Designing our “Best Life” with help from Montana Money Adventures Mentoring Questions

One of the biggest “Aha!” moments for me came from finding Jillian from Montana Money Adventures, initially while listening to her podcast on ChooseFI and then reading her article “Big Family Minimalism,” on Cait Flander’s website. I signed up for her email list in order to gain access to her awesome Resource Library, which contains mentoring questions and “Let’s Chat Worksheets.” These are pages of guided discussion and questions that can really challenge us to address what our true goals and passions are, instead of simply following the path of least resistance and hoping we end up somewhere decent.

This idea of intentionally designing the life I want started during my 3rd year of training when I realized that I wasn’t doing ANY of the stuff I enjoyed and was suffering from severe burnout as a result. After a few years of pondering these topics on my own, I was ecstatic to find Jillian’s excellent guidance. Answering these questions is HARD! Josh and I have been working through them together, and we can only do a few questions at a time before we are a little worn out mentally, and it takes us a few days to complete a worksheet. Nevertheless, going through the worksheets together has been a wonderful exercise for our relationship; it has gotten us communicating about these ambitious big goals and deeper motivations, and it has definitely helped us understand one another better. We will often be mulling over the same question and, lo and behold, come up with the same answers. It’s also amazing to hear him come up with a totally different answer than mine, as I then have something entirely new to consider. I definitely recommend these resources to any individual or couple who is interested in mindfully constructing their lives and purposely cultivating relationships, careers, possessions, time-management skills, etc.

I contacted Jillian by email to ask her permission to post the worksheets completed with our answers, and she graciously agreed. If you find value in these posts, please head over to her website and sign up for her email list, so that you can have access to her entire resource library. She never sends emails that aren’t very insightful and beneficial.

We decided to start our mentoring questions with the worksheet titled, “Highlight Reel.” The following is our completed worksheet…

What were the most significant moments from the last year?

Joy graduating general surgery residency.

Esmé being born.

Starting our website and podcast.

Starting research year.

Joy taking time to spend with the girls, having a real maternity leave with this one.

Finding FI information

Interviewing for jobs together.

What are our best memories from the last 10 years?

Eddy being born.

Esme being born.

Trip to Big Sur.

Matching at Mayo.

Music festivals together.

10 year anniversary

Choosing our sub-specialties—being liberated from pressure of doing cardiac/peds neurosurgery

Family vacation to smoky mountains

Family get-togethers in Nashville

Watching Archer on maternity leave with Eddy (seriously one of the most fun memories I have. We watched two episodes every night and laughed our heads off).

Camping trips

Duluth trip

Joy-trip to Ukraine and Guatemala

Joy-trip to ACS 2017 meeting global surgery sessions

What do we wish we would have done in the last 10 years?

Travel more for global health projects

Gotten an MPH or MBA during residency

Been more active in global surgery world instead of putting it on hold for training

Gone on more family vacations

Decided to do trauma earlier, let cardiac go earlier, not let myself become burned out

More date nights

What are our most significant achievements? What are we most proud of?

Beautiful girls. Toddler who is very sweet, affectionate, and confident.

Breastfeeding for 2.5 years.

Strong marriage through all of education and training challenges and parenting. Staying best friends and supporting one another.

Couples matching at Mayo.

Both of us succeeding through specialty training.

Living below our means during training despite needing SO MUCH childcare.

What would be amazing to see happen in the NEXT five or ten years?

Significant involvement in high-impact global surgery projects focused on alleviating suffering.

Network of folks working toward the same goal.

Girls traveling with us frequently and understanding our mission.

Spending down time near our extended families (hopefully moving closer to home)

Financial independence with funds for early mini-retirement.

Indie Docs having regular post and reaching anyone who might find it helpful (easily visible).

Financial highlights:

What are a few money goals we would love to hit? In five years? Ten years? Twenty years?

5-years: Debts paid, Financial independence with enough $$ for mini-retirement, couple of investment properties to maintain income while overseas, kids college funds fully-funded.

10-years: Enough money to give away generously to projects we believe in, passive income to sustain personal finances and giving and Indie Docs ventures.

20-years: Solidly funded full-retirement accounts, high-impact projects that are self-sustaining and more projects that we are investing in.

Do we have a net-worth goal?

Sorta. Arbitrary “fat-FIRE goal” of $3-3.5 million. Highly subject to change.

Passive income goal?

$3000/month or enough to just tread water when we are out of the country or not working (don’t really know about this number specifically )

Is our goal to pay off our home?

Yes

Certain amount or percentage donated or in a donor-advised fun?

Would like to eventually be able to donate all income.

Certain size inheritance to pass on?

Enough to fund kids retirement so they are able to pursue whatever career they are most passionate about.

Lifestyle Highlights

Any health/physical highlights that seem exciting to you?

Staying healthy and energetic, being able to do certain body weight exercises like pull-ups and pistol squats, and increasing flexibility to stay injury-free (for Joy).

General fitness, daily exercise would be a win (for Josh).

Any relationship highlights you want to add?

We want to be more intentional about doing fun and exciting things together, being more affectionate, having deeper conversations.

Get to work together on passion projects.

Travel goals?

Definitely want to be traveling regularly to sites of our global surgery projects.

Also would like some fun adventure travel to unplug and recharge.

Work highlights you would love to hit? Certain position/rank/awards/contribution?

Become confident and experienced surgeons.

Don’t care about rank or position.

Would like our practices to be impactful for local community.

If I’m running a private practice, would like to be maximizing impact and using smart financial strategies and tax strategies to run the business successfully.

It would be a huge bonus to be able to get back into academic medicine within the sphere of global health so we can be 100% into global neurosurgery and global trauma surgery AND teach residents AND publish high-impact projects that lead to real progress in these areas.

What would a highlight in your schedule be? In 10 years, about what would you like to be able to look back and say, “We always made time for…”

Time for family and each other. Want to have time to indulge in play activities in the evenings, take our time with meals and housework without feeling like we are rushing through the daily routine. Time to travel. Time for birthdays and special occasions with cousins.

Are there any highlights you want to create from your hobbies?

Start white-water kayaking and more “glamping” adventures in the mountains, time outdoors.

Impact Highlights?

What kind of impact do we want to leave in the world?

Alleviate suffering for a lot of people permanently, sustainably.

Create some new trauma systems where there aren’t any currently.

Improve the resilience of current trauma systems in settings of disasters.

Happy and generous, empathetic kids and grandkids

Create some training programs for neurosurgery, trauma and general surgery.

How would we finish these sentences?

The world is better because I…

Used my training to impact communities.

Paid attention to what people need.

Used my income to help people.

Told the stories of hard-working humanitarians.

Tried to help.

People around me are better because I …

Worked on my weaknesses.

Tried to become kinder, more thoughtful, and generous.

Don’t allow myself to become over-extended and grouchy, not exist in “survival mode” which makes us just try to make it through the day and through interactions with others. Make sure each interaction is dealt with thoughtfully and mindfully paying attention to that person. Treat people as people and not a task on the list.

When my time on this earth is done, how do I want each of these people to describe my contribution: Spouse, kids, extended family, coworkers, community members, customers, friends?

This section is pretty personal and unique for each individual, so I just left this set of questions here for you to ponder on your own.

For Conversation:

What’s your “most important” and what is “the rest”?

(Joy) My most important is having a happy marriage, making sure Josh feels loved and cherished, loving my two girls and keeping them safe and healthy, and having a career that feels like a calling. For me, “the rest” is academic prestige, stuff like cars and a fancy house, yuppy vacations.

(Josh) Most important: Caring for the poor. If I get to the end of my life and haven’t done that, I’ll think I haven’t done the thing that was really important.

What kinds of things do you want on your highlight reel?

Joyful and hard work that made a lot of people’s lives better. Generous giving of our time, money, and energy.

By creating more financial freedom, what would that make possible?

The main thing that having financial freedom would make possible would be control over our schedule so that we can travel and work overseas. We would also be able to choose any job or assignment that was a good fit for us, and we would be able to give generously to causes that we were passionate about.

October 2, 2018

Indie Docs: The Podcast!

Joy has really been the catalyst behind getting this website site started. On a drive home from Minneapolis one day, she started talking about an idea for a blog that could serve as a resource for people interested in global healthcare. She had done a lot of research, figured out how to obtain the domain name, start the website, etc, but she couldn’t figure out what to call it.

She was so excited about the concept; honestly, I didn’t think one thing or the other about it. I liked the idea, but didn’t intend to get involved much. But because I could tell it was important to her, I participated in brainstorming names, trying to help her dig-in to what was driving this desire in her to make a website and blog. Eventually, we came to Indie Docs, combining the thought of indie music (the liberated, do-it-yourself attitude that has changed the music industry over the past few decades and resulted in many of our favorite bands and tunes), and, of course, the concept we are hoping to achieve of being free to pursue global health projects. Like I said though, I thought of this website as her passion project, not mine, or even ours.

Part of my–dare I say it–disinterest, stemmed from the fact that at this time I had commenced my final and toughest year of training as a chief resident. Combine that with the fact that we have a little girl, and at the time, another on the way (who is now here as of September 24th!), and trying to find a job, I didn’t have much mental energy for other things. But Joy’s enthusiasm is infectious and, within the seed of her idea, I started to see the many possibilities in it.

I’ve always been a big fan of talk radio, mostly NPR shows like This American Life, Fresh Air, and Radiolab; eventually I have found my way to podcasts, of course, and I devoured Serial, S-Town, Malcom Gladwell’s Revisionist History, Missing Richard Simmons, and many, many others. It’s such a populist art form and a brilliant way to tell stories, share ideas, and explore all the little nooks and crannies that exist in our world. I mean, 15 years ago, would anyone ever have produced a radio show about figuring out why Richard Simmons has disappeared from public life? Or spend a whole series on telling the life-story of an eccentric paranoid genius in Sh**town, Alabama?

Stories have always influenced the direction I think I want to take in life. When I was young and watched Karate Kid, I wanted to take karate. When I saw Top Gun, I wanted to be a pilot. I abandoned both pursuits eventually (made if further in karate than in becoming a pilot). Maybe growing up is choosing a story that inspires you, and sticking with it. It was the story of Paul Farmer as told by Tracy Kidder in Mountain Beyond Mountains that led me to become a doctor. It’s the stories we were both raised on of Jesus physically ministering to the poorest, least powerful, least cared-for that I think serve as the bedrock for why we want to work in global healthcare.

Truthfully, we are just now figuring out how to enact both of these sensibilities and, other than becoming doctors, we haven’t done that much in the way of caring for the poor other than a couple of short-term trips, relief efforts from afar, small amounts of charitable giving, etc. We’ve been trying to get through school and training, but now that we are finishing up with that part, we are starting to look at each other as we enter our mid-to-late thirties and say, If not now, when? And beyond that, How do we start?

I don’t know how or when the idea of doing a podcast for the site came to my mind. There was no inciting event, or thunderbolt from the sky. I’ve always tried to learn the stories of people working in global neurosurgery. When I was a medical student, I went to the CURE hospital in Uganda, and learned about Dr. Ben Warf, who was the first neurosurgeon I came across that showed me neurosurgery was not only possible, but could thrive in an low-resource setting. When I go to national neurosurgery meetings, they almost always have a session on international neurosurgery efforts, and I am amazed during the presentations by the intelligence and effort of people like Drs. Kee Park, Dilan Ellegala, and Michael Haglund who are changing the paradigm of global neurosurgery. My former senior resident, Will Copeland, made the decision to go right out of residency to live and work in Kenya (with his wife and six kids!), and has shown me it’s really possible. Joy and I think these stories, and stories of people like them, hold the key to figuring out how we are going to achieve our ambitions of joining the global health community.

And so the past few weeks, I’ve learned about microphones and pop-filters, Garage Band and Zencaster, how to use the Seriously Simple Podcasting app for Word Press (how to use Word Press at all really), how to register a podcast with Apple, make a logo, and on and on. I’ve also learned that I am as passionate about this as Joy is, that it is our project. We set out together to become physicians, and eventually a neurosurgeon and trauma surgeon, so we could gain skills we enjoy and that would be useful in global healthcare. Now we are setting out to discover how to employ them, and as part of that, finding, sharing, and learning the stories of people who are already doing just that in a variety of ways.

The podcast will include episodes in which Joy and I tell our story as it unfolds, interview others about their experiences, and reflect on how these interviews are shaping our thinking about what we are going to do next. We have several great interviews lined up already, starting with Sean Dupont, a general surgeon who Joy did residency with, who is just getting started working in Niger, as well as Will Copeland and Kee Park, both of whom I mentioned above. We will talk about how they manage their lives and families, finances and careers, and what inspires them to do the work. Stay tuned!

~ Josh

August 12, 2018September 15, 2018

Two-resident-and-a-baby household: Logistics and finding balance

June 30, I walked out of the OR around 8:30 p.m., finished my floor work, and turned off my pager, placing it into a pre-addressed manila envelope. I changed clothes and walked out of the hospital for the last time as a General Surgery Resident at the Mayo Clinic in Rochester, Minnesota. It is surreal to have this challenge behind me; 6 all-consuming years of my life including my Surgical Critical Care Fellowship, not to mention medical school and the preceding marathon of hard work and stress. I started this website near the end of my residency and had planned to do a post on our crazy dual-residency routine (my husband Josh is a neurosurgery resident), but with board prep and trying to wrap up a million tasks on the to-do list, I never got around to it. Still, I think sharing what life was like these past few years might help someone else navigate their own rocky trail, so I thought I would share some of the more pragmatic aspects of how Josh and I managed our day-to-day routine. In the spirit of Indie Docs, I would like to emphasize that no two lives or routines look the same, and this is all about cultivating our best life and thriving where we have intentionally and stubbornly planted ourselves.

First, we needed quite a bit of help and intentionality to make having a family work. I researched possible childcare options before deciding to start a family; I could not even mentally commit to becoming a mother without having a workable plan. I honestly didn’t think it could work until I researched the au pair programs. I was surprised to realize that the program was affordable, particularly in comparison with the larger full-time daycares (with extended hours) in my city. Having someone live with us was essential since we were often both on-call. I planned to return to work after 6 weeks, and the au pair couldn’t start until the baby was 3 months, so I reached out to family members to help me and was so blessed that my aunts were able to move in with us for 6 weeks to fill in the gap. Looking back, I wish I had considered just slowing down and staying home; I didn’t even seriously look at the finances and just assumed I needed to get back to residency. This was a very hard time physically and emotionally and not something I ever advocate for families and babies, but I digress.

The au pair program limits work hours to 45 per week, so we needed daycare in addition to the au pair. My husband had a stroke of genius in finding our daycare. He searched for all the childcare licenses closest to us, and just started cold-calling them based on proximity. Less than a mile away, in our neighborhood, was a wonderful lady with decades of experience and an opening! Once we hit that 3 month mark, we had our au pair and day care established. For the next couple of years, the routine was essentially the same; I left home around 5:30 or 6, our au pair would keep the baby until 8:30, drop off at daycare until 3:30, then keep baby until we got home around 6:30 or 7. My husband and I did our best to stagger our call nights, but there were plenty of nights when the au pair knew she was also “on call” and we would wake her if we both got summoned to the hospital.

Next for my working-nursing-mom spinning-plate trick: I was hoping to breastfeed as much as possible, but I honestly expected to need to do a combination of formula and breastmilk. I even had a package of formula on hand when we got home from the hospital, just in case. I was lucky enough to have a great supply, and I managed to keep a schedule that allowed me to pump enough milk to create a surplus before going back from maternity leave and then more than enough to keep up with day to day demands for the next year. I’ll be candid here, I was freakin’ proud of myself for making all that milk and for having the discipline and determination to keep going through the year. I’m happy to share my specific schedule with anyone interested, but in general terms it took a lot of time, energy, and so so many calories. I ate more at this time of life than I could even have imagined before. I pumped while getting numbers, while dictating, answering pages, patient phone calls, reading…I may have also nodded off a time or two at 3 a.m. in the ED pump room. I also dealt with a few unsupportive colleagues and staff. One OR assistant told me not to tell him when I was going to pump because it was gross, to which I replied, “Well, considering you are alive, I’m assuming YOU were also breastfed around 50 years ago, so that’s a tad hypocritical.” He laughed and was very protective of my pump-time afterward. On the other hand, one of my attendings never ever wanted to hear about it and wouldn’t even give me 5 minutes between cases (she wanted me there for turnover) to hand-pump in the restroom (I attempted this out of pure desperation because I was in engorgement agony), and I got two bouts of mastitis on her service. Despite the challenges, it was worth it to have the bonding time with my baby and feel like I was providing for her even while we were separated so much by my work schedule.

As a money-saver, (and probably also as me wanting to go the extra-mommy-mile as over-compensation for working so much, ahem) we use cloth diapers. I had help with the laundry from my au pair, but honestly the effort expended on this routine was minimal. I would much rather do a load of laundry than rush out to the store to grab a pack of diapers. We used disposables for travel and at night. After getting used to the routine and realizing how much money you can save even using cloth diapers some of the time, it’s hard to believe that cloth diapers aren’t a more common part of life for most families.

Whenever we had a weekend off together, we were intentional about trying to spend time outdoors. We got into camping during the beautiful Minnesota summers, and we hiked as much as possible.

I used either a woven wrap or a Beco baby-carrier for hikes. We also have a big Osprey baby carrier gifted to us by a neighbor for serious backpacking, which we’ve only used a couple of times, including for a music festival (Eaux Claires).It was pretty awesome for keeping the baby strapped in and comfy while we carted her around from stage to stage.

Admittedly, we didn’t get much time to ourselves for the first 18 months or so, as we were constantly trying to maximize our family time during golden weekends. Having an itty-bitty is stressful for many healthy relationships, and we are no exception. For 10 years together before our first child, Josh and I thrived on spending lots of time with just the two of us, and suddenly we had almost none. One revolutionary change we’ve made in the last 6 months is having date-nights, which has been wonderful for our relationship.

The days and nights over the last couple of years have gone by in a blur. I could not possibly be prouder of my little girl or of my husband. She is thriving with her routine, and she is incredibly loving and affectionate with us, our animals, and her many baby-dolls. Josh is in the thick of his Chief service time now, but I have opted for a research fellowship with a flexible schedule this year in anticipation of baby #2 arriving in September. I know that I will always cherish having this short, precious time to spend with my girls while they are tiny, and it will help me feel eager and ready to take on my first position as a trauma surgeon after Josh graduates next year.

Moving forward as physicians with humanitarian-focused careers, we will need to remember how to focus our time and energy on what truly matters to us. I’ve discovered some amazing resources to help focus our priorities by Jillian at Montana Money Adventures. Mrs. Montana has created some wonderful mentoring worksheets for focusing time and resources that I will be utilizing and sharing here at Indie Docs. Many thanks to Jillian for sharing her wisdom and for being open to allowing us to document how we are utilizing her worksheets.

Until then, I hope that catching a glimpse into our world can help someone realize that having a happy family is possible even with our career demands. In fact, you can be an extended-breastfeeding, cloth-diapering, baby-wearing, semi-crunchy-granola mom AND a surgeon! The key for me has been accepting our reality and feeling satisfied in my efforts (no guilt) and cherishing the precious time I was able to spend with my baby. Also, asking for plenty of help, especially in the realm of childcare, was key. In turn, my hope looking ahead is for a happy future of global surgery work, travel, and a happy family. For me, that’s what Indie Docs is all about.

Enjoy this hilarious, heartbreaking, and candid tribute to nursing moms…

The Reality Of A Working/Breastfeeding Mom Sucks

May 13, 2018September 15, 2018

Happy Mother’s Day…Getting out of the “Mom Box”

I have to admit that I really feel like I have it all. I complain about my crazy and exhausting life sometimes, but I wouldn’t change it. I have the residency of my dreams and I’ve reached the end of my Chief year (Holla!!!), the man of my dreams (you’ll appreciate this more in a minute), and a beautiful and fascinating baby girl. I even have a borderline-magical beast of a dog that will get his own post one day, but suffice it to stay he’s my hero and definitely one of my besties.

There is a detail in here that is actually quite vexing to me, and it’s the mom part. We were married for 10 years before having a baby, and during that time, I was pretty hard core anti-motherhood. I read and related to articles examining the decision to never have kids. I was “not maternal.” I couldn’t talk to kids. I was impatient. I didn’t like clutter or messes. I was 100% career driven and proud of it. So what happened? Well, I slowly started to get to the point where I didn’t want to choose between a career and a family. Certain aspects of motherhood started to appeal to me, and for half a dozen little reasons that aren’t important, I decided I wanted a baby. I figured out that an au pair would be essential and also doable with our money and space. So I became a mother, fully expecting a tsunami of life-altering invasions of time and privacy that would leave me grouchy and struggling to maintain sanity. That’s what all the advice focused on, right? How to “survive” the first year. How your life as you know it gets destroyed by a baby and you deal with it for 18 years.

Well that’s not how it happened. From day 1 to now day 600-and-something, it’s been fairly awesome. Truly, I’ve loved it. I’ve given up lots of sleep, yep, and breastfed forever, pumped countless time between cases, felt the push and pull of work responsibilities and fatigue, but I’ve never felt like it wasn’t manageable or that it destroyed my life. It’s been fine.

How is this possible? Well, firstly I would say that I have no shame about asking for help raising this little angel. Yes it would have been more enjoyable to stay home more, I fully admit, but that’s not the path I chose or was meant for, so I enlisted the help of my two aunts when Eddy was an itty bitty (6 weeks to 3 months) and then an au pair plus day care as she got a little bigger. She loves day care and our au pair, so even though her day from 6 a.m. to 7 p.m. routinely is with them, I don’t get stressed about that. Secondly, Josh and I have equal parenting responsibilities. I’ve observed that in many families, even where the woman works full-time, the mom is the “dominant parent,” responsible for much of the mental burden of planning and decision making among the family. Josh simply doesn’t have the reflex to push that stuff onto me, and for the most part I let him do things his way. Admittedly, Dad-style can be less polished (like when the baby’s clothes don’t match or fit and are out of season), but is reliably more efficient. I’ve actually adopted some of his techniques and been happier for it!

From the beginning, I have had a routine of bathing Eddy and safely co-sleeping (according to pediatric safe sleep guidelines), and so we spend all night together. This has helped me feel like I wasn’t missing her so much and I think it also strengthened our bond and made nursing much easier at night. I think another key has been that I learned a parenting style from my Mother-In-Law, who had a very late in life baby, that allowed for a full range and display of emotions from the little one without taking it personally or even reacting. I joined a gentle parenting group on facebook that reinforced these principles, and I think it saved my sanity and helped me maintain patience. I got into a discussion one time with a friend who was absolutely miserable trying to stay firm with their 1 year old over sleep training, and in that discussion I created a new mantra, which is “If snuggles solves the problem, there really is no problem.” I will fully admit, this philosophy is as much about my happiness as my child’s.

I’ve been thinking about parenting in the context of pursuing humanitarian work and the Indie Docs lifestyle quite a bit. Josh and I have talked about the best way to raise our kids and make sure their education doesn’t suffer. In the process the topic of being flexible has come up, as has different parenting cultures. Josh sent me this article the other day: Secrets Of A Maya Supermom: What Parenting Books Don’t Tell You, and it was a great article talking about how skewed our idea of parenting is in Western Society. I love the author’s imagery of how we have put parenting, motherhood, in particular, but this is relevant to the many stay-at-home Dads I know, in a box and expect one person to do it all. It’s not normal or necessary, and I think it generates a lot of anxiety and misery among parents. Of course, reading the article I felt validated in my parenting style (after being called “crunchy” a few times in various contexts) and in my skepticism of some parenting advice I was hearing over and over (like hard-core sleep training, we can have that discussion another day).

Perhaps more relevant to Indie Docs per se is the fact that we will demand a lot from our kids as we pursue this mission in life. They will need to understand that a huge portion of our time and money goes to help others. They will have to be flexible and adaptable to other cultures, and will likely sacrifice some aspects of the prototypical American kid existence from a social or sports context.

Now to inject some reality that life is not a fairy-tale. I got mastitis 3 times on a rotation where my attending would not let me pump. I was so tired one time that I came home and while holding Eddy to nurse her, I hallucinated that it was raining inside my kitchen. I’ve gone on a job interview just to have a night away in a hotel, and I felt FABULOUS after getting that night of undisturbed sleep. I’ve let the au pair feed Eddy her dinner while I hid in my room either power napping or vegging out for 20 minutes. Our marriage has undergone a tectonic-plate-shifting adjustment, and I had to delve into relationship podcasts and articles to try to undo some of the damage done by the paucity of quality time we had together. Going back to work when Eddy was 6 weeks old was one of the hardest things I’ve ever done in life, and her sleep habits only got worse over the next 6 months when she was waking up every 2 hours to nurse. But we coped and managed and continued to enjoy the moments and milestones along the way.

Fortunately, I did not experience postpartum depression, or have a colicky baby, or have any major medical concerns that would be much more challenging and beyond my control.

This is a huge topic that is both paramount to life as a physician parent and in related to upcoming big decisions about where and how to raise our kids. I hope to become more open minded in how I guide my little one through life, and most of all I hope I can maintain the inner peace that motherhood has brought to me. And to any reluctant trainees contemplating whether it’s worth it, I can offer my anecdote that having this child in my life is the most interesting, entertaining, and warm-fuzzy-feeling-inducing thing I’ve ever done. As The Ruth Bader Ginsburg has said, having a career and being a mother gives balance, and one helps you find respite from the other. I hope everybody finds their tricks and techniques that can make this huge responsibility wonderfully enjoyable.

Happy Mother’s Day to all moms out there making it work!

May 13, 2018September 15, 2018

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.