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Financial success in Family Medicine

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  • Avatar DocNextDoor 
    Participant
    Status: Physician
    Posts: 35
    Joined: 01/27/2018
    Earnest refinancing bonus

    Slow but steady can win this race as I have discovered after 23 years of clinical practice.  From an inflation standpoint my income has minimally changed from my initial starting salary of 115 K until the present time.  Yet I have been able to obtain a Steve Austin net worth, that’s Colonel Steve Austin not Stone Cold Steve Austin for you young folks.  Compound interest is our friend.

    I have had help along the way, but my advice is not much different than others have mentioned.
    1.  Go to a low cost school and get out of debt as quick as possible, and it helps to have parents who had planned and helped pay for their children’s education.
    2.  Marry someone with similar financial goals and if they can work even part-time, their retirement savings can be substantial.
    3.  Maximize all of your retirement vehicles as soon as possible and then add even more into an after tax account, you will need that if you retire young.
    4.  Start saving for your kids’ education when they are born, 529 plans did not exist for mine but a $500 monthly investment for each covered their education and satisfies #1 for their future.
    5.  To succeed with #3 and #4:  Live like a resident, do not by an expensive house, high end cars or join a country club.   The house will be paid off before kids go off to college, expenses will stay controlled and the now enormous pile of marshmallows can be eaten slowly for the rest of your life.

    With investable assets enough to cover my expenses at a <2% withdrawal rate, and hoping future health insurance costs will not surpass 50 K per year, the rip cord will be pulled this year.

    Why not keep working part-time?  Well, I have tried going part-time by reducing from 4 days a week down to 3-1/2 days a week but have found minimal reduction in workload, still 45-50 hours per week.  This has been the curse of building a large patient population after all of these years and has resulted in an avalanche of messages, refill requests, consultant notes to review and an unimaginable variety of forms that will not end unless I am gone.  Hours of time at home and vacation time has been spent managing the never-ending In Basket of EMR.

    My desire to exit the field of medicine and enjoy life to its fullest has been hastened by first-hand knowledge of Time > $.  Having a sibling die in their early 40s from heart disease can be strongly motivating.  It also emphasized the importance of estate planning and asset protection.  Despite the current tax laws there undoubtedly will be future changes in power which may revert estate tax exemptions to their frightening lows, as they were only a decade ago.  His work in a small fruit company in California required a 500 large payment to Uncle Sam, a hard check to write.  So my advice to others would be to watch out for any future estate tax changes and make plans before you die.

    As I have been announcing my impending retirement later this year I have been met with almost universal anger, disdain and dejection by my patient population with the words “you are too young to retire” echoing endlessly through the halls.  This is a somewhat disappointing end to a career as the congratulatory statements are few and far between, making that last day not soon enough.  I look forward to moving on to the rest of my life and will look back fondly on the lives I have helped through it all and hope for the best for this next generation of doctors.

    Hank Hank 
    Moderator
    Status: Attorney
    Posts: 1225
    Joined: 03/27/2017

    Are you selling your private practice or retiring from a W-2 job? If you’re selling a practice, use the next year to introduce patients to the great new doc you picked to take over the practice.

    It’s a shame that people are angry instead of happy for you.

    #99858 Reply
    jfoxcpacfp jfoxcpacfp 
    Moderator
    Status: Financial Advisor, Accountant, Small Business Owner
    Posts: 7509
    Joined: 01/09/2016

    Thank you for posting your experience. Like @hank, I am sorry you are not hearing more congratulations and less disappointment from the patients you have served but I would interpret that as a panicky reaction to losing a professional relationship that they highly value and find irreplaceable rather than a personal attack. Your patients are viewing this (selfishly) as their loss (which we humans are prone to) instead of your gain. I bet they will come around after they adjust to the idea.

    Best wishes on the next chapter of your life and congratulations on living in such as way as to be able to accomplish this while you can still enjoy life to the fullest.

    Johanna Fox Turner, CPA, CFP, Fox Wealth Mgmt & Fox CPAs ~ 270-247-0555
    https://fox-cpas.com/for-doctors-only/

    #99880 Reply
    Liked by adventure
    ENT Doc ENT Doc 
    Participant
    Status: Physician
    Posts: 3159
    Joined: 01/14/2017

    Slow but steady can win this race as I have discovered after 23 years of clinical practice.  From an inflation standpoint my income has minimally changed from my initial starting salary of 115 K until the present time.  Yet I have been able to obtain a Steve Austin net worth, that’s Colonel Steve Austin not Stone Cold Steve Austin for you young folks.  Compound interest is our friend.

    I have had help along the way, but my advice is not much different than others have mentioned.
    1.  Go to a low cost school and get out of debt as quick as possible, and it helps to have parents who had planned and helped pay for their children’s education.
    2.  Marry someone with similar financial goals and if they can work even part-time, their retirement savings can be substantial.
    3.  Maximize all of your retirement vehicles as soon as possible and then add even more into an after tax account, you will need that if you retire young.
    4.  Start saving for your kids’ education when they are born, 529 plans did not exist for mine but a $500 monthly investment for each covered their education and satisfies #1 for their future.
    5.  To succeed with #3 and #4:  Live like a resident, do not by an expensive house, high end cars or join a country club.   The house will be paid off before kids go off to college, expenses will stay controlled and the now enormous pile of marshmallows can be eaten slowly for the rest of your life.

    With investable assets enough to cover my expenses at a <2% withdrawal rate, and hoping future health insurance costs will not surpass 50 K per year, the rip cord will be pulled this year.

    Why not keep working part-time?  Well, I have tried going part-time by reducing from 4 days a week down to 3-1/2 days a week but have found minimal reduction in workload, still 45-50 hours per week.  This has been the curse of building a large patient population after all of these years and has resulted in an avalanche of messages, refill requests, consultant notes to review and an unimaginable variety of forms that will not end unless I am gone.  Hours of time at home and vacation time has been spent managing the never-ending In Basket of EMR.

    My desire to exit the field of medicine and enjoy life to its fullest has been hastened by first-hand knowledge of Time > $.  Having a sibling die in their early 40s from heart disease can be strongly motivating.  It also emphasized the importance of estate planning and asset protection.  Despite the current tax laws there undoubtedly will be future changes in power which may revert estate tax exemptions to their frightening lows, as they were only a decade ago.  His work in a small fruit company in California required a 500 large payment to Uncle Sam, a hard check to write.  So my advice to others would be to watch out for any future estate tax changes and make plans before you die.

    As I have been announcing my impending retirement later this year I have been met with almost universal anger, disdain and dejection by my patient population with the words “you are too young to retire” echoing endlessly through the halls.  This is a somewhat disappointing end to a career as the congratulatory statements are few and far between, making that last day not soon enough.  I look forward to moving on to the rest of my life and will look back fondly on the lives I have helped through it all and hope for the best for this next generation of doctors.

    Click to expand…

    Don’t be dismayed by people being upset.  People like what they know and don’t want to see a good thing go away.  People also don’t like to work and venture into the unknown – finding a new doctor, finding a new job, etc.  Another reason it’s hard to cut down to part time (particularly as a solo practitioner or smaller number of providers) is that you have a lot of fixed costs to cover.  You are essentially working 1/2 the week to pay for the practice functioning, 1/4 of the remainder for Uncle Sam, and the rest for you.  Part time isn’t as easy in private practice.  Your advice is great though.  Best of luck to you!

    #99881 Reply
    Liked by Vagabond MD
    Avatar SValleyMD 
    Participant
    Status: Physician
    Posts: 413
    Joined: 05/12/2016

    Great post. Congrats. I’m sure you’ve done your part making this a better world. Enjoy retirement!

    #99883 Reply
    Rando Rando 
    Participant
    Status: Physician
    Posts: 202
    Joined: 01/08/2016

    Great post.  I would add that in my case it helps to work in a LCOL area where primary care is relatively well reimbursed and accepted.

    #99889 Reply
    Liked by jz, hatton1
    q-school q-school 
    Participant
    Status: Physician
    Posts: 2359
    Joined: 05/07/2017

    Give people a little time to adjust to the news.  I’m sure it came out of the blue from many of them.  Congratulations will come the next time they see you.

    In the meantime, congrats from the rest of us.  Well done

     

    #99898 Reply
    Avatar beagler 
    Participant
    Status: Physician
    Posts: 246
    Joined: 07/08/2017

    Have you considered concierge medicine? For the uninitiated, basically patients pay a yearly retainer of about $1500.

    You could work substantially less for similar pay. Your large loyal patient base is your asset. It is the one advantage we in primary care have over specialists. It can essentially be monitized and used to reduce your workload to at most 10 patients per day. It ensures you would have enough converts unless they’re mostly under 50 or on Medicaid.

    Being FI means if it doesn’t work out you can just quit. If it does work out you might actually enjoy working longer. There are a number of concierge companies that handle all the transitions with you.

    Solo Internist, Midwest

    #100001 Reply
    Avatar LIFO 
    Participant
    Status: Physician
    Posts: 128
    Joined: 01/27/2018

    Congratulations!  If you don’t mind sharing what were your primary investment vehicles?  Indexes, mutual funds, stock picking, real estate?  Have you calculated your ROI of your savings?

    #99884 Reply
    Avatar DocNextDoor 
    Participant
    Status: Physician
    Posts: 35
    Joined: 01/27/2018

    Thanks for the congrats.  I know its hitting hard for my patients, like I’m telling them I want a divorce. They will get over it I’m sure.  Many have said they chose me years ago to have a young doctor that would be around longer than they would.  Had they known I would plan on retiring in my early 50’s they would have still come to see me.

    For the first time I looked up the cost of living for where I live and its just above the national average. I’ve been at the same W2 job from the start and a replacement will be hired, although the demand for FPs looks to be strong and may take a while.  Shocking to read about early retirees from the Megacorps giving a month notice, worried they will be shown the door if they announce their intentions.

    Been asked by patients and spouse if I want to start a concierge clinic, there are several in town, and I have considered but don’t plan on pursuing that route. Maybe I’ll try out telemed as others have mentioned, or with the high demand for FP I could easily find an hourly gig without all the baggage.

    I think Black Monday occurring during college Econ class may have set the tone for my future. My investments initially were all self directed into low cost index funds, dollar cost average and then buy even more when low and never sell. After crossing 1M, at what age I can’t remember (amazing such a milestone is now just a blip on a long ago spreadsheet) I decided to go with —don’t ban me— a financial advisor.  It has served my purpose well with 60/30/10 equity, fixed and alternative. My bank account and paychecks amount to rounding errors at this point.

    #100032 Reply
    ReFinDoc ReFinDoc 
    Participant
    Status: Physician
    Posts: 143
    Joined: 01/09/2016

    Find a side gig that you can tolerate and always wanted to do. There are gobs of part time Primary care jobs of out there.  Maybe combine Travel with work.  Earned income with the ability to deduct health insurance premiums, travel for CME etc. can be very useful. Don’t give up your license…the ability to return to work is a powerful financial tool. Allowing your retirement  plans to compound is another powerful tool.

    I worried about my patients when I left, too. Gonna happen sooner or later. They didn’t need a burned out, grouchy doc. Let the young whippersnappers with high debt take over.

    #100056 Reply
    Liked by hatton1, Hank
    Avatar StarTrekDoc 
    Participant
    Status: Physician
    Posts: 1799
    Joined: 01/15/2017

    Congrats to setting the date!   We’re on the same slow-steady plot line — just a few years behind (19 years out of residency).   Since we’re in a HCOL situation, that retirement line probably is a few more years than yours for that additional buffer and fun spending splurges.

    Patients hopefully will progress through their 5 steps and say the appropriate good-byes next visit — glad you’re giving appropriate notice vs the 1month –  ‘thank you for all the fish’ wave good bye.

    This is the challenge of cutting down in time/vacation with Primary Care — the inbox never stops.  Attrition is low in a mature panel and hard to reduce time without actively culling the panel.   This is what I’ve been trying to manage on some of our part timers in finding the right balance for them and shifting over panel population to younger open paneled docs — it’s harder than said since patients (even healthy ones) get very attached to their PCP — a testament in itself right?!? 🙂

     

    #100070 Reply
    Miss Bonnie MD Miss Bonnie MD 
    Participant
    Status: Physician
    Posts: 497
    Joined: 02/14/2017

    Congrats! Love hearing the “success” stories!

    "Being rich is having money; being wealthy is having time."

    Miss Bonnie MD --> Wealthy Mom MD @ http://wealthymommd.com

    #100091 Reply
    Liked by hatton1
    PhysicianOnFIRE PhysicianOnFIRE 
    Moderator
    Status: Physician
    Posts: 1516
    Joined: 01/08/2016

    Thanks for the congrats.  I know its hitting hard for my patients, like I’m telling them I want a divorce. They will get over it I’m sure.  Many have said they chose me years ago to have a young doctor that would be around longer than they would.  Had they known I would plan on retiring in my early 50’s they would have still come to see me.

    For the first time I looked up the cost of living for where I live and its just above the national average. I’ve been at the same W2 job from the start and a replacement will be hired, although the demand for FPs looks to be strong and may take a while.  Shocking to read about early retirees from the Megacorps giving a month notice, worried they will be shown the door if they announce their intentions.

    Been asked by patients and spouse if I want to start a concierge clinic, there are several in town, and I have considered but don’t plan on pursuing that route. Maybe I’ll try out telemed as others have mentioned, or with the high demand for FP I could easily find an hourly gig without all the baggage.

    I think Black Monday occurring during college Econ class may have set the tone for my future. My investments initially were all self directed into low cost index funds, dollar cost average and then buy even more when low and never sell. After crossing 1M, at what age I can’t remember (amazing such a milestone is now just a blip on a long ago spreadsheet) I decided to go with —don’t ban me— a financial advisor.  It has served my purpose well with 60/30/10 equity, fixed and alternative. My bank account and paychecks amount to rounding errors at this point.

    Click to expand…

    Thank you @docnextdoor for sharing more of your story with me — the scorn from your patients and the first person to comment below the article has made your guest post (published this morning) one of the more popular and controversial posts I’ve published in a while.

    Physician Retires Early and is Met With Scorn

    40-something anesthesiologist and personal finance blogger @ https://physicianonfire.com [Part of the WCI Network] Find me on Twitter: @physicianonfire

    FIRE. Financial Independence. Retire Early.

    #175575 Reply
    Avatar bean1970 
    Participant
    Status: Physician
    Posts: 479
    Joined: 07/12/2017

    Thanks for the congrats.  I know its hitting hard for my patients, like I’m telling them I want a divorce. They will get over it I’m sure.  Many have said they chose me years ago to have a young doctor that would be around longer than they would.  Had they known I would plan on retiring in my early 50’s they would have still come to see me.

    For the first time I looked up the cost of living for where I live and its just above the national average. I’ve been at the same W2 job from the start and a replacement will be hired, although the demand for FPs looks to be strong and may take a while.  Shocking to read about early retirees from the Megacorps giving a month notice, worried they will be shown the door if they announce their intentions.

    Been asked by patients and spouse if I want to start a concierge clinic, there are several in town, and I have considered but don’t plan on pursuing that route. Maybe I’ll try out telemed as others have mentioned, or with the high demand for FP I could easily find an hourly gig without all the baggage.

    I think Black Monday occurring during college Econ class may have set the tone for my future. My investments initially were all self directed into low cost index funds, dollar cost average and then buy even more when low and never sell. After crossing 1M, at what age I can’t remember (amazing such a milestone is now just a blip on a long ago spreadsheet) I decided to go with —don’t ban me— a financial advisor.  It has served my purpose well with 60/30/10 equity, fixed and alternative. My bank account and paychecks amount to rounding errors at this point.

    Click to expand…

    Thank you @docnextdoor for sharing more of your story with me — the scorn from your patients and the first person to comment below the article has made your guest post (published this morning) one of the more popular and controversial posts I’ve published in a while.

    Physician Retires Early and is Met With Scorn

    Click to expand…

    I’ve been thinking about that guy’s comments all day. “you took someone else’s place”……does he not realize that 50% or more of medical schools are now female. Many will never work full time. Many leave medicine totally to tend to family needs (and more males are doing this as well!, kudos to the SAH doc dads!).  would “that place” be better filled by a male who will never take one, two, three, four or more  1-3 month (or longer) maternity leaves???  I think he is out of touch with what the work force in medicine really looks like in 2018.

    i was confused on the negativity from the patients. Is a physician never allowed to move? Can we not move from Nevada to New hampshire after 25 years in practice to be near a dying parent? Do they not realize we are people too?   Moving and retiring would have the same result for these patients. Am I missing something?

    Congrats to @docnextdoor! thanks for sharing.

    #175583 Reply

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