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.
More information here:
Going from Broke to Financially Fit in Just 5 Years
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:
Women and Money: Myths That Hold Us Back
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!
I am so tired of these articles. I don’t know if it just to try to sell the affiliate link for the burnout course or whatever it is, but I feel like I see these articles every other week and it is the same thing over and over again.
If you are burnt out the solution is: Save more money and retire early, get rid of the parts of your practice that you hate and focus on what you love, or cut down to part time. Really not that complicated.
Please ease up with these unhelpful burnout articles that probably only relevant to <0.05% of your readers
Thanks for the feedback. It’s always helpful even if we, like you, prefer to get our negative feedback privately.
Seems unlikely that only 0.05% are benefitting given that surveys of docs show burnout ranges from 40-60%. Getting your financial ducks in a row absolutely does help burnout, but it’s a longer term solution. Lots of docs can benefit from techniques that work a lot faster.
At any rate, I do think it’s kind of funny that you think the article was written just for the affiliate link, given the article was written by someone who doesn’t benefit from that link nor knew it would be in the article. Content and monetization have less overlap than it may appear at times. I bet we only have about 5 articles a year that are written primarily for a monetization purpose and they’re mostly written by me. Think articles about a new online course or WCICON for examples. The rest we thought was valuable content on its own merits.
Best solution to burnout is to start a website or blog that pays more than your clinical income. Either that or market to doctors with a burnout seminar. 🙂
I enjoy the content on whitecoatinvestor, but for me the true lesson of Jim’s story is that success doesn’t come primarily from investing skill (after all, he bought international and small cap value that hasn’t done well this past decade) but from increased income, either by starting a business or improving your clinical income. If you want to have the financial “good life” of a nice boat, above average house, less hours, etc. once you’ve met a basic level of financial literacy (which sounds like many residents and physicians lack hence the success of this website) improving income is the key item.
Greg, I too admire Jim for the business he has created but I can attest to the fact that most side gigs don’t bring in significant income for many years and even when they do, more money does not equal happiness. Success does not equal happiness. Does it make it easier to buy the finer things or keep a room over your head? Sure. But I disagree- money is not the key to happiness or the way out of burnout.
Disha
If someone is making $400k / year easier to go 50% time and that should help burnout quiet a bit. Harder to do if someone is making $200k / year to cut back to 50% time. While $100k / year is still a higher than average US salary, there will be bigger cutbacks in lifestyle than someone going from $400k to $200k even though the actual dollar amount lost is larger.
Hopefully the PCP at $200k likes their job but if they were paid more easier to trade off income for lifestyle when you have a higher base to start. It would be great if there are still PCPs around in 20-30 years when I might need their services myself, rather than only ones who do it are those with a high income spouse or family money.
While what you say is true, the difference isn’t as big as one might think due to the progressive nature of the tax code. You don’t lose 50% of your net income when you lose 50% of your gross income. At the highest tax levels (including state), you lose only 1/4 of your net income when you lose 50% of gross. New attendings are always amazed when they see how much of their money is going to taxes, but that process works in reverse too. A married couple with two kids and one income may not even pay federal income taxes at all on a gross of $50-60K. I had one year in the military when I paid less than 5% of my income in federal income taxes…on a six figure income.
Ding ding ding.
No doubt the secret to wealth is:
Make a lot of money
Don’t spent a lot of money
Make your money work as hard as you do (investing)
Don’t lose your money (risk management, insurance etc)
But it’s not JUST income. Lots of doctors make good money but spend it all. But you’re right that focusing on the big things makes a big difference. Big things are income, savings rate, stock:bond ratios etc.
I don’t think the message should be that docs can only get rich by starting a successful blog. That’s a terrible message. # 1 This is not a particularly replicable method and # 2 We were rich already before WCI started making money.
Hi Jamal,
I would hazard to guess you didn’t read the article in its entirety since you seem to have missed the main point of the article in your summary of solutions to burnout. I am offering an additional solution to the burnout problem- diversifying income, not necessarily cutting back as a whole. Also, as Jim mentioned, I had no idea there would be affiliate links in this article, although I am not unhappy about it as burnout IS a problem that is affecting our profession and I value people that are out there expending their life energy to create and offer solutions. I’m sorry you found my story so offensive but I’d encourage you to further explore why you feel so triggered by this topic.
Disha
I was triggered by the topic because it is repetitive and has been addressed many times before.
I am triggered because I look at this blog as one of the most resourceful financial blogs out there and trust Jim to put out the best and relevant information, but articles like this don’t fit that criteria.
Maybe my expectations are too high. I am used to so many great blog posts on this site full of information and I learn a lot from them, but then ones like this disappoint. I guess they can’t all be winners. Kind of like being a die hard fan for a certain sports team and then getting annoyed and angered when they lose.
But to answer your question, I was triggered because its a redundant topic and I guess my expectations are too high (which I mean as a compliment to this blog because I like it so much).
Hi Jamal,
As the WCI content director, I’m the one who assigns and edits posts like these. This is a financial blog, yes. But it’s also a blog about the lives of doctors, including those who are suffering from burnout (which, by the way, relates directly to their finances) and how they prevent that. We will continue to publish posts like this, so that a diverse group of writers who are in different parts of their lives and careers can put out information that will benefit a diverse group of readers who are in different parts of their lives and careers. Jim puts out all kinds of great, relevant information. But he’s not the only one who does so on the blog and he’s not the only one who will do so in the future.
You wrote that you “trust Jim to put out the best and relevant information, but articles like this don’t fit that criteria.” I guarantee you somebody read this today and found it completely relevant for their own criteria. I guarantee you somebody read this and related directly to what Disha was writing about it. I guarantee that this column helped somebody out there.
Personally, I think this is one of the best columns Disha has ever written. To me, this one was a clear winner.
I’m glad you like this site so much. We will keep pumping out high-quality content every day. You can always feel free to comment, but that doesn’t mean we’re going to stop publishing these kinds of columns. We’re a financial site, but we’re also so much more.
Thank you, Jamal, for your honest comment.
Contrary to what the WCI staff will probably say, it is not negative or hateful. It is just an opinion. I happen to agree with you and with your comment. At least this post was better than the one where she divorced her husband to save money.
I’m sure I will get blasted by the WCI staff and labeled again as a hater, but I do think there is a kernel of truth in some of the comments that are considered “negative”.
You can’t be “thin-skinned” or “defensive” when someone disagrees with you. Again, just because someone disagrees does not mean they are “negative” and should banned forever from the hallowed blog of the WCI.
Have a great day!
I’ll bet people would be a little less critical if they had to put their name and picture on their comments like the blog authors do. We’re still waiting on that guest post from Bev. 🙂
I liked this article and the divorce article a lot. Different authors though Bev…
https://www.whitecoatinvestor.com/i-got-divorced-to-save-money/
Haha, I won’t label you if you won’t label me. Just stopping by here to say I’m the founder of The Frugal Physician and am still happily married on most days. The divorce article was by a different brave author who dared share her story. Your comments are always appreciated. I can see the point about burnout articles being annoying because it labels a symptom rather than the cause of the problem (which is usually not the physicians). This is the presentation of a solution other than yoga, meditation, and self-healing. Take it or leave it.
Read what you like, and skip what you don’t. Burn out is almost as big a risk for our finances as divorce. Personally, I am tired of all the real estate articles, but as soon as I see something that is about real estate, or since I am not at that stage of my career anymore, student loans, I just skip that day’s article. I don’t even need this article, since I am retired. But I find it of interest sometimes, and sometimes, in my opinion anyway, think I have something valuable to contribute in the comments.
Thank you for stopping by and commenting, Jenn. It is much appreciated.
Disha
The content is variable here, and like Jenn, I skip the articles that don’t apply to me (student loans, military medicine, resident articles) unless I have something to contribute in the comments.
This article reminded me of my own struggle as an employed physician. Having all of your eggs in one basket is a bad idea. It was 1994 to 2001 and it was my first attending job. I learned I was at the whim of the employer and the economy due to recessions (>one per decade) with cuts despite dutiful service and excessive work.
It happened again in 2011 during those financial crisis years, so my guess is that many employee physicians will get a taste of it in 2022-2023.
The key point of the article is not burnout. It is about diversifying your income within medicine, and not with a blog. That is a pipe dream for most potential bloggers. WCI level success is about as rare as Michael Jordan basketball skills.
In about 2011 after getting my second large recession related pay cut, I’d had enough. I quit the job after they stopped paying for weekends (a 10% income loss of about 20K a year). I changed from inpatient/outpatient to outpatient only, and sold those weekends to someone else. Thus began the side gig that diversified my income within medicine.
This clinical weekend side gig came with malpractice (with a tail) and higher weekend wages. It stoked my kids college funds, paid for many family vacations, and sped up my retirement plans with a maxed out SEP-IRA every year. I was working the same hours but making an additional $80K a year. The side gig eventually brought in an additional $150K a year since 2016. I worked ten Thanksgiving weekends in a row, but was frequently done by 1pm or in 5-6 hours a day.
This diversification within medicine optimized my income to the top few percent in Psychiatry. Was I happier? Yes, because it sped up my retirement plans and I doubled my nest egg from 2017 to 2021. Was I less burned out? Yes, because we took great vacations, I could choose my own weekends, and was paid an excellent premium for this work, at times making double or even triple the regular wage in Psychiatry. More money simply makes paying for things easier. What things you buy…well that’s up to you.
So, by all means invest well. But also diversify your income within medicine and use leverage (making the most with the least time) to get to the finish line, wherever that is for you. As WCI said, monetizing a blog that will make >100K a year is no easy task. I didn’t have that skill set but could knock out some triple pay holiday (6 hour per day) weekends.
Thank you for your insightful comment! Unfortunately, I know many doctors that are getting a taste of what you and I have been through due to pay and staffing cuts during the pandemic. It pays to know your own worth and make a better future for yourself by diversifying within medicine.
Not everybody has the luxury of doing all the things to avoid burnout that were discussed in the article. One simple thing that I have done is focus on why I went to medicine and what I enjoy the most, which is patient care. Giving up all non-patient care responsibilities was the absolute best thing I did for my mental well being.
That means that I don’t have a single location where I am a Medical Director which causes me to move around quite a bit, but that brings its own joy.
I don’t see the same people all the time, and I have found that in this field familiarity does breed contempt. Now it’s more like, “hi doc, haven’t seen you in a while” and that is a lot more pleasant than “oh no, not this pain in the butt again”.
Anyway, find whatever works for you because if you are like most of us, you went into medicine because that is where you fit best. And probably where you will do best financially.
Kudos to you for having the courage to cut out the pain points. Thank you for your comment.
I rarely comment!
For the comment on “repetitive nature of the article”- You probably don’t drive or drive the car with a vision that shows you just the road and nothing but the road. Do you see billboards full of smartphone ads while driving? Everyone knows famous smartphone makers and everyone knows they have a new model every 1 to 1.5 years. Why do they launch new phones with a bang bigger than the big bang?
1) Keep in mind- “burn out” is not only for the physicians; it happens to every one, including the one who does not have a paying job. If you doubt, ask a few home makers and you will be surprised.
2) What if a “burnt out” person found the blog for the first time? The article might just serve as an “eye opener”. The person may not look through what was written six months ago.
3) Some of the take home points might be repetitive. However, a different writing style might make some readers to understand it better and some to get bored. That is nothing but appropriate.
FYI, I read the blog once a day. I have been reading it since Jim wrote his first blog post on the web. It takes me less than 15 seconds a day (mostly less than that) to figure out what I want to read. If its not relevant to me or does not appeal to me, my day has additional two to three minutes. Why 15 seconds? Because I have read, understood, and applied the science already; I am just looking for tweaks, if any.
Last but not the least- I do backdoor Roth IRA every year on January 1 and I read the blog on it every year before I start the process. Call me forgetful…….it has saved me and my tax person for filing incorrectly on at least two occasions since 2011.
Cheers.
Thank you for your comment, Vish. I absolutely reference the step-by-step guide by Jim and POF every year when I do my back-door Roth contributions. Some articles are evergreen. Others are different perspectives on the same problem.
It is only natural to see that various folks have various strokes for addressing the vexing problem of burnout.
Reading Cobra’s reply, I realized that in an alternate approach, retaining my medical directorship has been critical for my avoiding burnout. I have done it for over 10 years. Common sources of physician burnout include the lack of control over one’s work and a persistent top-down administration culture. Having the directorship has allowed me to counter these and to make decisions that will be in line with what I or my colleagues are seeking for a good work experience. While admin has profits and numbers in mind (I empathize), our proposals attached to “patient safety” or “sustained business model” or “patients-family centered care” invariably get their attention and tilt decisions in our favor.
How you link your work flexibility and control over your schedule with these “sacred concepts”, of course, is where the art/politics of medical directorship lives. For instance, colleagues with younger families wanted to work through the noon hour so they can leave early at 3 pm to be with their young ones. But admin did not want to pay MA/RN to support 2 MDs over the noon hour. Yet when offering this flexibility for our patients over the noon hour is raised as pivotal for PFCC, patient safety (no delay in care) and sustaining the business model, then 100% support from admin followed. Similar reasoning was applied to counter overbooking slots or shortening duration of slots. “They are not good for patients!”
Being part of the decision-making process and having a reasonable control over one’s work life goes a long way to minimize burnout.
I love this counterpoint. This goes back to Cobra’s comment that the way out of burnout is finding where we fit best. We so badly need people that can speak “admin” to advocate for us. Thank you for the work you are doing. I’m sure it’s appreciated by those that work with you.
We are all trying to find our way in this world. What matters to you when you are 50 may not matter when you are 60. Prepare for that. Be prepared to change your views. Every once in a while when reading an article like this I get an “epiphany” , an insight into the world I didn’t see before.
Being Primary Care; my superpower is the ability to tolerate ambiguity.
Thanks for writing this article, Dr. Spath. I totally agree that having more than one source of income is so important for physicians. Also, I’ve written a post for WCI in the past and got some negative comments, so kudos to you for being “in the arena.” Keep it up:)