Docs Who Cut Back #24: Dr. Y

Dr. Y is a rare and exotic species among Docs Who Cut Back: a surgical subspecialist who completed a decade-long course of training in a highly competitive field. More unusual still, she opted to cut back 4 years after working full-time as a subspecialist attending (to be fair, she worked one additional year as a general surgeon prior to entering her fellowship).

Dr. Y's journey to cutting back is instructive. On the one hand, she described her early years of practice as many of us might, "consumed with my job." In other ways, however, her approach varied dramatically from that of the typical physician. I'll let her tell her own story before I give away too many punchlines:

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

My specialty is Pediatric General Surgery. I spent 5 years in General Surgery training, 1 year doing research, 1 year in a critical care fellowship, 1 year working as a general surgeon, and 2 years in fellowship  .... 9 years of training (10 year if you count the year I was waiting to start my fellowship).

I began to cut back at age: 41

This was 4 years after completing my training.

2. What did your parents do for their livelihood?

My mom was an artist and the executive director of a non-profit art center. My dad was a human relations executive. My upbringing was financially secure but not what I would describe as “privileged.”

My mom was a “spender” and I learned some bad habits from her about appeasing instant gratification. I have gotten much better, but it took me a while to get on board with saving money.

I was also a chronic renter due to my nomadic lifestyle. I tended to rent in nice locations, i.e., close to the beach or in nice, walk friendly areas of a city. It wasn’t until I got married last year that I bought property. 

3. What motivated you to cut back?

My cutting back was an evolution. I really wanted to move back to California and there were no jobs I found attractive in the area I wanted to move. I found locums work as a bridge from my first job that allowed me to continue working but living where I wanted.

This freedom became very liberating and I enjoyed the variety of “being on” when I was working and then really being “off” when I was not on assignment. It helped me switch off – which I had started to see as a problem for me. I was not at a point of burnout but I was seeing my life consumed by work and I was having a hard time.

When I first cut back, I was single, not dating, and very much consumed with my job. Cutting back allowed me to explore other areas of my life – I was surfing more, reading more, dedicating more time to international service work – it was liberating on all fronts. 

4. What were the financial implications of cutting back?

The funny thing about my cutting back was that it finally made me pay attention to my financial situation. I continued to live where I wanted, but I finally found a financial advisor who helped me with retirement planning and saving. I had to watch the cycles of my income – as there were times I was not working as much, doing more international work as a volunteer, and I had to make sure I had enough to cover expenses while I was not actively bringing in money.

Now that I have settled into this style of working, I have a much better grasp on my finances. I put away the maximum each year for retirement and since I work two different jobs, one paid W-2 and one 1099, I can put away a little extra. I make a good living and certainly don’t “need” more. Even better, I have time to enjoy the money I do spend on travel, concerts, restaurants and experiences. 

5. How did colleagues react to your decision?

There have been mixed responses. Some colleagues feel I have opted “out.” I think this was the hardest part for me. After working so many years towards one single goal, when you feel like you step outside of the norm it takes a while to stop feeling that you are now an imposter.

I have continued to work with some surgical societies and go to meetings to stay in touch with my colleagues, but eventually, I found I just stopped caring what other people think. Ultimately I feel that I am a better doctor because I love going to work and rarely find myself exhausted by the job. 

Many colleagues have asked me about moving towards my current work style and I have gladly explained the advantages and disadvantages of cutting back. Many more colleagues have joked that I “figured it out” and expressed a desire to practice the way that I do. To those colleagues, I say that it is not for everyone and that the way I work, works for me. 

5b. Was your family supportive or critical?

My family was confused initially, but once they saw that I was not giving up practice all together, they were very supportive. They saw me thriving in other aspects of my life and realized I had made the right choice for me.  I was single when I cut back. 

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

I have had incredibly flexibility in my scheduling which has allowed me to participate in more international service work and more spontaneous travel. I founded a non-profit that was taking annual surgery mission trips to Haiti prior to the pandemic. I was able to spend a significant amount of time taking care of my mother before she passed away. I also started dating and ultimately met my husband. 

7. Main drawbacks?

The main drawbacks are that I am no longer doing as many of the big, index, pediatric surgery cases. Additionally, when you travel to multiple institutions, you have to invest in learning the institutional culture and capabilities.

Sometimes figuring that puzzle is fun and I sure have a wide perspective on what types of practices are out there. Sometimes that puzzle can be frustrating and restrictive. I tend to limit my work at these locations. 

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

Yes, this was and remains a concern. There is one institution I work in mainly and I do try to double scrub some bigger cases when I am there. Additionally, if there is a case I am unsure about, I am not afraid to call and ask for advice/help.

I have found that I operate about half as much as I did when I was full time – I try to keep my gaps in work to no more than two weeks so I keep operating at a constant pace. 

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

I feel like all physicians have a major portion of their identity tied up in being a physician. It is surely a part of who I am. I enjoy what I do. I am NOT the person who insists on being called “Dr,” but when people do refer to me with the title, I am not upset.

Prior to cutting back, I think I felt limited by my profession – oppressed by always being “on.” Cutting back liberated me from constant obligation and helped my lifestyle match my actual perspective on my job– it is what I do to make a living.

It is a profession I respect and I am proud to be a good physician, but I am more proud of being a good friend, daughter, sister, now wife and step-mom. It was easy to cope with the shift by recognizing that I continue to be a good doctor to my patients and a great support for the colleagues I support doing locums. 

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

I have wanted to be a doctor since I was five years old. That being said, I think a career in architecture could have been a good fit for me. Journalism and teaching were other career options that interested me. 

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

Travel, camping, sporting activities, hiking, surfing, international service work,  founding a non-profit, enjoying music festivals, spending time with family who live across the country, reading books for pleasure, sewing, attempting to garden ... I also went back to school and earned a masters in public health. 

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

Prior to covid my non-profit work was taking priority as I plan to continue this type of work after retirement ... but I am many years from retiring. 

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

I didn’t give it much thought ... I am fortunate in that my specialty is highly paid and in high demand in the locums environment. That is not true for all specialties.

If I had to give advice to someone finishing training, I would recommend getting a full or part-time job in a traditional practice after graduation in order to get through the hump of being a new attending. Flying without a net after training can be intimidating and it is good to do that in a nurturing, comfortable environment. I would not recommend a straight jump to locums from training. More and more jobs are offering part-time options and I would strongly recommend new practitioners critically evaluate all job options and approach their search honestly and unafraid to ask for what they want.

What a refreshing take on intentional lifestyle design from Dr. Y! Several facets of her story caught my attention:

• Geography was front and center in her list of considerations for choosing a job, but as many of us may relate to, she did not find attractive positions available where she wanted to live. Unwilling to compromise on her location, she discovered that locums work enabled her to live where she desired while serving communities that appreciated her skills. While she's the first to admit that it's not for everyone, this strategy gave her tremendous flexibility in developing work-life balance at the outset of her career.
  
• It might be more precise to say that Dr. Y cut back on her paid clinical hours: she founded a nonprofit to fund annual medical missionary work in Haiti. She works hard on those trips, she just doesn't get paid for some of the more meaningful medicine that she practices.
• It would be fair to say that becoming financially literate has enabled her to practice more of the medicine she finds rewarding without regard to the income it does or does not generate. She gets to actually be the doctor we all wanted to become in our med school essay.
  
• She also exemplifies a female physician who cut back at a time when she was single, and family obligations did not play a major role in her decision to reduce her clinical commitment. While it's perfectly reasonable to cut back based on considerations for one's partner or kids, Dr. Y reminds us that not every female physician chooses to do so for these reasons. Cutting back for yourself is reason enough.
  

Many thanks, Dr. Y, for taking the time to share your playbook with the rest of us!