Today I have a case study that delves into many important questions about early retirement, financial freedom and the morality of work. I started interacting with this doc via email and knew I needed to use his case as a starting point for many issues I’ve been wanting to write about for a while now. Life is often much simpler on paper than in the real world, especially when you are faced with the decisions that financial freedom brings. I hope you enjoy this one!
Dear Happy Philosopher,
I’m a doc in my mid 40’s, and due to a combination of good financial management, no major disasters in my life and a little luck, I’m essentially financially independent. I always imagined I would retire early so I could have more times for the things I love to backpack/hike/camp/travel, but along the way I discovered I really like what I do. I know it’s kind of cliché but practicing medicine is a kind of privilege. I work in an underserved area that is chronically understaffed with physicians, and I feel like I make a difference in the lives of my patients. If I leave there is a good chance there would be no one to replace me, at least in the immediate future. This would put a strain on the existing docs and would probably result in less care for the patients who need it. With kids in school and my wife still working and the fact that I like my job most days, I’m having a hard time walking away. Not changing is the comfortable choice.
I still have the urge to travel more and do the specific activities I want to do while I’m young enough and healthy enough to. We’ve had some serious family illnesses and deaths of family members this year and I’m not taking anything for granted these days.
Complicating things further is the moral question of stopping work. Retiring in my 40’s seems selfish, especially in light of the shortage of physicians in my area. What obligation do we have to society to continue to serve patients and the community with our skills and passion? Is it honorable to extract a couple million dollars from the health care system and then just walk away? In particular if I am in a hard to replace specialty or in a hard to recruit to place (or both) do I have a greater obligation?
My late father was a physician who worked until the end. What would he think of me leaving the profession so young? I don’t want to follow in his exact footsteps, but this weighs on me.
How would you approach my situation?
There is a lot to unpack here, and of course I can’t know someone completely through email exchanges, but there many issues worth exploring so let’s dig in.
Freedom and Happiness
On this blog I preach that we should maximize our life for happiness, and one of the main ways to accomplish that is through freedom. This is a major oversimplification though, as happiness and freedoms both take many forms, and at times contradict each other. I feel like this is one of those times.
Happiness is not the same as hedonistic pleasure. It is more of a state of peace and well-being. It is something that we all need to define ourselves, because depending on how you define it you may come to different conclusions about how to act in certain scenarios. For instance, you can work hard, be exhausted, suffer from occasional stress and still be much happier than a person who has his every whim and fantasy fulfilled by armies of servants. Ideally happiness and freedom align, but other times we give up some of our freedom to create conditions we think will bring us happiness. We may also sacrifice one in the present moment to increase the other in the future.
In this example the job affects both freedom and happiness, and I’m guessing for most people this is the case. His job takes some of his freedom from him, but also gives him happiness in the form of feeling needed and valuable to his patients. It also relieves him from the guilt or shame for not fulfilling his perceived moral duty to work and the possible disappointment his father may have felt.
Feelings vs Logic
It is easy to dismiss these benefits from work as nonsense as we parse through them intellectually, but the feelings are very real. We live our life through stories, feelings and emotions. Facts and logic are secondary. We are not immune to the pressures society places upon us, or the expectations of our parents or spouse or friends. We suffer from the same faults, tendencies and delusions as everyone else. The problem arises when these play too large of a roll in our decision making; when we become a slave to them.
Guilt and shame are toxic emotions. Hints of them steer us and shape our moral compass, but in even moderate doses they can become life-destroying. When we live our life for someone else in order to not feel guilt or shame, we are not living true to ourselves. My first bit of advice for this doc is to dig into this and see how strong of an influence others have upon him and decide if it is an acceptable level. It is possible to train our minds to care less about what others think. It is a skill like any other.
What is even more difficult in this case though, is that he likes his job most days. It is hard to walk away from comfort into an unknown emotional state. Humans crave comfort and security. If he was burned out or hated his job we probably wouldn’t even be discussing his case, but does the fact that he enjoys his job even matter from a moral and ethical standpoint?
Morality
Thought experiments can give us a new perspective on a situation. When we are in the middle of something often we can’t see the larger truth at play. Let’s address the moral issue of work first and move on from there.
I strongly believe we do not have a moral obligation to work. This doc asks is it honorable to leave after extracting a couple million dollars from the health care system, but I think this is the wrong question. Honor has nothing to do with it. We work because it is worthwhile to trade our time for some compensation (money, prestige, fame, sense of accomplishment, etc.).
Our job is a trade where everyone presumably benefits. It is not an extraction of money. If we really believe this then we should ask ourselves the question “Is it moral to keep extracting money from the health care system?” Maybe the moral thing to do it to quit and stop taking money from people. Framing is everything. I choose to frame work as something neutral. It is a mutually beneficial trade.
We live in a quasi-free market where anyone can be replaced at any time if the employer and employee disagree on the value of the trade they are making with one another. Presumably our service is of equal value to the money exchanged for it, and we make this trade as long as it makes sense. It really is this simple. There really is no magic amount of work or duration of work where we can nod our head and proclaim:
“Great job! You did your part to society and you are now free to stop. Here is your engraved pen bro, see you on the golf course.”
We should instead have an idea for ourselves of what we want out of our career and life in general. We should contribute to the world because we want to, not because we feel external pressure to live up to someone else’s expectation.
Thought Experiments
Let’s imagine ourselves in a few imaginary scenarios that our doc above could theoretically face:
Scenario 1: You need to move across the country to take care of a sick parent. You give 2 months’ notice and move. You take another part-time job there taking care of upper middle class patients who are not as sick and presumably could do just fine without you as there are plenty of docs in the area.
Scenario 2: You are diagnosed with a neurodegenerative disease that will likely kill you in the next 5-10 years, but wouldn’t affect your ability to practice medicine in the immediate future. You decide to retire so you can spend your remaining time with your wife and kids. You give 2 months’ notice.
Scenario 3: You are financially independent in your 40s, and although you like your job you don’t love it. You have dreams to travel the world while you are young. You give 2 month notice and go follow your passion.
Scenario 4: You get divorced. When the dust settles you fall in love with someone in another state. You decide to move to be with them as they can’t move due to some complex custody agreement. You give 2 months’ notice and move.
I could go on forever but you get the point. There is no difference in outcome to the employer or patients in each of these scenarios, but they feel very different to us. We have different moral judgements about the physician in each case. In each scenario he must choose between working his present job and sacrificing something, or leaving his job and getting something he wants or needs. Who are we to judge which sacrifice is worth making?
I can dream up hundreds of other scenarios and we wouldn’t agree on all of them. Maybe someone quits being a physician to start a biomedical company, or write a book, or teach medicine. Maybe he burns out and sits on the couch all day smoking pot and watching television. Maybe the job ruins his marriage or he becomes an alcoholic. It doesn’t really matter. We are free to make decisions about our work and career. They are personal decisions. There is no need for group morality on this one. Live your life how you want to live it and make no apologies.
Where Do We Draw the Line?
Apparently it is difficult to recruit physicians where this doc lives, and patients will suffer if he leaves. This is a horrible situation of course, but if we have a moral responsibility to work then maybe he should never retire. When does it become ok? Is there an age cut off? What if he develops arthritis or chronic pain? What if he is burned out or depressed? Is there a level of suffering or pain or dissatisfaction when the switch turns and it is suddenly ‘morally alright’ to retire? What if the area where they live becomes horrible for some reason? Are they morally justified leaving this part of the country or should they stay?
Furthermore, maybe he should actually work MORE. If we have a moral obligation then perhaps he should start seeing patients on the weekend or evenings. Why would he take any time off at all as long as there is a need for his service?
Beware of group morality. It is dangerous to your freedom. Society always wants you to do things that you don’t want to do using guilt and shame to coerce you. Don’t give in. My advice is to explore these feelings and make sure they are coming from you, not other people’s expectations of you. It is great to want to serve the community and help society. Most people derive satisfaction out of helping people and making society better, including me, but medicine will take every last minute of time and ounce of energy if you allow it.
We don’t hold many other professions to this level of obligation and morality. Would we be having the same moral discussion if he was the only personal injury lawyer in his city, or the only massage therapist? Of course not. Somehow only physicians have this strong moral obligation to keep working no matter what.
Recruitment
This is another elephant in the room. This doc is working in an area where they just can’t recruit physicians. What this really means is that this doc is being undercompensated for his work. When you are doing a job no one else wants to do you are either underpaid, or your skills are so rare the market is distorted. Physician skills are not that rare. The employer either needs to increase compensation, make the job more appealing in some other non-economic way, or hire cheaper employees. I know this sounds a bit cold and heartless, but if anyone reading this took salary into consideration when they took their first job they did the exact same thing as this doc.
Another thought experiment…
If it is not moral to leave a job that is understaffed and impossible to fill, then is it equally immoral for someone else to not take this job instead of another one where there is less need? Let me explain. When most of us look for a job we look around and see who is hiring. We then take into consideration a whole bunch of factors and pick the one that is best for us. Usually we pick selfish things like money, benefits, schedule, how ‘good’ the schools are and how nice it is to raise a family. Seldom do we do research on where we would be needed the most. Seldom have we argued for lower compensation so the hospital can hire more docs if short staffed. Maybe there are a handful of docs who have done this, but I don’t know any. More typically they will take the best job they can find…for them. Sometimes they will do volunteer or medical charity work somewhere, which brings me to my outside of the box thinking.
What if…
When we are free we have the power to shape our jobs any way we like. This doc is financially independent. He can do whatever he likes. So why not create a job that he loves which is a win-win scenario for him and his employer?
Everyone is a Winner
Always try to think in terms of win-win. This is how you get what you want from life and make the world a better place at the same time. There are really three entities here to consider: The doc, the employer and the patients. They all have different needs, goals and constraints, but it would be nice if we could find a win-win-win scenario. Since this doc is financially independent he really doesn’t need the money. He could work for free if he wanted (or for some nominal salary and health insurance which is enormously cheaper for a system to buy than an individual). Why not create your ideal job that you will love to go to each day and do it for nearly free? If you want a month off each summer to travel, no call and 0.6 time work, tell your employer you will do this job for pennies on the dollar and they can take the extra money to hire another FTE. Everyone benefits from this – the patients which will have more docs to see, the employer who has more resources to hire docs, and the doc who has created his ideal job.
If you are providing more value than you are taking, they will not say no. If they do they are foolish.
Anchoring
Humans are really crappy at seeing absolutes. We only know if something is good or bad, normal or abnormal by comparing it to what we see around us. Take full-time work for example. Everyone around us works 5 days a week, 8-10 hours a day. This is what we see so we call it normal. If we work 70 hours a week we are a crazy workaholic. If we work 15 hours a week we are a lazy bum.
One of the things I try and get people to realize is that what is ‘normal’ in society is often completely arbitrary. Why don’t we work 4 days a week? Or six? Why are there even 7 days in a week anyways? Why don’t we work 6 hours a day, or 11? It’s arbitrary. Just because society organizes behind some idea doesn’t mean you have to. Don’t anchor to whatever a FTE is in your job. Figure out what is right for you and create the job. If you are financially free you have this power.
At the end of the day all that matters is you follow your own personal code of morality and do what is right for you and your family. My gut tells me if you really like your job you should keep doing it, but make it a better one. Create a job you would do for free or nearly free and do it, not because you need the money, but because it will give you a sense of meaning and purpose in your life. Work part-time for a while and see how it feels. Take a sabbatical and travel the world.
Do whatever you want because you are free, but if you end up quitting work be honest with yourself about how it will impact you psychologically. I think many docs (and other high identity/ego careers) would do well with a gradual transition to less rather than an abrupt end to work, which probably defines a big part of who they are. Do not underestimate the power of ego and identity.
Summary
This doc is in a position most of us would love to be in. He is financially free in his 40’s and likes his job. Having a job you like and being financially independent is one of those problems I think many of us dream of. Life is not always so simple and straightforward though. When we are financially free, then we have to take more responsibility for our lives. Life is simple when there is only 1 path. It’s easy to make decisions when there are no choices. Without financial freedom it is a no brainer for this doc to keep working, but this is not the case. He is free to choose.
What becomes difficult now is the paradox of choice. We can become paralyzed with making a decision when the options are endless. We have to justify our decisions to ourselves because there is no longer the excuse of having to do something for money. In some ways the more financial independence we have, the more stress we can feel.
If I were in his shoes I would try and create a job that I loved instead of just liked. Don’t ignore feelings of guilt, obligation and personal morality, but make sure they are coming from you and not some external group. It’s not wrong to keep working and it’s not wrong to walk away, but it seems like there is a middle path that is optimal.
What do you think? Do we have an obligation to work? Where do we draw the line? How would you advise this doc?
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This was a timely read for me – I have been sprinting toward retirement in the hopes that I can retire in my early 40s, similar to this doctor. However, as much as I like to fantasize about what that would be like, I would probably also struggle with the same issues he brings up in his letter. I really appreciated your breakdown of group morality – it’s given me much to think about over the next 10 years til I achieve FIRE!
Thank you. I will dig more into the importance of cultivating individual morality and ignoring group morality in another post 🙂
I retired and hated it…moreover my wife hated it even more.
do tell.
Thanks for sharing this. We hear all too much from the “FIRE” community about the coming bliss of early retirement.
Hey, Ted – I’d be interested to hear why you hated retirement and what you’ve done since then to deal with it.
I took an “early retirement” from a prestigious, well-paying job that I enjoyed and where I was well-respected when my non-American husband’s parent became sick. So, I moved to a European country where I didn’t speak the language and had no friends except my husband.
This was about 1.5 years ago and I still struggle with a lot of things regarding the move and leaving my job. I can passably speak the local language now, but have very few friends (and no close ones) and miss my friends and life in the US, although there are many good things about living here as well. Even though I don’t need to work, I’ve applied for many jobs but have not received even a call back. A large part of my problem that I miss feeling competent and like I’m making a significant contribution – my job was a significant part of my self-worth and how I thought about myself.
I would be curious to hear how others deal with these feelings when leaving the work force.
Wow. Another fantastic and timely piece. I agree with THP that there is no moral obligation to work and that the duration of our work week or career is entirely arbitrary and fluctuates considerably both geographically and historically. What’s right? What’s wrong? I believe that it really is up to the individual to decide how much of our life force and personal freedom/happiness we are willing to trade for the salary, prestige, security and even satisfaction that a career in medicine provides.
The difficult part of this, as I have found out firsthand, is navigating the various reactions that choosing freedom elicits from patients, colleagues, friends, family members, even spouses. The group-think that governs work week or career norms in our society is very strong and one that very few people are willing to even question (not unlike ones religion or politics). It takes far more ego strength than I realized to swim against these norms. No matter how much thought or time you have spent on the topic, you will still be unprepared for how abnormal you seem to many that you encounter.
I would likewise echo THP’s recommendation regarding finding some middle ground, i.e. creating your own career that allows you to receive both the personal satisfaction of providing excellent medical care to those who need it and the freedom and time to pursue all the other avenues that life has to offer that you have never had the chance to pursue. This is the path that I ultimately took (albeit later than you: I’m 52 and a lowly pediatrician 😉 ), and despite the burden of others’ scrutiny and judgement re my being a physician who works ONLY two days per week, I am gradually attaining the serenity I need to navigate the fickle waters of societal norms.
Good luck!
Thank you for the thoughtful comment. I would love to hear more about your experiences with choosing a different career path, especially since you are firmly on the more clinical side of things (peds) than me. Email me 🙂
Another great piece!
Everyone is different. Financially I could have retired in my forties. I worked full time until 50 then went part-time. That worked great for me.
I have mixed feelings about work. I don’t think others are obligated to do it. I do feel I have devoted my life to service though. Work provides meaning and structure that just feels right.
Thanks Wealthy Doc. I think we all have mixed feelings about work. Even on my busiest and most stressful days I still feel like I’m making a difference and helping people, it’s just that sometimes it is not enough to counterbalance the negative. Balance is the key.
Thought provoking, balanced, helpful. I failed retirement twice. Now that it is reality, I miss the fascinating problem solving, my smart, funny, dedicated colleagues, and the feeling of satisfaction going home knowing I helped someone today. By comparison, full retirement is an empty feeling. Strongly agree with THP to engineer your perfect shortened hours or part time job, take sabbaticals to travel, hike in the mountains and spend more time and activities with your kids before they have flown.
Tony the rad
Thanks for sharing this. We hear all too much from the “FIRE” community about the coming bliss of early retirement.
I would love to hear more about your experiences with retirement Tony. Email me 🙂
Excellent analysis of “The Physician’s Dilemma” and the interplay of freedom, happiness, morality, and market trade offs.
Awesome and thoughtful response HP. I love this –
Why don’t we work 4 days a week? Or six? Why are there even 7 days in a week anyways? Why don’t we work 6 hours a day, or 11? It’s arbitrary
Now we’re getting deep! But my mind thinks that way, and I’ve asked those same questions before. Virtually all of our cultural practices are just arbitrary fabrications made long ago for some reason that just doesn’t matter anymore. It’s best to try to wipe the entire slate clean and try to create what you want from an empty canvas. But that’s hard indeed
It is tough to do, but I’ve found now that I “get it” is is hard to accept the arbitrary without fully questioning it. The curse of thinking deeply all the time 😉
Good post on a common problem. I am close to FIRE in late 30s (basically there) and see this exact dilemma arising for me in about 10 years. I wont have the underserved problem, but I don’t see that as my problem anyway. As you point out, that’s a systemic problem of recruitment, reimbursement, etc. That is not an individual physician responsibility, at least not one that is already full time clinical care.
I like this quote from your post:
Society always wants you to do things that you don’t want to do using guilt and shame to coerce you. Don’t give in. My advice is to explore these feelings and make sure they are coming from you, not other people’s expectations of you.
Society is defined by me as “anyone that is not me”. Including my wife, kids, previous nuclear family, etc in concentric enlarging circles until I reach the media. While not an atheist like her, I do believe in objectivism created by Ayn Rand and the virtue of selfishness. I agree with you HP that we need to “dig deep” to ask ourselves if what we want is what “we” want or what others want of us for whatever reason (using us, fulfulling societal expectations, helping us, etc).
It’s the old adage “know thyself” and its damn hard and takes me constant practice. Incidentally, I have found mediation to help.
Also, I hope your back is feeling better. I got hit by a car while crossing the street about 3 weeks ago to see a patient the other day. Sent me to the ED for a $10,000 ride and tests. Got some shoulder issues and was thinking of you and the posts you wrote about your back pain.
Wishing you a speedy recover GLMD, hopefully nothing too serious!
You may enjoy the book “How I Found Freedom In an Unfree World” by Harry Browne.
Meditation is a great way to get to know yourself and be comfortable with your thoughts. Many dilemmas can be simplified by just being more aware.
You have a great talent for deconstructing a question and dilemma such as this one. Posing alternate questions and flipping the script shows how the way in which the question is framed can change the way we approach it. Nicely done.
Best,
-PoF
Thanks PoF, much appreciated 🙂
Thought provoking post. None of us should feel morally obligated to continue working. Once financial independence is reached it becomes an individual decision. Started slowing down in my later 40s to the decision to retire completely in 3 months. Retirement needs to be individualized.
KEEP WORKING BUT DON’T WORK AS HARD! i’m a physician as well and could have retired some time ago. but i like my work, in spite of the occasional stress involved. starting about 10-12 years ago, i made 2 huge changes in how i practice, though.
1. i take a lot of vacations. 2017 was a new record for vacation time – 13 weeks. i go on hiking trips, trips to visit family, foreign travel, whatever. i have a partner so i have built in coverage when i take time off, which makes it easier.
2. the weeks i work, i work less than i used to. about 10-12 years ago i was seeing 125 patients/wk. now when i’m working i see about 75. a much lighter load, less paperwork, fewer issues to argue about with pharmacy benefits managers.
as an aside, so far in 2018 i’ve experimented with taking some shorter vacations- creating 4-5 day weekends for some shorter trips. i’m not sure yet what i think about this structure, but i have the freedom to experiment.
First, congratulations to the physcian for managing his money to reach FI in his 40’s. I don’t think he should feel a moral obligation to continue to work where he is, but the satisfaction he probably feels helping others and making a difference is important. The beauty is, he has choices. He can choose to continue working as much as he does now, not at all, or anywhere in between. There is no one right answer for any of us, but it is a great point to get to, to have the choice. I look forward to getting there.
Great post, THP! I think your advice is spot on. When I am in my mid 40s in the same spot, I plan to kick out all the things I don’t love about my job and to focus on what I am passionate about in my job. I may even do things I don’t get paid for (i.e. resrarch).
Freedom is so important, and moral obligations can seem huge as physicians…but we are not the only ones that carry them. So do our employers.
It’s all about choices. Sometimes they can be tough, just like this one.
Thanks for the thought provoking post!
TPP
I don’t think there is this much philosophy involved. My experience is once you reach FI you work till you’re done. I retired once, and found I wasn’t done. I was stuck in the mode of being a human doing and not a human being. At some point about 4 years ago, we closed our practice and hired into a big corporate group who took over our previous contract and became salaried physicians. It was the beginning of the end. We shut down because managing a small group practice became too time consuming and legalistic and we didn’t want to leave the center where we were working uncovered much like this doctor. We built the place from scratch and felt obligated till we found a solution. Once found, thus ended the moral dilemma. Hire somebody else to be the manager. What I found was corporate medicine sucked, so I was done, and by design it was somebody else’s problem to provide continuity. I didn’t find “slowing down” to be practical at all. If you “slow down” somebody else just has to pick up your slack because the work never ends. If anything it increases and everything is interdependent. At some point I realized continuing to work was just inviting liability since I didn’t need the money. The patients continued to be cared for regardless. My ex-partner quits at the end of March, he’s done. The place has 2 new gassers. Life goes on. Now retired I am ecstatic. I do what I want, as much as I want, whenever I want. Freedom’s just another word for nothing left to loose. Grabbing your “career” so hard it has fingerprints, no matter the rationalization, is not freedom.
My sister has a corporate job. She turns in her resignation and FIRE’s tomorrow. She worked and now she’s done. She’s so excited it’s a total gas to listen to her prattle on. She just finished writing her first novel and she’s going to spend a year in Alaska. Chick’s got her some goals!
Hello HP!
This all goes back to “know thyself”. I reached FI when I was 36 years old. I just wanted to be home with my children. Although I am good at delegation, I realized that fitness and relationships are not things I could pay someone else to do for me.
So I was a young female family doctor who stopped practicing at 36 years old. In Canada, female GP’s are in HUGE demand even to this day. I recall the first time someone said to me “you wasted the government’s money to help train you”, I just about busted a gut laughing my head off. I had never heard of anything so insane.
I knew exactly what I would regret and that would have been missing out on my children while they were growing up. Now that my youngest is heading to university, I am happy to work more in Medicine.
Life is just NOT that binary.
I am an RN who worked until age 62 but only because I loved my work. Hubby and I reached FI decades earlier so money wasn’t a factor in my continuing to work. He is a retired surgeon who mostly loved his work but the stress of being on call for a large hospital system with a Level I trauma center wore him down and he retired long before me. Two years later I struggle with exactly the same guilt as the writer. RNs are in short supply and even though I’ve developed a lot of activities in retirement, I miss the patients and the intellectual challenge of work.
I’ve been looking at part time opportunities and I suspect the answer for me is going to be some type of work as an RN even if it is unpaid. I agree with the other comments that the writer might want to try part time work as a first step.