Author Topic: Any coast-FIRE physicians out there?  (Read 2017 times)

fraylock

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Any coast-FIRE physicians out there?
« on: March 04, 2021, 01:39:45 PM »
My wife and I are both family physicians in our mid 30s and are thinking we will coast-FIRE in 3-5 years and then fat-FIRE 10-15 years after that.  We like the idea of continuing to practice medicine but on a more intermittent basis to allow for other life pursuits.  Primary care is rewarding, but it is difficult to get away for more than 1-2 weeks at a time. 

During coast FI, we would like to spend part of our time each year abroad, and during fat-FI we'd like for our professional work to be focused exclusively on volunteer/free clinic settings.  For coast-FI, we may start with a sabbatical (if employer allows), and have considered subsequently moving to per diem work (e.g. urgent care) or locums work (both domestic and abroad) and telehealth is now also an emerging opportunity. 

I'm wondering if there are any post-fire physicians out there who have taken a coast-FIRE approach?  If so, what kind of work arrangements did you find?  What was your experience with per diem or locums work?  Is it harder to find work if you're no longer employed full time?  Any license renewal issues?  I believe that in our state when you renew your license, you have to account for any 3 month period not actively employed in medicine.  Sometimes I wonder if it would be easier to skip the coast-FI and just power through to fat-FI.

Appreciate any experience you may have.


JGS1980

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Re: Any coast-FIRE physicians out there?
« Reply #1 on: March 04, 2021, 01:44:49 PM »
PTF (I'm also a Family Physician). About 5-7 years ahead of you in the FIRE process.

fraylock

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Re: Any coast-FIRE physicians out there?
« Reply #2 on: March 04, 2021, 08:43:53 PM »
PTF (I'm also a Family Physician). About 5-7 years ahead of you in the FIRE process.

Nice! Are you continuing traditional FM until you fully FIRE, or planning to scale back to some other kind of practice arrangement?

Josiecat23503

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Re: Any coast-FIRE physicians out there?
« Reply #3 on: March 04, 2021, 09:20:40 PM »
Am also a physician.  Just FIRED this fall in my early to mid-40s.  It is a difficult transition to go from working 60-80+ hours a week to having large swaths of unstructured time which is a sentiment you will find all over these boards.  The identity piece is a whole other challenge as being a physician is/has been such a large part of my identity.  I miss taking care of patients, but LOVE the freedom to sleep when I'm tired, eat when I'm hungry and enjoy time and conversation with my family without being interrupted by the pager.

fraylock

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Re: Any coast-FIRE physicians out there?
« Reply #4 on: March 04, 2021, 10:12:56 PM »
@Josiecat23503

Congrats on your recent FIRE!  I can see how the transition could be rough.  I think this is why the volunteer/free clinic setting appeals to me post-FIRE.  Maintain the physician identity while providing service to the community, but less red tape and corporate drama.  I hope your FIRE journey continues to serve you well.

Zamboni

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Re: Any coast-FIRE physicians out there?
« Reply #5 on: March 05, 2021, 01:36:39 AM »
Try checking out the documentary "Surfwise," about Dorian Paskowitz. He was one of the OG coast fire physicians.

JGS1980

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Re: Any coast-FIRE physicians out there?
« Reply #6 on: March 05, 2021, 06:20:48 AM »
PTF (I'm also a Family Physician). About 5-7 years ahead of you in the FIRE process.

Nice! Are you continuing traditional FM until you fully FIRE, or planning to scale back to some other kind of practice arrangement?

I LOVE traditional FM, and plan on continuing this form of practice until I Fat-Fire. As much as I love it, however, I believe I'll love doing whatever the heck I want on any given day more.

What I think will happen in 2-3 years is that I'll quit my job (the only one I've ever had since residency), take a LONG sabbatical 6-12 months, and then work Locums for 3 months per year interspersed with a regular weekly volunteering gig at a free clinic. I plan to keep my licensing indefinitely.

3 months Locums will actually pay for all my family's living expenses, so technically I will be coasting at that time as my stache grows. This will make my FIRE even more conservative and will free up cash for philanthropic concerns, of which we already partake while working anyway.

So that's my outline. We will see how things go in reality.

JGS

Question, do you two have kids? Student Loans paid off? Have you figured out where you will live permanently?

fraylock

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Re: Any coast-FIRE physicians out there?
« Reply #7 on: March 05, 2021, 08:06:55 AM »
Try checking out the documentary "Surfwise," about Dorian Paskowitz. He was one of the OG coast fire physicians.

Thanks! Will do.

@JGS1980

Interesting that our plans seem to be so similar.  It seems like our local free clinic is also staffed by retired docs in their 80s, but I always thought it would be fun to become part of the regular cast post-FI.  I don't personally know any family docs who have FIREd, and I'm surprised there aren't more.  It's great that you are so close to fat-FIRE, being only 2 to 3 years away.

We have two kids (3, <1) and student loans are paid.  It would be nice to be more present for them when they are a little older.

JGS1980

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Re: Any coast-FIRE physicians out there?
« Reply #8 on: March 05, 2021, 08:40:36 AM »
Try checking out the documentary "Surfwise," about Dorian Paskowitz. He was one of the OG coast fire physicians.

Thanks! Will do.

@JGS1980

Interesting that our plans seem to be so similar.  It seems like our local free clinic is also staffed by retired docs in their 80s, but I always thought it would be fun to become part of the regular cast post-FI.  I don't personally know any family docs who have FIREd, and I'm surprised there aren't more.  It's great that you are so close to fat-FIRE, being only 2 to 3 years away.

We have two kids (3, <1) and student loans are paid.  It would be nice to be more present for them when they are a little older.

People always complain about FP salary, but I never really had a problem with this, being as I never really needed to much cash to live comfortably. What they are really complaining about is Radiologists and Anesthesiologists getting paid so much more, and whether that is fair or not.

We have three kids, and are trying to raise them to be good human beings first of all, but we also want them to determine whether living a low environmental impact life is something they want to pursue. Sometimes this skips a generation. The kids will only really want you around constantly until age 10 or so, at which point their friends become more important. Enjoy these years.

nirodha

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Re: Any coast-FIRE physicians out there?
« Reply #9 on: March 05, 2021, 09:57:09 AM »
Not a doctor, but I experienced my own family physician downshifting. He went the concierge medicine route, through MDVIP. I believe it dropped his book of patients from over 2000 to a range of 300-600. It also cuts out the more challenging individuals, because they can't or won't afford the fee. It was frustrating as his patient, and I know the model gets some criticism within the medical community. From a FIRE perspective though - I was envious. What a smart way to downshift.

fraylock

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Re: Any coast-FIRE physicians out there?
« Reply #10 on: March 05, 2021, 10:18:58 AM »
Not a doctor, but I experienced my own family physician downshifting. He went the concierge medicine route, through MDVIP. I believe it dropped his book of patients from over 2000 to a range of 300-600. It also cuts out the more challenging individuals, because they can't or won't afford the fee. It was frustrating as his patient, and I know the model gets some criticism within the medical community. From a FIRE perspective though - I was envious. What a smart way to downshift.

I too know several primary care physicians who have left traditional practice for either concierge or DPC model.  Like you I can see the draw of less work for more pay, though I don't think I could ever bring myself to catering to only the wealthy.  Even DPC practices, which are more affordable, leave out those who probably are in the greatest need for care.

Post-fire, I've thought of doing a DPC-style free practice, providing free care to a small panel of high need patients who are unable to otherwise afford care elsewhere.  With the affordable care act, there are fewer truly uninsured patients out there, but there are still quite a few, especially among the immigrant community.  There are a smattering of free clinics out there but they often don't offer much continuity.

JGS1980

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Re: Any coast-FIRE physicians out there?
« Reply #11 on: March 05, 2021, 10:46:17 AM »
@fraylock this is getting a little eerie the similarities.

Yeah, Concierge and DPC models of care are generally selling out as far as Iím concerned.

Interestingly, The only providers I know who do that kind of thing are female PCPs whose Dr. husbands actually provide most of the income to their homes, and this allows them to cater their schedule to their needs without getting a nanny or worrying about childcare

They preach accessibility, but in my experience it all comes down to flexibility for themselves
« Last Edit: March 05, 2021, 01:28:02 PM by JGS1980 »

erutio

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Re: Any coast-FIRE physicians out there?
« Reply #12 on: March 05, 2021, 12:33:54 PM »
I would like to coast FIRE also, into a very part-time job.  But I also worry about how to maintain board certification and licensure.

Malcat

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Re: Any coast-FIRE physicians out there?
« Reply #13 on: March 05, 2021, 12:43:22 PM »
Where I live (not the US), and in my medical industry, it's easy to drop down to part time and coast, a lot of my colleagues only work 3 days a week, especially the clinic owners once their purchase debt has been paid off. We're also generally small clinics with a fee for service model, so minimal issues dealing with insurance and no corporate crap. There are some larger corporations who own a ton of clinics, but they tend to be pretty minimally invasive in their management and give the managing practitioners a wide berth as long as they make money.

So yeah, for me, cutting back was just a matter of being okay with making proportionally less money. I ended up making proportionally more money per hour worked though because I was far more energized on the days I did work, and managed to cram more procedures into my day as a result. So I cut a quarter of my hours, but only cut 15% of my income.

startingsmall

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Re: Any coast-FIRE physicians out there?
« Reply #14 on: March 05, 2021, 02:57:04 PM »
So yeah, for me, cutting back was just a matter of being okay with making proportionally less money. I ended up making proportionally more money per hour worked though because I was far more energized on the days I did work, and managed to cram more procedures into my day as a result. So I cut a quarter of my hours, but only cut 15% of my income.

I'm in veterinary and not human medicine, but I experienced the same thing. I went from 45ish hrs/wk to 15 hrs/wk a couple of years ago, but my pay only decreased by about 35% (although I also lost benefits). It was easier to power through and be more productive on the days I was working when I was no longer feeling so burned out.

fraylock

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Re: Any coast-FIRE physicians out there?
« Reply #15 on: March 05, 2021, 03:19:24 PM »
I am technically part time now (0.7 FTE) and highly recommend it, though the problem remains within primary care that it is hard to get away.  Not being shift based like some fields, you still have to cover your box when out of the office, and it can be challenging to leave the office for more than a week or two at a time due to needing coverage.  The appeal of coast-FI to me would be to have the flexibility to take longer stretches of time away from the office, especially for overseas travel.  Curious if anyone has found an arrangement that allowed them to do that.

Josiecat23503

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Re: Any coast-FIRE physicians out there?
« Reply #16 on: March 05, 2021, 04:06:22 PM »
I went from full time to full stop.  I have been a long time reader of this and other FIRE blogs, had aggressively paid off all student loans and mortgage and funded 529s, etc.  I knew we had enough on spreadsheets, but it wasn't until the situation at work became untenable that I walked away.  My spouse FIRED several years ago, (so I had a bit of perspective) and supported/encouraged me to work as long as I wanted to. Have considered locums or other PT gigs, but in the end, once you get used to being in control of your time, it is VERY hard to give it up.  Also, have a teenager who really likes having his family home, so in many ways this year has felt like a gift.  (I know that sounds crazy with the pandemic and all of the stress and craziness it has brought on, but being truly present at home has meant so much to my family.)

fraylock

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Re: Any coast-FIRE physicians out there?
« Reply #17 on: March 05, 2021, 06:14:10 PM »
@Josiecat23503

Good for you!  This would have been an especially hard year to juggle work and a homeschooled teenager.

Dicey

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Re: Any coast-FIRE physicians out there?
« Reply #18 on: March 07, 2021, 01:07:01 PM »
My Stanford trained, board certified ophthalmologist retired early to enjoy her kids while they were small. I am so proud of her! At my last appointment with my new doc, he said she fills in about once a month. Nice to think our paths might cross again one day. Of course, I told her about this place, so perhaps she'll pop up here.
« Last Edit: March 08, 2021, 12:00:09 AM by Dicey »

Malcat

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Re: Any coast-FIRE physicians out there?
« Reply #19 on: March 07, 2021, 01:21:41 PM »
So yeah, for me, cutting back was just a matter of being okay with making proportionally less money. I ended up making proportionally more money per hour worked though because I was far more energized on the days I did work, and managed to cram more procedures into my day as a result. So I cut a quarter of my hours, but only cut 15% of my income.

I'm in veterinary and not human medicine, but I experienced the same thing. I went from 45ish hrs/wk to 15 hrs/wk a couple of years ago, but my pay only decreased by about 35% (although I also lost benefits). It was easier to power through and be more productive on the days I was working when I was no longer feeling so burned out.

Yeah, I really loved it and would have kept at it with reduced hours, but my job is procedural and after I sustained a lot of injury to my cervical spine, I couldn't even do reduced hours anymore and had to medically retire.

Josiecat23503

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Re: Any coast-FIRE physicians out there?
« Reply #20 on: March 07, 2021, 07:26:27 PM »
@Malcat : I'm sorry to hear that you had to stop doing something you enjoyed

I would have considered some type of part time arrangement, but there were very few opportunities for that with the kind of practice I had short of locums and travelling and being a "temp" didn't sit well with my preferred practice model.   

Are any of you considering some level of nonclinical/patient based "work"?  I am looking into some volunteer opportunities but wouldn't rule out doing some other work utilizing my degree and experience.

startingsmall

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Re: Any coast-FIRE physicians out there?
« Reply #21 on: March 08, 2021, 05:04:11 PM »
Are any of you considering some level of nonclinical/patient based "work"?  I am looking into some volunteer opportunities but wouldn't rule out doing some other work utilizing my degree and experience.

Repeating the disclaimer that I'm a DVM and not an MD, I've actually completely transitioned from practice to freelance medical/veterinary writing. I'm in several medical writing groups and there seem to be a decent number of MDs who also used medical writing to ease out of clinical practice.

Josiecat23503

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Re: Any coast-FIRE physicians out there?
« Reply #22 on: March 08, 2021, 07:11:39 PM »
@starting small

How did you come upon that work?  It sounds really interesting and a good way to continue the "coast".


fraylock

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Re: Any coast-FIRE physicians out there?
« Reply #23 on: March 09, 2021, 06:58:09 AM »
Are any of you considering some level of nonclinical/patient based "work"?  I am looking into some volunteer opportunities but wouldn't rule out doing some other work utilizing my degree and experience.

Repeating the disclaimer that I'm a DVM and not an MD, I've actually completely transitioned from practice to freelance medical/veterinary writing. I'm in several medical writing groups and there seem to be a decent number of MDs who also used medical writing to ease out of clinical practice.

I do this also.  When I graduated residency, I contacted a POC clinician resource company to see if they were hiring, and ended up with a nice side gig of triage editing.  The volume of work is small (maybe 2 hours/week), but it is fun.

startingsmall

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Re: Any coast-FIRE physicians out there?
« Reply #24 on: March 09, 2021, 08:38:51 AM »
@starting small

How did you come upon that work?  It sounds really interesting and a good way to continue the "coast".

I've been gradually increasing my workload over the last 5 years, starting out as a side hustle while still practicing FT and then finally stepping away from practice completely about a year ago to focus more on my writing business. I started out editing medical manuscripts for non-native English speakers through Edanz, then took on some small writing jobs on Upwork.com, then gradually grew my clientele from there. The American Medical Writers Association  (www.amwa.org) is a great resource.

Missy B

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Re: Any coast-FIRE physicians out there?
« Reply #25 on: March 11, 2021, 11:16:33 AM »
Am also a physician.  Just FIRED this fall in my early to mid-40s.  It is a difficult transition to go from working 60-80+ hours a week to having large swaths of unstructured time which is a sentiment you will find all over these boards.  The identity piece is a whole other challenge as being a physician is/has been such a large part of my identity.  I miss taking care of patients, but LOVE the freedom to sleep when I'm tired, eat when I'm hungry and enjoy time and conversation with my family without being interrupted by the pager.

I'm not a doc, allied medical. It strikes me, reading this post particularly, that we must lose a lot of highly trained, expensive and time-intensive to train staff not because of the job itself, but because of the way the job is structured.

So we train them up and great cost to them and the public, then burn them out... wasting everyone's investment and their years of experience. Not because that's the only way medicine can possibly be delivered, but because of the culture and established institutional structures.

Lately all I've heard about the new grads here is that they don't want to start their own clinics and work at walk-in places so they can have more freedom.

Josiecat23503

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Re: Any coast-FIRE physicians out there?
« Reply #26 on: March 13, 2021, 06:32:45 PM »
@startingsmall  thanks for the info re: amwa.org; that looks interesting.

@Missy B...there's alot to unpack in your post....medicine is still an amazing and rewarding career and I will never regret the time I spent in it.  That said, the (personal) costs of training and then practice are tremendous.  In addition to long days, irregular schedules and call obligations there is also the expectation that work will take priority over home life.  That is certainly not unique to medicine, indeed many professionals feel this same pressure.  For me personally, leaving my child with a babysitter when he was sick, so that I could care for sick strangers never sat well with me.  And in my career, cancelling my day for a sick child was not only frowned upon, but openly mocked. 

I agree with you that we as a society could craft a better way to allow the skills and training of physicians (and likely other fields) to fit into a less traditional model.  Unfortunately, I have not yet found a way to make that work.

Icecreamarsenal

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Re: Any coast-FIRE physicians out there?
« Reply #27 on: March 23, 2021, 09:11:02 PM »
@FuckRx where you at
ptf