Doctors Who Cut Back Early

crispydoc Uncategorized 23 Comments

Old school medicine was not conducive to balance. Your family got the scraps of time leftover after your patients had staked their claim.

Cutting back on your clinical load was done reluctantly, of necessity. You cut back because you needed your aortic valve replaced, and your energy in clinic never fully returned; because the diagnosis of Parkinson’s meant you could no longer operate; because your divorce meant you had to pick up the kids from school on days you had custody. Life was relegated to the margins while work took center stage, and that order of priority was only begrudgingly disrupted.

A brave new breed of docs is upending tradition to tilt their work-life balance decidedly in favor of life. It’s a big deal. First, many of these docs graduated with record levels of educational debt. Second, some these docs defy traditional gender roles: instead of male providers and female homemakers, there are sensitive new age dads prioritizing time with their young children during the formative years married to high-earning women. Third, they are willing to leave money on the table to live the life they want and mold their careers to their values.

Roughly twenty years ago I read Malcolm Gladwell’s classic book The Tipping Point. It describes how ideas have the potential to spread like viruses until they reach a dramatic moment that turns an outbreak into an epidemic. Gladwell appropriated terms from virology and applied them to fads. He highlighted certain human vectors, individuals who have outsize influence in the transmission of ideas:

  • Connectors spread the idea throughout their extensive network.
  • Mavens develop such in-depth expertise that they develop enhanced status as go-to folks for advice.
  • Salespeople channel their unbridled enthusiasm for the product into a multiplier that drives its promotion.

Gladwell’s terms seem prescient when applied to online influencers. If you were to look over a list of 50 physician finance bloggers you’d easily identify the connectors, mavens and salespeople on that list who are promoting not only financial literacy but early financial independence (FI) for physicians.

I’ve written previously about my reasons for cutting back and my experiences after going to half-time. The WCI Forum has hosted multiple threads on this topic highlighting the pros and cons of cutting back to part-time status early in a medical career.

Today I’d like to highlight fellow physician finance bloggers who made the choice to reduce their clinical burden early in their careers. They have pulpits of varying sizes and differing motives for cutting back their clinical load far earlier than was historically the case. By setting public examples of unconventional career paths in medicine, I’d argue they bring us closer to a tipping point when the most talented physicians select jobs based on how the position suits work-life balance.

B.C. Krygowski is part of a dual-physician household with kids whose collective educational debts once totaled $750,000! Despite facing this large handicap out of the starting gate, a decade and a half later she and her husband have both gone to part-time work in order to prioritize their family and marriage over their careers. Her story is compelling, and the long journey that resulted in both spouses going part-time is well worth the read.

Cory Fawcett MD is a general surgeon who has written of the unique challenges that surgeons face in trying to go part-time. His solution was to leave his practice and spend the final three years of his career in locums positions in underserved rural areas. This creative solution allowed him the ability to control the amount of time he was working and schedule protected time off for recreational travel and family time, something a surgeon in private practice might otherwise have great difficulty in accomplishing. For those whose specialty is all or none, and whose personal circumstances permit (empty nesters come to mind) locums work offers a viable solution.

Doc Of All Tradez transitioned to part-time position as an anesthesiologist in March of this year, and has blogged about keeping the cash flowing to investment accounts while trimming fat from his spending. His self-imposed ban on Costco runs (he calculates he spent an extra $300 above what his wife spent on visits that were ostensibly for groceries) is one example of how thoughtfully removing an attractive nuisance can eliminate temptation and cultivate frugal habits.

The Happy Philosopher is a radiologist and father whose wife, also an MD, is currently home with the kids. He used early career burnout as motivation to simplify his life and adopt more mindful living. He now job-shares a 50% position that suits his life and values far better than full-time practice.

Nisha Mehta MD is a radiologist and mother of three married to a plastic surgeon. She left her academic position for a job as a VA radiologist in large part because academic time encroached continually on family needs. She has spoken movingly of the sacrifice she made, and the subsequent increase in personal happiness she and her husband experienced as a direct result of her more family friendly job. (Having briefly flirted with academia myself, I was reminded of Sayre’s law: “Academic politics is the most vicious and bitter form of politics, because the stakes are so low.” For the record, academia and I never made it past second base.)

Physician on Fire needs no introduction. An anesthesiologist with a  stay at home spouse, he applied his go-get-’em-tiger work ethic (spending the week between the end of residency and the start of his first attending job working a locums gig), a higher paying specialty, geographic arbitrage (lower cost of living + higher regional remuneration for his specialty) to reach financial independence after a decade of practicing medicine. He’s cut back to a 60% position by finding two partners in his practice who were each willing to pick up an additional 20% of the workload. His situation could be difficult to replicate for other rural docs as a lot of moons need to line up with Jupiter to get one’s partners on board with the plan.

Some Random Guy Online is an emergency physician who recently posted on his experience “flaming out” on the road to FI. He’s dropped two shifts a month from his clinical load, a feat that is admittedly easier to accomplish where a large group of physicians can pick up the slack with a negligible impact on their quality of life. Shift-based specialties like emergency medicine, anesthesia and urgent care are more likely to find success in cutting back in a large urban area (SRGO lives in the Bay Area). Certain large institutional physician entities like Kaiser may be more amenable to non-traditional per diem arrangements than single hospital private groups.

For workaholic docs, going “part-time” can mean cutting back to just one job or eliminating extracurricular aggravations. Vagabond MD, an interventional radiologist, wrote a moving guest post on how burnout led him to let go of those “extras” (chairing the department, taking weekend call) that had gone from sources of pride, status and supplemental income to causes of depletion.

Workaholic doc part-time is the equivalent of full-time for the rest of us. No one exemplifies this better than the White Coat Investor. Between his impressive online empire (which earns far more than his emergency medicine income), he’s been working the equivalent of two full-time jobs simultaneously for years. Dr. Dahle had previously cut back to .75 FTE and stopped working night shifts completely. As of summer 2018 he’ll go down to 6 8 shifts a month, officially making medicine his side hustle while blogging/podcasting becomes his primary job. (For the other 50+ physician finance bloggers out there, blogging in obscurity out of passion, Dr. Dahle’s success is an affirmation: Yes, Virginia, there is a Santa Claus.)

Someday physician groups will need to offer multiple career paths just to remain competitive in hiring the most talented docs. Until then, the folks above have generously shared their playbooks in public to use as templates for your own career longevity plan.

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Comments 23

  1. I wonder about your analysis. If you squeeze the balloon on one end making it smaller, what happens to the other end? Relieving your obsession with medicine and substituting an obsession with a blog is just making the other end larger with a crappier payback. You are still obsessed, and still burning out. (not you personally but the general YOU).

    Bill Bernstein characterizes YOU as a store of human capital, and you work till your human capital is exhausted, typically at 65. During the course of human capital exhaustion you stick value from your human capital into an account that compounds so you have something to live on once your human capital is exhausted. If you saved enough and compounded enough, and de-risk enough, and plan well enough you will have enough to die not poor. You have one life and one allotment of human capital. If you’re not effective with it you are hosed. The later you start in your accumulation the less likely you will be to succeed. If you start late with a lot of debt, and quit early = Russian roulette when it comes to adequate capitalization. 5 times you’ll be fine 1 time you’re dead. If Mr Market smiles on you and you enter the market lets say in 2009, you ride the rocket to the moon. If you entered say in 1999, not a rocket, totally different trajectory, so Mr Market giveth a big wad or Mr Market giveth a dinky drab and you don’t have the first clue what tomorrow brings, except for sure you are one day closer to exhausting your human capital. I think this is how it works.

    I have no more human capital to give and I’m acutely aware what that means. When I retired I engaged in the race to “not die poor” that is the target. One advantage is I’m old so I’m much closer to the target and my probability of not hitting the target (risk) is becoming smaller and smaller with each passing day. Makes me wonder about the aim of someone 30 years my junior (30 years farther away from the target) just how good their aim is going to be if they enter my race to “not die poor” that far away from the target, and waste their human capital on balloon squeezing. Not being negative just engaging the other side of the equation which is risk. I have the history of burning every cent of my human capital. I know what that felt like. In retrospect it wasn’t all that fun but I had me a good dose of denial going on so I didn’t really notice. Now I’m in the process of running the post retirement, human capital free race to “not die poor”.

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      Gasem,

      Appreciate the points you make as much as I enjoy how you make them.

      I’m not suggesting a blog will replace clinical income, but it’s interesting that many docs have found that as a passion project to recover mojo blogging seems to serve a purpose: “Meet your new analyst – your notes are now kept in the public domain as part of the New Catharsis.” If you are seeking support within the long tail of niche interests or niche annoyances (such as the 1% problems that face most docs) it provides a better chance of finding support with fellow eccentrics.

      I’m familiar with Bill Bernstein’s human capital to investment capital spectrum, and I’d agree that a big part of our success was plowing through the first 15 years of my career not knowing that it could be done differently. The early income diverted directly to retirement and time spent compounding combined with luck (Mr. Market smiled) propelled us forward. I benefited less from denial than resignation for a long time.

      Having said that, my wife and I chose to buy the doctor house and live in a HCOL state – we knew this was an expensive decision and had our reasons. We pay for services that many would not (child care, home cleaning).

      To offset those pricey choices, we front-loaded our savings by storing chestnuts for the winter while they were there to be harvested – we were savers first. We have a diversified income stream (dual-income professionals, my wife’s side gig exceeds her part-time income from clinical medicine), which provides me the luxury of a glide path without substantially reducing our living standard. We are dirtbags in pretty nice neighborhood – I like to think we are the riffraff the HOA failed to keep out (used cars, used clothes, kids walk to and from school).

      What are the things that folks who squeeze the balloon early forsaking? They can live a terrific middle class lifestyle with far less work, but not a full-fledged doctor lifestyle at a reduced clinical workload. They can own a home, but not a doctor home in a HCOL area. For some, the extra time is absolutely worth it. The Happy Philosopher is a great example of someone who can thrive with a 50% radiology job-share but hated full-time. By serendipity, his guest poster today is someone in precisely the situation you describe – crispy at a relatively young age, possibly still has debt to pay off, but not going to last in the current job given her high level of burnout. Those are the folks who could use an alternate career path and might welcome different role models from the capital “D” Doctors of yore.

      No one will ever argue that it’s important not to die poor. But what a tragedy if in order to do so, the only pathway available to you is to live sad.

      Thanks for the feedback,

      CD

      1. I want to make it clear I am just arguing my side, it’s pitfalls and my worries from my experience. I’m judging no one. You listed 10 people plus yourself who have taken the risk of a decreased workload to deal with the psychic pain associated with lack of balance medicine has caused in our lives. It’s a totally legit thing. Let me say that again, it’s a totally legit thing. I’m hoping it’s worth having a perspective from someone a little closer to the target, with a little experience in post human capital living. As long as I’m honest in what I say, you can take what I say or leave it as you like.

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      2. Not to eavesdrop on this conversation, but I am that guest poster on The Happy Philosopher. I do indeed have student loans yet to pay off and still chose to cut back, albeit cutting back from 50 to 40 hours a week which to most outside the medical field is still considered full time.

        Gasem’s points made me smile as this is the exact conversation I have with my father when I tell him I’m going to quit working in 10-15 years. He’s concerned I will run out of money as I will surely live til I’m at least 90 years old, and my earning potential and human capital will be nil at that point.

        All very valid points.

        However, if I burn out on my way there, what is the point? If I neglect my husband, friends and family, who will be there to spend the rest of my life with me and my bags of money?

        For me, personally, life is about true connection and meaningful experiences. If cutting back on work or spending my human capital on a blog that makes me zero money does this for me, I would argue this is well worth it.

        I’m still on my journey to figure out what will work best – perhaps if I cut down to 3 days a week I will have a longer career. But right now, I’m aiming for financial independence while keeping my sanity intact.

        Just my two cents 🙂

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          RoaM,

          You are welcome to join this conversation, as it’s more pertinent than ever to an increasing number of docs.

          In your conversations with your dad, I can hear you playing my song. When I spoke to my immigrant parents about cutting back, they were ambivalent – hadn’t they come here and worked hard so their children could become high earning professionals and pull our family higher up that socioeconomic ladder? Why would I reduce earnings just when my earning potential is greatest? Mom didn’t know how to take it, and dad worried if I became a deadbeat son my wife would have to support us both – a point embarrassment in the macho latin culture where he grew up. Ultimately, we are better off living the lives we want than those our parents want for us.

          50 to 40 is not so much cutting back as titrating to sanity – it may take more tweaking in different life stages. As long as you are okay with leading a luxurious middle class lifestyle instead of a luxurious upper class (traditional doctor) lifestyle, you ought to be fine.

          I, too, thought FI was my ticket out, but found along the way that as I cut back more and (thanks to FI) eliminated more of the aggravations of medicine, I rediscovered some of the joy in it. My repletion comes from interactions with women over 70 and girls under 7; I flirt shamelessly with the former, and all the magic tricks (think disappearing coin) that induce eye-rolls in my kids these days never fail to delight the latter. Point being, doing less of it may restore some of the former luster and (dare I say it?) joy it once brought you.

          As a final note, during our second year retreat in residency, there was a Jeopardy-type quiz show, and one of the questions deeply affected me.
          Q: What is the total number of wives for (names 3 tenured full professors in our department)?
          A: Nine.

          Divorce happens and none of us are immune, but that extremely high number suggested to me that medicine is a jealous mistress who can exact a steep price in other parts of our lives if we neglect that part of our garden.

          You will not regret investing time and passion in those other facets of your life that imbue value and meaning. While it can put a wind in your financial sails to frontload your workhorse years, it’s not worth a life of anhedonia to do that.

          Look forward to reading more great things from you, and thanks for stopping by!

          Fondly,

          CD

  2. Thanks for including me in your list. More and more doctors are looking for a new way of life. 1/3 of all practicing doctors want to make a major change. I think a big shake up is coming down the pike for doctors and medicine in general. Wish I could predict what it will be.

    Dr. Cory S. Fawcett
    Prescription for Financial Success

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  3. I have slowly made the transition myself to preserve my human capital as Gasem put it so eloquently. I have done this by paying someone to cover my shift that allows me to take 1 day off a week.

    That move in itself has preserved my sanity and allows me to recharge my batteries to hit the remaining 4 days.

    I can definitely see trying to go down another day and with a 3 day work week could carry that on indefinitely (though I would still likely retire in my early 50s).

    As more and more docs are using this escape plan from burnout it may generate a vicious cycle (clinical work gets placed on others who may burnout faster). The best and brightest in the younger generations may see this trend and not even want to pursue a career in medicine. At one point there will be a tipping point where not enough going into this career unless changes made

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      Four kids, a wife, the WCI empire, skiing, rock-climbing, canyoneering, lecturing, starting a new conference…and EIGHT shifts?
      I’d assumed it was six when you mentioned half-time. Thanks for the correction and the inspiration.

      Fondly,

      CD

  4. Our niece married a doctor at the beginning of a promising career. I wonder whether early retirement will hit his radar screen.

    I only know thee of the bloggers you mentioned. Thanks for the intro to the others.

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      Mrs. G,

      There’s a role model for every would-be slacker physician here – serial entrepreneurs, burnout victims, overachievers leaving academic aspirations behind.
      I’d advise you avoid sending your nephew this link lest you tempt him to prematurely end his promising new career.
      Congrats on the home sale, I’ve enjoyed reading about your victories on the fight-o-meter from that clearly well-trained husband of yours.

      Fondly,

      CD

  5. Yes, I shifted to part-time too. I work three days a week and it is awesome. It retains the benefits of working as a doctor but reduces the stress and hassle.
    You don’t have to wait until FI to go part-time, but that is the approach I chose and it worked great.

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      Wealthy Doc,

      Had I known I’d have included you in the lineup! While many FI bloggers advocate FI as a means of checking out, there’s something to be said for eliminating the aggravations to make medicine sustainable. I’d always envisioned an abrupt departure to a second act, but cutting back has made a glide path out of my career a far more appealing option, both for the added financial security and the greater pleasure of work.

      One more year syndrome sounds dreadful; three more days a week syndrome, not so much.

      Appreciate your “outing” yourself for our benefit,

      CD

  6. Thanks for the inclusion! My husband and I are not alone! (& for the record, that $750K of debt included a 2 Dr. McMansion we jettisoned. It’s a long story and was a big mistake – I shall blog about it in the future). I find I feel dim when I don’t write on a regular basis, hence (re) starting blogging to share our trials – hoping it will help others. And truth be told, I am a connector at heart. I love Malcolm Gladwell books! His Outliers made a profound impact on me. Great blogging btw! Wish you would join us on the cruise to Cuba this Sept! (#POF organized)

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      BC,

      I’ll look forward to reading about the downsizing soon! It was hard enough to get the time for FinCon (the start of school tends to find us packed with commitments) but I’ll look forward to hearing about your cruise afterward – hopefully we’ll have the opportunity to meet at finance geek summer camp if you are going. I haven’t yet read Outliers, will put it on the agenda!

      Fondly,

      CD

  7. Thank you also for the mention. I am now enjoying the part time glide (0.6 FTE) and look forward to the end of my current job next year (at age 54). What next…who knows?

    I wish that I had moved to part time sooner, but I was in one of those all-or-nothing jobs that did not allow it (IR), and I first had to reshape my job description and role. If I knew years ago what I know now, I would have chosen a more flexible sub specialty, maybe even a different specialty altogether.

    Cautionary tale for younger physicians, don’t assume that you will love your job forever and find fields, skills, and situations that allow maximum flexibility. Your future self will look kindly on it.

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      What a long, strange trip it continues to be. Your points are well-taken. Any seasoned physician, regardless of specialty, would agree that what thrills you in your thirties won’t always hold up in a decade or two, with a totally altered context (kids and a spouse might be added into the mix along with health changes). It’s also fascinating to me that so many docs from the ROAD to happiness specialties (Radiology, Ophtho, Anesthesia, Derm) feel this way as well.

      Autonomy and flexibility command a higher premium commensurate with their increased value over time, and leaving some money on the table in order to make the Venn diagrams of the lives we lead overlap the lives we want to lead can be worth it to a mature physician who has used early discipline to start downt he road to financial success.

      Thanks for stopping by,

      CD

  8. Of the ROAD specialists I personally know from my training generation (early-mid 90’s), I would guess that a disproportionate fraction are disenchanted with their careers 20 years on, when compared to other medical colleagues, with the possible exception of the dermatologists.

    Radiology, in particular, has become a major grind, and many friends from residency are also plotting their exits in their 50’s, if their financial lives will allow it. Fortunately, we graduated into a market where incomes and opportunities were initially rising, and if we were blessed with a reasonable cost of living, sensible with our lifestyles and or had a spouse with a high income, we are living in a medical world that we can escape.

  9. I think your last statement about physician groups offering multiple career paths for longevity is very insightful. To me, that doesn’t mean part-time versus full-time, but more about different roles. A common theme that I have observed in docs looking for a change, such as leaving clinical medicine due to not feeling fulfilled, is boredom. Personally, I get bored of just about anything within 5-10 years max. Our group offers a lot of flexibility which I think will prolong my career. Part of that is because with ICU, we can scale up and down in workload. However, a big part is that we have a well supported diverse practice. Many of us practice ICU and spend time in another specialty to mix it up. I have also been able to morph between educator, educational admin, building new clinical programmes, clinical leadership roles, research, and mentoring. If medicine doesn’t offer the options to practice and morph in different ways, then those who are most innovative and driven will look elsewhere. Having FI enables that, but it can also enable people to find fulfillment within their medical careers by not worrying about money as they morph.

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      Loonie Doc,

      I think your insights into Critical Care (one of the specialties consistently named as the leading edge burnout rate along with my specialty, Emergency Medicine) are highly instructive. The ability to scale up and down commensurate with different stages in life, and the ability to bob and weave into education and administration are great examples of how to create the job you want by following your interests.

      At the risk of sounding ribald, boredom should prompt you to try new positions. Our group nocturnist, who for years channeled her interest in technology by volunteering to solve problems with IT when we adopted computerized physician order entry (and later, “dynamic” documentation) is now transitioning to become our hospital’s inaugural Physician Chief Informatics Officer. I continue to enjoy serving on the Bioethics Committee, and my time heading up our group’s response to the opioid epidemic has led to being on a committee helping deal with the ED’s frequent flier population – a fascinating challenge that keeps me learning and collaborating with social services, case management and hospitalists.

      FI enables the option to reduce your clinical load in order to take on new responsibilities whose initial time investment may not result in immediate remuneration. It also empowers you to say no to suggestions you serve on cruddy committees. The freedom to decline and the time to pursue passions can reshape a career, augmenting satisfaction and longevity.

      FI let you do what you like even when it’s not what pays the most.

      Appreciate your thoughts, and I continue to enjoy the wonderfully absurd humor in your posts.

      Fondly,

      CD

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