TheDoctrepreneur
@Doctrepreneury
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I post about: -Bootstrapping a small business while maintaining a part-time career as a physician -Balancing the above with whats most important to me
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Joined April 2024
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Want to back away from a high paying career to pursue SMB ownership?
Here's what my pathway has looked like doing just that:
I'm a surgeon in a high demand subspecialty. My peak income was >$500k/year.
I dreamed of starting a business. A dream I had since I was a pre-teen
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@SMB_Attorney
My sweet spot for living close to family:
Close enough they can come for the day (and don’t have to spend the night), but far enough away there are no drop-ins.
Thats about 30-90 miles away for my family.
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@sweatystartup
home schooled our boys until 5th and 6th grade. (My wife did 95% of the education)
Just told my wife today I think it was one of the greatest gifts she has given our family.
If you’re serious and want to discuss, DM me. It was amazing.
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@sgremminger
The doctor office isn't a movie theatre. Not every "showing" has a predictable amount of time.
It is a daily occurrence where someone comes in for a routine visit and the patients asks "oh one more thing".
As doctors, we could approach this as a scheduled time slot and say
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@sweatystartup
Thinking of going into medicine?
Here’s what looking down the hall looks like:
-first branch in the decision tree- do you like surgery or not. From there start hanging out with people in one of those groups
-if interested in surgery, don’t just talk to different types of
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@sweatystartup
Can nicely leverage ChatGPT for this.
I asked it recently to give me 3 destinations for a family of 4 that likes outdoor activities, good food, mountain location, not too remote.
Once 3 locations were identified I asked for a 7 day itinerary including recommended places to
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@sweatystartup
Interested to see how this plays out with subsequent generations.
Because our generation witnessed the dawn of the internet, and most brands we know have been .com, we view it as “premium” and familiar.
But my kids will see all types of domains so perhaps they will have a
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"You MUST have a headshot on your SMB X profile."
Here's why I don't:
1. Click on mine, it's a lego figure that says "Never Give Up". My son made that for me when he was 10 and he say me cut down my W2 job to start a business. Kids see the stuff you do, be a good model.
2.
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@sweatystartup
Lots I agree with you on, this isn’t one of them.
We started “late” (not t-ball, kid pitch). It’s been so good for my two boys. Here’s why:
-baseball is great failure training. Lots of strike outs, dropped balls. Kids have to learn to fail and recover fast. Lots of
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@SolarOakmont
Age 22: Graduate from college
Age 26: Graduate from medical school
Age 29: complete 3 year Family Medicine residency
Pay: >$250k/year.
This isn't easy.
Earning $250k is never "easy" unless you start with $5,000,000 and can earn 6% annual return.
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@realEstateTrent
Arrival fallacy?
I’ve seen this and felt this. If I can only just “get to _____” I’ll be happy.
If there is sustained discontent with the daily grind but your still making a lot of money, their is a lot of opportunity there.
I started by creating time first. Then did some
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@girdley
Mill Valley- hear me out:
-Stay at the mill valley holiday inn (nicest holiday inn you’ll find)
-walk a quarter mile to the delicious pizza at The Junction with outdoor seating, great beer.
-holiday inn has 4 free bikes, check one out and ride to salaulito along the bay and
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@RegZeller
One of the most studied groups experiencing burnout is physicians. Having experience in both fields (medicine and SMB), I can see so many similarities.
Highly driven people
Pressure from multiple sources
High stakes with failure
Desire to achieve evolving metrics of success
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@sweatystartup
It’s hard work, but also low barrier to entry. 3-6 months of training with limited pre-reqs. Not the same as a paramedic.
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"You can't have it all." That's what my mentor told me in my final months of training to be a surgeon. He was right, but that didn't stop me from trying to do a lot. (and sometimes, too much)
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@girdley
Being able to articulate thoughts clearly without criticism is a skill I admire/respect.
Critical thinking and being critical are different things.
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I’m closer to death on a regular basis than most people in the SMB space.
I have seen a 40 year old come in thinking she had a minor problem and 1 year later die of metastatic cancer.
F’ing horrible.
How does that apply to business:
Come up for air. If your top 10 goals
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@realEstateTrent
Why is there a financial disincentive for extra asada? It seems like there should be savings with a bulk order.
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@SMB_Attorney
Didn't realize starting salary was 45-90k for lawyers. If you consider residency (post-med school apprenticeship lasting 3-7 years) a physicians first job, starting pay is very similar. I made 38k/year my first year of residency in 2008 working about 80 hours a week.
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@sweatystartup
Shifting a greater percentage of time from the things you need to do to the things you want to do. The need to / want to ratio.
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Bootstrap or acquire?
I should have given this more thought when we started our business in 2022.
But as a high earning W2, the bootstrapped startup was attractive.
Here’s what I’ve liked about it:
1. It didn’t take a huge initial capital investment. We rented 5000sqft of
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@awilkinson
Tesla is 10 years ahead of any driving software. (5 years for rivian).
FSD is something that needs to be experienced to be fully appreciated.
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Blood was filling my visual field, I couldn't see where it was coming from.
I was on the final few moments of a robotic laparoscopic surgery. "Almost done" I thought. I swept the bowel aside to take one last look at the "repair" I had done. This was when the bleeding started.
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@sweatystartup
The domain is the address. Agree with the real estate analogy.
Location (domain) location (domain) location (domain).
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@SBA_Matthias
When making that transition from W2 to SMB, what risks did he expose himself too financially?
How did he prepare for the period of having no income? (making an assumption here that there was some lag between last w2 paycheck and first distribution from his company).
Why did he
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Hard skills vs soft skills.
After 7 years of training and 9 years as a practicing surgeon, my hard skills in that realm are pretty honed.
I felt (feel) quite unprepared to start a business due most of my hard skills not translating to entrepreneurship.
For you seasoned
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@ClintFiore
A couple of thoughts (but only because you asked!)
1. Kids are typically relatively blind to financial fairness at this stage. Love them equally, that’s what they see and feel. I’m confident you’re already doing this.
2. You’re doing something amazing the supports the
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@TPP_MD
I have thought of this often. There will be no “entities” at my funeral.
In other words, focus goals on the people that will be there because they’re the ones whom I love.
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A luxury of being a physician while also starting a business:
You are highly employable and can go part time and still make a 6-figure income.
If you dream of starting a business, stop the torcher of searching BizBuySell every night.
Start cutting down your hours, define
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@sweatystartup
Have shifted my approach on this as life evolves. Over the last 10 years I have a shifted a lot of W2 income into 401k, HSA, backdoor Roth. All in the name of tax protected growth.
In a solid w2 career , this path works to build wealth.
But wealth comes in many forms.
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@drgurner
Being open to finding growth in unexpected places has opened numerous doors.
As a physician I didn’t expect to be starting a distribution business. But, my eyes and ears were open to opportunity and that’s how the business started. Opportunity from an unexpected place.
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@thejustinwelsh
It’s possible.
In medicine it’s been a slow transition. But also allowed for continued W2 income during building.
Why didn’t I just quit?
Security- I’m In my early 40’s with 2 kids and a spouse that does a lot of non income producing work at home. thats q machine needs to
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@sweatystartup
I know I'm working on the right things when I ask myself "who else could be doing this as well as me right now". When it's hard for me to come up with an answer that isn't "me", I know I'm on the right track.
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Want to make $300k/year?
Here's an easy way: Start with $5,000,000
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@rorysutherland
Challenge: Go 3 cups of coffee without a screen in front of you. If you can get through three cups without opening that laptop, we'll give you your fourth cup free.
(ok, you got us. The 4 cup is free anyway, but we sure love to see your face and not the back of your computer)
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"Don't sacrifice your family on the alter of your ambition"
I've repeated this to myself multiple times through the years.
Countless times I've had to decide whether to be present for family or working. Sometimes I didn't have the luxury to choose.
My perspective changed
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@mhp_guy
@CoFoundersNik
got close in concept...but you coined it.
Nothing is saturated.
It's an illusion.
Saturation means "when you can't stand out".
But is there really a market where you can't stand out?
Probably not.
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@aeroscouting
@pinpulleddrmf
@KrissBergTweets
Good perspective.
I like what Sam Harris has to say on the use of psychedelics as well.
I do think there is a place that contemplative exercise (meditation) just can't reach in the mind. It's probably my own ego that tempts me into believing there is a chance I can access
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@SievaKozinsky
I ecourage people to get second opinions for complex decisions, but many decisions are not complex.
Also, it’s hard to get a good second opinion with doctors because, unlike lawyers (and pretty much every other service), your insurance will largely dictate who you can see
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@SMB_Attorney
Who was the bill from, the hospital?
It’s likely the hospital because they didn’t get paid by the insurance company to cover their cost of the test.
Were you informed of the cost of the test before it was done (I mean, in writing by the insurance or the hospital). My guess
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Do you dream of escaping that high earning (>$250k/year) "day job" for the magic of SMB?
I've been slowing cutting down my hours as a physician for the past 2 years to spend time growing a business.
My income has decreased both years. Magical indeed!
If you still think SMB
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@girdley
Appreciate the perspective of experience.
Plenty of opportunities to get advice on this platform. Harder to find the voices that have the background to talk from years of experience.
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Listed to
@ShaanVP
talk about delegation recently and he referenced the adage “see one, do one, teach one” adage that is often repeated in surgical training.
Having gone through surgical training, it’s accurate to say “see 1000, do 1000, then teach.”
In other words, mastery
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Looking for a partner in entrepreneurship?
Physicians have a reputation for being “bad at business”.
Here’s why I think that’s wrong:
1. Cash flow: physicians have job security and can work part time and still make >$200k/year. This takes pressure off needing cash out of
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@SMB_Attorney
This plays out a lot of different ways.
Something I keep coming back to is having unencumbered time
Time to wrestle with kids
Time to go on a walk with spouse/partner
Time to think
Time to pursue something that is purely for pleasure.
There is this constant push to fill
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@realEstateTrent
As a 43 year old who entertained the idea of the FIRE movement, I also realized finding work you love to do is a gift.
I think FIRE works well for those that don’t enjoy what they do. But to find work that is enjoyable and have the time to do it has been, for me, another
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I interviewed 1500 people a year for the past 8 years. They were my patients. You learn lot about life from listening.
When I told my patients I was cutting back my hours, every single 80+ year-old (and I mean EVERY single one) congratulated me and said I was doing the right
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@sweatystartup
Walking through this path now. Updates to follow.
It’s possible to make this a slow exit in some fields. Thankfully mine allows it.
Lots of 20-something’s doing this. I’m playing a different game: Early 40’s, 2 kids. But it’s possible and happening.
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@thejustinwelsh
@Its_Jenn_Here
Congrats. It's a special experience to navigate through life with someone.
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We're B2B in a niche industry. New customers per month is a KPI on our dashboard. It's not hard to track with our CRM (salesforce). Anybody that places their first order is considered "new".
Below is what happens with no advertising or marketing, just word of mouth.
As we
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@MatznerJon
I wonder about this too. How many inexperienced buyers end up scrambling to run a business that nets 60k in owner income and it’s a full time job plus the stress of being the owner.
A 2 day course can be very helpful, but the riches of SMB isn’t 2 days away.
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“Only post your wins”
That’s not how you get better.
Once a month, 15 surgeons would sit around a table and as a surgeon-in-training it was my job to report complications from surgery over the past month.
It was very stressful. I reviewed the medical chart, studied the
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@AlexHormozi
Do you think the root cause is that people don't know how to define what winning looks like to them?
Or is it that they don't have the will to execute?
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@STLChrisH
Hmmm. Culture and success aren’t two sides of a scale. Variables that I would consider:
1. Industry specific. I would argue Patagonia has placed an extremely high value on culture and they are hugely successful
2. Professional goals. Does my company need to make money?
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Is medicine a path to wealth?
Let’s start with just the financial aspect of "wealth". As a surgeon it's possible to make up to $1m/year in my specialty, but you have to very work long hours everyday.
I’m not willing to do that, but knowing it’s possible puts earning potential
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Head down, back bent, twisting for position. Surgery is a physical activity.
Back and neck pain after a day of work is annoying.
I asked one of my closest friends what I needed to do to feel better. (more about why I asked him specifically below)
For the past 6 months I have
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@SMB_Attorney
Hard work gives opportunities for sure.
Here’s what that has looked like in my life:
Ages 23-34 (medical school, residency, sub specialty training) - 50-90 hour work weeks
Age 34-38 - 50-70 hour work weeks making “real” money
Age 39- 5 month sabbitical living in Europe with
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@thejustinwelsh
There is a wealth of personal finance info targeted at doctors on the White Coat Investors blog. And it’s free. He has book too.
I have no affiliation, just admiration for his mission of teaching personal finance to medium-high earners.
@WCInvestor
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@leo_szac
Aggressive saving. This was supported by not overspending. 25% of take-home pay was my "minimum" required savings amount for my first 3 years of real income.
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@realEstateTrent
Last thing you asked for?
For me: asked for continued insurance coverage despite cutting down w2 hours. Jury still out.
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@thejustinwelsh
Yes. Definitely.
Just posted what my story has looked like. It's not for everyone.
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@RobertMSterling
@huntercoldcalls
Cold shower coaches are a must if you’re going to reach closer level cinnamon rolls. Orange rolls are a whole different level.
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Pallet jack going in the truck, forklift ready to rock. 25 pallets to load in pinwheel config.
As stated yesterday, my wife is awesome and it’s amazing to have a good partner.
This is what SMB operating looks like some days.
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@jcolesimpson
What is the impact being a franchise owner has on your desire for independence/creativity that is part of entrepreneurship.
I have no experience in franchise, but my (perhaps way off base!) opinion is that it could feel restrictive in how the business is operated?
Always
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@SBA_Matthias
Weight isn’t a perfect metric. But I think I hear you saying you don’t have the level of fitness you want.
Count calories. There are free calorie counting apps (fitness pal is good, I receive not compensation from them). Do that for 2 weeks at a minimum so you understand what
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@SMB_Attorney
Goals shift with time. Marriage, personal goals, kids all shifted goal post for me.
Financially defined my goals:
1. Help pay for kids education
2. Provide enough family income that my spouse has the option work or not work based on her personal goals
3. Not be a financial
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Subscribing to hustle culture without clear goals is just work.
If my business has KPIs so should I.
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@SMB_Attorney
Trying to start a business while having a w2: Also hard. But when you’re an “old” founder (early 40’s) with kids and mortgage, etc you can still make it happen.
Part time w2, early mornings, weekend work, good partner, love for the game. All those are my prerequisites.
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@sweatystartup
Agree with this approach.
Competition can inspire improvement and bitterness/envy.
One of those makes you better the other does not.
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@FreightAlley
Great call. I’ve seen this on a small scale. We have used brokers, and several been great. Asset based carriers calling us more in past 6 weeks looking for business.
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I made a list of ways I can "win" because I didn't want someone else telling me what that looks like.
Here's how I broke it down to three categories:
1. Who I love - the health of my relationship with my wife and kids is bedrock winning
2. Who I am - without mental and
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@SMB_Attorney
I love the mentality to just chase the dream. There is nothing like urgency.
It is challenging to face the realities of meeting responsibilities (mortgage, food on table, health insurance).
It might be worth exploring a part-time position if thats possible. Keep the W2, start
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@mhp_guy
Married to a dentist. (She no longer practices).
A powerful marketing strategies for dental practice: find out what local parent groups there are on Facebook and try to become a recommended dentist in that group.
For example, in a middle class region of my city there is a
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@SBA_Matthias
Making assumptions here but most thyroid cancers are treated with surgery, so you would want a referral to either a general surgeon that does thyroid cancer or an ENT specialist.
An endocrinologist will help in the evaluation/diagnosis, but they are more on the medical side of
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@MananShahmd
@drgurner
@rossiadam
Never been allergic to dogs (just seasonal allergies). Got a dog 6 months ago and he’s giving me hives with skin to fur contact.
I had no idea this was even an option and I’m in freaking medicine. Going to take a closer look at what you’re doing. Good stuff Manan!
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@joshuamschultz
@MatznerJon
We are building our spreadsheet with links to sop documents, some integration with loom. It’s beginner mode of getting organized. But we’re small, just hired employee 1 for warehouse.
Thanks for the systems tips!
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@sweatystartup
the classic "helicopter parent scenario" to start a job interview. google does this too I think.
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Imagine trying to sell nails.
When you sell a product that is uniform across most manufacturers, it's very hard to sell the idea that you have a better product. So what do you do?
1. Better service
2. Lower prices
3. More sales touches
Q3 we're focusing on
#3
. Will post
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@ClintFiore
don't buy the hype that coffee needs to be avoided.
There is more evidence supporting net benefits for health than net harm. (like anything, some exceptions apply).
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@NoRiskNoParty
Had our first import April 2022. Had no idea how challenging logistics would be.
But it’s learnable. Thanks for telling your story.
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@CoFoundersNik
@SecretCFO
is fantastic. Smart, good story telling, educational, funny and way over my head most of the time.
I secretly want to be a CFO because of the secret cfo.
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@Codie_Sanchez
This is true in work and in school. I figured out that in college and medical school, I just had to study more if I wanted a score better than 90% of my classmates.
Why do that: opportunity. Obviously that came at a cost, but I was able to get into the competitive specialty I
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@Camp4
I took a sabbatical for 4.5 months. Lived in the UK for short period and Alps for most of in. My two kids were 6 and 8 at that time.
It will go down as one of the best things I have ever done for my family and myself.
I strongly encourage you to do this. It is life altering.
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