How will you escape the pit (the ER)?

[thegenius]

1728 hours per year is about 12 12 hours shifts a month, which is about what I do. I think that's quite doable.

Yea I work 16 9's. I would rather to 12 12's

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[southerndoc]

I think most people who make 300-450K / year can retire early. But lots of things have to happen for that to occur. And they usually don't. The principle one is to live like you make 50K a year which the majority of people do not once you make 300K/year.

Moreover there is the concept of doing something with your time. You can retire early but seriously what the F are you going to do when you retire at age 43? You have 40-50 more years of your life. You are single. You live in a home you paid off. You have a kitty of 4M and you live off of dividends and make 150K/year. What are you going to do every day of your life? Play golf? Masturbate? Trade options and watch CNBC? Take photography lessons? Garden? Bowl? What the F are you going to do every single day of your life?

I already golf and say hello to lefty, even garden on a regular basis. If I don't work I've got nothing to do. I could occupy my time for a month or two...but I would be so damn bored.

Lots of fun things in life require $$$. You can sail for a hobby and decide to sail around the world one year. That will cost you $$$$$$.

If you find a girl and you start f'ing, and she discovers that you have retired early at age 43 and living off dividends, she will not want to work and do **** with you. That will cost $$$$$. Not $$. If it costs you $$ she won't be f'ing you anymore.

Perhaps I'm a workalcoholic. I worked 1,728 hours last year. I could cut back but I swear I would get bored. And I even had kids. Teenagers. They hate me and do not want anything to do with me. (Well...they don't hate me they just want money to go hang out with their friends.)

Honestly maybe I'm a sad sod, but I would be bored if I retired early.

Plus....it's hard to retire early in the Bay Area. And I'm not gonna move because I like it here. Along with like 8M other people.

Exactly why I plan to go until I'm 70. Seriously. I went into medicine because I like it, and I don't want to give it up just to sit around the house, travel all the time, and get bored. Yea, you can entertain yourself traveling for a while, but eventually that's going to get boring.

Plus there's the concept that if you retire early, you aren't engaging your brain and you lose it quicker.

The only way I'm not working until I'm 70 (and possibly even longer) is if I'm in poor health (disabled or demented) or if I choose a second career. Heck even dementia might not stop me. After all, I might be the last to know I don't know what I'm doing. What were we talking about again?

 

[emergentmd]

The point is not retiring early and stop doing EM. The point is allowing you to do something else even if you hate EM. I bet most EM docs are burnt out b/c they work too much, and can't stand all the non clinical pressures. If these EM docs went from working 140hrs/mo to 36 hrs/mo, they would love their job again.

I will say that I will never stop working my 6 shifts/mo unless I physically can't. The job is easy, love my coworkers, love being the boss, love talking to pts, and get paid more than I ever did working in the pits.

 

[Kryptocoin]

Yeah, I'd be curious what the NW of the 5 mm-to-retire posters is, and also whether folks want 5 mm this inflation adjusted or not.

Also, this is a crazy low NW for physicians. Every EM doc out for 10 years should and could have a paid off house and 2 mm.

Paid off home and 2M in 10 yrs? That's quite ambitious. I'm not sure how that math works unless you live like a resident for 10yrs and brought home during the 2008 crash.

I think 1M liquid and a modest mortgage is pretty doable for most.

 

[Kryptocoin]

I think most people who make 300-450K / year can retire early. But lots of things have to happen for that to occur. And they usually don't. The principle one is to live like you make 50K a year (which the majority of people do not) once you make 300K/year.

Moreover there is the concept of doing something with your time. You can retire early but seriously what the F are you going to do when you retire at age 43? You have 40-50 more years of your life. You are single. You live in a home you paid off. You have a kitty of 4M and you live off of dividends and make 150K/year. What are you going to do every day of your life? Play golf? Masturbate? Trade options and watch CNBC? Take photography lessons? Garden? Bowl? What the F are you going to do every single day?

I already golf and say hello to lefty, even garden on a regular basis. If I don't work I've got nothing to do. I could occupy my time for a month or two...but I would be so damn bored.

Lots of fun things in life require $$$. You can sail for a hobby and decide to sail around the world one year. That will cost you $$$$$$.

If you find a girl and you start f'ing, and she discovers that you have retired early at age 43 and living off dividends, she will not want to work and instead will want to travel and do other shiiiit with you. That will cost $$$$$. Not $$. If it costs you $$ she won't be f'ing you anymore.

Perhaps I'm a workalcoholic. I worked 1,728 hours last year. I could cut back but I swear I would get bored. And I even have kids. Teenagers. They hate me and do not want anything to do with me. (Well...they don't hate me they just want money to go hang out with their friends.)

Honestly maybe I'm a sad sod, but I would be bored if I retired early.

Plus....it's hard to retire early in the Bay Area. And I'm not gonna move because I like it here. Along with like 8M other people.

Have you thought about seeing a life coach? Life shouldn't be binary : work or boredom. A good life coach can help you navigate those murky waters of "what's next?". Physicians are typically Type A and need to feel productive.

 

[dadaddadaBATMAN]

Paid off home and 2M in 10 yrs? That's quite ambitious. I'm not sure how that math works unless you live like a resident for 10yrs and brought home during the 2008 crash.

I think 1M liquid and a modest mortgage is pretty doable for most.

I have a spouse that works, live in a low cost of living place. I have been out two years, own my house outright (I know this is financially not best move but I have developed a pathological hate of debt) and have about 300k in retirement, 50 liquid between my wife and myself. If my wife didn’t work I’d be in the same place in 1-2 years, though med school debt would have more interest before I could have removed it.

With optimal investment I’d still have a home loan and would have more like 600k in the market. Maybe even 800 if I consolidated my student loans and refinanced rather than paying them off, though would be offset by 200k debt. Between returns and ongoing investment we could easily have 2-3 million at the current rate of spending without any of this optimization.

How much you can get very much depends on where you live, how you live, and who you married.

 

[bravotwozero]

Moreover there is the concept of doing something with your time. You can retire early but seriously what the F are you going to do when you retire at age 43? You have 40-50 more years of your life. You are single. You live in a home you paid off. You have a kitty of 4M and you live off of dividends and make 150K/year. What are you going to do every day of your life? Play golf? Masturbate? Trade options and watch CNBC? Take photography lessons? Garden? Bowl? What the F are you going to do every single day?

I already golf and say hello to lefty, even garden on a regular basis. If I don't work I've got nothing to do. I could occupy my time for a month or two...but I would be so damn bored.

Lots of fun things in life require $$$. You can sail for a hobby and decide to sail around the world one year. That will cost you $$$$$$.

I feel like I have enough on my plate to do right now on my days off. Errands to run that come up all the time, language class, gun range, 90 minutes at the gym, then pick up my kids from school. If I was FI, I'd be doing some of those things at greater frequency and it would easily take up my free time.

There's also the possibility of geographic arbitrage that opens up when you don't need to work anymore. I know you said you wouldn't move, but I would consider moving at least temporarily to a country where your dollars go much further - some of those countries even have citizenship by investment programs, where if you bought property or transferred a certain amount of money to a local bank and hold it for a few years, you'd get their passport. A lot of these places are great to retire in, but terrible places to work due to government bureaucracy, low pay etc.

Possibilities are endless, and one is only limited by their imagination.

 

[MechEDoc]

1. Lawn/tree service. Met a few guys that didn't have the capital but was hard working. Equipment was not terribly expensive and start up for a truck/equipment was around 100K. The numbers made sense, the demand is super high but key to network and find hard working guys.

In the right community, you can make really good money mowing lawns (at least during the growing season). Probably more per hour than as a nurse. However, you have to find really good workers... which is the hard part.

I've mowed thousands of lawns. It was nice, but I won't do that anymore!

 

[emergentmd]

In the right community, you can make really good money mowing lawns (at least during the growing season). Probably more per hour than as a nurse. However, you have to find really good workers... which is the hard part.

I've mowed thousands of lawns. It was nice, but I won't do that anymore!

As a doc, I would never mow lawns. Time and money is not worth it. But its starting a lawn care business that makes more sense. If you can find 2-3 hard workers, give them equity in the business, it will motivate them to stay. But it is all about connections.

I would only do a side business if I deal with the finances/scheduling.

 

[RustedFox]

I've mowed thousands of lawns. It was nice, but I won't do that anymore!

I've mowed one lawn, thousands of times. It was nice, but I won't do that anymore.

 

[bikERdoc]

When paid off, I'll have make about 60% of my current income in short term vacation rentals. I'll quit when I have enough places for that to be 100%

I'm also hoping to hit 6 figures with my photography within the next year.

6 figures in photography?! Hot dang

 

[visceral0775]

I made the complete jump to hospice about 3 years ago and "retired" from EM.
Much, much, much happier. Having control is priceless.
In "retiring" I was able to gracefully bow out, even though I work just as much now (technically 0.8 FTE, but hey, benefits.)

I dipped my toes in about 4 years ago and slowly eased my way in, while cutting my hours in the pit back. When covid hit and my colleages were looking for shifts, it was a no-brainer... and I haven't looked back. I don't miss it. I occasionally miss the flexibility of taking off for 3 weeks for a big trip, but honestly, the stress ain't worth it.

I am a graduating EM resident going to start HPM fellowship this July. After, I don't plan on practicing EM...at all. Sucks because I still have to pass the EM boards in order to be certified in HPM...ugh. Most people think I'm absolutely crazy but EM is just not where my heart is and I realize how unsustainable it is in the long-term. Reading your post made me smile inside. Do you practice Hospice exclusively?

 

[miacomet]

Paid off home and 2M in 10 yrs? That's quite ambitious. I'm not sure how that math works unless you live like a resident for 10yrs and brought home during the 2008 crash.

I think 1M liquid and a modest mortgage is pretty doable for most.

Save $150k/year, buy a 500-750k home, live on 50-100k a year. It does depend on PSLF or other loan repayment strategies. Agreed if you are buying this minute it's tough to find a home in that price range.

 

[dchristismi]

I am a graduating EM resident going to start HPM fellowship this July. After, I don't plan on practicing EM...at all. Sucks because I still have to pass the EM boards in order to be certified in HPM...ugh. Most people think I'm absolutely crazy but EM is just not where my heart is and I realize how unsustainable it is in the long-term. Reading your post made me smile inside. Do you practice Hospice exclusively?

Not even just hospice, but I have an exclusive inpatient practice. A unicorn ICU-style freestanding hospice house gig with no monitors, vents unless I'm removing them or pressors unless I'm removing them. I will say that having over a decade of experience in knowing what patients look like WITH monitors and labs makes it a lot easier to guess what someone's hemoglobin is just by the change in their murmur. Or that I'm actually hearing/seeing runs of nonsustained VT. (I do have a pulseox for when I can't count that fast.)

But I specifically negotiated it that way - they needed me, I like them. I do have way more administration-type stuff, but that's the nature of the beast. (IDG, certs.) I went the HMDC route which focuses more on the medicare regulatory ins and outs of hospice, which I understand most fellowships may not give that much time to. And in all honestly, probably shouldn't. You've only got a year to hone the nuances of palliative, which is HARD, especially in the hospital setting.

If you ever want to talk hospice, just drop me a PM.

 

[The Knife & Gun Club]

I remember seeing you post back when you were a medical student. Such a shame to see the toll EM takes. Hope you find the answer soon!

I remember him too.

Let this be a warning to all the naive med students out there that think that they're "different" and that "it won't be like that for them".

We are all telling you. Warning you. Waving huge red flags at you.

In the words of the prophet Birdstrike:

"This job is bad for you."

Yea man - I still love the practice of EM, it’s fun, stimulating, and I’m young enough that I can still do the nights. The issue is the being trapped in it. You can fix a lot of the issues if you’re able to walk and are at an institution that has your back…but those are getting fewer and further between.

So I’m gonna have a developed skill independent from EM, and then I can practice it as much or as little I want.

It’s official, I’ll be starting critical care fellowship (SICU focused Anes program) in 2023.

2 years then no one can force me to work in the ED again. If I’m pulling em shifts it will be on my terms in an environment I want to work in.

 

[TrailRun]

Not even just hospice, but I have an exclusive inpatient practice. A unicorn ICU-style freestanding hospice house gig with no monitors, vents unless I'm removing them or pressors unless I'm removing them. I will say that having over a decade of experience in knowing what patients look like WITH monitors and labs makes it a lot easier to guess what someone's hemoglobin is just by the change in their murmur. Or that I'm actually hearing/seeing runs of nonsustained VT. (I do have a pulseox for when I can't count that fast.)

But I specifically negotiated it that way - they needed me, I like them. I do have way more administration-type stuff, but that's the nature of the beast. (IDG, certs.) I went the HMDC route which focuses more on the medicare regulatory ins and outs of hospice, which I understand most fellowships may not give that much time to. And in all honestly, probably shouldn't. You've only got a year to hone the nuances of palliative, which is HARD, especially in the hospital setting.

If you ever want to talk hospice, just drop me a PM.

I’m really interested too, but mentally can’t get over the fact that it would be a year of fellowship to make less and work more, right? But eventually I know nights will get to me so that’s my plan.

 

[HunterGatherer]

For me is when I do not have to touch my retirement money. I am doing FSER and so easy that I could do this forever. But if I ever really want to get out, then its 300K net passive income bc we still have young kids. Once I pay off my rental mortgages, I should be right at 250K.

Fire to me means not to drop from my current lifestyle.

I'm in Houston TX area and FSEDs were popping up like crazy in the last ten years then 1-2 years pre-COVID many of them went into financial difficulty. The ones that lasted into the COVId era made a killing due to lowered number of FSEDs. Now the CMGs are expanding their foot print with their our own FSEDs. CMGs lucked out becuase I feel they were kinda late to doing FSEDs and the rapid expansion of private FSEDs kinda shot the privately owned FSEDs in their own foot. this is my understanding so I'm wondering, isn't opening a FSED super difficult now? I know difficult does not equal impossible.

 

[Frazier]

It’s official, I’ll be starting critical care fellowship (SICU focused Anes program) in 2023.

2 years then no one can force me to work in the ED again. If I’m pulling em shifts it will be on my terms in an environment I want to work in.

That's awesome.
Congrats, it sounds like a good plan!

 

[emergentmd]

I'm in Houston TX area and FSEDs were popping up like crazy in the last ten years then 1-2 years pre-COVID many of them went into financial difficulty. The ones that lasted into the COVId era made a killing due to lowered number of FSEDs. Now the CMGs are expanding their foot print with their our own FSEDs. CMGs lucked out becuase I feel they were kinda late to doing FSEDs and the rapid expansion of private FSEDs kinda shot the privately owned FSEDs in their own foot. this is my understanding so I'm wondering, isn't opening a FSED super difficult now? I know difficult does not equal impossible.

Correct. When it started 15 yrs ago, money was easy. As with every business model, more popped up. CMGS and VC jumped in. Then easy money wasn't as easy. CMGS/VC/FC/Neigbors all folded pre covid. Only the lean, well run groups or Hospital backed FSERs stayed opened. Covid made most FSERs successful, and many able to be debt free.

Now the ones who survived and went through covid are financially strong, so their operating costs are much lower when they are debt free.

If you are going to open a new FSER, expect a very difficult path given the high debt load. Better to buy a struggling one and figure out how to make it successful with little debt.

The ones who are doing well and have experience with running FSERs are able to snatch up the struggling ones given their in place infrastructure and put in their magic sauce. Someone starting one will find the path much harder b/c there is costs to put in the infrastructure. The ones who are opening new ones better have deep pockets as the debt is like swimming with a 50lb weight when the other FSER in the area are swimming with flippers.

 

[beebermd]

If all goes well, I should be able to be out in the next year or so. I got out of residency and went to be the medical director in a underserved area about an hour away from where I live. The state paid off 200k of student loans tax free. I cut back to half time there and invested big in FSER. In the end, the owners turned out to be just as toxic as the CMGs, work environment became malignant, so I sold my interests and went back to the pit full time. Then partnered up with a buddy and opened a practice doing HRT/IVs/weight loss/orthobiologics/aesthetics. This little side gig has been so much fun, I've spent the last year in training and am now doing liposuction and fat transfers, BBLs, etc. I have paid off everything including a1.8M house, a beach house, cars and a boat. got a nice SEP401K and NO DEBT. Im still in my 30s. As my practice continues to grow, im going to cut back in the ER hopefully turning this into 9-5 mon-thurs job. I will still pull some shifts, and its already so much better going to ER knowing I dont HAVE to. I really didnt like my job when I felt like I had no other options. My main drive in all of this is that I have wonderfull wife and two little boys and I feel like im missing out on so much due to the nights holidays and weekends that didnt bother me at at all before i had a family. I know its time ill never get back. I used to work very hard to buy "stuff". At this point in my life im working to buy "free time"......I feel like im soooo close. lol

 

[hundreddaysoff]

At this point in my life im working to buy "free time"

Bingo. Inspiring story! I'm not quite as driven as you to be able to raise my 2 little kids, pull three 12-hour nights a week in the ER, and learn a whole new set of medical skills at the same time as learning to manage a new business.

 

[beebermd]

Bingo. Inspiring story! I'm not quite as driven as you to be able to raise my 2 little kids, pull three 12-hour nights a week in the ER, and learn a whole new set of medical skills at the same time as learning to manage a new business.

Thanks for the credit, but in full disclosure…..I’m only there about 5-6 days a month right now…..my wife is the office manager and luckily it’s set up to run even when I’m not there. I’m working 12-12s/ month now in the ER. That ratio will change hopefully soon. Back when I was doing the FSED gig it was even worse…..8 24s there and 5 12s at my reg shop. 252 hrs/mth! Lol……granted the FSED acuity and pt volume was a laughable compared to my reg shop……it was super easy….but still…..24hrs away got old. Especially since there was just a lot of sitting around at times. Was Making a little over a 1m/yr, but for those 8 days, my wife was a single mom. I still feel like I’m playing catch up stuff I missed out on for the years I was doing that. Lol

 

[EctopicFetus]

I am with southern doc I’ll keep working well past reaching my FI number. Boredom and loss of brain ability are my concerns. I can work 2 days a week clinically and make a good living when the time comes for that. The goal to me has been FI. The purpose is to control my destiny. I used to be owned by my job. Then I hit coast FI a while back. Life was easier mentally but I never took my foot off the gas. my FI number / plan has just crept up but I think in reality it’s just moving goal posts. I had a goal age of 51 to hit my number. I did it at 43. Number has been moved. 2 more phases of the goal. One is when I think I’ll hit my actual new number and the other is simply a goal I want to hit because I think I can.

 

[Backpack234]

If all goes well, I should be able to be out in the next year or so. I got out of residency and went to be the medical director in a underserved area about an hour away from where I live. The state paid off 200k of student loans tax free. I cut back to half time there and invested big in FSER. In the end, the owners turned out to be just as toxic as the CMGs, work environment became malignant, so I sold my interests and went back to the pit full time. Then partnered up with a buddy and opened a practice doing HRT/IVs/weight loss/orthobiologics/aesthetics. This little side gig has been so much fun, I've spent the last year in training and am now doing liposuction and fat transfers, BBLs, etc. I have paid off everything including a1.8M house, a beach house, cars and a boat. got a nice SEP401K and NO DEBT. Im still in my 30s. As my practice continues to grow, im going to cut back in the ER hopefully turning this into 9-5 mon-thurs job. I will still pull some shifts, and its already so much better going to ER knowing I dont HAVE to. I really didnt like my job when I felt like I had no other options. My main drive in all of this is that I have wonderfull wife and two little boys and I feel like im missing out on so much due to the nights holidays and weekends that didnt bother me at at all before i had a family. I know its time ill never get back. I used to work very hard to buy "stuff". At this point in my life im working to buy "free time"......I feel like im soooo close. lol

How did you get into the iv weight loss clinic? This is a reason why I’ve considering becoming obesity medicine certified.

 

[southerndoc]

I am with southern doc I’ll keep working well past reaching my FI number. Boredom and loss of brain ability are my concerns. I can work 2 days a week clinically and make a good living when the time comes for that. The goal to me has been FI. The purpose is to control my destiny. I used to be owned by my job. Then I hit coast FI a while back. Life was easier mentally but I never took my foot off the gas. my FI number / plan has just crept up but I think in reality it’s just moving goal posts. I had a goal age of 51 to hit my number. I did it at 43. Number has been moved. 2 more phases of the goal. One is when I think I’ll hit my actual new number and the other is simply a goal I want to hit because I think I can.

I'm glad I'm not the only one. Everyone talks about getting out when they hit 50, 55, 60, whatever. I for one don't plan to work 12+ shifts/month but I at least want to work 4-8 shifts/month. With FI, that money will further delay withdrawing from Solo 401(k) which will allow it to compound more. Can also delay Medicare until 70 to increase savings from it. My main motivation, however, is to not be bored and to not lose mental function.

Having FI and working until 70 is different than working until 70 with a lot of financial obligations. With FI, if you get tired of it, somebody crosses you the wrong way, etc. you can just say "peace out!" and walk out the door. If you're drowning in debt, well you say "yes sir" and keep working. FI changes everything including the stress level you get from things you don't like at work.

 

[TrailRun]

I'm glad I'm not the only one. Everyone talks about getting out when they hit 50, 55, 60, whatever. I for one don't plan to work 12+ shifts/month but I at least want to work 4-8 shifts/month. With FI, that money will further delay withdrawing from Solo 401(k) which will allow it to compound more. Can also delay Medicare until 70 to increase savings from it. My main motivation, however, is to not be bored and to not lose mental function.

Having FI and working until 70 is different than working until 70 with a lot of financial obligations. With FI, if you get tired of it, somebody crosses you the wrong way, etc. you can just say "peace out!" and walk out the door. If you're drowning in debt, well you say "yes sir" and keep working. FI changes everything including the stress level you get from things you don't like at work.

Gosh I hope that’s the case, but I wonder. I mean, the job is still the job, right? Like I thought as a resident that once I was an attending I wouldn’t care about the angry patients, mean consultants, drunks etc since I would be getting paid so much more…. But if it sucks it still sucks, no matter how much you’re paid or how much you have in the bank

 

[hundreddaysoff]

Gosh I hope that’s the case, but I wonder. I mean, the job is still the job, right? Like I thought as a resident that once I was an attending I wouldn’t care about the angry patients, mean consultants, drunks etc since I would be getting paid so much more…. But if it sucks it still sucks, no matter how much you’re paid or how much you have in the bank

I feel like this is so much down to our individual makeups. I've been an attending for over 4 years and I still don't see drunks, personality disorders, etc, as problems with my job. I mean, there are pros and cons to any job, and that's what I signed up for, and now that I know the tricks of how to talk real pretty to these folks, they aren't so hard to handle. Helping these people who lack the insight to help themselves at night the best I can gives me the good feels a lot better than would, say, doing spinal fusion$$$ that I know my already-mostly-healthy patients don't need and might even harm them but that make me bank.

Where I differ with Southerndoc, WCI, and many others is that as cool as my job is, I was never the type who wanted or needed to be a doc personality wise, and I can think of about 1000 things in the world I'd rather do other than medicine that no one's willing to pay me for. This is why I want to FIRE. I will never grow dull in my old age because assuming I can escape the ER, I'll be too busy starting a permaculture farm or tutoring kids or writing folk songs or learning probability theory or woodworking or creating a video game or any of the other things on my very long to-do list.

Not trying to argue, just find the difference interesting as to what us individual docs will or will not tolerate in a job.

 

[EctopicFetus]

I feel like this is so much down to our individual makeups. I've been an attending for over 4 years and I still don't see drunks, personality disorders, etc, as problems with my job. I mean, there are pros and cons to any job, and that's what I signed up for, and now that I know the tricks of how to talk real pretty to these folks, they aren't so hard to handle. Helping these people who lack the insight to help themselves at night the best I can gives me the good feels a lot better than would, say, doing spinal fusion$$$ that I know my already-mostly-healthy patients don't need and might even harm them but that make me bank.

Where I differ with Southerndoc, WCI, and many others is that as cool as my job is, I was never the type who wanted or needed to be a doc personality wise, and I can think of about 1000 things in the world I'd rather do other than medicine that no one's willing to pay me for. This is why I want to FIRE. I will never grow dull in my old age because assuming I can escape the ER, I'll be too busy starting a permaculture farm or tutoring kids or writing folk songs or learning probability theory or woodworking or creating a video game or any of the other things on my very long to-do list.

Not trying to argue, just find the difference interesting as to what us individual docs will or will not tolerate in a job.

Yep. Different strokes for different folks. I thought long and hard about getting a real mba from a top notch school. I also tHought about an emba from a prestigious school. For me I decided against it cause I can learn what I need locally and I don’t need a degree. I think I could transition to finance and make serious bank but I don’t want to work 80-100 hours a week. I love my family and if I’m not willing to transition to finance the ROI is negative on a real top notch mba.

 

[EctopicFetus]

I'm glad I'm not the only one. Everyone talks about getting out when they hit 50, 55, 60, whatever. I for one don't plan to work 12+ shifts/month but I at least want to work 4-8 shifts/month. With FI, that money will further delay withdrawing from Solo 401(k) which will allow it to compound more. Can also delay Medicare until 70 to increase savings from it. My main motivation, however, is to not be bored and to not lose mental function.

Having FI and working until 70 is different than working until 70 with a lot of financial obligations. With FI, if you get tired of it, somebody crosses you the wrong way, etc. you can just say "peace out!" and walk out the door. If you're drowning in debt, well you say "yes sir" and keep working. FI changes everything including the stress level you get from things you don't like at work.

I’ll say if my group loses its contract ill figure things out. I wont work for PE unless it’s on my terms.

 

[thegenius]

I'm glad I'm not the only one. Everyone talks about getting out when they hit 50, 55, 60, whatever. I for one don't plan to work 12+ shifts/month but I at least want to work 4-8 shifts/month. With FI, that money will further delay withdrawing from Solo 401(k) which will allow it to compound more. Can also delay Medicare until 70 to increase savings from it. My main motivation, however, is to not be bored and to not lose mental function.

Having FI and working until 70 is different than working until 70 with a lot of financial obligations. With FI, if you get tired of it, somebody crosses you the wrong way, etc. you can just say "peace out!" and walk out the door. If you're drowning in debt, well you say "yes sir" and keep working. FI changes everything including the stress level you get from things you don't like at work.

yes I wrote above too that I'll be working until I can no longer do my job. All about not wanting to be bored. I don't have the capability to engage in daily hobbies for decades and not become bored. Plus I want to be a productive member of society too.

 

[Splenda88]

I don't get why one who is making 400k/yr can't be financially independent (FI) in 10-yr if this is what that person desires. Bearing some unforeseen circumstances (eg,. divorce etc...), you should be able to IMO.

My definition of FI is to have your home (a modest one) paid off and have 1.5+ mil nest egg.

 

[thegenius]

I don't get why one who is making 400k/yr can't be financially independent (FI) in 10-yr if this is what that person desires. Bearing some unforeseen circumstances (eg,. divorce etc...), you should be able to IMO.

My definition of FI is to have your home (a modest one) paid off and have 1.5+ mil nest egg.

If you are single...sure. There is no excuse if that is your main goal.

If you are married (with only the MD income) and have kids, it is much more difficult.

if you are married with kids and live in the Bay Area, then it's impossible!

 

[thegenius]

You know...when I think of retirement (which I guess is different than financial independence), I don't want to live modestly. I want to live in a really nice house, have some other nice things, a nice view, nice golf clubs, and maybe some other nice things. Note that I don't want to be extravagant...but I want nice stuff.

For instance, I would NOT want to retire in this modest home:

11459 Savage Dr, Sterling Heights, MI 48312 | Zillow

11459 Savage Dr, Sterling Heights MI, is a Single Family home that contains 2212 sq ft and was built in 1970.It contains 4 bedrooms and 3 bathrooms.This home last sold for $310,000 in May 2022. The Zestimate for this Single Family is $363,300, which has decreased by $5,045 in the last 30...

www.zillow.com

I would rather retire in something like this:

5790 Sussex St, Troy, MI 48098 | Zillow

5790 Sussex St, Troy MI. The Rent Zestimate for this property is $2,574/mo, which has increased by $2,574/mo in the last 30 days.

www.zillow.com

And if I retired early I would still get bored.

 

[southerndoc]

You know...when I think of retirement (which I guess is different than financial independence), I don't want to live modestly. I want to live in a really nice house, have some other nice things, a nice view, nice golf clubs, and maybe some other nice things. Note that I don't want to be extravagant...but I want nice stuff.

For instance, I would NOT want to retire in this modest home:

11459 Savage Dr, Sterling Heights, MI 48312 | Zillow

11459 Savage Dr, Sterling Heights MI, is a Single Family home that contains 2212 sq ft and was built in 1970.It contains 4 bedrooms and 3 bathrooms.This home last sold for $310,000 in May 2022. The Zestimate for this Single Family is $363,300, which has decreased by $5,045 in the last 30...

www.zillow.com

I would rather retire in something like this:

5790 Sussex St, Troy, MI 48098 | Zillow

5790 Sussex St, Troy MI. The Rent Zestimate for this property is $2,574/mo, which has increased by $2,574/mo in the last 30 days.

www.zillow.com

And if I retired early I would still get bored.

Just move to the South where the price of the second home gets you a 5,000+ sq ft really nice home.

 

[emergentmd]

My definition of FI is doing what I want, how I want, while I am physically able without much worry about money.

If medicine is my greatest joy, then so be it but I want the choice to work 1 day/mo or 15/month. But whatever I choose, I want to live the same lifestyle that I live right now which is spending about 300K/yr.

 

[miacomet]

My definition of FI is doing what I want, how I want, while I am physically able without much worry about money.

If medicine is my greatest joy, then so be it but I want the choice to work 1 day/mo or 15/month. But whatever I choose, I want to live the same lifestyle that I live right now which is spending about 300K/yr.

I would love to know how you spend 300k/year.

 

[Splenda88]

If you are single...sure. There is no excuse if that is your main goal.

If you are married (with only the MD income) and have kids, it is much more difficult.

if you are married with kids and live in the Bay Area, then it's impossible!

Might be extremely difficult in these very HCOL (LA, Bay Area, DC, NY City, Boston etc...). You just have to be strategic about things (eg., house hacking or go 30 minute outside of these places etc...)


Instead of getting a 3000+ sqft home, you get a 1600-1800 sqft even for a family of 4-5. Americans are jus obsessed with big homes. I am living in a 1600+ sqft home now, I think it's plenty of space for 4 people.


For instance, Atlanta is getting extremely expensive these days, but there are a few suburbs w/in 20-30 minutes of the city where one can get the same house for half of the price..

1999 Old Peachtree Rd, Lawrenceville, GA 30043 | Zillow

1999 Old Peachtree Rd, Lawrenceville GA, is a Single Family home that contains 2944 sq ft and was built in 2007.It contains 5 bedrooms and 4 bathrooms.This home last sold for $572,000 in June 2022. The Zestimate for this Single Family is $643,300, which has decreased by $6,513 in the last 30...

www.zillow.com

Above will cost you 1.3-1.5 mil in Midtown Atlanta, but you go to Gwinnett County or even Cobb County (30 minutes outside and family friendly), you will pay that price.

1489 Allanmere Dr, San Ramon, CA 94582 | Zillow

1489 Allanmere Dr, San Ramon CA, is a Single Family home that contains 3223 sq ft and was built in 2002.It contains 5 bedrooms and 4 bathrooms.This home last sold for $750,000 in March 2023. The Zestimate for this Single Family is $2,315,800, which has decreased by $62,587 in the last 30...

www.zillow.com

The Bay Area is really crazy. I can get that same house above for 500-550k where I am now.


Or buy something like that in the Bay Area, and turn the garage into a 1BR or a studio and rent it for $1500-1800

1018 Bockman Rd, San Lorenzo, CA 94580 | Zillow

1018 Bockman Rd, San Lorenzo CA, is a Single Family home that contains 1311 sq ft and was built in 1948.It contains 3 bedrooms and 1 bathroom.This home last sold for $825,000 in May 2022. The Zestimate for this Single Family is $882,400, which has decreased by $14,500 in the last 30 days.The...

www.zillow.com

My point is you just need to be a little bit creative

 

[visceral0775]

It’s official, I’ll be starting critical care fellowship (SICU focused Anes program) in 2023.

2 years then no one can force me to work in the ED again. If I’m pulling em shifts it will be on my terms in an environment I want to work in.

"No one can force me to work in the ED again"...I love this! I feel the same

 

[em1234]

Long time lurker, very infrequent poster

I don't know a single doctor from my cohort (11y out) who doesn't have an eye on the door or at least wastes an exorbitant amount of time sifting through linkedin ads for "nonclinical"-ish jobs that all seem pretty lame, all the while fantasizing about a professional life that doesn't so closely resemble hell. I have greatly benefited from being part of one of the last generations of residents to graduate into good jobs, with good pay, and with crazy hot markets throwing fistfuls of cash for shift coverage (a la Texas 2010's).

Early in my career, my wife and decided to geo-arbitrage a crappy paying mid Atlantic job for 2.5x paying job in Texas. best financial decision ever. after a near decade in texas, loans are gone, house is almost paid off, kids 529's have 150k each, and net worth not counting home or 529's of 2.8M. As my "babies" are now almost teenagers, I want my time more than the money. I missed so much of their childhood by working to secure their future that I am ready to ease my foot off the pedal to be around more. Fewer shifts, fewer nights, more time with them.

My "escape" will be more like a prison work furlough program, just less time at the prison. I currently work 13 12's across 2 systems. my goal in the next few months is to scale back to 11 12's and if all goes well scale back to 9 12's by years end. I would plan to work this schedule until my kids go to college, (7 more years), then I would go to 4 shifts per month or just retire out right and live off my wife's salary. Given our current savings rate, at 5% real, I should be at about 5.5M at 50yo.

My escape is being buttressed by my wife going back to work. The kids got big, and she got bored. Only so much peloton, pilates and lunching she could handle so she's putting her PhD to use and got a dream job she loves doing very nerdy niche research for a hospital system in our town that she plans to do until she dies at her desk, so I view her salary as my pension. She makes about 4 shifts worth of my pay per month so my going to 9 wouldn't really affect our financials and if need be, we could effectively just live off her salary though it would be tight with all the kids.

I am a bit of a worrier by nature, thus I have to say I have some trepidation about my plan given the rocky future landscape of EM. I am plagued by this feeling that in the near future our wages will bottom out to a point where I will no longer view the sacrifices of this career as worth the available pay and will find myself regretting leaving the game while the pay was still reasonable but I guess that's the risk. I truly feel for all the residents graduating in a few months and my heart breaks for all the future interns about to start. I don't want to imagine what this field will look like when you are finally ready to join it in earnest. My strongest recommendation is to pay off your loans and squirrel away your cash early. I'm 42 and I can't tell you how satisfying it is to have a strong financial base under me to allow me to contemplate these types of changes.

Always remember John Goodman in the gambler


I had forgotten the bit about the roof and the car. I just had my roof replaced and I drive a Toyota highlander. Maybe I subconsciously took this advice closer to heart that I thought.

Here is to all of us escaping the pit, in our own time, and on our own terms,
-1234

 

[miacomet]

I am with southern doc I’ll keep working well past reaching my FI number. Boredom and loss of brain ability are my concerns. I can work 2 days a week clinically and make a good living when the time comes for that. The goal to me has been FI. The purpose is to control my destiny. I used to be owned by my job. Then I hit coast FI a while back. Life was easier mentally but I never took my foot off the gas. my FI number / plan has just crept up but I think in reality it’s just moving goal posts. I had a goal age of 51 to hit my number. I did it at 43. Number has been moved. 2 more phases of the goal. One is when I think I’ll hit my actual new number and the other is simply a goal I want to hit because I think I can.

Kinda wanna know your new number- seems like most are shooting for 5 mm

 

[Pudortu]

Long time lurker, very infrequent poster

I don't know a single doctor from my cohort (11y out) who doesn't have an eye on the door or at least wastes an exorbitant amount of time sifting through linkedin ads for "nonclinical"-ish jobs that all seem pretty lame, all the while fantasizing about a professional life that doesn't so closely resemble hell. I have greatly benefited from being part of one of the last generations of residents to graduate into good jobs, with good pay, and with crazy hot markets throwing fistfuls of cash for shift coverage (a la Texas 2010's).

Early in my career, my wife and decided to geo-arbitrage a crappy paying mid Atlantic job for 2.5x paying job in Texas. best financial decision ever. after a near decade in texas, loans are gone, house is almost paid off, kids 529's have 150k each, and net worth not counting home or 529's of 2.8M. As my "babies" are now almost teenagers, I want my time more than the money. I missed so much of their childhood by working to secure their future that I am ready to ease my foot off the pedal to be around more. Fewer shifts, fewer nights, more time with them.

My "escape" will be more like a prison work furlough program, just less time at the prison. I currently work 13 12's across 2 systems. my goal in the next few months is to scale back to 11 12's and if all goes well scale back to 9 12's by years end. I would plan to work this schedule until my kids go to college, (7 more years), then I would go to 4 shifts per month or just retire out right and live off my wife's salary. Given our current savings rate, at 5% real, I should be at about 5.5M at 50yo.

My escape is being buttressed by my wife going back to work. The kids got big, and she got bored. Only so much peloton, pilates and lunching she could handle so she's putting her PhD to use and got a dream job she loves doing very nerdy niche research for a hospital system in our town that she plans to do until she dies at her desk, so I view her salary as my pension. She makes about 4 shifts worth of my pay per month so my going to 9 wouldn't really affect our financials and if need be, we could effectively just live off her salary though it would be tight with all the kids.

I am a bit of a worrier by nature, thus I have to say I have some trepidation about my plan given the rocky future landscape of EM. I am plagued by this feeling that in the near future our wages will bottom out to a point where I will no longer view the sacrifices of this career as worth the available pay and will find myself regretting leaving the game while the pay was still reasonable but I guess that's the risk. I truly feel for all the residents graduating in a few months and my heart breaks for all the future interns about to start. I don't want to imagine what this field will look like when you are finally ready to join it in earnest. My strongest recommendation is to pay off your loans and squirrel away your cash early. I'm 42 and I can't tell you how satisfying it is to have a strong financial base under me to allow me to contemplate these types of changes.

Always remember John Goodman in the gambler


I had forgotten the bit about the roof and the car. I just had my roof replaced and I drive a Toyota highlander. Maybe I subconsciously took this advice closer to heart that I thought.

Here is to all of us escaping the pit, in our own time, and on our own terms,
-1234

This was beautiful. Thank you for sharing.

 

[Cath Up]

All Young docs should come out of residency around 28 years old and do this. You are making about 300k/yr, and after taxes prob netting 225K.

Put 25K in your retirement. Take 100K and enjoy. Take 100K and pay down your loans.

After 3 years, your loans should be gone. Take 100K/yr and invest. Buy property. Throw it in the S&P, Dividend funds, or something safe.

In 10 years and age 45, you have put 1.25M into the market/investments. Assuming 8% returns, that should be close to 2M.

Now you can do the same for another 10 years at age 55 and will have about 6M. Now do what the heck you want.

OR

At age 45, you stop investing and now can splurge on 225k/yr or work 1/2 time and live off 100k/yr. Either is not bad. In 10 years and age 55, that 2M is now 4M. In another 10 years at age 65, you now have 9M.

Point is start early and time is more important in the long run than how much you put in. Don't outspend your income or get 2 more wives then wonder why you are still working 15 shifts a month hating your job at age 45 with little in retirement.

I had a partner who was maybe 10 years older who out earned me when I became an attending at 28. I saved, invested, bought properties. I must say I did spend alot but in most years I saved about 100-150K into some investment. He on the other hand had an expensive wife and when I left the Pit 15 years into being an attending, he literally was still working 20 dys/mo at age 55 with no end in site until all his kids were done with college.

Thank you for your posts- great ideas for investments in the future for upcoming residents. A lot is two different words FYI.

 

[emergentmd]

Thank you for your posts- great ideas for investments in the future for upcoming residents. A lot is two different words FYI.

Yeah Spell check keeps telling me the same but I'm too stubborn or lazy to push the extra key

 

[Apollyon]

Yeah Spell check keeps telling me the same but I'm too stubborn or lazy to push the extra key

You can't "allot" a period of time to fix it?
/sarcasm

 

[emergentmd]

You can't "allot" a period of time to fix it?
/sarcasm

alittle alot along

So why can you add an "a" to long but not to little or lot? hmmmmm

 

[Rekt]

I'm glad I'm not the only one. Everyone talks about getting out when they hit 50, 55, 60, whatever. I for one don't plan to work 12+ shifts/month but I at least want to work 4-8 shifts/month. With FI, that money will further delay withdrawing from Solo 401(k) which will allow it to compound more. Can also delay Medicare until 70 to increase savings from it. My main motivation, however, is to not be bored and to not lose mental function.

Having FI and working until 70 is different than working until 70 with a lot of financial obligations. With FI, if you get tired of it, somebody crosses you the wrong way, etc. you can just say "peace out!" and walk out the door. If you're drowning in debt, well you say "yes sir" and keep working. FI changes everything including the stress level you get from things you don't like at work.

To be fair, both of you work in SDGs with residents doing most of your work. Your job is much easier than a regular community pit doc.

 

[PTPuser]

I remember seeing you post back when you were a medical student. Such a shame to see the toll EM takes. Hope you find the answer soon!

I remember him too.

Let this be a warning to all the naive med students out there that think that they're "different" and that "it won't be like that for them".

We are all telling you. Warning you. Waving huge red flags at you.

In the words of the prophet Birdstrike:

"This job is bad for you."

ALL THIS. and my friends STILL shooting their entire existent dying for EM.

 

[emergentmd]

To be honest 90% of medical jobs are soul sucking in their own way. Looking back when I was in the hospital, I will name the soul sucking specialists that came to the ER.

Hospitalist, Surgeons, OB/GYN, Anesthesiologist. Essentially everyone I met in the ER looked depressed, sighed alot, and wondered why they picked their specialty.

EM is no different. You just got to figure out how to make it not soul sucking

 

[southerndoc]

To be fair, both of you work in SDGs with residents doing most of your work. Your job is much easier than a regular community pit doc.

I wouldn't say much easier. It's more difficult in another way. Yea, working with a third year resident I pretty much do nothing during the shift. Working with an intern is different. Trying to walk someone through their first, second, or third central line, watching them struggling with their first LP, etc. can be challenging not wanting to just take over the procedure for time's sake.

 

[EctopicFetus]

I also work some of my shifts without a resident at my main site and one of our other sites. You are right though. Not having someone steal a portion of my income definitely helps.

Keep in mind usacs posted their profit margin. After they steal a chunk of money through their msa (note as veers pointed out a lot of the real profit the docs don’t see comes from this) (insurance, billing and coding) and pay their worthless executive team they still make 10%. So if an em doc makes 380k which I think was the most recent average. It means usacs is keeping 38k every year.