Hey everyone, it’s Medicine Mondays again. Today is going to be a somewhat reflective and introspective post about “Your Medical Career“.
For all the new interns starting in July… how long do you plan to practice?
Your Medical Career?
Yea. I’ve touched upon this subject a few times since I’ve been writing my blog. Of course, my experience may not be the same as everyone else’s. However, I think that when people decide to become doctors, go to medical school, get into residency, and start working as attendings, the general plan is to retire at a “normal age”. By “normal age”, I mean 65 or so, in line with Social Security and Medicare and such.
For me, when I was a medical student, resident, and fellow, I always expected that I would work until I was 65. That’s just what people do right? I mean, I’ve spent so much of my time and money working toward becoming a doctor. 4 years of undergraduate courses. 4 years of medical school. 5 years of residency. 1 year of fellowship. Hundreds of thousands of dollars of debt.
It would be a waste to “only work” for 20 years… right?
There is this feeling of needing to be apologetic for wanting to retire early or leave medicine. I’ve noticed it whenever I talk to my other physician friends who are early-mid career like me. I define “early-mid career” as having been working as an attending for anywhere from 3-10 years. For the most part, my friends that are in primary care, as general internists or family practitioners seem to be the most “burnt out”. The feeling of “trying to survive the week” is common amongst them. Even so, among them that make a very good living with a reasonable lifestyle, and are conservative with their finances. As such, they probably don’t need to work until they’re 65, or maybe even until they’re 60. If you add in that their student loans are gone and/or no plans for marriage or children, then the question becomes… why aren’t they planning to retire early?
I think there are a few reasons. However, I think the most common one is the sense of duty that doctors have to both their patients and their profession. What will my patients do without me? How will the hospital replace me? Will my colleagues be ok when I leave?
The other one is that being a doctor becomes an identity, and for some, it may be their singular identity. It can be hard to imagine doing anything else — being anyone else. Can you really give up something that was so instrumental in how you shaped your life? Do you really want to be Mr. Smith and not Dr. Jones?
I see… so then what?
I’m here to tell everyone that it’s ok.
It’s ok to want to have the ability to retire early. It’s ok to want to move on with your life as a non-doctor. Life is short. Be happy.
We see over and over that we don’t have (and won’t have) enough doctors.
New Research Shows Increasing Physician Shortages in Both Primary and Specialty Care — AAMC
However, in my opinion, the worst possible case is to have doctors working because they have to and not because they want to. This will lead to an underestimation of the shortage that exists (and will continue to exist). Additionally, the current generation of early-mid career doctors are part of a new paradigm. As I talk to my colleagues now, especially the younger ones, the idea of working until they are 65 is not as common. For this reason, I think the idea of a 30 year medical career will become less and less common. A 25 year (or even 20 year) medical career may become the norm in my lifetime.
So what is your advice?
Give yourself options.
Like I said, the worst possible scenario I see for the mental health and well-being of a physician is working because you have to not because you want to. This also is detrimental to patient care as well. As a physician you’ll be able to have a reasonable lifestyle and still save a lot of money. However, you need to be honest with your needs versus your wants.
Don’t be Dr. Yoloswag – It’s hard go to back.
So for the medical students and residents in training, when you map out your medical career — start with the possibility that you may retire early. This means plan out what you will need to retire at like 60 instead of 65, or if you prefer, 55 instead of 60. This is kind of the continuation of my post “The Biggest Mistake of Your Life.” This allows you to get a better understanding of your needs and wants. It also helps you to understand how much money you actually spend, and how much you may need in retirement. However, the most important thing is it gives you flexibility later on.
What do you mean?
Here’s an example. You finish residency as a young physician and because you’re young and fit you decide to do an all-nights schedule. Doing so awards you with more money and you love doing the night shift. It’s more interesting to you with more hustle and bustle and the shifts go by faster. Ten years go by. You’re not as young as you used to be. Doing the night shifts is really wearing you down. So you have two options — drop down to a part-time nights schedule, move some day shifts into the mix, or go to all days. You may even need to find a new job. All of these options will almost certainly result in a significant decrease in pay.
So then, if you followed my advice with a plan to retire at 55 or 60, then you have some wiggle room to play with. You can decrease your lifestyle a little or, if necessary, maybe push retirement back a little. It’s likely not a huge deal. No harm, no foul.
However, if you didn’t take my advice and the plan was to always retire at 65… you have a problem. You’re used to the “night shift” money. You likely have increased liabilities to deal with. If you drop down to a different schedule and take a pay cut, your plan to retire at 65 won’t happen anymore, it’ll be more like 70. So your options now are to liquidate some assets and/or curb spending significantly. You may even need to dip into your 401k while you transition into the decrease in pay. This is not something you want to deal with.
That is kind of extreme…
Is it though?
Money problems can happen to anyone. Salaries change all the time. People change jobs all the time. Just because you got paid X at your old job doesn’t mean you’ll get that same pay at the new one. It could be more, but it also could be less — significantly less.
Let’s say you’re a big time partner at some physician owned practice. Everything is going great for 10 years and you’re doing very well financially. Then all of the sudden ACME company comes in and steals all your hospital contracts from you. What do you do now? Go work for ACME company as an employee with a significant pay cut? Find a new job somewhere else? How does this effect your retirement? What contingency plan did you have in place?
Like I’ve said many times before, when it comes to finances I’m a pessimist. Additionally, when it comes to business I am also a pessimist. Some of this may stem from my little hospital in Rhode Island getting taken over, displacing me and other groups — only to close the hospital itself in 2017. I’m not bitter about it. I know the hospital needed help because it had its own financial problems. However, I learned that things can change in a flash. Luckily, I was able to land on my feet somewhat and get another job which I like. However, it required a big move, significant increase in rent, and basically a lot of costs. These are costs I probably would not have been able to absorb unless I had been saving from the beginning.
I was lucky… but I won’t be blind-sided again.
Hope for the best, prepare for the worst.
It’s ok to want to retire early. You don’t need to be apologetic.
In fact, I recommend medical students and residents coming out plan to retire early when planning their medical careers.
I think the idea of the 30+ year medical career and retire at 65+ will become less and less common.
I’m not saying you should retire early. However, I think you should have the option — so plan for it.
Hope for the best, prepare for the worst.
Agree? Disagree? Questions, Comments and Suggestions are welcome.
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It’s a little sad to be honest: chronic understaffing, increased workload, and indemnity risk are definitely contributing to attrition rates in the UK.
I have friends that have just began their careers as F1-2’s, already dreading coming into work and hating Monday’s. Honestly quite disheartening, feeling they were mis sold. At 16-18, I just don’t think many truly understand what Medicine entails, unlike in the US.
On top of that many don’t care for the nuances of basic finance where it’s now imperative to even just keep pace.
It’s funny now that I’ve personally started the Med School journey myself. Having been lucky to get the FIRE money before beginning Medicine really is a blessing. Though the apprehension of “will I be the same?” is still there.
If you do decide to hang it up early, as long as you’re satisfied you’ve done all you wanted and what you’ve contributed. No-one can hold that against you.
Good reads as always. Remember to not forget the little things like you told yourself.
Thanks for your comment Will.
I wish you well in your journey. For many medicine truly is a “calling”… but for some, it ends up not being what they expected or wanted.