What the F*** should I do with my life?

[bravotwozero]

Who in their right mind wants to be stung by a bee? That’s also a good reason to NOT be a beekeeper lol

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[Apollyon]

One EM alternative could be to become a bee keeper and then have a sideline niche practice of doing bee sting therapy. No idea what its for or what the evidence is.

Way back when I was a resident, in the computer system were all the tests you could ever order, and, there were some REALLY exotic ones that we sent out to Mayo (like, I got a ceruloplasmin level on a Sunday evening without even a hiccup - more esoteric than that). One was a bee venom test, so, it's at least diagnostic. Therapeutic? I don't know, yet, but, on a PBS special, I recall something in the works (but that was pharmacological).

The MUCH better money is just become an apiarist, and sell the honey and beeswax at farmer's markets.

 

[WilcoWorld]

It's been proposed for MS, but doesn't appear to work.

 

[Qex]

Here's one application:

Clinical randomized study of bee-sting therapy for rheumatoid arthritis​

[Clinical randomized study of bee-sting therapy for rheumatoid arthritis] - PubMed

Combined application of bee-venom therapy and medication is superior to simple use of medication in relieving RA, and when bee-sting therapy used, the commonly-taken doses of western medicines may be reduced, and the relapse rate gets lower.

pubmed.ncbi.nlm.nih.gov

 

[Sushirolls]

Here's an alternative to Medicine:

 

[Old_Mil]

So the world has changed a lot in the last 2 years. When I started Med school and decided on EM my original goal was to do EM residency, maybe Med-Ed fellowship, and enter the world of academic EM. Debt burden between myself and my physician spouse is around $400k, so manageable for a double-doc household.

But the world of EM has changed drastically. Academic jobs are virtually non-existent, and jobs in general are getting harder to come by. In the current market it’ll be difficult to impossible to find work in the same location as my spouse, making the whole situation quite hairy. I’ve thought of a few options and wanted to hear takes from the SDN hive-mind.

1) Do crit. I love crit, have the CV to get a spot if I want (maybe not in my preferred location but whatever). Pros: Will give me a better chance of being able to teach/do academic something either in CCM or EM. Cons: BRUTAL 2 year fellowship, 2 years long distance from the SO while she finishes training. 2 years lost wages. CCM job market isn’t headed in the best direction either.

2) Pick up a rural job, fly to and from wherever I live to wherever I work. Pros: geographic flexibility for the SO’s career, some hospitals in the boonies still treat their ED docs well. Cons: crummy work life balance and long term outlook is poor as the job market squeezes further and doing runs of flight+nights at 40 is a lot harder than it is at 28. Won’t be able to re-enter academics later.

3) Yolo and apply to every pain fellowship in the country. Pros: Pain is cool, I love procedures, will have a bit more control over my life and work environment. Cons: 1 year of long distance from the SO, and while I’d enjoy pain my passion is teaching and that’d be off the table for the most part.

Switch into a family or internal medicine residency.

 

[Groove]

So the world has changed a lot in the last 2 years. When I started Med school and decided on EM my original goal was to do EM residency, maybe Med-Ed fellowship, and enter the world of academic EM. Debt burden between myself and my physician spouse is around $400k, so manageable for a double-doc household.

But the world of EM has changed drastically. Academic jobs are virtually non-existent, and jobs in general are getting harder to come by. In the current market it’ll be difficult to impossible to find work in the same location as my spouse, making the whole situation quite hairy. I’ve thought of a few options and wanted to hear takes from the SDN hive-mind.

1) Do crit. I love crit, have the CV to get a spot if I want (maybe not in my preferred location but whatever). Pros: Will give me a better chance of being able to teach/do academic something either in CCM or EM. Cons: BRUTAL 2 year fellowship, 2 years long distance from the SO while she finishes training. 2 years lost wages. CCM job market isn’t headed in the best direction either.

2) Pick up a rural job, fly to and from wherever I live to wherever I work. Pros: geographic flexibility for the SO’s career, some hospitals in the boonies still treat their ED docs well. Cons: crummy work life balance and long term outlook is poor as the job market squeezes further and doing runs of flight+nights at 40 is a lot harder than it is at 28. Won’t be able to re-enter academics later.

3) Yolo and apply to every pain fellowship in the country. Pros: Pain is cool, I love procedures, will have a bit more control over my life and work environment. Cons: 1 year of long distance from the SO, and while I’d enjoy pain my passion is teaching and that’d be off the table for the most part.

I think you sound burned out and perhaps life is not as terrible as you might think. Is your spouse amenable to moving? If so, how can you say there is no place ANYWHERE that you could find a job alongside your spouse? What specialty are they? I have three EM colleagues that came to this city as couples. # 1( EM, Plastics), #2 (EM, FM), #3 (EM, EM). All of them have jobs. All of them came in the last 3 years. One of them is in training. It definitely can be done if you look around and are willing to travel/move to a few second tier cities and be flexible within an hour radius from the city. Now, if your SO has a nice job that he/she likes and isn't willing to move somewhere that you would have better job prospects....well that's an entirely different matter as well as totally unfair by my standards unless they want to become the bread winner and let you work part time locums.

If you can't move...just grab a locums job for any firefighter agency/cmg and be willing to travel 7-10 days a month. Spend the rest of your time home. There's nothing insurmountable to that kind of lifestyle. Academics....meh. You can always work the clinical track for any residency regardless of whether you have been involved in a residency program.

Think long and hard before going back to do a fellowship that you may or may not enjoy. That just sounds brutal to me in my forties. There's no way I'd go back to training unless it was a 1 year fellowship that allowed me to immediately make 30% more than what I can make now with equal or less work. I'm 100% focused on FIRE and work probably 20-30 more hours than my younger colleagues for no other reason than to bank extra $$$ for my retirement. Do I enjoy the work like I did 10 years ago? Of course not. However, it's totally doable and I have found that there is a certain degree of external and internal factors that can be manipulated to maximize my enjoyment. (group, hospital, employer, psychology, etc..) It's all fairly intellectually stimulating and that beats working on a factory line. It's also much more stimulating when you work with some younger colleagues who are really interested in the medicine and want to learn new things. So, in some regards, changing location or job can sometimes renew you a little bit.

I worked corporate American prior to medicine and so many of my weeks were just a mindless and soulless grind from Monday to Friday. In fact, most people working in American have jobs like that. I sometimes think physicians are way too idealistic and most of us have/had totally unrealistic expectations for job happiness. My worst weeks don't compare to the ones back then. Maybe you just need to step back and change your perspective.

See if your spouse would pick a place that would give you better prospects and be willing to grab the rural gig 1.5 hours outside the city that the new grads have been avoiding.

 

[The Knife & Gun Club]

I think you sound burned out and perhaps life is not as terrible as you might think. Is your spouse amenable to moving? If so, how can you say there is no place ANYWHERE that you could find a job alongside your spouse? What specialty are they? I have three EM colleagues that came to this city as couples. # 1( EM, Plastics), #2 (EM, FM), #3 (EM, EM). All of them have jobs. All of them came in the last 3 years. One of them is in training. It definitely can be done if you look around and are willing to travel/move to a few second tier cities and be flexible within an hour radius from the city. Now, if your SO has a nice job that he/she likes and isn't willing to move somewhere that you would have better job prospects....well that's an entirely different matter as well as totally unfair by my standards unless they want to become the bread winner and let you work part time locums.

If you can't move...just grab a locums job for any firefighter agency/cmg and be willing to travel 7-10 days a month. Spend the rest of your time home. There's nothing insurmountable to that kind of lifestyle. Academics....meh. You can always work the clinical track for any residency regardless of whether you have been involved in a residency program.

Think long and hard before going back to do a fellowship that you may or may not enjoy. That just sounds brutal to me in my forties. There's no way I'd go back to training unless it was a 1 year fellowship that allowed me to immediately make 30% more than what I can make now with equal or less work. I'm 100% focused on FIRE and work probably 20-30 more hours than my younger colleagues for no other reason than to bank extra $$$ for my retirement. Do I enjoy the work like I did 10 years ago? Of course not. However, it's totally doable and I have found that there is a certain degree of external and internal factors that can be manipulated to maximize my enjoyment. (group, hospital, employer, psychology, etc..) It's all fairly intellectually stimulating and that beats working on a factory line. It's also much more stimulating when you work with some younger colleagues who are really interested in the medicine and want to learn new things. So, in some regards, changing location or job can sometimes renew you a little bit.

I worked corporate American prior to medicine and so many of my weeks were just a mindless and soulless grind from Monday to Friday. In fact, most people working in American have jobs like that. I sometimes think physicians are way too idealistic and most of us have/had totally unrealistic expectations for job happiness. My worst weeks don't compare to the ones back then. Maybe you just need to step back and change your perspective.

See if your spouse would pick a place that would give you better prospects and be willing to grab the rural gig 1.5 hours outside the city that the new grads have been avoiding.

Thanks for the thoughts Groove - you’ve always got well thought out detailed responses that shed a lot of light on things.

Burn out is definitely a factor. When I wrote this I was on the trauma service which gave me a not-so-glamorous look at what other people in the hospital think of EM. “Parasitic speciality that adds nothing to patient care and probably SHOULD be done by NPs” was the language our Cheif used.

But the bigger problem is the long term employment. It just seems like the EM market is so incredibly bad that at this rate by the time I’m 40 I could really be facing a situation with NO discernible employment opportunities. Spouse is happy to move for work, but not to the boonies.

Lately I’ve been entertaining doing a year as a rural doc to see how I like it, and then go back for fellowship after.

But youre right. End of PGY1 burn out is definitely a huge factor - lots of days I just spend feeling like I’m doing a very difficult job that is viewed by the hospital/admin as superfluous...and not doing it particularly well anyway because I feel like I suck at my job compared to my colleagues.

 

[southerndoc]

The doom and gloom is there, but it's not as bad as people have stated. CMG's are dumping physician spots and replacing them with NP's. COVID affected volumes, which affected hiring and rates. Now that volumes are coming back, we are seeing recruitment for positions again and the rates are starting to increase. Give it time.

However, the number of graduating residents each year will create challenges ahead, but not as doom and gloom as many have stated.

 

[Birdstrike]

I’d enjoy pain my passion is teaching and that’d be off the table for the most part.

Why would teaching be off the table? I do Pain and I teach. I have residents rotating with me constantly. I could also get a job at a place with a Pain fellowship and teach there, if I wanted to. I’m not sure why Pain and teaching would be mutually exclusive for you.

 

[alpinism]

So if you really want to work in academics it will probably still be possible after graduation as long as you're willing to be flexible with location.

Most likely you won't be able to land a coastal big city program without any connections but there are still a few midwestern small town programs that are still regularly looking to hire new faculty physicians. Now of course none of these are in desirable locations but if you're okay with living someplace like Dayton or Springfield in Ohio with 200K population you could probably land something where you'll be supervising residents.