The True Cost Of That Extra Shift

crispydoc Uncategorized 14 Comments

As an ER doc, my first perception of any large financial decision is, "How many shifts will this cost me?" I have an idea of my average income per shift, and it helps me to reconcile major expenses or splurges by deciding whether it's worth working those extra shifts.

There's an important caveat in how to frame any added shifts, which is to ensure that I consider those shifts to be additional shifts per month. Why do it this way? Funny you should ask...

Are You Funding Your Backside Roth?

Since I have a written financial plan, every dollar is a paratrooper with a mission to perform. It jumps out of my paycheck before it can land in my checking account.

  • Some goes to debt repayment or whittling down the mortgage.
  • Some goes to fund the kids' 529 plans.
  • Some goes into my Health Savings Account.
  • Some diverts to 401k and Profit-Sharing retirement accounts that lower my taxable income today while keeping a promise made to future me to save for the Toto bidet that will wash and then dry my backside tomorrow (I call it funding my "Backside Roth").
  • Some deploys to the taxable brokerage account that will bridge me for a possible decade or more of early retirement.
  • Some is invested in my backdoor Roth.
  • Some goes to dedicated funds that will pay for milestone events in my children's lives years from now.

My expected income is already fully accounted for, so any new luxury or expense means I not only need to pick up additional shifts but I also need to distribute them throughout the year that I plan to incur the expense.

But Crispy Doc, you protest, as someone who writes about cutting back as an antidote burnout, it seems antithetical to add to your shift load when you can just retire later and pay for today's added expense with an extra month or two of shifts tacked on at the end of your career, right?

Wrong. Nobody likes a person who preys on the elderly. That's why I refuse to kick the can down the road and rationalize poor decisions by saying I'll simply retire that many months later.

If I'm going to add an expense, I'm going to pay for it now when I'm young and yearning, not later when I'm hamstrung with hemorrhoids and heartburn.

Let's say I have an extravagant vacation in mind that I'd like to take in 5 months' time. I calculate it will take 10 additional shifts to pay for it. Assuming the shift supply exists, I'm going to have to add 2 shifts per month for the next 5 months to pay it off. This calculus sounds simple, but it's actually quite complex.

Adding two shifts a month means less time for working out, deepening and maintaining social connections, and playing with kids. It means missing basketball games, sleeping off additional nights and leaving my spouse to fend for herself at social engagements.

The difference between a toasty-just-right job and crispy-all-wrong job can be as little as two shifts.

Everyone is endowed with a fixed quantity of sanity per lifetime. Once spent, you don't get it back. Think of all the docs people you've interacted with over the past month. You can identify with great precision those who spent their allotment early.

To summarize, in calculating how many shifts an added expense will cost me, I can better assess the true costs by:

  • Agreeing to work the shifts now, in real-time.
  • Never using dollars that already have assigned jobs.
  • Acknowledging the impact on balance at home, health, family and partner (my partner always gets veto power)

This ensures any additional shifts I take must be absolutely worth the non-economic costs might inflict.

How do you evaluate the costs when deciding whether to increase your workload to increase income or offset special expenses?

Comments 14

  1. I like how you rationalize and convert extra expenses directly into actual shift costs. It drives home the point of what expense that item truly costs.

    Another thing to be wary of is the money that is coming in from your extra shift work is your least valuable money as it is coming from income that is the highest taxed (ie your last or extra dollar gets hit with the highest marginal tax).

    I too have envisioned a bathroom with a toto toilet. At $5k it truly is a luxury spend. Even though I can buy it now I have not pulled the trigger. Maybe one day though. Lol

    1. Post


      Beautiful point about your highest marginal income dollar also being your least remunerative.

      In “Tuesdays With Morrie” Mitch Albom wrote that his former professor acknowledged his fundamental human frailty with the statement, “Someday, someone else is going to have to wipe my ass.”

      It was a blunt but accurate admission of the humility needed with aging and debility. In my case, I’m hoping to save up so that someone can be a tiny robotic wand arm that sprays refreshing jets of water on my bum. I’m looking at the budget end of the spectrum, so far below $5k, but a splurge all the same. I figure when mobility limits travel, I can put those dollars toward hygiene…can you buy a Toto bidet with Chase Reward Points?

    2. First of all, great post CD. As a surgeon I can’t add in shifts to cover additional expenses, but there is an insidious pressure to work more hours in my system as well. It indeed has a cost that affects all aspects of life. I like your logical analysis of this.

      Xrayvsn, I’d like to mention that you can get a Toto toilet seat attachment for your bathroom on Amazon for $200-400.

      I got one as an attending “I’ve made it” splurge and it’s a nice addition to my life!

      — TDD

  2. Toto Bidet with Chase points? Ask McFrugal! I super like this post. It describes exactly what needs to be known about budgeting and the freedom to adjust the workload in a way that pays for wants, and yet doesn’t turn toasty doc crispy. There’s a lot to be said for freedom in warding off crispy.

    Good on ya daddy-o

  3. Interesting idea for people who are basically paid by the hour. For salaried people who don’t get overtime it is a little more abstract, you can still compare it to an amount of time you’ve already worked but you can’t make the analogy of spending the money making you actually work additional hours. You could do that kick the can down the road thing and say it is tacking more work on to the end of your career but in my case I worked years past my financial independence, I could have left any day I wanted, I just didn’t want to because it was a favorite hobby. I find it difficult in my early retirement deciding on a luxury purchase. I’ve just spent $6,000 to cool and heat one room in my house that has never been cool enough in the summer or warm enough in the winter. It’s tiny money to us in our early retirement, but its a lot for a one room HVAC system. Not unlike the Toto body washer, or maybe that should be booty washer?

    1. Steveark

      Best money you ever spent. I did it to my gym and it made that room completely comfortable every day. My gym is glass on 3 sides with a southern exposure and sun thermal radiation varies with season.

  4. The true cost is not monetary, or intellectual or physical.

    It is emotional.
    I call it the bank. The emotional bank.

    We all have a bank. A limited lifetime bank that can be split in many little units.

    When you burn the units slowly, one by one, spread out, the bank remains strong.
    But the closer they are in time and/or intensity, the faster the bank runs out.

    And then we have a bank run.
    A bank run is an exponential explosion.
    That leaves us emotionally empty: the burn out.
    The bank has burnt to the ground. The vaults are empty.

    Once we’re there, it’s incredibly hard to rebuild the bank.

    Better not burn the units too fast.

    My rule is to never do the extra shift.

    1. Post
  5. I like this post a lot. My family is further down life’s road, but there was a time in the not-too-distant past that I would equate shifts with the cost of an unexpected purchase. I never actually was required to do the extra shift as our income stream and budget were ample enough to handle vacations, home renovations, and cars and such, the larger discretionary expenses. (Unfortunately, the sanity account ran in arrears on a few occasions 😉 ).

    1. Post

      Vagabond, the exchange rate between cash and sanity means it’s always costlier to replace the latter, as there appears to be a finite quantity in circulation.

  6. Sounds like a deal with the Devil, but I think Lucifer makes a good point. It is the emotional drain of work that will get me.

    I am sure that it applies to all fields. However, I find in ICU dealing with demanding people with unrealistic expectations way more draining than long hours or intense situations. I have found 100h weeks with multiple complex resuscitations much less draining than quiet weeks filled with looking after patients that we really can’t fix and families that cannot accept that.

    When looking at risk factors for burnt-out, a feeling of purpose and some control over the environment are important. Those cases really lack both those things in the current healthcare environment. We need to be careful to recharge that emotional bank account.

    1. Post


      Every year our specialties of EM and Critical Care duke it out as the 1970s Lakers vs Celtics rivalry did for leading the surveys as highest rate of burnout, so I feel a kindred spirit with your depletion.

      Taking that extra shift is best characterized by C.S. Lewis in the Screwtape Letters, where a demon instructs his nephew as to how best to tempt mortals to the dark side: “The safest road to Hell is the gradual one, the gentle slope, soft underfoot, without sudden turnings, without milestones, without signposts.”

      The extra shift math begins with precisely this gradual road.

  7. Glad to know we’re not the only ones who calculate expenses as shifts 🙂 We took those calculations into effect when we planned out our summer and DH kicked up his gears and picked up more shifts to help cover our expenses. But yes, extra shifts do take their tolls! Great job not kicking the can down the road to your future self!

    1. Post

      I’ve stubbed my toe one too many times from kicking that can in the past. Excited to hear more about Medellin; sounds like it will certainly be worth those extra shifts.

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