Why I Quit My $300,000 Job

I resigned from my job on 3/27/2020. A resignation had been in the works for a while now and certainly should not be a shock to any reader of this blog.  It took me about 6 months of working to realize that I was in the wrong kind of job for what it is that I am trying to accomplish with my career. After being introduced to the concept of office interventional suites (OIS), my heart has been set on working in one. Earlier this year I was offered an equity position in a new OIS in my area. In the beginning of 2020, I gave my group notice that I will be leaving by the end of the year. 

So why did I quit so suddenly? It should be clear from my previous post, I absolutely hated my job. I hated the fact that DR was subsidizing my IR work. I hated that my partners did not share my vision for a real clinical IR service, Every case I did that was over 60 minutes was viewed as a “project.” I was losing support for doing cases that I worked incredibly hard to build, including high end PAD work. I certainly had minimal to no pre or post procedural support given my lack of a clinic infrastructure. I also felt I was being severely underpaid for my production on both the IR and DR side.

It all came to a head when my senior IR partner sat me down and told me that my cases are taking too long and I can’t be tying up a room for 2 hours doing a prostate artery embolization when we have to get through the regular stuff like paras, thoras and thyroid biopsies. This was the same physician who told me a year ago we can consider having an IR clinic if I had the volume to justify it. In February 2020 I averaged 8 new outpatient consults a week. That week he sat me down to talk, I did 2 prostate embolizations, a uterine fibroid embolization, 4 CLI cases, a renal cryoablation and a varicocele embolization. Imagine how you’d feel if the same person who told you to prove your worth was now telling you to “back off” after you proved that you were successful in building a practice only 18 months out of fellowship with no support? All the while taking Q3 IR call, being productive on the DR side and being paid at a below market rate. I was simply too tired of being unhappy and feeling professionally that I was living on an island by myself. These guys clearly do not care. Why am I putting up with this?  Enough was enough.

I gave my 30 day notice on the spot. I spent the next 2 weeks tearing down everything I built. I’m so sorry I can no longer be your doctor. A common line I said to patients.  I’m so sorry I will no longer be able to see your patients.  A standard line I gave to podiatrists, urologists and OB-GYNs. I worked so hard to build this practice and just like that I let it go. I hope none of you ever have to do what I did. 

On my final day, I received a nice card from the nurses and technologists. The younger of my two IR partners came up to me and said I respect your skills and drive. Sorry it didn’t work out. I received calls from ICU physicians and hospitalists saying that they’re going to miss me. It’s always nice to feel validated, but there are two groups that simply won’t care: the hospital and the radiology group. I would say more, but I think this post summarizes it nicely. 

It was during my last week where I realized how much I truly love doing IR. It’s amazing how fun it really is, something that’s easy to lose sight of in a routine grind. I was high-fiving my technologist after getting into a nasty Type 1 prostatic artery origin.  I did a PE thrombectomy and pulled a large saddle embolus out using the new Inari device. I did an iliac venous reconstruction for an inpatient with chronic MTS who was told that “nothing is possible.” That last case was a 4 hour throw down, but was successful. I remember looking at my senior partner who was watching me from the control room, probably pissed I was taking so long. You could only imagine what I was thinking.

And that was it. I conveniently quit my job during the middle of a viral pandemic.  Obviously, not by design. As I sit from home writing this on my laptop, in many ways I’m truly blessed. I’m safe and am able to make a true career change even in the middle of this global disaster. But this would not have been possible had it not been for some careful financial planning.

So what are you going to do, Line Monkey? Don’t you have student loans? A mortgage? Car payments? Why did you quit that $300,000 a year job, even if you hated it? That’s more money than most Americans will ever see! 

I no longer have student loans because I aggressively paid them off during my first 8 months on the job ($120,000 worth). I saved up a six figure equity buy-in for the new OBL. My spouse and I have a robust emergency fund that we will hopefully not have to tap into. I have saved up money doing teleradiology for the last year about 10-20 hours a week in addition to my IR/DR job that I just quit. 

How was I able to do this? Simply by living like a resident. My car is 17 years old and is paid for. Our total monthly expenses including our mortgage are roughly $2500. No country club memberships. No kids, and none on the immediate horizon.  No fancy vacations. 

If I wasn’t aggressively saving there is no way I’d be in a position to effectively throw up two middle fingers and walk out the door. There would be no Line Monkey. 

If I didn’t meet mentors both locally and nationally to help me out, how could I do this? If I didn’t have half the average student loan burden how could I do this? If I didn’t live in a low cost of living area how could I do this? If I didn’t have a spouse who has a job and if I had kids to support how could I do this? If I didn’t have a six figure moonlighting gig how could I do this? 

There is no question, I am incredibly lucky. I have been given every advantage known to man, and it is still a significant risk for me to embark on an outpatient physician owned endeavor knowing the opportunity cost is a six figure income in a relatively stable hospital setting. How can others do what I did? I’m not sure it’s possible for most young physicians. 

Maybe you’re not willing to pull a Line Monkey and quit your job in one of the worst economic climates in history, but maybe you can take away something from my experience and put it to good use as you build your career.

So what have I learned from all of this? 

1. Have a vision. Know your motivations for doing IR and what it is you are trying to accomplish. If you join an IR/DR group and/or a hospital system, make sure their vision for IR aligns with your own. If not, do not engage. They don’t care about you.
2. Find mentors. You need to learn from people who have “been there and done that.”
3. Seek financial independence. You must be financially solvent in order to take risks. Eliminating debt where it makes sense and having an emergency fund is critical.
4. Never stop learning. I have read more journal articles as an attending than I have as a fellow. 
5. Know the downside of every opportunity. Do your due diligence. Ask tough questions.
6. Leverage your skills. I’ve leveraged my DR skills to fund my future IR business. 
7. Recognize that it’s a very small world. Try not to burn bridges, but acknowledge that you may have to burn some bridges if you are really trying to do something out of the ordinary.
8. Have fun. Even during my most frustrating times, there was pure joy in opening up blood vessels or interacting with patients in “clinic.” Politics and money just get thrown out the window in those moments. Savor those moments.
9. Understand how you get paid. In most hospital settings, you will be forced to do DR to subsidize your IR endeavors. Make sure you are okay with this. I am not. I’d rather do DR on my own time independent of my IR work. To each their own.
10. Be ready to adapt. Nothing is a guarantee.

Despite the fact that I ended up in a position that was not right for me, in retrospect I’m glad it happened. Had I been happy with my job, I would have likely never been exposed to outpatient IR practices. I would have never sought advice from those who I have gotten to now know as incredible mentors and friends.  I would have never learned how to tackle PAD cases. I would not have the clinical and technical skills I now have having done dozens of complex embolizations on my own without any on-site mentorship. I wouldn’t be nearly as motivated in general as I currently am. For all of this, I’m extremely grateful. 

So how has COVID-19 changed your plans?

Well, that six figure teleradiology side-gig has evaporated given severely reduced DR volumes. It will come back, but like the rest of society, will take time. There will be a “new normal” we will all have to get used to.

Our OBL is opening in July, just as it would in a pre-COVID world. Volumes will be low, but we will make adjustments as necessary.

If things don’t work out (and I’m confident they will work out because I’m too stubborn and motivated for them not to, as is my partner), there will always be a need for Line Monkeys in some community somewhere. 

So what are you going to do with your time?

I’ll be doing some part time IR/DR locums work for a different group this summer. Only this time, it is merely a means to an end with a friend I trust who knows exactly what my purpose is. I will be working at a rate that is significantly higher than what my former group offers moonlighters. 

In the short term, I’m riding out COVID-19 from home. When teleradiology comes back up, I’ll be ready to work. In the meanwhile, I’ve gotten really good at cooking. I’m able to go on nice runs without my pager and am able devote more time to my family and friends, albeit virtually. 

Ultimately I’m grateful for having time to recharge, reflect and write more posts. While I left my IR/DR position, I’m still going to write about many things related to my old job as I feel it will be useful for trainees and those students interested in IR. It has become clear to me that my passion is not only doing high-end clinical IR, but helping to shape the future of our dynamic field. I cannot wait to get started on the next chapter of this journey.

Stay safe out there. More to come soon.