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!
Owe society: as said above, there was no contract (beyond mine with the US Army). But if there WAS any contract, perhaps it was that things would stay about as they were: that I could see a 99213 in 15-20 minutes including documentation and that I wouldn’t be staying an hour or three after patients are gone addressing mountains of paperwork not previously needed to provide decent care (if not still documenting the patient visits in cumbersome EHRs). That doctors would be the richest in the neighborhood, not only if one is a doctor-CEO of a health care company. I didn’t demand the latter- I DID go into FP- but when the pay went up a tiny bit or stayed level but the hours kept climbing- well if anyone broke the contract it wasn’t me.
I consider it almost my duty to retire in this lousy physician economy to increase the demand curve for remaining docs who still need to work. Even my last major locums gigs (in England) practices would gently tell me “we’d hire you more if you were as cheap as Dr John” and I’d say “Clearly Dr John needs the work more than I do! Hate to take bread from his mouth.”
Truthfully if I could work half time- I’d even do 5 half days/week rather than 2-3 full days/week- I’d still be employed. But I don’t want a 60-80 hour a week job, and that’s all that seems to be on offer locally. So I work 3% time, for absolutely free as a volunteer, and hope that if I want or need to resume full time someone will still be willing to hire me. Might dive into locums when the nest empties, or maybe I should start teaching school.
Via email:
My wife quit this year at 60.
Electronic Health records destroyed her face time with
her kids and their parents.
So she shrugged.
The EHR was definitely not in “the contract”. It’s true for my Gen Xers like me, and most definitely for baby boomers.
While I understand that I’m part of the millennial gen (barely) this whole EHR-drove-me-out-of-clinical-medicine trope has always struck me as pretty silly.
My assumptions:
1. You still had to do your charts when they were on paper, people just couldn’t read them half the time. Or you used T-sheets which are basically to maximize charge capture and minimize legal protection.
2. The amount of patient safety created by legible communication at this point has to far outweigh the med errors that came during initial phase of COE.
3. It isn’t like boomers and Gen-Xers don’t use technology. My mom claims that she can barely manage EHR yet spends hours every day on the internet.
4. Paper charting sucked, bad. Especially on those cases that were tricky or where you wanted to spell out your thought process for medico-legal reasons. On EHR it’s like typing an email. When I first started and used paper at one hospital I used to grab a blank progress note and try to write it all out legibly.
5. Are any of us seriously going to make a case that medicine should still be done on paper? We don’t do anything on paper now.
I think there is def a generation gap when it comes to the EMR. Since I”grew up” with one I don’t think it’s a big deal. My notes are done within 2 minutes of the patient leaving the room and thanks to the copy and paste function my documentation is very complete with only a few tweaks needed. But when I look back at paper notes, I see how little documentation was needed and understand what all the complaining is about. I’m glad I didn’t have to transition from one to the other.
The problem with the EMRs is not that paper is better than computer. Of course a legible note is better than illegible writing.
The problem with EMRs is all the extraneous regulation that has been added in to attempt to do things BEYOND the normal physician-patient encounter. The need to put everything in structured data so that the hospitals, insurers, CMS, etc can do data mining is the problem. The idea of collecting this data is not bad, but the reality of collecting it is very bad.
Caring for the patient should be the primary concern. Collecting data should be secondary. Unfortunately, it is reversed. So we spend all our time and mental energy trying to get info into the EMR so the data can be collected, and it leaves us less time and mental energy to care for the patient. Both time and mental energy are limited resources.
And don’t get me started on “note bloat.” I can’t even figure out why the patient went to see their primary care doctor when I try to read her 6 page note that I know was generated in 3 minutes.
I used to create preop and postop orders with one or 2 signatures, a date, and time.
Now, it’s log in to each patient, select “Orders”, Select “Order Sets”, choose the appropriate order sets, customize them, re-check the previously pre-checked orders that become unchecked when you order more than one order set at a time, click to Sign Orders, wait for clunky software, select today’s procedure, as if these orders I’m entering today might instead be for their PT appointment in three months, get a screen full of warnings that come up on every patient and are never read because of alarm fatigue, override the warnings, and sign again.
Paper was so much simpler.
I loved my personalized pre-printed orders. Now I sometimes forget to check a box and the phone calls begin.
As below. The only benefit to EMR I have seen is always being able (IF the patient’s prior care is all in your system- a mighty big if- and if you have functioning computers eg not down or power outage) to find the chart. I HATE getting print outs from ER or specialist EMRs with 20 pages I have to search through for the 2 line dx and recommendation, and maybe I need the 15 line xray or lab result and maybe 5 -15 lines of the specialist’s exam if I can ever find that.
It infuriates me that I get 10 pages of garbage from the ER with info about the IV gauge and fluid. Also what tests were ordered but if I want the results I still have to call medical records.
Wow, what a great post and exactly what I am dealing with right now. Also love that it’s a combined WCI/PoF post, nice perspective from you both.
First, I recommend anyone struggling with this issue to read “Do You Feel You Wasted All That Training?” by Mike McLaughlin M.D., former hand surgeon who left practice pretty early on to go into medical communications and now owns his own medical communications company. His wise and compassionate answers to all of the above questions opened up for me a new way of thinking about my career. Although I am still FT in medicine, I find myself growing unhappier and yearning more for a way out (I am 47, graduated med school 20 yrs ago this year). Funny, the closer that “way out” gets, the harder it is to convince myself to stay in practice!
The first two questions are the ones I struggle with the most. I wanted to be a doctor (specifically a family doc) from age 5 and came from very modest means, I worked my tail off to get into a good college and med school. There was so much sacrifice and self-deprivation along the way that I guess I fear leaving medicine somehow cancels out all my hard work. The fact that I was given an award at college graduation for “the pre-medical applicant most likely to serve the medically underserved” and that that is exactly what I am doing now makes me feel an even greater obligation to continue to “serve.” It really creates a moral dilemma for me, but the more annoying the job becomes (do I really have to do another lame-o CQI project to prove to myself and everyone else that I know how to manage patients?), the less return there is on my investment.
As far as lifestyle design, I did manage to demand three months at home with my firstborn, who arrived a month before med school graduation, and was able to start internship October 1 instead. Of course, I had to make up all that in house call three years later at the end of residency! I also negotiated 4 months of future leave time at my first job and stayed home with my second born for that amount of time seven years later. I have absolutely no regrets about this maternity leave time, I would have quit my job if necessary to get this time at home with my babies.
I have slowly come to understand that my ingrained selflessness is helping no one–not me, since it creates physical exhaustion, unhealthy eating and exercise habits and compassion fatigue; not my kids, who grew up with me not home some evenings and weekends; not the spouse who was home with the kids when I was working odd hours; not the marriage that suffers because I am either tired or in a bad mood or answering the phone on weekends; not the patients who deserve better than an overworked, irritated doctor who is stuck in a crappy system.
I completely agree with PoF on the morality of those increasing the burdens on physicians. What obligation do medical schools that keep raising tuition have to society to ensure that people can afford to go to medical school in the first place? What obligation do EMR companies have to design user friendly EMRs that keep docs from burning out on redundant and inconsequential documentation? What obligation do hospital/medical board executives have to design systems that work well for docs, rather than sitting in board rooms thinking up ways to squeeze more blood from a stone and overburdening us with ridiculous and time-consuming trainings, certifications, meetings, etc?
I have recently been feeling less and less guilt when I think about leaving medicine, I guess I have come to a point where the misery outweighs the fun/value of what I am doing and I have started thinking with a “save yourself” mentality. Reading blog posts from other docs about why they left medicine really helps solidify my thinking on this, I feel better knowing there are colleagues who went through the same emotional process that I did and came to the same conclusion. See “Goodbye to all that paperwork: an orthopedic surgeon leaves practice,” published 7/26/17 on KevinMD and so many other posts just like it!
Thanks WCI and PoF!
Interesting post. I am surprised there is so much (any) consternation about the implications to society from retiring. Unless someone paid for your education (e.g. military), you don’t owe them anything (morally or otherwise) in my view. In residency, you are being paid, yes, but you are also working, so not sure how a sense of obligation arises from that. When anyone productive retires, society is harmed in the short term as the highly skilled people retiring are replaced with young workers who are less skilled. You shouldn’t leave your patients or employers in the lurch if you can avoid it, but I am sure there are many qualified docs who can take your spot. Overall, I wouldn’t let these factors weigh that heavily in a decision to retire.
Ditto. I find it hard to believe that anyone considers this a valid question (i.e., Are physicians morally obligated to continue working–even if they are miserable?)
Lebron can only possibly play 48 minutes.
Loved the article. I went to private medical school and got underpaid for 6 years afterward. No chance I will be dealing with guilt when I retire.
Wow, people actually ask physicians questions like that?
I only had two parents, but it sounds like WCI and POF have hundreds of internet parents out there helping them keep their personal lives on track.
never feel an ounce of guilt retiring early
your health has no guarantees
when you reach FI do as you please as you have F U money
I liked the example of the anesthesiologist training CRNAs to do their job. If I practiced this and taught someone to do my job so I could “supervise” four cases, I would HATE my job too. Supervision is a business and I went to Medical School and not Business School. Fortunately I do not practice general anesthesia and personally evaluate and treat all of my patient’s. What a novel concept.
Guess what? CRNAs, PAs and NPs can’t do what I do – skillset or knowlege; Period!
But we have been driven down a Business pathway to keep up someone’s annuities based on patient visits. First of all, half of outpatient medicine is crap and supported by stupid people who should follow common sense and stop listening to stupid physician advice. Stop the drugs, get off your ass, eat what is healthy and stop doing stupid things. Kindergarten, sheople!
Secondly, imagine if you had the drive now that you had to get into medical school. Actually getting paid to perform rather than just be present. Imagine if it was interesting/enticing/challenging to figure out the simplest/cheapest/fastest/long-lasting way to solve all these silly problems people come to us for help.
Consider chronic low back pain:
“Here, take a pill every day and come back and see me every month because that is the staus quo and that is what is acceptable or expected.” or
“You have chronic LBP like a majority of people. Go for a walk. Stop smoking. Stop all the pills. Eat better. Be thankful you don’t have cancer. Oh, get a flipping job.”
Which one do you want to be?
I love my job and I hate my job also, but you have to take the good with the bad. I am almost at FI which will give me the opportunity to do something different with my life – but this too will probably be some type of work …that will have both good and bad..
Great post and thread. If I might expand on the prestige aspect brought up in several posts, I’d love to offer an alternate perspective. Being on the dating scene in LA and Boston during residency and fellowship, I was loathe to draw attention to my medical training – I wouldn’t want to attract someone who’d be attracted to me for that reason. For online profiles I enjoyed ambiguously listing my profession as “crisis management.”
I’m a dirtbag at heart, so my fellow dirtbag friends and I spent our free time in the outdoors (where prestige does not correspond to income) instead of in clubs and bars (where it does). The pal who drove with me cross-country from residency to fellowship was a spirited Frenchman working as a valet at the Beverly Hills Hotel (he said Schwarzenegger did not tip!). Being a doctor with a lowercase “d” opened me up to friendships outside the medical field, with the expanded horizon such friendships provide.
Perhaps those physicians open to early retirement encompass a subset of us who have less of their identity invested in their profession and more of a desire to realize alternate versions of their potential while they have the time and health to do so. It’s the doctors with the lowercase “d” that I’ve found to be the most fascinating folks in the hospital, with their culinary skills, punk bands, writing groups and other self-designed maps for living off the beaten path.
Sense of identity very well may be a factor between those who retire early and those who don’t even if they could.
I’ll tell you this though, if I need a procedure done on me, I think I’d rather have the Doc with awesome surgical skills than the doc with the awesome culinary skills. Put him in the hospital cafeteria where he can do some good!
Our debt to society includes, same as for anyone else, maintaining a balanced home environment for spouses and children if we have them. What service are we providing to society if we sacrifice our family’s stability for the sake of working out of guilt? Is it preferred to raise a child’s allowance or to spend more time with them by taking less call?
Furthermore, I will go as far as to say that being a workaholic if it comes at the expense of neglecting one’s well being is irresponsible. What good is it to self or society working oneself into the ground? It’s not impressive. It’s irresponsible.
First comment from this long time reader.
A Haiku on the topic –
She told me, “Keep shoveling”
Did it till my hands became shovels
Hurt to scratch my behind
Here’s the thing, even if there was an implicit contract with society that physicians should practice a “full” career upon graduating, that contract was broken by society a long time ago. In no way, shape or form is being a physician the same thing it was when I started medical school in 1992. I would gladly honor that contract if I didn’t have to get any prior authorizations, reimbursement rates were the same as 1992, I didn’t have to clean up after NPs and PAs, and there was no such thing as MOC or EMR.
In my experience there is a certain level of regret or even guilt with leaving the medical profession early or cutting back. I’ve talked to many docs who struggled with this. Although there is some societal pressure, much of the distress comes from within. There is this huge sunk cost to becoming a physician, and it feels wrong walking away from something you put so much time into.
I don’t think physicians “owe it to society” to work a single day unless they signed some sort of contract (like the military paying for it and requiring service). Our mission is to live a happy and meaningful life, and if that includes walking away from a job so be it. There is no moral obligation to work. If physicians are retiring early in droves (they are not – docs actually retire later than the average population) then there is something wrong with the job, not something wrong with the people.
Your comment about a burned out doctor being crummier is definitely right. Just listened to the recent podcast by “Dr. Burnout.”
https://art19.com/shows/sincerely-x/episodes/801e2bb1-2974-4e87-b869-b661ed6c887d
Thanks for sharing!
I found a balance as a general surgeon after 35 years in practice and 2 sabbaticals of 4 months each midcareer. Now I work Tues/Wed/Thur as a surgical assist with office patients 2 half days. I donate time in third world surgical practice overseas with a nonprofit and have no guilt in “retiring” at 72. I have the skills but choose not to have the nights, call and weekends. Other surgeons are happy to get my referrals for office patients who need operative intervention. Each doc needs to find the formula that fills the need to be useful and still be there for patients, colleagues, and family.
This post took some heavy thinking for sure, great job fellas. Crystallizing what we all feel as an amorphous guilt on the topic of early physician retirement isn’t an easy task. The comments alone are a treasure trove!
I thought I would feel guilt if I ever cut back. However, with the sudden departure of my only partner in a 2.5 FTE practice I was solo for close to a year. Now cutting back to lower than when it was 2 of us makes me realize how much better care my patients get and consequentially how much happier I am. I tend to do what makes me happy, not in a hedonistic way.
I am an individualist and fan of Ayn Rand (I’m not an atheist as she was), so what makes me happy is what I strive to make reality. I will never work that hard again, ever. Yes, I’m production based and made a huge chunk of cash but I’d give most of it back to have sanity during that time and not have experienced burnout. It wasn’t worth it, Burnout is like divorce, you don’t have to experience it to know it sucks even though many of your colleagues have, just better off knowing it is not a good option.
In a society that pushes docs to burnout, I feel no remorse for cutting back even to the point of early retirement if it prevents that level of discontent. My hope is that the system will correct itself before we have fewer docs than necessary to maintain our relatively good first-world country health. Maybe as we all cut back/retire early some of us will find the time and energy to solve some of the deep medical system problems.
Also, I believe PoF and WCI have cut back recently and who knows, may totally retire at some point. As a physician I have benefited from the extra time and energy both have, as a result of their blogs. We are all doctors and so have great focus. Like lighthouses, we can illuminate nearly any subject, including personal finance. These 2 cut back on medicine and serve the greater physician good (perhaps not altruistically which I don’t think is possible) and regardless of why, they choose blogging over medicine to some degree. They could be reading a journal rather than late night posting. I know I’m not alone in saying that my patients get better care because my financial house is in order in no small part to the work of docs like PoF and WCI that retire/semi-retire early. So, docs that see less patients can still help patients. But even if they don’t, I’m sure most of them aren’t binge watching and draining society for the X years before they kick the bucket.
Geez, you drop 3 shifts a month and everyone thinks you’re retired. 🙂
Reading all of these interesting, wise comments from other MDs that are in the same situation as me has been like therapy! I’m a primary care doc age 53 who just gave my resignation a few weeks ago to my corporate healthcare employer. I’ve practiced fulltime over 20 years in a corporate medicine outpatient clinic setting, transitioned to 2 EMRs–and despite all the tweaks, they never get more efficient or user-friendly– gone from revenue minus expense to an RVU compensation system, dealt with Press Ganey scores, performance metrics, doctor scorecards comparing me to other doctors in my group, seen insurance prior authorizations get unbelievably time-consuming and complex, worked with severe staffing shortages for over a year, and grown tired of trading call to get my vacation time. Stick a fork in it, I’m done now. I’ve planned for FI for 9 years so I could retire early. Worked my *ss off all these years, first taking on 6 figure student loans (my parents were not rich) so I could go to an elite college for premed, then medical school where I was AOA. Then went to a highly ranked but brutal Internal Medicine Residency. Battled health problems for most of my career, but despite that earned respect and accolades from my colleagues and patients. But it took a large personal toll with all of the time and sacrifice to accomplish this. Now I figure I’m still young enough to have a shot at building a personal life and happiness that has eluded me due to chronic overwork. But instead of feeling joyous and celebratory, I am surprised that initially I felt a sense of personal failure, regret, loss, and guilt. Guilt at giving up a good career that I had invested practically my entire life in, sacrificed so much for. Failure for choosing a career that I feel I cannot perform to normal retirement age. Even a bit of chagrin for fear that everyone will think I’m burned out or something wrong with me. After reading this blog, I feel so much better, and I realize now that I’m not alone in desiring early retirement and that I EARNED it–I DESERVE it. Knowing myself, after I rest for a few months and travel a little, I’ll probably be chomping at the bit to take classes or start a company or some project or something! After all, I’m a workaholic by nature, like most physicians. I will do a little locums work to keep my skills up, maybe a medical mission trip, which is something I always wanted to do but did not have the time or energy for. Thanks to this blog, I can accept my retirement as the happy celebratory milestone that it is, pat myself on the back with pride, and look forward to the next step of my journey, without remorse or guilt.