You don’t have to become a refugee from medicine.
Welcome to the first installment in what I hope will become a shared playbook for physicians who seek role models: docs who cut back to improve work-life balance.
Mime in a shrinking box, anyone?
When burnout strikes, the reflex is to desperately search for an escape hatch from medicine as quickly as possible.
This series is intended to demonstrate alternate paths to outright abandoning your medical career.
- Some folks made radical life changes.
- Some created a career glide path.
- Some looked at their biggest aggravations and subtracted them methodically, finding the job that was left over was one they actually enjoyed.
- In reclaiming time by reducing clinical work, they rediscovered joy.
Vagabond MD is internet famous in physician finance circles.
You’ll find witty guest posts and thoughtful comments sprinkled generously among veteran and fledgling physician finance bloggers alike.
For me, this is like starting a TV show in my garage on public access cable with Oprah as my first guest.
Without further ado, here is Vagabond in his own words.
(My questions are in bold).
1. What is your specialty? Diagnostic Radiology with IR Fellowship
1a. How many years of residency/fellowship did you complete? 5 years total
1b. How old were you when you began to cut back? 52
1c. How many years out after completing training was this? 21.5
2. What did your parents do for their livelihood?
Father was an orthodontist (who talked me out of “following in his footsteps”); mother was SAHM.
2a. Would you characterize your upbringing as financially secure or insecure?
We were technically financially secure BUT there was constant conflict between my keeping-up-with-the-Jones’ mother and my Depression-era-frugal father. It was a combustible match, and they eventually divorced but not before I was married and in my 30’s. Until they were split, there was always financial tension in the household.
2b. How did your upbringing affect the money blueprint you inherited – both positive and negative?
My mother taught me to appreciate “nice things” and to do whatever possible to “have the very best”. My affluent father, now 86, is very frugal; he instilled in me his work ethic and taught me about investing and the stock market.
3. What motivated you to cut back? [Family / burnout / relationship / divorce / lawsuit/ other?]
I experienced a spell of deep burnout, chronicled elsewhere, and I was contemplating retiring from medicine completely. I started to strip off the pieces of my professional job (IR, leadership, and, eventually, full time work) to see if I could salvage my career. It worked! The full time job was the last to go. By the time I dropped the former two, my burnout was probably 75% resolved.
4. What were the financial implications of cutting back?
4a. Did you downsize home or lifestyle?
4b. Slow your progress to retirement? Describe your thought process in making these trade-offs.
Though not the case throughout our lives together, my wife’s legal career has, over the last few years, generated an income comparable to mine. It has been like having two full time radiologists’ salaries, so cutting back to 1.6 radiologists has not exactly left us eating Alpo and living under a bridge. We have made no tangible sacrifices, other than that our saving rate has decreased.
At the start of the year, our nest egg stood at a value north of one bionic man, and I felt that we were already well-enough positioned for retirement. I am fortunate that any financial sacrifice has been modest.
5. How did colleagues react to your decision?
5a. How did you respond?
5b. Was your family supportive or critical? Partner? Parents? Children?
My radiology partners have been supportive and regularly acknowledge that I remain a valuable member of our group. Even as a part timer, I am billing more than three of my full time colleagues and on an RVU/FTE basis, I am the most productive person in my group. The quality of my work is better, my enthusiasm for work is greater, and my mood is improved.
Many other docs at the Hospital were quite curious, and many did not understand. It is unusual, to say the least, for an ostensibly mid-career male physician to cut back. “I hear you are semi-retired?”, some would ask with a smirk. I would reply, “No, part time.”
In my mind there is a huge difference. “Semi-retired” implies that one is transitioning toward retirement. “Part time” just means not working full time.
My family, especially my wife, has been extremely supportive. When I was mired in burnout, my wife gave me the all clear to just quit outright, and we would figure things out. I am glad that I did not. My father, who interestingly burned out in his career at about the same age as I did, was very understanding and was happy and relieved that I found a way to continue my career. My children, well, as long as there is gas in their car tanks and connectivity for their phones, not much phases them.
6. What have been the main benefits of your decision to cut back?
As alluded to above, one of the main benefits is that I am doing a better job at work. It benefits me, my partners, my referring colleagues, our patients, and our community. Yay!
Personally, I feel lighter, happier, and more relaxed. I feel like I probably can do this for a long time, indefinitely.
7. Main drawbacks?
Well, when you have two full time professionals sharing the household responsibilities of laundry, dish washing, shopping, errands, and such, and one of the two suddenly has more free time…
Obviously, there is less money coming in. However, if going part time extends my career, which I expect it will, the financial benefit of “working less but longer” will accrue over time.
8. Did you fear your procedural or clinical skills might decline? How did you address this concern?
I did not have such fear. I have been doing this for over 20 years, and working three days per week is not that much different than working 4 1/2-5 days per week. Paradoxically, I have renewed interest in learning and perfecting my craft. I will end this year with 75+ hours of CME.
9. If you are honest, what percent of your identity resides in being a physician? How did cutting back affect your self-image, and how did you cope?
In a vacuum, I would say that little of my identity is wrapped up in a white coat, but in the real world, yeah, my identity is intertwined with my MD degree a whole lot. I am working to unwind this. I think that one benefit of cutting back is that you can keep 100% of the identity of a physician without working at 100% capacity.
10. If you had not gone into medicine, what alternate career might you have pursued?
I did not know about it at the time, but I would probably like the work of an actuary. I might have gone into finance or mathematics. If my father would have encouraged it, I almost certainly would have been an orthodontist.
11. What activities have begun to fill your time since you cut back?
I do have a consulting side gig as a national medical director for an imaging company. I have enjoyed some aspects of it but not others. I have traveled for this work three times this year, and two of the trips were not very interesting and really wore me down. Early flights, crappy hotels, wearing a suit and tie, demanding schedules, etc. It made me realize that the most efficient way for me to convert my time into money is to keep practicing medicine.
Outside of work, there’s laundry, dishes, grocery shopping, meal preparation, etc. 😉 (see above). I enjoy reading more, posting more on forums and Twitter, additional guest blogging and writing, spinning, and taking long walks with my dogs. I have more time for trip planning, too, which I enjoy immensely. I am working on my photography skills. I am never bored for long!
12. If approaching retirement, what activities have you begun to prioritize outside of medicine so that you retire to something?
The consulting side hustle was one such effort. Ideally, a location indie gig like consulting should allow me to work from anywhere and on my terms. I would grade myself as “Incomplete” in the effort to have a retirement life outside medicine.
13. Did you front-load your working and savings, or did you adopt a reduced clinical load early in your career? What was the advantage of the route you chose? What would you do differently if you were graduating residency today?
Though it was not intentional, I guess I stumbled into front-loading by not knowing any better. Maybe I worked full time a few years too many. If I had to do it again, I would have tried to go part time sooner, but I am not sure part time was a viable option for me, say, 10 years ago. Times have changed, and people are more accepting of having part time partners and colleagues than they were 10 years ago.
In retrospect, I might have chosen a different fellowship coming out of residency, one that was less likely to lead to burnout (IR) and might have allowed me to have a more sustainable career and work life.
I would close by suggesting, and I believe that CrispyDoc would agree [Ed.: He most certainly would!], that newly minted docs should be aware of the high likelihood of burnout and make career decisions that reduce the risk and allow alternatives if/when it hits you. Twenty years ago, a colleague hinted this to me, and I ignored it. I subsequently watched colleagues burn out around me until it finally hit me. Network extensively throughout your career and keep your options open.
Thanks for taking the time, Vagabond!
Kind reader: Any suggestions for additional questions, improvement of format or constructive feedback would be welcomed and appreciated!