Docs Who Cut Back #21: Doc G

Doc G in an internist best known for his prodigious writing via his blog, DiverseFI, as well as being one half of the dynamic duo behind the What's Up Next? podcast. We met at Fin Con 18, and I was not the only person struck by his gift with words.

The details of how Doc G build his home-based concierge practice can be found here in concise written format, or more extensively in this interview on the White Coat Investor Podcast.

The essential details: He started out as a junior member of a group practice, where he rapidly upset the status quo to become one of the most productive members of the group, making the annual bonus that the veterans in the practice warned him he would never attain.

He subsequently switched to independent practice so he could keep more of his earnings, but the high overhead and tedious documentation requirements eventually took their toll.

When he looked at the numbers, his nursing home patients were generating more revenue than his clinic patients. He also realized that his more enjoyable patient encounters were those that occurred outside of his busy clinics, so he pivoted and closed two offices in favor of a home-based concierge practice.

At the same time, he developed a nursing home practice which led to his being appointed the director of a local hospice.

Doc G's story will be of particular interest to the primary care physician who feels stuck and is looking to redirect her destiny.

He demonstrates that one can choose primary care while still earning an income capable of exceeding that of most specialists.

His story also highlights how owning your business and structuring it on terms favorable to your situation can make an enormous difference in growing your income.

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

I completed a 3 year residency in Internal Medicine. I practiced general internal medicine from the ages of 32-45. At the age of 45, I took on a part time medical directorship with a hospice company.

2. What did your parents do for their livelihood?

I grew up with a mother who is an accountant and a step father who is a healthcare executive. They modeled perfect financial independence type behavior. They were high earners who saved a large percentage of their income, believed in stealth wealth, and started a number of side businesses and real estate ventures.

3. What motivated you to cut back?

I cut back for a few reasons. I definitely felt that medicine was no longer bringing me joy, and I was burned out from constant phone calls and stress. Furthermore, medicine was no longer fulfilling my sense of purpose and meaning in life.

4. What were the financial implications of cutting back?

My only implication of cutting back is that I am making less money. I have far more than enough to live comfortably. Everything else is just icing on the cake.

5. How did colleagues react to your decision? How did you respond?

Most of my colleagues were surprised and, if anything, jealous. I had no real response for them.

5b. Was your family supportive or critical?

My family was mainly supportive. My wife was anxious about having less income but also realizes that we have enough. My parents and siblings were surprised but happy for me.

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

The are so many benefits. I have Mondays and Fridays completely off to write, podcast, and brush up on public speaking. My stress levels are now almost nonexistent. I have much more time for my family. And I am simply happier.

7. Main drawbacks?

None that I can tell so far. I guess I am less resilient to a black swan event.

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

I am practicing Hospice medicine now. There are books I can read and meetings I can attend to brush up.

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

I thought my whole identity was being a physician until I stopped. I now realize that being a physician never actually felt all that comfortable.   Being a communicator, creator, and community member in the financial independence community feels much better.

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

Business for sure. I like starting and running small businesses.

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

I am spending a lot of time podcasting, writing, and public speaking.

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

The answer is similar to above. I am busying myself with creation and immersing myself in community.

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

I definitely front loaded the sacrifice and it made all the difference. I worked really hard when I was young so that I don’t have to now. It is the beauty of compounding.

I wouldn’t likely have done anything differently.

A few pertinent thoughts occur to me on Doc G's trajectory, some of which were not explicitly covered in the interview.

• He is a master of efficient time management and delegation to a high-functioning team. At FinCon18, he would text and sneak out to take calls that he later told me were part of his duties as a hospice director. He had people in place to manage most crises, and could phone in orders and text responses to put out small fires. He did this while remaining prominent on the Fin Con social scene and writing a daily blog post each morning of the conference.
• His business acumen is readily apparent. He identified the barriers to increasing his income (high office overhead, staffing costs), identified an opportunity (home-based and nursing home-based medical care) and took a large entrepreneurial risk (creating a concierge practice from scratch).
• His relationships led to further income opportunities. As his nursing home practice grew, it made him a natural pick for hospice director due to the large volume of hospice patients who resided in the homes where he was a familiar and trusted quantity. This created a "side hustle" in addition to his full-time practice that he continues even after having closed his concierge practice. This enables him to allow his nest egg to compound undisturbed while his side hustle covers a significant portion of his living expenses.
• His story emphasizes that front-loading work early, in his case over roughly a 15 year year time horizon, can generate sufficient income to enable early retirement.
• Unlike the emergency physicians, radiologists and anesthesiologists that dominate the financial independence blogosphere, he holds a beacon of hope that primary care fields can also achieve early FI. It's not easy, and not everyone will have what it takes, but it's certainly possible.