Well, I don't come to SDN much anymore, but wow here I am reading a post that I wrote 5 years ago. I still feel exactly the same way as when I wrote it. My practice has changed somewhat in that time. I have narrowed my focus to a more outpatient/breast/cosmetic practice although. Still do a lot of micro but it is 98% breast recon now. I still enjoy the heck out of my "job", but have evolved to a more balanced "work-life" equilibrium. I no longer feel the need to say "yes" to every single consultation. There are things that I have given up doing because I am too busy to do them, and I don't really want to do them. E.g. - pressure sores, chronic wounds, hand, head and neck recon, MOHS reconstructions.
The biggest thing that I have done in my practice though to improve my life overall is to constantly read and learn about finance, technology, healthcare, etc. I read a LOT about a lot of things. This has helped me identify excellent financial opportunities that are aligned with my long-term goals of being financially "free" before I turn 50. If you always look to your income that you earn from surgery as your primary income source, then you will never be able to quit working. Worse, you will always feel compelled to stay late and do that extra case, and say "yes" to stuff that you don't really want to do. That is a place where I think many surgeons find themselves in because they don't think outside what they are doing on a day-to-day basis. If you are 50 and you are still doing pressure sores, you are not "winning".
I have invested in a range of different income generating assets, and some speculative assets, and have so far done very well. I keep my risk to a tolerable level. And now, conservatively I will definitely be able to retire by age 50 if I am so inclined. I probably won't though because I love what I do. But what I am starting to do a lot more now is spend time traveling with my family, spending time developing outside interests (getting back to my basketball playing ways), and just generally enjoying life a lot more each and every year. The greatest feeling is that I get from my financial moves is that I feel much closer to work independence than I ever have before. I could conceivable narrow my practice to the point where I am only doing 2 or 3 things and that's it. I've set my practice up so that if I work less, I can reduce my overhead to match to a large degree.
Some basic things to do for new people coming out, is set up the following plans and max them out: 529 for each kid, whatever version of savings plan you have SEP IRA/401k/403b/457b/IRA (there are many different plans and options available depending on your work arrangement). Save as much money as you can in the first years of your practice by making a budget and sticking to it. You will make more money as time goes on, and that money should be viewed as extra savings and not extra disposable income. Invest in conservative investments, but also devote a percentage of your portfolio to some higher risk plays say 10-15%. You will be surprised at how fast you can accumulate money if you are mindful of your expenditures and strive to save. Look for some extra call to make some extra cash, or other side hustle, EARLY in your career.
Be ready to invest in yourself by learning new things, taking classes, travel to meetings, on-line courses, and any activity that will make you a better surgeon and investor. Try to invent something. Make as many friends as you can in financial and tech circles. Try to make sure that they are smarter than you are so that you are always learning. Opportunities come up all the time, but frequently we are too "busy" to recognize them. It is now time to open your eyes, and ears, and consider that there is tremendous opportunity for those who have some capital and are willing to take a small amount of risk.
No matter what field people choose, just remember that you cannot stop learning and grinding just because you finished your residency. Also, although you will work hard to build your practice the first 2-3 years, also be thinking about other opportunities straight out of the gate. My first "angel investment" I made was right after I finished residency in a health/tech company that eventually went bankrupt and I lost my entire investment! It was a couple of grand and it hurt at the time. But through that experience I made a lot of friends and valuable connections which ultimately led me to the next few things which turned out extremely well. Don't think that you have "arrived" just because you finished residency and have a job. Use all of your traits that made you a great resident to be a great physician, and a great investor/innovator/leader. There is tremendous opportunity out there and you can easily get some of it but you have to look.
Finally I want to leave you guys with my overall thought about money. Money in and of itself has no real value to me. Money is valuable to me for what it can give to me which is time freedom. The ability to finally do what I want to do whenever I want to do it, every day, all day. I am not quite there yet, but am pretty close. In five years when I check this thread again I'll give you the update. It might be from a ski slope somewhere.
Good luck.