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The Cost Of Picking Up Extra Shifts

As an Urgent Care doctor, I had the opportunity to pick up as many extra shifts as I wanted. The advantage of this specialty is that there is always way more supply than demand. But the cost of picking up extra shifts isn’t something we can inherently calculate in our heads well.

I call this the opportunity cost of picking up extra shifts. It’s a concept I learned recently.

Urgent Care is meant to bridge the gap in access to primary care services and mitigate the cost of emergency care. At my old medical group, Kaiser Permanente, I had all sorts of tactics to make sure I got the highest-paying gigs or at least the ones which were easiest.

I saw my colleagues struggling with picking up extra shifts, often because they weren’t able to get enough of them. But should they have even bothered picking up more shifts? Working more to earn more is the easiest lever to pull on, but it might not be the right one.


Time is a finite resource; money isn’t. Money is printed by whoever has the power to print it. Cost is manipulated through the printing of money, but value is much harder to manipulate.

I didn’t understand this before: cost is different from value.

The average physician consumer will treat cost and value identically, while the financially savvy doctor will focus mostly on value and put minimal emphasis on cost.

I used to be focused mostly on cost, which is why I was aiming for financial independence through building a portfolio of a specific amount. Later, I learned that costs are manipulated, not always nefariously, but still enough to make me rethink my definition of financial independence.

Of course, I still highly value investments because it has become the backbone of our financial societies, but I am recognizing that even though I cannot ever control cost at my level, I have a lot of control over value.

Your Free Time in Life

So much of this blog is geared towards the nontraditional physician even though the basic concepts are the same for any household; we have a finite amount of time on this earth, we have limited resources and yet have so much more autonomy than what society leads us to believe. We vote with where we spend our money and where we choose to live.

The opportunity cost of picking up extra shifts is the loss of the free time we could have. It’s the time spent learning a new trade or improving upon our character or lifestyle.

Our free time is whatever time we spend doing the things we enjoy most. Working an urgent care shift from 1pm-10pm four days a week is a job for some but it’s exactly how others want to spend their free time – I haven’t yet met the person who chooses to spend their free time working a job but I remain hopeful that one day I will.

The way our society is designed, there is absolutely no reason for a physician to need to work more than 10 hours a week. It’s important to recognize that we choose to work 40, 50, 60, 80 hours a week. I don’t doubt that some of us love doing it but I believe that’s more of a continuum than an absolute truth.

From 2006 until 2012, I couldn’t believe that companies were paying me anywhere from $80-$120/hour to work – I loved it so much that I would have done it for far less, maybe even free.

The Value Of Your Free Time

So much of who we are as adults is determined by our upbringing. When I was growing up, the only times that were of value were the times I had to do chores, the time I spent in school, the time I spent studying, and the time I spent playing organized sports. My free time spent playing, doing nothing, or hanging out with friends was considered to be of very little value – maybe even a waste of time.

As of this writing (2017), at age 39, I am realizing that the free time I spent doing nothing were some of the most meaningful. Granted, I had no idea how to structure my free time and so I binged on it when I had it and acted out during it.

I’m updating this post in 2021, and the most valuable times I have spent over the past few years have been unstructured time where I read, learned, exercised, and interacted with loved ones.

We Are All Aware Of The Cost Of Our Time

My friends tell me they don’t think like me. Breaking everything down into dollars and statistics is tedious. It takes away the pleasure of living.

Fair enough.

Yet they know what they are willing to spend on rent, entertainment, dining out, jewelry, and medical bills. They also know what they should be earning annually and what they should have in retirement.

It’s not that they aren’t thinking about it. They don’t like expressing it. If it’s swept under the rug, it’s easier to keep the momentum going.

Quantifying The Value Of Free Time

When I was just a wee lad, I placed no value on my free time. When I got older, I realized how valuable my free time was, but I had no way of quantifying it and so I went along and wasted it. This was around the same time when I didn’t understand the value of money and so I spent recklessly… on cars, homes, alcohol, food, and vacations.

Then I learned the value of money… “Ahhhh, I get it, this sum of money can do XYZ for me! Who woulda thunk!” I then devised a plan for my money after resolving the weird emotional attachments I had with it and I was able to achieve my goal of financial independence with the help of amazing financial advisers.

It wasn’t until after I figured out the value of money and after I achieved my goal of financial independence, that I learned the value of my free time. Remember, from before, cost is determined by others, but value is set by us.

Society considers my free time to be worth around $100/hour. I have been able to increase my hourly earnings to around $250. So I consider my free time to be worth at least 4x that. I wish I could think of it in less granular terms, but my mind’s vocabulary is still quite immature, having been brought up by a society focused on productivity and hierarchy.

Picking up extra shifts has the tradeoff of spending less time doing what I love. If practicing medicine is what I love, the opportunity cost is justified.

It’s not the practice of medicine I love but the art of being a physician. This is lost on many residents. Reading their comments on Reddit highlights how they view a medical career the same as the practice of medicine.

Opportunity Cost Of Your Free Time

If you pick up an extra shift as an Urgent Care doctor then you will be paid somewhere around $100/hour or you might get a little extra if you are working an overtime shift, perhaps $150/hour.

No doubt, it’s really hard to say no to this extra money. We see the extra zeros and we think about what it could do for our student loan debt and mortage debt.

Turning Free Time Into Money

The free time you have outside of your job is quite limited, especially if you have a family or you are into sports, reading, have friends, etc.

A week only has about 170 hours. You would need to spend 40 hours of it sleeping, leaving you with 130. Your job, along with the commute and prep time, will likely cost you about 50 hours, leaving you with 80 hours a week. For a workaholic, that’s potentially $8,000 of gross income a week, extra, on top of your base salary.

Since this would be taxed at the highest income tax level, you’re looking at a take-home of somewhere in the $4,000 range each week, or $16,000 extra a month.

Is The Income Sustainable?

To have a meaningful discussion about opportunity cost, we need to be able to put this sum of money into a larger and more relevant perspective.

  • How likely are you to get these many extra shifts, week after week?
  • How likely are you to burn out at this rate?
  • How much more money would you spend every week to support such a hectic lifestyle?
  • How much would your health, network of friends/family, and household suffer if you were to trade your free time for $16,000 extra per month?

Of course, for an NP or PA, it might be only $10,000 extra a month. For a radiologist or orthopedist, it might $20,000 more per month. It’s all relative so let’s focus more on the concepts.

Once you factor in having less time with family, less time with friends, no time to exercise, having to eat shittier food, working to the point of exhaustion, the risk of burnout, and losing out on the opportunity to diversify your skills, then it becomes clear that you are wasting your free time picking up extra shifts.

Your Hourly Wage And The Potential For A Higher Income

If my hourly wage is $100 then it really won’t make much of a difference if I could get $200/hour for overtime. The reasons are plenty but for one, there wouldn’t be enough opportunity to have so many overtime hours and earning $100/hour versus $200/hour will make a minimal difference in a traditional physician household.

How High Can Your Hourly Wage Go?

If my hourly wage is $100 and I can increase it to $1,000/hour then we’re talking about a significant worthwhile opportunity. Are there Family Medicine doctors making $1,000/hour? Of course. Are there Family Medicine doctors making $2k, $5k or $10k/hour? Absolutely. Do your own research regarding your own specialty and you will find that there are those who are making at least 100x what you earn an hour.

Not all of these high-earning physicians are clinicians. Some are CMO’s, some are business owners, some own massive restaurant franchises, some are consultants and some are MD/JD’s. An internist acquaintance earns $3 million a year as the head of a large hospital group plus his bonuses. That’s $2,000/hour for a primary care physician in my small network.

Alternative Uses Of Your Free Time

If I can earn $50/hour doing something I love, I’ll be far better off than earning $250/hour doing something that takes everything out of me. If I hate the latter job it’s far less likely for me to excel at it. If I love the former gig then I am much more likely to not only become more successful but also to increase my income over time.

This is a split of the opportunity cost of picking up extra shifts. It offsets the cost a bit.

What this post is eluding to is that we shouldn’t always reach for the lowest hanging fruit. The mentality of “I am working 50 hours this week, what’s another 10?” is quite detrimental. I believe it stems from not knowing how to place an appropriate value on our free time.

If each person can figure out for themselves what their free time is worth then it will make it much easier to decide how to spend it. If my free time is worth $1,000/hour then I wouldn’t be willing to take on anything unless it either affords me that fee or I know it will eventually get me to that hourly rate.

1. Learn A New Skill

As an Urgent Care doctor, I have no problem managing patients. I can do Primary Care and I can do acute care. Since these are the traditional roles of a UC doctor I won’t get paid more for being better at them (sadly).

Instead, I can develop one of the following skills:

  • administration
  • running an urgent care as a business (entrepreneurship)
  • managing staff (HR)
  • optimizing the flow of an urgent care (operations)

Each of these skills can lead to much higher income as an Urgent Care doctor per hour. Whether you will be paid a much higher salary to be the chief of the urgent care or whether you will earn a lot owning your own Urgent Care is up to you – the market is far, far, far from being saturated. You may have to dabble in different things to see what fancies you.

My time spent doing admin work for my medical group was quite lucrative. If I had pursued it further then I could have been the chief of my department sometime next year (2018). 3 years after that I could have been the director and 5 years after that I could have taken a regional role.

2. Pursue A Passion

Earlier I mentioned that I value my time now at $1,000/hour. That doesn’t mean that I won’t do something unless it earns me $1k/hour. It’s just that I will say no to any earning opportunity that makes me less than $1k/hour or at least has that potential.

I like to spend my time bouldering, walking, socializing with friends, learning homesteading skills, writing and reading. In fact, these are far more valuable than the $1,000/hour which I have set as my hypothetical cutoff. So, it’s not just about the money.

Is there passion that you wish you had more time for? This goes back to how valuable our free time is. Our passions are what can make life that much more pleasant to live. The term passion is hard to define, except for when you are doing something you are passionate about, you just know it. Defining your passion is as important as finding your passion.

3. Spend More Time With Those Who Matter

There is a time to earn and a time to build relationships. I don’t have kids and don’t want them, but spending quality time with your little ones is awesome. I loved it when my dad would do things with me, wish we had more time together when I was growing up.

Quite a few of my readers are younger single doctors who don’t have families and many of whom aren’t planning on having kids. Still, you guys have friends and parents whom you may want to spend more time with. Earning opportunities will always be available for a responsible and competent physician.

Building a solid base of friends and family strengthens you in less obvious ways. It’s that social capital that’s talked about. When you have genuine people you can depend on then whatever you do will seem easier.

4. Build A Business

You know, I mentioned entrepreneurship on here a lot. I think it’s because I have seen friends with their own businesses achieve the exact kind of lifestyle they desire. Being your own boss and deciding how you want to practice medicine is a really romantic idea to me.

I see 2 different kinds of healthcare businesses. The kind where you are the sole employee is less attractive to me. Taking a few ideas from Rich Dad, Poor Dad and the E-Myth, it would be good to switch from the employee mentality to the business mentality, where you take yourself out the working equation and focus on management.

An enlightened business can do so much good for your community or the world. Gaining the experience on the ground level as a worker bee is important, advancing to the next level of seeing the big picture of a business, learning how to manage people and how to delegate tasks is the next step in the evolution of earning a higher income.

5. Build Up Your Brand & Expertise

My friend’s dad successfully operates a massive restaurant franchise empire and has ventured into rental income real estate as well. His biggest asset isn’t the franchise empire nor the real estate business. He has spent decades building his brand and expertise – that can’t be taken away from him.

The best way to offset the opportunity cost of extra work is to make that extra work something which adds diversity to your professional portfolio.

He has almost completely taken himself out of the management part because he has amazing managers and district managers and a regional operations team. He doesn’t have to deal with hiring, firing, or marketing. However, his expertise is always needed when things don’t go the way they should.

Even for his own business empire, he has branded himself as the consulting expert. He has set this in place over many years and is earning millions a year through his personal ventures and gets hundreds of thousands a year consulting for other companies.

What’s your brand? What’s your expertise? If you could be paid disgusting sums of money for a particular skill or be world renowned for a skillset, what would it be? Find that niche and do everything in it that you can think of with your free time. Talk to those experts who are already doing it, write about it, podcast about it, and vlog about it.

I am still not sure what my niche would be. What would be the one thing I’d like to be an expert in… but I know that I have many different interests and I am pursuing each in a timely fashion. If I want to become a financial adviser one day then I have the exact kind of platform that would land me an ideal intern gig.

In Summary

Dabbling here and there in some overtime is perfectly fine. But, as physicians, we aren’t going to drastically increase our hourly rate by just doing more of the same and reaching for the low-hanging overtime fruit. The opportunity cost of what we could be doing with our time instead of working more shifts will be different for each of us. If you have aspirations of earning more money then picking overtime shifts is, in fact, a waste of time for many of us. Consider investing that extra time in adventures which could return far higher profits in the future and hopefully be more enjoyable ways to spend your time.

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