Docs Who Cut Back #8: Jordan Craig, MD

Dr. Jordan Craig is an OB/GYN who, like many of us, built her practice based on flawed physics: she assumed that she could remain in perpetual motion indefinitely.

On the surface, her career was ideal: she joined a unicorn independent group of mentors from her residency, took on significant administrative responsibilities and built a name for herself that drove patients to seek her out. Having created an office culture that never turned away patients, she became a victim of her own success.

Surgery, overbooked clinic days, administrative meetings and a depleting call schedule brought her to the brink of burnout. When she went to her group seeking to cut back, she was denied.

I hope you'll find Dr. Craig's story of finding sustainability through strategic reduction (of debt, clinical work and clutter) as inspiring as I did.

1. What is your specialty, and how many years of residency/fellowship did you complete? How old were you when you began to cut back? How many years out after completing training was this?

I am trained as a full scope OB/GYN, which requires 4 years of residency.   I now practice as an academic OB/GYN hospitalist providing labor and delivery care, midwife support and emergent GYN surgeries and consultations. I cut back significantly at age 36 after practicing for five years.

2. What did your parents do for their livelihood? Would you characterize your upbringing as financially secure or insecure? How did your upbringing affect the money blueprint you inherited - both positive and negative?

My parents both have master’s degrees. One is an engineer who works in sales and the other is a successful administrator in healthcare. As a young child, we didn’t have much but I would not say we were insecure. That rapidly changed as my parents grew in their own careers. My parents are both financially literate and enrolled us in Dave Ramsey’s course in my early twenties. This created a debt aversion that has informed many of our financial choices.

3. What motivated you to cut back?

Burnout. Plain and simple. What once seemed a trendy term or a cop-out became this insurmountable weight on my shoulders. I just could not picture walking out the front door towards full-time practice another second.

My burnout came from a few places. I took on a hefty administrative role on top of a full time practice very early in my career and then our hospital went through an upheaval of upper administration and the culture changed dramatically. My practice hit a critical mass of volume and the demand to see me increased. I had trained my staff to work everyone in and always “say yes” to referrals and urgent visits during my ramp-up and I could not reverse that behavior.   My days would start with rounds at 5am, surgeries, meetings, 30-40 patient in office and then a 24 hour call or back up call once a week starting at night (avoid these reverse calls like the plague!)   My personal tipping point was a week with really tough outcomes while staffing residents - both utterly unavoidable - and not having the space to breathe and recover from the trauma. That week really exposed how close to the breaking point I had chosen to function.

4. What were the financial implications of cutting back? Did you downsize home or lifestyle? Slow your progress to retirement? Describe your thought process in making these tradeoffs. 

I first realized something needed to change during my 4th year of practice, a few months after the tough week I mentioned above. I went to my group and asked for time away or the ability to cut back on call or job share. I was willing to take a huge financial hit to do so. The group wasn’t comfortable with creating a unique situation, even temporarily. I then took matters in to my own hands and axed everything that wasn’t essential. My husband asked for one year of trying to change everything before moving our family - my non compete meant I had no local options.

I resigned my medical directorship, stopped staffing residents while on call, took 1 full day off each week, limited my patient visits and started vacationing a great deal more. I cut out high intensity exercise and switched to yoga at home. I tried this for one year and despite a drop in workload that translated to a 40% pay decrease, I felt little relief. I was still a full time slot in the call pool, covering two facilities at once with high acuity and volume. I did almost all OB in the office to cover “my share” and my GYN volumes started to drop.

We hit the one year trial period of cutting back. I did a lot of personal work in that time as well, addressing my time management and stress levels. I learned to get my charts closed immediately after the last patient everyday and to not check on things when I wasn’t the one on call. It just wasn’t enough. You could’ve sent me to Bora Bora for a year and I still wouldn’t have been ready to return to a lifetime of inbox messages and covering two hospitals on the same call shift.

So… we basically put our life in a box and threw it out. Almost literally.

We sold our “Dream Home” (read: heavily financed midwestern McMansion with pool, tricked out basement, 6BR/BA in a desirable suburb). We filled 19 Honda Odyssey’s full of STUFF and took it to Goodwill.. and then sold the Odyssey. We pulled the kids out of school, moved to a new state and started 100% over.

Our new home is reasonably sized (2000 sq ft) for a family of five, adequately furnished, sparsely decorated and completely sufficient. We live in a walkable community in Grand Rapids. I have a 7 minute commute and work 12 days a month and rarely more than 12 hours. I am surrounded by support, sub-specialists and amazing partners. The residents are fantastic, well-read and happy to help me find my way.

Financially, a few factors help this work.

First, I hate debt. Irrationally and probably to our FIRE detriment, I detest debt. We sold our rental property in Indy and cashed out of a surgery center. I’d already paid most of my student debt off and these sales help us pay off the rest. Combined with the equity of our prior home, we were able to put down a huge chunk on our new place. It may be smaller, but due to the desirability, it certainly isn’t cheaper. We have a 20yr fixed rate mortgage that we will pay off early. I put a decent chunk in our 529s and will contribute to those minimally with the goal of paying for tuition only, in-state. We have no car or credit card debt.

Secondly, we found minimalism. (No, I don't live in a modern house with 3 identical shirts and one chair.) I do focus on access to amenities rather than ownership. I do leave surfaces clear and don’t fuss with seasonal decor or keeping items that aren’t durable and functional. We don’t really have a master closet and just share a single hanging rack and 6 drawers. I just simply stopped buying “stuff.”

With these changes, my big pay cut (about 50% from my peak earning years in private practice) has not been noticeable. We have essentially no expenses beyond the mortgage. We travel like fiends and are going to be able to retire even earlier because of our change in consumption.

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

My colleagues were kind but didn’t understand. How can they? Things were fine for them. I remember one saying, “Jordan, it isn’t that you can’t do this, it is that you don’t want to.” Another constantly commented about how he’d advocate to take me back when I come “crawling back.”

The financial separation went smoothly. I encouraged my patients to stay with the practice. I check in with them occasionally and have heard they are making structural changes to help with call burden. I hope that prevents the loss of other great docs.

5b. Was your family supportive or critical?

My partner is on board. The kids are far happier now - the new school is more personal and laid back. We pulled them out of advanced classes and in to grade level to alleviate the nights lost to homework and tears. They are learning to sail and we bought a couple sailing dinghies kept on a lake that they can walk to from home.

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

Oh, I have a real life now! I exercise, go on field trips, joined a book club, I sleep 10-12 hours on my days off. The sleep has been integral- this was a huge part of my problem in hindsight. My memory feels sharper and I am so much more patient.

I do love having weekdays off. Ever been skiing on a Tuesday? Grocery shopping on a weekday morning? Coffee in a silent house by the fire… Heavenly. I get to sit still a lot. I’ve probably read 10-20 books a month since July. I feel like I have my life back. I am so happy.

7. Main drawbacks?

I don’t have my own patients and really have lost the autonomous decision making of private practice. I teach residents, so while I may impart my opinion during rounds, ultimately I try to honor their plan whenever reasonable and evidence based.

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

I certainly won’t be great at office GYN or major GYN procedures in ten years! (I also probably won’t be working). My new job is at a big busy center with more pathology than is imaginable. I feel more challenged now than previously and consider that I’m honing a subset of skills that will be infinitely useful in the future.

9. If you are honest, how much of your identity resides in being a physician? How did cutting back affect your self-image, and how did you cope?

I never dreamt of being a doctor. It happened unintentionally when I took the MCAT on a whim, panicking about what to do after graduation. I’ve grown to love women’s health and specifically teaching evidence based practice. I think the teaching and love of science could be found in many careers. “Physician’ would not be part of my self-identity if asked.

In private practice, it was less about physician and more about being my own boss, setting my own hours. I am clearly the worst boss ever, since I chose to over commit and over work. My self image is the same. I am definitely a better mother and wife now that I am rested and my physical needs are met. More of my identity comes from these roles than from clinician.

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

I would be crew on a chartered catamaran in the BVI, leading dive trips and kayak excursions. Maybe swim coach on the collegiate level? Hard to say. Definitely water, sunshine, working with my hands.

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

I started swimming again. I have neurogenic thoracic outlet and was told this wouldn't ever be possible. With great sleep and not carrying around a laptop 9 hours a day (literally couldn't get a scribe or lighter laptop despite begging), my symptoms have completely resolved. I’m swimming competitively and hope to compete in Master’s Nationals in the spring. Yoga, field trips and cooking elaborate meals fill a fair amount of time as well.

I just bought snow skis for the kids and I to use this winter. Michigan skiing isn’t great but it is very accessible. We started sailing, as I mentioned above. I can bike to the sailing club, put my Butterfly in for an hour and still have a full day to get things done.

I do need a project. I am hopeful to provide mentoring and coaching to other burned-out docs. “Burn out triage,” if that makes sense? I love to write and connect people with resources and tools to find a way forward.

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

I’m not there yet. We were on the ten year plan (retire at 46), but honestly I think I could do this job for a while. If I can develop my mentoring practice and perhaps occasional public speaking on burnout, that will keep me busy. Our first stop after I retire will be selling the house and traveling for 6-12 months. We’ll figure out the rest after that. Maybe full time locums? Maybe back here if they can work with my sabbatical.

13. Did you front-load your working and savings, or did you adopt a reduced clinical load early in your career? What was the advantage of the route you chose? What would you do differently if you were graduating residency today?

Not intentionally. I’ve always maxed out 401k and profit sharing so I had five years of savings and aggressive debt reduction. The biggest advantage for our chosen path is cash flow. I truly can divert so many dollars towards mortgage pay down and retirement (and travel) because I don’t have a car payment or private school tuition. Embracing minimalism means that I’m not spending money on Target trips or a gaggle of after school activities. We don’t need childcare. Even replacing a roof would be 20% the cost of our old place, due simply to the dramatic change in square footage!   The extra cash flow is so empowering.

You can find Dr. Jordan Craig at invokemd.com, where she blogs and offers physician mentoring in transitioning from burnout to sustainability in medicine.

A few observations from Dr. Craig's story:

• Jordan created a "culture of yes" that built her practice rapidly, until her success in clinical medicine crowded out most of her personal time. First do no self-harm needs to be a precondition for any sustainable job in medicine.

• "We basically put our life in a box and threw it out." She chose a radical path to cutting back, and found that minimalism, reduced consumption and a right-sized home enabled her to accept a lower-paying but sustainable position. As high-income earners we tend to believe that if we can simply quit the wrong job and substitute the right one, we don't need to alter our spending habits. Sometimes reverse engineering our lives by adopting a lower cost lifestyle empowers us to work less or take a lower stress job in medicine.

• Her practice could not accommodate the immediate changes she needed to address her burnout. This ultimately led to the more radical solution of relocating to a different city and position. How your group culture has dealt with burnout in the past? Create the blueprint now to change your institution from within so it can evolve to meet your future needs.

• Many of us start our careers highly motivated to work extra in order to build a reputation and pay down debt. There's a good chance that superhero cape around your neck may eventually choke you. Make a deceleration plan before you need it.

• A non-compete clause limited Dr. Craig's option to continue working in the area where she might have leveraged her stellar reputation. As a newbie, I was so grateful to land a good job that I signed a contract with a similar non-compete clause (I later learned such clauses are unenforceable in California). Before you sign your contract, consider having it reviewed by a professional to negotiate favorable terms.