I Used to Be a Physician

I used to be a physician. I didn’t retire. Medicine let me go.

Most people retire. They are then retired.

I am disabled. But did I “disable”? Can that word even function as a verb in the way retire does?

Perhaps it should remain in the passive voice: I have been disabled.

That sounds awkward, but it also feels more accurate. I did not choose this. Something happened to me. My career did not end because I completed a carefully designed succession plan, handed over my patients, attended a retirement dinner, and rode into the sunset with a commemorative plaque.

Medicine stopped before I was ready.

I tried repeatedly to return to clinical work and the operating room. Each time, I hoped my body would cooperate. Each time, I imagined that perhaps the next treatment, the next recovery period, or the next attempt would get me back.

Eventually, the evidence became difficult to deny.

My working days as a physician were over.

Not paused. Not reduced. Over.

That was a hard sentence to write. It remains a hard sentence to read.

I Never Planned to Retire Early

Many people dream of retiring as soon as they can afford it.

I met plenty of them at this year’s EconoMe conference, a gathering focused on financial independence and the FIRE movement. FIRE stands for Financial Independence, Retire Early. Its followers generally save and invest aggressively so work becomes optional much earlier than the traditional retirement age.

I understand the appeal. Financial independence is a marvelous goal. I have encouraged physicians to pursue it for years.

I was just never eager for the second half of the acronym.

I did not want to retire early. I wanted the freedom to work on my own terms.

I imagined practicing into my seventies, perhaps even my eighties, as several of my mentors had done. One worked into his nineties. I admired that. Medicine seemed like one of the few careers in which accumulated experience could make you more valuable rather than less.

My ideal future involved fewer hours, more control, and less administrative nonsense. I pictured a gradual transition. Perhaps I would give up some clinical duties, mentor younger physicians, serve on committees, teach, write, or consult.

I expected to downshift.

I did not expect to hit a wall in my fifties.

That difference matters. Voluntary retirement and involuntary disability may produce the same empty spot on a work schedule, but they do not feel the same.

One is a departure.

The other can feel like an eviction.

Financial Independence Did Its Job

Here is the good news: we had prepared financially.

Through frugality, planning, investing, high earnings, and more than a little luck, my family had reached financial independence. Financial independence, or FI, means your investments and other resources can support your lifestyle without requiring employment income.

I did not need my next paycheck to pay the mortgage, buy groceries, or keep the lights on. We had no consumer debt. We had substantial investments. I also had disability insurance policies that replaced part of my lost income.

That preparation removed an enormous source of stress.

Losing a career is painful enough. Losing a career while wondering whether you can keep your home would be worse.

I remain grateful that money was not the main problem.

This experience confirmed something I have written for years: financial independence is not merely about escaping work. It is about creating options and protecting yourself when life does not go as planned.

A good financial plan should outlast the future you hope for. It should also help with the future you never imagined.

My financial plan did that.

But money solved only the money problem.

I soon discovered that employment had been providing much more than a salary.

The Nonfinancial Paycheck

When physicians calculate the value of work, we tend to focus on compensation.

That makes sense. Salary, bonuses, retirement contributions, health insurance, and other benefits matter. Yet a job also pays us in forms that never appear on a W-2.

Work had been giving me purpose, relationships, structure, challenge, identity, and money.

When it ended, I lost all six at once.

I summarized them with a fish mnemonic: PISCIS.

Why PISCIS?

Piscis is Latin for “fish” and is one of my nicknames.

Piscis Austrinus is a constellation in the southern celestial hemisphere. Its name means “the southern fish,” distinguishing it from Pisces, the better-known constellation represented by two fish.

The name gave me a memorable way to organize the six benefits I lost when my medical career ended:

P: Purpose

Medicine gave me a compelling reason to get up in the morning.

I knew why I was going to work.

Patients needed care. Colleagues needed support. A team counted on me. Problems needed solutions. Younger physicians needed mentoring. Committees needed someone willing to read the material before the meeting, which, as many physicians know, already narrows the field considerably.

I used my brain, knowledge, judgment, and experience to help thousands of people.

Not every day was dramatic. Much of medicine consists of ordinary, repetitive work. Notes must be completed. Forms must be signed. Calls must be returned. Schedules must be rearranged. Electronic medical records must be fed their daily ration of clicks.

Still, underneath the aggravation was a clear purpose.

Someone was suffering, limited, frightened, or confused. I could often help.

That mattered to me.

When work ended, I did not merely lose a place to go. I lost a dependable answer to the question, “Why am I doing this today?”

Financial independence can fund your life. It cannot automatically supply a reason to live it.

That part requires more thought.

I: Interaction

Work also provided a remarkable amount of social contact.

Every day, I spent time with nurses, technicians, therapists, physicians, administrators, office staff, and patients. Many were people I genuinely liked and respected.

I was also guaranteed to meet 10 or 12 new people on a typical clinical day.

Think about how unusual that is.

At most social gatherings, we make polite conversation. We discuss the weather, travel, children, sports, or whatever is happening near the snack table.

Medicine is different.

Within minutes of meeting someone, I might learn about that person’s pain, fears, work, marriage, sleep, finances, disappointments, or hopes. Patients trusted me with intimate details of their lives because the conversation had a purpose.

Those brief encounters were often substantive and human. They reminded me that every person carries a complicated story.

When I stopped working, that built-in social world disappeared.

My phone became quieter. My circle became smaller. Days could pass without meeting anyone new.

An introvert may initially enjoy that peace. I often did. But solitude can quietly become isolation if we do not replace the social contact that work once supplied.

S: Structure

Medicine organized my time.

It structured my year around vacations, conferences, call schedules, and clinical obligations. It shaped my months, weeks, and days. Even my free time had clearer boundaries because work surrounded it.

A packed operating room schedule also provided something rare in modern life: protected time.

No reasonable person expected me to answer a casual text while I was scrubbed into a procedure. The operating room created a firm boundary. For those hours, I knew exactly where I belonged and what deserved my attention.

Once work stopped, the boundaries blurred.

Every hour became available.

That sounds like freedom, and it is. It can also become strangely disorienting.

When every task could be done later, many tasks were done later. Weekdays and weekends began to resemble each other. A medical appointment, home repair, or trip to the grocery store could become the main event of the day.

Retirement advice often focuses on how to fill time.

I think a better question is how to shape it.

An open calendar is not the same as a meaningful life.

C: Challenge and Creativity

Medicine challenged me every day.

Patients did not read the textbook before arriving. They brought incomplete histories, conflicting symptoms, unusual circumstances, prior treatment failures, and deeply human complications.

The work demanded judgment.

Clinical medicine also required creativity. Not artistic creativity, perhaps, but practical creativity. How do we help this patient when the standard approach failed? How do we explain a complicated problem in understandable language? How do we guide a team through conflict? How do we solve a system problem without creating three new ones?

I continued growing as a physician, mentor, medical director, committee member, and person.

The challenges were sometimes exhausting, but they kept my mind active.

Without them, life can become comfortable but flat.

Comfort is pleasant. I have no objection to comfort. I have worked hard enough to appreciate a quiet afternoon.

Still, I do not want every afternoon to be quiet.

Human beings seem to need an appropriate amount of difficulty. Too much challenge overwhelms us. Too little leaves us bored and diminished.

I now need to create challenges rather than having them delivered to my office.

That requires intention.

I: Identity

This may be the most difficult loss.

Physicians vary widely in how much identity they draw from medicine.

A colleague who recently retired told me that being a physician represented “zero percent” of his identity. He was happy to drop the title, credentials, responsibilities, and expectations.

Part of me envies him.

Was I too narrow? Too attached? Did I confuse my career with my life?

Perhaps.

But I also understand why the identity mattered.

I struggled for decades to become a physician. I became the first college graduate in my family, completed medical school and residency, and built a respected subspecialty career. None of it came easily.

Plenty of teachers, counselors, acquaintances, and other naysayers would have reasonably bet against me.

Yet I did it.

I became a doctor.

Then I became a good one.

That accomplishment shaped how I saw myself. It also shaped how others saw me.

I hated hearing physicians complain endlessly about medicine because I often could not relate. Yes, the system was frustrating. The bureaucracy grew. Administrators multiplied. The electronic record seemed designed to test the outer limits of human patience.

But what did I want from a job?

I wanted to feel safe, respected, useful, and challenged. I wanted to work with people I admired while helping people I cared about. I wanted to use my brain and skills to improve someone’s life.

Medicine gave me all of that.

It does not get much better for me.

Now, when I meet someone new, I hesitate.

“I Used to Be a Physician”

They ask whether I am retired.

I usually say no, because retirement implies a choice I did not make.

Then they ask what I do.

Do I say I am a doctor?

If someone studied accounting but never practiced, is that person an accountant? Does a history degree make someone a historian? Why should studying medicine decades ago allow me to use the title forever?

Perhaps medicine is like the Marine Corps: once a Marine, always a Marine.

It felt strange to call myself a doctor during the first months after receiving my medical degree. Now it feels strange to use the title again, but for the opposite reason.

Saying “I am a physician” feels incomplete.

Saying “I used to be a physician” feels almost unbearable.

I have not solved that one yet.

S: Salary

Work also paid well.

That point should not be minimized simply because the other losses are more emotional.

I lost salary, bonuses, future raises, subsidized benefits, employer retirement contributions, group discounts, deferred compensation, free meals, office space, and the many small conveniences associated with employment.

My household absorbed a substantial financial hit.

We were prepared, but preparation does not make a loss imaginary.

Physicians sometimes confuse financial independence with financial invulnerability. They are not the same. A large portfolio can handle many shocks, but losing several years of peak earnings still changes the numbers.

Fortunately, I had maintained disability insurance. That decision mattered. Physicians depend heavily on their earning potential. Our future earnings, sometimes called human capital, may be our largest financial asset during much of our careers.

Protecting that asset matters, even when disability feels unlikely.

I have written more about that in Don’t Drop Disability Insurance and Disability Insurance for Physicians.

The financial lesson is straightforward: build wealth, reach financial independence, and insure against catastrophic loss.

The harder lesson is that no policy can replace the full value of meaningful work.

Financial Independence Is a Safety Net, Not a New Identity

I used to describe my ideal future as FINER: Financial Independence, Never-Ever Retire.

Life had other plans.

Still, the principle behind FINER remains sound. I never pursued financial independence because I hated medicine. I pursued it because I wanted control over my work and protection against uncertainty.

That protection worked.

It kept an unexpected disability from becoming a financial catastrophe.

Now I must do the next part: build a life that replaces as many elements of PISCIS as possible.

I need new sources of purpose.

I need regular interaction with people I respect.

I need enough structure to keep weeks from dissolving into one another.

I need challenges that stretch my mind and creativity.

I need an identity large enough to include medicine without depending entirely upon it.

And while I no longer receive a physician’s salary, I can use the resources we accumulated to support a meaningful life.

None of this will happen automatically.

I used to be a Physician

My next phase will require deliberate construction. It is time to Rebuild the Fish!

I’ve learned a lot from friends like Fritz Gilbert, Mike Drak, Jordan Grumet, and Cory Fawcett.

Purpose may come from writing, teaching, mentoring, volunteering, family, and helping other physicians gain financial control.

Interaction may come from scheduled lunches, conferences, community involvement, professional groups, and new friendships.

Structure may require a written weekly calendar, exercise appointments, project deadlines, travel plans, and protected work periods.

Challenge may come from writing better, learning new subjects, improving my health, building organizations, or tackling projects I once postponed.

Identity may broaden from “physician” to teacher, writer, investor, mentor, husband, father, friend, and former clinician.

The salary is harder to replace, but it is also the one we prepared for most directly.

I expect this process to be uneven.

Grief rarely follows a clean schedule. Some days I feel grateful. Other days I feel restless and displaced. A person can be financially secure and emotionally unsettled at the same time.

That is not ingratitude. It is reality.

Prepare for More Than the Money

Physicians spend years preparing financially for retirement.

We estimate expenses. We calculate withdrawal rates. We adjust asset allocations. We study Social Security, Medicare, pensions, taxes, and required minimum distributions.

Those calculations matter.

But before leaving medicine, voluntarily or otherwise, ask a second set of questions:

Where will I find purpose?

Who will I see regularly?

What will structure my days?

What will challenge me?

How will I describe myself?

What financial and nonfinancial benefits will disappear with my job?

A retirement plan that answers only the money questions is incomplete.

My financial preparation worked remarkably well. It bought safety, time, and options when my career ended years earlier than expected.

Now I am learning to prepare for the rest.

I did not choose to retire.

I have been disabled.

I used to be a physician.

Whether I still am one is a question I have not fully answered.

For now, I am rebuilding my PISCIS, one letter at a time.