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Financial Independence

3 Way Financial Independence May Save The Practice of Medicine

Physician Burnout

The burnout rates in practicing physicians and physicians in training (medical students, residents, and fellows) are simply alarming. The problem seems to be getting worse with the decreasing autonomy, unhelpful/encroaching administrators, and the ever increasing financial burden of our student loans.

While you may think that physician burnout only impacts doctors, evidence shows that it unfortunately leads to bad medical care for our patients, too.  With that big of a problem, what would you think if I told you that financial independence may have the power to save our physicians?

Let’s dig in.

Defining the Problem

When the average medical student graduates from medical school, they have accumulated  $190,000 in student loan debt.  That gets to compound (usually with interest rates between 5-7%) over a three to seven year training paradigm. It can often turn into $200,000-$300,000 in debt by that point.

Even worse, that number above doesn’t include undergraduate debt.  I have personally had residents with as much as $500,000 in student loans.

It can seem insurmountable.

(Note: Here is info on some of the best student loan refinance companies.)

Compound this on top of the long hours, lack of sleep, the loss of autonomy, and difficult life happenings outside the hospital; and you can see that a problem is brewing.

If the above wasn’t bad enough, burnout rates and suicide rates are climbing, too. Physicians have the highest rate of suicide of any profession.  Dr. Pamela Wible, one of the leaders in this arena, has compiled a list of nearly 1,000 doctors who have killed themselves.

These catastrophic events impact more than just the physicians and their families, too. Medical errors occur more often in overworked and burned out physicians.

Leading Contributors to Physician Burnout

Burnout, first described in the 1970s by Herbert Freudenberg, is characterized as emotional exhaustion, depersonalization (impersonal or apathetic feelings towards others), and feeling a lack of accomplishment in your work.

Juxtapose this description with that of someone entering medical school: people who want nothing more than to help others, to be good at it, and to feel like their work is truly changing lives for the better in this world.

All the opposites of a burned out doctor.  How does this transition happen?  The answer is that it is complicated.

Studies have shown that the three leading causes of satisfaction at work are autonomy, competence, and support at work (aka “relatedness”).

When the opposite occurs (lack of autonomy, incompetence, and lack of support) this is a recipe for burnout and failure. There are other causes, but these three are certainly a big part of the problem.

Autonomy at Work

Autonomy means self-governance, or independence.

Many physicians currently lack autonomy.  They no longer feel like the captains of their own ship.  The ship is owned by bureaucrats, hospital administrators, and insurance companies.

We are expected to see more patients in less time. And when we deem a certain modality the appropriate one to diagnose or treat a patient, the insurance company must agree with us first. Otherwise, it doesn’t happen.

It’s not just insurance companies, though.  Patients also have demands.

You are damned if you don’t fill that opioid prescription or give them antibiotics for their viral illness.  They have certain expectations they feel must be met (even if they aren’t the one with the medical degree).

Physician Support

Autonomy isn’t the only problem.

Doctors often can and do feel a complete lack of support from administrators who enforce rules without ever talking to the medical professionals on the front line.

More paper work, better billing documentation, more compliance.  The list goes on and on.

As an example, I’ll share a recent email interaction with you with a medical biller.  Her entire message basically said that I “forgot to attest for CPR” so that we could bill for it.  That night she was referencing was a rough night for me.  I had a very young trauma patient die on the table.

There was nothing I could do to prevent it, but a loss of a young life is troubling no matter how it occurs.

A more appropriate email from the biller may have read “I am really sorry for the patient that you lost last night. That must have been tough.  When you have some time, though, we do need to complete some documentation, including attesting for the CPR you administered.”

Nope, none of that.  The point was made clearly. My job is NOT to be a human being that thinks and cares and cries.

My job is to bill for CPR.  Oh, and to go take care of that next patient. We need to bill them, too. There is no time for crying or remorse in medicine.  How dare I have feelings?

The utter lack of autonomy and support leads to utter dissatisfaction and burnout at work.

But is there a solution to save our doctors?

Physician Burnout isn't just a problem for #doctors and those in the #Healthcare industry.  It's potentially a huge problem for you and me as well. Learn what  #PhysicianBurnout is, how it will impact your #health, and what you can do to help.

Financial Independence To The Rescue

At first glance, you might think that I am making the point that “as long as doctors earn enough money, these problems won’t bother them.”  That couldn’t be further from what I am saying.

Financial Independence reliably provides some direct counter action to the causes of burnout listed above.  It doesn’t fix all of the problems, but it does help with many of them.

I’ll mention three specific remedies that FI provides:

Remedy 1: A Way Out

Many physicians who get burned out do so because they feel stuck in the rat race.  There is no way out.  The financial burden is suffocating, and most doctors feel forced to work long hours to pay back their loans.

Financial Independence allows for increasing autonomy over our life.  Maybe we cut back to 70% of an FTE (Full Time Equivalent) or even 50%. We could also retire completely, though that’s not the message I normally preach.

Maybe we use that extra time to become human beings again and realize we have other hobbies like playing an instrument, writing, dancing, brewing beer, or playing sports.

Or maybe this additional time will let us be present for the people we love.  It would be nice to put our children, spouse, parents, siblings, and friends first instead of putting them on the back burner.

In fact, a bigger picture of burnout suggests that physicians often lose their self-identity in their profession.  FI allows us to get back to our roots and to re-examine what makes us who we are.

That 142nd email of the day can wait til our day off.

Remedy 2:  Less pressure to keep up with the Dr. Joneses

Dr. Cory S. Fawcett coined the term “Dr. Joneses.”  These people are no different from any of the other Joneses that anyone else tries to “keep up with.”

Doctors are notorious for being bad with money.  In part, this is because we have certain expectations placed on us by society, others in medicine, and even ourselves.

We should buy (err…finance) the right house, the right cars, and the right school for our kids.

The FI community can save us from this, because FI is part frugality and part aggressive saving.

When doctors are exposed to the frugality of the FI community, they then feel a freedom to no longer need to keep up with the Dr. Joneses.

This freedom provided by FI allows them to avoid the catastrophic financial mistakes most doctors make when they finish training (and buy all the things I listed above while trying to pay off hundreds of thousands of dollars in debt).

They realize that the right house, the right car, and the right school are the ones that help them accomplish their goals.  Not what makes them look good to others (who probably don’t care about them anyway).

When they doubt themselves or want to learn more, they can turn to the vibrant and blossoming physician finance community.  Here, they can find support for their ideas, which will provide some sanity.

The freedom that FI provides can release them from the shackles that bind them and their future!

Remedy 3: The Support Yourself Fund

One of the other causes of burnout I mentioned above is the ever encroaching presence of administrators.  They love to tell those of us on the front line how to do our jobs even if they have never done our job (or haven’t practiced in a decade and can’t do our job anymore).

Upon achieving financial independence (or even when you get to 50-75% of your goal), this provides a certain amount of courage that simply wasn’t there when we first finished training.

When administrators tell us how we are going to do our job and we find the change to be unhelpful for our patients or us, we can simply say, “No.”  We aren’t going to do it.

After saying “no” to an administrator, you’ll realize that they don’t have the power if you are nearing financial independence.  You do.

Replacing a physician costs a hospital between $250,000 and $1,000,000 depending on the physician’s experience, specialty, and abilities.

Diplomacy should always be used first.  But, if diplomacy fails, simply telling an administrator, “Well, if that’s what you are making me do, then I’ll go ahead and turn in my two weeks notice” will end that conversation pretty quickly.

People often call this an “F-Off” or “FU” account because you can tell the boss exactly what you think when they want you to do something that you disagree with.

I just see it as a fund that helps you to support yourself when others won’t.  There is power in saying no when someone isn’t valuing you or your time.

Financial freedom never felt so good!

Take Home

The FIRE movement has been good for many professions.  While I don’t focus as much on the RE aspect of FIRE, I do feel that the FI aspect is crucial to the future success of medicine.

When the medical community learns the doctrines of FI, it provides a remedy to the lack of autonomy and support physicians receive.  It also gives us the power to destroy the financial burden that plagues our doctors.  FI helps free them to have time to find their self-identity, which is often lost during medical training.

So, while the rates of burnout, depression, and suicide continue to climb in the physician community, I look forward to fighting back with FIRE and an attentive ear.

I hope you’ll join me in the cause.  It may just save a doctor’s life so that they can save yours someday.

Chime in below!
Do you know a burned out doctor (or are you one)?  Have you ever?  How did financial independence fit into their solution to the problem?  Leave a comment below.

The Physician Philosopher logoThe author is a husband and father of three little philosophers. He is an inventor, author and fellow journeyman. He also happens to be a physician anesthesiologist who blogs over at The Physician Philosopher where he encourages others to achieve wealth and wellness in the medical community.

 

17 replies on “3 Way Financial Independence May Save The Practice of Medicine”

The original post of this article included a stat about medical errors being one of the leading causes of mortality in the U.S. This was pointed out to me as being a false claim (thank you to those that did!). I’ve asked that it be removed from the current version.

Please accept my mea culpa!

TPP

Wonderfully stated post on an unfortunately growing issue in the medical profession. It is something that needs to be addressed or pretty soon I doubt the best and brightest will flock to medical careers like they did in past.

Financial independence definitely helps tremendously in combating burnout because once you reach a level where money is no longer the sole driving force, you can pick and choose how you want to work.
You don’t have to take the undesirable shifts and can cut down on clinical hours.

Financial independence certainly changes your bargaining power. I once had an administrator drag his feet for months telling me he would “take care of it.” Finally I told him I had run out of patience, if it wasn’t done by the first of next month, I was leaving and taking a job offer in Hawaii. Sounds fun to live there for a while. He knew I could and the feet dragging stopped. The issue was resolved in 3 days. He was used to pushing the doctors arround and blowing off their concerns because he could. He also knew I didn’t work because I needed money, and he needed me more than I needed him. FI makes a difference.

Dr. Cory S. Fawcett
Prescription for Financial Success

That’s a great example, Cory! FI really can be empowering. Though it doesn’t fix everything, it certainly can be helpful.

P.S. Thanks for catching my mistake in the article above about medical errors. I’ve asked Ty to remove that paragraph from the post. Sorry for not doing my due diligence!

TPP

Going part time is probably a good way to try to ward this off. As I’m sure you know Physician on Fire and the Happy Philosopher are two Docs who did that and had great results. I’m not a Doc but also had burnout and also went part time and it’s been great so far.

Great post!

At about your ten year anniversary out of residency, you look around and begin to notice a silent desperation creeping into your colleagues’ exchanges. Everyone is starting to feel deeply affected by the aggravations in medicine, and starting to put out feelers for an exit strategy.

Like Dr. Fawcett pointed out, FI is empowering by way of strengthening your bargaining chips. It allows you to practice the medicine you like, and pass on much of what you don’t (i.e., WCI no longer working night shifts). It allows you pursue passion projects like the large physician finance community of docs who blog. It also allows you to reduce your clinical load when the burden becomes to heavy to bear, creating a glide path (as opposed to a flame out) from your career.

You still need to figure out the right destination where your chosen offramp from medicine will take you, but it’s great to know you have the option.

Appreciate your highlighting FI as a tool of empowerment in the face of burnout.

Fondly,

CD

Thanks, CD! I appreciate your contributions in this space as well!

I completely agree as I look to my older colleagues and note the apparent burnout that seems present in their lives. I feel bad as many of them work because they have to and not because they want to… they were never taught how to do this.

Hopefully, all of us physician bloggers out there can help spread the word. I certainly try in my main hustle as an academic anesthesiologist. Trying to earn the platform at work while I anonymously build my platform online outside of work.

Thanks for the support,

TPP

Fantastic post.

My professional goal right now is to make a career change to be a financial advisor. My desire to do so stems from the idea of wanting to help people (like a doctor does).

I’ll never be a doctor. Don’t have the right mind for it or desire to study medicine. I’ve always wanted to make an impact the way a doctor does. I can only imagine the satisfaction one feels from saving a life. This goes to show that even in a profession as rewarding as medicine, there can still be burnout.

Getting to FI is not the answer to every problem but it can certainly help with many of them.

I’ve held off this long on becoming a financial advisor because I think I’d be in a better position to help when I’m already FI or close to it. I want to avoid the cycle you describe of focusing on maximizing revenue instead of helping people.

It is incredibly satisfying as long as you don’t lose site of what you are doing. For many of us, it turns into a job and we objectify people so that we can deal with the tradgedy we often deal with.

This depersonalization is one of the key symptom of a burned out doctor.

Keeping perspective is key.

I look forward to following your journey as you chase your dreams, WPF!

Good article.

Several years ago, when I became close to FI, I realized that I could eliminate the worst of my job, and only modestly decrease my income. I stopped night call and working weekends.

As I began working less, it left more time for other things I enjoyed. Those things began to bring in some money…and after a year of “part-time” medicine, I found I had more money left over after taxes and expenses than I ever had before!

I’m now completely debt-free. I have “enough” (I’ve not accumulated as much as many others, but “enough”). Most importantly, I now have the power of “no”.

“No, I won’t be able to do that”. “No, I think that’s not good medicine”. “No, I’m too tired to pull another shift on short notice”. “No, that contract is too one-sided”.

Had the FI community been around a few decades ago, I would have become an ardent follower. As my youngest son says “Dad, you were Dave Ramsey before there was Dave Ramsey”. Sadly, I wasted too much in my younger years

The power of saying no is crucial for our well being.

I am glad to have heard about the message of FIRE before I made the big bump in lifestyle after training. Since I stayed in academics I see it as one of my big callings to make sure all of my students and residents (and as many students and residents as I can reach through my web site) know about FIRE, too. Particularly the FI part.

Strong work on being debt free! I look forward to that.

TPP

It’s a sad fraternity we find ourselves in; the FBOP’s (fraternity of burned out physicians). Perhaps it’s better to enter the practice of medicine with the same expectations as a minister or priest, or even an elementary school teacher; you’ll work hard, encounter all the ailments in the world, either directly or by proxy, and there’s no guarantee you’ll ever be paid a dime for all the extra effort you put into it above and beyond what you might get for pushing a broom in a warehouse.
I immersed myself into that world of goodwill, benevolence, self sacrifice and marathon work. I poured out my heart and soul on the steps of that temple. by the grace of God, I managed to collect enough shekels to be secure in retirment (that’s different than financially independent) in spite of some spectacular speculative failures. I did, however, lose the joy in the art of practicing medicine and it took a radical dislocation to create the space for me to begin to find it again. We are not immune to the frailties of our forebearers; people dissapoint, even take advantage of us. We disappoint ourselves. Debt, and the perception of enslavement, control us when they have no actual tangible power over us. We are actually enslaved by our fear of hewing a different path than the herd. We were groomed to respect our forbearers and mentors. They failed us in one respect, however, that of innoculating us against the need to make up for all that deferred gratification as we studied late into the night under dim lights while others went dancing, camping, carousing. they took on the minor-league debt of a new car while we resisted the urge in trade for taking on major-league debt in refining our minds and earning a union card. Pent up need for gratification…far more insidious than the car salesman. “You deserve that; you have sacrificed so much”.
We have to change the narrative; “you deserve (the fastest pathway to financial independence you can tolerate); you’ve sacrificed so much. You deserve the right to enjoy the fruits of your labor, but they are not more stuff; they are an unhurried, unharried and unadulterated relationship with those you swore to aid and assist, whose health interest is your sacred vow. You deserve the right to say FU on their behalf and your own; no, we won’t prostitute our values for your carrot/stick game. Where else has someone said, we’ll pay you less, in return for exclusive access to more work, and a whole professional class sighed and said, “where do I sign?” What a concept! Volunteer. Work for your soul. Wear old clothes, drive a used car, and find the joy that is your birthright. Amazingly, the financial rewards, however much they may be, will be sufficient if there’s joy in your heart. If men and women can find a sense of inner joy in a concentration camp, hiding in an attic, as a political prisoner or as a wrongly convicted non-felon, you can feel free as a physician working to retire debt. One thing I told myself that turned out to be true, even at the depths of despair before my liberation, “it’s trouble in Paradise”. No one is really shooting at me…

The pain in medicine is palpable.

I see it in my older colleagues at work all of the time. I’ve even felt myself become jaded in my first year out. Without a hope or light at the end of the tunnel, it can become too much. The reason? Failed promises.

People promise that, at the end, it will all be worth it! But they fail to teach us how to get there. All they teach us about is the art of healing people. But who will be left to heal the people when the healer needs healing?

My aim is to teach our young students, residents, and early medical professionals how to save and protect themselves from the field that they aim to serve. The importance of financial independence and being able to stand up for yourself and your patient when you disagree with administration cannot be understated.

I am glad that you came out okay on the other side! Not everyone has been so fortunate.

TPP

The pain in medicine is palpable.

I see it in my older colleagues at work all of the time. I’ve even felt myself become jaded in my first year out. Without a hope or light at the end of the tunnel, it can become too much. The reason? Failed promises.

People promise that, at the end, it will all be worth it! But they fail to teach us how to get there. All they teach us about is the art of healing people. But who will be left to heal the people when the healer needs healing?

My aim is to teach our young students, residents, and early medical professionals how to save and protect themselves from the field that they aim to serve. The importance of financial independence and being able to stand up for yourself and your patient when you disagree with administration cannot be understated.

I am glad that you came out okay on the other side! Not everyone has been so fortunate.

TPP

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