Docs Who Cut Back #14: Dr. K

Dr. K is half of a dual physician, no kid household who started her career as a blazing young gun. Like Dr. Jordan Craig, she built her OB/GYN practice by never turning away a  patient, leading to a very recognizable workaholic doctor schedule.

A variety of factors prompted her to drastically course correct, among them the sense that she had become a cog in the wheel of Medicine, Inc.

I was struck by the tone of Dr. K's answers. She is a kid in the candy store of her new life, and her enthusiasm at becoming a multi-dimensional human being anew is contagious.

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

I am a Canadian Obstetrician/Gynecologist. I completed a five year residency post med school. At age 43, I resigned from all hospital duties (including my position as Chief of our department) and cut back to 3 days a week, office-only OB and (non-surgical) Gynecology. This was 13 years after I completed residency.

My husband is also an OB/Gyn, (20 years older) with 3 grown children from a previous marriage, we’ve been together 16 years. I too was previously married (briefly), but with no children and no alimony requirements, there was zero financial recourse.

2. What did your parents do for their livelihood?

Both of my parents were teachers (fun fact: my mom taught Jim Carey grade 7! In interviews he has often mentioned her as being someone who had a big influence on his life and pursuit of comedy.) My dad sometimes taught summer school as well (for extra cash, but mostly to escape his 4 kids I suspect). During her ten year “break” from teaching while she raised us, my mom sold Tupperware part time. Funds were tight, and we were “frugalist” for sure.

The six of us would pack into our tiny Chrysler K-car like sardines, and drive across the border to get cheap gas and groceries (back when the Canadian dollar wasn’t worthless.) In the blazing August sun, we’d head to the outlet stores for back to school shopping, driving home wearing our Bass Wejuns, Tretorns, and 4 layers of Ralph Lauren and Lacoste shirts (anything to avoid paying duty!) My mom desperately tried to convince us what a waste it was to care about designers and name brands (a lesson I have now 100% embraced) but didn’t want us to feel left out at school.

My parents helped me out with more than half of my undergraduate university costs, the rest paid by scholarships, student loans, summer jobs at Tim Horton’s and even a chicken processing factory.

Med school was “extra” and up to me. I saved every penny I could, still worked summer jobs, and managed to pay off my student loans by 2^nd year of residency (I know that tuition is WAY cheaper in Canada, but it was still an impressive feat that I was proud of.)

My life long aversion to debt and practical approach to spending is definitely rooted in my upbringing.

3. What motivated you to cut back?

In order of importance:

A) My husband’s upcoming retirement

I love my husband more than my career, more than money, more than anything. We have an amazing marriage and spend almost every minute of our free time together. With a twenty year age difference, I knew that our life together would be different than most couples, that we wouldn’t have a traditional timeline and “retirement years” together.

I always knew that I would go to part time at some point soon after his retirement, I just didn’t know exactly when or what it would look like. I hadn’t initially considered giving up all hospital privileges as part of going part time, so my recent decision was still a major “surprise” to all (including myself).

B) I realized that I had reached Financial Independence

I only discovered the concept of FI/FIRE a few months after we paid off our mega mortgage. I had previously done retirement projections with my financial advisor and knew I’d be able to fully retire (if I wanted to) in my late 40’s, but those numbers didn’t include all of my assets. With a new decision that we would be comfortable in downsizing our house (at some point…) the math worked out that I could actually fully retire at any time now.

C) Post FI, the reimbursement for on call (especially nights and weekends) just didn’t seem worth the stress anymore

It’s not that I ever outwardly hated or dreaded call - I was good at my job, and I think that for the most part I actually enjoyed it. But after the mortgage was paid and we started giving away all of our shifts for the first time ever, it was so heavenly and life was so much less stressful… suddenly the thought of even just one shift seemed like punishment (as soon as each call schedule came out, I was sending a mass email, trying to drop each shift like a hot potato!)

With such a dramatic shift in our financial picture, it just didn’t seem worth it anymore when I was making more than enough in the office, and there were others who were looking for extra income and wanted the shifts.

D) Hospital “corporatization”, poor morale, and a less than supportive/cohesive practice group dynamic

This was a minor factor in my decision, but my brief stint as department Chief left a very bad taste in my mouth. Our hospital seemed to be more and more a “corporation” every day, all about meaningless marketing (mission statements, catch phrases), metrics and length of stay percentiles, all about budgets and dollars (as Canadians, we’ve previously been fortunate to avoid this sort of atmosphere.)

We were facing bed shortages every day. The whole hospital was about to switch to EMR. Our government continues to claw back doctors’ pay. To say that morale at our hospital is low is an understatement. I am now far happier, far less stressed in my office microcosm.

4. What were the financial implications of cutting back?

There will be no significant change to our lifestyle.

Almost 10 years ago, we moved from a downtown penthouse condo to a beautiful (and admittedly way too big…) waterfront home in a small community. Although we have far too much house for the two of us, hanging out at home is essentially our life now. It’s a simple life, but we love it.

With the move, we instantly became more practical about cars, clothing, dining out… our monthly expenses dropped dramatically. Our biggest “extra” expense now is vacations (annual trips to Italy, Mexico twice a year, and we invested in a vacation condo near Banff that actually generates some passive income). Entertaining can also be expensive, but we love it when the house is packed with family and friends.

Our spending further decreased when I embraced the minimalism concept earlier this year (ha- the minimalist with the 5 bedroom house!) We cleaned out closet after closet- oh my god, just SO MUCH “STUFF”! I was nauseous and ashamed looking at it all.

So, by the time I made my decision to go to part time, we were already living a lifestyle that was very practical, and a little bit frugal.  Since then, we’ve gotten rid of our second (leased, brand new) car and we rely solely on my 2012 CRV.

I’m a little bit obsessed with saving money on groceries, it’s almost become a “sport” (I confess that previously I was horrible for just throwing things into the cart without looking at the price.) I do my own nails and dye my grey roots at home 😊 (couldn’t stand how long it took at the salon anyways!)

I now seriously consider the necessity of EVERY SINGLE THING I buy (and if a recurring expense, I automatically calculate the cost for the year, a decade… once you start doing that kind of math, it’s a hard habit to stop).

We won’t “need” to downsize but may chose to do so in the future (we are tempted to move to Banff full time, it’s beyond gorgeous there and the opportunities for an active lifestyle are endless.)

Oh - and did you know that if you earn less you pay less taxes?! 😊 It’s amazing to see that my take home income has not dropped as dramatically as I would have imagined, thanks to a shift in tax brackets.

5. How did colleagues react to your decision?

Most are confused. Some seem very bitter. Many are supportive. Nursing colleagues especially have shown understanding and have told me “we’ll miss you!” (I will miss the nurses most of all… so many friendships forged chatting at 4am with our hard working and fun birthing unit team).

Many anesthesia colleagues told me they were sorry to see me leave (again, so many great friends that I will miss.) Hospital Administration has said absolutely ZERO, not a single inquiry as to my decision.

It’s been hard to explain to people. A lot of it has to do with finances, which is a taboo discussion. Many at work have stumbled across some of my other guest blog posts (although submitted anonymously, not hard to figure out it was me I guess!) I wasn’t anticipating this, but I’m glad that they could hear the truth behind my decision (and not just hospital gossip… who even knows what the current “rumor” is?!)

Initially I was consumed with the idea of “what will everyone think/say”. Now that I’m enjoying my new part-time lifestyle, I care SO much less!

I understand that my colleagues are bitter that they’re the ones delivering my patients at 4 am, but that’s their choice- they are free to give up their own shifts, but they hang on to them because they want/need the income. My husband and I were the ones there at 4 am for many, many years (and that’s what got us to FI)!

But there’s still a bit of guilt, so as an attempt at reciprocity, I’ve volunteered to provide office coverage for OB patients while my colleagues are away. In the future, I’ll phase out OB entirely and see only non-surgical Gyn consults, so there really will be no burden on my colleagues and nothing to feel guilty about.

5b. Was your family supportive or critical?

All supportive. They’ve seen how hard I’ve worked, and they know that this is about prioritizing my marriage - not about laziness, not a “breakdown”. (My mom had actually discouraged me from going into medicine because she was worried about my stress level!)

My husband was initially a bit shocked at my decision to leave the hospital and abandon my technical OB/surgical skills - but after much scrutiny and reflection on our “big picture”, it was clear that this dramatic decision was the right one.

A month later, my husband decided to move up his own retirement date by two years and now will be done in June (when his currently scheduled surgeries will be completed).

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

The improvement in my life was immediate and enormous. It’s funny that I didn’t realize how stressed and over-worked I was until the stress was eliminated. I look back and think, “How did I do that for so many years?”

I don’t think I’ve ever been this happy, this relaxed, in my entire life. I feel like I’m floating. I’m absolutely giddy. I’m so damn excited to live my new life to the fullest and to have the opportunity for so much more quality time with my husband and family (insert celebratory and champagne popping emoticons here)!

7. Main drawbacks?

I will really miss my friends at the hospital and those day to day interactions you tend to take for granted. I hope I’ll be able to maintain some of those friendships on a social level.

At the beginning, the moments when doubt crept in (“What have I done?!”) were hard. And the guilt, oh the guilt! But the further I journey into this new chapter, the more that all fades. I’ll miss delivering babies, it has been such an honor and privilege to help patients during such an epic moment in their lives - but it’s been almost a year since I’ve done regular on call shifts, and I don’t seem to feel a sense of loss (my new passion for helping young girls and women access intrauterine contraception seems to have filled the void.)

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

Yes and no. Lots of people go on maternity leave, sabbaticals - they return after many months or a year and are able to jump back in. Forceps skills might decline, but in the current medico-legal climate, that art is dying anyways.

I feel like I could do a C-section in my sleep at this stage. Gyn surgery was always my least favorite aspect of on call, which I managed despite very low volumes of cases (so low that I had already given up my elective OR time almost 2 years before my decision to go to office only). Right now I feel I still have a window of a couple of years to change my mind and re-enter hospital practice if I choose (but I am feeling VERY confident that won’t happen).

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

>50%, <100%? It’s a HUGE part of my identity for sure, but now that I think of it, in many situations I’ve also made an effort to downplay that aspect of my life (you don’t want to seem boastful, afraid to ask the other person what they do for a living because you don’t want it to seem like you’re belittling them when you then reveal your profession…)

The most important people in my life, my family and friends, are mostly seeing me standing in the kitchen, making sure there are enough snacks and drinks for all… it’s a different world (although one in which IUD’s and other random gyn topics are discussed openly J!)

Although I’m not delivering babies or doing surgery, the 130+ patients that still see me in the office during my 3 days each week all still see me as their doctor. Lots of doctors have never had a hospital-based practice, that doesn’t negate their value as a physician. It’s taken me a while to come to peace with all of this and remind myself that I am still a productive and valuable physician in my new office-only life.

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

Law. And I would have HATED it and wished I had gone into teaching.

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

Can I just be brutally honest about how much I love sleep? I’ve had insomnia for years, still an issue - hopefully on it’s way to resolution- but in the meantime there are so many more days that I can still get 8 hours even if I toss and turn until 3 am. I continue my weekly Italian lessons via Skype (and finally have time in between lessons to study).

I’ve started up guitar lessons again (and now actually have time to practice). I started song writing and play with my husband (he’s an awesome drummer), we’ve even done a couple of open mic nights!  I’ve dusted off my old piano books and will get to them eventually. I’ve been teaching myself to play violin (while my husband reaches for his noise cancelling headphones).

I’ve rediscovered my love of step aerobics classes. I’m trying to love cycling because my husband does. Who knew you could read a book even if you aren’t on an airplane or a beach? We are planning to spend as much time as possible at our vacation condo near Banff. We’ll have much more time for family and may even brave some extended babysitting stints with the grandkids. When all that’s done, I’ll get to organizing the 14,000 vacation and family photos downloaded onto my computer.

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

Music. Exercise. Reading. “Mountain life”. Family!

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

I unintentionally front-loaded. It was never a conscious decision to work like a maniac, it was just the only work ethic I knew. I wasn’t striving for FI, didn’t realize I was actually saving >70% of my income - we just didn’t want any debt, wanted to pay the mortgage off as quickly as humanly possible, still had enough left for all the trips and “stuff” we desired.

For me, it worked out well, given the situation with my husband and his retirement. If this factor were eliminated, I think it would have been better to slow down and pace myself for a longer haul. I still would advise anyone to save big, spend smart, and strive for early(ish) FI - the feeling of freedom it affords is priceless.

There are several take home points to assimilate from the effusive Dr. K.

• For those with older spouses, synchronizing your career with your spouse's retirement is important. Ideally you will have time, health and interests to share in abundance.
• Dr. K noted a major shift in the time value of money when she reached Financial Independence. Taking call or working nights and weekends was no longer worth the added income. This is a common theme - feeling empowered to say no to those work-related stressors and aggravations that drain our health and well-being if continued in perpetuity.
• Because most of our peers are in medicine, cutting back can fill us with a sense of guilt or fear of how these peers may perceive us. After cutting back, Dr. K cared less about external perception of her motives. Perhaps she developed a stronger internal scorecard. Perhaps she found and connected with peers beyond medicine who broadened her perspective. Either way, she learned to let go of the martyrdom in medicine.
• Dr. K found a renewed sense of purpose in helping her patients obtain IUDs that helped offset leaving behind deliveries. Maintaining a sense of purpose for a surgeon who no longer enters the OR has helped ease the transition to her second act in medicine. This echoes Dr. Cory Fawcett's charming concept of becoming a "repurposed" surgeon.
• Financial Independence brought about a shift in mindset that has profoundly affected Dr. K's decision-making process, leading to an embrace of minimalism and a newfound price-sensitivity during grocery shopping. On a granular level, buying discounted groceries likely makes a negligible impact on annual costs. At the macro level, changing how you think seems key to changing how you spend, and has implications that might make a significant difference to your bottom line (ditching one car, considering downsizing / relocating to the Banff home). Don't discount frugal habits - rewiring those neurons can make a big difference over time.
  
• Enjoying selective luxuries, like frequent entertaining or maintaining a second home in Banff, echoes the sentiments of Dr. McFrugal. Spend on those pleasures that are consistent with your values to get the most bang for your buck (in Canada: the most laughter for your loonie?).
• Who knew? Americans visit Canada to buy cheaper pharmaceuticals, and Canadians visit the U.S. to buy designer clothes!