Docs Who Cut Back #10: Cory Fawcett, MD

I had the pleasure of meeting Dr. Cory Fawcett, a "repurposed" general surgeon, at FinCon18. Since leaving medicine, Cory has authored several books and started a business, Prescription For Financial Success, geared toward helping physicians live sustainable lifestyles free from debt. He is credited by many, including my friend B.C. Krygowski, as having been a key figure in helping them turn their financial lives around.

Many of those who have offered to share their stories in this series have come from hospital-based specialties where a physician works a shift schedule. It's refreshing to hear from a physician in an office-based practice, where the business is the physician.

Note how Cory was able to find creative ways to tailor his practice to his preferences to create a more sustainable career in a very demanding field, and how he created a plan to cut back in stages near the end of his medical career.

1. What is your specialty, and how many years of residency/fellowship did you complete?

I went straight through my training without taking any breaks. After medical school I completed a five year general surgery residency followed by 23 years practicing general surgery as an attending. I was 31 years old when I started my practice.

I cut back in steps. The first reduction happened when I became debt free, 8 years after starting my practice. With no debt hanging over my head, I finally felt comfortable eliminating cases I didn’t enjoy, so I give up thoracic and vascular surgery. I was only holding on to them because they paid more than the other cases. I thought my income would drop if I stopped doing them, but after becoming debt free, I didn’t worry about my income dropping.

I took the plunge and gave those procedures to my partner who liked them. Funny thing about it, my income didn’t drop. The holes left in my practice from those cases I didn’t like, were filled up with cases I did like. This cut back gave me no drop in income and a better, happier, more fulfilling life as a surgeon. What a great deal that was. I should have done it sooner?

The next cut back came when I was 50 years old. Since I was in medical school my goal was to retire at age 50. But when I reached 50 I wasn’t ready to completely retire from medicine. I was, however, ready to start slowing down. At that point I was financially independent so I didn’t need to earn a living anymore.

Throughout my career my earnings were less than the median for my specialty, due to living in an economically depressed area and taking a lot of vacation. So contrary to many doctor’s beliefs, I did not become financially independent because I made a lot of money, or more money than they did.

I reached that goal by living on substantially less than I made and saving and investing for my future, even during residency. I didn’t earn more money than anyone else during residency. But how many other doctors were living on 50% of their household income during residency? The value of the money I saved in residency will pass $1,000,000 by the time I reach age 70.

As I cut back my work hours, my fixed expenses in the practice did not decrease, so my take home income fell. My wife said, if I keep this up I will be paying my partners for the privilege of operating. So we needed to make a change.

I left my practice of 20 years and began locum tenens work at critical access hospitals with only one surgeon who is on call 24-7. That lone surgeon got a much needed vacation or at least a week without call. Since I was working in a small hospital, I usually wasn’t very busy. The first two years I did locums I worked two and a half weeks a month. The following year I gradually tapered down to just one week a month, finally stopping completely in 2017 at age 54.

2. What did your parents do for their livelihood?

I was raised in a lower middle class home. My father was a butcher at a custom meat packing facility and my mother was a hair dresser. I never had the feeling we were “doing without” during my childhood. We had everything we needed. But we didn’t have many extras. Our vacations consisted of visiting relatives.

I took my first airplane trip the summer between my junior and senior year in high school. We didn’t have a lot, but what we had was paid for with cash. Except for the home mortgages, my parents and grandparents, did not acquire any debt.

They also did not change houses much. In fact, my parents still live in the house they bought when I was 1 year old. So I did not learn to borrow money or purchase things on a credit card. Although my parents weren’t able to help me with college or medical school costs, I did my best to follow their example. I left medical school with only $18,000 of debt.

3. What motivated you to cut back?

The first cut back was motivated by anxiety. I did not like performing vascular and thoracic cases. They were more critical patients who needed ICU care post op and had the biggest risk of complications. They also stayed in the hospital an extended length of time and required multiple after hours phone calls, often waking me at night. I cut these cases from my practice to improve my well-being.

The second move was planned. In medical school I set the goal to retire at age 50. So I set our saving rate to reach that goal. When I hit 50, my goal was met; I was financially ready to retire, but I was not mentally ready. So I cut back to a lighter schedule.

I also wanted to be productive in my retirement so I spent the extra time figuring out what I would do. I ended up writing three books on physician finance during that period and started my business Prescription for Financial Success.

I now have a new mission for my retirement years. I seem to be busier now than I was as a surgeon, but I’m now working when and where I choose. Since I can write from anywhere, we travel about 50% of the time and are now sleeping all the way through every night. No more pager.

4. What were the financial implications of cutting back?

The first cutback, dropping thoracic and vascular surgery, was delayed because I thought my income would fall. So in preparation, we paid off all our debts. In reality, my income didn’t fall with this move.

During my slow down after age 50, I didn’t need the money so the loss of income didn’t affect me. There was one stretch where I went six full months without taking a paycheck. I don’t think many surgeons would work for free, but I did for a while. Looking back, that was a dumb idea. My wife was right, I shouldn’t work for free. So we moved on to the locums period.

During the third cut back, locums, I had a significant pay increase. I was now back to earning what I did before, but I only worked 2.5 weeks a month. We put a lot of money away during that phase.

5. How did colleagues react to your decision?

I never got any push back or bad reactions. Most of my colleagues wished they could follow in my footsteps. But I moved gradually and it didn’t really affect anyone adversely when I made the moves. When I quit doing vascular cases, my partner was happy with the shift of workload. When I quit my practice, there were ten surgeons in town.

My prior partners hired me as their employee to take call three days a month, which is the amount of call that I was previously covering, so they didn’t feel any effect of my leaving. As I cut back on my locums, I dropped assignments where I was no longer needed. My home town hospital started paying for call, so my old partners decided they wanted those three days of call I was doing and ended our relationship. I was happy to give up the call at this busy hospital.

The next locums spot hired a new full time surgeon and didn’t need me anymore. The last position I dropped had hired two new surgeons, they would have liked me to stay but leaving didn’t leave them in a lurch. On my last day of practice, one of the doctors asked me what song I would like to hear as I left the hospital. I said “Eighteen wheels and I dozen Roses.” When I finished my last rounds and charting, she put that song on and I left singing a happy tune.

5b. Was your family supportive or critical?

My wife would have liked me to stop sooner. She kept telling me we had plenty of money and I no longer needed to work. Part of me always worried that my calculations might be wrong. But she supported my decision either way. I mentioned fellow doctors in the last answer.

At age 50 I told one of my senior partners that I was going to retire at the end of the year. I am 15 years younger than him. He was supportive but asked me a very crucial question: What will you retire to? I hadn’t given that much thought. I figured I would decide that when I had lots of free time. He told me that the doctors he had watched retire, who didn’t have a good plan for their life after retirement, were back to work in 6-12 months out of boredom. So I postponed retiring as I made plans for what I would do next with my life. That was how Prescription for Financial Success was born.

My kids probably didn’t notice any of the cutbacks. When I left my practice and started locums, they were both away at college.

My parents were a little apprehensive it seemed. They were concerned that I was giving up a very prestigious position as a surgeon. How would I feel if I gave it up? They were, however, supportive of my decision.

6. What have been the main benefits of your decision to cut back?

I have been able to travel the world. Up until 2012, I had visited only three countries. Next summer the count will be up to 27 countries. That averages four countries a year for the last six years.

I have also become an award-winning and best-selling author. That is something I would have never predicted ten years ago. I always thought I would make my mark as a musician and songwriter, not as a book writer.

I have really enjoyed having the time and the money to do whatever I want.

7. Main drawbacks?

When we started traveling with the locums assignments, we had to give up weekly activities that we had been involve in for years at home. Since we were not home regularly, I was no longer able to lead worship at church, for example.

In the first year after retiring from medicine I only missed surgery for a moment one day when I was watching a Hallmark Christmas movie about a physician. That movie brought back memories and made me miss seeing patients. My wife reminded me why I left medicine and the feeling left immediately.

I watched that same movie again this year, as a test, but this time I didn’t have those feelings. I think I am over it now. I really can’t imagine going back to my life as a surgeon. I wrote about that day I missed surgery in an article titled, Will You Miss Medicine When You Retire.

8. Did you fear your procedural or clinical skills might decline?

Yes, I did worry about losing my surgical skills. After I stopped working at the busy location during my locums years, I was only seeing about one new patient a day and those patients didn’t all need surgery. The number of cases I was doing dropped dramatically. The good news was, even though I was doing fewer cases, they were all the same cases: Appendectomy, incarcerated hernia, bowel obstruction, and cholecystectomy. Small hospitals don’t have the staff or the equipment to do the hard cases.

Toward the end of my locums years, I was starting to question what step came next during surgery. That’s when I knew that my operating skills were declining. That is when I knew it was time to consider ending my career. You can only cut back so far before you begin to lose your skills. I can probably still do an appendectomy in my sleep after doing so many over the years, but I was beginning to wonder how good I was.

9. If you are honest, how much of your identity resides in being a physician?

I was worried about losing my identity as a physician at first. But when I found my new mission, teaching physicians about personal finance, I realized my identity hadn’t changed. I am a surgeon and have been for most of my life, and the reason doctors value my writing, speaking and coaching is because I am one of them. I have experienced what they are going through and I can show them the path to financial success. It is very satisfying to know that I am giving back to my fellow doctors and helping them have a better life. Without my new mission, however, I might have felt a loss of my identity.

10. If you had not gone into medicine, what alternate career might you have pursued?

I had two other career paths I dabbled in. One was music. I played in a cover band for five years in junior high and high school, and recorded an album of original music during medical school. After recording the album I almost quit medical school to become a full time musician. In the end, I knew a lot of very talented musicians who didn’t eat very well, but all the doctors I knew were doing very well financially. I decided to stick with medicine and play music for fun.

The other possibility was computer programming. I attended Stanford University right in the heart of Silicon Valley when the Apple Macintosh came out. I was very good at writing computer programs. In fact, I liked programming so much that my computer classes were the only classes I turned in my projects well in advance. My final grades were higher than 100% due to the extra credit I completed. I loved it.

My computer science teacher’s assistant asked me what career path I planned to pursue. I told him I wanted to be a physician. He said that was a waste of my talent. Anyone who can get good grades can become a physician, but not everyone was skilled at writing computer code. I’ve always wondered what would have happened if I had chosen a career in computer programming instead of becoming a surgeon. I was in the right place at the right time for that explosion.

11. What activities have begun to fill your time since you cut back?

I’m busier now than I was as a surgeon. When I was operating, my work ended when I went home. Now as a writer, there is always something that needs to be done. I have written three books. I started a blog, which publishes one article a week. I write guest posts for other blogs and appear on podcasts. I’m just finishing my first video course. I will be starting my 4^th book this month once the video course is complete.

I have ideas for at least a dozen books and would like to put out a video course every other year. The good part is I can do most of my writing on the road so we have been doing lots of traveling. I’m walking at least five times a week preparing to walk the Camino de Santiago in Spain next summer. It will be hard to write during the walk, so our time in Spain will turn into a real vacation.

12. If approaching retirement, what activities have you begun to prioritize outside of medicine so that you retire to something?

I have retired from medicine and have repurposed my life to help doctors succeed in their financial lives. I developed and began this new mission before I pulled the trigger to leave active medicine. I told my publisher I could write books and blogs, coach and speak for at least 20 more years. I don’t know what will happen after that but I suspect I will gradually cut back throughout the rest of my life. I love helping people with their finances and writing books is fun too.

If you would have asked me ten years ago what I would do after retiring from medicine I would have said, get back into music. I was looking at forming another band and writing songs again. The books won out.

13. Did you front-load your working and savings, or did you adopt a reduced clinical load early in your career?

When we got married during my internship year, we vowed to always live on 50% of our income and save the rest. We have continued that philosophy to this day. The habit of spending far less than you earn is a good one to develop. I always had extra money available when an opportunity arose so I was able to invest in investments that other doctors couldn’t afford. I don’t think I would change anything if I had the chance to do it again. If you don’t have debt, you can live a fabulous life on 50% of a doctor’s salary.

One of the best things I did was to invest in real estate after I became debt free. Over time, with rents raising, my real estate now spins off enough cash flow to support me in retirement. I purchased one small apartment complex each year for five years and then just let it ride. Today I would have to say life is good.

I think you'll agree that Cory's life story has had a fascinating trajectory.

• Cory's pact with his wife to live on 50% of their take-home income was a cornerstone of their success. He was living on half before Physician On FIRE was urging the rest of us to do so.
• Cory's wife was another great secret weapon. The White Coat Investor likes to say that you and your partner don't have to be on the same page, but you should be reading from the same book. She was supportive of both frugal living and debt elimination from the start.
• Locums work was a creative solution to Cory's desire to practice less intensively near the end of his career. Critical access hospitals were grateful for his help in offering their overworked surgeons much-needed respite.
• Cory is extremely debt-averse at a time when debt in med school grads has reached historic highs. Cultivating a debt aversion can be the healthy habit. In his case, it created multiple positive downstream benefits.
• It is considerably more challenging to cut back in an office-based practice where you run every aspect of the business. As Cory has shown, there are steps you can take to modify the workload, choose your cases or patients more deliberately, and find a graceful glide path via locums work.