Practicing Medicine in Australia – Podcast #178

Podcast #178 Show Notes: Practicing Medicine in Australia

What is it like to practice medicine in Australia? Our guest, Dev Raga from Melbourne, Australia, walks us through the training and practicing of physicians in the land down under. We talk about what the medical system is like in Australia as well as how physicians are compensated. From time to time we bring doctors on the show from other countries, we’ve had a British physician and a doctor who trained in Venezuela on. It is fun to dive into the medical and financial world of another country as we do in this episode. Sometimes in the U.S. we get these almost blinders on and think we’re the only country in the world. We don’t really realize that there are a lot of lessons that could be learned from other countries that we can really apply in our own lives to simplify both our medical system and our financial system. I think you will find this interview really interesting.

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Quote of the Day

Our quote of the day comes from George Goodman who said,

“If you don’t know who you are, the stock market is an expensive place to find out.”

That is talking a little bit about behavior and what kind of an investor you are. In a lot of ways, the investor matters a lot more than the investment. Although we are all busy seeing patients, working our butts off, taking call, working night shifts, you still have to put a little bit of time into taking care of your finances. Don’t drop the ball with the last 5% of your life, which is taking care of the money that you’re making, and you’ll be successful.

Practicing Medicine in Australia

I split this episode into two halves. In the first part we talk about medicine in Australia, the training path, practicing of medicine as an attending, and the health care system. The second half we talk about finances in Australia, both among doctors and others, how they are compensated and how they save for retirement.

Becoming a Doctor in Australia

There are two main ways of becoming a doctor in Australia. You can do the undergraduate way, which is the way this doctor did it. You go K through 12th grade and do your year 12 exams and an entrance exam for medical school. Based on your year 12 marks and your aptitude test entrance exam, you might get selected for an interview and then get into medicine that way. That is the undergraduate process, direct entry into med school after year 12. That was the most common way that people did medicine, in the 1990s and 2000s.

You can also do medicine through what is called postgraduate entry. This is very similar to the U.S. system where after year 12, you might want to do an undergraduate degree such as biomedical sciences or medical sciences, or really any degree. Then you sit for the aptitude test to get into postgraduate medicine. Then you have to go through the interview process for postgraduate medical degrees. Not all universities offer undergraduate and postgraduate degrees, although they are moving towards more postgraduate degrees in the MD system in Australia over the last five years.

Most of the medical school placements are based on merit. That means that it is Commonwealth supported. So, most of your education is paid by the taxpayer. There are some full fee-paying medical schools in Australia, but that is relatively rare for the Australian graduate.

It would be very unusual for an Aussie graduate to do year 12 and then go for full fee-paying medical school, because it is quite expensive. Most of the full fee-paying medical school places are for international students that come from overseas.

Most people that become doctors in Australia basically decide at 18 to go to medical school.

Cost of Medical School

Most of these Australian doctors are basically going to school for free.  There are students loans but they work differently than in the U.S. The cost of becoming a doctor is $30-40,000. This doctor graduated with student loans of $36,000 after six years to become a doctor. He didn’t have to pay any of that upfront. Each year his yearly fees, which get added to the student debt, were capped at $6,000. Now that has increased, capped at around $9,000 – $9,500 for medical school per year. At the end of medical school, four years postgraduate or six years, then you may graduate with a student loan debt of around $40,000 to $70,000, depending on which university that you go to.

At the point of study, when you get into medical school, you don’t have to pay that yearly fee. You pay it when you graduate and you get a job, and it’s automatically linked up to your taxation accounts.

So, when you get a job and you’ve earned a certain amount, if you earn $45,000 to $50,000 a year, which every single doctor in Australia, including the newly graduated medical student, earns, then it automatically gets deducted from your taxation.

So, it’s money that you kind of never see. One day you get a letter or email from the government saying, “Congratulations, you’ve paid your student loans off”. But it’s a subsidized education. So, if $6,000 or $9,000 is added to the student loans, the rest of the $30,000 to $40,000 comes from the taxpayer.

I asked if anyone writes a check to pay off that amount early.

“No, actually it’s encouraged not to pay it off early. And this is why I think most Aussies are very proud of the university system here because they don’t charge any interest. So, all these loans come from the federal government and the federal government policy is that it’s not privatized. So, at the end of your medical school, your loan is only indexed to inflation. There is no interest on the line. So, it makes no sense to pay it off upfront. It makes sense to earn a living and invest outside of that. And then one day the bills just get paid off automatically.”

Interesting difference to our system. The cost of medical school there is certainly quite affordable in the sense that you don’t need to have the money upfront to study medicine. He felt like it was a fairly equitable system from an Aussie point of view.

Training

You go into medical school at 18, you come out after six years, at 24. Then what?

At the end of your medical training, halfway through, you have to apply for internship. Every doctor has to do an internship, which is kind of your training year. You apply for it at your designated hospital that you want to go to. That is a state-based system, and it’s a relatively competitive process.

So, if you want to get to a particular hospital, then you have to go and sit the interviews for that particular hospital. But most people stick around at the hospital where they’ve trained the most. So, with your undergraduate training, three years might be preclinical, three might be clinical, and you might be attached to a particular hospital. If they know you and like you, then they’ll just employ you as an intern.

“Now, if you did internship in Adelaide versus if you did internship in Melbourne versus Sydney, there are some basic things that you need to do. So, you need to do basic general surgery, basic general medicine, emergency medicine. So those are the basic things that you need to do across the board nationally. So, you can’t just do internship in cardiology for example, and call it a day.

Then, during internship, you get assessed during each rotation. And you’ve got to pass that rotation and you finish the internship and your provisional registration as a doctor becomes a general registration as a doctor. That means you are a fully fledged doctor.”

You still get paid during the internship. Then you become a resident. And generally, most doctors in Australia do one- or two-year residency in their chosen field.

“So, for example you can do internship and say, I want to do neurosurgery so I can do a surgical specialty resident year. And part of that might mean neurosurgery ophthalmology, ENT, plastics, orthopedics. And then during that year, you may wish to apply for neurosurgical specialty training as a registrar. And a registrar here is basically the actual training process of becoming let’s say a neurosurgeon, for example, and that takes about five or six years, and you’re assessed every six months during that time. And then at the end of that six years, you take an exam and you become a neurosurgeon. So, the whole process, 6 years plus another 6 to 10 years, you’re looking at about 15 years, if you wanted to do a surgical specialty.”

It sounds like the postgraduate training is not dramatically different from the U.S. There are combinations of internships, residencies, and fellowships. It all ends up being about the same length. They just call them different things for different years.

Australian Medical System

They have what they call a two-tier health system. The primary health care system in Australia is public. Then they have a very expensive private health care system, which is the equivalent of single-payer.

“So, essentially public hospitals exist. Public outpatients exist. You get doctors, nurses, pretty good standard of care, actually pretty fantastic standard of care for public health. And then we have a private system in Australia as well, which also has private hospitals. You can see specialists privately, et cetera.

Now, generally speaking, that’s the hospital systems. The outpatient systems, the general practice, for example, most general practitioners have their own small businesses that they see patients through. So general practice is federally funded and the GP charges a fee to see the patient and the patient gets a rebate back from the government. So, it is also heavily subsidized by the government. And also, you’ve got your private specialist. Again, you can go see a cardiologist and pay upfront, and then you get a rebate back from the government, as well.”

They also have a pharmaceutical benefit scheme, where when you are prescribed something like a heart medication, for example, that medication, the actual cost to the taxpayer might be, let’s say $500 or whatever it is per script, but the average Australian may only pay $40. So, they cap it at the pharmacy. You are not expected to pay the full price and you don’t need to have private health insurance to be able to buy the medication. That cap is lower for low-income earners.

They also have allied health, which is mainly in the public system, but also there is also a private allied health system, as well. He felt like the dental system was the biggest gap in Australia. Most of the dentists are private unless you are a child or low-income earner. They have national programs for immunizations and cancer screenings that are all free.

Most people don’t have private health insurance. Those that do use it for non urgent elective stuff that they would have to wait several months for in the public system. For emergencies like cancer surgery, heart surgery, brain surgery, most people just use the public system.

I asked how the private system works. You go see a private doctor, you pay him cash out of pocket to get your care. Then you get some money back from the government. Is that most of the money of what that private doctor charged, some tiny percentage of that money, all of the money? What does it work out to be, usually?

He said the cost is highly variable and depends on the type of consultation. The fees are completely up to the doctor. One ENT may charge you $100 for a consult and another $500 for a consult. Basically free market.

“But with the government, you have to put an item number for a consultation. So, the item number might be, let’s say, 104, which is I think the item number for specialists. And that 104, that rebate, is government set. So that rebate might be, let’s say, $50, for example. Mum pays $100. She gets $50 back from the government, which is all sort of electronic. And the gap fee is $50 that the mother has to pay for the consultation. And likewise, when they go to the operating theater, if they went to the private hospital, then the hospital and the health insurance have a very similar system.

That is relatively standardized. It’s not a huge discrepancy between ENT specialist one and two, because it’s all sort of market forces. But that really depends on the health insurance and the type of operation that they do and the ENT surgeon and what sort of fees they charge. And that’s called a gap fee.

So, in the private system, just because you have a private health insurance doesn’t mean that your entire care is fully covered by private. Some surgeons choose to gap fee. Other surgeons say, ‘No, I don’t want to charge you gap fee, just pay me whatever the private health insurance sets their rebate at, basically’.”

It seems the main difference between the public and private systems is the wait time for care and the cost. He feels like the quality of care is exactly the same because a lot of doctors work across both.

“In fact, to have a public appointment is seen as revered. If you’re a physician or a surgeon or an ER specialist that works in the public system and the private system, on your resume, on your curriculum vitae, that looks great to be affiliated with a public hospital. Because most of the research, most of the guidelines, most of the procedures, the standard of care is set by the public system.”

I asked about maldistribution of services. Is there a big difference in the care you get if you live in some tiny town in the Outback versus in Sydney?

“The advantage for Australia is that we’re a very urbanized country. So about 90% of the population live in major cities, capital cities of each state, and about 40% of the population live in Melbourne and Sydney. So that’s a considerable advantage, which means 90% of the population get the care that they need in their own city.

There is a maldistribution in terms of regional and rural areas. So, we have regional centers, we have rural centers, and we have remote centers, and we also have indigenous population, indigenous communities in rural and remote Australia. There’s definitely a maldistribution there.”

Deficiencies in the System

Here in the U.S. I would say the majority of doctors are at least a little bit embarrassed about our medical system. It’s embarrassing to be a part of sometimes. Do Australian doctors feel embarrassed about their medical system at all?

He asked this question in an Aussie doctor forum recently, and most people said they’re very proud of the Australian health system. Generally speaking, they would consider health care as a human right. So, because it’s not something that you choose, to be sick, in a sense, or if you’re a child born with a deficiency or developmental delay, it’s not the child’s fault. That sort of human right element is definitely there.

“And I think most doctors would agree that public health systems should exist. And most doctors would also agree that the private health system also should exist. And each of their respective sort of health systems can partner with each other to sort of help out. Of course, with the private health system, you need private health insurance in Australia.

If you don’t have private health insurance in Australia, you can still go to a private hospital, but the cost would be quite prohibitive. And most private hospitals would probably say, “Look, the cost is just too much for you to get your surgery here. So, we recommend you go to a public system”. And that sort of transfer of patients happens quite a lot.

In the public system, it is a public system, so you don’t get access to the doctor of your choice. So that’s a bit of a deficiency. In the private system you can say, I want to see Dr. Jim Dahle because he’s the best at the surgery that I want to have.”

So you don’t get a choice in who you see and you most often are seen by Australia’s equivalent of residents and fellows, as most of the training positions are in the public system. And you may be waiting a long time.

“Patients can go to the emergency department for whatever they want. The triage nurse has to triage them based on the guidelines. Category one, which is trauma, immediately to be seen. Triage category two within 10 minutes, triage category three within 30 minutes. Four, which is one hour, I think it is. And five, which is within two hours.

Now technically a rash would be categorized as category five, and they need to be seen within two hours. But in reality, they probably will wait much longer because of the workload, but they’re not allowed to send people away. What they may do is they give patients the option.

So obviously if it’s a non-urgent issue, a lot of the emergency departments might have an after-hours, general practice clinic attached to them. So, they may say, ‘Look, you’re welcome to wait here. It’s free of cost. Or you might want to go to an after-hours GP center nearby. They might choose to charge you, most don’t.’”

Cost of Health Care

The Australia Healthcare system is quite efficient from a cost benefit analysis. They are able to do things relatively cheaply compared to some of the other countries except, obviously, in the developing countries it is much cheaper, but to have hip surgery in Australia is relatively cheaper than perhaps in most of North America.

Lots of American doctors are terrified of a single payer system, thinking it’ll lead to less access to quality care and low doctor pay. Are they right to be afraid?

“It would be quite perplexing to a lot of Aussie doctors, this sort of fear about a single payer system. In Australia, doctors are pretty well paid and the quality of care is actually pretty good. So, the life expectancy here is 82, which is, I think it’s higher than North America. And most of our research comes from the public system here. And we’ve got world class research institutions attached to universities and hospitals here.

And pay-wise, if you’re in the public system, then your pay is quite transparent. So, it’s called the enterprise bargaining agreement, which basically the statewide doctor union bargains with the state government. And they sort of say, “Okay, if you’re a consultant emergency physician year three, this is your pay”. And that’s statewide.

So, if you went to hospital two, somewhere in a rural area, and they are part of that agreement, then that hospital can’t say, “Oh, you are an emergency physician, we will pay you this much less”. They can’t say that. So, there’s sort of a transparent process. And of course, in the private sector, that’s all sort of fee-for-service. So, there’s no sort of standardized sort of pay right of the private sector.

I think it’s interesting why some people may be a little bit afraid of the sort of single system, this sort of control of healthcare, et cetera. But when I see patients in the public system, I don’t have to ask for permission to do an x-ray or do a blood test or prescribe a certain medication. I’ve got complete medical autonomy to do that, to make sure the patient gets the best care they need.

There’s no hospital executive telling me what to do in terms of my clinical practice. And the nurse is not told to do something by executives. It’s autonomous. So, I can practice within guidelines, within policies and procedures, without being interrogated.”

It is extremely rare for anyone to go bankrupt from a medical bill in Australia. It’s actually something that most people don’t worry about.

Medical-Legal Liability

How much do Aussie doctors worry about getting sued by a patient?

Medical litigation in Australia has risen in the last 20 years or so. It really depends on the specialty. But generally, overall, most doctors wouldn’t be worried constantly about it.

“Now, the interesting thing about medical indemnity is public doctors get free medical indemnity by statewide insurance.  If you work in the public system, then you are protected by that. Having said that, most doctors, whether they’re public or private, will have their own indemnity as well, just in case the public system indemnity is not enough.

And in terms of specialties, I think emergency medicine would probably be a place where indemnity is an issue where patients are more likely to sue for malpractice, surgery and obstetrics would probably be the highest. And general practice, because you’re dealing with a lot of undifferentiated patients.

But on the whole, most people don’t worry about it constantly. So, I’ve got my public insurance and I’ve got my private indemnity insurance. So, I’ve got my own policy because I need to make sure that, in the rare event that I get a complaint or get sued, I’ve got that back up. So, every doctor here has medical indemnity for sure.”

Cost depends on the specialty. If you’re a general practitioner between $2,000 and $4,000 a year. If you’re a non-procedural specialist, then you’re probably around $2,000 and $6,000 a year. If you’re a procedural specialist, but non-surgical, so let’s say if you’re a cardiologist that put stents in, looking at between $7,000 and $14,000 a year. And if you’re a surgical specialist somewhere between sort of $7,000 and $36,000 per year.
Those costs are rising, unfortunately. If you’re a medical student, medical indemnity is free. If you’re a training doctor in Australia, it’s about $100.

Electronic Health Record

Australia has a national electronic health record. It seems amazing to me. I can’t get records from across town without three phone calls and a couple of faxes in order to get records from another hospital. Did Australia’s government just mandate an electronic health record, or how did that happen?

“They kind of did and they didn’t. Actually, the electronic health record it’s not something that Australians are very proud of because not many of us actually use it. So, what happened was there was a push towards electronic medical records in 2016-2017. And there was a federally funded My Health Record, which is a fantastic system at its core because it has the medications, it has summaries, scans, prescriptions, allergies, advanced care plans, all that sort of stuff. And the aim then was to get that system to talk to all the health services, public, private outpatients, general practice and specialists, as well, but it needs a lot of work. And the public faith in it is actually quite low. They spent about 2 billion Aussie dollars on it and they spend about $400 to $500 million on it every year. But a lot of the public actually don’t know about it. It’s been poorly sort of advertised. And a lot of doctors and practitioners don’t actively use it.”

They have had some security issues. Some states got hacked by overseas hackers and medical information was stolen. So, security is a major issue. He felt like a lot of work needs to be done to get the faith of the public and of the doctors and nurses to use that system on a daily basis. He compared it to the financial sector, where the Australian Taxation Office automatically cross-references over 800 million transactions a year. So almost all Australians use My Gov, which is the online sort of system for Medicare and Australian Taxation Office. They submit their claims online. The accountants do the same. In the financial sector, they are almost completely paperless.  The Australian tax office knows exactly how much he earned before he gets a pay summary at the end of the year, whereas the health record needs a lot of work. But they all agree that they need to move forward with that.

Opportunities for U.S. Doctors to Practice in Australia

What opportunities are there for U.S. licensed doctors to practice medicine in Australia? Either short term or long term.

“There are two main ways that U.S. doctors can practice in Australia. You can either apply for a permanent residency and migrate here as a skilled migrant, which is quite tricky in the sense that there’s a bit of a wait. Unfortunately, Australia has become a very popular country in the last 20 years. You come here, you get your permanent residency, and then you apply for a job, but you would need to have completed some entrance processes to be able to make sure that your qualification is accredited and credentialed locally. So, the Australian health practitioners board and the medical board may ask you for evidence as to what training you’ve done, et cetera. And that gets assessed.

The other route, which is probably a little bit easier, is that you directly apply for a job in Australia, from the United States. So again, if you’re an emergency physician, you may apply to a hospital for an ER position job if the hospital wants to employ someone from overseas. And then they do their credentialing checks.

Then, when you come, you may need to do some additional training in order to “get your credentialing done for the Australian system”. And that may mean, unfortunately, going back as a registrar, as a trainee doctor, or doing a few more years of fellowship, et cetera, depending on the experience that you bring.

Again, it’s a fairly competitive process because we do have a lot of overseas trained doctors that are in Australia and they have come here over many years. It’s a very, very tough road, and they don’t make it very easy, unfortunately, for overseas trained graduates. In Australia, they tend to prefer local graduates. The hospital really has to have a pretty good reason why they are not advertising the position for local doctors, as opposed to getting someone from overseas. And you would be paid exactly the same as the local graduate. The overseas graduate working in a public system would not be paid anything lower than what the average Aussie doctor is. So, the process is relatively transparent.”

For short term, like a locum tenens stint for three or six months in a rural area, the biggest issue would be credentialing. He wasn’t sure if you can go and do a three- to six-month term in Australia without having your credentials assessed by the hospital.  You may not need to do additional training just for those three months but it really depends on the specialty.

If you’re from New Zealand, it would be a lot easier because the Australian-New Zealand system is very similar, but any other country, they don’t make it very easy.

Finances in Australia

Physician Salaries

What kind of money do Australian doctors earn? Both during training, after training, in the public system and the private system?

Of course, medical students don’t get paid. As an intern your base salary is dependent on the state you live in. Go to a less populated place to make more money. Generally, the salaries range from $51,000 U.S. to $73,000 U.S.

After internship, as hospital medical officer or a resident, you’re looking at anywhere between $60,000 U.S. to $90,000 U.S., depending on the specialties.

As a registrar, you’re in a training program, that income dramatically improves. It becomes $88,000 to about $150,000 or more U.S. dollars based on the specialty.

As a consultant, that’s your fully fledged fellow doctor after all of your exams. If you do public and a bit of private, a family physician can make $150,000 to $300,000 U.S. dollars. As a non-GP specialist who’s not a proceduralist, you’re looking at about $150,000 to $350,000 U.S.

As a non-GP specialist proceduralist, for example, cardiology, you’re looking at about $250,000 to $400,000. As a surgical proceduralist, general surgery, neurosurgery, orthopedics, et cetera, huge variability there. You’re looking at about $300,000 to $750,000 U.S. per year.

“And I’ll say variable, because if you’re an emergency physician and you work in the public sector full time, you’re looking at between $300,000 to $400,000. You’re not going to be earning more than $400,000 in the public system for most specialties, but in the private system, it’s completely up to how much you work and how much you make, because it’s all fee for service.

So interestingly, I actually spoke to one of my anesthetic colleagues who had been in the surgical proceduralist category, and he makes over a million dollars U.S. a year and he thought that was normal.”

That may make a lot of U.S. doctors jealous. Coming out of medical school only owing $50,000 in loans and then go and make $150,000 to $700,000 compares very favorably to the U.S. system. He felt like Aussie doctors are probably one of the highest paid in the world. The perception is that doctors in Australia are rich. The average income in Australia is around $80,000 to $84,000 Aussie dollars.

How much of that high-income is due to the unionization of doctors?

“I think probably a lot of it. A lot of the fees are set by the Australian medical association in conjunction with the liaison, with the government. Obviously, a lot of the state public hospital systems, their pay is enterprise bargaining. The union is the Australian medical association, and they have state representatives in each state. And every three years, for consultants and doctors in training, they bargain with the government to either keep wages the same or increase wages.”

Taxes

How much do doctors in Australia pay in taxes? If you had to estimate the percentage of your gross income that goes toward income taxes, how much would it be?

If I’m working in the public system, I would certainly be in the highest tax bracket. So, the highest tax bracket marginal tax rate is 45%. For the first $18,000 you earn, you get charged no tax. And then it incrementally rises. Most doctors would probably be in the 30% to 40% tax range. And the reason for that is we have a reasonably generous tax deduction system in Australia. So, no one would be paying always the 45% tax rate, which is the highest tax bracket. So, if I have investment properties, if I have margin loans, anything that I invest that produces income, the cost of that investment, I can then tax deduct from my income. In the private sector, because you have your own business, business tax rates are quite low here, 25% to 30%. Then you can write your money via your business and your family trusts, so you pay a lot less taxes. But we are a relatively high tax nation. And part of that is because health education is relatively cheap, if not free.”

Saving for Retirement

How do Australian doctors save for retirement? In retirement accounts like U.S. doctors. The retirement funds are called superannuation funds.  The employer pays 9.5% of your gross wages on behalf of you to the superannuation fund of your choosing. That money gets taxed at a flat rate of 15% when it hits your superannuation account. Aussies also love property.

“It’s something that we all aspire to buy. And property prices and values in Australia are quite high. So, a lot of our net worth, at the time of retirement, may be engrossed in the personal property that we own. So, property is definitely something that we would all invest in. And that includes residential property or commercial property. And that includes your principal place of residence that you stay in, but also investment properties.”

Lastly, they also invest in their personal businesses. Growing their medical practices and then selling them to a corporate GP clinic or something like that.

The money in the superannuation fund grows tax free up to $1.6 million. You can withdraw that much tax free in retirement. A superannuation investment portfolio is structured based on your need. That could be invested in the stock market, index funds, international stocks, local stocks, bonds, ETFs, commodities, cash, property rates, et cetera.

“For example, when I log into my superannuation account, I’ve got variable options. So, I’ve just selected, “I want 50% of my money invested in the stock market. And I want 50% of my money invested in what’s called a balanced fund”. And the balanced fund might be a combination of the stock market. These are all sort of premade, pre-portfolio made. You don’t have to individually select the exact index fund that you want to invest in when it comes to superannuation. If you want that sort of level of personalized control, there’s something called self-managed super fund, where you don’t need to go through one of the big retirement funds. You can just create your own self-managed super funds, and there are regulations for that. And then you can sort of say, “Okay, I want to go buy the Vanguard S&P 500 or ASX 300 index, and that’s going to be my retirement and that’s going to be my superannuation”. And that’s completely fine as well.”

Ending

Our guest is a podcaster himself. He started a couple of years ago wanting to leave a blueprint for his two young children in the rare event that dad was not around or was not able to support them, and teach them about finances. His podcast topics range from saving, investing, debt reduction, personal insurance and many more.  You can follow him on Facebook or his website devraga.com. His podcast is available on all major podcasting apps: Dev Raga Personal Finance.

His final words of wisdom to our listeners are:

  1. Learn about money. It is okay to talk about money. You work hard for your patients, and it is okay to make money as a result. There is nothing wrong with being wealthy.
  2. Skills are not transferable. If you’re a great neurosurgeon, that doesn’t mean that you’ll be a great investor. Doctors are very vulnerable for doing silly things with their money. Because we make so much money, we think that we can sort of out earn a knowledge deficit and we can’t. So, you need to be financially literate and you need to empower yourself with that knowledge.

Sounds very similar to what I tell listeners every week. Given the physician incomes in Australia, Dev is astounded why every doctor in Australia doesn’t retire with a seven-figure portfolio. Same with all of us practicing in the U.S.

Full Transcription

Intro:
This is the White Coat Investor podcast where we help those who wear the white coat get a fair shake on Wall Street. We’ve been helping doctors and other high-income professionals stop doing dumb things with their money since 2011. Here’s your host, Dr. Jim Dahle.
Dr. Jim Dahle:
This is White Coat Investor podcast number 178 – Practicing medicine in Australia.
Dr. Jim Dahle:

Now is the time to start thinking about whether your current tax plan is truly tax efficient and keeping more of your hard-earned money in your pocket. At Cerebral Tax Advisors they focus on all year proactive tax planning.
Dr. Jim Dahle:
As a spouse of physician, their founder, Alexis Gallati has over 18 years of experience using court tested IRS approved tax strategies to lower your effective tax rate and increase your wealth. Her services are flat rate, and she’ll show you your return on investment before you invest in cerebral services.
Dr. Jim Dahle:
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Dr. Jim Dahle:
We’ll put links to both of those in the show notes, which you should check out, by the way. They’re excellent, very well done. They run on Thursdays on the blog, same day this podcast drops. It is September 21st. We’re recording this to run on October 1st and it’s going to be a great episode. I think you’re really going to enjoy it.
Dr. Jim Dahle:
From time to time, we’ve brought on doctors from other countries. The White Coat Investor, both the blog and the podcast does have an international readership and viewership. It’s the vast majority is U.S. docs, but there are people from other countries that read and listen to the White Coat Investor.

Dr. Jim Dahle:
So, it’s a lot of fun, I think, to bring people on from other countries every now and then, and give you a sense for what it’s like to practice medicine in another country. In the past, we’ve had a doc from the UK on here. We’ve had a doc from Venezuela in here. And today we’re going to have a doc from Australia on here, which I think it would be particularly interesting, especially since a lot of docs look into locums’ opportunities to go to Australia and practice themselves.
Dr. Jim Dahle:
Before we get into that, I wanted to talk about a couple of other things. First of all, let’s give you the quote of the day. This one comes from George Goodman who says, “If you don’t know who you are, the stock market is an expensive place to find out”. And I think that is talking a little bit about behavior and what kind of an investor you are. In a lot of ways, the investor matters a lot more than the investment.
Dr. Jim Dahle:
And although we’re all busy seeing patients, working our butts off, taking call working night shifts, you still got to put a little bit of time in to taking care of your finances. So, thank you for what you do. Don’t drop the ball with the last 5% of your life, which is taking care of the money that you’re making and you’ll be successful.
Dr. Jim Dahle:
Also, if you need help, it’s okay to need help. We recognize that most docs are going to need help from some type of financial professional at some time. And that’s why we keep the recommended lists at the White Coat Investor that we do.
Dr. Jim Dahle:
For example, I estimate that about 80% of docs want and need financial advisor. So, we keep a list of financial advisors that we think are fantastic. It’s under our recommended tab at whitecoatinvestor.com and it’s whitecoatinvestor.com /financial-advisors.
Dr. Jim Dahle:
We keep a list there of dozens of advisors that we’ve vetted that our readers and listeners are continually vetting. They give good advice at a fair price. And if you need to use them temporarily or for the rest of your life, that’s a place you can know you’re not going to be ripped off. So, feel free to check out that recommendation page as well as our other recommendations pages if you need help with something.
Dr. Jim Dahle:
All right, I think it’s about time to get into this interview. Let’s get this doc on the phone and I think you’re really going to enjoy and learn a little bit about how medicine is practiced in Australia.
Dr. Jim Dahle:
Okay. We have got our Australian doc on the line here. He’s going to remain anonymous today, but welcome to the White Coat Investor podcast.

 

 

Australian doc:
Thank you very much, Jim, for having me.
Dr. Jim Dahle:
It’s wonderful to have you on. Let’s start with just to learn a little bit more about you. Tell us a little bit about your background and how that affected your views on money.

Australian doc:
Yeah. So, I was actually born in India, but I came to Australia as a child, about seven years old with mum and dad and elder brother. So, most of what I remember in most of my life has been being in Australia. I don’t really remember much of my life in India actually.
Australian doc:
We were an average middle-class family in the early 90s in a town called Adelaide or the city which is one of the capital cities of the state here in Australia. And I’ve always grown up with frugality mindset. I’ve always been very careful with money, even during my high school years and medical school years when I had a job and certainly my internship and training years.
Australian doc:
And one of the biggest sorts of mindset that I had, I always wanted to be financially secure. And this is going to sound a little bit weird, but I always wanted to go into a shop and not really think about money when I wanted to buy a TV. That was the thing, because I remember when I was growing up, plasma TVs were just coming on and the very first plasma TV was like $40,000 in Australia back in the 90s.
Australian doc:
And I thought, imagine walking into a shop and not having to think about money because I wanted to buy a TV and I didn’t have to worry about it. So that sort of financial security was always very, very important. And that sort of carried through to my high school and my medical school.
Australian doc:
Then I would sort of use the 50% rule, which is basically whenever I had a job, I tried to save 50% of my money, to put it aside and that over the years, instead of doing double down to 20%, when you have a family and kids.
Australian doc:
But basically, coming from an average middle-class family although money wasn’t the most important thing, it was constantly a feature during my childhood. And I think that sort of relationship brought in a frugality mindset.

Dr. Jim Dahle:
Thanks for sharing that. It’s interesting this idea of not having to think about the price when you buy something is a wonderful aspect. I think that’s a point beyond financial independence. Financial independence is obviously when you don’t have to work for money.
Dr. Jim Dahle:
When it ceases to be a factor in your life, that’s usually an even higher level of wealth than that. But an interesting goal, nonetheless, that I don’t think we hear verbalized very often.
Australian doc:
Yeah. I’m sort of learning obviously more about finances now than I did back in the day, but I’ll say, I’m more wealthy now and I make more money than I ever have before, but I still think about it when I walk into shops, that’s for sure.

Dr. Jim Dahle:
Yeah. So, I wanted to split this podcast into two halves really. And in the first half, I wanted to talk about medicine in Australia, because it’s fascinating to see how it’s done somewhere else, especially when we think about our own dysfunctional system here in the states.
Dr. Jim Dahle:
And then the second half to talk a little bit about finances in Australia, both among doctors and others. So, let’s start with just learning about the process of becoming a doctor in Australia. How do you become a doctor in Australia?

Australian doc:
There’s two main ways of becoming a doctor in Australia. Overall, the process here is quite competitive. It’s obviously a very well sought-after degree and that’s probably because of the financial aspect of it, as much as it is about helping people to be honest. Doctors here make a pretty good living.
Australian doc:
But the two main streams are you can do the undergraduate way, which is the way that I did it. So, you do kindergarten to year 12, you do your year 12 exams and part of that, you do an entrance exam for medical school, which is a nationalized process.

Australian doc:
And then based on your year 12 marks and your aptitude test entrance exam, you might get selected for an interview and you go and sit there and be amongst a panel of people and you might get into medicine that way. And that’s the undergraduate process. That’s direct entry into med school after year 12. That was the most common way that people did medicine, in the 1990s and 2000s.
Australian doc:
We can also do medicine here through what’s called postgraduate entry. So, this is very similar to the U.S. system where after year 12, you might want to do an undergraduate degree such as biomedical sciences or medical sciences, or really any degree.
Australian doc:
And then you sit the aptitude test to get into postgraduate medicine. And then you have to sit the interview process for postgraduate medical degrees. And not all universities offer undergraduate and postgraduate degrees. Although we are moving towards more postgraduate degrees in the MD system in Australia over the last five years.
Australian doc:
Most of our medical school placements are based on merit. And that means that it is Commonwealth supported. So, most of your education is paid by the taxpayer, but there are some full fee-paying medical schools in Australia, that is relatively rare for the Australian graduate.
Australian doc:
It would be very unusual for an Aussie graduate to do year 12 and gun for full fee-paying medical school, because it is quite expensive. But most of the full fee-paying medical school places are for international that come from overseas.
Australian doc:
So, those are the two main streams of just the process of becoming a doctor. And of course, you’ve got to sit your exams at the end of your medical school, et cetera.

Dr. Jim Dahle:
But most people that become doctors in Australia basically decided at 18, it sounds like, to go to medical school.

Australian doc:
Yeah, that’s right. That was certainly the case in the 1990s and 2000s. Nowadays we have a little bit more choice because more and more postgraduate medical schools are around and you have that option of doing something else with a hope of doing medicine.
Australian doc:
But it would make sense for postgraduate students to think about doing something in the health sciences field before getting into postgraduate medicine. So, you kind of have to plan your entrance to medical school relatively early on.

Dr. Jim Dahle:
And most of these Australian doctors, it sounds like are basically going to school for free. Is that right?
Australian doc:
Yeah.
Dr. Jim Dahle:
No tuition, no student loans, et cetera?

Australian doc:
Well, there is student loans. Basically, the way that it works is that if you get from marks and you get into medical school, then the cost of becoming a doctor per year is around $30,000 to $40,000. That is the actual cost of becoming a doctor. But the actual student doesn’t have to pay that much.
Australian doc:
To give you an example, my medical school, I went to medical school from 2001 to 2006. I graduated with student loans of $36,000 after six years to become a doctor. I didn’t have to pay any of that upfront. And each year my yearly fees, which gets added to the student debt was capped at $6,000.
Australian doc:
Now that has increased now. So nowadays it’s capped at around $9,000 – $9,500 for medical school per year. And at the end of medical school, four years, postgraduate or six years, then you may graduate with a student loan debt of around sort of $40,000 to $70,000, depending on which university that you go to.

Australian doc:
At the point of study, when you get into medical school, you don’t have to pay that yearly fee, but you pay it when you graduate and you get a job and it’s automatically linked up to your taxation accounts.

Australian doc:
So, when you get a job and you’ve earned a certain amount, so if you earn $45,000 to $50,000 a year, which every single doctor in Australia, including the newly graduated medical student earns, then automatically gets deducted from your taxation.
Australian doc:
So, it’s money that you kind of never see. And one day you get a letter or email from the government saying, “Congratulations, you’ve paid your student loans off”. But it’s a subsidized education. So, if $6,000 or $9,000 is added to the student loans, the rest of the $30,000 to $40,000 comes from the taxpayer.

Dr. Jim Dahle:
Does anybody ever pay it off early by writing a check?
Australian doc:
No, actually it’s encouraged not to pay it off early. And this is why I think most Aussies are very proud of the university system here because they don’t charge any interest. So, all these loans come from the federal government and the federal government policy is that it’s not privatized.
Australian doc:
So, at the end of your medical school, your loan is only indexed to inflation. There is no interest on the line. So, it makes no sense to pay it off upfront. It makes sense to earn a living and invest outside of that. And just one day the bills just get paid automatic.

Dr. Jim Dahle:
Interesting difference, isn’t it?
Australian doc:
Yeah. So, I think the cost of medical school certainly here to the actual individual person is quite affordable in the sense that you kind of don’t need to have the money upfront to study medicine. So, it’s a fairly equitable system from an Aussie point of view.
Dr. Jim Dahle:
So, you go into medical school at 18, you come out at six years, right? You come out at 24.
Australian doc:
Correct.

Dr. Jim Dahle:
Then what happens?
Australian doc:
At the end of your medical training, halfway through, you have to apply for internship. Every doctor has to do an internship, which is kind of your training year. And you apply for it at your designated hospital that you want to go to. And that’s sort of a state-based system, and it’s a relatively competitive process.
Australian doc:
So, if you want to get to a particular hospital, then you have to go and sit the interviews for that particular hospital. But most people stick around at the hospital that they’ve trained the most. So, with your undergraduate training, three years might be preclinical, three it might be clinical, and you might be attached to a particular hospital. If they know you and like you, then they’ll just employ you as an intern. It just makes sense.
Australian doc:
Now, if you did internship in Adelaide, versus if you did internship in Melbourne versus Sydney, there are some basic things that you need to do. So, you need to do basic general surgery, basic general medicine, emergency medicine, not relieving an elective rotation. So those are the basic things that you need to do across the board nationally. So, you can’t just do internship in cardiology for example, and call it a day.
Australian doc:
Then during internship, you get assessed during each rotation. And you’ve got to pass that rotation and you finish the internship and your provisional registration as a doctor becomes a general registration as a doctor. That means you are fully fledged doctor.
Australian doc:
Now you still get paid during internship. And we can talk about the financial aspect of it later, but at the end of that, you get the general registration. Then you become a resident. And generally, most doctors in Australia do one- or two-year residency in their chosen field.
Australian doc:
So, for example you can do internship and say, I want to do neurosurgery so I can do a surgical specialty resident year. And part of that might mean neurosurgery ophthalmology, ENT plastics, orthopedics.
Australian doc:
And then during that year, you may wish to apply for neurosurgical specialty training as a registrar. And a registrar here is basically the actual training process of becoming let’s say a neurosurgeon, for example, and that takes about five or six years, and you’re assessed every six months during that time. And then at the end of that six years, you ran an exam and you become a neurosurgeon. So, the whole process, 6 years plus another 6 to 10 years, looking at about sort of 15 years, if you wanted to do a surgical specialty.
Australian doc:
Now that process is the same for most specialties. If you want to do general practice, which is also a specialty here, a family physician specialty, you might want to do an internship and do a general resident year, obstetrics, psychiatry, et cetera, because that’s all sort of compulsory. Then apply to the general practice training program and that’s another two to three years in community general practice. And then sit your fellowship exams.
Dr. Jim Dahle:
It sounds like the postgraduate training is not dramatically different from the U.S.
Australian doc:
No.
Dr. Jim Dahle:
There are combinations of internships, residencies, and fellowships. It all ends up being about the same length. We just call them different things for different years.

Australian doc:
Correct. I think the length of training is anywhere between sort of 8 or 9 to sort of 15 years, depending on whether you pass the exam straight up. So, it’s very, very similar in terms of the length of training. Yes.

Dr. Jim Dahle:
Have you ever practiced in another country?

Australian doc:
No, I haven’t done paid practice in another country. I actually went back to India for about four months and did an elective term in a 2000 plus bed hospital just to see how things are as part of my medical student training. And that was a bit of an eye opener because as a med student there, I worked, I didn’t get paid. It was six days a week and I did various rotations in those four months. So, every few weeks I’ve changed rotations.

Australian doc:
But I haven’t lived in another country as a doctor, paid doctor, but I’ve just worked as a medical student for four months as part of a team in Southern India. And boy, that was a very interesting experience. I learned a lot.
Dr. Jim Dahle:
Just because it was more under developed than in Australia.
Australian doc:
Absolutely. Yeah. The pathology, the health system, the hours is completely different.
Dr. Jim Dahle:
Tell us about the Australian medical system. Can you describe it for us?
Australian doc:
Yes. We have what’s called a two-tier health system. So, the primary health care system in Australia is public. And we have a very expensive public health care system, which is I think the equivalent of single-payer I think, you guys call it in the states.
Australian doc:
So, essentially public hospitals exist. Public outpatients exist. You get doctors, nurses, pretty good standard of care, actually pretty fantastic standard of care for public health. And then we have a private system in Australia as well, which also has private hospitals. You can see specialists privately, et cetera.
Australian doc:
Now, generally speaking, that’s the hospital systems. The outpatient systems, the general practice, for example, most general practitioners have their own small businesses that they see patients through. So general practice is federally funded and the GP charges a fee to see the patient and the patient gets a rebate back from the government. So, it is also heavily subsidized by the government. And also, you’ve got your private specialist. Again, you can go see a cardiologist and pay upfront, and then you get a rebate back from the government as well.
Australian doc:
We also have what’s called a pharmaceutical benefit scheme, which a lot of people sort of forget as part of the health system. And what that means is when I prescribed something like a heart medication, for example, that medication, the actual cost of the taxpayer might be, let’s say $500 or whatever it is per script, but the average Australian may only pay $40. So, they cap it at the pharmacy.

Australian doc:
So, you’re not expected to pay the full price and you don’t need to have private health insurance to be able to buy the medication. So, if I wanted it, I can go to the chemist, hand over the script, it’s for heart failure and I pay $40 and they give me the script and that’s the end of story.
Australian doc:
If you’re a low-income earner, that $40 capping is actually even less. It’s about $6 Aussie to get the same medication. So, the pharmaceutical benefits scheme is sort of designed as a sort of capping on pharmaceutical prices so that generally people are able to afford it.
Australian doc:
And we also have allied health, which is mainly in the public system, but also there’s a vibrant, private allied health system here as well. So, if you wanted to go see a physio, occupational therapist, et cetera, then you can do that as well.
Australian doc:
And the dental system, that’s probably the biggest gap in Australia. We don’t really have a very robust public dental system. So, most of the dentists here are private, except if you’re a child or a low-income earner, then there is public dentist system available, but there’s a bit of a wait for that.
Australian doc:
And lastly, we have national programs like immunizations and colorectal cancer screening and breast screening and pap smears and things like that. Cervical screening. That’s all national and that’s all just free. And that’s administered by the general practice.

Dr. Jim Dahle:
So, do most people buy private health insurance or do most people not buy it?

Australian doc:
Most people actually don’t have private health insurance. Private health insurance only became popular in the 1990s to try and take the load off the public system. So, most Australians don’t have private health insurance, but a lot of Australians do because for non-urgent elective stuff in the public system, like a hernia repair or go bag or something like that, the waits can be long.

Australian doc:
So, you might be waiting up to sort of three months to get your gallbladder out or even four months, sometimes even longer. Particularly your hip surgeries, your arthroplasties et cetera, there might be a bit of a wait.
Australian doc:
So, a lot of Aussies might have private health insurance for those purposes, but if it’s emergency like cancer surgery, heart surgery, brain surgery, most people just use the public system.
Australian doc:
I actually, as a medical student and as a doctor I’ve used the public system myself and I just go to the ER and get seen by a doctor and go home. It’s not the world’s best healthcare system. There’s a lot of deficiencies in it, but at the core, at the point of treatment in the public system, it doesn’t cost the patient any money.

Dr. Jim Dahle:
How does the private system work? You go see a private doctor, you pay him cash, cash out of pocket to get your care. And then you get some money back from the government. Is that most of the money of what that private doctor charged, some tiny percentage of that money, all of the money? What does it work out to be usually?

Australian doc:
Yeah, so that’s highly variable and that depends also on the type of consultation. So probably easier if I explain it as an example. So, let’s say a patient comes in and they need a tonsillectomy. So, it’s a child that needs a tonsillectomy.
Australian doc:
As a family physician, I can say to the parent, “Look, I can refer you to the public system, which is completely free. There might be a bit of a waiting list to get into the outpatients. And there’s a waiting list to get onto the operating table, but there’s no cost to you.
Australian doc:
Or I can give you a referral to see dr. so and so who’s an ENT specialist and they may charge you a fee to see them privately. And if you’ve got private health insurance, then they can take you to theater a little bit quicker, and you may be charged at out of pocket cost as part of the procedure”.

Australian doc:
Now, the charges that the ENT doctor does and the charges that they do for the operation, et cetera, is completely sort of up to the doctor. So, ENT specialist 1 can charge you $100 for a consult. ENT specialist 2 might charge you $500, et cetera, et cetera. So that’s basically free market.
Australian doc:
But with the government, you have to put an item number for a consultation. So, the item number might be let’s say 104, which is I think the item number for specialists. And that 104 that rebate is government set. So that rebate might be let’s say $50, for example. I don’t know exactly what the rebate is. I’m just making this up.
Australian doc:
So, the mum pays $100. She gets $50 back from the government, which is all sort of electronic. And the gap fee is a $50 that the mother has to pay for the consultation. And likewise, when they go to the operating theater, if they went to the private hospital, then the hospital and the health insurance have a very similar system.
Australian doc:
And that’s relatively standardized. It’s not a huge sort of discrepancy between ENT specialist one and two, because it’s all sort of market forces. But that really depends on the health insurance and the type of operation that they do and the ENT surgeon and what sort of fees they charge. And that’s called a gap fee.
Australian doc:
So, in the private system, just because you have a private health insurance doesn’t mean that your entire care is fully covered by private. Some surgeons choose to gap fee. Other surgeons say, “No, I don’t want to charge you gap fee, just pay me whatever the private health insurance sits their rebate at, basically”.

Dr. Jim Dahle:
Is the main difference between the public system and the private system, how long you wait for care, or do you feel like there’s a difference in the quality of care that the best doctors and the best hospitals are in the private system?

Australian doc:
Yeah, that’s an interesting question. I think the actual quality of care is exactly the same, if not very, very similar. An ST elevation, myocardial infarction traded in the private system versus a public system, I think you get the exact same care.

Australian doc:
The difference is probably the waiting time and the cost. So, in the public system, of course, it’s free. In the private system then you pay whatever the gap fees are. But generally speaking, the quality of care is pretty much the same because a lot of doctors work across both sites. So, a lot of the doctors, work in public hospitals and also work in their private practice.
Australian doc:
In fact, to have a public appointment is seen as revered. If you’re a physician or a surgeon or an ER specialist that works in the public system and the private system on your resume, on your curriculum veto, that looks great to be affiliated with a public hospital. Because most of the research, most of the guidelines, most of the procedures, the standard of care is set by the public system.

Dr. Jim Dahle:
Do you find that there’s a big issue with maldistribution of services? I mean, the vast majority of Australia is very rural. Is there a big difference in the care you get if you live in some tiny town in the Outback versus in Sydney?

Australian doc:
Yeah. The biggest tyranny Australia is distance. What was interesting that I actually didn’t know this having lived here for many, many, many years is the size of Australia is actually almost the same as the size of the United States. We’re a very vast country in terms of the geographical size. And the biggest problem for us is the tyranny of distance.
Australian doc:
The advantage for Australia is that we’re a very urbanized country. So about 90% of the population live in major cities, capital cities of each state, and about 40% of the population live in Melbourne and Sydney. So that’s a considerable advantage, which means 90% of the population get the care that they need at pretty much, most things that they need in their own city.
Australian doc:
There is a maldistribution in terms of regional and rural areas. So, we have regional centers, we have rural centers and we have remote centers and we also have indigenous population, indigenous communities in rural and remote Australia. There’s definitely a maldistribution there.

Australian doc:
So, if you are in the middle of Australia, in Alice Springs with a head injury and you need neurosurgical services that are a little bit more complex, you will need to be flown down four hours south to Adelaide to get that service.
Australian doc:
So certainly, living in a rural town puts you at a risk, not because of the cost of healthcare. Although the cost of healthcare is embedded in your travel distance and your specialty availability, et cetera. But certainly, the tyranny of distance is a big factor. And there are sorts of partnerships between public sector.
Australian doc:
So, your public hospital in 150 kilometers north of Melbourne might have a relationship with a tertiary hospital in Melbourne. So, they have that sort of, “Okay, look, if we get a complex cardiac patient, you will accept our patients”. So that sort of is done via state-based agreements. But absolutely maldistribution, the distance is a big problem in Australia.

Dr. Jim Dahle:
Now you mentioned before that the system has some deficiencies. And here in the U.S. I would say the majority of doctors are at least a little bit embarrassed about our medical system. It’s embarrassing to be a part of sometimes. Do Australian doctors feel embarrassed about their medical system or what’s the deal with the deficiencies you mentioned?

Australian doc:
Yeah. Look, I actually asked this question in an Aussie doctor forum recently, and as expected, most people said they’re very proud of the Australian health system. There’s probably only one or two people that said, “No, no things could be a lot better. Things are a lot worse now than they were before”.
Australian doc:
So, the vast majority of Aussie doctors and nurses, I would say are very, very proud of our health system. Because generally speaking, we would consider a health care as a human right. So, because it’s not something that you don’t choose to be sick in the sense that if you’re a child born with a deficiency or developmental delay, it’s not the child’s fault. So, we would say that sort of human right element is definitely there.
Australian doc:
And I think most doctors would agree that public health system should exist. And most doctors would also agree that the private health system also should exist. And each of their respective sort of health systems can partner with each other to sort of help out. Of course, with the private health system, you need private health insurance in Australia.
Australian doc:
If you don’t have private health insurance in Australia, you can still go to a private hospital, but the cost would be quite prohibitive. And most private hospitals would probably say, “Look, the cost is just too much for you to get your surgery here. So, we recommend you go to a public system”. And that sort of transfer of patients happens quite a lot.
Australian doc:
In the public system, it is a public system so you don’t get access to the doctor of your choice. So that’s a bit of a deficiency. In the private system you can say, I want to see Dr. Jim Dahle in the private system. I want to see him because he’s the best at the surgery that I want to have.
Australian doc:
Whereas if you go to the ER, you don’t get that choice. And if you go to the public outpatients, you don’t get that choice. It’s whoever that you get. And mostly it’s registrars and consultants and residents.
Australian doc:
So, all of the training positions, well, most of the training positions, I beg your pardon is in the public system. Although there are some training positions in the private system now, but most of the medical specialty training system is in the public system. So, you kind of need to know the public system to be able to become a doctor and then become a fully-fledged fellow.
Australian doc:
And surprisingly, in terms of efficiency, I think they did a study, the Australia Healthcare system, surprisingly is quite efficient from a cost benefit analysis. We’re able to do things relatively cheaply compared to some of the other country countries. Except obviously in the developing countries is much cheaper, but to have hip surgery in Australia is relatively cheaper than perhaps in most of North America.

Dr. Jim Dahle:
I’ve heard that the triage nurses in the emergency department simply send people home if they don’t think they have an emergency without ever having seen the doctor. Is that true?

Australian doc:
That actually it’s not true. So, what happens is patients can go to the emergency department for whatever they want. I’ve worked in EDs and people have rocked up with rashes for like 10 years and decided to rock up at midnight because they’re worried about the rash.
Australian doc:
So, the triage nurse has to triage them based on the guidelines. And there’s tragic category one, which is trauma immediately to seen. Triage category two within 10 minutes, triage category three within 30 minutes. Four, which is one hour I think it is. And five, which is within two hours.
Australian doc:
Now technically a rash would be categorized as category five and they need to be seen within two hours. But in reality, they probably will wait much longer because of the workload, but they’re not allowed to send people away. What they may do is they give patients the option.
Australian doc:
So obviously if it’s a non-urgent issue, lot of the emergency departments might have an after-hours, general practice clinic attached to them. So, they may say, “Look, you’re welcome to wait here. It’s free of cost. Or you might want to go to an after-hours GP center nearby. They might choose to charge you, most don’t”.
Australian doc:
So, they give you that sort of options, but know that they are not allowed to send people away. Every patient that presents must be seen or given the option. And if it’s a non-urgent thing, they may be given the option. And some of them wait to be seen.
Australian doc:
I’ve seen patients when I was training in the emergency department who have patiently waited for five, six hours for a skin spot that they’re worried about, which is always interesting and I’ve always found it interesting that people are happy to wait that long. But yeah, if you wait, then you will be seen at some stage.

Dr. Jim Dahle:
So, lots of American doctors are terrified of a single payer system thinking it’ll lead to less access to quality care and low doctor pay. Are they right to be afraid? Or do you think this is a boogeyman that they’ve designed and there’s really nothing to worry about?

Australian doc:
That’s a very interesting perplexing thing to me. And I think that would be quite perplexing to a lot of Aussie doctors about this sort of fear about a single payer system. In Australia, doctors are pretty well paid and the quality of care is actually pretty good. So, the life expectancy here is 82, which is, I think it’s higher than North America. And most of our research comes from public system here. And we’ve got world class research institutions attached to universities and hospitals here.
Australian doc:
And pay wise, if you’re in the public system, then your pay is quite transparent. So, it’s called the enterprise bargaining agreement, which basically the statewide doctor union bargains with the state government. And they sort of say, “Okay, if you’re a consultant emergency physician year three, this is your pay”. And that’s statewide.
Australian doc:
So, if you went to hospital two, somewhere in rural area, and they are part of that ABI agreement, then that hospital can’t say, “Oh, you are emergency physician we will pay you this much. We’ll pay you less than the EPA”. They can’t say that. So, there’s sort of a transparent process. And of course, in the private sector, that’s all sort of fee for service. So, there’s no sort of standardized sort of pay right of the private sector.
Australian doc:
I think it’s interesting why some people may be a little bit afraid of the sort of single system, this sort of control of healthcare, et cetera. But when I see patients in the public system, I don’t have to ask for permission to do an x-ray or do a blood test or prescribe a certain medication. I’ve got complete medical autonomy to do that, to make sure the patient gets the best care they need.
Australian doc:
There’s no hospital executive telling me what to do in terms of my clinical practice. And the nurse is not told to do something by executives, it’s autonomous. So, I can practice within guidelines within policies and procedures without being interrogated.

Dr. Jim Dahle:
And how much or how often if ever do people go bankrupt due to medical bills in Australia? Is it essentially a non-event? It never happens? Nobody goes bankrupt due to medical bills?

Australian doc:
No. I’m sure there are some cases where people have gone bankrupt due to medical bills in the private sector, but in the public sector it’s free. So, it would be extremely rare for anyone to go bankrupt from a medical bill in Australia. It’s actually something that most people don’t worry about. And certainly, I’ve never worried about it growing up here. And I’ve been to the emergency department a few times.
Australian doc:
It’s not in our mind constantly. We don’t worry about medical bills as a such in the public sector. In the private sector, of course, because if I’m going to see an ENT specialist who charges $500, that’s a lot of money for a lot of Australians.
Australian doc:
So yeah, money would be a problem, but to go bankrupt would be extremely rare. I haven’t heard of it in my own personal medical experience, but I’m sure somewhere in Australia, someone has gone bankrupt, but it’s certainly not common.

Dr. Jim Dahle:
Let’s talk about medical legal liability. How much do you worry about getting sued by a patient?

Australian doc:
I asked this question again in the forum because personally I’m not worried at all. And the response that I got was most doctors are not constantly worried about being sued by a patient. Medical litigation in Australia has risen in the last sort of 20 years or so. And it really depends on the specialty. But generally, overall, most doctors wouldn’t be worried constantly about it.
Australian doc:
Now, the interesting thing about medical indemnity is public doctors get free medical indemnity by statewide insurance scheme. So, it’s actually free. If you work in the public system, then you are protected by that. Having said that, most doctors, whether they’re public or private will have their own indemnity as well, just in case the public system indemnity is not enough.
Australian doc:
And in terms of specialties, I think emergency medicine would probably be a place where indemnity is an issue where patients are more likely to sue for malpractice surgery and obstetrics would probably be the highest. And general practice because you’re dealing with a lot of undifferentiated patients.
Australian doc:
But on the whole, most people don’t worry about it constantly, but it is something that we all have. So, I’ve got my public insurance and I’ve got my private indemnity insurance. So, I’ve got my own policy because I need to make sure that in the rare event that I get a complaint or get sued, I’ve got that back up. So, every doctor here has medical indemnity for sure.

Dr. Jim Dahle:
And what does it cost? What do you pay for your premium each year?

Australian doc:
Again, it depends on the specialties. These numbers are in U.S. dollars. I’ve converted it. If you’re a general practitioner between $2,000 and $4,000 a year. If you’re a non-procedural specialist, then you’re probably around $2,000 and $6,000 a year.
Australian doc:
If you’re a procedural specialist, but non-surgical, so let’s say if you’re a cardiologist that put stents in, looking at between $7,000 and $14,000 a year. And if you’re a surgical specialist somewhere between sort of $7,000 and $36,000 per year.
Australian doc:
And those costs are rising, unfortunately. If you’re a medical student, medical indemnity is free. If you’re a training doctor in Australia, it’s about $100.

Dr. Jim Dahle:
Now you guys also have a national electronic health record. How did you pull that off? It seems amazing to us. I can’t get records from across town without three phone calls and a couple of faxes in order to get records from another hospital. Did Australia’s government just mandate an electronic health record, or how did that happen?
Australian doc:
They kind of did and they didn’t. Actually, the electronic health record it’s not something that Australians are very proud of because not many of us actually use it. So, what happened was there was a sort of push towards electronic medical records in 2016-2017.
Australian doc:
And there was a federally funded My Health Record, which is a fantastic system at its core because it has the medications, it helps summaries, scans, prescriptions, allergies, advanced care plans, all that sort of stuff.
Australian doc:
And the aim then was to get that system to talk to all the health services, public, private outpatients, general practice and specialists as well, but it needs a lot of work. And the public faith in it is actually quite low. They spend about 2 billion Aussie dollars on it and they spend about $400 to $500 million on it every year. But a lot of public actually don’t know about it. It’s been poorly sort of advertised. And a lot of doctors and practitioners don’t actively use it.
Australian doc:
Now that is changing. So, what’s happening is security has been beefed up because there’s been a lot of health security issues. Last year, we had some states got hacked by overseas hackers and medical information was stolen. So, security is a major issue and the system is relatively scattered.
Australian doc:
So, for example, one health service might be automatically linked up to my health record, whereas other health services might not be. But I think what’s happening is they are recruiting health services. For example, my health services just signed up to my health record, which means that I’m able to access and upload information. A lot of the public hospitals have electronic medical records within the hospital. And it’s a matter of electronically linking that up to my health record.
Australian doc:
And I think over time it will happen, but it’s certainly not a great system at the moment. I think there’s needs to be a lot of work that needs to be done to get the faith of the public and get the faith of the doctors and nurses to use that system on a daily basis.
Australian doc:
Now what’s interesting about it is that compare that to the financial sector where the Australian ATO, the Australian Taxation Office automatically cross-references over 800 million transactions a year. So almost all Australians use My Gov, which is the online sort of system for Medicare and Australian Taxation Office. And they submit their claims online. The accountants do the same.
Australian doc:
We’ve completely gone, well, I wish it was completely, but 99% completely gone paperless system for the taxation of electronics and financial systems. But when it comes to health, we’re very much still paper-based health system. And I think over time that will change as more and more people have faith.
Australian doc:
So, the Australian tax office knows exactly how much I earn before I get a pay summary at the end of the year, whereas my health record needs a lot of work. But in principle, I think we all agree that we need to move forward with that.

Dr. Jim Dahle:
What opportunities are there for U.S. licensed doctors to practice medicine in Australia? Either short term or long term.

Australian doc:
There are two main ways that U.S. doctors can practice in Australia. You can either apply for a permanent residency and migrate here as a skilled migrant, which is quite tricky in the sense that there’s a bit of a wait, there’s a waiting list. And unfortunately, Australia has become a very popular country in the last sort of 20 years. So, there’s a big wait list for that.
Australian doc:
And you come here, you get your permanent residency and then you apply for a job, but you would need to have completed some entrance processes to be able to make sure that your qualification is accredited and credentialed locally. So, the Australian health practitioners board and the medical board may ask you for evidence as to what training you’ve done, et cetera. And that gets assessed.
Australian doc:
The other route, which is probably a little bit easier is that you directly apply for a job in Australia, from the United States. So again, if you’re an emergency physician, you may apply to a hospital for an ER position job if the hospital wants to employ someone from overseas. And then they do their credentialing checks.
Australian doc:
Then when you come, you may need to do some additional training in order to sort of “get your credentialing done for the Australian system”. And that may mean, unfortunately, going back as a registrar, as a trainee doctor, or doing a few more years of fellowship, et cetera, depending on the experience that you bring.
Australian doc:
Again, it’s a fairly competitive process because we do have a lot of overseas trained doctors that are in Australia and they have come here over many years. It’s a very, very tough road that they don’t make it very easy unfortunately, for overseas trained graduates.
Australian doc:
In Australia, they tend to prefer local graduates. The hospital really has to have a pretty good reason why they are not advertising the position for local doctors, as opposed to getting someone from overseas. And you would be paid exactly the same as the local graduate.
Australian doc:
The overseas graduate working in a public system would not be paid anything lower than what the average Aussie doctor is. So, the process is relatively transparent.

Dr. Jim Dahle:
What about short term? Something like “I’m coming there to do a locum tenens stint for three or six months in a rural area”. Would that be hard to line up do you think or relatively easy?

Australian doc:
I think the biggest issue would be credentialing. I’m not sure whether you can come and do a three- to six-month term in Australia without having your credentials assessed and the hospital would do that for you. You may not need to do additional training just for those three months. And it really depends on the specialty.
Australian doc:
Emergency medicine is probably a little bit easier because it’s a sort of a hospital based, but if you’re doing like obstetrics or surgery or something like that, even if it is hospital based, I think you still would need to go through the college to make sure that their credentials are okay.
Australian doc:
I’m not sure about the locum opportunities. Certainly, Trans-Tasman. So, if you’re from New Zealand, it would be a lot easier because the Australian-New Zealand system is very similar, but any other country, I think they don’t make it very easy.

Dr. Jim Dahle:
Let’s turn the page now. Let’s talk a little bit about money, finances, et cetera. What kind of money do Australian doctors earn? Both during training and afterward and whether you convert them to U.S. dollars or not. For those who don’t know U.S. dollar is worth about $1.37 in Australia. So, what Australian doctors earned both during training, after training, in the public system and the private system, et cetera? What do they make?

Australian doc:
There’s a term here, “You’re on a very good wicket”. That means that Aussie doctors get paid pretty well compared to global standards. And that’s despite having sort of public and private.

Australian doc:
So, running through some figures, obviously as a medical student, you don’t get paid. And as an intern, your first year out, your base salary is depending on the state. Because if you work in a state that doesn’t have much populations, if you work in South Australia, which capital city is Adelaide, you might get paid a little bit more than if you work in a more popular state like New South Wales or Victoria in terms of popularity of trying to get intern positions.
Australian doc:
But generally, the salaries range from $51,000 U.S. to $73,000 U.S. base. And that again, depends on the state and cities as an intern.
Australian doc:
Generally, if you work in a rural area, you get paid a little bit more. If you work in a major, major city, you get paid a little bit less because we want to attract more doctors to go to rural areas. So, that’s sort of a supply-demand issue.
Australian doc:
After internship, you’re turned hospital medical officer or a resident, and that’s year one after internship. You’re looking at anywhere between $60,000 U.S. to $90,000 U.S. and depending on the specialties.
Australian doc:
So, the surgical specialties generally tend to get paid a little bit more because your hours are a little bit more. Your medical specialties are probably in the $60,000 to $70,000 range, as a first year after internship. And that increases every year based on the state award, the enterprise bargaining agreement.
Australian doc:
As a registrar, you’re in a training program, that income sort of dramatically improves. It becomes $88,000 to about $150,000 or more U.S. dollars based on the specialty. So, if you are surgical specialty, your hours are a lot more, so you probably earn closer to $150,000 to $200,000. But if you’re a medical specialty, your hours are not that much. So, you might earn between sort of $80,000 to $120,000 as a registrar.
Australian doc:
As a consultant, that’s your fully fledged fellow doctor after all of your exams. If you do public and a bit of private. As a family physician, pretty good, $150,000 to $300,000 U.S. dollars. As a non-GP specialist who’s not a proceduralist, you’re looking at about $150,000 to $350,000 U.S.

Australian doc:
As a non-GP specialist proceduralists, for example, cardiology, you’re looking at about $250,000 to $400,000. As a surgical proceduralists, general surgery, neurosurgery, orthopedics, et cetera, huge variability there. You’re looking at about $300,000 to $750,000 U.S. per year.
Australian doc:
And I’ll say variable, because if you’re an emergency physician and you work in the public sector full time, you’re looking at between $300,000 to $400,000. You’re not going to be earning more than $400,000 in the public system for most specialties, but in the private system completely up to how much you work and how much you make, because it’s all fee for service.
Australian doc:
So interestingly, I actually spoke to one of my anesthetic colleagues who had been in the surgical proceduralists category and he makes over a million dollars U.S. a year and he thought that was normal. So, I decided to flip this idea to the doctor’s forum online. And I thought, well, surely, not every doctor makes a million dollars. So, that’s sort of rough figures in terms of training, registrarship, residency, internship, and consultancy.

Dr. Jim Dahle:
Okay. So that’s pretty good. You just made a lot of my listeners, very, very jealous. I mean, to come out of medical school only owing $50,000 in loans and then go and make $150,000 to $700,000 compares very favorably to the U.S. system.

Australian doc:
Yeah. What’s interesting about this is that Aussie doctors are probably one of the highest paid in the world. I was actually quite surprised myself. We sort of… Well, when I say “we”, I’ve sort of reflected on my earnings over the last 12 years as a doctor here and I’ve sort of whinged a little bit. “Oh, I work so hard. I don’t make much money and blah, blah, blah”.
Australian doc:
And then when I did some research about it, I went, “Oh, wow, we’re actually quite lucky”. So, I think we’re very fortunate, very lucky to be able to earn that sort of income. There’s always orthopedic surgeons and neurosurgeons that earn over $3 million in every country. And there are some in Australia as well.
Australian doc:
The average here is actually pretty good. So, I was speaking to an intern last week and she said, in Victoria, which is sort of a Southern State in Melbourne. The base salary for an intern is $76,000 Australian dollars, which is around sort of $55,000 base. So, she’ll probably walk away as an intern with about sort of $60,000 U.S. That’s base working 76 to 80 hours a fortnight. And I thought that’s actually pretty good.

Dr. Jim Dahle:
Does the general population view doctors in Australia as being rich?
Australian doc:
Yes. The average person would consider, the perception is that doctors in Australia are rich. The average income in Australia is around $80,000 to $84,000 Aussie dollars. So, when you graduate from medical school, that could be your salary. So, you’re well and truly above average in Australia.
Australian doc:
And to be honest, most doctors, and again, I asked this question in the online forum. Do you consider yourself to be lucky to be working in Australia as a doctor? It was pretty much a unanimous answer and that is yes. I think most of us would consider ourselves very lucky to earn and work here reasonably comfortably compared to the average population.

Dr. Jim Dahle:
How much of that high-income do you think is due to the unionization of doctors?
Australian doc:
I think probably a lot of it. A lot of the fees set by the Australian medical association in conjunction with the liaison, with the government. Obviously, a lot of the state public hospital systems, their pay is enterprise bargaining.
Australian doc:
We have a union. The union is Australian medical association and they have state representatives in each state. And every three years for consultants and doctors in training, they bargain with the government to either keep wages the same or increase wages.
Australian doc:
In 2018, we had the largest increase in wages in doctors in a very long time. So, they gave 9% increase for the first year. Then every year after that, they’re going to give 3% increase. So, overall, the increase became like something like 19% pay increase with all sorts of shift penalties and all that sort of stuff.

Australian doc:
The advantage of having a union is that you have a bit of a voice and that voice gets taken up to the higher powers and government to try and make sure that you get good candidates that apply for medicine.
Australian doc:
Because let’s face it. One of the factors that people consider in university is what sort of job opportunities they’re going to get at the end of university and what sort of pay they get. And if they didn’t get paid well, then it’s going to be very hard to attract good candidates for medicine.

Dr. Jim Dahle:
How much do doctors in Australia pay in taxes? If you had to estimate the percentage of your gross income that goes toward income taxes, how much would it be?

Australian doc:
If I’m working in the public system, I would certainly be in the highest tax bracket. So, the highest tax bracket marginal tax rate is 45%. For the first $18,000 you get, you get charged no tax. And then it incrementally rises.
Australian doc:
Most doctors would probably be in the 30% to 40% tax range. And the reason for that is we have a reasonably generous tax deduction system in Australia. So, no one would be paying always the 45% tax rate, which is the highest tax bracket.
Australian doc:
So, if I have investments, if I have investment properties, if I have margin loans, anything that I invest that produces income, the cost of that investment, I can then tax deduct from my income.
Australian doc:
In the private sector, because you have your own business, business tax rates are quite low here, 25% to 30%. Then you can write your money via your business and your family trusts so you pay a lot less taxes. But we are a relatively high tax nation. And part of that is because health education is relatively cheap if not free.

Dr. Jim Dahle:
So, how do Australian doctors save for retirement?

Australian doc:
Just like any other Aussie, basically, our biggest savings for most Australians is retirement funds. So, I think the equivalent would be the Roth IRA or 401(k) in the U.S. Our retirement funds are called superannuation funds. And the reason why they are tax effective is that if you are an employee, your employer has to pay 9.5% of your gross wages on behalf of you to the superannuation fund of your choosing.
Australian doc:
So, if you’re at $100,000 as a doctor in the public system, then the hospital has to pay $9,500 on top of that, to the superannuation system. And it is tax effective because that money gets taxed at a flat rate of 15% when it hits your superannuation account.
Australian doc:
So, superannuation is probably one of the major ways that we save for retirement property. It’s outside of super investments. Aussies love property. It’s something that we all aspire to buy. And property prices and values in Australia are quite high. So, a lot of our net worth, at the time of retirement, may be engrossed in the personal property that we own.
Australian doc:
So, property is definitely something that we would all invest in. And that includes residential property or commercial property. And that includes your principal place of residence that you stay in, but also investment properties.
Australian doc:
So, for example, myself. I live in a house, but also have homes that I invest in and are rented out and any interest, any cost associated with that investment, I can then deduct out of my taxable income. And of course, the stock market as well. That’s the other main avenue that doctors may invest in.
Australian doc:
And lastly, they’ll invest in their personal business. If you’re a private orthopedic surgeon, then you invest in your business and hopefully, it grows your business. Or if you’re a JP, you grow your business and then hopefully sell it off to a corporate GP clinic or something like that.

Dr. Jim Dahle:
You mentioned the taxation on the superannuation that you get a 15% tax rate on money as it goes in, which obviously is better than 45%. And then it grows tax free and comes out tax free in retirement or how does that work?

Australian doc:
Yeah, up to $1.6 million. So, you can accumulate up to $1.6 million in superannuation funds and then withdraw it at the other end, completely tax free.
Dr. Jim Dahle:
And what does that money invested in?
Australian doc:
Basically, a superannuation has investment portfolios structured based on your need. That could be invested in the stock market, index funds, international stocks, local stocks, bonds, ETFs, commodities, cash, property rates, et cetera. There’s a whole portfolio.
Australian doc:
For example, when I log into my superannuation account, I’ve got variable options. So, I’ve just selected, “I want 50% of my money invested in the stock market. And I want 50% of my money invested in what’s called a balanced fund”. And the balanced fund might be a combination of the stock market.
Australian doc:
These are all sort of premade, pre-portfolio made. You don’t have to individually select the exact index fund that you want to invest in when it comes to superannuation. If you want that sort of level of personalized control, there’s something called self-managed super fund, where you don’t need to go through one of the big retirement funds. You can just create your own self-managed super funds, and there are regulations for that.
Australian doc:
And then you can sort of say, “Okay, I want to go buy the Vanguard S&P 500 or ASX 300 index, and that’s going to be my retirement and that’s going to be my superannuation”. And that’s completely fine as well.

Dr. Jim Dahle:
Awesome. Now, you have a finance podcast that you started. The idea wasn’t necessarily to podcast only the doctors, but I think you ended up with mostly doctors listening to you. Can you tell us about your podcast?
Australian doc:
Yeah. Actually, I started my podcast about two- and a-bit years ago because I wanted to leave a blueprint for my two young children in the rare event that dad was not around or was not able to support them, learn about finances.

Australian doc:
So, I did 10-episode series for them and I just uploaded it. And I floated it to a couple of my friends and family and said, “Have a listen to this. These are 10 episodes, and really that’s all you need to do for your finances”. And that was about pay yourself first, invest and max out superannuation, get rid of debt, get personal insurance, et cetera, et cetera.
Australian doc:
Then they came back to me and said, “Hey, look, these are some of the things that we didn’t know about. Like, we’ve never heard of pay yourself first. So why don’t you do more episodes?” And it sorts of became a bit of a hobby.
Australian doc:
So, I mainly podcast about financial principles, economic principles. And I’m not a financial advisor of course, I don’t advise people personally, but basic things that they could do in their life in order to get their finances sort of more organized.
Australian doc:
And that has sort of grown into mainly medical listeners, but also, I have a lot of nonmedical listeners. And my podcast episodes are aimed at principles to apply in your life. Yeah, so that’s sort of grown over the sort of two years. And I sort of released an episode once every week or once every fortnight and people ask me questions and I just respond to their questions.
Australian doc:
The aim is to make sure that this information really should be taught in our school curriculum which it isn’t and really should be taught in every universities before people become doctors or lawyers or dentists, but it isn’t. So, it tries to equalize the knowledge as much as possible.
Australian doc:
It just turns out that a lot of my colleagues started spreading the message. And a lot of the listeners are doctors because we’re very vulnerable. Medical professionals are so vulnerable to making silly mistakes. As you say, Jim, “Doctors do dumb things with their money”, and hopefully this helps avoid that.
Dr. Jim Dahle:
Where can people find your podcast?
Australian doc:
My website is devraga.com, which has got all my episodes on it. I’m available on most podcasts or podcasting apps. So, Apple and Google, et cetera. And it’s free. You can just download it, share it, post it, whatever you want to do. And I encourage everyone if you’ve got time, my podcast episodes around sort of 30 to 40 minutes. So, for that sort of drive time for listening. And I’m always happy to have feedback.

Dr. Jim Dahle:
So, we’re looking to wrap up here, but you’ve got the year of somewhere between 30,000 and 40,000 high income professionals, mostly doctors. What else haven’t we talked about today that they should know?

Australian doc:
I think finances and medicine, it’s almost as if you’re a doctor, I mean, most doctors are smart, have a high IQ, but what I’ve found is that those skills are not transferable to the domain of finances.
Australian doc:
So, number one, learn about money. And number two, it’s okay to talk and discuss about money. There’s a lot of taboo about it, but it’s okay to do that. And it’s okay to work hard for your patients and it’s okay to make money as a result of it.
Australian doc:
So, there’s nothing wrong with being wealthy. There’s nothing wrong with working hard. There’s nothing wrong with learning about finances. That’s number one.
Australian doc:
Number two is skills are not transferable. If you’re a great neurosurgeon, that doesn’t mean that you’ll be a great investor. Doctors are very vulnerable for doing silly things with their money. And because we make so much money, we think that we can sort of out earn a knowledge deficit and we can’t. So, you need to be financially literate and you need to sort of empower yourself with that knowledge.
Australian doc:
And I think Jim, your podcast series, you have big fans in Australia. I hope you know that, but you do. Listening to your podcast and similar podcasts is very useful because it really does highlight how important this topic really, really is. And can I suggest maybe one time you can all come down to Australia for a White Coat Investor conference, hopefully in the future and we can all catch up.
Australian doc:
And the last thing is it really does astound me certainly in Australia in terms of the incomes that doctors make, why every doctor in Australia doesn’t retire with a seven-figure portfolio. That’s quite astounding because we make a decent amount of money. It’s just a matter of simple things that we need to do to protect it so that it grows over time.

Dr. Jim Dahle:
All right. You heard it here first. WCIcon 23 in Australia.

Australian doc:
Absolutely. It’s a beautiful crispy Melbourne morning and I would love to have you guys over.
Dr. Jim Dahle:
Awesome. Well, thank you so much for coming on the podcast and sharing your thoughts and your wisdom with us. We appreciate it. It’s wonderful to look into how things work in other countries.
Dr. Jim Dahle:
Because especially in the U.S. we get these almost blinders on and think we’re the only country in the world and we don’t really realize that there are a lot of lessons that could be learned from other countries and how they’ve done it, that we could really apply in our own lives to simplify both our medical system and our financial system. So, thank you so much for being on the White Coat Investor podcast.

Australian doc:
Thank you very much for having me, Jim. It was an absolute privilege and have a great day.
Dr. Jim Dahle:
I hope you enjoyed that as much as I did. That’s a lot of fun. One of the best parts of podcasting is bringing people on that you want to learn something from and just bringing the listener along on the journey. So, I hope you enjoyed that as much as I did, maybe a little bit longer as our episodes go, but I hope it was worth it to you.
Dr. Jim Dahle:
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Thanks for those of you leaving us a five-star review and those telling your friends about the podcast. Our most recent review came in from an MS4 who said, “Must listen. Even if you don’t care about the game. I got the White Coat Investor from a friend for Christmas last year”.
Dr. Jim Dahle:
He said, “My friend is not in the medical field, but he likes finance and wanted to help me out, I guess. I kind of turned my nose up to it at first, but then I decided to give it a read and since then I have read all of your books and several you recommend for beginners from your page.
Dr. Jim Dahle:
I have opened a Roth IRA and have some savings. You’ve helped change my life around. And I feel as if I have a head start, because I was able to get your information in medical school. You always bring down the financial speak to beginner’s level and the topics of your podcast are always interesting. Thank you, WCI for all you and your team do”.
Dr. Jim Dahle:
Thanks for the kind words. Thank you for the five-star review. It really does help spread the word.
Dr. Jim Dahle:
Keep your head up, your shoulders back. You’ve got this and we can help. Stay safe in the pandemic and we’ll see you next week on the White Coat Investor with a fabulous episode. We’re going to be talking about some of the benefits and risks of when you become a partner.

Disclaimer:
My dad, your host, Dr. Dahle, is a practicing emergency physician, blogger, author, and podcaster. He’s not a licensed accountant, attorney or financial advisor. So, this podcast is for your entertainment and information only and should not be considered official personalized financial advice.

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