Physician finance
Your freedom number is smaller than you think
Haseeb Aslam, MD7 min read
A freedom number is the annual spend you can fund without the job. It is not a net-worth trophy. It is not a round figure you borrowed from a partner who wants a different house. It is a working number. You price the life you actually want to live for one year. Then you ask how large a pile has to be to fund that year without a paycheck.
Most physicians never write that number down. They carry a feeling instead. The feeling is large. It has a second home in it, private school, a new car on a cycle, and a buffer that never quite feels like a buffer. The feeling grows with the last raise. It grows with the last wedding they attended. It is not a plan. It is a mood with a dollar sign.
The job trains you to treat a high salary like proof. The deposit hits. The loans are still there. The house gets bigger because the lender says yes. Years pass. The account is large and still too small to leave. That is the leash. A paycheck you cannot walk away from is not wealth. I wrote that line for The Freedom Prescription. It is still the whole argument.
What the number actually is
Start with a year of the life you would keep if the hospital stopped calling. Mortgage or rent. Food. Insurance you would buy if the group plan vanished. Taxes on withdrawals, not on W-2 income. Travel you would still take. Gifts you would still give. A car you would still replace. Do not price the life you perform for other physicians. Price the life you would live on a Tuesday in a town you actually like.
That annual figure is the numerator. The denominator is a withdrawal rate you choose with your own adviser, or a capitalization rate you are willing to defend. I will not pick a rate for you. I will not pretend a single percentage is a law of nature. The honest move is to name the year of spending first. Most people skip that and jump to a pile. The pile is a consequence. The year of spending is the decision.
If you want a smaller number, you do not need a miracle return. You need a cheaper year. That sentence offends people who have been waiting for the market to rescue a lifestyle they never inspected. Inspect it. The number often falls when you write the year in a notebook instead of in your head.
Why physicians overestimate it
Training delays adulthood in a specific way. You live like a resident for a long time. Then an attending salary arrives and the delayed life shows up in one year: house, car, childcare, the trip you postponed. None of that is immoral. All of it is a raise in the year of spending. The freedom number moves with that year. People treat the new spending as weather. It is not weather. It is a setting.
Comparison does the rest. Someone in your class bought a lake place. Someone’s spouse wants a neighborhood with a certain school. Someone’s parents still need help. You add those scenes to the number without adding them to a spreadsheet. The number in your head is a collage. Collages do not compound. Spreadsheets do.
Taxes are the other silent inflate. A W-2 physician thinks in gross. Freedom thinking has to think in spendable. Payroll withholding disappears when the job does. Healthcare costs change when the group plan does. Those are not reasons to panic. They are reasons to stop using salary as a proxy for a life.
Identity does the last bit of damage. If the job is who you are, the number has to be large enough that leaving would not feel like a loss of self. That is not a financial problem. It is a reason people keep moving the finish line after the math would have let them go part-time. Optional work is a schedule. It is not a personality transplant.
The three variables that move it most
You do not control markets. You control three levers that matter more than a hot year in an index fund.
1. The year of spending
This is the loud lever. A cheaper year shrinks the pile. A fancier year grows it. Housing is usually the largest line. Cars are the loudest line people pretend not to see. Childcare is real and time-limited. Subscriptions are not the story, but they teach you whether you can look at a line and cut it. If you cannot cut a small line, you will not cut a large one.
I am not asking you to live like a resident forever. I am asking you to stop funding a life you do not even like. Plenty of physicians are paying for a house that makes them tired and a calendar that makes them angry. That is an expensive year. It is also optional.
2. The surplus you keep
Income is not the lever. Surplus is. Two hospitalists with the same paycheck can have wildly different finish lines because one of them kept the raise. Savings rate is the polite name. Surplus is the honest one. It is what remains after the year of spending. It is what you can point at a taxable account, a retirement account, or a loan that is charging you more than you will earn.
A raise that you spend is a longer leash. A raise that you keep is time. If you want the number to arrive while you still like medicine, keep the next raise. That is less exciting than a new strategy and more reliable than one.
3. What the pile has to earn
Returns matter. They do not matter as much as people who are avoiding the first two levers want them to matter. If you need an aggressive return for the plan to work, the plan is a hope. Hope is not an order of operations.
This is the same honesty I want from option sellers. A short premium is not a year. I wrote about that in Annualized return is the number most option sellers get wrong. Do not dress a monthly paycheck in annual clothing and then size a life to the costume. The pile has to survive a bad stretch. If your freedom number only works in a calm tape, it is not a freedom number. It is a fair-weather salary.
An order of operations for this year
- Write last year’s actual spending. Not the budget. The spending.
- Cross out anything you would not keep if the job ended. That is the draft of a freedom year.
- Name the surplus you can defend for the next twelve months. A rate you will not negotiate with a kitchen remodel.
- Point the surplus at the highest-interest claim on your future, then at accounts that will still be there when you want the option to leave.
- Recalculate the pile from the year of spending, not from a number you liked in someone else’s story.
That sequence is boring on purpose. Boring is runnable between shifts. If a step requires a product pitch, skip the pitch. If a step requires a private fund, you are solving a status problem with a spreadsheet.
Loans sit in this sequence as math, not as morality. High-interest consumer debt is a tax on the surplus. Student loans are a long claim that may or may not beat investing. I will not pick a payoff order for you. I will tell you to stop treating “the loans” as weather. They are a line. Lines can be ordered.
Put your own numbers in
A post cannot finish this for you. A worksheet can. The Practice by Choice planner on this site is that worksheet. Enter a few non-identifying numbers. The math stays on your device. You leave with a freedom number, a timeline, and this year’s order of operations. It will not flatter you. That is the point.
If you want the longer argument in book form, The Freedom Prescription is the map. Practice by Choice is the same voice at handbook length. Stethoscope to Freedom is the earlier, more personal version of the same math. None of them will spend the year for you.
The body has a version of this problem. People treat waist, blood sugar, and cholesterol as three wars and then wonder why the plan dies on a Tuesday. I wrote that out in Waist, A1c, and LDL are three readouts of one engine. Money is the same shape. Income, spending, and the pile are readouts. Separate wars fail. One order of operations holds.
A paycheck you cannot walk away from is not wealth. It is a leash.
Write the year. Keep the surplus. Stop asking the market to fund a life you have not priced. The number in your head is a collage. The number on the planner is smaller because it is real. Real is the only number that can buy you a Tuesday without a pager.
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Questions or pushback? Write to hello@themargindoc.com. I read everything. I can't give individual medical or financial advice, but I answer the general version of good questions in future posts.
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Educational only. Not financial advice. Not a recommendation to buy or sell any security. Not a broker. Disclosures.