Docs Who Cut Back #17: Dr. S

 I heart radiologists. They decipher clinical mysteries, continually teach me, and I could not work effectively without their contributions.

Some radiologists interpret a chest x-ray by noting degenerative changes in the spine and calcific tendonitis of the shoulders before gradually making their way to the lungs. Others cut to the chase: "negative". If Shakespeare had worked in the ER, he'd have observed that brevity is the soul of a useful emergency chest x-ray read.

Dr. S, a fellowship-trained radiologist, came to my attention via comments on the blog. Based on her succinct replies, she'd make one hell of an emergency radiologist. Don't let this woman of few words fool you - her story is complex, compelling and instructive. Take it away Dr. S:

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

I am a radiologist who spent 4 years in residency and 2 years in fellowship. I began to cut back starting at age 40 through age 43, which was
10 years after I'd become an attending. I came from Europe which delayed my career somewhat.

2. What did your parents do for their livelihood?

My father was a mid-level executive and my mother was a teacher. I grew up feeling financially secure. My home life developed my ethos to save and save and invest and save. Despite these ingrained habits, I retain a sense of insecurity no matter the number I attain. I came from a non-practicing Catholic background, perhaps explaining why I feel guilty about making money.

3. What motivated you to cut back?

At first, I enjoyed the time off (initially I took 12 weeks off a year). Then I developed cancer probably around 2008, ultimately diagnosed in 2010. I have been downsizing yearly ever since, going from from 12 to now 40 weeks off each year.

Cancer/life events are sometimes a blessing in disguise, making you realize that life is fragile and that balance/time is far more important than gross income.
Income can always be replaced. Not time nor health.
I'll add that my income remained quite high, and my Revenue Value Units (RVUs = a metric for physician productivity) remained quite high as well, just that the distribution over the year was more concentrated.
I'll say that my RVUs/year at 12 weeks of work are close to full time RVUs in a big city inefficient/political/academic practice.
I live in a big city on the east coast and commute to small town in the midwest. As I grow older and see bad things happening to good people, this reinforces my need for free time. Life is really short. I personally think that many docs are in stealth burn out: we think it's normal to work hard simply because of the medical culture. It's really not normal to sacrifice so much for work even if it's a passion. It gets back to you in many ways , including disease.

4. What were the financial implications of cutting back?

None.
I'm an expensive frugal type.
I'll define: I live a luxurious lifestyle in many ways.
Loft in NYC, penthouse in Manhattan, fly business, jet set around the world. etc...
However: I'm a specialist in the things that I buy, meaning that I will find a 2k business ticket to Paris when it costs 8k,
I'll buy 1k shoes for 200$ , a President Rolex at auction, etc...
I buy real estate when the sky is falling, everything at deep discount.
I started investing at 20 (15?) and have substantial passive income.
I always lived well below my means.
I was never able to overwrite my "save money" programming.
For example if I stay in a hotel at a few hundred dollars a night and the bottled water in the room is 8$, I won't touch it, I'll go to the pharmacy.
I go to the airport by subway...some call it cheap (including my boyfriend), I call it wise spending. It's a bit neurotic.
I also always had a high income since the age of 34, and always made money since forever ( I bought my first condo at the age of 23 with savings from my childhood, lol).
I could have retired maybe 15 years ago based on my current lifestyle, maybe 25 years ago at a middle class lifestyle.
I don't see retirement as a goal.
I see myself as a professional who works because it brings something to my well being.
It keeps me engaged and keeps my cognitive skills high. It also pays all my lifestyle bills and healthcare.
It allows a "front image" for those in society who need to define you (importantly, that includes banks and lenders).
At the same time I have an enormous amount of time off ( 40 weeks/year) and have lived that time off long enough to know that idleness does not work for me.
I see many docs dreaming of retirement yet not really knowing if they will like it or even if it's good for them.
I always take the example of people building their dream house in the wilderness with images of sipping coffee on the terrace then heading to the beach ,etc until they realize 9 months later that they are bored to death. You need to live your time off long enough before you make drastic moves.

5. How did colleagues react to your decision?

They loved it . We reshuffled the schedule so that all would have more time off (with commensurate reduction in income, of course).

I responded by taking even more time off.

Radiology has had tremendous gains in productivity in the last 10 years as everything is PACs based. We used that to get rid of some physical commuting between sites and going electronic. We hired 2 partners as well. That decreased overall income per head and increased income per hour worked, which in the end is the real measure of productivity. Yes, some took advantage to work more relative to those who worked less, but in the end not much more (if anything) than they themselves worked before if you annualize.

My partners are all frugal, strangely enough, and all quite wealthy as a result.

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

My partner loved it and did the same. I travel with him half the time and by myself half the time.
He's the big spender of my money, although he's a millionaire in his own right (at age 35).

7. Main drawbacks?

Not sure. None?

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

Yes, but you settle in a routine where there is no decline if you practice enough, which I think is 1 week every 6-8 weeks.
The body and brain adapts very well. If you stop more than 6 months, at least in radiology, you are done.

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

When I work 90%, the remainder of the time 10%. When I'm off I'm not a doctor. I never felt the need to be a doctor outside work.
So that never changed.

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

Finance or real estate.

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

Trading futures and real estate investing.

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

Same as 11.

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

You cannot become rich by working too much. I would immediately go part time. Life is short, and making money is not that hard.

[CD: My distinct interpretation of this statement follows below, but upon further correspondence, Dr. S elaborated with a reply that diverged from my interpretation:]

Earned income is the worst WORST way to make money (taxed to death and not scalable). Real estate is quasi non taxable and the least effort demanding.
So if you maximize work income you cannot find deals, all you have is a stock portfolio which is ok but not that great ( no cash flow). IMO you cannot retire without cash flow ( I know many people would disagree but that's my very strong opinion).
I make significant annual passive income. I recycle it in investments but I could stop work tomorrow and live forever on that without "slaughtering the pig".

The interview with Dr. S reads like a flourless chocolate cake - a small volume containing surprising density.

• "You need to live your time off long enough before you make drastic moves." The beauty of cutting back gradually is you provide the opportunity to test drive your future to ensure what you think you'll want will actually fulfill your needs.
• Sometimes physician finance geeks play the "What if I'd gone into finance?" game. Dr. S has channeled her time off into pursuing her passion for real estate and futures trading.
• While not unique to this series, other FIRE bloggers stopped working in order to travel as part of an ideal retirement plan only to find that travel can be lonelier than expected. Dr. S has devised a creative solution to this conundrum by traveling half-time with her partner and half-time on her own.
• No need to let guilt stop you from making money. In fact, there's no shortage of ways to absolve your guilt by contributing to charitable causes if you decide you'd like to celebrate your success by healing the world a little.
• Worth noting that working less did not adversely impact Dr. S's productivity as measured by RVUs or income. Cutting back need not cost you in efficiency.
• Stealth burnout is my new favorite term - brilliant, Dr. S! It results from the institutional normalization of pathological behavior as endorsed by medical culture.
• Dr. S found a creative way to avail herself of geographic arbitrage. She lives in a HCOL city on the east coast, but commutes to a more remunerative job in the midwest where she batches her shifts. Slightly more hassle to work less to earn more.
• "I never felt the need to be a doctor outside work." If you can allow your identity to encompass more than your career, the dividends accrue throughout your lifetime.
• Interesting to note that while a cancer diagnosis was a catalyst for cutting back more radically, the time off and the improved life balance appear to have been reason enough to continue cutting back further. When I first asked Dr. S to participate, I expected cancer to figure centrally in her responses. I was surprised to see her relegate it to a footnote in her highly unconventional medical career.
• "You cannot become rich by working too much." I love this conclusion, which I interpret to mean that wealth goes beyond reaching a particular number. It represents both acquiring enough and enjoying what you have earned. A favorite toast in Spanish goes: Salud, amor, dinero...y tiempo para gozarlos. Health, love, money...and time to enjoy them.