Smart Career Alternatives and Retirement for Physicians


It’s no secret that many physicians are looking to do something different with their careers and their lives. Burnout, resilience, and wellness are a growing focus as we realize that the status quo is untenable for many of today’s practicing physicians.

Larger employers and institutions are appointing Chief Wellness Officers. The Physician Side Gigs Facebook group has over 13,000 verified physician members; my new Physicians on FIRE group has seen over 1,000 physicians join in its first week.

Ideally, we’d like to see every doctor remain happily and gainfully engaged as a medical professional, but this isn’t a perfect world. Some will be better off finding something else to do with their lives.

Dr. Cory S. Fawcett, a recently “repurposed” general surgeon has recognized the fact that there are other physicians looking for a new purpose, too. Last year, he published a guide for them. It’s the book I was reading when I wrote about Regret After Leaving a Medical Career Behind.

 

The Doctors Guide to Smart Career Alternatives and Retirement

 

I’ve previously reviewed the first two books in Dr. Fawcett’s Doctors Guide Series, the guides to Eliminating Debt and to Starting Your Practice Right. This is the third book in the series that I’ve been told is just getting started.

In the introductory paragraph, we learn that more than a third of current full-time physicians have a plan in the next three years to retire, go part-time, or switch to a non-clinical career. If you fall into one of these three categories, this book is for you.

Similar in length to his other books, this one is about 230 pages in length divided into eleven chapters. It can easily be read and digested over one to two evenings or a single long plane ride.

Although it’s not organized this way, exactly, the book could also be seen as having three individual sections. The first two chapters deal with the impetus for change and ways to avoid  a transition out of clinical medicine. Chapters three through five discuss alternative careers, and the final six chapters discuss the transition to not working and finances of the life of a retiree.

 

Why do You Want a Change?

 

Dr. Fawcett first asks you to consider why it is that you picked up his book. Are you burned out? Anxious to try something different? Tired of taking call, doing the big cases, or afraid of a lawsuit?

Contract DiagnosticsDon’t want to deal with MOC? Electronic health record driving you up a wall? Tired of dealing with trouble patients or trouble colleagues?

Whatever reason or combination of reasons has led you to consider a drastic career move deserves to be fleshed out. Before you move on to the next chapters, have a firm understanding of why it is you don’t want to keep doing what it is you do now.

Also, it can be unhealthy to go directly from working 60 hours a week to none. As I’ve said, you should plan to retire on something, a play on the common advice to retire to something.

Personally, there’s no shortage of activities I’d like to pursue further when retired — it didn’t take long to make this list of fifty of them — and I have a side gig that will take all the time and attention I care to give it.

It may be that like the author, my retirement from medicine will be more of a repurposing or career transition. Still, it’s a change that I believe I will welcome. I first considered early retirement a few years ago. I’ve spent the past several years contemplating what would come next. The author is wise to suggest you do the same.

 

Career Alternatives for Physicians

 

The next section discusses your options if you decide you’re ready to move on from the job you’re doing. Of course, if you’ve identified why you’re feeling this way, you may find that changing your job could alleviate most of the symptoms that are distressing you. Leaving clinical medicine isn’t always the answer.

He discusses dropping to part-time, narrowing your scope of practice, practicing locum tenens, doing case review or expert witness work, and even adding work in the form of volunteer or medical mission work. I’ve tried most of these, although I’ve done no case review or expert witness work. My first medical mission will take place next month in Honduras.

 

smart career alternatives and retirement

 

If that chapter doesn’t excite you, and you’re truly ready for an alternative to practicing clinical medicine, Dr. Fawcett presents a number of options for non-clinical work.

Fed up with the electronic health record? Become a consultant and help make Epic better! There are plenty of other opportunities in the area of healthcare informatics.

Research and teaching may be a good option if you’re in an academic center. Big pharma is taking applications. A number of physicians have sought public office and 17 congresspeople carried an MD or DO behind their name at last check.

If you like endless meetings, and who doesn’t like endless meetings, you may find a comfy home in administration as Dr. John Jurica did for a while. I hear there’s even money to be made as a physician writer or blogger. I was pleased to see Dr. Jim Dahle of The White Coat Investor featured, along with a number of other physicians with outside-the-box jobs.

Dr. Fawcett closes out this section with a chapter describing how he chose to finish his career with a variety of locum tenens stints as the lone general surgeon at a number of critical access hospitals in Oregon. While the specific plan won’t apply to many physicians, I liked how he was able to weave a personal story into the web of more generalized recommendations.

 

 

Retiring From Medicine

 

The final 100 pages discuss what to do with your life once you’ve left both your clinical and non-clinical working years behind. He refers to the financial phases of your life as the learning, earning, and burning years. I like the simplicity and rhyming structure, although I don’t like to think of the retirement years as burning money, exactly. I just plan to grow the portfolio more slowly then.




The mechanics of accessing your money are discussed. There could be more detail on which accounts to access when, how to do so efficiently, etcetera, but entire books exist on that subject. He mentions expenses that will drop when you retire and new expenses you will take on.

Social Security is discussed, and he makes an argument for taking your benefit early or at least not delaying it. It’s a controversial view that was the subject of a pro-con piece between Dr. Fawcett and Dr. Dahle, but it’s one that might make sense for certain individuals.

His aversion to debt is loud and clear, and I agree with him here. There’s no sense going into retirement with ongoing financial obligations that require a steady income. You may very well have that income in the form of a pension, dividends, or other passive income, and these are discussed, as well.

The lifestyle changes that accompany retirement are not ignored. He made a scary declaration that the state of “caught up” doesn’t exist. But that’s why I want to retire! To get caught up!

But, knowing myself, for every task I complete, I’ll create two more for myself, proving the good doctor’s point.

 

 

Travel, a keystone in many a physician’s retirement plan, is featured, and Dr. Fawcett offers up an alternative lifestyle — living on a cruise ship, which can be surprisingly affordable. The importance of health and fitness is emphasized appropriately, as are the importance of hobbies, friends, and relatives in maintaining an active and meaningful life as a retiree.

The final chapter briefly touches on estate planning before delving into charitable giving as another way to disperse any leftover funds that you won’t need in this lifetime.

 

Summary and Review

 

I liked this book. I don’t love the fact that he wrote and published it, because now I’ve got to make sure any book I might write someday is dissimilar enough to be worthwhile!

As he’s done in his other books, Dr. Fawcett uses both theoretical examples mixed with stories of real people including himself to illustrate the lessons he’s conveying. He goes into an appropriate level of detail on most subjects and often gives references for more complete study for those with a deeper level of interest.

While this book is probably not a great read for an early career physician unless he or she has become rapidly disenchanted with the medical profession, the mid-to-late career physician would certainly benefit from the information presented.

I’d tell you to pick it up as a gift, but there are no real gift-giving holidays on the horizon. I suppose you could give the book to a friend for Arbor Day or Earth Day, both of which are coming up in April, but you should probably make it the Kindle version. A paperback on Arbor day seems just plain wrong.

 


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Have you read this book? Do you know anyone that might benefit from it? If you do purchase via any links here, I will receive a few dimes, and I donate half of my profits to charity. Perhaps I could use the money to plant a few trees.

 

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22 comments

  • A paperback on Arbor day….haha. Killing me, man.

    I know for me there is a happy middle, which it seems like is discussed in those early chapters. I hope to fairly rapidly get pulled into the parts of my job that I love and to be able to separate from the aspects I don’t like at all. That’s certainly part of my financial independence plan, to have the leverage to ask for that.

    I cannot imagine leaving medicine completely, but sure can imagine cutting back to part time and focusing on other things I enjoy. For example, I find expert witness work to be absolutely fascinating. The cases are interesting. Reviewing them is also mentally engaging and intellectually rewarding. Oh, and it makes you a better physician, in my opinion. Forces you to review literature and to think about what you would do and what ought to have been done.

    I may give this one a go at some point, and will be sure to purchase it from your links. Thanks for the review, POF.

    TPP

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  • Retired Doc

    Just bought the book… I am currently on a break from medicine and am trying to decide if I want to go back to any part of it. At this point, I have had no problem filling my time but “everyone” tells me that I will one day regret it if I leave completely.

    • Vagabond MD

      Wow, it would be interesting if you were willing to tell the story behind your break, what you hoped to gain from it, and how you planned to return….as a guest blog, on the PoF Facebook group, or on the WCI forum. It’s pretty unusual for a doc to skip out and then return.

    • Retired Doc,
      Thanks for buying my book. If you really follow the advice in the beginning of the book and get full understanding of why you are wanting out, then you will not regret it if you choose to leave. I had one day during the first year when I felt some regret, after watching a movie about a doctor. My wife reminded me of what my reasons were and I was back on track. I wrote about this in a blog (Feb 15th) called “Will you miss medicine when you retire.” If you leave for the wrong reasons, you might indeed feel regret.

      When you talk about “everyone” telling you of the regret you will have, are they people who have walked that road? Get your advice from someone who has done it before. People who are not in medicine, like your mother or your plumber, or people who are still working and don’t know what it feels like to stop, cannot give you the advice you need. Find some docs in your town who have left and talk to them about how they feel. Or find a doctor who has transitioned to something you would like to do and ask them about it.

      Best of luck to you,
      Dr. Cory S. Fawcett
      Prescription for Financial Success

  • I’m curious if this is a new phenomenon with doctors wanting to leave traditional practice? I know you’ve cited the test you have to take every 10 years as one of the catalysts to you looking into FIRE, do you think that is a factor for other doctors as well? Or is it just harder to do the job in this day in age due to electronic medical records and insurance expectations/oversight?

    • AG

      The complexities of EHR reflect the complexities of medicine. I joined a practice that still uses paper records and the charts are almost worthless to me compared to EHR.

      Medicine constantly changes and what was gospel (“pain is the fifth vital sign”) later is found to have been awful (“the opioid crisis.”) One of my mentors practiced from the sixties until 2000 and once told me “just keep the blood sugar under 200 and it’s fine.” In his defense there was only insulin and a couple of pills with lots of side effects during his years in practice and now we have multiple drugs from multiple classes and as soon as one goes generic the formulary changes from “unproven benefit-not preferred” to “preferred drug.”

      Medicine is a surprisingly dog-eat-dog world. Docs are quick to criticize each other and our professional organizations battle it out: DO’s vs. MD’s, ACC vs. AAFP vs. JNC 6 or 7 (or 8.) Meanwhile many of us are now competing with PA’s and NP’s for jobs and patients-guess who gets the fun “well visits” and simple one-symptom visits and who gets the “all ROS positive,” “chronic pain,” “intractable edema,” etc., visits?

      The board certification issue is just part of the dog-eat-dog part of medicine. If I’d been born 4 years earlier I’d have a lifetime certificate. Funny how those in power at the time gave themselves a free pass. Now I’m suing my professional organization, and didn’t even know it until I read about it in a news article!

      Lawyers tend to get a bad rap, but many of the “lawyer jokes” out there could apply to physcians as well: It’s disheartening to read about greedy docs going to prison. It’s also sad (but necessary) that our medical groups must hire coders to review our charts for excessive billing. It’s sad that the government had to pass laws to prevent financial conflicts of interest between physicians and drug/device companies.

      • I’ve known a few docs who have missed the lifetime board certification by a year or 2; they were not pleased.

        I don’t know a ton about the medical profession, but it seems like it is designed from med school on to be very competitive, which probably feeds the dog-eat-dog nature you describe. Which is unfortunate because I think a lot of doctors got into the field to help people and it seems like that goal can be obscured by all of the ancillary factors you described.

        • AG

          Yes, it’s very competitive and expensive. I truly believe that financial pressures may lurk behind “naughty” physician behaviors. But here am commenting on a FIRE blog, so I may be biased!

  • Another great post. I should read the book. There is so much to read. I am an advocate for the slow path to retirement. I stopped OB and went to part-time. I am going to completely retire this summer. Only one season left. I have started blog a that is a surprising amount of work. I might be posting about my complete loss of identity after retirement or hopefully not. I am trying to increase my fitness, socialize with friends, volunteer, and travel. I may be going to Israel later this year. Time to renew the passport.

    • Zac

      Israel is wonderful. I visited it this past November. If you have any Abrahamic religious affiliation it’s a must-see!

    • Hatton1,
      I visited Israel last year and it was well worth the visit. It was great to see things I had only read about. Bible stories come to life if you have actually been in the spot they are describing. It was also interesting to eat the food of the land.

      Dr. Cory S. Fawcett
      Prescription for Financial Success

  • POF thanks for the nice review. It is sad that people want to leave the great profession of medicine. We will all be leaving it at some point in life. Some will be sooner than others. I left last year, 29 years after getting MD put behind my name. For some, it will not be an easy transition. Others made a mistake in choosing medicine for a career and can’t wait to get out. I wrote the book to help us all make a graceful exit when the right time comes.

    Thanks again for your work in teaching about FIRE,

    Dr. Cory S. Fawcett
    Prescription for Financial Success

  • I left my general practice in 2006 when my husband was doing a residency. I had saved “only” 1 million investable at the time. But I knew it was enough since we lived on my husband’s resident salary with money left over!

    I wanted to be home with my two children but I was also determined to save the money myself to allow that. Looking back it would have been smarter to just work part time like many of my two doc household girlfriends since my husband was training to be a surgeon. But I did not want to put undue pressure on my husband to be a surgeon in case he found out that he didn’t like to do it after his training.

    The many years of my FI has been FANTASTIC! However our licensing body recently imposed minimal clinical practice requirements which have forced me to work about 1 day weekly. As well my youngest is graduating high school this year so time to re-evaluate my plans again.

    I appreciate Medicine but I enjoy practicing on my terms much more.

    My husband always gave away his weekend calls when anyone wanted them and he would take 1 month off during summers since he started practice. We also did our best to attend all of our kids’ events while they were growing up.

    My husband could use your book Dr. Fawcett since will need to stop practicing someday!

  • Lupa

    Thanks for the review. I will definitely give this a look in the hopes that at least some of it is applicable to an international audience.

    Sadly I’m miles from FI and the only realistic option is a career change.

    Right now I’m trying to decide if I genuinely hate medicine, or if I just dislike my speciality, or (more likely) if I just really really hate being a registrar (resident).

    • Lupa,

      I hope you can find your answer in the book. If you are still a resident, you might try my other book, “The Doctors Guide to Starting Your Practice Right.” It is aimed at making a successful transition out of residency and into practice. You might find it very helpful at this stage in your life.

      Best of Luck and I hope you find your happy place,

      Dr. Cory S. Fawcett
      Prescription for Financial Success

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  • I want to read your book, but at 36 Im not mentally ready yet although financially I could. I feel like I should just suck it up a bit more and see if my attitude changes. Im changing jobs soon to a lower workload job 1500 miles closer to family. Well be back in our known culture and family/friends and have family help with the kids so I think my work/life balance will shift dramatically and my happiness with being a physician return to baseline.
    Having recent burnout and still recovering, I dont want to make a decision with clouded judgement so I’ll read your book in a few years.

    • aGoodlifeMD,

      Sorry for your recent burnout. Since you are moving to a new job, you might be better served by reading my first book, The Doctors Guide to Starting Your Practice Right. (Non-fiction book of the year, by the Idaho author awards) It contains a lot of tips to make the transition to your new job a smooth one and help you set up your new life so that it is better going forward. POF references his review of this book in the 5th paragraph of this blog.

      Another book you might find helpful is “Physician Burnout; A guide to Recognition and Recovery” by my friend Dr. Tom Murphy.

      Good luck to you,
      Dr. Cory S. Fawcett
      Prescription for Financial Success

  • Ruben Salinas

    How about getting a Masters in Clinical informatics. 71 year old Ophthalmologist part time working, but still trying to do something diferent?

  • Rr

    What about consulting with these firms like McKinsey, Accenture, etc? When I was in the last year of med school these firms came and talked to us about opportunities to work with them and it seemed as if that is a viable career option as you complete various mile stones such as med school graduation, residency, fellowship (they didn’t want you to quit before fnishing whatever part of the track you are currently on). I’m not sure if they consider applicants who are already attendings — perhaps it is more of a job geared those not beyond their 30s, but it seemed like an interesting job that pays similarly to medicine and has the potential to be even more lucrative if you turn out to be really effective. Major downside is that it seemed to involve full-time travel.

  • AQ

    After reading comments here, I get the feeling that medical doctors think they have some strange problem that others don’t. Doctors have the luxury of leaving or try another career because they are financially well off compared to many other professions. They can go back if something new does not work out. This is not the case with many other professions; most feel frustrated and miserable. Some degree of misery is common to all professions but many professions are littered with massive misery. All of my science friends tell me that the academic world is probably the most unhappiest in the world. Doctors should consider themselves lucky because their profession allows for greater degree of freedom than anybody else. Please stop making it sound like your life is awfully miserable. You complain about paper work and regulations; it sounds silly. Be grateful for all the opportunities you have.

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