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.”
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?
— Senior Resident, MD (@ResidentSensei) February 16, 2017
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.
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:
- Live like a poor college student.
- Get rid of your student loans.
- Be flexible with where you live.
- 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 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.
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.
Agree? Disagree? Questions, Comments and Suggestions are welcome.
You don’t need to fill out your email address, just write your name or nickname.
Like these posts? Make sure to subscribe to get email alerts!