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.