People who go to medical school are generally very selfless people. So selfless, in fact, that they sometimes feel compelled to work at a job they hate mostly out of feeling too guilty to quit. Here's a good example from a comment on a blog post a few months ago:
I could retire financially, but I look at it differently than the early retirement enthusiasts. [Consider Fortune 500 execs, athletes, and performers.] Why in the world are these people still working? They certainly can retire, RIGHT NOW and not have to work again?
I think the answer, for pro athletes, Fortune 500 CEOs and lots of doctors and other working stiffs is the same.
In a sports metaphor- “they want to leave it all out there”. Do their jobs as hard and as long as they can….It is not ONLY the pay that keeps them on the field, in the corner office or in the OR. The pay is part of it, particularly for doctors. But the drive and ambition that got them that successful practice, big contract or corner office were not just about saving enough to scrape by while doing nothing.
The goal was never to do the minimum amount of work for a lifetime. In a medical analogy, why not save a bit more and then hire someone to stick a tube down your trachea and pump an ambu bag so you are relieved of the work of breathing for the rest of your life? Is indolence a goal?
I plan to retire in my mid 70’s, not because I want to, but because I project that is around the time I will no longer be able to produce at the level required. If that time comes and I am still able, then I have no intention of quitting.
I do NOT like my job, let alone love it, but it is the best job I can get, so I will do it as long as I can. Retiring because you have to is part of life. Retiring because you want to is just laziness.
I was 100% with him, right up until the point where he confessed that despite his financial independence he not only didn't love his job, but he didn't even like it. Financial independence is about doing what you want to do, whether you get paid well for it, paid poorly for it, not paid at all for it, or pay for it yourself.
Today we're going to talk about guilt and our careers and some of the arguments I have seen well-meaning people put forth against early retirement, part-time work, and sabbaticals. I've invited our own Physician on FIRE to assist me in addressing these issues. It's not really a Pro/Con, since we're both pretty much in agreement, but I hope to give you two perspectives on each of these subjects.
Q. Don't Physicians Owe Society For Putting Them Through Medical School?
I hear this a lot from all kinds of docs. I guess the idea is that because the state government paid some portion of your med school tuition and Medicare dollars were used to pay your salary during residency that you cannot retire early. I think people who believe this simply haven't really thought the whole thing through logically.
First of all, the state government didn't pay any of my tuition. The military paid the whole out of state tuition bill. And what did they demand for doing so? They demanded that I be at their beck and call for four years. After residency, I was at their beck and call for four years. Obligation paid. Since your state government contributed an even smaller fraction of the cost of your education then the military contributed to mine, at most you might “owe society” 1-2 years of time practicing to fulfill that “debt.”
More importantly, what are the real inputs to making a doctor and how many of them came from government/society? While there is the cost of tuition, and there is the cost of a resident's salary and benefits, those pale in comparison to the other inputs- the doctor's efforts and the prime years of that doctor's life. The doctor put FAR MORE into her education than society did. So who is really at a loss when a doctor retires early, goes part-time, or has large gaps in her career? The doctor is. So if the doctor is the main one losing out, whose business is that besides the doctor's?
I don't remember all of society waking to round at 0400, staying in the OR until midnight, or pulling all-nighters for exams. That was me!
I suppose the question refers to society “putting me through medical school” as financial support. The same could be said of residency, which is partially funded by Medicare dollars.
As a product of public schools from kindergarten through MS-4, my education has been supported by tax dollars every step of the way, as has the education and training of every single classmate of mine. That investment results in some people who serve the public altruistically for many decades, some who drop out before finishing high school, and every permutation in between.
If the expectation is that everyone who has benefited from public education goes on to do something that benefits society, I feel pretty good about what I've done, even if I only work a dozen years as an anesthesiologist. I've added value and provided a needed service. That is not true of numerous professions, some of which genuinely hurt people and exist largely for personal gain.
I can't say I haven't benefited from personal gain in this career; in fact, I've earned enough to never have to work again if I so choose. I see my career not so much as a contribution to society, but as a transaction with society. I do something useful and am handsomely rewarded. If I did it for free, I would be inclined to call it a contribution.
Speaking of contributions, I will have contributed about $1.8 million in taxes over a 12-year career. If I owed society a return on its investment in me, I've already paid that debt back several times over.
Q. Given the Rarity of Your Knowledge and Talent, Is It Morally Wrong to Not Work As Much As You Can?
This is a bit of a riff off of the previous question. But let's apply it to some other professions. Can you imagine someone asking this to Lebron James? “You're so good, why don't you play in a game every night?” “Why can't you play all 60 minutes?” At a certain point, it becomes nonsensical. Nobody asks this to performers, athletes, executives, janitors, teachers etc, so why would it apply to physicians?
It's a supply and demand issue. If the supply becomes too low or the demand quite high, perhaps changes could be made to make the job more enticing. Instead, we see increasing layers of bureaucracy, frustrating implementation of electronic health records, lengthening and tedious credentialing applications, new metrics and patient satisfaction measurements, etc…
I question the morality of those who increase the burdens of practicing physicians, often to their own benefit, such as those forcing Maintenance of Certification on us while padding their pockets with the proceeds. In a free society, we should be able to work as much as we choose, not as much as we can.
Q. How Could You Take A Med School Spot From Someone Who Would Have Worked A Full Career?
Who hasn't heard this one? But usually, it is applied to an underrepresented minority or a woman who is presumed to have “stolen” a spot from a white male. It gets applied just as easily to those who retire early, go part-time, take time off to raise a kid, etc. Here is my response to that: There was no contract you had to sign when you applied or matriculated to medical school specifying a certain amount of work would be done later. The applicant most likely had no idea how much he would like to work in his 50s, and the school had no idea if this student really “had an interest in rural family practice” as he wrote in his essay. 10 years later, he's an ENT in the capital city. Life changes. Both the school and the student took on that risk when they hooked up for this crazy journey.
Woulda. Coulda. Shoulda.
To be honest, as a college junior applying to medical school, I had no idea what my future would look like. I would not have guessed that I would end up in anesthesia, or that I would find the possibility of retiring early appealing. I didn't pursue this path; early retirement chose me.
If we apply the question more broadly, we need to consider those dozens of students who graduate from medical school in the Bay Area or other places with no intention of pursuing a residency, choosing instead to cash in by joining a tech or biotech startup.
I say more power to them. Medical school acceptance does not imply indentured servitude. If studies were to show that members of a particular gender and ethnicity work, on average, a 15% longer career, should medical schools take only people that fit that demographic? Of course not. Take the best, hope for the best, and understand that for a myriad of reasons, some graduates will not be full time practicing physicians for several decades.
Q. Don't You Owe Your Spouse A Very Nice Lifestyle For Putting Up With You Through Training and Career?
Society isn't the only one you may owe for your education. Maybe your partner busted his butt to get you through with minimal debt. He stayed up all night feeding that kiddo while you were on 36 hour calls. He sacrificed his own career, his own health, and his own dreams so you could be a doctor. Don't you think you owe him a “doctor's lifestyle” for that? My answer? Every relationship is unique. Maybe your spouse would rather have you home for dinner at 5 than some extra money and prestige. Maybe he would rather you actually get to stay for the entire vacation rather than fly home halfway through to work some shifts. Work it out amongst yourselves. Maybe you do owe your spouse something. Make sure he or she gets paid.
I'm trying to give my wife a better lifestyle by working less. The more we talk about our future plans, the less excited she is about having me continue to work.
Currently, I'm on call 20% of the days on the calendar, which means she's effectively single parenting our boys (ages 6 & 8) 20% of her life. Actually, it's more than that, because she'll choose to spend most of the summer at our modest second home, and I'm 500 miles away most of that time. I'll be cutting back to part-time this fall, and our lifestyle will improve quite a bit. It will only get better when I have the same amount of freedom she does, and we can travel the world as a family.
OK. I'll admit I've ignored what the question probably implies when discussing “lifestyle.” The word lifestyle is often equated with spending, and I strongly disagree with that notion. Lifestyle is more about having the freedom to live the life you want to live, and mine involves less work and less stress.
But, since we do talk about money quite a lot on our sites, we're at the point where we could spend $100,000 a year without violating a 4% safe withdrawal rate, but last year, we only spent $62,000. If we wanted more, we would spend more. We're not big shoppers or big spenders, but we do spend on meaningful family experiences, like our recent trip to Paris and Reykjavik
Q. Do You Owe It To Your Patients To Work Full-time? i.e. Is a Part-time/Multiple Sabbatical Doctor a Crummy Doctor?
This is one I've actually seriously worried about as I've cut back on shifts. If I'm going to do something, I want to do it well. If working part-time means I'm a crap doctor, then I'll work full-time until I can't take it anymore or simply want to do something else even more, and then quit. But I think there is some middle ground here.
I'd be pretty hesitant to go part-time in your first five years in practice. But after that? I think you can stay just as competent working 1/2-3/4 time. 1/4 time? I think you probably lose a step, but hopefully not to the point of being dangerous. One benefit of working less is you are less burned out, your compassion meter is much more likely to be at 100% when interacting with patients, and you are much more willing to come in early, stay late, and work hard while you're there knowing you have the day off tomorrow.
In my opinion, a burned-out doctor is crummier than one who has defeated burnout by working part-time (like The Happy Philosopher), or taken an extended sabbatical (like EJ from DadsDollarsDebts). Most physicians who pursue part-time work are doing so to live a more well-rounded life, making more time for family, for travel, or other pursuits that give them a life outside of the exam room.
This is not to say that most full-time physicians are burned out. A recent study has shown symptoms of burnout in more than half of the respondents, but plenty of doctors are perfectly content to work full time or more. However, if you are feeling like you'd rather take a huge pay cut to work less, you might owe it to your patients to not work full-time.
A part-time physician has more time to read journal articles, participate in CME, and engage in non-work related activities to improve the mind, body, and soul. As long as the doctor remains engaged with his or her profession, I would have no hesitation having a part-time physician care for me and my loved ones.
Q. Is It Fair To Your Partners/Employer For You To Be Taking Lots of Maternity/Paternity Leave?
Here's a touchy subject. Everybody knows it is illegal to discriminate against hiring women even though everybody knows that most women who are coming out of residency are going to have a kid or two at some point in the next five years. Now even men are getting in on the paternity leave act.
Here's how I look at it: Medicine is one of many things I do, and certainly not the most important. Sometimes things that are less important have to make way for things that are more important. Groups of physicians need to figure out a way to make sure these important things are taken care of for parents. But just as importantly, they need to make sure that those who remain single and/or childless aren't getting continually hosed by it. You shouldn't have to work every Christmas morning just because you don't have any kids at home.
This is a human resources issue, and I'm not sure “fairness” comes into play. I do believe that the guidelines should be spelled out clearly and that all affected parties should know and understand the policy.
The same is true with any time away from work, whether it's vacation time, medical leave, a sabbatical, decreasing call, you name it. There is X amount of work to be done by N number of people. When N becomes (N – 1) or (N – 2), plans need to be in place to make sure X still gets done. Locum tenens physicians can play a role here.
Resentment and anger are more likely to come into play when clearly delineated policies are not established. Legal issues can arise in larger groups (50+ employees) if policies are not consistent with the Family and Medical Leave Act. The smaller the group, the larger the impact of any kind of time off. When I start working 40% fewer shifts, each of my partners will be working 10% more. Pay will be adjusted accordingly, and everyone is happy. If my colleagues hadn't volunteered to pick up my slack, I wouldn't have pursued the issue further.
What do you think? Do you feel any guilt about working part-time, taking sabbaticals, or retiring early? Why or why not? What (if anything) have you done about it? Comment below!