[Editor's Note: Today's guest post is from Crispy Doc, a blogger who describes himself as “a mojo recovery specialist and financial literacy evangelist helping physicians who feel stuck change the axis their lives revolve around.” We have no financial relationship.]
The World Turned Upside Down by COVID-19
It was late March of this year, and I was intubating my first suspected COVID patient. Dressed like an astronaut in my powered, air-purifying respirator and supplemental PPE, the situation felt surreal.
Adding to the sense of the bizarre, our Emergency Department (ED) was a ghost town. What had been a steady 15% patient volume increase over the prior year seemed to evaporate overnight, as fear of contracting COVID in healthcare settings frightened away many who would otherwise seek help in the ED. A 60% drop in volume made us all nervous: In our group, we only generate revenue when we see patients, so our incomes were due for a hit. The longstanding belief in medicine as a recession-proof career was disproven quickly and brutally. It was hard to conceive of the economic suffering those without the benefit of a medical income would endure.
Intubations like this one made me apprehensive about bringing illness home to my family. I was less anxious than many, however, over the economic impact of COVID to me personally, thanks to a financial plan I'd implemented several years earlier. Although assuming control of my finances had resulted from a difficult brush with burnout, the payout was the peace of mind I felt at moments like this.
Burnout Was Not Supposed to Happen to Me
I entered medical school over twenty years ago, fully expecting it would become my life's calling. A perennial optimist, I sought a medical career as part of a spiritual fulfillment program to heal a broken world. The nice income would be an incidental perk, as I was pursuing medicine for the right reasons.
Somewhere along my career trajectory, however, medicine harmed me instead of nourishing me. It's possible that the fissure began during my second year of medical school. Studying to keep up with the volume of material left me isolated, despite spending hours daily in class among my fellow medical students. I was in a friendly crowd but felt utterly alone. Accepting that this sacrifice was simply the cost of admission to medicine and assuming it would be offset by later rewards, I pressed on despite what I would later recognize as classic symptoms of depression. Eventually, the feelings dissipated.
Residency was an unexpected high point. I found my tribe and learned from a set of brilliant researcher-clinicians in my specialty of emergency medicine, where every day caring for society's most vulnerable reinforced my sense of serving as an agent of social justice.
Burnout, as my mentors explained it, was unique to those who had entered emergency medicine before it was a formal specialty. My forebears did not know what they were signing up for, so it was predictable that they reported high rates of disillusionment. As part of the first cohort to undergo standardized training with realistic expectations for my career, faculty mentors assured me that burnout was not in my future. I mistakenly believed them.
Medicine Was a Meaningful Career, But Never a Calling
Serendipitously, I worked with Dr. Rick Hodes, an internist who has spent his career in the horn of Africa caring for the sick and destitute. Rick is an observant Jew serving as medical director for a mission run by Catholic nuns treating patients whose spiritual beliefs range from Muslim to Ethiopian Orthodox Christian to animist. (There is a joke in there somewhere.)
Meeting Rick showed me what a true calling in medicine can look like, and I am proud to continue supporting his work. It also helped me realize that despite the meaning I found in medicine, I did not feel a calling in the same sense (or on the same order of magnitude) that Rick did.
Burnout Attacked from Every Direction, All at Once
Fast forward five years. Around the time our second child was on the way, I was mid-career in a position at a well-respected community hospital. It was a collegial environment, caring for an appreciative population alongside doctors I admired and considered friends, but our group was short-staffed due to illness, maternity leaves, and relocation. All of us worked more than we wanted to for a couple of years. Chronic exhaustion from work made it hard to be fully present at home.
My limited availability for our toddler and my worsening schedule became sources of resentment for my pregnant wife, a part-time physician. My chronic absence required her to pick up the slack at home, in addition to her clinical workload, while also nurturing a nascent business. My unsustainable schedule was being maintained at her expense. I also faced my first malpractice lawsuit at this time. (It would be dismissed years later.) The uncertainty of being named in a suit caused our bank lender to threaten to withdraw our loan after we'd entered escrow on our first home.
While trying to navigate this perfect storm from what felt like a balsa raft, I began to feel depleted, anhedonic and uncharacteristically cynical. The lawsuit transformed my patients from objects of my care and protection into land mines waiting to explode. Work changed from an adventure I enjoyed into a burden I dreaded. Medicine was consuming me entirely, and the most important people in my life were getting the dregs. Something had to change.
A small voice in my head started asking uncomfortable questions:
- If physicians are wealthy, why do I feel poor?
- Why don't I control my time, and why does it feel scarce?
- What if I can't slog it out for another 20+ years until retirement?
- What if this is as good as it gets?
Financial Literacy Became My Escape Hatch from Burnout
Escapist fantasies became a refuge, as I asked myself how much longer I needed to stay in medicine before I could leave it behind forever. But then, by inexplicable coincidence, I stumbled across the financial independence movement through Mr. Money Mustache, eventually discovering a budding physician finance blogosphere that inspired me to become financially literate.
I sat down with my wife, who never wavered as my ultimate support in my lowest moments. We agreed on what needed to change to place our family priorities back at the center of our decision-making universe. We also agreed that increasing the time I had available to dedicate to our family was more valuable at our stage of life than the income we'd lose to reclaim that time.
We used several levers to accelerate our journey to financial independence:
- We pared down recurring expenses we could not justify. The accumulation of marginal gains on a sustained basis worked in our favor.
- I assumed control of our finances, and we parted ways with our financial advisor, who was charging a 1% assets under management fee on top of expenses. This move saved us tens of thousands of dollars in the first year alone. This strategy succeeded because I invested both passion and time into becoming a do-it-yourself investor.
- We spent several years as super-savers, maximizing dual contributions to investments in a profit-sharing 401k, a corporate defined benefits plan, backdoor Roth IRAs, and our family HSA contribution.
- My wife started and grew a side-hustle that increasingly decoupled her income from her clinical work as a physician.
- We had the luxury of a dual-income household.
- We got lucky investing during the longest bull market in history.
We considered radical solutions such as relocation to a lower cost of living area and job change. Ultimately, we decided on a long-term plan to incrementally change my existing job into one that could accommodate our needs and priorities.
With an eye toward the long game, I initiated a series of proposals at work that were respectful of the needs and priorities of others in my group. After a couple of years of patience and persistence, the schedule I have today allows me to live the life I want. Equally important, the feedback I've received from my colleagues is that since adopting these proposals, the added flexibility our job incorporates has similarly improved their quality of life outside of the hospital.
Time Became More Valuable Than Money
A critical aspect of what allowed us to successfully reprioritize was the ability to reassess the time value of money at different stages in life. When I was young and hungry in my medical career, I had ample time and very little wealth. It made sense to accept every shift I was offered because I needed the cash more than the Saturday night off.
When burnout hit me in middle age, part of the problem was that my mindset had remained static, whereas my life stage now encompassed a wife, two young kids, and a growing net worth. If I'd stopped to consider it, I'd have realized that controlling my time was far more precious to me than earning additional income. Taking control of my finances allowed me to redefine my relationship with medicine for the better by cutting back my clinical shifts. Now I'm more engaged with the science, more present for my patients, and the hassles bother me less than they used to.
Medicine is now a well-paid and fascinating hobby, one of many hats I wear – father, husband, outdoor enthusiast, reader, reluctant provider of free medical opinions, etc. Diversifying my identity means I no longer rely on my career in medicine to be the major determinant of my happiness – a strategy learned from managing our finances.
Start Stitching Your Financial Parachute Now
Physician finance blogs like the White Coat Investor began preaching to a tiny contingent of the converted – an online Trekkie convention of sorts. That geeky subculture is now leading the way for our fellow physicians as they cope with job insecurity and unexpected disruptions in cash flow during the current pandemic. Practicing medicine in the era of COVID has been devastating; I am loath to suggest there's been a silver lining. It has, however, underscored the need for understanding and managing risk.
Cultivating financial literacy is analogous to mastering a power tool. A skilled user wields these instruments to build a shelter that protects loved ones and provides security in tumultuous times. As for the unskilled user of power tools, I see one of those every shift, usually missing a finger.
[Speaking of financial literacy, our Fire Your Financial Advisor and 2020 Continuing Financial Education courses are a perfect way to “cultivate financial literacy” and build your own path to financial independence! You can even hear a little more from Crispy Doc in the 2020 CFE course.– ed]
How is COVID-19 affecting you and your family? How are you coping? What advice do you have for others feeling insecurity, depression, anxiety, etc. during these unprecedented times? Please share your experiences below or join the conversation on our Facebook, Forum, or Reddit groups!
Really enjoyed reading this!
I truly believe that financial well being is a critical part of financial well being. It’s unfortunate that many physicians still view a focus on finances as dirty or somehow mutually exclusive to the focusing on patient care. Really, the opposite is true as you point out so well. Being able to have financial security allows us to bring the focus back where we always wanted it – our family of course, but also to the patient, the science and the reasons we went into medicine in the first place!
I am a graduating fellow about to start my first attending job (as a plastic surgeon I am used to being the one putting the amputated fingers back on). I feel fortunate to have gone from financially clueless to managing my own finances right at the cusp of this transition. However, it’s scary to realize how close I was to making even more potentially devastating financial mistakes that would have pulled my focus further from my passion in medicine.
Great post.
Jordan,
Appreciate the kind words. Glad to hear you course-corrected before making the big mistakes and the big money. Thanks for taking the inconvenient calls from docs like me and for sewing those suckers back on,
CD
Great post crispy. Financial literacy followed by financial independence gives one the negotiating power to design your life and handle burnout and eventually retire like me.
Hatton,
Crusty veterans like you inspire (formerly) young turks like me.
Congratulations on a well-earned (and possibly long-overdue?) retirement, my friend.
CD
COVID has actually been very good for us. We’ve been in the OPs shoes but a few years ago found out we needed better financial and work/life balance. We increased our savings rate from 15% to 35% and the goal was to get rid of all non-mortgage debt by the end of 2020. Then the physician in the HH could cut back 10% of time and 10% of salary. If we decided that wasn’t enough, in 2021 we’d cut back another 10%. COVID actually forced a 10% paycut but with the transition to tele-health that got rid of the commute, easily giving 10% of hours back to personal development and time. And the 10% salary cut sucks and we weren’t quite ready for the cut we’re still on track to meet our goals by the end of the year so this 10% salary cut is probably permanent and we’ll get 10% of hours reduced by the end of the year
JBME,
Kudos on the decision to make such a large and disciplined savings plan a central part of your roadmap to balance. Sounds like the end of this year will provide cause for celebration even if it wasn’t exactly what you’d expected thanks to your buying that huge financial umbrella years before the first cloud appeared.
Enjoy the freedom you’ve purchased through hard work and super-saving. You’ll never regret the reallocation of time,
CD
Thanks for sharing your story. I’m glad to hear you made some much needed positive changes to your life and medical practice. And you made it out the other side safely with your life intact. So many in medicine have fallen by the wayside.
I don’t know if its a silver lining or not, but like so many of you, the massive decrease in work hours helped me see in a crystal clear way just how burnt out and overworked I’d become. Working 6-80 hours a week, all the overnight call and stress for 15-20 years… it’s too much for me and my values, it’s too much for any of us in medicine.
Having more time with my family, for exercise and time outside, for personal growth, to work on a side business – I can’t put a price on any of this. In many ways, I’ve been pretty upset at all the time I’ve given to medicine and all the life events I’ve missed over the years because of it.
Finally, truly knowing that medicine is not the secure – financially or physically – profession many of us thought was eye-opening. It has given so many of us all the more encouragement to get financially free from medicine. Or at the very least, not so financially dependent on clinical time. Seeing colleagues, in their 50s and 60s, need to take out personal lines of credit during the last few months has been shocking. It shouldn’t be, but dang…
Hey Altadoc,
It’s heartbreaking to see how medical training can cause good people to internalize dysfunction.
You are far from alone in feeling that medicine is asking too much. The problem with placing medicine at the center of your life is that for most of us, it’s a lopsided relationship (she’s just not that into you). It’s completely understandable to feel upset. Then you go out and ride a bike; reconnect with a dear friend; invest time in something you are passionate about, whether a business or a kid or tonight’s dinner, and the anger dissipates.
Vagabond MD has written elsewhere that hospital won’t love you back, and he’s right. You are wise to seek alternate sources of love, meaning and (who knew?) income. COVID unfortunately forced many of us to that conclusion more abruptly than would have been ideal, but the lesson is still real and important.
I’ll look forward to hearing what more you decide to do with your newly reclaimed time,
CD
Much of this post resonated with my own story remarkably closely. The second year of medical school early warning signs, the effect of being sued, effects on family time, the financial education, etc….. I would add in the ever increasing EMR nonsense and regulatory and recertification burdens that ultimately led me to abandon medicine altogether in my early 50’s. Once our portfolio crossed from a few million to more than that, the question of whether to go through the toxic re-certification process (which has since been forced to change a little since it was so stupidly burdensome) was enough to set my exit date. I retired when my board certification ran out with the full support of my spouse.
I do not miss medicine at all. Been there, done that, go the t-shirt. My medical life is a book of memories, – some pleasant, some not – that sits on my shelf while I build new memories and experiences of a life of freedom. It’s pretty sweet. And is only possible because we saved and spent wisely.
Would love to hear more specifics of your story. Congrats on taking control of your life. Just over 10 years into attending life and I feel life energy getting sucked by the day.
Hey Fun2Bfree,
I’m pleased that things have worked out so well for you – being in the financially secure position where leaving medicine on your terms is a valid option provides a position of strength from which to play the hands you are dealt on other fronts (health, family, philanthropy, art, etc.).
I relate to the idea of a career in medicine being one of several versions of yourself you can strive to realize during a short life; I look forward to hearing what t-shirt you plan to pick up next.
-CD
Great post CD! Sounds like you are entering the Vanaprastha stage of your life, and I wish you continued success on your journey!!
CrispyDoc, this is such a life-giving post!
I got canned during this pandemic after nearly 5 years as an over-worked employed psychiatrist. This summer has been the BEST of my adult life, enjoying the time with my family and reassessing priorities. I have since opened a private practice and choose my fees/hours and to some extent referrals of patients. I’ve been thinking about a blog post about being a COVID Casualty. Learning about FIRE and readjusting our financial priorities in the past 2 years really helped soften the blow of the news I was being let go. My wife and I used to get excited about a savings account number approaching $50 or 100K. Wish I’d put it to work sooner but now we have been doing those basic steps and even bought 2 rentals.
Thanks,
ZXM
ZXM,
It’s refreshing to hear how you transformed your situation into one where you were able to frame job loss as an opportunity to take back the narrative and lay a foundation for future financial security.
Loss of control is a bitter pill for control freaks like physicians, but often it turns out to be a matter of your point of view. Now that you own your business and orient it around your life goals, you are in a position to retain control in ways you could not as an employee serving at the pleasure of the C suite.
Combine a physician’s income with an attention to growing your net worth and a priority-driven allocation of your time, and you have suddenly given your life a vector (force + direction) where it’s only a matter of time until you achieve both financial security and the quality of life it enables.
I’ll keep my eyes peeled for that post on being a COVID casualty – sounds like we could all learn from how you overcame this professional obstacle.
Fondly,
CD