Matching Your Life and Your Job | Life

Evidence based insights into physician compensation, RVUs, contracts, healthcare economics, and personal finances. For residents, fellows, and early-career attendings.

Life and Finances, in Medicine.

What Is This About?

Life is about balance. Balance between good and bad, between duties and pleasure, between your life circumstances and the type of practice you choose. When you look at a job offer only from a reimbursement standpoint, you're missing a big piece of what makes the type of practice you are considering an appropriate match for you.

Why Should Medical Professionals Care?

Whether you are married or single, with children or without, your circumstances affect the type of practice that fits you. When I finished residency, I was far from ready to establish myself in one place and in one practice. I wanted to travel and meet new people. And since I was single and not committed, I chose my job type based on these circumstances. A job that allowed me to travel as a backpacker, while I volunteered as a doctor in different parts of the world. If you are in this same boat, and you want to stay locally another good option to consider is locum tenens. I also did this for some time. And I met very interesting people in places that I would not have otherwise visited, let alone lived in.

But if you are on the other side of that spectrum and you are ready to start a family and grow roots in a specific place, then joining a hospital or private group where you can nurture your expertise, your time and even your investments, could be far more suitable for you.

Eventually, I also became ready to start a family and grow roots. For many of us, this path leads to multiple life changing decisions at once, like joining a new practice, getting married, buying a house with a nice, big mortgage included, and beginning the expansion of our families before anyone can say:

Pneumonoultramicroscopicsilicovolcanoconiosis.

How many of these are substantial, life changing decisions? All of them. And juggling those many delicate balls at the same time, each with its own nuances, could be a lot to handle.

Ranking your decisions based on urgency and impact helps. Making one big decision at a time also helps. But sometimes in life, we can’t think pragmatically. That is why, when I face decisions of this magnitude, I frequently resort to a new variation of an old idea. My version of Pascal’s Wager.

Pascal, a French philosopher, argued that if God exists, the potential gains from believing are infinite, while the potential gains from not believing are finite. So even without proof, the consequences matter. This is not a religious approach, but a philosophical one. When faced with uncertainty in my decisions, I usually consider not only the likelihood of the options, but the magnitude of the consequences attached to each of them.

Many of these big personal and economic decisions that we make are financially supported by the type of practice we choose and influenced by the professional life that comes with that job.

So, for example, what happens if you join a salaried practice and later realize it is not the right type of practice for you? I lived that. Your finances and your family may be part of your decision to leave that practice.

What happens if you are in an academic program in a large institution and you realize the egos are too big for you to feel comfortable in that kind of environment? I lived that too. What is the magnitude of the consequence of your departure from such a practice? That is the application of Pascal’s Wager. Considering the magnitude of the consequences of each option you might choose.

When job changes happen, everything else that depends on that job must adjust to the new reality. Sometimes quickly. We have this symbiotic, perhaps even mutualist relationship between our jobs and our lives.

Sometimes your job must bend around your life. For example, if you are divorced, the type and location of your practice may need to adjust for you to remain close to your children. We can't easily change personal circumstances like this. But we may have more control over our work circumstances.

The other side of the equation is also true, sometimes you must adjust your life to fit your job. For example, if you don’t find a position that you like where you want to live, you may accept a job far away, leaving your family behind. I lived this and I travelled twice a week, three to four hours each way, just to see my family and come back to work. That's adjusting your life circumstances to your career. And the consequences must be factored into your decision, not be treated as a side effect of it.

So, before you choose a practice, think about your circumstances and your plans. If you're single, financially driven, and don't have major time commitments outside of work, a production-based private practice may fit you well. That type of practice may demand more from you. That doesn't mean people with families can't do it; most of us do. But it tends to suit someone without competing demands more comfortably.

If you need more predictable time for family or other parts of your life, perhaps a salaried position might feel more sustainable. Your income isn't tied to how many patients you see day to day. There are real compensation tradeoffs that may not be evident when you sign a contract of this type. You may be trading finances for time, which is valuable in its own right.

Regardless of your decision, the real issue is sustainability. We can all adjust either side of the equation, our circumstances to our jobs, or our jobs to our circumstances, for some time. But these adjustments are hard to keep for a long time. That’s why another question I often ask myself when faced with these decisions is: How sustainable is this? Consistency matters more than we think. Results don't usually come from sudden changes, but from small, consistent decisions over time.

Thankfully my family and I have successfully weathered many storms together. But the goal is not perfection. It's finding a balance you can sustain, so you can have both the work and the life you want.

If you're early in your career, don't expect to nail this right away. It takes time. Just stay aware of the importance of both your job and your life circumstances, because they are both part of you. Choosing a practice is never just about the money. It's about building a life that works and finding the balance to live it wisely.

The Bottom Line

The best type of practice is not necessarily the one that pays the most or gives you the most free time. It is the one that fits your priorities, and the life you are trying to build.

Key Takeaways

1. Choose a practice that fits your life, not just your income goals.

2. Consider both the probability and the consequences of your decision.

3. Sustainability matters as much as short-term adaptation.

“The heart has its reasons which reason knows nothing of.”
Blaise Pascal

MD&D Quote of the Day

Have a Question?

Have a question about compensation, contracts, personal finance, or life decisions in medicine? Send it to MD&D. Your question may be answered in a future article, podcast, or Q&A.

email: [email protected]

MD&D is a FREE platform for residents, fellows, and early-career attendings who want to better understand RVUs, compensation, contracts, and finances in medicine.

Website:
mddecisions.org

Newsletter:
read.mddecisions.org

Free RVU Playbook:
playbook.mddecisions.org