My Plan to become a Multi-Millionaire Barista/Surf Instructor/Deadbeat

[surfguy84]

Why is that necessarily burn out? Some work better in a sprint and coast mentality. Personally I work better that way. When I used to be on call in residency I wouldn’t sit down or eat or socialize until all calls and notes were done. Then I’d coast. Taking a test I’ll knock out boards in 3 hours no breaks then leave. So why not just smash all work together then coast and travel or what ever. Burn out to me would be doing that for 20 days a month or more.

In a more macro scale, this is essentially what I'm trying to do w my life. Cram all the work into 4 years then coast hard.

---

Members don't see this ad.

 

[psychmd03]

I think what everyone forgets here is that even in retirement, that initial nest egg of $2.5M will continue to grow. The idea is withdrawing 3-4% and living off of it and letting the rest of the market growth compound on itself.

Assuming OP retires at age 40 with 2.5m and withdraws 4% which comes out to 100k to spend during his first year, a statistical projection of his finances will look something like this.

View attachment 359410

Meaning that by age 50 (10 years into retirement) - his NW will be between $2-8 million, withdrawing $96-372k annually
By age 60 (20 years into retirement) - NW between $3-22 million, withdrawing $138-951k annually
By age 70 (30 years into retirement) - NW between $5-53 million, withdrawing $207k-2.2M annually

Not a bad life considering OP hasn't worked a single day past age 40.

The true question OP should be asking is which charities/foundations he wants to leave his money to.

I enjoy these charts what website did you use? I normally just use a few simple calculators back to back even know I know truly I’ll never have an issue unless I can’t work starting today. But after a few years it truly wouldn’t even matter but still fun to mess with these.

 

[psychmd03]

2.5m nest egg gets crudded on too much nowadays... at some point that 100-120k yearly being used for mortgage/cars will all be eventually paid off and the kid will be done with school. My rent is 2400 and i have 2 cars costing 1500 total per month and easily stay under 120k without trying granted its just me and my wife for now.

I’m not doing so good. Rent is 2850 for me no other debt and I still spend 120 by myself a year lol. The food I like is too expensive and going out in the damn city costs too much.

 

[finalpsychyear]

I’m not doing so good. Rent is 2850 for me no other debt and I still spend 120 by myself a year lol. The food I like is too expensive and going out in the damn city costs too much.

Yeah city is expensive. I don't go out of my way anymore to live like a resident since i paid off all my loans. So after essentials rent, plus 2 cars, plus health/dental etc insurances I avg 7-8k total expenses. I also don't eat out other than chipotle/pho and when i do drink its vodka soda simply because its hard to maintain a 6 pack if you eat most of the processed junk cause it screws up my motivation to exercise so indirectly it probably saves me money and saves my health.

 

[Stagg737]

Why is that necessarily burn out? Some work better in a sprint and coast mentality. Personally I work better that way. When I used to be on call in residency I wouldn’t sit down or eat or socialize until all calls and notes were done. Then I’d coast. Taking a test I’ll knock out boards in 3 hours no breaks then leave. So why not just smash all work together then coast and travel or what ever. Burn out to me would be doing that for 20 days a month or more.

I wasn’t referring to burnout with “burn and churn”. I meant seeing a high volume of patients in a short amount of time like in derm offices or psych clinics that do 10-15 minute follow-ups all day long, typically a “factory-line” style set up that’s often associated with prioritizing income at the expense of quality of care.

 

[AD04]

That’s not a remarkable gig he’s probably working very long hours with high liability risk with an unpleasant population

Quit downplaying other people's job unless you can do better.

I believe in balance. Currently working per diem psych ER job making 47k a month working half the month. The other half of the month, I'm in South east asia. I'm single male with no kids. 31 yo.

I respected your post on how you got into residency. It was unorthodox and I still remember it to this day. I'm not surprised that you're doing well financially and living it up like a king given your ability to think outside the box. I may have done the same thing if I didn't hate traveling so much. I feel like I waste a day each time I'm flying in an airplane.

Do you have family in the country? If not, how do you maintain your social life as I suspect most expats are either way older than your or transient digital nomads.

 

[forchinet121]

Anyone can do better as psych ER work is a dime a dozen and few want to do it, I wouldn’t classify it as thinking outside the box. I’m currently on the job hunt and there are more attractive options unless of course you enjoy psych ER work.

 

[AD04]

Anyone can do better as psych ER work is a dime a dozen and few want to do it, I wouldn’t classify it as thinking outside the box. I’m currently on the job hunt and there are more attractive options unless of course you enjoy psych ER work.

When you get the job, share the details. Frankly, not too many psychiatrist working full-time makes more than what @twospadz makes. I don't think you can make more either. From the really successful people I know, none of them downplays other people's jobs.

 

[G Sheb]

I believe in balance. Currently working per diem psych ER job making 47k a month working half the month. The other half of the month, I'm in South east asia. I'm single male with no kids. 31 yo.

If he's making $47k per 15 days that's pretty impressive at ~$3k/day unless he's basically just doing churn and burn seeing 10+ patients per day. I'm also interested in hearing more about that set up.

Missed the psych part of psych ER, but as you describe sounds like a basic burn and churn volume position even if it's an hourly rate.

ER work can vary greatly.
If you're doing nights, you could get up to 6/7 hours of sleep if you're working with residents or you cross cover with another doctor.
I do something similar. Work 11/12 shifts a month and get upwards of 350K a year while I am setting up my practice, which I've been delaying cause this setup is so good, lol. Actual time worked is more like 20/25 hours a week max if you count the sleeping and all the downtime, if not less.
It certainly does not feel like burn/churn either. Some places are busy, but you do good work.
PRN work is actually a pretty good gig. Not many people are willing to do it for the odd hours and the downside is that sometimes it's hard to sell it on your CV if you're thinking of going back to a full time employed position (why would anyone do that though). But you get so much flexibility. Essentially I pick my shifts a few months in advance, decide how much vacation I want/when I want to take them...etc. I have other interests I pursue, if not ,you could easily chill for most of your time while making significantly more than the average salaried position.

 

[surfguy84]

Nothing is ever "for no reason". I see the dads for a living. Sometimes I see the sons (years later).

And perhaps it's at least justifiable if you are working 80 hours a week. It'd even be inspirational if you are super duper excited about your work and it's of some importance and your family might understand. Imagine you tell your kid that you'd rather surf 80 hours a week because ... well, you enjoy it more than anything else, and that 1. you have millions in the bank but you don't want to spend it; 2. instead of working you'd rather sit there. Who wouldn't drop that kind of dad like a bag of hot potatoes? Choices have consequences. Boundaries exist for a reason.

And I'm not saying that any of this is "right" or "wrong". There's no singular model that would sustain fulfillment for everyone. My point is simply that one ought to think of the reality of the situation in a stark way and truly evaluate the consequences.

Who's talking about surfing 80 hours a week at the expense of seeing my child? An ideal day would be dropping my kid off at school, catching waves, maybe taking a couple beginners out. Wrapping up around 11. Maybe get a round of golf in or work out. Be there when the kid gets home from school. Make dinner or do other family stuff. Catch a sunset on the beach with fam +/- friends and a bottle of wine, maybe get in a quick sunset surf sesh. Repeat.

Not to mention, my kid is young but also getting into surfing. This is a lifelong thing we can share together.

 

[jbomba]

ER work can vary greatly.
If you're doing nights, you could get up to 6/7 hours of sleep if you're working with residents or you cross cover with another doctor.
I do something similar. Work 11/12 shifts a month and get upwards of 350K a year while I am setting up my practice, which I've been delaying cause this setup is so good, lol. Actual time worked is more like 20/25 hours a week max if you count the sleeping and all the downtime, if not less.
It certainly does not feel like burn/churn either. Some places are busy, but you do good work.
PRN work is actually a pretty good gig. Not many people are willing to do it for the odd hours and the downside is that sometimes it's hard to sell it on your CV if you're thinking of going back to a full time employed position (why would anyone do that though). But you get so much flexibility. Essentially I pick my shifts a few months in advance, decide how much vacation I want/when I want to take them...etc. I have other interests I pursue, if not ,you could easily chill for most of your time while making significantly more than the average salaried position.

I've got a similar gig. How much is your ER job paying you out of curiosity on an hourly basis.

 

[TheRightMedication]

Who's talking about surfing 80 hours a week at the expense of seeing my child? An ideal day would be dropping my kid off at school, catching waves, maybe taking a couple beginners out. Wrapping up around 11. Maybe get a round of golf in or work out. Be there when the kid gets home from school. Make dinner or do other family stuff. Catch a sunset on the beach with fam +/- friends and a bottle of wine, maybe get in a quick sunset surf sesh. Repeat.

Not to mention, my kid is young but also getting into surfing. This is a lifelong thing we can share together. So when you start talking about "who wouldnt drop that kind of dad like a bag of hot potatoes..." you're just kind of being an ignorant dick tbh.

All right that sounds pretty good. Random internet stranger approves.

 

[Liquid8]

For me the main downside of an ER style job is that you’re always having to start over new with each patient but the plus side is the followup is non-existent and your shift ends where it ends, so it’s more suitable to working hard in bursts and taking longer breaks. The other thing, is that it takes away continuity of care which is what makes psychiatry most rewarding and meaningful (for me at least).

Here our locum jobs that are somewhat similar are advertised pay $2k AUD a day, but the drawback is that you’re usually working in rural and remote areas and even these rates are well below the opportunities available in a private practice. If I wasn’t a prolific saver when younger it would have been an option when I qualified, and quite a few of my younger peers have gone down this path in the short term to quickly save a home deposit. I’ve taken the perspective that when I burn out or retire, it might be an option to supplement income and travel. Could easily do a 3 month stint that would pay for 9 months of leisure time, and some of the older psychiatrists I’ve met have definitely proven this is viable.

As it stands however, my current outpatient setup remains part time (2.5-3 days/week) and has gradually built up good numbers over the last 7-8 years. Years ago I think I contributed a graph of earnings in one of Sushi Roll’s threads, but things have boomed since Covid and the introduction of billing codes for telehealth items which I can’t see our government fully taking away means that I’m now able to claim costs for things that previously I would have done for free.

Updated income graphs ($AUD)

Drops in December and June are due to taking annual leave at those times. Big spike in March 2021 was due to adding another half day session.

What I’ve noticed is that work does have a tendency to creep into my off days so maintaining those boundaries is something that still needs paying attention too. In addition, as your waiting list gets longer and longer it also means you have to be more proactive about booking out time in advance. Part of me also worries that if I’m away from working too long my clinical skills will be less sharp although it’s tough to find where the balance is with not overworking and burning out.

 

[ArdorAyurveda]

How would you all compare and contrast

• Psych ER
• Inpatient psychiatry
• Inpatient correctional psychiatry

In terms of patient population, team dynamics, call expectations, and overall growth and development of the psychiatrists skills? Which would be most conducive to setting up a outpatient cash private practice on the side?

Never really considered psych ER work but it seems the most lucrative from a time standpoint at least

 

[ObsequiousAplomb]

How would you all compare and contrast

• Psych ER
• Inpatient psychiatry
• Inpatient correctional psychiatry

In terms of patient population, team dynamics, call expectations, and overall growth and development of the psychiatrists skills? Which would be most conducive to setting up a outpatient cash private practice on the side?

Never really considered psych ER work but it seems the most lucrative from a time standpoint at least

Not interested in outpatient correctional? It's way less stressful than the inpatient units, but you still know exactly where your patients are. And like inpatient you know exactly how many times your patients picked up their meds from the window.

The patient populations can be incredibly similar or widely different in the three listed, depending on the facilities. Same with the staff. Correctional probably has a more prominent skill atrophy due to very narrow formularies. Again, difficult to say without more specifics of which correctional system, which ER, or which hospital.

Typically correctional jobs don't have restrictions on external work. Hospital based jobs are more likely to. I know very few correctional facility psychiatrists who don't work external jobs.

 

[ArdorAyurveda]

Not interested in outpatient correctional? It's way less stressful than the inpatient units, but you still know exactly where your patients are. And like inpatient you know exactly how many times your patients picked up their meds from the window.

The patient populations can be incredibly similar or widely different in the three listed, depending on the facilities. Same with the staff. Correctional probably has a more prominent skill atrophy due to very narrow formularies. Again, difficult to say without more specifics of which correctional system, which ER, or which hospital.

Typically correctional jobs don't have restrictions on external work. Hospital based jobs are more likely to. I know very few correctional facility psychiatrists who don't work external jobs.

Thanks! I would be interested in outpatient correctional, I just didn't know it was a thing! Also could see myself working in a community mental health center or in assertive community treatment. I suppose I have a bias towards inpatient psych because I'm still just a med student.

 

[dl2dp2]

Who's talking about surfing 80 hours a week at the expense of seeing my child? An ideal day would be dropping my kid off at school, catching waves, maybe taking a couple beginners out. Wrapping up around 11. Maybe get a round of golf in or work out. Be there when the kid gets home from school. Make dinner or do other family stuff. Catch a sunset on the beach with fam +/- friends and a bottle of wine, maybe get in a quick sunset surf sesh. Repeat.

Not to mention, my kid is young but also getting into surfing. This is a lifelong thing we can share together. So when you start talking about "who wouldnt drop that kind of dad like a bag of hot potatoes..." you're just kind of being an ignorant dick tbh.

Interestingly, this is typically the reaction my patients tell me at first when I point out the obvious to them: I am "spending so much time with my kids" but I don't know why he's not into stuff that I am into. This dynamic happens especially when the kid turns a teenager. And then they turn to me and tell me that I'm on the wrong side as the therapist. As they become more engaged with treatment, they start to realize that other people also have a state of mind and that perceptions from others can become relevant to their relationships. E.g. you need to anticipate how teenage boys might react to their father having "so much money so he's golfing all day" but would not yield to their desire to buy an Xbox. Obviously, this doesn't happen to everyone, but hopefully, you have enough psychological insight to recognize that it has nothing to do with me "being a dick".

 

[Psychresy]

Interestingly, this is typically the reaction my patients tell me at first when I point out the obvious to them: I am "spending so much time with my kids" but I don't know why he's not into stuff that I am into. This dynamic happens especially when the kid turns a teenager. And then they turn to me and tell me that I'm on the wrong side as the therapist. As they become more engaged with treatment, they start to realize that other people also have a state of mind and that perceptions from others can become relevant to their relationships. E.g. you need to anticipate how teenage boys might react to their father having "so much money so he's golfing all day" but would not yield to their desire to buy an Xbox. Obviously, this doesn't happen to everyone, but hopefully, you have enough psychological insight to recognize that it has nothing to do with me "being a dick".

You kind of seem like you're projecting a bit. I'm with OP on this one.

 

[Psychresy]

Thanks! I would be interested in outpatient correctional, I just didn't know it was a thing! Also could see myself working in a community mental health center or in assertive community treatment. I suppose I have a bias towards inpatient psych because I'm still just a med student.

I've seen these type of jobs paying 300+/hr. Might be worth looking into.

 

[forchinet121]

I've seen these type of jobs paying 300+/hr. Might be worth looking into.

I haven’t seen 300+ can you post any that high? Highest I’ve seen that is reasonable to get is 250

 

[dl2dp2]

Your interpretations are based on a bunch of assumptions unrelated to anything I've said. I'll point to the surfing 80 hours a week to start with...That's what makes you a dick.

Maybe. Or maybe I’m triggering you because it’s hitting a sore spot. This is the internet, no one cares what you think, and so typically when someone gets all edgy about something someone else says it says more about you than me. I’m just cool as cucumber as per usual.

You kind of seem like you're projecting a bit. I'm with OP on this one.

The question itself is kind of a bore, *except* the underlying psychodynamics. Even if I were “projecting” it would be a very obvious projection. It’s more of a projective identification: you ask me if it’s a good idea to retire at 50, I ask you do you feel meaningful surfing 80 hours a week—you call me a dick presumably because people who ask that question (aka your parents and your wife and maybe one day your son) are making you equally uneasy and therefore are just “dicks” whose opinion you can rightfully ignore.

 

[Psychresy]

Lol. Okay. Guy can be a dick but proceed to psychodynamically explain why he isn't.... thereby defending himself. This thread is too much.

 

[surfguy84]

@dl2dp2

I think the difference is all those people know me, so their opinions would be potentially valid. You're a stranger on the internet who's posing as my therapist. It's just weird. I hope you don't do this in your offline life.

 

[calvnandhobbs68]

Maybe. Or maybe I’m triggering you because it’s hitting a sore spot. This is the internet, no one cares what you think, and so typically when someone gets all edgy about something someone else says it says more about you than me. I’m just cool as cucumber as per usual.

This whole thing (including the hilariously cringey “cool as a cucumber” statement) sounds like…I don’t even know like a statement an undergrad psychology major would say who was attempting to defend their amateur therapizing of someone over the internet.

Probably stop while you’re still just a little behind. Got it, you don’t agree with OPs life choices and gave some reasons for this, one can do that without pretending they’re doing psychodynamics over forum posts.

Although OP to be fair you did say “feel free to criticize as indicated” and then proceeded to argue with the criticism.

 

[surfguy84]

This whole thing (including the hilariously cringey “cool as a cucumber” statement) sounds like…I don’t even know like a statement an undergrad psychology major would say who was attempting to defend their amateur therapizing of someone over the internet.

Probably stop while you’re still just a little behind. Got it, you don’t agree with OPs life choices and gave some reasons for this, one can do that without pretending they’re doing psychodynamics over forum posts.

Although OP to be fair you did say “feel free to criticize as indicated” and then proceeded to argue with the criticism.

This is true, point taken. Though I said that expecting criticism about the feasibility of this, not about what a worthless father I am lol.

 

[finalpsychyear]

It seems like the thread has deviated from the original OP question...

If you take the job gives us an update after the first few months if your projecting the large sums you anticipated. Nothing more to talk about till then as you may or may not decide on doing this next year. Good luck but I say give it a go and you may be surfing more than you can imagine earlier if this is as good as it sounds.

 

[G Sheb]

Why not find a gig that pays you 200k+ with part time hours (2/3 days a week max, very possible to find it) and surf the rest of the time? Do this as long as you want.
Why do you have to kill yourself for 4 or 5 years? (and at the same time provide questionable care). You can lead a healthy and fulfilling life while having plenty of interests if you're willing a 200-300k range.
I am just not sure I understand the point of overworking yourself.

 

[dl2dp2]

Although OP to be fair you did say “feel free to criticize as indicated” and then proceeded to argue with the criticism.

You can call it whatever you want, but ultimately the “criticism” that I pointed out is the only valid criticism of this entire silly exercise. And I’m not the only poster pointed this out.

You know what LARPing is? OP is larping.

 

[VA Hopeful Dr]

We can discuss the pros and cons of OPs question without resorting to personal attacks.

I've editing/deleted a few posts that went a bit over the line.

 

[ObsequiousAplomb]

Thanks! I would be interested in outpatient correctional, I just didn't know it was a thing! Also could see myself working in a community mental health center or in assertive community treatment. I suppose I have a bias towards inpatient psych because I'm still just a med student.

I'm always pleasantly surprised when people haven't heard of outpatient correctional. It's outpatient care provided to people in prisons and jails. The inpatient care in correctional settings is reserved for people who require inpatient level of care.

The prison population is rather large. The overwhelming majority of the psychiatric care provided is outpatient-level. People like to throw around the statement that the largest provider of psychiatric care in most states is the department of corrections. The jobs are incredibly similar to most community mental health system jobs. In some states, the place medicaid patients are most likely to get detailed psychological testing is the prison. In general, these departments are slightly more understaffed than the community mental health centers. W-2 jobs tend to pay on par with the CMHCs. 1099 tend to be much more lucrative.

 

[psychmd03]

Yeah city is expensive. I don't go out of my way anymore to live like a resident since i paid off all my loans. So after essentials rent, plus 2 cars, plus health/dental etc insurances I avg 7-8k total expenses. I also don't eat out other than chipotle/pho and when i do drink its vodka soda simply because its hard to maintain a 6 pack if you eat most of the processed junk cause it screws up my motivation to exercise so indirectly it probably saves me money and saves my health.

Agreed on the drinks I go with tequila and diet coke for the same reasons they still will run $10-15 and luckily I have figured how to be able to go out on a weekend night or two and eat some fun stuff and have some drinks and maintain a non dad bod. But it does rack up the money but at this point in my life I am ok with it. Everyone has to learn what truly gives them last happiness and for me experiences and memories are a place I am ok spending on.

 

[psychmd03]

Thanks! I would be interested in outpatient correctional, I just didn't know it was a thing! Also could see myself working in a community mental health center or in assertive community treatment. I suppose I have a bias towards inpatient psych because I'm still just a med student.

Correctional normally will have everything within the jail/prison that you would outside. So they will have normal OP level care patients all the way to super sick inpatient level

 

[psychmd03]

I haven’t seen 300+ can you post any that high? Highest I’ve seen that is reasonable to get is 250

I feel like maybe Cali will run numbers that high I would also imagine in the less desirable states the jails might pay quite good since the demand will be very low

 

[psychmd03]

Why not find a gig that pays you 200k+ with part time hours (2/3 days a week max, very possible to find it) and surf the rest of the time? Do this as long as you want.
Why do you have to kill yourself for 4 or 5 years? (and at the same time provide questionable care). You can lead a healthy and fulfilling life while having plenty of interests if you're willing a 200-300k range.
I am just not sure I understand the point of overworking yourself.

I would push back agains that idea it is not the same. In the option where you work hard for a bit and get a nice large snow ball of a nest egg to allow it to grow creates FI. And with FI you know have much more leverage when it comes to working and jobs in the future. And what if in the future where you are not at FI the healthcare field massively changes and there are no more jobs that pay decent with liveable hours? But because you dont have that nest egg you just have to do it. I would personally prefer to sprint and then coast and be fully free to do what I want and also know that if things really change I am set. Also I would say the job laid out in the OP leaves ample time to still live a fun and fulfilling life. That job wouldn't take more than 50 hours in a week and could easily take much less if there is good staff/work flow and someone that is efficient.

 

[Monocles]

I enjoy these charts what website did you use? I normally just use a few simple calculators back to back even know I know truly I’ll never have an issue unless I can’t work starting today. But after a few years it truly wouldn’t even matter but still fun to mess with these.

Portfolio Visualizer

Portfolio Visualizer provides online portfolio analysis tools for backtesting, Monte Carlo simulation, tactical asset allocation and optimization, and investment analysis tools for exploring factor regressions, correlations and efficient frontiers.

www.portfoliovisualizer.com

Tons of really fun graphs and charts to play around with. The one I am using is Monte Carlo simulator.

Beware if you're an excel nerd you could be sucked in for HOURS!

 

[twospadz]

Quit downplaying other people's job unless you can do better.



I respected your post on how you got into residency. It was unorthodox and I still remember it to this day. I'm not surprised that you're doing well financially and living it up like a king given your ability to think outside the box. I may have done the same thing if I didn't hate traveling so much. I feel like I waste a day each time I'm flying in an airplane.

Do you have family in the country? If not, how do you maintain your social life as I suspect most expats are either way older than your or transient digital nomads.

I don't have family there but I do have friends that travel and live in SEA. You be amazed how easily it is to make friends amongst other travelers too. I have tighter relationships with those people than some of the people I've gone to medical school with. Although I work hard for half the month (Psych ER was the rotation during residency I liked the most and time generally flies too), it is totally worth it when I'm off and traveling around the world during the other half.

 

[Stagg737]

Glad the measuring sticks got put away, though pretty surprised people are throwing d***s around but someone else got banned. Yikes.

Anyone can do better as psych ER work is a dime a dozen and few want to do it, I wouldn’t classify it as thinking outside the box. I’m currently on the job hunt and there are more attractive options unless of course you enjoy psych ER work.

I'd like to see postings for those positions. I have a very difficult time believing that it's easy to find hospitals paying psychiatrists $200+/hr to staff their ERs if there's not a significant patient burden when they can hire SWers for a fraction of the price. When I've looked into these positions top end of hourly pay was $200 and around $175/hr was typical. The only reason for an ER to specifically hire a psychiatrist is if there's a large enough patient volume to support it (burn and churn) or if there are other indirect or intangible benefits to saying there's a psychiatrist on staff instead of "behavioral health services".

I do something similar. Work 11/12 shifts a month and get upwards of 350K a year while I am setting up my practice, which I've been delaying cause this setup is so good, lol. Actual time worked is more like 20/25 hours a week max if you count the sleeping and all the downtime, if not less.
It certainly does not feel like burn/churn either. Some places are busy, but you do good work.

Curious regarding the patient volume you're seeing and the number of hours in those shifts. Idk why a hospital would hire an overnight psychiatrist at a premium rate who can sleep for half of the shift or more (due to lower volume) when patients could just be seen the following morning. At 11 shifts/mo and $350k/yr that's averaging around $220/hr if you're doing 12-hour shifts.

 

[Stagg737]

Why not find a gig that pays you 200k+ with part time hours (2/3 days a week max, very possible to find it) and surf the rest of the time? Do this as long as you want.
Why do you have to kill yourself for 4 or 5 years? (and at the same time provide questionable care). You can lead a healthy and fulfilling life while having plenty of interests if you're willing a 200-300k range.
I am just not sure I understand the point of overworking yourself.

I'm with you, but I can see why people would do it, especially if they're single or their spouse is also in a high-paying position with no kids. There's a big appeal to having total financial independence by 40-45 and never having to work again if one doesn't want to. Plus some people just legitimately enjoy the work and don't mind putting in 10-12 hour days or working in longer stretches (14/14 setups).

Kids change everything though, and I've met plenty of docs and other professionals who worked long hours and regretted doing that later because of the toll it took on their family life.

I would push back agains that idea it is not the same. In the option where you work hard for a bit and get a nice large snow ball of a nest egg to allow it to grow creates FI. And with FI you know have much more leverage when it comes to working and jobs in the future. And what if in the future where you are not at FI the healthcare field massively changes and there are no more jobs that pay decent with liveable hours? But because you dont have that nest egg you just have to do it. I would personally prefer to sprint and then coast and be fully free to do what I want and also know that if things really change I am set.

True, but the flip side of this can happen too. Sure, there are extreme arguments like dropping dead at 40 or having a kid die. But much more likely is significant marital strain d/t the job leading to divorce and/or resentment from one's children. Not only does it screw up family relationships, but one can kiss half of that hard-earned money goodbye in the settlement or through child support. So 3-5 years of busting your butt gone up in smoke and now you have to keep working for that FI. Sure, maybe things change down the road, but plenty of other things can happen irl outside of job market/pay shifting that could ruin those retirement plans. To each their own, but if there's one thing I learned from my PM&R rotation in med school it's that I would be hesitant to fall into a false sense of security because one reaches "financial independence".

Also I would say the job laid out in the OP leaves ample time to still live a fun and fulfilling life. That job wouldn't take more than 50 hours in a week and could easily take much less if there is good staff/work flow and someone that is efficient.

Uh, wut? Idk if the job OP described even exists (24 patients with only 1-2 new intakes per day...) outside of rehab programs. If it does I'd be genuinely interested to see it. Realistically carrying 24 patients (aka 4-5 new per day) is more like 28-30 encounters per day when including intakes and discharge. There's no way someone is providing decent care to those patients working 50 hours a week, and their documentation is most likely going to be garbage too.

The only ways to make bank with clinical work in psych is through high volume, which will undoubtedly sacrifice the quality of care, or being niche enough that you can charge a high premium for your services. At 50 hours per week, one would have to charge $400/hr to make $1mil in a year and work 50 weeks. That's also only if all 50 hours are spent seeing patients meaning either you're going to be spending significantly more time when you account for admin work or you'll need to charge a much higher rate (at least $500/hr) if you want total work hours per week to be 50.

I'm surprised at how people are coming to the conclusion that OP's first post is actually feasible as laid out and absolutely baffled that people are suggesting he could do it in even less time. And now I'm sad that the 'mind blown' emoji is gone.

 

[G Sheb]

Curious regarding the patient volume you're seeing and the number of hours in those shifts. Idk why a hospital would hire an overnight psychiatrist at a premium rate who can sleep for half of the shift or more (due to lower volume) when patients could just be seen the following morning. At 11 shifts/mo and $350k/yr that's averaging around $220/hr if you're doing 12-hour shifts.

No one is going to let patients marinate for hours without being evaluated. I am talking about places with dedicated psych ER spaces.
And no, most places where I am at would not let SW or residents dispo patients without being evaluated by an attending.
So that alone means a psychiatrist needs to cover overnight.
At the busiest place, there are two psychiatrists who cover overnight and split the shift to make it easy on each other. So essentially you're getting paid the full shift for half the work. You go at your own pace, but the limit I put for myself is 1 patient an hour, including documentation and everything. These places have still trouble recruiting cause who the hell wants to work overnight.

 

[Stagg737]

No one is going to let patients marinate for hours without being evaluated. I am talking about places with dedicated psych ER spaces.
And no, most places where I am at would not let SW or residents dispo patients without being evaluated by an attending.
So that alone means a psychiatrist needs to cover overnight.
At the busiest place, there are two psychiatrists who cover overnight and split the shift to make it easy on each other. So essentially you're getting paid the full shift for half the work. You go at your own pace, but the limit I put for myself is 1 patient an hour, including documentation and everything. These places have still trouble recruiting cause who the hell wants to work overnight.

I'd be interested in PMing if you don't mind as it sounds like we have somewhat similar positions/employers with VERY different policies...maybe partially d/t geography.

 

[voxveritatisetlucis]

Inflation not coming down to 2% for at least a decade. Will stagnate around the 4-5% range. You should probably double or triple whatever you think you’ll need, especially if living on the coast.

 

[forchinet121]

Inflation not coming down to 2% for at least a decade. Will stagnate around the 4-5% range. You should probably double or triple whatever you think you’ll need, especially if living on the coast.

If we are in trouble think about the average American..I don’t think that will be the case

 

[Stagg737]

No one is going to let patients marinate for hours without being evaluated. I am talking about places with dedicated psych ER spaces.
And no, most places where I am at would not let SW or residents dispo patients without being evaluated by an attending.

I'd be interested to hear the opinion of others on this board, as I think their experience with ERs letting patients sit for hours is probably quite common. Even in places with areas of ERs dedicated to psych (though may certainly be different with separate dedicated psych ERs). For the latter, you're lucky to be in an area where just manning an ER with a SW is not acceptable as it is in many places including some VAs.

 

[G Sheb]

I'd be interested to hear the opinion of others on this board, as I think their experience with ERs letting patients sit for hours is probably quite common. Even in places with areas of ERs dedicated to psych (though may certainly be different with separate dedicated psych ERs). For the latter, you're lucky to be in an area where just manning an ER with a SW is not acceptable as it is in many places including some VAs.

How does a SW "man" the ER when they can't order medications, like say an IM for an agitated patient? These places have dedicated nursing teams and mental health workers, so we're not talking about the occasional psych patient in the ED. Is a SW going to run that place? Do you think ER attendings have time to deal with that or restraints..etc?
I have certainly come across places that expect attendings to "supervise" SW or NPs without actually being on site or seeing the patients. I run from these setups like the plague, cause it is inviting a lawsuit, and I think at least in my region they realize that, and don't want that risk either. I'm sure it happens in some places especially with low volume, but I doubt they are providing good care. I supervise SW, and let's just say, I wouldn't want a relative to be dispo'ed by anyone without a medical license.
You actually do need a medical background and training in psychiatry to properly assess, diagnose and treat patients in the ER.

 

[SmallBird]

How does a SW "man" the ER when they can't order medications, like say an IM for an agitated patient? These places have dedicated nursing teams and mental health workers, so we're not talking about the occasional psych patient in the ED. Is a SW going to run that place? Do you think ER attendings have time to deal with that or restraints..etc?
I have certainly come across places that expect attendings to "supervise" SW or NPs without actually being on site or seeing the patients. I run from these setups like the plague, cause it is inviting a lawsuit, and I think at least in my region they realize that, and don't want that risk either. I'm sure it happens in some places especially with low volume, but I doubt they are providing good care. I supervise SW, and let's just say, I wouldn't want a relative to be dispo'ed by anyone without a medical license.
You actually do need a medical background and training in psychiatry to properly assess, diagnose and treat patients in the ER.

Extremely common arrangement. The ER attending remains the attending for the patient and can order agitation meds. A social worker will do a crisis eval and that will form the basis of the recommendation. In other instances, an attending is available as backup. And then off course some places have psychiatrists 24/7 in their EDs but it is absolutely not universal. Even some large academic hospitals don't do this. I'm not addressing what is best for patients but just pointing out that this is the existing landscape.

 

[FlowRate]

I think what everyone forgets here is that even in retirement, that initial nest egg of $2.5M will continue to grow. The idea is withdrawing 3-4% and living off of it and letting the rest of the market growth compound on itself.

Portfolio Visualizer

Portfolio Visualizer provides online portfolio analysis tools for backtesting, Monte Carlo simulation, tactical asset allocation and optimization, and investment analysis tools for exploring factor regressions, correlations and efficient frontiers.

www.portfoliovisualizer.com

Tons of really fun graphs and charts to play around with. The one I am using is Monte Carlo simulator.

Beware if you're an excel nerd you could be sucked in for HOURS!

I'm a big fan of FI Calc which has more complex withdrawal methods. Last time I tested 4% while also guaranteeing close to that much as minimum withdrawal, there's about 5-10% chance of failure or near-failure with backtesting. If you're okay with living some years on much less than your initial withdrawal amount then no percentage withdrawal method will completely fail (meaning percent of current assets, not percent of starting assets.)

 

[voxveritatisetlucis]

If we are in trouble think about the average American..I don’t think that will be the case

Inflation back up .1% MoM this morning. Was supposed to decline. Stocks tanking. This is before the student loan cancellation.

 

[comp1]

Concur, social workers will most often be the person handling the legal and evaluative aspect of mental health overnight. ED physicians (or NPs/PAs) handle the only actually emergent part, ie severe agitation. Ultimately it'll likely be the social worker figuring out how and where to get the person they need to go, too. The vast majority of EDs across the country do not have an attached psych unit.

 

[Monocles]

Inflation back up .1% MoM this morning. Was supposed to decline. Stocks tanking. This is before the student loan cancellation.

General investors seem to be panic selling over this in the short term, but if you look at places like boglehead forums, this news didn't even get mentioned as people are in the for the long run (decades).

 

[voxveritatisetlucis]

General investors seem to be panic selling over this in the short term, but if you look at places like boglehead forums, this news didn't even get mentioned as people are in the for the long run (decades).

That is true but Bogleheads are always like that (not saying it’s a bad thing). But to be honest, Lehman Brothers could have went bankrupt today and they would be saying the same thing.

I didn’t panic sell but I only have about 25% of cash in stocks, the rest in short term inflation protected bonds (which are also down today but not nearly as much). Will wait for S&P to test 3200-3300 before cycling from the short term bonds back to equities