Is Financial Independence the Key to a Global Medicine Career?

If I had to point to one single resource that has motivated and inspired me like no other these past few months, it must be the “FI” community, particularly the Choose FI podcast.

I am a complete newbie to this world. In fact, I got connected to “Physicians on FIRE” on facebook (through my Physician Moms Group), and I did not know that FIRE was an acronym for Financial-Independence-Retire-Early. So for anyone out there as clueless as me, FI stands for Financial Independence, and it’s propounded “Fye.”

At first encounter, this seems like a fairly narrow focus. I was peripherally aware of some nuts who wanted to retire by age 30 and did all sorts of weird financial acrobatics to accomplish this, but I did not consider any of that relevant to me. I finally listened to one of the Choose FI podcast as I was exploring options for accomplishing the Indie Docs lifestyle (although I did not have that term for it at the time). Josh and I kept discussing the best plan for funding our dream of being humanitarian physicians, and without charity funding it seemed that achieving financial independence was essentially mandatory. Otherwise, debt obligations alone would be prohibitive to traveling and working for little-to-no pay. While religiously affiliated programs and some fellowships exist that can fund 1-2 year projects or even longer missionary careers (topic for another post), we ultimately decided to leverage our income potential to control our own destiny. Hence, my portal into the Financial Independence world.

I quickly discovered that FI is so much more than extreme budgeting, saving, and investing. Mr. Money Mustache was for me, as for many people, the gateway to a whole new mindfulness toward how I should spend my attention and time in addition to money. He calls out many ridiculous notions of consumerism in a compelling and entertaining way, and at this point I’m practically inhaling 2-3 of his archived posts every day. On a very practical level, he convinced me to ride my bike regularly to work and for errands around town, and this has been a very enjoyable, economical, and healthy transition. His post “What do you mean ‘You Don’t Have a Bike’?!” is what first intrigued me–Click the hyperlink to judge for yourself!

Saturday grocery trip. Hauled a full load of groceries in the bike trailer with Eddy. Workout-check.

While riding my bike, I’ve listened to several more episodes of the ChooseFI podcasts, and discovered resources like Get Rich Slowly, Raptitude, Frugalwoods, Making Sense of Cents, and many other blogs. I explored the travel rewards section of the Choose FI website and listened to the Travel Rewards podcast episode. This topic also deserves an entire post in it’s own right. The obvious practical implications of finding a way to travel at a huge discount would be a total game-changer for humanitarian physicians. I realized that I had done a very mini-version of their travel hacking by opening the Chase Sapphire credit card years ago and using the miles for airline tickets and recently a sweet deal on a rental car, and subsequently opening two Delta cards between myself and my husband to qualify for bonus miles and free companion tickets. So in the past 6 years we have played this game 3 times, but not in a super-savvy way and totally unaware that there was a whole busy and geeked-out world of travel hacking teeming below the surface.

Yesterday, I listened to the Choose FI podcast episode 48, which featured Jeff from The Happy Philosopher, a radiologist who experienced severe burnout and found a path to professional fulfillment and happiness again as he pursued financial independence. The episode gets fairly deep into a discussion about burnout and it’s effect on all aspects of life, and practical approaches to emerge from this crisis. I myself have experience full-fledged burnout and will definitely devote a post to this topic, and I was again amazed at how relevant the FI discussion is to so many of life’s complex emotional problems.

On the most basic level, achieving FI will open up possibilities to spend our time and money on the projects we are most passionate about. One of the earliest steps in the path to FI is becoming debt-free, and this is a particularly large hurdle for many physicians. It seems that the college and med school tuition and student loan structure are practically designed to keep us working as many hours for as long as possible just to pay back this obligation. When we get past residency and find a “real job,” our work schedules are optimized for billing, and many physicians would find it impossible to spend a significant amount of time pursuing humanitarian projects; in fact, I personally know several wonderful physicians who devote over half their vacation time to short term projects. In addition to paying back the loans, we need to make up for a decade of lost time funding retirement accounts and other funds, such as kids’ college.

However, if you can imagine that suddenly you are financially independent, the game changes drastically. You can insist on a part time schedule, find a work-share situation with another physician, or simply walk away forever. Even if you have a full time physician job that you love, it frees up your financial obligations to make a huge impact on your passion projects rather than paying back the bank.

Josh and I have just started investigated new strategies to start our FI journey. I love the easy equation that comes up often on the Choose FI podcast that (Money Made) – (Expenses) = Your Gap, and the Gap is what you invest to achieve FI. Our income is relatively fixed as two residents, but I do supplement with teaching courses and plan to do Locums this year for some bigger boosts. The big category I’m fired up about now is minimizing expenses to maximize our Gap. I’ve started taking my lunch to work, riding my bike to work, really cut dining out. (I truly enjoy my PB&J, which is super charged with rich omega-3 supplemented peanut butter, rhubarb and strawberry jam, and gourmet whole grain bread).

Packed lunch for the playground, pretty identical to work lunch except more “snacks” for Eddy.

I bring my coffee to work every morning; I don’t have a coffee thermos that I can toss into my backpack, so I rigged one using a mason jar and a breast-milk insulated carrier from my diaper bag (see photo), and I have no plans to upgrade as it works great. We have always used cloth diapers at home (day care requires disposable), and it is a huge money saver that is so easy I have no idea how all families don’t at least have a hybrid cloth/disposable diaper system.

After July, we will no longer employ an au pair, and I will be able to cut out a smart phone line and cable and sell a car (saving money on the insurance also). At that point, I’ll look into budget smart phone carriers to try to find something cheaper than Verizon (have a feeling that will be pretty easy). We have a few low-interest debts that I will look into paying off, but we are in a debate as to whether it’s wise to use part of our emergency fund to do this when we are only a year away from both having full-time attending jobs and can reasonably float these small loans a little bit longer. I think we are paying too much for house and auto insurance, so I’ll look into switching that in the next few months. I have to take my general surgery boards in July, so some of these items will have to wait until that task is complete.

We will revisit FI again and again on Indie Docs, as well as explore other ways of funding a humanitarian medicine career. For now, enjoy visiting the amazing resources available through the hyperlinks above. Please leave comments with your favorite financial blogs, websites, or podcasts, as well as any practical tips and tricks you have for maximizing The Gap.

 

 

How to start a global health interest group at your institution

Despite having a huge campus, state of the art healthcare, and an amazingly diverse group of employees, my hospital did not have a Global Surgery “group.” There were surgeons, nurses, scrub technicians, and even pharmacist going on medical and surgery missions projects and lots of individual efforts going on. We have a fund available to us as residents for competitive scholarships to various locations for humanitarian health endeavors. But no one was getting together to have discussions and provide wisdom and support to the group. No one was addressing the enthusiasm of our medical students for this field. And no one was promoting education of the larger group of employees regarding all the potential benefits of participating in humanitarian projects. I could imagine an amazing Global Surgery department at our hospital, much like what I explored via the internet sites from Harvard and Stanford.

I tried to think of the most basic first step. What was the move that would be completely without controversy, free, and easy for this one person to pull off? The answer: Organize a journal club. Journal clubs are ubiquitous, 100% educational and therefore in line with the mission of my program, and flexible. I could design it to meet when and where was convenient for me (I hosted the first few), and also drum up enthusiasm and support from others that might want to participate.

So that’s what I did, and we just decided to see what might happen next…

We had a small group of highly enthusiastic participants, including medical students. We met at the homes of group members and enjoyed very wonderful home made food. I was thrilled that some of our attending physicians agreed to host!

I was committed to meeting monthly with the exception of December and selected articles that tried to set the groundwork for understand the current state of the Global Surgery arena. We started with the Lancet publications (see http://www.lancetglobalsurgery.org/) and ended up talking through various publications from this series for the first 3 meetings. We branched out to publications featured on the Lifebox website (see http://www.lifebox.org/professional/publications/).

Group members started to undertake fantastic research projects and promotion of humanitarian missions. As a group, we brainstormed about how to establish a Global Surgery center, which is our current active goal.

Perhaps most importantly, we became a close-knit and defined group of Global Surgery enthusiasts, and there is tremendous motivation in having this support from peers and mentors.

Starting a Global Surgery, or medicine, or pharmacy, or simply global health, journal club, is a quick and easy first step for starting the fire at your institution. With consistency, you can build an alliance of folks looking for camaraderie and practical advice. There are no downsides!

Let me know if you’ve had a successful strategy for starting a humanitarian medicine group of any subspecialty at your institution in the comments below. It would be great to share strategies for success!

Why “Indie Docs?”

The idea for this website emerged from feeling completely overwhelmed by all the decisions and seemingly difficult lifestyle demands of pursuing humanitarian medicine. Josh and I talked about options for full time missions, part time missions, advanced degree programs, traveling fellowships, how we would raise our daughter…the challenges seemed infinite.

I thought about this website and blog as a means to organize the vast information and generate discussion among a like-minded community, and for months I waited for the right domain name to pop into my head. I was frustrated that I couldn’t come up with something that encompassed all the ideas behind humanitarianism, global medicine, travel, professional independence, and philanthropy. Luckily, my husband has a habit of solving these types of problems, and on a long car ride I explained to him all the ideas I was trying to tie together. His face brightened up, eyebrows raised, and he said, “Hey, what about “Indie Docs?” My response: Yeah, good one! After all, physicians pursuing global and/or humanitarian projects need independence, both professional and financial, and a willingness to go against the mainstream. There is also a spirit of fun in the name. It doesn’t emphasize philanthropy or humanitarianism overtly, but I think this broadens our purpose a bit while still providing room for these motivations behind pursuing one’s professional ambitions as a physician, whatever they might be.

Of course I would be dishonest if I didn’t share our love of Indie music as a big influencer in the moniker. Josh and I fell in love at a Christian Indie-rock music festival in Memphis, TN, 15 years ago, and we’ve been bonding over great music ever since. The year before we had our first baby, we decided to go to every music show possible for a year, which despite our demanding residency schedules, was quite a few shows in our area near Minneapolis, MN, one of the best indie music cities in the country (thanks in part to the amazing 89.3 TheCURRENT radio station), and some shows in Nashville, TN. We rocked out to Wilco, Dr. Dog, Feist, Trampled by Turtles, Lucius, Father John Misty, Benjamin Booker, Houndmouth, and maybe a dozen other awesome indie bands. We went to Festival Palamino (VIP tickets!) and Eaux Claires music festival (put on by Justin Vernon of Bon Iver fame).

She’s ready for the show.

Why is indie music special? Without writing a tome on the subject, the artists work hard to simply make and promote good freakin’ music and challenge themselves creatively. Indie musicians have created an amazing community of artists and fans who share their ideals of loving the music rather than chasing commercial appeal and financial success. (For instance, FEIST refused to play her most commercially successful single, “1-2-3-4,” at both of her shows that we saw. Given the chance, I would request at least a performance of the Sesame Street version, “Counting to 4,” which my daughter absolutely loves).

My mom recently paid me one of the highest compliments of my life when she said she listens to Lucius’s “On the Run,” with tears in her eyes thinking of Josh and me. I can’t even count how many times I’ve listened to that song with a little mist in my eyes thinking of the exhausting effort of this path and all the hurting people I can’t reach.

So, if the Indie revolutions in  music, journalism, film making, and other creative fields occurred because the talented artists wanted to take back control of what they produced, give it to the people who needed and appreciated it most, and embrace the idealism that filled their young imaginations in the first place, the medical field might be similarly primed for this same transformation. Rumblings of discontent are growing in the medical community-at-large due to the endless pressures to increase billing and revenue at the expense of spending quality time with our patients. We see small pockets of counter-culture movements, including boutique healthcare, as a response, but there is definitely  a major grassroots movement of many idealistic (no longer a dirty word) physicians towards working in the global health and humanitarian arena.

Cliche as it may be, we went to med school to help people. Doctors have worked too hard and sacrificed too much to get to the end of training and face an unfulfilling career they never imagined or desired. As the oft-quoted study in JACR concludes, participating in global health projects reduces burnout,* and for anyone who has participated in even the smallest humanitarian mission, it’s easy to remember that pure joy of working with clear and present purpose and feeling effective. It is my hope that Indiedocs.org becomes a place for professionals to connect, encourage one another, and share the tips and tricks to maximize our ability to change all the little worlds we can reach with the hardest-working kind of love.

Happy Trails,

Joy

-On the Run-

“And now we pass so many people on the road
They could come along, I wish they’d been told
They may call it a shot in the dark
From what we know, it’s not unheard of

And we’ll one day tell our story
Of how we made something of ourselves now.”Lucius

 

*https://www.jacr.org/article/S1546-1440(17)31353-4/fulltext

http://www.thecurrent.org