Docs Who Cut Back #3: Xrayvsn

crispydoc Uncategorized 19 Comments

Xrayvsn is a radiologist practicing in the Southeastern U.S.  He’s a kindred spirit who factored lifestyle considerations into choosing his optimal job. His posts are notable for their candor and vulnerability; reading his personal account of divorce will leave you raw and grateful.

He’s also created terrific series interviewing fellow bloggers (The X-ray Beam), assessing whether physicians can afford items on their wish list (The Doctor’s Bill), and highlighting FIRE topics that deserve our interest and attention.

As he demonstrates, even cutting back one day a week can have significant implications for happiness. Without further ado, heeeeere’s Xrayvsn!

1. What is your specialty?

Radiology

1a. How many years of residency/fellowship did you complete?

Did 2 years of general surgery before I saw the light (the lifestyle as a resident as well as the witnessed lifestyle for attendings was not how I wanted to practice medicine)

I then did an additional 4 years of radiology residency.

After completing general radiology residency I stayed at the same institution and completed an interventional radiology fellowship.

1b. How old were you when you began to cut back?

There are probably two points in my career where it could be perceived that I cut back.

The first was when I joined my current practice in 2006 at the age of 35 (part of a multispecialty outpatient medical clinic of around 70 doctors).

This practice did not have any need for an interventional radiologist so for the past 12 years I have only been a general diagnostic radiologist.

I chose this job over the other 5 choices I had in the area based purely on lifestyle.

This was the only practice that allowed me to only work Monday through Friday, 8:30 am-5pm.

The enticement of no calls and no weekends was the main reason for choosing this over the other opportunities.

I can’t remember exactly when I reduced this clinical workload further by having locum coverage for 1 day a week, but it was in my early 40s (I am 47 now).

Currently I have either a Monday or Wednesday off each week (it cycles on alternative weeks).

1c. How many years out after completing training was this?

I finished my residency program in 2003 so it was 3 years out when I chose my current practice.

2. What did your parents do for their livelihood?

My father was an Internal Medicine doctor (passed away at age 50 when I was 14 years old).

My mother was a stay at home mom.

2b. Would you characterize your upbringing as financially secure or insecure?

I definitely had a very financially secure childhood being an only child with a father as a physician.

2c. How did your upbringing affect the money blueprint you inherited – both positive and negative?

I never really got involved with my father’s finances so didn’t pick up any financial tidbits.

I knew the lifestyle available to a doctor because of a high income was very promising but I did not know the sacrifice of what it took to become a doctor at that time.

3. What motivated you to cut back? [Family / burnout / relationship / divorce / lawsuit/ other?]

The choice of my current job was to have more time to spend with my daughter (who was less than a year old when we made the move here).

Burnout later on was the main impetus for me further reducing my clinical workload to 4 days a week.

4. What were the financial implications of cutting back?

There were of course some financial ramifications of cutting back but it was not a pure 1:1 relationship.

The money I lost was the least valuable money in my mind as it would come in at the highest tax rate.

I also started developing nice passive income streams that currently more than offset the money I would have kept had I continued a 5-day work week schedule like in the past.

I like to say that it is the direct result of my money working for me that allows me to work less.

4b. Did you downsize home or lifestyle?

I always had a “live below my means” lifestyle.

The home I live in is already completely paid for.

Whenever I want to buy an expensive item I usually can cashflow it without too much thought with or without working that extra day.

4c. Slow your progress to retirement? Describe your thought process in making these tradeoffs.

I don’t think my clinical reduction has dramatically decreased my time to retirement but of course I’m sure it has some impact.

I might have to practice an extra year or two if I wanted to make up the difference.

Working a full 5 days a week, however, would have been far more miserable as the feelings of burnout I had started noticing would have only gotten worse.

5. How did colleagues react to your decision?

My radiology partner is in a similar situation as me financially and also made the same decision to reduce his clinical workload by also taking a day off each week.

5b. Was your family supportive or critical? Partner? Parents? Children?

Really did not have anyone to answer to as I was divorced and on my own when this started.

6. What have been the main benefits of your decision to cut back?

It has allowed me extra time to recharge my batteries and makes the remaining work week much more tolerable.

I feel that I actually extended my career by cutting back which results in an overall gain in lifetime income.

7. Main drawbacks?

The only one I can see is the financial loss, but at this stage of my life I am doing fine as is and don’t need to squeeze every dollar out of a practice by working all the time.

8. Did you fear your procedural or clinical skills might decline? How did you address this concern?

Reducing my clinical practice by 1 day a week has absolutely no impact on my skills.

Sometimes I notice it takes a day to get back on track with workflow if I take a week off for vacation but even then it is pretty easy to snap back to the normal routine.

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?

I never was caught up with the “I am a physician” complex that some colleagues have.

Co-workers here call me by my first name.

At home when I have people come over to work on the house they are pretty shocked to find out that I am a physician. They tell me that I certainly don’t act like the typical physicians they know.

Me needing to show everyone I am a physician was never a priority of mine.

I prefer to blend into the crowd and dress down quite a bit (which as a radiologist is a great perk.)

I have probably worn a white coat a total of 5 times in 12 years (all for photo opportunities or if I had to give a large presentation to the community).

10. If you had not gone into medicine, what alternate career might you have pursued?

I have a love for music (I play the piano and guitar) and would have loved to be a musician but do not think I have the talent to have been very successful at it (I would classify myself only as above average).

11. What activities have begun to fill your time since you cut back?

Most of the time I’m off I relax. Catch up on watching TV or doing yard work.

Blogging now has also consumed a lot of the free hours I have.

12. If approaching retirement, what activities have you begun to prioritize outside of medicine so that you retire to something?

I envision myself leaving medicine at the age of 53 or so (chose that age because at 53 my daughter will enter college).

I think I would like to travel more.

If this blogging thing works out I would also like to concentrate on that endeavor as well.

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?

Based on my high income and low spend rate, I tend to accumulate a lot of money quickly.

It just took me a while to discover where to direct that money to get the best results (it was only after my divorce and at the age of 40 that I saw the financial light).

If I was graduating today with the knowledge I know now, I would definitely have channeled all my money to pay off debt sooner (took me way too long to pay my student loans) and start investing more in index funds and real estate.

If I followed this advice, I probably could have retired in my early 40s with the equivalent of what I anticipate retiring with at age 53.

In the end I still feel retiring at my current projected age will still allow me to have a large window of time to enjoy life.

Thanks for taking the time!

A few observations regarding Xrayvsn’s journey:

  • The income loss from cutting back one day a week was the income on which he would have paid the highest marginal tax rate on, so 20% fewer days at work yielded less than a 20% reduction in income.
  • A low burn, high earn lifestyle is key to his financial success. He lives in a low cost of living region, has a paid off home, hobbies are frugal (TV, yard work, blogging) and major purchases are easy to cash flow from passive income. First-name familiarity with co-workers rounds out an impression of Dr. Xrayvsn as Six-Pack Ray.
  •  Accepting a lifestyle-friendly job allotted him time to spend with his young daughter after a divorce.
  • He expects he’ll have increased his lifetime earning potential by extending the time over which he can happily practice medicine.

Comments 19

  1. A low burn, high earn lifestyle…. I am gonna steal that from you, Crispy Doc. What a great way to describe what Xrayvsn is doing.

    Xrayvsn, I applaud you for the intentional choices that you have made. Glad to know stepping back hasn’t hurt much. I also have no doubt that blogging consumes a lot of time! You might be the most prolific commenter out there in the physician finance space right now. Everywhere I go, I see you!

    Loving this series, Crispy Doc!

    TPP

  2. Thanks CD for thinking my story was worthy of this great series you have going here.

    Appreciate the kind words and observations at the end. Although looking at me I don’t think six pack would ever be the first thing on your mind. So probably kegger Ray more appropriate for both meanings. Lol

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      Author

      Xrayvsn,

      Self-deprecating humor aside, you are one of this community’s treasures. Collaborative, innovative (your recent series, “If you could see medicine through my eyes” was absolutely brilliant!), vulnerable and raw.

      Appreciate your willingness to bring your name and fine reputation to my house of ill repute.

      With gratitude,

      CD

  3. As someone who has no plans to cut back any time soon, I consistently enjoy this series.

    Maybe it’s the great guest lineup. Maybe it’s the insightful questions. Maybe it’s just comforting to know that when I’m ready to cut back the sky won’t fall.

    Thanks for my daily dose of entertainment and inspiration.

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      Author

      SHS,

      With apologies to Mike Tyson, “No doc has a plan to cut back…until they get punched in the face by a screaming meth patient hurling feces on a Saturday overnight shift.”

      It’s definitely the strength of the brilliant guests that brings you back. My writing is the “Seven minute abs” from There’s Something About Mary.

      Regardless of why you come back, I’m grateful for your company, my friend.

  4. The best part of XRVs story has been how quickly he could right his ship. And he has often been very outspoken in reminding folks.

    When you earn a lot, it can overcome many other errors and runs of bad luck. His blog is a testament to this.

    Excellent job XRV!

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      Author

      Could not agree more, Dr. MB. Xrayvsn is the poster boy for financial course-correction after divorce, and being fearless about putting his story front and center continues to give many folks going through similar hardship a role model to steer them through the storm.

    1. Hey Vagabond, the only performances I have done were in front of anout 200 people singing an original song I wrote on the guitar at a talent show and also some open mic nights. In residency a group of us practiced in a band but never did a gig. Trust me you would not confuse me with a true singer but it is fun and another creative outlet for me.

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      Author
  5. I commented this morning but not sure if it went through.

    Anyway thank you for inviting me to be a part of this great series. Vagabond MD and Hatton1 are tough acts to follow (although I did lower the bar considerably for the next person).

    And I’m not sure six pack and me have ever been used in the same sentence before (I think a kegger would be a lot more apropo for my body habitus. Lol)

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      Author
  6. Lol TPP. I think I go by the maxim of quantity over quality so probably explains a lot of my comments. Lol.

    As my work gets busier at the end of year my free time at work is severely diminished and my ability to continue that pace will likely suffer.

  7. That day off a week makes a world of difference. Occasionally I will get a day off but instead of relaxing, I use to do catch up with everything else I’ve been putting off. Great interview Xrayvsn.

    1. Post
      Author

      We have a very narrow therapeutic window in medicine – for some, the day off is the difference between a toxic and a healthy dose of work. Part of what appeals so much about Xrayvsn’s story is that he went into his career, eyes wide open, aware of that difference. If only we all exercised such judgement at the outset of our careers.

      Thanks for stopping by, MD!

  8. “I feel that I actually extended my career by cutting back which results in an overall gain in lifetime income.”

    I couldn’t agree with you more on this! I think this same thought about DH and I who continue to work, albeit part-time.

    Thanks for giving this interview—I was excited to read it when I saw that you’d done one. And thanks again to CD for this great interview series!

    Strong work you two!

  9. Here’s a series to follow! I think your 4 day per week schedule is great. The extra day off per week really does wonders to offset burnout. I currently have every other Friday off from my job and find those days off to be invaluable for recharging my batteries.

    My wife wants to start with the slow burn medical lifestyle to focus on raising kids. She says she plans to go full-time after the kids enter school (4 days per week in dermatology) but I don’t know if she’ll need to or want to.

    Neither of us have a self-imposed retire early mandate but would like to have the option beginning in our 50s. By then, however, I hope we both have careers which allow for flexibility and part-time work. That way, we stay busy with some decent cash flow but also don’t have to miss out on activities, travel, or events we enjoy.

    But we’re young, so perhaps I’m being overly naive.

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      Author

      You are wise beyond your years. With derm, your wife should have many options to scale up her clinical load once the kids hit school. Perhaps, like you, she’ll opt to preserve the time she currently takes off to recharge. Every other weekend a 3 day weekend is a well-planned longevity plan. The only thing I can guarantee is your needs (and plans) will change in ways you cannot predict, although that won’t the allure of dreaming.

      Fondly,

      Old and Invested

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