Let’s Talk About Leaving Medicine #illumedati 10

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Hey guys, it’s Medicine Mondays again. Remember my previous post “I’m Leaving Medicine”? Well, I recently caught up with the friend of mine who was/is planning to leave medicine, hence the title: Let’s Talk About Leaving Medicine.

Stock Photo from: Pexels

Slight edit: 3-20-2017 @ ~ 5:45 pm PST, fixed some small calculation errors.

So like I was saying, I was just talking to my friend and he linked me this article:

Retired at 37: Breaking Up With a Career in Medicine – from kevinmd.com

Feel free to read the full article if you’d like, but I can summarize it here for the most part.

An OB/Gyn described a timeline similar to my prior post I Wouldn’t Choose Medicine Again. For simplicity I’ll link the part of the post I am referring to:

To be honest, this may even be the normal progression of our training. (this is a little bit exaggerated, but is to illustrate a point)

  • Start as a bright-eyed medical student ready to change the world.
  • Keep your nose in a book for 2 years and shut out communication with the outside world to get the top grades and highest USMLE score.
  • Start clinical rotations and spend every day trying not to make a mistake. Study like crazy for the shelf in fear that you may not get honors.
  • Get into residency and work 80 hour weeks like clockwork until residency ends, 3-7+ years later.
  • Start your job where you may even work harder than residency.
  • Do your best to help as many patients as possible under a time crunch and budget crunch.
  • Get called to a meeting about your Press-Ganey scores being low because a patient was angry that you wouldn’t prescribe what they wanted.
  • 30+ years old, $300k in debt, 7+ years behind in retirement, trying your very best to help patients despite the weight of the world on your shoulders.
  • Then some big media outlet calls doctors “overpaid” and the “problem with healthcare”.

I think that’s enough to extinguish any light.

Interestingly, the author of this particular article did not leave medicine from “burnout”.

She simply decided that other things in life were simply more important than her career in medicine. She talks about personal health scare, happiness, family and time being important.

In my opinion, the most interesting part of the article is:

You are not “burned out.” The problem is the current environment in medicine which puts physicians last on the list. Your stories are not unique, and all too common amongst others in the field. Leaving for you is taking control back. Control of your life and also making a statement for those still in this unhealthy relationship. You join the increasing ranks of young physicians that are finally taking a stand and demanding better from this toxic relationship. The hope is that someone is listening.

My friend and I talked about this a little.

An interesting point my friend brought up is that “The hospital isn’t going to give me days back at the end of my life.”

He’s right.

Time is fleeting. Life is too short to do something you really don’t want to do anymore. However, while some may make the decision to leave medicine, it’s worthless without a plan:

How many people want to leave medicine and can’t? And… more so that that, is it that they can’t or that they won’t?

So we had a discussion and ran some back of the napkin math to see how people could really leave medicine.

Let’s look at a hypothetical situation.

Dr. Smith is an early-mid career hospitalist. Let’s say he’s 35 and he had the normal “Track”, meaning he graduated college at 22, med school at 26, and internal medicine residency at 29. So he’s been working as an attending for 6 years.

Remember my Twitter poll?

So let’s just say he’s right in the middle at $250k in debt at the end of medical school.

However, his loans were at 6% interest and he couldn’t pay them during his 3 year residency. So after those 3 years, it’s $300k.

(If you don’t believe me, go here and enter 250,000, 0, 3, 6%) = ~$297k. I rounded to $300k to simplify things.

According to this salary survey, a 50th %ile hospitalist makes ~$215k a year, so let’s use that.

So here are the numbers then:

He starts his first attending job at 29, he makes $215k/year and owes $300k in student loans.

He starts paying back his loans over a 30 year time period, paying ~$1611/month or ~ $19,332 a year. Interest rate is still at 6%. After 6 years he still owes $269k.

He’s been able to manage a comfortable lifestyle, maximizing his 401k, maybe even doing a Backdoor Roth IRA.

However, he’s now 35 and he really doesn’t want to practice medicine anymore…

Can he walk away?

The answer is… of course he can, but it will require significant lifestyle changes and likely a fundamental change in priorities.

First of all, he currently makes $215k/year as a hospitalist. He has put a ton of resources into obtaining the education and skills for this position. However, just about any new job he takes will not make the same amount. A reasonable consideration would be being hired by big pharma or some other company as a consultant or something. To be honest I don’t know what kind of salary those positions command, but I would imagine somewhere between $80-100k a year. The other options of hospital administration are probably out of reach for someone who is still this early in his career, unless he has positioned himself over the last 6 years to move into that roll.

So basically $215k –> $90k (split the difference between 80 and 100k)

However, remember, the debt hasn’t gone away. He’s still $269k in debt and will need to pay $1611/month for the next 24 years.

Let’s calculate his salary ($90k annually, single male, 0 allowances) in:

California – Gross pay $7500 and Net Pay $4,890.90 (monthly)

Nevada – Gross pay $7500 and Net Pay $5,454.27 (monthly)

Why the difference? Nevada has no state income tax.

Ok let’s continue on:

California (~”Southern California)

He makes $4890.90 a month and pays $1611 in loans. He probably pays $1500/month for rent.

$4890.90 – $1611 – $1500 = $1779.90

Now include other expenses like car payment, car insurance, gas, electricity, internet, cell phone, groceries, fast food/eating out, and that may dwindle pretty quickly. This is especially true in a high cost of living area like certain parts of Southern California.

Nevada (~Las Vegas)

He makes $4890.90 a month and pays $1611 in loans. He probably pays $1000/month for rent. (less than California)

$4890.90 – $1611 – $1000 = $2279.90

Now include other expenses like car payment, car insurance, gas, electricity, internet, cell phone, groceries, fast food/eating out… but you’re probably still ok. Cost of living is relatively low in Nevada.

So what’s your point?

If you want to leave medicine, you will probably need to be flexible. The amount of debt you carry on your shoulders is very difficult to get rid of without a physicians’s salary to help you pay it off. You will need to make leaving medicine your #1 priority. Finding a good job in a low cost of living area is probably necessary.

Wait… what about retirement?

Oh yea, that’s right… what about his 401k? His new job outside of medicine pays $90k gross. So if he maximizes his 401k, he really grosses $72k.

That’s $6000 gross and $4,047.60 net a month in California.

After $1611 for student loans and $1500 for rent you’re left with $936.60.

That’s $6000 gross and $4,444.02 net a month in Nevada.

After $1611 for student loans and $1000 for rent you’re left with $1833.02.

That’s not a ton of money to budget for a car payment, car insurance, gas, electricity, internet, cell phone, groceries, fast food/eating out.

This is depressing… so basically I can’t leave medicine?

I didn’t say that.

I’m just trying to illustrate that it probably won’t be easy.

The easiest way to have the option of leaving medicine is:

  1. Live like a poor college student.
  2. Get rid of your student loans.
  3. Be flexible with where you live.
  4. Take a job that fits you and that you like.

If you don’t have loans hanging over your head, leaving medicine is 100x easier (if you so choose).

In the above examples, without the $1611/month in student loan payments:

In California you have $2547.60/month to use.

In Nevada you have $2944.02/month to use.

This is reasonable, I think.

Wait, your example is for a single person… what if I’m married?

Yup, you’re exactly right. Unfortunately, having a spouse complicates things because of the near infinite variables.

The most important of which is:

How much does your spouse make?

If your spouse is 100% behind you leaving medicine and his/her salary is enough to offset your decrease in salary, then the transition is much easier. However, if your spouse makes significantly less than you or only works part-time (or both) then you are probably in the same situation I described above.

The second most important variable is probably:

Does he/she have student loans of their own?

If he/she has her own student loans, even if he/she makes a good salary, a good portion of that will go toward student loans. This places you in the situation of making significantly less, but still having the same high loan payments overall combined, for the both of you.

 Ok, you like dream scenarios… is there a “dream scenario” for this?

Well, if you are coming out of residency -right now- and have already decided you may want leave medicine eventually or want to keep that option open, then you need to make a plan to pay off your loans asap. This would mean making the decision of paying them off over less than 5 years.

If you are $300k in debt at 6% interest, your monthly payment for a 5 year plan is $5799 A MONTH and you will have paid $47,990.43 in interest.

Note: If you refinance them at 4% interest, your monthly payment for a 5 year plan is slightly less at: $5524.96 A MONTH and you will have paid $31,497.40 in interest.

For most specialties, this is possible if you continue to live like a college student.

You probably net around $9000+ a month,  pay ~$6000 toward your loans, and live off the other $3000.

That doesn’t seem too bad.

Yeah, but it’s easier said than done. You’ve been living like a college student since you were 18.. and you’re now 30+ .

So you think you deserve it, start spending money, and get accustomed… it’s hard to go back.

So you need to ask yourself “Can I do it for another 5 years?”

That’s the cost of freedom.

What about you?

I’m lucky.

I don’t plan to leave medicine for a long time, if ever. I like my specialty and I’ve found a job I really like.

As such, even though I advocate paying your loans off as fast as you can on my blog, I’m not doing that just yet.

Some may disagree with me, but I’ve prioritized buying a house in order to secure a good public school district for my children.

Nonetheless, I do plan to pay off all my loans (and my wife’s) within the next 10 years, just not in the super accelerated time frame of 5 years.

TL;DR

Leaving medicine isn’t impossible.

However, it will probably require lifestyle changes and fundamental changes in priorities.

Student Loans are an anchor which prevent many that want to leave from actually leaving.

If you want to keep the option to leave medicine open, you need to get rid of your student loans a priority one.

You need to live like a college student.. so ask yourself “Can I do it for another 5 years?”

That’s the price of freedom.

-Sensei

Agree? Disagree? Questions, Comments and Suggestions are welcome.

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10 thoughts on “Let’s Talk About Leaving Medicine #illumedati”

  • Physician on FIRE

    I wouldn’t fault anyone for leaving medicine if that’s what they feel is best for themselves and / or their family. Of course, it’s best to reap the rewards of a high-paying career for more than a few years if at all possible.

    I will most likely retire from clinical medicine much earlier than I once thought I might, but I will have put in at least as many years (12) as it took to become educated and trained to do this anesthesiologist job. Living well below our means over that time frame allows us to live a life of freedom rather than transitioning to a lower paying career.

    Cheers!
    -PoF

    • Sensei Post author

      I’m aiming for the ability to go part-time by the time I hit 55, which would give me a 20 year career. However, life tends to throw me curveballs, so we’ll see.

      Thanks for your comment!

      -Sensei

  • VagabondMD

    I was hoping for a piece about the emotional, social, and behavioral aspects of leaving medicine, which is far more interesting than the math, IMO.

    As for not planning to leave medicine for many years as you have found a job and specialty that you really like, be careful projecting the present too far into the future. You will change, the job will change, and at some point, you might wake up and wonder how the hell you ended up where you are. It happens to many of us. This is the best reason to get your financial house in order, ASAP. Good luck!

    • Sensei Post author

      Hi VagabondMD,

      I don’t have any real world experience with the emotional, social, or behavioral aspects of leaving medicine. However, I do have a few collegues that want to leave and they have expressed their concerns (primarily financial) with the prospect of leaving medicine. For many, I think one of the biggest hurdles is the financial one, especially if you have a significant amount of student loans.

      That said, I do agree that a post about the emotional, social, and behavioral aspects of leaving medicine would be very interesting. I will reach out to some of my colleagues and try to write a follow-up post in the future.

      Also, you are absolutely correct. While my current job situation is very favorable, this can change quickly. As such, I am still trying my best to save enough money to have the flexibility to go part-time when/if necessary, as soon as possible. This “shakeup” already happened to be before when I started my first job after fellowship. After a hospital merger, my radiology group’s services were no longer required, and I had to look for a new job within a few months of starting that one.

      Thanks for your comment!

      -Sensei

  • John Jurica

    Sensei,

    Here is the path I followed. I became very frustrated with direct patient care for reasons similar to those mentioned.

    Without going into all of the boring details, I began attending courses to enhance my business and management skills, and volunteered for multiple hospital committees. After a few years I landed a job as vice president for medical affairs and cut back my clinical hours significantly. Later I went full time as chief medical officer and stopped all direct patient care.

    It took me several years, for sure. But the process can be accelerated.

    The two points I want to make are:

    1. The annual salary will generally start at $220,000 or more (FT equivalent) and a chief quality officer or chief medical offficer can easily earn $350,000 plus really good benefits, 403(b) matching, and deferred compensation on top of that.

    2. It is one of the few non-clinical careers where you can make a difference in other physicians’ lives. Many of the frustrations described in the post by you and your friend can be diminished or eliminated by working in an organization with a humble and sympathetic chief medical officer or physician CEO.

    As CMO, I had many of the physicians tell me that they were appreciative of my support. Finding such an organization to work for might be a challenge. Then why not take the lead in improving our colleagues’ lives? It can be very rewarding.

    • Sensei Post author

      Hi John,

      Your transition is an ideal one. You were able to leverage your clinical experience into a non-clinical, but medicine-related job moving into VP of Medical Affairs and then CMO. However, I think for some physicians, they want to leave medicine completely with a complete change in careers. For some, they may be “starting from scratch” with no leverage at all. Also, some may not be the “right fit” to transition into a more administrative role such as VP of Medical Affairs or CMO. In my article, I tried to paint what I considered to be a “reasonable estimation” of what was possible. Of course there will be outliers on both sides of the spectrum. Those who are able to move into relatively high paying positions and those are not. I opted for the ~$90k salary number because I think financial concerns are one of the greatest concerns about those wanting to leave medicine. I don’t think it should be a given that you will fall into another career paying something to similar to your physician salary ($200k+), aside from your scenario.

      As a physician, although we have a lot education/experience, it doesn’t amount to all that much outside of the medical field. However, the point you make is a good one. I would love to see more physicians transition into CMO and CEO roles in the medical field, especially if they have been “in the trenches” previously. As you alluded to, for those who want to leave clinical medicine, but still want to be within the medical field, moving into a more administrative role is an excellent option. Serving on multiple important committees and taking the initiative to enroll in business/management courses will serve you well. Unfortunately, it is not all that common.

      Maybe we could change that?

      -Sensei

  • Live Free MD

    I agree that the price of freedom isn’t cheap. After spending 12+ years working hard to become a physician, you must continue to work very hard to pay off debt and accumulate enough savings to be able to do WHATEVER you want to do. This might mean continuing to practice medicine, or it might mean becoming a surf instructor.

Comments are closed.