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Career Minimalism in Medicine

We would never be talking about minimalism if our lives hadn’t gotten so bloated. Some bloating is good because we get to leverage certain tools to create a better lifestyle. Other things we add into our lives thinking they’ll be beneficial but they end up just adding more frustration. Minimalism rose up from that excess. Career minimalism is now relevant because we’re earning a lot more money than we need. For which we are trading very valuable resources.

You can live in a tiny little house or studio, own only a few items, and live a minimalist existence without missing out on too much. The reason we can live such a minimal lifestyle is because there is always a grocery store to purchase food from. There are bookstores and libraries we can go read at. There are gyms we can exercise at. There are even tool co-ops we can use to fix something or borrow tools from. We can hail an Uber or take public transportation.

My grandparents could never have been minimalists, not in their lifestyles, nor in their career. My medical colleagues from the 1980’s couldn’t have been career minimalists. Medicine was very different back then. It’s exactly this transformation in medicine which allows career minimalism which might be right for some physicians – like this guy.

 

Career Minimalism in Medicine

A medical career used to mean that you’d have to start your own practice somewhere. You got to perform surgeries at a local hospital but you had find your own patients and see them in your own practice. In some ways things were more complicated, in other ways it was simpler.

Now that many of us can work part-time or as per diems we have a lot more options. Medicine has shifted to larger medical groups who take on all the headache and risk of following the endless rules of medicine. We can show up with a stethoscope and just see the patients. Clock in, clock out.

We don’t have to source our own patients. We don’t have to do the customer service work. We don’t have to do the billing and don’t have to deal with compliance issues. We don’t need to keep up-to-date on legal changes. Despite all this not enough of us have taken full advantage of this shift in medicine. Few of us are pursuing medical career minimalism – doing even less and earning even more.

Meaningful Work

I haven’t yet met a doctor who hates the art of medicine. I know many who hate the practice of medicine but not the science, not the problem solving, not those delightful patients who love us for what we do for them or to them.

Do you think your work will feel more meaningful if you’re doing 60 hours a week of it or 15 hours a week? The full-time schedule will leave very little time for you to advance your knowledge in your field. Very little time for you to play tennis or learn how to make a macaroni necklace. The anemic schedule will get you enough hours to feel capable and competent. It leaves just enough room that you miss the work.

I never thought that I’d miss seeing patients. It wasn’t until I had several months off that I realized that there was a sweet-spot for me. Not so much work that I feel exhausted. But enough to feel like I’m making a difference. One runny nose and diarrhea at a time; saving the world!

 

Full-time Work

Why work full-time when you can be a per diem and build your own benefit structure? By working full-time or even part-time you are often stuck with one employer. You have to abide by their work schedule. You lose your ability to take advantage of the flexibility of minimalism.

A medical career often spans 3-5 decades. You have all your life to become a full-time employee. It certainly might make sense early on in your career to work full-time to pay down some debt, build an emergency fund, and take advantage of the benefits.

Cost Difference

Full-time physicians get benefits but we pay for those benefits. As a full-time employee I might get paid $120/hour. As a per diem physician at the same organization I usually will earn $140/hour. The extra $20 is what the employer would put towards health insurance, disability insurance, life insurance, and retirement matching.

Flexibility

What we give up in return is the flexibility to work when we want and for whom we want. If I were to take a full-time job at Kaiser Permanente or a telemedicine company then I wouldn’t be allowed to work for other companies.

I would also lose the ability to choose my own schedule. I would have a set schedule and would have to live my life around that schedule. I wouldn’t be able to take a last-minute vacation. I couldn’t jump on a gig that’s higher paying. I wouldn’t be able to take time off to take care of family.

 

Earning Less Income

When you can earn $300k as an Urgent Care doctor but you choose to earn just $125k you might feel as though you are leaving money on the table. One could argue that you could earn $1M if you went into real estate. Even though you’re forgoing that extra income you’re also doing something you love more – medicine. Working less and earning less might mean that you are able to spend more of your free time as you like.

Earning less can be shameful, no doubt about it. You’ll feel it yourself and others will remind you. As the wealthy doctors spend their money like rappers you’ll sit there feeling like a pauper.

Career minimalism means giving yourself permission to earn only what you need. Anything extra is wasted effort. Of course if you love what you do, by all means, go crazy. But if you don’t need all of that income and can get by on less then why not practice some minimalism and enjoy your extra free time. Maybe you’ll find something better to do with your free time.

Taxes

When you earn less you pay less taxes, not just proportionally but whatever the opposite of proportional is – logarithmically? We have a progressive tax system so the more you earn the more you pay.

Even if your hourly wage stayed the same you would keep more money by earning less money. That’s why career minimalism can actually earn you more money. We always think that we need a bigger paycheck but sometimes we just need a smaller tax burden.

 

Living a Frugal Lifestyle

To practice career minimalism in medicine you’ll probably need to cut back on your spending. Fewer vacations, fewer gadgets, and perhaps crafting a macaroni necklace for an anniversary gift instead of the Rolly.

You can live on the bare essentials in life. A simple house, one car – no car, a few basic gadgets. No A/C? No problem. A 4 year-old cell phone? No big deal. You live a minimal lifestyle so that you can work fewer hours. But those hours will be more meaningful which many overlook.

You don’t have to live like me. I gave up my cell phone and my car. I gave up my A/C and my TV. I still brush my teeth and shower, so maybe I’m not a total minimalist? But I make my own deodorant so it’s a wash.

Each of us can shave a little off of our lifestyles. Just enough to allow us to work a little less. Don’t suffer, of course. That’s not the point. I wouldn’t have given up my car if I didn’t live in Portland. I wouldn’t have given up my cell if there wasn’t WiFi at every corner.

 

Getting Rid of Excess Hours

You can ask for fewer hours at work. You won’t know until you try. I do consulting calls with you guys, many of you who are Kaiser physicians, and many of you don’t think it’s possible to work part-time at your job. And yet we’ve figured out some great tricks together, haven’t we?

Just because your employer hasn’t allowed anyone else to go part-time doesn’t mean they won’t make an exception for you. A career minimalist will negotiate every which way possible.

Negotiating

One option is to ask your employer for a few months of going part-time. You can tell them that you need a little break from work. You want to work at 60% or 75% just for 6 months so that you can address a few family issues or personal issues.

You can then demonstrate to your employer that you’ve been even more productive by working fewer hours.

  • “Look, I did 2 extra surgical cases”
  • “I had fewer adverse outcomes”
  • “I picked up more last-minute shifts”
  • “I did more weekend rounding”
  • “I flirted with fewer nurses”

You can even ask to go per diem for a while with a guarantee that you can return to your full-time work after a 6-12 month trial. What do you have to lose? You give it a try, see if you and career minimalism are the right match for each other, and go from there.

Filling the Void

Some of you chronic workaholics will have a hard time with career minimalism. You’ll either drive your partners crazy or will spend more time on YouTube. That’s okay, it’s normal the first few months. But eventually you will find things to engage you.

Maybe you want to work from home a little more. So you can take my Healthcare Consulting Course with all your free time. You’ll learn how to put your clinical skills to use and get paid for your expertise. In the process you’ll help companies improve their products.

 

Peer Pressure

I never realized how much peer pressure there is in medicine. The pressure to work as hard if not harder than our colleagues. Earn the most money possible. See more patients than the next doctor. Work the weekends. Work from home.

That peer pressure extends to our lifestyles as well. I’ve discussed it in other posts that this isn’t a greedy thing. It’s often because we want to connect with colleagues. We want to signal to other doctors that we belong in their club and that we can be trusted. So we live in similar homes as other doctors. We buy similar cars. We take similar vacations.

Self-Imposed Pressure

Many of us haven’t yet scratched off that competitive process which got us into medical school. Trying to set the curve in undergrad. Doing volunteer work, while working part-time, while tutoring, while doing research. But we were 20-year-olds back then. Now we’re 30, 40, or have families or significant others or actual hobbies.

It’s good to expect a little less of ourselves. We already are physicians which is an accomplishment nobody will take away from you. Even if they take your medical license away they won’t take your knowledge away.

Comparing Ourselves to Others

It wasn’t easy for me to downsize my lifestyle when I lived in San Diego. It was even harder because I was living like a rapper. I had a blacked out Hummer. I had a bachelor pad near the beach. I had a race car and an auto mechanic shop. I was taking luxurious vacations and spending my money on expensive clothes and gadgets.

I thought that’s what was expected of me. I grew up thinking that whoever had nicer stuff was better off or more successful.

I had to downsize drastically to prove to myself that I was still successful even without all that shit.

To be honest, I still feel a little inferior from time to time. When I see my buddies with brand new Beemers or the newest cell phones I wonder to myself if I’m just being a loser for not having all of that. A Family Medicine buddy of mine just bought a $1.7 million house in LA. He spent another $300k renovating it. The thing is out of Dwell magazine. He takes a shit every morning in a bathroom twice the size of my entire condo.

I, on the other hand, take a shit in a bathroom the size of his Mercedes SUV. Am I missing out? Should I be trying to achieve a little more in life? Could I take a shit in his Mercedes?

Inferiority Complex

The inferiority complex comes standard with being a doctor. You must have that to cope with all the difficulties of medicine. You must feel inferior to your colleague who has far fewer surgical complications in order to become a better surgeon. You must feel inferior to your urgent care buddy who can see twice as many patients as you.

Guess what, the more you learn the more you realize how little you know. There is always something new to learn in medicine. Maybe you’ve mastered the art of ballooning a patulous eustachian tube but then you realize how much there is to learn about sinus surgeries. It will never end. There will always be someone or something else that will make you feel inferior.

Your $3M house, your $100k electric car, your smart-connected home, all of that can be inferior to the ortho dude who just build a 10,000 sqft home on a hill in La Jolla.

You’re trying to figure out how to come up with the $150k to repaint the outside walls and replace the windows while your colleague just installed an indoor lap pool.

It goes the other way too. I’m a minimalist – no doubt about it; I use a metal Q-tip so that I don’t have to keep throwing out Q-tips. I get it, I’m a little crazy but I still get an inferiority complex because some dude somewhere out there figured out how to not even use toilet paper. There is just no way to win this shit. You win man, you win; you and your goddamn solar-powered bidet!

 

We Were All Once Minimalists

Do you remember college? I lived in a 2-br, 2-bath apartment with 4 other dudes. I paid $375/month in rent. I didn’t have a cell phone. I didn’t have internet at home in college. I didn’t have a car the first couple of years. I had one pair of shoes and one jacket. One backpack.

Life wasn’t bad in college. I had a blast. I hung out at the gym and played basketball. I studied at the library and tortured rats in the research lab. Minimalism was awesome. I had less shit then than I have now. I see homeless people who own more stuff than I did in college.

Career minimalism is a new-age term that I probably didn’t invent but I think it’s pertinent to physicians who bust their ass every day taking care of patients. The money is good but the more we work the more expensive our lives become. Cutting back on your hours might make you happier. And if it doesn’t you can always return to your normal work schedule.

 

 

10 replies on “Career Minimalism in Medicine”

Kaiser pays their nurses nearly as much as their UC docs. Insane. Ask for a raise, Kaiser docs.

For the work you do as a Kaiser doctor there is no better income out there. Kaiser pretty much does everything for you. There is nearly 0 admin work to do and you are left with purely clinical work. Especially when you compare it to any other medical group out there. Nobody recognizes how easy they have it at Kaiser until they leave. The income is absurdly high. KP is also insanely profitable and not a public company which is why it can compensate their doctors at such a high rate.
Nurses are paid by a whole different organization and that’s the Health Plan side. They are unionized so it’s not a value=work thing but a negotiation thing. Because their mobility is so restricted and overtime tightly regulated I’m okay with them getting paid a shit ton of money. The KP doctor on the other hand can pick up overtime or work in different departments and take on admin work etc.

The ROI for medical school (and not just the loans, but the sunk time) is simply not there for $120-$140 an hour. If this is what salaries have really come to, I would strongly suggest pre meds look into nursing. Even if you get a full scholarship, you are wasting valuable years of compounding, especially when nurses can start working at age 20 with no loans and a $100 an hour income, not counting their mad benefits, huge pensions, and time and half for shifts longer than eight hours.

Not to mention the licensing fees, lawsuits, medical board issues etc that RNs just don’t have to deal with to the same degree.

this is very relevant! agree 100% that anyone going into medicine to be a physician really should recognize that the return on investment is not there. Even a 400k or 600k annual salary is absolutely nothing compared to other ventures which can earn you the same money without the time sink or taking out debt which you can never declare bankruptcy on.
I like the idea of being an RN but would also point people to physical therapy, naturopathic medicine, dietetics, PA. There are so many ways one can intervene in someone’s life to help them achieve better health least of which is being a physician. Great comment.

Loved this one, Mo. What you call career minimalism I call cutting back, and it’s amazing how much of the burnout goes out the window once you take that plunge and reduce that burden. Like investing, it pays to diversify your source of identity.

My kids know more people who drive Teslas than Kias (the latter is what we drive), but I think cultivating that outsider identity is the secret to being free of societal expectations.

Once you own your weirdness, it becomes your super power, because the validation you seek is internal instead of external.

Nice. Well said.
We used to have a few Kia’s in the auto shop and they are great cars. A doctor buddy of mine just bought their second one here. I certainly don’t want to make the Tesla the Latte Factor for doctors but it’s just an easy lever to pull especially when transportation is such a large part of what we spend. Add in the time we spend commuting, repairing, maintaining, licensing, and insuring, it’s often more resource intensive than a home.

You cut back in medicine and then you realize what you used to love about medicine. It’s really interesting. I haven’t been able to express it all too well and hoping to hear someone put that into some good words.
Stay crispy man, stay crispy.

Absolut briliant read, i am a big fan of your texts and your lifestyle, since im a medical student in germany, who figures out to be an independent worker as soon as possible when university and practical-year ends. This minimalistic lifestyle was something i witnessed first 2015 by a teacher friend of mine in playa del carmen, she has super frugal lifestyle, now travels the world and works everywhere as teacher. I was very impressed and whished i could do this also. But then i saw your incredible blog and you gave me a lot of inspiration. I hope i can find a similar solution for me when i finished med school, especially because the study was now towards the end makes me disenchanted . Please go on with your brilliant educational work for us physicians. Greets Moritz

Hallo, willkommen im Blog!
Ich habe einige Jahre in Göttingen gelebt. Ich vermisse Deutschland sehr, aber es ist mir jetzt etwas zu teuer. Spain seems to fit my pocketbook a little better, though Göttingen was and is still rather cheap. Thank you for your kind words, let me know what you’d be interested in hearing more about and I can publish more relevant topics.
With your Germany medical degree you will have many options. Telemedicine is rolling out in Europe pretty well so you’ll have the opportunity to work remotely and if you choose to do some consulting, you’ll have that option as well. Any idea what you’re going to go into for your training later?
Hope you won’t have too many educational expenses like the student loans we have in the US.
Viel Glück Moritz

Thats interesting and funny that you miss Germany, since the people here are so cold and unsympathetic compared to spain, USA or nearly rhe rest of the world, but thats just my impression:) . Our student loans are compared to the US quite low, so we are lucky. Interesting topics would be 1. How to become an independent working telemedicine physician with an european degree and without the requirement of the specialisation ( 5 Jahre Facharzt Ausbildung—> too much time not independent work in another dark,cold, soulless hospital with narcistic bosses) 2. More stuff concerned the health coach/ health consultant idea which is quite interesting, because the physican in this role could have more time for the client (more than the standart 7 minutes in germany) and offer better interventions like adherence strategies/programs for more physical activity, overall movement and lifestyle changes in contrast to another blood pressure lowering agent.—>the things that work really longetime but which are harder to implement in a patients life. I dont know yet which specialisation i should choose, because i dont want these 5+specialsiation years in a hospital so i am searching for other options. Im quite into fitness and in coaching other people to get fit or even do a competition, maybe i can do something in this field and connect it with my degree, when i have finished university. Psychiatrist for kids and teenagers would be also interesting. Thank you for your interest and if you have any questions about fitness, bodybuilding/ life as an german med school student in Giessen,you are also welcome to ask 🙂 greets Moritz

Quite a few people these days are stopping once they have their MD, you will not be alone. The MD degree (the knowledge it represents) is very valuable. Even one year of clinical experience will give you a step more credibility but it’s not absolutely necessary. There are some brilliant, brilliant minds out there these days who are personal trainers for high level athletes; often without any degree. One way to make name for yourself is to start publishing some papers in exercise physiology. With an MD behind you or the fact that you are in medical school it should be very easy to get in on projects like that. Research is changing man, in a very real way. You run your own little studies these days with how much technology is advanced and get micro funding for it – but that’s another topic.
Decide if you want to be a health coach to the average person who simply cannot stay motivated or if you want be the health coach to the pro/semipro athlete. The former patient population needs a lot of handholding and you need to be very maternal, sometimes paternal. The latter are looking for a guidance and are excessively fact-based. But the latter isn’t needy and is willing to pay more. Marketing is important in this space because there is a lot of competition – most of whom won’t be around long enough to really steal business away from you but add static to the space. You can check out medicalhealthcoach.com which is my attempt at using my medical information in a non-clinical manner. I have no desire to stick my finger in another anus or vagina unless it’s in my own bedroom. Like yourself, I’m drained by cement walls and a set schedule. Where is the fun, the excitement, the glory of being a doctor? Where is the healing and the grace? Dunno, I can’t see it. I know that I have colleagues who say they have developed that niche for themselves. You can look into Direct Primary Care – if you wanna do something more clinical, very interesting.
You can also start your own further training/residency. Reach out to the government and tell them that you want to establish the first telemedicine residency. You want to focus on providing access to those who live far from medical facilities. You want to provide in-home hospice and you want to partner up with EMT’s and nurses to extend to the physician to many more households than traditionally possible.

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