Planning Out the Next Phase in Life

[AD04]

I've been out of residency for a little over 4 years. The past 4 years have been a whirlwind of professional growth (in terms of clinical skills and medical business knowledge) and wealth building. I really like the place I'm at. They accommodate many of my requests. I get along with staff (including administration) and with my fellow physicians. I get paid well with excellent job security. However, winters are brutal and because I work so much, it's hard for me to explore new things outside of medicine. My learning plateaued and don't have new things to look forward to.

I'm planning on staying for another 1 - 7 years and then it'll be time for me to do something different.

If I stay for 7 years, I'm guaranteed to not have to work ever again and can retire in luxury anywhere in the world. The downside is I cannot see myself not working in my 40's and letting my hard-earned clinical skills die. So working at the current place for another 7 years and facing its harsh winters won't do much to improve my lifestyle as I'll still be working (just not in the cold).

The other option is to leave earlier. In one year, my student loans will be paid off after fulfilling my contract. Then I want to work 6 months of the year and travel for the other 6 months. Or I can move to a place without winter and work there. For example, I can call up my friend and get a job making $400k - $500k in FL. The downside is leaving the people here. I've built up a sizeable patient panel and my no-show rates are quite low. I practice however I want and am free to conduct therapy and restrict controlled medications. Saying bye to my patients is tough. I did that during my first year of being an attending and I still remember the look of disappointment on some of my patients' face when I told them I was leaving. I'm one of the few psychiatrists in the area, so if I leave, it'll open up a big hole. And disappointing my work partner is tough as he's a good guy and very capable and taught me a lot. He will likely burn out if I leave. When one of our partners left, he was demoralized for a bit. I wouldn't mind working where I'm at now 6 months of the year (in the spring and summer and fall).

I have a few questions:

1. Is it possible to just work 6 months per year without jeopardizing licensing in other states and credentialing with other facilities?

2. What would you do if you were in my situation? It could even be something I overlooked and didn't write about.

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[Celexa]

Can you work in person from your current location 6 months of the year and tele from somewhere else the other six months? If you only took new pts when you are in person you shouldn't run into issues with controlled substance prescribing under either the current or the most recent proposed rule changes.

Also if they want to keep you, and you don't need to earn at your continued rate (I assume you're productivity based?) it shouldn't be a big deal to pare back hours as long as you are ok with the reduced income.

 

[Sushirolls]

1) get the licenses now and unlikely to be issues. Its more when applying for a new license that they hone in on the gaps. Facilities boil down to bylaws. Read the bylaws first and you'll know your answer, most won't care.

2) Consider staying and figure out how to enjoy winter. Ice fishing. Cross country skiing. Sledding. Playing in snow, building forts, snow ball fights with teenagers. Look up state trapping laws, learn how to go trapping and setting lines. Buy a chain saw and look into world of ice sculpture? Jacuzzi outside staring at stars in winter time is amazing. Get a house/home that has a real wood fireplace. Just can't beat the ritual of the seasonality of getting wood, getting the fire place going and enjoying that toastie heat, and the glow. Ice skating.

Or take xmas tree hunting to the professional level. Most national forests have a permit that's like $5 or $7 to go bag a wild tree. Spend early winter trudging through the forest GPS marking maybe trees, take photos, or videos. Compare your collection before you go bag the one. Then you can instagram that, or tik tok, and be like look at my ethically sourced, wild caught, sustainable carbon friendly Christmas tree that doesn't look like Charlie Brown's.

Oh, and did I mention ice fishing?

 

[psychemdoc]

1) get the licenses now and unlikely to be issues. Its more when applying for a new license that they hone in on the gaps. Facilities boil down to bylaws. Read the bylaws first and you'll know your answer, most won't care.

2) Consider staying and figure out how to enjoy winter. Ice fishing. Cross country skiing. Sledding. Playing in snow, building forts, snow ball fights with teenagers. Look up state trapping laws, learn how to go trapping and setting lines. Buy a chain saw and look into world of ice sculpture? Jacuzzi outside staring at stars in winter time is amazing. Get a house/home that has a real wood fireplace. Just can't beat the ritual of the seasonality of getting wood, getting the fire place going and enjoying that toastie heat, and the glow. Ice skating.

Or take xmas tree hunting to the professional level. Most national forests have a permit that's like $5 or $7 to go bag a wild tree. Spend early winter trudging through the forest GPS marking maybe trees, take photos, or videos. Compare your collection before you go bag the one. Then you can instagram that, or tik tok, and be like look at my ethically sourced, wild caught, sustainable carbon friendly Christmas tree that doesn't look like Charlie Brown's.

Oh, and did I mention ice fishing?

Lol sushi I love how much you embrace your rural, cold, rugged, best farmer life. I wish you the best as a farmer but I have enjoyed your inputs as you build your pp and will miss it whenever you’re done!

And to OP I definitely like the recommendations by others to try to figure out ways to stay with the other physician and those patients that you connected with. Telemedicine for part of the year is very reasonable. I know a rural IM Dr who does telemedicine every other week and goes in the other weeks. Works for him and his practice and works for his family as they live in a big city and he doesn’t want to leave behind his patients. Is it easy and sustainable? I doubt it he’s nearing retirement so he’s not going to do anything else if not this so not exactly identical to your shoes but as a psychiatrist you have even more opportunity for telemedicine than the primary care medicine clinics. Just an encouragement if you can sustain your good gig that you love so much and pays well and are respected at. Not the case at a lot of other places.

 

[Merovinge]

Telepsych 1/2 the year, in-person 1/2 the year sounds like the best possible option. You keep a high paying and satisfying job (Unicorn status) and really won't need to worry about tele-med concerns with controlled substances. Patients and work partner are happy. You can even try out different places for the winter to see about future places to live.

If that won't work, I worked with an attending during residency who was from Brazil and took all their vacation during the winter months. With how much you make, nothing wrong with taking 4-6 weeks off during whatever 2-3 months of winter are the worst, it's much easier to sustain the cold knowing you will be on a beach in a week. Honestly with climate change there are very few places in the continental US (sorry Alaska) that are uninhabitable over the winter, I think you might be able to find a few ways to enjoy some of it if you find friends to do winter activities with.

 

[AD04]

Can you work in person from your current location 6 months of the year and tele from somewhere else the other six months? If you only took new pts when you are in person you shouldn't run into issues with controlled substance prescribing under either the current or the most recent proposed rule changes.

Also if they want to keep you, and you don't need to earn at your continued rate (I assume you're productivity based?) it shouldn't be a big deal to pare back hours as long as you are ok with the reduced income.

The telepsych angle is a good suggestion. I also do inpatient and consult and ECT so it's kind of hard to do straight telepsych. And I prefer 6 months off to travel and to explore and experiment. I don't mind reducing income.

1) get the licenses now and unlikely to be issues. Its more when applying for a new license that they hone in on the gaps. Facilities boil down to bylaws. Read the bylaws first and you'll know your answer, most won't care.

2) Consider staying and figure out how to enjoy winter.

Good idea about the license. The only one I'm interested in that I don't have yet is TX.

No, I can't enjoy winter. I hate the cold way too much.

If that won't work, I worked with an attending during residency who was from Brazil and took all their vacation during the winter months. With how much you make, nothing wrong with taking 4-6 weeks off during whatever 2-3 months of winter are the worst, it's much easier to sustain the cold knowing you will be on a beach in a week. Honestly with climate change there are very few places in the continental US (sorry Alaska) that are uninhabitable over the winter, I think you might be able to find a few ways to enjoy some of it if you find friends to do winter activities with.

I think this will be the most likely option. After 1 year, I'll have to sit down with my partner and lay out the situation. I'll likely take all my vacation during the winter. Winter here isn't like on the northeastern coast. It gets so cold to the extent that cars have trouble starting.

 

[finalpsychyear]

The fact that in 7 years you will only work by choice is very significant and it seems other than the winters, you like the work environment. I would do whatever it takes to get close to that timeline. Vacation, shorter weeks so you have multiple 3 day long wknds for quick beach escapes, or heck my buddy has an NP while he goes somewhere in the winter that function sorta like his right hand in person although I know with some of your responsibilities that may not work. Also, maybe a hybrid set up during the winter may also be something that works.

Bottom line: as long as you are happy with the work, people, and colleagues make it work and hit that magical status in 7 years. Yes, I get you'll probably still work after you achieve this status but you will be in a whole different level about your life, career, and personal growth. I plan to be sipping Mai Tai's while working in some exotic locations remotely maybe by 2030 ( come on tesla)... but as i progress yes work is still necessary like working out imo even after you achieve Fat Fire status.

 

[Merovinge]

I think this will be the most likely option. After 1 year, I'll have to sit down with my partner and lay out the situation. I'll likely take all my vacation during the winter. Winter here isn't like on the northeastern coast. It gets so cold to the extent that cars have trouble starting.

I have some family who grew up in the Twin Cities so I think I get it. There is still fun to be had in the winter even if there are some days that all the gear in the world isn't going to make you want to go outside. That said take 6 weeks off each winter and I bet you enjoy it a whole lot more 🏖️