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Old 04-16-2014, 03:03 PM   #61
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Originally Posted by urn2bfree View Post
.... The other thing that amazes me is the series of unfortunate and unusual expenses that have befallen us in this first 4 months- each of us needing root canal for the first time, a broken tooth, an ER visit for stitches, frozen broken pipes, a dryer repair, leaky sink, new timing belt needed, some new tires...I am hoping to see these death by a thousand cuts expenses taper off for a while, but who knows? If my wife were not still providing it would be even more unsettling no matter how much cushion I think we have.
Similar things happened to us coupled with daily swings in the markets of -7 to +5% swings. It caused extreme short term anxiety for the first 4 or 5 months. Enjoy!
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Old 04-16-2014, 07:51 PM   #62
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Similar things happened to us coupled with daily swings in the markets of -7 to +5% swings. It caused extreme short term anxiety for the first 4 or 5 months. Enjoy!
That's why I'm focusing more on buying stocks (inc via funds) as, to use John Bogle's term, "income streams". So long as the dividend/income stream is stable to increasing, those short-term market swings become pretty meaningless.
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Old 04-16-2014, 08:23 PM   #63
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Hi Doc,

I am semi retired, 57 yr old physician , in private practice 3 days a week, yearning for a full retirement one day.

How did you get Medical Insurance as a retired doc ?

Thanks and regards
Right now my spouse still works so we get coverage from her employer, but if she quit tomorrow, I included the expense in our possible needs when seeing if we have enough to retire. In other words, You have to budget for insurance. With the ACA guarantees of no denial for pre-existing conditions (like being in your 50's) Retiring Early became possible. Without it, I would worry that we could not get insurance at any cost. In fact, both sides of the political spectrum have noted this effect of the ACA on freeing people,to,reitre early, but of course each emphasizes it quite differently. ("Freeing up workers to retire early and opening opportunity for younger workers!" Or "Allowing lazy louts to not work and lowering employment!" Whatever.)
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Old 04-16-2014, 11:32 PM   #64
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......You have to budget for insurance. With the ACA guarantees of no denial for pre-existing conditions (like being in your 50's) Retiring Early became possible. Without it, I would worry that we could not get insurance at any cost.....
Agree, and not just for premiums. THE issue here is and will remain overall HC costs. Guaranteed issue is worthless if total costs, (inc premiums, copays, deductibles, & OOPmax), are so high folks cannot afford it. For most ER's, generous budgeting for HC remains critical (excuse the pun) to avoiding medical bankruptcy. Full Silver Exchange plan HI premiums for pre-Medicare ER's often exceed $12k/yr and couple/family OOPmax is $12,700 (PLUS any non-covered &/or out of network care). According to Kaiser's Subsidy Calculator, a 60yo ER couple with chronic HC issues & MAGI of $62,500/yr could spend a budget-busting 42+% of their PRE-tax income on HC costs (even with unlikely assumption of NO non-covered or out-of-network care).
Subsidy Calculator | The Henry J. Kaiser Family Foundation

IMHO guaranteed issue is here to stay even if ACA is repealed (unlikely) or modified (almost certain). Bank on it. It already existed pre-ACA in many states (if only in hi-risk pools). During HC reform debate the concept was NOT unique to ACA, but had (& continues to have) widespread bipartisan support. It was included in almost every other serious competing HC reform bill (Ryan's HR 2520, Price's HR 3400, Coburn's S1099).
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Old 04-17-2014, 06:51 PM   #65
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Thanks Urn2bfree & Erhoosier for the info and insights.

One can buy the Obama HC Plan but finding doctors and hospital to accept it is a problem in our town.

Hopefully the networks will evolve and increase the number of participating doctors and tertiary care hospitals.

That is the main deterrent in taking the early retirement for many, including myself.

Best
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Old 04-18-2014, 08:25 PM   #66
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How Being a Doctor Became the Most Miserable Profession

http://www.thedailybeast.com/article...rofession.html

The title of the article tells you what this is about
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Old 04-19-2014, 10:19 AM   #67
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Yes to the article above.

I'm already halfway out, working 3 days a week, but still have to "make my productivity numbers" and it is still stressful.

In one year's time I won't be entirely free but will be on COBRA before Medicare kicks in and will just supervise nurse practitioners and work one day a week, and if that's too much, I will just ship out of medicine (licensed, 1983).

I already have a lot of interests, stepped down from leadership positions many years ago - in a hospital, it is all politics and CYA without any non-MD administrator wanting to effect real positive change imho. BTDT as the lone wolf trying to improve care, systems, blah, blah. I was just a cog in the wheel. Plus they refused to pay me what a male department chair would get paid.

It's been a great profession but 30 years is long enough doing one thing!
I may not be as financially secure as all of you but I'm pulling the plug on this work thing anyway.
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Old 04-19-2014, 02:34 PM   #68
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It saddens me to hear of all this burn-out, though I certainly understand it after 35 years of patient care.

I'm no mentor for anyone but myself but here are some solutions that have helped me remain engaged and content (semi-retired for 5 years, academic internist):

1. I have a 10% telemedicine gig which I enjoy tremendously. It pays pocket change but motivates me to read, keep up CME credits, licenses, and so on. IOW, it makes me feel like I am still a doctor. Amazing what even video medicine can provide.

2. I have commitments as a volunteer teacher of English as a Second Language. Great way to give back to my new community and meet some true heroes with fascinating stories to tell. Stimulating, interesting, socially rewarding.

3. I am writing what passes as a pathetic piece of fiction. Occupational therapy for me.

4. I meditate (have for decades) and that helps keep me centered and nonreactive.

5. I have given myself permission to sleep late, not work when I don't have to, and to enjoy even trivial chores like food shopping. Probably a side-effect of meditation.

6. Maintain a satisfying and loving 43-year marriage by being more compromising, etc; moved near the kids and grandkids.

7. Recognizing that my choice of profession isn't really that important to people I meet. It is incidental to most of them, negative for a few and god-like to, well, just about nobody.

8. Retired neither too wealthy nor too poor to support a comfortable lifestyle. We are a one-car family, entertain modestly, etc. but live in a high-cost area near San Francisco. Only time will tell on this one but for now it looks like we got it right, more or less <knocking on wood>.

It's not nirvana but we want for little else.
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As if you didn't know..If the above message contains medical content, it's NOT intended as advice, and may not be accurate, applicable or sufficient. Don't rely on it for any purpose. Consult your own doctor for all medical advice.
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Old 04-19-2014, 05:23 PM   #69
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Rich_by_the_Bay - I never took your name to be boasting (weren't you "Rich_in_Tampa"?) but that sounds like a very rich life
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Old 04-21-2014, 06:27 PM   #70
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How Being a Doctor Became the Most Miserable Profession

How Being a Doctor Became the Most Miserable Profession - The Daily Beast

The title of the article tells you what this is about
Sadly, here's some evidence to support that view-

How many doctors contemplate suicide?
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Old 04-21-2014, 06:46 PM   #71
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This is a significant problem internationally. Here are some links on the problem in Ireland, where working conditions have deteriorated significantly in recent years:

Inquest into junior doctor death told of long hospital hours - Courts | The Irish Times - Mon, Nov 18, 2013

http://www.suicidology-online.com/pd...13-4-92-95.pdf

I have personally known two Irish doctors who committed suicide (one by insulin overdose) and two residents in Canada who committed suicide, both using pills. One of them in particular was considered the "cream of the crop" with excellent career prospects and a loving family.

Edited to add: I have just become aware that a wonderful oncologist that I used to know recently died by his own hand. He was ~ 60 years old.
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Old 04-23-2014, 07:15 AM   #72
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I just got back in town and noticed that this thread was active again and it made me sad to read about suicide, depression, and PTSD among doctors. I am now almost 2 years out and can tell you that I still think about the intensity of the work and stress that made me think: This is no way to live. In my case it was figurative and I was able to get out, but in the described cases, people literally ended their lives. I will post a 2 year update in a few weeks but here are a couple of pictures from what I was up to this past week. Life in early retirement is great. I wake up and look forward to what the new day will bring rather than dreading what I face at work.

The pictures are of Point Lobos State Park and the waterfall at Julia Pfeiffer Burns State Park, taken on a driving trip along California Highway 1.
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Old 04-23-2014, 01:31 PM   #73
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Wonderful pics Jackson. Wish i lived closer to you. Would love to chat about your experiences as I plan my own FIRE adventure.
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