I have a close friend who has been doing outpatient anesthesia for the past 10 years and she has been burnt out for the past 3. Her health has declined drastically and it’s time for a career transition.

Once this month she had a severe panic attack and had to cancel her cases for the day. Several times last month she got bouts of vomiting due to anxiety.

She’s single, she has no partner to depend on, she lives in a high cost of living area, and she is desperate to get out of outpatient anesthesia but petrified of a career transition.

In this post I’ll talk about her current situation of which I have detailed and intimate knowledge and talk about her transitioning out of outpatient anesthesia into running her own laser hair removal practice.

Her Outpatient Practice

She has a mobile outpatient anesthesia practice which means that she drives to the various clinics which require her services. She schedules these offices 3-5 months out.

50% of the time she will need to cancel patients since they don’t make for good outpatient anesthesia cases. Her population is 95% pediatrics which means dealing with allergies, cold & flu’s, and non-compliance with an empty stomach.

She has nobody helping her with scheduling patients or handling post-op or pre-op. All that work falls on her not because she isn’t willing to give up control but because it’s not easy finding reliable help when you’re stretched so thin already.

Driving/Commuting

She lives in California and flies out about 3x a month to another part of the state in order to service clinics there. This requires her to have a second set of equipment in another city and commute by air.

She starts her mornings off around 4-4:30 and gets back somewhere around 1pm-3pm. Once home, she will call patients for the following day, schedule offices, handle paperwork, and order supplies.

A 1-hour commute easily turns into 3 hours if there is an accident or if her cases end around rush-hour.

Her Income

She makes on average $3,000/day but it can be as high as $5,000 and as low as $1,000.

She works 4 days a week on average after accounting for case cancellations and adding on last-minute cases. At this rate her gross income can be as much as $60,000/month…. $60k!! I think that’s my total take-home last year.

Perspective

Her income is so high that it has her head spinning – with this much income she should be rich as fuck, right? It doesn’t work that way unfortunately.

Once you account for the supplies, paying for all the things you don’t have time to do yourself, the traveling, maintaining an expensive home, and solving day-to-day problems by throwing money at them, you aren’t left with much at all.

Student loans are gone but there is a $1M mortgage and car payments.

Cutting Hours

It’s important to note that she is burnt out. Some medical professionals understand this but many don’t. Once you’re burnt out there isn’t much you can do that feels productive.

Burnout

Common advice to the burnouts is to cut back on their hours, decrease their case complexities, take more vacations, do more things for themselves.

No fucking way! If you’ve been burnt out like I have then you know that shit is like putting Aveeno on your genital herpes.

She has tried to cut back her hours but the problem is that she’ll spend 5-6 miserable days waiting for the night before she starts her workday again.

On top of this she’ll have to deal with the guilt feelings I mentioned above of not earning enough money and leaving income on the table. A career transition is the only thing left for her to try which we’ll get into later.

The Guilt Yo-yo

For those who have the ability to earn a very high income by working more shifts it’s a very familiar feeling to have guilt when you’re not working. It makes no sense economically but behavioral finance explains this well – we sense a loss even for things we’ve never owned.

Out of guilt she went and bought a $1M+ home and drives luxury vehicles. Out of guilt she has maintained an upper middle class lifestyle to please friends and family. The more you earn the more pressure is on you.

Her parents give her shit if she drops down to part-time and her friends constantly remind her how lucky she is that she can earn as much money as she does.

Because she is so much more affluent than her friends, she also gets hit up a lot for money whether directly or indirectly.

Feeling Useless

When you don’t work full-time then you don’t feel as productive and when you leave money on the table then you feel borderline incompetent. Who understands that? High-earning medical professionals. Even more so if you run your own business.

I suspect she takes on higher debt to motivate her to continue working – this is one of the most detrimental aspects of debt.

A nurturer

I’m selfish as fuck and I am a major introvert. I don’t take advantage of people but I don’t have an inviting shoulder to cry on and therefore don’t have a lot of people depending on me.

She, on the other hand, nurtures a lot of people around her. Her professional female friends come to her for advice, for marketing help, for relationship stuff, and everything else in-between.

When you have a lot of people depending on you as a female medical professional then cutting back on work and bringing in less income makes you feel that much more vulnerable and guilty to boot.

She’s Tried Other Things

Cutting back. She’s tried cutting back on work – numerous times. But unfortunately it was causing more stress than helping her cope with the burnout.

Teaching. She tried training medical office staff by putting on lectures but she didn’t enjoy it and the income was too little for all the work involved.

Working with a single office. She tried to focus on one particular large medical group who had a lot of cases. Unfortunately, as soon as she started offering more hours to this medical group they started running into financial problems. She nearly lost her other clients because of this group.

Seeking employment. She even tried to get hired by a few medical groups. In fact, she even tried to work for Kaiser Permanente, only to be strung along with empty promises and offered a ridiculous salary for a lot more work compared to what she can make on her own.

Her Support Structure

She is closest to her family and a large group of friends whom she sees regularly. Though she is a bit of an introvert she has quite a few individuals around her who know about her struggles with her career.

The problem is that everyone who knows her sees her in the same light as the person she has been for the past decade – a hardworking, hustling. An entrepreneurial woman who handles any setback.

When I wanted to become frugal, to retire early, to save and invest my money for the purposes of financial independence, I got very little support from those around me. It wasn’t until after I achieved my goal that everyone voiced their praise and how they would have preferred to have done the same.

My friend has been in no-man’s land for 2-3 years now. She is feeling the rift between herself and friends and family who all expect her to be who she’s been for the past decade. Nobody wants to face the reality of their own lives and seeing your friends make major changes puts you suddenly in the driver’s seat of dealing with reality.

Her Health

All those hours stuck in traffic, stuck in a chair worrying about an unconscious patient, and finding alternative suppliers for IV bags which conveniently and routinely are in short supply, wear you out even more so as you get older.

The times we spend being sedentary or stressed are the times we’ll have to spend in ill-health later in life.

My own workaholic times caught up with me and I burnt out. My blood pressure escalated and I started getting my own health problems which has taken me years to recover from.

Money Means Shit

The first thing to recognize is that money doesn’t solve problems, doesn’t add to your happiness, and doesn’t make your life easier. I have earned $400k/year, I have been in massive debt, I have been completely debt-free, and I’ve been retired – I assure you that money is only a tool if you’re willing to wield it.

My family medicine readers who drool over a $60k/month income hopefully will read this and realize that there is no free lunch.

The more money you make in medicine the more stress you’ll have, the more you’ll have to sacrifice, and the more important it is that you pave your exit strategy.

I started my family medicine attending career in 2009 and I started working on my exit strategy December of 2012 because I didn’t see family medicine as a sustainable full-time practice.

Fortunately I became financially independent at age 38 in 2016, right in time for the medical board to start fucking with me.

What You Earn & What You Keep

My friend’s lifestyle requires nearly as much money as she makes every month. By the end of that grueling month she isn’t left with a whole lot of money. More stress means more spending and more work means having to visit her doctor more frequently.

What matters is what you keep. Investing means forgoing the spending power of an asset presently, for the sake of income and appreciation in the future. You can call it deferred gratification but there is no need to suffer in the presence.

A Career Transition

Outpatient anesthesia is no longer a feasible career choice for my good friend. Even if she’s willing to torture her mind longer with it, her health is violently protesting and winning. What is a smart girl to do?

1. Keep suffering until she’s forced out?
2. Settle for a low income?
3. Cut all expenses and save as much as possible the next few years?
4. Find a sugar-daddy?

In her case none of these are viable options – we’ve discussed them over the years, at length.

Despite this impressive income for the past decade she has less than $200k of assets to show for it. She isn’t in the minority at her age especially when you’re a single medical professional without the extra income from your partner or rich parents to help you out.

Elective Outpatient Clinic

She is good with marketing, she’s great with people, she knows how to deal with patients, and can handle office staff.

She definitely enjoys the practice of medicine which is fortunate and she’s good at it. All this makes her the ideal candidate to switch to an outpatient elective practice.

I did urgent care medicine right up until 2016 – the furthest thing from elective outpatient medicine. One of my friends own 3 successful aesthetic clinics in California even though he is a family medicine trained DO.

People are willing to pay for elective care whether it’s aesthetics or mental health. Because of our broken monetary system there is an absurd amount of cash floating around with terribly low interest rates. People are ready and willing to spend.

Laser Hair Removal Clinic

There are a ton of options when it comes to elective outpatient medical services. There are laser tattoo removal clinics, hair removal clinics, nail disease centers, weight loss clinics, sexual dysfunction clinics, and the list goes on.

Such a business is a great option for my friend’s career transition.

We settled on the idea of a laser hair removal clinic for many reasons. She has used such a service herself in the past, she’s experienced good clinics and bad clinics, and she enjoys the idea of having happy clients who are getting a service they actually want versus a surgical procedure that they need.

The Business Model

We’ve brainstormed over the past few months and have done research to come up with a viable business plan, a good location, and the kind of services she can offer.

An esthetic laser clinic will always make money if the right clients can be reached because there is no short supply of demand for such services. Few such clinics go out of business because of competition unlike restaurants and cafe’s.

Barrier To Entry

We have identified a few barriers to entry which includes:

• upfront investment capital
• finding the right laser
• time needed to do marketing
• cutting back on her current practice
• finding the right employees

Overcoming Barriers

There comes a time when you have to accept certain risks and move forward. This is best achieved by realizing that you cannot continue doing what you’re doing any longer.

Starting a new business always requires investment capital but we figured out ways to minimize this by changing the business location, by considering a used laser, and by finding non-traditional investment capital.

Marketing is something that you can never master but you can always get better at. Either you spend a lot of money on CAC (customer acquisition costs) or you hustle yourself and do the legwork.

As for employees, it’s expected that you will hire the wrong people initially. You’ll butt heads with your staff, you’ll have to deal with theft, and you’ll have to learn the right way for you, individually, to communicate with your staff that works for you.

The idea of trying to do everything yourself including the hair removal, the marketing, the front office work, the taxes and books is unrealistic. It would be going from a lucrative anesthesia practice to a less lucrative laser practice with the same headaches you dealt with previously.

The Next Steps

Leaving outpatient anesthesia for this career transition is something she will have to do on her own. But taking the next steps towards the laser clinic is something others can help her with.

1. Get A Mentor

She will need to find a mentor who has established and run a laser clinic successfully. Ideally someone who is still doing this.

Clarity.fm is a great place for such resources but there are many others as well.

2. Set Deadlines

Deadlines suck because they add more stress but nothing gets done if you can’t set deadlines.

The least painful way to approach an action is to break it down into as many individual steps as possible.

It’s not so much that I need to buy the laser, rather I need to:

• email Candela to inquire about a local rep
• get pricing on used lasers
• ask about service protocols if tech service is needed
• come up with an agreeable price-point for used lasers
• have laser delivered within 1 month of securing office space
• schedule training through Candela within 2 weeks of buying laser

3. Secure Office Space

It’s easy to put excess emphasis on the location of the office, the exact kind of office space, and the perfect price. There is no such thing when it comes to commercial real estate.

But set parameters that you cannot do without and then delegate a good commercial realtor to find the space for you.

Price, parking spaces, lease terms, and signage should be the main criteria. Everything else is negotiable – it’s always negotiable.

4. Hire Staff

It’s normal to want to do everything yourself. The problem with buying yourself another job is that it inevitably will lead to twice the work down the road.

Simplify your life and learn to outsource and delegate work to others. If it means giving up some control and profits then do so.

I recommend a dry-run by placing an ad in Craigslist or hiring a recruiter to find the right employees. Sit down and interview these people. Even if you don’t have anything secured it will give you a great idea as to what to expect.

Fears of a New Business

1. What if you don’t make any money?

Then you’ll figure out why you’re not making money and you’ll fix whatever you have to. Sometimes the reasons are obvious and other times you can hire a business consultant who can point you in the right direction.

You have to enjoy the work ideally and be willing to do the work necessary in order to succeed.

2. What if you can’t find the right employee?

Then you’ll keep hiring new ones until you find the right person or figure out what is wrong with your managing method that makes everyone a poor employee.

3. What if the competition outcompetes you?

Then you will figure out a way to outcompete them or change your target customers in order to not worry about competition.

Service, marketing, and value are the tenets of repeat customers. It’s not that there is another office doing the same thing across from yours that’s causing you to lose money, it’s that you aren’t offering a better service than them which is driving patients to your competitor.

4. What if it takes forever to take off?

It’s not that the business is taking forever to take off is that your expectations may have been unrealistic or your marketing isn’t up to par.

Bring in a marketing firm and revisit your business strategy. Moving your laser to a different office in a different neighborhood doesn’t mean you failed, it means that you rolled with the punches and strategized.

5. What’s the worst thing that could happen?

You make mistakes, you learn from the mistakes, you adjust your method, and you try something different.

No matter what business you start everyone will tell you it’s saturated, it’s too competitive, it requires too much time, too much effort, it doesn’t make enough money, and that the chance of failure is really high.

I have failed a lot in my life and I can’t wait to fail some more as long as I keep doing what I enjoy.

What About Investing?

I write about personal finance and investing so where does investing come in?

Investing in a 401k, and IRA, or even the hottest stock won’t make a lick of difference in her situation. Her biggest opportunity comes from investing in herself.

Regardless of this we have optimized her investing so that she is always working towards financial freedom. She is investing in a low expense ratio index fund and she is maximizing her SEP IRA.

Maybe she’ll have to leave outpatient anesthesia altogether – the stress is too much to even do it sporadically. But she can diversify her income by having money coming in from this laser hair removal clinic.

Next, she can take her skills of doing outpatient anesthesia and try to profit for that in different ways that we’ve discussed.

Budgeting

Likely most healthcare professionals, she has solved the budgeting and frugality problem by earning more money. I haven’t been able to get her hooked on YNAB even though I’ve tried for 3 years now.

And just like many other such professionals she has come to the crossroads of burnout. Increasing her net worth and passive income will now need to be her main priority or else she’ll risk losing her health and her anesthesia income.