Cutting Down On Work, Early 30s

[DwightKSchrute]

I had a question for those who are FIRE and/or working part time. (or simply those further in their career with helpful advice)

I recently received an offer from my employer to go down to part time.

The way my practice is currently structured is that I perform Procedure A in the mornings and Procedure B in the afternoons.

My employer wants to increase the number of cases I do in the morning and eliminate my afternoons. (obviously Procedure A is much more lucrative than Procedure B and they have other physicians who can do Procedure B). Theoretically this should allow me to make more money, retain my employee benefits, and return home by early afternoon.

This sounds like a win win to me but I had a couple of concerns:

1) I'm not sure my hospital system will be able to keep me as busy with Procedure A as they claim. That being said, even if I don't get any more morning cases, eliminating my afternoons only represents a 10% drop in my take home pay. Financially I am OK doing this but mentally, given my age and the uncertainty of reimbursement patterns, I sometimes wonder if I'll regret "leaving money on the table" or not "making hay while the sun is shining"

2) I'm not sure if this would be best for my professional development. Eliminating the afternoons means essentially giving up on every other aspect of my specialty and focusing on one procedure. Financially this puts me at risk if they ever slash reimbursement for that CPT code. I also worry about what would happen if I ever left my current job and needed to redevelop those old skill sets since I anticipate on having a long career

What are your thoughts? Anyone with a similar transition or move in their early 30s? Would anyone recommend that I reject this proposal?

[Hatton]

Just like you need diversification in stocks you need it in procedures.  Reimbursement for procedures can be dramatically reduced.  I think this would be ok if you were FI.  Also the procedure could be completely replaced by a new procedure.

[ticker]

Doing 50% less work for 10% less pay seems like an obvious decision.  But... several years ago, a lot of people in my specialty were doing only Procedure A.  One year, medicare reimbursement for Procedure A was cut 50%.  Be cautious about becoming a one trick pony.

[VagabondMD]

ticker wrote:

Doing 50% less work for 10% less pay seems like an obvious decision.  But… several years ago, a lot of people in my specialty were doing only Procedure A.  One year, medicare reimbursement for Procedure A was cut 50%.  Be cautious about becoming a one trick pony.

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I totally agree. If you could somehow guarantee that this arrangement continues indefinitely into the future, it would seem to be a no-brainer. Absent said guarantee, it is a risky move to make.

And what if somebody else comes that is also capable of doing Procedure A?  If the hospital is ************************-bent on having a lot of Procedure A, they will not hesitate to bring in more people to do it.

[Craigy]

Pigeon-holing is usually a negative.

 

What is their offer?  Are they cutting your pay 10%?  Seeing how it goes?  Or do you just eat what you kill?

[DwightKSchrute]

hatton1 wrote:

Just like you need diversification in stocks you need it in procedures.  Reimbursement for procedures can be dramatically reduced.  I think this would be ok if you were FI.  Also the procedure could be completely replaced by a new procedure.

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Thanks for the feedback, that is definitely one of my concerns

 

I am in good shape financially (no debt, high savings rate, net worth above average for my age) but cannot consider myself FI yet

[childay]

Can you cut down procedure B to a few days a week instead?

[hightower]

If I were you I would take the offer AND start some side hustles with your afternoons free. I agree with comments about being pigeon-holed into one procedure for the reasons stated.  I have no idea what else you might be interested in or capable of doing, but if you have afternoons free, you could certainly start up another job/procedure/business/whatever.

[DwightKSchrute]

Craigy wrote:

Pigeon-holing is usually a negative.

 

What is their offer?  Are they cutting your pay 10%?  Seeing how it goes?  Or do you just eat what you kill?

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It's eat what you kill so assuming they provide the caseload they're promising, I'd earn more but increasing my morning volume and eliminating afternoons

 

Assuming I don't get any new cases, I'd take a 10% cut by eliminating afternoons

[DwightKSchrute]

childay wrote:

Can you cut down procedure B to a few days a week instead?

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That is an option as well, instead of eliminating all my afternoons, I could keep M/Tu/Wed and have Thursday and Friday afternoons off

[DwightKSchrute]

hightower wrote:

If I were you I would take the offer AND start some side hustles with your afternoons free. I agree with comments about being pigeon-holed into one procedure for the reasons stated.  I have no idea what else you might be interested in or capable of doing, but if you have afternoons free, you could certainly start up another job/procedure/business/whatever.

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That's interesting, I don't have many business interests out of medicine but my wife has been prodding me towards real estate

 

That could be an interesting venture we do together

 

We also have young children at home so I could.simply just spend more time with them

[PhysicianOnFIRE]

The lifestyle change for a small change in reimbursement sounds wonderful, but I echo the sentiment that it could be dangerous professionally to limit yourself to a single procedure.

If there's a way to do some other work in your specialty either with your current employer (maybe one afternoon per week) or as a locum with a different institution, that would be ideal. You don't want to give up all those skills just yet.

Best,

-PoF

[q-school]

too young to give up skills that were obtained through blood sweat and tears.

future is hard to predict.  don't let arbitrary reimbursement rules drive all the decision.  they are a factor, a big factor even, but not the only factor.  one thing that has gotten lost as physicians transitioned to the employed model, is that we forget how much charity care we used to provide.

there were tons of days where I (and everyone) took on all the liability of care but got paid nothing.  didn't matter whether procedure, visit, etc was high rvu or low rvu.  patients still benefited.  community still benefited.  it was part of the messed up health care system we worked in.  someday we may find ourselves not in rvu model and be evaluating how we spend our time differently.

jmo

ymmv

 

[G]

DwightKSchrute wrote:

We also have young children at home so I could.simply just spend more time with them

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Assuming the rest of my financial house was in order, this would be my first line in the conversation.

It's a big assumption about that financial house and I don't disagree with the concerns about profession/skills/pigeonholing.  However, in the blink of an eye, I'll have the rest of my life with no child in the house--I'm taking full advantage of my extra free time by being a healthy dad.  YMMV

[DwightKSchrute]

PhysicianOnFIRE wrote:

The lifestyle change for a small change in reimbursement sounds wonderful, but I echo the sentiment that it could be dangerous professionally to limit yourself to a single procedure.

If there’s a way to do some other work in your specialty either with your current employer (maybe one afternoon per week) or as a locum with a different institution, that would be ideal. You don’t want to give up all those skills just yet.

Best,

-PoF

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Thanks for the advice everyone, really appreciate it

I think I will decline that proposal after all. It sounded great but I do agree with everyone's point of view stunting professional growth so early in my career. I am going to see if perhaps I could just eliminate a few afternoons later in the week (maybe Thurs/Fri) and hopefully that will be the best blend of maintaining diversity in my skillset, spending more time at home, and perhaps flexing those entrepreneurial muscles (or at the least, catching up on all these blogs and forum posts!)