OB GYN, Physician Training, retirement

Is it Ethical to Retire Early from a Career in Medicine?

Eight weeks after I delivered my 3rd child, I was diagnosed with a 4 cm lung mass.  Yes, you heard that right. For those in medicine, this is terrifying to hear as the first thing that comes to mind is lung cancer.  Lung cancer is notoriously hard to treat, typically fatal with a short life expectancy after diagnosis, and extremely unfair to a lifelong nonsmoker who has spent 12 years in the prime of her life dedicated to training to become a physician.

Luckily, I soon found out my situation was not as grave as first expected.  A PET scan leaned toward benign diagnosis (or at least consolidated disease).  I could temporarily push aside the paralyzing fear of leaving my 3 young children with no mother and focus on getting rid of this mass that was causing pneumonia, difficulty breathing, coughing for 2+ years, and go ahead with scheduling the thoracotomy.  After resection of the mass which was densely adherent to my pericardial sac and phrenic nerve, I lost about a 1/3 of my left lung.  To my amazement, after my ICU stay I left breathing better than I had been in years.  Benign diagnosis was confirmed.

This experience made me reevaluate my life and it stopped my “hamster wheel” of life I had been running on at a dizzying speed.  I viewed this health scare as a second chance at life.  I didn’t take this lightly as it almost seemed unfair that I got this chance to live while others who have a lung mass often have it turn out to be one of the most fatal of cancers.  Having to face the prospect of this potentially devastating diagnosis changed the course of my life. I was able to view my career for what it was and had become.

 

I had planned to work in my medical career as a physician indefinitely, or at least well into my 60’s.  It had always been my passion to work in obstetrics and I love my patients and the bonds I build with their families. It was never my intention to leave early, and it didn’t factor into choices along the way for my career.  But here I was, ready to retire in my late 30’s after several years of increasing disillusionment with the health care environment.  Apparently, I just needed this wake-up call for a chance to realign my priorities.

Loss of physician autonomy, pressure to increase productivity as opposed to quality care, and placing cost effectiveness ahead of best medical practice were weighing heavy on me.  In addition, the litigious environment in the US has become out of control and encourages frivolous lawsuits without any repercussions for those seeking damages without merit or basis for the claim.

I could no longer honestly tell myself that I was working so hard for the good of my patients, and I became cynical that my efforts were to the benefit of the financial bottom line of a health care system with its priorities out of sync with my own.  This is not specific to any health care employer, physician group, or hospital.  It is emblematic of the US healthcare system in general.  It is the reason I left medicine entirely and did not merely seek to work elsewhere. The problem is pervasive.

The decision to leave became a question of “why am I doing this, and for whom”?  I decided to retire early.

I have since learned that many feel this is not an appropriate thing to do in your late 30’s.  There is the argument that I owe a debt to society now that I have the skills acquired from all of those years of training. Or that the government paid for my residency salary and that I am indebted due to that.  Or that it is selfish to stop working to spend more time with my family.  There is the argument that it is not fair to leave my patients that I have been caring for over the years.
My response to the ethics of my decision to retire early: If you pay for the privilege of a medical degree and work hard to pay off this debt, should it be your decision if you want to continue to practice?  The government did pay my salary as a resident, which amounted to a little more than minimum wage for 4 years of 80 hour work weeks.  Do I owe something because of this?

As for leaving my patients, I actually do feel a little guilty about his one.  I love my patients.  I also struggle with no longer using my degree for clinical practice, something I worked so hard for.  We are already feeling the strain of physician shortages and this another thing that gives me pause.

In the end, the burden of practicing medicine in today’s environment no longer outweighed the positives for me.

Ironically, it’s my patients who hugged me and told me how happy they were for me to live the life I felt I needed to.  It’s my patients that spoke up (without me saying a word) about how the medical field has changed and that we are losing good doctors as the control of medicine is being handed to hospital administrators and politicians who are making choices about health care without a medical degree. It’s my patients that brought presents on my last days and thanked me for the care I did provide throughout my career instead of lament about what I “could” have done if I stayed longer.

It was a very personal and difficult decision for me to leave medicine and luckily, my colleagues who know me have been incredibly supportive.  On the other hand, one thing that has surprised me is the number of physicians contacting me who want out of healthcare but don’t know how, or can’t, get out.

How do we retain physicians? It is not by increasing salaries. Doctors aren’t in it for the money, we chose this profession to help people and save lives.  We do it by reforming the current health care environment and making this a profession that is sustainable.

Give medical decision making back to physicians.  Decrease the cost of health care by cutting out costly administrators and through tort reform.  This is the way to keep our best physicians and improve health care in our country for our patients.

Ultimately, is it ethical to retire early from a career in medicine? Or is it a bigger picture issue of how do physicians take back control of medicine so that we aren’t leaving at a time of shortage? This is a major concern for our country moving forward.

 

hospital birth, retirement

Is your City on the list for the coming Ob-Gyn Shortage Crisis? Find out here…

New research released this week from Doximity looked at how the upcoming Ob-gyn shortage will be affecting certain cities more than others. This really hits home for women who are planning families, currently pregnant, and wish to deliver in a hospital in one of those cities most at risk.

 
OB’s in these cities are likely feeling the pressure from the increased workload. Doximity compared number of deliveries in each city to number of practicing Ob-gyns.

 
Cities with the biggest workload per Ob-gyn:
Riverside, CA
St. Louis, MO
Las Vegas, NV
Oklahoma City, OK
Phoenix, AZ
Houston, TX
San Antonio, TX
Los Angeles, CA
Dallas, TX
San Diego, CA

 

Please note that these are major metropolitan areas and not the rural locations we often think of when mentioning the coming “ob-gyn shortage”

 

Smallest Ob-gyn workload: (lowest birth to OB-GYN ratios)
Hartford, CT
Richmond, VA
Louisville, KY
San Jose, CA
Birmingham, AL
Boston, MA
Portland, OR
San Francisco, CA
New York, NY
Providence, RI

 
If you want concrete numbers, ratio of births to Ob-gyn is 248 in Riverside, CA compared to the low end of 58 births to Ob-gyn in Hartford, CT.

We know the higher workloads mean that those cities are hurting for more Ob-gyns.
Interestingly, the research also looked at percentage of Ob-gyns older than 55 in these cities as that is important when considering when these doctors will be retiring. In Las Vegas, a whopping 39% of Ob-gyns are older than 55. According to ACOG, average age of retirement for Ob-gyns 59-69.

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What does this mean for cities like Las Vegas? They will be feeling this shortage intensely, and really soon.

 
The reality of the matter is that most Ob-gyns actually drop the OB part of their practice much earlier due to the physically demanding lifestyle an on call Obstetrician’s schedule entails. ACOG has reported the average age to stop doing obstetrics to be 48 years old.  In addition, we are not seeing a big enough influx of younger ob-gyn’s to take their place.

There has been a dramatic increase in residents choosing to sub-specialize in Reproductive Endocrinology, gynecologic oncology, minimally invasive surgery, and pediatric gynecology. Most of these specialists do not deliver babies. In addition, we are even seeing less subspecialists in maternal fetal medicine (MFM) willing to do deliveries anymore.

 
So, here is the crux of the matter: Ob-gyns are aging, retiring early, and choosing sub specialization at increasing rates. However, the number of patients seeking care has exploded due to health care reform and population statistics.

 
Some possible ways to address this include:

 
1. Increase number of Ob-Gyn residency spots (perhaps even consider specifically increasing in areas at greatest risk of shortage). Often Ob-gyns continue to work in the area of their residency where connections are made and their lives have become settled.

 
2. Support currently practicing Ob-gyns and provide the infrastructure necessary to maintain this workforce. This can mean utilizing midwives or nurse practitioners/physician assistants to answer phone calls at night, triage patients in the ER and labor and delivery, and write admission notes and prescriptions. This leaves more time for the obstetrician to focus on the patient and provide the best possible care as needed for complex deliveries, cesarean sections or high risk patients that are increasingly at the doorstep.

 
3. Malpractice reform. Residents are choosing to go into a field where there are told to be prepared to get sued 2-3 times during their career (perhaps even without any negligence or merit to a suit). Are there bad doctors out there? Yes. Are they in the overwhelming minority? Yes. Should all ob-gyns practice medicine in an environment of fear with defensive medicine because of a few bad apples? NO. This current litigious system is not helpful to our patients or our practicing ob-gyns.

 

If you are an Ob-gyn, would you consider practicing in one of these locations? What are your thoughts on the coming Ob-gyn shortage?
Are you a resident who is subspecializing to avoid obstetrics?

Patients- are you feeling the shortage already? Is it hard to get an appointment or see a physician? Are you already seeing midwives or nurse practitioners? Do you live in one of these cities?

If you are interested in this topic, you can read more about it in recent news coverage:

https://www.yahoo.com/news/growing-shortage-ob-gyn-doctors-threatens-womens-health-150842816.html

https://www.statnews.com/2017/07/20/ob-gyn-shortages/

 

retirement

The FINANCES behind retiring from medicine at 37

I originally wrote this article as a guest blog for the site http://www.physicianonfire.com/ last month.  The physician author of this blog specifically requested I write on this topic as his site deals with financial independence and retiring early (FIRE).  I am now posting here since I have had requests from readers to share the financial decisions that allowed me to retire early from a medical career. Please let me know if you have suggestions/thoughts, or what has worked for you in the comments below.

Usually, when I tell people I retired from my physician career at age 37 they respond with shock.  Some look at me like I am the most foolish person they have ever seen.  Some with disdain (“all that medical education wasted”).  Some doubt that my future will be secure without having a steady paycheck.  However, as it is only my close friends/family I discuss this with, they mostly respond with sincere happiness as they understand this is a life choice I made after much deliberation and know that it is the right decision for me and my family in pursuit of the life I want to lead.  There are many factors that led to this decision and I have written about some of it in previous articles Retired at 37: Breaking Up With a Career in Medicine.  However, this article focuses on the financial aspect.

Finances can be a tough subject for physicians.  We are notorious for being poor money managers.  Most of us don’t have the time or desire to commit to understanding personal finances in detail. Who has time to learn about 401K’s, the stock market, and budgets while learning about anatomy, pharmacology, and immunology while in medical school?  Or while working 80+ hours per week in residency?  Besides, we won’t be earning an attending physician paycheck for years.  By the time we earn a real paycheck we are so exhausted by the delayed gratification of our 20’s that we want to splurge a little, right?

I don’t proclaim to be an expert by any stretch.  However, I found the freedom that comes with financial independence to be life changing and something that should be attainable for all physicians. I am not here to encourage everyone to retire in their 30’s from medicine, but to gain financial freedom.  I hope you can continue practicing medicine into your 60’s (if this is what you want), but to not feel trapped in a situation when encountering unsustainable job structure, illness, divorce, etc.  Of course, finances did factor into my decision to retire.  I have 3 kids and wouldn’t stop working if I needed a steady paycheck to support them. Luckily, some decisions along the way helped me not to rely on this paycheck moving forward.  There are many different paths to financial independence.  Here are some steps that led me down my path to financial freedom and ability to retire early:

  1. Kept medical school loans to a minimum. Yes, you do have control over this. Most people outside of medicine are shocked to find out that medical students are essentially able to get loans for as much as they want.  You can determine your own “living expenses” and someone will be ready and willing to give you this loan as medical students are typically good about ultimately paying it back (although years down the road and with a ton of interest).  I was lucky my parents paid for my undergraduate studies but medical school was on my own.  I probably started my “frugal” mentality at this time.  My husband, who I was dating at the start of medical school, would often make fun of me for my bare cabinets with canned green beans and ramen noodles as my main staples.  Of note, he also had loans from undergraduate school that we had to factor in as well. Don’t worry, we didn’t eat like that forever!
  1. Started paying off loans immediately after forbearance ended at the maximum amount we could, not the minimum required.
  1. Lived well below my means. We continued living in my residency townhouse for a while, even after accepting an attending job.
  2. Looked for job with high earning guaranteed right from the start. Many positions I was offered entailed low salary the first few years and then potential for partnership and jump in salary but not until 4-6 years down the road. This was downright scary to me.  What if I didn’t like the job? What if they never actually promote to partner?  The writing was on the wall for private practice in ob-gyn with soaring malpractice premiums and it seemed unsustainable to me for most of these private practices.  I wasn’t willing to take the chance. I had also heard that many people may leave their first job after 2 years.  So, I figured why not at least get a large salary those first two years while I get a better feel for the landscape? Luckily, my job did not have a non-compete agreement, so I knew I would have options if I decided to leave (I actually stayed with my first job as I was initially very happy with my choice out of residency- this lasted for about 7 years).
  1. Maxed out yearly contributions to retirement vehicles. 403B during residency, 401K with new job (which also had a pension that vested after 5 years), and started a Roth IRA. I had to devote some time to learn about what all of these things are and why they are important! Investing is key.finance
  1. 529. My first child was born in residency, but I did not start a 529 at that time as wanted to maximize retirement account yearly contributions first. Once those were being maxed out, I started 529 for oldest child and then when subsequent children were born funded those too.
  1. Lived off one income. I feel this one factor made the absolute most difference!! Certainly not all, but most of my colleagues are in a dual income household.  We always lived off one income (mine) and paid off loans with the other.  This always forced us to live within our means. This may be hard to accept initially as many physicians feel that the delayed gratification never ends, but trust me it’s worth it! I do have to admit, our one splurge was a nice vacation every year.  “Work hard, play hard” is my motto and I probably wouldn’t have made it without those necessary times of respite to recharge. Travel is one of my passions.
  1. Got Creative. For those who have a partner who does not have a career in medicine, there may be options opened for them since a physician job is very secure.  You will always be able to find work as a physician and it is quite unlikely you would lose your job. In addition, health benefits are common with employed physician jobs and therefore you can take a big burden off your partner to worry about this.

–          This can free up some room for ingenuity with your partner if their job allows for different payment structures. Commission based jobs with a low salary and no health benefits may be unsustainable for someone supporting a family. However, if you use the idea of living off one person’s salary (your physician salary) and allow your partner to get creative it can really pay off.  Employers may jump at the opportunity for this type of pay structure which would have very little risk for them but could have huge potential upswing for the partner.   We chose to take this risk. We couldn’t have done it without the stable physician salary/benefits component.  It was possible my husband would make barely anything certain years or alternatively, make large sums depending on the work flow.  Nothing was guaranteed to last and so any windfall that came from his work was immediately placed into debt repayment or kid’s college funds.

When starting out of residency at my first attending job, I planned to continue to practice medicine until my 60’s, cutting back on hours if needed, but I assumed my love for medicine would keep me wanting to work indefinitely. Several things changed my mindset, including financial independence.  Once I knew I didn’t “have” to work, I started to view my career a little differently.  Maybe I wasn’t honest with myself previously with how the stresses of on call nights, sleep deprivation and increasing administrative workload was negatively impacting my life and health. It sometimes feels like you are on this treadmill that keeps going and you don’t have the time or energy to ever stop and think about what you are doing and if you are leading the life you envisioned for yourself.

time

Once financially independent, it became my choice whether or not to work.  The frustrations of salaried work in ob-gyn, the negatively changing healthcare climate, and missing time with my young children was weighing on my mind.  I wanted (needed) out for myself and my family.   However, I needed a push to get off that treadmill and realize what was going on.  “Luckily” for me I had a major health scare that also occurred at the same time that I reached financial independence.   Decision made.

Now, the choice can be mine if I decide to ever return to medicine.  I’ll never close that door completely, although I don’t see it in my future if you ask me now.  There is so much out there I am still excited to explore.

retirement

You Retired From Medicine- Now What? 

There is time for recovering.

 I’ll be honest, I feel like the first 2 months after retiring from my career in OB/GYN were about reclaiming my life. I got a full night’s sleep.  Actually, my nights were still broken up by 1 & 3 year old tears regularly (which I don’t mind so much when I know I don’t have to go to work in the morning).  However, I was having much more restful sleep as I was no longer on call or answering my pager/phone calls from the hospital throughout the night. I rediscovered exercise.  I haven’t exercised regularly in 8 years. Wow, what a difference going to the gym on a regular basis makes!  In summary, step 1 was take better care of myself.

 

Learning about something completely new.

I want to learn about finances.  This is important when you retire at 37.  You need to make sure the future is secure for yourself and your family.  Although I had reached financial independence at the time of decision to retire, finances will remain on your mind when you retire young since there is so much life ahead.  I finally had a chance to delve into finance books, learn about the stock market, how to make passive income.  Luckily this was a good time to get interested in the stock market as it has been on a record streak.  I don’t presume to think it is my expertise in stock trading that has made it so much fun, but being in the right place at the right time and jumping in.  If you are interested, I found the following books helpful: The White Coat Investor: A Doctor’s Guide To Personal Finance And Investing,and  The Millionaire Next Door: The Surprising Secrets of America’s Wealthy.

 

Pursuing something I always wanted to do.

I am writing!  My first article was about the decision to retire at 37.  It was published on the website KevinMD.com.  I was shocked and impressed by the reach of his website to other physicians.  It was wonderful to reconnect with colleagues when contacted after seeing the article.  I also enjoyed hearing from internet “strangers” who have been in remarkably similar circumstances and felt like I was telling their story.  Since the article appeared to resonate with a lot of physicians, it made me want to write more.  There are obviously people going through the same struggles and maybe it helps to let each other know about it. I also feel it is important to know your life can take another path if you need it to and I want to help others realize this.  Hence my blog.

 

Blogging. 

If you told me I would be blogging 6 months ago I would have said, “Not a chance”.  I am typically a very private person but I’ll admit that sending in my article about leaving medicine was cathartic and liberating.  Maybe it’s not such a bad idea to share your life with other people, especially if it may help them.  Besides, I am not bound by an employer or hospital anymore so I can pretty much say whatever is on my mind. 

 

Travel. 

This is one of my main passions.  I would go anywhere, anytime. I am always up for a trip to somewhere new.  So far, in my 6 months of retirement, I have been to the following places:

Clearwater, FL

Wilmington, NC

New Orleans, LA

Las Vegas, NV

Aruba

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 Plans in the next few months:

Fernandina Beach, FL

Outer Banks, NC

Sonoma, CA 

Trips out of the country are limited for now with 3 young kids.  I have to convince my husband that you can travel long distances with little ones first.

 

 Being available and present for my kids.

 I haven’t been able to be there for so much in the past.  It’s hard for all working parents- I get it. I absolutely understand this is a luxury and am so grateful for this. I wish there could be a better balance so that mothers and fathers wouldn’t feel so conflicted between their jobs and their family life. So, since I have this opportunity I am excited to relish it.  I will be there now for all field trips, doctor’s appointments, teacher conferences and soccer games.  All things I had to miss in the past.  I know kids are resilient and they know their parents love them when they are working but it’s hard on the parents sometimes more so than the kids.  We want to be there for those things. So for now, I am doing things like writing and investing and exploring new adventures that are flexible so that I can make my own schedule with my own priorities first.  I have been missing this control over my own life so much over the years.

 

Planning next steps.  

Retirees like to travel but when you have young kids you need to get creative.  In the next few years I want to start coordinating summer long trips to other countries with my family.  I don’t want to uproot them from their schedules/school life, so I plan to use the summers to experience other cultures and expose them to different ways of life.  I want my children to know more than the comfortable lifestyle in America that they are privileged to experience currently.  We are such a small piece of this world and I want them to understand that. There are things bigger than ourselves.

 

Lastly, I want to learn how to cook! 

Going straight from college to medical school, to residency, to full time employment as a physician left no time for learning to cook for myself or family (also no time to actually make a meal even if I knew how). I currently know how to make a pizza using premade pizza shells or “breakfast for dinner” which includes pancakes and eggs.  Yes, sad I know.   So, my goal is to learn how to make one thing every 3 weeks.  I need to start small- cooking is overwhelming to me!

Thoughts, comments? Suggestions?  Are you retired or do you have plans for what to do if you retire early from medicine? I would love to hear from you.

retirement

Retired at 37: Breaking Up With a Career in Medicine

Leaving your career in medicine is like breaking up in a long term relationship.  It may have all started out with lofty expectations, excitement about the future, and becoming your best self.  However, somewhere along the way things got messy and twisted and not what you signed up for.

There were hiccups along the way, signs that maybe it wasn’t good for you. There was the time you fell asleep at the wheel and totaled your car on interstate 95.  You were in a daze, driving home after 30+ hours awake delivering babies, doing surgeries, and rounding on patients in the hospital. You walked away fine but the car was demolished. It was scary, but not enough to make you leave.  It was like a big fight in a relationship.  It made you realize your shortcomings and problems with a system that encourages working in unsafe conditions, but you decide it was just a mistake. Next time you’ll sleep at the hospital first before heading home. You think it is your fault and can’t be the relationship that is broken.   

Or perhaps, the time when you were in your first year of obstetrics training.  Your hands were shaking from adrenaline after a tough delivery. You breathe a sigh of relief when the baby’s limp body begins to move and he gasps for air.  You attempt to obtain blood from the umbilical cord for testing.  A large bore needle sliced its way through the flimsy protection of a rubber glove as you clumsily tried to obtain the sample. You were acutely aware that your patient has HIV.  What was her viral load?  Your head spins and suddenly you feel nauseated. Now you were potentially exposed to HIV through a needle stick.  You take the antiretroviral medications prescribed to decrease your exposure risk of HIV despite the toll it takes on your body.  You can barely complete your busy days in residency due to the nausea and fatigue from the medications.   Thankfully, it works.  After follow up testing for over a year, you are cleared from the infectious disease physician and no longer need to worry about the exposure. You think to yourself, this is just a test of my commitment. There are risks with being a doctor, ones we agree to accept. Just as you risk opening yourself to heartbreak in a relationship by giving of yourself.  In medicine, you do the same.  It is for a greater purpose.  You acknowledge the risk and forge on.

There were happy times too.  The day you emergently took a woman with a ruptured ectopic pregnancy to the operating room, her abdomen filled with a liter of blood.  You transfused life-saving blood while swiftly removing the fallopian tube that had been irreparably damaged.  Your patient hugged you afterward for saving her life and you discuss getting pregnant in the future.  Two years later you embrace again, in celebration of a healthy pregnancy now growing safely in her uterus.

Or the time you discuss infertility with a patient, handing her tissues and listening intently while she tearfully describes her years of inability to get pregnant- the one thing she desires more than anything in this world. You discuss risks and benefits of a medication to enhance ovulation and review next steps.  She returns several months later, absolutely beaming and you confirm her pregnancy.  This is why you went into medicine.

The good times keep you going, holding on.  Plus, there were the expectations and investments put into this relationship.

Now it’s been 7 years in a busy Obstetrics and Gynecology practice. You made it through 3 of your own high risk, complicated pregnancies. You have hit your stride in practice.  Confident in your skills, comfortable with your decisions, and patients are waiting to see you. You are doing all of the right things but something has changed.  Is it you?  Is it the relationship?

You notice that increasingly over the last few years, health care has changed.  Hospitals, administrators, employers, and even patients all seem to have a more powerful voice in the field of medicine than physicians.  Physicians who have tirelessly devoted themselves to patients, often at the expense of their own families, are being marginalized. Expertise is being overlooked for cost effectiveness, “patient satisfaction scores”, and computerized check lists. Your love for the medicine has not changed, yet somehow everything surrounding it has.

The years invested in training amounted to 8 years after undergraduate school.  In residency training you worked over 80 hours per week for little more than minimum wage. The debt incurred from medical school was enormous.  You can’t just walk away.  This is a commitment. You made a promise.

Change is hard.  Especially when you have invested so much. You have lost years of time with your family and friends.  You missed weddings, funerals, birthdays. You feel pressure that the noble thing to do is “stick it out” and not complain.   No one wants to hear a doctor complaining about their job.

It takes a personal health scare to make you realize that you actually do matter.  Your happiness matters.  Your family and time are important.   The only way to recapture yourself is to leave medicine.  You decide to leave this destructive relationship when you realize that you are not the problem.  You are not “burned out”.  The problem is the current environment in medicine which puts physicians last on the list.  Your stories are not unique, and all too common amongst others in the field.  Leaving for you is taking control back. Control of your life and also making a statement for those still in this unhealthy relationship. You join the increasing ranks of young physicians that are finally taking a stand and demanding better from this toxic relationship.