[Editor's Note: This is a post by Physician on FIRE, a WCI Network partner blogger. The original post ran here. This is a great post as it discusses the dramatic difference ongoing earned income can make financially even after reaching financial independence.]
In the Tale of 4 Physicians, we analyzed the impact of different spending budgets on wealth creation. Each of our 4 physicians was married with 2 kids and had a household income of $300,000.
I’d like to revisit one of these physicians, crunch some more numbers, and learn what might happen to her nest egg if she were to continue working by choice after achieving financial independence (FI).
The Budget of a Frugal Physician
Dr. Anderson was the most frugal of our 4 physicians. Dr. A had household spending of $80,000 a year. She had a net savings rate of 64% and was on track to be FI in about 10 years, give or take a year. Let’s have another look at her numbers.
Hitting Financial Independence
OK, fast forward 11 years. Dr. Anderson has stayed the course, her index funds have given her market returns, which haven’t been stellar, but have outpaced inflation by 4%. She’s got a nest egg with the purchasing power of about $2 million in today’s dollars (she’s got closer to $2.5 million but inflation has eroded the purchasing power).
She doesn’t love every aspect of her workday, but finds fulfillment in providing care to her patients. She knows that she could retire today, and likely have enough money to support her and her family indefinitely with a 4% withdrawal rate.
But there are many uncertainties. She won’t be eligible for Medicare for more than 20 years and she has no idea how our health care system might change in the meantime. She and her husband may live another 50 years or more. From her reading, she knows that the 4% withdrawal rate was considered safe for a 30-year retirement. She recently read an article that convinced her that 3% might be safer.
She can’t imagine retiring in her early forties after all the sacrifices she has made to practice medicine, which she still feels is her calling. She is not ready to hang up the stethoscope and she wonders how her financial picture might change if she chooses to work another 5 or 10 years.
Running The Numbers
Allow me to channel my inner mathlete and work some numbers for Dr. A. To keep things simple, we’ll use real (inflation-adjusted) returns, rather than nominal returns. That will keep us looking at dollar amounts in terms of their purchasing power today.
We’ll also assume that she’ll maintain a budget equal to $80,000, even after the mortgage is paid off and the 529s are fully funded. Perhaps she’ll use that money to travel more or for charitable causes.
We’ll look at her future nest egg balance if she were to
- retire now
- retire in 5 years
- retire in 10 years
- retire in 20 years
and consider the following real rates of return:
- 0%,
- 2%
- 4%
- 6%
Retiring Now
What if Dr. Anderson retired right now?
If Dr. A retires now and maintains her current level of spending, the equivalent of $80,000 today, she’s got a good shot at making her money last. If she earns 4% real, her nest egg will remain steady. A better return will allow her nest egg to slowly grow while she lives out a long, comfortable retirement.
If her baseline spending exceeds her returns, she will watch that nest egg shrink over time. If it only keeps up with inflation, a 0% real return, she will run out of money in 25 years. Doh!
Can Dr. A avoid catastrophe in the case of a long-term sluggish market? Sure. She should expect to have a social security check coming her way eventually, having contributed the max for 11 years. She’ll be able to cut back on expenses in lean years, more easily after the mortgage debt is gone.
What are the odds of 25 years of 0% real return? If she has a diversified portfolio, I would say it’s quite slim. Even the best case scenario offered, a 6% real return, is below what the stock market has given in the modern era.
Retiring in 5 Years
What if Dr. A decides to continue working and retire in 5 years?
Dang! Even in the worst given scenario, she’s doing alright. The odds of running out of money have been minimized. In the best case scenario, with a 6% real return, she’s sitting on a massive 8-figure portfolio 25 years after her retirement, 30 years after she attained FI. That’s more than double what she might have had given the same 6% rate of return had she retired 5 years earlier.
Retiring in 10 Years
What if Dr. A worked another 10 years beyond attaining FI?
At the 10 year mark from her original FI / potential retirement date, she’s got darn near triple what she would have had if she had quit back then. She can expect to be a millionaire the rest of her life, and she can now focus her energies on how to best utilize her oversized nest egg. She is accustomed to a comfortable, but not outlandish lifestyle. But she can easily upgrade from the Ramada to Ritz Carlton without concern. She’s in great shape.
Working A Full Career
What if she doesn’t retire early?
Holy Schnikes!
Time to contact the alma mater and look into getting your name on a building or two. The Anderson Center for Financial Awesomeness sounds about right. By spending more than most Americans, but less than most physician colleagues, Dr. Anderson can expect to have 20 million dollars or more in her early 70s, after retiring in her early 60s. Simply amazing!
The Take Home Message
I think a dozen people could look at the data and come up with 13 opinions. Some will wonder why she didn’t retire a year ago, since she’s got a decent shot at making retirement last under the circumstances. Others will pick their jaw up off the floor after seeing a potential net worth north of 20 million and wonder why anyone in their right mind wouldn’t strive for that.
Personally, I expect to be in Dr. A’s position in a year or two. Looking at the numbers, another five years or more seems totally worthwhile. Unless I’m experiencing total burnout, I will gladly continue practicing medicine to better ensure a comfortable future where the likelihood of retirement failure and regret all but disappear.
Would I consider another 20 years? I’ll Never Say Never, but the likelihood is pretty darned low. An absurd net worth is quite possible, but I don’t know what I would do with all that money (besides pay a boatload in taxes).
*Accounting for inflation can be complex and I’m striving for simplicity here. For example, a 4% real return could represent a 5% return with 1% inflation or a 7% return with 3% inflation. The final values in absolute and today’s dollars will be a bit different with different scenarios.
To see the effects of different rates of return and inflation on compound savings, see this Investment Inflation Calculator
Other calculators used in the projections above:
**Another factor that will skew the numbers is the sequence of returns. My simulation assumes a steady growth rate that doesn’t vary, which is not how the markets work. Negative returns late in one’s career are more detrimental than negative returns at the end of one’s retirement, when the nest egg has grown quite large. Again, I’m trying to keep it simple here. Please understand that returns will vary.
What do you think? How about you? What would you do in Dr. Anderson’s situation? Retire now? Work indefinitely? Learn how to spend more and retire somewhere in between? Work part-time? Comment below!
I would work part time. It would keep your skills sharp if you change your mind about early retirement, and give you the necessary cash cushion to weather the worst-case scenario of prolonged low market returns. Since you work part time and are FI, you would be able to select a job that has very favorable working conditions, such as no call, etc.
Stay tuned for a post on my part-time plans, perhaps as soon as this Tuesday (on http://physicianonfire.com /not here) if I can get my act together this weekend and write it!
I’ve also got a 4 Physicians post on the impact of part-time work at various points in one career / financial life. The longer you can put it off, the better. Even a few years of full-time work early on can make a big difference down the road as that saved money starts compounding (or loans are paid off and debt interest stops compounding).
Cheers!
-PoF
Great post, even though I read it before. Dr. A. is basically modeling my reality. This does a good job of making reasonable financial assumptions and predictions. The biggest issues are alluded to and are the most difficult to predict: non-financial aspects of being retired (would I get depressed or be bored?), cost of health insurance (Who knows what TrumpCare is?), living to 100, and SOR risk. After a 8 year bull, retiring now would create significant risk. None of this invalidates the analysis – just nudges us into the “one more year” camp.
I have the same reservations, Wealthy Doc. It helps that I don’t hate my job, either.
I’m currently in my third “One More Year” since I realized I had attained a basic level of financial independence. I’ll probably overshoot the 25x by 50% before moving on eventually.
Best,
-PoF
I love reading your posts!!!
I think we think alike. I am a semi retired part time Radiologist , that firmly has lived my life living below my means and saving/investing the rest in equities. Most of my colleagues are money/financial/tax illiterate. You definitely speak my lingo. It pays off , and I am living proof. Sacrifice (living below ones means and investing lots in the early years) brings loads of returns later on. I am 54 and have accumulated over 13 M in investable assets (doesn’t include houses). My dividends alone would provide over 300K a year after tax , yet my “budget” in any year is never over 250, and this is living very very well. This doesn’t include any capital gain that I may get and is invested in large companies (42) that have not cut their dividends ever.
I currently work about 1 week a month, for enjoyment and travel the world with my wife for the rest . Life is great.
Slow and steady will win the race in the end, keep up the enjoyable and informative posts!!!
We’re more alike than you know!
You’ve got 13 years and about $10 Million on me, but I will be cutting back this fall and should be able to squeeze my monthly hours into a busy 7-day stretch. Last week, we met with our boys’ principal to see how much travel we could get away with and still be enrolled. We should be good to go with a few trips of 3-weeks or so throughout the school year, and of course, we’ll have the summers free, too.
You’ve done amazingly well, and I would put “sacrifice” in quotes. It’s not much of a sacrifice to live below your means when your means include a salary of a few hundred thousand dollars. I make conscientious choice when I spend, but I don’t feel like I’m sacrificing by living on less than the average physician. There are trade-offs, of course, so maybe it’s just a matter of semantics or psychology.
Best,
-PoF
Great work.
Also, I was pleased to hear you mention dividend investing. I think that approach has great value, but I’m in a minority here.
Would you mind posting a few more details? Did you have a fixed savings rate? Did you invest mostly outside of retirement accounts? Lessons learned?
@ wealthydoc I have always been interested in investing in equities, as well have been very knowledgeable with taxation. I am Canadian and although live in a different country the methods of wealth building and the potential savings vehicles are somewhat similar in our countries.( I have converted our dollar to yours to not make any confusion). Medicine provides a good income that allows us to invest significant dollars into companies that will grow and grow aka the stock markets . Most of my investments are in non retirement accounts (less than 8% in retirement accounts). For many years I have saved more than 50% of my ‘take home pay” and invested in 90 % equities both in the US and Canada with a little over seas. I have not used mutual funds for maybe 15 years and use either individual stocks (purchased through low cost brokers at $10 a trade), and generally am a buy and hold guy. i avoid fees like the plague. I am not a trader.I have never purchased bonds , and look mostly to large companies that have proven themselves in growth over many years and paying a dividend. I am more the turtle in the race of wealth building. I look basically to never touch capital and live off of returns from my investments in the . I will leave a substantial amount to my heirs. Hope they will live the same way. Of course I hope that is not for a few decades..lol.. I have always (last 20 years) controlled my own finances, and investments, as the best person to control and look after your money should be yourself. It is not rocket science, but does require the occasional bottle of wine when stocks tank like 2008. I read over tax and financial articles as much as I do medical articles. I invest for the long term… in my case forever, as I plan not to touch capital. Lessons learned: the stock market always comes back… you might have to wait but it will. Keep yourself well diversified in the market, When markets are low, that’s a great time to invest and not to sell. I always keep 10-15% cash for those times. I also keep cash that would last me more than a few years of living. That generally would withstand any major downturn. I never invest in interest bearing funds , I like to be an owner rather than a loaner. I also do frequent spreadsheets monitoring income/expenses and investments so as to follow net worth over time to see how I am doing. Remember to to look at the total return after taxes hence why tax knowledge is important as taxes will be the #1 expense you will pay in your lifetime. My experience in looking to my colleagues is that they dont save enough and they look for getting rich quick, then they count on middle men that take some of their investment, and they sell at the wrong times. I think those docs that follow this site however are the few that don’t make those mistakes.
🙂 Happy savings and investing 🙂 Then track your results.
It doesn’t really matter what our investing strategy is, if you invest 50% of your income for many years you are going to be very wealthy.
Thank you Dr. Adkins!
Another Canadian dividend investor here. I’m behind the Doc on numbers but on the same curve. Great advice. Our strategy is the same as his with a couple of minor tweaks.
I would also agree the tax optimization makes a big difference to the next income you have to spend from this type of portfolio. At the investment income level he is talking about or that I am at, it’s the difference between a 15-20% overall tax rate or a 35-50% overall tax rate, in Canada.
We have about 20% of assets in very productive fixed income investments that return superior results. We pay full freight Canadian tax on those, but it’s an effective diversity hedge in our opinion. In a downturn, we would draw from these as needed and rebalance accordingly at low equity prices. Until that happens, they are a very productive part of the total portfolio.
Most of the rest (80%) is invested in tax-favourable Canadian dividend paying equities – the same as your tax approach with US qualified dividends and LTCGs.
As part of this 80%, a portion is tax sheltered in RRSP and TFSAs,
In tax deferred RRSP accounts, which function exactly the same as your traditional IRAs, we also put US and world equities that pay dividends. Since there is no favourable tax treatment, and everything that comes out of there as “income” gets taxed the same way as regular income. But it grows and compounds tax free until needed.
In our TFSAs, which are identical to your Roth IRAs, we maximize for dividend growth and income as well as we can withdraw dividends and capital gains anytime completely tax free. These accounts are great but the TFSA program only started 10 years ago and the limit is only $5500 per annum per adult.
The other thing I’d add is that if you are married, you have to have spouse in the game with you in all respects and if the spouse is not able or willing to maintain the strategy, there needs to be a written and understood transition plan if you die (along with suitable transition instructions for everything of course, but I’m just picking on the fact that a portfolio like this is not “automatic” for a widow or widower that has no ability or interest to maintain it).
Sounds like my life too. If you put that money to work in your 30s then working part time is very feasible to keep your mind active. I also have 200k or so of passive income and work 3 days per week because I want to at 59.
While I understand that this is a financial web site I hope that most doctors get something more than their salary out of helping the sick. Now I do understand the frustrations in dealing with our insurance system, legal system, and pharma system. So perhaps as long as you can help people doing it part time or even full time would be great. I am not a doctor but would if I could help people for free. Just an alternative point of view.
Lots of people say they would be a doctor for free. They’re called medical students. Then they realize that they’re not quite that idealistic and altruistic. I know very few people who are qualified to practice as a physician who would do it for free. Consider for a minute why that might be.
I’m sorry but I think once you actually went through what you had to do to become a doctor and stay a doctor you would see the world very differently. I respect your desire to help. Doctors do it all day long.
But like you said, this is a financial website. So you are going to read doctors post talking about money. There are other websites where doctors talk about diseases and treatments.
I’ve started to look into the possibility of doing a little volunteer global outreach work once I am working less than full-time. It’s something I want to try before I consider letting my skills, licenses, and certifications lapse.
I don’t envision working for free for an extended period of time, but it could be personally rewarding and good for my family to spend a little time in an impoverished nation helping people for a short stretch.
Best,
-PoF
I’m a pathologist who retired 2 years ago at 58 from a big league academic medical center.
All my life I’ve lived very frugally, but set money aside for an “encore career” in my late 50’s.
Now with >5.5 M in total assets in my portfolio.
From taxable sources, I’m getting about~100K annual distributions mostly through capital gains / qualified dividends and I have 60-80K in total spending.
Also, my taxes have dramatically decreased since these distributions are more favorable, than was earned income.
The IRA continues to accumulate….
I still living below my means….I like to park my 1989 Toyota Corolla next to the newest car in the doctor’s parking lot.
’89 Corolla? Yup, you win! I drive an ’06 Chevy. You’ve also got a portfolio at least twice as large as mine.
I think there are quite a few of us “multimillionaire next door” types reading this site.
Cheers!
-PoF
Did you end up developing an “encore career”?
My “encore career” is evolving, but not generating much income apart from a few lectures now and then.
Frankly the days pass by so fast: my time now spent working / repairing my 105 y.o. house and landscaping the gardens, volunteering in gardening groups, still teaching med students / house staff, learning Spanish and perfecting French.
With the grim future in pathology (few entry level jobs, mega corporate labs, decreasing reimbursement, etc),
I tell the pathology residents that they should pick up a trade (carpentry, plumbing, etc), become a cook, or drive for Uber.
https://forums.studentdoctor.net/threads/no-jobs-in-pathology.1185558/
https://forums.studentdoctor.net/threads/yet-another-large-labcorp-acquisition.1242719/
These skills may prove useful in the future should they lose their jobs….
One thing. In real time, meaning if someone were to retire today, the math works only if the market doesn’t have long term downturn in the next 5 years. So if the market had a down turn and she lost 15% and got 0% for the next 5 years. Her retirement would last about 20 years or less.
I guess the point is to remember that no one knows or can predict anything, calculators are fun but many, many people have made mistakes and retired too soon and keeping one foot in the workforce (especially for doctors) is a good idea. Find your ideal job, somewhere where you will be happy and keep working and give yourself plenty of vacation. Then you don’t need to retire early or too early. Unless your the radiologist with 13 million. Then it does matter. Good for you.
Sequence of Returns risk is a concern, and there are different strategies that can be used to mitigate it.
One is to have a large “cash cushion” like Vagabond MD does (http://www.physicianonfire.com/top-5-reasons-physician-holds-500000-cash/).
Most of us will also have some ability to decrease expenses in the event of a major downturn. Take more affordable vacations and avoid major purchases when you would be forced to sell low to do so.
Another strategy is to build up more than you need like Dr. A does in this exercise. If you’ve got a million dollars more than you require, you can weather many storms. Most bear markets recover within a few years. If you can ride it out without depleting your portfolio rapidly, you should be OK.
Best,
-PoF
I agree everything you mention will help. I guess it depends on every ones comfort level and risk level. For me I know statistically even 3.5% withdrawals will last much more than 40 years. I will most likely have more than I started but I’m still feeling if I’m going to have a 45 year retirement, then 2.5% is better. But to do that I would have to work part time until SS kicks in and I feel more comfortable with a 3.0% draw. At 3.5% I’m well over my FI number.
We’re fi but not md two phds and I haven’t worked since getting it. Last year my DH took a sabbatical of a year and is back working. He started climbing walls at 38 and couldn’t take being at home all day with kids. I working now part time too. Anyway now he just works for fun and says whatever he wants at work. He loves it. He loves saying what he thinks now and says if they don’t like it he’ll walk away. I also think he loves the challenge and creating something that is working to change how we work. So he’ll do it until he decides it’s enough. I am guessing when our 4 year old leaves for college lol.
But seriously we vacation a lot, he usually has 6 weeks or more a year. Live nicely and probably should just quit. But kids college and truthfully being bored is reason enough. I think he’ll hang it up when they piss him off. It happened when he just walked out for a sabbatical and didn’t come back.
Thanks for sharing Livingalmostlarge.
I think a lot of us here would have a difficult time with a traditional “retirement” at a young age – although many of us dream otherwise. I read that depression goes up 40% at retirement. That doesn’t surprise me. Work provides a lot of non-monetary benefits that we often forget. Nevertheless, it is great to be FI and have the freedom to walk away whenever you like!
No question that affective disorders, depression and / or anxiety do go up in the first few years of retirement.
By staying busy, volunteering in good causes, and reaching out to non-medical people really helps
one regain that sense of purpose that brought us into medicine in the first place.
When I go back to the academic medical center or go to meetings, some of my colleagues who are still working will make you feel worse (and potentially get a vicarious thrill out of it):
1. those older than me, i.e. in their late 60’s to 70’s are so wrapped up in their career that they haven’t developed outside interests. Now they shun me….
2. those of my age or slightly younger are jealous: one guy called me a traitor.
Secretly,they want to retire but they can’t afford to do so (children going through college, expense tastes, etc)
The bright spot is that there are other colleagues who will be congratulatory and want to know
“how to retire early”: I turn them to this forum and others, if they want the information.
Congrats to the two of you!
“I think he’ll hang it up when they piss him off.” It sounds like you’ve got what some call FU money, which is not an acronym for a university in Florida.
Cheers!
-PoF
Self financing is the better way to reduce no show at your practice, because due to high treatment cost patient change their mind at the end of the appointment. Make treatment affordable for everyone by financing your patients.
I could retire financially, but I look at it differently than the early retirement enthusiasts.
Not to put myself in the same category as the people I am about to name, but I mention them because they are famous, so everyone knows who they are.
Why doesn’t Lebron James retire?
From an early retirement view, why didn’t he retire 10 years ago?
At that point he was far wealthier than a doctor is ever likely to be. He could have created a budget that provided for a very comfortable life without lifting a finger ever again. Heck, he could have hired someone to feed him so he would not have to lift a fork to his mouth.
One could ask the same question of Steph Curry. Has is already rich. Why keep working?
What about Tom Brady? It has to be harder at 39 to let 300lb giants bash you into the ground than it was at 25. He is rich.
Continuing to work, even at something a lot safer than playing quarterback, cannot improve his financial security.
OK, they are all athletes. They make their money young, so,even if they don’t need it, someone obsessed with early retirement might at least get why they keep working. When your career could end tomorrow with an injury and you are 25, you might figure you will keep working until it happens. You will not be a pro athlete that much longer in any case. They still put out more effort than required to have a roof over their their heads and food on the table.
What about Fortune 500 executives. Most of them make more than most physicians. The average Fortune 500 CEO is 58. They were probably all richer than most docs ever will be well before they became CEOs, with the exception of startup owners who got rich as CEOs. 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. Don’t walk away until the coach, or the board, or their colleagues, tell them that they are no longer good enough to do the job. 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 a lone 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.
That is an interesting perspective, and not one that would be shared by very many in the FIRE community. To be honest, it kind of makes me sad to think about you spending a large portion of your life doing something you don’t even like out of a sense of obligation to work at something. Why not figure out what you DO like, and go do that, assuming the finances will permit that transition?
I would assume that Tom Brady et al actually like playing sports and CEOs actually like being CEOs and that’s why they continue to work. It just seems bizarre to me to see someone doing something they don’t like that they don’t have to do.
I see your point up until the part where you said you don’t like what you are doing. In my opinion, if you like what you are doing and want to keep doing it full time or part time (if possible) then your happy. If you have time and money to travel and buy what you want and still enjoy working, then great. Do that. But if you are unhappy and don’t like your job but keep doing it because you feel you are lazy if you retire? There is a problem.
People in the FIRE community are not Lazy. Far from it. Most have busted their behinds to get to where they are and feel there are better choices and things to do with their time.
Ideally, I would like to retire AFTER a few years of a very severe bear market. That way I would be intellectually and emotionally secure that I can survive despite the SOR risk. The SOR risk is real and underappreciated I think. Also, a lot of this is emotional though too. Some of us panic even when we think we won’t.
You are relying on a potentially dangerous assumption that just because the market went down the last few years it must soon go up. That isn’t necessarily true. It could continue down. While it’s probably more likely to go up, it certainly isn’t guaranteed. That doesn’t eliminate SOR risk and perhaps may even make it worse since the ratio of your nest egg to your needs is now lower.
DBH,
I agree with a lot of what you are saying. We tend to obsess about the financial aspects of retirement. I don’t want to introduce too much politics here… but how about Trump too? He is a billionaire and he is 70 yo. He obviously isn’t in the RE camp.
I hope to contribute as part of our economy for as long as I can. For me most of it is about the service I provide rather than the money. The money does serve as a marker for how many lives you have improved though.
The part I differ is if I didn’t love what I do I would literally quit Monday morning. Life is too short to do work you don’t like. You have more power over your life than you may realize. I encourage you to make your current or future work closer to your ideal. It will bring you joy – as my work does for me.
I’m working on a post for my site called “Moving Away From Financial Independence” — describing some recent life changes (and a slight pushback at what is sometimes the overbearing nature of many in the FIRE community, though I do not include PoF in that group).
We’re doing well with our savings (not as well as Dr. A or Pof), but well enough.
I will say I enjoy my job — I don’t love it everyday, but I am generally motivated to keep going back every day to work on the projects I have or to work a shift in the ED. Other than the days I am trying to write a grant, I almost always look forward to my work.
I think it’s a legitimate debate whether the time spent in medical education is a sunk cost when deciding whether to consider working out of a sense of obligation to the profession. I certainly wouldn’t work into my 70’s at a job I dislike out of that obligation, however I have no desire to retire at 40. That’s in part because by then many docs are just hitting their peak skill level — I’m still getting better as a doctor despite having been out of training for 4.5 years.
I’m not Jim Brown — I don’t plan to walk away at my peak if I still enjoy the job. Lebron and Steph enjoy their job too, and Lebron 10% below his peak is still the best player in the NBA (not that I’ll ever be as good in my profession as Lebron is in his).
As a pathologist, we live on the “bread crumbs” of others. In other words, our livelihood is based on material sent to the laboratories by clinicians (who have more control).
The past few years, with laboratory consolidation / buyouts, decreasing reimbursement, increasing regulation / paperwork complexity, etc, has generated a lot of frustration and sense of hopelessness in my field and perhaps in others.
Just last week the FDA allowed whole slide imaging in digital pathology: https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm552742.htm This could lead to the development of off shore pathology mills, analogous to tele-radiology / nighthawk.
So, by “retiring” at 58, I’m no longer a practicing “academic pathologist”, but rather I’m involved in those
“things medical” that are still important:
– teaching med students and housestaff
– developing curriculum in foreign language training for healthcare providers
– giving lectures at national and international meetings
– writing articles and book chapters on medical history
– volunteering at community health fairs
– perhaps later on getting involved with consulting
More important, I can now devote time to my other non-medical passions that were put on a back burner for so many years.