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The First Quarter of Staff Life

Wow, it has been a while! And there have been a lot of changes.

When I first started writing this blog, I was a resident. Time has passed, exams have passed, I have passed those exams, and now I’m in my first (and hopefully last) staff physician position. Woohoo!

…Woohoo…I think?

So many mixed feelings. Many times, over the last couple of months, I thought about writing this post, and discarded the idea. Staff life – how often have my co-residents and I bandied that term about – seemed like this glorious light at the end of tunnel of residency.

I think the reality can be a bit more mixed.

Dr. FIREfly’s Situation

The post-residency/post-fellowship(s) path can vary a lot. Mr. Sparks and I are on very different trajectories with regard to the framework of our post-training life, and I do plan to interview him to share with readers too. He has gone through the process of hiring staff (we were never taught that in our medical training!) and is in the process of setting up his own clinic space. I think the gist so far is – if you are newly out of training, strongly consider joining a practice if possible.

From my end, I was able to parachute into a position. Office space already set up (shared, which was surprising, but nice in some ways), workplace set up (partly hospital-based, clinic also located in hospital), no overhead (whew!). Referrals are set up in a pool, and there is always work waiting (no need to “build up a practice”).

The Pay

Let’s start with the positive – the one positive I can think of that is unique to staffhood compared to residency. (The other positives, like working with learners and learning from each other, working with great allied health team members, having collegial physician colleagues, seeing patients get better, supporting family members – those have happily remained through my many transitions in workplaces, including this most recent transition to a completely new city and province).

The first paycheque was fantastic.

Truly, residents in most provinces make comparable money compared to the national average. It is not a lot to live on in some of our country’s most expensive cities, and certainly Quebec’s salary is noticeably less than the other provinces (but I think is made up for in the benefits provided within the provinces borders?). Nevertheless, for me, it was enough to finish my five years of residency with a positive net worth in the five-figure range, a fair amount of travel to be treasured in my memory banks, and no sense of having sacrificed significantly in my lifestyle to attain this. And by the middle of my sixth year of training, my net worth had broken the six-figure mark (aided in no small part by leveraging and a helpful market).

But that first paycheque? It was five figures.

That blew my mind.

(I think taxes brings it down to four figures, haha. But still!)

The Paperwork

This con is meh. It’s manageable. Though real.

There is a lot more paperwork as a staff physician. From a clinical side, all these forms to fill in order to properly advocate for your patients, fulfill provincial regulations, communicate with other healthcare entities…

From a non-clinical side, for the first time ever I’ve had to think about my own insurance. Healthcare insurance, dental coverage, disability, critical illness – which ones? How much? And goodness, it feels bad to have to pay almost double for disability insurance just for being female! (Men pay more for life insurance).  

And I’m spending fifteen to twenty minutes a day submitting billings so that I will get paid. Never had to worry about getting paid as a resident.

(Mr. Sparks has a lot more ancillary paperwork to deal with, with starting up his own clinic – more on that coming)

The Work-Life Balance

This con is significant, and the main source of my struggles, particularly in the first two months.

I was late for my birthday dinner.

I was late for my wedding anniversary dinner.

I was late coming home every day.

It has gotten a little bit better, but continues to be a struggle.

It turns out that even in a “lifestyle” specialty, you can work an infinite number of hours. And everyone is happy for you to work more – the allied health members you work with, your fellow physician colleagues, your patients, their families, the system…

No one else will protect your time. (And medical school + residency has been all about telling you your time is not as valuable as everyone else’s – this does not translate well when you’re suddenly staff).

And the work is never “done”. At least, that’s how it feels for me. As a *cough* somewhat type A personality, I like to complete tasks and cross them off my list. But with these human beings in my care – and I am the end of the line – it never feels done.

Which leads me into the next bit…

The Responsibility

I used to wake up in the night for whatever reason – maybe Mr. Sparks snoring, maybe an itch – turn over, and go right back to sleep.

Now, as soon as I wake up, I start thinking about my patients, their treatment plans, and thinking about what I can do differently. And this is without any major crises going on.

I stand at the kitchen sink, doing dishes, thinking about whether I’m on the right track with my patients’ care.

On my way to work, I’m thinking about what I need to do at work today.

On my way home from work, I’m thinking about whether I’ve missed something.

I’m now dreaming about work too – this never used to happen in residency!

Conclusion

Well, I’m a staff physician now. There is not really sense in thinking about whether I would prefer to be a resident or a staff – that is not really an option.

My goal these days is to improve my efficiency, draw that line in the sand for myself of when my day is finished, and still provide what I feel is the best patient care that I can provide (without having to stay till 9PM every day to do it).

It’s an ongoing process. Some days are better than others. Some weeks, I feel a bit burnt out by the end of Tuesday, which doesn’t bode well for the remainder of the week.

Two of my co-fellows in my PGY6 training spot asked me staff life was better (they were both slightly off-cycle in terms of time line for finishing training). I blurted out a somewhat disjointed answer to the effect of “well, it’s complicated.”

This post would have been a more organized approach to my answer.

Food for Thought

To all the trainees out there making their way through medical school and residency (and maybe also staff physicians of any stage in their career for whom these struggles still resonate), I would suggest:

  1. Your time is valuable. Everyone has finite time. It’s worth protecting.
  2. It is okay to take care of yourself. I have found it easier to have a hard end time to my day if I have a time-based commitment to someone else waiting. I am working on being able to hold that commitment just to myself.
  3. And on a more prosaic and optimistic note, the pay is solid. Without inflating lifestyle right away, (and if you do not have significant start up costs, like Mr. Sparks is facing) you can start making rather rapid headway towards financial independence once you transition to staff life. Starting saving and investing habits earlier in training will pave your Maglev rail to FI/RE.

Until next time!

-Dr. FIREfly

This Post Has 7 Comments

  1. Matt

    Congratulations on entering independent practice. Reading your report brings me back 15 years to when I was in the same position. It’s great – but complicated, for sure.

    “you can work an infinite number of hours. And everyone is happy for you to work more” This is SO true. I found it far easier to set boundaries from the start, then you can selectively break them and people are grateful. On the other hand, if you say yes yes yes, then no, people get resentful. Also, it’s a fast track to burnout. Sounds like you’re perspective is very balanced.

    I’m curious about the financial side of things – do you have a plan for how you are going to spend/save with this higher income? The “doctor lifestyle” can be pretty seductive 🙂

    Thanks for the update. ~Matt (aka Big Family Small World)

    1. Dr. FIREfly

      Hi Matt, thanks for your words of wisdom! I will try to set boundaries from the start and try the selective breaking. Doctor guilt is real. Doesn’t help that, in the moment, I really do love what I do and forget that I have to document it all later. The charting is the worst part XD

      From the financial side of things, I plan to keep living like a resident…but maybe a PGY7 😉 Give myself a slight pay bump. My most frivolous splurge since becoming staff was a pair of mini solid gold hoops for passing my last exam ever – I think with tax and shipping, they were $130. Savings rate since starting in August has been 85%, which I’m quite content with. Zero feelings of deprivation these days.

      The housing market where I’m at is a bit weird though – will see to what degree the savings rate goes down if/when we get a home… Doesn’t compare with folks who live out in Toronto or Vancouver, but this market is juuust weird enough that I think it’s going to hurt a bit.

      I’m curious – do you think having kids is very impactful on finances? Obviously there are clothing and food costs (and initially infancy-related costs), but starting to wonder what the impact is for most folks. Any advice and thoughts are appreciated!

      1. Matt

        If you have found a way to continue living more or less like a resident and still feel “zero feelings of deprivation” AND your partner is equally content, then you ‘re golden!

        Re: kids . . . As you may recall, we have four of them. Our oldest is now 15 and our youngest is 10. When I left medicine ~3 years ago, we traveled around the world as a family for a whole year. It probably cost about $100k for the year, but would have been worth 10x that.

        There are some things in life where the price does not correlate with value. Kids are like that. If you want kids, don’t think about the money. Seriously, stop thinking about how much they might cost. Two reasons. First, you will have control over how much they cost. Just like anything else, you can spend $2000/year on a child or $200 000/year – and the outcome will probably be the same. But more importantly, when it comes to kids, money is the easy part. The moment they are born and you realize you would fight a 1000lb grizzly for them without a thought, you will realize that on the list of “Things to worry about with kids”, money will be at the very bottom.

        I could go on about this forever, and if you want to chat individually sometime I’d be happy to, but the bottom line is this: we need to remember what money is for. It’s just a tool to build a life in line with our values. If you value kids (and, yes, I highly recommend them), there will be no greater purpose for your money, no matter how much they cost.

        I hope you don’t mind if I add that these are exactly the kind of ideas my course explores to help physicians get on the path to financial independence: moneySmartMD.com

        1. Dr. FIREfly

          Yes, I loved reading about your family’s adventures ^ ^ It’s great you pivoted and started Money Smart MD! I will check it out.

          Thanks for the advice about kids. I’ve heard it said that it is hard to understand a parent’s heart until one is a parent, yet your description of fighting a 1000lb grizzly paints it so vividly. Hope to cross that bridge at some point in the future!

  2. Chris @ Mindful Explorer

    Congratulations on the next stage in your career and journey in life. Be steadfast and mindful on the work life balance you spoke of as it is the most crucial dedicated work we can do for ourselves. You are in the profession of lives so the understanding that we never get back those hours we spend each day so it is imperative we align them with our own well being is most likely front of mind for you. All the best

    1. Dr. FIREfly

      Thanks Chris! Yes, and I will be diverting some of those hours I keep for myself to go outside, being re-inspired by your blog!

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