Advice: return to EM or no?

[rogerrabbit221]

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I worked for ~3 yrs after graduating residency before I decided I needed to get out of EM. Did a 1 yr fellowship and starting a full-time inpatient job soon. My new schedule is normal business hours and most weekends off. I didn't do any moonlighting during fellowship and I did NOT miss the ED at all. It's taken me the past year to recover from burnout and I don't remember the last time I had a nightmare about working in the ED.

Here's my conundrum. I'm a worst-case scenario person and I worry about my inpatient job not working out for me. I worry about my future job prospects and that I won't be able to return to EM if I'm out for too long. I have the opportunity with the new hospital to do some moonlighting in their satellite ED. 1-2 shifts/month, 12 hr shifts. Single coverage for a few hrs, then APP will come in to help out. PPH is ~1.7.

I don't need the money, I don't miss EM, I don't care about procedures, but I DO worry about being unemployable in the future if I don't do any EM for a few yrs and my inpatient job doesn't work out. It's much easier to get a job in EM. Is it even worth doing 1 shift/month in the ED to keep something on the resume? I know my skills will still degrade over time. I also had really bad pre-shift anxiety (ie. hoping for a car accident on my drive into work), but I should be able to manage 1 shift/month.

Hoping for advice and/or brutal honesty about what others think.

 

[Porfirio]

Do one to two shifts a month. Find an even lower volume shop. If you ever returned full time to EM, you wouldn’t want a high acuity/high volume shop anyways.

Live your life in peace and chill.

 

[cyanide12345678]

What inpatient job are you doing that you got after 1 year of a fellowship. Which fellowship did you Do?

Very unusual for physicians to lose their jobs. The job insecurity you feel is psychological only, probably not real. Even if you lose your job, you can get another one somewhere else as a fellowship trained doc.

Skip the ER. Keep moving forward and don’t look back

 

[rogerrabbit221]

What inpatient job are you doing that you got after 1 year of a fellowship. Which fellowship did you Do?

Very unusual for physicians to lose their jobs. The job insecurity you feel is psychological only, probably not real. Even if you lose your job, you can get another one somewhere else as a fellowship trained doc.

Skip the ER. Keep moving forward and don’t look back

Palliative

 

[emergentmd]

Don't look back. Doing 1-2 shifts a month will not change anything.

 

[AlmostAnMD]

I was in the same boat man (but different exit).

These intrusive thoughts go away after a while

Your post does not at all write like someone that has any business in an ed

Carve out a niche for yourself in your new palliative life to make yourself valuable and never look back imo

I reject the assertion you need to do 1-2 shifts a month to both-sides this issue. Just lean into your destiny.

 

[Pinner Doc]

I worked for ~3 yrs after graduating residency before I decided I needed to get out of EM. Did a 1 yr fellowship and starting a full-time inpatient job soon. My new schedule is normal business hours and most weekends off. I didn't do any moonlighting during fellowship and I did NOT miss the ED at all. It's taken me the past year to recover from burnout and I don't remember the last time I had a nightmare about working in the ED.

Here's my conundrum. I'm a worst-case scenario person and I worry about my inpatient job not working out for me. I worry about my future job prospects and that I won't be able to return to EM if I'm out for too long. I have the opportunity with the new hospital to do some moonlighting in their satellite ED. 1-2 shifts/month, 12 hr shifts. Single coverage for a few hrs, then APP will come in to help out. PPH is ~1.7.

I don't need the money, I don't miss EM, I don't care about procedures, but I DO worry about being unemployable in the future if I don't do any EM for a few yrs and my inpatient job doesn't work out. It's much easier to get a job in EM. Is it even worth doing 1 shift/month in the ED to keep something on the resume? I know my skills will still degrade over time. I also had really bad pre-shift anxiety (ie. hoping for a car accident on my drive into work), but I should be able to manage 1 shift/month.

Hoping for advice and/or brutal honesty about what others think.

I’m currently doing a one year palliative fellowship (not moonlighting during it) and I likely won’t return. They want us taking at least 4 shifts a month in our network to maintain skills, which is more than I want to commit.

Also, I sat in on a staff meeting yesterday by phone (was hoping it would inform my decision) and it raised my blood pressure a bunch. Resources and staffing are being cut left and right. Sounded nightmarish.

 

[BoardingDoc]

I worked for ~3 yrs after graduating residency before I decided I needed to get out of EM. Did a 1 yr fellowship and starting a full-time inpatient job soon. My new schedule is normal business hours and most weekends off. I didn't do any moonlighting during fellowship and I did NOT miss the ED at all. It's taken me the past year to recover from burnout and I don't remember the last time I had a nightmare about working in the ED.

Here's my conundrum. I'm a worst-case scenario person and I worry about my inpatient job not working out for me. I worry about my future job prospects and that I won't be able to return to EM if I'm out for too long. I have the opportunity with the new hospital to do some moonlighting in their satellite ED. 1-2 shifts/month, 12 hr shifts. Single coverage for a few hrs, then APP will come in to help out. PPH is ~1.7.

I don't need the money, I don't miss EM, I don't care about procedures, but I DO worry about being unemployable in the future if I don't do any EM for a few yrs and my inpatient job doesn't work out. It's much easier to get a job in EM. Is it even worth doing 1 shift/month in the ED to keep something on the resume? I know my skills will still degrade over time. I also had really bad pre-shift anxiety (ie. hoping for a car accident on my drive into work), but I should be able to manage 1 shift/month.

Hoping for advice and/or brutal honesty about what others think.

Do you hate your palliative job to the point that you'd rather go back to the ER than find a different palliative gig?

If yes: go work some shifts in the ER.

If no (which is overwhelmingly what it sounds like): Stay out of the ER. I moonlighted in the ER during fellowship but ever since then I've been 100% pain. 0 regrets.

 

[WhatJobDoIPick]

EM is trash tier.

If you like it, sure, do a handful of shifts.

Sounds like you hate it though.

Run away and never look back.

 

[GatorCHOMPions]

I worked for ~3 yrs after graduating residency before I decided I needed to get out of EM. Did a 1 yr fellowship and starting a full-time inpatient job soon. My new schedule is normal business hours and most weekends off. I didn't do any moonlighting during fellowship and I did NOT miss the ED at all. It's taken me the past year to recover from burnout and I don't remember the last time I had a nightmare about working in the ED.

Here's my conundrum. I'm a worst-case scenario person and I worry about my inpatient job not working out for me. I worry about my future job prospects and that I won't be able to return to EM if I'm out for too long. I have the opportunity with the new hospital to do some moonlighting in their satellite ED. 1-2 shifts/month, 12 hr shifts. Single coverage for a few hrs, then APP will come in to help out. PPH is ~1.7.

I don't need the money, I don't miss EM, I don't care about procedures, but I DO worry about being unemployable in the future if I don't do any EM for a few yrs and my inpatient job doesn't work out. It's much easier to get a job in EM. Is it even worth doing 1 shift/month in the ED to keep something on the resume? I know my skills will still degrade over time. I also had really bad pre-shift anxiety (ie. hoping for a car accident on my drive into work), but I should be able to manage 1 shift/month.

Hoping for advice and/or brutal honesty about what others think.

I chose the opposite path than posters above. I still work about 30 EM hours per month but it's mid acuity and very well staffed. Also I can pick weekday daytime shifts. I was never as burned out as you, though. I still can't let go of my EM identity plus the extra money is nice as I'm still not 100% full in my pain practice.

 

[Goodlife1119]

With fellowship training you can work in inpatient/outpatient hospice and inpatient/outpatient palliative settings likely making similar to hospitalist FM salary. With your EM board certification you can also work in UC settings/wound care. You have more options then a average physician. Also assuming you work 2-4 shifts EM a month, you will most likely feel rusty (in my opinion). Also, consider that being single physician coverage is more nerve wracking than working in a trauma center with multiple physicians on shift. With your self described pre shift anxiety- I suspect you will dread your upcoming (1) shift a month, 1-2 weeks before your actual shift.

OTH, you wouldn't be the first Palliative care physician to return to full time EM. Many become disenchanted with the low pay, midlevel creep, dumping by other specialties, admin . If there is any chance of this happening, I would continue working EM shifts. Working EM pays well and gives you time wealth(to spend with your family and be outside of the hospital). Although time wealth is negated if you continue worrying about the work when your outside of the hospital.

 

[DeadCactus]

Ask yourself: if you lost this job would you rather go back to the ED or explore all the other non-ED options (another palliative gig, urgent care, wound care, occupational exams, public health, utilization review, non-clinical work, etc)? As an additional thought, would you rather work in the ED now just in case or risk having to arrange some sort of remediation for a bit?

 

[dchristismi]

Nah, your easy exit is to hospice. You've already done the work to get there.
I jumped ship to inpatient hospice (I exclusively do GIP at a freestanding hospice house - aside from occasionally guest hosting team IDGs) 7, almost 8 years ago and the nightmares of the ED have finally quieted.
You sounds like you do NOT want to go back. Enjoy your HPM life. And when you are ready to leave the hospital, you transition to outpatient hospice.

What you feel is normal. Worrying about losing skills is normal. FWIW, lots of palliative folks change jobs just like EM people. Finding the right fit is important, and if your first gig isn't right, it's not the end of the world. You do not have to go back to the Pit.

 

[Pinner Doc]

Nah, your easy exit is to hospice. You've already done the work to get there.
I jumped ship to inpatient hospice (I exclusively do GIP at a freestanding hospice house - aside from occasionally guest hosting team IDGs) 7, almost 8 years ago and the nightmares of the ED have finally quieted.
You sounds like you do NOT want to go back. Enjoy your HPM life. And when you are ready to leave the hospital, you transition to outpatient hospice.

What you feel is normal. Worrying about losing skills is normal. FWIW, lots of palliative folks change jobs just like EM people. Finding the right fit is important, and if your first gig isn't right, it's not the end of the world. You do not have to go back to the Pit.

This right here. Our local Respite House is my dream job after fellowship. A mix of routine and GIP patients, leading the IDG, covering home hospice patients as well.

 

[The Knife & Gun Club]

Idk but I struggle with the same question a lot. I did lots of ED shifts in fellowship. Then some life priorities changed and I haven’t played the game in nearly a year.

But now that I’m getting settled back into a more normal life rhythm I feel like I should do some EM because I can feel the skills melting before my eyes. What do you mean I can’t order a procal as part of my work up? You mean to tell me my nurses have more than a 2:1 ratio? Thats preposterous. I don’t think I even remember the pediatric dose for Tylenol anymore.

I decided I do need to do some EM because the ability to do EM means the security to never be broke or out of work. I was out of work for a few months and holy hell that was scary. Your mileage may vary though - I’m CCM so the schedule has it own quirks and can be pretty rigid - there’s not a 4 shift/month or outpatient version of CCM.

 

[thegenius]

I worked for ~3 yrs after graduating residency before I decided I needed to get out of EM. Did a 1 yr fellowship and starting a full-time inpatient job soon. My new schedule is normal business hours and most weekends off. I didn't do any moonlighting during fellowship and I did NOT miss the ED at all. It's taken me the past year to recover from burnout and I don't remember the last time I had a nightmare about working in the ED.

Here's my conundrum. I'm a worst-case scenario person and I worry about my inpatient job not working out for me. I worry about my future job prospects and that I won't be able to return to EM if I'm out for too long. I have the opportunity with the new hospital to do some moonlighting in their satellite ED. 1-2 shifts/month, 12 hr shifts. Single coverage for a few hrs, then APP will come in to help out. PPH is ~1.7.

I don't need the money, I don't miss EM, I don't care about procedures, but I DO worry about being unemployable in the future if I don't do any EM for a few yrs and my inpatient job doesn't work out. It's much easier to get a job in EM. Is it even worth doing 1 shift/month in the ED to keep something on the resume? I know my skills will still degrade over time. I also had really bad pre-shift anxiety (ie. hoping for a car accident on my drive into work), but I should be able to manage 1 shift/month.

Hoping for advice and/or brutal honesty about what others think.

Most places won’t accept you for 1 shift/month.

Better question is why would I hire you? You don’t want to be an ER doc. There are plenty of ER docs who want to be one. You’re too much of a risk.

 

[Groove]

1 year without any EM shifts? I hate saying it but you've kind of made your bed already at this point so you might as well get used to sleeping in it. If it's any consolation, I think palliative will be plenty secure from a job standpoint and much more doable as you get older compared to EM. But...please don't do your EM patients a disservice by trying to hack a shift or two each month when your skills have no doubt deteriorated. I think a much safer back up would just be urgent care which you could probably do with no problem. Plus, as others have said already....who's going to hire you for 1-2 shifts a month and why?

 

[RustedFox]

1 year without any EM shifts? I hate saying it but you've kind of made your bed already at this point so you might as well get used to sleeping in it. If it's any consolation, I think palliative will be plenty secure from a job standpoint and much more doable as you get older compared to EM. But...please don't do your EM patients a disservice by trying to hack a shift or two each month when your skills have no doubt deteriorated. I think a much safer back up would just be urgent care which you could probably do with no problem. Plus, as others have said already....who's going to hire you for 1-2 shifts a month and why?

Politely disagree.
I came back after a calendar year away.
There was modest rust that got busted quickly, and I felt the normal twitch-reflexes and danger sense return very quickly.

 

[Groove]

Politely disagree.
I came back after a calendar year away.
There was modest rust that got busted quickly, and I felt the normal twitch-reflexes and danger sense return very quickly.

Weird. I feel like I'm in molasses for the first few hours if I've been off for 2 weeks. I once met a locums guy who took 6 months off to travel and he said it took him a good couple of weeks to get his feet back underneath and it scared him so bad he said he'd never take that long off again because he had some critical cases those first few shifts that scared the s*** out of him.

I mean, would you want a surgeon to operate on you that only operates twice a month? Cath lab with a doc who only does heart catheterizations once a month and took last year off?

I don't know that we really have much data on EM physician re-entry but if you acclimatized that quickly after being a year off, you should probably consider yourself lucky and more of an exception than the norm. One year off and I'd be wearing ipods around asking Grok to remind me how to do everything.

 

[thegenius]

If someone worked ER full time for ~5 years, took a year off, and wanted to come back and work full time again, I would probably hire them all other things considered. If they took two years off..probably not.

The issue above is OP doesn't like ER, wants to avoid it all costs, but potentially wants to keep the door open to make some $$ if times are tough. Sorry that's a red flag I wouldn't hire him. You can't work 1 or 2 times a month and be good at our craft.

 

[Pinner Doc]

1 year without any EM shifts? I hate saying it but you've kind of made your bed already at this point so you might as well get used to sleeping in it. If it's any consolation, I think palliative will be plenty secure from a job standpoint and much more doable as you get older compared to EM. But...please don't do your EM patients a disservice by trying to hack a shift or two each month when your skills have no doubt deteriorated. I think a much safer back up would just be urgent care which you could probably do with no problem. Plus, as others have said already....who's going to hire you for 1-2 shifts a month and why?

I also have to respectfully disagree. Millions of EM physicians take a year of maternity leave, some more than once, across the world, and then resume work.

My network, which wants a strict 4 shift monthly minimum on EM docs to “maintain skills,” has no qualms about me taking a year off.

AFAIK, there’s no official statement on time away where it’s not prudent to return, thought I’ve heard two years tossed around. I’ve talked to several folks who have stepped away for one year who had apprehension about returning but felt fine after a shift or two, and just made sure they weren’t solo coverage at first.

 

[Groove]

I also have to respectfully disagree. Millions of EM physicians take a year of maternity leave, some more than once, across the world, and then resume work.

My network, which wants a strict 4 shift monthly minimum on EM docs to “maintain skills,” has no qualms about me taking a year off.

AFAIK, there’s no official statement on time away where it’s not prudent to return, thought I’ve heard two years tossed around. I’ve talked to several folks who have stepped away for one year who had apprehension about returning but felt fine after a shift or two, and just made sure they weren’t solo coverage at first.

There's less than 150K of us world wide so I think millions would be a little bit of a stretch. You're palliative as well, right? I get why you guys and gals have a vested interest in maintaining proficiency as a back up but I just honestly think it's such a terrible idea for all of you that are a) not interested and b) trying to do as little as possible. I do think 4/mo would minimize skill decay though.

As for the year off maternity leave, I've never seen a doc do that in EM. You guys do that routinely? Grok calls BS on that if you work in the US btw but seems to think it might be normal if you lived in another country. Do you work for a CMG? I've never even heard of any of the major CMGs offering year long maternity. And I don't mean to sound like a insensitive male but like....why would someone need an entire year of maternity/paternity leave? One YEAR?!

 

[BoardingDoc]

Why would someone need an entire year of maternity/paternity leave? One YEAR?!

Do you have kids? To be clear, this isn't one of those "you're not a parent so you don't get a vote" a-hole comments. It's more of a "I was very surprised once I became a father by how much time parenting can absorb." Maybe you know that firsthand too. I personally wouldn't want to take 1 year off as I'd go insane. I know many people who would disagree with me, including some whole countries. The UK for example mandates a full year of maternity leave. The whole thing isn't paid, but something like 40 weeks is. I know Bulgaria is the world outlier with over a year mandated at nearly full pay rates.

 

[Groove]

Do you have kids? To be clear, this isn't one of those "you're not a parent so you don't get a vote" a-hole comments. It's more of a "I was very surprised once I became a father by how much time parenting can absorb." Maybe you know that firsthand too. I personally wouldn't want to take 1 year off as I'd go insane. I know many people who would disagree with me. The UK for example mandates a full year of maternity leave. The whole thing isn't paid, but something like 40 weeks is. I know Bulgaria is the world outlier with over a year mandated at nearly full pay rates.

I don't have kids and I'm guessing it shows in this thread so nobody throw rocks at me but I'm doing the math and let's say me and my wife want to have 3 kids, spaced 2 years apart and each want a year of maternity/paternity after each kid. So, I'm only working 2 out of 5 years? Is my math right on that? That's crazy, lol. It's a good thing I don't live in Bulgaria....I'd have all types of kids by now. Anytime I was close to having to go back to work, I'd convince my wife to let us have another one.

 

[Pinner Doc]

There's less than 150K of us world wide so I think millions would be a little bit of a stretch. You're palliative as well, right? I get why you guys and gals have a vested interest in maintaining proficiency as a back up but I just honestly think it's such a terrible idea for all of you that are a) not interested and b) trying to do as little as possible. I do think 4/mo would minimize skill decay though.

As for the year off maternity leave, I've never seen a doc do that in EM. You guys do that routinely? Grok calls BS on that if you work in the US btw but seems to think it might be normal if you lived in another country. Do you work for a CMG? I've never even heard of any of the major CMGs offering year long maternity. And I don't mean to sound like a insensitive male but like....why would someone need an entire year of maternity/paternity leave? One YEAR?!

There are only 150k worldwide? Yes, millions may be off 😂

It is not uncommon *outside the US* to have a maternity leave of a year. I took 10 weeks unpaid leave for both my kids.

This is not to get into the weeds on maternity leave policies- just that knowing this gave me comfort in taking a year away for a fellowship.

 

[JacobMcCandles]

Some people may be able to come back after an extended leave and pick things back up quickly when going back full time. The few people I know who work minimally, especially early in their career, are typically subpar physicians.

 

[Porfirio]

Very few in power care how long or how many shifts a month, all in power care about filling the shift.

 

[JacobMcCandles]

Very few in power care how long or how many shifts a month, all in power care about filling the shift.

Filling the shift is top priority but those who only work one or two shifts a month are generally a pain, typically aren’t available for the shifts that need to be filled, and there’s always a conversation about moving away from them.

 

[rogerrabbit221]

About the 1-2 shifts/month, the hospital I work at IS willing to hire me for that. I've had conversations with their med director. And I know a couple of EM docs personally who took a yr off and were able to return whether it was back to full-time, 50/50, or some other breakdown. All in all, sounds like consensus is I shouldn't go back to EM, and stick with palliative.