EM to palliative/hospice?

[rogerrabbit221]

I'm considering doing a hospice/palliative medicine fellowship. Goals are to leave EM permanently or make it a side job.

Wondering if anyone's made the transition and what it's like post-fellowship? Can you comment on job market? Job satisfaction? Schedule? Stress level? Any regrets? Things you wish you knew before making the switch?

I did see a thread about it in 2020 but wanted some recent thoughts about it.

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[RustedFox]

*Paging @dchristismi*

 

[Angry Birds]

I’m assuming it would result in a substantial pay decrease.

 

[Apollyon]

I’m assuming it would result in a substantial pay decrease.

And a substantial mental health and happiness increase.

 

[crop]

I’m leaving after 5 years of practice in a private em group…will be starting hpm fellowship in July will post if I made the right choice….hopefully I did hahah!

 

[dchristismi]

I didn't do a fellowship as I only do hospice. If you want to focus on palliative, you need the fellowship as many palliative jobs are hospital-based. EM is the perfect jumping off specialty, IMHO.

I had enough experience, and already knew what I wanted to do: retire! I spent about 3 years slowly making the transition to what in EM would be considered a unicorn gig. I only do GIP-level (inpatient) hospice now, and yes, it was a pay cut, but I had a big enough nest egg of "FU money" I could have walked away. I could make more. I choose not to because I've been burned and I don't need to burn the candle at both ends. I was crispy as hell when I made the choice to leave EM. The call is a little annoying, but you get used to it.

HPM can be emotionally draining, but the patient population is light-years better than what you're used to. The personal satisfaction is incredible.
I have hard days, but it's nothing like EM was. PM if you want to talk details. There are others here who do Palliative and EM, but you couldn't pay me enough to go back to EM now.

 

[throway134]

I'm considering doing a hospice/palliative medicine fellowship. Goals are to leave EM permanently or make it a side job.

Wondering if anyone's made the transition and what it's like post-fellowship? Can you comment on job market? Job satisfaction? Schedule? Stress level? Any regrets? Things you wish you knew before making the switch?

I did see a thread about it in 2020 but wanted some recent thoughts about it.

I practiced em for <5 years and left for a hpm fellowship after covid turbocharged both my burnout and patients going (even more) insane.

I now do exclusively hospice in a primarily inpt setting: despite there being two people on this thread doing it, this is not a common setup in hospice. I might go back to doing palliative at some point if my job becomes less cushy, because I actually prefer it. Having a few full code patients sprinkled in makes things more interesting.

Pay is ~250k with 401k/bonus included, I could have made it ~300 or a little more at a harder job.

my job has very little call and I prefer that to chasing dollars (which are higher in em anyway). I have a ridiculous amount of vacation, the exact details of which I cannot give without a full dox of myself, but it’s more than enough to have a week off every month. I do work weekends but that’s mostly by choice as it allows me more flexibility in scheduling.

I am thanked at least 4-5x a day, which is more than I got in most months in the Ed. I don’t have to tolerate abuse, I work exclusively days, I see my children every single day and sleep in my bed every single night. I enjoy my work a great deal.On my worst day I am never as stressed as the dread of beginning a new em shift run. Amusingly, your stress threshold does reset at some point and I occasionally get worked up about stupid **** before I realize “at least I’m not in the Ed” and then I feel content/warm fuzzies.

While there are occasionally thought stimulating patients with complex symptoms and weird solutions, it is much less intellectually stimulating than EM or really anywhere that your patients will come out alive. It is much more emotional management and communication: if these are weak points, you will not be happy in this job.

Despite how much I hated it, the hardest part of the transition was letting go of em for me. Partially an ego thing, partially that I liked procedures, and partially just plain old Stockholm syndrome. I loved it and hated it all the time, but I am very glad to be out with some distance from it.

Job market was and is fine where I am, it’s a rapidly expanding area, but there’s a lot of midlevels and new fellowships, so who knows what it will look like in future. My spouse also makes good money, and I don’t need much to be happy.

 

[Fox800]

Despite how much I hated it, the hardest part of the transition was letting go of em for me. Partially an ego thing, partially that I liked procedures, and partially just plain old Stockholm syndrome. I loved it and hated it all the time, but I am very glad to be out with some distance from it.

This is what I'm dealing with. The idea of ego death after leaving EM (starting fellowship later this year). I don't want to work in a community ED any more. Have thought about maybe working now and then at a VA ED.

In a dream world I'd do pre-hospital work, but that's not an option in the US.

Have even thought about the reserves or national guard (in an EM capacity), but I don't think that would go over well with trying to get a job in a private practice group.

 

[RustedFox]

Despite how much I hated it, the hardest part of the transition was letting go of em for me. Partially an ego thing, partially that I liked procedures, and partially just plain old Stockholm syndrome. I loved it and hated it all the time, but I am very glad to be out with some distance from it.

BRO.

Same-same.

 

[cyanide12345678]

So here’s the real question for those in this space - what’s the job market like in desirable cities especially given the mid level encroachment. This is another specialty which i feel is ripe for slow replacement of physician hours with mlp hours

 

[Birdstrike]

the hardest part of the transition was letting go of em for me

I had this same thing.

I wanted out of EM. I needed out of EM. Getting out of EM saved my life. But it still took some time get the EM mind-virus out of me. That part required an adjustment.

But when I did, I was a helluva lot better off and have been.

Some day we’ll all retire completely and go through the same transition again. Change is always an adjustment. But not doing it, is not an option.

 

[emergentmd]

I guess I am essentially out of EM too, or at least some would say I am. The Longevity to work past 60 if I want is one of the best parts.

 

[dchristismi]

Despite how much I hated it, the hardest part of the transition was letting go of em for me. Partially an ego thing, partially that I liked procedures, and partially just plain old Stockholm syndrome. I loved it and hated it all the time, but I am very glad to be out with some distance from it.

Indeed, two inpatient hospice docs in the same thread? Crazy. I'm not going to AAHPM in person this year, but last time I did go (precovid, because it was nearby), I got lots of incredulous looks. Because it is very rare.

Anyway, the above is absolutely true. When your identity is all about being an ER Doc, it is a really, REALLY hard thing to let go of. It took me about 5 years to actually get there. We worked awfully hard for it, and even though we all know the awful nitty gritty, it still awes people like very few other specialties.

On my worst day I am never as stressed as the dread of beginning a new em shift run. Amusingly, your stress threshold does reset at some point and I occasionally get worked up about stupid **** before I realize “at least I’m not in the Ed” and then I feel content/warm fuzzies.

This is also absolutely true. I also have all the time I need to spend with patients and mostly their families. There's no rush to see the next disaster.

 

[timpview]

How much are hospice directorships going for or jobs that are hospice outpatient only, ie signing certs/recerts, participating in bimonthly IDTs and just being available for the nurses/midlevels if needed.

 

[throway134]

So here’s the real question for those in this space - what’s the job market like in desirable cities especially given the mid level encroachment. This is another specialty which i feel is ripe for slow replacement of physician hours with mlp hours

Sure, if it’s non surgical there’s vulnerability. The reality is this is neither a sexy specialty nor a high paying one. That drives away midlevels as fast or faster than docs.

Also, when it comes to prognosis and goals discussions patients get really choosy sometimes. I have been asked my credentials far more often and had midlevels fired over their credentials much more often than as an Ed doc. No hard numbers on this.

At least in my area there are no shortage of jobs. This can of course change quickly

Indeed, two inpatient hospice docs in the same thread? Crazy. I'm not going to AAHPM in person this year, but last time I did go (precovid, because it was nearby), I got lots of incredulous looks. Because it is very rare.

Anyway, the above is absolutely true. When your identity is all about being an ER Doc, it is a really, REALLY hard thing to let go of. It took me about 5 years to actually get there. We worked awfully hard for it, and even though we all know the awful nitty gritty, it still awes people like very few other specialties.

This is also absolutely true. I also have all the time I need to spend with patients and mostly their families. There's no rush to see the next disaster.

Yeah, I can only think of a handful of free standing ipus in the entire state I live in (outside va).

We probably represent 1% or less of the specialty: for non-hospice folk, even ipu heavy jobs usually have an outpt component where you also round in ipu. To also be em trained is even more odd

How much are hospice directorships going for or jobs that are hospice outpatient only, ie signing certs/recerts, participating in bimonthly IDTs and just being available for the nurses/midlevels if needed.

Jobs where you are a Md/do stamp do exist, but in my opinion are less fulfilling.

Also, many of them pay very little if you aren’t patient facing, e.g. 25-50k for being “med director” and “collaborating”

Most outpt hospice jobs have above, and call, backup call, and home visits etc. +/- rounding on wherever they send inpts. Those are more in the 200-300k range.

 

[EmergentMagician]

I am finishing up HPM fellowship this year.

I wrote a pretty lengthy 'eulogy' to EM about 6 months ago, posted it here, feel free to look it up and pm me after

 

[Frazier]

I'm considering doing a hospice/palliative medicine fellowship. Goals are to leave EM permanently or make it a side job.

Wondering if anyone's made the transition and what it's like post-fellowship? Can you comment on job market? Job satisfaction? Schedule? Stress level? Any regrets? Things you wish you knew before making the switch?

I did see a thread about it in 2020 but wanted some recent thoughts about it.

Job market is okay. There are jobs coast to coast -- just not all at any given time. You might not get into the market you want for year/s. HPM docs can work into ripe old age.

The schedule is good. Stress level is good, as long as you actually like the specialty. Income is uptrending, but on the lower-end of physician spectrum. No regrets.

Currently make about 275k, work M-F banker hours w/ a day of telemed from home, no holidays, no weekends, no call, about 10 weeks PTO.
Daily patient encounters range 0-9 patients. Averaged out likely about 5 encounters/day [with remainder of workday spent across IDT interactions, teaching, research, huddles, committees, etc.]

Now I go for 2+ hours of outdoor walks daily when on campus, as most of these virtual meetings can just be done with a Bluetooth earbud and chiming in when needed. I could leave the ED for like a couple 15-min breaks during a 10 hour shift, thinking back.

It is a vastly different day-to-day life than working in the ED... But I don't make 400k.