career trajectory? hoping to avoid burnout!!!

[la gringa]

about to begin the job search - current situation just not working out, my values don't jibe well with group and frustrated w/ lack of support when issues do arise. feel that my strengths don't match up well with the group's objectives and this has led to a lot of misery on my part. came here mostly due to geography which means i'll likely have to relocate...

grew up in the area but there isn't much variety in the area - just 1 semi-academic group, few if any SDG's left, and the ones left are struggling. big dominant healthcare system that is VERY nurse-run. socially looking for a change as well...

trying to avoid making the same mistake twice - my first job out of residency was better and i may try to go back there - left for non-job related reasons. had scribes, fewer pph, felt that people's strengths were recognized better and utilized to help the group. that's how i remember it, at least

looking for any insight - my strengths are patient satisfaction (mostly from LISTENING, not rampant rx patterns by any means), medical knowledge, relationships with consultants, very functional in Spanish. good relationship with majority of nursing but as a friendlier younger woman - well, not loved by all. current group has almost no female leadership which has lead to no mentorship in that regard... have interests in IT, hospice/pall care, sports med, critical care. may consider fellowship or academia at some point. middle of the road overall productivity.

trained at a well-regarded midwest program but prefer east coast, would consider TX but not licensed so, no time soon!

appreciate any public or private input, thank you.

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[Birdstrike]

about to begin the job search - current situation just not working out, my values don't jibe well with group and frustrated w/ lack of support when issues do arise. feel that my strengths don't match up well with the group's objectives and this has led to a lot of misery on my part. came here mostly due to geography which means i'll likely have to relocate...

grew up in the area but there isn't much variety in the area - just 1 semi-academic group, few if any SDG's left, and the ones left are struggling. big dominant healthcare system that is VERY nurse-run. socially looking for a change as well...

trying to avoid making the same mistake twice - my first job out of residency was better and i may try to go back there - left for non-job related reasons. had scribes, fewer pph, felt that people's strengths were recognized better and utilized to help the group. that's how i remember it, at least

looking for any insight - my strengths are patient satisfaction (mostly from LISTENING, not rampant rx patterns by any means), medical knowledge, relationships with consultants, very functional in Spanish. good relationship with majority of nursing but as a friendlier younger woman - well, not loved by all. current group has almost no female leadership which has lead to no mentorship in that regard... have interests in IT, hospice/pall care, sports med, critical care. may consider fellowship or academia at some point. middle of the road overall productivity.

trained at a well-regarded midwest program but prefer east coast, would consider TX but not licensed so, no time soon!

appreciate any public or private input, thank you.

You wrote that you're "looking for insight" but didn't really say about what.

What to do? What kind of job to look for? Do a fellowship?

 

[la gringa]

sorry for not being more clear, came out more stream of consciousness. what i meant was, trying to figure out in what setting my strengths would be best utilized. move to academia, fellowship to transition out of primarily EM, different type of group...??

 

[suckstobeme]

Let's look at your options:
1) Stay at your current job- why put yourself through that misery? Is the location worth it?

2) Leave your current group and find another- If you are open to moving, the sky is the limit. There are plenty of wonderful groups out there. It sounds like you might feel like you are stagnating, and you want to "move up". If I might, I would suggest a Hospital Employed position. There are always oppurtunities to join committees and such. Opportunities sporadically arise to move into less clinical and more administrative type stuff if you're interested in that sort of thing. Whether or not you choose Hospital Employed, if you choose leave your current job and start work as an ED Doctor somewhere else you get to do what you were trained to do and make a lot of money, pay off debts, and get to a point financially where you don't have to work (or work as much) quickly.

3) Do a fellowship- I guess you have to ask yourself: am I really that passionate about critical care/palliative care/sports med or is this just escapism? The fact that you'd be willing to do any one of those fellowships makes me think that maybe you're not super-duper passionate about any one of those. So why start a fellowship in something you don't absolutely love to make less money on the other side? Also, I think you've mentioned before that you were into Palliative Care. Do you really think you need a fellowship for that or would it be enough to self-educate by reading a bunch of relavant journals/going to the appropriate conferences/etc?

4) Academia- I once wanted to go back to the place I did residency. But then I was honest with myself. I didn't want to go back because I loved teaching residents (although I do kinda like it in moderate doses), nor because I loved research (I truly hate doing any real research-y stuff). I wanted to go back because it was comfortable, because it felt like a nice warm/fuzzy/safe place. I think a certain type of person can do really well in an academic environment, but it has to be a good fit for you. Too many people go into academics for the wrong reasons and that isn't good for anybody. But maybe you would be the right kinda of person.

I think there are 2 ways to go about this job search. You can just kinda see what's out there and weigh the pros and cons and see what is available and what fits into your life now. This is definately easier and more flexible, but it's kinda unfocused.

The other way is to find out what job you want and then work toward it. For example, do you wanna be a department head or a residency director or a textbook author or the Donald Trump of CMGs or the world's leading authority on palliative care in the ED or just a really awesome clinician working in a great community hospital? They all require different skill sets and different career trajectories. If you know what you want, you can just work toward that goal.

That's my two cents. Hope you get something useful from it.

 

[la gringa]

thanks sucks...

i guess i mention academia mostly b/c i'm always known as the "brainiest" doc around and nurses always compliment me on my ability and willingness to teach them. did NOT enjoy teaching at my residency where you were often saddled w/ too much work and then a student who either 1. knew nothing (M3) or 2. wasn't interested (M4's after the 2-3 months of those who wanted to do EM). we didn't teach the other residents as much due to the patient workload - won't say "volume" as it was a county hospital and there was just so much to be done, doc level and not.

my current job seems to put ZERO value on clinical acumen, actual patient satisfaction (ie lack of complaints not necessarily PG), patient advocacy, when the rubber meets the road (despite what their company motto may say). i don't enjoy the "move the meat" mentality where you can be criticized for only seeing 2 pph over the shift when 24 came in your first 8 hours, some admits, all solo doc where you do your own procedures.

i'm really not sure what i "endeavor" to do, but something like quality director or assistant director/director of something like patient experience etc would probably be more my preference were i to stay in EM proper.

many of you know that i've had some physical issues well beyond my young age, and this weighs on my mind as well.... ergo the allure of an EM boarded subspecialty/fellowship that is less physically demanding and has fewer day/night switches, if any.

i guess i'm just venting in a way, and trying to figure out if i'm unrealistic in trying to find a job that really does value good patient care...

 

[Doctor Bob]

or a textbook author...

In the EM world, there's not a tremendous amount of job satisfaction from doing this. Patients will never care, consultants will never care. Coworkers will find it neat, but unless it's the definitive text in a very small niche, like EM in general there will always be a more thorough text out there. But... it does look nice on the bookshelf.

 

[Old_Mil]

More days off, fewer pph, good systems, and good coworkers are all great ways to avoid burnout. Sounds like your present gig isn't making you happy in at least one of those categories. Urgent care? Overseas?

Sent from my Z10 using Tapatalk

 

[MSmentor018]

sorry you're feeling it
how about locums? gives you a chance to get out of your present location and with each assignment there's an end in sight. but you never know what you're getting. could be a nice vacation out of it too
another option is work for the VA (spa) or civilian contract for the military. lower pay, great bennies, low stress. I've haven't heard of a complaint yet
I know a few people that left and went to Australia and new Zealand.....they describe this mecca as "old school I am here to help you medicine". they moved their families and not coming back

 

[Birdstrike]

See my PM

 

[DreamingTheLive]

I'd really identify what exactly it is about the culture/nature of your current gig and go about identifying a job which best remedies these areas. Perhaps a whole-scale change might be in order (i.e., private --> academia, etc.) but only you truly know where your heart/interests are. However, academics and the lot have their own issues.....You should only pursue academics IMHO because you love: 1) research 2) teaching. Being "brainy" is irrelevant and that would insinuate that academic EM docs are somehow more intelligent than their non-academic peers.

You referenced the level of culture and support as a major issue. Sounds like you need a change of scenery which in the EM world could mean a whole lot of things (Less/more administrative support; less/more ancillary and subspecialty support; less/more non-clinical responsibilities; less/more clinical shifts; shorter/longer clinical shifts; less/more patients per hour; different patient demographics; less/more nurses surfing pinterest and Facebook endlessly during their shifts; different personalities/ages/gender/etc. of group; different location-specific amenities; more mountains or beaches nearby (can never go wrong here); more beer/cocktails or way-more beer/cocktails in-between shifts. You listed a bunch of areas you're interested in and that you see as strengths, find another democratic group that perhaps is looking for leadership in one of these areas and start dominating it.

Either way, it always bums me out when I hear young EM physicians becoming disenchanted with their gigs, so I really feel for ya and I'm pulling for you. Hopefully I'll be reading a post in the coming months about how you landed your dream job somewhere and couldn't be happier.

Good luck!