High income physician seeking financial and life advice

Non-investing personal finance issues including insurance, credit, real estate, taxes, employment and legal issues such as trusts and wills.
bltn
Posts: 1844
Joined: Mon Feb 20, 2017 8:32 pm

Re: High income physician seeking financial and life advice

Post by bltn »

RadDad915

Congratulations on your hard work and accumulation to this point. I admire your work ethic and interest in accumulating a comfortable financial future, not merely gaining an opportunity to retire early.
Your accumulation goals remind me of myself at your age. I faced some job stress from the long hours I worked, 60-70 hours weekly, at your stage in my career. By about age 40, though I wasn t able to decrease my work week, I was able to arrange to take off every 6 th week. That helped immensely.

Looking at your numbers, with annual spending of 200k, you ll need 7 million in invested assets to support a 40-50 year retirement. Saving 450k yearly means another 4 years of work at this level. Or 5 years with more vacations.

I agree with the above posters who said you re in a great position, professionally and financially with your jobs. I would modify the work conditions to be able to continue my profession indefinitely. Being part of a team that takes care of people is rewarding in ways other than financial . And the respect you receive from the community is not often found in other jobs. Of course you know this.

As to those who suggest modifying your spending to increase your financial security, I believe that s not the optimal approach to financial well being. You have the opportunity to to continue to accumulate with a work pace more comfortable for you. This will afford you the opportunity to increase your budget safely in the next few years. This will make the rising cost of education easier to deal with. And you ll be able to increase your lifestyle a bit. Think vacation home.

Adjust your jobs and enjoy life. Best of luck.
obgraham
Posts: 1618
Joined: Mon Jan 28, 2013 6:30 pm

Re: High income physician seeking financial and life advice

Post by obgraham »

Well OP you have plenty of radiologists here giving you relevant advice. Mine's more generic, and perhaps too nasty:
You are sacrificing your young children's upbringing in order to make more money. I recommend you stop that immediately. You will NEVER have to worry about finding work if you need it, and I question whether you need it even now.

There are aspects of this thread that point out just what is wrong with the medical profession now. Including one person who thinks the key to life is to make twenty million dollars, family and mental health be damned. I find that disgusting.
Radman
Posts: 77
Joined: Tue Oct 25, 2011 5:42 pm

Re: High income physician seeking financial and life advice

Post by Radman »

You may also want to check out the physician philosopher website and podcast. He posts quite a bit on physician burnout and the mindset component of being satisfied in your career. Knowing your “why” in life, the 3 kinder questions, etc. You might find it really valuable.
redfan11
Posts: 129
Joined: Sat Oct 26, 2019 7:02 pm

Re: High income physician seeking financial and life advice

Post by redfan11 »

Have you thought of moving to a smaller town? My wife and I are a few years behind you and very early career but living in a rural area has been a blessing in disguise. Life is good , commute short, well respected in the community , love my job and can’t complain about the pay. If I am able to do this for the next 30-40 years I won’t complain. Consider moving to small town America. If you cannot move, I would consider switching to 3 days a week and become an Iberian contractor. Even at 60% of your current salary you will vastly increase your net worth and remember you probably will get a bigger chunk of your money due to the decrease in your tax burden. 99% of Americans will kill to be in your position. Good luck!
Topic Author
RadDad915
Posts: 30
Joined: Fri Aug 20, 2021 4:08 pm

Re: High income physician seeking financial and life advice

Post by RadDad915 »

arsenalfan wrote: Sat Aug 21, 2021 8:59 pm 1. Sprint and get to a big number and leave medicine.
2. Go Part Time, make your vocation an avocation, and find other interests outside medicine. Kids, wife, travel, fitness, food, etc.

I chose 2 and it's been great for me. As an aside, see if you can become 1099 paid and make a solo defined benefits plan. Sock away a ton of money pretax over 10 years and retire.

Is there a conversion that one can typically use between W2 and 1099 compensation? I’ve done some reading on the subject and frankly find it confusing. For simplicity’s sake let’s say one was paid $50/case reading studies as a W2 radiologist, and total comp was $500k yearly. If that same radiologist were to switch to 1099, should they ask for more compensation per case (and how much) to bring home the same post-tax amount? Or less?
Topic Author
RadDad915
Posts: 30
Joined: Fri Aug 20, 2021 4:08 pm

Re: High income physician seeking financial and life advice

Post by RadDad915 »

Dennisl wrote: Sat Aug 21, 2021 11:26 pm
ElJefeDelQueso wrote: Sat Aug 21, 2021 8:55 pm
RadDad915 wrote: Fri Aug 20, 2021 4:51 pm I am a mid 30s sub-specialized radiologist married to another subspecialty physician. We have a toddler, another on the way, and live in a MCOL region.

Annual income: $1M

Liquid net worth: $5.2M. Including home equity and subtracting $450k remaining mortgage, total net worth is $5.8M.

—Liquid asset allocation is 95% equities and 5% bonds+cash. Of the equities, 85% is in VTSAX (total US stock market index fund), 10% is in assorted individual equities, and 5% is in VTIAX (total international stock index fund).

—$215k invested 100% in VTSAX in toddler’s 529 plan. Plan to similarly aggressively fund a 529 plan for next child.

—Approximately $1M of our liquid NW lies in tax-advantaged accounts; remainder (majority) lies in taxable accounts.

—Annual spending is variable but currently approximately $200k per year (half of which goes to mortgage). Once mortgage is paid off, anticipate perhaps $150k annual spend.

My wife and I work extremely hard, and are frequently mentally exhausted at the end of the workday. Often times there is not enough gas in the tank for us to spend quality time with our toddler in the evenings, and we feel guilty about this. I rarely if ever have time to relax or pursue my many hobbies, instead being consumed with work and the never ending honey-to-do list. As time passes and our wealth has grown, I find myself increasingly wondering whether we should continue working so hard. For a variety of reasons, I derive very little personal satisfaction from my job: loss of physician autonomy, widespread corporate/PE takeover of radiology practices around the country, excessive administrative control with little regard to patient care, and declining compensation year after year with escalating workload are all major contributors. Radiology is a numbers game in which we are paid per study. The sad reality is that quality and accuracy are barely valued in most modern radiology practices. Churning out more and more volume for less and less reimbursement is the name of the game now.

On the positive side, as a radiologist, my job particularly lends itself to part time work and remote work. There is also a national radiology shortage with most groups desperate to hire radiologists to keep up with surging study volumes. However, given my relatively young age, I am reluctant to go significantly part time (e.g., 3-4 workdays per week). To be frank, my assessment of the future of radiology is quite bleak: I expect only declining compensation in the future, and strongly suspect that non-physician practitioners (midlevels) with little training will be hired to make cursory “prelim” reads while radiologists sign off on unsafe study volumes and incur all medicolegal liability. The American College of Radiology very recently introduced legislation to congress asking for non-physician radiology assistants to be paid for independent radiology work, if there was any doubt as to the veracity of my suspicions. Similar non-physician practitioner scope creep has irreparably damaged many fields in medicine such as Anesthesia, Emergency medicine, and hospitalist/pediatric hospitalist medicine, among others. Personally, I would rather leave radiology altogether than to participate in the destruction of my noble profession in the name of unfettered greed.

My question to the boglehead community is this: what would you do if you were in my shoes? Would you go part time? Eke out another few years working full time (“make hay while the sun shines”)? Both my wife and I go part time? Something else entirely?

From a financial standpoint, should I change my asset allocation? I worry about being overly aggressive, however I also don’t want to own excessive bonds at my youngish age. I have zero issue with bear markets and watching my NW fluctuate significantly. In fact, I’ve typically looked forward to bear markets as an opportunity to purchase equities on sale.

I am well aware that my wife and I are in strong financial shape, and I feel fortunate for what we have earned and accomplished. I’ve lurked on this site for many years and am grateful for all of the financial knowledge I’ve gleaned. It is a wonderful resource full of intelligent and successful people from all walks of life. I look forward to your thoughtful responses.
Training for subspecialty radiology is typically 10 years after college, so mid 30s is like 2-4 years out of training assuming you went straight through. You've done really well financially for such a short time in practice. But I think you're in the wrong practice if you're so disenchanted already. You've hardly started.
I don’t know if it’s covid or what, but pretty much every person that I’ve talked to recently at the hospital has felt this way. We’ve been calling it midlife crisis. We don’t want to trade in our cars or wives. Just disillusioned with this being it. The constant demands to pay the bills, increase pt volume, electronic records, calm angry patients (there are a lot more angry/anxious pts now), fighting insurance claims, shutting down potential lawsuits, dealing with call, demands from family, cme, boards, etc. most of us are fed up and don’t care if the older gen calls us wimps. When we hit our FI, we’re ready to walk. That’s a bad sign when the docs want to churn through and cash out ASAP, not because we want to be wealthy, but we are miserable w the lifestyle. Each person has their limit for when they break. When I hit mine several months back, I was advised to see a psychologist for burnout. We didn’t have much to talk about. He agreed it was the job. 🤷‍♂️

Many of the young physicians I know are already strategizing about how to achieve FI, so they can either significantly cut back or leave medicine altogether. Money notwithstanding, who will replace us when we leave medicine? Non physician practitioners? As much as that seems like a panacea to the corporate/PE entities (with $$$ in their eyes) and our ignorant politicians, the reality as we know is far different. Costs will continue to skyrocket as NPPs shotgun order unnecessary studies and tests. The system will be flooded with frivolous and inane consults. Quality and actual patient care will continue to decline.
arsenalfan
Posts: 1132
Joined: Sun Dec 08, 2013 11:26 pm

Re: High income physician seeking financial and life advice

Post by arsenalfan »

RadDad915 wrote: Thu Aug 26, 2021 7:44 pm
arsenalfan wrote: Sat Aug 21, 2021 8:59 pm 1. Sprint and get to a big number and leave medicine.
2. Go Part Time, make your vocation an avocation, and find other interests outside medicine. Kids, wife, travel, fitness, food, etc.

I chose 2 and it's been great for me. As an aside, see if you can become 1099 paid and make a solo defined benefits plan. Sock away a ton of money pretax over 10 years and retire.

Is there a conversion that one can typically use between W2 and 1099 compensation? I’ve done some reading on the subject and frankly find it confusing. For simplicity’s sake let’s say one was paid $50/case reading studies as a W2 radiologist, and total comp was $500k yearly. If that same radiologist were to switch to 1099, should they ask for more compensation per case (and how much) to bring home the same post-tax amount? Or less?
WCI has a brief post on it with rough calculators for the taxes - you are both empolyEE and employER, so have to pay the employER payroll taxes.
https://www.whitecoatinvestor.com/w2-vs-self-employed/
anna.day
Posts: 59
Joined: Mon Sep 14, 2020 12:22 pm

Re: High income physician seeking financial and life advice

Post by anna.day »

I think you and your wife should be very proud of what you have achieved so far.

However, with a young child at home, and another on the way, I don't think you can continue on as you have been.

Honestly, as I assume your wife is about to go out on maternity leave shortly....and then will be post partum with two little kids ... my first suggestion is for you both to consider whether she can go part-time (if she wants to go back to work) or move to something extremely temporary (just to keep her skills going). I have a friend who is a pediatrician who only works a couple days a week and is home with her kids the other days, and I have another friend who was an internist but now homeschools her kids and does medical reviews at night a couple days a month for an insurance company just to keep her hand in a little. (She's got 6 kids, so that is what is feasible for her). I think probably the easiest thing to do is see if your wife can cut down her hours and/or go to something very temporary.

If she wants to keep working full time, then *you* should be the one to think about cutting down your hours dramatically. From practical experience, both my own and looking at friends, two very high powered full-time careers just doesn't work well with two or more little kids at home. You can logistically kind of keep things moving along, but everyone suffers: parents and kids. The money isn't worth it.

I also wouldn't recommend trying for just a "few more years" of the crazy and then quitting work entirely (or something equally dramatic). I assume both you and your wife worked very hard to get where you are. It's really hard to step off the hamster wheel. I've noticed in myself (and others) that sometimes that can make it seem like you have to run yourself ragged and then leave the workforce 100%. But I don't think that's really the choice. Moderation in all things. Good luck!!!
bradinsky
Posts: 2295
Joined: Sat Jul 21, 2018 6:32 am
Location: Ohio

Re: High income physician seeking financial and life advice

Post by bradinsky »

I wasn’t a physician, I owned & operated a manufacturing business for 40 years. You certainly aren’t unique. The more money you make, the more responsibility & stress you typically have. Like many in stressful positions, I faced “burnout” many times. The long hours, finances, customer induced stress & lots of time away from my wife & children made me want to quit many times, but I always found a work-a-round. New challenges, vacations, weekend getaways & the knowledge that we’d be better off in retirement if I persisted, kept me going & honestly, I’m glad I did.
At this point, you’re fairly young & not that far into your working career. Challenge yourself & modify your schedule. You could start your own practice, build it up & then sell it & retire. That would challenge you & probably take care of the burnout for a while. Retiring now, I think you would eventually get bored & find that you missed some of the challenges that you full time work offers & also the financial rewards. 5 or 6 more years will yield you & your family financial security that might not be currently evident to you. Whatever you choose, I wish you the very best of luck & happiness!

Brad
toomanysidehustles
Posts: 594
Joined: Tue Oct 06, 2020 10:09 am

Re: High income physician seeking financial and life advice

Post by toomanysidehustles »

michaelingp wrote: Fri Aug 20, 2021 6:42 pm
RadDad915 wrote: Fri Aug 20, 2021 4:51 pm I rarely if ever have time to relax or pursue my many hobbies, instead being consumed with work and the never ending honey-to-do list.
I question the honey-to-do list. At your income level you should have a live-in "home manager" who pays people to do everything on the honey-to-do list.
I agree. My wife told me a few years back "think of yourself as you charge $1,000/an hour - what can you outsource and hire out for to get more time back to do what you want to do."
protagonist
Posts: 9277
Joined: Sun Dec 26, 2010 11:47 am

Re: High income physician seeking financial and life advice

Post by protagonist »

Retired radiologist here. Specialized in MRI. Retired at 55 in 2008. Started in private practice and then transitioned into academia, running an MRI service and fellowship program.
Throughout my career I worked (average) 3 days/week. Most of the time I didn't take call. I lived where I wanted to live. I took lots of vacations and had loads of interesting experiences and adventures, leaving me with no bucket list in retirement. I pretty much wrote my own ticket. I did so by being creative, not settling, compromising very litlle and being willing to take risks regarding my future . (Future is inherently risky anyway). I had lots of time to be a good father, which paid off emotionally big time in retirement, much more than if I made more money.

I never made anywhere close to $1M/year. I never cared to. Most of the time I made about a quarter of that. I dealt with uncertainty and I went a few short periods unemployed because I couldn't find the job I wanted and I refused to settle. I could have made a lot more if I was willing to compromise more and do things I didn't really want to do. I can't imagine that I would have been any happier or more secure if I made $1M/year. I have everything I need or want that money can buy.

I won't offer financial advice because everybody else here will anyway, and people who frequent this forum pretty much agree on that stuff anyway..

I can offer life advice. It differs from what a lot of others might say, so you will have to decide for yourself. ("Tell me, great hero, but please make it brief" -Bob Dylan):

Take chances. Do what makes you happy- you never really know what the future will bring. Put family and friends and what (and who) you love in life first. You are one of the fortunate ones who can do that. Do things you can be proud of. Make money, but don't let money make you. There is no joy in dying exhausted on a huge pile of money.
Last edited by protagonist on Fri Aug 27, 2021 10:35 am, edited 2 times in total.
protagonist
Posts: 9277
Joined: Sun Dec 26, 2010 11:47 am

Re: High income physician seeking financial and life advice

Post by protagonist »

RadDad915 wrote: Fri Aug 20, 2021 4:51 pm To be frank, my assessment of the future of radiology is quite bleak: I expect only declining compensation in the future

By the way, I have heard this mantra over and over from most of my doctor colleagues ever since I graduated med school in 1980 (the big culprit then was HMOs).

Please read my other post above, and never think that you can predict the future. If you ever have any spare time after working your butt off and looking after your family, read about chaos and complexity theory.
Living Free
Posts: 822
Joined: Thu Jul 19, 2018 7:31 pm

Re: High income physician seeking financial and life advice

Post by Living Free »

I agree with above recommendations that you should cut back on work and so should your spouse. You will never get back the time that you children were young.
Nowizard
Posts: 4839
Joined: Tue Oct 23, 2007 5:33 pm

Re: High income physician seeking financial and life advice

Post by Nowizard »

Having numerous relatives and friends who are physicians while being in healthcare as a Ph.D. non-physician before retirement, here are a couple of observations. Though obtaining a Ph.D. requires discipline and commitment, the commitment to medicine is different in terms of the appeal to those who are intelligent, want financial security and have a desire to do meaningful things with their lives. Often, the commitment to becoming a physician requires early declaration and planning starting in high school or earlier. By the time one has met educational, clinical, internship and fellowship requirements, there have been many things put on hold. It may the one of the best examples of required delay of gratification professions.
In short, after being on the spinning, gerbil wheel for years, there is finally time to take notice of the emotional toll involved in achieving the goal. Making shifts in major areas of life is a challenge with things such as life/balance. Many more consider FIRE today, a concept basically unthinkable fifty years ago.
The relatives and friends mentioned above are younger, and are definitely finding that they want more balance in life than their job demands allow. The Covid19 epidemic adds stress in multiple ways, too. Essentially, relatives, along with our children, are in the same decision pattern as you. Some have moved to PT, others are in the process of probably doing so. You have financial goals well under control, and you have options to consider. In other words, there are those who love their work and will be carried out feet first, those who wear track shoes to work in order to run out as fast as possible, and those who are in between. Simply put, you will get support for having met the financial questions. The rest is up to you, and there are various sources at your disposal if confused about decisions or experiencing differences of opinion about how to proceed in your own home. You will possibly get some comments about why would you want to move away from a goal you worked so hard to attain.

Tim
MikeG62
Posts: 5065
Joined: Tue Nov 15, 2016 2:20 pm
Location: New Jersey

Re: High income physician seeking financial and life advice

Post by MikeG62 »

OP, although not a doc, here is my experience with hitting burn out and transitioning to part time and nine years later to fully retired. Hope it helps.

In 2005 (at the age of 42) I felt I had enough of the 60 hour work weeks and constant pressure and stress and spoke with my CEO about retiring. I had been a senior executive of a multi-billion dollar NYSE listed public company with over 10,000 employees for well over a decade. Lots of responsibility and tons of stress. I was done.

Much to my surprise he was incredibly flexible and willing to negotiate a part-time work schedule (~3 days per week - generally Monday’s and Fridays off) - following a 15 month period where I transitioned my responsibilities to my successor. I remained in a senior finance capacity, but more of a consultative role (although I remained an employee with all the benefits that go along with that). No G&O’s, no performance reviews, no travel, unless I was up for it. I worked on what I wanted and passed on things that did not interest me. I was able to sleep in a bit later each day, go the gym between 7:30am-9:00am and float into work after that (typically around 9:30-10:00). This continued for 9 years.

Ultimately I fully retired in 2016 (at the age of 53), after the company was acquired and the senior leadership team was exited.

It was the best decision I ever I made. Zero regrets. It also helped me transition to full retirement (as I avoided going from 60 hours working per week to zero).
Real Knowledge Comes Only From Experience
Ajcorpus
Posts: 120
Joined: Fri Sep 25, 2020 2:41 pm

Re: High income physician seeking financial and life advice

Post by Ajcorpus »

RadDad915 wrote: Sun Aug 22, 2021 12:39 pm
stoptothink wrote: Sun Aug 22, 2021 12:05 pm
am wrote: Sun Aug 22, 2021 11:57 am
RadDad915 wrote: Fri Aug 20, 2021 4:51 pm I am a mid 30s sub-specialized radiologist married to another subspecialty physician. We have a toddler, another on the way, and live in a MCOL region.

Annual income: $1M

Liquid net worth: $5.2M. Including home equity and subtracting $450k remaining mortgage, total net worth is $5.8M.

—Liquid asset allocation is 95% equities and 5% bonds+cash. Of the equities, 85% is in VTSAX (total US stock market index fund), 10% is in assorted individual equities, and 5% is in VTIAX (total international stock index fund).

—$215k invested 100% in VTSAX in toddler’s 529 plan. Plan to similarly aggressively fund a 529 plan for next child.

—Approximately $1M of our liquid NW lies in tax-advantaged accounts; remainder (majority) lies in taxable accounts.

—Annual spending is variable but currently approximately $200k per year (half of which goes to mortgage). Once mortgage is paid off, anticipate perhaps $150k annual spend.

My wife and I work extremely hard, and are frequently mentally exhausted at the end of the workday. Often times there is not enough gas in the tank for us to spend quality time with our toddler in the evenings, and we feel guilty about this. I rarely if ever have time to relax or pursue my many hobbies, instead being consumed with work and the never ending honey-to-do list. As time passes and our wealth has grown, I find myself increasingly wondering whether we should continue working so hard. For a variety of reasons, I derive very little personal satisfaction from my job: loss of physician autonomy, widespread corporate/PE takeover of radiology practices around the country, excessive administrative control with little regard to patient care, and declining compensation year after year with escalating workload are all major contributors. Radiology is a numbers game in which we are paid per study. The sad reality is that quality and accuracy are barely valued in most modern radiology practices. Churning out more and more volume for less and less reimbursement is the name of the game now.

On the positive side, as a radiologist, my job particularly lends itself to part time work and remote work. There is also a national radiology shortage with most groups desperate to hire radiologists to keep up with surging study volumes. However, given my relatively young age, I am reluctant to go significantly part time (e.g., 3-4 workdays per week). To be frank, my assessment of the future of radiology is quite bleak: I expect only declining compensation in the future, and strongly suspect that non-physician practitioners (midlevels) with little training will be hired to make cursory “prelim” reads while radiologists sign off on unsafe study volumes and incur all medicolegal liability. The American College of Radiology very recently introduced legislation to congress asking for non-physician radiology assistants to be paid for independent radiology work, if there was any doubt as to the veracity of my suspicions. Similar non-physician practitioner scope creep has irreparably damaged many fields in medicine such as Anesthesia, Emergency medicine, and hospitalist/pediatric hospitalist medicine, among others. Personally, I would rather leave radiology altogether than to participate in the destruction of my noble profession in the name of unfettered greed.

My question to the boglehead community is this: what would you do if you were in my shoes? Would you go part time? Eke out another few years working full time (“make hay while the sun shines”)? Both my wife and I go part time? Something else entirely?

From a financial standpoint, should I change my asset allocation? I worry about being overly aggressive, however I also don’t want to own excessive bonds at my youngish age. I have zero issue with bear markets and watching my NW fluctuate significantly. In fact, I’ve typically looked forward to bear markets as an opportunity to purchase equities on sale.

I am well aware that my wife and I are in strong financial shape, and I feel fortunate for what we have earned and accomplished. I’ve lurked on this site for many years and am grateful for all of the financial knowledge I’ve gleaned. It is a wonderful resource full of intelligent and successful people from all walks of life. I look forward to your thoughtful responses.
How in the heck did you save up so much in less then 5 yrs if practice? There’s got to be more then just work earnings in that 5 mil.
Also $1M in tax advantaged accounts, in 5yrs? No medical school loans, 5yrs out for two physicians? I hate to speculate, but maybe the OP really wants to continue working when retirement is financially viable for 99% of the rest of us because much of their current NW was not earned by them...or it's a troll.

What’s that saying about assumptions…?

It’s highly amusing to me when people assume that a full time practicing radiologist would take the time to compose such an elaborate post, with the express goal of trolling an anonymous Internet forum. This is not a humblebrag. Nowhere have I asked if “I’m doing ok” compared to the average person.

—My wife and I were fortunate to graduate without medical school loans. Our immigrant parents did everything they could to ensure this reality—both of my parents worked 2-3 jobs each when I was a child. My mother came to this country with $8 in her bank account, FWIW.

—*ETA* Both my wife and I earned substantial merit based scholarships to undergrad and medical school.

—My wife and I have each been able to put almost $80,000 per year per person into tax advantaged accounts. This excludes additional employer match. The stock market has done pretty well in the past 5-6 years, particularly if one was investing heavily in 2020.

—You assume that my current income is the highest income my wife and I have earned since we’ve practiced. That’s wrong.

—You assume that I’ve only been investing since I’ve been an attending. That’s wrong. Some residencies and fellowships offer ample opportunities to moonlight for motivated residents—mine did. And I worked my tail off doing so.

—Let’s say I won a scratch off lottery for $1M years ago and invested it. Or received a $1M inheritance. Or invested in BTC in 2018. Or invested heavily in TSLA before realizing the folly of uncompensated single stock risk, and realized those gains recently. Or bought a house years ago that has massively appreciated given the current market. Or any number of the above. Does that change the validity of what I’ve written? Should it change the sincerity of the responses I should expect? My post has nothing to do with you—the title makes the content explicitly clear, and if you didn’t want to read it you should have kept on scrolling.

Hey man, I’m also in healthcare but not a doc. Also have only 1/5th of your net worth and it took me 12 years to get there. This may not be helpful but I will say it anyway. Your parents are immigrants here, so was I. And whenever I feel a tad bit burnout or negative about my life, I take a trip back home ( a third world country) and realize how freaking amazing my life is. I actually don’t have to worry about running water and electricity. I dont have to worry about living expenses for the next few years even if I quit. So what I’m trying to say is, once I lose perspective, I just need a reminder. Have you tried volunteering in a third world country? If you haven’t, please do so as I truly believe that it will help.
swampwiz
Posts: 123
Joined: Thu Jan 03, 2013 2:55 am

Re: High income physician seeking financial and life advice

Post by swampwiz »

I realize that you and the missus have busted a33 to get to your income level, but you have more than enough of critical-mass to just walk away - or at least do some type of part-time physicianing.
Topic Author
RadDad915
Posts: 30
Joined: Fri Aug 20, 2021 4:08 pm

Re: High income physician seeking financial and life advice

Post by RadDad915 »

anna.day wrote: Fri Aug 27, 2021 7:17 am I think you and your wife should be very proud of what you have achieved so far.

However, with a young child at home, and another on the way, I don't think you can continue on as you have been.

Honestly, as I assume your wife is about to go out on maternity leave shortly....and then will be post partum with two little kids ... my first suggestion is for you both to consider whether she can go part-time (if she wants to go back to work) or move to something extremely temporary (just to keep her skills going). I have a friend who is a pediatrician who only works a couple days a week and is home with her kids the other days, and I have another friend who was an internist but now homeschools her kids and does medical reviews at night a couple days a month for an insurance company just to keep her hand in a little. (She's got 6 kids, so that is what is feasible for her). I think probably the easiest thing to do is see if your wife can cut down her hours and/or go to something very temporary.

If she wants to keep working full time, then *you* should be the one to think about cutting down your hours dramatically. From practical experience, both my own and looking at friends, two very high powered full-time careers just doesn't work well with two or more little kids at home. You can logistically kind of keep things moving along, but everyone suffers: parents and kids. The money isn't worth it.

I also wouldn't recommend trying for just a "few more years" of the crazy and then quitting work entirely (or something equally dramatic). I assume both you and your wife worked very hard to get where you are. It's really hard to step off the hamster wheel. I've noticed in myself (and others) that sometimes that can make it seem like you have to run yourself ragged and then leave the workforce 100%. But I don't think that's really the choice. Moderation in all things. Good luck!!!
Thank you for your post. I agree with you - part of the timing of my post is that we are expecting a new addition to the family next year. I am very concerned about the logistics of how we will manage this with our demanding specialist jobs as they now stand. My ideal scenario would probably be for my wife and I to both go 0.75 FTE or less—however it has proven challenging to do this, particularly as I’m confident that radiology’s best days are long behind it. Compensation and reimbursements have been steadily declining in the field for 10-15 years, despite skyrocketing work loads. I’m not aware of really any other profession in the same situation.
User avatar
cchrissyy
Posts: 2355
Joined: Fri May 05, 2017 10:35 pm
Location: SF bay area

Re: High income physician seeking financial and life advice

Post by cchrissyy »

I think if you could disengage from work with a long vacation to clear your head, you would realize the future of radiology is really not your problem.
you have already made "enough" and even if you cut to half time and even if wages fall, you are absolutely fine.
I would recommend you do that - .50 time or .75 time at the most - in order to focus on your family and to avoid total burnout where you go 100% for a couple more years and crash to zero.
60-20-20 us-intl-bond
Cruncher
Posts: 193
Joined: Sun Jan 31, 2010 11:56 pm

Re: High income physician seeking financial and life advice

Post by Cruncher »

If you need help burning through your assets, but a boat. A big sailboat with lots of beautiful teak! :D

At least, that's what I am doing ... Ha

Learn to live in the moment... enjoy the ride, there is no dress rehearsal. Eddie Van Halen taught me that.
newpup
Posts: 97
Joined: Sun Sep 30, 2007 5:11 pm

Re: High income physician seeking financial and life advice

Post by newpup »

Hi Rad Dad-
Fellow subspecialty Radiologist here. I agree with your bleak outlook for the future of Radiology, which seems to be suffering from decreased compensation and increased workload every year- this in combination with the threat of higher taxes. Having said that, it's still a better job than 99% of what else is out there, particularly in medicine. You spent at least 10 miserable years after college for the privilege of doing this job. I say: try to continue making hay while the sun shines. Find all the pain points you can eliminate from the rest of your life and pay to have them done if possible.

Keep your eye out for other jobs- outpatient clinics close at night and call (or lack thereof) determines happiness. Know that you can bail at any moment if need be. Marginal dollars start to decrease in value when you hit the upper echelons- continue maximizing pre-tax savings with an eye to long-term drawdown in lower brackets after your primary income is gone.
Emptykeg
Posts: 98
Joined: Thu Nov 26, 2020 6:18 pm

Re: High income physician seeking financial and life advice

Post by Emptykeg »

Delete
Last edited by Emptykeg on Thu Sep 09, 2021 6:26 pm, edited 1 time in total.
chw
Posts: 1315
Joined: Thu May 24, 2012 4:22 pm

Re: High income physician seeking financial and life advice

Post by chw »

I'm not a doc, but a few thoughts...

1) Could you dial back your hours (either or both of you) to avoid the burnout you are heading towards?

2) I would consider a live in professional nanny to assist with all aspects of running your household so you don't have to. You have the income and net worth in place to easily do this. I think it would greatly reduce some of the home chores so that you can spend that time with your children.

You can figure this out, and the fact that you are asking, is a good sign that you are open to change.
sc9182
Posts: 2178
Joined: Wed Aug 17, 2016 7:43 pm

Re: High income physician seeking financial and life advice

Post by sc9182 »

Non-physician here. Got nothing important to add - life is a journey, enjoy (in moderation) each leg/phase of it along the way.

Know that you will never be a billionaire nor 50+ millionaire (doing job). If necessary slow down a bit and start to savor life a bit more (away from work). Have/develop diverse set of friends, cohorts - who can relate well and discuss/enjoy non-work items.

Money is a score for your hard work, and investing prowess., but it’s not the destination (it’s merely a byproduct of your work/investing). Once you cross limits of mere-mortals’ FI numbers., money is nothing but a mere score - it really doesn’t (should not) matter - unless you have different set or priorities.

Then again - hv fun., enjoy the journey.
make_a_better_world
Posts: 292
Joined: Mon Mar 18, 2013 11:55 pm

Re: High income physician seeking financial and life advice

Post by make_a_better_world »

Cardiologist here, 41 yo M. I was in a very similar situation two years ago. My typical clinic census was 20 to 25 patients per day. I took call every month during which I’d receive both emergent and non-emergent pages at any hour of the night even direct from patients as my employer decided that’s what we’d do. I had to type my note while the patient was in the room and rush from one to the next. My infamous inbox of results and phone calls was relentless. When I covered the hospital, call was particularly brutal. I couldn’t spend enough time with patients. I couldn’t find the energy to learn as much as I wanted to. I couldn't find the energy to do much at all when I got home. It is pressure of truly profound dimensions that oppresses the individual, forcing out every last instance of life like a hand wringing water from a damp sponge. I was mentally and physically exhausted all the time. I’d look at my partners, some in their late 60s, and they were still at it. The money was great. I tried very hard to scale back and make less. My employer would not allow it in any meaningful way.

I do not believe you are having a mid-life crisis. I do not believe the answer is a new hobby. Many of us love medicine. We did not go to medical school to be factory drones to deliver substandard care and treat patients and ourselves this way. Virtually all of us in every field have been experiencing burn out.

At age 39 in December 2019 I answered a 3-part series of questions called the Kinder questions in constructing my annual goals. I’ll list them below. My understanding is they were designed to help people allocate wealth and set up a financial plan in a meaningful way, but for me they helped put many things into perspective for what is a meaningful life. After carefully contemplating the answers and writing them out, I decided my current career was no way to live. It was a very difficult decision that took a month of internal debate and anxiety and then I resigned my position. I soon later started a private practice, during a pandemic mind you, which I had heard was essentially impossible these days. I can tell you it’s not impossible.

I make a lot less. I work a lot less and currently have 4 days off a week. I can ramp that up or down anytime. I have no call and focus mostly on outpatient. I spend time with patients and the visits are unrushed and they appreciate me. I love being able to help my friends and family free of charge. If I want to take time off I simply block it off my schedule so the staff cannot book appointments. I have as close to complete autonomy as it can get. I returned today from 4 days in Yosemite. I might go to Colorado in a week and half for 4 days. I might not. I’ll see what I feel like and decide this weekend. No regrets.

https://youtu.be/M-vQGxTFfPU?t=405

Here are the Kinder questions:

Question 1: Design Your Life
I want you to imagine that you are financially secure, that you have enough money to take care of your needs, now and in the future. The question is, how would you live your life? What would you do with the money? Would you change anything? Let yourself go. Don’t hold back your dreams. Describe a life that is complete, that is richly yours.

Question 2: You have less time
This time, you visit your doctor who tells you that you have five to ten years left to live. The good part is that you won’t ever feel sick. The bad news is that you will have no notice of the moment of your death. What will you do in the time you have remaining to live? Will you change your life, and how will you do it?

Question 3: Today’s the day
This time, your doctor shocks you with the news that you have only one day left to live. Notice what feelings arise as you confront your very real mortality. Ask yourself: What dreams will be left unfulfilled? What do I wish I had finished or had been? What do I wish I had done? [Did I miss anything]?
travelbirder
Posts: 7
Joined: Sun Aug 25, 2019 9:49 am

Re: High income physician seeking financial and life advice

Post by travelbirder »

make_a_better_world wrote: Wed Sep 01, 2021 8:24 pm Cardiologist here, 41 yo M. I was in a very similar situation two years ago. My typical clinic census was 20 to 25 patients per day. I took call every month during which I’d receive both emergent and non-emergent pages at any hour of the night even direct from patients as my employer decided that’s what we’d do. I had to type my note while the patient was in the room and rush from one to the next. My infamous inbox of results and phone calls was relentless. When I covered the hospital, call was particularly brutal. I couldn’t spend enough time with patients. I couldn’t find the energy to learn as much as I wanted to. I couldn't find the energy to do much at all when I got home. It is pressure of truly profound dimensions that oppresses the individual, forcing out every last instance of life like a hand wringing water from a damp sponge. I was mentally and physically exhausted all the time. I’d look at my partners, some in their late 60s, and they were still at it. The money was great. I tried very hard to scale back and make less. My employer would not allow it in any meaningful way.

I do not believe you are having a mid-life crisis. I do not believe the answer is a new hobby. Many of us love medicine. We did not go to medical school to be factory drones to deliver substandard care and treat patients and ourselves this way. Virtually all of us in every field have been experiencing burn out.

At age 39 in December 2019 I answered a 3-part series of questions called the Kinder questions in constructing my annual goals. I’ll list them below. My understanding is they were designed to help people allocate wealth and set up a financial plan in a meaningful way, but for me they helped put many things into perspective for what is a meaningful life. After carefully contemplating the answers and writing them out, I decided my current career was no way to live. It was a very difficult decision that took a month of internal debate and anxiety and then I resigned my position. I soon later started a private practice, during a pandemic mind you, which I had heard was essentially impossible these days. I can tell you it’s not impossible.

I make a lot less. I work a lot less and currently have 4 days off a week. I can ramp that up or down anytime. I have no call and focus mostly on outpatient. I spend time with patients and the visits are unrushed and they appreciate me. I love being able to help my friends and family free of charge. If I want to take time off I simply block it off my schedule so the staff cannot book appointments. I have as close to complete autonomy as it can get. I returned today from 4 days in Yosemite. I might go to Colorado in a week and half for 4 days. I might not. I’ll see what I feel like and decide this weekend. No regrets.

https://youtu.be/M-vQGxTFfPU?t=405

Here are the Kinder questions:

Question 1: Design Your Life
I want you to imagine that you are financially secure, that you have enough money to take care of your needs, now and in the future. The question is, how would you live your life? What would you do with the money? Would you change anything? Let yourself go. Don’t hold back your dreams. Describe a life that is complete, that is richly yours.

Question 2: You have less time
This time, you visit your doctor who tells you that you have five to ten years left to live. The good part is that you won’t ever feel sick. The bad news is that you will have no notice of the moment of your death. What will you do in the time you have remaining to live? Will you change your life, and how will you do it?

Question 3: Today’s the day
This time, your doctor shocks you with the news that you have only one day left to live. Notice what feelings arise as you confront your very real mortality. Ask yourself: What dreams will be left unfulfilled? What do I wish I had finished or had been? What do I wish I had done? [Did I miss anything]?
This post is amazing! Thank you!
I am a newly retired orthopedic surgeon shoulder specialist (age 58) who FINALLY had everything figured out when my hospital sold the whole department to private equity! Yikes! We had to sign a non-disclosure agreement so we couldn't even tell our co-workers what was coming down the pike. We had a few choices: stay with the vastly downsized department (strongly discouraged by the buying/selling parties) until the end of our current contract, go to the private equity group (and perhaps be offered partnership after 6 months if deemed worthy), or leave town. I did not want to do "Factory Farm Orthopedics".

Luckily, I had a fourth option! I was Financially Independent and had what JL Collins calls "FU money".

I made it say it's name.

Who knows if I'm on a 1 year sabbatical waiting out my non-compete or if I'm truly retired? With each passing day, however, sweet, sweet freedom is claiming my undivided attention.

Yes, the corporate takeover of medicine sucks. But you are in an awesome place. You and the missus have FU money. Let that wash over you like a cool, soothing wave. The consensus is to scale back. You seem to be wise beyond your years financially for a doc. Just don't go nuts and get divorced, or have stress-related health problems. "More time off, more vacations" is my (and every other docs!) prescription on this forum!

Take your foot off the gas--your toddler already will have enough in that 529 to go thru med school and have enough left over to put his or her kids thru!
psy1
Posts: 238
Joined: Thu Jan 31, 2019 12:40 am

Re: High income physician seeking financial and life advice

Post by psy1 »

Long thread and did not read all the responses. My wife and I are both physicians and have been in similar situations. Sounds like you have had a linear career and that is an issue. Think of your career as if you are a pitcher rather than a catcher. Instead of playing every pitch and every out until your knees and your back fail (the catcher), you start as a young pitcher with a good arm. You throw a lot of complete games and have a good record. Then you get beat up a little, injured a little, and get a little older. You have to reduce your pitch count, maybe transition to being a reliever. If you can master a knuckle ball, you can pitch a long time. Find your knuckleball. Maybe it is locums, maybe a sabbatical, maybe part-time work.

You should also consider taxation arbitrage over your career. Why work like a dog and get taxed to death (the world we live in) rather than work less and keep more of your income. Doing the latter might mean working longer (ejoyably) with a higher net.

In our case it made no sense for us, as a couple, to even work 1.5 FTE combined with call once we figured in taxation and quality of life issues. You did not mention your wife's position in this and it is important to figure out the team's game plan in conjunction with each player's.
Archimedes
Posts: 374
Joined: Wed Feb 15, 2017 10:27 am

Re: High income physician seeking financial and life advice

Post by Archimedes »

I’m a physician. Long ago, I decided to follow a different path. I did a variety of things. I took a part time academic job that offered many attractions. I also had a part time private practice, and I did some entrepreneurial things on the side. I did an interesting mix of things and the variety was stimulating. I would get too busy with one pursuit or another, and then make another pivot by pruning and changing things.

It has been quite a ride. I spend time with family and friends every day. I exercise outdoors in the woods every day. Before Covid, we were traveling the world. I miss that now. But the creative, untrodden path worked out well for us. The net worth is well into the 8-figure range, and we continue to design our life in the way that we want. I continue to work hard, not because I have to, but because I am passionate about what I pursue, what I choose to spend my time doing. Yes, I still work, but I cannot even call it work because I am doing exactly what I want to do with my time.

Figure out your passion, combine it with your career, and simultaneously design the life that will allow you the time that you want with your spouse and your kids. You are smart and creative. I have the confidence that you will find your path to fulfillment. You have arrived at the fork in the road. Don’t be afraid to choose the turn that is right for you. Be fearless!
GratuitousScrubs
Posts: 47
Joined: Fri Sep 03, 2021 1:19 am

Re: High income physician seeking financial and life advice

Post by GratuitousScrubs »

Long time lurker, also a radiologist (40s), on my second job. My thoughts to OP:

1) There is a considerable range between different situations. Large vs. small, Private vs. Academic, Hospital vs. OP, etc. Sure, "correlations converge to 1" is a possibility and there may be no long term escape from the downsides that you have articulated (e.g. maybe we're all headed for the RadPartners factory). I realize that your wife's career is a constraining factor, but I do not see within your posts adequate evidence of having exhausted your effort to find the right type of career fit. Related....

2) You have clearly devoted yourself to achieving excellence in this field, and seem frustrated by the disconnect between your professional values and the reality of medical practice, understandably so. Nevertheless, it seems early to abandon the search for harmony between these things. If your training was entirely in ivory tower academic medical centers, it is possible that you have some inherited beliefs about how work should be done that will evolve if you keep an open mind. It is also possible that you will find a job where you can have an opportunity to do the work the way you currently think it should be done.

3) I think "work less", and "retire early" advice are blunt solutions that are oriented toward lessening the pain of work. I suggest that you challenge yourself to find joy in work, even if that means changing jobs again. I do not concede that corporate, mid-level, and AI incursions into our field will make it impossible to find joy and meaning in this work. Paradoxically, perhaps the Rx is to take on some additional un-/undercompensated work: committee service, interdisciplinary conference staffing, or something that will help create a greater sense of connection, purpose, and agency. Burnout is a popular phrase these days, and it is sometimes misunderstood as overwork. That is not exactly what burnout is. "The three key dimensions...are an overwhelming exhaustion, feelings of cynicism and detachment from the job, and a sense of ineffectiveness and lack of accomplishment". Relentless overwork can produce all of these things, but I think that's not really the reason for radiologists. I think it's the isolation and feeling of no control, which can be mitigated in other ways.

4) The job does get easier. You simply get much more efficient when it's the 10,000th+ time you've read that type of study. Even the most complex cases mostly begin to fall into the "another one of these," bucket. You spend less effort accessing knowledge to read a hard case, because you've already retrieved that knowledge many times. You will also access your experience more often on these cases, largely on a subconscious level, which requires less mental effort. I absolutely do know the feeling you describe of being mentally drained from a 9-hr bolted-to-the-chair sprint: the stimulus needed to produce this feeling in me has increased substantially over time.

Good luck to you on your journey
iamblessed
Posts: 1808
Joined: Sat Jun 09, 2018 11:52 am
Location: St. Louis

Re: High income physician seeking financial and life advice

Post by iamblessed »

RadDad915 wrote: Fri Aug 20, 2021 4:51 pm I am a mid 30s sub-specialized radiologist married to another subspecialty physician. We have a toddler, another on the way, and live in a MCOL region.

Annual income: $1M

Liquid net worth: $5.2M. Including home equity and subtracting $450k remaining mortgage, total net worth is $5.8M.

—Liquid asset allocation is 95% equities and 5% bonds+cash. Of the equities, 85% is in VTSAX (total US stock market index fund), 10% is in assorted individual equities, and 5% is in VTIAX (total international stock index fund).

—$215k invested 100% in VTSAX in toddler’s 529 plan. Plan to similarly aggressively fund a 529 plan for next child.

—Approximately $1M of our liquid NW lies in tax-advantaged accounts; remainder (majority) lies in taxable accounts.

—Annual spending is variable but currently approximately $200k per year (half of which goes to mortgage). Once mortgage is paid off, anticipate perhaps $150k annual spend.

My wife and I work extremely hard, and are frequently mentally exhausted at the end of the workday. Often times there is not enough gas in the tank for us to spend quality time with our toddler in the evenings, and we feel guilty about this. I rarely if ever have time to relax or pursue my many hobbies, instead being consumed with work and the never ending honey-to-do list. As time passes and our wealth has grown, I find myself increasingly wondering whether we should continue working so hard. For a variety of reasons, I derive very little personal satisfaction from my job: loss of physician autonomy, widespread corporate/PE takeover of radiology practices around the country, excessive administrative control with little regard to patient care, and declining compensation year after year with escalating workload are all major contributors. Radiology is a numbers game in which we are paid per study. The sad reality is that quality and accuracy are barely valued in most modern radiology practices. Churning out more and more volume for less and less reimbursement is the name of the game now.

On the positive side, as a radiologist, my job particularly lends itself to part time work and remote work. There is also a national radiology shortage with most groups desperate to hire radiologists to keep up with surging study volumes. However, given my relatively young age, I am reluctant to go significantly part time (e.g., 3-4 workdays per week). To be frank, my assessment of the future of radiology is quite bleak: I expect only declining compensation in the future, and strongly suspect that non-physician practitioners (midlevels) with little training will be hired to make cursory “prelim” reads while radiologists sign off on unsafe study volumes and incur all medicolegal liability. The American College of Radiology very recently introduced legislation to congress asking for non-physician radiology assistants to be paid for independent radiology work, if there was any doubt as to the veracity of my suspicions. Similar non-physician practitioner scope creep has irreparably damaged many fields in medicine such as Anesthesia, Emergency medicine, and hospitalist/pediatric hospitalist medicine, among others. Personally, I would rather leave radiology altogether than to participate in the destruction of my noble profession in the name of unfettered greed.

My question to the boglehead community is this: what would you do if you were in my shoes? Would you go part time? Eke out another few years working full time (“make hay while the sun shines”)? Both my wife and I go part time? Something else entirely?

From a financial standpoint, should I change my asset allocation? I worry about being overly aggressive, however I also don’t want to own excessive bonds at my youngish age. I have zero issue with bear markets and watching my NW fluctuate significantly. In fact, I’ve typically looked forward to bear markets as an opportunity to purchase equities on sale.

I am well aware that my wife and I are in strong financial shape, and I feel fortunate for what we have earned and accomplished. I’ve lurked on this site for many years and am grateful for all of the financial knowledge I’ve gleaned. It is a wonderful resource full of intelligent and successful people from all walks of life. I look forward to your thoughtful responses.
I retired at 38 on way less money than you have so you know my answer.
Sagefemme
Posts: 352
Joined: Mon Mar 12, 2018 9:31 pm

Re: High income physician seeking financial and life advice

Post by Sagefemme »

You described your profession as "noble" in your original post. How did you come to believe that it's noble? What doctor or mentor in your past showed you the nobility of practicing medicine? Can you conjure up what work situation or condition would give you that conviction of nobility again? Do you know any physicians in radiology who have the job satisfaction that you desire? Surely there exists a job where you can go home tired but hugely satisfied with your day's work. You are too highly trained and valuable to humanity to stop working!! I hate the thought of "grinding it out" for a few more years and then quitting--there must be a better way. PS--is there a way for medical students and residents to understand better what they are headed for when they choose their specialty-subspecialty-subsubspecialty? Or did you know what it would be like? I'm very curious about this part of the culture of doctor school. And best of luck to you and your family.
Topic Author
RadDad915
Posts: 30
Joined: Fri Aug 20, 2021 4:08 pm

Re: High income physician seeking financial and life advice

Post by RadDad915 »

GratuitousScrubs wrote: Fri Sep 03, 2021 2:10 am Long time lurker, also a radiologist (40s), on my second job. My thoughts to OP:

1) There is a considerable range between different situations. Large vs. small, Private vs. Academic, Hospital vs. OP, etc. Sure, "correlations converge to 1" is a possibility and there may be no long term escape from the downsides that you have articulated (e.g. maybe we're all headed for the RadPartners factory). I realize that your wife's career is a constraining factor, but I do not see within your posts adequate evidence of having exhausted your effort to find the right type of career fit. Related....

2) You have clearly devoted yourself to achieving excellence in this field, and seem frustrated by the disconnect between your professional values and the reality of medical practice, understandably so. Nevertheless, it seems early to abandon the search for harmony between these things. If your training was entirely in ivory tower academic medical centers, it is possible that you have some inherited beliefs about how work should be done that will evolve if you keep an open mind. It is also possible that you will find a job where you can have an opportunity to do the work the way you currently think it should be done.

3) I think "work less", and "retire early" advice are blunt solutions that are oriented toward lessening the pain of work. I suggest that you challenge yourself to find joy in work, even if that means changing jobs again. I do not concede that corporate, mid-level, and AI incursions into our field will make it impossible to find joy and meaning in this work. Paradoxically, perhaps the Rx is to take on some additional un-/undercompensated work: committee service, interdisciplinary conference staffing, or something that will help create a greater sense of connection, purpose, and agency. Burnout is a popular phrase these days, and it is sometimes misunderstood as overwork. That is not exactly what burnout is. "The three key dimensions...are an overwhelming exhaustion, feelings of cynicism and detachment from the job, and a sense of ineffectiveness and lack of accomplishment". Relentless overwork can produce all of these things, but I think that's not really the reason for radiologists. I think it's the isolation and feeling of no control, which can be mitigated in other ways.

4) The job does get easier. You simply get much more efficient when it's the 10,000th+ time you've read that type of study. Even the most complex cases mostly begin to fall into the "another one of these," bucket. You spend less effort accessing knowledge to read a hard case, because you've already retrieved that knowledge many times. You will also access your experience more often on these cases, largely on a subconscious level, which requires less mental effort. I absolutely do know the feeling you describe of being mentally drained from a 9-hr bolted-to-the-chair sprint: the stimulus needed to produce this feeling in me has increased substantially over time.

Good luck to you on your journey

Thanks for your response. In my experience, outside of (some) ivory tower academic medical centers, radiology has become so commoditized that churning though volume as fast as possible is all that matters to the practice. A radiologist could be of truly exceptional quality—rarely if ever missing significant findings, making amazingly difficult calls, etc. while still reading average to above average volumes—but will not be rewarded or recognized. In fact, in pay-per-case practices, the exceptionally accurate radiologist is actually financially penalized for their skill; meanwhile, the mediocre or substandard radiologist that reads every single case in the same amount of time (no matter how difficult) is actually paid and cherished more. As a radiologist you no doubt understand exactly what I’m saying.

Simple example. I made an outstanding call on an MRI the other day that will likely result in saving the patient’s life. By my estimation, a majority of subspecialized radiologists in my field would have missed this call—they certainly would have in my practice. Yet the patient will never know that I saved her. The referring clinician will not understand that this was an amazing call, as he isn’t a radiologist. The section chiefs, administrators, and c suite running the practice will never see the case, plus the non-physician administrators lack the ability to even understand anything I’m saying (let alone the difficulty of the case). I have made literally hundreds of calls like this in my career thus far, yet have nothing to show for it except (fleeting) internal satisfaction. The referring physicians always want me to read their studies and overwhelmingly preferably consult me, but this is of little to no import. Sometimes I feel like I’m shooting accurate three pointers all day long while my colleagues are sloppily missing layups; however, at the end of the day, there is zero external differentiation between myself and them. Other professions seem to reward and promote their stars; why doesn’t radiology?

My issue is not exhaustion because of the difficulty of radiology. In fact, largely due to my incredibly demanding and high volume training, I actually find the work quite monotonous (including most “challenging” cases that I have already seen dozens of times in real life or through study). I only read in my subspecialty and have done so ever since I completed my rigorous fellowship—the issue is rarely if ever lack of experience or comfort at this point. Put another way: imagine you were asked to read 75 pulmonary nodule followup chest CTs each and every day. Every day was almost exactly the same. And no matter how accurately you read, or how much better your quality was than your peers, you were never promoted or recognized—not verbally nor financially. How would you feel? That’s probably the closest approximation to what I feel now.
Young Boglehead
Posts: 321
Joined: Wed Jan 02, 2019 4:11 pm

Re: High income physician seeking financial and life advice

Post by Young Boglehead »

Forgive me if you've already answered this but are you able to reduce your hours? Not getting that satisfaction from referrers and/or patients seems like a downside of radiology that isn't really fixable. Considering that, I wonder if reducing your hours will at least allow you to find more fulfillment in other parts of your life if you don't feel like you're getting it from radiology.

I'm a med student interested in radiology btw... your comments definitely point to the downsides, but out of all of medicine it still seems like a pretty good choice!
Topic Author
RadDad915
Posts: 30
Joined: Fri Aug 20, 2021 4:08 pm

Re: High income physician seeking financial and life advice

Post by RadDad915 »

One other point: medicine is probably the only high level profession (and among the only professions anywhere) in which the medium to long term trend for compensation is DOWN. Sure, a coal worker may experience this as well, but most coal workers aren’t valedictorians that train for 10 years after college and pay $400k for the privilege.

While I may not technically “need the money” at this point, job satisfaction is undeniably linked to compensation and rewards (tangible or intangible). In 10 years, there is probably a 99% chance that my compensation will be markedly reduced compared to today, with simultaneous ever-increasing workloads and worsened commoditization. I read some of the forums in which techies making similar money to myself talk about “expected promotions” and “making 2.5x current salary in 6-8 years” and shake my head; I will never make more in clinical radiology than I make right now. In 6-8 years I may have to read 1.5-2x the volume I read now to make my same salary.

Again, I do grasp how fortunate my situation is. However, I absolutely busted my * and spent the entirety of my 20s becoming a world class radiologist (my wife did the same in her field). I could have joined virtually any profession, but chose to become a physician due to my desire to improve the world and help others while being well-compensated for the incredible difficulty and importance of what I do. With compensation perpetually falling, society routinely questioning our expertise, greedy megacorps and private equity seeking to replace us with midlevel providers…I’m not sure what the solution is, except to gradually transition away from clinical medicine. And I’m far from alone.
qwertyjazz
Posts: 2000
Joined: Tue Feb 23, 2016 3:24 am

Re: High income physician seeking financial and life advice

Post by qwertyjazz »

RadDad915 wrote: Thu Sep 09, 2021 9:01 pm
GratuitousScrubs wrote: Fri Sep 03, 2021 2:10 am Long time lurker, also a radiologist (40s), on my second job. My thoughts to OP:

1) There is a considerable range between different situations. Large vs. small, Private vs. Academic, Hospital vs. OP, etc. Sure, "correlations converge to 1" is a possibility and there may be no long term escape from the downsides that you have articulated (e.g. maybe we're all headed for the RadPartners factory). I realize that your wife's career is a constraining factor, but I do not see within your posts adequate evidence of having exhausted your effort to find the right type of career fit. Related....

2) You have clearly devoted yourself to achieving excellence in this field, and seem frustrated by the disconnect between your professional values and the reality of medical practice, understandably so. Nevertheless, it seems early to abandon the search for harmony between these things. If your training was entirely in ivory tower academic medical centers, it is possible that you have some inherited beliefs about how work should be done that will evolve if you keep an open mind. It is also possible that you will find a job where you can have an opportunity to do the work the way you currently think it should be done.

3) I think "work less", and "retire early" advice are blunt solutions that are oriented toward lessening the pain of work. I suggest that you challenge yourself to find joy in work, even if that means changing jobs again. I do not concede that corporate, mid-level, and AI incursions into our field will make it impossible to find joy and meaning in this work. Paradoxically, perhaps the Rx is to take on some additional un-/undercompensated work: committee service, interdisciplinary conference staffing, or something that will help create a greater sense of connection, purpose, and agency. Burnout is a popular phrase these days, and it is sometimes misunderstood as overwork. That is not exactly what burnout is. "The three key dimensions...are an overwhelming exhaustion, feelings of cynicism and detachment from the job, and a sense of ineffectiveness and lack of accomplishment". Relentless overwork can produce all of these things, but I think that's not really the reason for radiologists. I think it's the isolation and feeling of no control, which can be mitigated in other ways.

4) The job does get easier. You simply get much more efficient when it's the 10,000th+ time you've read that type of study. Even the most complex cases mostly begin to fall into the "another one of these," bucket. You spend less effort accessing knowledge to read a hard case, because you've already retrieved that knowledge many times. You will also access your experience more often on these cases, largely on a subconscious level, which requires less mental effort. I absolutely do know the feeling you describe of being mentally drained from a 9-hr bolted-to-the-chair sprint: the stimulus needed to produce this feeling in me has increased substantially over time.

Good luck to you on your journey

Thanks for your response. In my experience, outside of (some) ivory tower academic medical centers, radiology has become so commoditized that churning though volume as fast as possible is all that matters to the practice. A radiologist could be of truly exceptional quality—rarely if ever missing significant findings, making amazingly difficult calls, etc. while still reading average to above average volumes—but will not be rewarded or recognized. In fact, in pay-per-case practices, the exceptionally accurate radiologist is actually financially penalized for their skill; meanwhile, the mediocre or substandard radiologist that reads every single case in the same amount of time (no matter how difficult) is actually paid and cherished more. As a radiologist you no doubt understand exactly what I’m saying.

Simple example. I made an outstanding call on an MRI the other day that will likely result in saving the patient’s life. By my estimation, a majority of subspecialized radiologists in my field would have missed this call—they certainly would have in my practice. Yet the patient will never know that I saved her. The referring clinician will not understand that this was an amazing call, as he isn’t a radiologist. The section chiefs, administrators, and c suite running the practice will never see the case, plus the non-physician administrators lack the ability to even understand anything I’m saying (let alone the difficulty of the case). I have made literally hundreds of calls like this in my career thus far, yet have nothing to show for it except (fleeting) internal satisfaction. The referring physicians always want me to read their studies and overwhelmingly preferably consult me, but this is of little to no import. Sometimes I feel like I’m shooting accurate three pointers all day long while my colleagues are sloppily missing layups; however, at the end of the day, there is zero external differentiation between myself and them. Other professions seem to reward and promote their stars; why doesn’t radiology?

My issue is not exhaustion because of the difficulty of radiology. In fact, largely due to my incredibly demanding and high volume training, I actually find the work quite monotonous (including most “challenging” cases that I have already seen dozens of times in real life or through study). I only read in my subspecialty and have done so ever since I completed my rigorous fellowship—the issue is rarely if ever lack of experience or comfort at this point. Put another way: imagine you were asked to read 75 pulmonary nodule followup chest CTs each and every day. Every day was almost exactly the same. And no matter how accurately you read, or how much better your quality was than your peers, you were never promoted or recognized—not verbally nor financially. How would you feel? That’s probably the closest approximation to what I feel now.
That is not unique to radiology. You saved a life. Good for you. Someone will have another birthday. There will be someone giving their kid a hug. That is why you entered medicine. Yeah no one will notice. No one else will care. We suck at measuring quality. Same is true in being a great surgeon or primary care doc etc.
You do it because it is a good thing and for yourself. If you only optimize pay and administrator happiness, you become an awful doctor. Not sure how to reconnect that in rads though to the patient. There were some studies of having pictures of patients helps quality of calls. But yeah you get the big bucks in rads but less of the gratitude. But there is still a human being on the other end.
G.E. Box "All models are wrong, but some are useful."
sc9182
Posts: 2178
Joined: Wed Aug 17, 2016 7:43 pm

Re: High income physician seeking financial and life advice

Post by sc9182 »

Last 5-6 years IT/software salaries/Comps/RSUs are driven high especially due to FAANGM and/or FinTech companies. Outside of those Co.s or Geographies - IT salaries haven’t been all that much —
let alone did not increase significantly.

Iirc - late 1970s/80s.. IT Salaries were gravy., then came along contracting/outsourcing/offshoring/commoditization/ageism, now automation, AI — has nearly decimated IT salaries/comps of bygone era.

The Job satisfaction continue to suffer for many — but IT/Software still has its appeal ..
Such OP expressed feelings are not exclusive to one field or sub-speciality ..
Last edited by sc9182 on Fri Sep 10, 2021 7:27 am, edited 2 times in total.
hmw
Posts: 1246
Joined: Sun Mar 02, 2014 10:44 am

Re: High income physician seeking financial and life advice

Post by hmw »

RadDad915 wrote: Thu Sep 09, 2021 9:01 pm




Thanks for your response. In my experience, outside of (some) ivory tower academic medical centers, radiology has become so commoditized that churning though volume as fast as possible is all that matters to the practice. A radiologist could be of truly exceptional quality—rarely if ever missing significant findings, making amazingly difficult calls, etc. while still reading average to above average volumes—but will not be rewarded or recognized. In fact, in pay-per-case practices, the exceptionally accurate radiologist is actually financially penalized for their skill; meanwhile, the mediocre or substandard radiologist that reads every single case in the same amount of time (no matter how difficult) is actually paid and cherished more. As a radiologist you no doubt understand exactly what I’m saying.

Simple example. I made an outstanding call on an MRI the other day that will likely result in saving the patient’s life. By my estimation, a majority of subspecialized radiologists in my field would have missed this call—they certainly would have in my practice. Yet the patient will never know that I saved her. The referring clinician will not understand that this was an amazing call, as he isn’t a radiologist. The section chiefs, administrators, and c suite running the practice will never see the case, plus the non-physician administrators lack the ability to even understand anything I’m saying (let alone the difficulty of the case). I have made literally hundreds of calls like this in my career thus far, yet have nothing to show for it except (fleeting) internal satisfaction. The referring physicians always want me to read their studies and overwhelmingly preferably consult me, but this is of little to no import. Sometimes I feel like I’m shooting accurate three pointers all day long while my colleagues are sloppily missing layups; however, at the end of the day, there is zero external differentiation between myself and them. Other professions seem to reward and promote their stars; why doesn’t radiology?
Is there no negative consequence for routinely producing substandard radiology reports other than potential future law suits? Do most radiology groups have some kind of internal quality control?

I am a surgeon and my specialty is very image intensive. I look at all the imaging studies I order. Like you said, the quality of the rad reports vary a great deal. I have come across many radiology reads that were just subpar. Occasionally I see a major miss.
Young Boglehead
Posts: 321
Joined: Wed Jan 02, 2019 4:11 pm

Re: High income physician seeking financial and life advice

Post by Young Boglehead »

RadDad915 wrote: Thu Sep 09, 2021 9:49 pm One other point: medicine is probably the only high level profession (and among the only professions anywhere) in which the medium to long term trend for compensation is DOWN. Sure, a coal worker may experience this as well, but most coal workers aren’t valedictorians that train for 10 years after college and pay $400k for the privilege.

While I may not technically “need the money” at this point, job satisfaction is undeniably linked to compensation and rewards (tangible or intangible). In 10 years, there is probably a 99% chance that my compensation will be markedly reduced compared to today, with simultaneous ever-increasing workloads and worsened commoditization. I read some of the forums in which techies making similar money to myself talk about “expected promotions” and “making 2.5x current salary in 6-8 years” and shake my head; I will never make more in clinical radiology than I make right now. In 6-8 years I may have to read 1.5-2x the volume I read now to make my same salary.

Again, I do grasp how fortunate my situation is. However, I absolutely busted my * and spent the entirety of my 20s becoming a world class radiologist (my wife did the same in her field). I could have joined virtually any profession, but chose to become a physician due to my desire to improve the world and help others while being well-compensated for the incredible difficulty and importance of what I do. With compensation perpetually falling, society routinely questioning our expertise, greedy megacorps and private equity seeking to replace us with midlevel providers…I’m not sure what the solution is, except to gradually transition away from clinical medicine. And I’m far from alone.
I guess I just don’t understand why these ideas are affecting you so much. It seems to me like you could go part time RIGHT NOW, or even retire, and live your same lifestyle right now or better for the next 60 years. That’s a pretty incredible place to be!

I’m only at about half my expected negative net worth and won’t be making attending money for like 10 years and it seems like you’re feeling far more stressed and less secure about your future than I am about mine. That doesn’t seem right!

If you don’t go part time or switch jobs to something less intense I don’t see how you’re going to feel better. But the great thing is that you are in an incredibly strong position to do that. You should take advantage of that privilege!
GratuitousScrubs
Posts: 47
Joined: Fri Sep 03, 2021 1:19 am

Re: High income physician seeking financial and life advice

Post by GratuitousScrubs »

hmw wrote: Thu Sep 09, 2021 10:12 pm
RadDad915 wrote: Thu Sep 09, 2021 9:01 pm




Thanks for your response. In my experience, outside of (some) ivory tower academic medical centers, radiology has become so commoditized that churning though volume as fast as possible is all that matters to the practice. A radiologist could be of truly exceptional quality—rarely if ever missing significant findings, making amazingly difficult calls, etc. while still reading average to above average volumes—but will not be rewarded or recognized. In fact, in pay-per-case practices, the exceptionally accurate radiologist is actually financially penalized for their skill; meanwhile, the mediocre or substandard radiologist that reads every single case in the same amount of time (no matter how difficult) is actually paid and cherished more. As a radiologist you no doubt understand exactly what I’m saying.

Simple example. I made an outstanding call on an MRI the other day that will likely result in saving the patient’s life. By my estimation, a majority of subspecialized radiologists in my field would have missed this call—they certainly would have in my practice. Yet the patient will never know that I saved her. The referring clinician will not understand that this was an amazing call, as he isn’t a radiologist. The section chiefs, administrators, and c suite running the practice will never see the case, plus the non-physician administrators lack the ability to even understand anything I’m saying (let alone the difficulty of the case). I have made literally hundreds of calls like this in my career thus far, yet have nothing to show for it except (fleeting) internal satisfaction. The referring physicians always want me to read their studies and overwhelmingly preferably consult me, but this is of little to no import. Sometimes I feel like I’m shooting accurate three pointers all day long while my colleagues are sloppily missing layups; however, at the end of the day, there is zero external differentiation between myself and them. Other professions seem to reward and promote their stars; why doesn’t radiology?
Is there no negative consequence for routinely producing substandard radiology reports other than potential future law suits? Do most radiology groups have some kind of internal quality control?

I am a surgeon and my specialty is very image intensive. I look at all the imaging studies I order. Like you said, the quality of the rad reports vary a great deal. I have come across many radiology reads that were just subpar. Occasionally I see a major miss.
Negative consequences only come from being a (VERY) bad outlier. Most people are somewhere in that meaty middle. Major misses happen to everyone. They are stochastic events, often with unknown causes and/or multiple contributing factors. It's like misplacing your keys. Sure, sometimes it's a marker of a disorganized person, but usually not. Undoubtedly the weaker rads have more major misses, but it's only a clearly apparent trend for the very worst ones because of how much noise is in the data. Even when those people are identified, the common response is to reduce the range of their duties to keep them operating within their safe parameters. Thus the burden gets shifted to the stronger partners.

OP is correct that external rewards for excellence are nearly nonexistent. I have experienced the same things he has discussed, having also spent most of my career practicing only in my subspecialty area, and making some high stakes, very difficult calls on cases that had been passed around to all the best people.

RadDad915....I don't disagree with anything you've said. I've experienced these things and I have been similarly frustrated by them. I'll just say that my experience has been that these problems have come to bother me less over time, and also that I think it helped when I changed jobs.

I don't know that my experience is valid as a template for you: we are different people with different background experiences. All I can say is that I was once very deeply frustrated, and now I'm not. I'm grateful to have a place to go, to work with colleagues that I like and respect, doing something I am good at, where good work has a real value in the world beyond peddling garbage, where I have a voice in how the practice is run, and a reasonable degree of autonomy. There are other professions where merit is more rewarded, but those come with other tradeoffs that I don't prefer.

Basically... yes, everything OP says is true. And still, I think this is a great profession that provides opportunity for deep satisfaction and the financial power to build a comfortable life for yourself and others.
Topic Author
RadDad915
Posts: 30
Joined: Fri Aug 20, 2021 4:08 pm

Re: High income physician seeking financial and life advice

Post by RadDad915 »

qwertyjazz wrote: Thu Sep 09, 2021 10:00 pm
RadDad915 wrote: Thu Sep 09, 2021 9:01 pm
GratuitousScrubs wrote: Fri Sep 03, 2021 2:10 am Long time lurker, also a radiologist (40s), on my second job. My thoughts to OP:

1) There is a considerable range between different situations. Large vs. small, Private vs. Academic, Hospital vs. OP, etc. Sure, "correlations converge to 1" is a possibility and there may be no long term escape from the downsides that you have articulated (e.g. maybe we're all headed for the RadPartners factory). I realize that your wife's career is a constraining factor, but I do not see within your posts adequate evidence of having exhausted your effort to find the right type of career fit. Related....

2) You have clearly devoted yourself to achieving excellence in this field, and seem frustrated by the disconnect between your professional values and the reality of medical practice, understandably so. Nevertheless, it seems early to abandon the search for harmony between these things. If your training was entirely in ivory tower academic medical centers, it is possible that you have some inherited beliefs about how work should be done that will evolve if you keep an open mind. It is also possible that you will find a job where you can have an opportunity to do the work the way you currently think it should be done.

3) I think "work less", and "retire early" advice are blunt solutions that are oriented toward lessening the pain of work. I suggest that you challenge yourself to find joy in work, even if that means changing jobs again. I do not concede that corporate, mid-level, and AI incursions into our field will make it impossible to find joy and meaning in this work. Paradoxically, perhaps the Rx is to take on some additional un-/undercompensated work: committee service, interdisciplinary conference staffing, or something that will help create a greater sense of connection, purpose, and agency. Burnout is a popular phrase these days, and it is sometimes misunderstood as overwork. That is not exactly what burnout is. "The three key dimensions...are an overwhelming exhaustion, feelings of cynicism and detachment from the job, and a sense of ineffectiveness and lack of accomplishment". Relentless overwork can produce all of these things, but I think that's not really the reason for radiologists. I think it's the isolation and feeling of no control, which can be mitigated in other ways.

4) The job does get easier. You simply get much more efficient when it's the 10,000th+ time you've read that type of study. Even the most complex cases mostly begin to fall into the "another one of these," bucket. You spend less effort accessing knowledge to read a hard case, because you've already retrieved that knowledge many times. You will also access your experience more often on these cases, largely on a subconscious level, which requires less mental effort. I absolutely do know the feeling you describe of being mentally drained from a 9-hr bolted-to-the-chair sprint: the stimulus needed to produce this feeling in me has increased substantially over time.

Good luck to you on your journey

Thanks for your response. In my experience, outside of (some) ivory tower academic medical centers, radiology has become so commoditized that churning though volume as fast as possible is all that matters to the practice. A radiologist could be of truly exceptional quality—rarely if ever missing significant findings, making amazingly difficult calls, etc. while still reading average to above average volumes—but will not be rewarded or recognized. In fact, in pay-per-case practices, the exceptionally accurate radiologist is actually financially penalized for their skill; meanwhile, the mediocre or substandard radiologist that reads every single case in the same amount of time (no matter how difficult) is actually paid and cherished more. As a radiologist you no doubt understand exactly what I’m saying.

Simple example. I made an outstanding call on an MRI the other day that will likely result in saving the patient’s life. By my estimation, a majority of subspecialized radiologists in my field would have missed this call—they certainly would have in my practice. Yet the patient will never know that I saved her. The referring clinician will not understand that this was an amazing call, as he isn’t a radiologist. The section chiefs, administrators, and c suite running the practice will never see the case, plus the non-physician administrators lack the ability to even understand anything I’m saying (let alone the difficulty of the case). I have made literally hundreds of calls like this in my career thus far, yet have nothing to show for it except (fleeting) internal satisfaction. The referring physicians always want me to read their studies and overwhelmingly preferably consult me, but this is of little to no import. Sometimes I feel like I’m shooting accurate three pointers all day long while my colleagues are sloppily missing layups; however, at the end of the day, there is zero external differentiation between myself and them. Other professions seem to reward and promote their stars; why doesn’t radiology?

My issue is not exhaustion because of the difficulty of radiology. In fact, largely due to my incredibly demanding and high volume training, I actually find the work quite monotonous (including most “challenging” cases that I have already seen dozens of times in real life or through study). I only read in my subspecialty and have done so ever since I completed my rigorous fellowship—the issue is rarely if ever lack of experience or comfort at this point. Put another way: imagine you were asked to read 75 pulmonary nodule followup chest CTs each and every day. Every day was almost exactly the same. And no matter how accurately you read, or how much better your quality was than your peers, you were never promoted or recognized—not verbally nor financially. How would you feel? That’s probably the closest approximation to what I feel now.
That is not unique to radiology. You saved a life. Good for you. Someone will have another birthday. There will be someone giving their kid a hug. That is why you entered medicine. Yeah no one will notice. No one else will care. We suck at measuring quality. Same is true in being a great surgeon or primary care doc etc.
You do it because it is a good thing and for yourself. If you only optimize pay and administrator happiness, you become an awful doctor. Not sure how to reconnect that in rads though to the patient. There were some studies of having pictures of patients helps quality of calls. But yeah you get the big bucks in rads but less of the gratitude. But there is still a human being on the other end.

I’m familiar with the studies you cited, and I find them very intriguing. If patient photos were implemented at a large scale, I believe they would help to reintroduce a small bit of humanity that is sorely lacking in modern diagnostic radiology. However, I can certainly envision scenarios in which patients worry about receiving biased care—followed by legal ramifications (regardless if unwarranted).

It is very, very easy for a radiologist to become jaded and essentially forget that the endless scans represent actual human beings. The CT abdomen/pelvis is “41 yo male with abdominal pain,” not “41 year old firefighter from local town that injured his abdomen carrying an unconscious victim out of a burning apartment.” When speed is the only priority and quality/accuracy are mere afterthoughts, this is the inevitable result. Layering on loss of physician autonomy, corporate takeover of the field (with $$ prioritized over patient care), and midlevel encroachment, you have a recipe for disaster.
SalishSea
Posts: 41
Joined: Tue Apr 13, 2021 9:44 pm

Re: High income physician seeking financial and life advice

Post by SalishSea »

RadDad915, thank you for sharing your experience. I think that a lot of people, including physicians and fellow radiologists have shared valuable insight. In particular, GratuitousScrubs.

It seems like you're a fantastic radiologist who feels unrecognized and under appreciated. You're excellent at what you do, and it feels like few people appreciate that.

I hope you don't mind me sharing that I also think that you may be experiencing symptoms of burnout. To add on to what GratuitousScrubs did a nice of describing, it seems to be driven more by the sense of clinical isolation, under appreciation, and lack of autonomy/control/volition, than the hours per se.

With this in mind, I wonder if there are other places where you can practice where you'd have less of the above. What comes to mind is seeing if you can find work as a Clinical Instructor / Professor in an academic setting. Although this may not help with autonomy, you would presumably have residents and fellows who could learn from you and also appreciate your skillset. I also imagine that the work environment may be more collegial than a typical private practice setting. The obvious downside is that I imagine your compensation would decrease, and maybe substantially.

That may not be the answer, but I do think that you can find a practice setting that will provide more meaning because the work that you do is incredibly valuable to patients (and other doctors) and is a crucial guide for important diagnostic and treatment decisions.
TXDoc21
Posts: 94
Joined: Tue Dec 15, 2020 10:02 am

Re: High income physician seeking financial and life advice

Post by TXDoc21 »

I would make a list of what you love about your job and what you don't love about your job. You have saved a large amount thus far that should allow you to plan your life as you would like. Eliminate all (or as many of the negatives) as you can now. I would say that one or both of you should go part time tomorrow. Your kids are only young once. You can never get those times back. Enjoy these moments!

I have a similar income as a physician and my wife decided to leave her job today to be able to eliminate some of the unnecessary hassle of life.
Topic Author
RadDad915
Posts: 30
Joined: Fri Aug 20, 2021 4:08 pm

Re: High income physician seeking financial and life advice

Post by RadDad915 »

Thanks to all for your thoughtful responses.

To the physicians (and radiologists) in particular, I ask you to perform a simple thought experiment.

Imagine that money was no longer an issue in your life. Let’s say you had $10M safely invested, fairly low expenses, and your family was well taken care of. Would you still go to work every day? If so, why?

To those of you that have practiced for many years or even decades, what kept you going when 99% of your day to day cases were routine (or effectively monotonous)? Was it truly a need for more money, or something else? What specific tools or thought processes/mindsets did you utilize to derive continued satisfaction from your job?
an_asker
Posts: 4903
Joined: Thu Jun 27, 2013 2:15 pm

Re: High income physician seeking financial and life advice

Post by an_asker »

RadDad915 wrote: Thu Sep 23, 2021 9:19 pm Thanks to all for your thoughtful responses.

To the physicians (and radiologists) in particular, I ask you to perform a simple thought experiment.

Imagine that money was no longer an issue in your life. Let’s say you had $10M safely invested, fairly low expenses, and your family was well taken care of. Would you still go to work every day? If so, why?

To those of you that have practiced for many years or even decades, what kept you going when 99% of your day to day cases were routine (or effectively monotonous)? Was it truly a need for more money, or something else? What specific tools or thought processes/mindsets did you utilize to derive continued satisfaction from your job?
Not a physician or radiologist, but I believe I've participated upthread, so might as well share my two cents worth.

I think I can answer the question as well as the physicians can (and I would like to think that to a certain extent, their answers will be similar).

Reasons (in no particular order):

- scared of inflation (future*)
- scared of medical costs (future)
- DW doesn't want me to
- I believe I can still contribute - and my teammates say that I am helping them with their worklife [maybe this is partly my ego speakin here, because a) no one is irreplaceable and b) management has definitely not "shown me the money" to deem my presence as anywhere close to needed]
- what can I do retiring into a pandemic? At least keep plugging away until things open up (not just within the USA which has opened up, but abroad too)
- why not keep getting paid doing something I enjoy doing, if I can take time off and I can work from home (this might not be a reason for most doctors ... but surely radiologists can work from home)?

* note that when I say future, I refer to the future that's more than, say, five years away
GratuitousScrubs
Posts: 47
Joined: Fri Sep 03, 2021 1:19 am

Re: High income physician seeking financial and life advice

Post by GratuitousScrubs »

RadDad915 wrote: Thu Sep 23, 2021 9:19 pm Thanks to all for your thoughtful responses.

To the physicians (and radiologists) in particular, I ask you to perform a simple thought experiment.

Imagine that money was no longer an issue in your life. Let’s say you had $10M safely invested, fairly low expenses, and your family was well taken care of. Would you still go to work every day? If so, why?

To those of you that have practiced for many years or even decades, what kept you going when 99% of your day to day cases were routine (or effectively monotonous)? Was it truly a need for more money, or something else? What specific tools or thought processes/mindsets did you utilize to derive continued satisfaction from your job?
I ask myself this question all the time.

I'd still go to work, but that's just my current thought. When I was 5 years into practice I would've said that I'd be outta there.

I accept the monotony as the cost of admission to being an expert. You can't be an expert without this stuff happening mostly on autopilot. I try to embrace it and feel the flow state.

Social aspects of work, friendships and inside jokes with colleagues, and the respect of referrers are all things that make the job enjoyable.

It's hard to separate being a physician from my identity. It's not just what I do, but also what I am. I suppose there will have to be a reckoning there if I ever become disabled.

In an ideal world, I'd work just a little less in order to have an ideal balance of work, family time, and exercise/nutrition. Hard to find this. While radiology is more amenable than most fields to part time work, it seems that parttimers are often marginalized.

Curious to hear from more experienced physicians. I am mid career.
cheapindexer
Posts: 57
Joined: Tue Feb 02, 2016 1:33 pm

Re: High income physician seeking financial and life advice

Post by cheapindexer »

As a two physician household as well in early 50’s I would cut back for sure

You already won the game !

Life is short

Do you know many “ happy “ physicians ? I sure don’t . Overly competitive people riddled with personality disorders . I think you will find happier people on this thread for good advice compared to docs
Rex66
Posts: 2955
Joined: Tue Aug 04, 2020 5:13 pm

Re: High income physician seeking financial and life advice

Post by Rex66 »

Already planning for it

We have established a charity and intend to provide more free care when I get closer to economic retirement age
JPM
Posts: 586
Joined: Sun Aug 19, 2018 2:29 pm

Re: High income physician seeking financial and life advice

Post by JPM »

Random thoughts on happy radiologists;

I have lived and practiced in midwestern exurbia for 42 years. I have worked with 3 generations of radiologists over that time. Perhaps it is the prosperous midwestern milieu that has made them seem to me a particularly happy group of men and women.

One core group of four work in a hospital that serves a declining industrial town with a shrinking middle class and an expanding welfare population. They make less money than they did 20 years ago. They seem to enjoy the work and they are good at it. They enjoy the respect of the referring docs and feel a sense of duty to the struggling communities they serve. Each of them could have made a lot more money elsewhere and each has achieved FI long ago. As a radiologist said to me more than 30 years ago, "In my class the bright guys went into internal medicine and the smart guys went into radiology."

Another hospital is part of a large regional system and has a large group of radiologists among whom 4 or 5 rotate through our local hospital. The town is growing and the well-insured (i.e. lucrative) clientele of the hospital is growing too. The radiologists are mostly young. The senior man is probably in his sixties or early seventies and seems to simply enjoy his work.

Twenty years ago the catholic hospital went defunct and the radiology group migrated to other institutions. I saw one of them recently and he is in his late 70s still working part time at the closest VA. He has been FI for at least 20 years.

What keeps these guys working 20 years past FI? Enjoying the sense of mission, comradeship of the team and not wanting to let the team down, respect of their colleagues, enjoyment of the work itself, and probably other things less obvious to me. I have yet to meet a burned out radiologist hereabout. Maybe OP should move to Wisconsin.
EventHorizon
Posts: 34
Joined: Sun Mar 22, 2015 4:54 pm

Re: High income physician seeking financial and life advice

Post by EventHorizon »

Similar position, two physician household
Not 10M, but probably FI
Mid 40s

Still working
I’ll tell you my reasons.

I like work, when I’m not double-booked in every slot
I talk to patients and coworkers at work, but not very social outside of the tight family circle
If I retire I would need to find some social activity
Empty nest is years away
Older kids seem to need you less, except for driving them to activities
I fill a specialized niche and it would be hard for my coworkers to find a replacement. Minor issue, but we are a team.

But I had a breakthrough based on Peter Singer’s effective altruism writings
The money is very good
FIRE means charitable contributions drop markedly. I never see that discussed.
Continuing to work at this level means a continued significant amount to charity
Costs $3,000-5,000 to save a life

Staying at work basically means
Saving (a few) more lives at work
Saving (a few) more lives via charity

You do have problems, which you have detailed eloquently
One solution may be lifting your head above water and looking outside yourself

I’m no saint
Our nest egg is growing while we try to make this world a little better.
MedSaver
Posts: 260
Joined: Sun Jul 02, 2017 5:33 pm

Re: High income physician seeking financial and life advice

Post by MedSaver »

I had a job in high school that paid $14/hr (which was, and is still considered a good wage for that age). There was a component of manual labor, an outside chance of personal injury and the work itself could be tedious. Then I had a job right after college in a lab. It was super boring and I made about $26k per year. Then I became a doctor.

Whenever I feel like my current job is bad, boring, tedious, etc, I just remember my past jobs and feel better immediately. I just calculated my hourly “wage” based on my total compensation. It comes to a little over $7 per MINUTE. Which means, when i take 2 minutes to go pee, I make more than I made in an hour at my first job (and no manual labor to boot). For me, this really puts things in perspective. I am very privileged and lucky to be able to do this thing called practicing medicine.
Locked