Docs Who Cut Back #13: Family Medicine Doc

Few 30 year olds are able to accurately predict what they'd like to eat for dinner, much less how their future selves will feel in a career 1-2 decades out from completion of training, which is why this next interviewee rocked my world. She and her husband trained in Family Medicine and began a job-sharing arrangement from day one.

They exemplify a concept I learned about from the Financial Samurai: forecast your misery to lead a happier life.

The premise of Financial Samurai's argument is that if you accept the inevitability of suffering, you will immediately start planning for that rainy day and the anticipation will allow you to devise strategies to manage it effectively when it arrives.

A corollary to forecasting your misery is that it sets the tone for what psychologists have shown to be a successful approach to contentment: The secret to happiness is low expectations. Unhappy people bemoan life's failure to meet expectations. Happy people are grateful, because they know it could have been worse.

Family Medicine Doc knew she wanted to have kids and be involved in raising them. She also realized in advance that trying to balance it with a full-time practice would, in her specific situation, result in feeling inadequate at home and at work.

She's from Cleveland (Spinal Tap fans click here) where she's affiliated with the MetroHealth Medical Center. Let's dive in and let her tell the rest of the story.

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

Family Medicine, 3 years. I was 33 years old when I completed residency, and I started work as a part time attending immediately after completing residency (0.5 FTE). My range has varied from 0.5 to 0.65 FTE over the last 20 years. I share my job with my husband, so we are both part time and alternate days at home with days at work.

2. What did your parents do for their livelihood?

Plumber and home-maker. I felt financially secure. I was taught value of education, saving and not over-spending. I did not have any medical school debt when I finished training, which allowed me to work part-time from the beginning. Living in the Midwest makes the cost of living easier. My husband and I always focused on a budget that fit our income (i.e. we worked less, but we spent less).

3. What motivated you to cut back?

Family. I was always a half-time provider because I wanted to spend time with my children raising them. And I knew I was less likely to get burned out by working part-time.

4. What were the financial implications of cutting back?

We bought a modest home that was within our budget as part-time doctors and our children attended public schools. We focused on college savings and retirement from the beginning, but we did not have to work increased hours to accomplish that. We’re still able to enjoy travel, eating out, etc.

5. How did colleagues react to your decision?

Most were very supportive of our job-sharing arrangement. A few were frustrated or jealous.

5b. Was your family supportive or critical?

All family was supportive.

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

Less burnout and more time with the kids and each other. I think we are more relaxed and happy than our full time colleagues.

7. Main drawbacks?

It is hard to have career advancement as a part-time physician. Most promotions and positions of authority are not open to half-time doctors.

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

Not really. Even a part time provider spends many hours reading articles, attending conferences, teaching, writing notes, and practicing medicine.

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

A big part of my identity came from being a doctor when I was younger, but it feels less important to “who I am” as I get older. I have always been part-time and never felt like “less” of a doctor because of that. (It was just more of a challenge to find leadership roles as a part-time provider.)

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

Counseling or psychology.

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

Exercise, family and community volunteer work.

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

The same. Community work, exercise, travel, and caring for aging parents (and launching growing kids).

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

I have always had a reduced clinical load. It gave me a more balanced life and less burnout with medicine. I am not sure I would do anything differently.

Family Medicine Doctor's story is full of fortune cookie wisdom, brief answers rich with deeper meaning. Let's review some highlights and implications.

• She and her husband knew their destination early: they wanted to be hands on parents who were both involved in their children's upbringing. They reverse-engineered their careers around this paramount goal. This is substantially different from most physicians, who make their medical career their destination and create family arrangements that uphold the primacy of the job.
• A dual primary care couple was able to create and sustain a high quality of life through a novel job-sharing arrangement. This type of outside the box thinking demonstrates that designing a job and creating an actionable outline of what it might look like for an employer can create nontraditional niche employment opportunities, in this case at a large academic medical center (institutions of this size are not known for flexibility).
• A look at a rare balanced life means that life after retirement will largely resemble life prior to retirement. When your actual life and your ideal life overlap significantly, you don't need to make drastic changes.
• This story is an inspiration and template for dual physician primary care households looking for role models. A low cost of living area, modest housing, public school education for children, and frugal habits have created a four-legged strategy to support a sustainable medical career.
• She was sanguine about the sacrifice she was making in a half-time career: professional advancement and positions of authority were harder to come by, and she was less likely to be promoted. She was willing to accept these trade-offs, but went in with eyes wide open.
• "My husband and I always focused on a budget that fit our income." They spent based on the reality of earnings, not based on external expectations of how a doctor should spend. The ability to rely on internal rather than external sources of validation is critical for this to succeed.
• Over time, her identity grew less invested in her profession as a physician. She realized early on that the hospital would not love her back.