Doomsday Prepping

As an emergency physician, part of my job is to always assume the worst while hoping for the best.  Until I can prove otherwise, every chest pain is an MI, every headache a subarachnoid bleed and every abdominal pain is an appy.  That level of high alert eventually creeped into other parts of my life.

One of the hundred reasons I like to have more than one income stream is to prepare for the potential threats to my financial security. You can call me crazy, you can call me paranoid but you’ll never call me unprepared. Here are a few of the doomsday scenarios I’m prepping for.

Unexpected Expenses

Although I have a well stocked emergency fund, my first line of defense against unexpected expenses is my side hustle income.  Since I live on none of that money, it is always ready to be deployed.  Last summer when the central air in my big dumb house went kaput I didn’t have to worry about where the $7,000 to replace it was coming from. Jeep needs a new radiator? No worries.

woman holding pen while using calculator
Not all surprises are fun.

Being able to cash flow surprise expenses helps me sleep better at night.

Reimbursement Cuts

How often have you heard of a physician taking an unexpected hit from changes in reimbursement?  Blue Cross suddenly wants to pay you half of what it used to.  Medicare no longer thinks cardiac caths need to cost so much.  That hospital subsidy your group relies on to help stay fully staffed just dried up.

She who writes the checks makes the rules.  These threats to your business are out of your control but they can have devastating consequences.  I have seen multiple private practices implode after these unanticipated cuts.

gray medical equipment lot
The first cut is the deepest.

Do you know who can walk right through the flames without blinking? The guy who already has alternative income streams to make up the difference. I would be bummed if my specialty took a big pay cut, but I’ve already figured out how to replace my salary outside the ED.

Business Dissolves 

My financial security is very much tied up in my private practice.  Although running a business is harder than punching the clock as an employee, it is also much more lucrative.  There is no way I would make as much money working for a hospital or a contract management group.  Aside from the extra income, I control how we staff the ED and I get to brag about a big package.

There are many potential threats to the longevity of our group.  1/3 of our owners are over the age of 50 and could retire comfortably at any moment.  The hospital could get bought out and the new owners may not want us staffing the ED.  Other hospitals could build freestanding EDs within our catchment area and siphon off business.  Bundled care payments could become more commonplace, forcing us to become hospital employees.

Anything that causes my group to fold would be a devastating blow to my bottom line.  I’d estimate the odds of my group existing in its current form in 10 years at 60%.  I’m creating a big golden parachute for myself so when the plane goes down I can pull the rip cord.

Night Shifts Take Their Toll

The bane of every ER doc’s existence is night shift (followed by fibromyalgia and never being able to find the hemoccult developer).  It’s bad for my health.  It’s bad for my sanity.  It’s bad for my family.  60% of my shifts occur evenings and overnights, and there is no way out.  Our group doesn’t have a “no nights” option (because we would all opt for it).

full moon
I’d like to see less of this on the drive to work.

At age 36 I can already see the writing on the wall.  I’m not going to want to be constantly messing up my circadian rhythm for another 25 years.  It would be nice to actually eat dinner with my family and go to bed the same time my wife does. When the day comes that I can’t take this schedule any more, I want a plan B that will allow me to work part-time cushy day shifts.

A Different Type of Disability Insurance

Of course I have own occupation disability insurance.  If I lose the ability to intubate or suture, my income will keep flowing. Disability is about more than losing money though.

Being a physician is part of my identity. It doesn’t define me, but losing the ability to care for patients would be a depressing blow to my ego. Disability insurance can replace a paycheck but it can’t replace feeling productive. Many of these non-clinical side gigs could be done with a disability as long as I keep an active medical license.

If I ever am truly disabled (trach, PEG, sacral decub) the cash I have saved should be enough to pay someone to smother me with the biggest pillow money can buy.

Ending misery in comfort.

The End is Near!

These doomsday scenarios may never play out.  They also might happen tomorrow.  You can’t predict the future but you can prepare for it.  Since I’m not financially independent yet, having multiple income streams is the safest option to mitigate these threats.  Emergency medicine may be my golden goose, but I’m not willing to put all my eggs in one basket.

What do you think?  Are these doomsday threats overrated?  Are these the maniacal ramblings of a lunatic?  Share your thoughts and comments below.  

Can’t get enough Side Hustle Scrubs?  Follow me on Twitter, Facebook or Pinterest and never miss another post!


16 thoughts on “Doomsday Prepping

      1. We pay a lot of money to stipend the night shifts. The young guys have the strength and need the money, the old guys don’t have the strength and don’t need the money. Ponzi scheme or symbiosis?


      2. Definitely symbiosis. I’m in the middle ground – would love to give up nights but still too hungry to take the pay cut. I’d rather my older partners keep working days than have them quit because they were sick of working nights.


  1. I’ve been planning for doomsday for the last 15 years. I’ll be happy if I never move to contingencies, but who knows? I expect to have the first real test when our party-aligned legislature and governor put their heads together; in the past, we’ve been protected by a governor who vetoed anti-doctor/anti-patient bills. The gov-elect is already on record saying he’ll sign a bill that caps our charges. Our best guess is that our income will go down by 25-30%, not to mention that the job will suck more (referrals, ER call coverage, etc). Now is probably a good time to go long with the insurance companies and self-funded entities. Are there any leveraged long ETFs for unions?

    And then there are always the unknown unknowns.


  2. Always good to be over prepared. I think side hustles and additional income streams are great safety nets in case your main gig does cause you to tumble.

    Radiology has been in the cross hairs of reimbursement cuts lately. Some have compensated by doing more but that only burns the candle down faster to burnout.


  3. I still read the article, but man you had me excited for a second. I keep wondering why more FIRE people aren’t into actual prepping. I keep waiting for company. If you stay curiously paranoid about all the things that could go wrong you will eventually tumble down the rabbit hole and I will be waiting 🙂


    1. I got into a habit of living below my means my first year as an attending. Any raise after that has been a pleasant surprise and funneled to paying off debt and investing. The result is that I now live on less than half my income. That leaves a lot of wiggle room for the unexpected.


Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s