Last fall I had the pleasure of interviewing Dr. Juan Aragon, Executive Director of Primary Care, Specialties and Physicians’ Services at Evergreen Health.
His story begins in Costa Rica where he grew up and completed his medical training. His journey into medicine was sparked on a casual car ride with his father who asked Juan the question: “what are you going to do for a living?” When Juan told him that he wanted to be a missionary, his father pressed back, asking how he would pay the bills. Right then and there, Juan decided he would go into medicine.
After starting a medical training program in Costa Rica, Juan took 9 months off for bible school at Capernwray Hall in England. His goal was to mature, away from his family, and spend some time in self-reflection to ensure that medical school was truly the right path for him.
Juan finished medical school at age 24 and took a job in the remote location of Drakes Bay on the Oso Peninsula in Costa Rica. Juan was the second doctor Drakes Bay ever had and, needless to say, he gained a ton of clinical experience there.
Missionary work continued to call to him, so he left Drakes Bay to work for a bible school, and did pro-bono work for the affiliated hospital. This is where he learned the administrative side of medicine. And, how much he liked it. He wore a lot of hats: Chief of Human Resources, Chief Risk Officer, etc., and by the time he moved on, the school had built up an unprecedented $300,000 cash reserve.
In 2008 he received his Master of Medical Management, Health Systems Management from Tulane University. He moved to Seattle in 2009 to start his career at Evergreen Health.
After learning about his background, I asked Dr. Aragon a series of questions, as follows:
Lowell: How do you give back?
Juan: My religion – Christianity – should have a visible impact. It is not just a philosophy. Early on I gave back with my talents and skills via board participation. I focused on organizations that had youth programs, like the YMCA, with the goal of helping kids navigate the messy teen years. I have continued to work with the YMCA in tandem with Evergreen.
I am currently involved with the University of Washington Masters in Health Administration program. I see these kids as the ones who will be here when I am not. Investing in their future is paramount. My participation in panels and business cases also helps me learn and succeed in my current role at Evergreen Health.
Lowell: How do you “Live Fully”?
Juan: At the end of the day when you look back at a day’s worth, a year’s worth or even 10 years’ worth of time, you need to ask: did I invest enough time in my family that I am preparing them to be better individuals to face the challenges of this world than I am? Am I fully investing in the people I love the most? Was I conscious enough to be grateful to the people who contributed to my life, in recognition that I am where I am because of them? Answering “yes” to these question brings fullness. A friend once told me – “be grateful with your treasures, be grateful with your talents and be grateful with your touch.”
Lowell: What is the best piece of financial advice you ever received?
Juan: Live like it’s your last day but plan like you are going to live a hundred years. Don’t get into credit card debt. Save enough money to have fun. Always have the attitude that if you are willing to give, opportunities will present themselves constantly. Look at things as opportunities. The same thing is true with investing: Don’t leave it all in one place. Leave it where you can take advantage of opportunities.
Lowell: Do you miss practicing medicine?
Juan: Yes. But, I made the choice in 2008 to pursue an administrative career. I find alternative ways to be with people, and I see the long term impact that my work will have on patients. I know that at some point, I or my loved ones will need these services and I want to make sure they are the best services possible.
Lowell: What is the biggest challenge and opportunity for health care?
Juan: Challenge – Affordability. Our health care is so expensive that it is not sustainable. For the past 6 years, we have tried 200 experiments and none have delivered results. Opportunity – Same thing. If you think about how our nation was formed, it has always figured out how to force its way through complex problems. The US is the way it is because it figures out innovative solutions to transform the market. We will break through. Consider the innovations of Amazon, Google and Apple for instance.
Lowell: What advice do you have for physicians?
Juan: As you are figuring out what you want to do with your life, take the time to figure out what you are passionate about. Make sure you have the skills and financial support to do it. Figure out your priorities and have a plan to make sure those priorities are met. As long as you have a plan, you know where you are going. You can figure it out. Ask for help. Design the map to fit your lifestyle. Develop a plan to make enough money and enjoy it. Have a plan and understand choices and tradeoffs. Understand where true north is. Figure out how to overcome obstacles and stay on track.
Society presses kids to have it all figured out; this pressure is incredible. You do not have to have it all figured out. Have a plan. Talk to smart people. Work hard. Have a good attitude. Don’t think that when you go to college you need to have your retirement date figured out. It’s okay to not know all the answers. Never be afraid to ask for help.
Juan is an impressive person, and I thoroughly enjoyed speaking with him. His global perspective, work ethic, and humble attitude bring a unique perspective to the medical field. I hope you glean some insight from his thoughts, and that they lead you to a fuller place.
From the heights of K2 to the war struck Syrian-Jordan border, Albert (Skip) Edmonds’ journey is one of intrigue and insight. I had the pleasure of sitting down with him to hear his story.
As the son of a pediatrician, medicine presented itself as a likely career path for Skip at an early age, although his route was somewhat circuitous. Upon graduating from Williams College, he pursued oceanographic research in the Antarctic. He spent 200 days at sea, south of Australia in a 200-foot vessel, stomaching choppy waters. During this time, he was also able to pursue his love for mountaineering in the mountains of New Zealand.
After a year in the Antarctic, Skip was faced with a decision: Continue with oceanography and get a PhD, or pursue an MD. The variety of opportunities in medicine ultimately won out and Skip headed to Virginia for medical school.
Early in his career as a practicing physician, Skip put his mountaineering skills to the ultimate test as part of the first American expedition to K2 in 1978. Led by Jim Whitaker of REI, the group was 14 people strong. It was a long trip, beginning in mid-June and lasting well into October. Skip remembers the toughest elements being the weather and the confinement, not to mention dehydration and limited oxygen. Just when the group’s food supply was on the brink of depletion, there was a break in the weather and two groups of two made it to the summit in two successive days, marking the first American ascent of K2 and the third overall ascent.
After many years practicing medicine in Seattle, Skip was ready to retire. It was then that an opportunity to join Doctors Without Borders (DWB) presented itself. Skip was at his cabin in 2010 when the Haiti earthquake struck, and he immediately realized his skill set would be useful. He sent in his application to DWB and went through a rigorous selection process. DWB is very careful in selecting its members, and for good reason. Electricity is intermittent and the living conditions are tough. Experiencing third world medicine is a shock for most American physicians, and DWB wants to make sure each physician can not only handle it, but will want to come back for a second mission. Surgical missions are typically in trauma zones and last about a month, with physicians working around the clock. Non-surgical missions last 3-6 months and have a less intense daily schedule.
Skip says it’s the individual patients you remember the most. There is one 7-year-old Nigerian boy he remembers well. The boy was hit by a car and, after a dozen surgeries, lost both of his legs to infection. Despite his trial, the boy always had a smile for Skip and his colleagues and appreciated their work.
In 2012 he was stationed on the Syrian-Jordan border during the Syrian civil war. They could see the bombs going off a few kilometers away and patients were pouring in. It was an emotionally challenging experience. Skip and his team attempted to save one woman for over a month, and Skip recalled how brave she was to endure. Unfortunately, the infection eventually took her life.
His advice for physicians who are thinking about joining DWB is to do your homework. Make sure you understand it will be harder than you think. Something will come around the corner, either medically or culturally, that will shock you. In the end, Skip always learns an incredible amount on his missions. And, he takes home more than he is able to give back.
If you are interested in more information, you can visit the DWB website. Skip would also be happy to talk with you one-on-one; e-mail me and I will make the introduction.
Skip’s advice for life in general is to find something that occupies your head and that you love to do. It will take you away from the stresses of medicine, allowing you to unplug, decompress and approach your work with a clear head. For Skip, this is rock climbing because it takes total focus and concentration and doesn’t allow him to worry about the daily stresses of life.
The best piece of financial advice Skip ever received was to not try and do it himself. When the tech bubble popped in 1999 that became clear. Skip was in his late 40s at the time and lost half of his retirement nest egg. Later, he entrusted money to a friend and got burned. All in all, he had little interest for investing and therefore was not going to stay on top of it. Hiring a financial advisor allowed him to focus more on the things he really enjoys, like rock climbing.
For this edition of Living Fully, I had the pleasure of interviewing Tony Armada, CEO of Western WA at Providence Health & Services and CEO of Swedish Health Services. Tony has been part of our local health care community since 2013 when he relocated from Chicago to work at Providence and Swedish Health Services. Before Chicago, he spent 16 years in Los Angeles and Detroit prior to that. He likes to joke that he brings professional sports championships with him. In Detroit it was the Pistons. In LA it was the Lakers. In Chicago it was the Blackhawks. When he came to Seattle in 2013, the Seahawks won the Super Bowl.
It’s clear, however, that Tony brought much more than sports to our city. He is actively involved in the Seattle Metropolitan Chamber of Commerce, the Washington State Hospital Association and the World Trade Center Seattle. Amidst this busy professional life, he puts friends and family first and takes time to enjoy life. I sat down with Tony to understand how he manages to Invest Wisely and Live Fully.
Tony grew up in a health care family. His father was a physician and his mother was a pharmacist. From a young age, Tony knew he would follow a similar path. After earning his undergraduate degree in human medicine and technology at Michigan State University, he practiced medical technology for four years in a 400-bed hospital.
Because education is important to Tony, he went back to school for a Master of Health Administration (MHA) and Master of Business Administration (MBA) as a backup in case the MHA didn’t work out. In the end, Tony found them complimentary, and they taught him about both sides of the health care equation.
Fast forward to today, Tony manages nine hospitals and 16,000 caregivers in the greater Seattle area and western Washington. Maintaining the right work/life balance is important to Tony. On the work side, he loves what he does and his family supports those endeavors. But, family and leisure are a top priority, and Tony makes a point to use his vacation days and spend time with family.
Now that his daughters are attending out-of-state colleges, that adds a layer of complexity. His oldest daughter is following in his health care footsteps, working as an EMT in Chicago. Ultimately, she would like to go back to school to become a Physician’s Assistant. Tony’s youngest daughter is following the business path and is studying business management. She is also a Division 1 scholarship athlete, playing volleyball.
As you can imagine, not much keeps Tony up at night. As he puts it, “I am too tired!” Instead, he asks himself the question: Did I make a difference in somebody’s life today? If the answer is yes, he feels good going to bed. Whether it’s giving his daughters the opportunity to enjoy life, or making sure patients are well-cared for, the answer is almost always yes.
In the near future, Tony would like to set aside money for a foundation that will use funds in perpetuity to fund and create opportunities for young adults via coaching, mentoring and internships. Tony will also give back with his time. That question he asks himself before bed? Soon, the answer will always be yes.
Whether you are a resident, new physician or thirty years into it like Tony, my hope is that his story will give you some guidance and inspiration on how to manage a busy life and live fully. Did you make a difference in somebody’s life today?
Stefan Turkula is in his five-year residency for orthopedic surgery. At 32, his ability to Live Fully and Invest Wisely despite 80-hour work weeks and a daunting debt burden is impressive. My hope is that you can pull a few nuggets of inspiration from his interview. I know I did.
What drove you to medicine in general, and specifically to orthopedics?
Medicine was something that was always on my radar as a career. My grandfather was a family physician in a rural town in North Dakota, and I have an Aunt who is a plastic surgeon. So, I sort of had them to look up to for a while. That being said, I never thought of medicine as a career until I started thinking of ways to apply myself in things I was passionate about; using science, technology, and physical skill to care for and treat people in their time of greatest need. Medicine affords me that privilege and I’m thankful every day that I get to do my job (some days more than others, however).
Orthopedic surgery, as it would turn out, was essentially my destiny. For me it is the perfect symphony of medicine, science, and technology being used to make people more functional and feel better than before they met me. Which is sort of a mantra of mine, I want to leave every patient feeling at least a little better than they did when they first met me.
Typically, if someone is seeing me in the emergency room they’re having one of the worst days of their life. Being able to take someone from that point, to being able to enjoy life in a meaningful way for him or her is a pretty cool feeling.
Additionally, having been an orthopedic patient many times myself, I find myself easily identifying with many people musculoskeletal problems and appreciating their desire to get back to functioning at a high level again. I love being able to help them achieve their goals.
Now, it’s no secret that becoming a doctor isn’t cheap. How are you dealing with the debt burden of medical school?
Ah, the debt burden. It’s substantial. I funded 100% of my medical school and graduate program with student loans, and I graduated with about $400,000 of debt (which includes my $20k from undergrad). Now, what is my plan to pay it off? Public Service Loan Forgiveness (PSLF). The amount of debt I have and my salary as a resident ($52,000 this year) are so mismatched that repaying anything substantial while I’m still in training is essentially impossible.
Luckily there are some very reasonable programs. The Income-Based Repayment (IBR) and Pay as You Earn (PYE) options are the only reasonable choices for me, but in the long run I’m relying on the PSLF program. PSLF is a godsend for those in medicine with a lot of debt. With the criteria being that you must work for a non-profit (99% of teaching hospitals are non-profits) and make the minimum IBR or PYE payments for 10 years, it’s a no-brainer to start that as soon as possible.
When I’m finished with residency and fellowship, 6 years, I will have 4 years of payments left if I continue to work at a non-profit hospital until the remainder of my loans will be forgiven. Now with the crushing interest rates given to student loans (I think my average over all loans is like 7%), my total amount forgiven, which accounts for future interest and minimum payments for 20 years, will be close to $900,000. That’s just an insane number that’s hard to comprehend now, much less when I was student taking out those loans. So, I’m pretty much reliant on the PSLF program.
What is the best piece of financial advice you ever received?
“Save money for what you hate, spend money on what you love.” I have no idea where I heard/read that, I guess I could just take credit for making it up, but it’s been a good mindset for my money management. I take it to mean that make sure you’ve covered everything that is a burden (rent, car payment, utilities, etc) so they’re no longer burdens and just out of your mind. Whatever you have left over, do with as you please.
I don’t go crazy, and tend save a small amount each month, but there are things that are important for me, like travel, and I’m more than happy to spend a lot of my income on that rather than squirrel it all away. Let’s be honest, I’m a 32 year-old single guy and I work 80+ hours a week. I don’t have much time to spend money, and I don’t make a large enough salary to realistically save much for my retirement or future at the moment.
So, my current philosophy is that I’m going to invest in my happiness rather than an investment portfolio. That will change quite a bit once I finish training and start making a real orthopaedic surgeon salary in a few years, but in the meantime I’m happy just being happy.
At Merriman, we focus on helping our clients live fully. It sounds like you do this part well!
I skied competitively in freestyle skiing from the age of 10 on, and eventually won the Junior Olympics when I was 17. Skiing gave me an incredible amount of freedom and appreciation for travel and seeing new places. I got to see and do a great number of things that I wouldn’t have been able to without skiing. Just because I was a good skier I was able to be exposed to the outdoors and love being there. As a teenager you barely realize these things, but all those experiences are what have shaped me to be an adventure seeking, outdoors loving person.
Like I said before, at the moment, I invest in my happiness. My schedule is such that when I take vacation, it has to be for an entire week at a time. We get 4 weeks a year in my program and that usually means 1 week every 3-4 months. No random 3-day weekends or anything like that. So, I’ve committed myself to making the most each vacation. Each week is an opportunity for a new adventure, and so far it’s worked out for me.
I have the privilege of having lived all over the country and can find a place to crash in almost any city if need be. That being said, I did take a solo trip to Canada last winter that was astounding affordable. I flew into Calgary on a cheap ticket, rented the cheapest car I could find, and spent a week sleeping in youth hostels with crazy 20 year old Australian and German students on holiday while skiing and exploring the Canadian Rockies, making some pretty interesting friends along the way. The strength of the US dollar vs the Canadian made the trip so much cheaper than I had expected. So by sacrificing any semblance of luxury, I was able to have a pretty amazing adventure on the cheap.
I’m always on the lookout for what might be a good, inexpensive trip. Such as camping in Zion national park for 4 days, which was another vacation I took last year. I took a super cheap flight to Las Vegas, got a car for $20/day and went backcountry camping in Zion, which is pretty much free, and you get see some of the most beautiful scenery on earth. Those sorts of trips are what I’m always on the lookout for. Fairly simple to plan, and the major expense is the plane ticket.
Clearly, Stefan is doing things right. His ability to live a full and meaningful life in the face of limited time and economic resources is inspiring. If you are resident or young physician reading this, my hope is that it inspires you to work within your means financially, enjoy life and make wise decisions about your debt management.
Stefan Turkula is not a current or former client of Merriman, nor is he an employee of the firm. Stefan authorized Merriman to share his personal story in the interview and subsequent blog post for illustrative purposes only. Merriman did not pay Stefan to participate in the interview.
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