By Dr. Disha Spath, WCI Ambassador
I felt so stuck. I had worked hard. While others tailgated at University of Georgia football games, I holed up inside the student learning center with my headphones, piles of books, and a sneer for the loud fans interrupting my reverie on their bathroom breaks. I was determined to make the grade. Then, more of the same in medical school. In residency, my determination was tested by sleep deprivation, and my composure was tested by running cardiac arrests in the wee hours of the morning.
But all of that was for the glorious attending job at the end of the rainbow. I always imagined I would sign with one employer and spend the rest of my days serving my community. But the reality was different, much different. I worked endlessly, working 16-hour back-to-back overnight shifts as the only attending on-call overnight in the hospital. I saw everyone but I didn’t feel seen. I was working so much but didn't feel whole. I sacrificed myself and my family for patients who were often abusive and mean. I was at the height of burnout. I had one job, one employer, one contract, and one large bonus to pay back if I wanted to leave this job early. I felt stuck because I couldn’t afford to leave.
So, I got my act together and bought some finance books. My husband and I devised a plan to buy our freedom by paying down debts and increasing our investing. Once this was done, I had all intentions of cutting back my clinical hours, reducing my income, and spending more time with my babies.
But as I started to cut back, I unexpectedly found the headspace and gumption to look for additional, better-paying work. As I started to think outside the box, I realized that I could devise whatever schedule I wanted on my own terms. I started adding different streams of income with different employers. This allowed me to make the same amount of money by working fewer hours.
Much is written about the value of diversifying income streams. Often these writings focus on adding income streams from non-clinical ventures, such as real estate and side gigs. But as I have practiced medicine for the last decade or so, I have also come to appreciate the value of diversifying income within medicine.
If the COVID pandemic has taught us anything, it is that no employer is infallible . . . even a hospital system. Many of us had to face the reality of decreased income during the pandemic. Many of my colleagues were asked to take pay cuts or saw a decrease in their available shifts to work. That’s why I believe strongly in having a diversity of employers within medicine.
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Cutting Back and Earning the Same
Currently, I work as a primary care physician at 0.75 FTE (which is considered full-time), a per diem hospitalist for a different system, and here at The White Coat Investor. And turns out, I didn’t take a pay cut at all. I still earn what I did when I worked full-time at one employer. Back then, I was a full-time hospitalist at seven days on and seven days off, and I averaged 35-40 hours per week. But now, I work about 32 hours per week, and I don’t work holidays or nights. I have found renewed energy to give to and heal my patients while indulging in a passion project.
The biggest advantages of diversifying active income that I have found are that I am better able to make a schedule that suits my life and my schedule. I get less bogged down in office politics, because I have a diversity of perspectives between different systems. I can make the same amount of money but work fewer hours working per diem, and I can adjust for my family’s needs easily and work more if necessary to save for specific goals (it’s a constant rebalancing act, but I can get my kids on and off the bus two days a week, which is a big win). I’m able to learn new EMRs, which then increases my employability. Most importantly, I can mitigate the risk of not having work by spreading my time out over multiple employers.
The disadvantages of this setup are that the onus of juggling the different requirements and systems now falls on me, so I have to make sure I keep my calendar up to date with all my commitments. Also, there are some headaches between EMR systems that don’t communicate well, and I have to juggle inpatient and outpatient inboxes. Plus, I have double the bureaucratic tasks and training to do for each of the EMRs and system requirements.
More information here:
What to Know About Diversifying Your Income
If you are considering a similar setup, here are a few things to consider:
- Retirement and benefits: Working full-time for one employer provides ease of accounting for retirement contributions, health insurance, and other ancillary benefits. When diversifying income, it’s important to think about how you and your family would be covered if you cut back and how you’d save for retirement. Most employers provide benefits down to a certain FTE, so it’s important to know that cutoff. In my case, most of my insurance comes from my husband’s job, so this was a little less important to me. Still, I only cut down to the FTE where insurance would be covered for my family and me, should I ever need it in the future.
- Per diem work can be W-2 or 1099, depending on the employer’s preference: W-2-employed work will often include malpractice coverage, so that can be a big benefit. 1099 contractor work provides the ability to deduct expenses—such as transportation, gas, and office space—but doesn’t provide benefits such as insurance, CME, and vacation time.
- Malpractice coverage and contract obligations: It is important to make sure that our work is covered everywhere, with tail. Also, many employment contracts prohibit work for others unless approved by leadership. It’s important to keep everyone in the know and to be transparent about other work. It is also important to look at non-compete clauses and make sure other work would not violate an existing contract.
So much of my burnout came from feeling “stuck” and like a cog in a machine that I had no control over. Diversifying my clinical income has helped me overcome burnout and create a better balance in my life while mitigating the risk of job loss. It does come with its headaches, but the pros very much outweigh the cons for me.
I've cut back, but it ended up making me whole.
If you’re a physician who’s feeling burned out, The White Coat Investor and Dr. Dike Drummond can help. With our Burnout Proof MD program, Drummond—who will be featured at WCICON23—can help get you back to the place, mentally and physically, where you can be at your best. End the struggle and remember why you wanted to be a doctor with Burnout Proof MD.
Have you taken on other jobs to diversify your income? Has burnout been a factor for you? What else can you do to make yourself feel whole again? Comment below!