Negotiating the Three F’s: Fame, Fortune, or FIRE?

This entry is more of a philosophical debate that I’m sure many of my colleagues (myself included) have contemplated at least once. Ambition can be a powerful motivator in our daily lives, and I’m sure that every doctor is no stranger to ambition. While one would hope that every person who has any authority to dictate our health have good attention to detail, there are doctors who surpass the normal expectations of being a doctor. We all know those people as “gunners”. Some of us might even be “gunners” at heart.

So how does ambition relate to our finances? For the professional who has dedicated her life to delivering excellent healthcare to our society, ambition can be self-defeating.


Many of us dream of fame. Some of us strive to be famous.  Only a select few in our profession achieve fame. Some of this fame can even become notoriety. Fame in medicine is represented in many forms. Academic medicine is a common route to achieve fame in our field. We work under the auspices of a university or academic setting. By default, there is some prestige from association with higher learning.

You might also like: Is a prestigious medical school useful for doctors?

There is a trade-off, however. Are you going to earn a similar amount from working at an academic institution? Probably not. Most academic hospitals will provide doctors with a fixed salary with a small incentive for productivity. By working there you are essentially accepting a potentially lower salary in order to have your name tied to an institution of higher learning. Is it worth it? Some people would agree.

Fame in medicine can come in another form.  There is mass-appeal fame. These are the doctors who are known to be public communicators to the world. Mehmet Oz is a clear example of this. Following in his father’s footsteps as a highly skilled thoracic surgeon, Dr. Oz himself trained to become a famed cardiothoracic surgeon. He tied himself to an academic institution and was willing to accept a potentially lower salary.  He then associated himself to daytime television and established widespread mass appeal. In a way, he was able to achieve the fame of being associated with an academic institution and fortune. In the process, he likely transitioned himself out of truly practicing medicine. I doubt that he’s scrubbing into Milstein OR 23 for any heart valve surgeries with any frequency these days.

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Aside from Dr. Oz who has the fame and fortune, doctors can simply go the fortune route. This is most commonly achieved by working at regional hospitals or, better yet, a private medical group. Hard work, long hours, and some business savviness can translate into a nice income. These are incomes that can fund family vacations into exotic regions in the world, all without gaming any credit card points or strategizing hotel stays. I’ll be first to admit that I’m sort of jealous of some doctors who can pull in the annual 7-figure incomes. They may not have the fame of medicine, but they can surely get the fortune aspect of it. Pick your poison.


Okay, some of us just don’t have the fortune to amass a fortune or fame through medicine. We’re not doomed. In fact, we might be the luckiest of the bunch. These are guys that worked hard to enter a career in medicine and are able to earn a relatively comfortable salary. There is perhaps some flexibility in our schedules and we aren’t necessarily burdened by the perils of crazy-high incomes or fame. We can still achieve some financial independence in the process.

Sipping a cup of ‘joe on a weekend morning at home probably isn’t the worst thing in the world.

Having a relatively high income, saving up a decent amount of our earnings, investing in some real estate, and counting up our pennies isn’t necessarily a bad arrangement. You’re not going to be in any extreme category of medicine, but the lifestyle probably isn’t too much to gripe about either.

I’ve struggled to identify myself in one of these three F’s in medicine. The ego in my psyche wants to achieve the first F. The ambition side of me wants the second one. The rational side of me realizes that I probably belong in the third F, and that is okay. If I play my cards right, I’ll still turn out okay.

Which F do you belong to?

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2 thoughts on “Negotiating the Three F’s: Fame, Fortune, or FIRE?

  1. Interesting post. I think the “fame vs. fortune” argument comes up a lot in subspeciality peds. Especially in peds critical care. You have have salary differences of 50-100k of jobs in the same geographic area. However, the higher paying jobs have more call in less acute less academic environments while the lower paying jobs are in more prestigious academic places where you can build your research career. There’s a trade off. Especially if you take a job in a “sleepy” PICU you worry about losing your skills and getting bored but you may end up more financially successful.

    1. Yup. I’ve seen so many situations where even the brightest physicians with unique training who end up taking up a more mundane career path since it gives them both the fortune and lifestyle aspects. One example is a guy I know who was a plastic surgeon who was subspecialty trained in burn victim repairs. He ended up in a sleepy town that absolutely had no framework to support his skills. He ended up taking a job doing basic stuff.

      Which is better? No idea. Really depends on what gets you out of bed every day.

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