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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?
The Happy Philosopher: Adventures in Burnout
Doctor of Finance: Fire your FIRE plans. Go part time instead.
The White Coat Investor: Podcast interview with VagabondMD
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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We share the same two fears (being bored and unuseful). I’ve always enjoyed your story, and the important perspective that you bring. You’ve done a good job balancing work and life. In doing so, you’ve set a good example of what that looks like and why it is important through your own experiences. Thanks for contributing to the physician blogging world for a while now. You’ve obviously made a great impact given that people know who you are despite not having a blog. Your advice has always been sound, and us young-guns appreciate that. P.S. Vagabond, it sounds like it… Read more »
Vagabond MD’s story, especially of being in the grips of true burnout and then finding away to fall back in love with medicine is a powerful example to any doc. Thanks for the comment 🙂
TPP, I am happy to do a guest blog for you. If you have an idea, hit me up.
Thank you for reading and your kind words. ?
Another great guest post Vagabond. Part time is great time. I think it helps to have a challenge to work on also. You are internet famous.
I think you are both internet famous 🙂 Thanks for stopping by and as always I appreciate your support.
Hatton1, thank you for reading and for your unwavering support and friendship.
I hadn’t heard the “ROAD” acronym before when describing the desireable medical fields for practicing. It seems most folks who fall into those fields wouldn’t ever consider moving into a different specialty were they given the chance to do it all over. I can’t say I blame them. I did a grueling (non-medical) 2-year stint in my last position and don’t know if I’d have the appetite to go back to a similar role in terms of time commitment and intensity. Medical school and residency are probably enough for most folks and really just want to hit the “ROAD”. I… Read more »
I think you and your wife are way ahead of the game and it will pay dividends just a few more years down the road. I had my “aha” moment probably 10+ years after you have, so I had a delayed start to it. The ROAD acronym was definitely a popular medical student phrase when choosing a specialty (and those residencies are very competitive because of it). I guess it is a good sign that people are now prioritizing lifestyle but the warning is you have to have a desire to be in the field otherwise it won’t matter and… Read more »
IMO, the whole ROAD thing is overrated. At some level, it was a way to put down people who were not macho enough to do surgery or IM. Any job can cause burnout, and as a field, Radiology is in the top third of specialties for burnout, per the annual Medscape surveys.
My wife is in her third year of the “D” residency of ROAD. I find it so entertaining when I see her fellow physicians always need to comment about her speciality and how nice it must be. I’m lucky to have her for many reasons. The flexibility for her to work part-time in her field will allow us to focus on raising our family early on. And I’ll agree about the burnout. It can (and does) happen everywhere. This is especially the case when you’re working an inordinate number of hours regularly and it takes away from other parts of… Read more »
Vagabond is the bomb. And yes, I enjoyed Rolf Potts book as well.
I originally trained in one of the so-called ROAD specialties. But it struck me clearly that you only get a great lifestyle, IF. YOU. DON’T. WORK.
Perfect example. The anesthetists show up BEFORE and stay AFTER the surgeon leaves. This struck me when I was 25.
Vagabomb. I like it 🙂 I always thought it was odd that anesthesiology was considered a lifestyle specialty myself as their hours could be similar to a surgeon, although I guess it falls under the purview of shift work specialties which denotes some lifestyle benefits. Some have added Emergency Med to this (E-ROAD) because of it.
I think that Dermatology is the only true lifestyle specialty. When was the last time you saw a Dermatologist at the Hospital in the middle of the night?
I rest my case.?
MB, thanks for the props!
Very True. I guess it should be the D specialty, but not quite as catchy as ROAD. lol
Are we all dumb to be non-dermatologists?
Fun derm anecdote digression: On a 6-week semi-rural family practice rotation at the end of medical school, our regular FP mentor announced that an emeritus professor of dermatology was going to come and spend an afternoon seeing exclusively derm cases with us. The professor, a delightful and clearly intellectual fellow, went over a particularly challenging case by reviewing the broad differential diagnosis and the distinguishing features of each clinical entity. At the end of his discourse, the FP mentor winked at us discreetly and summarized, “Let me guess, you’ll try throwing some steroids at that rash to see if it… Read more »
I wanted something more than acne. Little did I realize all the cosmetic surgery that derm has morphed into. You never know what a speciality will be like 10-20 years in the future.
Really enjoyed that interview. The radiologist gets X-rayed by another radiologist. Part-time work sounds like it solves a lot of problems. I’m mid-career now, but I’ve been thinking about how my last half of my career will look like and part-time looks very appealing. It’s also quite sustainable. I share the same fear of being bored and not useful. We have a couple of retired rads that fill in as locums for us. One of them is obviously bored at home. Whenever I call him at 7 am to fill in for a sick colleague, he says Yes! before I… Read more »
Thanks for dropping by MD. I think part-time would be an ideal solution for me too. Working radiology 2 or 3 days a week could prolong my useful medical career well beyond what I have been contemplating (early/mid 50s). My coverage when I have my day off a week is from a semi-retired radiologist as well and he seems to have found a great compromise between earning money and saving his sanity.
MD, it is good that you are thinking of this ahead of time. I did not have the foresight to plan future stages, until recently.
I am considering a different position, one where I work 20 weeks per year, but in one or two week chunks. We’ll see how that turns out.
Cutting back is the new black!
Great interview. It’s nice to get to know you a little bit more, but I’m still curious to learn more…. Did you actually do any vagabonding, RV’ing and slow travel? Or did you just choose the name based on the book because it seemed like a cool lifestyle but never implemented it? Please elaborate, I’m dying to know! Also… What’s the URL to your medical travel blog. I love traveling and I would like to read it. Maybe you can drop the link in here. And finally… Would you consider a guest post on my blog? Maybe something that intersects… Read more »
Hi, Dr. McF,
Vagabonding became an aspiration, not yet fulfilled, but there’s still some time left on the clock.
I let the domain of the travel blog expire. It was not very good.
I would love to do a guest blog for you (four requests today!). Maybe I could write about why frugality goes out the window when I travel. ?
That’s a fantastic topic! I would love to read and publish it!!! 😀
I’ll reach out to you some time soon with my email:
Nice to know there is another mathematician in the house. My undergraduate was in Mathematics and actuarial science would have been my top choice too. My friends who did actuarial and were able to finish the exams started earning what I earn now in their mid 20s. I love your play on the time continuum. There is an actual show called continuum, awesome show about future people coming to fix the mistakes that the current generation were about to make. I can see one of them putting Vagabond in a detention to prevent asking that girl out. Unfortunately, the show… Read more »
Thanks for the great comment DBEF. That Continuum show actually sounded like a great one. I personally hate it when I get caught up in a TV series and it gets canceled leaving us hanging.
Your X-ray beam interview actually is 2nd in line (hope you like how it turned out). I will leave it a mystery as to the next one in two weeks. 🙂
It’s always interesting to get to know some one better. You seem pretty centered so never would have guessed low self esteem. I liked my job but never thought of it as a “life style specialty” whatever that means. When they call at 2 AM for a ruptured AAA or a baby dying in utereo and I’m driving 90 mph while on the horn to the nurse supervisor to get the blood lined up for the inevitable bleed out, didn’t seem like much of a life style choice. I know the IR guys has similar experience. I guess the grass… Read more »
Great interview and solid advice Vagabond. Our stories are important for others to hear so they know they are not alone. Burnout is a very lonely place indeed. Cheers!
Thanks for stopping by. I’m glad both you and Vagabond brought out the message of burnout in that amazing post on your site
Vagabond, I appreciate a new facet of you with every successive post and interview. It makes your stone sparkle that much brighter. I came across the Rolf Potts book last year, about 20 years late for the time it would have had greatest impact, but still inspiring. I completely get the appeal. The great Bar Mitzvah investing fiasco is my new favorite cautionary tale! You are gracious to let so many of us inside your head at times of your greatest self-doubt. It’s helped many of us continually course-correct in careers known for imbalance. Final fortune cookie wisdom thought of… Read more »
What a wonderful comment CD and I concur with your feelings to VagabondMD. That burnout post was so moving when I first read it. It vocalized what I had in my head for years and shed light that my problem was not mine alone to bear. Thanks for always having something great to say on this blog and yours. Have a great Thanksgiving. XRV
Low self-esteem and burned out doc to Camus trusted judge in the same post. Wow. A great post with great comments.