Lemon's Journal

Where are you and where are you going?
Lemon
Posts: 261
Joined: Sat May 30, 2015 2:29 am

Re: Lemon's Journal

Post by Lemon »

Well it has been a while.

Training is now almost over - really just waiting on my membership exam results - not all that worried. That means being done with training and so having to actually apply for jobs. Resulting in immediate panic of 'oh god I am unemployed from August' and 'Oh god I hate CV writing and job applications'. Which is something I last felt at the end of the foundation training scheme. It is as completely unfounded now as it was then - even more so. But I really don't feel comfortable without that job lined up - even though GPs are in acute shortage.

Would be part time only 2 days a week which would result in a pay cut of 20k but for 3 days back a week worth it. Or possibly 2.5 days with a 10k cut. Given I would only see half that in income drop due to taxes. Plus with funding to take up either a MSc or PGDip which if I value equally to pay cuts that to only a few k for only 2 days work. It is also local and so commutable by bike and so importantly does not require a car. Plus I know half the colleagues form previous jobs and they are a fun lot. So lots of pluses if I get offered it but I worry am I missing out by taking the first offer. Not the worst problem to have but certainly something to think about.

Given I last month I hit and SWR of 4.6% I am basically there in terms of FIRE. Mentally wouldn't be ready for it from a place of security. But more than that I like what I do and I couldn't do it outside of working as a doctor. So working out how to do more of the aspects I like about GP and probably a bit of a portfolio of different jobs and roles it likely to be the goal. The previously mentioned 2 days a week job would give a base for developing that. I think my problem is going to be picking what to do and what that then means excluding. Currently would like to and in a bit of minor surgery and urgent care/minor injuries. The issues is all the fun simple stuff is more and more being taken over by paramedics and Nurse practitioners because they can be trained to do it and are much cheaper. But it leaves GPs dealing with the more complex difficult cases which while I enjoy I prefer a mix with less cerebral work (yes minor surgery/suturing wounds or setting bones is far less taxing than the day job - to me at least). I mean I could just offer to work at a similar pay grade given I don't need the money. That would then require pretty firm line drawing of saying no when asked to do things only a GP could deal with because I wouldn't be getting the pay consummate with that work. I have had to do this before in other jobs and it always creates a bit of friction.

Expenses are going up this year due to moving flat - this mainly to keep partner happy so he can have a dedicated workspace now he is WFH. Same location so any move to more rural climbs is on hold for now - we will see. But this is just as well as this relaxation of COVID has resulted in more of a community forming locally and helping to develop and become more integrated is something I want to do.

Fitness regime going well. The investment in a personal trainer well worth it. Given I plan to continue working looking at other aspects of life which can be invested for financial or otherwise payoff is I think something I have been neglecting and should potentially look at.

Lemon
Posts: 261
Joined: Sat May 30, 2015 2:29 am

Re: Lemon's Journal

Post by Lemon »

Exam passed so just got to get the paperwork sorted and that's the end of 'training'

Somewhat unsurprisingly I have been offered the job. I discovered my boss called and effectively said 'you would be an idiot if you didn't hire him' which was nice to find out :lol:
But...I have looked elsewhere now and found...somewhere else. They want more time - 3 days. But I get a better vibe and I think they practice in a way closer to how I want to practice. So now I am torn. Going to see this one tomorrow to get the full in person experience. I suspect a better place to grow as a doctor. There are some slight concerns that the funding would be less certain for the further study and whether I want to have 3 days of work and a part time postgrad course in terms of bandwidth consumption and whether that leaves me with to little time to develop other aspects of life. If they would acquiesce to 2 days then no contest they win. So at the very least I will be offering that tomorrow, which might work as I am apparently a stronger applicant than I self assessed...But even if they don't perhaps I take it and see how I cope. I mean nothing is going to be as bad as 13 hour shifts on an overflow ICU where you are fighting a disease no-one knows how to treat. Perhaps the higher risk/reward is worth it.

But I wonder if this is the salarydoctor talking and I should be thinking of looking at other horizons which the less inspiring job might facilitate. Although I am not sure I have the 'freedom to' nailed down enough just yet. This could be all academic depending on how tomorrow actually goes!

Lemon
Posts: 261
Joined: Sat May 30, 2015 2:29 am

Re: Lemon's Journal

Post by Lemon »

Work

Took the second job. Start in a few weeks. Negotiated and got what I wanted out of it and I think they have underestimated the value of the flexibility they have given me. But, perhaps it is more mutually beneficial than I can currently see. Either way a good outcome for me and negotiating was fun. Fellowship money also pretty much nailed down and the local patch is well run and seems to be somewhat amenable to giving me money to do interesting things in the future should I choose to. Which is nice. I mean it means I am contributing to the 'good doctors go to better run areas' problem and so contributing to self reinforcing cycles in care inequity.

What 7wb5 mentioned here neatly summarises some of my unease with the idea of chucking it all in eventually, 'not using the embedded value of your training/education that has already been expensed is really no different than choosing to allow a tractor to rust in a barn'. Now obviously if you feel your work is pointless or harmful then maybe that doesn't ring true. But I don't spend time filling in TPS reports and I work in a profession with massive shortages. I am reducing my hours by ~50% now I am out of training but I am then doing further postgrad study so still not permitting depreciation but ongoing investment in human capital. I think part of it is also that much of my education was paid for by someone else/society/the state which gives a sense of duty.

There is always the possibility this is just post hoc rationalisation when it is more about fear of a life without work. But I don't think so. Certainly not entirely.

I am also aware that while leaving training to job/fellowship combo I have devised has in essence just meant creating my own training scheme that locks me in for 2 years. It isn't quite as restrictive as the consequences of 'dropping out' would be less.

Well I have a few weeks off to try and think about these things.

Fitness/health

Both going well and enjoying it. The PT continues to give good value despite being a ridiculous expense that is the second most expensive line item on my budget after rent/head taxes. Things continue to improve at a sustainable positive pace that I am content with

Healthy eating I don't find particularly difficult because I can cook and am happy with at a level of consistency that many would describe as monotony. Including my parter who is not an INTJ and got annoyed at meal prep, decided to try and sort out his own meals, and, found out that good macros/time to cook/taste was very difficult to square without planning and preparation (which he hates). He is back tagging on to my meal prep. I didn't say told you so :lol:

Social

With the COVID threat receding it has been nice to socialise with more people again which has a lot of value to me despite my introvert leanings.
Ended up as the de-facto doctor on a hiking challenge trip. Minimal doctoring needed. Spent more time pointing out that pacing wise we were not going to hit our time targets which I was told I was being 'too pessimistic about' to be proven right several hours later. No different from any other human endeavour!

Brother is doing well fortunately. Nephew is now 1 which has just hi lighted just how much time flies.

Finance

Savings go up. Savings rate at 60% not including pension/student loan repayments. If I cut nice to haves out of the budget I could probably get it to show 4% and call myself done for all the meaning that would have. Again doing some more reading on investing and not just chucking it in trackers is something I should probably do but don't yet feel dissatisfied with this enough to push it up my priority list. Probably will at some point.

Bikes

I keep up with the basic maintenance but there is probably value in up-skilling. There is a local bike co-op that is reopening soon post COVID that I will probably look at volunteering at depending on how much time and energy everything else takes.



In general things are going pretty good. Niggling feeling that I am in some sort of optimisation trap and that any change from that is going to need wholesale re-evaluation of goals and values. But at the same time if you asked If I would be happy with continuing as is for 5 years currently I would say yes. So perhaps I just carry on for now gradually reflecting on this and let things evolve.

Lemon
Posts: 261
Joined: Sat May 30, 2015 2:29 am

Re: Lemon's Journal

Post by Lemon »

Some b*****d decided to nick the front wheel of my bike. They have also managed to damage the front fork in the process. Fantastic value destruction there. For bonus points because it is insured everything takes a million times longer to sort and I have to get crime reference numbers and approved quotes etc. etc. Easier solution going forward is probably to just not get a bike that is worth insuring so I can just fix it all myself like I do with my normal commuter bike with the added bonus of being not worth targeting for theft :lol:

Work

Really enjoying the new job. Nice team and I enjoy the work. I go to work and generally have fun trying to fix problems in a system that is very much creaking under the strain. Bonus is my special interest is one no one else likes dealing with really so I get even more of it (with colleagues going 'are you sure you are ok with this) and the patients get better care so win/win/win.

Buuuuut they have just tried to change things to make me work (a bit) more. I don't like this so am trying to negotiate on this. I think they underestimate how much I will dig my heels in on this to prevent mission creep. If 'nice' negotiation doesn't work out I ultimately have my union and multiple byzantine processes at my disposal to delay a change and waste their time.
If that all fails I can then promptly go nuclear and hand my notice in should I so choose. That will cause them far more problems than it will me. Especially given the (short) contractual notice period. I mean earnings wise I could earn ~double my hourly equivalent rate starting tomorrow (with admittedly less security). They know this because that is what they pay me when I choose to pick up extra non-contractual shifts. So I don't feel all that concerned. Good doctors are hard to find these days ;)

I would however rather prefer to not poison the well as I like them and have a setup that otherwise is very nice. I think it would be nice to settle down too for a bit given because of the nature of training I have never been in one place for more than 12 months.

Very much enjoying my post-graduate studies but worried I might want to actually start doing research. I really need to make sure I want to make that time commitment before I do anything rash.

Being part time has now started to get me focusing a bit more on the hinterland which I really do think I needed.

It all still feels a bit surreal and like I am in the 'post game' when it comes to work after ~11 years of training to get here...I can sort of choose to do whatever I want and that is a very new position to be in, but pleasant.


Internet

Recently really ticked up far above what I would like to but I think this was in part due to going part time and have a few weeks where I had not a lot planned on off days and so it just sucked the time up. Seems to be slowly coming down again but I have to remain frustratingly vigilant that productive internet time does not degenerate in to chasing down media rabbit holes.

Finances

Savings rate is now only just above 50%. I have gone from full time to 2.5 days a week which was always going to be an income hit. Plus artefact of more pension contribution which I don't count in this figure (NHS pensions are weird and while my pay is down more of it is 'pensionable')
So while it seems like 'not ideal' I now have more time to do other things and generally fits far more with my likely course of continuing to work as I love it but just, not too much.
Numbers keep going up.

Lemon
Posts: 261
Joined: Sat May 30, 2015 2:29 am

Re: Lemon's Journal

Post by Lemon »

Work

Well the work change solved itself with no further intervention from me. Ideal really.

But I think I underestimated the amount of time the PG study was going to take up. With that plus work my free time has been much more scarce than I would like. I also got reminded how much I dislike assignments I don't want to do. Which has now swung me very much away from research which I don't think my supervisor is all that happy about...

The day job I have some conflicting feelings. I enjoy it but the area I work in is rather deprived which means a high disease burden along with social issues which means I am providing real value and impact...but It can be pretty emotionally heavy and long term...that probably isn't good.
I then think of how much easier I could make things by becoming agency and with the increase rate be able to work juuust over a day a week on average. But I don't think I would find it as satisfying and I wouldn't be able to make the same difference.
Then I could also look at going private which means longer appointments for the about same hourly pay. And removal of some of the complexities and other frustrations. But again I feel some guilt at the idea of doing less 'good'.
I don't have immediate plans to change so for now I can just look at options while I think. Pseudo locked-in for another 18 months and I probably just need that to try and get established and build experience.

Internet

This got totally out of control as a procrastination measure while having assignments to do. I think I am now slowly bringing it back under control.

Finances

Continues much the same

Fitness

Happy with my ongoing progress

Lemon
Posts: 261
Joined: Sat May 30, 2015 2:29 am

Re: Lemon's Journal

Post by Lemon »

Been a while!

I have to admit ERE has very much been on a back burner. Having said that I could technically call myself FI, at least by the 4% rule if I just dropped my expenditure to where it was 2 years ago - which I don't mainly to please the other half. I also have no intention in packing in my work anytime soon. Still keeping up with the cycling/bike maintenance/cooking/fixing things/etc. The problem is more of a what next to try in terms of non-work development...

My work gives me rather a lot of satisfaction and purpose, probably because it is mainly service to others. I have now been in the same job for just over year, making it my longest time working with the same people in the same building to date...and I am getting itchy feet. While most doctors seem to moan about the endless rotating through departments and hospitals throughout training I generally love it. Variety, inability to get too ensnared in departmental politics, and you don't get time to get bored because by the time you are getting a handle on the job you are due to move on to the next place. Whereas now have been here a year I could stay here for 35 years if I wanted. That sounds absolutely terrifying. But at the same time I know my effectiveness in terms of clinical outcome or best public good would be to stay because continuity of care matters. I don't think I would be able to do it though, particularly in the current climate. Frontline NHS work is becoming more unpleasant and I can foresee the cost benefit moving to 'just not worth it' which isn't going to make the situation for the public any better. Saying to myself someone else will do it is a lie in the context of a GP shortage...If I leave I am in a small way making that worse.

My brilliant solution? Take on 2 new jobs! On top of my old job. Because that was the logical. I mean they are both different and interesting and give me variety (essentially I get to do things you can't really do out of formal employment and I think are fun/interesting). But, I can foresee wanting to reduce my patient facing time before long depending on the total combined workload. Plus I am now applying to another training scheme because I find training fun and the end job in the new specialty right now looks more fun than my current job so...why not? The number of spaces is incredibly small and competition fierce, especially as I am geographically locked but...might as well give it a go? That is the plus of ERE I don't have to care if this all sorts of results in what for most people would be a financial disaster of halving pay to go back in to training, it is a great freedom to perk.

I still feel some niggling guilt that if this all goes to plan I will be leaving primary care, my team, and my patients. Which I haven't made peace with yet.

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