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