Dr. F is a high-achieving female physician whose impressive academic pedigree launched her on a prestigious academic trajectory at the outset of her career. She took the unusual step of pivoting away from academia, relocating geographically to an area that was more in tune with her lifestyle goals, and creating a business that evolved into an entrepreneurial exit strategy from medicine.
What is your specialty, and how many years of residency/fellowship did you complete?
I am an emergency physician, and I completed a four-year residency program before starting a full-time academic career. I was selected as the Assistant Residency Director at my institution early on, but I unhappily trudged through academics, unable to find many role models. My department was very woman-unfriendly, and I was looking to leave when I, very fortunately, met my husband and moved to California with him. I went to part-time within a year of coming to the West Coast and starting a position at a community hospital (around age 36) because I was pregnant, starting Insider Medical Admissions, and realizing that emergency medicine simply wasn’t the only thing I wanted to do.
What did your parents do for their livelihood?
My father was an orthopedic surgeon, and my mother – to her credit - went back to school when I was in the first grade to become an attorney. My father’s parents were immigrants, and he came from a modest background. He worked four side jobs during residency to help support us. When my brother and I were very little, then, there was not a lot of money in the household, but my parents both worked a lot when we were growing up, and they eventually lifted us into the upper middle class. By the time I was older, we were financially very secure.
Because money was scarce early on – and maybe because my paternal grandparents and maternal great-grandparents were immigrants – our household was a frugal one. I remember telling a neighbor that my parents did not buy us juice at the grocery store because my mom said it was too expensive. The neighbor looked surprised. Even when my parents became financially secure, we were careful with spending. I am still like that today.
What motivated you to cut back?
There were a variety of reasons: First, I started realizing I was dreading work a bit. In academics, I was happy to see the residents and medical students, but in the community, they were gone. I don’t think I had realized how much those residents and medical students had been keeping me going. Second, I got pregnant with our first child and needed more autonomy and flexibility. Third, I had what I thought was a good business plan for a satisfying alternative income stream in Insider Medical Admissions.
What were the financial implications of cutting back?
My parents graciously financed my education, which made all the difference; I had no school loans. Also, at first, I cut back only a few shifts monthly, and my husband was still working full-time. So, although there were financial implications, they weren’t severe. Slowly, as my business grew, I was robustly supplanting my income with my “side hustle,” so cutting shifts was a no-brainer.
How did colleagues react to your decision?
I’m really not sure. I didn’t showcase my business in conversations with my colleagues, so they may not have realized I had a growing and, eventually, hearty alternative income stream. I heard one colleague pejoratively refer to a female emergency physician’s choice to work part-time as the “mommy track,” which was troubling.
Was your family supportive or critical?
My husband has always been supportive and encouraging; he has never wavered. My parents may have had some understandable hesitations, but they mostly kept them to themselves; my brother left law to pursue a master’s degree in fine arts, so he had already paved the way for an alternative career path. My kids are thrilled I can work from home.
What have been the main benefits of your decision to cut back?
There are so many. Now I have flexibility and autonomy, which allows me to be around for my children, grow my business, be supportive of my husband’s work, make myself available for friends and extended family, exercise daily, and not rely on a singular source or emergency department director for a paycheck. I have been able to explore creativity and entrepreneurship in a way I never could have if I had had less time and mental energy.
Main drawbacks?
As I just alluded to, growing a company is labor intensive. My husband jokingly says Insider Medical Admissions is like our third child. I’ve learned to rely on several excellent professionals who help me keep the company running smoothly.
Did you fear your procedural or clinical skills might decline?
Yes, so over the years, I have kept working clinically (even as the business grew), which I strongly recommend. I suspect, though, I’ll retire from clinical medicine in the next year or two. We’ll see.
If you are honest, how much of your identity resides in being a physician?
Not much of my identity resides in being a physician per se, but I must admit – with embarrassment – that some of my identity resides in having what is considered a strong academic pedigree. I graduated from Stanford and then Harvard Medical School, and I stayed on at Harvard until I moved to California. As I have gotten older, though, I’ve realized that happiness is much more important than fancy school names. I loved Stanford, but Harvard – especially for residency and as a faculty member – did not make me happy.
So, cutting back didn’t really affect my self-image much, although I do notice that neighbors ask my husband medical questions – not me. That might be gender bias, though, more than cutting back.
If you had not gone into medicine, what alternate career might you have pursued?
I might have been a journalist. I was afforded the great opportunity to be an American Association for the Advancement of Science (AAAS) Mass Media Fellow during a gap year in medical school. As an AAAS Fellow, I worked as a science reporter at the Oregonian newspaper. I saw the tremendous impact the media can make.
What activities have begun to fill your time since you cut back?
I exercise and read more. I’m also in better contact with friends and extended family. Importantly, I’m around for my kids, and while they are remote learning during the pandemic, that ability to be present for them has been a big deal.
If approaching retirement, what activities have you begun to prioritize outside of medicine so that you retire to something?
Well, I may retire from clinical medicine in the near future, but I will keep mentoring applicants through Insider Medical Admissions. I really enjoy the work.
Did you front-load your working and savings, or did you adopt a reduced clinical load early in your career?
I was never a big spender, and as I said earlier, I am eternally grateful that I did not have student loans. What I would do differently – and what I advise the applicants who hire me – is to consider happiness – including being in a place and with people you love - before prestige.
There's a deep wisdom reflected in Dr. F's gradual change in priorities that mirrors the evolution of professional maturity about coming to terms with what makes each of us truly happy.
- The idea of an internal scorecard, where you evaluate life decisions based on independently-derived personal criteria instead of applying external values (societal notions of prestige; familial expectations) is a mark of a sophisticated mind. All too often, we arrive at these conclusions late in life after having based our decisions on someone else's values.
- While a dual-physician income clearly helped, it's no surprise that someone who was able to chart an unconventional path by pivoting from academic to community medicine is likely to possess the same contrarian characteristics that enabled her to develop a successful business. Historically, medicine tends to attract a subset of achievers who seek financial security in part due to a risk-averse nature. This can be a double-edged sword, as failure to take on risk can limit our options later in our medical careers.
- Dr. F's business reflected an ability to play the long game - starting out small and building her business over years ultimately allowed her to reduce her clinical commitment significantly. As we've discussed throughout this Docs Who Cut Back series, reducing clinical load is a powerful tool in combating burnout and rediscovering satisfaction in medicine. Building that alternate income stream over time provided the opportunity to practice medicine on her terms.
- Dr. F's business is in many ways an extension of the philosophy she's developed around cultivating a positive practice of medicine. By counseling her clients to strongly consider support systems and proximity to loved ones in their ranking of training sites, she is able to instill the importance of work-life balance in the next generation of physicians.