At a crossroad

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justanotherdoc
Posts: 1
Joined: Tue Nov 20, 2018 9:38 pm

At a crossroad

Post by justanotherdoc » Tue Nov 20, 2018 10:51 pm

Hello everyone,

First-time poster. I have been lurking for about a year and have learned a lot from the collective wisdom on this board. Now I am hoping to get some comments about my current situation from all of you especially the physicians on this forum.

I am a new subspecialist physician that has been in private practice as an employee after my fellowship for about a year. I make a good salary (not as good as my partners) and have a good amount of vacation (80% of what my partners get). My group is doing well financially and will likely to continue to do well due to expansion, ownership in medical facilities and lack of real competition in the region. I really like my partners especially my senior partners and was told a few months ago that I will likely be offered partnership in the next year or two as retirement happens within the group. The group is located in a small city of 100k in a semi-rural region of the country, but it's about a 1.5 hr away from a major metro area. I am indifferent to the location but an improvement would be nice. I fit in well at work but I do not feel I fit in with the local culture. Also, I was hired for my specialty training, however, I currently do not practice to the full extent of my training to the point I feel I am stagnating in my subspecialty. On a personal note, I have been in a long distance relationship with my gf for almost 2 yrs and we are seriously discussing closing the distance by moving to her home city which fits me better personally. I am close in joining an academic group in that city that will allow me to practice my subspecialty and my gf would be able to move with me as well.

I joined private practice in the first place because I was so turned off by academia (the bureaucracy/the politics/the hypocrisy/hubris) during training. Unfortunately, my sub-specialty is mainly practiced in academia in this country. I feel conflicted in that by moving I am giving up millions in potential earning/perks as a full partner in private practice and will have to deal with the potential shortcomings of being an academic physician. It seems I am giving up a lot, money and vacation, for improved personal life and professional satisfaction.

Financially I've paid off my student loans 9 mo into practice and just have a 12k car loan at 0.9% APR. I should have about 200k saved in various accounts prior to my move. I currently make about 400k and will be about the same in academia, but with a higher COL (for the midwest, not LA/NYC/SF) and no major bump in pay in the future. I am pretty frugal and gf is less so, but she is not extravagant. So we will maintain her current lifestyle which will be about 80k per year total for both of us while we will make about 530k-550k combined.

I apologize for the long-winded post and the lack of specific questions. The purpose of this post is just to make sure I am not making a major life mistake by missing some huge red flag in my current situation. Thank you for reading and please let me know if anything needs clarification.

Just another doc

mhalley
Posts: 7768
Joined: Tue Nov 20, 2007 6:02 am

Re: At a crossroad

Post by mhalley » Tue Nov 20, 2018 11:32 pm

Sounds like a good portion of the move is to get back into the sub specialty practice? Everyone has to decide between work and personal life. The great thing about being a physician is that you can practice anywhere in the country. If you don’t like the academic job in the new city, you can always look into private practice there, or in any city in the US. Making 500k ain’t hay, and you just have to decide if being with your gf home town plus sub specialty practice is worth giving up millions. You will still have millions when you retire, but maybe not 10s of millions. What extravagances will you actually be giving up by having “only” millions? Will you miss the McMansion, private jet & Lamborghini? Can you settle for a great house, flying first class,and a Lexus?Why is she not willing to move out to your great city? Seems like lots couples go where the high earner gets the best career opportunities.
When I finished residency I decided to stay in my home town, near my wife’s and my family. I practiced at the same hospital until I retired, which is practically unheard of in emergency medicine. It is all about what is most important to you.

abonder
Posts: 260
Joined: Sat Nov 03, 2012 10:52 am

Re: At a crossroad

Post by abonder » Wed Nov 21, 2018 2:47 am

Just a brief comment - I don’t think you’re making a mistake. Based on your solid savings and modest expenditures, you’ll be successful in almost any setting. Id go where you are happiest, both professionally and personally. That usually means some sort of compromise. Don’t beat yourself up over potential lost earnings. There’s always a job somewhere that pays more!

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Watty
Posts: 18076
Joined: Wed Oct 10, 2007 3:55 pm

Re: At a crossroad

Post by Watty » Wed Nov 21, 2018 4:49 am

You should also check out the White Coat Investor web site which is run by a doctor that is a regular poster here.

https://www.whitecoatinvestor.com/

There may be more doctors there that could give useful input on your situation.

Olemiss540
Posts: 1171
Joined: Fri Aug 18, 2017 8:46 pm

Re: At a crossroad

Post by Olemiss540 » Wed Nov 21, 2018 12:21 pm

abonder wrote:
Wed Nov 21, 2018 2:47 am
Just a brief comment - I don’t think you’re making a mistake. Based on your solid savings and modest expenditures, you’ll be successful in almost any setting. Id go where you are happiest, both professionally and personally. That usually means some sort of compromise. Don’t beat yourself up over potential lost earnings. There’s always a job somewhere that pays more!
+1. OPs situation is not a matter of enough money. Pick the best of both worlds and give it a try. If academia doesnt work, can always go into private practice.
I hold index funds because I do not overestimate my ability to pick stocks OR stock pickers.

yougotitdude
Posts: 72
Joined: Fri Sep 15, 2017 12:40 pm

Re: At a crossroad

Post by yougotitdude » Wed Nov 21, 2018 1:36 pm

I'm torn on this but from a different angle. My spouse is in academic medicine. She would more than double her income and work less if she took a job in a small town that's not terribly far from us. She really likes the academic side though. I'd love if she took the small town job because it would give a lot of breathing room financially and she'd be home at dinner time. Though, with her sub-specialty it would be almost impossible for her to focus in a non-academic institution. So that's the big thing holding us back. I work from home so I'm open to just about anything.

fourwheelcycle
Posts: 763
Joined: Sun May 25, 2014 5:55 pm

Re: At a crossroad

Post by fourwheelcycle » Wed Nov 21, 2018 2:26 pm

I agree on the recommendation to ask your question at The White Coat Investor forum. I have seen young MDs agonize both ways on this issue, and I have seen good and bad outcomes as a result of going in either direction. Money should simply not be an issue - with reasonable Boglehead spending and investment habits you will do fine on $500K+ per year, even with "only" inflation or COL level annual increases. Also, you will find that annual salary increases become greater with longevity and seniority in one place, whether you stay in your private practice group or move to academia. If you live on $120K expenses per year, before taxes, your employment-related and taxable savings will swamp likely index fund growth during the next ten years. Your money should be in low ER index funds, not fancy real estate or other deals marketed to MDs, but you will find your annual savings is the real driver to your investment growth at this stage of your life.

Local culture fit is a big consideration in where you choose to live, and the general culture of private practice vs. academia is also a major consideration. However, the biggest consideration, apart from your spouse or life partner, is your immediate work group. Whether in private practice or academia, your immediate professional colleagues and your day to day practice environment (OR, cath lab, practice site staff and "rules", etc.) can make your work life enjoyable and stimulating, OK, or hell. You need to look very closely at your current private practice setting and at the particular academic setting you would be moving to. You need to consider your personal fit with the key senior people, and the younger but long term docs, in either setting. If the fit is not right, the best time to recognize it is now, before you decide to stay or before you decide to move.

Many young specialists got to where they are by being "A" students and they are hooked on the stimulation and recognition they get in an academic environment, even if they have to give up some income compared to private practice. As you have noted, you would also hopefully get to practice full or almost full time in your chosen specialty area in academia compared to a rural setting. However, one difficult but entrenched senior partner or section head can undo many of the benefits of either setting, so you have to keep your eyes open as you consider whether to stay or move.

PFInterest
Posts: 2684
Joined: Sun Jan 08, 2017 12:25 pm

Re: At a crossroad

Post by PFInterest » Thu Nov 22, 2018 9:57 am

justanotherdoc wrote:
Tue Nov 20, 2018 10:51 pm
Hello everyone,

First-time poster. I have been lurking for about a year and have learned a lot from the collective wisdom on this board. Now I am hoping to get some comments about my current situation from all of you especially the physicians on this forum.

I am a new subspecialist physician that has been in private practice as an employee after my fellowship for about a year. I make a good salary (not as good as my partners) and have a good amount of vacation (80% of what my partners get). My group is doing well financially and will likely to continue to do well due to expansion, ownership in medical facilities and lack of real competition in the region. I really like my partners especially my senior partners and was told a few months ago that I will likely be offered partnership in the next year or two as retirement happens within the group. The group is located in a small city of 100k in a semi-rural region of the country, but it's about a 1.5 hr away from a major metro area. I am indifferent to the location but an improvement would be nice. I fit in well at work but I do not feel I fit in with the local culture. Also, I was hired for my specialty training, however, I currently do not practice to the full extent of my training to the point I feel I am stagnating in my subspecialty. On a personal note, I have been in a long distance relationship with my gf for almost 2 yrs and we are seriously discussing closing the distance by moving to her home city which fits me better personally. I am close in joining an academic group in that city that will allow me to practice my subspecialty and my gf would be able to move with me as well.

I joined private practice in the first place because I was so turned off by academia (the bureaucracy/the politics/the hypocrisy/hubris) during training. Unfortunately, my sub-specialty is mainly practiced in academia in this country. I feel conflicted in that by moving I am giving up millions in potential earning/perks as a full partner in private practice and will have to deal with the potential shortcomings of being an academic physician. It seems I am giving up a lot, money and vacation, for improved personal life and professional satisfaction.

Financially I've paid off my student loans 9 mo into practice and just have a 12k car loan at 0.9% APR. I should have about 200k saved in various accounts prior to my move. I currently make about 400k and will be about the same in academia, but with a higher COL (for the midwest, not LA/NYC/SF) and no major bump in pay in the future. I am pretty frugal and gf is less so, but she is not extravagant. So we will maintain her current lifestyle which will be about 80k per year total for both of us while we will make about 530k-550k combined.

I apologize for the long-winded post and the lack of specific questions. The purpose of this post is just to make sure I am not making a major life mistake by missing some huge red flag in my current situation. Thank you for reading and please let me know if anything needs clarification.

Just another doc
if you are not married, i wouldnt do anything about it.
she can move to be closer to you.

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