Six Months of Part-Time Work. Or How to Save $60,000 on Taxes.

In 2017, I executed a bold move based on a decision I couldn’t have imagined I’d be making in my early forties. I made an intentional choice to slash my income by 40% while showing up for work quite a bit less.

I had been contemplating such a move for over a year. Time and time again on this site, I would sing the praises of financial independence (FI) and all the wonderful things you can do with FI to give yourself a better life. Why was I burning the candle at both ends, working full-time while spending much of my free time spreading the word online?

I didn’t have a good answer to that question, and I wasn’t interested in taking a step back from my online activities, so I decided to pursue working less in my anesthesia job.

I didn’t think a part-time position would be readily available in my current position, but I was pleasantly surprised when we were able to make it happen. My four partners were willing to work and earn 10% more each, allowing me to work 40% less.


The Financial Implications of Part-Time Work


Part-time work is admittedly easier to arrange in some situations than others. Factors that make such an opportunity more likely include being part of a large group, working in a shift-based specialty, and perhaps being an employeed physician.

If you own a private practice and have significant overhead, are part of a small group, or are in a specialty where long-term patient relationships are paramount, part-time work may be more difficult to arrange.

If you fall into the latter categories, I wouldn’t throw in the towel. Creative solutions may allow you to work less if that’s what you really want to do. Locum tenens physicians can help fill in the gaps. They won’t replace you (no one can replace you!) but many locums docs are quite capable. 50 / 50 job sharing may be an option — it works for The Happy Philosopher.

You may also have the option to sell or leave the practice and be a locum tenens provider yourself. That’s all I did the first two years of my practice, and it’s what Dr. Nii Darko of Docs Outside the Box does as a trauma surgeon to create a flexible schedule that meets his family’s needs.

Likewise, the financial impact of part-time work will vary depending on your situation.


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If you’re lucky, the drop in compensation will be commensurate with your drop in workload. If you’re really lucky or maybe just smart, you might find a way to drop the low-value hours in your workday, or leverage additional hires to drop your workload significantly with a smaller reduction in earnings.

On the other hand, it’s not unusual for a physician to be in a situation where a reduction in workload results in a disproportionately large drop in pay. Working 30% less while earning 50% less is certainly far from ideal, but that may be the case if you own a clinic, have employees, or have other significant fixed expenses related to your practice.


My Part-Time Work Arrangement


Again, I consider myself lucky to be in a situation where dropping to part-time was surprisingly easy. It’s not pure luck since one feature of anesthesia that attracted me was the flexibility of the schedule and lifestyle, but I’ll readily admit I had an easier time making this shift than most will.

Years ago, I worked exclusively as a locum tenens provider for the first two years after finishing residency, working hard most of the time, but I also took my first three-week vacation when I was less than a year into my anesthesia career.

My bride-to-be and I visited Iceland, England, Ireland, and Italy in one long trip. It was fantastic, but before long I started working regular jobs and it would be over a decade before I’d be off work for that length of time again.


Reykjavik Duck

a duck keeps watch over lake tjörnin


For six months, I had a three-week break nearly every month. My work schedule looked like this:

  • Work four days (usually consecutive) at our outpatient surgical center. That’s about a 40-hour workweek.
  • Work 72 hours at our hospital. Usually, at least half of the long weekend (Friday morning to Monday morning) will be home call, but weekends can be busy at all hours, particularly during the summer months (both of them).
  • Enjoy the rest of the month off.


This schedule represented a 40% reduction in my clinical workload from my previous full-time schedule, which was admittedly designed to allow for a very reasonable work-life balance in the first place. Still, I was quite happy to tip the scale more to life and less to work.

The result was a 40% lower salary than I had as a full-time employee. I still had full benefits, a feature that I’m told is provided for physicians working at least a half-time job in our health system.

Now, 40% less than a rural anesthesiologist’s salary is still a handsome salary. Taking advantage of geographic arbitrage here in the upper midwest, a place where for some reason not everyone wants to be (horrendous cold and snow, funny accent, mosquitoes in the summer), we earn an above-average salary. According to Garrison Keillor, all the children here are above average, as well.

Rounding to avoid using my exact salary, let’s say I was making $400,000 per year before. With the part-time schedule, I’m making $240,000. Let’s also say the benefits package is worth $50,000.

Effectively, my total compensation dropped from a value of $450,000 to $290,000. That’s a 35.6% reduction in compensation for 40% less work. If I were to work 50% less than full-time, earning $200,000 and receiving the $50,000 in benefits, that would represent a 44.4% reduction in total compensation.

In a previous post announcing my part-time employment, I did a detailed analysis of the tax implications. I learned that my after-tax pay is roughly 40% higher on the shifts I’ll be working as compared to the shifts I’ve given up. That’s another tick in the win column.

How do I come up the $60,000 in savings? Well, I expect to have online income that, when combined with my larger clinical income, will push me close to or into the 32% federal income tax bracket. Add on the 1.45% Medicare tax and a 9.85% state income tax, and my marginal tax rate on the $140,000 I’m not earning is 43.3%, resulting in a tax savings of about $60,000.


Part-Time Work with Fixed Costs


If I were still working exclusively as a locum tenens provider, the math wouldn’t look so rosy. My benefits would represent a fixed cost rather than a fixed benefit. Let’s say working full-time as a locum, I could gross $500,000 with $50,000 in fixed costs to cover my benefits. That works out to the same total compensation of $450,000 for full-time work.

Working 40% less would result in $300,000 in gross income, minus $50,000 in benefits for total compensation of $250,000. Now I’m earning 50% less for a 40% lighter workload. Working half-time at 50% less works out to $200,000 in total compensation, or a 60% reduction in net income to work half as much after accounting for the $50,000 in fixed costs.

The math can look much worse for a solo practitioner with fixed overhead that could add up to tens of thousands of dollars per week. If you have to shut down the office while you’re away, the actual cost and opportunity cost of taking time off can be enormous. This is where more creative solutions to keep the practice running in your absence can be invaluable.


What Do You Do With Three Weeks Off Per Month?


That’s a great question! What would you do with three weeks off per month? It’s fun to think about, isn’t it?

In our first month of partial freedom, I attended a couple of four-day conferences in the latter part of the month  — one for anesthesiologists and the other for bloggers.

My wife’s primary job has been to raise our young boys. Now that they’re both in grade school, she has done a little substitute teaching at their public elementary school, but it’s a very flexible position with maybe a few shifts a month if she’s interested.

Our boys’ teachers and principal have been generously flexible, allowing us to disappear for a few weeks at a time as long as they stay in touch and get some schoolwork done while away.


We Travel!


In November of 2017, we took our first big trip, spending three weeks in Guanajuato. The getaway was a wonderful family experience. We learned some Spanish, explored Mexico’s central highlands, and spent all of our days together, rather than running in different directions as we so often do at home.

December brought the holidays, and we were able to spend ample time with family in two states. I was hoping to have a reason to travel to a decent Bowl game, but alas, my home team struggled in 2017, so I’ll have to wait for another year or ten for that.

January had me traveling twice as the Physician on FIRE. Early in the month, I flew to Florida to hang out with some awesome people at various points along their FI paths at Camp FI near Gainesville.

I was off to New York City at the end of the month to see a few friends and witness the ringing of the closing bell as a guest blogger at the New York Stock Exchange. Such a cool experience, and I totally got on TV, lurking behind the talking heads on CNBC.



By February, we were overdue for another family getaway. I had registered for a four-day anesthesia seminar in Hawaii, and we decided to tack on another 19 days before and after, exploring three of the Hawaiian islands. It wasn’t a frugal trip by any stretch, but you can’t witness the grandeur of the Hawaiian mountains, beaches, volcanoes, and waterfalls without spending some dough. Money well spent.

I went straight from Oahu to Park City, Utah to be a speaker at the White Coat Investor’s Financial Literacy Conference in early March, and by the time I got back to work, I hadn’t been home in a month and hadn’t seen an operating room in about six weeks. To make up for lost time, I performed double duty with a busy work schedule in March.

That spring, my family and I traveled to Honduras for a medical mission.

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I performed anesthesia at a surgical center while my wife and boys spent time with the children at the on-site orphanage which provides a home for up to 500 children.

Much of our travel is paid for via travel rewards points from cards like these.

I may not be working as much, but I’m clearly no less busy than I was before. I’m just busy doing more things I’ve been wanting to do, and less time doing the things I’ve felt I had to do. Financial independence has given us the freedom to make that choice


Is Part-Time Work a Viable Option?


I certainly recommend it for those who can afford it and find a way to make it happen.

How do you determine whether or not you can afford part-time work? That’s a personal and family decision; you’ll have to examine your current financial situation before deciding if a lighter workload makes sense for you. I can provide a little guidance, though.

If you’re in debt, early in your career, and rely on a single income, you’re not a great candidate for part-time work. Conversely, if you’re debt free and / or have a substantial net worth, are later in your career and have a second household income, you can start formulating a plan today.

Most likely, your circumstances lie somewhere in between. Some people work part-time from day one after residency and do quite well maintaining a favorable work / life balance in a full-length career. Others choose to make hay while the sun is shining, not knowing what the future of healthcare will mean for their livelihood.

If you fall into the latter camp, as I did, I recommend getting at least halfway to financial independence before considering a substantial reduction in your income. By the time you’ve got 12 to 15 years of expenses saved up, in most years your investments will contribute significantly towards your progress to FI, lifting some of that heavy burden off your shoulders.

A couple of years ago, I wrote a post examining the effects of beginning part-time work at different points in one’s career. Unsurprisingly, making bank in those early years is key. Full-time income that has time to compound is instrumental in achieving FI or other net worth goals. The closer you are to your goal, the more flexibility you will have.


Interested in reading more about part-time work as a physician? I”ve got you covered.



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Have you worked part-time? How did you handle that transition financially? What do you do (or would you do) with the additional free time? I look forward to hearing from you.


  • OMFS

    Great Post! I am still heavily in debt (197k student loans and 225k business loan), so can’t really cut back to part time yet. However, I did cut back a bit about 4 years ago. I owned the practice for about 3 years and was surprised at how well things were going. When I first opened, I decide to participate with most insurance, including medicaid, as a way to build things up. I ended up making a lot of money, but working way more then I wanted. I missed my family. I was obscenely indebted, but decided life was too short.

    Without really running too many numbers I dropped medicaid. That one change was a huge difference! When I finally ran the numbers, I produced about 100k worth of work less than the previous year. But I collected only 19k less. Not even counting overhead and taxes (I likely only got to kept a few thousand of that 19k), I think it was one of my smarter moves. It didn’t take me to part time, but got me back to about 45 hours a week. I already have the next insurance company to be dropped picked out once the debt is done!

    Even if you own your own practice and are the sole provider there are certainly ways to cut back.

    • For oral surgeons like you and many other physicians, cutting back to something resembling a normal full-time job can be a huge relief. It’s a bummer the incentive to drop Medicaid is so strong. People tend to get angry when it’s not accepted, but when the cost of suppplies isn’t even covered, it’s tough to blame the provider for making those choices. FWIW, I work for a health system and we care for all comers, but I know the reimbursement for Medicaid (and Medicare specifically for anesthesia) is very low compared to private insurance.


      • OMFS

        It really was a relief to not deal with medicaid anymore. It was the administrative hassle just as much as it was the low reimbursement. For instance, they used to give out my personal cell phone number to patients who called asking for participating providers. To this day, I still get the occasional random person calling my cell phone for an appointment.

        So far as reimbursement goes, I don’t remember what they pay for anesthesia, but in NY they pay 14$ for a problem focused oral exam for which self pay patients pay 100$. Private insurance typically pays between 45 and 100 depending on the plan. Crazy system, for sure!

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  • I am enjoying living vicariously through you while I work out the early stages of my FI (making hay while the sun is shining). It’s pretty awesome to follow along with your story, though, because (despite living in a warmer part of the country) I think my work trajectory timeline will mirror yours quite closely.

    I love anesthesiology, and I love making it better. That’s why I stayed in academics. However, I also want to be around for my wife and kids and the things that interest them. We aren’t guaranteed one more day in this world. So, while I look forward to being FI and going part-time in 10-12 years, I’ll try to work out balancing work and life even now while I am full-time. For now, that means that I am having to learn the art of “saying no.”

    Thanks for setting a great example, POF!

    • We see it all the time, don’t we? Took care of someone a few years older than me with metastatic cancer last weekend. It was a palliative, not a curative, procedure. Time is precious.


  • How do you avoid becoming “rusty” with frequent 3-week breaks from work?

    • Medicine is like riding a bike. But after you’ve done it for as long as POF has I bet it’s become old hat. I’m still an up and come though. So, maybe I’m wrong.

      P.s. listened to your podcast with Pete over at Do You Even Blog yesterday. really good stuff. I appreciate all the advice for us rookie bloggers.

    • Yeah, most of the hands-on procedures I do are things I’ve done hundreds or thousands of times. The only “rust” I notice has nothing to do with clinical care, but I have to remember to dot the right I’s and cross the right T’s with the computer work and paperwork.

      If it were three months, I might notice more issues. And three years off would require some remedial training.


  • Great post, thanks for sharing the details of your part-time situation. As you know I’m part time as well but doing it differently than you. Instead of stacking all the work up and having 3 weeks off every month, I just work 20 hours each week and get half of my salary. Maybe this is one of those “the grass is always greener” situations, but I’m really diggin’ the thought of your arrangement. Those three straight weeks off allow you to travel more and do “bigger” things like your trips. I still have to take some leave if I want to go away more than 10 days.

    Question – because your work is all stacked up in a short period, do you get a case of “the dreads” right before you have your work time approaching? Is it hard to make the transition between the two?

    • Your mind-reading abilities are phenomenal AF.

      Dread is too strong a word, but usually at some point during that workweek, I find myself asking why I haven’t gone to no-time sooner. Then I’ll have a good day or redeeming patient interaction and I’ll remind myself that the timeline I’ve got is a good one. I know I can stick it out until next summer.


  • It is possible to go to part-time while owning a practice. I did it 5 years ago. I was financially independent plus at the time. Health insurance limitations have kept me working. I agree with OMFS that looking at your payor mix can really cut the stress and possibly increase your income. I do not take Medicaid. The overhead has finally caught me so I am going to retire my practice this summer. I think it is easier to go part-time if you are solo because you are only negotiating with yourself. You have to be ready for the income drop. I also have found it is easy to find employees to work part-time. Most of my staff also works at the hospital and this job is helping them become financially independent.

  • It’s great that you’re being purposeful in enjoying life along the journey. So many people struggle and suffer through miserable hours (sometimes at jobs they hate) with the hopes that they can enjoy life at some point in the future. It’s a MUCH better plan to integrate the joyful parts early in life and develop a good personal balance.

  • Love this! I’m a nurse practitioner – I teach nursing online because it provides a lot of flexibility in terms of when and where I work. But I *love* clinical practice and am not ready to give it up (I might not ever be). So I do what my colleagues lovingly (I hope?) call “princess coverage”. I cover vacation shifts, the occasional staffing gap, whatever, and I come in and help as an extra set of hands when they need it. I still get to do a fair amount of clinical work, but if I want to take a month off or go away spur-of-the-moment I can, because I don’t have a set schedule. So far it has worked out great.

    • I think a good mix of clinical work and online work from home (or anywhere in the world) can give you a great work / life balance. That’s basically what we’ve achieved now, too.

      I haven’t ruled out staying minimally clinically active on as-needed basis after I leave my job, but the “rust” that Jim asked about could become an issue if it’s truly minimal.


  • Jacq

    Last week, my workplace announced the possibility of alternative work schedules, such as 4 days x 10 hours, or 9 hours a day with 1 day off every 2 weeks, and work from home options. Because I am currently committed to teaching a yoga class not at my workplace at 5 pm every Monday, I don’t know that the extended hour options are a possibility for me right now. Even if I took the Monday as my day off, fighting rush hour from home to teach to fight it back home is not appealing. To be determined if I can make something work.
    Thanks for a great article on how well an alternate schedule is working for you!

    • It’s great to have those options. Most physicians I know are not shift workers (aside from ED where shifts can run over), but many nurses and CRNAs I’ve worked with will do four 10’s or three 12’s and that’s their workweek.

      I hope you find a schedule that suits your needs.


  • Mom MD

    I did part time by accident as a single mom with my child’s illness. I ended up working the minimum which would still provide insurance benefits for us and dropping our lifestyle. The kids never noticed. I’m not living as richly as people making $300k yearly but the gift of our profession is that half time pediatricians still make a little less than a standard 2 income couple makes. I wasn’t able to be there all the time for my child but I came pretty close. FI looks different for everybody. I’m able to retire now at the more modest level and am weighing my options for more time vs a bit more nest egg. The beauty of FI is that it works either voluntarily or forced. We have had a pretty decent run and the numbers work at all scales.

    • I’m sorry to hear about your child, but I’m glad you were able to find a schedule that accommodated your family’s needs while still earning a reasonably good living.

      Good point about the kids not noticing the lifestyle deflation. They value your time more than your stuff.


      p.s. gotta take a break from the comments. My sone is ready to play Crazy Eights!

  • It’s wonderful to read about your spending more time on the other side of the looking glass. Traveling together while the boys are in this small window (not looking to define themselves in contrast to you and the Mrs.) will lay a foundation for shared memories to last a lifetime. Enjoy your well-earned glide path!

    • Thank you, kind sir. This is the time to make memories, no doubt. And we’ve been prepping them for the idea of more extended vacations and a break from traditional school that will still include a fair amount of online and in situ education.


  • Shhhh, don’t tell your partners that their 10% increase will net them like 3-4%, haha.

    It’s so cool that you dropped the most expensive part of work for more time away, awesome!

  • Hey PoF. Thanks for being a role model. I am pretty close to doing the same thing. Hopefully over the next year. My schedule, however, will be about 16 hours a week of meetings on Tuesday, Wednesday, and Thursdays with being on call for Hospice nurses Monday-Friday. This would allow for many long weekends and travel.

    • That’s good to hear, Doc G.

      When you have so much time and / or identity invested in a career, I think it’s wise to wind down slowly as long as you aren’t in the throes of serious burnout. I know you can afford to retire, but if part-time work suits you, keep at it.


  • CM

    I have a verbal commitment from the administration that I’ll be able to cut down to a roughly 55-hour work week plus one 10-hour Saturday per month, but with no call, starting in September.

    Unless you work in investment banking, Big Law, Big 3 Consulting, or medicine, that schedule may sound hellish. To me, it sounds like heaven.

    • Sheesh. I shudder to think about the hours you’re working now. I imagine you enjoy the work, though, or you wouldn’t make the choice to be there quite so much.

      “Normal” certainly depends on your perspective. There are plenty of people who can’t believe I only work a week a month. But they’ve never before worked a 72-hour shift after a normal workweek, either. When the weekend is busy, my “week” is two or three of theirs.


  • Liz

    I started working part time 30 years ago when I became a mom; realized I liked family medicine more on that schedule, so kept up the part time (3 days a week) till I retired 3 months ago.

    I now have the opportunity to work “occasional”, and am wondering how much I’d need to work to avoid getting rusty.

    Don’t need the $$, but do miss the clinical challenges a bit. Love not having a schedule…decisions!

  • Well done PoF! I’m not sure I would have the willpower to go back to work after a three week vacation. Love the details and it sounds like a pretty sweet deal!

  • You articulate very well what a rational person does if they take the time to consider the return on time/effort within a progressive tax system. Our 54% marginal rate in Canada kicks in at about $180K/yr USD. It is a strong disincentive to work more if you pause long enough to rationally consider your time-money exchange. Since following your blog, I have cut back about 25% in work. Unfortunately, my tax bill didn’t drop much since our government keeps creating new special taxes aimed at those making >200K/yr, professionals with stay-at-home spouses, and now professionals who save too much to invest. This year, we now have a tax on earning too much passive income (>50K/yr CAD) by saving in a professional corporation coming. Funnily, the penalty on passive income disappears if you stop working. I also did the math and a Canadian physician with an average physician income and an above average savings rate would cross into the penalty box almost exactly at the same time that they save enough for fatFIRE. Our government cares about us so much that they want us to find better/work life balance I think. Your message about the freedom FI gives you to shape your work-life and how to use that in a positive way is really important.

    • That is brutal, my man. 54% at $180,000 per year. There’s a disincentive to work if there ever was one. Are there province income taxes like our state income tax on top of that?

      Not to rub it in, but are you aware of our 0% capital gains bracket for people with taxable income up to about $78,000? Passive income is treated quite favorably for the retired here.

      You know, Minnesota looks a lot like Canada if you’re ever looking to defect. 😉


      • That is the combined Federal/Provincial rate. Passive income here (as long as you aren’t working) is taxed favourably also – that could happen by retiring or being born into money like our political leaders. It is the “working wealthy” that seem to be the optimal targets. One of the three parties in our provincial election just released their platform suggesting a new 56.4% marginal rate. I hope and don’t think that they’ll win, but the fact anyone could think that is a good idea scares me.

        There are many beautiful places in the U.S. – and nice people too.

        • Gasem

          If you count the standard deduction you can make about 101k married filing jointly before cap gains kick in. Another reason to own post tax stocks

        • Sadly not in Canada. You are taxed as individuals and not a family here. All capital gains in Canada except on your primary residence or in a sheltered account are taxed from dollar number one. We have good beer though!

  • Nice write-up.
    It hits home for me. As I think you know, I went to part-time work at the beginning of this year. Man is it awesome. My analysis wasn’t as in-depth as yours, but I think my benefit was similar.
    My pay cut wasn’t dramatic -at least as an impact on my lifestyle. We naturally live at a spending level that is so far below my income that the cut decreased only taxes and my investments. We didn’t change anything about our lifestyle because of less money.
    The only thing that changed is my quality of life went up. I have more time to help my wife, play with my kids, be present in my life, read, study, meet friends, travel, and exercise. I’m not sure I could ever go back to full-time!

    • Glad to hear you’ve had a similarly positive outcome, WD. Like you, I’ve noticed the fact that the paychecks are smaller but that just means smaller monthly investments to the taxable account and a little slower time to front-load the tax-deferred investments.


      • HarjotSingh

        I like this strategy by WD. Especially if you have front-loaded savings and have enough that you don’t really need to contribute there much. For example, if your savings rate was 40%, you can just work that much less without any dent in your lifestyle.

  • VagabondMD

    ^^ Ditto. My numbers are similar, and while I am 0.6 FTE, our work schedules are vastly different. I have two weekends every week. 😉 Like you, I have a side gig. Unlike you, mine is not very time consuming and not nearly as lucrative. Like you, I am happy with my schedule change and am hurtling toward a retirement in late 2019. Unlike you, I am not yet fluent in Spanish (Mierda!)


    • We certainly have a lot in common, including the lack of fluency in Spanish. I think we realized the only way we’re really going to make that happen is by spending a good deal of time in another country. So that dream is on hold for a bit, too. I should probably resume the Duolingo work, though.


  • I’ve kind of transitioned into part-time work since closing down my hedge fund. Instead I’m now trading my own portfolio, and I’m trying to keep busy (like writing a blog) in the spare time I have available.

    • Good for you, Troy. I would guess running a hedge fund leaves you with a good pile of money to play with. Enjoy it and make the most of the free time you’ve got when you’re not blogging & trading.


  • HarjotSingh

    Very inspiring read. And supported some of the ideas that I have been mulling over. I have always worked part time after finishing training.
    I think some of the ambivalence/inertia is due to my current clinical work being a source of joy.

    • I’ll bet there’s some correlation between part-time work and work being a source of joy. I might even go so far as to say causation. Maybe?

      Glad it’s working well for you, too.


      • HarjotSingh

        I think working less has an equilibrium too, just a different set-point.
        Just like earning more has a hedonic treadmill, working less has an “anti-treadmill” (trademarked, LOL) too. For me, working part-time has been my “full-time work”.
        And if you have fun things lined up outside of work that are always calling you, working 20 or 30 hours also can feel like work at times.
        It’s definitely less stressful because there is a lot more time for recovery, and Physicians are always in demand so you can negotiate on so many other intangibles to make your life easy.

  • What a life! Nice job. It’s great that you have this option.
    My brother is an emergency room physician and he’s worn out now. I hope he can do something like this, but I have no idea how.

    • I can’t complain, Joe.

      Bummer to hear about your brother — Emergency Medicine has the highest rates of burnout. Fortunately, EM also has some of the most flexibility when it comes to work. Locums can be lucrative. You don’t have to work too much to have a nice living when you have the ability to earn hundreds of dollars per hour.


      • I think he’s stuck for a while. He lives in the Bay area, has 3 young children, and his wife works minimally.
        Locums is like substitute teaching? That might work in a cheaper location, but probably not in the Bay area. I’ll talk to him more when we visit this summer.

  • Gasem

    I think no matter what you do PoF your life will be a GAS! It’s in your nature. In my own case I worked about half a year my last year and FINALLY made little enough money to open and fund a Roth for my wife and myself, and I actually was able to write off some college costs on my taxes! I was ecstatic.

    As you transition out think about your liability. In 3 weeks you probably won’t be rusty, but as time goes on you do loose your edge, and the last thing you want is a bad outcome after being off for several months, as you head off to your new life. You routinely care for people with CADlung diseaserenaldiseaseinfectiondiabetesvasculardisease and drain circling behavior all in the same body. At least that was my typical patient.

    I practiced anesthesia for 33 years, did about 27,000 cases and 25,000 pain procedures and was never involved in a malpractice suit but I’ve known a few who were and the last thing I would want is to exit stage right facing down a 4 year malpractice struggle. All of my credentials are still active including my SDSC appointment but the farther away I get the less inclined I am to consider sticking my hand back in the bear trap.

  • The upper midwest is Lake Wobegon, where everyone is above average! I say this as I pack to move back to the South for reasons in the post – family, time, kids, friends NOT more money. It’ll be Will Rogers Phenomenon – I’ll raise the IQ in both places when I move…..

    I’ll be working 30% less and making 60% less factoring in a big paycut. Geographic arbitrage cuts both ways, see Bay Area comment above on burnt out ER doc still practicing.

    I know from you and other FIRE bloggers that cutting back can be done psychologically despite leaving so much money on the table. I am worried about how that will feel in a few months, but I’m prepared as I’ll get, thank largely to this blog. FIRE blogs are like premeditation with IV Zofran before chemo, they keep you from puking when the new low paycheck comes.

  • This is a great post! It really underscores how being balanced and efficient can make for both a healthy life and financial future. Kudos to you for leading by example POF!

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  • J White

    Good to read this perspective and well done. Implied ,but not made obvious, what drives everything in this discussion is 1) choice of specialty and 2) location. I think one needs to be clear and ingenuous about that (as you are if reader is paying attention) I strongly suspect your values and goals were evident to you even as an MS1- its no mystery you have been able to accomplish your goals but I would submit it is impossible for anyone in primary care or living in expensive coastal cities esp where public schooling is simply not an option (thats doenst make one a snob or a Republican by the way- ) and especially if you want to have more than one kid and /or one spouse be at home. Once you make thes fundamental choices its just a matter of executing, but if you live in Northeast (often because that is homes or where family is) , choose for whatever reason to not train inb RAOD specialty, teach in academics, thsi just isnt gonna happen, even in concierge medicine where you are alwasy onc all., so thats where the emphasis needs to be. For many physicians reading your blog its already too late- med students need to be thinking about what you are espousing.

    • Thanks for sharing your thoughts, J White.

      I always knew I’d probably end up back in the midwest. That’s where my family is, and the cost-of-living tends to be lower while the salaries in medicine tend to be higher — we call that geographic arbitrage.

      I was pretty open to any specialty, and honestly thought about pediatrics until I discovered I didn’t enjoy clinic.

      In primary care, you really do need to think outside the box to achieve better salaries. You may want to check out Diverse FI, a blog by a primary care doc in Chicagoland who earned twice as much as I did in his peak years.


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