Docs Who Cut Back #15: Dr. Mo

Dr. Mo, who blogs anonymously at A Sustainable Medical Career, is a voice you are unlikely to mistake for any other. His writing combines radical candor, strategic  expletives and a casual conversational tone. Reading his posts combines the pleasures of grabbing coffee with a new friend and the intimate feel that your friend is entrusting you to be his confessor.

Dr. Mo is a fascinating serial entrepreneur, perennially exploring multiple avenues for his next hustle; a technologically savvy doc who has created and marketed workflow algorithms to maximize productivity on telemedicine and other online platforms; and an unconventional thinker who dramatically shifted his life's axis after the sudden epiphany that he could own his time completely.

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

I chose family medicine only because I didn’t get into EM. I ended up scrambling into
FM and I'm really glad I did. I stayed an extra year of chief residency because family
medicine was just so easy and I loved working with residents and having more time
to moonlight. I finished in 2009 and started my first job at Kaiser Permanente right
away.

I started cutting back in 2016 - so I was 37 years old. But remember that I started
moonlighting in 2006, my 2nd year of residency. I was a beast of a moonlighter, too.
By 2009 when I was a chief resident I had already made $180k from moonlighting
and residency alone.

Doing the math - I started my attending job in 2009 and quit in 2016. But that created
all sorts of problems in my personal life with family not accepting it and me not being
ready. So I went back to part time for a few months and then dropped down to per
diem and finally quit Kaiser officially in 2017.

2. What did your parents do for their livelihood?

Dad had a wholesale fruits/veggie business but never really was able to make it
profitable. Mom had a family daycare which made great money but we still managed
to have problems financially.

We had a lot of insecurities surrounding money. Parents lost their $1.5M home after
perpetually borrowing against it. I had to drop out of college for a quarter because I
had over-borrowed loans. It was a disaster for a while.

I remember doing grocery shopping as a college student and never knowing if my
card would be declined or accepted. It was excitingly embarrassing. So all this
carried over once I became an attending and started earning $300k/year.

I spent like green was going out of fashion. I ended up with $150k of credit card debt. $70k
in auto debt and my $200k+ of student loan debt.

3. What motivated you to cut back?

I never stopped loving the practice of medicine but it was becoming repetitive and
stopped being challenging. The same patients in the urgent care requesting the same
medications and really needing nothing more than a hug and a hot tea.

I was working full-time as an urgent care doctor right out of residency. I would pick
up some shifts in pediatrics, primary care, in ER, and even in occupational medicine.
I worked a lot - easily in the 55-60 hours/week range.

Cutting back was never an option or even a possibility until I learned to budget
using You Need A Budget (YNAB) in 2012. That’s when I came across the concept of financial
independence and what retirement meant. That’s also when I decided that I didn’t
need $1,000 boots or a $10k Rolex.

The idea that I could have my entire day to myself to do all the things I loved - that
was my motivation. While I was an attending at Kaiser I had started an auto
mechanic shop which I owned for 2 years before selling it to my partner. I was also
in love with construction and had bought a dilapidated condo which I renovated
myself. I wanted more time to do shit like that.

4. What were the financial implications of cutting back?

I’m an all-or-none kind of person. It was end of 2012 - I was married to a woman
then and she was a big spender like myself. I had my little epiphany and told her
that I wanted to be retired in 5 years. She’s like: “You crazy?!”

In hindsight, I probably created so much stress in her life because I suddenly changed
and didn’t bother bringing her along for the ride. But that’s kinda my MO - a little selfish.
We ended up divorcing a few months later but remained good friends. I sold my H2
Hummer and downgraded to a Smart Car. I sold my condo and moved into the
tiniest place possible in San Diego - a 220 sq ft studio with no kitchen for
$825/month.

Honestly, the idea of never having to work again (unless I wanted to), having my
entire day to myself, playing as many sports as I wanted, cooking and baking
however much I wanted - those were such big motivators for me that I had zero
problems downsizing.

The biggest issue was that I didn’t know how to downsize - nobody taught me. I’m a
spender at heart. Give me a $100k and I’ll go through it like a fat kid through cake.

So I just decided one day that I would get rid of EVERYTHING. It coincided with the
day I moved out of my condo with the wifey - I told her she could have all of my shit.
The fancy blenders and kitchen gadgets. The $1,500 mattress, the $2,000 dresser -
you name it.

I remember waking up the next morning in my new apartment sleeping on the floor
with the sun shining through because I hadn’t yet bought curtains. I was looking
over at the corner where I had put my clothes (no closet) and some books - I was in
heaven, I tell ya! I knew this was my path to freedom.

Once I realized this was possible I became obsessed with what else I could cut while
still remaining happy. I wanted to figure out how else I could save money. Though
probably not the best move, I ended up hooking up with the landlord which gave me
free WiFi and waived the deposit. Later I learned there are better ways of saving
money than giving up ass.

5. How did colleagues react to your decision?

People knew me as the big baller. I would always pick up my friends from the clubs
with my Hummer. I would sport the newest clothes and always had the nicest
watches in my collection.

But I was generous, too - a douchebag, yes, but generous. I would treat my friends to
dinners and drinks and it never bothered me to pay for others.

When Dr. Mo became homeless Mo, people freaked the fuck out. They thought I had
gone bankrupt. I told them it was intentional and that I was done with that part of
my life and wanted to retire early. As you can imagine, everyone said that it’s a bad
idea.

At the time my goal was to retire on $1.5M - that was my number. People said I
would need way more and that I’d be miserable living like that. And I totally got it -
they thought I was suffering living in that tiny studio.

But I wasn’t. I had so much more freedom now. All that shit which I used to own required
so much upkeep. My car needed regular maintenance and car washes. My watches needed to have batteries replaced.
All my clothes needed dry cleaning. My fancy condo had all sorts of gadgets and needed batteries for every damn thing in there.

5b. Was your family supportive or critical?

My mom nearly had a heart attack. She thought it was a shame for a doctor to live
like a slob. My sister didn’t care though she probably didn’t keep up with my
shenanigans.

I was already divorced at the time and dating really didn’t work out too well in San
Diego. I’m not saying that people were/are superficial there. But if you say you’re a
doctor and roll up with a Smart Car as a 6’-tall dude, it looks weird. Didn’t work out
too well for me.

So in 2015 I made the move to Portland, Oregon - where the young go to retire.

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

I now do maybe 4-5 hours of work week. To give you a sense of this, today is a
Wednesday and while I was preparing my breakfast I was replying to some
questions on JA and while I’m typing out this reply to your questions I’m replying to
a few other customers. In total I’ll do about 30 minutes for the day and I do this
every other morning.

Because I work so little I have a lot of free time to do the things I love. So the main
benefits are that I have my free time all to myself. I can get up whenever I want and
go to the gym. I can buy any new book and know I have endless time to read it. I can
go on YouTube and learn about a new topic until I throw up.

I’ve always been in good physical form but at age 40, this is the best shape of my life.
I do cardio, racquetball, bouldering, yoga, weightlifting, and I go for long walks since
I no longer own a car. I gave the car thing up the same time I moved to Portland -
2015.

7. Main drawbacks?

Not having a set schedule means it’s easy to get lost up in your head a little. It’s easy
to waste time when you have no place to be, no deadlines to meet. But I have
learned to set these deadlines for myself.

Cutting back also means that you have to now take the reigns of your professional
life. I love being productive but didn’t want to do it to the tune of an employer. So
now I do some healthcare consulting, building my own brand, learn about investing,
telemedicine, etc.

The drawbacks to the above is that it can be a lot of work and if you like doing it and
want to improve at it, it’s easy for it to suddenly feel like a chore. As in, why the F did
I leave my full-time gig if I’m just gonna torture myself with all this responsibility.

So, even with that, you learn to have a good balance. NOT being productive these
days is my biggest hurdle. So I’m perpetually trying to do less.

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

Big-time. So I reached out to my colleagues who always deal with this - our preggos.

My best friend is a very competent family doctor who took 1 year off for each of her
pregnancies. She’s a great mother and a great clinician - did she lose her skills?
Nope. I asked other friends the same and they said no.

That said, I read a lot. I’m constantly staying up to date on medical news. The
problem is that no matter how many new studies are published, medicine just isn’t
changing. If anything, I feel that medicine has stayed rather stagnant since I
graduated medical school at UCLA in 2005.

For a while I was very active on Figure1 which is the most brilliant way for doctors
all over the world to learn from each other. But after cutting back from practicing
medicine, I just don’t feel as engaged.

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

I spent the majority of my time from 2012 until 2016 dis-identifying from medicine.
This has taken a lot of work because one of my biggest ego boosters and sources of
confidence was being a doctor. I’d drop that I’m an MD whenever I could -
strategically so not to come across as a douche.

Sometime in 2015 I thought I had it licked. But when I pulled the plug on work after
saving up enough money and having some other income streams I realized that I
was still strongly identifying with being a doctor.

Now, in 2019, it’s much better. I don’t care to tell people that I’m a doctor. I love
medicine - the whole science of it and the detective aspect of it - but it’s no longer
something I care about. This reflected nicely when the medical board investigated
me for something benign and threatened to terminate my medical license; I was
okay with it but they ended up just suspending it for 30 days.

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

Mechanic or general contractor. Love both of these fields still. The problem is that I
likely would have never gained the confidence from these careers as I did with
medicine.

I think parents can help in that regard. Being good at what you do and doing it for
the good of others and supporting your community can give you a lot of confidence.
No MD or DO or JD needed.

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

I write a lot and I publish podcasts. I am learning about alternative medicine and do
consulting for 2 healthcare startups. One is based on artificial intelligence and
chronic disease prediction and the other on mental health.

I also do some telemedicine because the money is so damn easy. I work for Oscar
Health and DialCare and Just Answer.

I do a lot more rock climbing - bouldering. Working my way up to V7’s right now. And I
play racquetball which I’ve always loved. I do yoga though I suck at it.

I was volunteering at multiple places in Portland practicing medicine but after my
medical board investigation I decided that it wasn’t worth my time. Maybe I was just
butt hurt because of the license suspension and maybe I’ll reconsider it in the future.

I’ve also been spending 3 months at a time in Spain. I finally got my visa to live in
Spain long-term. Don’t know what I’ll end up doing with that in the long run but for
now I love having the ability to live overseas for far cheaper than I could here in
Portland.

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

I consider myself retired. I have enough money coming in to support my lifestyle
and my spending. I don’t intend to mobilize my investments yet because I enjoy
earning the income I’m earning from the activities I’m engaged in.

I had way too many hobbies so for me ‘retiring to something’ wasn’t an issue. But I
realize how important this is because the identity aspect can be a big hindrance.
Having other things which bring us joy and help us connect with others is critical.

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

I worked like a farm horse as soon as I realized that I could become financially
independent and retire early from medicine. I was keenly aware that few careers
and even medical specialties allowed the employee to pick up this much overtime.

As a family medicine doctor practicing urgent care in a place like Kaiser I’ve always
earned more than $300k. In 2014 I made $427k. People say it’s still impossible - I’m
happy to show my tax returns and W2’s.

I love practicing medicine so it wasn’t hard for me to do more of it. The problem was
that once I was getting into the 60-hour weeks, it left very little time to live a
balanced lifestyle. But it still allowed me to pay off all of my debt and set money
aside left and right.

What I would do differently is obviously not accumulate $150k in credit card debt
after residency, haha. Besides that, I would have focused on maximizing only my
tax-deferred funds and put everything else towards debt. I would have never bought
a primary residence - rent is just so much easier.

I then would have cut back on work more gradually. I would have definitely
increased my workload as I did. But then gradually I would have switched down to
part-time and then per diem. Doing it suddenly is a shock on the system.

Dr. Mo is distinct from prior interviewees in a number of ways. Let's dive into a few lessons gleaned from his trajectory:

• Until now, the workaholics profiled in the series consisted of folks like Loonie Doc (an academic who cut back to full time) and Wealthy Doc (who reduced his clinical commitments to a more sustainable level). Neither had any intention of leaving medicine. Dr. Mo's trajectory is unusual because part of his FI objective is the desire to be completely free from clinical medicine.
• Dr. Mo is all the more anomalous for deciding to opt out as despite being a highly productive physician (as measured by income).  He soaked up shifts like a sponge while a moonlighting resident, then kept up his aggressive work habits in pursuit of FI. This was not someone whose productivity was paralyzed from burnout.
• Impressive example of a family practice doc who used his skills to maximize income from the start of his job through urgent care. This was as a W2 employee - imagine if he had run his own urgent care!
• The Internet Retirement Police will object to his use of "retired" and point out that he still works in telemedicine. Dr. Mo counter that this "work" averages 1-2 hours a day, that he hammers out written responses while resting between problems at the climbing gym or over a latte at his local coffee house.
• Impressive financial frog-to-prince story, going from $150k in credit card debt to living far below his means.
• As a married guy with kids who has a tough time getting out of that mindset, I appreciate seeing the road map for a single person's approach to financial independence. (Spain 3 months at a time is my favorite section of that road map).
• I have friends who, like Dr. Mo, can never seem to sit still for long without looking to learn new "easy" ways generate income or learn something new (ears burning, Side Hustle Scrubs?). While I relate less to the money than the skill development, I deeply respect the drive. These folks inevitably earn a middle-class income after they retire from clinical medicine. They end up wealthy because they earn enough in passion projects to enable their nest egg to compound untouched for years after leaving their clinical career in medicine.
  
• It fascinates me that Dr. Mo has devised a remedy to the routine aspects of medicine by jumping into the bleeding edge of new opportunities that technology has brought to bear on medical practice. He has further leveraged his position as an early adopter to consult for digital medical startups, where he has accumulated experience and demonstrated expertise.
  
• Another note on the optimizer gene so many folks who cut back seem to share: Dr. Mo has created workflows to maximize revenue with online platforms, removing the obstacles and busy work that make for drudgery. This is how continued work on his terms becomes manageable - he makes it manageable.