You may think his career has been rather atypical until you realize that a story like this is closer to the norm than the exception. I’ve read that between one half and two thirds of physicians leave their first “permanent” position in the first few years after residency.
I didn’t realize it at the time that I penned it, but when I came up with the headline, I was clearly channeling another Doctor who goes by the name of Suess. From Oh, the Places You’ll Go!:
You won’t lag behind, because you’ll have the speed.
You’ll pass the whole gang and you’ll soon take the lead.
Wherever you fly, you’ll be best of the best.
Wherever you go, you will top all the rest.
Except when you don’t.
Because, sometimes, you won’t.
When Your Physician Career Doesn’t Go as Planned (Because It Won’t)
I’m a 35-year old Physician Anesthesiologist, and my life and career just haven’t quite turned out how I expected.
I became interested in medicine, as many of us do, through personal experience. After a nearly year-long bout with a chronic Strep infection as a child, and requiring corrective orthopedic surgery as a teen, I knew that I wanted to dedicate my life to helping people live healthier lives.
During my second year, I developed a love for cardiovascular physiology and entered my third year aiming for a career in cardiology, or even cardio-thoracic surgery. It turned out that all the general surgery residents I met were miserable, and I hated nothing more than going to clinic. So, as you may have guessed, I became an anesthesiologist so that I wouldn’t hate my job.
I matched to a good out-of-state residency in 2008, and couldn’t be more happy with the career I chose.
Residency and an Awakening
Starting residency at the beginning of the Great Recession proved pivotal in our financial lives. My wife and I married while I was in med school, and knew essentially nothing about money until we felt the pressures of parental responsibility after our first daughter was born. We recognized the spending habits we’d had in our early twenties weren’t going to provide for much financial stability.
During those years of national economic difficulty, a new collective consciousness seemed to arise among professionals, which placed value on financial responsibility over consumer spending. An awareness that keeping up with the Joneses and living a lifestyle of entitlement had severely handicapped the previous generation of physicians.
That awakening, combined with our limited resident salaries, forced us to reprioritize our lackluster spending habits and live life with a financial plan. We learned to only spend money on things that added actual value to our lives and to ignore the societal pressures to dress a certain way, drive a certain vehicle, and meet certain lifestyle expectations.
During residency, our family grew from three to four. After doing some figuring, we realized that the amount of money my wife could earn would pay for childcare and not much else. For us, there was tremendously more value to her staying home with our babies, than for her to work just to pay someone else to raise the kids.
In 2010, I was diagnosed with autoimmune kidney disease. This new life challenge placed an even greater emphasis on responsible financial management. My health has been stable since the diagnosis, but there’s nothing quite like the possibility of losing one’s income potential to change one’s approach to life and finances.
As my residency career advanced, the number of available jobs and starting salaries seemed to decrease annually. Older physicians, who had taken a hit during the recession, just weren’t giving up their jobs, and existing groups were trying to conserve capital in the face of downward pressure on physician reimbursement.
My wife and I knew we wanted to move back to Central Texas to be closer to my family and because of the very reasonable cost of living. But, it turned out that Central Texas was one of the areas that seemed to be less hard-hit by the recession, so everyone else wanted to move there, as well.
The First “Permanent” Attending Position
My first job out of residency was in a rural community just outside of Dallas. My wife and our two kids started saving like crazy. We recognized the trend towards decreasing physician salaries, and we wanted to maximize the benefit of my income. We paid off my $128k of student loans in a year and a half, built an emergency fund of six months of expenses, bought a minivan, and welcomed our third and final kiddo into our family.
I enjoyed the group I worked for. We served a wonderful, albeit challenging, rural patient population. Our group employed 28 nurse anesthetists and anesthesia assistants. I stepped in and managed their vacation scheduling, sick day requests, and other personnel issues, resulting in an uptick in overall employee satisfaction.
Our busy practice, however, left me feeling a little disappointed. I spent the majority of my days doing histories and physicals and very little time actually caring for patients. After working for about a year, a national company came in and bought the group that I worked for.
Suddenly, my ability to become a partner changed. Because of my pre-partner track, I did not benefit from “buyout” money that our senior partners received, and my track to partnership became muddled with conflicting promises that never did quite find their way onto paper. I realized newly increased buy-in costs, delayed years to buy-in, and a net decrease in attending salaries would cost me nearly a million dollars over the next three years.
The Second “Permanent” Attending Position
So, I became one of the nearly 70% of physicians who leave their first job in the first two years. A job opened up about an hour from where my parents live, in a physician-only group. We seized the opportunity and moved about three months later.
My wife and I purchased our first home and finally replaced the car I was driving, a car my wife had owned since college. I have been happily settled at my current place of employment for nearly four years. I became partner this last summer, and am currently serving as the anesthesiology chief at one of our local hospitals.
During that period of time, our home, which had been renovated prior to purchase, developed a leaky roof that couldn’t seem to be fixed, despite having the entire thing replaced. It also had a number of high-end finishes that simply weren’t intended to be used by small children.
Then our kids got bigger, and the house’s layout became suddenly challenging. We determined we could live in it for another five or six years, but then the cost for needed replacements would be higher than what it would cost to sell early and buy something newly built.
So, we sold our first home and started building a higher-end tract home, on a beautiful lot in a nearby neighborhood. But after several months of the builder making floor plan changes, changes to the exterior stone color, and ignoring essentially every custom selection we had asked and paid for, we had our doubts. Sounds like fun, right?
We bailed. We were able to find a house in a phenomenal neighborhood, and after a little DIY elbow grease, it’s a perfect fit for our family.
Finally, over this last year, our large group has taken a pay cut as local hospitals (under national pressure) have stopped paying certain guaranteed revenues that had previously covered under-insured patients.
That’s quite the adventure, huh?? I love my career in medicine, but there seems to be an alternative plan to the quite predictable life that I envisioned in my premed and medical school years.
So, how do/did we deal with all of the changes?? We developed some skills that allow us to adapt to life’s shifting norms.
Lessons From My First Five Years as an Attending Physician
1. Have a plan!
We only get one shot at this thing called life, so decide what kind of life you want to have. Then figure out how your finances best line up with that. For me, receiving an auto-immune diagnosis has made it easier to say “no” to certain luxuries, and to make sure we are storing adequate financial reserves for our future.
I’ve also realized, I may not want to do medicine full time till I’m 65. As much fun as I’ve had sacrificing nights, weekends, and holidays, I would so much rather spend those with my family and friends. On our current trajectory, we should be FI in under 10 years. Once we’ve reached FI, I don’t know that I’ll give up clinical medicine entirely, but I would love to dedicate some of my time to other meaningful interests in my life.
2. Be flexible!
Life changes. Your plans shouldn’t be so etched in stone, that they can’t survive a few surprises. When you face a major life change, take the time to redevelop your life plan to meet the new changes, and ADAPT. Not all change is bad!!
3. Live within your means.
It’s so tempting, when finishing residency, to buy that big house or that luxury car or status symbol. We chose to rent modest dwellings during medical school and residency even though many of our friends bought. After comparing notes at graduation, we actually came out ahead on housing costs. In our case, there was the recession to consider, but I’m not sure the results would have been considerably different given today’s real estate trends.
As Americans and professionals, many of us have ideas of things we “need,” and some of us may have even had financial motivations to select our field of expertise. A great question to ask yourself is, “Does this purchase/experience enhance or otherwise add value my life?”.
In the times where it does, and you can afford it, do it. For me, I have a yard that’s about an acre, and I choose to have a landscaping company mow it. For $50 I can have someone come and do 3 hours worth of work, freeing me up to spend that time with the family. My son, who is eight, has expressed interest in learning how to mow. Later this year, it may provide him a good opportunity to “earn a living”.
My wife and I made a habit of saving, even in residency. After funding an emergency account, most of our money went into a Roth IRA, and it is still the account that I have the most sentimental value for, even if it’s not the most valuable. Saving during those leaner times meant that we had to sacrifice some conveniences, but I can’t seem to really remember what those were.kids 529’s. We accomplish this by choosing a low cost of living area and by making active choices about what we spend our money on.
Saving the first million dollars is really not a lot of fun. The first half was great! Every dollar that you sock away increases your account value significantly, but somehow, after you pass the halfway mark, it seems like the balance gets STUCK at one particular place, and never advances. Stick with it!!
Most of the financial books and blogs you read say the first million is the hardest. We should reach that milestone by the end of the year. Here’s hoping!!
I know there are lots of opinions out there about this one. We have always made it a point to give a minimum of 10% of our gross income each year. Some of that money we’ve given to our church or local organizations that build and serve our community, and to individuals that we know facing unexpected emergencies.
Last year, we helped some friends with unexpected legal costs involving custody of their daughter. Having been given so much in life, we feel the privilege, and responsibility, to care for those around us and to share what we have with others.
[PoF: I like to encourage giving to and from a donor advised fund to get the most bang for your donated buck.
6. Life isn’t all about money.
This year I celebrate my 5th year in private practice, and I am beginning to develop some new perspectives on life. I enjoy taking care of my patients. I enjoy group administrative activities.
But, sometimes I sometimes feel stunted, and that being a physician leaves a few of my buttons un-pushed. Like many physicians, spouses, and parents who may have sacrificed for the “plan”, I’m in the process of re-discovering some buttons that I’ve completely forgotten over the years.
In the end, it’s not about whether or not your portfolio allows you to remove 4% annually, and still leave you with something to pass on to the next generation. It’s about what you make of this life and the opportunities that you are given every day. Find the thing that makes you excited, that once-in-a-lifetime memory, that purpose that will define you, and LIVE IT!
I’d like to thank our guest author for taking the time to share his insights with us.
Did the first five years of your career go exactly as planned? Did you end up switching jobs? What lesson(s) did you take away from your experience in launching your career?