Docs Who Cut Back #1: Vagabond MD

crispydoc Uncategorized 31 Comments

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!

Comments 31

    1. @WealthyDoc,
      I intend to work quite a bit longer than my plan was 18 months ago, but I will not work full time (in medicine) again.

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  1. Insightful questions, thoughtful answers…..I would expect nothing less.

    With many physicians’ salaries tied to productivity, income isn’t always directly tied to work hours. I think it’s interesting that Vagabond’s renewed vigor allows his to crank out more RVUs than some of his full time partners.

    Vagabond – does your group provide benefits to part timers? If they didn’t and your wife was a SAHM would that have changed the way you cut back?

    Did I catch a side hustle in there?! Although I prefer the pantsless kind over the suit and tie kind, I am glad to see you start exploring some non-clinical uses of your medical degree.

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      I can echo Vagabond’s experience that working less has resulted in increased effectiveness on an RVU basis. I’m squarely in the middle of the pack in terms of my patient volume, but have become one of our top billers in critical care, simply by doing a better job of documenting the care I provide.

  2. @SHS,

    Our group takes a “total compensation” approach to part time partners. For every $100 the full time partners receive in salary and benefits, I receive $60. No one cares if I take that $60 in salary or health insurance. The money is fungible. What I do not receive are random days off the partners get, maybe one or two per month, in addition to vacation days.

    And, yes, very observant to notice that my wife picks up benefits, too, like our family health insurance. If she were a SAHM, there would have to have been a different approach.

    And, yes, there is a side hustle, a consulting job (actually a couple of related jobs), that will earn me around $25k this year.

  3. Nice interview. It’s great to learn more about Vagabond MD.

    One burning question that I have (and I apologize if it has been answered elsewhere) is… What’s the story behind the name “Vagabond MD”??? I was always under the assumption that its because he likes to travel and go from place to place. But I never knew for sure. Thanks for entertaining my question.

    1. @Dr.McF, thanks for reading and checking me out.

      This burning question will be answered in full in my upcoming X-ray beam interview, next week, I believe, so you will have to tune in. 😀 Honestly, I am surprised no one really ever asks.

      That said, I have become a Vagabond MD blogger, of sorts, leaving both impromptu and invited essays on numerous other MD personal finance and lifestyle websites.

      1. Can’t wait to see the story in the X-Ray Beam interview!

        By the way, you are more than welcome and invited to write an essay / guest post for my MD personal finance and lifestyle website any time! 🙂

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        Get your “Vagabond MD – World Tour 2018” T-shirts now! Concert cities include major metropolitan areas like Doctor of Finance MD and Xrayvsn, as well as occasional small rural venues in intimate settings like Crispy Doc, where Vagabond plays acoustic sets without the band.

        Note the beautiful hippie twenty-somethings camped out on blankets in front of the concert who smile as they sway rhythmically to music in their heads, pleading, “I need a miracle every day!” and hoping a passing Samaritan will buy them a ticket to enter the show.

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      DMF,

      My years in the ED have taught me that most burning my patients complain of ends a few days after 250mg of IM ceftriaxone and a gram of azithromycin.
      We’re open 24/7 if your burning persists…

      CD

  4. VagabondMD is one of my hero’s. He is the proof you can make medicine into what you want. I did the full bore 100% practice for about 18 years and saved hard and heavy and planned all the contingencies like college, new cars, trips etc. We lost that contract so I took a year off, and went another direction and helped start a SDSC and practiced there for 7 more years. By then I was old and over funded so I quit. I ended on my own terms and was content to end. I never hated my career from start to finish but also it never defined me. It was a role I played and I was expert at making that role happen, but when the role was over I was still me and there was no hole to fill because I never dug the hole. Sing: “Oh yea life goes on long after the thrill of living is gone…” Rock on!

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  5. Man, I had this exact conversation with CrispyDoc at FinCon. I am only two and a half years out from residency and one and a half out from fellowship, but when my wife started back full time it kicked our family square in the nuts. It’s been painful and sometimes overwhelming.

    I’ve kept all of my same responsibilities at work (research, teaching, and a full time clinical work load) while my duties at home have tripled (cooking, cleaning, etc). I want to support my wife, but this has led me to the realization that I’m heading towards part-time work pretty early in my career despite the many great things others saw for me in my career ahead.

    In the end, my family is the most important thing to me. I’ll give myself another couple of years to pay down debt and put our family in a better situation, but I’d be shocked at this point if I am not part-time by five years out from residency (another two and a half years) unless something changes at work that allows for better work-life balance.

    Thanks for sharing your story, as always, Vagabond.

    TPP

    1. @TPP, when the kids were young, we had lots of help in the house. At one point, we had a morning helper, an afternoon helper/driver, a cook, and a cleaning service. From a financial standpoint (only), it is more cost effective to hire someone to do the scout work while you stay full time. Of course, there are other trade-offs.

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        I’d second Vagabond’s idea of getting help, TPP. My wife and I have in-home help, which made perfect sense when the kids were little, but makes less as they are out of the house more. Tempted as I am to cut off that help, my wife says that if we did, she’d take on extra work to be able to afford the assistance. It’s our luxury splurge, and it enables us both to work without needing to pack lunches, clean dishes and bathrooms, etc. Outsourcing the scut can be expensive (it’s our second greatest expense after housing), but the tension it relieves is priceless for us.

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      You and your wife both need a wife. Thankfully they exist, and with careful screening, you may be able to find and hire one to look after your kids, cook, clean, do laundry, etc.

  6. Great start to the series crispy doc and an absolute perfect individual to showcase it.

    I love measuring your net with in terms of bionic man multiples. Lol

    Definitely reducing the aspects of medicine that cause you to burn out is the best way to preserve your sanity. It is important to realize burnout early signs and minimize it by shaping your practice. This is only possible if you are not living paycheck to paycheck and a benefit of becoming FI

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  7. @Gasem, thanks, but I wish I could say that everything was perfectly orchestrated and planned. I mostly stumbled and bumbled into it, and I was lucky my that the timing of my part time transition coincided with a hot job market.

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      No doubt aided immensely by your visible interpersonal skills. I’d guess you are exceptionally good at playing well with others, and your group recognized that value.

  8. Thanks for sharing your story Vagabond MD. It’s great hear that you were able to build work around your life instead of letting work take over your life. Physicians do have options- it doesn’t have to be a one-size-fits all model. I’ve made conscious choices in my career to make work sustainable for the long run. I chose my current practice because it is lifestyle friendly. Years ago I was asked to join another startup practice as a founding member along with some other young hungry rads but I said no. It would have meant a 2x pay raise but it would also have meant 2x the workload and stress. That was not the life I wanted. I was hungry, but not hungry enough to potentially destroy my life. Looking back, I know I made the right choice.

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      With your living in the land of startup fever, I know the temptation must be great to get a piece of that action, MD. It’s a credit to your keeping a level head and a view to the long game that you’ve been able to build the career you want without sacrificing your home life.

      Keep at it, my friend.

      CD

    2. Yes, there seem to be an abundance of options to work harder/longer/earn more, etc. There are not so many opportunities to work a decent amount, earn an okay amount and live well. Many medical jobs are disguised as lifestyle jobs and are anything but that…with the possible exception that you busting your butt benefits the lifestyle of the admins, owners, or senior partners. No thanks!

  9. Everyone can use help when the kids are young. Use whatever means you are comfy with to help during that time.

    I am such a DIYer that hiring more help would have given me more logistical nightmares. But I am not normal so do whatever makes your own family tick.

    I though Vagabond was from the lovely book from Rolf Potts. Interested to see what it really stands for.

    We all bumble our way during all this Vagabond. My husband and I certainly did.

    But we would never be afraid to admit when things didn’t feel right. And we were willing to rip whatever terrible bandaid off quickly to regain some sanity.

    We also found that the less we worked, the more efficient and effective we became. Very similar to your story.

    Hopefully our fellow physicians can see that many of us struggled with similar issues.

    As with many aspects of life, being able to bend and be flexible can be more powerful.

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      Dr. MB,

      Funny, I read the Potts book and never made the connection until you mentioned it! I’ll look forward to Vagabond’s upcoming lurid tell-all origin story.

      being able to bend and be flexible can be more powerful.

      Can’t put it better than that!

      Fondly,

      CD

  10. Great interview Vagabond as usual. We are the part-time leaders out of a world of forest fires. I always enjoy your thoughts. Looking forward to the Xray interview.

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