Why I Still Work After Achieving Financial Independence

[This article is a guest post contribution from Dr. Neill Slater, MD, MBA. He is one of the founding partners at Business Is The Best Medicine. His work has proven to be well written, entertaining, and a welcome perspective. I encourage you to check out his website as well! It offers great information regarding physician finance and real estate investing through the lens of a financially independent physician.]

My father and older sister both died in their late forties, teaching me at a young age the ephemeral nature of life.  I told myself I would retire if I reached fifty, which seemed so far away at the time.  This was long before I discovered the FIRE movement, but even then I understood there was more to life than a career.  However, time passed far faster than I imagined in my youth, and now that I’m a financially independent physician in my late 40s, I have no intention of retiring. 

In this post, I will outline seven reasons why I still work after achieving financial independence.  Are they legitimate, or am I betraying the FIRE movement and my youthful ideals?

Why I Still Work After Achieving Financial Independence:

1. Money

Do I need more money?  No.  I am financially independent by any measure.  I like to say that I’m FI three ways: from real estate income, using the 4% rule, and from my non-ER businesses.  So, money isn’t an issue.  But . . . I still get paid a lot for working in the ER.  I remember thinking when I landed my first moonlighting job as a resident that for $70/hour, I would not only see the patients but also clean toilets and mow the grass.  Twenty years of working in the ER hasn’t tempered the feeling that I get paid a tremendous amount of money for a job I generally like.     

Money will almost certainly be a top reason for anyone having trouble pulling the trigger on full retirement.  While the math of early retirement is simple, the emotional baggage we carry concerning money is often a more significant challenge to overcome.

I freely admit I am wearing golden handcuffs.  Because I’m a partner in a small ER staffing company, I would lose my income and the partnership distributions should I retire.  This combination makes my $/hour earnings higher than they would otherwise be.  To not work the required eight shifts per month seems, I don’t know, irresponsible, short-sighted, arrogant, lazy, or ungrateful.  I don’t know the exact adjective, but it somehow seems wrong.  Surely, the money will have a purpose, even if I just give it away.

2. Identity

Many physicians view their profession as their identity.  Retirement may alter the way they are perceived by others, and the way they see themselves.  If I’m not a doctor anymore, who am I?  This is likely less of an issue for me, as I’ve never identified primarily as a physician. 

Outside the hospital, I don’t typically think of myself as a doctor.  I am many other things: a father, husband, businessman, mentor, and student.  Doctor is pretty far down on my list.  I hope this mindset will allow me to avoid these issues when I fully retire from clinical practice.  Eventually, I will be happy not to be a doctor if it means no CME, credentialing, licensing, and board certification renewal.

3. Skills

Medicine is a field that rewards continuity.  Once you stop practicing, it’s hard to return; procedural skills atrophy and knowledge quickly becomes outdated.  Even if you manage to stay proficient and updated, licensure and board certification requirements lapse.  In many professions, you can un-retire, but not always in ours, which increases the gravity of our retirement decision.  The medical system rewards inertia, keeping you in motion by creating a disincentive to any outside force that could stop you.    

After medical school, residency, and years of work in the trenches of the ER, I have acquired valuable knowledge and skills.  It is hard to stop using something I’ve worked so hard to obtain.  I don’t consider myself an expert on many topics.  I am interested in business and personal finance, which has led me to spend countless hours studying these subjects, yet I would not consider myself an expert.  But I know I have expertise in community-based emergency medicine, making quitting more difficult. 

4. Friendship

I have worked in the same ER for 17 years, building a reputation, a business, and deep friendships.  There have been good times, bad times, births and deaths.  I know my colleagues’ spouses and have watched their children grow.  A few are truly work friends, while others I text with daily. 

It isn’t easy to make friends as you age, with work being the primary source for many adults.  Work is often the common thread that binds.  In a busy ER, there are additional trauma bonds that bring people closer through shared experiences.  It sometimes feels like it’s us against the world, that we understand each other in a way that outsiders just can’t.  These friendships should be able to withstand retirement, and I’m sure some of them will.  But it won’t be the same. 

I’ll miss the inside jokes, the venting about specialists, and the suspiciously calm recaps of exhilarating critical care cases.  When I do retire, I’m sure I will make friends in whatever new ventures I pursue, but I will always miss the unique ER camaraderie.

5. Family

Roll out of the sack every mornin’, head on down to the mill

Give ’em all I got for eight, ’cause that’s the deal.

I wrote these lyrics from the song I Got It Honest by Aaron Tippin on my personal statement when applying to ER residency programs.  I have always envisioned emergency medicine as a blue-collar specialty, probably because my father was a coal miner who did shift work.  While I can earn in a month what he did in a year, I have always imagined similarities between our careers. 

I vividly remember running up to his car when he pulled into our driveway in the afternoon after a morning shift and savoring the last few sips of his RC Cola or Orange Crush.  I also remember trying hard to be quiet in our small house while he slept during the day after working nights.  Even as a child, I recognized how hard he worked for our family.  

I am fully aware that I am romanticizing certain aspects of blue-collar work, but I still would like my children to look at me in that same light:  strong, hardworking, and dedicated.  I like that my children know their dad is a doctor.  I smile when I hear them say that I help hurt or sick people.  I choke up every time they run to hug me when I come home after a stretch of shifts.  They don’t know the details of what I do in the ER, nor do I want them to.  But I take pride in the fact that they are proud of my career. 

While I want my children to see me as a hard worker, I also want to spend time with them, which is why I have already cut back to working about eight shifts per month.  Paradoxically, my family is the reason I quit working full time, and one of the reasons I keep working at all. 

6. Service

No one would ever mistake me for an altruist, but I follow a concept I call “inadvertent good.”  While I never wanted to devote my life to benevolence or charity, I still wanted some of that sweet, sweet karma by default.  This led me to structure my life so that service is a byproduct of my day-to-day actions.  I chose medicine over law for this very reason.  I figured I could make a lot of money as a doctor yet still look back on my deathbed at all the good I had done for the world.  To earn a lot of money as a lawyer . . . well, I stand by my decision. 

I am fortunate to work in a high-acuity ER in a hospital subsidized by local tax revenue.  Forty percent of our patients are uninsured, yet we are still able to run a profitable partnership, partly due to the taxpayer’s largesse.  Unfortunately, taking care of the less fortunate has grown on me over the years, and I would miss that part of my life should I fully retire.  I might even have to find a way to do some (gulp) purposeful good.

7. Fear

Finally, fear plays a role in any retirement decision.  To deny that would be lying to you and myself.  I am afraid, not of running out of money, but of the thought of shutting off a steady income stream.  Afraid of losing friendships built over decades, losing a piece of my identity and hard-won skills.  Afraid of what my kids might think of me when they’re older, what I might think of myself, and what the universe might think when I die.  Afraid of what comes next.

Take Home Points

I believe the pursuit of financial independence as a medical professional to be a noble one.  Just because I am not RE doesn’t mean that every physician shouldn’t purse FI.  It isn’t about money or retirement, but about choice.  You may or may not agree with my seven reasons for continuing to work past FI, but I am making a conscious choice.  I continue to see patients because I want to, not because I need to pay off my student loans. 

I still work in the ER because I genuinely care for my colleagues, not because my mortgage payment is due.  I can speak out concerning any problems in my hospital or the current U.S. healthcare system without concern for repercussions.  What are they going to do, fire me?  That’s one thing I’m not afraid of anymore.  If every healthcare professional was in a similar situation, we would have a more powerful voice in shaping the future of medicine in this country and be happier and more fulfilled in the process. 

I hope you enjoyed this guest article Why I Still Work. Dr. Slater has more great content on Business Is The Best Medicine. I encourage you to check it out! If you did, please share it with others using the ‘share’ buttons located on the left-hand sidebar (on desktop) or below this article. It would also be very helpful if you would follow us on social media! Instagram and X (Twitter) accounts can be found using the right-handed sidebar (on desktop) or below (on mobile devices). Thank you!

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