One of my goals has been to figure out what to do with that new balance of time I've carved out. I want to find something that will keep me busy after the kids leave home; a fiefdom of my own that lets me settle into an empty nest rhythm; something to sustain me going forward.
It's hard to figure out what I want to be when I grow up. I've thrown a number of interests at the wall, all in the name of finding something that might stick. Turns out the wall is coated with Teflon.
Like many physician finance bloggers, I often focus on the successes that come with assuming responsibility for your finances and asserting control over your time. This is partly to inspire other docs who suffer from burnout as I once did with a message of hope that it can get better.
I thought it might prove beneficial to highlight the negative results for two reasons. First, as with the medical literature, we physician finance bloggers exhibit a bias toward publishing only positive results.
Most readers of these blogs have a notion that the White Coat Investor is making significant income from his website. Fewer readers appreciate that the vast majority of physician finance bloggers make about what our summer lawn mowing job in junior high school pulled in, minus the complimentary lemonade offered by that kind elderly neighbor. Rarely, passion projects reward us in income; mostly they reward us in non-monetary ways. If you have income taken care of, then by all means relish that fun pursuit.
The second reason is that figuring out my Act Two after medicine (a work very much in progress) has been messy, with a number of false starts and plenty of dead ends.
I've read up on topics and interviewed for positions that never quite panned out.
I've considered ideas that seemed perfect, only to find during the execution phase that they weren't particularly enjoyable (Ask any group of doctors how many fantasize about opening an ice cream shop someday; then ask someone who actually runs an ice cream shop what it takes, and you'll see what I mean).
I've dreamed big, only to wake up with slobber on my pillow.
I've overused metaphors.
Like any journey, you can't succeed until you define your destination and map out how to get there. I started out making a list of characteristics I thought my ideal second act job might possess:
- No night shifts.
- No weekends.
- Flexibility.
- Can be done remotely / will not conflict with international travel.
- Autonomy.
- Low stress.
- Intellectually stimulating, with new skills to master.
(Note that ditching medicine completely, which used to be my main goal, was no longer a requirement once I started cutting back. The less clinical medicine I engaged in, the more enjoyable it became.)
Outpatient Palliative Care
One of my mentors from medical school, a (now emeritus) professor I call monthly, impressed on me that "There's good work to be done at the end of life." My interest in bioethics, which dates back to my undergraduate years, continues to be an arena I participate in regularly and find extremely rewarding. I decided to explore and network with local docs to see how they were practicing end of life medicine.
First, I had coffee and several phone conversations with a colleague from my specialty who became director of a small hospice program after his children were grown, and who continued his hospice directorship after leaving the emergency department. He was encouraging and supportive, and even dropped off a book he'd used to study for his recent hospice boards. He implied that someone always needed to be present for hospice, so I had reservations about that specific avenue.
I also reached out via common friends to another hospice director, someone who had made a major change in his practice mid-career and attended a hospice fellowship. He encouraged me to do what he had done, uproot the family and relocate to do a fellowship. That was not feasible.
Another friend I'd come to know as a hospitalist had transitioned to running an inpatient palliative care service, and was helpful in explaining the opportunities and benefits of working within our hospital's employed physician positions. I attended a couple of meetings with his service, and quickly understood the appeal of supervising a team of clinicians.
This conversation naturally prompted me to speak with a friend who happened to also be the business director of an outpatient clinic run by the hospital. It was intended to offload some of ED volume by targeting a population with high ED utilization and terminal conditions - perhaps joining this clinic might be a way of fusing my skills and interests while fulfilling some unmet needs of the hospital administration.
I explained that what I sought was to supervise a team rather than practice clinical medicine directly. My friend outlined a position with a fixed time commitment including an element of clinical work, but which also included benefits as W-2 employee. As an ER doc I've always been an independent contractor, so the prospect of health and dental coverage for my family seemed to tip the scales toward committing to the position. I followed up with another meeting with a senior level administrator who seemed cautious but interested.
Alas, when it came time for the offer, the hourly compensation was substantially less than my emergency medicine work; the clinical commitment expected from me was greater; the position did not have a plan for transitioning to the supervisory role I envisioned; and the offer did not come with benefits. I passed and thanked them for their time.
Join A Med-Tech Startup
As an extension of a passion project, I connected with several purveyors who license software intended to provide complex case management tools for docs at the point of care through an information exchange database. One product stood out in particular. I had coffee with the CEO as he traveled through our area, and I continued to advocate that our hospital purchase their product. After several years of persistence, the hospital opted to purchase the software license.
I was able to cobble together a multidisciplinary team and visit a sister institution that already employed the software. We started strong and gained momentum, inviting stakeholders to join our committee and obtaining buy-in from our administration. We developed plans to care for challenging patients, implemented these plans across the hospital, and our successes pleased the administration and provided additional proof of concept for the software maker.
Based on our utilization of the software, I was one of twenty physician-leaders invited to participate in an ad hoc advisory retreat out of state. While there, I had the chance to pick the brain of their Chief Medical Officer, to get a flavor for what his job entailed and how he had gained entry into this nonclinical world.
He shared that he'd taught himself to code in college, then joined some startups as a programmer in the late 90s. He'd worked clinically in medicine, eventually using his IT background to become Chief Medical Informatics Officer for his health system. Most recently, his background in Silicon Valley entrepreneurship combined with his medical degree had helped him become the CMO of this company as he could credibly claim to bridge the technical side of IT with the needs of the clinician at the point of care.
As for the current job, he traveled extensively, averaging two weeks away every month. Furthermore, he'd had to relocate his family to another state for his CMO job opportunity. He said his family (wife, 2 school-aged kids slightly older than my own) had adapted, reluctantly, to the hours and travel associated with the job. Despite these trade-offs, he loved the work and believed in the mission of the company.
He suggested that for someone like me without a tech background to try to enter the med-tech space, it would involve reaching out and spending many hours offering free consulting services to one or more early stage companies that could eventually be leveraged into a job offer as the company grew.
I thanked him and assessed what Id' learned from him. Pursuing a med-tech job would require a large, up-front investment of uncompensated time with no guarantee of income to follow. At best, that would lead to an offer potentially requiring significant travel time away from home.
Much as this CMO loved his work and it rated highly on the intellectual stimulation front, it did not fit with the remaining objectives of my Act Two job, so I crossed it off my list of possibilities.
If you are also mulling over your exit strategy from medicine or just enjoyed this post, please check out Part 2!