Really great information, thanks everyone!
200k/yr gross without benefits is plenty for me. Love medicine but if conventional wisdom says nearly any specialty will eventually turn into just another job and I’ll want more time to myself outside of work, I yield and can accept that truth.
So to me, the goal becomes finding the path of least resistance to the specialty that hits around 200k while minimizing required hours in training, on the job, and burnout probability.
Is that EM? Maybe a combined EM/FM residency where I plug EM holes while building up a DPC FM practice? I’m all ears.
I think your math is way off, I think you are over-valuing how much the average ER physician makes and undervaluing the average PCP/IM.
As an example, I make about 330k a year base wages/salary and about another 70k in benefits/retirement contribution/profit sharing that I am only entitled to by working full time. So the difference in 0.5 FTE and 1.0 FTE is more than 2x; its 165k vs 400k total comp, so close to 2.5x. Most PCP's are making at least 300, so you are making dramatically less than a PCP working half time ER.
Second of all is logistics. Your overhead has a physician (practice integration, billing, malpractice) are essentially fixed and not prorated to how much you work. So a potential employer has the same fixed expenses on you and you are brining in less income for them, why would they hire you compared to someone working full time? They wouldn't. Or if they would, only temporarily until they can get a fulltimer and then your toast.
In the same vein, you may view a full-timer as "having to work" this many shifts, but they also "Get to work" that many shifts, their minimums are a guarantee. Once a group has the shifts covered, they don't need a part-timer anymore who has no shifts they get to work. Thus the only shops that have plenty of part-time hours tend to be places that cannot keep full-timers because they are crappy shops with bad work environments.
So to put together a part time career, you will need multiple jobs and multiple credentials at multiple places in possibly multiple states. The shops will generally have a worse work environment. Your work will be uncertain and you may not know what your income will be in a few months. This can complicate getting loans to buy a vehicle, buy a house, etc.
At this point why go through all that hassle to make less than half of a full timer? Might be easier to just work full time at a good shop.
Petomed, this is going to sound very judgemental, but I want you to understand that what you are saying is worthy of being judged harshly.
Why do you want to go into a field where you do not intend to do a good job and don't intend to be the best you can for your patients?
You haven't even already started residency, and you are already talking about "path of least resistance" and doing as little as possible. Residency is largely what you make of it, if you aren't focused 100% on becoming the best physician you can, you will certainly be outpaced by your peers.
Why would I hire a new grad who has gotten less out of their training and isn't as committed to working hard in practice?
Also, emergency medicine is an intensely clinical specialty, you cannot learn it in a book. You need reps, lots of them. I feel it took a solid 5 years post residency for me to consolidate my skill set, maybe some people its faster, some slower. But you need a razor sharp clinical edge to do well in this specialty. We are literally looking for the needles in the haystack, that person who just looks a little "off" or "more uncomfortable than you would expect" who actually has an aortic dissection lost in the sea of benign chest paineurs.
Procedures take reps to. We aren't surgeons we don't do the same procedure every single day, so you need lots of days to get it in. The difference between an intubator who gets 100% of their tubes and 99% is everything, its life and death. 99% is not good enough.
furthermore, just providing safe effective medicine is not enough in this field, you need to do all that, AND do it fast. Speed and efficiency are based on experience and practice.
This is a field with high stakes, I don't think we need people in it who aren't committed to getting the most out of their training, the most of their practice, and giving their patients 100%.
Yes it's true, some people are better than others, I'm sure there are many ER physicians better than me, but my conscience is clear that I am giving MY patients 100% of what I got.
I think one can start cutting back to part time after AT least 5 years in practice, planning to go part time right out the gate will make you an absolutely less effective and probably inadequate ER physician.
Bottom Line, and I want the other medical students lurking to see this:
This is not a life-style specialty. It is a good specialty for people who are interested and passionate about emergency medicine. There are no short cuts. The guy you heard of who practices 6 days a month, is well-off, and spends the rest of the time surfing probably spent 20 years first working hard in the pit, saving money, and consolidating their skills. That probably wont be you right out the gate. The other part-time "exceptions" are making some other sacrifice, working only weekends, only nights, etc. Those all have their own downsides.
Life style specialty if you have the grades are derm and ophtho, if you don't have the grades consider psychiatry or low key PCP/FP.
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