By the time you read this, I will have completed a transition to working half-time. Now, I know a lot of docs out there think emergency docs are already only working half-time, so perhaps I ought to start with explaining why that isn't the case, even if emergency physicians work fewer hours than many other physicians.
Emergency Doctors Work Full-Time
Let's start with the fact that most Americans consider 35-40 hours a week to be a full-time job. A typical emergency physician works 12 twelve-hour shifts a month or 16 eight-hour shifts per month. Add an hour on to the end of each of those shifts “to clean up” and perhaps another half day at some other point in the month for administrative duties and you get to something around 150 hours per month, or about 1800 hours per year. Let's compare that to a typical office worker with a 40 hour work week.
52 weeks a year x 40 hours per week = 2080 hours
That's 280 hours more than our hypothetical emergency physician. But we've forgotten a few things. We haven't considered the paid holidays. Emergency docs get paid holidays because they work on holidays! EDs are open 24/7/365, remember? If you're working half the days in a month, you work half of the holidays in the year, and the other half were unpaid. According to the Bureau of Labor Statistics (BLS) the average professional worker gets 8.5 paid holidays a year. 8.5 days x 8 hours = 68 hours.
What about vacation? When emergency docs go on vacation, they cram their shifts into the rest of the month to free up time to go. There's no “paid vacation.” They worked the exact same number of shifts in a month when they went on vacation as they did in a month when they did not. The BLS says the average professional worker gets about 17 days a year of paid vacation. So 17 x 8 = 136 hours.
What about sick days? Emergency physicians don't get sick. Okay, we know that's not true. But they rarely miss work for illness, and when they do, it usually becomes a shift trade, not a day off. The BLS says that not only do most professional workers get to have the day off, but they get paid for it too! About 10 days a year. 10 days x 8 hours/day = 80 hours. Let's see where we're at here:
2,080 hours – 68 hours – 136 hours – 80 hours = 1,796 hours, amazingly similar to what the average emergency physician works.
But wait, there's more. We haven't adjusted for the rotating shifts factor. If you go to work at 9 pm and work until 9 am, which day did you have off? That second day is referred to by emergency physicians as a DOMA (Day Off My Arse) because you're so jet-lagged that you're useless. In fact, it might be several days before you get back to normal, and that's before you hit your 50s. Those night shifts typically make up somewhere between 20% and 50% of your shifts, so you've probably got a couple of DOMAs each month. One emergency physician I know feels that every hour worked between midnight and 6 am is the equivalent of 1.5 hours at any other time. I think that's about right, and in fact, that's about how my group reimburses the shift. Add in a factor for most EM shifts being in the evenings (because that's when most patients come to the ED) and you can quickly see why EM has the highest burnout rate in medicine. We thought we chose a lifestyle specialty but in reality, we work more non-banker's hours than anyone else (although there are some other hospital-based specialties that get awfully close.)
At any rate, emergency docs work full-time, even though they work significantly fewer hours than many specialists. Just because you're working 1.5 Full-Time Equivalents doesn't mean someone else isn't working full-time. Now let's get back to talking about half-time. Here are
7 Reasons I Practice Medicine Part Time
# 1) I Can Afford To
This is perhaps the major factor, and I'm hardly alone. The informal surveys that I do when I speak to groups of physicians suggest that nearly every physician would like to work less than they are working now. So why do they work more? Sometimes it is out of a sense of duty- they're the only doc around and patients need them. Sometimes it is due to contractual obligations. But most often, the reason is financial. They've got big student loan, mortgage, car, and boat payments they need to make, and that doesn't even count paying for the kids' private school and activities, the Paris vacation the partner wants, saving for college, or saving for retirement.
However, I was lucky enough to become financially literate as a resident, hit the ground running as an attending, and build wealth rapidly. My wife and I became millionaires seven years out of residency, multi-millionaires shortly afterward, and financially independent not long after that. That process was sped up a few years by the financial success The White Coat Investor, LLC has seen, but from early in my career I knew I was going to be financially independent at least by my early 50s and work part-time after that. At any rate, between our savings and that second income, I don't HAVE to practice medicine at all. So I get to choose how and how much I practice. I choose to practice between 6 am and 10 pm and to only do it eight days a month (plus a little administrative time.)
# 2) Other Interests
If you pay attention in medical school, and actually attend a medical school where the students take real call, you get to learn a lot about yourself and what you want out of your career relatively early. I learned that I didn't like being in the hospital 120 hours a week. I learned that I didn't like being attached to a pager. I learned that if I was going to be in a hospital at 3 am, I might as well be awake and working. And most importantly, I learned that there were a lot of other things I wanted to do with my life other than practice medicine. That's not the case for every doctor. By MS4, I could see a pretty clear divide in my med school class between those for whom medicine was a calling and those for whom medicine was a job. That's not to denigrate the “medicine is a job” crowd. They're generally excellent, dedicated doctors. But they didn't live for medicine. They had other interests. Well, I had other interests too. In fact, I have yet to find anything in my life that I enjoy doing for more than 20 hours a week (except sleeping.) That includes medicine. It includes blogging. It includes exercising or even adventuring. It even includes spending time with my kids! Maybe it's a little bit of ADHD, but I'm a big fan of variety in my life. It's not necessarily laziness; I'm perfectly happy to have three different 20 hour a week jobs, it's just me. You may very well be different in this matter and that's fine. But knowing yourself and what makes you happy certainly makes it easier for you to find happiness in your life!
# 3) I'm a Better Doctor
When I was working full-time, I had very limited time to go to conferences or read journals. Now I can do those things. In addition, my compassion-o-meter tends to run dry by the end of the third shift in a row. If I'm working seven in a row, my annoyance, cynicism, and eventually hatred start skyrocketing. I remember early one morning on a trauma rotation as a resident when I'd already been awake in the hospital for over 24 hours straight and probably hadn't had a day off for a week. I was rounding on a patient with two chest tubes, a PCA pump, two limbs in splints, and a catheter and thinking “I need that bed more than you do.” Compassion fatigue is very real. Our jobs are demanding and patients deserve a doctor that actually cares about them. Maybe I'm just a jerk, but I care a lot more working 8 shifts a month than I do 22. Now I don't actually recommend anyone go part-time for at least 5 years out of residency. In my case, I didn't go to 3/4 time until I'd been out 10 years and to 1/2 time until I'd been out 12. I think those first few years are critical to solidifying clinical skills. But eventually, part-time work can make you a better doctor, not a worse one. Certainly, it can help you become a happier, more well-rounded person.
# 4) Promotes Longevity
Not a good place to watch a sunset – the summit of the Grand Teton, the fifth summit of the day reached after 20 hours of climbing on the Cathedral Traverse
Here's another interesting point. I enjoy my job a lot more when I do it less. I look forward to going into the hospital. I miss the work and my co-workers. I'm more willing to stay late instead of signing a patient out. I sit longer with the patients. I find it is almost impossible to feel burnt out when you have 22 days off in a month. 65% of my EM colleagues have symptoms of burnout. But I don't. Why not? Well, a big part of it is part-time work. (Another big part is owning my job which helps minimize its toxic aspects.) I feel like I can do this until I'm 70.
# 5) I Hate Missing Out
You know what the problem with Q2 call is? You miss half the good cases. Well, after a decade practicing, the “good cases” were becoming exceedingly rare. While there's always something to learn and see, I began to regret missing out on stuff outside of the hospital more than missing out on the good cases. I got sick of flying home early from a vacation to work some shifts. I got sick of missing kids' soccer games, recitals, and performances. Missing out on trips with friends. Missing church and opportunities to volunteer. Bedtime with the kids. Sure, I had lots of time off, but it was time when the kids were in school and my friends were at work. By reducing shifts and especially evening and night shifts, I'm able to catch a lot higher percentage of those things I had been missing out on. In addition, when your spouse knows you don't need the money from work, that career starts looking more like your choice than something that has to be done for the benefit of the family. “If you want to spend your free time practicing medicine that's fine, but when you're home, you're going to have to make up the chores you missed instead of running off to go rock climbing.” I mean, I like practicing medicine but I don't quite like it enough that I'm willing to give up all my recreational pursuits to do it!
# 6) Marginal Utility of Wealth Changes
As you get older, and hopefully wealthier, your marginal utility of wealth changes. With no student loans, mortgage, or car payments hanging over my head, motivation to work more, at least for money, falls. If there were something else I could buy that would make me happier, I would have bought it already. It gets even worse when you apply a progressive tax code to those earnings. A larger and larger percentage of your income goes to the tax man and at a certain point, Atlas shrugs. How much more do you want to work just to pay more taxes, give more to charity, and leave more to your heirs? At a certain point, it becomes “What do you want to do with the rest of your life?”
# 7) I'm Lazy
Just kidding. I'm actually more of a workaholic. I mean, I'm certainly lazier than lots of people in medicine, but compared to the general population, I'm a pretty hard worker. However, I feel called to do something else with a big chunk of my time. I feel about as passionately about bringing financial peace to the lives of doctors, other high-income earners, and their families and creating jobs as I do about healing the sick and injured. And I simply ran out of time to do it all. One of my attorneys asked me the other day, “When are you going to quit practicing medicine? Isn't your time worth too much to do that anymore?” While flattering, the truth is being a doctor is a big part of who I am, and paid clinical work is likely going to make up a meaningful part of my life for years to come. I want to do it all, but I've got to find a balance in order to keep all the balls in the air. For now, that balance means practicing medicine half-time.
What do you think? How do you feel about part-time work? Would you like to do it? Do you look down on those who go part-time for family reasons, health reasons, or simply because they can? Can a part-time doc still be a good physician? Do you work part-time? Why or why not? At what point would you consider it? Comment below!
Do you feel guilty and/or selfish for withholding a skill that you have acquired that could benefit society more than extra recreational pursuits?
Do you feel that you are contributing to the doctor shortage, especially in less desirable areas? As more doctors will be required to pick up the slack of a less productive doctor, it will be easier to fill the vacancies in more highly desirable areas, and harder to fill the vacancies in less desirable areas, leading to the doctors in those areas suffering burnout faster?
I hate this argument. I guess I missed the part in the med school or residency agreement where I am conscripted to work a certain number of hours per week or years in my career. By your argument, any time I am not working I should feel guilty.
If society wants more doctors in undesirable (or desirable) areas perhaps they can craft the positions to make the jobs more desirable. Maybe more doctors should be minted and trained. Perhaps we should stop treating docs like piñatas.
I also hate that this standard is applied only to doctors. Should a fire fighter who retires at age 50 with a full pension feel guilty for withholding skills? A teacher? A police officer? A plumber?
I couldn’t agree with you more VagabondMD. The idea that a doctor goes part time or retires early will hurt patients or cause doctor shortages never makes sense to me. Because they never apply this logic to other professions. It’s almost the same logic to the saying that people should spend more more for the economy to keep booming instead of saving all their raises. I just think it’s hogwash. You get to do what is best for you and your family. Society will still be ok. And like you suggested, the country can decide to train more doctors, give more incentives for doctors to practice so more don’t go into burn out, reduce the student loan burdens of medical students and doctors. At the individual level, every doctor should do what’s best for them. Thank you Jim for the post and enjoy your part-time practice!
Yes, if nothing else part-timers are raising the pay for other docs!
Amen
No, I don’t. I did have an obligation to society for paying for my medical school. I paid it off. It took four years and involved two deployments. I’m free and clear now.
Do you feel guilty for not working 100 hours a week? If you’re not doing that, maybe you’re withholding a skill that could benefit society. See how slippery that slope gets?
This exactly. I paid a lot for my education. What I do with it is my business. I don’t owe anyone anything.
Is attending medical school now a crime for which me must repay a debt to society?
For me, in primary care I worked 50-60 hours per week, when I wasn’t on call.
So to have a “normal” full time 40 hour work week required a “part-time” schedule.
Carrying the pager may not be considered work hours but it means no travel, no drinking, no Tylenol PM, and avoid making other plans. By the end of a hospital call week my body would shudder each time the Nextel went off.
“Do you feel guilty and/or selfish for withholding a skill… ”
It appears I have been sentenced to work in the ED for a crime I did not commit.
(adapted from Gary Shteyngart)
No one is required to pick up anyone else’s slack- we aren’t slaves (yet). I would hope that the number of physicians going part-time will cause our corporate overlords to rethink the horror that many medical jobs have become, and also increase pay.
But who knows? Maybe they will just replace us with NPs…who work even fewer hours, and whose training is more likely to be paid for by society.
Not my problem. I paid what was required for my education and I pay more taxes than most.
What a load of garbage. We MDs owe society nothing when it comes to how long we work. The time, effort and sacrifice we make, as well as the unpleasantness we have to put up with (EMRs, insurance approvals, etc) , absolves us of any responsibility to work until we drop.. Now I don’t know what you do Impromptu (I’m a Medical Oncologist) but given that me and my colleagues cure patients of their cancers from time to time, and/or prolong their lives and relieve suffering, makes me think that you may have to work until the day you die to have given back as much to society ?. No God complex intended – just making a point !
I agree with the stupidity of this argument. As a newly retired 50 year old, I can not see the validity of this debate. Part of the reason I decided to retire was the way medicine changed over my career. If society thinks I should still be working, they could have stepped in and stopped some of the changes that physicians do not like that are happening to us. Who else gets told they have to keep working on a job that they no longer like if they are willing to walk away from it and give up great compensation when doing so?
Arkad,
I agree with you. As a 61 yo whose been retired for almost a year, I do miss some of my patients, but definitely not the health system administrators. Compensation cuts for “quality” metrics not met were the final straw for me!
Love being retired!
What do you do for health insurance.? I would love to retire but the cost until Medicare kicks in so expensive!!
I agree with all of the above (except that you are lazy 🙂 )! Going part time has helped me recover from burnout and enjoy work again. I am more enthusiastic about work, come to the Hospital fresh and eager to work, and am spending more time learning new things and exploring new opportunities. I am also the most productive person in the group per hours work and am even more productive (unadjusted for part time) than a few of the full timers! I have not felt like this in years and told my partners so at a recent monthly meeting.
Congrats to going part time. I greatly look forward to the opportunity some day. I’ll probably go part time for a bit once PSLF disappears my loans in a few years. It will delay my eventual FI but I want to be home more with my kid when he is young. And then go full time again to finish building our perpetual money machine.
Learning what my “enough” is has really shaped how I view work and accumulating wealth. Up to a point more stuff rarely brings more happiness. If the work itself isn’t providing that fulfillment and we already have enough then why not enjoy our lives in other ways. If I still find it enjoyable when we hit FI then doing it less is almost certainly going to be even better.
Goodluck with part time doctoring! I have a suspicion that even with part time doctoring you still work more than one FTE if you add in WCI 🙂
Oh, for sure. In fact, I’ve been part-time (3/4 time) clinical or the last 2 years, I’m just going to half time now. But I figure I was 3/4 time medicine and 3/4 time WCI. My goal has been to cut back to full-time total but cutting shifts and hiring help at WCI. I think I’m finally there.
#MeToo
I don’t know how I worked full-time for nearly twenty years. I can’t imagine going back to that. Of course that would always be an option. The decision is reversible for anyone who cannot stand being part-time. I haven’t yet met any of those people.
I didn’t realize how much of my own life I was missing until I made the change. My life as a part-timer isn’t really any easier, it is just more aligned with my true values and interests.
Dike Drummond compares a medical career to having a 800-pound gorilla in your house. It will be more than happy to take up a lot of space, destroy your house, your life, and to poop wherever it wants throughout your house. Unless you plan carefully that is exactly what happens.
Now I’m going to go delete my draft on this subject. Sometimes I wish you were lazy, but clearly you are not.
During medical school, one of the family medical doctors in the student’s and student’s family’s clinic was also one of the assigned student mentors during our first two years of med school (I happened to be in his mentor group). After a particularly busy period of time with many tests and clinical practical exams, we had a good one-on-one discussion about it. This man had been in family medicine (active duty Army) for almost 25 years. Although a devout Catholic, he astutely said that medicine is like a jealous mistress, will steal everything good from you personally and from your life unless you set and keep strict boundaries. I’m still working on that, but it was very sage advice.
I’m not a doctor but I’ve now been part time at my main job for a full year. It’s been a mostly positive experience, especially for my stress level and health. I’m financially independent and can easily afford it, and I also keep my health insurance coverage through my employer.
To me it’s a great way to “ease” into a possible early retirement and to explore what weekdays off actually feel like and how you will handle them, without going full on FIRE.
Ha ha. I never had a trouble exploring what “weekdays off” are like. I’m looking at my schedule for the last week and this next week. I have five weekdays off from clinical work in both of them. Guess how many weekend days I’m working though? That’s right. Four.
Well the weekdays are when the running and riding trails aren’t crowded, so that “opposite lifestyle” would be pretty ideal in that aspect for me
You should see the lakes and ski resorts. MUCH better on weekdays.
Love this post Jim. You know you have it made when someone suggests that your time is more valuable than what you get as a paid physician :).
I agree that your career longevity increases when you go down in clinical hours. In the long run this may actually provide more to your financial bottom line (you can make more working like a dog for a shorter time period, but making less over a far greater time period will have the most financial impact).
There are some specialties that toning down your clinical duties is a lot easier than others: ER, Anesthesia, Radiology come to mind as these can be considered “shift work” type setups.
It is a bit harder for those specialties where a practice is built up on relationships with patients but of course it can be done too (either with locum coverage or partners picking up the extra hours). But shift work physicians have the advantage as the benefit of continuity of care is never in play.
Financial independence is key for so many things in life. You have a stronger negotiating standpoint and you do things now not out of fear of losing money but because you want to.
Longevity is huge. Making less per year over more years instead of more per year in fewer years is also advantageous tax-wise.
For sure it’s easier in hospital based shift specialties. No doubt there.
Man, hit the nail on the head with this one. I completely relate to 90% of this. Anesthesia is pretty shift work-ish, too. Though a lot of our shifts are during normal person hours and only one of us is on at nights. So while we have longer hours than bankers (probably work 50-60 hours each week), we don’t have as many nights as you guys.
I realized pretty early I had passions outside of the hospital. I still view medicine as a calling, but don’t feel indebted to work a certain number of hours because I feel even more called to be a husband and a father. Like you, I don’t want to miss out on all of my family stuff.
I’ll probably go part time in ten years and focus exclusively on my fellowship trained area (regional anesthesia). If any of my side hustles take off, which it looks like they might, I might reduce my FTE based on the income they make up from my current salary.
TPP
Congrats on being able to reduce your hours to part time.
As an attorney, I can relate to the fact that ER doctors cannot escape their shifts and there are no “real” vacation hours.
For us, we have billable hour requirements and the needs of clients that will never go away and are waiting for us when we return.
If a lawyer takes a few weeks of vacation off, then they just have to make it up over a shorter period of time. It’s also increasingly difficult to have a vacation not interrupted by a real or perceived client emergency.
The part time gig is exactly what I am pursuing over the next year. With my specialty, Locums is the obvious option although I would entertain a part time clinical position if a local practice offered it. I have one major obligation that ceases in a couple years and beyond that my expenses will be quite minimal. It’s very freeing to realize you don’t have to work but can work when you want.
Congrats on a great post. I feel like I started the movement for the FI independent doctor (or others) to go part-time and eliminate call. I have been working 3 days per week with no call for 5 years now and I would totally retire if I had to get up in the middle of the night again. Anyone can examine their financial situation and figure out how to do it. I did it with OB/GYN. Yes going to work is pleasant if you are not stressed out and tired all the time.
Congrats WCI! Well deserved.
I transitioned to part time at the start of this year after hitting my first tier of financial independence, and it’s been great for my overall health and well being. I agree with the sentiment that this has made me a better doctor. It’s a much different mindset when you know you can walk away at any time and still be okay.
I am in step with you on all the same reasons, except for #1, which unfortunately is kind of a linchpin in the whole idea. With my current setup as an academic physician, I’m probably 2-3 years away. If I get creative, maybe I could do it sooner. I’m mulling over the options.
And, btw, call em what you want, but you’ve got the equivalent of “academic days” in spades. 🙂
Surprised you didn’t call me out on that when I said it.
I’ve been working part-time for six years now and you hit a home run with this article. The most surprising to me personally was number 4, Promotes Longevity. When I was full-time in complete burnout mode, I couldn’t wait to retire. Now that I’m part-time I feel like I can practice as long I’m physically able. It’s been a refreshing change.
I feel exactly the same. I was ready to quit. Now, my timeline is at least 5-7 years, maybe longer.
Maybe it’s just because I receive the message better from a fellow emergency physician, but this is the most compelling argument I’ve heard for cutting back on clinical hours. I still enjoy full time work, but I plan to eventually follow in your footsteps. First cutting out nights, then cutting back on total hours. We’ll always have weekends and holidays to complain about, but I think I could also do this job til age 70 with that schedule.
Maybe in some groups you could buy you way out of weekends and holidays, but not mine….yet.
Yeah, there is a number for getting off Christmas Day…I felt it out last year and that number is just higher than I care to pay at this point.
I work 0.6 FTE (with no nights) and still feel crispy…I wish the longevity piece applied to me! I guess there are degrees of burn out, so could probably be worse.
I understand the positives of working less (especially regarding family time), but any doubts about not working more from a money perspective to use for future family? Not interested in opening up the discussion of pros/cons of inheritance…but if you worked a couple extra days a month, say make an extra $50k/yr for a couple years…after compounding, that is serious money for great grandkids.
Good question. It does seem easier for me to make lots of money and pass it to the kids rather than have them make money. The problem is that if you give them too much, it could affect their work ethic.
At any rate, not so much an issue for me because I actually make more money with my non-clinical activity. I’m still making plenty of money I’ll have to figure out what to do with.
Excellent post.
I am a family doc who started working part time after my child was born 30 years ago. When he was a year old, my colleague asked when I’d go back to full time. “Never” was my reply. I enjoyed medicine so much more working 60% time (and was a much nicer person)
I did that for 29 years. My patients knew which days I was at clinic, EMR made it easy to handle results days I wasn’t in. I retired last year because I saved enough (would’ve been easier if WCI was around earlier, but I guess you wouldn’t have written as well as a 10 year old).
I think I would’ve worked a few more years if there was a way to give up hospital night call, and if work subsidized health insurance was available for less than 60% time. As it happened, an opportunity to work one afternoon/week at a different clinic in the same system came up, so that’s what I’m doing now. It’s fun! Not sure how long I’ll do that, sure nice to know I can afford to do whatever.
Congrats WCI! Happy for you. Me? I’ve got a ways to go.
Excellent post!
For the past 5 years, I have worked as a urologist 7-5 Monday to Friday.
The last 2 months I had a taste of the “part time” life by using accumulated vacation time one weekday a week.
I agree 100% with all the 7 points.
I am 50-75% FI
Would you suggest waiting to FI to pull the part time trigger or just doing it right now? I am saving 80% of my income now and this is my 5th year in practice. Thanks!!
I don’t think there’s a right answer to that question, but for someone saving 80% of their (presumably net) income, I suspect you could go part-time right now and be just fine, although your savings rate and obviously your savings amount would drop dramatically.
Like the article. 1 Comment and 1 question.
Comment: I think the entire first section about Emergency physicians truly do work full time is unnecessary. Trying to define what is “full time” is only what we make it. My specialty is very different. I work Monday-Friday and put in about 60 hours a week doing so. It is all during the day and no weekends. The advantage is I always get to be with my kids on the weekends, and I get my regular night sleep every day without having to worry about calls and being off sleep patterns. The disadvantage is time off for extended periods is hard as it can dramatically hurt my income and the practice. Although I have taken many vacations, since starting in 2010 I haven’t taken more than a 5 day weekend/vacation. Very hard to travel around the world in 5 days. There is no way for me to work for 2 weeks straight and then take 2 weeks off without repercussions. A plumber, and a roofer have very different hours as well. A roofer can’t work in a rainstorm….but she might work 3 weeks straight catching up from said weather. Does that mean either one doesn’t work full time? No.
Question: Why is summit of Grand Teton not a good place to watch the sunset. Seems like an awesome place to watch the sunset to me! Just hope you brought your tent.
Yea, I got hate mail from an orthopedist’s husband telling me to quit whining since emergency docs don’t work that much compared to surgeons. I’d be miserable spending 12 hours a day M-F at any job. It’s important to know yourself. And yes, full-time is subjective and field dependent, but I’d argue you have 1 1/2 jobs my friend. I hope you’re getting paid like it.
The summit of the Grand Teton was 6 hours away from my sleeping bag, 2 hours of which involved treacherous terrain and difficult routefinding in the dark and the other 4 hours of which simply involved hiking on a loose trail past cliffs. I already had everything I had brought on and the temperature was dropping rapidly. The time to be on the summit of the Grand Teton is more like 7-11 am, not 7-11 pm. Camping at 13,770 feet in Wyoming isn’t a particularly pleasant experience especially when like me you don’t have a sleeping bag, much less a tent. More details here:
https://www.whitecoatinvestor.com/how-mere-mortals-can-do-the-cathedral-traverse-in-a-day/
Wow…I have read WCI since the beginning, but never saw this post. Haven’t gotten all the way through it yet, but I am very jealous of trip! Frickin awesome man! And although I am a bit of a thrill seeker, the photo of the steep sheet of ice/snow with you in the middle of it freaks me out. I hope that is just a photo effect!
This wasn’t published on the blog.
I wish it was a photo effect. In retrospect, I would have made a different decision. It really wouldn’t have been a big deal with stiff boots and two ice tools though. Would have been very comfortable soloing it like that.
Finally finished reading this trek. Reminded me of Colin O’Brady….Surely you know who he is. Realized you should have him as your keynote at the next WCI conference! Not financial but pure inspiration! Metaphoric financial goals 😉
In case you don’t know him:
https://www.colinobrady.com/blog-landing-page/
Seems like a cool guy. Thanks for the suggestion.
You nailed it.
For the past year, I’ve worked 6 shifts per month. It’s given me a second honeymoon with emergency medicine, eliminated burnout, and given me more time for wife, kids and kayak. Just enjoyed the best summer of my adult life, which included five weeks of international travel with the family. Front-loading the pain (and the savings) when I didn’t know better enabled a glide-path at this stage, which looks to be sustainable for a long time to come while I allow the nest egg to compound.
Thanks for this piece.
What are , if any, your malpractice concerns, fears, anxiety given your wealth ?
Sure, it’s always possible I could be the 1/10,000 (maybe 1/20,000 in my area) who is sued above policy limits, but it seems unlikely and actually IS less likely given that I’m seeing half the patients. Maybe 1/40,000. Not sure I need to have much anxiety for something so rare.
Why do you not recommend “anyone go part-time for at least 5 years out of residency”? For spending more time with my family, I had considered going part time at say 3-4 years out of residency.
I don’t know that there is some definitive time period, but the idea is to solidify clinical skills early on before cutting back. Is 3-4 years enough for some? Probably. Might others need 10? Probably.
As I’ve progressed through my experience with cutting back, I have found there is a spectrum of reaction to part-time doctoring, with WCI “I can do this until I’m 70” on one end, and PoF “I’m weaning down to a 0.0 FTE” on the other end. Initially, I thought that cutting back would make me more patient, happier, a better doctor, and more tolerant of the nonsense that comes with working at my organization. And it did. Then, slowly, I adjusted to my new (better) baseline, and many of the former irritants began to irritate me again.
Recently, I was able to cut back further, to an even sweeter schedule, seeing patients 8 hours per day, 3 days per week (no weekends, and call is light). Yes, it’s awesome. Yes, I consider myself extraordinarily fortunate that I have the financial means to quit tomorrow and not worry (thanks to living like a resident for a looooonnnnggggg time).
But, interestingly, this has not made me more tolerant of a portion of my administrative duties. Part of it is that I have an innate need to call BS when I see it; I am not skilled at diplomacy (well, I can be, but I often choose to not be) or just letting things go. So I recently decided that I need to step down from those duties that cause me angst and irritation.
Part of me is concerned that I am too quickly weaning myself out of a job that I am not yet totally ready to give up, while the other part of me is saying, “Hey dummy, you don’t need this aggravation, so jettison the stuff that bugs you.” Then there is the third voice that says, “Learning to deal with, manage, and ultimately embrace discomfort is a useful life skill – probably one with which you could use more practice. Not to mention the fact that you’re trying to teach your kid resilience. Hypocrite.” So yeah, there’s that.
Overall, I highly endorse the concept of cutting back, as it has helped me create mental and physical space for all kinds of good things in my life. But there is a fair amount of psychological baggage that some of us will carry into our new situations, so I’d caution the new part-timers out there to not beat themselves up if they don’t feel like they could continue on until 70.
Amen to that. I do find that I swing back and forth like you do. Although when I was asked yesterday if they could nominate me to be the medical staff chief of staff I said no. I’m actually amazed at how going from 3/4 time to 1/2 has made me identify less as a doctor than going from full time to 3/4 did. Very interesting.
Great post!
I think the biggest thing that I like from your post is the ability for us to take a step back and appreciate how terribly lucky we are to even have working part time doing what we love as an option.
I (and i’m sure many others) spend a few minutes before every shift being thankful for how lucky I am for being paid enough to where my biggest concern is on how many shifts I can squeeze into a vacation month – and not – “can i take a vacation”.
Exactly. First world problems for sure. To even have work that you find fulfilling in any way is an incredible thing many people don’t enjoy.
One thing I’m curious about out (especially in those fields that are procedure based or ones that require quick thinking: ER, ICU, surgery ,etc) is if there’s a limit to how much you can cut back before you can lose your technical skills. I don’t think that’s a half time or even quarter time but at some point those who do less clinical medicine start to get rusty if they don’t work enough. I see this with my colleagues who are very administratively inclined.
Our group decided the limit to remain a partner was 6 shifts a month. I’m working 8 now. I think that’s probably enough. I think it’s less of an issue if you’ve been full time for 10-20 years than if you were only full time for 1 or something.