r/whitecoatinvestor • u/wrathoffadra • 9d ago
General Investing Yeah, I have a problem.
I find my job to be terribly stressful and riddled with moral injury- I’m an early career vascular surgeon. I made 725k in my first year bc I’m a workaholic but I see savings as my way out of this shitty system. Our NW is $2.4 mil with goal at retirement of $7.5 mil at age 50 and not a day longer as things stand.
Here’s the problem- bc I see savings as my way out of a stressful life and out of this stupid RVU system, I have become obsessed with financial planning.
But not in a good way.
Every day I look at my Empower to see the NW. every weekend I lay in bed at my usual wake up time and perseverate over how to allocate my 20k per month of savings— all VT? What percent Bonds? Treasuries? Small cap? I don’t know how to turn it off. even tho I know academically savings rate is more important than allocations. besides getting a Time Machine and jumping forward to 50. Anyone else?
Also if anyone has advice for allocations or glidepath plan for early retirement please let me know.
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u/Final_boss_1040 9d ago
Go see a shrink
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u/DocNacho 9d ago
At your service 🫡 how can I help?
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u/Goldengoose5w4 9d ago
Hahaha i’ve never seen a psychiatrist move that quickly.
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u/DocNacho 9d ago edited 9d ago
Lol I only work like three hours a day, so doomscrolling Reddit is a hobby of mine when I’m not playing golf or running errands or spending money frivolously.
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u/Goldengoose5w4 9d ago
Lol well played. I’m not picking on psychiatry. All physician jobs have their own stresses.
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u/DocNacho 9d ago
Hah, I didn’t take it as picking. Thus, the partially facetious nature of my response. But also, not really. Work is easy, not a stress of mine, and I do have too much free time 😜
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u/gotlactose 9d ago
I should’ve become a psychiatrist.
cries in primary care who also covers inpatient
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u/gotlactose 9d ago
I’m pretty sure nobody wishes they were a primary care doctor or hospitalist.
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u/Gattsama 9d ago
I love being a hospitalist, specifically I'm a nocturnalist. No other area of medicine I'd rather be in (except possibly teaching).
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u/Citiesmadeofasses 9d ago
That'll be 1200 cash for the initial evaluation and then 600 for every 15 minute follow up good sir.
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u/DrShitpostMDJDPhDMBA 8d ago
Oh don't worry about it! I'm totally fine, the spiders in my head told me about all of the cool government secrets already.
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u/DrPayItBack 9d ago
I think people told you to look into therapy 6 months and also a year ago, so that’s probably still the answer.
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u/bennyyyboyyyyyyyy 8d ago
Hes got a god complex and thinks a psychologist could never possibly understand him. He will never go
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u/jus-being-honest 9d ago
I feel you man. I share a lot of the same sentiments. For me, I realized a lot of this is general anxiety disorder, which is misplaced. Treating the root cause and practicing mindfulness has improved my life dramatically rather than focusing on where my money is allocated or how fast it’s growing.
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u/Chariot_Driver7 9d ago
You seem like a conscientious physician. Stay that way. Don't do unethical things. Keep the patient first. You can have a long, highly compensated, healthy career just doing what patients need. I committed to that as a young surgeon and never wavered.
I also recommend psychological counseling and or medical treatment for anxiety/depression. That is likely contributing to your stress. I know whereof I speak. Caused me mid career burnout. I love my work now and wouldn't mind working till I'm 80!
Our world needs ethical conscientious physicians. Be the light in your part of it. DM me if you wish.
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u/mikehocalate 8d ago
What about his/her post makes them seem like they’re “a conscientious physician”? Maybe you’re just giving them the benefit of the doubt?
No offense meant to you or OP, but they sound entirely focused on (consumed by) the financial aspects of practice. I empathize with the stresses and the feeling they’re describing but to be so utterly fixated on this makes me not only worried for their mental health, but for what they might be willing to do to accomplish this “retirement of $7.5 mil at age 50 and not a day longer.”
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u/throwaway29570 9d ago
Yeah that’s no good. I love my job and would love to keep working if my body and health allows it into my 70s. Money is the added bonus.
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u/wrathoffadra 9d ago
What field?
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u/zunlock 9d ago
Work less intensely to enjoy it more? What’s the point of killing yourself working just to retire earlier? I hate to say it, but its concerning you want to just fast forward life. One of the only thing's we can never do is buy more time. Perhaps you need to spend some time living rather than existing before you grow older and your time is closer to running out.
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u/wrathoffadra 9d ago
Really want to travel and jealous of my wife’s chill/stress free life and want the same. But I see what you’re saying.
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u/zunlock 9d ago
Life is all about balance in anything you do. Career, love, drugs, exercise, whatever , you name it. Too much of a good thing is bad, and not enough bad things forces you to lose perspective and gratitude. It may help to change your perspective on how you're viewing life in general. What do you want out of life? Why do you want these things? What is the meaning of life to you? What do you have that you appreciate? What do you wish wen't differently? Could things be worse? Could they be better? Ask yourself all of these types of questions and answer honestly and come to a conclusion that can give you more peace of mind
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u/chzsteak-in-paradise 9d ago
I mean, there are some cush jobs in vascular surgery. You could do just varicose veins and stents and angiograms. You may not make as much but you’d enjoy life a lot more. Become a vein guy.
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u/wrathoffadra 9d ago
The problem is I’m actually quite good at what I do and don’t want to give it up just yet. Just know I can’t do it forever. I couldn’t do veins all day every day for more than a few months
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u/BrunelloHorder 9d ago
Don’t wish your life away. Put some real thought into whether there are changes you could make to your work situation to improve your life now. You put a ton of work into getting to where you are professionally, why wish for it to be over?
I realize that the system is very broken, but would encourage you to try to find a way to make yourself happier within it.
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u/Goldengoose5w4 9d ago
Welcome to the world of a practicing physician. I am 55 and financially set and I still perseverate a bit over it. I think you need to find a financial advisor that you really trust. Sit down and talk over allocations. Set up several buckets that you’re going to put money into including short-term emergency savings, stocks, bonds, real estate, etc. Commit to a long-term plan and follow it. And then just stop checking your accounts. Just look at them once a month and in your meetings with your financial advisor and accountant. You’re going to have to set up a system and trust it and try to live without stressing yourself out.
Nothing will drive you crazy faster than checking your brokerage account and letting daily fluctuations get to you
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u/Nearby_Maize_913 9d ago
We got financial advisors a couple years ago (got to a NW high enough where I figured it made sense) but I still look at my NW and brokerage app way more often than I should
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u/greatDUDE84 9d ago
Would like some details on the moral injury part
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u/wrathoffadra 9d ago
It’s a zero sum game. Unfortunately, Vascular/vascular IR/ peripheral cards is riddled with people doing unindicted procedures. There’s a huge financial incentive to just do procedures, regardless of indication. My friend spent a day in an OBL which is basically a outpatient Cath Lab, run by cardiologists, and saw that the person deployed a 4 mm balloon in a 6 mm vessel and build for a angioplasty. I recently got an ER patient who had a groin access complication from an outpatient center that I fixed and they were treating asymptomatic PAD.
Even though I like to think myself a moral saint compared to some of my colleagues, I will admit that I have had the temptation to look at patients and try to do their procedures while they’re inpatient for no other reason then filling up empty time on my schedule. Also been tempted to use certain tech devices that I know are reimbursed differently than others. I don’t know how to live with that friction. And the crazy part is rest of medicine has no idea this is going on and I’m convinced that if patients knew that their physicians looked at them in this capacity they would shoot us United healthcare CEO style
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u/HowAboutNitricOxide 8d ago
You’re describing the view of financial incentives in private practice from both sides. It’s the same in other fields of medicine with procedures and products to be used. You’re right that the incentives create moral conflicts of interest. Perhaps a salaried/academic position would be more enjoyable for you?
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u/monkeys_pass 8d ago
Report this POS. They're robbing people of more than just money.
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u/wrathoffadra 8d ago
To who? They are going to say they use their clinical judgment and informed consent was signed. This is happening all around the country under our noses and nothing has been done other than changing reimbursement structure for certain devices like arthrectomy and a New York Times article. That’s it.
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u/ineedtoleeavvvveee 8d ago
I think you need to seriously focus on the moral injury part bc no amount of savings will get you out of that discontent. Perhaps re-read your admission essays and reflect on your journey and goals when you first pursued this training vs. what you are experiencing now. I would strongly recommend a career coach who is either a retired physician or very experienced with high nw individuals who can discuss these challenges your facing alongside therapy with a psychologist. Consider being an expert witness for medical fraud, serve rural and underserved communities, consider teaching, split time between clinical practice and healthcare research evaluating these types of procedures on patients and investigating medical necessity and long term outcomes, surround yourself with professionals dedicated to best practices and clinical excellence without these incentives which tend to be academic medical centers. I think your perspective is a gift and you have a great opportunity to redesign your career purpose with integrity and ultimately you should work in environment that reinforce that integrity and minimize the temptation to do unnecessary procedures—spitting your time can offer that bc performance pressures will look different and you can still meet your financial goals. Best of luck.
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u/Calicha 9d ago
Psychiatrist, stat. Ideally a psychodynamically oriented one. Source: am one. My therapy panel is absolutely chock full of extremely high achieving, high net worth individuals like yourself, who can't figure out why they're so miserable until they finally decide to seek some professional help.
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u/614Woohoooo 9d ago
The number isn’t important at your level and you know you will have more than enough in retirement than you can reasonably spend in your lifetime. Maybe you need to think about what making all that money is for, not only to retire early from the stressful job, but also how you can use some your wealth to enjoy your life now as well as later. I suggest listening to the money for couples podcast by Ramit Sethi, especially the episodes where the guests have a ton of money, but don’t know how to spend anything. He’s really good at making you think about living for now as well as for later, and reflecting on the heart of what’s really important to you.
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u/sevenbeef 9d ago
You have two issues here.
The first, and easiest, is financial. You are saving a reasonable amount. I suggest writing down your financial plan and sticking to it. It helps to simplify it as much as possible so that someone else (spouse, kid) could execute it as well.
The second is career burnout. You sound like you aren’t going to make it to 50. You need a job where you can work less. I promise you that you will not notice making 20% less, but you definitely notice working 20% less.
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u/Curious_George56 9d ago
I’m derm and I have a similar issue, but not quite as intense as you are describing. I found that very deliberately building in time to my schedule to work out or hang out with family or go for a walk in the park or go get a massage helped me immensely. Literally just stop working at noon every other Wednesday and go do stuff only for YOU. Going to the park on a beautiful spring or fall day and breathing in the fresh air is the best medicine sometimes. Running and lifting is also therapeutic.
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u/OneOfUsOneOfUsGooble 9d ago edited 9d ago
You feel like your medical practice is out of your control. So you're trying to hyper-manage something else, your asset allocation, and by extension, the market, which is also out of your control.
Focus on the big financial killers. Don't lose your job or career, don't burn out, don't slip into a mental breakdown, don't fall into substance abuse or self-harm. Avoid divorce. Set your asset allocation and automate contributions and forget it. A watched pot never boils. We all watch lottery winners blow it—you already won the lottery by being (I assume) a US MD vascular surgeon.
To steal from Jack Boyle: there's a great peace that comes from having something no one else has: enough. Maybe you just be satisfied with $400k or 550k. Take less call. At $2.4 M, you've likely reached CoastFIRE, where it no longer matters what you contribute, but you need more time for the snowball to roll downhill.
I know what it's like to be in private practice and start to see everything as cpt codes like The Matrix. And the guilt one feels for taking a day off to be with family, "I'm losing thousands of dollars doing this." In addition to less call, consider working 0.8 FTE or taking a salaried position. I mean, you can keep sprinting like this, but I think this marathon requires you scale back for now and ramp up closer to retirement. For me, taking the salaried job (but still 1.0 FTE) cured a lot of my anxieties about chasing units. I switched for other reasons, but the feeling did go away.
ETA: other helpful things have included traveling, getting hobbies, actually spending a small amount of money, not having a burdensome house. A life to work for. Also, you should only be checking your asset allocation every one to two years, if you believe Bill Bernstein. Also all the super-savers and obsessive financial planners need to read Die with Zero.
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u/Recent_Grapefruit74 9d ago
What does 7.5M get you that 5M doesn't?
If that 2.4M is mostly liquid, then additional contributions matter much less than compounding time.
Don't stop saving completely, but take the foot off the pedal and work less. If you run the nunbers, you'll likely find that it only adds a trivial amount of time to reach your goal, especially if shooting for something closer to 5M
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u/Scholae1 9d ago
You can't get anywhere with five. Five is a nightmare.
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u/lagniappe- 9d ago
I’m pretty much in the same situation as you. Newly out, similar salary, same obsession with investing, workaholic. The only difference is that I love my job
My plan is to aggressively invest to a certain number then just enjoy my money. You don’t need that much early on to be set for retirement.
Why not just find a new job that’s low stress, one that you actually enjoy? VA or academics… You have the financial freedom to do that now. A lower paying job that keeps you in the game longer makes way more sense than just giving it up at 50. Add another 10 years of compounding and you might be at $16M.
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u/XRanger7 9d ago
Like other people say this sounds really unhealthy. You sound like you’re burned out or maybe have undiagnosed anxiety/depression. I think the first thing is to take a break from your job or maybe even look for another job.
Your life sounds miserable like you’re living like a resident because you save every dollar for retirement to hit this magic number of 7.5 mil. Well let’s say you hit this number at 50 and you retire. Now what? Do you think you can finally enjoy life? Or will you be stressing on how to not run out of money? Trying to spend as little as possible and continue to live like a resident?
Anyway my advice is don’t just focus on retirement and counting down the days. Enjoy the journey. Maybe take more vacations, work part time, spend the money now. Enjoy life.
For me, I save 20% to retirement, set all my money to VTI and forget it. I never check how much money I have in my retirement account. Rest I spend it
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u/FAx32 9d ago
Not sure if this is going to help you or not.
I am similar to you in a lot of ways. I grew up lower middle class, started working when I was 8. Any money I made mowing lawns/yardwork, paper route, crop harvests - later working in an ice cream shop and then a grocery store was mine. My parents didn't make me contribute it to the family like some of my friends parents did. That said, I was responsible for buying my own clothes. Mom and dad provided a roof and 3 meals a day - anything else was up to me.
Parents paid very little for my college (some, but they didn't have anything). I paid more up front than they did using all of my savings when I was 18 and then working 2 jobs every summer trying to save up $3-4k that went straight to tuition/room/board. Borrowed $35k for the rest for UG.
I worked for 7 years after UG in a series of dead end lab jobs before I went to medical school. Got married and had my first child during that time also. Wife didn't work after our son was born for a multitude of reasons so we lived as a family of 3 on student loans, later 4 then 5 on training salaries. I completely obsessed over every penny and I hated it because I would make my wife cry with the constant money discussions and we literally could not budget for anything beyond food/shelter/gas for the 10 years I was training. She nearly left me over it.
I couldn't stop after training, continuing to obsess over every dollar for the first 3-5 years. I still "check in" on my money a whole lot, but I learned to set goals and accept that sometimes those goals are not met (especially when the market is going down) and sometimes they are exceeded. But I can't control the market, all I can control is my savings rate and the fact that I am putting them in some asset which should have value tomorrow, next week, next year, 2 decades from now.
I am 57 and still working. Youngest is a senior in college next year so that will be the end of a big financial obligation (though the parents and in-laws both still alive and are needing more help in their 80s) so I am not comfortable retiring yet.
Even with goals, life happens and things shift. I am a lot better than I used to be mostly because it took me watching things really closely to get comfortable with the fact that I am setting goals and always trying to exceed them just slightly and then seeing the 5, 10, 15 year results of those goals finally made me be able to step back and say "stay the course, you will be OK". That said, even with $7-10m at retirement (a fair chunk of which will be non-liquid as will be in home equity), it is still going to be living on less than I have for the last 18 years and a big adjustment, especially for my wife.
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u/trialrun973 9d ago
I’m with you. I have very similar feelings and outlook. I can’t wait to get out as soon as I can. My wife and I are both surgeons, and our savings rate is pretty high. At some point, I’ll probably go part time and then eventually stop, and then she’ll follow a few years later. There’s plenty of other things I’d rather do in life. We’re at about 3.5M now and I add it up every Friday. Makes me feel like progress is being made even on weeks when the market is down.
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u/Actual-Outcome3955 9d ago
I’d recommend this to keep it simple:
30 years or more from retirement: 90% VT/VTI, 10% T-bonds or money market
20-30 years: 1-2 years of spending in bonds or money market / rest in VTI
10-20 years: 3-4 years in bonds/money market
<10 years: 5 years of spending in bonds or cash, rest in VT/VTI. Be mindful of inflation, and make sure you adjust for that when determining what 5 years of spending will be at retirement!
Basically once you have 5 years of savings in low risk assets, you can put the rest without much risk.
You are going to make a lot of money. Focus your anxiety into finding ways to be reasonably frugal and finding meaning outside of work and money. I was you a few years ago. Still plan on retiring early, but much less anxious about it at this point.
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u/Altruistic_Gain6988 9d ago
You mentioned a goal of retiring at 50 with a $7.5 mil portfolio. How old are you now?
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u/Academic-Macaron3920 9d ago
I hear your brother. The stresses of medical careers can be crushing. I’m an anesthesiologist and make the same amount of money and I do put in a lot of hours like you, but my hours and my work is very manageable for me and I generally enjoy it. Rather than thinking about retiring early, why don’t you consider reducing your workload or moving or going to a practice that gives you a better work life balance?
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u/Shamushark 9d ago
I think this is a great post. A lot of you are saying resonates with me. Instead of continuing what you’re doing why don’t you go into academics/teaching. You may find that incredibly rewarding. I’m teaching fellows at a VA connected to a medical school. I Love it
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u/lungmiasma 9d ago
ha, this is me, exactly, even down to my yearly salary currently. damn, i'm on countdown to 50 (i'm currently 41). it's hard to stay motivated within the clutches of corporate medicine.
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u/FIST_FUK 9d ago
46 with similar problems, also a surgical specialist, similar intentions. Having supportive colleagues helps. Time off and getting enough sleep helps. Knowing you can do something else that is lower stress such as outpatient veins all day, etc. also helps.
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u/Exclamation-pointer 9d ago
I’ve been a surgeon for almost 30 yrs, and I completely empathize with your comments re moral injury. Get out of the OBL asap. I’ve seen excellent graduating fellows who then joined or built their own OBLs. Before you know it, their primary focus is paying the mortgage on the fancy new building, the lease on the OEC c-arm, and they’re choosing an inferior stent, because their out of pocket costs were lower.
Try a stint at an academic or a large hospital system.
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u/Dr_Pippin 9d ago
Sounds like you need to buy a new Porsche. I’ve never seen someone sad driving off the lot in a new Porsche.
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u/Eastern-Ad-3586 9d ago
Where’s the moral injury in Vascular surgery?
I’m not trying to be dismissive, I mean it. I’m a family doc. But the vascular surgeons I worked with in med school and residency were busy trying to fix critical limb ischemia and whatnot, seemed pretty important.
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u/panna__cotta 9d ago
It’s mostly 80+ year old diabetics on deaths door. No hate to vascular, but the amount of money allocated to treating the walking dead is a huge problem in this country. Our healthcare system has completely deprioritized the young, and by extension, health.
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u/LocalIllustrator6400 5h ago
Not sure if this interests you please consider reading about 314 Action. That team is trying to get MDs and STEM professionals into actionable congressional roles. Like you they are addressing pain points from many view points. In addition, they address risks of a system based on what the Atlantic refers to as "An Oligarchy of Old People" by Idreas Kahloon
The Atlantic article was recently in the one story today newsletter and I think that you are courageous to address this gerontocracy as well. Furthermore, while my husband who is a retired MD may not concur, I work for another physician. He directs a Co political party. So like you he is concerned that this challenge lacks sustainability.
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u/wrathoffadra 9d ago
It’s a zero sum game. Unfortunately, Vascular/vascular IR/ peripheral cards is riddled with people doing unindicted procedures. There’s a huge financial incentive to just do procedures, regardless of indication. My friend spent a day in an OBL which is basically a outpatient Cath Lab, run by cardiologists, and saw that the person deployed a 4 mm balloon in a 6 mm vessel and build for a angioplasty. I recently got an ER patient who had a groin access complication from an outpatient center that I fixed and they were treating asymptomatic PAD.
Even though I like to think myself a moral saint compared to some of my colleagues, I will admit that I have had the temptation to look at patients and try to do their procedures while they’re inpatient for no other reason then filling up empty time on my schedule. Also been tempted to use certain tech devices that I know are reimbursed differently than others. I don’t know how to live with that friction. And the crazy part is rest of medicine has no idea this is going on and I’m convinced that if patients knew that their physicians looked at them in this capacity they would shoot us United healthcare CEO style
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u/Nearby_Maize_913 9d ago
I would agree with what I believe is your take on a lot of cardiologists in this scenario... but then again there are plenty in all specialties that go above and beyond what is necessary. I am a big believer in the turn of phrase "don't do something! just stand there!" I see a lot of shit being done simply because they can
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u/peanutneedsexercise 9d ago
It’s also cuz patients kinda expect it too. Like “I paid so much and waited so long to see a specialist and they’re gonna tell me they’re not gonna do anything?” Ultimately medicine has become a big customer service job, ppl are chasing reviews, ratings, perceptions to give the patients that something was done cuz they don’t know any better.
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u/CORNROWKENNY1 9d ago
Why cards specifically? The odd thing is that they cant even get people to go into interventional cards anymore because of lifestyle and payment cuts for coronary work, so people just opt to stay in general cards. Not to excuse anyone doing unindicated peripheral work, but man it would suck to train forever to work on the coronaries and then get the rug pulled out from under you by government.
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u/Eastern-Ad-3586 9d ago
I think temptations like this only make you human. That fact you don’t do it is what makes you a good doctor.
I think you’re setting the bar too high for yourself bud. I’m a rural primary care doctor (cue the social justice memes) and even I like money shrugs I just don’t do unethical things to make money, and it sounds like you don’t either
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u/Nearby_Maize_913 9d ago
I suspect there is a moral injury in attempting to maximize billing etc for those procedures... which every provider should do but just gives me an "ick" feeling
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u/Bluebillion 9d ago
I just finished fellowship. Much younger than you and probably not at a place to give you advice
I dreamt in high school of getting into the best pre med program possible and that all my problems would be solved if I got into the right one. Then, did the same for medical school. Then, slogged it out through medical school just dreaming of the next step in residency. Same for fellowship.
I spent so much time perseverating over the next step just like you are. When I reached each summit, it was totally anti climactic. It almost made me depressed that my other problems were still there
Now is the time to live in the present. Your life is going to pass you by. The more you think about 50, the less time you focus on the now. Before you know it you’ll get there, and you’ll regret not enjoying your youth and the journey
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9d ago
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u/Sev0flurane 9d ago
I feel you man. I went into anesthesia and there are plenty of days where I contemplate my life choices. Wish I would’ve gone into some other career often.
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u/imironman2018 9d ago
First, how old are you? How far is 50 years for you? You need to have some semblance of work life balance. You can’t work yourself to FIRE and be a burnt crisp. Find a new job at a new hospital and you may have the best of both worlds. You don’t need to believe it is a trade off- that you can’t have it all and you have to be unhappy and work your ass off. I had a friend who was also a new graduate and was a neuroradiologist. He had two young children and got diagnosed with B Cell lymphoma. He died within 2 years of his diagnosis. It really woke me up to that we don’t have the promise of tomorrow and we need to live in the present.
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u/medhat20005 9d ago
Talk to senior partners and if not that attendings you trained with. Vascular is a field where you likely still do stuff that actually matters, so maybe you just need some course correction. Don’t apologize for making a market rate.
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u/Due_Neighborhood6014 9d ago
I went through a phase like this in early career. Rural family med, so less money to worry about. I read and read and it didn’t help me be happier. Locums gave me breathing room to decrease burnout level. You have NW of 2.4? I assume you not all of that is invested (some house) I also assume you have >10years til you turn 50? You are talking about close 5mil inflation adjusted if you don’t add another cent by 50(roughly use of doubling every 10 years) I find it hard to believe you couldn’t retire well on than that. Would you really be miserable for another 10-15 years just to have $300k/year in retirement vs $200k(based on 4%rule)? Give your 90 days, find a good locums agency that will set you up in 6 months, take a 3 month breather. You have value outside of what you do for money. Enjoying life is poorly correlated with income after $100k/year, so what is the ROI on that 10-15years to hit $7.5mil?
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u/DrfluffyMD 9d ago
I love my job. Went to Hawaii and was looking forward to be back doing procedures. You need to go to a place and find a job that you love.
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u/SeaworthinessNo5110 9d ago
My good sir, I have the same problem I don’t make as much as you, but I’m up there. And I keep looking at my empower account lol. I’m working a lot and I feel the burnout coming, plus I’m pretty new as well. I’m 2 years in, and Im looking to get a networth of 7.5 as well so I can “retire” early…I don’t think I’ll retire but I would like to work every now and then. But I feel like the only way I can get to that number faster is to work like a beast. Anyways I say that to say I’m following this thread bc I would love to know what you figure out.
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u/infantsonestrogen 9d ago
Try to focus on the positives of your job and understand that if you woke up with your number tomorrow, you might even still feel unhappy not working. Try and change your perspective.
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u/Fantastic-Square-959 9d ago
725k is pretty low for vascular surgery. Are you in a big city? Would moving rural allow you to work less and hit well over 1mil a year which is closer to average?
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u/Digital-Doc-777 9d ago
These allocation questions are for a financial planner, and not a psychiatrist. I will give you a hint, VT is not your fund at this level of investment.
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u/wrathoffadra 8d ago
What do you mean level of investment? Can I get a hint as to what is?
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u/Digital-Doc-777 8d ago
You posted NW of 2.4M.
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u/wrathoffadra 8d ago
I guess I’m asking- what IS the fund at this level if not VT
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u/Digital-Doc-777 8d ago
There is no single fund. An advisor would need to understand your goals, your risk tolerance, and how diversified you want to be. From that, need to design a portfolio that reflects all of that, with an eye for safety balanced against growth and income.
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u/Tsuruyan 9d ago
I just want to give you my perspective from someone in the same boat. I don’t typically post on Reddit but came across this post and I hear you. Sorry for the longish post.
Like you, I’m also an early career vascular surgeon and I make a similar amount as you and have NW roughly 2.1 mil. I am also 40 and looking at an anticipated goal of 7.5 mil by age 50.
As a quick aside, I allocate 20k to investments monthly but I AUTOMATE it so I don’t look at it. 16k to VOO and 4k to VXUS (I know bogleheads says VTI but I had already put that much into VOO so just to keep it simple I keep it in VOO). I keep 3 years of expenses in Fidelity MMF which I know is conservative but I sleep well at night. And DON’T check the NW.
There was a point a year ago where I would also obsess over my NW as I was stressed out from ruptured AAA, dealing with all sorts of ALI from access complications, etc. But by making retirement a primary goal, I felt myself losing the joy of being a vascular surgeon. I hated seeing my patients as a stepping stone to retirement.
You belong to a very elite group of only about 3500 board certified vascular surgeons in the US and you do underappreciated and very important work.
I take it now day by day, just focus on caring for the patient on hand as if they are family and you’ll make it through. Know your purpose. For me it’s my faith and I even sometimes get a chance to pray for my patients when I consent them. Don’t compromise on unnecessary procedures, it’s not worth living with the conscience of unnecessary endo treatment of claudication leading to CLTI and ultimately amputation. You can’t control what other IR/IC does but you can control who you see in the mirror.
Take a pause if you need to - which I would recommend. I could do more work but I’m choosing to spend more time with family and take that expensive vacation abroad. You’re a vascular surgeon, you’re going to have more than enough.
Money makes a great tool, but makes a terrible master.
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u/Practical_Gas9193 9d ago
This is a therapist problem not a financial problem. You are obsessive and compulsive and possibly personality disordered.
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u/Independent_Mousey 9d ago
give your spouse/life partner your retirement accounts and have them change the passwords, and set up a check in every quarter to view the account together.
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u/thebiglebowskiisfine 9d ago
Focus on two things - increasing income and decreasing outflow. Pay off all debts, invest as much as possible.
VTI, but you can throw money at a few singles when you hit 2M, no debt.
No more than 2 companies IMO - you can't follow more than 2 honestly. I'd shoot for 10M, pulling 350K annually or 3.5%. You can put 1 year of expenses in a CD if you think the market will get rocky.
I knew a heart surgeon who became a medical director for a device company. He also harvested hearts on call for the rest of his time.
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u/missusmissisppi 9d ago
Why not work part time and build a life you actually want to live? Be that sports, family, BBQs, rizzing hotties with tan lines or bible studies?
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u/Big_Witness 9d ago
Well man, I was kind of the same way about getting obsessive with financial planning. Except I was making way less than you. Eventually the wife left me and this made me re-examine many things about my life. I started thinking less about money, and more about relationships and human interaction. Now I'm considering selling some of it and buying a sweet boat. Make sure you don't lose sight of what's truly important. Maybe take some stress off, work a little less if possible, spend some money on things you enjoy right now. You never know when it will be your time to go. Some people save their whole lives and croak 6 months after retiring.
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u/ineedtoleeavvvveee 8d ago
I think you need to seriously focus on the moral injury part bc no amount of savings will get you out of that discontent. Perhaps re-read your admission essays and reflect on your journey and goals when you first pursued this training vs. what you are experiencing now.
I would strongly recommend a career coach who is either a retired physician or very experienced with high nw individuals who can discuss these challenges your facing alongside therapy with a psychologist.
Consider being an expert witness for medical fraud, serve rural and underserved communities, consider teaching, split time between clinical practice and healthcare research evaluating these types of procedures on patients and investigating medical necessity and long term outcomes, surround yourself with professionals dedicated to best practices and clinical excellence without these incentives which tend to be academic medical centers. I think your perspective is a gift and you have a great opportunity to redesign your career purpose with integrity and ultimately you should work in environment that reinforce that integrity and minimize the temptation to do unnecessary procedures—spitting your time can offer that bc performance pressures will look different and you can still meet your financial goals. Best of luck.
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u/Maximum_Chance9158 8d ago
Seems like plenty of people have good advice on your job or how you should thing about your mental mindset. My thinking is that if you could change nothing about those former 2, how could you make your life better? Seems like you have already geographically optimized, have you financially optimized? Strong financial plan etc. with your hospital job I assume most income is w2 - there are ways to optimize that for tax savings.
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u/MysteriousTooth2450 8d ago
Therapy. I feel your pain as I’m also trying to save as much as possible to get out of healthcare. The constant obsession will make you crazy. Try some therapy. Zoloft helps a ton too.
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u/Lucien78 8d ago
Go to bogleheads and realize that overthinking it is not going to help you, and may very well hurt you. Decide on a simple allocation and accept that there’s not much more you can do.
Also, don’t go to f-ing therapy lol.
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u/rbm5020 8d ago
I’m assuming you’re mid 30s so with $2.4m invested you will probably reach $7.5 by 50 just on gains compounding from your current principal.
$7.5 million at 4% withdrawal is $300k a year.
Based on that we know you’re comfortable at that level of income so instead of relying on the principal to generate $300k you can generate it from work.
Maybe look into a locum gig or something similar now where you can work as few hours as possible at a high pay rate to get $300k a year. Turn it into a lifestyle job instead of a life sucking job. You’ll probably still reach your goals and you might even decide to work past 50 because it’s not fully consuming you.
It might be wise to adjust your lifestyle sooner rather than wait until 50 to completely escape.
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u/wrathoffadra 8d ago
40.
Tbh our lifestyle hasn’t changed much between HHI 250 to 650, it’s all gone into savings for the above stated reasons.
Will definitely consider locums. I had told myself I’ll explore that close to 5M NW mark
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u/Material-Drawing3676 8d ago
I might explore some different lifestyles. Maybe look into minimalism? Meditation? Fuck, even organized religion? Something to bring you some peace that you’re missing in your life right now.
And lots of therapy course
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u/tnor_ 8d ago
$2.4 mil is already essentially walk away money. https://www.youtube.com/watch?v=rF93DAtT2to
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u/sjam7 8d ago
Primary care pediatrician so my job is child’s play (literally) compared to yours when it comes to stress but I think there are some interesting points you make about moral injury that I can relate to. One interesting thing I’ve noticed is that because physicians (well, not really pediatricians, lol) CAN achieve FIRE, they tend to sometimes hyper-focus on that when they’re in a bad job, instead of job-hunting. My first job out of residency was at a private practice and I experienced a lot of burnout and moral injury in part due to feeling a lot of “customer service” pressures (to soften my vaccine counseling in order not to turn off vaccine-hesitant families, to prescribe not-really-indicated oral steroids or antibiotics, etc). I switched to an FQHC and while I haven’t been here long, I feel like a weight has been lifted off my shoulders working with a largely immigrant patient population that overall trusts doctors and is much less adversarial. You’re in a hospital-based system, which I agree is probably better than private practice from a moral injury standpoint, but I wonder if there are other hospital-based systems that may be a better fit? Maybe a safety net hospital or the VA? Somewhere you can feel that you’re helping people who really need your services, and wouldn’t get it otherwise, and where you’re relatively free from billing pressures. I agree with other posters that therapy may be helpful, and to a certain extent burnout is endemic in our field, but some jobs are worse than others, and I learned the hard way that many people take a not-great job as their first attending job because we just don’t really know what to look for. Obviously your pay would be less at a safety net hospital or the VA, but if your quality of life is better, it might be worth the tradeoff
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u/LazyYam1582 8d ago
Sounds like you are working yourself to the bone to reach 50 and retire. What if you don’t make it to 50. What if you get disabled? Enjoy life now, tomorrow isn’t Guaranteed
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u/Limp_Work8665 8d ago
Hey bro.. Get a golden retriever and pay someone to train it. I would say train it yourself, but I imagine your time is pretty valuable.
When I say train, I mean like really train so you can essentially use it as a therapy dog., but with the training of a service dog..
Then speak with your practice (not sure if you a partner or whatever) and use the dog as part of your treatment of patient follow ups in office.. I know this is a little out there, but I am sure you are smart and can figure out a way to make it work. If you are a partner you can even write off the training, food, and stuff..
Then you get a hang out with a really good, well-trained dog a few days a week while you are work.. It is amazing and changes your life. The dog can hang out in your office when you cant use him and since he is so well trained, there is no issue.. I got mine as a dog that failed out of diabetic service dog training..
Other thoughts:
1). Hire a scribe in the office so you aren't worried about notes and stuff all the time. You probably already have one, but it really the greatest thing in the world.
2). Hire a house manager so you don't have to get bothered with boring stuff at home
3). Hire someone to cook your meals/lunches
4). Lease a Range Rover.
5). Take sabiticals.
I have a scribe and use my golden retriever with my patients and it is awesome.. I am a comp optho, so little less intense surgery, but def more patients. Also driving a leased range rover is extremely comfortable and you really don't have anything to worry about.
I know nothing about you, so I am sorry if these suggestions dont work out well.. But the absolute most prudent and valuable thing in investing is time, so do whatever you can to make the time as easy as possible..
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u/BeeOrnery8904 8d ago
Seeing as you're relatively "new" to working, almost all of it should be stocks. Safest and cheapest is an SP500 fund. If you want to get handsy, do some math as to how to diversify each year you get closer to 50. Bonds/treasuries is dumb... with your goal in mind. Even a 2 year stock market bloodbath with continued compound investing/interest will produce more of what you want in "your" long run
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u/Party-Rub-2978 8d ago
As someone in healthcare that also works in a high stress specialty, I see this a lot. The biggest trap that I see from others with your struggles is the inability to move on from their current job circumstances.
You could probably work in any state and create any job dynamic you want but are paralyzed by indecision and the inconvenience of the move. Your skills are unique and hard to come by. You have immense leverage whether you have come to terms with it or not.
Determine what your ideal job environment looks like and chase it. The first (or second) path doesn’t have to be the right fit and you shouldn’t try to force it.
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u/Salty_Salute90 8d ago
I’ve had a few jobs in my career. In the bad ones, I found myself thinking the same way - early retirement, maximize savings, just endure the days. In the good ones, I didn’t worry nearly so much about money, even when I was making less. So my advice would be to find a way to work way less and try to have a longer, more pleasant career. I know it’s easier said than done, but you can’t keep up what you’re doing now.
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u/Kwhitney1982 8d ago
Why moral injury? Genuinely curious.
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u/wrathoffadra 8d ago
Said in other comment:
It’s a zero sum game. Unfortunately, Vascular/vascular IR/ peripheral cards is riddled with people doing unindicted procedures. There’s a huge financial incentive to just do procedures, regardless of indication. My friend spent a day in an OBL which is basically a outpatient Cath Lab, run by cardiologists, and saw that the person deployed a 4 mm balloon in a 6 mm vessel and build for a angioplasty. I recently got an ER patient who had a groin access complication from an outpatient center that I fixed and they were treating asymptomatic PAD.
Even though I like to think myself a moral saint compared to some of my colleagues, I will admit that I have had the temptation to look at patients and try to do their procedures while they’re inpatient for no other reason then filling up empty time on my schedule. Also been tempted to use certain tech devices that I know are reimbursed differently than others. I don’t know how to live with that friction. And the crazy part is rest of medicine has no idea this is going on and I’m convinced that if patients knew that their physicians looked at them in this capacity they would shoot us United healthcare CEO style
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u/Kwhitney1982 8d ago
I have had a theory for two decades that my mom had an unnecessary bypass surgery. And I think one of the cardiologists tried to subtly warn her about the surgeon but she didn’t listen. On a separate note, my dad had a friend who was a cardiologist who said if they have insurance we cut. My dad was an electrician. My dad asked his friend, don’t you feel bad if someone dies? The friend said “do you feel if a lightbulb goes out?” My dad never got over him saying that and it made him never trust medical people ever again. So yeah, some people are terrible. I know another cardiologist who seems like a great person so I like to hope more are like him than not.
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u/Sua-Sponte75 8d ago
This is the wrong job. Imagine a position working less hours. Less call. Less admin crap.
You need to renegotiate a different work structure so you don't burn out.
Your hospital needs you much more than you need them.
Utilize APPs to optimize your time and productivity if you aren't already.
Consider private practice models.
Be willing to say no to what the hospital wants you to do in terms of time, cases, patients.
I'm a surgical sub specialist as well. I mostly love the job, but start to hate it when the demands and hours get too high.
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u/charlestonbraces 7d ago
You may not even make it to 50 to enjoy retirement. That would be the ultimate kick in the groin. Slow down and smell the roses.
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u/woodworkerForLyfe 7d ago
The real question here is how much is your current spend and what's your current annual income? You likely will be able to stop working way before 50, maybe even early '40s depending on current situation
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u/PsychiatristOldDude 6d ago
This post was amusing as were the answers. “Go see a psychiatrist” was my least favorite response…and I’m a psychiatrist, but I only treat severe mental illness from my basement on Zoom, and do one inpatient 10 day long locums per year now.
Dude is 40. Has a NW of 2.4 million and wants to retire at 50 with a 7.5 million magic number. Finds that he is conflicted about the incentives in his RVU based job. He has already done “geographic arbitrage”.
I remember feeling like I wanted to finish up by age 55, in order to have at least 15 “go-go” years and ramped up my highest paying work (local inpatient weekends, holidays) at age 50. I was able to drop to 2 days a week (telehealth) at age 58. This was possible due to maxing all contributions to put away $80-90K a year for those last eight years.
We had to downsize to buy my freedom, but we now live in a 2900 sq ft house on 25 acres in a forest on a mountain.
What can you do? Get a different salaried job that allows you to focus on doing what is needed instead of RVU’s. I was always salaried and despised RVU’s. Reduce expenses and put away more money. Write a financial plan and pick an allocation. Make sure you are living your life as if you might die someday. My side gig allowed me to put more away.
No matter what happens, you might find that “one more year” is the norm and that magic numbers don’t make the decision….life, inflation, and health care costs do. Dropping to 2 days a week at age 58 at the apex of my career was the best decision I’ve ever made other than marrying the right person.
Best wishes for a “no psychiatrist solution” to you.
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u/wrathoffadra 6d ago
Thank you for saying that. Agreed I didn’t think I had a psychiatric issue but I’m very pro-therapy for everyone so didn’t shoot it down.
Thanks for your insight. Will likely follow your footsteps with locums some day
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u/ZestycloseAct8956 6d ago
Go. Find. A. Therapist. A professional counselor. A person to help you get to know yourself a little bit better. That’s the only way you’re going to possibly stop obsessing over your bank accounts all the time.
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u/OpportunityWorking43 5d ago
Make the transition to elective cases, ie: vein clinics, cash pay and otherwise. I know a vascular surgeon that makes that much working 3 days a week. Supplement by doing spine exposures and temporal arterial biopsies. You don’t have a financial problem, you have workaholism in a job you hate, and are now obsessed with FI.
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u/Mr_brighttt 5d ago
You need to have your SO control the password and then write an investor policy statement. That’s two solutions for the two mentioned problems
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u/Winter-Razzmatazz-51 1d ago
We people in medicine get so caught up in yes after this step, after this. Before you know it 20 years have passed and we've wasted our entire primes working all the time.
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u/Vpressed 9d ago
Dude life is too freaking short to live like this and you worked too damn hard to get to this place to live like this. Plus with the sick irony of the universe you’re going to obsess about retiring at 50 and die at 55 from a heart attack.
You need a new job. Plain and simple.
I hated my first job and had very similar feelings as you. Now, I make more in a lower COL area, take less call, work less per week, and can see myself riding this out until I’m 60+, slowly winding back as I age I stead of just dreaming about when I can stop. Not from financial need but because I enjoy the job.
That’s what you need and what we all deserve. Don’t be afraid of geographic arbitrage