3 years out - officially a millionaire and one step closer to saying goodbye to EM

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cyanide12345678 said:
I know a few team health sites that do 3.5-4 pph because of residents.

Imagine generating revenue from 4 pph and then getting paid $200/hr. That’s probably $400/hr in to the pockets of team health.

It’s the inevitable, every CMG is incentivized to turn every level 2 hospital in the country in to a residency program. I don’t understand why our own people willingly become program directors and effectively screw the specialty further.

Imgs will always fill the specialty. I have so many people from Pakistan now messaging me about advice to applying to EM - my advice remains the same - dont do it.
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Field is on life support.

I went to a "powerhouse" that used to only take top candidates. Now they're taking Caribbean IMGs.
 
WhatJobDoIPick said:
Field is on life support.

I went to a "powerhouse" that used to only take top candidates. Now they're taking Caribbean IMGs.
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This is the part that I still can't shake.

I went to a T10 medical school. I scored in the 99% percentile for Step 1. Integrated plastics? ortho? derm? All of it was within reach, not just a pipedream.

And yet, I chose EM.

Truly the worst decision one could have made in that scenario. It's COMICAL to think about the various pieces of information, life circumstances, and my own personal psychology that led to making such a stupid and terrible decision.

It's hilarious to think about. I would have fared better if I had just taken a dart and thrown it on a scatterboard of specialties.

If I had just picked what my parents told me, I would be in some subspecialty and have options, respect, income, and so many other perks that EM doesn't afford.

If I had just listened to MULTIPLE attendings who warned me (granted they were all in other specialties, every EM academician I interacted with had a unicorn-type job that was not generalizable and thus gave trash-tier advice, but how was I supposed to know as a ******ed 24 year old)

No. I listened to my heart. I listened to the gut feeling I had. I wanted to help all walks of life.

I can only blame myself for my position, and now I have to figure out a way to claw myself out.

Though I, too, am human, I have likely become soft now that I've FIRE'd in a lovely VHCOL city.

Sigh.
 
Splenda88 said:
I really don't see why an EM doc can't be a hospitalist TBH.

EM make a lot per hrs than us, but our lifestyle might be better.

I am pleasantly surprised how good lifestyle has been for the past 3 yrs I have been a hospitalist. I sometimes watch 2 entire soccer games (4 hrs) at the lounge and still make it out of the hospital by 4pm.

Some of my colleagues would go to do their nails, go shopping, go watch their kid recitals, basketball/soccer games etc... and come back to the hospital to finish their work

I have actually documented the time I spend at the hospital this year. I make 453k this year working 18.7 days/month (~43 hrs/week being in the hospital) on average.
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Telehospitalist is the real hack (until we get replaced too)

All of the same, but no commute, and in your PJs
 
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JacobMcCandles said:
It’s difficult to make money if your underlying message is financial independence by educating yourself and doing it yourself. If you really want to make money then the chance is high you’re going to become more like the person you preach against. You can try to ride the fence but your crotch is going to get sore.
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Sadly, realizing this as well.
One must become the admin they grew to loathe.
Only then will one attain nirvana.
 
HemorrhagicShock said:
This is the part that I still can't shake.

I went to a T10 medical school. I scored in the 99% percentile for Step 1. Integrated plastics? ortho? derm? All of it was within reach, not just a pipedream.

And yet, I chose EM.

Truly the worst decision one could have made in that scenario. It's COMICAL to think about the various pieces of information, life circumstances, and my own personal psychology that led to making such a stupid and terrible decision.

It's hilarious to think about. I would have fared better if I had just taken a dart and thrown it on a scatterboard of specialties.

If I had just picked what my parents told me, I would be in some subspecialty and have options, respect, income, and so many other perks that EM doesn't afford.

If I had just listened to MULTIPLE attendings who warned me (granted they were all in other specialties, every EM academician I interacted with had a unicorn-type job that was not generalizable and thus gave trash-tier advice, but how was I supposed to know as a ******ed 24 year old)

No. I listened to my heart. I listened to the gut feeling I had. I wanted to help all walks of life.

I can only blame myself for my position, and now I have to figure out a way to claw myself out.

Though I, too, am human, I have likely become soft now that I've FIRE'd in a lovely VHCOL city.

Sigh.
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Same here brother. Any specialty I wanted was within reach. Fell into the same trap you described. As the waiting room piledd up the other day and the screams and alarms and EKGs and interruptions kept flowing I reflected on the absurdity of our jobs.

I wish I recognized the insanity of it intern year and switched out.

Oh well. At least we didn't do peds or obgyn.
 
WhatJobDoIPick said:
Same here brother. Any specialty I wanted was within reach. Fell into the same trap you described. As the waiting room piledd up the other day and the screams and alarms and EKGs and interruptions kept flowing I reflected on the absurdity of our jobs.

I wish I recognized the insanity of it intern year and switched out.

Oh well. At least we didn't do peds or obgyn.
Click to expand...

We're not alone either. There's LOTS of us who got trapped in the ROAD-E myth.

And honestly my first few attending years were great until the endemic problems accelerated during the run-up to and during covid.

I do think I at least caught a few of the "Golden Ages" of EM, and thank god I internalized the "live like a resident" mantra for effectively the entire time I practiced. It allowed me to escape with the VOO/VTI DCA along with a few concentrated bets.

Here's one question I have for you (as somebody who was swindled on EM in medical school):

Were you shielded from all the BS when you were a rotator? I never even knew how bad the disrespect was from other consultants was a medical student. I had zero concept of billing, and coding, and RVUs and patient satisfaction. Those were not terms I could define as an MS4 who went to a hyper-academic medical school.

Perhaps part of that was when we chose EM, it was a specialty that was a step below Derm in competitiveness. So I had this idea that "well, if it's broadly accepted as a competitive specialty, only have to work 12 days a month, and gets paid pretty damn well, and it's actually sexy to laypeople unlike the rest of the ROAD...."

Seemed like a no-brainer.

Then, I never switched in residency (despite thinking about it) because it was hard to tell what the newness of being a responsible physician vs what I intrinsically hated about the specialty. Thus I pressed on because mentors told me, "This is normal to feel in residency." (THIS IS OFTEN TIMES A MASSIVE LIE TO ANY MEDICAL STUDENT OR RESIDENT READING THIS)

Despite this, and clearly because I am a high-achiever that's pretty damn capable (not trying to fluff myself here, just stating that I have a pretty solid track record throughout my life), I was able to excel at the job.

It just took me YEARS of being an attending to realize that I actually just hated the job, hated the uneducated patients who felt no responsibility towards their own health (educated and reasonable patients were great, but they were 1% of the population), and above all else hated the constant disrespect and uphill battle every ER doc has to face.

EM has to perform at 100%, no-miss, near perfect, all with a smile, 24/7 just to not get **** on and keep your job.

Ortho or cards? They can literally sexually abuse nurses, get caught, and somehow the RNs will be fired, because well, the hospital doesn't want to lose its money makers.

It's so insane to me that we all started on the same footing on day 1 of medical school.

I'm honestly glad medicine is losing popularity among college students. The entire nation needs to feel the deep pain of a tragically undereducated "provider" workforce combined with an increasingly hostile for-profit payor system before anything will change.

Blood in the streets indeed.

We're gonna need a BUS FULL of dead Libby Zions to overwork this behemoth of a system though.

Not hopeful anytime during my life.

Maybe I can start a Walmart drop-ship business. Seems like it has more upside than being a board-certified ER doc if you want to live in a VHCOL/desirable city. Wanna teach me? @cyanide12345678
 
HemorrhagicShock said:
We're not alone either. There's LOTS of us who got trapped in the ROAD-E myth.

And honestly my first few attending years were great until the endemic problems accelerated during the run-up to and during covid.

I do think I at least caught a few of the "Golden Ages" of EM, and thank god I internalized the "live like a resident" mantra for effectively the entire time I practiced. It allowed me to escape with the VOO/VTI DCA along with a few concentrated bets.

Here's one question I have for you (as somebody who was swindled on EM in medical school):

Were you shielded from all the BS when you were a rotator? I never even knew how bad the disrespect was from other consultants was a medical student. I had zero concept of billing, and coding, and RVUs and patient satisfaction. Those were not terms I could define as an MS4 who went to a hyper-academic medical school.

Perhaps part of that was when we chose EM, it was a specialty that was a step below Derm in competitiveness. So I had this idea that "well, if it's broadly accepted as a competitive specialty, only have to work 12 days a month, and gets paid pretty damn well, and it's actually sexy to laypeople unlike the rest of the ROAD...."

Seemed like a no-brainer.

Then, I never switched in residency (despite thinking about it) because it was hard to tell what the newness of being a responsible physician vs what I intrinsically hated about the specialty. Thus I pressed on because mentors told me, "This is normal to feel in residency." (THIS IS OFTEN TIMES A MASSIVE LIE TO ANY MEDICAL STUDENT OR RESIDENT READING THIS)

Despite this, and clearly because I am a high-achiever that's pretty damn capable (not trying to fluff myself here, just stating that I have a pretty solid track record throughout my life), I was able to excel at the job.

It just took me YEARS of being an attending to realize that I actually just hated the job, hated the uneducated patients who felt no responsibility towards their own health (educated and reasonable patients were great, but they were 1% of the population), and above all else hated the constant disrespect and uphill battle every ER doc has to face.

EM has to perform at 100%, no-miss, near perfect, all with a smile, 24/7 just to not get **** on and keep your job.

Ortho or cards? They can literally sexually abuse nurses, get caught, and somehow the RNs will be fired, because well, the hospital doesn't want to lose its money makers.

It's so insane to me that we all started on the same footing on day 1 of medical school.

I'm honestly glad medicine is losing popularity among college students. The entire nation needs to feel the deep pain of a tragically undereducated "provider" workforce combined with an increasingly hostile for-profit payor system before anything will change.

Blood in the streets indeed.

We're gonna need a BUS FULL of dead Libby Zions to overwork this behemoth of a system though.

Not hopeful anytime during my life.

Maybe I can start a Walmart drop-ship business. Seems like it has more upside than being a board-certified ER doc if you want to live in a VHCOL/desirable city. Wanna teach me? @cyanide12345678
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I don't think I was shielded necessarily. The work is just different once youre in it.

I think it might be the only specialty that gets worse once you're an attending.
 
WhatJobDoIPick said:
I don't think I was shielded necessarily. The work is just different once youre in it.

I think it might be the only specialty that gets worse once you're an attending.
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Radiology, though their lives are better.
 
Osteoth said:
Radiology, though their lives are better.
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How is this possible?

They seem like they have the best of all worlds?

Yea it's a grind to sit and crank out studies, but the ED is a similar mental/physical grind except a thousand times worse for a thousand reasons

Maybe I need to look harder but I don't have a single unhappy radiologist friend or colleague. In fact they're the only specialty that routinely says they'll encourage their kids to go into medicine, they'd do it over again, no regrets, love medicine, etc.
 
HemorrhagicShock said:
How is this possible?

They seem like they have the best of all worlds?

Yea it's a grind to sit and crank out studies, but the ED is a similar mental/physical grind except a thousand times worse for a thousand reasons

Maybe I need to look harder but I don't have a single unhappy radiologist friend or colleague. In fact they're the only specialty that routinely says they'll encourage their kids to go into medicine, they'd do it over again, no regrets, love medicine, etc.
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Yeah, I think of my friend from med school, married 25+ years to a non-doctor, happy mother, 7k sq ft house in Seattle, in her BMW.

Yes, 7,000 square foot house. It has 4 furnaces.
 
HemorrhagicShock said:
How is this possible?

They seem like they have the best of all worlds?

Yea it's a grind to sit and crank out studies, but the ED is a similar mental/physical grind except a thousand times worse for a thousand reasons

Maybe I need to look harder but I don't have a single unhappy radiologist friend or colleague. In fact they're the only specialty that routinely says they'll encourage their kids to go into medicine, they'd do it over again, no regrets, love medicine, etc.
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No just being an attending is harder than being a resident. Volume requirements etc.
 
TysonCook said:
My bro is a rads... same problems we face... decreasing reimbursements, increased productivity, PE firms gobbling up groups and no "local market" for rates in diagnostics (i.e. if you can read from New York you can work in Denver). Screws up "local rate" market mentality.
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Radiology job supply / demand ratio is great for the foreseeable future, though. Barring some AI revolution I guess. Everywhere is desperate for them.

EM is already cooked everywhere - god forbid you want to live somewhere desirable, enjoy making a PA wage as a ABEM doc. USACS recently advertised a 175/h job in a BFE city. Embarrassing.
 
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In mid 2000s i knew.. i was told no respect, you need to have a thick skin etc. Maybe rotating in super ****ty hospitals prevented the BS.

I would 100% discourage my kids from doing EM. I have told my old scribes.. avoid EM.. at all costs.. The kids still dont listen.. if i can help 1 person its worth the message since it costs me 0 to tell the truth and my well being isnt reliant on having residents.

The pay is about to start to trend down.. a year from today (mark it down) we will be talking about this openly.. ACEP wants it both ways.. the workforce issues arent real and yet here are the ways to get out of EM (you know in case they are). That the study they reference shows the career longevity to be incredibly short seems to not matter to these people.

IMO get your $$ in order, always be hustling.. find a side gig.. make sure it pays.. or at least has tremendous upside. It can be in medicine (medspa etc) or outside (rental real estate, development, flipping homes, owning /starting a business).

I have been looking for a coin laundromat for some time.. to me this is how you maximize what EM does do for you.. relatively low hours for relatively high pay.. the hours are hard. I spend very little time at the hospital not generating income.

Surgeons sit around and wait for the OR.. they make $0 here.. just food for thought.. we have talked about this before and has been covered but the advice still stands.. @emergentmd has it figured out.. we should all learn..
 
1. Medicine, really no matter what field you go into, will suck your best years from you. Bye bye 20's. This is just the reality. Do the best you can to enjoy the ride and find time to have some fun. being top 10 isn't worth the Grind.
2. EM was and is a good field if you go into it with the correct mindset. But this goes with all fields. I know many unhappy cardiologist, surgeons, OB, internist, anesthesiologist. Every field has their plus/minuses. Focus on what is great about the field and be happy that you are making a bunch of $$$. Stop comparing yourself to the unicorn Tech or finance or law friend who is making $1M at age 25. They are the unicorn just like I know many ER docs making 7 figures working very little or even at all.
3. Do whatever you need to make your job the long game. Don't get burned out in 5 years. If working less is the key, do it. Just find the key.
4. Have an escape plan and once you get their, EM like any other job is very enjoyable b/c you are doing it because you want to.
5. EM docs at 30 make 400K/yr. You are in an extremely rare financial spot. It is now up to you to decide what you want when you are 40 or 50. If you are 50 and still have to grind to make 400K, then you have made some poor decisions.

@EctopicFetus, with alot of luck, I have figured it out. EM is a great platform for making high $/hr and alot of time to do something else. When you are in the EM grind, it is hard to see the other side. Now that I am on the other side, I am very grateful for what EM has given me.

I am right at 50 years old. I have more money that I could spend and spend on things just because I can. Just took a ski trip and took the HS daughter shopping. She liked a 5K purse but didn't dare ask to buy it. Well, I went back and got it for her as a Bday gift. My wife wanted a bracelet and was shocked when I told her to get the ones with all the diamonds. A waste of money? Absolutely. But when you are on the other side, you start to think of time/money/life differently. I have another good 10-20 years left on this earth. I have worked hard and am going to pamper myself/my family because when I die, guess who is going to spend all of my hard work? It could be some lazy in law or grandkid who I may not have ever met, so might as well spend it on myself and the ones who supported me during my selfish journey.

Now I live on my own terms and with no money constraints, it is absolutely liberating. I work 4 dys a month and just decided to cut down to 2 because my EM workplace is fun. I still have a few side gigs because it doesn't take much time and I enjoy it. I golf all the time. When I am working, my kids are shocked. When my kids are out of school, I am off. I have yearly ski, vegas, lake, golf trips with my buddies. I go to the gym 3 times a week with my wife.

I am not some unicorn. EM docs finish relatively early, make a high rate, have lots of off days. Plan, take some risks, and you can be 50 with FIRE while your Tech, Law, finance buddies are still working full time.
 
emergentmd said:
1. Medicine, really no matter what field you go into, will suck your best years from you. Bye bye 20's. This is just the reality. Do the best you can to enjoy the ride and find time to have some fun. being top 10 isn't worth the Grind.
2. EM was and is a good field if you go into it with the correct mindset. But this goes with all fields. I know many unhappy cardiologist, surgeons, OB, internist, anesthesiologist. Every field has their plus/minuses. Focus on what is great about the field and be happy that you are making a bunch of $$$. Stop comparing yourself to the unicorn Tech or finance or law friend who is making $1M at age 25. They are the unicorn just like I know many ER docs making 7 figures working very little or even at all.
3. Do whatever you need to make your job the long game. Don't get burned out in 5 years. If working less is the key, do it. Just find the key.
4. Have an escape plan and once you get their, EM like any other job is very enjoyable b/c you are doing it because you want to.
5. EM docs at 30 make 400K/yr. You are in an extremely rare financial spot. It is now up to you to decide what you want when you are 40 or 50. If you are 50 and still have to grind to make 400K, then you have made some poor decisions.

@EctopicFetus, with alot of luck, I have figured it out. EM is a great platform for making high $/hr and alot of time to do something else. When you are in the EM grind, it is hard to see the other side. Now that I am on the other side, I am very grateful for what EM has given me.

I am right at 50 years old. I have more money that I could spend and spend on things just because I can. Just took a ski trip and took the HS daughter shopping. She liked a 5K purse but didn't dare ask to buy it. Well, I went back and got it for her as a Bday gift. My wife wanted a bracelet and was shocked when I told her to get the ones with all the diamonds. A waste of money? Absolutely. But when you are on the other side, you start to think of time/money/life differently. I have another good 10-20 years left on this earth. I have worked hard and am going to pamper myself/my family because when I die, guess who is going to spend all of my hard work? It could be some lazy in law or grandkid who I may not have ever met, so might as well spend it on myself and the ones who supported me during my selfish journey.

Now I live on my own terms and with no money constraints, it is absolutely liberating. I work 4 dys a month and just decided to cut down to 2 because my EM workplace is fun. I still have a few side gigs because it doesn't take much time and I enjoy it. I golf all the time. When I am working, my kids are shocked. When my kids are out of school, I am off. I have yearly ski, vegas, lake, golf trips with my buddies. I go to the gym 3 times a week with my wife.

I am not some unicorn. EM docs finish relatively early, make a high rate, have lots of off days. Plan, take some risks, and you can be 50 with FIRE while your Tech, Law, finance buddies are still working full time.
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I just don't understand that concept because most 22-30 yr old are working 50 hrs a week making 40-70k yr to pay their bills. They are not enjoying life (eg., going to parties, traveling every 3-4 months etc...) like people in SDN usually portrays it.

The idea that people in SDN think most people in that age are enjoying life is a myth.

I was a nontrad student and my med school classmates who were less than 30s party/travel than most of 20-30 yr old that I knew at that time.

The 3-7 yrs of residency is a different story, then again some residencies such as FM, psych, PM&R, even some IM etc... are not that brutal
 
Splenda88 said:
I just don't understand that concept because most 22-30 yr old are working 50 hrs a week making 40-70k yr to pay their bills. They are not enjoying life (eg., going to parties, traveling every 3-4 months etc...) like people in SDN usually portrays it.

The idea that people in SDN think most people in that age are enjoying life is a myth.

I was a nontrad student and my med school classmates who were less than 30s party/travel than most of 20-30 yr old that I knew at that time.

The 3-7 yrs of residency is a different story, then again some residencies such as FM, psych, PM&R, even some IM etc... are not that brutal
Click to expand...
I think the world is changing a bit.. an EM buddy of mine had his daughter go to a really good school, took a job with a fortune 100 company and she was a CompSci major.. She was making 170k+ benefits by 28. It’s not EM / doc money.. but its no weekends or holidays.

I do tend to agree. I was also non trad and did management consulting prior to med school. I remember working and not seeing the sun for 5 days in a row and thinking WTF am i doing. I was making pretty good money at the time and frankly had no time to spend it. It’s not all easy sledding for others but it is very different. Keep in mind your 23 year old friend is making 60-70k and you are going 60-70k in debt for a net 120k opportunity cost (more if you include interest on your loans and their potentially saving some money). That money they earn provides opportunity. When I left consulting a friend of mine did an excel spreadsheet using the best available data and my financial break even was in my mid to late 50s. It was a different world back then. I have far exceeded things financially but I will say the “lower tier” partners in consulting 20+ years ago were making 425k/yr plus some other very lucrative benefits..
 
Splenda88 said:
I just don't understand that concept because most 22-30 yr old are working 50 hrs a week making 40-70k yr to pay their bills. They are not enjoying life (eg., going to parties, traveling every 3-4 months etc...) like people in SDN usually portrays it.

The idea that people in SDN think most people in that age are enjoying life is a myth.

I was a nontrad student and my med school classmates who were less than 30s party/travel than most of 20-30 yr old that I knew at that time.

The 3-7 yrs of residency is a different story, then again some residencies such as FM, psych, PM&R, even some IM etc... are not that brutal
Click to expand...

When I did med school/residency 25 years ago may be different than today. I was poor, and med school was a time suck. Class, study, sleep. Too poor and tired to do anything else. Residency back then didn't have the 80 hr limit so 2/3 of the residency was 80-120hrs/wk. So work, work out alittle, sleep. Too poor and tired to do anything else.

So for someone poor, those are 7 years that was void of fun. I guess if I came from a rich family, it would have been different.

I was an engineer by trade. I had a very good job lined up back in the day that I didn't take b/c went to med school. This was 30 years ago, had a 70K job offer which was a hell of alot of money in 1994. 20 year old, making 70K, very little debt. In todays dollars, 70k=140K. I think I would have enjoyed my 20's a heck of alot more than working 80+hrs/wk and broke.

TBH, I have always wondered what life was like if I stayed an engineer. I was top of my class at a top school, had offers with most top tech companies.
 
emergentmd said:
When I did med school/residency 25 years ago may be different than today. I was poor, and med school was a time suck. Class, study, sleep. Too poor and tired to do anything else. Residency back then didn't have the 80 hr limit so 2/3 of the residency was 80-120hrs/wk. So work, work out alittle, sleep. Too poor and tired to do anything else.

So for someone poor, those are 7 years that was void of fun. I guess if I came from a rich family, it would have been different.

I was an engineer by trade. I had a very good job lined up back in the day that I didn't take b/c went to med school. This was 30 years ago, had a 70K job offer which was a hell of alot of money in 1994. 20 year old, making 70K, very little debt. In todays dollars, 70k=140K. I think I would have enjoyed my 20's a heck of alot more than working 80+hrs/wk and broke.

TBH, I have always wondered what life was like if I stayed an engineer. I was top of my class at a top school, had offers with most top tech companies.
Click to expand...

You wanna think that one all the way thru, bud?
 
RustedFox said:
But what does that 70k get you today? A whole lot less.
Click to expand...
My post was my opportunity cost 25 yrs ago and medicine costing me my 20's as a poor dude.

25 yrs ago, I turned down a 70K job that would be 140K in today's money. Medicine, atleast for a poor educated person, is a huge opportunity cost.
 
emergentmd said:
My post was my opportunity cost 25 yrs ago and medicine costing me my 20's as a poor dude.

25 yrs ago, I turned down a 70K job that would be 140K in today's money. Medicine, atleast for a poor educated person, is a huge opportunity cost.
Click to expand...

You're right, bud.
I read the whole thing incorrectly. Watching "The PITT" at the same time.
 
emergentmd said:
When I did med school/residency 25 years ago may be different than today. I was poor, and med school was a time suck. Class, study, sleep. Too poor and tired to do anything else. Residency back then didn't have the 80 hr limit so 2/3 of the residency was 80-120hrs/wk. So work, work out alittle, sleep. Too poor and tired to do anything else.

So for someone poor, those are 7 years that was void of fun. I guess if I came from a rich family, it would have been different.

I was an engineer by trade. I had a very good job lined up back in the day that I didn't take b/c went to med school. This was 30 years ago, had a 70K job offer which was a hell of alot of money in 1994. 20 year old, making 70K, very little debt. In todays dollars, 70k=140K. I think I would have enjoyed my 20's a heck of alot more than working 80+hrs/wk and broke.

TBH, I have always wondered what life was like if I stayed an engineer. I was top of my class at a top school, had offers with most top tech companies.
Click to expand...
That reminds me of something. In an earlier episode of ER, George Clooney, as the pediatrician, talks about taking an office job for "90 grand a year, and no nights in the pit", or some such. That 90K in 1995 was righteous buxx back then.
 
HemorrhagicShock said:
How is it?

I say this as somebody who generally can't watch any medical show because I don't want anything in my out-of-the-pit life to remind me of my in-the-pit-life
Click to expand...

I got :15 minutes left in the first two episodes (that's all that's released right now).
I'll keep it all in the other thread about it.
 
I have never been able to watch any medical shows. My wife keeps giving me the look when I tell them it is all wrong. 🙂
 
emergentmd said:
I have never been able to watch any medical shows. My wife keeps giving me the look when I tell them it is all wrong. 🙂
Click to expand...

Except for being a wealthy self-made double-digit millionaire who caught lightning in a bottle while living in a perfectly deregulated state where you could leverage your skills outside of a traditional ED environment....

.... it seems we live a similar life :laugh:
 
EctopicFetus said:
I think the world is changing a bit.. an EM buddy of mine had his daughter go to a really good school, took a job with a fortune 100 company and she was a CompSci major.. She was making 170k+ benefits by 28. It’s not EM / doc money.. but its no weekends or holidays.

I do tend to agree. I was also non trad and did management consulting prior to med school. I remember working and not seeing the sun for 5 days in a row and thinking WTF am i doing. I was making pretty good money at the time and frankly had no time to spend it. It’s not all easy sledding for others but it is very different. Keep in mind your 23 year old friend is making 60-70k and you are going 60-70k in debt for a net 120k opportunity cost (more if you include interest on your loans and their potentially saving some money). That money they earn provides opportunity. When I left consulting a friend of mine did an excel spreadsheet using the best available data and my financial break even was in my mid to late 50s. It was a different world back then. I have far exceeded things financially but I will say the “lower tier” partners in consulting 20+ years ago were making 425k/yr plus some other very lucrative benefits..
Click to expand...
I agree about loan, but the break even aspect is hard to calculate, because once we become attending, our purchasing power exceed that of most people.

For instance, I already have 3 houses. 2 of them I have yet to pay off with a total ~245k balance. I can go out there and purchase another 500k home, and the banks would not hesitate to finance it because of my salary (453K last year).
 
emergentmd said:
When I did med school/residency 25 years ago may be different than today. I was poor, and med school was a time suck. Class, study, sleep. Too poor and tired to do anything else. Residency back then didn't have the 80 hr limit so 2/3 of the residency was 80-120hrs/wk. So work, work out alittle, sleep. Too poor and tired to do anything else.

So for someone poor, those are 7 years that was void of fun. I guess if I came from a rich family, it would have been different.

I was an engineer by trade. I had a very good job lined up back in the day that I didn't take b/c went to med school. This was 30 years ago, had a 70K job offer which was a hell of alot of money in 1994. 20 year old, making 70K, very little debt. In todays dollars, 70k=140K. I think I would have enjoyed my 20's a heck of alot more than working 80+hrs/wk and broke.

TBH, I have always wondered what life was like if I stayed an engineer. I was top of my class at a top school, had offers with most top tech companies.
Click to expand...
No need to wonder, at least financially, when your net worth is 15+ mil. Lol
 
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If we’re talking opportunity cost, why not go even earlier? My high school had a good vocational program, so we had guys walk straight into apprenticeships in the trades at 18 making the equivalent of $60k back then. 4 or so years to hit journeyman and a pay jump, even more if they make master at 8-10 years. Zero educational debt. Overtime is common and benefits are good if you’re union. Them boys still found plenty of time to party.

Not uncommon to be at 6 figures by their mid-20s. Employment anywhere.
 
eyeeye_captain said:
If we’re talking opportunity cost, why not go even earlier? My high school had a good vocational program, so we had guys walk straight into apprenticeships in the trades at 18 making the equivalent of $60k back then. 4 or so years to hit journeyman and a pay jump, even more if they make master at 8-10 years. Zero educational debt. Overtime is common and benefits are good if you’re union. Them boys still found plenty of time to party.

Not uncommon to be at 6 figures by their mid-20s. Employment anywhere.
Click to expand...

Your username and image get me to laugh hard every time you post.
 
RustedFox said:
Your username and image get me to laugh hard every time you post.
Click to expand...
IMG_0324.gif
 
eyeeye_captain said:
If we’re talking opportunity cost, why not go even earlier? My high school had a good vocational program, so we had guys walk straight into apprenticeships in the trades at 18 making the equivalent of $60k back then. 4 or so years to hit journeyman and a pay jump, even more if they make master at 8-10 years. Zero educational debt. Overtime is common and benefits are good if you’re union. Them boys still found plenty of time to party.

Not uncommon to be at 6 figures by their mid-20s. Employment anywhere.
Click to expand...
One thing about those jobs is they usually arent long term sustainable. Maybe in a union but the amount of money some of these jobs are making is a relatively new phenomenon. I used to be able to get manual labor fairly cheaply. Now it is much more expensive. Also, there are a lot of 70 year old consultants, 70 year old docs but i dont see a lot of 70 year old construction workers. I am not downplaying the opportunity of working a trade just that it is a more physically demanding job, the conditions are harsher (often have to work outside or without heat or AC), injuries are more common etc.

Also, depending on what we are comparing to, ill say there is a difference in making 150k vs 400k/yr..
 
emergentmd said:
1. Medicine, really no matter what field you go into, will suck your best years from you. Bye bye 20's. This is just the reality. Do the best you can to enjoy the ride and find time to have some fun. being top 10 isn't worth the Grind.
2. EM was and is a good field if you go into it with the correct mindset. But this goes with all fields. I know many unhappy cardiologist, surgeons, OB, internist, anesthesiologist. Every field has their plus/minuses. Focus on what is great about the field and be happy that you are making a bunch of $$$. Stop comparing yourself to the unicorn Tech or finance or law friend who is making $1M at age 25. They are the unicorn just like I know many ER docs making 7 figures working very little or even at all.
3. Do whatever you need to make your job the long game. Don't get burned out in 5 years. If working less is the key, do it. Just find the key.
4. Have an escape plan and once you get their, EM like any other job is very enjoyable b/c you are doing it because you want to.
5. EM docs at 30 make 400K/yr. You are in an extremely rare financial spot. It is now up to you to decide what you want when you are 40 or 50. If you are 50 and still have to grind to make 400K, then you have made some poor decisions.

@EctopicFetus, with alot of luck, I have figured it out. EM is a great platform for making high $/hr and alot of time to do something else. When you are in the EM grind, it is hard to see the other side. Now that I am on the other side, I am very grateful for what EM has given me.

I am right at 50 years old. I have more money that I could spend and spend on things just because I can. Just took a ski trip and took the HS daughter shopping. She liked a 5K purse but didn't dare ask to buy it. Well, I went back and got it for her as a Bday gift. My wife wanted a bracelet and was shocked when I told her to get the ones with all the diamonds. A waste of money? Absolutely. But when you are on the other side, you start to think of time/money/life differently. I have another good 10-20 years left on this earth. I have worked hard and am going to pamper myself/my family because when I die, guess who is going to spend all of my hard work? It could be some lazy in law or grandkid who I may not have ever met, so might as well spend it on myself and the ones who supported me during my selfish journey.

Now I live on my own terms and with no money constraints, it is absolutely liberating. I work 4 dys a month and just decided to cut down to 2 because my EM workplace is fun. I still have a few side gigs because it doesn't take much time and I enjoy it. I golf all the time. When I am working, my kids are shocked. When my kids are out of school, I am off. I have yearly ski, vegas, lake, golf trips with my buddies. I go to the gym 3 times a week with my wife.

I am not some unicorn. EM docs finish relatively early, make a high rate, have lots of off days. Plan, take some risks, and you can be 50 with FIRE while your Tech, Law, finance buddies are still working full time.
Click to expand...

lucky girl. Here I am giving my attending gas sis year 1 a little scoff when i found out she bought a bag for 3500 that looks as small as a sub 1000 bag. Not counting trips, flights or experiences I dont think ive ever bought myself anything more than 500-1000 bc i just keep dumping it into the market.

You have a good amount of money you should invest it in health : trainers/food/supplements. Even if it gets you another 5-10 years of quality life into your early 80s its worth it but you need to start now.
 
retro said:
Quick question for people more financially savvy. I'm ~ 5 years out of my residency training and currently have 1.6 million saved up. I'm very risk averse and conservative when it comes to investing, so I've been putting most of my asset in CD account, content with 4-5% return in interest. Now that the fed is cutting rate, CD interest rates are also going down drastically. I'm considering taking my asset out of the CD account when the term expires, but I can't think of an alternative investment option. I feel like the stock market is way too fired up right now, and I have concerns over how 2025 market is going to pan out. Should I look into real estate options? Or should I wait until the stock market cools down a bit to start buying? Any recs would be appreciated.
Click to expand...

I did something this silly early on too except my interest rates were like 2% from a savings account. Bc of my dumb good luck I ended up lump sum investing everything i had right after covid crash which basicallly gave me VOO at prices that were right when i started attendinghood 3-4 years before then. I read a lot of WCI and was also risk averse till i read and learned enough. Like others echo dca in over next 12 months and if we crash hard dump it all into the market but make sure you already have it in your brokerage way before.

Good luck you should be on a path to FIRE in the next 5-7 years just from that large sum which it breaks my heart could be 3m had you known some of this 5 years ago but you still get there so who cares.
 
The key is continuing to save. Work like a dog to get your finances in a healthy trajectory. Then work as much as you wish to meet your goals. I still enjoy working so I work more than I need but it lets me save even more. I expanded my lifestyle some but nothing wild. We all make tons of money so we can be smart and invest and get where we need to financially. For me hitting CoastFI a few years back changed my mindset. I stopped worrying quite as much, expanded my lifestyle a bit, did as mentioned and invested in health for things like a personal trainer etc.

Financial wellbeing matters but I think it might be horrible to have financial wellbeing and lose your physical health. i have seen this happen both with sudden death at a young age as well as having really bad back, knee medical issues which wouldn't allow for travel (or at least not the type of travel the person wished for).

When your kids are very young.. save like the dickens so when they are older and remember the nicer things you can do you do them. I don't think you should live a miserly life now and expect you will open the purse strings later. You have to enjoy the journey not just the destination.
 
finalpsychyear said:
lucky girl. Here I am giving my attending gas sis year 1 a little scoff when i found out she bought a bag for 3500 that looks as small as a sub 1000 bag. Not counting trips, flights or experiences I dont think ive ever bought myself anything more than 500-1000 bc i just keep dumping it into the market.

You have a good amount of money you should invest it in health : trainers/food/supplements. Even if it gets you another 5-10 years of quality life into your early 80s its worth it but you need to start now.
Click to expand...
I completely agree. I have always lived a healthy lifestyle and will continue this. Alot of Golf, still working out, low stress life, sleep alot. I have a friend that does all of the health/fitness/lifestyle modification that I may look into but I just don't have the motivation right now.

What I have learned at 50 that I wish I knew at 20 is to balance out your life. I remember in residency, growing up poor, I took out the absolute minimum loan to get through med school. I should have taken out another 100K allowed and lived in a nicer place/eat better/get a better car because 100K now is becoming a rounding error. I wish when I became an attending, I enjoyed my hard work more. But it is never too late and if I have 20 more good healthy years left, I am going to enjoy what life has to offer. A 5K purse may sound crazy but if this makes her feel special, its well worth it as putting another 5K into retirement is immaterial. I hope all docs can learn this. I see way too many that just saves, saves and can never enjoy their hard work only to find out that they are too unhealthy to enjoy it. I have many stories and I do not want the same tragic story.
 
EctopicFetus said:
. I don't think you should live a miserly life now and expect you will open the purse strings later. You have to enjoy the journey not just the destination.
Click to expand...
This is very difficult for most. You can't live one way for 40 years then suddenly flip the switch. I was able to do this around 45 and made me a much happier person. I wish I could have done it at 25.

I ended med school with 100K in student loans. If I took out another 100K, I would have enjoyed residency much more. Even when I worked in the hospital, that is only a 3 month trade off for 4 years. It is a no brainer.
 
emergentmd said:
This is very difficult for most. You can't live one way for 40 years then suddenly flip the switch. I was able to do this around 45 and made me a much happier person. I wish I could have done it at 25.

I ended med school with 100K in student loans. If I took out another 100K, I would have enjoyed residency much more. Even when I worked in the hospital, that is only a 3 month trade off for 4 years. It is a no brainer.
Click to expand...

It is difficult for sure even if its planned out. Doing that live like a resident for 5 years i was spending 35-50k for a single person since drove a paid off car and had moonlighted enuf in residency to pay off most loans. spending some months everything combined like 4-5k on myself (as an attending) vs when i was only making 3k a month in residency with bills felt amazing.

Let me just add that if you save and invest a ton early on as a single doc working 1.5-2 FTE for 3-4 years this whole spending thing is a lot easier to do when your married since you can have a good chunk invested and growing. I think at least what i did spend on even single was travel/dating/outings/events. I didnt buy a house as a single guy when rates were 2-3% but tbh renting a house now for 50% less than what current mortagage rates are sits ok with me.

I get that not everyone can do this and is already married and has kids or felt like already given up too much. For the rest, its a one time rare opportunity to level up your entire financial future and have the 8th wonder of the world on your side.
 
Last edited:
sloh said:
Good thing is health and fitness (good diet and effective training) come at little cost.
Click to expand...

Id like to be in the position someday to do some of things bryan johnson is doing so it could be close to 100k and this is something in the future i hope to have the budget for. Also will have to get a bit lucky with investments and hope that tesla/crypto can be doubled by the end of the decade which i delusionally like to think is very likely.
 
finalpsychyear said:
Id like to be in the position someday to do some of things bryan johnson is doing so it could be close to 100k and this is something in the future i hope to have the budget for
Click to expand...
You hope to be in such amazing shape that you sprain your ankle dancing?
 
I don't think getting a Bryan Johnson-type outcome takes 100k per year. Honestly, with how much he experiments on himself, it's only a matter of time until he does something foolish that takes off who knows how many years of life he's gained by min-maxing everything else.

Eat healthy
Lift weights, do some cardio that gets you out of breath
Prioritize good sleep
Avoid excessive stress

Optimizing these things does not take an extra $100k per year
 
HemorrhagicShock said:
I don't think getting a Bryan Johnson-type outcome takes 100k per year. Honestly, with how much he experiments on himself, it's only a matter of time until he does something foolish that takes off who knows how many years of life he's gained by min-maxing everything else.

Eat healthy
Lift weights, do some cardio that gets you out of breath
Prioritize good sleep
Avoid excessive stress

Optimizing these things does not take an extra $100k per year
Click to expand...

I agree but gene therapy, peptides its not cheap and esp if we figure out the right combo. Agree that its likely less than 100k once its figured out but doesnt hurt to have it in the future budget.
 
finalpsychyear said:
I agree but gene therapy, peptides its not cheap and esp if we figure out the right combo. Agree that its likely less than 100k once its figured out but doesnt hurt to have it in the future budget.
Click to expand...

Oh boy, you're on the peptide train too now?

I think we should start a worthwhile discussion about this because I can't tell you how many of my physician friends are peptide dabbling and it all seems like a bunch of snake oil. There is no convincing data anywhere, and other than following parameters in an N = 1 kind of way, how can you know these are doing anything beneficial on the long-term?
 
HemorrhagicShock said:
Oh boy, you're on the peptide train too now?

I think we should start a worthwhile discussion about this because I can't tell you how many of my physician friends are peptide dabbling and it all seems like a bunch of snake oil. There is no convincing data anywhere, and other than following parameters in an N = 1 kind of way, how can you know these are doing anything beneficial on the long-term?
Click to expand...

Im at least open to the idea but need more data and im talking about 5 years from now at the earliest so depends what it looks like.

Bone broth plus collagen powder took away my joint/knee pain from playing singles tennis 2-3x a week on hard court. Told my ortho/pmr friends who are my tennis buddies they said theres no data to back it up. Then they started having issues and tried it themselves and got results and dont know what to say.

Regardless, sleep, exercise (wts/cardio/interval), low processed/fresh food diet, meditation and then fasting (all variants have a role) i'd argue are going to be 90-95% of the answer to lasting longevity regardless.


P.S. maybe i misread but were you able to take time away from the grind due to hitting FIRE?
 
finalpsychyear said:
P.S. maybe i misread but were you able to take time away from the grind due to hitting FIRE?
Click to expand...

Yea, I left the ED permanently a few months ago (just before respiratory hell season hit) and it's done wonders for my life.

Outside of rent, I have a very low COL situation for me and my family, and I got to my "FIRE" number early in 2024. Ran the numbers, and worked a little bit more to ensure a little icing on top of that cake, and finally pulled the plug.

I'm now just trying to figure out how I can use my physician experience, license, and medical-know-how to start or do some side hustle that I can build out into a main hustle.

But I'm currently having the problem of finding anybody who wants to pay an ER doctor for ANYTHING that isn't generating RVUs in an ER.

UR/UM remote work, med mal expertise stuff, case review, urgent care, expert network stuff (GLG etc), pharma remote jobs.

Can't find anything that will pay me a 1099 income. Not a single bite despite over 100 applications sent out.
 
finalpsychyear said:
Id like to be in the position someday to do some of things bryan johnson is doing so it could be close to 100k and this is something in the future i hope to have the budget for. Also will have to get a bit lucky with investments and hope that tesla/crypto can be doubled by the end of the decade which i delusionally like to think is very likely.
Click to expand...

The stuff Bryan Johnson promotes is analogous to people promoting fully body MRI’s. Every time you run a placebo controlled trial on regen med potions the results are either null or clinically not meaningful. Placebo is strong.
 
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