Why I Started This Blog

A Physician Blog of Ice & FIRE

physician fee clawbacks

“Night gathers, and now my watch begins. It shall not end until my death. I shall take no wife, hold no lands, father no children. I shall wear no crowns and win no glory. I shall live and die at my post. I am the sword in the darkness. I am the watcher on the walls. I am the shield that guards the realms of men. I  pledge my life and honor to the Night’s Watch. For this night and all the nights to come.” – The Night’s Watch Oath, George R.R. Martin.

Well, you can scratch the first few lines for me. I have lands, a wife, and children. All of which I have no intentions of giving up. However, I have decided to start this blog to try and help the Free Folk (or Wildling) Physicians who live “North of the Wall” in Canada to weather the coming financial storms. 

The environment for physicians and other high-income professionals waxes and wanes. We must be prepared.

The environment in Canada for physicians has a lot of parallels to the seasons in Westeros, the fantasy setting of Game of Thrones. There are bountiful Summers of variable multi-year lengths. They usually follow a brutal winter that decimates the physician work-force for a long enough period that it impacts the public. And therefore politicians. I hope that we are moving towards spring soon.

I trained towards the end of a “Winter” in the late 1990s. The brain drain.

There had been a little over a decade of vilifying physicians as greedy whilst cutting their pay and their ability to provide quality care by starving the healthcare system. Sound familiar? The government had also discovered that since physicians ordered expensive tests and treatments for patients. Logically, money would be saved if there were fewer docs to do that. So, they cut medical school enrollment drastically. Predictably, these moves led to a doctor shortage due to the “brain drain” to greener pastures in the USA coupled with the decreased production of new doctors.

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Ultimately, it reached the point where there was a public outcry and Summer returned.

There was a doubling of medical school/residency slots over a few years. Doctor fees increased over the course of the ensuing decade to help recoup some of the lost ground. This eventually worked and the brain drain was reversed around 2010. Since then, we have been heading back into Winter. The most Stark example being Ontario where there have been unilateral government clawbacks to fees of about 5-10%. Alberta recently followed that example. The Federal Government started targeting high-income earners in 2015.

This cycle of seasons will no doubt continue as governments think in 4-year terms. They react by over and undershooting the longer term target as the pendulum of public opinion swings.

With this latest winter over the past few years, I found myself becoming burnt out and cynical.

Not a good place to be only 11 years into my practice at the tender age of 41, but not uncommon. A couple of Canadian surveys done in 2006 showed about 50% of doctors have symptoms of burn out. Perceived lack of control over one’s situation is a strong risk factor for burn out. That certainly described how I felt due to the unilateral government actions, associated media campaign, and challenges within our hospital from continually tightened budgets. It wasn’t hard work that was burning me out. It was the feeling of being taken for granted and maligned despite my efforts.

My case was relatively mild with largely some irritability and a bunch of bitching-moaning-feeling-sorry-for-myself.

This gave me significant internal conflict because, by any measure, I really have it made in the shade. I have built a rewarding career. I am usually a glass-half-full kind of guy. Moreover, I strongly subscribe to the mentality that you should be proactive and act on your environment. If you do not, then it will act on you. You’ll be stuck reacting. Or even worse, take on a victim mentality. My bitching-moaning-feeling-sorry-for-myself was definitely incongruent with my stated values.

My wife saved me, with a well-placed kick in the butt.

I’d like to say that with my awesome inner-awareness and powers of self-mastery that I diligently embarked on a process of evaluating my priorities in work and life, and explored my options (eg. retire, move, change up my practice or career). What really happened is my wife gave me a kick in the ass (she’s great for that) and told me to do just that.

If my wife were a Game of Thrones character, she’d probably be Daenerys Targaryen. Sadly, I identify most with Tyrian whose self-described role is to “drink and know stuff”.

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Why I decided to start this blog:

Physician burn-out is hurting physicians, their families, and their patients. It doesn’t need to be that way. We have the intellect, drive, and resilience to change it.
We must band together.

It is easy to feel isolated as a professional. Our popular culture is still very much one of consumerism instead of rational spending. Further, your colleagues are (or seem to be) very career focused or “workaholics”. Anything less than medical martyrdom can be scorned as being a sign of weakness or lack of dedication. Reading the stories of other doctors in the FIRE online community like Physician on  FIREHappy Philosopher, or  Dads Dollars Debts was like hearing my own story. They resonated deeply with me and were inspiring and affirming. I hope this blog, with both my story and those of others that participate, provides this comfort and motivation to others.

Financial Independence resonates differently with many professionals. Financial independence gives us the power to direct our lives and careers. It is a tool. Some of the issues high-income professionals face in making that tool are different from the average population. Further, we often want to use that tool differently. Retiring early is a common goal for the FIRE movement. However, a professional may not be as driven to retire from their career. Instead they can use their financial muscle to re-shape it.

I think that I have something to contribute. It may be starting discussions. I can also bring the lessons that I have learned to the table. So, that you don’t have to pay the same “tuition” that I did from all of my financial mistakes. There are also many things that I did right and things that I have learned on my own financial wellness journey. Perhaps, sharing them will give you ideas for your own context.

Having achieved FI, I still don’t want to retire early (RE).

I have found a fulfilling career using symbiosis. When I started this blog in 2017, I was approaching financial independence. However, I was still pretty heavy on the spending and working. Writing this blog helped my to further hone my objectives and take action. In the fall of 2019, I made a plan to downsize, becoming fully financially independent, and go part-time. That was delayed by the clinical and leadership demands on my time due to the pandemic. With that settling down, I will use my financial independence to re-focus efforts on my mission.

My Mission:

  • To empower Canadian professionals to proactively take charge of their financial lives.
  • To inspire them to use that power over their time and money. To have a fulfilling life and career. To lead and expand their impact on their families and communities.
  • To outlive the main characters in Game of Thrones. This blog will only survive and thrive with your engagement.


  1. I’ve had a similar trajectory in my medical career. Refusing to be a “victim” of burnout, after 13 years, I decided to take the more radical step of leaving medicine. Instead, I am traveling the world with my family. I am finding that this hard reset is what we all needed as a family to see things more clearly. Insights from that: I actually still like medicine – just not the system and I cannot escape the system. Medicine is not my most important job – being a good dad is. Full-time family travel is the best investment I can make with our savings. We need less money than I thought we did to live a better simpler life.

    Thanks for this post and your blog. I couldn’t agree more that financial security is a key component of not only avoiding burnout. But living well in general.

    1. Thanks BFSW. Sometimes it takes not only lifting your head up from the grindstone but actually walking away from it for a while to get perspective. Happy travels and I look forward to following your adventures and the insights gained from your radical move.

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