I just signed a contract amendment to reduce my clinical FTE from 1.0 to 0.8. Once I had finished signing, I felt a moment of relief, followed closely by “Oh shit, this is really happening!” I first broached the topic in October of last year. It was a long process, but now it is real and staring me in the face. The new schedule starts in May, after I return from paternity leave.

This may seem like a strange time to voluntarily take a pay cut. I’m also doing this much earlier than most. Traditionally, an FTE reduction is more of a downshift leading to retirement. But this was an intentional plan, and my real estate and note business I have been building on the side is making it a reality. It has given me the freedom to choose how I want to practice.

I am not following the traditional path and I am aware that medicine has seen significant changes over the past several decades. Physician autonomy has declined in many settings as large health systems have taken a larger role in the landscape. These trends have contributed to higher rates of burnout across the profession. Rather than simply complain about the shifting landscape, I decided to focus on the things that I can control.

The reality of clinical 1.0 FTE neurology outpatient practice is not bad on the surface. 36 patient contact hours a week is manageable. However, I found myself entering a cycle that felt unsustainable. Go to work, come home, crash from fatigue, repeat M-F. I experienced intermittent burnout and felt stuck at times. I found little energy or desire to do any of my favorite hobbies or activities. It was then that I realized I was trading my most valuable asset, my time, and I could never get that back.

I had been building toward this moment for years without having a specific target in mind. My wife and I became landlords in 2020 when the Army moved us to Washington, and we didn’t want to sell our home. It made economic sense at the time but was not a targeted strategy yet. As we got more involved, we fell in love with rentals and mortgage notes as investments and cash flow strategies.

My desire for greater freedom of choice and career autonomy became the North Star for our growth strategy. I set my sights on dropping one clinical day a week. To make this comfortable, I calculated what a 20% clinical reduction would mean for my monthly income. This number became my target for portfolio income, plus a 10-15% buffer for comfort. My goal wasn’t to quit medicine or become a full-time real estate investor. That is when something clicked. I didn’t need to buy back 100% of my time, just one day a week.

Once I had my goal and my portfolio income could back it up, I submitted my request October 2025. From there, it was a long wait while the request worked its way through the system. During the waiting months, I had plenty of time to second guess the move and wonder if it would ultimately get denied. This gave me the opportunity to take stock of what really matters to me and consider how I want to shape my future. Building a roadmap with multiple future options allowed me to retain a sense of agency. The key is to have multiple viable options, as life and priorities can quickly change.

What will 0.8 FTE actually look like for me? Well, I have deleted Mondays from my work week, and I’ll start clinic a half hour later. I also have an early finish on Fridays. This is meaningful time recaptured. What can I do with this added time? Spend more time with my family, invest more intentionally, and continue to build businesses and systems that give me flexibility in the future. This is me charting the course of my career with purpose and on my terms.

If I could go back 5-6 years, what would I tell myself? Time is the most important asset; it is not renewable. Build alternative income streams intentionally to increase options and freedom. This is the modern version of physician autonomy. Don’t wait until “later in career” like the traditional line of thinking. Make the call as soon as numbers justify, if not a little early. Life is too short to spend feeling disconnected from the parts of life that matter most.

Bottom line, the physician career is evolving, and much of that is out of our individual control. The traditional physician path works very well for many people. Full-time practice combined with disciplined investing in retirement accounts can build tremendous wealth over a career. I simply wanted to design a version of that path that gave me more control over my time earlier in life.