How would you like to leave medicine, right now?

Close your clinic. Work your last shift. Say goodbye and maybe never go back?

Do you have enough money? Could you get your finances in order?

How would you manage an identity change?

Meet Dr. Matt Poyner

Matt is 42 and free. He and his wife, Lindsay, sold everything and took their four boys on a trip around the world for a year.

Dr. Poyner graduated from Mac and completed family med at UBC, plus a year in EM. He practiced emergency medicine for 13 years. Then he walked away.

Matt might return to medicine. He suspects probably not but keeps his options open.

Aside from admiring his courage, I wanted to know how Matt and Lindsay could do it.

How could they leave medicine and give up being a medical family?

Did Matt win a lottery?

Did he work two jobs?

I sent Matt a list of probing questions: everything from finances to burnout and fear of the CPSO. He answered them all.

Could you or I be the next Dr. Matt Poyner?

How to Leave Medicine and Travel

Did you feel that your identity changed not practicing medicine?

It seems to me that identity has two parts:  how other people see you and how you see yourself.  I have enjoyed the external identity of ‘doctor’ because, in general, it comes bundled with certain favourable personality traits.  Most people assume that, being a doctor, I am intelligent, honest, and kind – which I would like to think is true – but the “MD” behind my name is kind of like a shortcut to making that impression upon others.

External identities like “doctor” or “Muslim” or “feminist” are big, clear, and easy to understand.  Internal identities are nuanced, flexible and more accurate. We all have a unique profile, kind of like a mosaic of all the things we know and do and believe but this is often very different than the assumptions others might make about us.

Not practicing medicine probably means that fewer people will make those favourable assumptions about me.  And that’s okay. I have to prove myself like anyone else. I was never one to introduce myself as a doctor, and even less so these days.  There are so many other things that define me – and there is more room for those now.

So, that’s a long-winded way of saying that not practicing medicine will change the way other people see me more than the way I see myself.

Were you scared that you put your career on hold? Or are these bogus lies that chain us to the clinic?

Actually, it’s even worse than that – I am not sure if I am pushing the pause button or the stop/eject button on this career.  Almost all doctors I talk to about quitting medicine seem to assume that getting back into it at some point is the ultimate goal.

On the other hand, I have a high school friend in the tech industry who I keep in touch with who has a different perspective.  When I told him what we were doing, he was shocked that I had persisted in the same job for thirteen years and wasn’t at all surprised that I would be looking for a major change.  To him, even 3-5 years in one job is “an eternity” (his words). That got me questioning the largely unspoken assumption that medicine should be a lifelong career.

Did friends and relatives say you were crazy to give up practice for the year?

No one said it but I’m sure there were plenty who thought it!  And I understand that – it’s a respected, high-paying, stable career.  Having said that, most people also understand that the window of time we get with our kids is short and we want to make the most of it.

Have you decided to leave medicine completely? Are you keeping options open?

This is the million dollar question and I think about it all the time.  In fact, it took me six months to finally feel ready to write about it on our blog.

When I started practicing I felt like medicine was my calling – it was challenging but I loved it.  But as the years went by, the joy of the work was overwhelmed by the strain of working in a system that was not only endlessly frustrating but wasn’t meeting my expectations or those of patients.  Being on the front lines of that system, constantly apologizing for long wait times, limited resources, hallway admissions – none of which were under my control – it wore me down.

A calling is intrinsically rewarding. A job is done for money.  My calling turned into a job and I was very uncomfortable with that.  Once we had enough money to be financially independent (although not rich), it became even harder to persist in a job that was more frustrating than fun.

I am proud of the fact that I got out before I became bitter and resentful – we all know those docs.  Sure, I had to fake it sometimes, but very few people knew that I was unhappy.

So, the question now is whether the system has improved enough to make the job fun again or I have changed enough to have a different perspective on the system.  Unfortunately, I don’t think either are true. So, I am keeping my options open in case of financial calamity, but that’s about all. The CPSO says we get two years off before we have to undergo a formal review prior to re-entering practice – the clock is ticking.

Did you practice with a continual fear of the CPSO?

Yes.  Even though I didn’t have issues of my own with them, I saw how they treated some of my excellent colleagues and it really pissed me off.   Great docs put under a microscope and then shamed without an appreciation for the real-world implications of CPSO’s actions and directives. You’ve written HERE about the corruption of justice that occurs when there is no separation between those who create laws, those who enforce them and those who punish the lawbreakers, and I wholeheartedly agree.

I was always proud of the quality of care I gave my patients, but knew that when my turn came to be reviewed, the experience would be demoralizing – I’d never met a doc who’d had any other experience.  The apprehension weighed on me.

I have four kids.  A cardinal rule of parenting is not to set your kids up for failure.  When you raise expectations at the same time as stripping away resources and autonomy you are setting the stage for failure.  Physicians carry the dual burden of over-regulation and hyper-accountability. We are also especially sensitive to failure – we should be since the stakes are so high.  I wish the CPSO would realize that their tactics do more harm than good and will ultimately harm patients.

What do foreigners tell you about their impression of Canadians?

Canadians seem to have a reputation for being “nice” – we’ve all heard that.  But a reputation for niceness doesn’t get you very far – you have to actually be nice!

One of the more interesting conversations I had about this was with a Russian woman and her Turkish boyfriend a few months ago.  They were politely objecting to Canadians’ preoccupation with rigid rules. In their eyes, we have rules, policies, and procedures about everything and, as we know well in health care, it can often get in the way of doing what needs to be done.  Furthermore, when there’s a rulebook for everything it’s too easy to dodge responsibility for independent or innovative thought.

So, Canadians are usually nice – but, apparently, we can be sticks in the mud!

What were the financial implications of taking a year off?

Not as much as you might think.  I just finished accounting for our first six months of travel: ten countries, mostly European, with a six-person family and we spent just under $60k Canadian – that’s about $55 per person per day.  Now that we’re in Asia, I anticipate the next six months might be less.

Interestingly, this is only 50% more than we would spend just to exist in Canada and we are collecting experiences that will define us as individuals and as a family forever.  I think that’s a good deal.

By leaving in July 2018, we also timed our trip to span two calendar years so that my six months of working income would have a much lower tax rate than it would have if I had worked a full year, then taken a full calendar year off.

How are you financing this trip?

I have always had a strong interest in investing and even do a bit of writing for The Canadian Moneysaver magazine as a DIY investor, so I’m pretty comfortable with the world of personal finance.  Having said that, my amazing wife hasn’t worked outside the home since we were married, we were blessed with the joys and expenses of four kids, and I didn’t work long enough to accumulate a multi-million dollar nest-egg!  So, here’s what we did:

1. Saved about a third my income during my working years
2. Worked as general contractor and laborer in the building and/or renovation of three homes which we were able to sell in a rising market (including our last home – yes, we’re homeless!)
3. Invest that money mostly in Canadian blue-chip dividend-paying stocks which yield about 5% per year not including capital gains.  (If readers are interested, I have a little non-profit website that outlines the strategy:  www.dividendstrategy.ca)
4. Made the conscious decision to trade a high standard of living for financial security and an epic family experience

The dividends we receive from our investments won’t quite cover our travel expenses at the current rate, but that’s fine.  When the kids are more independent, I’d be happy to work again at something that I love – woodworking, homebuilding, writing, painting . . . who knows.  I doubt it will be medicine.

How have your children benefited/suffered from being on the road for a year?

We have four boys who are 7, 9, 11, and 12 years of and we are constantly checking in with the kids because this trip really is a big experiment.  Other families who have done this unanimously swear the kids are better off for the experience, but results may vary.

I can tell you our boys love this life.  We thought there would be painful phases of homesickness, but that hasn’t happened.  They love the constant adventure, the freestyle learning, and the realization that the world is big and friendly, not scary.  But what they love most of all is what we love too: being together all the time. Quality time with your kids is great, but there is no substitute for quantity of time.  I never knew that before this trip.

What we have noticed as parents is that the kids’ learning has skyrocketed because they are constantly inspired and have the time to pursue those inspirations.  But more important than the stuff we know is the stuff we are, and I am seeing four little men that show bravery, kindness and integrity in little ways every day.

What do you plan to do next year?

Funny you should ask.  We are currently shopping for a sailboat and plan to continue our adventures by sea!

What do you miss about home?

Fair question – this is not a vacation, so there are tradeoffs.  What I miss most of all is having a place to call home that I don’t have to book in advance and cross my fingers that the online description is accurate.  There is an uncertainty that you just have to accept with this lifestyle. I also miss friends and family, my old CrossFit gym, and backcountry camping in the gorgeous Canadian wilderness.  Oh, and craft beer.

Could anyone do what you are doing? Why or why not?

I would answer this the same way I would answer whether or not someone can manage their own money: the only necessary ingredient is genuine interest.  You can’t just like the idea of it – you have to actually enjoy the work of it. This is family life in unfamiliar places, not a vacation. Something as simple as grocery shopping or buying a SIM card can take all day.  The kids need haircuts, meals need preparing, we get tired and cranky.

Sometimes we have to remind ourselves that the richness of the experience is usually determined by the challenge:  braving unfamiliar food, navigating unfamiliar public transit, staying positive when we’re so tired we could collapse.  But we get to do all this together and that means all the struggles are really shared learning experiences. And in between the struggles are heart-pounding vistas in Iceland, sharing meals with new friends in Istanbul, and snorkeling with sea turtles in Sri Lanka.

So, if you want to do this (and have a willing partner), start doing a little research.  You will find it is very doable!

Do you have any books or websites to suggest for someone wanted to do what you are doing?

• The documentary that sparked our decision was “Given” in which a surfing family travels around the world and the whole beautiful adventure is narrated by their five year old boy. Amazing.
• One Year Off by David Elliot Cohen is a great novel documenting an American family’s hilarious challenges and victories on their gap year.
• The Bucketlist Family traveled around the world for a few years putting out YouTube videos every week – very inspiring!
• There are also several Facebook groups on family travel and worldschooling.

Would you tell your kids to go into medicine?

No, but I wouldn’t dissuade them either.  I would simply treat medicine like any other career choice, investigating the pros and cons.  There are a lot of pros – I feel very lucky to have been an ER doctor for thirteen years. But I would caution them against assuming it will be a lifelong calling.

Would you become a physician if you could do it all over again?

Yes, I would but I would have saved even more so that we could have achieved financial independence even sooner.

What does your wife think about all this?

She loves it.  In Canada she felt like we were spinning our wheels, spending so much time and money on a “normal” life which is such a narrow sliver of what the world has to offer.  She could see that the boys are motivated and capable students but were getting increasingly frustrated at school. And it hurt her that I was hurting in medicine.

Since leaving, Linds has found she loves exploring new places, the minimalism of living out of a backpack, and being together as a family all the time.  If anyone is interested, she’s written a few great posts for our blog which are always very popular.

Why are so many doctors burned out? (did you want a long answer to this one?? 🙂 )

If there were a simple answer, there might be a simple solution.  I don’t want to be overly negative, but unfortunately, I think there are numerous reasons:

• Patients expect high quality healthcare but are constantly disappointed.  Doctors are the navigators and interpreters of this broken system, so in many cases, patients blame us.
• Pressure to do more with less.  Whether you’re a surgeon with limited OR time, an ER doc with no beds, or a GP buried in paperwork – we can do less for patients at the same time that patients’ needs are greater than ever
• Efforts to improve the system are often frustrating, slow, and exhausting.  Many people who would make amazing leaders see this and make the rational decision not to participate.
• There is often not enough support in dealing with patient complaints – a big source of stress
• CPSO complaint process is a fiasco of pain and suffering (and often injustice)
• CPSO practice audits make good docs feel bad
• Lawsuits suck (but at least you have a professional advocate)
• Medicine has changed from diagnosis and treatment of acute problems to management of chronic conditions – not as much fun
• Medicine is measured with metrics – a poor proxy for what really matters: individual experience of illness and injury
• Doctors are increasingly forced to deliver patient care via policies, procedures, and directives rather than careful listening, assessment and individualized care plans
• Provincial and federal governments consistently undermine and attack physicians, snuffing out any hope of a higher level solution.
• I’m going to stop here because I’m not sure if I can get antidepressants at Thai pharmacies

What would return joy to doctors’ work/lives?

How radical can we get?  First of all, I think governments and hospitals should ditch words like “excellent” and “exceptional” when describing healthcare in Ontario, opting for something more rational and realistic like “Doing the best we can with what we’ve got.”

Expectations are everything.

Canada needs to choose between maintaining the universal model and making physicians government employees or opening the doors for a parallel private system.

Physicians should realize that medicine has changed drastically in the last few decades.  There is a huge investment of time and energy for a career that may last 10-20 years. So, develop other interests, take care of your personal life, and try to save 30-50% of your income – because every dollar you don’t save now is a piece of your future that you are handing control over to someone else.

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Matt and Lindsay did it. You can too.

Check out Lindsay’s Six-Month Check Up.  She seems even more pumped about it than Matt.

Even if you do not travel the world, you can choose to live free. Make a plan. Pick a date.

Dreams and reality never seem the same, even when our dreams become reality.

“We travel not to escape life but for life not to escape us.”