Docs Who Cut Back #6: Dawn Baker, MD / Practice Balance

1. What is your specialty?

Anesthesiology

1a. How many years of residency/fellowship did you complete?

4 years of residency

1b. How old were you when you began to cut back?

I started working 0.75 FTE straight out of residency (I was 37). After my daughter was born, I cut back to 0.5 FTE at age 42.

1c. How many years out after completing training was this?

When I went 0.5 FTE, I was about 5 years out from training.

2. What did your parents do for their livelihood?

My dad climbed the corporate ladder at a regional utility company, eventually retiring as a VP at 55. My mom stayed at home with us when we were young, but she worked at various periods as a school librarian.

2b. Would you characterize your upbringing as financially secure or insecure?

Definitely secure. I never worried about money and never witnessed my parents worrying about it.

2c. How did your upbringing affect the money blueprint you inherited - both positive and negative?

I recently wrote a blog post about this. My family is luckily financially secure because my dad worked very hard for years at his job, but we’re a family of spenders. During college and my early adult years working as an engineer (my career before medicine), I followed the typical consumerist path. I succumbed to lifestyle inflation by living in a pricey apartment, buying lots of fancy work clothing, financing a new car, and saving the bare minimum for retirement. Luckily, I woke up from this habit loop.

On the positive side, my parents made sure to spend money on experiences for us (travel, meals out, music concerts, etc.), which made for great childhood memories. Also, I think that having a financially secure childhood liberated me from wanting to accumulate more than I truly need, out of a fear of scarcity. I have friends who grew up poor, which motivated them to work very long hours and make as much money as possible. I’ve never felt that way.

3. What motivated you to cut back?

I started rock climbing in college, and it was my first exposure to people who chose to lead a simpler, frugal lifestyle and make their ends meet around their passion for climbing. I met lots of people in a variety of fields (even science and medicine) who deliberately worked less in order to climb more. Before being exposed to this culture, I never even knew that you could be a “professional” and still work part time. So ever since my early 20’s, I had my eye on a career path that is less of a “shatter the glass ceiling” and more of a balanced approach.

As an anesthesiology resident, I drank the proverbial academic Kool-Aid and was on the path to a fellowship when I started experiencing some nonspecific symptoms that caused me to take caution. To make a very long story short, I was diagnosed with a brain tumor. Luckily it was a benign pituitary macroadenoma vs. much worse diagnoses that we’ve all seen in medicine, but this changed my entire career and life trajectory. The things that mattered to me before suddenly became insignificant, and while I still desired to complete my training and board certification, I no longer wanted to be defined by a medical career.

Instead of going into academic medicine where one fills many different complex roles along with clinical work, I sought out to find a job that had a simple set of clinical duties only. This became a theme in my life that still holds true – the constant pursuit of simplicity and balance. I didn’t set out to work part-time straight out of residency, and despite having a relatively manageable disability due to my tumor removal (adrenal insufficiency), I was willing to take call. But I found the perfect job for me right under my nose: three days a week of clinical anesthesiology doing all my own cases with no call and no weekend shifts, at the institution where I trained. I was one of the first people to take a position on this new clinical track, which has now grown to 6-7 anesthesiologists.

After years of infertility (all related to my pituitary problems), I finally became a mother. This was the “lightning bolt” moment that caused me to cut back even further at work; I wanted to spend as much time as possible with my baby. I now work two days in the OR, but I’ve added a “side gig” of doing sedation anesthesia for fertility procedures like the ones I had. I really enjoy it, and I do it 1-3 mornings a week.

4. What were the financial implications of cutting back?

Everyone in my group gets paid the same rate hourly, so there is a commensurate decrease in pay based on my decreased hours. However, I still work enough to qualify for any benefits.

4b. Did you downsize home or lifestyle?

We’ve kept our lifestyle very similar to how we lived at the time I started med school. Granted, I started at 28. We already had some investments by then. My husband was also making money as a lawyer by that time. However, shaped by our years as climbing bums, we tend to live fairly simply and don’t care about flashy things. We’ve been happily living below our means for years.

4c. Slow your progress to retirement?

When I chose to work part time straight out of residency, I never worried about how long it was going to take me to accumulate enough for retirement. Part of the point of working part time is to have more work/life balance and satisfaction while working, which leads to better career longevity. After some years of long hours in law firms, my husband started his own law practice and now also works part time. The combination good balance between work and home time, along with living below your means, makes rushing to “early retirement” a moot point. When I cut back my hours even further, we coincidentally realized that we had already reached FI at our current standard of living, so I wasn’t worried about progress to retirement then, either.

5. How did colleagues react to your decision?

I work in a very large group at an academic hospital. There are a lot of people there who work long hours and hold lots of concomitant roles in research and administration. However, it’s a very egalitarian group and there are others like me who simply want to do some anesthesia and go home afterwards. I probably work one of the lowest hours of anyone in the group, and I really don’t care. No one has ever overtly said anything to me, and the clinical track I’m on has been widely accepted by the department.

5b. Was your family supportive or critical?

As mentioned, my husband also works part time and loves me being around more. Residency (the long and unpredictable hours) was a hard time for us. We get along better as a couple when we spend more time together, which is not the case for all couples.

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

I’m not the type of person to thrive when I’m super busy. I tend to shut down with overwhelm. Having less on my plate gives me the space I need to be happy and to sometimes just “putter”. Recently, I’ve been able to write more on my blog, which is a passion of mine and something I’d like to grow even more in the future.

7. Main drawbacks?

For me the only drawback is that I don’t connect as much as I’d like socially with my partners. Because I’m only at the hospital twice a week and we have a big group, months will sometimes go by when I haven’t seen certain people. I don’t have as many work friends or get invited to as many work-related social events. Since I’m an introvert, this isn’t a huge issue for me, but at times it becomes an apparent negative.

8. Did you fear your procedural or clinical skills might decline? How did you address this concern?

Because I don’t take call or work on the weekends, I miss out on doing certain procedures in my field. I never do OB anesthesia or peripheral nerve blocks, and I do miss doing them. If I were to ever leave my current position, I’d probably need to retrain on these things. Luckily, I could easily do so because I work at an academic hospital with lots of educational and shadowing opportunities.

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

I can honestly say that only a very small percentage of my identity resides in being a physician. First off, this is my second career, and it was never something I dreamed of doing as a child like many physicians do. Secondly, I’ve consciously made efforts in my life to avoid identifying with jobs, physical appearance, etc. In contrast to the more social identity of being a physician, the one part of being a physician (particularly an anesthesiologist) that I identify with is the addictive nature of what we do. In my work, we alter physiological and pharmacological parameters and immediately see results. We perform procedures, face challenges, make big decisions and take significant risks every day, and it’s exhilarating. I think I would miss that if I’m not doing it anymore.

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

Before I decided to go to medical school, I was a chemical engineer. I even earned a Master’s degree. I probably could have been relatively happy doing something in that field, but I craved a more active workday where I saw direct impacts on people’s lives and worked around a more diverse group of people. I’ve now got that with medicine! As far as a “dream” job, I have had inklings of wanting to be a jewelry designer or a stylist of some sort.

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

Motherhood, fitness, travel, and blogging. We still climb but have lately gotten more into strength training. I’ve recently increased my blogging frequency to about once a week instead of once a month.

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

I’d like to grow my blog more, potentially turn it into a source of passive income, and accompany my writing with a book, a course, or coaching/speaking engagements. We hope to travel more and homeschool/road-school our daughter. I always have fitness goals: I’d like to do a yoga teacher training course someday and possibly teach yoga to senior citizens, disabled patients or kids; I hope to rock climb at an elite level again someday; I want to compete in a kettlebell spot competition again; I want to learn how to surf… I could go on and on.

Observations about Dawn's interview:

• Dawn and her husband are the perfect examples of dirtbag millionaires. Prior to pursuing medicine, they grew accustomed to low cost happiness exemplified by their rock climbing peers. Scaling back to the Joneses was their unfair advantage as "climbing bums," allowing them to achieve FI despite an early reduction in clinical work.
• Dawn's path is characterized by obstacles and reinvention. Spender to saver. Engineer to physician. Fertility disappointments to mother to anesthesiologist helping other aspiring mothers. Academic physician to clinical physician in an academic setting.
• Unconventional job opportunities are available for those who take the time to inquire. Dawn preserved her benefits and stayed in the academic environment she loved without needing to work nights or weekends. Being known as the unconventional doctor may serve to attract unconventional offers.
• Dawn's story is unique in that she experienced a health crisis in training. Instead of a deathbed conversion, she decided early on to prioritize living her values and eschew the typical physician playbook of advancing her academic career.
• Again, we see that diversification of identity enables the successful pursuit of an unconventional medical career. Being a physician is just the beginning of a long bucket list of skills and goals that Dawn hopes to accomplish in one lifetime. Having met her at FinCon18, my money's on her succeeding.

Dawn blogs at practicebalance.com and tweets as @DLBakerMD.