The X-ray Beam: Vagabond MD
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I would like to go behind the scenes and get an in-depth look into Vagabond MD, a fellow interventional radiologist who, despite not running a blog of his own, has contributed numerous posts and podcasts which are guaranteed to make you smarter for reading/listening to them..
If you can please give a brief introduction of yourself (age, medical specialty, years of medical practice):
I am a 53 year old fellowship-trained interventional radiologist, in my 23rd year of practice, no longer doing IR.
1) First off, thank you for taking the time out of your schedule to answer these questions.
I love your moniker, Vagabond MD. Can you explain how you decided that this was the descriptor most appropriate for you?
Yeah, no one really ever asks that. [I am known for asking those deep probing questions that others are afraid to ask 🙂]
A few years ago, at the depths of burnout, I was looking for an escape.
I happened to be reading Rolf Potts’ Vagabonding, a book about intermediate term slow travel and minimalism, and the lifestyle seemed very appealing.
So I became the Vagabond MD!
2) When did you know you wanted to become a doctor? Were there any influential people or events that made you embark on this career path?
I was raised to be a doctor by my orthodontist father, who ironically wished that he had become an MD.
Early in my life, I wanted to be an orthodontist, too, like many who look up to a parent.
Midway through high school, especially under the influence of two good family friends, one an internist and the other an orthopedist, I decided to pursue the MD route.
3) What were some of the deciding factors that led into choosing the medical specialty of radiology and specifically interventional radiology?
Were there any other specialties that you considered?
I had early academic inklings and originally strongly considered Internal Medicine, with a non-procedural subspecialty like Oncology.
I spent a couple of years away from med school at the NIH [National Institute of Health] doing neuroscience research.
It made me aware of two things:
- I like lifestyle.
- I like neuroscience.
Therefore, I decided to become an academic neuroradiologist.
After matching in a top radiology program, I realized that, at the time, our department was relatively weak in Neuroradiology and very strong in Interventional Radiology.
The latter had incredibly talented and charismatic mentors, and doing IR was lots of fun and high status in our Hospital.
So that is the direction I took.
4) If you had to do it all over again, would you choose the same medical profession/specialty?
There are a couple questions embedded in that one.
Knowing the trajectory of my life and career, I would absolutely choose Radiology and IR all over again.
If I were coming out of training today, I would either try to do Derm or Ortho, depending on how surgical I was feeling in my final year of med school.
I think I probably would choose medicine again, too.
I am not creative or entrepreneurial and not sure what other path I would have taken in the 1980’s.
Maybe I would go against my father’s wishes and do orthodontics!
5) If you were not a physician, what alternative career would you have gone into?
I am math/science strong but not engineer-minded.
Perhaps something in finance or an actuary.
6) When did you first realize that you had a passion for finance?
My first stock purchase was around 1980 when I took my Bar Mitzvah money and bought 50 shares of Boeing (BA) based on a “hot tip” from a tenth grade classmate. (LOL)
Later, in Residency, there was a core of residents that were really interested in investing.
I bought Advanced Magnetics (AVM) with a couple of other residents and fellows, a then fledgling MRI contrast company.
I know that I later sold the position for a loss but do not remember what happened to the company or their product.
As residency progressed, I became more serious about investing.
One of my IR mentors was also a mutual fund geek, and he advised me to read Jane Bryan Quinn’s Making the Most of Your Money, a classic tome of all things financial.
Right after I finished training (1996), The Millionaire Next Door was released.
I probably heard an NPR interview of author Thomas Stanley, bought the book, and was hooked.
I told my friends about it, and they read it, too.
It was an instant classic, still relevant today.
7) Have you personally fallen trap to any of the typical mistakes physicians make, and if so can you name some of your biggest ones?
Lordy, where do I start.
My biggest mistake was buying a $38,000 Volvo on credit, two weeks into my first Attending job, before I had actually even received a single paycheck. [Must be something in the water in IR fellowship training, as I bought my $42,000 Mercedes on credit 1 month BEFORE my first Attending job]
I did have the dubious distinction of living in and owning three different houses in two cities within a nine month span (and lived with my in-laws for two months in there, too!). [You one upped me here, as I “only” bought two houses during my residency]
I have made some unwise car purchases, like many.
8) As I have mentioned previously, you are known for numerous guest posts and podcasts throughout the physician financial blogosphere.
Have you considered creating a blog of your own?
I have and for a short time, I did have my own blog on MD-oriented travel.
I realized that it is very hard to consistently put out an excellent product.
DocG is an Iron Man, pumping out quality material daily.
Even the two most successful physician personal finance bloggers (The White Coat Investor and Physician on Fire) use guest blogs and each other’s evergreen material.
I have decided that I do not have a cohesive message but occasionally have a decent idea, rant, or lesson, and I have been able to find the right venue for publication.
This puts zero pressure on me.
At the time of me filling out this questionnaire, I have had guest blog appearances in The White Coat Investor (and was a podcast guest), Physician on Fire, The Happy Philosopher, Doctor of Finance, Rogue MD, Wall Street Physician, The Doughroller (podcast guest), Bonnie MD, Crispy Doc, and now here.
I feel honored that good folks are willing to post and read my ramblings.
9) Radiology is part of the ROAD (Radiology, Ophthalmology, Anesthesiology, and Dermatology) acronym medical students use for the so-called “Lifestyle Specialties.”
However physicians in these specialties are still not immune to burnout.
One of the most powerful stories I have ever read regarding physician burnout was your post on The Happy Philosopher.
Tell me your thought process why you wished to share such an emotionally charged story to the public.
Well, truth be told, The Happy Philosopher and his story had a tremendous positive effect on me.
I listened to him being interviewed on Radical Personal Finance on a particularly brutal holiday call weekend, when I was in a downward spiral.
His message and lesson helped me very much, and, in turn, we both agreed that my lesson might inspire others.
So far, that has been the case.
I get messages now and again, sometimes from strangers out of the blue, how reading my story helped them come to grips with their own burnout.
Back to ROAD specialties being “lifestyle specialties”, many of us in those fields know otherwise.
Yeah, one of the senior partners in my radiology practice, in the old days, might read ten or fifteen exams in a day, but even then, that was unusual.
In radiology, the treadmill gets a little faster every year and the average reimbursement gets squeezed a little bit.
[This is absolutely true. Every year CMS (Center for Medicare and Medicaid Services) decreases reimbursement for Radiology services. To maintain a similar income to previous years, the only option for a radiologist is to increase the amount of studies to interpret which pours gasoline on the burnout fire]
10) What steps have you taken in both your work and personal life to prevent descending back into the depths of burnout?
Three discrete steps:
- I gave up my leadership roles and committee work.
- I gave up IR.
- I went part time.
I like my work again. 🙂
11) What is your advice to physicians who may be on the path to burnout but have not realized it yet?
I would say that my own thoughts and behaviors were self-defeating.
I had very low professional self-esteem, and it made me feel trapped.
With a counselor (a social worker) and a career coach (Heather Fork at Doctor’s Crossing), I was able to eliminate the anxiety and low self-esteem that I was experiencing.
I would advise docs who seem like they might be on the burnout trajectory to:
- Recognize it
- Get help
- Assess your options (change in job description, change in job, change in location, leave medicine, retire, etc.)
- Peel off the undesirable aspects of your current position, if you can.
- Be kind to yourself.
12) Complete the following sentence: The thing that most surprised me about a career in medicine was….
Most things are boring and routine.
It makes it much more fun when there is an unusual case or medical mystery to solve.
13) What is your greatest non-financial achievement?
I have been a runner since 1988, my third year of med school and ran competitively throughout residency, getting my 10k time to just under 6:00 per mile.
With a demanding IR job, a growing family, etc., my times and distances dropped off significantly.
In 2013, at age 48, I was able to claw my way back and run a 10K at a 6:27 pace and a half marathon at 6:40 pace.
Other than raising family, etc., I was very excited to get my running mojo back.
14) For a reader unfamiliar with your work, what are three posts (or podcasts) you are most proud of that they can gain an insight about you and your philosophies?
15) Is there a book or books that have made a major impact in your financial well-being?
I mentioned previously Jane Brian Quinn’s tome, Making the Most of Your Money (which has been updated), and she also since published, How to Make Your Money Last, the latter geared for those nearing and in retirement.
Still, Stanley’s The Millionaire Next Door.
Also, all books by Jonathan Clements, Larry Swedroe, and William Bernstein.
If you want to know where I am learning my secret sauce, read Gary Antonacci’s Dual Momentum Investing.
- It’s not for the dyed-in-the-wool Boglehead investors but an inside peek into what it might be like to take some equity risk off the table.
16) Can you name 5 things that had the greatest financial impact on you?
- Growing up in an upper middle class+ family – I never had to pay for education or really worry about money.
- I will likely see a nice little inheritance at some point in the future, hopefully not for many years.
- Living the typical college and med student lifestyle, not the glitzy one on borrowed dollars that some of my classmates did.
- My parents provided enough money to live but not live like a king!
- Marrying a professional, high-earning potential woman with similar financial values.
- Not (yet) having to pay (much) toward the generation before us (our parents).
- It is unlikely that we will need to make a major financial contribution on their behalf.
- Luck – born at the right time, in the right place, and not randomly dying from an accident or cancer or youthful stupidity.
- Much of our successes, financial and otherwise, can be attributed to good fortune (not the money kind).
- I have two good friends from my 6 man fellowship class that were dead from cancer by age 50.
17) If you had a time machine and go back and change one thing about your life, what would it be?
I have recently read two consecutive time travel novels, and it scares me!
The bigger the impact the protagonist was trying to make, the larger the negative repercussions.
I would stick to something small and trivial like asking a girl in 7th grade that I liked to the amusement park.
That should not substantially mess up the time-space continuum.
[But little did Vagabond MD know that by asking THAT very girl to THAT particular amusement park on THAT very fateful day, a chain of events was initiated that would lead to the end of the world as we know it……]
Hoping to change the time-space continuum rift created by his initial answer, Vagabond MD recanted his original statement and replaced it with the following:
If I could roll back time, one thing I would do is embrace the Three Fund Portfolio (which essentially did not exist when I started investing) as soon as possible.
I have learned quite a bit about investing theory since then, and it constantly clouds my judgement and leads me away from simplicity.
Instead of knowing about small value tilting, momentum, Sharpe ratios, real estate crowdfunding, how to tilt an emerging markets portfolio, and other mind clutter, I would be a much more interesting and complete human being if I were learned in Italian Renaissance Art or Essentials of Dog Training, or How to Cook Paella, or….you get the idea.
18) Knowing what you know now about medicine as well as the way the medical landscape is changing, would you advise a child or friend to pursue a career in medicine?
This has been discussed ad nauseous all over physician blogs, forums, and Facebook groups.
If the young man or woman feels that it is a calling and has the aptitude and grit, I would say go for it.
Don’t do it, for the money, for the status, or because it’s what your family wants or expects you to do.
19) Do you have an annual retirement spending goal that you are aiming for? A target net worth? What would be your exit strategy after achieving these goals?
My retirement spending goal is $200k per year, but it is really the max and not the expected annual spend.
I did the math, and that number seems to easily allow the lifestyle that we want for us and our family, some contingencies for financial or health emergencies, and some cushion for adult children that are having a tough time launching.
My original nest egg goal was $4M (mostly because that was one of my partners and mentors advised), and the number is a good starting point.
Then it was $5M, and soon I realized that I kept moving the goalposts.
Suffice to say, we could today retire and have a greater than 95% chance of hitting our $200k spending goal.
I am having fun again at work, enjoy contributing, and no longer plan to retire early.
If it happens, so be it, but I am not counting the days like I was 18 months ago.
I was a “donkey on the edge” (Shrek reference).
20) Periodically there are news stories regarding how artificial intelligence is rapidly progressing to the point that certain specialties, with radiology being at the forefront, are at risk for becoming obsolete.
What are your thoughts on this?
I am not an expert in this area, but I have heard experts talk about it and read some articles.
It is unlikely that it will materially affect my career (assuming another 5-10 years).
I think there is great promise for the future, and AI will start to gradually creep into our workflow soon.
21) What is your greatest fear, if any, you have for retirement, and are there any ways you are addressing that now?
My greatest fear is not being useful and being bored.
I also fear cognitive and physical decline.
Part time work helps counter all of these.
I do have a consulting side gig related to radiology, the quality and operations side.
I am enjoying it, but it essentially requires me to be a practicing radiologist to continue.
I do not believe that I could presently leave the practice and continue this nationwide medical director role.
Again thank you so much for your time answering these questions and being placed under the “X-ray beam.” I look forward to your continued guest posts, comments, and podcasts and wish you much success.
I do hope you consider this platform to host your “next idea, rant, or lesson,” as you will always be a welcomed contributor here.
Thank you for the opportunity.
If readers want to reach out, I am available on the WCI forum and by email (VagabondMD@protonmail.com).
Privacy and discretion are guaranteed.
I will stick around and answer any questions that come up from this X-ray beam expose.
And please don’t forget to subscribe to this blog so you will never miss another post like this again (also it makes me happy)
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