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partial or fully retired before age 55: questions for those who've done it

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  • #31
    Originally posted by Tim View Post
    uptoolate

    Just curious. How do you think the Canadian System would work on the scale and US socioeconomic demographics?

    Alot of similarities but tons of differences. I have heard anecdotal stories of Canadians getting healthcare in the US on occasion. Of course some US go to Mexico. These stories have zero to do with the training. Some US docs actually have side gigs in Mexico. It is a question of the solution to the local population.
    For example, is anyone ever denied ER treatment or assistance?
    Would the system accommodate 1000 people coming across the border seeking medical treatment? My point is only are the demands on the system different and would it work in the USA. What might work well in situation A, might not work in situation B.
    Where to begin. First a disclaimer that I am not a health economist and my views are my own and are certainly biased. As Dorothy says, 'There's no place like home'. I'm not sure whether I have seen the episode that Anne posted but I'll definitely have a look at it later.

    The first thing to bear in mind is that for all of their similarities, Canadians and Americans are very different peoples. Heck, as we have been seeing for quite some time, Americans and Americans are very different peoples. It absolutely could work but there would sure be some pain along the way. The first thing that comes to mind is the massive health insurance infrastructure in the US. People say that it takes government to really mess things up, but please tell me that anyone can honestly believe that the 'health insurance' industry in the US has as its primary goal providing health and wellness to the American people. Sorry, one of the most striking things I noticed when I worked in the US was the incredible level of bureaucracy and paperwork. The even more striking thing was that it didn't seem to matter whether one was uninsured, underinsured or overinsured - care seemed to be hamstrung for one reason or another.

    No people are not denied care in the ER, whichever ER they turn up in, anywhere in the country. Nor will they ever be expecting a bill for anything other than a pair of crutches (which will be an amount similar to what they could have got them at the local drugstore). If they are from outside the country then they can expect a bill and it will be modest. People get good care and they come early because no one is concerned about the cost or being bankrupted. Living close to the border, we cared for many Americans who were 'taking advantage' of 'better prices' (or at least prices that they could see and understand). We also cared for many medical tourists from all over the world. It was very, very rare that we didn't get paid for providing these services. Yes, Canadians certainly go to the US for care. If Buffalo or Detroit have a huge excess of MRI capacity, why wouldn't I negotiate a good fee and use the capacity. And the US population is 10-fold that of Canada so for some fascinoma a Canadian on the prairies might wind up in a big US center but the same is true for an American in many smaller places. (This is one thing that a universal system does very well though is concentrating complex care which generally results in better outcomes). Flow also goes the other way when needed - although less so of course because a system that is built for a universal care is much less likely to wind up with huge excess capacity. It's more about providing care than making shareholders happy. I think the question about the border is more to do with immigration policy than health care. Do people come from Mexico mainly for healthcare or to work and then use healthcare resources. Should they be seen as foreigners or locals as far as healthcare goes. Our part of Canada has a large influx of seasonal farm labour each year and these folks are covered by the plan while here without significant issue AFAIK but I don't have huge knowledge here.

    At the end of the day, the US is financially the richest country in the world and countries with far less resources are able to provide quite good healthcare. Also, in frequenting US retirement forums, and as evidenced by the outgoing Administration's inability to get rid of the ACA, there is a desire for some form of universal care model. The obstacles are immense but from what I see it is definitely not Joe Average who is the obstacle. When universal healthcare came online in Canada, many doctors complained bitterly but it turns out that there is something to be said for getting paid reliably and very simply and I suspect that most are very happy with the system now - especially when they look south.

    Oh and of course we all know that MDs are crazy underpaid in Canada - not. See the current retirement thread. I retired from clinical at 52. Four children. Two nice homes. Decent cars. Anyway, this is one of those areas that is so complex (and the vested interests want all to believe that it is even more complex) that it will likely take some major upheaval to address. Fingers-crossed though, it would be nice not to be 'afraid' to visit your wonderful country because of concerns about healthcare.

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    • #32
      I appreciate your comments. As a retiree I don’t suspect you would have any problems as a healthcare consumer. I don’t either in the USA.
      Probably no problems if I actually immigrated to any place in Canada.

      I really question whether ACA was healthcare or politically motivated. I really question whether immigration is socially motivated or politically motivated. I do know that when 20% of government resources are devoted to government services that I have to wait that much longer if not more.

      The circular argument about insurance, drug pricing, physicians and hospitals seems to be centered on dividing the pot, rather than providing valuable services.

      One point sticks out: much of private and government spending in healthcare is not providing direct benefits to patients. By the time it is commercialized, it costs more in the USA. There is a structural inequity that is really more of a cost recovery issue. I don’t pretend to have an answer.

      Universal healthcare is probably supported at a basic level. But much of the population doesn’t want the lowest cost basic item. Upgrade is desired. The other part says I deserve that too, but won’t or can’t afford it. Simply another iteration of you can have anything you want but not everything.

      No easy solution. I have yet to meet an individual in the USA that did not receive healthcare. Of course, some didn’t pay for it.
      Last edited by Tim; 12-06-2020, 11:11 AM.

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      • #33
        Originally posted by uptoolate View Post

        I don't know many (any?) Canadians who don't feel that their healthcare system is very, very good. Having worked in several systems in different countries, including the US, I would not trade our system for another. I have encountered a couple of systems in Europe that seem quite good but the I would definitely not wish the US system on anyone. As you are aware, there is a multi-billion dollar industry (more than one in fact) that will go to great lengths to maintain the status quo in the US and there is really no money on the other side of the argument. To never really give a thought as to whether one will be looked after when they are sick or whether one's family will be is a pretty valuable thing in a world full of endless stress. My local medical school just moved up to number 11 on the Times list of top schools (and our big rival down the street is number 6) so I am thinking that the care provided must be pretty good. Of course, I know from experience that the training and care is excellent, I don't need the Times to tell me but it is fun to know. My overall tax burden is no more than in pretty much any state in which we would consider living and I have always felt it was money very well spent. Only thing that Canada is missing is a hot and sunny winter destination! lol.
        Thanks for writing this. I’m a Canadian living in the US - there’s no question in my mind the medical system in America is an embarrassment for the richest country in the world. Reflective of different population values. I live in a pretty unique part of the country/world and we never want to leave because of that, but I miss Canadian health care for all my patients’ sake. Sorry to continue the thread derail.


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        • #34
          Maybe to bring the thread back to topic of FIRE... if we were to reach FI, with the only problem preventing us from RE being access to healthcare.. could we just move to Canada?

          I’d work in Canada if they let me (I hear ophthalmologists there make more than in the US and love it there). But I hear that it’s not easy to transfer there in from a medical licensing standpoint. Is it easier for internal medicine?
          Last edited by Dusn; 12-07-2020, 06:30 AM.

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          • #35
            Warning this is a really good thread but it is becoming too political. Lets keep the discussion focused on retirement and possible sources of health insurance for retirees. I would hate to see the thread closed.

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            • #36
              Yeah I’m watching this thread as I’m trying to figure out what to do about myself. I’m late 30s and hit regular fire numbers. My wife wants to move closer to my family as she dislikes the area we’re in now.

              Problem is it’s hard finding a job where we want to live. So if I can’t find anything I’ll try to do some locums from time to time and keep up trading in the market to continue to fatfire numbers.

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              • #37
                Healthcare is a real issue and determining factor in regards to retirement, all of know that one disease can have a serious impact on financial future. I know several who thought O-Care was the savior for this to buy into the market place , but after years have been discouraged by the never ending price increasing and terrible coverage available .Maybe Medicare for all will be the new savior , but I dont think so, as long as you are a "target" in the US with a large net wealth, there will be no economically feasible program to mitigate health care risks in the future other than working. Most of us price our selves out of any market place or other plans currently available. Even predicting the future cost is more difficult than predicting future investment returns. So most of us who feel that we could retire otherwise will continue working. My last market place cost of insurance was 36,000 a year for the cheap plan, but predicting this going forward is almost impossible

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                • #38
                  This. Medical costs IS the driving force and unknown for FIRE. Medicare takes up 15% of current Federal budget and expected to grow as America greys.

                  Worthy of a separate thread on the specifics, as this great thread is about FIRE issues.

                  The biggest threat/unknowns at early age:
                  1. Medical costs - premiums as well as events
                  2. Adult children - boomeranging back or needs startup assist
                  3. Lifestyle creep - travel


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                  • #39
                    Another question when looking to cut back (rather than completely RE) if you are in a field with continuity of care (rather than episodic shift work): did cutting back just increase your stress/work/headaches on your working days from inbox piling up/patients wanting to be seen right now and only seen by you for nonurgent issues/etc.? The ideal way/schedule to cut back to in a specialty with continuity seems tricky.

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                    • #40


                      Bringing it back from Canadian to American track -


                      1. How old were you when you did this? In what field of medicine? Why did you do it?

                      Started to cut back in mid 50's from half day Friday to full day Fri off. The added half days Monday and Thu. Then half days Wed. I see much less number of patients the rest of the time that now I hardly work even 2 full days. Reasons are slow burn of being solo, wanting to take care of my health and wanting to see my daughter grow before it becomes too late.

                      2. To how many workdays/week did you cut down? Did this number subsequently change?

                      See above.

                      3. What was your net worth at that time (not including your home and 529/UTMA)?

                      Probably around $4-5M.

                      4. What were the financial mechanics of your life post-retirement: what were your expenses and how did you pay for them? Did you have any other sources of income (real estate, non-clinical gig, significant other's income)? Did you structure your investments so that they would produce income? How much was your annual post-retirement income?

                      Not fully retired. My investments are not touched. I reinvest the dividends and distributions from my investment income. Being solo and having significant overhead to start a retirement plan for all my employees, my retirement money is almost fully in taxable accounts, except for a small one from my fellowship days. No regrets about that. My small income from my current part time work takes care of my living expenses and travel expenses - about $125-175K.

                      5. Any advice looking back on it?

                      If you have health issues, family history of early CAD or other morbidity / mortality issues, have young children or have other interests then slow down. Can be from 40 or 45 or 50 or 55. Your pick. Don't go to a full burnout and seek job counselors. Enjoy time with children before they grow wings and are gone. Work a bit hard in early days and live frugally and invest the rest. The compounding works wonders in the later years and gives you the luxury of slowing down. I have no idea how long I will practice part time since I enjoy the mental stimulation and gives me a purpose in life.
                      Last edited by Kamban; 12-07-2020, 08:23 AM.

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                      • #41
                        Originally posted by Anne View Post
                        Another question when looking to cut back (rather than completely RE) if you are in a field with continuity of care (rather than episodic shift work): did cutting back just increase your stress/work/headaches on your working days from inbox piling up/patients wanting to be seen right now and only seen by you for nonurgent issues/etc.? The ideal way/schedule to cut back to in a specialty with continuity seems tricky.
                        Yeah the things you mentioned are also frustrating issues. I’ve noticed that if you’re employed and try to cut back to part-time your employer will gladly cut your pay but then will try to squeeze the same number of patients/work into fewer days of work. This is especially true if there aren’t enough specialists who do the same thing you do.

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                        • #42
                          Like this thread. Impressed by some of the high net worth of individuals who have shared. I am curious if many of you have your net worth tied up in retirement accounts with the associated tax consequences? In our late 40's, we are rapidly approaching 8 figures in net worth, but I'd say 90% of that is in retirement accounts due to some fortuitous stock investing, mainly in 2020. Then maybe 6% in home equity and 4% in truly liquid cash accounts.

                          Anyone else in the same situation and, if so, how do you plan to turn that wealth into something accessible without having high taxes and/or penalties before 59 1/2. Currently looking at SEPP 72(t) options for my 401k which is over 50% of our net worth.

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                          • #43
                            Originally posted by jjandjab View Post
                            Like this thread. Impressed by some of the high net worth of individuals who have shared. I am curious if many of you have your net worth tied up in retirement accounts with the associated tax consequences? In our late 40's, we are rapidly approaching 8 figures in net worth, but I'd say 90% of that is in retirement accounts due to some fortuitous stock investing, mainly in 2020. Then maybe 6% in home equity and 4% in truly liquid cash accounts.

                            Anyone else in the same situation and, if so, how do you plan to turn that wealth into something accessible without having high taxes and/or penalties before 59 1/2. Currently looking at SEPP 72(t) options for my 401k which is over 50% of our net worth.
                            if you search physician on fire's blog, I think he has a blog post on it. Or it was from WCI blog. But its out there.

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                            • #44
                              Originally posted by jjandjab View Post
                              Like this thread. Impressed by some of the high net worth of individuals who have shared. I am curious if many of you have your net worth tied up in retirement accounts with the associated tax consequences? In our late 40's, we are rapidly approaching 8 figures in net worth, but I'd say 90% of that is in retirement accounts due to some fortuitous stock investing, mainly in 2020. Then maybe 6% in home equity and 4% in truly liquid cash accounts.

                              Anyone else in the same situation and, if so, how do you plan to turn that wealth into something accessible without having high taxes and/or penalties before 59 1/2. Currently looking at SEPP 72(t) options for my 401k which is over 50% of our net worth.
                              You also need to think of RMDs and roth conversions

                              Comment


                              • #45
                                Originally posted by jjandjab View Post
                                Like this thread. Impressed by some of the high net worth of individuals who have shared. I am curious if many of you have your net worth tied up in retirement accounts with the associated tax consequences? In our late 40's, we are rapidly approaching 8 figures in net worth, but I'd say 90% of that is in retirement accounts due to some fortuitous stock investing, mainly in 2020. Then maybe 6% in home equity and 4% in truly liquid cash accounts.

                                Anyone else in the same situation and, if so, how do you plan to turn that wealth into something accessible without having high taxes and/or penalties before 59 1/2. Currently looking at SEPP 72(t) options for my 401k which is over 50% of our net worth.
                                wow. yeah, I'd say that was fortuitous stock investing!

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