Podcast Episode 40 | The Ins and Outs of Medical-Legal Consulting

With Dr. Armin Feldman

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The Prosperous Doc® podcast by Spaugh Dameron Tenny highlights real-life stories from doctors and dentist to encourage and inspire listeners through discussions of professional successes and failures in addition to personal stories and financial wellness advice.

Shane Tenny, CFP® is our podcast host and Partner at SDT. He has lectured numerous times for hospitals and physician groups and, most importantly, helped hundreds of clients develop strategies to navigate through turbulent times toward their financial goals.

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Dr. Armin Feldm...: 00:00 One of the great things about this is nonclinical, but I know that I am continuing to help people.

Intro: 00:08 From Spaugh Dameron Tenny, it's the Prosperous Doc® Podcast, real stories, real inspiration, real growth, a show for doctors who are ready to improve their overall wellness in every aspect of life. Now here's your host, Shane Tenny.

Shane Tenny: 00:26 Welcome back to the Prosperous Doc Podcast. I'm Shane Tenny. Glad to have you with us today. You may know that over the last year, we've talked to several docs who have side gigs, opportunities to explore other interests and earn additional revenue on the side. That's a great way and an area of growing interest I think for a lot of physicians as medicine becomes more complicated, more stressful, as incomes come under pressure.

Shane Tenny:    00:51    If you listen to the show regularly, I think it was episode 38 [correction: episode 36], we talked with Dr. Nithin Natwa about the work that he's doing and the value his MBA is bringing to him and his career. We've talked recently with Dr. Marshall Kuremsky about his work in private equity. And today I'm excited to have as our guest, Dr. Armin Feldman. Dr. Feldman has a great story I think about transitioning from 20 years of seeing patients to now working as an entrepreneur, owning a business, and providing legal medical consultative services.

Shane Tenny:     01:25     He's hosted a conference for the last eight years or so teaching other docs how to do this. The conference is coming up, we'll get some details on that, but a great opportunity for you if this topic sounds of interest to you. Dr. Feldman, thanks so much for being with us today.

Dr. Armin Feldm...: 01:40 Hi Shane. It is a pleasure to be here talking with you.

Shane Tenny:     01:44     Absolutely. Well, why don't you start with a little bit of background. How'd you go from 20 years of clinical work seeing patients to being a leading voice for medical legal consulting?

Dr. Armin Feldm...:          01:56     Sure. So maybe what I'll start with is these days when someone asks me, "Well, what's your specialty?" I tell them it's forensic medicine, because that's what I've been doing for the last 13 years and actually working in a subspecialty in forensic medicine that I started and have developed over the years. But prior to that, I am trained as a psychiatrist and psychoanalyst. Very early on in my career, I met a young man who was a personal injury attorney and now we've been friends for almost 40 years, and he started sending me his clients who had head injuries. So that evolved for me and my specialty wound up being mild traumatic brain injury. I wound up owning outpatient head injury rehabilitation clinics around the country, which I was fortunate enough to eventually sell.

Dr. Armin Feldm...:          03:00     My first clinic was in Denver, my next role was in Colorado Springs, and the next one was in Detroit because the insurance laws were similar to Colorado. It just grew and grew from there and it was based on a treatment program of my own design. I thought we did a really great job of getting head injured individuals back up on their feet.

Dr. Armin Feldm...:          03:24     I sold those clinics and essentially at that point I was out of a job. So I was thinking about, well, what do I want to do next? And I thought, well, maybe what I could do... by the way, I have testified as an expert witness as a medical expert really more times than I want to remember on behalf of my patients who were either being cut off of their medical care or offered some pittance of a settlement. So I thought based on all of that, well, maybe what I could do is just consult to attorneys on any kind of medical questions that they had in a case. And that turned out to fill a niche that hadn't been filled, and really now 13 years later has developed into a new subspecialty of forensic medicine.

Dr. Armin Feldm...:          04:18     One of the things that makes this kind of consulting viable, makes it go, is that in the areas of the law in which I consult, which is primarily personal injury cases and workers' compensation cases, although physicians in any specialty can learn how to do this, but in those areas of the law, probably nine out of 10 cases settle. And that's where we come in.

Dr. Armin Feldm...:          04:43     So I work as a medical consultant in legal cases, I don't work as a medical expert. I don't work in medical malpractice cases. Anything that we can do to help attorneys to better negotiate and settle their cases for more money with less attorney time, help them get the appropriate medical care for their clients, help them negotiate the medical issues and cases, that's something that is very appealing to many, actually most, attorneys. We're working in those cases that never go to court, for which I would never be deposed nor act as a medical expert, but help that attorney and the case and the injured person to get to a better settlement.

Shane Tenny:     05:31     So describe for us, what's the typical process or timeline of a medical legal case? Maybe there's one that comes to your mind, or you can give an example. Where does it start? Because I know probably a lot of folks when I introduce you, they're thinking, "Wait, expert witness, this sort of thing." So maybe you can describe that and then what the settlement path looks like versus trial.

Dr. Armin Feldm...:          05:53     Sure. So unlike medical expert work, which takes a lot more time, but the average case, average consultation in these cases takes somewhere between maybe five and 12 hours. Most of the time that is eventually going to end with me writing a report, which I'll come back to in just a moment. But in answer to your question, there are a little over 16 different types of services and consultations that I provide and other physicians that I've trained provide to these attorneys.

Dr. Armin Feldm...:          06:29     So for example, one thing is to provide them with comprehensive medical summary reports with my medical opinions and other things in the report that the attorney uses as part of their settlement demand letter. And by using these reports, attorneys, the feedback from attorneys, are that they are in fact settling their cases for better value with less attorney time.

Dr. Armin Feldm...:          06:55     Other things that medical legal consultants do as opposed to medical experts is... so for example, I actually physically sit in and I observe independent medical exams done by other physicians. For years, probably since the '80s, there have been physicians providing IMEs to insurance companies. Apparently until I started doing this 13 years ago, there were not physicians working on the injured person's side. So I observe these IMEs and then that puts me in a position to write an IME rebuttal report.

Dr. Armin Feldm...:          07:33     Another kind of thing that I do is I answer specific medical questions in cases. The translation of that into legalese is that I am helping the attorney to decide in a case. There are two opposing views. There's a fact pattern in legal language and so the attorney will take a look at the medical fact pattern and then ask me, "Hey, I have a particular theory for this case. Is this a theory that holds water? Can you help me to prove this up with evidence, or is this a theory that won't hold water?" I'll write a report that answers a specific medical question in a case.

Dr. Armin Feldm...:          08:17     So let me give you an example. This is a case of a 68-year-old man who lived... I live in Denver and he lived in a mountain town up in the Rocky Mountains and he was retired. He was actually at his son's bachelor party and he was walking home, not intoxicated or anything, but he was walking home and he walked past, in this small mountain town, he walked past a construction site. Well, this construction site had no signs, no flashing lights, no fences, and unfortunately, it was in January, and unfortunately he fell into a five foot deep hole. It had rocks on the bottom, it had rebar on the sides, and he was quite severely injured. He had broken bones, he had a head injury, and he was actually in that hole until the next morning when he was discovered. And when they brought him out, he was essentially... his body temperature was 61 degrees. He was essentially frozen into a fetal position.

Dr. Armin Feldm...:          09:32     He got absolutely spectacular medical care at this small hospital. He had big problems and he was sent by flight for life to a much bigger hospital in Colorado Springs, where he also got just great care. But one of the things that happened when he was in the Colorado Springs hospital is that they noticed that his blood sugar levels were elevated and they diagnosed him with type two diabetes. Well, his niece was his primary care doctor, great medical records, saw her for years. There is no history of this guy having diabetes, having elevated blood sugars, having an elevated A1C.

Dr. Armin Feldm...:          10:13     And so the attorney asked me, "Well, is the onset of his diabetes accident related?" That was the first question. Then the second question was would he have gotten it anyway? In every case, what I first do, of course talk to the attorney, then I will read the medical records, examine everything. I interview the client and the attorney, typically I'll do that by phone or Zoom. Then I will do the medical research that I need to do to see how I'm going to formulate my opinions.

Dr. Armin Feldm...:          10:46     Well, when I went through the medical research, I found out and could back this up with innumerable papers from the medical literature, that in certain predisposed individuals, which he met those criteria, either physical trauma and/or emotional trauma can precipitate type two diabetes. He had a lot of physical trauma, but as well, he was unconscious for a while, but when he was back conscious, he thought he was going to die. He didn't think he was coming out of this. I can't think of a worse emotional drama.

Dr. Armin Feldm...:          11:22     So between the physical trauma and emotional trauma and based on the medical literature, and it was my medical opinion to a reasonable degree of medical probability that the injuries he sustained physical and mental were, using legal language, was the immediate and proximate cause of this man developing diabetes, and it became a damage in the case, a medical damage in the case. And based on my report alone, no experts involved, this damage was added to the settlement. Well, that's a big damage because that's a serious illness. That is another kind of thing that I do on a routine basis among many, many others.

Shane Tenny:     12:07     How long in a case like that, is that type of case typical for what you deal with or is that more robust? Because it sounds like it takes a fair amount of time and involvement on your part.

Dr. Armin Feldm...:          12:17     It's typical.

Shane Tenny:     12:19     So how much time did your work on that case take?

Dr. Armin Feldm...:          12:22     That was probably a 10- or 12-hour case.

Shane Tenny:     12:24     Okay. So between all the conversations and that sort of thing, you have 12 hours in. Is your work as a medical legal consultant, is it a part-time job now or a full-time job?

Dr. Armin Feldm...:          12:33     When I started, I started with the intent of it being a full-time job and it's been a full-time job for me for the past 13 years. Now, my other full-time job is a couple of years into doing this, I realized... I looked around the country for other physicians doing this, and maybe there are some doing some of the things that I do, but apparently there weren't. I realized a couple of years in that I could train other physicians how to do what I was doing.

Dr. Armin Feldm...:          13:05     And for the past 11 years I've been training other doctors. I have a one-year remote training program and I also train doctors in my conference. I've trained over 1600 doctors in the past 11 years to do what I'm doing. Now that training by the way, which I'm sure would interest you, is both on the business side. In other words, how do you start up, but then run long-term, a successful medical legal consulting business? And it's also on the medicine that you need to know.

Shane Tenny:     13:38     Fascinating. Now I want to talk a little bit more about the training and the conference that you've got coming up, but I want to circle back to your story because I'm just curious. When you write the opinion, the medical opinion on a fact pattern like that, if the case doesn't settle, what is the process that prevents you from being the one that gets called as an expert witness if there was a trial?

Dr. Armin Feldm...:          13:58     Let me try to elucidate that a little bit.

Shane Tenny:     13:59     Yeah, thanks.

Dr. Armin Feldm...:          14:00     So every... Using some legal language, I'm not a lawyer by the way, but you pick this stuff up. But everyone in the case is going to stipulate, including opposing counsel, everyone is going to stipulate. I'm not an expert in everything. And so in those one out of 10 cases that go to trial, then the attorney is going to need medical experts in every area of the injury. But for the purpose of negotiating and settling the case, the way our legal system works, physicians, MDs, DOs, they are able and sanctioned to give medical opinions about medical questions and that's what I do. So in that one out of 10 case, everyone's going to stipulate Dr. Feldman is not an expert.

Dr. Armin Feldm...:          14:50     But let me elucidate on that for a minute. Now this doesn't happen to me anymore because I've been doing this for 13 years. The attorneys in Colorado know who I am. But when I started, let's say the issue was about a torn rotator cuff, a work-related injury. And the attorney that hires me is trying to negotiate out something in the settlement related to that rotator cuff injury. So he hires me and I do what I told you I did before in terms of the steps, and I produce a report with my medical opinions backed up with medical evidence. By the way, my medical opinions are evidence and evidence from medical literature.

Dr. Armin Feldm...:          15:33     The attorney that hires me sends that report to opposing counsel. Quick aside, I'm not in the background. My reports are seen by opposing counsel, insurance adjusters, judges, IME doctors, treating doctors, a whole bunch of people. What's the first thing that opposing counsel's going to do? Well, they're going to look me up, right? They'll get on the phone and say, "Hey, why should I pay any attention to this report by Dr. Feldman? He's no expert in rotator cuffs." And what the attorney that hires me says is, "Well, Dr. Feldman acts as a medical consultant for me in all my cases. And I can tell you that if we can't get this issue negotiated in the settlement based on Dr. Feldman's opinions in his report and you force me to take this case to trial, when I hire my routine orthopedic expert, he's going to say exactly what Dr. Feldman said in his report. In fact, he would be relying on exactly the same literature that Dr. Feldman relied on in his report. So let's get this done."

Shane Tenny:     16:38     Plus, I'm going to bill you for his time.

Dr. Armin Feldm...:          16:40     Right.

Shane Tenny:     16:40     Yeah. Okay, excellent. So that kind of helps me understand and hopefully some of our listeners understand a little bit about how that process works. I'm going to take a quick break here. We'll come back, we'll talk a little bit about the training that you provide through your conference and those sorts of things.

Shane Tenny:     17:00     Do you have a financial junk drawer? Even before I describe it you probably know what I'm talking about. Just like that proverbial drawer in your kitchen or laundry room, you know, the one filled with pens and pencils, screws, and duct tape, matches, chopsticks, maybe even an old sock, the drawer filled with things that you didn't know where else they belong. Well, many of us as we go through life accumulate a sort of financial junk drawer filled with an insurance policy we bought from a college roommate after graduation, an old 401(k) that we never moved from an early job, or bank accounts that we opened to get a car loan or mortgage even though we don't bank with that institution.

Shane Tenny:     17:43     The more products, accounts, and policies you have, the harder it is to create a centralized vision and progress towards the goals that you have. Whether you're working with a professional financial planner or trying to tackle these things by yourself, the more organized you can be, the more effective you'll be at making the changes and monitoring the results towards the goals that you have.

Shane Tenny:     18:09     If you need help in this regard, click on the show notes below and download our free guide, Five Steps To Organize Your Finances. I can't say it's a fun way to spend a weekend, but you'll be amazed at the progress you can make if you'll just start cleaning out your financial junk drawer.

Shane Tenny:     18:30     All right. So Dr. Feldman, thanks so much for opening my eyes and I'm sure others to the world of working as a medical legal consultant. I can see in you as we're recording this just the intellectual and emotional stimulation that it brings and maybe too great to say the joie de vivre of finding good work to do, whether you're transitioning in a career like I think you did through selling your practices and moving into this or supplementing other clinical work. You've hosted a conference the last eight years. You've got it coming up at the end of April. Tell us a little bit about that and what's involved. What do you cover? Who is a good candidate to attend?

Dr. Armin Feldm...:          19:07     Sure. Yeah, I'm so glad you asked me that because I was a little remiss earlier. You asked me if you do it full-time and I said yes. But there are physicians that do this full-time, there are others that do it in lieu of retiring, but the vast majority of physicians that I train in doing this are doing it as part-time as part of an existing practice. That's the largest group.

Dr. Armin Feldm...:          19:32     And what I tell physicians is you really need at a minimum about eight hours a week in order to do this justice to make it fly. If you don't have that much time, don't do it. If you can carve out that much time or more, then this might be something that you want to do.

Dr. Armin Feldm...:          19:46     The second answer to your question, the conference coming up April 24th and 25th, that is a two-day crash course in how to do this. And one of the very first things that I say at the conference... By the way, the conference is by live stream only. To register for that conference, you can go to med, M-E-D, medlegal2021.com.

Dr. Armin Feldm...:          20:11     So one of the first things I say is when you leave this conference, you will have all of the tools and all of the instruction that you need to go out and successfully do this. And many physicians have done that, attended the conference. So the conference is about two things. It's about the business side and it's about the medical side. I'm big on systems, I have a system for everything that I do. And what I try to impart to the attendees of the conference is I'm going to give you every system I've ever created to watch your business, to market your business, to operate your business on a day-to-day basis. In addition to the medicine that you need to know, I will give you the tools in a binder that you'll get for the conference. So you'll have the tools at your disposal that you need, you'll have the education that you need, and you can go out and do this.

Shane Tenny:     21:08     Is this a good thing to attend for anyone who's interested? If you're a new physician recently out of residency or fellowship, are you too young? Is there a sweet spot or who's a good fit?

Dr. Armin Feldm...:          21:19     By the way, the conference is for 15 category one CME credits. You have to be licensed to do this. You have to be past your residency training. But other than that, here are the criteria. If you enjoy... Some doctors just like to stay in their lane, just in their space. But if you enjoy medicine in general, if you're a person that enjoys continuous learning as an intellectual curiosity about the whole field of medicine, then this would be for you.

Dr. Armin Feldm...:          21:53     I know that based on the hundreds, maybe thousands of hours of research that I've done over the years, I've done over 3000 cases now, I have learned a tremendous amount of medicine, which for me has been really a lot of fun, very interesting. Now, I'm not prepared to do any orthopedic or neurosurgery, but I'll put my knowledge base of spine injuries, rotator cuff injuries, other things really up against anyone, and that's been the fun of doing the work and I've gotten paid to do that education.

Shane Tenny:     22:27     So within the training, the folks in the field that you're training are bringing clinical knowledge with them in their training. I'm thinking that you've developed some skills and things that are helpful to learn as well, maybe in communication or negotiation or those. Talk a little bit about some of those ancillary skills and characteristics that are helpful.

Dr. Armin Feldm...:       22:47    Sure, sure. So this is a new field of medicine so there is not a set of knowledge base that you have to require. One of the things that I tell physicians that I train at the conference is I learned by the school of hard knocks. My MBA is from the school of hard knocks too. Basically, almost everything I teach is based on mistakes that I've made along the way big and small, because there was no one there to train me on how to do this. But there's a kind of prescribed set of things that you need to know in order to do this. It's a specialty in a sense like any other specialty. The nice thing about that is you can learn it rather quickly, and you are putting your hard-earned medical knowledge to work in this context.

Dr. Armin Feldm...:          23:38     Now, one of the things that I'd like to say about that, Shane, is that one of the great things about this is nonclinical, but I know that I am continuing to help people. Like most doctors, it's always been important to me in my work to help people, and this has helped that these injured people, they desperately need and just didn't have before.

Dr. Armin Feldm...:          24:01     I always work on the side of the little guy going up against the insurance companies. Often their own insurance companies denying legitimate claims and these injured people, based on the way our crazy system works, they often need help from attorneys and they often now get additional help from medical legal consultants to help them through the medical issues in the case.

Shane Tenny:     24:27     And it sounds like from your comment that medical legal consulting is not expert witness testimony, or it's not medical malpractice testimony or those sorts of things. There's really not any significant additional or unique liability that is a concern or needs to be insured against or things like that, is that correct?

Dr. Armin Feldm...:       24:48    Let me answer that for you, yes, that is correct. The way I advise physicians is if you are concerned about your liability, whether you need medical malpractice or not, the bottom-line answer on that is hire an attorney in your state who is versed in this. It would probably take them only a couple hours of your time and have them give you a written opinion. That's the bottom-line answer.

Dr. Armin Feldm...:          25:13     There is another answer, which is I've been doing this for 13 years. I think I do a good job, I suppose I could get sued anyway. All of my clients are attorneys. They certainly know how to sue people. My client is not the injured person, my client is the attorney. I don't think it's a high risk. I don't think you need medical malpractice for this unless you just want to have it. At the bottom line, what I am hired to do is render medical opinions in these cases. So if you do that in good faith, you do all the things you're supposed to do, you read the records, you interview the client, you talk to the attorney, you do the research, you write a prudent [inaudible 00:25:56] report, it's very hard to get sued, even if the attorney didn't like your opinion, which almost never happens, I'll tell you why in a second. It's very hard to get sued if you're hired to render a medical opinion and you render that in good faith.

Dr. Armin Feldm...:          26:10     Which brings up one thing I do want to mention, which is sometimes doctors ask me about being a hired gun. One of the great things about being on this side of the fence, that is working with plaintiff and claimant attorneys, is that these attorneys want and they value my straight up medical opinions. They don't want to be carrying loser cases with their time and with their money. So if I tell them, "Look, you don't have a case here," then I'm done with my part of the case, for whatever the reason, there's a pre-existing condition, the person is malingering, which doesn't happen very often, they're driven by primary gain, and then they'll just try to settle the case as quickly as they can for whatever they can get. I am never faced with the kind of secondary gain issues that may face some physicians working on the other side.

Shane Tenny:     27:03     That's a great explanation, because I think it helps address the concern that you end up in a position of conflict of interest, where I feel obligated to render an opinion that's helpful to the plaintiff, but I know that medically that doesn't really hold water, those sorts of things. I guess to your point, you're being hired for your objective opinion and here's what it is and [crosstalk 00:27:22].

Dr. Armin Feldm...:          27:22     Whatever it is, it's good.

Shane Tenny:     27:24     Yeah. Absolutely. Now you said there was a scenario, or you said you wanted to elaborate on the point of just writing opinions that you rarely have the attorneys come back and say, "We don't like your opinion."

Dr. Armin Feldm...:          27:35     Let's see if I can remember.

Shane Tenny:     27:37     Or maybe that was just the very point, which is they're hiring you for an opinion, and even if it's not favorable, then it allows them to be efficient with their time and the case and just get it settled.

Dr. Armin Feldm...:          27:46     That was it.

Shane Tenny:     27:47     Gotcha. Gotcha. The last question, I guess to wrap up for today, and then we'll give the details of the conference again, as we're talking and recording this, of course by Zoom, I know you've mentioned earlier you've done a lot of conversations over the last year by Zoom. Any other ways that COVID and social distancing have impacted the field, or has it been pretty much business as usual?

Dr. Armin Feldm...:          28:06     It's been pretty much business as usual. When the country was shut down, things were shut down, but they're certainly not now. I have to say much to my chagrin, because I'm a big believer in meeting face-to-face. But we switched to doing our initial meetings with attorneys by Zoom, and I'm happy to report that the conversion rate from prospect to client turning client hasn't changed at all. Now when we can, hopefully in the near future or in '22 when we can meet face-to-face again, there are plenty of other reasons to meet face-to-face, but it really hasn't affected the way we're doing business.

Shane Tenny:     28:45     I just thought of one more question before I let you go, because I'm trying to think what are our listeners wondering as they're listening to our conversation and that is, how do they come up with their hourly rate? Does their RVU or their hourly salary rate, does that convert to what they would charge an attorney or do attorneys have set rates that they would bill? How does work?

Dr. Armin Feldm...:       29:05    Sure. So as I'm sure you know, I can't talk specifics about fees, it's a fair- trade practice violation.

Shane Tenny:     29:11     Sure.

Dr. Armin Feldm...:          29:12     And you can't fix fees so I'm not going to do that. But the way that I have advised physicians over the years is do an informal survey of your colleagues, determine what you think is the average fee per hour for doing medical expert work in your community. Now, obviously there's a range, but it's not that hard to figure the average.

Dr. Armin Feldm...:       29:33    Once you get that average, as a medical consultant you're going to come in maybe half to two thirds of what the experts are charging. When doctors and lawyers think about lawyers hiring doctors, they only think of one thing, it's hiring medical experts. So that's the only thing they have to compare your fee against. Sometimes the attorney will say, "You're cheap," or, "That's really reasonable, that's inexpensive." But when you think about what that fee actually is, it's a mind-boggling number of dollars per hour, even as a medical consultant.

Shane Tenny:     30:07     Yeah, especially for the amount of stress considering you have no call, no patients per hour, no insurance billing issues, and relatively little stress because you get to choose the work you're doing.

Dr. Armin Feldm...:          30:18     Right. Yeah, you don't have to work with every attorney.

Shane Tenny:     30:21     Yeah. Great point. So again, you've got the virtual conference. I want to get the dates right, April 24th and 25th. What's the website again to check out?

Dr. Armin Feldm...:          30:31     It is med, M-E-D, medlegal2021.com.

Shane Tenny:     30:36     Excellent. And if you're driving in the car listening to this or exercising, we'll put a link to the conference in the show notes down below, so you can scroll down and click on this later if you would like to participate in Dr. Feldman's conference. Dr. Feldman, thanks so much for your time today. Thanks for opening our eyes to another side gig that's available to physicians out there looking to grow in their emotional, intellectual, and professional prosperity.

Dr. Armin Feldm...:          31:01     Pleasure to be with you.

Shane Tenny:     31:02     All right, and thank you for joining us. As always, you can find us on a variety of social media channels. If you have suggestions for guests or topics you'd like us to tackle, we would love to hear from you. You can email me directly, it's shane@whitecoatwell.com. Thanks so much. We'll see you back here next time.

Outro:   31:21     This episode of the Prosperous Doc Podcast is over, but you're not alone on your journey. Spaugh Dameron Tenny has been helping physicians and dentists prosper through financial planning for over 60 years. To connect with us, visit sdtplanning.com today and take your financial wellness to new levels. Join us on the next episode of the Prosperous Doc Podcast.