Job Cobbler after Residency - Advice?

[vespers]

Spending that much extra on a car is unimaginable to me. The emotional pain of putting $50k extra out on the street instead of in an investment would be unbearable. Or to just cobble one less job.

Some people spend hours a day in their car, or just enjoy cars. And not everyone cares about accumulating a Dave Ramsey / White Coat Investor approved mountain of cash before they die.

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[calvnandhobbs68]

When people make that claim, they aren't talking about comparing new top-model offerings. They're talking about used late model vehicles. Mercedes is indeed cheaper than most other luxury brands on this front.

Another way to say that is they depreciate faster….

 

[vespers]

Another way to say that is they depreciate faster….

Yeah, I think they require a lot of repairs. But the original assertion holds; you've just identified the reason.

 

[mistafab]

I appreciate all the good advice in this thread. I'm still on the fence about going full throttle, work-a-holic job cobbler, however it seems very reasonable to start 1 job and add on from there depending on how things go. The wife is very supportive, and I think we are under-exposed to Job-Cobbler lifestyles, despite psychiatry being very well suited for it.

Grateful for all the advice and I definitely agree that time with the kids/family is priceless at any age. I'm predisposed to love work so 40-50 hours seems underwhelming at times. I was someone on the fence between psychiatry and general surgery as a MS4 so go figure. However, taking on a job without a non-compete covenant at 30-40 hours/wk and seeing what a few shifts elsewhere feels like seems to be a sustainable option where I can pause/stop anytime, or pull back as needed.

I'm staring down the barrel of all these contracts right now and am feeling somewhat disgusted. There is a lot of unfavorable language in contracts that have me a bit disillusioned. I would hope long-term to build a practice, so I don't want to sign these common, abusive covenants. At the same time, it seems a bit risky to go straight 1099 all-in after residency without any attending-level practice under my belt.

 

[vespers]

At the same time, it seems a bit risky to go straight 1099 all-in after residency without any attending-level practice under my belt.

Meh, YOLO. Could just have a 2-3d/wk contractor job as your cushion as you set up and tinker with your other stuff. If the big picture doesn't work out, you can drop the projects and scrape by on that original contract work as you apply for academics or whatever.

 

[Lee Ik-jun MD]

Spending that much extra on a car is unimaginable to me. The emotional pain of putting $50k extra out on the street instead of in an investment would be unbearable. Or to just cobble one less job.

talk to your accountant. I have it set up that my cars/SUV payments are tax write offs.

 

[TexasPhysician]

honestly people always say this but mercedes are highly affordable cars when compared to other luxury brands or trucks/suvs

In the context of living like a resident, any luxury car brand would have fit in that sentence. The poster just chose “Mercedes”. If the goal is to pay down high debt fast, something reliable and simple like a Honda Fit for $16k is plenty. $34,000 for a Mercedes a class is 2x the money for less reliability.

Being that this thread is about smashing debt and adding up jobs, any remotely luxurious car sounds like it doesn’t fit the goal.

I don’t like financing a depreciating asset either. It’ll have you spending more than you would have otherwise.

 

[reca]

talk to your accountant. I have it set up that my cars/SUV payments are tax write offs.

Tax write off doesn’t mean free, it means a discount (at the rate of whatever your marginal tax rate is).

 

[ObsequiousAplomb]

In the context of living like a resident, any luxury car brand would have fit in that sentence. The poster just chose “Mercedes”. If the goal is to pay down high debt fast, something reliable and simple like a Honda Fit for $16k is plenty. $34,000 for a Mercedes a class is 2x the money for less reliability.

Being that this thread is about smashing debt and adding up jobs, any remotely luxurious car sounds like it doesn’t fit the goal.

I don’t like financing a depreciating asset either. It’ll have you spending more than you would have otherwise.

To further your point, a $16k fit would also be at least 3 years old. So you're saying to buy a used cheap car instead of literally anything newish.

 

[TheRightMedication]

talk to your accountant. I have it set up that my cars/SUV payments are tax write offs.

Is your accountant Saul Goodman?

 

[Lee Ik-jun MD]

Is your accountant Saul Goodman?

let's just say that one of his client was a former US president LOL!
seriously though, he has it set up that he 's able to use my monthly payments for 3 luxury cars ( Range Rover, Tesla Model X Plaid, Merc G Wagon) as deduction, my gasoline allowance, etc..
Something about the weight of the vehicles too, that's why 2 are V8. the other docs in our practice use his firm too..
if anyone is interested just shoot me a message, he's based here in Beverly Hills.
if I'm not mistaken he has a retainer and and $1500/ yr per client in our practice.

 

[vespers]

In the context of living like a resident, any luxury car brand would have fit in that sentence. The poster just chose “Mercedes”. If the goal is to pay down high debt fast, something reliable and simple like a Honda Fit for $16k is plenty. $34,000 for a Mercedes a class is 2x the money for less reliability.

Being that this thread is about smashing debt and adding up jobs, any remotely luxurious car sounds like it doesn’t fit the goal.

I don’t like financing a depreciating asset either. It’ll have you spending more than you would have otherwise.

I know what OP asked, and I'm picking a little at the underlying thing. I personally don't see the purpose in being a hyper-purist total optimization savings machine. I know it's a huge part of physician finance culture at this point and that everyone's situation is a little different. But it seems alright to me if you get a $25k used Lexus or whatever instead of the $16k used Fit when you're earning $250-800k?

 

[Merovinge]

I know what OP asked, and I'm picking a little at the underlying thing. I personally don't see the purpose in being a hyper-purist total optimization savings machine. I know it's a huge part of physician finance culture at this point and that everyone's situation is a little different. But it seems alright to me if you get a $25k used Lexus or whatever instead of the $16k used Fit when you're earning $250-800k?

Yeash, even this is not the kind of thing that ruins doctor finances. If you buy a new car for $40k and keep it 7-10 years on a doctor salary you will be A okay. It's the folks getting porsches out of training with huge loan burden, multimillion dollar home, and expensive tastes/hobbies that are doing themselves a disservice. You can afford a new car as an attending.

 

[Orgone]

At the same time, it seems a bit risky to go straight 1099 all-in after residency without any attending-level practice under my belt.

I did. Worked out fine for me. I've actually only done private practice and locums (with 2 assignments lasting several years).

 

[Candidate2017]

The thing is, I'm feeling like it might be better to put my so called "career" on hold after graduating, and just going out there and making money by working my face off.

As a physician in clinical practice, being a board cert physician is the apex of your career. Unless you change roles, there are no more steps on the ladder to climb, no made up titles to earn like "North American Sr MD VP in Charge of Seeing 2 Patients an Hour".

At the same time, it feels a little unsettling to consider doing the Job Cobbler gig, when nothing is as set in stone. I have my kids and family to consider so I don't want to take large risks.

Job cobbling is low risk. You're diversifying income and experience. Moving across the country to sign a contract to work for The Man may be a bigger risk. As an employee, duties always expand beyond what you originally negotiated. It will never be as advertised, and you can't leave without holes in your CV.

The disadvantage of cobbling is it may ruin you from ever being a W-2 employee. The freedom is too much. You may also lose out on W-2 benefits like insurance, loan repayment, sign on bonuses. This may or may not be a big deal depending on tax write offs.

This is the psych board. Be warned if you work more than 35 clinical hours a week, your level of care will bring untold shame to your former attendings who advocate for NP practice, you will get divorced, your kids will be drug addicts, and you will die of alone from a stress-induced cardiovascular event. In actuality, the odds are no greater or lesser than for anyone else. 60-80 hours a week is the norm for many professionals. And a large percentage are able to do so without ill effects on their personal life or health. Work as much or as little as you want.

 

[TexasPhysician]

To further your point, a $16k fit would also be at least 3 years old. So you're saying to buy a used cheap car instead of literally anything newish.

A $16k Honda Fit with 35k miles will likely be just as reliable as a new Mercedes with lower repair costs over the next 5-10 years.

There is a reason that most psychiatrists drive Honda, Acura, Toyota, Lexus, and Subaru over alternatives. They actually did a study on this.

 

[calvnandhobbs68]

This is the psych board. Be warned if you work more than 35 clinical hours a week, your level of care will bring untold shame to your former attendings who advocate for NP practice, you will get divorced, your kids will be drug addicts, and you will die of alone from a stress-induced cardiovascular event. In actuality, the odds are no greater or lesser than for anyone else. 60-80 hours a week is the norm for many professionals. And a large percentage are able to do so without ill effects on their personal life or health. Work as much or as little as you want.

Yeah that's a bit of a stretch, ask their kids what they thought about never seeing mom/dad in the morning and them never being home for dinner or bedtime. Or their spouses. Everyone should do their own thing but there's a big gap between 35 and 60 hours a week...25 hours to be exact.

 

[clausewitz2]

A $16k Honda Fit with 35k miles will likely be just as reliable as a new Mercedes with lower repair costs over the next 5-10 years.

There is a reason that most psychiatrists drive Honda, Acura, Toyota, Lexus, and Subaru over alternatives. They actually did a study on this.

I think there is a significant bias here in terms of the SES that is disproportionately represented in psychiatry. More so than most specialties we seem to attract people from the stratum of society that regards splashy vehicles as rather gauche or in poor taste. I am trying to phrase this neutrally, genuinely not meant as an insult to anyone.

 

[Celexa]

I think there is a significant bias here in terms of the SES that is disproportionately represented in psychiatry. More so than most specialties we seem to attract people from the stratum of society that regards splashy vehicles as rather gauche or in poor taste. I am trying to phrase this neutrally, genuinely not meant as an insult to anyone.

Ha. I bought a new car from the general category of sensible cars described here, at the height of the Covid era bubble where paying msrp for a brand new car from the factory was a better deal than used, if the purchase wasn't time sensitive and still had to work to shake off generational guilt.

Walking into a dealership and just placing an order knowing there would be zero negotiating and I would be paying exactly the advertised factory price made it the easiest car buying experience I've ever had, and it's exactly the car I wanted. No regrets

 

[Stagg737]

I know what OP asked, and I'm picking a little at the underlying thing. I personally don't see the purpose in being a hyper-purist total optimization savings machine. I know it's a huge part of physician finance culture at this point and that everyone's situation is a little different. But it seems alright to me if you get a $25k used Lexus or whatever instead of the $16k used Fit when you're earning $250-800k?

I don't think that's really what's being described. I agree that paying even $40k-$50k for a new car that you'll drive for the next 10+ years isn't something that should cause most physicians to lose any sleep. But there is a big difference between being economical and paying <$30k for a reliable car that you'll keep for 10+ years vs. buying a "luxury" car for $60k+ that's going to depreciate significantly that you're going to trade in every 5-7 years. Putting that extra money into investments early can make a huge difference in the long run.

This is the psych board. Be warned if you work more than 35 clinical hours a week, your level of care will bring untold shame to your former attendings who advocate for NP practice, you will get divorced, your kids will be drug addicts, and you will die of alone from a stress-induced cardiovascular event. In actuality, the odds are no greater or lesser than for anyone else. 60-80 hours a week is the norm for many professionals. And a large percentage are able to do so without ill effects on their personal life or health. Work as much or as little as you want.

That's fair and I know plenty of docs who work those hours. But unlike money and many other aspects of life, time is a zero sum game. You can't work more without taking that time from somewhere else. For people who value their personal time or time with family, especially time with kids where time is limited to build the relationship during development, reflection on where the extra hours are spent beyond work to hit the necessary income is important as once those years pass you never get them back.

 

[mistafab]

There was an excellent article recently by Dr. Nasrallah in Current Psychiatry called “the joys and rewards from an unbalanced life.”

I think about his take on ‘work life balance’ - and think about some perspectives on this thread. It’s cool Psychiatry has such a range of personalities and lifestyles it can afford.

 

[the5thelement]

There was an excellent article recently by Dr. Nasrallah in Current Psychiatry called “the joys and rewards from an unbalanced life.”

I think about his take on ‘work life balance’ - and think about some perspectives on this thread. It’s cool Psychiatry has such a range of personalities and lifestyles it can afford.

That article seems like a humble brag (or simply just a brag) , full of praises for what he has accomplished. I asked Chatgpt to summarize it and this is what it came up with:"
Let's say it's 30 years from now, and here I am, still the king of the hill. You wanna know the secret? Here it is: I didn't just play the game, I changed it. Authoring hundreds of scientific papers, pushing out 13 books, snagging those grants like they were low-hanging fruit. Editor of not one, but three journals. And hey, I didn't just join the international schizophrenia society, I built it from the ground up.
Leadership? I didn't just take a seat at the table; I was the head of the table at two universities, not to mention the big shot president of more associations than I've got fingers for. Lectures? I've given more than a bartender pours drinks, all over the globe. Patients? I've seen more faces than a subway driver in rush hour.
Teaching, supervising, mentoring — I've lit more fires under more asses than you can count. And that foundation, CURESZ.org? That's my grand slam, my walk-off home run. That was taking the impossible and telling it to take a hike because I prescribed the miracle that no one else would.
How did I do it? By not giving a damn about balance. By squeezing every second for its worth. No hours lost to the TV or the black hole of social media. And you know what? Through all this so-called 'unbalance,' my heart's been full. Married to my first love, kids and grandkids topping the charts. I made sure that while I was busy shooting for the stars, I never missed a soccer game or a ballet recital.
So, there you have it. How did I make my mark? By living every minute like it was my last and never, ever betting small."

 

[calvnandhobbs68]

That article seems like a humble brag (or simply just a brag)

For sure
Again, everyone should do what they really feel makes them happy and they value, but also be honest with themselves about where they're putting their completely unknown amount but still finite amount of time. I don't even get this from that article. Just the fact it exists is interesting, the gist of it is basically "no really guys, look, it was all worth it, I'm super happy!". People who are secure in their accomplishments don't feel the need to list off every single one and invoke Einstein and Freud to justify their life choices.

Great quotes:
"I was lucky to have a very supportive and competent wife (a psychologist), who spared me from having to wake up at night to feed our first baby or do various household chores"
"have a son and a daughter who are very high achievers and make me proud"

I guess value is derived from competence, achievements and how much others support you?

 

[vespers]

Great quotes:
"I was lucky to have a very supportive and competent wife (a psychologist), who spared me from having to wake up at night to feed our first baby or do various household chores"
"have a son and a daughter who are very high achievers and make me proud"

Lol

To be fair, the point of the baby and chores comment was just to demonstrate how he managed to achieve the things he did.

I will say though that I agree with his sentiment that people should push themselves to do great things if they're capable. It's just that a sort of ugly and reductionistic utilitarianism tends to follow such a sentiment. But it doesn't necessarily have to.

The practical relation between the two things is unfortunate. Because of it, by buying into resentment politics, fending off the "boomer" love of work, etc., younger people do often inadvertently eschew greatness, I think.

 

[the5thelement]

For sure
Again, everyone should do what they really feel makes them happy and they value, but also be honest with themselves about where they're putting their completely unknown amount but still finite amount of time. I don't even get this from that article. Just the fact it exists is interesting, the gist of it is basically "no really guys, look, it was all worth it, I'm super happy!". People who are secure in their accomplishments don't feel the need to list off every single one and invoke Einstein and Freud to justify their life choices.

Great quotes:
"I was lucky to have a very supportive and competent wife (a psychologist), who spared me from having to wake up at night to feed our first baby or do various household chores"
"have a son and a daughter who are very high achievers and make me proud"

I guess value is derived from competence, achievements and how much others support you?

Personally for me , it sounds a like a nightmare. I far prefer to
sit on the dock of the bay
Watch the tide roll away
Wastin' time....

 

[Candidate2017]

Yeah that's a bit of a stretch, ask their kids what they thought about never seeing mom/dad in the morning and them never being home for dinner or bedtime. Or their spouses. Everyone should do their own thing but there's a big gap between 35 and 60 hours a week...25 hours to be exact.

Many households have parent(s) who work a lot due to professional choice or because they need to (i.e., live in a HCOL or are the working poor/immigrants/middle class who are trying to put food on the table and give their kids a better life). Many of your physician colleagues likely grew up in such households. There are also divorced households, military households, etc. whose kids turn out all right. \

As psychiatrists, we see the mentally ill. Even if we restrict our practices to non-severe patients (i.e. the well to do worried well), they are still psychiatric patients with "issues". But we shouldn't fall for sampling bias and extrapolate sampling what we see in our work to the general population. Most people are not raging borderlines, psychotically meth'ed out, pint sized demon spawns in need of Adderall and IEPs, or rich kids rebelling against their parents.

Again, many, many people have parents who worked a lot. They generally aren't sitting in your waiting room.

 

[calvnandhobbs68]

Many households have parent(s) who work a lot due to professional choice or because they need to (i.e., live in a HCOL or are the working poor/immigrants/middle class who are trying to put food on the table and give their kids a better life). Many of your physician colleagues likely grew up in such households. There are also divorced households, military households, etc. whose kids turn out all right. \

As psychiatrists, we see the mentally ill. Even if we restrict our practices to non-severe patients (i.e. the well to do worried well), they are still psychiatric patients with "issues". But we shouldn't fall for sampling bias and extrapolate sampling what we see in our work to the general population. Most people are not raging borderlines, psychotically meth'ed out, pint sized demon spawns in need of Adderall and IEPs, or rich kids rebelling against their parents.

Again, many, many people have parents who worked a lot. They generally aren't sitting in your waiting room.

You're really failing to understand the difference between "parents who had to work a lot" and "parents who decided to work twice as many hours a week so they could make 600K/year instead of 300k/year".
There's quite a difference between "mom had to work 80 hours a week to put food on the table" (by the way, those kids often still wish they saw their parents more but understand the situation) and "mom worked 80 hours a week so she could do something called FIRE and retire when I go to college I guess?" or "mom worked 80 hours a week so she and dad could drive porsches and buy a million dollar house".

I have no idea where the second paragraph came from. There are plenty of people who resent their parents or wished they could have spent more time with them who don't end up in our offices. There are also plenty of people who wish when their kids are surly 17 year olds that they spent more time with them 10 years ago. Just ask around.

People should do what makes them happy and be honest with themselves about where they're spending their time and what that likely impacts. I'm never going to be big researcher or make twice my current salary, but my kids will remember me being home with them three days a week. Maybe you'll make a ton of money and retire when your kids are 20 or do some awesome research but I can guarantee that your kids won't remember you being home much if you're working 80 hours a week during their childhood...and I mean you just have to be honest and accept that.

 

[dl2dp2]

That article seems like a humble brag (or simply just a brag) , full of praises for what he has accomplished. I asked Chatgpt to summarize it and this is what it came up with:"
Let's say it's 30 years from now, and here I am, still the king of the hill. You wanna know the secret? Here it is: I didn't just play the game, I changed it. Authoring hundreds of scientific papers, pushing out 13 books, snagging those grants like they were low-hanging fruit. Editor of not one, but three journals. And hey, I didn't just join the international schizophrenia society, I built it from the ground up.
Leadership? I didn't just take a seat at the table; I was the head of the table at two universities, not to mention the big shot president of more associations than I've got fingers for. Lectures? I've given more than a bartender pours drinks, all over the globe. Patients? I've seen more faces than a subway driver in rush hour.
Teaching, supervising, mentoring — I've lit more fires under more asses than you can count. And that foundation, CURESZ.org? That's my grand slam, my walk-off home run. That was taking the impossible and telling it to take a hike because I prescribed the miracle that no one else would.
How did I do it? By not giving a damn about balance. By squeezing every second for its worth. No hours lost to the TV or the black hole of social media. And you know what? Through all this so-called 'unbalance,' my heart's been full. Married to my first love, kids and grandkids topping the charts. I made sure that while I was busy shooting for the stars, I never missed a soccer game or a ballet recital.
So, there you have it. How did I make my mark? By living every minute like it was my last and never, ever betting small."

This *maybe* sour graping but still: is being chair at St. Louis University really that big of an achievement that you'd publicly brag about?

I feel like being a group head at Goldman Sachs or being a billionaire or even a highly successful and well-known private psychiatrist might be a bit more desirable/higher achieving. Maybe my brain is completely screwed up now. Not sure. I feel like my value system has been poisoned by the academic cult and it's kind of hard to engage with reality.

 

[Merovinge]

This *maybe* sour graping but still: is being chair at St. Louis University really that big of an achievement that you'd publicly brag about?

I feel like being a group head at Goldman Sachs or being a billionaire or even a highly successful and well-known private psychiatrist might be a bit more desirable/higher achieving. Maybe my brain is completely screwed up now. Not sure. I feel like my value system has been poisoned by the academic cult and it's kind of hard to engage with reality.

I hear ya, it would be one thing if he was chair of WashU but SLU is not the brag I would be expecting.

 

[TexasPhysician]

This *maybe* sour graping but still: is being chair at St. Louis University really that big of an achievement that you'd publicly brag about?

I feel like being a group head at Goldman Sachs or being a billionaire or even a highly successful and well-known private psychiatrist might be a bit more desirable/higher achieving. Maybe my brain is completely screwed up now. Not sure. I feel like my value system has been poisoned by the academic cult and it's kind of hard to engage with reality.

In the academia world, being chair in your preferred city where you have significant power is probably the pinnacle of all career possibilities. When you control everything, the prestige is more yours to develop or maintain. If the name doesn’t mean more in psych, it is your fault eventually.

Most in private practice won’t find academic appointments important or prestigious, in his world it is everything.

 

[mistafab]

I mean not that I particularly care to defend him, however he’s been significantly involved at OSU, SLU, and Cinci. So in the Midwest at least he’s clearly the people’s champ in the academic world.

The main thing in his article was that as editor, he is responding to the pendulum in psych that is swinging towards lifestyle over everything. My thread particularly is getting advice between balancing early career energy /hunger for cash and desire to be a decent dad/husband.

Nasrallah would probably argue that lifestyle “balance” is often unbalanced at times, and that is okay, especially when you’re pushing to achieve something. I’m not sure I care so much to “achieve” as he does, but man can I feel how light the wallet is these days. Achieving some financial peace is a big driving factor for me, but not at the expense of everything.

I continue to appreciate all your thoughts. I think accepting a primary gig with minimal contract obligations would allow me to build a second job in there PRN as I want/desire. I don’t want to take on too much at once, but now I’m pretty firm in refusing to sign very restrictive covenants and making that a big priority. I eventually will dip into private practice (or dive in) but not sure when I’ll pull the trigger on that.

 

[Lee Ik-jun MD]

Some people spend hours a day in their car, or just enjoy cars. And not everyone cares about accumulating a Dave Ramsey / White Coat Investor approved mountain of cash before they die.

12 miles.... 45 minutes ( LA traffic) . a nicer car makes this bearable.

 

[Merovinge]

In the academia world, being chair in your preferred city where you have significant power is probably the pinnacle of all career possibilities. When you control everything, the prestige is more yours to develop or maintain. If the name doesn’t mean more in psych, it is your fault eventually.

Most in private practice won’t find academic appointments important or prestigious, in his world it is everything.

I don't mean to disparage anyone, but I think there is a very very small percentage of the US who's preferred city is St Louis. To each their own, but there is virtually nothing about that city that is well ranked. Obviously if you have other family or reason to be there it can make sense, but I just find that it being his preferred city to be pretty unlikely.

 

[Stagg737]

I don't mean to disparage anyone, but I think there is a very very small percentage of the US who's preferred city is St Louis. To each their own, but there is virtually nothing about that city that is well ranked. Obviously if you have other family or reason to be there it can make sense, but I just find that it being his preferred city to be pretty unlikely.

What are you talking about? Just the opportunity to have Nelly pour your drinks in a bar while his greatest hits blasts in the background makes it the promised land. I can't think of anything more desirable than that...

Seriously though, my ex was from St. Louis area and outside of City Park and a few random spots I don't see why people would find it preferable other than growing up there, and I'm someone who generally likes being in the midwest.

ETA: Forgot that they actually do have some really nice lakes (some private) within 30-40 minutes of the city. It's definitely a lakehouse kind of city and it looks like you can easily find decent lakehouses near there for under $400k.

 

[finalpsychyear]

The most signficant money you will ever make and invest will be in the first 10 years as an attending. Do it right and keep your wife happy you'll be on cruise control.

 

[TexasPhysician]

I don't mean to disparage anyone, but I think there is a very very small percentage of the US who's preferred city is St Louis. To each their own, but there is virtually nothing about that city that is well ranked. Obviously if you have other family or reason to be there it can make sense, but I just find that it being his preferred city to be pretty unlikely.

While I’ve never lived in St Louis, similar phrasing has been said about every city I’ve ever lived in. “Weren’t you glad to get out of there?” is not uncommon when discussing the past. I have family in parts of New Mexico with high crime that have the $ to leave but never will. They love it.

What little i know - St Louis is a large, low cost of living city with MLB and NHL teams with plenty of food and low cost art scene. It is a day trip away from many other cities and outdoor attractions. That’ll attract plenty of people.

Similar thought - look at Nick Saban. He could take any coaching job in any city. He has plenty of money. He loves Alabama. He loves being a huge personality in an average area. He can do no wrong, and no one questions his decisions there.

 

[mistafab]

Just giving an update.

Currently have several potential options to be a solid job cobbler. These are two primary gigs, where I can use that as a skeleton/base and wrap in a second job on the side to supplement (likely 1099).

One gig i'm considering is 14 days a month ER (no nights, no weekeds). It's VA so benefits are covered. I'm considering this stuff as the main gig while I work a second job to either pay off loans faster or use the time to build my PP. They initially quoted me 260k, but now the offer is around 275 and may be higher when they apply for the position in the new calendar year. There is a 15k per year bonus if you do a small QI project and document correctly. Overall seems very solid for a job cobbler base while having tons of time for my kids. Since it is VA there is no restrictive covenant or noncompete which is great.

Other gig I'm considering is a department of mental health Job. More footprint on my week but excessively easy. The call they offer is also a great deal given frequency of optional call (1-3 calls per week) at pay rate of several thousand per week. They give a lot of flexibility on when I do my hours, So I could also probably squish it to 3 big days per week. Again, I'm not considering overnight work because I value my sleep. They offer ballpark 240k for this, and as people have mentioned elsewhere, you are expected to copy-past a note once a week or so. The biggest drag, per providers there, is how boring it is. If I go this route, then I have space to moonlight or build an afternoon practice and eventually quit the main job.

So essentially, I am moving forward with Job Cobbler Psychiatry - but given the advice in this thread, I will be building it on the skeleton of a main gig to get more stability in lifestyle/hours. Additionally, I will not be working as many hours as I had initially proposed, given that I like to spend time with family.

So far, Job Cobbling seems to be very doable, and I can definitely hit my goal of 400k in a year with either of these bad boys. Will update when I actually start making this happen. I have contracts in hand (not signed) but will not move forward for sure until I get more competitive offers / negotiating time. Seems everywhere I apply is willing to hire me so long as I have a pulse, so market is great right now in psychiatry - even fresh grads.

 

[TheRightMedication]

Congrats on getting some offers !

Edit - I mean good offers that suit you.

 

[comp1]

Assuming that is a full time VA job, it will come with EDRP which is $200k loan forgiveness spread out over 5 years. (That's in addition to PSLF.)

 

[mistafab]

Assuming that is a full time VA job, it will come with EDRP which is $200k loan forgiveness spread out over 5 years. (That's in addition to PSLF.)

Yep, that particular gig is tied to a 25 k per year EDRP to that total.

 

[Splenda88]

The most signficant money you will ever make and invest will be in the first 10 years as an attending. Do it right and keep your wife happy you'll be on cruise control.

I wish I understood that when I was younger. Not easy trying to catch up when you are already in your 40s (non traditional route to become an MD).

If you rake up some cash early as an attending while having the semblance of an ok lifestyle, you will be ahead of the game financially IMO. No need to work 80 hrs, but 55-60 is not that bad. I don't have any stats but based on anecdotes, most people who work FT put in ~50 hrs/wk

Which is better?

1) Making 600k/yr (working 60 hrs/wk), and invest aggressively for 10 yrs and then cut back to 20 hrs/wk until you truly retire.

Or

2) Work 35 hrs/wk for 350k until you retire

I am choosing something in between but many of my colleagues think #1 is better.

 

[Merovinge]

I wish I understood that when I was younger. Not easy trying to catch up when you are already in your 40s (non traditional route to become an MD).

If you rake up some cash early as an attending while having the semblance of an ok lifestyle, you will be ahead of the game financially IMO. No need to work 80 hrs, but 55-60 is not that bad. I don't have any stats but based on anecdotes, most people who work FT put in ~50 hrs/wk

Which is better?

1) Making 600k/yr (working 60 hrs/wk), and invest aggressively for 10 yrs and then cut back to 20 hrs/wk until you truly retire.

Or

2) Work 35 hrs/wk for 350k until you retire

I am choosing something in between but many of my colleagues think #1 is better.

There is no better. Everyone has different priorities. If option 1 comes when you have young children, that is time you will never be able to recapture. If it comes by making you jaded and performing suboptimal medicine, those people's lives will never experience what optimal you could have provided. If you get fired up about working hard for a decade and then working part-time and it makes you a better doctor, partner, what have you, then of course it could be best.

The whole point of being in a position of privilege is to have optionality. Psychiatrists have far more optionality than 99.9% of the world and we should also have the introspection to determine what works best for us. Use your MD and psychotherapy/psyche understanding to real world use and pick the best option for yourself.

 

[uhmocksuhsillen]

I am inundated with locums looking for community mental health clinics. 6 months contracts, 225 an hour. I've considered doing one of these 6 months a year and taking the other 6 off. How many other people can find jobs like this? We are indeed lucky.

 

[mistafab]

Got a different DMH job offer which has great cobbler footprint.

242k base, 30k additional in form of retention.
No nights. No weekends. Flexible to do 4-10s 7-5, one of which is from home (3-10s on site, one is pure admin from home). Similar “shift” in that no work is completed outside of work hours.

Gov employee generous benefits. But more importantly, again no restrictive covenant or noncompete.

Overall feels very equal to the VA gig. These patients are a bit more interesting to me due to it being forensic work, and it being local I can flex the network more and increase my forensic/pp side gig more fluidly.

Currently (and unexpectedly) favoring this gig over the VA due to some intangibles, but continuing to interview and not sign anywhere yet.

Job cobbling is definitely possible folks. There are jobs out there with less footprint on your week. There is no requirement in psychiatry to work a full week or do nights/weekends even straight out of residency.

 

[psychemdoc]

Keep preaching the gospel and maybe more people will realize the truth soon enough. Thanks for sharing this!

 

[SeniorWrangler]

Try to find a decent job with loan forgiveness if you can live in an underserved area for a while, it is probably the biggest favor you can do yourself.