SEND US A TEXT MESSAGE!!! Let Drs. Nii & Renee know what you think about the show!

A first year general surgery resident slid into my DMs after our previous episode on how GHANA MADE ME BETTER. She’d been following the show for almost 10 years, and she had one question:

“How can I best start preparing for global surgery, especially in places like Ghana?”

That question deserved more than a simple reply. It deserved an entire episode.

So I’m sharing what I’ve learned from 14 years of humanitarian surgical work at KNUST University Hospital in Kumasi, Ghana, alongside International Healthcare Volunteers.

You’ll hear:

→ Why global surgery is the truest test of your surgical foundation

→ The #1 mistake residents make when they arrive (and why it destroys everything)

→ How to start preparing RIGHT NOW. Not in fellowship, not as an attending, NOW

→ What to look for in a global surgery program (and the red flags to avoid)

→ What your first trip will actually look like. The OR, the clinical experience, and the emotional reality

→ What 14 years of showing up consistently has taught me about this work

For general surgery residents, all surgical specialty residents, medical students, and any physician who has ever thought about doing meaningful work beyond their hospital walls.

"Global surgery is not a break from your training. It IS your training in its purest form."

Find us on YouTube: www.youtube.com/@docsoutsidetheboxpodcast

FREE DOWNLOAD: First-Gen Doctor Blueprint — Everything we wish someone had told us about finances, career planning, and building a life in medicine. Visit: https://darkos.lpages.co/first-gen-physicians/

Have a question for us?

• Send us a Voice Message: https://www.speakpipe.com/docsoutsidethebox
• Text us: 833-230-2860
• DM us on Instagram: @docsoutsidethebox
• Email: [email protected]

ABOUT DOCS OUTSIDE THE BOX:

Dr. Nii is a General Surgeon. Dr. Renee is an OB/GYN. We are first-generation Ghanaian and Haitian physicians who paid off $662,000 in student loan debt in 3 years, built a locum tenens agency, and navigated every major medical career decision without a family blueprint.

We created this podcast for first-generation doctors — physicians who are the first in their families and lack the inherited knowledge about money, contracts, career strategy, and the unwritten rules of medicine that many of their colleagues learned growing up.

Real conversations for first-gen doctors.

Website: https://drniidarko.com/

DISCLAIMER: Dr. Nii and Dr. Renee are physicians, not financial advisors or attorneys. Content shared in this podcast reflects personal experience and should not be considered financial, legal, or medical advice. Please consult qualified professionals before making financial or career decisions.

© 2026 Docs Outside the Box. All rights reserved.

SEND US A TEXT MESSAGE!!! Let Drs. Nii & Renee know what you think about the show!

In just a few days, we leave for Ghana, and this year, our boys are coming with us.

This is our 14th year doing humanitarian work at KNUST University Hospital in Kumasi with International Healthcare Volunteers. Before we board that plane, we’re talking about what humanitarian medicine actually looks like. Not the Instagram version. The real version.

You’ll hear:

• What International Healthcare Volunteers actually does and why the focus is sustainability and education, not fly-in-fly-out surgery
• The white savior complex in humanitarian medicine and why that mindset can destroy more than it builds
• Why Nii comes back a better surgeon every year from complex tissue repairs to the CO₂ tank story and the GIST tumor patient
• The OB/GYN cases Renee encounters, including patients arriving with hemoglobin levels of 4 and 5
• What medical students and residents can learn in Ghana that they simply can’t learn in the U.S.
• How we make two weeks in Ghana work with two boys, an apartment in Accra, alternating weeks, and homeschooling this year
• And the mindset behind why we keep going back: “I’m not going to save Ghana. Ghana doesn’t need saving. I’m going because Ghana made me.”

If you're the first doctor in your family and you've ever felt behind, confused, or alone in navigating medicine, this is your community.

And if you’ve ever done humanitarian medical work, or wondered what it really looks like beyond the highlight reel, this episode is for you. 

Find us on YouTube: www.youtube.com/@docsoutsidetheboxpodcast

RESOURCES MENTIONED IN THIS EPISODE:

• Locumstory.com - a free resource with unbiased information about locum tenens opportunities, real physician stories, and practical guidance to help you make informed decisions about your career. Check them out at https://dotb.s.gy/Pod 
• International Healthcare Volunteers - https://www.ihcv.org/

FREE DOWNLOAD: First-Gen Doctor Blueprint — Everything we wish someone had told us about finances, career planning, and building a life in medicine. Visit: https://darkos.lpages.co/first-gen-physicians/

Have a question for us?

• Send us a Voice Message: https://www.speakpipe.com/docsoutsidethebox
• Text us: 833-230-2860
• DM us on Instagram: @docsoutsidethebox
• Email: [email protected]

ABOUT DOCS OUTSIDE THE BOX:

Dr. Nii is a General Surgeon. Dr. Renee is an OB/GYN. We are first-generation Ghanaian and Haitian physicians who paid off $662,000 in student loan debt in 3 years, built a locum tenens agency, and navigated every major medical career decision without a family blueprint.

We created this podcast for first-generation doctors — physicians who are the first in their families and lack the inherited knowledge about money, contracts, career strategy, and the unwritten rules of medicine that many of their colleagues learned growing up.

Real conversations for first-gen doctors.

Website: https://drniidarko.com/

DISCLAIMER: Dr. Nii and Dr. Renee are physicians, not financial advisors or attorneys. Content shared in this podcast reflects personal experience and should not be considered financial, legal, or medical advice. Please consult qualified professionals before making financial or career decisions.
© 2026 Docs Outside the Box. All rights reserved.

SEND US A TEXT MESSAGE!!! Let Drs. Nii & Renee know what you think about the show!

We got married in our thirties. Started IVF in the middle of paying off $700,000 in student loan debt. And Nii was working locums shifts several states away — the very thing funding our fertility journey was also making it harder.

This is the episode we've never been able to fully tell. Until now.

You'll hear:

→ Why we got married later — and what that cost us biologically

 → The rule we made when paying off debt (and how it complicated everything) 

→ IVF at $25,000 per round with no insurance coverage in Pennsylvania 

→ How locums income was our financial lifeline — and our biggest complication 

→ The appointments Renee attended alone while Nii was on the road 

→ What the IVF doctor said when Renee ovulated through her medications (and where Nii was) → Multiple rounds. None of them worked. 

→ How our boys came naturally — and the joke we make about their 529s 

→ 3 practical tips for physician couples navigating debt and fertility simultaneously

TEXT US: Have you ever had to choose between your financial goals and starting your family? Tell us your story. 1-833-230-2860 We read every message.

3 PRACTICAL TIPS FROM THIS EPISODE:

1. Know your state's IVF insurance laws before you choose where to live or work. Some states mandate insurance coverage for IVF (NJ, NY, MA, IL, and others). Pennsylvania did not cover us at the time. This is a factor worth researching — especially if you're in your thirties or planning to start a family.

2. Have the fertility conversation with your partner before you need it. Don't wait until you're in the middle of debt payoff to find out you need IVF. Talk to a reproductive specialist early. Get your baseline numbers. If you're a woman in medicine who wants children — consider freezing your eggs earlier rather than later.

3. Build your financial plan around your whole life — not just your debt. Your financial plan needs to account for more than the numbers. Build in the fertility timeline. Build in the family goals. Build in the geographic constraints. And if locums is part of your debt payoff plan — decide how far is too far before you take the assignments. Not after.

Find us on YouTube: www.youtube.com/@docsoutsidetheboxpodcast

RESOURCES MENTIONED IN THIS EPISODE: 

Locumstory.com - a free resource with unbiased information about locum tenens opportunities, real physician stories, and practical guidance to help you make informed decisions about your career. Check them out at https://dotb.s.gy/Pod

Resolve Website - https://resolve.org/

FREE DOWNLOAD: 

Download the First-Gen Doctor Blueprint — everything we wish someone had told us about finances, career planning, and building a life in medicine. Visit: https://darkos.lpages.co/first-gen-physicians/

Have a question for us?

• Send us a Voice Message: https://www.speakpipe.com/docsoutsidethebox 
• Text us: 833-230-2860
• DM us on Instagram: @docsoutsidethebox
• Email: [email protected] 

ABOUT DOCS OUTSIDE THE BOX:  

Dr. Nii is a General Surgeon. Dr. Renee is an OB/GYN. We are first-generation Ghanaian and Haitian physicians who paid off $662,000 in student loan debt in 3 years, built a locum tenens agency, and navigated every major medical career decision without a family blueprint.

We created this podcast for first-generation doctors — physicians who are the first in their families and lack the inherited knowledge about money, contracts, career strategy, and the unwritten rules of medicine that many of their colleagues learned growing up.

Real conversations for first-gen doctors.

Website: https://drniidarko.com/ 

DISCLAIMER: Dr. Nii and Dr. Renee are physicians, not financial advisors or attorneys. Content shared in this podcast reflects personal experience and should not be considered financial, legal, or medical advice. Please consult qualified professionals before making financial or career decisions.

© 2026 Docs Outside the Box. All rights reserved.

SEND US A TEXT MESSAGE!!! Let Drs. Nii & Renee know what you think about the show!

Nearly 50,000 people watched our co-parenting reel and asked the same question: "Why don't you just get a nanny?"

People expected us to have full-time help. We don't. Not because we can't afford it. Because we made a different choice.

In this episode, Nii and Renee pull back the curtain on the real systems, the real schedule, and the real financial trade-offs behind running a two-physician household with two boys — without a nanny.

You’ll hear:

→ Why Renee refuses to hire a nanny (4 specific reasons)

→ The Sunday Night Meeting — how we plan every week before it starts

→ The Primary Parent Rule — the core rule that keeps our household from falling apart

→ Our calendar system — how Nii builds his locums schedule around Renee's call

→ The Date Night Rule — the one non-negotiable that protects our marriage

→ Why our boys know the plan (and why it matters)

→ The REAL financial cost of this choice (Forbes data + our honest numbers)

→ Our one-income philosophy — if we can't build wealth on one physician income, we're doing it wrong

→ What we sacrifice. What we refuse to sacrifice.

If you're a first-generation doctor in your family, this is your community.

Find us on YouTube: www.youtube.com/@docsoutsidetheboxpodcast

RESOURCES MENTIONED IN THIS EPISODE: 

Locumstory. Learn how locum tenens helps doctors make more and have the lifestyle they deserve!. Check them out HERE!

Forbes article - https://www.forbes.com/sites/christinecarter/2025/02/11/motherhoods-price-tag-the-financial-reality-of-working-vs-leaving/ 

FREE DOWNLOAD: 

Download the First-Gen Doctor Blueprint — everything we wish someone had told us about finances, career planning, and building a life in medicine. Visit: https://darkos.lpages.co/first-gen-physicians/

Have a question for the podcast?

• Send us a Voice Message: https://www.speakpipe.com/docsoutsidethebox 
• Text us: 833-230-2860
• DM us on Instagram: @docsoutsidethebox
• Email: [email protected] 

ABOUT DOCS OUTSIDE THE BOX:

Dr. Nii is a General Surgeon. Dr. Renee is an OB/GYN. We are first-generation Ghanaian and Haitian physicians who paid off $662,000 in student loan debt in 3 years, built a locum tenens agency, and navigated every major medical career decision without a family blueprint.

We created this podcast for first-generation doctors — physicians who are the first in their families and lack the inherited knowledge about money, contracts, career strategy, and the unwritten rules of medicine that many of their colleagues learned growing up.

Real conversations for first-gen doctors.

DISCLAIMER: Dr. Nii and Dr. Renee are physicians, not financial advisors or attorneys. Content shared in this podcast reflects personal experience and should not be considered financial, legal, or medical advice. Please consult qualified professionals before making financial or career decisions.

© 2026 Docs Outside the Box. All rights reserved.

SEND US A TEXT MESSAGE!!! Let Drs. Nii & Renee know what you think about the show!

You didn't match. Now what?

Every year, roughly 7% of U.S. medical students don't match into residency. If you're one of them, you're not alone—and this isn't the end.

Reddit Question We're Answering: "M4 here. Didn't match into the only specialty I cared about. No backup plan. Would it be insane to just get off the hamster wheel? Years of sacrifice, crushing debt, and the light at the end of the tunnel isn't real. These two degrees feel useless now. Is there any coming back from this?"

In this episode, we break down exactly what to do when you don't match, how to navigate SOAP, and when to consider pivoting versus pushing through. 

What we cover:

→ How to navigate SOAP strategically (don't waste your 45 tokens) 

→ Why preliminary programs aren't stepping stones—they're your proving ground 

→ The one exam that makes the difference between 1 interview and 14 interviews 

→ Renee's story: Switching specialties days before the Match deadline 

→ When to pivot versus when to push through 

🎧 PODCAST EXCLUSIVE BONUS SEGMENT (25 minutes):

"The Surgery Resident Dismissed Because He Couldn't Pass Step 3"

In this podcast-only bonus segment, Nii tells the story of a co-resident who was one of the best technical surgeons he'd ever worked with. But he couldn't pass USMLE Step 3.

This 25-minute segment is exclusively available on the podcast version of this episode.

SIGN UP FOR OUR NEWSLETTER! 

WATCH THIS EPISODE ON YOUTUBE!

Send us a Voice Message - https://www.speakpipe.com/docsoutsidethebox

Have a question for the podcast?

Text us at 833-230-2860

CONNECT WITH US:

Instagram: @docsoutsidethebox

Email: [email protected]

Twitter: @drniidarko

Merch: https://docs-outside-the-box.creator-spring.com

SEND US A TEXT MESSAGE!!! Let Drs. Nii & Renee know what you think about the show!

In this episode, we share our honest struggle with fitness as first-generation doctors - from not being able to run a mile in residency to building a consistent 5-6 day per week workout habit using the Atomic Habits framework.

You'll hear:

• Why Nii couldn't run a mile by year 3 of surgery residency (and the McDonald's breakfast ritual)
• The Atomic Habits identity shift: "I am an athlete"
• How to make working out frictionless (clothes laid out, space ready, zero decisions)
• Why working out is protection against burnout, not just exercise
• How stress, imposter syndrome, and work follow you home (and what to do about it)
• The 6-step system to build fitness consistency
• Renee's honest take: "I don't love working out" (and why that's okay)

If you're the first doctor in your family trying to build fitness habits and protect yourself from burnout without the boundary-setting model your colleagues inherited, this is your community.

Find us on YouTube: https://www.youtube.com/@docsoutsidetheboxpodcast

Mentioned in this episode:

• Atomic Habits by James Clear
• T25 Workout Program
• Beachbody.com

FREE DOWNLOAD -  7 Considerations Before Starting Locum Tenens - https://darkos.lpages.co/7-considerations-before-locums

SIGN UP FOR OUR NEWSLETTER!

Send us a Voice Message - https://www.speakpipe.com/docsoutsidethebox

Have a question for the podcast?

Text us at 833-230-2860

Instagram: @docsoutsidethebox

Email: [email protected]

Twitter: @drniidarko

Merch: https://docs-outside-the-box.creator-spring.com

SEND US A TEXT MESSAGE!!! Let Drs. Nii & Renee know what you think about the show!

Two first-gen doctors answer your real questions: How to open a business bank account, and whether starting Medical school at 40 is still possible. 

This week's Q&A covers two questions that represent completely different stages of the first-gen doctor journey: a neurology resident finishing training and building her business, and a 40-year-old premed, wondering if the dream of becoming a doctor is still possible.

THIS WEEK'S QUESTIONS:

QUESTION 1 — From Mouna (Neurology Resident):

"I just created my LLC to do locum work, and I'm looking into opening a business bank account. Do you recommend a traditional bank versus newer online banks? Some of the online options have built-in bookkeeping tools — do you have experience or a preference?"

QUESTION 2 — From YouTube Comments:

"I am 40, coming from a career as a psychotherapist, married with children, with a mortgage, and $135K in student loan debt. I'm considering general surgery, psychiatry, neurology, internal medicine, and family medicine. I'm taking one class at a time and targeting 2030 for application. Any advice?"

SUBMIT YOUR QUESTION FOR NEXT WEEK:

We do Q&A episodes every week and we read every question submitted. Here is how to reach us:

📱 Text us: 833-230-2860

📸 DM us on Instagram: @docsoutsidethebox

💬 YouTube comments: www.youtube.com/@docsoutsidetheboxpodcast

📧 Email: [email protected]

Your question could be answered in next week's episode.

RESOURCES MENTIONED:

Business Banking:

- Relay: relayfi.com

- Found: found.com

- Novo: novo.co

Disability Insurance (mentioned by Mouna):

- Set for Life: setforlifeinsurance.com

Student Loans and Financial Aid:

- Federal Student Aid Loan Simulator: studentaid.gov/loan-simulator

- Income-Driven Repayment: studentaid.gov

Non-Traditional Medical Students:

- AAMC Non-Traditional Resources: students-residents.aamc.org

ABOUT DOCS OUTSIDE THE BOX:

Dr. Nii is a General Surgeon. Dr. Renee is an OB/GYN. We are first-generation Ghanaian and Haitian physicians who paid off $662,000 in student loan debt in 3 years, built a locum tenens agency, and navigated every major medical career decision without a family blueprint.

We created this podcast for first-generation doctors — physicians who are the first in their families and lack the inherited knowledge about money, contracts, career strategy, and the unwritten rules of medicine that many of their colleagues learned growing up.

New Q&A episodes every week. Real questions from real first-gen doctors.

Find us everywhere:

- YouTube: www.youtube.com/@docsoutsidetheboxpodcast

- Instagram: @docsoutsidethebox

- Website: https://drniidarko.com/

DISCLAIMER: Dr. Nii and Dr. Renee are physicians, not financial advisors or attorneys. Content shared in this podcast reflects personal experience and should not be considered financial, legal, or medical advice. Please consult qualified professionals before making financial or career decisions.

SEND US A TEXT MESSAGE!!! Let Drs. Nii & Renee know what you think about the show!

In this episode, we share our complete story - how we went from $662,000 in medical school debt to completely debt-free in just three years, as first-generation doctors without any family financial blueprint.

You'll hear:

• Why we accrued over $100,000 in interest (and how to avoid it)
• The exact moment we decided to pay off our debt aggressively
• Our real budget: $200/month groceries, $50/month fast food
• The sacrifices we made (and whether they were worth it)
• Why we're creating this podcast specifically for first-gen doctors

If you're the first doctor in your family navigating medicine without the insider knowledge your colleagues inherited, this is your community.

Find us on YouTube: https://www.youtube.com/@docsoutsidetheboxpodcast

Download our free First-Gen Doctor Blueprint: https://docs.google.com/document/d/1X4oH1EAkmVMSFDbHmeIN3M6w97GfhW16BTGOX7kK3nc/edit?usp=sharing

SIGN UP FOR OUR NEWSLETTER! 

Send us a Voice Message - https://www.speakpipe.com/docsoutsidethebox

Have a question for the podcast?

Text us at 833-230-2860

Instagram: @docsoutsidethebox

Email: [email protected]

Twitter: @drniidarko

Merch: https://docs-outside-the-box.creator-spring.com

This episode is sponsored by 

Set For Life Insurance. What the Darkos use for great disability insurance at a low cost!! Check them out athttps://setforlifeinsurance.com/

SEND US A TEXT MESSAGE!!! Let Drs. Nii & Renee know what you think about the show!

This episode hits EVERY corner of healthcare. Medical students, residents, nursing students, and attendings. 

We’re diving deep into: 

1. The Department of Education’s classification of nursing as not a professional degree 

● What does this actually mean? 

● Does it affect student loans? 

● Will this change the future of nursing?

● Why EVERY healthcare worker should pay attention 

This episode hits home for: 

● Nursing students 

● Medical students 

● Residents & fellows 

● Attending physicians 

● 1099 & locums doctors

● Anyone interested in healthcare policy or physician lifestyle 

If you’re studying, training, practicing, or thinking about locums… this one’s for you. 

Comment Below: 

● Are you a nursing student affected by the DOE classification? 

● Would you listen to Wale’s new album in the OR? 

● Are you making your HSA contribution this year? 

● Are you considering locums in 2025–2026?

FREE DOWNLOAD -  7 Considerations Before Starting Locum Tenens - https://darkos.lpages.co/7-considerations-before-locums

SIGN UP FOR OUR NEWSLETTER!

WATCH THIS EPISODE ON YOUTUBE!

Send us a Voice Message - https://www.speakpipe.com/docsoutsidethebox

Have a question for the podcast?

Text us at 833-230-2860

Instagram: @docsoutsidethebox

Email: [email protected]

Twitter: @drniidarko

Merch: https://docs-outside-the-box.creator-spring.com

This episode is sponsored by 

Set For Life Insurance. What the Darkos use for great disability insurance at a low cost!! Check them out at www.setforlifeinsurance.com

SEND US A TEXT MESSAGE!!! Let Drs. Nii & Renee know what you think about the show!

In this episode, we’re diving deep into: 

1. Wale’s new album. Is it worth playing in the OR? 

A quick, fun review: focus, vibe, and OR compatibility. 

 2. HSA Deadline Reminder. LAST MONTH to contribute 

We’re making ours… are you? If you’re a med student, resident, or attending in a high deductible plan, this is the best tax tool available. 

This episode hits home for: 

● Nursing students 

● Medical students 

● Residents & fellows 

● Attending physicians 

● 1099 & locums doctors

● Anyone interested in healthcare policy or physician lifestyle 

If you’re studying, training, practicing, or thinking about locums… this one’s for you. 

Comment Below: 

● Would you listen to Wale’s new album in the OR? 

● Are you making your HSA contribution this year? 

FREE DOWNLOAD -  7 Considerations Before Starting Locum Tenens - https://darkos.lpages.co/7-considerations-before-locums

SIGN UP FOR OUR NEWSLETTER!  

WATCH THIS EPISODE ON YOUTUBE!

Send us a Voice Message - https://www.speakpipe.com/docsoutsidethebox

Have a question for the podcast?

Text us at 833-230-2860

Instagram: @docsoutsidethebox

Email: [email protected]

Twitter: @drniidarko

Merch: https://docs-outside-the-box.creator-spring.com

This episode is sponsored by 

Set For Life Insurance. What the Darkos use for great disability insurance at a low cost!! Check them out at https://setforlifeinsurance.com/

SEND US A TEXT MESSAGE!!! Let Drs. Nii & Renee know what you think about the show!

In this episode we're discussing a life update which is renting out part of our home + kitchen renovations we are doing.
We are breaking down the financial lessons we’re learning as a physician household with tenants. 

FREE DOWNLOAD -  7 Considerations Before Starting Locum Tenens - https://darkos.lpages.co/7-considerations-before-locums

SIGN UP FOR OUR NEWSLETTER!

WATCH THIS EPISODE ON YOUTUBE!

Send us a Voice Message - https://www.speakpipe.com/docsoutsidethebox

Have a question for the podcast?

Text us at 833-230-2860

Instagram: @docsoutsidethebox

Email: [email protected]

Twitter: @drniidarko

Merch: https://docs-outside-the-box.creator-spring.com

This episode is sponsored by 

Set For Life Insurance. What the Darkos use for great disability insurance at a low cost!! Check them out at https://setforlifeinsurance.com/