013: Is Remote Work Financially Secure?

Are you a physician feeling hesitant to leave hospital employment due to financial fears? In this episode, Dr. Kristine dives into the realities of financial security in medicine and how to build a more resilient, diverse income strategy outside traditional hospital roles. Discover the truth behind hospital job stability, the real costs involved, and actionable steps to reclaim control over your income and health.

Key topics:

• The misconception of hospital employment as the ultimate safety net
• Hidden costs and non-cash benefits in hospital compensation
• The instability of employment contracts and organizational risks
• How diversification and leverage create true financial security
• The importance of multiple income streams, including remote work and consulting
• The long-term health impacts of burnout and loss of control over schedule
• Strategies for building financial security before making a transition
• Geographic arbitrage as a method to enhance income and quality of life
• Practical steps for a calculated transition from hospital work to independent income streams

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Transcript

SPEAKER_00 0:00

The number one reason physicians don't leave hospital employment isn't that they're too tired. It isn't fear of being visible outside their institution. It isn't even not knowing what they do. It's this. I can't afford to take the risk. Today, we're going to look at whether that belief is actually true and what financial security and medicine really looks like when you examine it honestly. And if you're at the point where you want to build income that gives you more control over your time, your schedule, and where you live, I do one-on-one Freedom Calls where we look at your specialty, run your actual numbers, and build a real transition plan. The link is in the show notes. Let's get into it. 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. Today's episode is a personal one for me because financial fear was the first and last thing I had to really examine before I left the hospital and the United States. I had addressed the mindset piece. I had started building income. But when it got real, when leaving was actually on the table, the question that stopped me was is this actually safe? And I want to answer that honestly today, not with general reassurance, but with a real look at what financial security in medicine actually means, what you think you have, what it's actually costing you, and what's possible on the other side. So let me start by saying the financial fear is legitimate. And I had it too. I want to be really clear about that. Before I left the hospital, I had over $300,000 of student loan debt. I had rent in DC, which, if you've ever lived there, is not cheap. I had a lifestyle that my hospital salary was supporting. And when I started thinking seriously about building something outside of that system, the fear didn't show up as a vague discomfort. It showed up as specific middle of the night calculations. What happens if this shift doesn't work? What if I lose the income I have before I build something new? What will I need to feel safe in this transition? And underneath all of those questions was a belief I hadn't fully examined. That the hospital was the safe choice, that employed medicine was where security actually lived. That trading my autonomy and my time and my energy for that paycheck was actually a reasonable trade because at least it was guaranteed. I want to spend some time examining that because I think for a lot of us, we've accepted it as true without ever really looking at it closely. When physicians talk about the security of hospital employment, they usually mean a few things: a predictable salary, benefits, malpractice coverage, a retirement plan, and the sense that as long as you show up and do your job, the income continues. And that feels stable. And in some ways it is because it's known. But I want to look at what the arrangement actually consists of, because I don't think most of us have ever done that math. So here's something worth sitting with. So your health insurance, your malpractice coverage, your PTO, your retirement contributions, your disability coverage. Now that's not nothing, right? Those benefits have a real dollar value. Malpractice alone could run from $5,000 all the way up to $50,000 a year, depending on your specialty. Health insurance for a family is another 18 to 30,000. These are real costs you need to account for if you leave. So you're not replacing necessarily an entire 400K. You're replacing the cash portion and then strategically accounting for the benefits piece separately, which for most people can be a lot more affordable and provide cost savings. And I'm going to get into that a little bit later. The reframe alone changes the math for a lot of doctors. Now let's talk about the guarantee itself. Hospital employment feels stable because that paycheck comes every two weeks. But I want to ask you something. How many physicians in the last five years have had their contracts restructured? How many have had their RVU targets increased? How many have had their compensation models changed mid-contract, or their non-compete clauses enforced, or their departments merged or eliminated, or leadership completely changed, impacting their position? When adjusted for inflation, Medicare physician payment has dropped 26% since 2001. The institutions that employ us are operating under the same reimbursement pressures. And when those pressures build, the people who absorb the costs are the physicians. We do. So your paycheck feels guaranteed, yet your employment arrangement is considerably more negotiable than you think, but in their favor, not yours. And here's the thing about having one employer when something changes, and in healthcare nowadays, something always changes, you have no buffer. Your income is entirely dependent on one organization's financial health, one administration's priorities, one contract that they can restructure or choose not to renew. You have no diversification. You have the appearance of stability and the reality of complete dependence. Most financial advisors would never tell you to put all of your investment capital into a single stock. But we've all accepted an arrangement where 100% of our income comes from a single source and we call it security. So if hospital employment isn't actually the safe choice, or at least not as safe as we've been treating it, then what does real financial security look like in medicine? I think about it in two ways: diversification and leverage. And both of them look very different from what most physicians have been taught to build towards. The physicians I know who feel the most financially secure are not the ones with the highest hospital salaries. They are the ones with multiple income streams. A direct contract with a hospital or clinic when they could control a telemedicine arrangement that covers a consistent patient panel, a consulting relationship with a health tech company, legal team, or a pharmaceutical company, a part-time clinical role that maintains licensure and clinical skills. These streams don't all need to be 40-hour a week roles, but together, they create something that a single employer never can. A situation where losing one income source doesn't destabilize everything. So when I decided that I needed to leave the hospital setting for my physical health, for ownership over my time, and quite honestly, for my sanity, I was able to do it because I had more than one income stream and one that could be fully remote. And the stability of that arrangement, knowing that if one contract changed, I still had others felt more secure than anything I experienced in just being employed by a hospital. And feeling like whatever they said on a given day, I just needed to suck it up. Here's the other piece. Your hospital salary has a ceiling. It's determined by RVU benchmarks, by market surveys, by what the institution has decided your specialty is worth to them. And you can negotiate within a range, but you can't change the fundamental structure of how you're compensated unless you change your entire positioning, right? Outside of that system, your income potential is determined by the value of your expertise in the market itself, which is a completely different calculation. Direct contracts, consulting agreements, specialized telemedicine practices, these are not capped the way the hospital employment is. So when I left the hospital, I started making more than I did in my highest earning year in hospital medicine, not because I was working more, but because I was now operating in a compensation structure where the ceiling was set by the market, not by a hospital administration. The institution was never the source of your financial security. If anything, it was the thing that was most effectively limiting it. And I want to come back to that 40% non-cash piece because I know it is sitting there. Malpractice, health insurance, retirement, these are real and they need to be planned for. This is not something to wave away by any means. But here's what I want physicians to understand these are solvable. They are line items that can be budgeted, replaced, and restructured. You can carry your own malpractice, you can purchase health insurance, and depending on your income structure as an independent contractor, there are significant tax advantages to how you do it. You can build a retirement strategy that is actually more flexible and more lucrative than the defined contribution plan your employer offers. It's actually quite simple. It doesn't take very long. I replaced each and every one of those within 30 days. And so have my clients because they received the right guidance and treated it like a step-by-step replacement plan instead of fear of change. I want to talk about something that also almost never comes up in these financial conversations. And it's the most personal part of this for me. I had so many health issues from working in the hospital environment, like real ones. The overwork, the chronic stress, the inability to control my schedule. It literally took a physical toll. And here's what that means financially: chronic stress isn't a wellness issue. It is a long-term wealth issue. The research shows that burnout is associated with type 2 diabetes, hypertension, and significantly higher rates of cardiovascular hospitalization. I myself, with no history of diabetes, had my A1C skyrocket while working in the hospital system. One review found that chronic psychological stress is associated with 22% higher all-cause mortality rate and a 31% higher mortality rate for cardiovascular events. There's data linking physician burnout to shorter overall survival in individuals under 45. And as someone turning 40 in a few weeks, it scares me, right? It's really saying something about the structure of these environments when almost half of us report at least one symptom of burnout. Our body's running a chronic stress response that accelerates aging and it drives inflammation and it increases our risk of the diseases we spend our entire careers treating in other people. When I left the hospital environment and gained control over my schedule, my health changed. That was not by accident. Autonomy over your time is not just a preferred lifestyle choice. It is a health intervention. And here's why this belongs in a financial conversation. A physician who can work well into their 60s or 70s, who isn't burning out, who isn't managing chronic illness from decades of overwork, that physician accumulates significantly more wealth over a lifetime than one who retires early because their body gave out. Your long-term earning potential is directly tied to your long-term health. And your long-term health is directly tied to how much control you have over your time and how you work. It is also owning enough of your time that no employer's demands can ever take your health with it. So remote work, when built right, is not only an income strategy, it is a longevity strategy. And let me be honest about another thing. I'm not suggesting that you walk into your hospital tomorrow and resign without a plan. That is not what financial security looks like either. What I did and what I've watched physicians do successfully is build before leaving. You start the conversations while you're still employed. You build the first income stream before you need it. You run the numbers on what your actual cash needs are, not necessarily your full salary replacement all at once, but your real monthly requirements and you build to that number before you make a move. My first remote contract came while I was still in employed medicine. I wasn't replacing my entire income overnight. I was adding to it at that time. And by the time I left, I wasn't stepping into uncertainty. I was stepping into something I had already built. That is what a financially secure transition looks like. Not a leap of faith in that, I hope everything works out when I leave here. A calculated move with a runway underneath it. So let me come back to that question this episode started with. Done carelessly, without a plan, without understanding your real numbers, no, it's not secure. But then again, neither is any income arrangement you approach carelessly. But done with intention, with a clear transition plan, with two income streams or more, with an honest accounting of what your actual needs are versus what you've been told that you need, remote income can be significantly more secure than a single hospital employer because you own it, because it diversifies, because the ceiling is yours to set. And here's a dimension of financial security that most physicians haven't really considered geographic arbitrage, earning US or UK level income while living in a country with a significantly lower cost of living changes the math entirely. Simply relocating from a high-cost US city to a lower cost city can save tens of thousands of dollars a year in housing, transportation, and taxes without changing your income at all. And the savings are much more substantial. For me, well over six figures a year for a physician earning remote income in US dollars or pounds while living in a country with a fraction of the cost of living, but a much higher quality of life. And with this, the effective value of that income multiplies. You don't just earn more than you did in the hospital. Your money does more. Your income streams expand. So I hope this gave you more of an honest framework for thinking about what financial security actually means. Not the version that we inherited from medical training, but the version we can actually build for ourselves. If you want to run your specific numbers, what you actually need to replace, what your transition timeline looks like, what a realistic remote income build looks like for your specialty and expertise, that is exactly what I do on a one-on-one Freedom Call. We look at your situation specifically and build a real plan. The link to book is in the show notes. And if you're now thinking more seriously about what leaving actually looks like in practice, not just financially, but logistically and emotionally, stay with us because that's exactly what I'm going to talk about in the next episode. What it actually looks like to leave full-time hospital work, the timeline, the preparation, what I put in place before I gave notice, what I actually said to my boss, and what leaving felt like. That episode is coming next. And if you haven't yet listened to episode three, why hospital employment is not as stable as it seems, that one paired well with today. It goes deeper on the institutional side of what we touched on here. 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.