Welcome to the first installment of the Choose Your Own Adventure profiles I’ll be doing at drdavidpowers.com.
My focus in life and business is to seek adventure, but that may not mean what you’re thinking. Most people think adventure only refers to danger and excitement, but it doesn’t have to. My intent with these interviews is to show that adventure can be wherever you find something new and different.
Meet Jim Cunagin.
The first time I met Jim was on a deployment to New Orleans right after Hurricane Katrina. He was an ER doc back then and actually ended up running all the medical operations by the time we left. A lot’s changed since then, right?
“I was actually a Family Medicine doc and had just completed my second residency in Psychiatry. But, if I left the impression that I was an ER doc, then I’ll take that as a compliment. Not because ER docs are better than family med docs in general, but it was a very ER-centric sort of thing we were doing, so if you thought I was an ER doc, I must have seemed competent.”
So, what’s changed since then? Didn’t you leave the medical profession? A lot of people would think you’re crazy leaving the medical profession after all that time in school for it. What would you say to those folks?
“A lot of people would think that I’m crazy for several reasons. But, I haven’t left medicine yet. I don’t know if I’ll ever pull that off completely, or if I’d be happy if I wasn’t in some sort of helping profession. I’ve given up on primary care/family medicine, and have limited myself to just psychiatry.”
“Explaining that alone could take some time. The short version is that I am at least trying to move to a more independent life/career path. Psychiatry offers a lot of flexibility and, in general, an easier lifestyle, compared to family medicine. Not that I’m looking for easy. But I’m looking for some balance, and the formal career needed some more easiness in order for it to balance better with the rest of my life. I might stay in family medicine if I could just hang out a shingle saying “Doc Cunagin” and go to work. But that sort of behavior isn’t exactly encouraged amongst docs these days.
“But back to the question. Yes, I’ve put a significant chunk of my life into medicine. I don’t know that it was the wrong path at the time, but it became the wrong path. Is someone crazy for turning around once they’ve discovered that they’re on the wrong path? It seems to me that they’d be crazy to continue down the wrong path for some piddling reason like “I’ve already spent a lot of time on this path”.
What brought about all the changes?
“Well, the short-ish version is that I needed some more professional autonomy. I had worked for an academic medical center for a few years and hated it more every year. Then I tried working in a community setting, owned by one of the large medical centers in Cleveland. It was supposed to mimic a private practice, and on paper, it did. But, I joined an established doc with some very firm ideas about how we should be working that were not at all aligned with my own. Result? Net zero increase in professional autonomy.”
“It’s a cliché to say that I don’t want to work for “the man”, but I don’t. Especially since most of the time (at least in my experience), “the man” doesn’t know what he’s doing.
I feel like I need to interject right here that when Jim and I met, we both worked for “the man” at the Department of Homeland Security. At least at a disaster site we had quite a bit of autonomy, mainly because there was no one around to watch us.
Didn’t you spend time at a prison somewhere or work in a prison or something?
“After I left the community family med job, I just did inpatient psychiatry. That wasn’t working for a number of reasons, so after a few years, I got out. I didn’t have a back-up plan, but had a little financial cushion, and had decided to just do something called locum tenens for a while. I think that’s Latin for temp worker. There are a number of agencies that will hire you as a contractor for relatively short term (3+ months) gigs. After working at several “permanent” or “long term” positions, and hating them, I decided to give the locum thing a try. It’s not very glamorous, but I didn’t care. I wanted something that would put bread on the table that wouldn’t make me dread waking up and going to work in the morning.”
“A lot of normal, “permanent” doctoring jobs include some form of soft indentured servitude, anything from multi-year contracts, non-compete clauses that can cover most of the local area, or to forcing the doc to pay up to tens of thousands of dollars to cover their own malpractice insurance if they want to leave. Locums jobs don’t have any of that. They are sort of one night stand/no strings attached sorts of jobs. If you like it, great. If you don’t like it, no problem. There are more fish in the sea. “Permanent” jobs in Big Medicine are more like marrying someone whose brother happens to be a divorce attorney. If you like it, then good for you. If you don’t, and you want to get out, then there will be some hassle involved, and it will likely cost you.”
“But I like the simple, straightforwardness of contract work: you do a day’s work, you get a day’s wages, the end. But, after taking a month off and half-heartedly looking for other work, I only had a little financial cushion left, and I needed to get into some sort of paying gig. A lot of locums jobs still need some advanced notice to get you into, because wherever you’re going to work, they need to get you on all of the local insurance panels. The locums recruiter I was working with pointed out that none of that is an issue with prison work. The State is paying for the patients’ care, so I just need to pass their credentialing procedure. Considering that the State needs to job filled, they have an incentive to move the credentialing process right along. So, prison work ends up being great last-minute temp doctoring work. I never intended to be there this long. But, my wife ended up getting hurt, and couldn’t work and needed to be taken to frequent doctor and physical therapy appointments, and the flexibility of the prison gig couldn’t be beat. If you work at an office practice, and cancel, lots of patients that made appointments are going to be unhappy. They took time off from work and scheduled in advance and etc. No one is thrilled if you call off from a prison psych clinic day, but as long as you can make it up sometime in the near future, it will work out. It’s not like the patients are going anywhere.”
Tell me about your non-medical hobbies. You know, those things that make you want to work hard so that you can go home and have fun kind of things.
“I started homebrewing beer in maybe 2006. I think I saw Alton Brown do it on Good Eats, and had to do it myself. From homebrewing, I got into gardening. Guys on homebrewing internet forums were raising their own hops and other ingredients. I have a weird mental hang-up about self-sufficiency. So, I had to do that too. From homebrewing and gardening, came beekeeping.”
“Again, some guy on one of the mead-making threads on a homebrewing forum asked about how many mead-makers were beekeepers. And the rest was history.”
“I’ve also said that I keep bees because after the zombies come, I’m going to need something to ferment.”
And 3-D printing too?
“There’s a lot of enthusiasm for 3D printing amongst libertarians. Oh yeah, that hasn’t come up yet, but I’m libertarian. Ron Paul doesn’t want to shrink the government enough, in my opinion. Part of the appeal of 3D printers is that it puts production into people’s homes. If only a handful of companies/factories are making gizmos of some sort, then it’s fairly easy for government to regulate or tax the production of gizmos. If regular Jim’s are able to make gizmos in their basement, in every home in America, then regulating or taxing gizmos becomes a lot tougher.”
“This is another example of one interest of mine meshing synergistically with others. Brewing meshed with gardening, and they both meshed with beekeeping. There is some work being done out there to use 3D printers in beekeeping, but I’m only peripherally aware of it. Open Source Beehives is one such example that I’m aware of. But, there’s plenty of room for more. A lot of beekeepers are woodworkers. I am not. But, I’m getting to be fairly competent at designing beekeeping gear on Tinkercad.com.”
“Again, I like being self-sufficient. (Yes, I am on the grid… for now.) Being able to design and print my own beekeeping gear is really appealing to me. I don’t plan on printing out one of Cody Wilson’s 3D printed Liberator handguns, but I know where to go find the files if I want to.” <insert evil laugh here>
What would you call your 2nd, 3rd, or 4th career if you could put a label on it?
“Works in progress. Yes, works is plural on purpose. Is what you’re doing now a placeholder of sorts for something coming in the future?”
“I doubt I’ll ever get out of medicine altogether. Though I have some fantasy idea about getting ordained through the Chrysippus School of Theology, so that I can do pastoral counseling without having to worry about all of the bureaucracy that exists in modern medicine. Getting that is about a two year process, though. I also need to look into the legal details of pastoral counseling. I’m certain that if it is done in a way that involves money changing hands, that the State has some involvement.”
“I also recently found out about something called practicing philosophy, or practicing philosophers, that I need to look into some more. I dabble in Stoic Philosophy, which is something like the evolutionary precursor (by something like 2000 years) to modern psychotherapies, like Cognitive Behavioral Therapy. So, there is some sense to the practicing philosopher thing. It also probably overlaps with life coaching, which you’d know more about than I do. Imagine someone going to see their Philosopher for regular visits to help them live their life well, instead of their therapist because they are depressed. I don’t know enough about it, yet, but it seems interesting. Also, the less regulated a career is, the better it is, at least as far as I’m concerned.”
“But, for the foreseeable future, I’ll probably need to keep working in psychiatry, as a part time gig, while trying to get some sort of sustainable income out of beekeeping and eventually mead making. That’ll take a while. Also, ironically, the mead making part will involve more government regulation in my life. I have a wife and kids. I can’t afford to take the risk involved in the Uncle Jesse route with the mead making. There are few commercial beekeepers that are also mead makers. There was one in Vermont that I was aware of, but they got big enough to make mead year ‘round, I guess, and just started buying honey for their mead. I don’t ever figure on getting that big. If I need to hire people, that’ll mean more regulations and unwanted complexity in my life. Beekeeping is seasonal work, and I don’t see any reason why mead can’t be made in the beekeeping off-season. The two seem complementary to me.
You talk a lot about family. How big a part did they play in moving on to a second career?
“When I was in the pseudo-private practice family medicine job, my wife told me that she wasn’t going to just watch that job kill me. There’s a wakeup call for you. It’s probably one of the most loving things that she’s ever done for me. At the same time, she’s been resistant to me just going into private, solo-practice. If you go that way, you only eat what you kill, so to speak. We’ve got kids and a mortgage and I’ve still got six figures of student loans to pay off, so she much prefers I have something with some fairly guaranteed income. I think that as long as I’m able to pay for my share of the bills, and am not courting a lawsuit or criminal charges in the process, she’ll have my back. She would have liked for me to stay in academic medicine, and to become a big time researcher, but she knows that that just isn’t me.”
“My kids have a lot to do with my backing out of full time medicine. I wasn’t getting to see them. I’d go to work as they were waking up, and get home to find they were already asleep. Not every day, but more often than I cared for. My 7-year-old daughter “helps” me with the bees. She has her own head to toe protective bee suit and everything. My son wants to help, but is only 3. He’ll inherit his sister’s bee suit next spring.”
What does your wife do for a living?
“She is a fancy-schmancy psychiatrist at one of the major hospital systems in Cleveland. It’s not for me, but she loves it. She’s getting some recognition at the national level for the stuff she does, which is why I’m not giving her name or being too specific about where she works or what she does. It may just be hubris on my part to think that my antics could hurt her, career-wise, but it may not just be hubris.”
Is she the financial back up for now?
“I think we probably bring home equivalent income at this point. She’s made more than me, on an hourly basis, since we’ve been dating. But, she’s been working part time since our daughter was born, so I was making more per year, until these past few years when I really scaled back. I’m told that some guys have a hard time coping with their woman (or partner, or something else more politically correct than “woman” if you want) making more money than they do. I don’t seem to have that problem.
Please add anything you’d like to answer questions that I’m not astute enough to ask.
“I like turtles. But I like more than just turtles. I like a lot of things. It’s sort of a specialist’s world. I’m a generalist (except for woodworking, I’m just no good at it). That’s part of what first drew me to family medicine. But family medicine has been gradually watered down. Family med docs don’t do nearly as many procedures as they used to do a generation ago. There are incentives a’plenty to keep family docs working in an office, keeping to a relatively narrow range of activities. Some rural family med docs still do appendectomies, or colonoscopies, or whatever, but they’re the exception. They’re bucking the system, and good on ‘em. But, they’re a dying breed.”
“I was bucking the system by having two specialties, for a while. I sort of caved by cutting back to just one. But, I’ve opened up a lot of other things in my life by doing that. I just needed to generalize into areas of life that hadn’t been regulated or organized and bureaucratized as much as medicine has been. I’m trying to do a better job of choosing my battles.”
If you’re interested in homebrewing, check out my reprint of the classic text Monzert’s Practical Distiller that covers everything from spirits to vinegar.
This message was written by a team of geeks, nerds, gamers, and Dr. David Powers. You can always find us at www.callsignredbeard.com. Thanks for reading!
In the words of Starship Troopers, “Would you like to know more?”