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  • Value of job satisfaction vs. compensation

    I spent several years in FM private practice before transitioning to my current job as faculty in a residency program about 5 years ago. I acknowledged at the time that I would be working more hours for less money, but justified it because I enjoy the work so much more.

    However, times change; priorities change. The truth is I'm making 25% less than the average family doc and put in a fair amount of nights and weekends (inpatient, outpatient, and OB call). I do like the work, but it can be tiring. More importantly - I now have kids at home and it's a whole different ballgame than when it was just my wife and me.

    I know the choice is mine to stay. I am happy enough, but feel very underpaid. I would probably be happiest if I was working a 0.7 but then of course compensation would be even lower. My options are to stay or find a similar job. I could at least get up to average salary with a better schedule by going to a competitor, but it would require a 45 minute (vs 15 minute) commute, which again, leads to quality of life issues.

    As I have gotten some years of experience in medicine I have started to question my own motives around what a "satisfying" job really is. I fear that it is difficult to separate out the ego aspects. Most of why I enjoy teaching is because I love the science of medicine and the mentorship of watching young doctors develop; the truth is I get very frustrated with direct patient care and it causes me too much stress to be worth it.

    Most likely, I will suck it up and stay at my current job (and of course try to negotiate a substantial raise) because it is the best of the options (close commute and mostly enjoyable work). But I do realize that I am paying a very high price for "satisfaction," and could be making more money elsewhere if I were willing to give that up.

    Just wondering: I'm sure others have struggled with the trade off of a "better" job vs better compensation vs better lifestyle, and how you all have addressed this question for yourselves.

  • #2
    I'm sure most people here have struggled with this. You have to prioritize and know what you really want (which it seems like you've done) and accept the drawbacks and be truly fine with them (which it seems like you haven't). Who cares if you are missing out/could get more money if you are FI or on your way, even if at a reduced salary, if it means you get to do what you love to do and also allows for time with family? I assume you love your family and want to be around them as much as you can, while also being at work...not everyone does, there are workaholics who don't want to be around family but this doesn't seem to be you.

    Yes it's a high price, but when you are in your 60s or older, you don't want to wonder "did I make a difference? was I there for my family?" I believe those who say when they are older that no one but really greedy people ask "geez, could I have made a lot more money in my life?" and live with that regret

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    • #3
      it doesn't really sound like you purchased satisfaction with your increased hours and decreased pay.....

      how exactly is this a good fit?

      respectfully, as an academic doc myself, i have seen a subset of people who don't like clinical care much and "love to teach" meaning they love to have residents do their work for them while they argue that their mere presence is educational. is this you?

      here are some good questions for yourself:
      1. when was the last time you provided a resident with meaningful feedback? not "good job" but sat them down at the end of the day and went through a list of constructive and positive stuff?
      2. when was the last time you prepared and delivered a core content lecture?
      3. when you have clinical assignments without a resident do you find that you feel that you need a resident to be functional?

      not trying to troll you at all, but the combo of saying that you love to teach but find direct pt care very frustrating makes me very nervous.

      Comment


      • #4
        I declined a huge pay raise (or took a huge pay cut depending on how you look at it) in order to not take call, and then cut down to 4 days a week so I can spend more time at home. Its >200k/yr difference. My only regret is that I did not push for it sooner to spend more time with my terminally ill wife. Cutting back has also turned me from a "fiRE/burn out by 45" plan to a I could do this as long as the BS at work doesn't get worse plan. Listening to @crispydoc on a podcast helped convince me to go for it. You can still get to FI, it just may take you a little longer. FWIW, I'm still on target to FI by 48. I still paid off my student loans within 5.5 years post residency. Your saving/spending will have a lot to do with reaching your goals. My new goal is cutting back even more once I hit FI and coasting to a 2-3 day workweek just to cover living expenses while allowing my accounts to grow more until I fade into retirement at ~55-57. But who knows, with the reduced work schedule, I may choose to work even past that age. BUT- I like my current job. So my decreased work hours brought me better work life balance and job satisfaction. I would not like my job as a calltaker. Do you actually like your job now, or would you if you cut back?

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        • #5
          OP, I just read Housel's book and he highlights a couple things that could be germane to you. 1) Things change (us, our environment). 2) Ignore sunk costs. 3) Shoot for good enough, as opposed to the extremes of the spectrum. It's actually an interesting work when considering The Happiness Curve as well.

          At my stage, there is no way on God's green earth that I would be working nights and weekends for a 25% paycut unless the job was so fabulous that I left each day energized to return ASAP. Eighteen years ago, different story.

          Your post suggests there is a lot more than money to unpack. (I did smile at the concept that you are frustrated with direct patient care but are mentoring young doctors...as FM....)

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          • #6
            This is the fallacy of academic medicine. In the old days there was an ability for systems to pay less for more work. No longer. Any gap larger than 15% lends to brain flight these days to the competition --- especially in Primary Care. I would get local offers and then approach your leadership. This does mean upsetting the apple cart a bit and be ready to move along if they think you're bluffing. You have one real chance at it to coarse correct within the system and if not, that pay differential will always remain.

            Comment


            • #7
              Originally posted by MPMD View Post

              respectfully, as an academic doc myself, i have seen a subset of people who don't like clinical care much and "love to teach" meaning they love to have residents do their work for them while they argue that their mere presence is educational. is this you?
              Respectfully, I know why you are asking, and this couldn't be further from the truth. Consistent accolades from the residents speak for themselves. I have loved teaching since my undergrad days (SAT prep courses) and have consistently taken that role throughout my career.

              Regarding yours and others' concerns over not loving patient care but liking teaching - it is related to the big business takeover of healthcare that I was not really prepared for when I entered medicine. It's not the actual taking care of patients.

              And I hope this was implied, but of course I do love my current job, otherwise I wouldn't work more hours for less pay. It's just that it's a spectrum, and as the balance shifts it can be hard to know when to make a change.
              Last edited by familydocPA; 02-15-2021, 03:21 PM.

              Comment


              • #8
                Originally posted by billy View Post
                I declined a huge pay raise (or took a huge pay cut depending on how you look at it) in order to not take call, and then cut down to 4 days a week so I can spend more time at home. Its >200k/yr difference. My only regret is that I did not push for it sooner to spend more time with my terminally ill wife. Cutting back has also turned me from a "fiRE/burn out by 45" plan to a I could do this as long as the BS at work doesn't get worse plan. Listening to @crispydoc on a podcast helped convince me to go for it. You can still get to FI, it just may take you a little longer. FWIW, I'm still on target to FI by 48. I still paid off my student loans within 5.5 years post residency. Your saving/spending will have a lot to do with reaching your goals. My new goal is cutting back even more once I hit FI and coasting to a 2-3 day workweek just to cover living expenses while allowing my accounts to grow more until I fade into retirement at ~55-57. But who knows, with the reduced work schedule, I may choose to work even past that age. BUT- I like my current job. So my decreased work hours brought me better work life balance and job satisfaction. I would not like my job as a calltaker. Do you actually like your job now, or would you if you cut back?
                Billy - thanks for your thoughts, it really puts things into perspective.

                I think that I love my job now, I just feel a little bit overworked, and am having a hard time thinking about cutting back when I already feel underpaid. But those are my choices.

                Comment


                • #9
                  Originally posted by StarTrekDoc View Post
                  This is the fallacy of academic medicine. In the old days there was an ability for systems to pay less for more work. No longer. Any gap larger than 15% lends to brain flight these days to the competition --- especially in Primary Care. I would get local offers and then approach your leadership. This does mean upsetting the apple cart a bit and be ready to move along if they think you're bluffing. You have one real chance at it to coarse correct within the system and if not, that pay differential will always remain.
                  I think the other fallacy of academic medicine is that we are supposed to be so pure intentioned that we do not care about money. This is all well and good right up until you realize that others are simply keeping the profits of your work.

                  Comment


                  • #10
                    Originally posted by familydocPA View Post

                    Billy - thanks for your thoughts, it really puts things into perspective.

                    I think that I love my job now, I just feel a little bit overworked, and am having a hard time thinking about cutting back when I already feel underpaid. But those are my choices.
                    When I initially dropped to no call, I found a different job that paid better than my then call job and I took it. I left a malignant group for my current group. Then after proving my worth at my current job, I countered their "hey why not take call for all this more money" with a "hey I need to cut back even more". They were agreeable, but I was willing to walk if they weren't. Perhaps finding out what other offers are out there can help you negotiate with your current job. Know your worth, but again, money isnt everything. Work environment and work life balance are also extremely important. You should google the crispy doc blog also if you see yourself headed towards burn out.

                    Comment


                    • #11
                      Originally posted by billy View Post

                      When I initially dropped to no call, I found a different job that paid better than my then call job and I took it. I left a malignant group for my current group. Then after proving my worth at my current job, I countered their "hey why not take call for all this more money" with a "hey I need to cut back even more". They were agreeable, but I was willing to walk if they weren't.
                      That's the best position to negotiate from.

                      Agreed, Crispy Doc is a great blog. I wouldn't say that I'm burned out, but definitely striving for a better balance. There's more to life than money and medicine.

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                      • #12
                        Going to work feeling underpaid will do nothing but lead to resentment and lead you on a downhill path to burnout. Something will need to change.

                        Comment


                        • #13
                          I can understand working harder because one loves academics. But to get paid less to work more would really grind my gears.

                          I looked at a academic job out of residency and they were paying 65% the other offers. They would not budge and only wanted "team players". It was way more work and in a smaller crappier town. I have no idea how they recruit. People are suckers I guess.

                          Make sure you actually love it and just don't love saying that you love it.

                          Comment


                          • #14
                            Originally posted by familydocPA View Post

                            Respectfully, I know why you are asking, and this couldn't be further from the truth. Consistent accolades from the residents speak for themselves. I have loved teaching since my undergrad days (SAT prep courses) and have consistently taken that role throughout my career.

                            Regarding yours and others' concerns over not loving patient care but liking teaching - it is related to the big business takeover of healthcare that I was not really prepared for when I entered medicine. It's not the actual taking care of patients.

                            And I hope this was implied, but of course I do love my current job, otherwise I wouldn't work more hours for less pay. It's just that it's a spectrum, and as the balance shifts it can be hard to know when to make a change.
                            The problem IMO is you will be doing more direct patient care in a non-academic setting than you are currently doing. So while you would be getting paid more, you would also be doing something you don't like, more often. I guess it would be in a more preferable setting though as you're likely to do less nights and ob stuff probably.

                            Comment


                            • #15
                              Originally posted by MPMD View Post
                              it doesn't really sound like you purchased satisfaction with your increased hours and decreased pay.....

                              how exactly is this a good fit?

                              respectfully, as an academic doc myself, i have seen a subset of people who don't like clinical care much and "love to teach" meaning they love to have residents do their work for them while they argue that their mere presence is educational. is this you?

                              here are some good questions for yourself:
                              1. when was the last time you provided a resident with meaningful feedback? not "good job" but sat them down at the end of the day and went through a list of constructive and positive stuff?
                              2. when was the last time you prepared and delivered a core content lecture?
                              3. when you have clinical assignments without a resident do you find that you feel that you need a resident to be functional?

                              not trying to troll you at all, but the combo of saying that you love to teach but find direct pt care very frustrating makes me very nervous.
                              These are some great questions . I personally can answer
                              1:last week
                              2 :many within last year
                              3:I am more efficient without residents in clinic or OR

                              I would still add that thought of being underpaid crosses my mind , but I know probably I am working less than my pvt practice colleagues , but end up spending a lot of time in hospital due to inefficiencies , meetings etc

                              But at the end , it is my choice and so is OP’s.



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