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I retired from a career as an anesthesiologist in the summer of 2019, at the age of 43. Do I feel any guilt as a result of my early retirement?

Sure, a little. I could have worked another 20 to 30 years in the field. I chose to go a different direction with my life.

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To be honest, I feel like I can help far more people with this website than the 3 or 4 patients I could care for at a time as an anesthesiologist in a medical direction model. By having this website and its charitable mission, my guilt is greatly diminished.

Dr. Jim Dahle asked me to join him in answering a series of questions addressing the topics of guilt and early retirement.

Do we owe something more to society? Is early retirement immoral? Did I “steal a spot” from someone who might have worked longer? We address these questions and more.

This post was originally published on The White Coat Investor.

 

Dealing With the Guilt of Early Retirement

 

People who go to medical school are generally very selfless people. So selfless, in fact, that they sometimes feel compelled to work at a job they hate mostly out of feeling too guilty to quit. Here’s a good example from a comment on a blog post a few months ago:

I could retire financially, but I look at it differently than the early retirement enthusiasts. [Consider Fortune 500 execs, athletes, and performers.] Why in the world are these people still working? They certainly can retire, RIGHT NOW and not have to work again?

I think the answer, for pro athletes, Fortune 500 CEOs and lots of doctors and other working stiffs is the same.

In a sports metaphor- “they want to leave it all out there”. Do their jobs as hard and as long as they can….It is not ONLY the pay that keeps them on the field, in the corner office or in the OR. The pay is part of it, particularly for doctors. But the drive and ambition that got them that successful practice, big contract or corner office were not just about saving enough to scrape by while doing nothing.

The goal was never to do the minimum amount of work for a lifetime. In a medical analogy, why not save a bit more and then hire someone to stick a tube down your trachea and pump an ambu bag so you are relieved of the work of breathing for the rest of your life? Is indolence a goal?

I plan to retire in my mid 70’s, not because I want to, but because I project that is around the time I will no longer be able to produce at the level required. If that time comes and I am still able, then I have no intention of quitting.

I do NOT like my job, let alone love it, but it is the best job I can get, so I will do it as long as I can. Retiring because you have to is part of life. Retiring because you want to is just laziness.

I was 100% with him, right up until the point where he confessed that despite his financial independence he not only didn’t love his job, but he didn’t even like it. Financial independence is about doing what you want to do, whether you get paid well for it, paid poorly for it, not paid at all for it, or pay for it yourself.

Today we’re going to talk about guilt and our careers and some of the arguments I have seen well-meaning people put forth against early retirement, part-time work, and sabbaticals. I’ve invited our own Physician on FIRE to assist me in addressing these issues. It’s not really a Pro/Con piece, since we’re both pretty much in agreement, but I hope to give you two perspectives on each of these subjects.

 

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Q. Don’t Physicians Owe Society For Putting Them Through Medical School?

 

The White Coat Investor

I hear this a lot from all kinds of docs. I guess the idea is that because the state government paid some portion of your med school tuition and Medicare dollars were used to pay your salary during residency that you cannot retire early. I think people who believe this simply haven’t really thought the whole thing through logically.

First of all, the state government didn’t pay any of my tuition. The military paid the whole out of state tuition bill. And what did they demand for doing so? They demanded that I be at their beck and call for four years. After residency, I was at their beck and call for four years. Obligation paid.

Since your state government contributed an even smaller fraction of the cost of your education then the military contributed to mine, at most you might “owe society” 1-2 years of time practicing to fulfill that “debt.”

More importantly, what are the real inputs to making a doctor and how many of them came from government/society? While there is the cost of tuition, and there is the cost of a resident’s salary and benefits, those pale in comparison to the other inputs- the doctor’s efforts and the prime years of that doctor’s life.

The doctor put FAR MORE into her education than society did. So who is really at a loss when a doctor retires early, goes part-time, or has large gaps in her career? The doctor is. So if the doctor is the main one losing out, whose business is that besides the doctor’s?

 

Physician on FIRE

I don’t remember all of society waking to round at 0400, staying in the OR until midnight, or pulling all-nighters for exams. That was me!
I suppose the question refers to society “putting me through medical school” as financial support. The same could be said of residency, which is partially funded by Medicare dollars.

As a product of public schools from kindergarten through MS-4, my education has been supported by tax dollars every step of the way, as has the education and training of every single classmate of mine at every level. That investment results in some people who serve the public altruistically for many decades, some who drop out before finishing high school, and every permutation in between.

If the expectation is that everyone who has benefited from public education goes on to do something that benefits society, I feel pretty good about what I’ve done, even if I only worked 13 years as an anesthesiologist. I’ve added value and provided a needed service. That is not true of numerous professions, some of which genuinely hurt people and exist largely for personal gain.

Speaking of contributions, I contributed nearly $2 million in taxes over a 13-year career. If I owed society a return on its investment in me, I’ve already paid that debt back several times over. I can’t say I haven’t benefited from personal gain in this career; in fact, I’ve earned enough to never have to work again if I so choose.

I see my career not so much as a contribution to society, but as a transaction with society. I do something useful and am handsomely rewarded. If I did it for free, I would be inclined to call it a contribution.

 

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Barbi does not approve of my early retirement

 

Q. Given the Rarity of Your Knowledge and Talent, Is It Morally Wrong to Not Work As Much As You Can?

 

The White Coat Investor

This is a bit of a riff off of the previous question. But let’s apply it to some other professions. Can you imagine someone asking this to Lebron James? “You’re so good, why don’t you play in a game every night?” “Why can’t you play all 48 minutes?”

At a certain point, it becomes nonsensical. Nobody asks this to performers, athletes, executives, janitors, teachers etc, so why would it apply to physicians?

 

Physician on FIRE

It’s a supply and demand issue. If the supply becomes too low or the demand quite high, perhaps changes could be made to make the job more enticing.

Instead, we see increasing layers of bureaucracy, frustrating implementation of electronic health records, lengthening and tedious credentialing applications, new metrics and patient satisfaction measurements, etc…

I question the morality of those who increase the burdens of practicing physicians, often to their own benefit, such as those forcing Maintenance of Certification on us while padding their pockets with the proceeds. In a free society, we should be able to work as much as we choose, not as much as we can.

 

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Q. How Could You Take A Med School Spot From Someone Who Would Have Worked A Full Career?

 

The White Coat Investor

Who hasn’t heard this one? But usually, it is applied to an underrepresented minority or a woman who is presumed to have “stolen” a spot from a white male. It gets applied just as easily to those who retire early, go part-time, take time off to raise a kid, etc. Here is my response to that: There was no contract you had to sign when you applied or matriculated to medical school specifying a certain amount of work would be done later.

The applicant most likely had no idea how much he would like to work in his 50s, and the school had no idea if this student really “had an interest in rural family practice” as he wrote in his essay. 10 years later, he’s an ENT in the capital city. Life changes. Both the school and the student took on that risk when they hooked up for this crazy journey.

 

Physician on FIRE

Woulda. Coulda. Shoulda.

To be honest, as a college junior applying to medical school, I had no idea what my future would look like. I would not have guessed that I would end up in anesthesia, or that I would find the possibility of retiring early appealing. I didn’t pursue this path; early retirement chose me.

If we apply the question more broadly, we need to consider those dozens of students who graduate from medical school in the Bay Area or other places with no intention of pursuing a residency, choosing instead to cash in by joining a tech or biotech startup.

I say more power to them. Medical school acceptance does not imply indentured servitude. If studies were to show that members of a particular gender and ethnicity work, on average, a 15% longer career, should medical schools take only people that fit that demographic? Of course not.

Take the best, hope for the best, and understand that for a myriad of reasons, some graduates will not be full time practicing physicians for several decades.

 

 

Q. Don’t You Owe Your Spouse A Very Nice Lifestyle For Putting Up With You Through Training and Career?

 

The White Coat InvestorSociety isn’t the only one you may owe for your education. Maybe your partner busted his butt to get you through with minimal debt. He stayed up all night feeding that kiddo while you were on 36 hour calls. He sacrificed his own career, his own health, and his own dreams so you could be a doctor. Don’t you think you owe him a “doctor’s lifestyle” for that?

My answer? Every relationship is unique. Maybe your spouse would rather have you home for dinner at 5 than some extra money and prestige. Maybe he would rather you actually get to stay for the entire vacation rather than fly home halfway through to work some shifts. Work it out amongst yourselves. Maybe you do owe your spouse something. Make sure he or she gets paid.

 

Physician on FIRE

I gave my wife a better lifestyle by working less. The more we talked about our future plans, the less excited she was about having me keeping a doctor job.

In my final position, I was on call 20% of the days on the calendar, which means my wife was effectively single parenting our boys 20% of their lives. Actually, it’s more than that, because she often chose to spend most of the summer at our modest second home, and I was 500 miles away most of that time. When I cut back to part-time, our lifestyle will improved quite a bit. It only got better when I attained the same amount of freedom, and we can now travel the world as a family.

OK. I’ll admit I’ve ignored what the question probably implies when discussing “lifestyle.” The word lifestyle is often equated with spending, and I strongly disagree with that notion. Lifestyle is more about having the freedom to live the life you want to live, and mine involves less work and less stress.

But, since we do talk about money quite a lot on our sites, we’re at the point where we could spend $100,000 a year without violating a 4% safe withdrawal rate, but when I actually tracked our spending for a year, we only spent $62,000. If we wanted more, we would spend more. We’re not big shoppers or big spenders, but we do spend on meaningful family experiences, like our family trips to Paris and Reykjavik, Hawaii, and Mexico.

 

M3 Global august 20202

 

Q. Do You Owe It To Your Patients To Work Full-time? i.e. Is a Part-time/Multiple Sabbatical Doctor a Crummy Doctor?

 

The White Coat InvestorThis is one I’ve actually seriously worried about as I’ve cut back on shifts (and am considering doing so again.) If I’m going to do something, I want to do it well. If working part-time means I’m a crap doctor, then I’ll work full-time until I can’t take it anymore or simply want to do something else even more, and then quit. But I think there is some middle ground here.

I’d be pretty hesitant to go part-time in your first five years in practice. But after that? I think you can stay just as competent working 1/2-3/4 time. 1/4 time? I think you probably lose a step, but hopefully not to the point of being dangerous. One benefit of working less is you are less burned out, your compassion meter is much more likely to be at 100% when interacting with patients, and you are much more willing to come in early, stay late, and work hard while you’re there knowing you have the day off tomorrow.

 

Physician on FIRE

In my opinion, a burned-out doctor is crummier than one who has defeated burnout by working part-time (like The Happy Philosopher), or taken an extended sabbatical (like EJ from DadsDollarsDebts). Most physicians who pursue part-time work are doing so to live a more well-rounded life, making more time for family, for travel, or other pursuits that give them a life outside of the exam room.

This is not to say that most full-time physicians are burned out. A recent study has shown symptoms of burnout in more than half of the respondents, but plenty of doctors are perfectly content to work full time or more. However, if you are feeling like you’d rather take a huge pay cut to work less, you might owe it to your patients to not work full-time.

A part-time physician has more time to read journal articles, participate in CME, and engage in non-work related activities to improve the mind, body, and soul. As long as the doctor remains engaged with his or her profession, I would have no hesitation having a part-time physician care for me and my loved ones.

 

Q. Is It Fair To Your Partners/Employer For You To Be Taking Lots of Maternity/Paternity Leave? 

 

The White Coat InvestorHere’s a touchy subject. Everybody knows it is illegal to discriminate against hiring women even though everybody knows that most women who are coming out of residency are going to have a kid or two at some point in the next five years. Now even men are getting in on the paternity leave act.

Here’s how I look at it: Medicine is one of many things I do, and certainly not the most important. Sometimes things that are less important have to make way for things that are more important. Groups of physicians need to figure out a way to make sure these important things are taken care of for parents. But just as importantly, they need to make sure that those who remain single and/or childless aren’t getting continually hosed by it. You shouldn’t have to work every Christmas morning just because you don’t have any kids at home.

Physician on FIRE
This is a human resources issue, and I’m not sure “fairness” comes into play. I do believe that the guidelines should be spelled out clearly and that all affected parties should know and understand the policy.

The same is true with any time away from work, whether it’s vacation time, medical leave, a sabbatical, decreasing call, you name it. There is X amount of work to be done by N number of people. When N becomes (N – 1) or (N – 2), plans need to be in place to make sure X still gets done. Locum tenens physicians can play a role here.

Resentment and anger are more likely to come into play when clearly delineated policies are not established. Legal issues can arise in larger groups (50+ employees) if policies are not consistent with the Family and Medical Leave Act.

The smaller the group, the larger the impact of any kind of time off. When I started working 40% fewer shifts, each of my partners worked 10% more. Pay was adjusted accordingly, and everyone wass happy. If my colleagues hadn’t volunteered to pick up my slack, I wouldn’t have pursued the issue further.

 

 

What do you think? Do you feel any guilt about working part-time, taking sabbaticals, or retiring early? Why or why not? What (if anything) have you done about it? 

 

26 thoughts on “Dealing With the Guilt of Early Retirement”

  1. As a former marketing executive, I can tell you that there are far less comments on abandoning my vocation. No one needs another marketing devil to run the world. At the same time, about a month after early retiring, I struck up a conversation with a guy my age in a long movie theater line who was working hard for his family. He was a first generation immigrant. When I asked what he and his wife did he said he was a doorman and his wife was a ‘cleaner’ at a hotel. It really put the great fortune of my situation in perspective.

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  3. My net worth just passed 20M. Yet I continue to work. Working and contributing to society is simply in my DNA.

    The company that started with an idea in my head now employs 165 people. Most of them earn a six figure income. It feels a little weird, but I continue to feel that I need to “earn the oxygen that I breathe “.

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  4. The constitution guarantees me the right to Life, liberty, and the pursuits of happiness.

    My responsibility is to myself. I did the hard work and sacrifice so I reap the rewards.

    I retired at age 56 when investment income replaced practice income.

    I view this as stepping aside to make room for a younger person.

    I’ve been retired 5 years now and it’s the second best decision I’ve made. Going into a profession that allowed me a chance to become financially independent was the first best decision.

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    • Life is a balance. I balance my responsibility to myself with my responsibility to my family, my community, my country and finally to the world we live in.

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  5. I gave up on fairness in life a long time ago. However, for those who believe there is a an order, wouldn’t that order suggest that the dollars you earn somehow reflect your contribution? If so, having the dollars = contribution paid. I left traditional full time work 15 months ago. However I still apply myself every day. What is the contribution of me writing songs with that time, writing a blog to help others and myself with that time, being a more present father with that time, teaching part time, or being more fit with that time? I could make a strong argument philosophically for pursuing all. For me personally it is only important that I engage with that time I have while I do have it

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  6. @PoF: Unrelated but I’m getting ready to start 4th year, applying to Anesthesia. I was looking at your trip to Honduras and planning a global health trip for next year. It seems that staff varies by the brigade. Did it seem like med students would have been able to join the trips you’ve been on with them?

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  7. This is such a great post!! My thoughts exactly POF- the key is that Dr. Ziggy is his own boss. I’m a CRNA and my husband is a physician. My husband loves his job but it is because he chose a specialty where his is his own boss, has a great lifestyle and is highly compensated for his work. He also takes a lot of vacation so maintains a great work life balance. I on the other hand have come to the realization that I not happy with my job. There are a number of reasons but the biggest is that I am not my own boss. I think this is a huge factor leading to burnout for physicians as well so I have concerns for my husband as private equity becomes more popular. I have Continued to work for the past 15 years as a CRNA because I put a lot of time and energy in my education and it is in my DNA to work hard so I totally understand how the anesthesiologist feels in your quote above. Many time our identity is wrapped up in our jobs and we desire contributing to society in a meaningful way. I applaud POF for being a voice speaking out against our materialistic culture. I think the key POF is that you retired to something meaningful- it isn’t about money but you are still feeding the need to contribute to society in a meaningful way. It is hard to walk away from a career at a young age until you have somethings to move towards.

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    • I also really identify with your point about part-time physicians having more in the compassion department and more time to advance their education in their chosen specialty. As the wife of a busy doctor and mother to multiple children, I’ve had to let a lot go of a lot in order to continue working as a CRNA. I decided if I ever gave an inferior quality of care because I work less than my colleagues, I would quit working. I had to give up putting in fancy peripheral blocks, taking OB shifts, etc and instead focus on giving my patients the best care possible by continuing to stay updated on evidence based practice and treating each patients as if they were my own family. This requires I put hours into reading journals when I am not at work. I find that many of my fellow CRNAs that work a lot more than me are not as on top of current literature. I’ll stop being a CRNA soon and contribute to society in another way but I just haven’t quite figured what that part out yet.

      Reply
  8. Perhaps it’s my head of grey hair, or the fact that I just applied for Medicare, but acquaintances often ask me when I’m going to retire. It’s a vexing question. While I encounter frustrations at work, they are far fewer and less stressful than those I experienced as a resident (2 residencies) and as a fellow, so working as an attending doesn’t seem so bad. In terms of income, I could probably retire tomorrow if I wanted to live LEAN FIRE. I have a feeling that FAT FIRE is more my style, however, and I’m not there yet. Income aside, I have plenty of other passions besides medicine to keep my busy (i.e., writing, scuba diving, family).
    But the main thing is, I finally feel that I am getting GOOD at what I do (clinical neurology). Seems a shame to retire when all that training and experience is just beginning to pay off! Caring for patients is a lot more enjoyable when you have the confidence of training, experience, and actually know what you are doing!

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  9. Great article. The whole concept that people owe the world their continued labor seems like some kind of ancient systematic brainwashing. One to keep the peasants in line for continued service to the kingdom. I left my engineer career at age 51. It was getting increasingly harder to maintain my high level of accomplishments and compete with younger and the more eager-to-please-the-master peers. I could have stayed on but I left at the top of my game so to leave them wanting. Long before there were signs of decline in attitude and capability. Early retirement guilt? None. I chose FIRE so I could pick and choose where I contribute my skills. As an MD with unique skills you can do that far easier than I. You’re spot on, no guilt necessary and you’ve paid your dues to deserve the life you have chosen.

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  10. I keep reading about a looming doctor shortage. However, it also appears that doctors are facing soaring malpractice costs, ballooning administrative work loads and increased interactions with insurance companies. Add in Medicaid and Medicare payments that don’t always cover costs and it’s no wonder doctors are younger and younger when deciding enough is enough.

    You don’t owe anybody anything after paying loans back and meeting service obligations. If society wants more doctors, (especially general practice) these and other issues will have to be addressed.

    And I don’t want to contemplate what the secondary and tertiary effects on the doctor shortage will be should M4A be passed.

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    • We don’t owe anyone anything but I personally am happiest when 1) my life is in balance and 2)I do things for people other than myself.

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  12. Right on! POF you rock!
    I am an anesthesiologist who will probably “retire” at 47. Time is the most precious currency anyone owns. I think JL Collins said the only thing anyone owes society is to not become a burden. There is a big wonderful world out there and life is an adventure. Go!

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  13. The guilt typically comes from “What will other people say?”. But it’s really time for us to think about ourselves, even if it sounds selfish, because if we are not mentally and physically okay then we will be doing more harm than good.

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  14. I haven’t noticed many folks caring all that much when the anesthetist, ER doc or radiologist early retires.

    But let’s see a popular female doc early retire into the same community as her patients and see how that one flies.

    It should not be that way. But it happens. I think it should have been relatively easy as an anesthetist PoF.

    You put it on the internet but you benefit from income from it.

    No pain, no gain as they say.

    Reply
    • Would anyone care if the retiring popular female doc was an anesthesiologist, ER doc, or radiologist?

      I think specialty does make a difference, and primary care physicians with their own roster of patients will receive more ire from those patients, as noted the previously published Physician Retires Early and is Met With Scorn.

      The rest of us get it more from resentful physicians than anyone else, it seems.

      Does gender play a role in the public’s perception? Maybe. I think society more readily accepts a woman retiring to stay home and help raise her children. It raises more eyebrows when a father does the same. Ultimately, it’s a free country, we have free will, and we shouldn’t be too concerned with what others say or think about our choices.

      Best,
      -PoF

      Reply

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