Exit Strategy

[Craigy]

Kamban wrote:

Jaqen Haghar, MD wrote:

Working as a psychiatrist at $250,000/year (-35,000/yr) x 3 years “without a strong work ethic”… and you’ve got a net worth of $1,400,000?…. A man has questions…. 

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He has $450K in retirement accounts and $300K in home equity. These can be significantly more than what we expect due to employer match, rising stock market, rising home values and home interest deduction.

So he has only $650 in taxable accounts. This can also be due to the wonderful stock market gains since 2009.

He is lucky in that he has a low annual expenses, a good salary and made all his investments at the right time when the markets were skyrocketing.

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Obviously I can't speak for Lithium, but that clearly sounds like some sort of family money or inheritance.  That or a unique investment (how do you stash 450k into retirement accounts in 3 years, etc).

Even generously assuming a dollar for dollar match in retirement, that's about $268,000 annually, less spending, less tax, less mortgage interest, generous ballpark of about $175k/year, for three years is $525,000.  Even if you assume the $300k in equity is all appreciation (been paying extra on the mortgage, so it's not), that's still $1.1M, or a delta of $575k .  I suppose it's possible $525,000 has all been invested and doubled (again, assuming $0 down on the house and all appreciation).  Or Lithium is one of those who worked a lot before or during medschool.  Or Lithium is married and left that out. Or Lithium is Doogie Howser, finished medschool at 15, worked as a cardiologist until he was 27, went back in for a Psych residency...  :P  IMO pretty safe to assume, but would love to be proven wrong.

Young, zero student debt, lots of money in the bank, very frugal lifestyle, went to medschool despite not enjoying medicine, general feelings of malaise...    sounds like my friends and clients who are trust fund babies.   8-)  8-)  8-)

[Lithium]

It's nice to see a pretty sizable consensus.  For some context, I do work more than full time really.  I don't want to get more specific, but I have extra responsibilities that really probably bring me closer to 1.25 FTE's.

Meeting with director this AM went about as I expected.  Completely understood why I want to unload the add-on stuff I do, even at the possible inconvenience of others.  But the message I got beyond that was "I don't have part-time positions.  How can we make a full time position that would work for you?"  That might fix or cure the dissatisfaction or burnout but still doesn't feel like the job I want really exists in those parameters.  So it's time to start looking.  They are actively recruiting for positions throughout the department and supposedly have more qualified applicants than spots to fill.

To address the above post, my financial situation isn't due to an inheritance, though family generosity has a lot to do with it.  I've had savings and a frugal personality ever since I started working at 16, never had student loan debt (scholarships, cheap public schools, and family help), made well over six figures by moonlighting through most of residency, and have earned nice returns throughout this eight and a half year bull, and haven't had to take care of anyone but myself.  I was maxing out the 403b, 457b, Roth IRA, and HSA all through residency.  It's been a lot of hard work and discipline, but timing and luck have played an enormous role too.

[Craigy]

Lithium wrote:

 

To address the above post, my financial situation isn’t due to an inheritance, though family generosity has a lot to do with it.  I’ve had savings and a frugal personality ever since I started working at 16, never had student loan debt (scholarships, cheap public schools, and family help), made well over six figures by moonlighting through most of residency, and have earned nice returns throughout this eight and a half year bull, and haven’t had to take care of anyone but myself.  I was maxing out the 403b, 457b, Roth IRA, and HSA all through residency.  It’s been a lot of hard work and discipline, but timing and luck have played an enormous role too.

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"don’t have a strong work ethic"  SUCH A LIAR!!!  :lol:

Very impressive, even with family help.

Also, congrats on the meeting.  Even though the message wasn't what you might have hoped for, at least you have some clear direction.

[childay]

Lithium wrote:

I don’t want to get more specific, but I have extra responsibilities that really probably bring me closer to 1.25 FTE’s.

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What are you doing man?  You're killing yourself as a psychiatrist?  And only making 250k?  I am going to assume you live in Boston or NYC or something.  I am also an inpatient only psychiatrist.  How many patients are you seeing a day?  Feel free to PM.  You are getting good advice re: burnout and getting laid..

[Lithium]

childay wrote:

Lithium wrote:

I don’t want to get more specific, but I have extra responsibilities that really probably bring me closer to 1.25 FTE’s.

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What are you doing man?  You’re killing yourself as a psychiatrist?  And only making 250k?  I am going to assume you live in Boston or NYC or something.  I am also an inpatient only psychiatrist.  How many patients are you seeing a day?  Feel free to PM.  You are getting good advice re: burnout and getting laid..

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I could be billing and working more efficiently, but I've stopped caring.  A lot of it is spending too much ************************ time on the phone (mostly due to the extra 0.25 I want to stop), but I've also been undercoding a lot just to have the coders off my back and almost completely stopped billing psychotherapy codes altogether.  I do whatever it takes to get out of the office.  I also don't spend as much time (several hours a month) double checking to make sure all my bills are actually getting submitted and reconciled, so there's that too.

[YSH]

Be weary of "under" or "up" coding, can get you into trouble that is hard to dig out for a long time. Not worth it.

You had me at burn out after 3 years.  And at 34, you don't really need the exit strategy. In my opinion, you just need to exit (the job).

Go find some joy.

[Dr.V. Investor]

OP, with your discipline, do not worry about finances.  You know that even if you have a 50% paycut, you will still be able to save. You are living like a nanny- not even like a resident. Maybe it's your personality that it makes you happy seeing your net worth grow. You already reached millionaire status in your bucket list.  What else do you want to accomplish- travel, participate in charities, build a foundation, have a partner?  All the best!

[Dr. Mom]

Two of your comments make the mom in me come out so please forgive me if I am off base.  Your original comment about feeling poor in your personal life combined with your second comment about not caring at work anymore concern me.  You are in psych, so you know how helpful it can be to talk to someone professionally.  Please consider this for yourself.  You are worth getting yourself back on track, whatever that means for you!  Best wishes!

[Kamban]

Dr. Mom wrote:

Two of your comments make the mom in me come out so please forgive me if I am off base. Your original comment about feeling poor in your personal life combined with your second comment about not caring at work anymore concern me. You are in psych, so you know how helpful it can be to talk to someone professionally.

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Sometimes we don't take care of ourselves as well as we take care of our patients and we don't see the obvious diagnoses in ourselves that we can spot in others.

I was also about to say the same thing earlier on but was not sure if that was appropriate. Even though you are in psych I would still recommend as an internist in me for you to have a consult from a psychiatrist or even a counselor not known to you to see if you have an underlying depression that is on top of your work stress etc. You are also free to disregard this advice.

[Dansignal]

This is a serious response from one who has changed careers a few times. I sought psychiatric care 4 years into a high stress business career. The psychiatrist did his job and after assuring me that there was no organic issue he said "you hate your job, do something else". I went to medical school and even after that refined specialties. My advice to you is to find something you want to do and do it.  Landscape architecture, fireman, accountant.  The good news is that you have the intellectual horsepower to do just about anything.

[Lithium]

It would be hard to envision how seeing anyone in my line of work would be helpful, and for obvious reasons I'm pretty averse to asking for it.  Besides hearing myself talk and venting (which I can do just as well with my pets) and getting advice (which is what this thread is for), I can't think of anything I'd want out of it.  I guess there is always the possibility of something being off biologically, but I don't think so.  Obviously what I'm feeling isn't going to change drastically by doing yoga or reading a book.

 Life/job coach may be a great idea, on the other hand.  Right now I feel a lot like Peter from Office Space:

Peter Gibbons: Our high school guidance counselor used to ask us what you'd do if you had a million dollars and you didn't have to work. And invariably what you'd say was supposed to be your career. So, if you wanted to fix old cars then you're supposed to be an auto mechanic.

Samir: So what did you say?

Peter Gibbons: I never had an answer. I guess that's why I'm working at Initech.

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[Craigy]

Lithium wrote:

It would be hard to envision how seeing anyone in my line of work would be helpful, and for obvious reasons I’m pretty averse to asking for it.  Besides hearing myself talk and venting (which I can do just as well with my pets) and getting advice (which is what this thread is for), I can’t think of anything I’d want out of it.  I guess there is always the possibility of something being off biologically, but I don’t think so.  Obviously what I’m feeling isn’t going to change drastically by doing yoga or reading a book.

 Life/job coach may be a great idea, on the other hand.  Right now I feel a lot like Peter from Office Space:

Peter Gibbons: Our high school guidance counselor used to ask us what you’d do if you had a million dollars and you didn’t have to work. And invariably what you’d say was supposed to be your career. So, if you wanted to fix old cars then you’re supposed to be an auto mechanic.

Samir: So what did you say?

Peter Gibbons: I never had an answer. I guess that’s why I’m working at Initech.

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Greatest movie of all time.  I feel like Peter, would probably do nothing.  Although it would take more than a million bucks today for me to feel comfortable doing nothing.  Otherwise my answer would be something like "watch movies" or "drive cars."  So I suppose I should be a valet at a movie theater.  Somehow "manage a real estate empire" isn't a job you can just pick up until you have the capital.   :cry:  Seriously though that outlook of "do what you love" "I've never worked a day in my life" "find your true passion" etc. etc. is a bunch of horseshit, which has been pounded into our heads growing up as children and adolescents and in college, which invariably leads to many people being depressed that they're not astronauts or fashion designers or movie stars.

I will recommend finding time to read.  It's surprising how nice it can be to read a book.  It doesn't have to be anything profound, just something entertaining that keeps you interested, preferably fiction.  A series will keep you interested for a longer period of time, something to look forward to.  Great way to clear your head, at least I've found it to be.  Also, drink wine (good wine), take baths, or some combination thereof.  

[adventure]

Lithium wrote:

Right now I feel a lot like Peter from Office Space:

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Keep watching the rest of that conversation, haha.

 

I'd start by taking a month off, or however much vacation time you can do at once. Or start blowing vacation time and take every Friday off for the rest of the year. Something to lighten up, but "stay" at your FTE.

I'd also interview for other jobs. See how it goes.

Also... Why are you going to sell your house? What gives there?

[Lithium]

A brief update:

i've contacted the director at the hospital 30 minutes away, and the jobs there are more promising.  I would have the option to do basically what I'm doing now, but see a higher volume of patients now for about 23 weeks a year rather than fewer for 36.  16 weeks off a year sounds like a lot, but it is the 36 weekends in the hospital every year that are a killer.  For example, Monday was my first day off in August.  I'll probably take a week to think this over, but it seems like a good option for now.

I'm selling my house because I live alone and don't like taking care of it.  The market is also pretty favorable, and I would rather have the freedom to pick up and move if I decide I want to leave.

 

[PhysicianOnFIRE]

Congrats!

Non-medical people are always jealous of the "excessive vacation" time I get. What they never seem to grasp is that for every week I get to take off, I've worked a 72-hour weekend.