UPDATE: [physician, career options, life options]

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Re: [physician wants to explore career options]

Postby Jazztonight » Tue Apr 30, 2013 12:32 pm

I'm an optometrist, and have been since 1976.

There are differences and similarities to medicine, but i certainly empathize with the OPs lament.

I've often observed that an MDs identity is very much tied up with his/her being a physician, even after retiring--it's just impossible to let go even if a person is miserable.

I've examined close to 40,000 patients in my career, and it's been very rewarding; but I have always maintained a parallel "career" in my own passion--music. So I can identify with letsgobobby's interests outside his profession.

After the group I worked in went HMO, I decided it was time to semi-retire and work PT, on salary, two days a week. It was just "amazing" how I was and still am able to somehow "survive" on a reduced income.

That's when I went back to college and pursued my dreams and interests.

When I was working FT, I began to feel like I was drowning. Not so much from the patients, but from the administrative BS and third-party misery. (If I had 30 minutes to see a patient, sometimes 10 minutes of that was wasted on paperwork.)

I've worked two days a week for 13 years. Now I'm planning to fully retire at the end of the year--from optometry. I will continue to pursue my other passions and interests. Do I have enough invested and saved to do this?

If a person waits until he/she has "enough," you may as well just keep working. "Enough" can be very elusive!

Whatever you decide to do, good luck!
"What does not destroy me, makes me stronger." Nietzsche
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Re: [physician wants to explore career options]

Postby staythecourse » Tue Apr 30, 2013 12:38 pm

Jazztonight wrote:I'm an optometrist, and have been since 1976.

There are differences and similarities to medicine, but i certainly empathize with the OPs lament.

I've often observed that an MDs identity is very much tied up with his/her being a physician, even after retiring--it's just impossible to let go even if a person is miserable.

I've examined close to 40,000 patients in my career, and it's been very rewarding; but I have always maintained a parallel "career" in my own passion--music. So I can identify with letsgobobby's interests outside his profession.

After the group I worked in went HMO, I decided it was time to semi-retire and work PT, on salary, two days a week. It was just "amazing" how I was and still am able to somehow "survive" on a reduced income.

That's when I went back to college and pursued my dreams and interests.

When I was working FT, I began to feel like I was drowning. Not so much from the patients, but from the administrative BS and third-party misery. (If I had 30 minutes to see a patient, sometimes 10 minutes of that was wasted on paperwork.)

I've worked two days a week for 13 years. Now I'm planning to fully retire at the end of the year--from optometry. I will continue to pursue my other passions and interests. Do I have enough invested and saved to do this?

If a person waits until he/she has "enough," you may as well just keep working. "Enough" can be very elusive!

Whatever you decide to do, good luck!


Excellent post and the feeling of "drowning" is quite familiar. In high school baseball we used to be taught, "see ball, hit ball". Would love to just "see the patient and take care of the patient". All the other stuff is what drags me down, i.e. paperwork, insurance stuff, administration work, production pressure, etc...

Good luck.
...we all think we're above average investors just like we all think we're above average dressers... -Jack Bogle
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Re: [physician wants to explore career options]

Postby Christine_NM » Tue Apr 30, 2013 1:18 pm

I can sympathize with the Medicaid problem. I get stunning patient profiles twice a week from my cleaning lady, whom I met as a home health aide last summer. She sees two worlds, those like me who pay full freight and live in nice houses, and those on Medicaid who live in cramped apartments with godawful medical conditions from which they soon die.

But do you get away from society's problems by changing careers, or do you just see the same stuff from a different perspective and it hurts less for a little while? Will the first market crash be the downfall of your clients and yourself? Will you indeed not touch that 25x income savings -- it will be awfully tempting in a supposed crisis.

One thing bothers me in the OP - planning to be a finance type and hoping the market will support the timetable to change. That is the kind of magical thinking that you will need to root out of finance clients. There is a business cycle and there is always regulation.

Sorry, but I don't see the upside in making the change. Maybe it would be better to become more realistic about what you can expect from medicine. As a nurse turned software developer (which worked out well but it was close), I hope this helps.
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Re: [physician wants to explore career options]

Postby afan » Fri May 03, 2013 10:44 pm

I can understand the frustration with medicine, but you need a practical alternative. Ideally, you would use your medical background. MBA, MPP, MPH and go into management or health policy? You would still be in the medical business, but you would not be delivering care.

Becoming a CFP, ChFA, etc seems like something to do as a hobby. Hardly an alternative to medicine, even with the poor future prospects. You are looking at a huge drop in income and stature, perhaps never getting back to where you are now. Perhaps you could learn enough to get a job working as an analyst for health care stocks. But that is a tenuous option at best. As a Boglehead, I am sure you realize that you are unlikely to actually pick stocks that outperform the sector. So making it as an analyst will have a large element of luck.

I could not consider retiring with 25x my annual expenses if I had the option to continue working. We are at about 40x right now, with no intention of retiring. Remember that your 25x could become 12x in a bad down market. Perhaps you could wait it out over a long period, but would you really feel comfortable having walked away from a good high paying job if that were to happen?

Medicine is no longer a great career, and it can be a terrible investment for those who rack up large debts. But it is likely to remain a decent career, and better than being a financial planner. As people have discussed, there is not that much for a planner to do. Even clients who do need some advice on the list given above do not need it on a continuing basis. Most of those are one time decisions. What is going to justify your fee year in year out when all they are getting is indexing?
"We don't know how to beat the market on a risk-adjusted basis, and we don't know anyone that does know either." | | --Larry Swedroe
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Re: [physician wants to explore career options]

Postby DFWinvestor » Sat May 04, 2013 5:07 pm

Another physician here. Emergency Medicine.

Just a shot in the dark and this may be way off target, but is there any possibility you are just not doing enough to enjoy yourself in your free time? The only reason I mention this is the fact that you are projecting you will have 25x your annual income (or expenses?) by the age of 45. That is an incredible feat as someone who started their career at the age of 30 presumably, if you were a traditional student.

I am six years out of training, I have been incredibly disciplined with my finances compared to many of my peers, and I will have nowhere near 25x my annual salary (or expenses) at the age of 45. Retiring at 50 is my optimistic goal right now, if everything falls into place just right and I have some passive income streams which I'm working to build right now.

I am slowly loosening up and spending more than I have in the past, for a variety of reasons. Fixed monthly expenses and debts have begun to vanish, and my wife has an income now too. What I have found in the process is, sometimes spending a little money can make you happier. This may be contrary to some "save every penny you ever earned" types, and I'm still pretty conservative, but I'm at a point now where spending money to do things I have put on hold for years has given me a new perspective. Sometimes there is just no joy in stashing it all away, dealing with everything we deal with in our professional lives and living like someone who makes a fraction of what we do. That's where I have been for many years, that's where I suspect you are given your retirement timeline.

Enjoying your free time doesn't have to equate to spending large sums of cash, but sometimes a splurge is in order and can be enjoyable. Right now I'm doing a big project in my back yard and I'll soon be able to enjoy our yard rather than it sit there unused on nice weather days. I know I will enjoy that far more than watching my balance go up by another $7K had I just stashed that money away.
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Re: [physician wants to explore career options]

Postby letsgobobby » Sat May 04, 2013 5:38 pm

yes just to clarify, I am talking about 25 x expenses, not income.

I do have trouble spending money. But I don't think spending more is what I'm looking for. I want more blocks of time off for myself, and less pressure during the hours I actually work. I almost think a part time hospitalist would be a better fit for me, but I'm not interested in doing an IM residency.

I continue to follow all the responses to this thread, and appreciate the feedback.
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Re: [physician wants to explore career options]

Postby DFWinvestor » Sat May 04, 2013 7:04 pm

letsgobobby wrote:yes just to clarify, I am talking about 25 x expenses, not income.

I do have trouble spending money. But I don't think spending more is what I'm looking for. I want more blocks of time off for myself, and less pressure during the hours I actually work.


I get what you are saying. One of my friends from medical school told me a few years back, "I think we will continue to make a good living in medicine, but we'll just have to run a lot harder and move more volume to make it". I think he was spot on. In my field I have zero control over that; I can choose to work in high or low volume facilities but these days regardless of that, unless you are in a "sleeper ER" attached to a surgery center, they are going to tailor the patients/hour to make sure you are busy. It seems that you should have more control over that in your field if you can find the right niche.

I have watched many of my colleagues spend more money on a variety of things (cars, country clubs, bigger homes, more/nicer vacations) and at times I have felt like I was a little too much of a glutton for punishment. They say that "the best revenge is living well". I can't say for sure if splurging a little more will have any impact on my career satisfaction at all, but I'm weary of having a lifestyle of someone who earns 1/3 of what I do. It's been tough for me to find the right balance, but right now I'm at a point where I feel that it's time to start enjoying myself a bit more.
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Re: [physician wants to explore career options]

Postby frugaltype » Sat May 04, 2013 7:19 pm

I haven't had time to read all the replies, but here's my two cents -

My internist is part of a 6-7 doctor practice that's independent. One doctor covers on the weekend and at night on a rotating basis, so it's not like people are getting rooted out of bed every day. They have an electronic records system, so the on call doctor has every patient's records and test results at her finger tips, even at home.

Most of them work full time, but mine works three days a week because she has small kids.

I think you folks are not creative enough or up to date enough in how your practice is set up.

As far as I know, all my doc's patients think she walks on water, because even with difficult cases, you know she cares, is smart, and is doing her best.

The partners seem to screen new people to get doctors with those characteristics.
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Re: [physician wants to explore career options]

Postby 6miths » Sat May 04, 2013 10:17 pm

It has seemed to me through the years that many (most?) physicians go through a stage at 10-15 years out into practice where they find themselves in a rut and would like to get out. My answer to this was to leave a high powered academic position and take my family overseas for 3 years to recharge in an academic job that was less clinically challenging and more fun in areas of teaching. I returned to a very busy clinical practice with university affiliations and good teaching opportunities. Now at age 52 (next week), I am in position to retire outright if I want but I have just decided to scale back on the call side of things. I have been doing this to varying degrees over the last 3 years. Basically taking each opportunity to slow down as it came up. The biggest change has been no weekend call for the last 4 months - what an incredible difference!

I too have toyed with the idea of getting my financial planning papers - not really as an alternate source of income but because I see so many of our colleagues making such senseless financial mistakes. I think if you went that way, you could certainly find yourself a niche in offering advice to doctors and dentists and others who might see you as 'one of their own'. Others have commented on how can one make money dispensing Boglehead type advice which is so easy to obtain free of charge. I would say that it may be free but it is not common that our colleagues have either found it or implemented it. So as a fee-only planner I would say there is great need. Whether your nature is such that you could bring it off in a business model is another matter of course. Also as pointed out, there are many other components of the financial planning that someone who has been 'in the business' could provide.

Personally, I would, and have, looked for more opportunities within medicine. Many options have been suggested. I will continue to slow down clinically and probably within 1-2 years let my group know that I am packing it in at which point they will likely try to convince me to at least keep doing clinic work with no call. I might consider it but I have trouble with the credibility side of that arrangement. In the meantime, I still love teaching and see myself doing that for years to come - that is one of my favorite hobbies. When students ask me why I do something that pays so poorly compared to other areas where I could be spending my time, I tell them that I love learning from them and borrowing some of their unbridled enthusiasm to get me through the tougher moments of my clinical practice.

One last comment that has already been made repeatedly is that I suspect that doctors will continue to make a great living wage and be greatly respected by the general public.


Good luck with whatever you decide.
'It ain't what you don't know that gets you into trouble. It's what you know for sure that just ain't so!' Mark Twain
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Re: [physician wants to explore career options]

Postby letsgobobby » Fri Feb 28, 2014 3:23 pm

I am bumping this old thread for more thoughts and a more specific question.

Forget all the alternative careers. I just want to work less. For me, going to 0.8 FTE would maintain my health insurance but cut my pay by about 30-35%, because I'd give up some administrative duties.

I was hoping to get to 25x expenses by age 45, but might settle for 22x expenses instead, just to have more time with my family and for hobbies. At 0.8 FTE we'd still save money, about 20% of our income. This money excludes college savings which will be about $500k by then, barring a market meltdown, and my kids will be 9 and 11 at that time.

What do you think? Would you feel comfortable cutting your hours and (probably semi-permamently) lowering your career trajectory with these numbers? For simplicity make this purely a numbers question, not a life satisfaction question. thanks.
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Re: [physician wants to explore career options]

Postby herbie » Fri Feb 28, 2014 3:35 pm

May I suggest that you edit your OP to include your new question at the top? Otherwise people will waste a bunch of time reading all the responses to the previous question and are less likely to see your new question.
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Re: UPDATE: [physician, career options, life options]

Postby letsgobobby » Fri Feb 28, 2014 3:40 pm

thank you, good idea.
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Re: UPDATE: [physician, career options, life options]

Postby Zabar » Fri Feb 28, 2014 3:59 pm

I understand where you're coming from. I'm a clinical psychologist by training. My focus was on hospital-based psychosomatic medicine. I realized during my internship that I didn't have a passion for the type of traditional careers that all of my classmates aspired to. Rather than be pushed along by momentum, I took the leap and started a series of careers that allowed me to use my training in different ways, such as health and science journalism, writing books on child development, and leading a large nonprofit organization. Throughout this, I kept an academic affiliation in psychiatry and/or epidemiology as a part-time prof.

The key for me was thinking of the career change as integrating new fields rather than abandoning old ones. I never regretted the move. Many of my colleagues thought I was crazy when I started doing this. Now I regularly get calls from them asking how they can change what they're doing for a living.

One thought that I had about testing the waters of financial planning: have you considered offering (free) workshops to low- and middle-income families on the psychology of money and personal finance. This would seem to draw upon your clinical skills and experience, and would not involve you in fiduciary relationships. Besides, it would feel nice to help some people who are basically healthy, and to do so without having to fill out an insurance form! :happy
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Re: [physician wants to explore career options]

Postby herbie » Fri Feb 28, 2014 4:03 pm

It's tough to make this a pure numbers question without actual numbers, not to mention that it's hard to quantify the impact to your career trajectory. ;)

My short answer: I do not think I would not be comfortable with 22x expenses @ 45 if I planned to completely retire.

In my own current situation I would jump at the chance for the 0.8 FTE deal that you describe. But I think my happiness would be maximized if I were working part time so I think I could/would do that a long time. I would be content with a 20% savings rate at the phase of life that you are at (kids ~10yrs old with college funded, with a solid nest egg). But again, that would assume that you would continue to work for "awhile".
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Re: [physician wants to explore career options]

Postby englishgirl » Fri Feb 28, 2014 5:02 pm

letsgobobby wrote:..... At 0.8 FTE we'd still save money, about 20% of our income.
...
What do you think? Would you feel comfortable cutting your hours and (probably semi-permamently) lowering your career trajectory with these numbers?...


Let me see, I'm 45, have nowhere near 22x my annual expenses saved, and don't save 20% of my income. So, um, yes. I'd be comfortable with those numbers.

However, as someone that's done the 0.8 thing (well, actually, 0.75), and is now doing the 0.5 thing (while growing a biz on the side), I will say that at 0.8 you really don't escape as much of the administrative nonsense as you think you will. Unless you're actually going to step back from being a partner and stop going to practice meetings, or whatever. Also, it seems to work a lot better if you set your schedule so that everybody knows you are not in on Fridays (or whichever day). Otherwise people will still leave stuff for you. At least if they know you are not in, they might go and ask someone else or figure out the answer themselves, or just get it done. For me, the nonsense really only slowed down dramatically once I was down to 0.5.

Alternatively, as a first step, if you're in a private practice where you have some decision making power, set your schedule up differently. Split up your time for working "in" the business as opposed to working "on" the business. If you think you'll convince the others in your practice to let you do 0.8, why not initially try to convince them to let you take charge of your schedule. Only allow appointments to be scheduled for 0.8 of the time. Save the other day for admin, reading, teaching, whatever. A whole day. And allow yourself to leave early on that day if your kids have a football match or a recital. I can't tell you how much better I feel with time built in my schedule for actually catching up on journals.
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Re: UPDATE: [physician, career options, life options]

Postby livesoft » Fri Feb 28, 2014 5:25 pm

As you may already know, I stopped working full-time about 6 years ago. I went to half-time, but after my kids "retired" from extracurricular activities, I bumped up to about 75% effort. My spouse still works, but also took a pay cut for a job with a much shorter commute.

So yes, I would and did feel comfortable lowering my trajectory. Basically, I've dumped my buckets and get to do mostly what I like to do. Some of my colleagues are jealous, but so what?
It's all about short-term opportunistic rebalancing due to a short-term change in one's asset allocation, uh, I mean opportunistic rebalancing, uh I mean rebalancing, uh I mean market timing.
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Re: UPDATE: [physician, career options, life options]

Postby letsgobobby » Fri Feb 28, 2014 6:03 pm

Giving up on a lot of things at this age is harder to actually do than I imagined it would be. Instead of pursuing committee this, med staff that, system leadership whatever, I'd give up 0.2 FTE formal administrative duties, plus another 0.1-0.2 worth of clinical duties, and pretty much check out of the rat race.

Would I be disappointing my father? I need a shrink. :?
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Re: UPDATE: [physician, career options, life options]

Postby DFWinvestor » Fri Feb 28, 2014 6:31 pm

letsgobobby wrote:Giving up on a lot of things at this age is harder to actually do than I imagined it would be. Instead of pursuing committee this, med staff that, system leadership whatever, I'd give up 0.2 FTE formal administrative duties, plus another 0.1-0.2 worth of clinical duties, and pretty much check out of the rat race.

Would I be disappointing my father? I need a shrink. :?


I think you need to just do it and you can always go back to working more if you so desire. At the age of 45 if you have 22x your annual expenses, you could survive until the age of 67 with no additional income. I can't imagine a situation where you couldn't make that work. You could continue scaling back over the years and be part time for a number of years. Working 1-2 days a week will be a breeze and keep you from tapping into your retirement money, no reason why you couldn't maintain that for a few years longer than you had anticipated if you have to.

I have slowly scaled back on my clinical hours already and I'm only 6.5 years out of training. What I've found is I am more efficient when I am at work now because I am not worn out, and my income hasn't really dropped at all despite cutting back 20 hours/month compared to when I finished training.

I suspect if you cut back you will enjoy it immensely and wonder why you didn't do so before. Planning for the long term is a good thing but worrying excessively about 2-3 decades from now is not always healthy.
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Re: UPDATE: [physician, career options, life options]

Postby goodenyou » Fri Feb 28, 2014 10:55 pm

I would reduce my hours and look for alternate income streams. I knew an Ivy-Trained Urologist who quit after a few years and did disability exams in the state of Ohio. The guy made $300-400k doing exams on "disabled" people. Some were legit. You can also do IME exams. My best friend is an orthopaedic surgeon who hates it too, so he does IMEs. He makes more doing IMEs than government surgery with a lot less stress and malpractice risk. Look for chart reviews. There are companies looking for this too. You can also become an Insurance Denier; the doctors with no expertise that try to deny patients surgery at first until you have to educate them why it is the standard of care. The physician posts are a sad commentary on the toxic state of medicine in this country both for doctors and patients. The worst part is that unsuspecting young adults are signing up for this after assuming crushing debt loads and long time commitments.
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Re: UPDATE: [physician, career options, life options]

Postby LowER » Sat Mar 01, 2014 1:50 am

Great thread, and thanks for the update. I am yet another physician feeling the same way as many posters here. Instead of cutting hours, I have maximized mine and cut spending to a minimum in so many ways. I haven't taken any vacation in almost 2 years and am selling my time off for cash. Making a game and a competition with myself to save, save, save has made it kind of fun and in a strange way, exhilarating. I am now working for my freedom from all the BS that is polluting medicine to its core. I am now able to shrug it off fairly effortlessly and have fun with and poke fun at the BS. I have a goal, a tool to get there, and every day, every patient encounter, is one more step up the mountain, and at this point I'm jogging, not slogging. Every extra day that I work now is one (to two depending on investments) less that I have to work later in life. I know I'm flirting with burnout but lately this plan has been so energizing that I feel less prone to burnout than ever in my career. Early on I fought the stupidity energetically - and it was beyond exhausting; I never taught the pig to sing, made a teeny bit of headway, and left my soul out to dry.

I'm not sure how this "bring-it-on" attitude came about, but having a financial plan and seeing that the light at the end of the tunnel is not a train, has helped tremendously. Instead of thinking of new consults as hits, I am very grateful and gracious to the referrer, and make sure they know how I feel (even when it's a ridiculous consult), because they just got me one more step up the mountain, and hey, the more ridiculous the consult, the less the risk, less emotional burden, less thought consuming, less taxing, and I can tell those patients that they can buy green bananas and long-playing records, but they can't run up their credit cards too high because they'll live long enough to be forced to pay them off over their remaining long lifetimes.

I don't know how resilient this new mindset will be, but I'm going to make as much hay as I can while the sun's out, hit my number as soon as possible, and walk whenever I want, though at that point I may be having so much fun with such a stupid system that I stay. Either way, the choice will be mine - to be able to do good solely for the sake of doing good - not for the administrators, the ABIM, the paycheck, the benefits, blah blah blah. And if I don't feel like taking boards AGAIN, I will give the ABIM the single-finger wave and trade it all for downhill boards in the winter and surf boards in the summer. I have a long way to go to get to 25X expenses, but I'm getting there more rapidly than I ever thought possible, largely because of all the wonderful, generous, altruistic advice I have gotten on this website.

To the OP, I feel your pain, was there for too many years, looked into alternative careers, alternative settings, part time, and more, and somehow ended up here…with the wisdom of no escape: bring on the work and laissez faire acceptance/rebellion against the BS that I cannot change.

By the way, I don't recommend this for anyone but me, and only for as long as it works. My update in 2 years on this thread may be 180 degrees, but my retirement assets will be getting very close to allow me to u-turn whenever and however I want.

And the main thing for me, has been to now (finally) live WAY below my means.
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Re: UPDATE: [physician, career options, life options]

Postby am » Sat Mar 01, 2014 10:25 am

Interesting thread. Young people are signing up because alternatives in many cases are worse. Medicine is still a near guarantee to a comfortable financial life. Young people do not understand how toxic and unpleasant this profession can be however. They see nice salaries and relative prestige. Some things need to be experienced to understand.

To the poster working his butt off, would not take this route. Best to optimize your current situation for maximal happiness. You know we are not guaranteed anything so your plans can get derailed for a multitude of reasons.

Think all the uncertainty is ruining the field. The incessant cuts to reimbursement, new burdensome regulations, stress to be perfect, doing more for less, lack of malpractice reforms, lack of control, The skills we have acquired over the years are of limited use outside of medicine. Often can not come close to the income we get in medicine. The economy has hit my field of radiology with limited job opportunities in more relaxed positions like VA or more lifestyle oriented practices.

Think many physicians feel trapped. Perhaps the unhappy ones are the most vocal but I have seen surveys showing that majority of physicians show some signs of burnout. The politicians can keep cutting and destroying the field, but the result may not be very good. What kind of people will be going into medicine and taking care of us if we get sick when all is said and done?
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Re: UPDATE: [physician, career options, life options]

Postby avenger » Sat Mar 01, 2014 11:30 am

letsgobobby wrote:Update 2/28/14:
I am bumping this old thread for more thoughts and a more specific question.

Forget all the alternative careers. I just want to work less. For me, going to 0.8 FTE would maintain my health insurance but cut my pay by about 30-35%, because I'd give up some administrative duties.

I was hoping to get to 25x expenses by age 45, but might settle for 22x expenses instead, just to have more time with my family and for hobbies. At 0.8 FTE we'd still save money, about 20% of our income. This money excludes college savings which will be about $500k by then, barring a market meltdown, and my kids will be 9 and 11 at that time.

What do you think? Would you feel comfortable cutting your hours and (probably semi-permamently) lowering your career trajectory with these numbers? For simplicity make this purely a numbers question, not a life satisfaction question. thanks.
.


Have you considered a government job? Much more control over hours. You get a paycheck. Reimbursements are not your concern (at least not directly).
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Re: UPDATE: [physician, career options, life options]

Postby Phatphoeater » Sat Mar 01, 2014 1:41 pm

Voice of dissent here. I love my job and wouldn't consider doing anything else. I probably earn half of many of you other physicians but at least I can say I enjoy what I do. For those reading this thread for insight into the world of physicians, take what's described here for what it is. Every profession has people that are unhappy.

I find the frustration with "regulation" or "government control" or "being perfect" disappointing. Almost every other high risk industry has some standard to maintain quality and only recently have these principles been applied to medicine. It's laughable that people still want to practice medicine without regard to evidenced based standards where they exist.
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Re: UPDATE: [physician, career options, life options]

Postby wshang » Sat Mar 01, 2014 2:12 pm

I am a physician who got out recently at a young age. A couple of psychological caveats:
1) You actually have to overshoot your number. While it might be exhilarating to reach it, exceeding it is only safe.
2) You need a plan. Or a hobby. After I comfortably surpassed my number, every little bit of crap was less tolerable. It is like being in the North, enduring this cold, knowing that you are no longer bound to the geography.
3) Yeah, I had the same musing as LetsGoBobby. At some point, you realize your father will die and there is no other expectation to live off - that it was a ridiculous vestige of adolescence. Defining yourself, setting your own value on health, free time, personal growth, friendship, kinship, etc. Mel said this in a previous post, learning to get along without letters after your name is a mark of self-confidence.
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Re: UPDATE: [physician, career options, life options]

Postby DTSC » Sat Mar 01, 2014 3:19 pm

I can relate. I've been in a similar rut. I'm in primary care, 12 years out of training. About 3.5 years ago, I hated going to work. I was over-committed at work. At home we had 3 young children, including (an unexpected) newborn. I had to study to re-certify for my Boards and then was hit with my first (and hopefully only) lawsuit.

I was burned out. I went to see a shrink colleague. He recommended that I scale back my hours. I was worried about saving enough. But the way he explained it was: "If you worked 10% less hard for 10 years, but are able to extend your career for another year because you didn't burn out, then you really didn't lose any income in the end."

I think you are fine financially to cut back 20%-30% of your income. Really. I 've learned a ton from Bogleheads.org, but frankly coming here greatly skews your perspective about how much you have to save. Most people don't save nearly as much as the average Boglehead and many of them will still do just fine. I suspect MOST Bogleheads will die with plenty of money in the bank. That's fine, unless it's at the cost of your *present* happiness. I would go so far as to say that many Bogleheads seem to worry too much about money and saving. Maybe even obsessed? One doesn't log 6000 posts without spending a few hours here.

How are you compensated? Sounds like you're on production, with added fixed income for administrative work. If this is so, then just dump the administrative work, since you say that you still don't mind seeing patients. It sounds like you're sick of all the other B.S. that is associated with practicing medicine, but not patient care itself.

How about if your try this: Bag all the non-patient care activities. Bag all the administrative stuff. Take more Fridays and Mondays off so you have 4 day weekends to go pursue your hobby. You don't have to make a big announcement that you are going part time (and hear all the talk associated with it). Just go ahead and DO it for half or a whole year. If anyone asks, just tell them lots of your friends are getting married this year and you just have to take more weekends off to go the weddings or make up some other B.S. What I'm trying to say is: stop and smell the flowers once in a while. We are all one big car accident away from death or inability to pursue our favorite activities. Also, your kids are not always going to be young. Nor do many teenagers want to spend time with you. They will be attending college (which you already saved for) in no time. You can always work more when they're gone.

Finally, without sounding snarky, instead of getting advise about this from a finance site, maybe find a trusted friend (or a therapist!) to talk to about your life values and goals. Once you figure that out, the financial/work part will become clear. I really am not trying to be offensive - we all have a blind spot. I didn't find mine until I talked to someone else.
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Re: UPDATE: [physician, career options, life options]

Postby am » Sat Mar 01, 2014 3:34 pm

Agree with working less now to extend career potentially. Not every physician has that option unfortunately.

Seeing a therapist/psych as an MD is risky. Some medical boards and hospital credentialing applications ask about this. But wonder how they would find out if you paid cash? Perhaps a deposition for a lawsuit where they would ask about this but would a psych/emotional problem history ever be relevant? Anyone have any knowledge about this?
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Re: UPDATE: [physician, career options, life options]

Postby DTSC » Sat Mar 01, 2014 3:42 pm

am wrote:Agree with working less now to extend career potentially. Not every physician has that option unfortunately.

Seeing a therapist/psych as an MD is risky. Some medical boards and hospital credentialing applications ask about this. But wonder how they would find out if you paid cash? Perhaps a deposition for a lawsuit where they would ask about this but would a psych/emotional problem history ever be relevant? Anyone have any knowledge about this?


Not seeking help by seeing a psychiatrist/therapist when you need to is also dangerous.
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Re: UPDATE: [physician, career options, life options]

Postby staythecourse » Sat Mar 01, 2014 4:02 pm

I have not read the other replies so sorry if I am repeating here in my comments.

My answer is simply do what you want to do that would make you happy and give you some balance. As far as I know you are a responsible individual so the nuts and bolts don't worry me. All these calculations are useless. I can GAURANTEE whatever your calculation is it won't matter, i.e. 22x vs. 25x. I would counter with the what ifs? What if you cut down and the market does well and you still get to 25x? What if your significant other dies early and you don't need the 25x? What if by the time your children leave for school and you attain the x number you want it will be too late to spend quality family time as they are now in college? What if...

Great part and frustrating part of life is NO ONE can make the perfect plan. You have done a great job planning thus far so if you feel you are being stretched and miss other important relationships in your life as a result of work then do what will make you happy. What I can tell you is you don't want to be 60 looking back and thinking "Boy I really wish I could have..." just to come to some random number on your balance sheet.

Good luck.
...we all think we're above average investors just like we all think we're above average dressers... -Jack Bogle
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Re: UPDATE: [physician, career options, life options]

Postby Emilyjane » Sat Mar 01, 2014 4:25 pm

Family physician here, practicing 30 years, cut down to 3 days per week 25 years ago when child was born, best decision ever. I could maybe be retired by now if I hadn't, but maybe I would have just spent more money. Am at 29x expenses now, nice to work knowing that I don't HAVE to, but really enjoy 90% of my patients. When I first cut back, I thought of it as retiring part time, knew I'd work more years as a trade-off.

That said, I am sad to see the direction medicine is going in the name of "quality", I believe I've practiced quality medicine for years, and now the proliferation of checkboxes and quality metrics makes it harder to continue doing what it think is quality! To sit with a patient and discuss what is important to them (instead need to document hgba1c, document that I counseled re: good diet and exercise.... What, you wanted to talk about how sad you are that your mom died, sorry, that is not a quality metric...)

When I find myself being annoyed with a patient who eats poorly and doesn't exercise, because they are spoiling my "quality" statistics, I think about retiring. But most of the time I can avoid that, and can enjoy my work. Part time work helps me do that.

Re: saving money, it does get much easier when those children fly the coop.

So, my advice would be cut back the hours. Easier to be a good doc that way. I like the advice to cut back without being too blatant about it.
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Re: UPDATE: [physician, career options, life options]

Postby goodenyou » Sat Mar 01, 2014 5:46 pm

I would caution taking the "suck it up because every job has it's downside" advice. The job as a physician is uniquely different. The stakes are a lot higher. You are not doing paperwork, meeting a deadline or hitting sales goals. Whether you are treating mental illness or doing complex surgery, your patients rely on you to be "on". Burnout is serious. It makes one yearn for financial freedom as salvation from the misery. You start to focus on outcome not process. The deferred lifestyle plan, while the common life plan for many, is sometimes too intolerable to endure. I encourage you to look for alternate income streams in medicine to allow you to take a step back from the current situation. It will give you clarity and a breather. Look for IMEs and possibly chart reviews.
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Re: UPDATE: [physician, career options, life options]

Postby jackpullo997 » Sat Mar 01, 2014 6:56 pm

Can you be more specific with your ratios?
You have saved 25x annual spending?
I'm guessing your monthy nut is $5k. $60k year.
25x = $1.5mm

You got a million bucks and an MD degree.
You'll never be poor.

Forget the numbers, just work less.
You won't regret it, and won't be watching your bank balance.

Enjoy the work/life balance, you've earned it.
Enjoy your life before you're too old to do things,
and your money is useless to you.
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Re: UPDATE: [physician, career options, life options]

Postby jackpullo997 » Sat Mar 01, 2014 7:03 pm

The more cynical take is that if you save a ton of money working like a dog,
you have a 50% chance of losing 1/2 of it in a divorce to your wife.

If you take time off, the wife can never steal those experiences from you, like she can your assets.

This is why it does not pay to work too hard.
Save, but not at the expense of living your life.,

I went to part time career 10 years ago, and my life has been much better.
I am a more interesting person, have developed skills in many hobbies,
and I still have money money than I can spend.

Come on over to the dark side!
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Re: UPDATE: [physician, career options, life options]

Postby bayview » Sat Mar 01, 2014 8:47 pm

Off-the-wall suggestion: get certified as an AHIMA ICD-10 trainer. It would help if you were familiar with the intricacies of ICD-9, of course. :D

My inbox is flooded with job openings for those who can review I-9 codes and translate them into I-10, especially providers like you.

At least half the coders that I know are quitting on 9/30, before I-10 hits on October 1. There will be a huge shortage of people who understand ICD-10 coding, and if you are trained in this with an MD credential as well, you should be able to name your own price.
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Re: UPDATE: [physician, career options, life options]

Postby am » Sat Mar 01, 2014 8:55 pm

Bayview, how do you get trained as an ICD 10 coder? Is becoming a coder a reasonable choice for an MD who wants to get out of clinical medicine? What kind of income and hours?
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Re: UPDATE: [physician, career options, life options]

Postby LowER » Sat Mar 01, 2014 11:01 pm

jackpullo997 wrote:The more cynical take is that if you save a ton of money working like a dog,
you have a 50% chance of losing 1/2 of it in a divorce to your wife.

If you take time off, the wife can never steal those experiences from you, like she can your assets. (snip)

Come on over to the dark side!


You are so right, so so so right.

But,….she can't take it if you're already divorced and single! Thank goodness!!

Re-starting from far less than zero after divorce can motivate in mysterious ways. Hello dark side!
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Re: UPDATE: [physician, career options, life options]

Postby EnjoyIt » Sun Mar 02, 2014 1:45 am

Great post and an exact replica of my goals. I will admit I have cut hours from work and have been much happier. Because we are taxed at such a high rate, it is actually better to work less hours a year for more years (because you are taxed less cumulatively.) IE: you make more money working 10 shifts a month for 20 years than 20 shifts a month for 10 years and enjoy your life more in the process.

Financially you are in great shape, and working 0.8 FTE will keep you on track financially. Feel free to decrease to .7 FTE if you find yourself still exhausted. I experienced it myself, and you will find that there is an FTE that will set you free emotionally. For me, 13 days a month does it. Lots of free time to enjoy life, and still make enough money to contribute to retirement. You will find your place, I promise.

Lastly, I am in full agreement with your views on medicine today and its future outlook being very bleak. It is a shame, because if you take out all the BS, I really love my job. Now that I work less the BS doesn't seam to bother me as much. I also realize that lower pay and increased BS is on its way. I may have to cut down to 12 or 11 days in the future.

good luck,

-Beck
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Re: UPDATE: [physician, career options, life options]

Postby Texas hold em71 » Sun Mar 02, 2014 12:52 pm

From a pure numbers standpoint, I would say yes.

I know from your other posts that you want to save a lot for college but I can't tell from this one if you are going to stop saving for college when you cut back. My answer assumes you will stop funding the 529s and all savings will start going to retirement.

You are still going to be saving 20 percent of your income and that is still a pretty nice income- so you will still be growing retirement savings by a fairly sizable amount during this period of working less.

Of course you will have to keep an eye on the portfolio to see when you have hit your number to quit altogether. I suspect you will be there by the time you want to stop.
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Re: [physician wants to explore career options]

Postby fsrph » Sun Mar 02, 2014 3:19 pm

letsgobobby wrote:I am bumping this old thread for more thoughts and a more specific question.

Forget all the alternative careers. I just want to work less. For me, going to 0.8 FTE would maintain my health insurance but cut my pay by about 30-35%, because I'd give up some administrative duties.

I was hoping to get to 25x expenses by age 45, but might settle for 22x expenses instead, just to have more time with my family and for hobbies. At 0.8 FTE we'd still save money, about 20% of our income. This money excludes college savings which will be about $500k by then, barring a market meltdown, and my kids will be 9 and 11 at that time.

What do you think? Would you feel comfortable cutting your hours and (probably semi-permamently) lowering your career trajectory with these numbers? For simplicity make this purely a numbers question, not a life satisfaction question. thanks.


Letsgobobby,

Since you wanted responses from a purely numbers standpoint, of course you can reduce your hours. You'll have at least 22x expenses PLUS after the hours reduction you'll still be saving 20% of your income. You are not stopping to work at 45years of age. I think many people (me included) have trouble tapering work hours as they age. Sometimes it's as simple as they have a strong work ethic and are used to putting the long hours. There is nothing wrong with tilting the work/life balance more to the lifestyle side.

Francis
“Never ask a barber if you need a haircut.” ― Warren Buffett
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Re: UPDATE: [physician, career options, life options]

Postby LowER » Sun Mar 02, 2014 4:14 pm

I'm not discouraging going 0.8 or 0.7 at all but you may want to check with your partners about how they feel or how they might feel covering for your patients in your absence. The nurses' questions, the calls from the EDs and pharmacies and other physicians asking about your patients, etc., can add up after a while. In my specialty there are very few part-time docs because when they have their days off, the 1.0+ docs get slammed with a lot of their non-reimbursed/nonrecognized scut. Resentments can build, and in fact, someone in our department is currently interviewing elsewhere solely because his part-time partner is dumping on him.

I have no idea how your specialty works. Hopefully this is a non issue for you.

Just something to consider; I would hate to work in an environment where I was resented by my colleagues.
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Re: UPDATE: [physician, career options, life options]

Postby bayview » Wed Mar 05, 2014 11:40 pm

am wrote:Bayview, how do you get trained as an ICD 10 coder? Is becoming a coder a reasonable choice for an MD who wants to get out of clinical medicine? What kind of income and hours?

Sorry for the late reply. :( This wasn't the most serious option that I could have posted, but it's definitely a possibility. If someone is an MD and is willing to take on figuring out the arcane world of medical coding, the combination of MD + ICD-10 skills could create some income possibilities in auditing and consulting. Most providers have very little idea of how coding works; understandably, because it has gotten incredibly complex in the last decade or so, with a ton of thou-shalt-nots and if-the-moon-is-in-the-second-phase rules. But having the clinical understanding that an MD (or PA, or NP) has gives a ton of value to a coding credential.

There are multiple sources of training on this, but I would start with AHIMA (www.ahima.org) and AAPC (www.aapc.com). I'd be VERY wary of for-profit schools and colleges that offer this training, although of course many of them are reputable and offer good education.

I have noticed that when I wander through the ads for the various coding contractors, I see quite a few that brag on having MD's on staff. So it's definitely not a common option, but they're out there, and they're unusual enough and have enough of a distinctive edge that I can see a niche opportunity.
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