From the Suits of Wall Street to the Scrubs of the Operating Room: Managing Portfolios and Patients

“If there is one thing people are more sensitive about than their health…it’s their money.” – TFF

That is my standard response when people ask why I traded a nearly decade long and fairly lucrative career on Wall Street as a financial advisor for a chance to practice medicine. The question was most frequently raised when I was in PA school, and my receding hairline gave a hint that I was probably not someone straight out of undergrad. It made for good conversation while I was scrubbed into a case not doing much of anything productive, and resulted in the attending surgeon getting a free consultation on their 403B plan.

These days, as a practicing Physician Assistant in Trauma and Acute Care surgery, the topic of my former life gets brought up mostly by the interns and residents who I help talk off the ledge when they start thinking too much about their massive medical school debt.

But how does one go from managing $300 million in client portfolios to placing chest tubes in trauma patients? Let me elaborate…

It all started at the bar.

Not in the I had one too many and am going to regret this in the morning sense of things, but at the bar-restaurant where I worked as a barback/busboy/delivery driver for most of my teenage years and the start of college. It was great money for a teenager. As most of my friends slaved away at grocery stores for 8 bucks an hour, on a good night I would clear $200-300 cash in hand.

I thought I was doing fairly well as I plugged away at my fundamental college classes, not sure what I really wanted to do in life. I took every civil service exam you can think of and was fairly confident I would follow the path of many of my high school classmates into the ranks of the NYPD or FDNY.

That is until a friend and fellow bus boy abruptly left the bar to do this “stock thing” with one of the bartenders who was previously in the brokerage business. He left his job at the bar and disappeared off the face of the earth for six months. One random night he returned driving a brand new, candy blue Lexus GS 300, paid for in cash. I didn’t know what he was doing, but in the words of Seth Davis from Boiler Room  “I just wanted in.”

From bar-back to stock broker.

Thus began my daily drive to a nondescript building in Long Island that would be my home and prison for the next two years. As a broker trainee I started out cold calling wealthy people from coast to coast, trying to convince them that the scared 19 year old on the other end of the phone had found the next great investment idea.

I dialed the phone anywhere from 400 to 800 times a day, repeating the same lines each time to a different name written on a lead card. I battled daily with angry secretaries, pissed off businessmen who received several similar calls a day, and the occasional receptive farmer who listened to my spiel and then politely told me to take a long walk off a short pier.

I was given 2 weeks to pass my Series 7 General Securities licensing exam, a test most people take 6 months to a year studying for and still fail. After I passed on my first attempt with an 86%, the CEO of the firm told me I would be out of the business in 5 years because I was ” too smart.” It’s something that stuck with me my entire career, and motivated me daily to prove him wrong.

Learning from The Wolf of Wall Street.

6 Degrees of separation: Leonardo DiCaprio played Jordan Belfort in Wolf of Wall Street, who trained my first boss at Stratton Oakmont.

Thanks to Leonardo DiCaprio with his drug and debauchery ridden depiction of the life of Jordan Belfort in The Wolf of Wall Street, anytime someone hears of my former career they half jokingly ask if it was anything like the movie. My answer is, in a way, yes.

My first boss, the aforementioned broker turned bartender turned broker again, actually got his start at Stratton Oakmont. If that sounds familiar it’s because it was the name of the firm founded by Jordan Belfort . The sales training I received was the same Straight Line sales methodology my boss learned directly from The Wolf himself. It was emblazoned into my DNA, so much so that more than a decade later I could still pitch anyone, any stock, on command, just pick a ticker symbol.

The parking lot of the building where we worked was a daily car show, with a rotating ensemble of Ferrari’s and Hummers and Corvettes. It was a world of $30k a month paychecks and $35K a month in expenses.  A lifestyle of living paycheck to paycheck despite having incomes easily over $250k year.  It was a firm full of salesmen, very good and highly trained salesmen, whose sole interest was charging a 5% commission on every purchase or sale of stock.

I realized early on that this lifestyle and this way of earning a living was unsustainable. What’s worse, I was doing nothing to help the financial situations of my clients except to relieve them of some of their hard earned cash in the form of my commission. My personal finances were also a mess, and I had exactly the same amount of money in savings as when I started. ZERO.

So I left the world of small time stock pitching and somehow, despite not having a college degree, managed to get myself into one of the largest and most respected firms on Wall Street.

The Land of Bulls, Umbrellas and Blue Ties.

I had no idea what true wealth was until I started working at a real investment bank. At the small stock firms, managing $1 million in total client assets meant you were doing exceptionally well, and earning a more than decent living. At the large firms, some advisors had a $1 million minimum account size before you could even talk to them. 

But how was it that people entrusted these advisors with tens of millions when I could barely convince people to send me ten thousand while working at the smaller firms? I learned it was because instead of spending your time dialing for dollars, you spent your days building relationships.

It meant demonstrating to already successful people you had knowledge and expertise in an area they did not. Clients would call YOU when they were making investment decisions, or needed a home loan, or help planning for their retirement, because they valued the advice you could offer and sought out your insight.

That is exactly my goal with The Finance Fellow Blog. To provide a financial education to the already highly educated men and women of healthcare.

Specifically this blog is geared toward my fellow Physician Assistants, PAs, Physician Associates, Mid Level Providers, Advanced Practice Providers, whatever you want to call us. 

Let me explain why I think the personal finances of this particular group requires special attention:

  • Delayed savings : To start saving early on in life while trying to complete a medical education is not easy. The nomadic lifestyle, living off student loans, costly exams, the insane application and interview processes. These things are not conducive to having excess income
  • High student loan debt: When you’re facing student loans over $100,000 it can be overwhelming, sometimes downright suffocating.
  • High incomes when finally practicing: The medical profession is the ultimate example of delayed gratification.
  • Non traditional retirement age: Starting your career in your early 30’s means you hit 55 rather quickly.
  • Limited time to spend managing personal finances: It is extremely difficult to invest the proper amount of time into financial research and planning when managing a busy practice, but I’ll show you it is in fact possible!

Back to my story…Flash cards and fleeing Wall Street

I found out quickly that my sales abilities would take me only so far in this new world, and I needed to increase my financial savvy pronto. I finished my undergrad degree at night while working full time ( fully paid for by my employers I might add ) and added as many letters to the back of my name as I could.

I became a Chartered Retirement Planning Counselor (CRPC®) and started studying to become a Certified Financial Planner (CFP®)I became an integral part of team that managed about $300 million in client assets, all before I was legally able to drink.

But when the markets are going well and you’re making people money, everything is roses. Then the recession of 2007-2008 happened, and suddenly the same clients who previously invited you over for family dinner were leaving you messages that would make a truck driver blush.

In my eyes, there were only two personally satisfying attributes of being a financial advisor; seeing other people meet their financial goals and making a living for yourself and your family in the process. The Great Recession stripped both of those things away. The true nature of people was suddenly revealed to my otherwise naive twenty something self. It was time for a complete change, but I had no idea in what direction to travel. Until I saw the writing on the cards.

No, not tarot cards, but the flash cards my then girlfriend (now wife) and I would flip through while studying for her nursing classes. Anatomy, physiology, pharmacology, for someone in finance it was like reading Chinese. One night, I found myself flipping through her study cards long after she had passed out beside me.

A fire that was otherwise absent during my entire career in finance was suddenly lit. I discovered something I was truly passionate about and could see myself learning and doing for the rest of my life. I decided to make the plunge head first into medicine.

The next morning I told my girlfriend I was going to leave my finance career, go back to school and become a doctor. After she collected herself and found her words, she suggested I become an EMT first, just to see if I could handle the blood and guts of it all. So it went that my days were spent at the brokerage firm, and the nights were spent as an EMT in the New York City 911 system.

I really loved being an EMT. Someone once told me “It’s a backstage pass to the greatest show on earth”. Working in NYC, you were never short on entertainment, and the basic medicine I learned resonates with me even today. It was a great medical foundation for PA school, and the ability to recognize “sick” versus “not sick” you develop on the street cannot be taught in school. Still, I wanted to learn more, to do more for my patients.

But working 2 full time jobs and going to school was not a viable option with my first child on the way, so I bid a final farewell to the bulls and the bears, and said hello to my post baccalaureate pre-med program.

Time to call an audible.

The walls of the classroom at my EMT base were painted with special dry erase paint. By the end of PA school it looked like something out of A Beautiful Mind.

School, ambulance,, ambulance, study. The cycle repeated and often overlapped for days on end. I lamented that in front of me lay 2 or 3 years of post-bacc science courses, 4 years of medical school, 3 to 5 years of residency and 1 or 2 year fellowship.

My never ending education really became daunting when I found out my wife was pregnant with our second child just 4 months after the birth of our first. How on Earth was I going to maintain this insane schedule and support a family of 4 for the next 12 plus years! Did I forget to mention that I went from a six figure income to $24.60 an hour as an EMT?

The first time I heard the term “Physician Assistant” I was in my last semester of my pre med post bacc program and beginning to study for my MCAT. I didn’t know what a PA was or did until I met several of them in the various emergency rooms I frequented while dropping off my patients. Everything I saw and all the conversations I had with other PAs really peaked my interest in the profession. I researched further, crunched some numbers and had some soul scratching conversions with my spouse.

It was time to call an audible. PA was the way to go. I analyzed my transcripts and risk adjusted my chances of applying to one local ( albeit Ivy League) PA program. It was the only program I applied to because it was the only one that I had already completed all the prerequisites. Worst case scenario, I spend a few hundred dollars in application fees and got some interview practice while I took more prerequisite courses that would open up other potential schools for me to apply to next cycle.

But God had other plans for me. I was accepted and started as a PA-S less than a year later. While being a PA might not have been the path I started out on when I left the world of high finance, I am eternally grateful it is the path I am currently traveling.

Coming full circle.

I can honestly say, managing patients is a thousand times more difficult, but also a thousand times more rewarding than managing portfolios. But there is still a part of me that perks up when someone asks “hey, could you help me with my retirement accounts.”

The dissection of financial statements and debtectomy I perform on my colleagues personal balance sheets are some of my favorite non medical procedures. Today, standing next to the OR table I am a bit more useful than when I was a PA student, and I get to enjoy the look on the attendings face as I explain how they can pay off their medical school loans if they just sell their Porsche.