003: Why Hospital Employment Is Not as Stable as It Seems

In this episode, Dr. Kristine explores the misconceptions surrounding hospital employment and its perceived stability. She delves into the challenges physicians face, such as burnout and financial dependency, and introduces the concept of income decoupling as a pathway to achieving true financial independence and career flexibility. Learn how to diversify your income streams and take control of your professional future.

Key topics: 

• The myth of hospital employment as stability and what true stability looks like
• How physician burnout accelerates early retirement and economic loss
• The concept of income coupling versus income decoupling
• Practical strategies for building remote income streams
• Real-life example of transitioning from traditional practice to remote consulting
• The importance of diversifying income to reduce vulnerability
• How structural issues in healthcare contribute to physician stress and health issues
• Step-by-step approach to transforming expertise into alternative income sources
• The role of gradual income diversification in creating career choice and freedom

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Transcript

SPEAKER_00 0:01

You're listening to Doctors Abroad, the podcast for doctors who want to build remote income and create location independence. I'm Dr. Christine Goins, founder of Nomadem D. I've exceeded my hospital income while working part-time and living abroad, and on this show, we break down how to make hospital income optional. Let's get started. I can't keep working like this. She was seeing 28 patients a day, charting until 10 p.m., missing dinners with her family. And what kept her going back every day, regardless, was that she believed leaving the clinic, leaving the hospital, leaving that institution would be risky. But what we unraveled together was that staying exactly where she was carried its own set of risks. And I'm sure you or doctors that you know have also ended up in a similar position at some point. And it's not because they don't care about patients or that they regret becoming doctors or that they even hate medicine. But rather, it is the way their work is structured that has become unsustainable. The hours, the patient volume, the productivity pressure, the lack of control over their schedule. And yet many doctors stay in those roles for years, decades, longer than they want to. Why? Because we have been trained to believe something very deeply. Hospital employment equals stability. But today, I want to challenge that belief. Because stability is more than a paycheck that shows up every two weeks. It's whether the structure of your work is sustainable for your health, your relationships, and your long-term earning capacity. As we know, physician burnout now affects over 60% of physicians in the U.S., according to Mayo Clinic and Medscape Physician Burnout Reports. But more importantly, burnout is now one of the leading drivers of early retirement in medicine. And here are a few numbers that most physicians never see during training. Studies estimate that physicians leaving clinical practice early costs the healthcare system over $4.6 billion per year in turnover and reduced clinical hours. But what matters even more for individual doctors is what that means financially. If a physician earning $350,000 per year leaves medicine 15 years earlier than planned, that represents over $5 million in lost lifetime income. That doesn't even include lost retirement contributions, lost investment growth, or increased health care costs from chronic stress and burnout. So the real question becomes: is hospital employment actually the stable option? Or does it only feel stable in the short term? And I say this as a doctor who has been there myself only one year out of fellowship training. And I was already feeling the physical manifestations of burnout, fatigue, difficulty sleeping, chest pains in between clinics. Now, of course, at that time, my weekly schedule consisted of me working at 10 different clinics across two cities, utilizing four different EMRs. But was I thinking that this was a structural systematic issue? No. I was thinking I'm a newbie. Obviously, I'm incompetent, right? Being that I'm spending hours after work doing documentation, or maybe my entire weekend catching up on documentation while everyone else is looking very busy and ragged, but they seem to overall be doing just fine. But by year two, I really wasn't doing just fine. Yeah, I was performing well at work and I was being promoted quickly, but it didn't take too long for those physical signals to turn into emotional signals, constant anxiety and episodes of depression. And definitely as a psychiatrist, that was a warning sign for me because I was like, mm, this is not me. I was utilizing all of my tools. And one day I sat down and I saw yoga isn't helping. Swimming isn't helping. Spending time with family and church isn't making this go away. And that made me realize there is something unsustainable structurally in my day-to-day work life that is causing this. Another hidden instability in hospital employment is the productivity model. RVUs, patient quotas, shorter visits, more documentation. In theory, productivity models reward effort. But in practice, they often create a treadmill where over time physicians must continually do more work to maintain the same income. More patients, more charting, more administrative tasks. And it doesn't just affect your time. It affects how you practice medicine, how present you can be with patients, your ability to recover between shifts. One thing I see constantly among physicians is chronic health issues, sleep deprivation, hypertension, autoimmune disease, depression, and anxiety. And many doctors push through these issues for years because they feel financially trapped. But health is not separate from income. Health is a determinant of income. When physicians become physically or mentally unable to sustain their workload, they begin to reduce their hours abruptly, not by choice. They take extended leave. They leave clinical medicine earlier than planned, which means the very system that was supposed to provide stability can actually shorten a physician's earning lifespan. So the core issue here isn't just burnout, it's something deeper. It's income dependency. Most physicians earn money in a way that is tightly tied to an employer, an institution, a building, a city or state, a schedule they did not create. And so if you stop showing up, the income stops. And that isn't stability, that's coupling. Okay, in engineering, a coupling is a device used to connect two shafts so power can be transmitted from one system to another. The important thing about a coupling is that the system only works if both sides move together. If one shaft stops turning, the other one stops too. Most physicians earn money in a system that works exactly the same way. Your earning power is mechanically connected to a hospital, a building, a schedule you don't control. If you stop showing up, the income stops. If the hospital changes policies, your income changes. If you move cities or countries, your earning ability resets to zero. Right? That's what I call income coupling. The power isn't fully yours anymore. It's flowing through a system someone else controls. Income decoupling means redesigning how you earn so that your income is no longer mechanically tied to an employer, location, or schedule. When physicians decouple their income, whether through telemedicine, consulting, advisory work, or hybrid models, their earning power stops depending on one machine continuing to run. And that's when something really important happens. Hospital income stops being a necessity and it starts becoming a choice. Inside Nomad D, we work on something called the income decoupling method. Instead of earning money in a single location-dependent structure, physicians redesign how they earn so their income is no longer tied to an employer, a physical location, or one fixed schedule. So income decoupling can look like telemedicine, consulting for healthcare organizations, advisory roles for startups or medical companies, education or coaching in your area of expertise, hybrid clinical or remote models. The goal is not to replace your entire hospital income overnight. The goal is to gradually build one or more income streams so that no single institution controls your financial life. One physician I worked with, a psychiatrist, came into our work together with a lot of expertise and a strong desire to build something remote. But she was completely stuck in fear and avoidance. Like many doctors, she had spent years working inside employed clinical structures where income was tied directly to showing up in a specific system on a specific schedule. She knew that she wanted something different for her life. But she kept hesitating. Questions like, is this allowed? Will anyone actually pay me for this? What if I try and it doesn't work? But what changed for her wasn't learning something completely new or getting a new certification or more degrees. It was translating the expertise she already had into a different income model. She identified a niche, providing peer-to-peer consultation to primary care practices, clinics that regularly manage patients with mental health needs, but don't always have direct access to psychiatric expertise. Once she had clarity on the model, she built the structure around it, defining the consultation service, how it would work, how she would communicate its value. Then she started executing. And over time, she went from zero remote income to building a consultation business with active clients, systems of place, and a clear path towards fully decoupling her income from an employer. And the important thing about this story is that she didn't become someone brand new. She simply structured the expertise she already had in a different way. So I want to ask you something honestly. If your hospital or clinic job disappeared tomorrow, how many different ways would you have to generate income with the expertise that you already have? For most physicians, the answer is one. And that is the real vulnerability. When doctors begin building even one additional income stream, something shifts. The pressure changes because now their hospital job is no longer their only option. And once that happens, something powerful becomes possible. The goal is not to abandon medicine or abandon our patients. The goal is to stop structuring our careers in a way where an institution controls our financial survival. Hospital income can be a powerful tool, but it should never be your only option. So if you are ready to explore how to build remote income and make hospital work optional, you can book a one-to-one freedom consultation at thenomadmd.com. We'll look at your specialty, your current income structure, and what decoupling your income could mean for freedom and flexibility in your career. Thanks for listening to Doctors Abroad. If this episode was helpful, share it with a colleague who's been thinking about building more freedom and flexibility in medicine. And if you're ready to make hospital income optional, book a one-to-one freedom consultation at thenomadmd.com. I'll see you in the next episode.