If I’m FI, Now What?

As I figured out in my last post, I think the PiN household is financially independent (FI).

This leads to the next question: will I retire early(-ish), the RE in FIRE?

Although I wasn’t sure about financial independence until I calculated our numbers for 2024, I have had a strong suspicion since the spring of 2024, when my taxable investment account hit, and then blew by, a very interesting round number. For several months, I have been kicking around the idea of stopping work vs. cutting back vs. continuing as I am.

With the financial excuses for why I can’t retire yet out of the way (mostly), I now have to seriously consider whether what I get out of work is worth what I give up to practice medicine.

Should I stay?

In no particular order, what I get from practicing medicine in my current position:

1. Mental stimulation. Seeing patients means that I have to use my brain. Both for the oddball presentations, but also for the bread and butter stuff.
   
2. Making the world a better place. I don’t practice public policy. My efforts won’t change the lives of millions. But for the patient in front of me, I do my best to make things better: address their symptoms, prevent bad outcomes, offer a listening ear. I don’t get a win with each and every patient, but I usually come home with at least one positive interaction per day.
   
3. Socializing. My schedule keeps me busy. Very busy. But on the days I am in the office, I still see my medical assistant, a couple nurses, some partners—all in addition to the patients I see. I spent a few days home on staycation recently and never left the house. Of course, it was freezing with dangerous roads, but the point is that I see many times more people at work than I do when left to my own devices.
   
4. Respect. While doctors can say that respect for the profession is falling, being a medical doctor still garners respect from patients and the general public.
   I give lip-service to “not playing the doctor card,” but I am pretty bad at it. If my loved one is in the hospital, their doctors and nurses usually know that I am on-staff at the teaching hospital in town, and I think we have better discussions. I still try not to be a jerk about it. My students, for better or worse, still treat me with respect when they work with me, as do the hospital staff I work with.
   
5. Financial benefits. I know we are now FI. However, retiring would mean a big change in our finances: paying more for health insurance (which might not be as generous), switching from saving to spending, feeling more vulnerable to the swings of the stock market. Keeping a paycheck means I wouldn’t have to deal with all that for a bit longer. I will also say, getting paid feels like a validation of my efforts, so it also makes me feel appreciated.

Or should I go?

Of course, there are some real drawbacks to working.

1. Difficult patients. You know, the ones who don’t respect you and don’t follow your advice, but get mad when they don’t do better. Then there are the lovely patients who break your heart by getting sick and dying.

2. Difficult work conditions. I’ve been working at the same place since the Great Recession, and I don’t think I’ve ever heard anyone in administration say that things are going well. It’s always worry about reduced reimbursements, or that we are missing targets that other people have put forward.

3. Grading students. I hate doing this. We have a real grade inflation problem at our school, and if I were to evaluate students honestly, most would complain to their deans that they were not being graded fairly. If I never had to assign a grade again, I would be happy.

4. The threat of a lawsuit. I often block this from my mind for weeks on end, but doctors get sued. Good doctors get sued, nice doctors get sued, careful doctors get sued. Bad things happen, and human beings sometimes make mistakes. If you see patients, you increase your risk of being sued. If you retire, your risk of being named in a suit goes down each year.

5. Time constraints. The nerve! Being asked to work “after hours” for a high salary. But seriously, continuing to work means early morning appointments, pajama time for charting, weekends working in the hospital, overnight and weekend call, and not very much flexibility in taking time off.

Nothing but a dreamer

Despite all the negatives, I am not yet quite ready to hang up my stethoscope. I feel like I have a little more to offer my community as a physician (I suspect the professional respect I get may be playing a role as well, to be honest).

However, I really wouldn’t mind getting rid of, or minimizing, some of the drawbacks of practice.

I last wrote about this in 2021, with Building a Better Life, and strangely enough, most of the issues are the same, except that I have already cut back on the hospital work.

With the backing of financial independence, I can think more seriously about cutting out the more annoying parts of practice:

• Keeping my favorite patients healthy and alive forever: unfortunately this is beyond my current capabilities.
• Ditching call and student grading: less likely, but not impossible.
• Changing the focus of my clinical time, from full primary care to part-time in my new specialty: possible, but will require buy-in from administration.
• Reducing hours: the easiest to arrange, and will likely offer many downstream benefits.

I think it’s time to get creative.

Have you cut back at work? How did you prioritize which aspects you kept and which you gave up?