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Physician Financial Independence

You need courage to believe in financial independence. Even if you don’t think it’s possible, it’s something that has existed for hundreds of years and will continue to exist.

There was a time when you could buy a piece of land, build your own home on it, grow your own crops, own some livestock, and barter with your neighbors for goods and services. You’d depend on your government to provide infrastructure and you’d pay some taxes towards those means.

I’m not referring to the Dark Ages, we’re talking like 2 generations ago. If you wanted to live off of your own land, by all means, nobody was going to stop you. Uncle Sam didn’t care even though you weren’t contributing much towards taxes. There were plenty others who would be paying taxes and your self-sufficiency meant that they had one less family to worry about.

Permits for Everything

But soon the governments limited how much farmland you could have per person in non-farm communities. They capped your head of livestock and forbade you from adding any more buildings on your property without a “permit”. These permits could cost as much $25,000. They could be denied, held up in a backlogged system, and eventually need a lawyer who can come in to untangle the whole mess.

Growing Property Taxes

Then came the property taxes which kept going up, outpacing inflation. Next, governments made it illegal for you to build a home under a certain size – usually in the 800-1,000 sqft range. Anything under this size wouldn’t be permitted. Anything beyond this size required some hefty engineering or else it wouldn’t be permitted.

So they turned those who were willing to live self-sufficiently and sustainably into poor people. People who could no longer afford the property they already owned and who were forced to sell their land and move into government housing.

New Poverty Generation

And so a generation of poor people who used to be once self-sufficient was born. These individuals learned quickly how to live off of the government. They, in fact, figured out how to be financially independent once again and passed this knowledge down to the next generation.

The legal and tax code slowly became so complex that most chose to work for an employer rather than figure it out on their own. Soon, they couldn’t figure it out on their own even if they wanted. Which meant that the business with the bigger lawyers and deeper pockets could have their way.

That’s how AirBnb was able to illegally turn residential homes into hotels, to which the lawmakers just turn a blind eye. And that’s how Uber can bypass the medallion system of taxis, also illegally. And Amazon can sell across state lines without tax consequences and Apple can hire child labor or destroy a whole ecosystem in order to mine for parts.

This isn’t meant to criticize the governments. Governments are businesses as much as any publicly traded company on the exchange. On the local, state, and federal level. They sell a product, the passport sitting unguarded in your dresser. That product has a value to you and others like you and your government guards that value with tanks and ammo.

Financial Independence

What I’m talking about is physician financial independence. Self-sufficiency. A sustainable lifestyle for us doctors. An independent way of life. The ability to coexist within the walls of your country, alongside your government, while both of you profit. Financial independence is nothing new. New term, maybe, but the concept is old. Nobody works thinking that they can work until they drop.

Many of you have grandparents or great grandparents who retired in their 30’s or 40’s. Definitely in their 50’s. Even if they didn’t retire, they were financially independent by then. The concept was as basic as electricity to those generations.

The whole concept of saving and investing is based on trying to one day live sustainably and in a self-sufficient manner. It can feel overwhelming to achieve it but it’s what damn near everyone before us managed to achieved in some fashion.

Sure, if you found something that you loved doing, something which benefited others around you and didn’t cause you panic attacks, you’d keep doing it even if you didn’t need the money. In fact, you could start offering the work at a better price to some. You could maybe work a more flexible schedule. You even had enough time to really master your craft.

Infinite Career in Medicine

What percentage of doctors would continue working the same schedule, in the same setting, for the same employer if they were financially independent?

Naturally, 50% will raise their hand. Of these misguided souls, how many will continue working 6 months into realizing that they can not show up to work and enjoy the same amenities as having worked a 60-hour week?

Work has become a very loaded word. It’s not just a way to help your community out or feel connected to others. Because if that’s the case then why in the fuck would people move to depressing suburbs, with row-home after row-home, sitting in terrible traffic to get from one point to the next?

Why would they live in a neighborhood where they cannot walk to a grocery store? They can’t enjoy beautifully designed sidewalks with walk-up cafes. No park to stroll through.

Mandatory Employment

Work now is synonymous with power. As a physician employee, you’re a tiny little ant and you’re always squirming under the shadow of your employer’s boot. You may think so otherwise but try to post a negative review of your employer online and let’s see how you hold up against the rubber.

If you don’t have an employment history it’s hard to rent in a competitive real estate market. It’s damn near impossible to get approved for a mortgage if you’re earning an income from your own business. Without your employer’s help your health insurance premiums could actually be cost prohibitive, even as a physician. As for benefits, sure, it’s possible to have your own individual 401k and IRA and disability insurance, but it’s a nightmare to navigate that whole mess unless you’re quite financially savvy.

People have flocked to jobs because they lost faith in their government. They don’t believe that their autonomy will be protected. What they have seen is that a company like Amazon can shut down hundreds of businesses within a handful of years. Which is great from a free market perspective. But the guy who had to shut down his independently owned bookstore is scratching his head as to how in the shit Amazon was able to build a 1,000,000 sqft warehouse 1 mile outside of his city, when that same city wouldn’t allow him to build a 200 sqft granny flat on his own property. He couldn’t even get a permit to add an extra shitter to his upstairs bedroom.

Self-Employed Physicians

When you, as a private practice Primary Care doctor, can’t compete with a large medical group in keeping up with all of the legal change in healthcare, and the government won’t give you a break for being a small-fry, what option do you have but to close?

Your state won’t let you dispense meds from your clinic. But you see that the branded Medical Office Building across the street has clinics upstairs and a pharmacy downstairs.

So, you walk in and apply for a job. You recognize within a couple of weeks on the job that the patients are cattle in a massive and well orchestrated system. You’ll even get thoughtfully crafted emails every few weeks by a committee of specialists who, after reviewing highly scientific documents, conclude that all patients with new onset Type 2 DM should have this exact medication regimen started for them.

So now you no longer think about passing your clinic down to your daughter who followed in your footsteps. You’re not going to be working in that clinic until you die. There goes your previous iteration of financial independence and self-sufficiency.

Now, you’ll work with your employer long enough to vest. Then you’ll hope you get Social Security and probably Medicare. You might even eek out a small pension – though it won’t be inflation adjusted.

Financial independence for a doctor is something all of us think about. Some start at age 20, others at age 60. But all of us will think about it and all of us will do some planning for it. It’s not a new concept and though there will be hundreds of permutations of it in the future centuries, each person will have to figure out their own path towards and through financial independence.

Money Isn’t Evil

Yes, even those who say “Oh gosh, I hate thinking about money, why is everyone so obsessed with it? I don’t work for money, I work because I love it.” will have to face their mortality some day. “Money is evil!”

Yea, well, only when you don’t have it or think that you don’t need it or are too afraid to save it and invest it. When your mind is too slow to work or your body too frail to hold a stethoscope without shaking the diaphragm loose, you’ll ❤️the shit out of your money.

Financial independence isn’t some invented concept. It’s a very old concept. Some will invest in their children hoping that one day they will support them financially. They will tightly guard their family unit and create generational wealth.

At the same time financial independence isn’t a promise. There is nothing dubious about it. It doesn’t care whether you believe in it or not. In fact, your social and economic lives will coexist side-by-side, regardless of how you feel about it.

You don’t believe in stocks? Well, IPO’s will continue to be offered. You believe bonds are a waste of money? Your government will still issue bonds to pay their employees. You think inflation is ridiculous and that the feds should put a stop to it? Your $100 will still be work $3 less next year. You think real estate investing is a waste of time? Your neighbor will still pay rent to a landlord because they never managed to put a downpayment together.


Nobody told me that financial independence takes a lot of courage even to believe that economic independence is a possibility. Fear is sold to us daily to force us to continue working in jobs we don’t like. To not have enough faith in stock markets which we are fueling so that we spend our money.

It takes courage to believe in a system that has to be volatile in order for it to function. But it has worked when you look at it in hindsight. Somehow you have to convince yourself of that even when your investments drop by 45% in a week.

5 replies on “Physician Financial Independence”

I like the radreads article about the dubious promise of financial independence. As someone just starting her journey to medical school, it makes me think about WHY I am working towards financial independence. What am I going to do with all that free-time? What makes me happy? Is there any way to figure that out now and pursue those meaningful activities right now?

Thank you, Dr. Mo!

This is why I like posting this stuff. See, I read it and went on to write this post because I don’t see the doubt in financial independence. I can’t see how it could hurt to be financially independent and the upside of the freedom it affords is all of that extra time.
Like, when I work for an employer as a physician I’m dealing with all sorts of inefficiencies which have to be present in order for the system to be equitable. As a medical director at Kaiser I had to put on weekly department meetings and email out the team regularly with mostly fluff. And when a provider complained that the patient volume was too much, I had to address it. I mean, I genuinely didn’t want them to suffer but at the same time the irony didn’t escape me that they were employed and so didn’t have a whole lot of say in the way that employer ran things.
That’s why it’s said that the individual investor has so much more potential for higher returns than a hedge fund or index fund manager or other institutional investor. We can choose whatever we want with our investments without having to beat a particular index. We don’t have any benchmarks to meet and an pivot in and out of investments based on what’s best for our finances.
To address the WHY… totally get that. I have to say that once I grasped the concept of financial self-sufficiency, I had zero doubts that it was the right thing for me. From December 2012 until March 2016 I didn’t hesitate once to work towards that goal. Sure, I felt a little frugal fatigue but otherwise I didn’t doubt the final result.
I think this is because I’ve always had a ton of interests outside of medicine and outside of the traditional 9-5 in general. From working on cars, to reading, to writing, to building stuff, to making art, to furniture restoration, home renovation, learning languages. I also loved medicine but didn’t want to be held to a poor working schedule.
As to what makes me happy … it seems that that’s a moving target. I’m reading Aristotle’s Way right now and the author, she sort of addresses this topic a little from Aristotle’s perspective. I think when you’re younger you’re more likely to pivot and want one thing one year and something else another. But even when you’re working your ass off, even if you’re suffering on rounds, you can still be happy. It’s like being in the gym and in terrible pain lifting weights or solving a bouldering problem. Miserable but fun and you want to get back to it the next day.
I think once you grasp the concept of financial independence, you’re done, that’s the hardest part. After that you just save what you can and spend wisely. You will inevitably stumble on the kind of work you love so much that you’ll stop thinking about income, barring any health disaster which the financial independence sort of solves. If I like working on cars and get a job at an automotive tuning shop, I’d be in heaven. Sure, a few shitty oil changes might keep me from doing the suspension tuning work I enjoy but still good work. If I like working on homes and I advertise my masonry work for older homes, I’ll enjoy doing the work every day. If I love practicing medicine and I see patients in a local urgent care once a week, perfect.
I think I just typed out a lot of shit but didn’t say anything … thank god words are free.

OK, I’m lost in the ramble:)
But anonymous, for some us we hate work so much that it’s not about the time outside work. It’s the not having to work.

Dr. Mo,

I have been struggling with the FIRE community and kind of dropped off it because it seems like most of the blogs have shifted towards selling financial products rather getting to deeper question of happiness, work, and life and how they fit together. Right now, I am stilling paying off loans, so I am working more than I would like. But honestly, even I were financiall independent, I would probably still work about 2/3-3/4 of what I work now. Which would be very little. I work about 10 days a month (on call 24 hours/day), so that works about to about 200-240 hours of call a month (so imagine 3/4 of that) with that I still make above average income for a family doc as a 1099. I have no inbox, I occasionally save a life, The patient’s are among the least entitled and most appreciative I have worked with.

So, once my loans are paid off, even if I had a mortgage, if I am working exactly as much as I want to and have plenty of time for other pursuits, I would argue that has all the benefits of financial independence in the moment. Why delay gratification any longer to meet a specific monetary goal?

The business plan of FIRE will only apply to a very select few. It’s a very intricate plan and rather tough to execute and chances are that for many life will get in the way or they’ll abandon it or come up with fucked up names like lean-FIRE and fat-FIRE and FIER. If financial independence doesn’t mean much to you or you don’t see a big value in it, then I would say it’s a massive waste of time.
As long as you can practice medicine the way you want and for however long you want, it’s probably the best retirement plan and financial independence engine out there. The point of financial independence is to have a passive income stream to cover your living expenses. It matters little where that passive income comes from. Whether it’s index funds, real estate, day trading, P2P lending, Forex trading, writing, etc. If you love practicing medicine enough that you’d do it for free then that’s your passive income. I write for this blog and create some products and coach some doctors – shit I love doing and have been doing for free for several years. It now happens to make me money; passive income.
And it doesn’t have to be medicine. Many of us would do just find working in other fields. And I’ve read your writing, so I’m sure you could make a decent living as a writer if the life-saving thing doesn’t work out for you.
When something has a “following” and is given an acronym, it’s because a marketer found a bunch of suckers off of whom they can make money. The concept that index funds and being debt-free will make you financially independent is an easy-to-sell lie, much like weight loss shakes and diet plans.
But, for any physician who hates their career and doesn’t know what else they could do to earn money while providing value to their society, I don’t believe they are savvy if they spend their money on their wants. For that person every last possible dollar should go towards conservative investments and they should be focused on being financially independent as early as possible. From that position they might just avoid total burnout and then be able to transition into another career. Medicine doesn’t need more burnt out doctors. Nor do we need any more white coat criminals like myself.

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