Thank you for your input,
@cyanide12345678 ! For some reason I cannot reply directly to your post. Please see my comments below.
"EM sure seems like a great specialty. when you have 4-5 patients at a time as an off service resident and the expectations are minimal."
I was ambitious during my EM rotations in residency and was juggling 4-11 patients at a time.
"But when you have 20+ on the board by yourself, seeing 2-3 patients per hour, and sometimes even more in the beginning of the shift, it sure doesn't seem that exciting."
Without an PA / NP? How often does this happen?
"But hey you want that nice chill rural job.
Will it be there when you graduate? Let's say you are ready to work in 4 years from today, that's another 8000 board certified docs in that time span, can the EM market absorb that without market pressures leading to decreasing incomes?"
Well, in 4 years some older EM docs will retire and the IM and FM good folks working in EDs will be replaced by ABEM docs. That should somewhat offset the EM doc surplus, correct?
"Your goal is to work less from what i understand, not see as many patients, and make a decent income.
Have you done the math and accounted for the opportunity cost?"
My primary goal is to be more professionally fulfilled. You are assuming I want to continue to work in / I'm able to tolerate hospital medicine enough to make $400K-$500K a year x 3 years. The other thing is I'm hoping for student loan forgiveness through the PSLF program, so I'll end up paying less towards my student loans during the 3 years of EM residency (10 % of $55K a year vs $400-$500K). So, I'll save on my student loans and come out of EM residency making probably at least $30 more per hour than I ever could as a hospitalist. It does not seem like a horrible financial decision, especially when we don't know what the stock market will do during those 3 years.
Having 20+ by myself happens maybe 3-4 shifts every month out of 12. I used to work at a 20,000 annual volume shop, 24 hour physician coverage and 10 hours mlp coverage. I'm now however moving to a very rural place, so it shouldn't happen much after. But ridiculously common in a normal paced EM job.
According to acep, there will be a 10,000 board certified EM doctor surplus by 2030. So that's about 8 years left. If you read their research paper, this number already accounts for older docs retiring and some FM/IM docs being replaced. But if you really evaluate their methods you soon realize that they also assume that residency expansion only continues at a rate of some 2 or so percent. It's been a while since i read their research paper but it was a very very soft assumption when in the last decade the number of residency spots have gone up at a much much much higher rate. In fact EM has seen the no. 1 growth in residency positions out of any other specialty. I don't feel like googling the exact numbers - but this is not a secret - 1 in 5 EM docs aka 10,000 surplus may potentially not have an EM job. I think 4-5 years is when we truly hit a point where every new doctor is essentially "surplus". So you think that the older docs retiring will cover the surplus - the biggest ER organization ACEP disagrees with you after extensive market research. It won't be surprising if people have to do fellowships after 5-6 years to get a job.
Take a 1-2 month hiatus. You are just burned out right now. Trust me, EM will not solve your burn out. Like hospitalist medicine, EM also happens to be one of the highest burn out inducing fields. You think EM might give you professional satisfaction, but what if it doesn't? What if you find yourself in the likely scenario of competing for **it jobs with 2000 other grads.
And yes I'm assuming that you can work 3 more years and grind it out. However hard your hispitalist job is, residency will be harder and suckier. In fact when you get paid $50k for working 70-80 hours a week, you feel even worse. At least when you go home after your hospitalist gig, you can tell yourself "hey at least I'm paid to do this crap".
Also you are accounting for pslf in your math. How many years are left before you hit your 120 payments. If its more than 3, then boy o boy you are setting yourself up for a disaster as most EM jobs, even in rural sites are private corporate groups, very few direct employment with universities and hospitals. If you had 1-2 years of pslf left after your EM residency, you my friend might not even be able to find a 503B kind of a job when the job market will already be terrible.
Also, don't be offended, but i don't think you know what you're talking about from a numbers perspective. 30/hr ??? That implies that you are required to pay $8000 in monthly loan payments - assuming you used the correct 70 hrs a week figure that you will work in residency rather than a 40 hours per week. Even then, with 40 hours per week, that translates to $5000/month minimum payments. Sounds high. But given the way you wrote that you will make $30/hr more than your hospitalist job, somehow you think you will make what $230/hr or something similar in residency accounting for loans?!?!?!? That makes absolutely no sense. If your on pslf, then your hospitalist job already is one that you should have picked to qualify. If it is, then pslf is a moot point, and the only difference would be the payments you make in 3 years. So the only difference will be that for 3 years you will make lower income based repayments. So maybe $200/month instead of $3000 per month or whatever. Your statement makes no sense.
Also your statement also makes no sense about what the market will do in those 3 years. My assumption for those 3 years is that the 900k is all YOUR savings. Because your gross income of 1.5 million, after expenses and taxes should leave you a good 900k if you live like a resident (like you would of you went back to residency making 50k/yr). 0 percent gain in 3 years was my assumption. My 7% assumption is over the next 10 years and the next 30 years. The stock market is a lot more predictable over long periods of time. So again, i don't think you truly understand the financial side of things, most doctors don't. Which is fine. So whatever you want, it's your life. But just understand that you will be working more and have a smaller net worth and will likely increase the number of years you will need to work before you hit financial Independence. And understand that you could go through this million dollar mistake and still feel unfulfilled because it's the needy, demanding, disrespectful patients burning you out, which EM has plenty of. And 2-3 years after practicing EM, you could be back to where you are currently - burned out and unhappy.
Also if your burning yourself out while working too many shifts, the answer isn't to waste 3 years on a residency with minimum pay, the answer usually is to pull back, take a vacation, cut back your hours, talk to someone for your unhappiness and burn out, and then eventually decide if a change in career is worth it.
I was burned out - haven't worked a shift for over 1 month because I'm on a hiatus. Feel pretty great and refreshed again and feel ready to put in another 2 or so years. Another 1.5 months of no work left.
