$400K a year hospitalist gig or pulmonary / critical care fellowship

[IM.MD]

Hi everyone! I realize this is a very individual decision but would still appreciate your input. From a mainly financial perspective, is it worth doing a Pulm/CCM fellowship if I'm currently making $400K a year as a hospitalist? I enjoy critical care and pulmonology more than hospital medicine. Let's say 25% more but I also don't mind being a hospitalist and I get some fulfillment out of it. I was the de facto intensivist at my first hospitalist job out of residency and kinda wished I could spend all of my time in the ICU but did not feel adequately trained to do that (hence, I left that job). I like my current gig. 7 on / 7 off, 12 hour in house shifts (tiring but cool staff to chat with), one week PTO, 90K population, fun Midwestern town (local women seem to like my euro accent and sports car 🙂), about 18 patient encounters a shift with the PA seeing 10 of them, open ICU with 24/7 intensivist coverage, most sub-specialties available. I'm getting $320K yearly base salary + $30K yearly if meeting quality metrics + $20K a year retention bonus x 5 years + $200 per hour for extra shifts, $5K for CME, good benefits (403b + 457b, etc.), only 14 overnight shifts required yearly. I make $400K a year with ~ 192 twelve hour shifts. I'm 37 years old and completed IM residency in 2017 (had a late academic start in the US). I'm not married, have $390K student loan debt (hoping PSLF goes through), renting. I feel like I may get bored being a hospitalist in 5-10 years and perhaps I should preemptively do the fellowship before marriage, kids, buying a house, etc. Should I spend 2-3 years (open to CCM only too) in fellowship at $60K a year in the pursuit of higher job satisfaction or focus on the positives of hospital medicine, learn to love it and continue getting paid handsomely without the pay cut during fellowship? Thanks!

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[IM2GI]

From a purely financial perspective, no. You will likely never make up the opportunity cost of the salary you lose for 3 years of fellowship. You are also kind of old to be starting fellowship at 39/40.

That said, if you ever move and get a more standard hospitalist salary that equation could change. Sounds like you've got a good setup. I would probably sit tight and figure out the more important things in life you mentioned.

 

[GastriqueGraffin]

Hi everyone! I realize this is a very individual decision but would still appreciate your input. From a mainly financial perspective, is it worth doing a Pulm/CCM fellowship if I'm currently making $400K a year as a hospitalist? I enjoy critical care and pulmonology more than hospital medicine. Let's say 25% more but I also don't mind being a hospitalist and I get some fulfillment out of it. I was the de facto intensivist at my first hospitalist job out of residency and kinda wished I could spend all of my time in the ICU but did not feel adequately trained to do that (hence, I left that job). I like my current gig. 7 on / 7 off, 12 hour in house shifts (tiring but cool staff to chat with), one week PTO, 90K population, fun Midwestern town (local women seem to like my euro accent and sports car 🙂), about 18 patient encounters a shift with the PA seeing 10 of them, open ICU with 24/7 intensivist coverage, most sub-specialties available. I'm getting $320K yearly base salary + $30K yearly if meeting quality metrics + $20K a year retention bonus x 5 years + $200 per hour for extra shifts, $5K for CME, good benefits (403b + 457b, etc.), only 14 overnight shifts required yearly. I make $400K a year with ~ 192 twelve hour shifts. I'm 38 years old, completed IM residency in 2018 (had a late academic start). I'm not married, have $390K student loan debt (hoping PSLF goes through), renting. I feel like I may get bored being a hospitalist in 5-10 years and perhaps I should preemptively do the fellowship before marriage, kids, buying a house, etc. Should I spend 2-3 years (open to CCM only too) in fellowship at $60K a year in the pursuit of higher job satisfaction or focus on the positives of hospital medicine, learn to love it and continue getting paid handsomely without the pay cut during fellowship? Thanks!

Only you can answer that. If you’re happy with your job, location, etc. then keep it. If not then do fellowship.

 

[DennisReynolds]

Frickin' GOALS.

 

[wamcp]

Hi everyone! I realize this is a very individual decision but would still appreciate your input. From a mainly financial perspective, is it worth doing a Pulm/CCM fellowship if I'm currently making $400K a year as a hospitalist? I enjoy critical care and pulmonology more than hospital medicine. Let's say 25% more but I also don't mind being a hospitalist and I get some fulfillment out of it. I was the de facto intensivist at my first hospitalist job out of residency and kinda wished I could spend all of my time in the ICU but did not feel adequately trained to do that (hence, I left that job). I like my current gig. 7 on / 7 off, 12 hour in house shifts (tiring but cool staff to chat with), one week PTO, 90K population, fun Midwestern town (local women seem to like my euro accent and sports car 🙂), about 18 patient encounters a shift with the PA seeing 10 of them, open ICU with 24/7 intensivist coverage, most sub-specialties available. I'm getting $320K yearly base salary + $30K yearly if meeting quality metrics + $20K a year retention bonus x 5 years + $200 per hour for extra shifts, $5K for CME, good benefits (403b + 457b, etc.), only 14 overnight shifts required yearly. I make $400K a year with ~ 192 twelve hour shifts. I'm 38 years old, completed IM residency in 2018 (had a late academic start). I'm not married, have $390K student loan debt (hoping PSLF goes through), renting. I feel like I may get bored being a hospitalist in 5-10 years and perhaps I should preemptively do the fellowship before marriage, kids, buying a house, etc. Should I spend 2-3 years (open to CCM only too) in fellowship at $60K a year in the pursuit of higher job satisfaction or focus on the positives of hospital medicine, learn to love it and continue getting paid handsomely without the pay cut during fellowship? Thanks!

Not worth it, physically, unless you were several years younger.

Not worth it financially at all.

Up to you to decide if it’s mentally worth it.

 

[shemer77]

Where you at getting 400k in the midwest?

 

[IM.MD]

Where you at getting 400k in the midwest?

The great state of Wisconsin 🙂 $400K working about 192 shifts a year though.

 

[fldoctorgirl]

I'm currently making $400K a year as a hospitalist

Goals

7 on / 7 off, 12 hour in house shifts

Not sure if goals


In all seriousness, you sound like you like your job overall and like others have noted, doesn't seem like it would be financially worth it to pursue a fellowship.

 

[deleted547631]

Hi everyone! I realize this is a very individual decision but would still appreciate your input. From a mainly financial perspective, is it worth doing a Pulm/CCM fellowship if I'm currently making $400K a year as a hospitalist? I enjoy critical care and pulmonology more than hospital medicine. Let's say 25% more but I also don't mind being a hospitalist and I get some fulfillment out of it. I was the de facto intensivist at my first hospitalist job out of residency and kinda wished I could spend all of my time in the ICU but did not feel adequately trained to do that (hence, I left that job). I like my current gig. 7 on / 7 off, 12 hour in house shifts (tiring but cool staff to chat with), one week PTO, 90K population, fun Midwestern town (local women seem to like my euro accent and sports car 🙂), about 18 patient encounters a shift with the PA seeing 10 of them, open ICU with 24/7 intensivist coverage, most sub-specialties available. I'm getting $320K yearly base salary + $30K yearly if meeting quality metrics + $20K a year retention bonus x 5 years + $200 per hour for extra shifts, $5K for CME, good benefits (403b + 457b, etc.), only 14 overnight shifts required yearly. I make $400K a year with ~ 192 twelve hour shifts. I'm 38 years old, completed IM residency in 2018 (had a late academic start). I'm not married, have $390K student loan debt (hoping PSLF goes through), renting. I feel like I may get bored being a hospitalist in 5-10 years and perhaps I should preemptively do the fellowship before marriage, kids, buying a house, etc. Should I spend 2-3 years (open to CCM only too) in fellowship at $60K a year in the pursuit of higher job satisfaction or focus on the positives of hospital medicine, learn to love it and continue getting paid handsomely without the pay cut during fellowship? Thanks!

Say you do a CCM-only fellowship. How much do you think your income could jump?

 

[bronx43]

If you can tolerate hospital medicine, you’ve already won. If I didnt hate my year as a hospitalist, I would still be one right now.

 

[IM.MD]

Say you do a CCM-only fellowship. How much do you think your income could jump?

Perhaps $450-$550K a year depending on where I work and how many shifts a month.

 

[IM.MD]

If you can tolerate hospital medicine, you’ve already won. If I didnt hate my year as a hospitalist, I would still be one right now.

I can tolerate it now and probably for the next 5 years but I'm questioning whether I should do a fellowship preemptively. What sub-specialty are you in?

 

[bronx43]

I can tolerate it now and probably for the next 5 years but I'm questioning whether I should do a fellowship preemptively. What sub-specialty are you in?

Rheum. Didn’t wanna take call ever. It’s better than hospital medicine for me. Financially, it is typically a wash unless you’re high volume in an underserved area.

 

[BoolaHI]

Hmmmn, my wife had the exact situation and question 10 years ago when she was about 38. So, after roughly 10 years as a hospitalist, she was growing bored and as well had found a great interest in critical care medicine. Her ultimate question to herself is whether she would still be fulfilled in another 5-10 years—the answer is no. The CC fellowship was candidly difficult from a time basis, many 70 hour weeks with a family in tow and being just south of 40 years old, but she says she absolutely loved it and it was the right decision for her.

Currently she works for a CC/Pulm group, works no more than 12-13 nights a month or about 145-150 night shifts in a year and makes mid 400s, with lots and lots of flexibility.

 

[IM.MD]

Hmmmn, my wife had the exact situation and question 10 years ago when she was about 38. So, after roughly 10 years as a hospitalist, she was growing bored and as well had found a great interest in critical care medicine. Her ultimate question to herself is whether she would still be fulfilled in another 5-10 years—the answer is no. The CC fellowship was candidly difficult from a time basis, many 70 hour weeks with a family in tow and being just south of 40 years old, but she says she absolutely loved it and it was the right decision for her.

Currently she works for a CC/Pulm group, works no more than 12-13 nights a month or about 145-150 night shifts in a year and makes mid 400s, with lots and lots of flexibility.

It's good to hear about folks who go back to training after years of being an attending. Having a supportive spouse definitely helps, so hats off to you, sir 🙂 Sounds like she did CC fellowship. Does she regret not doing Pulm/CC instead? Is she concerned about the detrimental health effects of nocturnal work? How much does her group pay their day time intensivists? Thanks!

 

[BoolaHI]

Thank you. Her interest lie mainly doing procedures and she really likes running the unit at night (thus, the preference for CC work)—further she relishes that she does not have to speak with families and such, as I take it, is very much part of the day responsibilities. She has a team of PAs and nurses that she work with at night, so there is fair amount of camaraderie—she says might consider switching over in 5 years or so to primarily days, but I doubt it. I know her night differential comes out to an additional 4 hours, so by way of specific example, for every 8pm to 8am shift she does, she makes 16 hours instead of 12. Doing the math in my head, that makes the day folks base roughly 410-420. Hers is closer to 450-460. There are many months where she says she wished she worked more....and I never hear other docs say that....

 

[BoolaHI]

Oh, for what it is worth, according to my wife, ICU work in general in growing, and they are in constant hiring mode. It’s anecdotal, but she said, just check JAMA and there are literally hundreds of positions being advertised.

 

[DrRealistic]

Would it be possible for you to earn that cash while working 4x4 rather than 7x7? The total days/month will be the same, if not more...

Working 4 days a week and earning that would be dope af. Sure, EM docs can do it with 3 days/week but they also have a more competitive and longer residency...

 

[BoolaHI]

I’m not sure whether ER residency is more competitive than CC at this point—youngest d who is just out of residency, says CC are pretty competitive.

 

[Prehealth1011]

I’m not sure whether ER residency is more competitive than CC at this point—youngest d who is just out of residency, says CC are pretty competitive.

Did she do research during her residency? I'm always curious to hear about IM docs suddenly choosing to do a fellowship later in their career. From what I heard, Pulm/cc is pretty competitive and you almost always need research + competitive app to match.

 

[BoolaHI]

Yes she did—it was a requirement—and she wasn’t initially thrilled with that portion, but got it done.

 

[gutonc]

Would it be possible for you to earn that cash while working 4x4 rather than 7x7? The total days/month will be the same, if not more...

Working 4 days a week and earning that would be dope af. Sure, EM docs can do it with 3 days/week but they also have a more competitive and longer residency...

EM is 3 years (4 at a few places). IM+CCM is at least 5 years. I suspect the competitiveness is roughly equal with EM being ever so slightly more competitive, but primarily because the number of spots/programs is fewer than IM and once you get an IM position, CCM is pretty reasonable for most applicants.

EDIT: since you didn't quote a post, hard to tell if you're talking about IM or IM/CCM. In any case, the above point stands.

 

[spacegun]

Hmmmn, my wife had the exact situation and question 10 years ago when she was about 38. So, after roughly 10 years as a hospitalist, she was growing bored and as well had found a great interest in critical care medicine. Her ultimate question to herself is whether she would still be fulfilled in another 5-10 years—the answer is no. The CC fellowship was candidly difficult from a time basis, many 70 hour weeks with a family in tow and being just south of 40 years old, but she says she absolutely loved it and it was the right decision for her.

Currently she works for a CC/Pulm group, works no more than 12-13 nights a month or about 145-150 night shifts in a year and makes mid 400s, with lots and lots of flexibility.

Mind if I ask you what area or region of the country your wife is working in? Her life as an intensivist sounds great.

 

[BoolaHI]

Southwest, though she tells me her contemporaries have similar arrangements and comp in both the NW and NE. For what’s it worth, her brother runs a hospital group out of Dallas (not our same city) and pretty much verified that she could get a similar deal at many places in Dallas.

 

[IM.MD]

Would it be possible for you to earn that cash while working 4x4 rather than 7x7? The total days/month will be the same, if not more...

Working 4 days a week and earning that would be dope af. Sure, EM docs can do it with 3 days/week but they also have a more competitive and longer residency...

I could do 5 on / 5 off at my hospital as a hospitalist. EM shifts are more intense - multi-tasking, LOTS of talking on the phone, lots of EKG readings without even seeing the patient, triaging and urgent care / primary care...it sucks 🙂 And the impressive locum EM hourly rates are going down per my EM friends.

 

[BoolaHI]

And an aside, but wife said that she knows of some of her colleagues who pick-up locums cc/pulm shifts and they go for about or close to 2500 per...

 

[xoggyux]

I think this is not a financial question at all and it shouldn't be either. For one, from a financial perspective, it does not make much sense. There is a significant opportunity cost when it comes to going for fellowship. In your case, it is at least 800k for a 2 year fellowship but if you take into account that during fellowship you will be putting way more hours of your time or you consider a 3 year one, you could make an argument that the opportunity cost is actually in the ballpark of 1M.

Now let's say that you manage a pay differential of 100k/year between hospitalist and CCM while working the exact same hours. It would still take you a decade to catch up. No big deal because if this is what you want, eventually you are expecting to come ahead after 15, 20 or 30 years of practice but it is not really a "great" investment either financially speaking. Keep in mind there is an unperceived risk (for instance, the pay differential could drop over time and it could get longer to catch up, there are plenty of fellowships that barely make more than IM these days).
Remember the old saying "a bird in the hand, is worth 100 birds in the bush" this is sort of like that. Arguably 1M in your savings or a paid house is worth more in my oppinion that the extra income that you will have 10 years in the future

At the end of the day, as I said at the beginning. I don't think financial should play much weight in your decision at all. If you will be happier doing CCM for the next 30 years, go for it. Wether you end up making a bit more a or a lot more that is just a bonus. And if it happens that on the long run you actually don't end up making as much money due to salary changes over time and opportunity cost and medicine cost reform in the US or some other crap... then oh well, no big deal because at the end of the day, you chose this because you enjoy it more, and not to make a few bucks more.

One last thing. Have you run the numbers yourself or with a financial advisor regarding PSLF? With your high income, even paying some sort of IBR might end up paying a significant sum of money. If you already have 3-4 years that are certified and qualify for PSLF it makes sense to stick with the plan but if for some reason you just started (e.i your residency did not count) you might want to run the numbers. Quick sloppy math tells me that you could end up paying upwards of 200k over a 10-year re-payment program and I don't think I would personally take the risk. If those numbers are right, I would probably live like a resident for 1 year and get it over with, that alone will feel like a bigger salary increase than any specialty salary differential in my opinion. Something to keep in mind, maybe im way off here.

 

[CCM-MD]

CCM is seems to be very competitive this cycle according to this thread.

2019/2020 Critical Care Fellowship Application Thread

Hi all. Starting this thread primarily for those applying for the ABIM CCM fellowship this year. Good luck!

forums.studentdoctor.net

 

[BoolaHI]

Very interesting, I guess the wifey got lucky, as she applied to one and received one offer. Then again, she always did have the brains in the family....

 

[wamcp]

.

 

[IM.MD]

I think this is not a financial question at all and it shouldn't be either. For one, from a financial perspective, it does not make much sense. There is a significant opportunity cost when it comes to going for fellowship. In your case, it is at least 800k for a 2 year fellowship but if you take into account that during fellowship you will be putting way more hours of your time or you consider a 3 year one, you could make an argument that the opportunity cost is actually in the ballpark of 1M.

Now let's say that you manage a pay differential of 100k/year between hospitalist and CCM while working the exact same hours. It would still take you a decade to catch up. No big deal because if this is what you want, eventually you are expecting to come ahead after 15, 20 or 30 years of practice but it is not really a "great" investment either financially speaking. Keep in mind there is an unperceived risk (for instance, the pay differential could drop over time and it could get longer to catch up, there are plenty of fellowships that barely make more than IM these days).
Remember the old saying "a bird in the hand, is worth 100 birds in the bush" this is sort of like that. Arguably 1M in your savings or a paid house is worth more in my oppinion that the extra income that you will have 10 years in the future

At the end of the day, as I said at the beginning. I don't think financial should play much weight in your decision at all. If you will be happier doing CCM for the next 30 years, go for it. Wether you end up making a bit more a or a lot more that is just a bonus. And if it happens that on the long run you actually don't end up making as much money due to salary changes over time and opportunity cost and medicine cost reform in the US or some other crap... then oh well, no big deal because at the end of the day, you chose this because you enjoy it more, and not to make a few bucks more.

One last thing. Have you run the numbers yourself or with a financial advisor regarding PSLF? With your high income, even paying some sort of IBR might end up paying a significant sum of money. If you already have 3-4 years that are certified and qualify for PSLF it makes sense to stick with the plan but if for some reason you just started (e.i your residency did not count) you might want to run the numbers. Quick sloppy math tells me that you could end up paying upwards of 200k over a 10-year re-payment program and I don't think I would personally take the risk. If those numbers are right, I would probably live like a resident for 1 year and get it over with, that alone will feel like a bigger salary increase than any specialty salary differential in my opinion. Something to keep in mind, maybe im way off here.

If I continue making $400K at a non-profit, I would have about $150K forgiven if PSLF goes through.

 

[xoggyux]

If I continue making $400K at a non-profit, I would have about $150K forgiven if PSLF goes through.

I am worried about what you end up paying and not what you end up getting forgiven. If over 10 years your debt grows from 400k - > 150k and you end up paying 400k and having 150k forgiven it is not worth it in my opinion especially considering the uncertainties associated with the program (granted, some of these are blown out of proportion).
If you already ran the numbers and it makes sense then absolutely go for it, though have a contingency plan (savings) just in case something comes up with the program.
Just making sure that anyone else understands, that having $$ forgiven is not the goal, minimizing payments with as little risk as possible is. When I ran my numbers for me (my residency wouldn't count as it was a non-profit) my savings are minimal even though I would expect to have 100k+ forgiven (most of it would be interest $$ forgiven). I am better off if I pay it quickly which is my plan.

 

[asuka99]

Goals


Not sure if goals


In all seriousness, you sound like you like your job overall and like others have noted, doesn't seem like it would be financially worth it to pursue a fellowship.

12 hour 7 on 7 off is pretty standard for a hospitalist tho

 

[fldoctorgirl]

12 hour 7 on 7 off is pretty standard for a hospitalist tho

I know haha, that's why I'm not sure if I would want to do it. I have heard of people with different schedules, though.

 

[Dr.Pulm]

Hmmmn, my wife had the exact situation and question 10 years ago when she was about 38. So, after roughly 10 years as a hospitalist, she was growing bored and as well had found a great interest in critical care medicine. Her ultimate question to herself is whether she would still be fulfilled in another 5-10 years—the answer is no. The CC fellowship was candidly difficult from a time basis, many 70 hour weeks with a family in tow and being just south of 40 years old, but she says she absolutely loved it and it was the right decision for her.

Currently she works for a CC/Pulm group, works no more than 12-13 nights a month or about 145-150 night shifts in a year and makes mid 400s, with lots and lots of flexibility.

That's Sound really interesting.
Which Town Is she practicing?

 

[tantacles]

I know someone who went back to do fellowship after 4 years of hospitalist, and he was happy with his decision. That being said, he only did hospitalist so he could waiver his visa, so that definitely played into it. I think I would be unhappy going back to fellowship, but it's an intensely personal decision. so questions:

1. What are your financial goals:? Will you be able to meet them if you switch careers?

2. What are your career goals? Will you be able to meet them if you stay a hospitalist?

3. Could you potentially meet both?

 

[spacegun]

That's Sound really interesting.
Which Town Is she practicing?

Above, I asked him which region his wife is working in and he said:

Southwest, though she tells me her contemporaries have similar arrangements and comp in both the NW and NE. For what’s it worth, her brother runs a hospital group out of Dallas (not our same city) and pretty much verified that she could get a similar deal at many places in Dallas.