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This month's Annals of Emergency Medicine Change of Shift column was written by Dr. Mark Debard, an emergency physician who was grandfathered into the specialty 40 years ago and notes he had few if any mentors throughout his career and now as he moves into retirement. It takes a lot of guts to write about your own fears, finances, and life and publish it to the world, and I'm sure Dr. Debard will eventually read what is written here, so I'm going to make an effort to remain very polite and sympathetic and encourage you to do the same.
Reading the column made me sad for a number of reasons, which I can't list without seeming critical of important decisions Dr. DeBard made in his life, but which I think are worthwhile for young emergency physicians, residents, and students to consider.
1) When To Drop Nights
Dr. DeBard gives a recommendation that you should go to "half-nights" at 55 and "no-nights" at 60 and notes that he had to convince his partners of the wisdom of that policy. In my mind, he's at least 10-15 years too late! If I were going to give recommendations to a junior colleague, I would tell him to plan his life so that he can go to "half-nights" at 40 and off them completely by 50. I would also tell him to avoid a group that doesn't get that. Nights suck. Working them is a cardiac risk factor. It decreases your longevity, increases your burnout, and has serious effects on family life that are compounded by the fact that the vast majority of emergency medicine shifts are NOT banker's hours. In fact, in my department, less than 2 out of 7 shifts are even close to banker's hours (the 6 am to 2 pm shift and the 11am to 7 pm shift on weekdays that aren't holidays.)
2) Cutting Back
Dr. DeBard also notes he "went to three quarters clinical time at age 62, which is also helping prolong my career. I'd recommend it to anyone over 55 or 60. It really improves attitude and enthusiasm. Plus, it gave me enough time to finally get serious about my physical fitness." Again, I'd say he's 20 years too late. If you plan your finances well, you can be 3/4 time by 40, 1/2 time by 45, and retired by 50. If you find that you don't even have enough time to stay physically fit as an emergency physician, you're working WAAAYYYY too much. There's only one reason people do that, and it isn't for the love of seeing more cases of alcohol intoxication. Cutting back improves your attitude and enthusiasm at 40 just as much as at 60. What's the point of making gobs of money if you can't use it to create exactly the life you want?
3) One House, One Spouse
Dr. DeBard notes he went through two divorces (and three marriages.) One of the cardinal rules of personal finance is one house, one spouse. Every time you get divorced you not only cut your wealth in half, but you decrease your ability to accumulate it for years afterward due to the alimony that almost every divorcing emergency physician is going to pay.
4) Paying for children's college
Dr. DeBard laments that "Financially, 2 divorces, late-in-life children with college expenses, and the income of an inner-city emergency physician haven't left me in a great position." Another important rule of personal finance is that retirement comes before college. Kids can dramatically reduce the cost of college by choosing a less expensive institution or going to one to which they get a scholarship. They can also take out loans and work. Many of us (and probably Dr. DeBard) did. But it's pretty tough to get a loan for retirement. If you make decisions like that, you might find that just like Dr. DeBard, you'll get to retirement and find that you "traveled a lot and lived well while working [but] will just need to tighten the belt and resolve to live with it." That's a crappy feeling I don't want to have on the eve of my retirement. I want my thought to be "how am I ever going to spend all this and who can I give it to where it will make the biggest difference?"
5) Low pay?
And about that "inner-city emergency physician" income, I have no idea what Dr. DeBard makes/made. It appears he is at Ohio State College of Medicine as an academic physician. Last I checked, Ohio has about the lowest cost of living in the country. Academics do get paid less than most private practice emergency physicians, especially partners. But it's hardly poverty wages. The 25th percentile for employee emergency physicians in the 2015 Daniel Sterns Survey was $250K. Let's assume he did even worse than that. We'll call it the equivalent of $200K over his ~35 year career. If he had saved just 20% of that income, that's $40K a year. At 8% a year, that should have grown to nearly $7 Million. Even with a divorce or two he shouldn't be feeling like he has to cut back his lifestyle significantly in order to retire. Remember that with no need to save for retirement or college, no kids at home, no work expenses, no disability or life insurance, and a much lower tax bill, he should be able to retire at the exact same lifestyle on $100K of retirement income. If there is a significant spousal retirement and Social Security, he may need as little as $1-2M in retirement savings to maintain his pre-retirement lifestyle.
6) What to do in retirement?
Another big issue for anyone who eventually plans to retire is how they will fill their time. Dr. DeBard doesn't want to work fast-track, has no interest in administration, and doesn't want to work at least 4 shifts a month (all of which might improve the financial situation.) Instead, he's been keeping a list the last few years of what he'd like to do once retired. I would submit rather than going full bore to 62, then 3/4 speed to 65, he would have a lot less difficulty knowing exactly what he wanted to do with his time if he'd been working a lot less all along. Figure out what you want to do "once you're retired" and start doing it now as much as possible. Then all you have to do is expand your plethora of hobbies and interests when you actually do pull the ejection handle.
The bottom line is this for young emergency physicians:
1) Assume you will want to stop working nights at 40, that you will want to start cutting back on shifts in your 40s, and that you will want to retire completely at some point in your 50s. Plan your finances accordingly. If that turns out not to be true, then you'll have a lot more money to spend, give, or leave to heirs.
2) Find your balance in life as early as possible. Too many shifts, especially night shifts, is incredibly stressful on a marriage. Far better to work less (and make less) and not have to split your assets in half once or twice. Balance also includes hobbies and other interests. If you don't have 4 or 5 things that make you excited about life at any given time, you're spending too much time at work. If you can't live on $200-400K, you have a spending problem, not an earning problem.
3) The secret to longevity in emergency medicine is to work less, be financially secure, and have the freedom to explore the academic and professional interests that come up along the way.
Reading the column made me sad for a number of reasons, which I can't list without seeming critical of important decisions Dr. DeBard made in his life, but which I think are worthwhile for young emergency physicians, residents, and students to consider.
1) When To Drop Nights
Dr. DeBard gives a recommendation that you should go to "half-nights" at 55 and "no-nights" at 60 and notes that he had to convince his partners of the wisdom of that policy. In my mind, he's at least 10-15 years too late! If I were going to give recommendations to a junior colleague, I would tell him to plan his life so that he can go to "half-nights" at 40 and off them completely by 50. I would also tell him to avoid a group that doesn't get that. Nights suck. Working them is a cardiac risk factor. It decreases your longevity, increases your burnout, and has serious effects on family life that are compounded by the fact that the vast majority of emergency medicine shifts are NOT banker's hours. In fact, in my department, less than 2 out of 7 shifts are even close to banker's hours (the 6 am to 2 pm shift and the 11am to 7 pm shift on weekdays that aren't holidays.)
2) Cutting Back
Dr. DeBard also notes he "went to three quarters clinical time at age 62, which is also helping prolong my career. I'd recommend it to anyone over 55 or 60. It really improves attitude and enthusiasm. Plus, it gave me enough time to finally get serious about my physical fitness." Again, I'd say he's 20 years too late. If you plan your finances well, you can be 3/4 time by 40, 1/2 time by 45, and retired by 50. If you find that you don't even have enough time to stay physically fit as an emergency physician, you're working WAAAYYYY too much. There's only one reason people do that, and it isn't for the love of seeing more cases of alcohol intoxication. Cutting back improves your attitude and enthusiasm at 40 just as much as at 60. What's the point of making gobs of money if you can't use it to create exactly the life you want?
3) One House, One Spouse
Dr. DeBard notes he went through two divorces (and three marriages.) One of the cardinal rules of personal finance is one house, one spouse. Every time you get divorced you not only cut your wealth in half, but you decrease your ability to accumulate it for years afterward due to the alimony that almost every divorcing emergency physician is going to pay.
4) Paying for children's college
Dr. DeBard laments that "Financially, 2 divorces, late-in-life children with college expenses, and the income of an inner-city emergency physician haven't left me in a great position." Another important rule of personal finance is that retirement comes before college. Kids can dramatically reduce the cost of college by choosing a less expensive institution or going to one to which they get a scholarship. They can also take out loans and work. Many of us (and probably Dr. DeBard) did. But it's pretty tough to get a loan for retirement. If you make decisions like that, you might find that just like Dr. DeBard, you'll get to retirement and find that you "traveled a lot and lived well while working [but] will just need to tighten the belt and resolve to live with it." That's a crappy feeling I don't want to have on the eve of my retirement. I want my thought to be "how am I ever going to spend all this and who can I give it to where it will make the biggest difference?"
5) Low pay?
And about that "inner-city emergency physician" income, I have no idea what Dr. DeBard makes/made. It appears he is at Ohio State College of Medicine as an academic physician. Last I checked, Ohio has about the lowest cost of living in the country. Academics do get paid less than most private practice emergency physicians, especially partners. But it's hardly poverty wages. The 25th percentile for employee emergency physicians in the 2015 Daniel Sterns Survey was $250K. Let's assume he did even worse than that. We'll call it the equivalent of $200K over his ~35 year career. If he had saved just 20% of that income, that's $40K a year. At 8% a year, that should have grown to nearly $7 Million. Even with a divorce or two he shouldn't be feeling like he has to cut back his lifestyle significantly in order to retire. Remember that with no need to save for retirement or college, no kids at home, no work expenses, no disability or life insurance, and a much lower tax bill, he should be able to retire at the exact same lifestyle on $100K of retirement income. If there is a significant spousal retirement and Social Security, he may need as little as $1-2M in retirement savings to maintain his pre-retirement lifestyle.
6) What to do in retirement?
Another big issue for anyone who eventually plans to retire is how they will fill their time. Dr. DeBard doesn't want to work fast-track, has no interest in administration, and doesn't want to work at least 4 shifts a month (all of which might improve the financial situation.) Instead, he's been keeping a list the last few years of what he'd like to do once retired. I would submit rather than going full bore to 62, then 3/4 speed to 65, he would have a lot less difficulty knowing exactly what he wanted to do with his time if he'd been working a lot less all along. Figure out what you want to do "once you're retired" and start doing it now as much as possible. Then all you have to do is expand your plethora of hobbies and interests when you actually do pull the ejection handle.
The bottom line is this for young emergency physicians:
1) Assume you will want to stop working nights at 40, that you will want to start cutting back on shifts in your 40s, and that you will want to retire completely at some point in your 50s. Plan your finances accordingly. If that turns out not to be true, then you'll have a lot more money to spend, give, or leave to heirs.
2) Find your balance in life as early as possible. Too many shifts, especially night shifts, is incredibly stressful on a marriage. Far better to work less (and make less) and not have to split your assets in half once or twice. Balance also includes hobbies and other interests. If you don't have 4 or 5 things that make you excited about life at any given time, you're spending too much time at work. If you can't live on $200-400K, you have a spending problem, not an earning problem.
3) The secret to longevity in emergency medicine is to work less, be financially secure, and have the freedom to explore the academic and professional interests that come up along the way.
