Help the lady leave EM

[Jball43]

Hello all,

I have spoken to some of you privately about this sort of thing, but my scrounging around here has convinced my partner to get your collective wisdom on leaving EM. Their anonymous message to the hive mind is this…

“Hello! EM resident here, finishing up my third and final year of training. I was drawn to the field by the excitement, ability to provide care to a safety net population, and the variety. I severely underestimated the cost the field would take on my mental, social, and emotional help (having panic attacks at and outside of work, pretty bad anxiety outside of work, etc). I quit the community job that I had lined up and the anxiety has improved significantly. I am incredibly disappointed that what I thought my dream job was is not actually my dream job, and the toll it was taking on my mental health was too much to tolerate. I am doing well in my personal life now but have no idea what to do career wise. I have $250,000 in debt. I want to settle down, have a family, and live a quiet farm life. However, my partner is starting medical school so it will be a few years before that is a feasible dream. I have done a lot of research into nonclinical careers or clinical careers with fewer demands but nothing has gotten me excited yet. I am ok with anything to pay the bills at this point and making some headway on the loans.

So here's my request: *help me find* what I should do besides emergency medicine! Tell me all of your experiences with nonclinical work: what was great, what wasn't great, and help me figure out what I should do instead.

Thank you all in advance!”

Me again - thank you all in double advance.

Edit: it’s worth noting they’ve been having a hard time mentally in medicine in general, which isn’t been improving. They have tried moonlighting and some more common approaches.

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[deuist]

Utilization review / denials management
Agency for Healthcare Research and Quality
FDA medical officer
CIA medical officer
CDC Epidemic Intelligence Service
Clinical informatics

 

[BoardingDoc]

Hello all,

I have spoken to some of you privately about this sort of thing, but my scrounging around here has convinced my partner to get your collective wisdom on leaving EM. Their anonymous message to the hive mind is this…

“Hello! EM resident here, finishing up my third and final year of training. I was drawn to the field by the excitement, ability to provide care to a safety net population, and the variety. I severely underestimated the cost the field would take on my mental, social, and emotional help (having panic attacks at and outside of work, pretty bad anxiety outside of work, etc). I quit the community job that I had lined up and the anxiety has improved significantly. I am incredibly disappointed that what I thought my dream job was is not actually my dream job, and the toll it was taking on my mental health was too much to tolerate. I am doing well in my personal life now but have no idea what to do career wise. I have $250,000 in debt. I want to settle down, have a family, and live a quiet farm life. However, my partner is starting medical school so it will be a few years before that is a feasible dream. I have done a lot of research into nonclinical careers or clinical careers with fewer demands but nothing has gotten me excited yet. I am ok with anything to pay the bills at this point and making some headway on the loans.

So here's my request: *help me find* what I should do besides emergency medicine! Tell me all of your experiences with nonclinical work: what was great, what wasn't great, and help me figure out what I should do instead.

Thank you all in advance!”

Me again - thank you all in double advance.

Edit: it’s worth noting they’ve been having a hard time mentally in medicine in general, which isn’t been improving. They have tried moonlighting and some more common approaches.

While it is certainly possible that you will find something that you want to do in the next 6 months, I would seriously consider doing something clinical when you graduate. 1: if you don't, its going to be hard to get employed clinically later if you ever decide you want to. 2: You've got, you know 250k in debt. Doctor money will help pay that down. Being a farmer won't.

If working in the ER is giving you panic attacks, I'd consider urgent care. The pay ranges from tolerable to rather good depending on where you're working and the work is very easy. Mind numbingly boring, for sure, but easy. That way you have more doors open to you as an attending and can keep on looking for alternative options while you're still pulling a salary.

All of that said, if you manage to get something lined up before you graduate that's entirely non-clinical and will pay the bills, by all means do that. I have simply found that most things in life which are worth having take time to put together / do correctly. 6 months isn't a lot of time.

 

[JacobMcCandles]

I would work hard clinically at least until your partner gets out of residency (what if they hate medicine, too, and now it's all on them) and then you should be in good shape financially to really take a step back. Financially, you're likely going to be in tough shape if you don't at least work clinically for a bit.

 

[Fox800]

You're going to have a hard time getting a non-clinical job without clinical attending experience.

Do a fellowship in something chill. Hyperbarics, sports medicine, pain. Problem is you've missed the window because you're about to graduate. Work at a low-volume rural place or an FSED or something then apply to fellowship.

 

[AlmostAnMD]

Virtually every good non-clinical job requires 5 year minimum of attending experience. They list it right in the description as mandatory.

Even if you don't like EM you won't be taken seriously even for the lowest level UR jobs

 

[cyanide12345678]

You might just need a different work setting.

Find a job that is ‘easy’. There are some places with annual volume of 3500 or so. 24 hour shift, see 10 patients a day kind of gig. Sometimes you get critical patients, but you know EM is anxiety provoking when you have 2-3 sick patients with another 8-10 patients that aren’t really sick, just taking away your time. Multi tasking between high patient volume is stressful, having your patient board empty for hours and hours is not as stressful.

It’s actually refreshing to have a chill gig where you see very few patients. Plus some of those places still pay a decent amount.

 

[cyanide12345678]

Or just do urgent care.

 

[cyanide12345678]

Virtually every good non-clinical job requires 5 year minimum of attending experience. They list it right in the description as mandatory.

Even if you don't like EM you won't be taken seriously even for the lowest level UR jobs

Yeah i applied for utilization review jobs, definitely need experience. Otherwise you’re not getting hired.

 

[painER]

Yea agree with everyone else that you need to do something clinical. That gives you the credibility to do something non-clinical.

Have they done any research? There are private companies who serve as sites for clinical trials that will hire a doc as a sub-I/PI. This can be full time but also part time which would allow for some balance with clinical work. May be worth looking into if there is interest.

 

[Tenk]

Gonna take a different approach here. Having panic attacks in and outside of work is a much bigger problem than just emergency medicine. That is not normal at all.

My advice would be seeking professional help and then going into something like urgent care as mentioned above. Still decent money although not EM money. From there you can transition to something non clinical in a few years.

 

[EctopicFetus]

See a therapist / psych and get your mental health under control. Today it’s clinical medicine. Tomorrow it’s your kids, neighbors, friends. The job is simply unmasking the underlying issue.
find a job at a cah see 1 pph. Make 150-200/ hr. Pay off your debts until the so can make money.

 

[Groove]

You need to work as an EM doc for 3-4 years before you try to get out of clinical medicine. That will be time enough to season and temper your skills. Even then, you should still work 3-4 shifts a month to maintain your skills. It would be horribly unwise to get out of EM altogether only then to realize later on in life that you want to work EM. It will be too late at that point and nobody will hire you.

How do you intend to pay off your 250K on the farm?

 

[Jball43]

Thank you all for the for the comments! You guys are thorough and amazing as usual.

Some general thoughts are;
She is currently in therapy for these issues, and the general consensus seems it may not be healthy or safe for her to continue. It’s not lost on us that avoiding clinical medicine is the hardest route but it might be legitimately necessary.
As far as how to pay off debt? Very good question. She will have 3 years paid into PLSF so only 7 more years since her loans are eligible. So that’s an option I suppose.

It might narrow it down more to say she’s looking for a job that doesn’t have to be comparable to the income she would make in clinical medicine. Breaking six figures would probably be a win at this point.

 

[Groove]

So, she can make it though an EM residency and graduate but is deemed by psych to be too mentally unhealthy to practice medicine? Like...as in EM or any medicine in general? I guess full time telemedicine should be fairly easy and is completely doable from home.

 

[Goro]

Hello all,

I have spoken to some of you privately about this sort of thing, but my scrounging around here has convinced my partner to get your collective wisdom on leaving EM. Their anonymous message to the hive mind is this…

“Hello! EM resident here, finishing up my third and final year of training. I was drawn to the field by the excitement, ability to provide care to a safety net population, and the variety. I severely underestimated the cost the field would take on my mental, social, and emotional help (having panic attacks at and outside of work, pretty bad anxiety outside of work, etc). I quit the community job that I had lined up and the anxiety has improved significantly. I am incredibly disappointed that what I thought my dream job was is not actually my dream job, and the toll it was taking on my mental health was too much to tolerate. I am doing well in my personal life now but have no idea what to do career wise. I have $250,000 in debt. I want to settle down, have a family, and live a quiet farm life. However, my partner is starting medical school so it will be a few years before that is a feasible dream. I have done a lot of research into nonclinical careers or clinical careers with fewer demands but nothing has gotten me excited yet. I am ok with anything to pay the bills at this point and making some headway on the loans.

So here's my request: *help me find* what I should do besides emergency medicine! Tell me all of your experiences with nonclinical work: what was great, what wasn't great, and help me figure out what I should do instead.

Thank you all in advance!”

Me again - thank you all in double advance.

Edit: it’s worth noting they’ve been having a hard time mentally in medicine in general, which isn’t been improving. They have tried moonlighting and some more common approaches.

Teaching

 

[Keona]

Thank you all for the for the comments! You guys are thorough and amazing as usual.

Some general thoughts are;
She is currently in therapy for these issues, and the general consensus seems it may not be healthy or safe for her to continue. It’s not lost on us that avoiding clinical medicine is the hardest route but it might be legitimately necessary.
As far as how to pay off debt? Very good question. She will have 3 years paid into PLSF so only 7 more years since her loans are eligible. So that’s an option I suppose.

It might narrow it down more to say she’s looking for a job that doesn’t have to be comparable to the income she would make in clinical medicine. Breaking six figures would probably be a win at this point.

What about telemedicine urgent care? If her anxiety is this severe is she considered disabled from working? I have a friend that stopped clinical medicine. She worked for 3 years after residency. Paid off all her student loans and is now a housewife. She’s thinking she might tutor part time. Huge loss to medicine because she was amazing at her job but got bogged down by in buckets etc.

 

[Jball43]

So, she can make it though an EM residency and graduate but is deemed by psych to be too mentally unhealthy to practice medicine? Like...as in EM or any medicine in general? I guess full time telemedicine should be fairly easy and is completely doable from home.

Good question. She has no interest in medicine at all at the moment, but the real damage to her mentally has been through EM. It’s progressively gotten worse and her program has been very reasonable at trying to help drag her across the finish line. She’s excellent and well liked. They’ve given her a month of electives to do online like ultrasound and dermatology and have been limiting her nights. So we appreciate that. I don’t like thinking of her as just mentally unhealthy when she was so excited and consistent before her second year of residency. It went down hill fast and we’ve spent a lot of time and money just trying to keep things functioning.

On a brighter note, do you have any telehealth suggestions? Thank you for your comment!

Teaching

Academic teaching or some sort of tutoring system? This is an interesting suggestion that could also fit into PLSF! Thank you for commenting, grandmaster Goro.

What about telemedicine urgent care? If her anxiety is this severe is she considered disabled from working? I have a friend that stopped clinical medicine. She worked for 3 years after residency. Paid off all her student loans and is now a housewife. She’s thinking she might tutor part time. Huge loss to medicine because she was amazing at her job but got bogged down by in buckets etc.

I’m really curious about this telemedicine concept, and have you tried urgent care? We know almost nothing about it.

The anxiety issue seems to be largely related to the stimulation and demands of EM specifically. By that I mean the inconsistency of the schedule, overwhelming environments, and in her words, “hurting people who are all unappreciative.” One of her colleagues said she suffers from “work induced autism” for whatever that’s worth.

Also, thank you for commenting! I hope everyone knows how much we appreciate the input from everyone.

 

[sloh]

QME work

 

[Goro]

Good question. She has no interest in medicine at all at the moment, but the real damage to her mentally has been through EM. It’s progressively gotten worse and her program has been very reasonable at trying to help drag her across the finish line. She’s excellent and well liked. They’ve given her a month of electives to do online like ultrasound and dermatology and have been limiting her nights. So we appreciate that. I don’t like thinking of her as just mentally unhealthy when she was so excited and consistent before her second year of residency. It went down hill fast and we’ve spent a lot of time and money just trying to keep things functioning.

On a brighter note, do you have any telehealth suggestions? Thank you for your comment!


Academic teaching or some sort of tutoring system? This is an interesting suggestion that could also fit into PLSF! Thank you for commenting, grandmaster Goro.


I’m really curious about this telemedicine concept, and have you tried urgent care? We know almost nothing about it.

The anxiety issue seems to be largely related to the stimulation and demands of EM specifically. By that I mean the inconsistency of the schedule, overwhelming environments, and in her words, “hurting people who are all unappreciative.” One of her colleagues said she suffers from “work induced autism” for whatever that’s worth.

Also, thank you for commenting! I hope everyone knows how much we appreciate the input from everyone.

Academic teaching. Anatomy profs are now in short supply!

So sorry to hear of her woes

 

[wholeheartedly]

could do training for preventive med or occ health, which would both be mellow with reasonable hours.

 

[Keona]

Good question. She has no interest in medicine at all at the moment, but the real damage to her mentally has been through EM. It’s progressively gotten worse and her program has been very reasonable at trying to help drag her across the finish line. She’s excellent and well liked. They’ve given her a month of electives to do online like ultrasound and dermatology and have been limiting her nights. So we appreciate that. I don’t like thinking of her as just mentally unhealthy when she was so excited and consistent before her second year of residency. It went down hill fast and we’ve spent a lot of time and money just trying to keep things functioning.

On a brighter note, do you have any telehealth suggestions? Thank you for your comment!


Academic teaching or some sort of tutoring system? This is an interesting suggestion that could also fit into PLSF! Thank you for commenting, grandmaster Goro.


I’m really curious about this telemedicine concept, and have you tried urgent care? We know almost nothing about it.

The anxiety issue seems to be largely related to the stimulation and demands of EM specifically. By that I mean the inconsistency of the schedule, overwhelming environments, and in her words, “hurting people who are all unappreciative.” One of her colleagues said she suffers from “work induced autism” for whatever that’s worth.

Also, thank you for commenting! I hope everyone knows how much we appreciate the input from everyone.

I’m family medicine but during my training we moonlighted at a local urgent care. It would still have the inconsistency in terms of how many patients you’re seeing but the clientele is different than the ED. (I also rotates through Ed during residency). I much preferred the urgent care. I’m general outpatient primary care at this time with a small amount of nursing home care as well. I don’t have much advice on where to find telehealth jobs but different people have posted about them. A lot of them require licenses in multiple states and that sounded to exhausting for me to investigate further. There is a local surgeon I know of who retired and did Medicare visits at home. It’s very very chill as a a job and seems to have no medical decision making other than send back to pcp to discuss further. I’m not sure who is employed by but I think it is not high stress at all and she’d know exactly what her schedule was. Humana Medicare advantage plan visits are what I get the most of from him. They’re a visit where you’re not supposed to address anything other than routine screenings and I think they did a blood flow test and vitals on the home ones.

 

[Apollyon]

Academic teaching. Anatomy profs are now in short supply!

So sorry to hear of her woes

That's a REAL bad sign of a med school, as per Ken Iserson. If you have doctors teaching anatomy, and not PhD anatomists, that's a red flag.

 

[Birdstrike]

If we had the faintest idea for a practical way to get out of Medicine entirely we would would have already done it.

 

[JacobMcCandles]

One of her colleagues said she suffers from “work induced autism” for whatever that’s worth.

She needs to quit hanging around this person.

 

[GassYous]

She needs to quit hanging around this person.

Yeah it might be contagious

 

[PTPuser]

In our wound care clinic we have some EM trained docs there. All left EM for all the reason stated on this site. I'm not EM, I'm DPM so I don't know what the process is like for the transition.

 

[DOswag]

The anxiety issue seems to be largely related to the stimulation and demands of EM specifically. By that I mean the inconsistency of the schedule, overwhelming environments, and in her words, “hurting people who are all unappreciative.” One of her colleagues said she suffers from “work induced autism” for whatever that’s worth.

Also, thank you for commenting! I hope everyone knows how much we appreciate the input from everyone.

Wooooooooooooow, this is the first time I've heard of this one. Maybe it'll be added in the next installment of the DSM...

As a psychiatrist, I can tell you this is absolutely not a thing.

 

[HemeOncHopeful19]

Urgent care
The VA

 

[EctopicFetus]

One of the saddest parts of this frankly is the loss of time. 4 years of med school, 3 (or4) in residency and seemingly she doesnt care if she works as a doctor. What an incredibly sad waste of time. Also the sacrifice in the peak years of youth only compounds things. I hope she finds something that makes her happier.

 

[Angry Birds]

Hello all,

I have spoken to some of you privately about this sort of thing, but my scrounging around here has convinced my partner to get your collective wisdom on leaving EM. Their anonymous message to the hive mind is this…

“Hello! EM resident here, finishing up my third and final year of training. I was drawn to the field by the excitement, ability to provide care to a safety net population, and the variety. I severely underestimated the cost the field would take on my mental, social, and emotional help (having panic attacks at and outside of work, pretty bad anxiety outside of work, etc). I quit the community job that I had lined up and the anxiety has improved significantly. I am incredibly disappointed that what I thought my dream job was is not actually my dream job, and the toll it was taking on my mental health was too much to tolerate. I am doing well in my personal life now but have no idea what to do career wise. I have $250,000 in debt. I want to settle down, have a family, and live a quiet farm life. However, my partner is starting medical school so it will be a few years before that is a feasible dream. I have done a lot of research into nonclinical careers or clinical careers with fewer demands but nothing has gotten me excited yet. I am ok with anything to pay the bills at this point and making some headway on the loans.

So here's my request: *help me find* what I should do besides emergency medicine! Tell me all of your experiences with nonclinical work: what was great, what wasn't great, and help me figure out what I should do instead.

Thank you all in advance!”

Me again - thank you all in double advance.

Edit: it’s worth noting they’ve been having a hard time mentally in medicine in general, which isn’t been improving. They have tried moonlighting and some more common approaches.

Find a super chill ER to work in. Try it out before calling it quits.

We all felt this way sometime in residency.

 

[Angry Birds]

Urgent care
The VA

Why an urgent care over a slow chill ER?

 

[HemeOncHopeful19]

Why an urgent care over a slow chill ER?

I mean personally I think the answer is find a good therapist/psychiatrist but they didn’t post a lot of detail, it seemed like some of their existential crisis was about working overnight shifts so I figured maybe urgent care would help that

 

[TooMuchResearch]

Why an urgent care over a slow chill ER?

There are still things that come into slow, chill ERs that aren't slow or chill.

 

[cyanide12345678]

Why an urgent care over a slow chill ER?

A urgent care is a grind, plus half the income.

A chill ER is just better. I’ve been at work 2.5 hours now, seen 0 patients. $200/hr for 0 patients is better than $125/hr for 3/hr low acuity patients.

 

[cyanide12345678]

There are still things that come into slow, chill ERs that aren't slow or chill.

They do. And slow chill ERs can get very very busy too. I’ve seen as low as 4 in 12 hours on a night shift and as many as 35 in 12 hours on a day shift.

But it’s not everyday, the average day is better than an urgent care. Also, having a critical patient while the rest of the department isn’t blowing up is actually refreshing.