Staying Lean #illumedati

Hey everyone, it’s Medicine Mondays again. Today we’re going to talk about the importance of “Staying Lean”.

Staying Lean
Photo by Hiago Italo from Pexels

Staying Lean?


I don’t mean lean in terms of body habitus — although that is of course important too. Today I’m talking about staying lean in terms of possessions.



I’ve talked about it before, but the path of medicine usually is not a straight line. There are many places where you potentially will make some turns, ut-turns, and treks. College, medical school, internship, residency, fellowship, job 1, job 2, etc — these may all be in different areas.

Or, if you’re like me, they may be across of a body of water, since I went to medical school in the Caribbean, did residency and had my first job on the East Coast, only to eventually end up in Hawaii.

What I’m trying to say is

Moving is no fun

No one wants to help you move. (Key and Peele)

Pivoting is hard.

Let’s look at my path:

  1. Grew up in Southern California
  2. Moved to Northern California for college at Berkeley
  3. Moved 3 separate times while at Berkeley across 4 years.
  4. Went to medical school in the Caribbean.
  5. Moved home for a short while after Step 1.
  6. Then moved to Central California for clinical rotations
  7. Onto Staten Island, NY for internship.
  8. Then to Albany, NY for residency.
  9. Moved to Baltimore, MD for fellowship.
  10. Then moved Barrington, RI for first job.
  11. Onto Honolulu, HI for this job.
  12. Bought a house in Hawaii, moved there.

That’s A LOT of moving.

I don’t think there is all that much you can do to get around this if you choose the path of medicine. I can’t think of anyone I know of who went to college, medical school, internship, residency, fellowship, and took a job in the same area. I’m sure some of these people exist, but even then they still had to move at least a few times. There is a higher likelihood that you will need to move pretty far away at least once or twice in your medical career.

Hmm.. I guess you’re right.

So here’s the thing. Most of the time you won’t have much of a choice in where you’re moving to, but you will usually know “when”.

Once you find out you’re moving across the country for residency or fellowship or wherever, the last thing you’ll want to do is to try to figure out how to move your enormous dresser, huge couch, or 80″ TV there.

This is why I advise medical students to stay lean and mean for their residency/fellowship. Even after taking your first job, don’t get too crazy. After you’ve been at a job for awhile and feel stable, you can start to put down some roots. Just remember, when you change jobs you lose money.

How lean?

Well, that’s kind of a personal decision.

Let me reflect on how I did things, why, and how it turned out:

Clinical Rotations

While I was doing my clinical rotations in Central California, I knew I was only going to be there for a 2 years. For this reason, I bought only what I considered to be essential. I bought a bed, a desk, and a small dining table. That’s literally the only furniture I had. I didn’t even have a couch!

I’m not saying you have to be that minimalist, but just remember everything you own will need to either be moved or thrown away when you leave. After I finished my clinical rotations, I gave my bed and desk to a friend of mine who was starting his rotations.

Intern Year

A similar thing happened my intern year. I was only going to be there for on year. The only things I had were a bed and a dining table. I didn’t have a couch or a TV. As an intern, you have so little time, you’re either in the hospital or out doing stuff. The only time I spent in in my studio apartment were to eat and sleep.


It wasn’t until I started residency that I bought real furniture for my 1 bedroom apartment. I thought, I’m going to be here four years, I should buy something reasonable. So I bought a desk, a couch, a coffee table, TV, TV stand, and a bed. I actually took apart my dining table from internship and brought that to residency with me — it was the only piece of furniture I brought with me.

Looking back on it now, I didn’t need all that stuff. I hardly used that couch or ever watched TV. I probably didn’t need a 1 bedroom apartment either. The only reason I was renting the 1 bedroom apartment was because it came with a garage, which I felt was really important in Albany because of the snow. Also, it had its own washer/dryer which I think is pretty key. However, it would have been a little weird to have a completely empty living room aside from a desk and a dining table.

However, since I was there for 4 years, I think it was pretty reasonable overall.


Then when I moved to Baltimore, MD to join up with my wife for fellowship I had to downsize everything. I pretty much threw away or gave away all my stuff except for that trusty dining table. We just moved all of her stuff into our apartment from her old apartment in Baltimore. To be honest, we had way too much stuff for our little apartment — which seemed even smaller once my daughter Kylie was born.

First Job

Our first jobs were in Rhode Island and Southern Massachusetts. We moved to Barrington, RI to a nice little apartment. However, once again,we pretty much got rid of all of all of our stuff and packed up whatever we could into our Rav4s. My wife was a champion driving to Barrington, RI from Baltimore, MD with our daughter sleeping in the back the whole way.

This was probably when we made our first mistake, at least in my eyes. Since we both took jobs that we felt were pretty stable, we wanted “real furniture” and tried to set down some roots. We felt that we would probably be staying in Rhode Island for the immediate future. As such as bought a bunch of “real furniture”. It was not expensive, but it was stuff we didn’t build ourselves. We bought a real TV stand, coffee table, dresser, night stands, dining table etc. We did exercise some restraint though because we could have bought a lot more stuff, and a lot more expensive stuff.

Then what?

Unfortunately, if you know my story you already know that I started the job in July, but then was told in September that my last day would be in April. I’ll spare the details, but basically it had to do with hospital restructuring and contracts, etc. The hospital I used to work for closed January 2018. It is now and outpatient care only center.

Perhaps in that way it was a blessing in disguise since by 2018 I would have been well ingrained in the Rhode Island area. I would probably have been looking for a job end of 2017 and most likely needed to move somewhere else.

Anyways, at the end of the day, all that furniture we bought we ended up selling way below what we paid for it in an effort to recoup any kind of costs. It simply did not make sense to ship it to Hawaii since shipping it would probably cost more than the furniture itself was worth.

What about now?

It’s kind of funny how life works out.

The house I bought has a ton of built in stuff. Built in bookcases, desk, tv consoles, nightstands, etc. As such, I didn’t need to buy much furniture. We only bought a couch and a dining table when we moved in. We actually bought less furniture for our house than we did for our apartment in Rhode Island.

For our kids they have transitioned to their own bedrooms, so we will need to start buying some furniture for them soon. For example, Kylie has her own full bed now — but she will need a desk at some point. Luckily she has a pretty big closet, so she may not need her own dresser. However, my son Lucas has a slightly bigger room, but a smaller closet. So he’ll probably need his own dresser at some point when he transitions from his toddler bed to a full size bed as well.

Even at this point in our lives, we’re still pretty lean. If it came down to it, if we had to move again for some reason, there wouldn’t be a ton of furniture to move. Most likely it would just be a lot of stuff to throw out.

Also, I did finally frame all of diplomas and board certifications and stuff. They look really nice… but they’re sitting in my office and not on a wall yet. The reason for this is because I worry my son will knock them down. Someday I’ll put them up… someday.

What’s the bottom line?

I think in general people always feel rushed to have nice things and rush to the “finish line”. Like, look how nice my apartment looks with all this nice furniture. However, before you buy something, put some thought of how long you plan to have it — and more so than that, do you want to move it?

I harp on this a lot… but you need to utilize your Value Cost Ratio. For example, my buying a couch in residency was probably unnecessary. I could probably count on two hands how many times I actually sat on that couch for any extended period of time. Now then, if you’re a “couch person” and you like to snuggle on your couch to read books or study, then maybe it’s worth it for you. My wife is one of those people who likes to sit on the couch to study/read.

However, for me, it’s essentially unnecessary. I do most things at a desk with a computer. The presence or absence of a couch doesn’t change much for me — and especially not in residency.


Staying lean — in regards to moving.

You will be moving more than you think.

Just remember, anytime you buy something, will you want to move it later?

Utilize your Value Cost Ratio.

For guidance, remember:
No one wants to help you move and Pivoting is hard.

 Medicine Mondays Sensei


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

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