Docs Who Cut Back #8: Jordan Craig, MD

crispydoc Uncategorized 19 Comments

Dr. Jordan Craig is an OB/GYN who, like many of us, built her practice based on flawed physics: she assumed that she could remain in perpetual motion indefinitely.

On the surface, her career was ideal: she joined a unicorn independent group of mentors from her residency, took on significant administrative responsibilities and built a name for herself that drove patients to seek her out. Having created an office culture that never turned away patients, she became a victim of her own success.

Surgery, overbooked clinic days, administrative meetings and a depleting call schedule brought her to the brink of burnout. When she went to her group seeking to cut back, she was denied.

I hope you’ll find Dr. Craig’s story of finding sustainability through strategic reduction (of debt, clinical work and clutter) as inspiring as I did.

1. What is your specialty, and how many years of residency/fellowship did you complete? How old were you when you began to cut back? How many years out after completing training was this?

I am trained as a full scope OB/GYN, which requires 4 years of residency.   I now practice as an academic OB/GYN hospitalist providing labor and delivery care, midwife support and emergent GYN surgeries and consultations. I cut back significantly at age 36 after practicing for five years.

2. What did your parents do for their livelihood? Would you characterize your upbringing as financially secure or insecure? How did your upbringing affect the money blueprint you inherited – both positive and negative?

My parents both have master’s degrees. One is an engineer who works in sales and the other is a successful administrator in healthcare. As a young child, we didn’t have much but I would not say we were insecure. That rapidly changed as my parents grew in their own careers. My parents are both financially literate and enrolled us in Dave Ramsey’s course in my early twenties. This created a debt aversion that has informed many of our financial choices.

3. What motivated you to cut back?

Burnout. Plain and simple. What once seemed a trendy term or a cop-out became this insurmountable weight on my shoulders. I just could not picture walking out the front door towards full-time practice another second.

My burnout came from a few places. I took on a hefty administrative role on top of a full time practice very early in my career and then our hospital went through an upheaval of upper administration and the culture changed dramatically. My practice hit a critical mass of volume and the demand to see me increased. I had trained my staff to work everyone in and always “say yes” to referrals and urgent visits during my ramp-up and I could not reverse that behavior.   My days would start with rounds at 5am, surgeries, meetings, 30-40 patient in office and then a 24 hour call or back up call once a week starting at night (avoid these reverse calls like the plague!)   My personal tipping point was a week with really tough outcomes while staffing residents – both utterly unavoidable – and not having the space to breathe and recover from the trauma. That week really exposed how close to the breaking point I had chosen to function.

4. What were the financial implications of cutting back? Did you downsize home or lifestyle? Slow your progress to retirement? Describe your thought process in making these tradeoffs. 

I first realized something needed to change during my 4th year of practice, a few months after the tough week I mentioned above. I went to my group and asked for time away or the ability to cut back on call or job share. I was willing to take a huge financial hit to do so. The group wasn’t comfortable with creating a unique situation, even temporarily. I then took matters in to my own hands and axed everything that wasn’t essential. My husband asked for one year of trying to change everything before moving our family – my non compete meant I had no local options.

I resigned my medical directorship, stopped staffing residents while on call, took 1 full day off each week, limited my patient visits and started vacationing a great deal more. I cut out high intensity exercise and switched to yoga at home. I tried this for one year and despite a drop in workload that translated to a 40% pay decrease, I felt little relief. I was still a full time slot in the call pool, covering two facilities at once with high acuity and volume. I did almost all OB in the office to cover “my share” and my GYN volumes started to drop.

We hit the one year trial period of cutting back. I did a lot of personal work in that time as well, addressing my time management and stress levels. I learned to get my charts closed immediately after the last patient everyday and to not check on things when I wasn’t the one on call. It just wasn’t enough. You could’ve sent me to Bora Bora for a year and I still wouldn’t have been ready to return to a lifetime of inbox messages and covering two hospitals on the same call shift.

So… we basically put our life in a box and threw it out. Almost literally.

We sold our “Dream Home” (read: heavily financed midwestern McMansion with pool, tricked out basement, 6BR/BA in a desirable suburb). We filled 19 Honda Odyssey’s full of STUFF and took it to Goodwill.. and then sold the Odyssey. We pulled the kids out of school, moved to a new state and started 100% over.

Our new home is reasonably sized (2000 sq ft) for a family of five, adequately furnished, sparsely decorated and completely sufficient. We live in a walkable community in Grand Rapids. I have a 7 minute commute and work 12 days a month and rarely more than 12 hours. I am surrounded by support, sub-specialists and amazing partners. The residents are fantastic, well-read and happy to help me find my way.

Financially, a few factors help this work.

First, I hate debt. Irrationally and probably to our FIRE detriment, I detest debt. We sold our rental property in Indy and cashed out of a surgery center. I’d already paid most of my student debt off and these sales help us pay off the rest. Combined with the equity of our prior home, we were able to put down a huge chunk on our new place. It may be smaller, but due to the desirability, it certainly isn’t cheaper. We have a 20yr fixed rate mortgage that we will pay off early. I put a decent chunk in our 529s and will contribute to those minimally with the goal of paying for tuition only, in-state. We have no car or credit card debt.

Secondly, we found minimalism. (No, I don’t live in a modern house with 3 identical shirts and one chair.) I do focus on access to amenities rather than ownership. I do leave surfaces clear and don’t fuss with seasonal decor or keeping items that aren’t durable and functional. We don’t really have a master closet and just share a single hanging rack and 6 drawers. I just simply stopped buying “stuff.”

With these changes, my big pay cut (about 50% from my peak earning years in private practice) has not been noticeable. We have essentially no expenses beyond the mortgage. We travel like fiends and are going to be able to retire even earlier because of our change in consumption.

5. How did colleagues react to your decision? How did you respond?

My colleagues were kind but didn’t understand. How can they? Things were fine for them. I remember one saying, “Jordan, it isn’t that you can’t do this, it is that you don’t want to.” Another constantly commented about how he’d advocate to take me back when I come “crawling back.”

The financial separation went smoothly. I encouraged my patients to stay with the practice. I check in with them occasionally and have heard they are making structural changes to help with call burden. I hope that prevents the loss of other great docs.

5b. Was your family supportive or critical?

My partner is on board. The kids are far happier now – the new school is more personal and laid back. We pulled them out of advanced classes and in to grade level to alleviate the nights lost to homework and tears. They are learning to sail and we bought a couple sailing dinghies kept on a lake that they can walk to from home.

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

Oh, I have a real life now! I exercise, go on field trips, joined a book club, I sleep 10-12 hours on my days off. The sleep has been integral- this was a huge part of my problem in hindsight. My memory feels sharper and I am so much more patient.

I do love having weekdays off. Ever been skiing on a Tuesday? Grocery shopping on a weekday morning? Coffee in a silent house by the fire… Heavenly. I get to sit still a lot. I’ve probably read 10-20 books a month since July. I feel like I have my life back. I am so happy.

7. Main drawbacks?

I don’t have my own patients and really have lost the autonomous decision making of private practice. I teach residents, so while I may impart my opinion during rounds, ultimately I try to honor their plan whenever reasonable and evidence based.

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

I certainly won’t be great at office GYN or major GYN procedures in ten years! (I also probably won’t be working). My new job is at a big busy center with more pathology than is imaginable. I feel more challenged now than previously and consider that I’m honing a subset of skills that will be infinitely useful in the future.

9. If you are honest, how much of your identity resides in being a physician? How did cutting back affect your self-image, and how did you cope?

I never dreamt of being a doctor. It happened unintentionally when I took the MCAT on a whim, panicking about what to do after graduation. I’ve grown to love women’s health and specifically teaching evidence based practice. I think the teaching and love of science could be found in many careers. “Physician’ would not be part of my self-identity if asked.

In private practice, it was less about physician and more about being my own boss, setting my own hours. I am clearly the worst boss ever, since I chose to over commit and over work. My self image is the same. I am definitely a better mother and wife now that I am rested and my physical needs are met. More of my identity comes from these roles than from clinician.

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

I would be crew on a chartered catamaran in the BVI, leading dive trips and kayak excursions. Maybe swim coach on the collegiate level? Hard to say. Definitely water, sunshine, working with my hands.

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

I started swimming again. I have neurogenic thoracic outlet and was told this wouldn’t ever be possible. With great sleep and not carrying around a laptop 9 hours a day (literally couldn’t get a scribe or lighter laptop despite begging), my symptoms have completely resolved. I’m swimming competitively and hope to compete in Master’s Nationals in the spring. Yoga, field trips and cooking elaborate meals fill a fair amount of time as well.

I just bought snow skis for the kids and I to use this winter. Michigan skiing isn’t great but it is very accessible. We started sailing, as I mentioned above. I can bike to the sailing club, put my Butterfly in for an hour and still have a full day to get things done.

I do need a project. I am hopeful to provide mentoring and coaching to other burned-out docs. “Burn out triage,” if that makes sense? I love to write and connect people with resources and tools to find a way forward.

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

I’m not there yet. We were on the ten year plan (retire at 46), but honestly I think I could do this job for a while. If I can develop my mentoring practice and perhaps occasional public speaking on burnout, that will keep me busy. Our first stop after I retire will be selling the house and traveling for 6-12 months. We’ll figure out the rest after that. Maybe full time locums? Maybe back here if they can work with my sabbatical.

  1. 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?

Not intentionally. I’ve always maxed out 401k and profit sharing so I had five years of savings and aggressive debt reduction. The biggest advantage for our chosen path is cash flow. I truly can divert so many dollars towards mortgage pay down and retirement (and travel) because I don’t have a car payment or private school tuition. Embracing minimalism means that I’m not spending money on Target trips or a gaggle of after school activities. We don’t need childcare. Even replacing a roof would be 20% the cost of our old place, due simply to the dramatic change in square footage!   The extra cash flow is so empowering.

You can find Dr. Jordan Craig at invokemd.com, where she blogs and offers physician mentoring in transitioning from burnout to sustainability in medicine.

A few observations from Dr. Craig’s story:

  • Jordan created a “culture of yes” that built her practice rapidly, until her success in clinical medicine crowded out most of her personal time. First do no self-harm needs to be a precondition for any sustainable job in medicine.
  • “We basically put our life in a box and threw it out.” She chose a radical path to cutting back, and found that minimalism, reduced consumption and a right-sized home enabled her to accept a lower-paying but sustainable position. As high-income earners we tend to believe that if we can simply quit the wrong job and substitute the right one, we don’t need to alter our spending habits. Sometimes reverse engineering our lives by adopting a lower cost lifestyle empowers us to work less or take a lower stress job in medicine.

  • Her practice could not accommodate the immediate changes she needed to address her burnout. This ultimately led to the more radical solution of relocating to a different city and position. How your group culture has dealt with burnout in the past? Create the blueprint now to change your institution from within so it can evolve to meet your future needs.

  • Many of us start our careers highly motivated to work extra in order to build a reputation and pay down debt. There’s a good chance that superhero cape around your neck may eventually choke you. Make a deceleration plan before you need it.

  • A non-compete clause limited Dr. Craig’s option to continue working in the area where she might have leveraged her stellar reputation. As a newbie, I was so grateful to land a good job that I signed a contract with a similar non-compete clause (I later learned such clauses are unenforceable in California). Before you sign your contract, consider having it reviewed by a professional to negotiate favorable terms.

Comments 19

  1. As a physician nobody “forces” you to do anything, you force yourself by setting up artificial boundaries which may be productive initially but reach peak efficiency and then decline in rate of return. This is quantitatively defined as the inflection point, (so you can read about it). The inflection point is the point where a curve goes from concave to convex or vis versa, and is mathematically defined as when the second derivative of the curve changes sign. Understanding this concept is incredibly useful. It informs you that doubling your effort results in barely any change in return. You can look at Jordan’s trajectory and see what she did, she changed curves. She moved from an inefficient curve where she was well beyond the inflection point to a more efficient curve. She moved from a curve above the inflection point with retarded growth and nowhere to go, to a curve below the inflection point with growth in otherwise neglected areas. A very useful construct. I ran my group like this using 90% as my rule of thumb inflection point. If you joined my group you had to be satisfied with 90% of what you want. Going after the last 10% blows things up. You can surge occasionally to 100% but it is not sustainable or even desirable from an efficiency point of view. This same concept can be applied to creating a retirement portfolio or designing the gear ratios for best gas efficiency for a diesel powered tractor trailer at 65 MPH. Understanding the inflection point is the solution to burnout. Great read

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      Author

      Gasem,

      I’d never considered that burnout could be characterized mathematically (beyond the simple economic concept of diminishing returns), but what you describe makes intuitive sense. Perhaps your efficiency curves and Vagabond’s Burnout Factor Units are waiting to be synthesized into a single unifying theory of burnout, complete with predictive modelling.

      Forget the FIREcalc. I want every newbie doc plugging their number into your BURNcalc to see if their intended lifestyle will be sustainable, and to identify the job offer with the most desirable inflection point.

      Fondly,

      CD

      1. Actually the Bell curve’s inflection point is 1 SD. Beyond 1 SD more work is required for less return, which is why the area at 2 SD only increases by 40% for doubling the effort. If it was linear you would expect 100% increase in output for 100% increase in input. Burnout is entirely predictable and is primarily driven by greed, not necessarily your own greed but the greed of the system it exists in. MBA’s and senior partners know this and drive the system into default from a burnout perspective, and then things blow up. 100% predictable and recovery is 100% possible without blowing up simply by recognizing the math.

        I wrote about it here http://mdonfire.com/2018/12/09/the-dope-on-burnout/

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          Thanks, Gasem. I have got to catch up on my blogs (I’m about 80 posts behind according to feedly). Thanks for the refresher on SD, makes sense as you explain it. Where were you when I could have used an O. Chem tutor in college?

          With gratitude,

          CD

          1. I actually did tutor O chem, Gen chem and Physics and Algebra in college. Had me a lil side gig going on I did.

  2. What a great story and example. It’s amazing how big of a difference the change made for Dr. Craig.

    The more and more I think about it the more I realize how finding work-life balance is different for everyone and that financial independence – or a glidepath in that direction – provides so much leverage in these situations.

    Your ability to pay down debt and have some freedom (despite the loss in income) is very empowering.

    TPP

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      It’s in your blood, TPP, and you’ve caught the tropical fever. It’s just a matter of time before your case of CBV (Cut-Back Virus) becomes fulminant.

      I’ll save you a cot next to mine in the infirmary,

      CD

  3. Well done Dr Craig – recognizing the source of your stress(es) and being in a position to act on them. It’s amazing to me how many practices – even ones owned by fellow physicians – how little to no tolerance for anyone wanting to practice less than full-time. Keeping physicians from burning out benefits everyone.

  4. These stories are very inspiring and hope give fodder to people in similar situations.

    Too often we feel trapped. Don’t want to move because of the kids used to schooling etc. I actually moved 3 times in my childhood and though it was tough transition you learn to rebound quickly.

    I love the superhero cape choking you line if you are not too careful. It is true. Physicians typically go sbove and beyond to help others to their own detriment

  5. I can relate to a lot of this.

    I built several different practices on the “always say YES” habit. It works great for building a business. It can take its toll on the doctor though. And it happens so slowly that we may not notice. Until we are – well …. crispy.

    I was surprised how after 1 year of being part-time I felt only a partial detox. Going from 90 hours to 70 and then 50-60 hours a week is cutting back but it isn’t like a normal workload. It wasn’t until I got at or below the 30-hour mark that I even felt some “balance.” I’m at 24 hours per week now. I enjoy the simple pleasures like the ones mentioned: reading, quiet, shopping with a little elbow room etc.

    I also found that physicians can withstand enormous pay cuts with the right mental framework. I took two voluntary huge pay cuts in my career so far. I don’t regret either.
    Thanks to both of you for sharing.

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      Author

      You are my sage on the mountain for stories like these, Wealthy Doc. You have the work ethic and the stamina to build and rebuild extremely successful practice environments, and the business savvy to make them extremely rewarding financially.

      Then you reach a point where the exchange rate of time for money suddenly undergoes a huge shift – you realize your time is finite and you have enough. Fresh out of residency you are more than willing to exchange time for money, because we all assume we’ll have plenty on the back end. Burnout, a health scare, a divorce, an ill family member or a special needs child and suddenly our world transforms and our time allocation exposes the flaws in our assumptions.

      That’s when you cut back. If done the way you and Dr. Craig have done, with care and a deliberate eye to values, the dividends on reclaimed time far exceed the lost income. Even with the pay cuts, as a dear friend in medicine is fond of saying, “You’re still a rich doctor!”

      For a recovering workaholic like you, Wealthy Doc, 24 hours or fewer is a key part of your 12 step program. Glad the head space and quiet have been restored.

      Warmly,

      CD

  6. Great blog post, Crispy Doc. I also enjoyed your recent appearance on the WCI podcast. My wife and I listened to it and we truly enjoyed hearing your story, background, and how you helped change the negative landscape in your current position. Hope to see you again this year at FinCon19.

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      Ed,

      Appreciate the kind feedback! You were an honorary doc for most of FinCon, and we enjoyed your company. While I’ll regrettably miss it this year, I’d love to attend again in the future and recapture that feeling and reconnect with old friends.

      Fondly,

      CD

  7. Reading this post felt like reading an autobiography I haven’t yet written! I too was a workaholic OB/Gyn who prided myself in NEVER refusing a new OB consult, always making room. In my last year before deciding to leave our group and cut back to office only practice at age 43 (I am also now down to 12 days per month), administrative duties on top a full time load was one of many “straws” on this camel’s back. I too have recently embraced minimalism, which has meant little change in lifestyle and happiness despite less pay (eg. we got rid of our second car last week, so proud to be making common sense financial decisions!) I give myself a little high five every time I wake up after a 10-12 hour sleep marathon, so much joy in just being able to SLEEP! I read by the fire for hours (previously I read only when on vacation, maybe about one book every 4 months?) My new grocery shopping window is Thursday at 1pm (right after my guitar lesson). In short: workaholic OB life= brutal; balanced, part time life= amazing! Kudos to my comrade Dr. Craig, so happy to be in good company on this path!

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      Author

      Kristina,

      You are precisely the “after” scenario that so many of us hope to resemble in our medical careers. It’s wonderful to hear you enjoy sleep marathons after a decade of sprints and insomnia.

      I find in your story a common thread that folks feel more true to a younger and more idealistic version of themselves after cutting back. Making an effort to reduce their environmental footprint in a conscientious manner (ditching the car), reading voraciously, learning an instrument, cooking new recipes.

      It’s like getting a second chance at being that multi-dimensional person you were before medicine. May we all be so lucky.

      Thanks for stopping by, and I hope you’ll consider participating in this series (look for my email!).

      Fondly,

      CD

  8. Women doctors in particular might want to practice saying “No” regularly. We are often expected to be the “nicer” one amongst our colleagues.

    It is very liberating to simply not care about making everyone else happy all the time.

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      Author

      You are so very right, Dr. MB. It’s unfortunate that women are expected to work without the same compensation as men. This can manifest in insidious ways.

      A decade ago, a PA asked to do some training shifts with our group. A collegial, universally adored female physician was “selected” by then leadership (since changed) to have this PA on shift with her for a month. There was no added compensation to make up for the loss of efficiency, extra work, and loss of income.

      Being “nice” should never be a liability this way.

  9. Very inspiring interview to read, thanks for sharing it. I was telling my husband about this interview because he cut back this past May and still finds he’s tired a lot and having to catch up on sleep. He’s not alone in recovery! 🙂 Thanks again.

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