to cost us financially. When done with the right structure, it actually compounds everything that we do. It compounds our wealth. So if you created a version of your life right now that gave you real space to rest, to think, to build, what kind of idea or business or creative project do you think would emerge? And how would that change your wealth and freedom trajectory over the next three to five years? I just want you to think about that. And let me be clear about something. Living first does not mean stopping the investment in our future selves, right? It means doing both simultaneously, even while living abroad. Working part-time and traveling, I never stopped investing aggressively. Maxing out my retirement accounts was a non-negotiable for me. Investing six figures in myself every year was a principle that I kept without exception. The future self was always being paid. That was the foundation that made everything else feel safe rather than reckless. The framework I have used since my first year of attending life came from a simple principle. Master one money-making formula, execute it consistently, and then when that is working, layer in the next one. So in my attending years, the focus was learning to invest, understanding the mechanics, building the discipline, getting the system, my system, right. That came first. Once that was running, my focus shifted to another money-making formula, entrepreneurship. And that became Nomad MD. Building income that was not capped by anyone else's compensation survey. And eventually, my next money-making formula will be international real estate. A third formula, each one building on the last. The sequential model can apply to the formulas for building wealth, but it doesn't have to apply to your life, to determining when you get to live the type of life in medicine you really want. We can learn one money-making system, master it, and then add the next. But the life that you want to live, your schedule, the time you spend doing the things you love with the people you love, it can be in parallel the entire time, not after, not later, now. So think about it. What is your current money-making formula? Is it investing? Is it entrepreneurship? Is it real estate? And is that money-making formula working consistently? And if it is, what would be the next formula to layer in? The one that would create your next income that doesn't require more and more of your time in order for it to grow. So I want to share two thought approaches that have shaped how I think about all of this and have become the intellectual foundation for pay yourself twice. And the first is essentialism. The core idea is about identifying what is truly essential. What would need to be true for this to be a life genuinely well lived for you and building everything around that, not necessarily accumulating more and more and more, not optimizing for the largest possible portfolio number at your death, but asking what actually matters to you in this life and making sure that gets prioritized and resourced. Applied to money and time, essentialism is what keeps the present self from being perpetually underfunded. And the second approach is the die with zero approach. And I know many of us have read that book. The principle that challenges us to really ask whether we are overallocating to our future selves at the expense of our present selves. There is a version of financial responsibility that becomes its own kind of waste, arriving at the end of life with an enormous portfolio that was never fully enjoyed, and experiences that could only have been had at a specific time in life that is now past. So the goal for some of us is not the largest possible portfolio number at death, but the goal is a life fully funded at every stage and in every season. Together, these approaches point toward the same thing, really. The sequencing, most of us were handed, especially in medicine, to earn the life after the wealth is not the only way. And for many of us, it's not the best way. And so when you consider what a life well lived actually requires for you, what is it specifically? And are you currently funding that life or are you still deferring it? Now let me tell you what pay yourself twice actually produces, not in theory, but in practice. Pay yourself twice produces options. The option to stop contributing to retirement and be fine. The option to stop working and be fine. The option to work as much or as little as you want. The option to live anywhere. The option to build multiple careers simultaneously. The option to wake up without an alarm every single day and choose how the day goes. I know that those are real options for doctors because I live with them every day and so do my clients. And having an option that we do not exercise is completely different from not having the option at all, right? The physician who could retire but chooses to keep doing meaningful work is in a fundamentally different position from the physician who feels that they have to keep working in order to survive, in order to provide for their family. The life might look similar to someone from the outside, but it feels completely different from the inside. And here is what the sequential model almost never produces the limitless ceiling. Nobody has set a cap on what we can earn when we build income outside of an institution, outside of our hospital employment. Nobody is telling us how many patients we have to see or the RVU targets that we need to hit. We get to decide. We build, we grow. The number is not fixed. And when that limitless income potential is combined with a lifestyle that does not require a hospital salary to sustain it, because of geographic arbitrage, tax efficiency, and intentional spending and investing, the wealth compounds in ways that waiting inside the hospital just never could. The physicians who live first are not being reckless. They are being strategic. They are creating the conditions for options that most physicians spend an entire career hoping to earn and often arrive at too late, too tired, or too compromised in health to fully use. So what would having options actually feel like for you? Not just the number, the feeling, the specific things that you would do or stop doing or start doing if you had that kind of freedom. I want you to sit with that because it really does matter. And before we close, I want to leave you with the questions from today because I think these are worth sitting with and not just hearing once. So number one, what are you currently deferring to some future version of your life? And what is the cost of that deferral right now, financially, creatively, physically? Number two, are you paying your future self? And are you paying your present self? Which one are you robbing? If either, and what would it look like to invest in both simultaneously? Number three, if you created real space in your life right now, what idea or business or creative project do you think would emerge? How would that change your wealth and freedom trajectory over the next three to five years? Number four, what is your current money-making formula? Is it working consistently? And what would the next formula be, the one that creates income that does not require more of your time forevermore to grow? Number five, what does a life well lived actually require for you specifically? And are you currently funding that or deferring it? And number six, what would having options actually feel like? Not just the number, but the feeling, the specific things that you would do or stop doing or start doing if you had that kind of freedom. So pay yourself twice, your present self and your future self at the same time without robbing either one. If you want to build the remote income that makes this possible, that creates the space, the options, and the conditions for the life you want and your wealth to grow, book a one-to-one freedom call. The link is in the show notes. And if the financial philosophy is something that you want to contemplate more deeply about as you create a life of time and location freedom, the geographic arbitrage, the tax efficiency, the smarter income structure. Episode 18, Why Living Abroad is a wealth strategy for physicians, goes deeper on the specific mechanics. The two episodes pair well together. Thanks for listening to Doctors Abroad. If this episode was helpful, share it with a colleague who's been thinking about building more freedom and flexibility in medicine. And if you're ready to make hospital income optional, book a one-to-one freedom consultation at thenomadmd.com. I'll see you in the next episode.