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Financial Self-Sufficiency and Career Satisfaction in Medicine

An urgent care doctor works hard for their money – most of it isn’t even the kind of work they signed up for. When they chose a medical career path they assumed that they would be seeing patient, treating illness, and spending the majority of their time face to face with the sick. We got duped. Some of us were blind to the facts and few of us anticipated EHR’s ruining whatever was left. Career satisfaction in medicine has decreased as more medicine has gotten more regulated. In this post I’ll share how financial self-sufficiency brought me back full-circle to medicine. It’s not at all romantic but it has been pleasantly surprising.

The average urgent care doctor sees 5 patients per hour which wouldn’t be that bad if the majority of the work was patient-facing. This volume takes a bite out of our career satisfaction and sets us up for burnout or emotional detachment from medicine. As a doctor you see the next patient as an obstacle to your paycheck rather than a beautiful human being who is suffering and needs your help.

In this post I want to focus on regaining our career satisfaction through financial self-sufficiency;  that’s my shtick. I’m sure you can find career satisfaction by other means, too, but this worked for me so I thought I would share it with the 4 of you reading this blog.

 

Peek Career Satisfaction in Medicine

Medical school at UCLA sucled but residency was cake. Residency was hands-on and if you made a mistake there was someone to catch it. I didn’t get a chance to do any formal urgent care training at my UCLA Family Medicine residency but my moonlighting experience was more than enough.

I’m sure I made plenty of mistakes once I started moonlighting but I had the interest and passion to look shit up. I had my Uptodate subscription and Epocrates and I had 2 urgent care reference books. I was armed and ready, earning $75/hour moonlighting in 2006.

My career satisfaction was closely tied to my interest in learning. And urgent care medicine offered immediate results. I could give a Toradol injection to a patient for pain relief, give IV fluids to a dehydrated GI patient, or relocate a shoulder. These made up for the drug seekers, the complainers, and the nasty patients which all doctors eventually comes across.

My career satisfaction remained high when I started my full-time gig at Kaiser Permanente in 2009 as an urgentologist… that’s what they actually called it so don’t kill the messenger. I even picked up extra shifts – I couldn’t get enough. It was exciting to learn new things. Every time I would consult a specialist I’d learn something new.

There is nothing unique about my experience. It’s a carbon copy of the stories other doctors have shared with me. The learning is exciting. Becoming a better doctor is motivating. The paychecks are still sexy when you first start and you feel rather invincible. But eventually you’ll have to deal with the monotony of the career.

 

Career Satisfaction Disappears

In 2009 when I started my full-time urgentologist gig I was high on medicine. By 2013 the work started feeling like a grind. The 5-digit paychecks were no longer impressive and nobody was patting me on the back for outstanding medical work. It was the same patients with the same complaints and the same clinic bottlenecks.

My excitement for my career would peak every once in a while, always overshadowed by the clinic sludge. The rest of the time I had to keep myself from burning out and had to stay motivated. I tried reading a lot more and subscribed to more journals. But as physicians know, more knowledge doesn’t make you a better doctor and the longer you’ve practiced, the less delta you’ll witness in your patient outcomes.

When career satisfaction disappears we focus on all the negative shit. We get annoyed at the staff, the HR department, taxes, the debt, and even the patients. Is it our fault that we’re no longer enjoying medicine? Have we done anything differently?

In a way it’s like being married to someone. You’re in the honeymoon phase and you’re going on lots of vacations together. Then you get into a bit of a funk and decide to have kids. Then the kids start being self-sufficient and that starts highlighting your differences. After a while that’s all you can think about and no matter what you try to do, you just want to see less and less of your partner; you don’t want to deal with any of their crap.

 

Money and Medicine

It’s 2019 and a physician earns at the very least $100/hour and can earn $200/hour even as an urgent care doctor. The money is good but even the money can’t keep you in love with medicine. Those zeros become routine after a while. Remember the hardon you had for your $15,000 paychecks? That’s gone. You look at a $20k paycheck and only see the amount that has to go to taxes.

The money isn’t a big deal but it’s part of medicine. It’s what motivates us and helps us live comfortable lives as physicians. And though we think that more money would make us happier, the truth is that it won’t make a lick of difference. Even if you earned $2M a year, you’d find a way to leverage your life to that limit and the work would still be a grind. You’d just be complaining while sporting a $30k Omega, rolling in your matte-wrapped Bentley.

Could less money make you love medicine more? To put it into perspective, you’d be doing the kind of work in medicine you enjoy but less of it, while enjoying more financial stability. Some stumble on this pot of gold coincidentally. Perhaps they are the sole breadwinner and right before complete burnout they decided to drop down their hours, change their job, and downsize their lives. They hit the medical jackpot and assumed it was all luck.

 

Financial Self-Sufficiency

My grandma and grandpa were self-sufficient very early on. Bibi was a stay-at-home mom and gramps was a police officer. They saved enough money and bought a house. They grew some veggies and had fruit trees. They had chickens and stored food in the cellar. There was an elaborate permaculture going on from the yard to the the rooftop.

In our modern society it’s very hard to be self-sufficient but you can get very close to it by being financially self-sufficient.

As medical professionals we start out negative, we are financially dependent and quite at risk. If we lose our jobs as physicians it’s not like our student loan debt would be wiped clean. Nor could we go and find alternative careers easily; such is the plight of being a highly specialized worker.

There are two ways to become financially self-sufficient; one is to earn a ton of money and use the excess to pay down debt. The other is to spend very little, pay down debt, and set aside a lot of dough.

Financial self-sufficiency matters a lot in the medical profession because whether you acknowledge it or not, you’re only one step away from losing it all. A medical malpractice suit, a burnout, a bad divorce, an administrative action, a medical board investigation, a sexual harassment lawsuit – any of these could ruin your medical reputation and make you a white coat criminal – an MD leper.

 

For the Love of Medicine

Even though I burnt out from medicine in 2016 and got my license suspended in 2018, and even though I am still dealing with 2 other states fighting for my medical license, I somehow am not hating medicine. What gives?

My theory is that I started liking medicine a lot more when I became financially independent in 2016. The same year I got burnt out is the same year I retired from full-time medicine. I did some healthcare consulting and I dabbled in telemedicine. There was no longer a pressure to earn money, to pay down debt, to save for retirement. All that was lifted and I could focus on the practice of medicine.

Maybe not the love but the passion for medicine was resurfacing now that I was no longer in debt. I could work 10 hours a week and make twice my household budget. The work became interesting again and there was a renewed passion to learn more medicine.

Not that I want to work full-time again – hell no. Whatever interest I had in medicine and the joy I got from helping patients feel better, that never disappeared. Doing it a few hours a week is once again enjoyable, despite worries of a lawsuit or another medical board event.

As Mark Manson said, there will always be battles in life, it’s about which battles you want to fight. Even though I am still drowning in paperwork and bullshit dealing with the medical boards, I can’t help but enjoy a genuine patient interaction (in small, controlled doses). I don’t need the money from it anymore because I am financially independent but I want to keep enjoying the positive interactions with my patients.

 

Career Options in Medicine

Not all, but many, of us picked a career after residency which would secure a solid income. I recall interviewing for and passing on a $93k community clinic job for my $165k Kaiser urgent care gig. A no-brainer at the time. I maxed out at $430k at that same job in 2014 with a little overtime.

With financial independence the physician gets to choose where they like to work, how they like to work, and how much they like to work. Many may continue working full-time, but at least when you’re financially independent and working a shift you can’t bring yourself to whine or complain. Nobody is forcing you to be there, you don’t have to be there, nor do you need to be there.

It’s so fucking liberating to do the kind of work you enjoy – you can hardly call it a job. To see patient when you want, on your own terms. Practice medicine on your own terms so that you can still be a great doctor without having to deal with an employer’s bullshit.

 

Full-Circle Medical Career

I hated my career in medicine in 2016. For a while I thought I was hating medicine. I was having panic attacks in the damn exam room, so I associated it with medicine not my career. You know the difference right? As in, you like human being and you like dating but you just hate your husband or wife. You love automotive technology and love racing cars but just don’t want to own a commuter car. (Subscribe to the blog for more terrible analogies!)

I did everything possible to become financially independent as quickly as possible starting 2013. I achieved just that 3 years later. It’s 2019 and even though a part of me wants to having nothing to do with a chaotic medical career, I still have a tiny crush on it.

I don’t want more money. I got enough saved up.

I don’t need steady income coming in. I am earning money from consulting and my investments.

Professionally, I still want to be busy and I want to be challenged. So that’s why I’ve come full-circle, back to medicine after trying healthcare consulting full-time and teaching at the community college and owning an auto mechanic shop.

This time around it’s on my own terms. I can become a Direct Primary Care physician or I can run a health coaching business or just do some telemedicine on the side. I can start a low-income clinic and see patients 3 days a week. Whatever – it’s full-circle on my own terms.

 

Actionable Steps

Looking back, the fact that I had a plan to get out of debt was 80% of what helped me cope with the burnout. If I were to advise a young, handsome Dr. Mo I’d tell him to focus on the debt-payoff plan and trust that the debt will be gone by whatever time I planned to pay it off.

I would tell charming Dr. Mo to start dabbling in whatever interests him. If he has an entrepreneurial itch then look into how other docs have started their own clinics. Look into concierge clinics, DPC’s, private urgent cares, or a group practice.

I would tell Dr. Mo that’s it’s okay to pull the plug on a full-time career in medicine and just do some telemedicine while traveling the world. All he would need is a laptop and an internet connection anywhere in the world. Move to Spain, sip on wine, enjoy a fresh baguette and see patients at a cafe. Heaven.

Overcoming the guilt of leaving money on the table is hard to overcome. I could go back for KP and work full-time and take home $300k/year. With my hobo budget of $2k/month I would be rich AF.

  • get rid of debt
  • save up and invest $500k
  • cut down on spending
  • cut back on work hours
  • dabble in alternative careers in medicine
  • take time off

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