Hey all. Looking for some perspective. I'm too in my head about this, and I just need a place to write it out. Sorry for the wall of text, thanks for your time.
tl;dr: Current job slow-mid pace, 275ish/hr, kinda boring town but ultimately good for family, potential new job 350-400+/hr but much faster paced, slightly less boring town, worried about burning out from higher stress but also wanna get that bag while the getting is good
Current job: 1650ish hours a year, democratic group with people I generally enjoy working with, avg 270/hr, should be going up to 280/hr or so in a year with renegotiations but won't go higher than that, flat rate/no RVU based pay, W2/K1, can put away about 80k a year pretax with some other nice side benefits that are too specific to mention here. 1.6-1.7ish pph, single shop about 10 minutes from home with minimal traffic, not knife and gun club in a pretty LCOL area. No hounding about metrics. Few nights, only 10-12 so far this year due to nocturnists that will probably stick around for at least another 3-4 years, then might be more nights, who knows. Hospital/staff definitely have some difficulties but overall it's fine if I don't think about it too much, medicine is just broken overall in the US and we suffer from that sometimes like anywhere else. The kind of place where I can usually get all my notes done, browse reddit, play a game on night shift, etc. Some days are crazy and I go home frazzled, many days are fine, though I don't really look forward to work, I don't dread it either, I'm just in the "EM/healthcare is dying and I'm riding this rocket into the ground" doldrums like so many here. No midlevels. Geographically a bit isolated (~3 hours to a major city, ~1.5hrs to big enough city for a costco, etc), but definitely has a "good place to raise the kids" vibe. Socially, very insular, a town I can only describe as incestuous with how everyone knows everyone and most people are "from here", very religious (we're happy heathens), we've had to fight tooth and nail to make few friends, wife often feels isolated and like we are quickly outgrowing this area, I can count my close friends on zero fingers, a full day road trip to nearest family so that's rare. Kids like it here but don't know any different. Don't feel like jobs close to family are in the cards, my hometown market is about 200/hr for significantly higher COL, hers is a popular mountain west area where opportunity cost for EM is insane and a non-starter.
Potential new job: Also democratic. Multiple shops, would sometimes have to drive ~1 hour each way a few times a month, but mostly at one shop. Purely RVU based, with true potential for 350-400+/hr, but working like a dog for it, upwards of 3pph is not uncommon. I jived with the group when I visited. Options to cut down more aggressively after putting in the time/making bank for a few years, no real minimum, could coast into retirement well. Not a predatory setup. Almost certainly more nights. Very geographically different, slightly bigger town (has a costco/trader joe's/airport), closer to wife's fam but still a 1-ish hour drive and a shorter flight away. Wife isn't thrilled about the area (crime stats, etc., though probably overblown by those I've spoken to, is more brown compared to the green we're used to) but willing to give it a shot for the sake of the job if I want it, socially it's hard to say because we both knew church as our social safety net growing up, and we haven't figured out how to replace that yet, so it'll likely be starting from scratch again.
Honestly, I think I'm most afraid that I can't hack a higher acuity faster paced setup anymore. I'm only 3-4 years out of residency, but even in residency I can admit I wasn't the fastest (wasn't the slowest either). I get a bit flustered sometimes but in general run things smoothly. It's not uncommon to see 3-4pph for 2-4 hours on solo coverage hours at my current job, but every time I do, I find myself thinking "holy $#*%" and I need 30-60 minutes to catch up when my double coverage shows up. Thinking about doing that every hour for 90% of my shifts and having my income tied to that makes me a bit anxious, but I also keep thinking, I'm at work already, why not try and maximize the hours while I'm there anyway? But then I have a chill shift at my current job and I think "I'm getting paid WHAT to be here doing this amount of work?!" I can't seem to find internal peace about this one way or the other. I feel drawn to the money and I have aspirations of retiring early (read: ASAP), but I also am very aware that my current pay is above the mean (I'm pretty sure?) for EM, and I feel like I should be happy with what I have and keep what feels like a sustainable job, for now. I'm open to any thoughts/feedback, I don't feel like there are many people I can discuss this with in my life, obviously can't talk to my current partners about it. Feels like because of family geography that we are just in the wind and it's hard to really call somewhere home, but as above, jobs near family aren't really options.
tl;dr: Current job slow-mid pace, 275ish/hr, kinda boring town but ultimately good for family, potential new job 350-400+/hr but much faster paced, slightly less boring town, worried about burning out from higher stress but also wanna get that bag while the getting is good
Current job: 1650ish hours a year, democratic group with people I generally enjoy working with, avg 270/hr, should be going up to 280/hr or so in a year with renegotiations but won't go higher than that, flat rate/no RVU based pay, W2/K1, can put away about 80k a year pretax with some other nice side benefits that are too specific to mention here. 1.6-1.7ish pph, single shop about 10 minutes from home with minimal traffic, not knife and gun club in a pretty LCOL area. No hounding about metrics. Few nights, only 10-12 so far this year due to nocturnists that will probably stick around for at least another 3-4 years, then might be more nights, who knows. Hospital/staff definitely have some difficulties but overall it's fine if I don't think about it too much, medicine is just broken overall in the US and we suffer from that sometimes like anywhere else. The kind of place where I can usually get all my notes done, browse reddit, play a game on night shift, etc. Some days are crazy and I go home frazzled, many days are fine, though I don't really look forward to work, I don't dread it either, I'm just in the "EM/healthcare is dying and I'm riding this rocket into the ground" doldrums like so many here. No midlevels. Geographically a bit isolated (~3 hours to a major city, ~1.5hrs to big enough city for a costco, etc), but definitely has a "good place to raise the kids" vibe. Socially, very insular, a town I can only describe as incestuous with how everyone knows everyone and most people are "from here", very religious (we're happy heathens), we've had to fight tooth and nail to make few friends, wife often feels isolated and like we are quickly outgrowing this area, I can count my close friends on zero fingers, a full day road trip to nearest family so that's rare. Kids like it here but don't know any different. Don't feel like jobs close to family are in the cards, my hometown market is about 200/hr for significantly higher COL, hers is a popular mountain west area where opportunity cost for EM is insane and a non-starter.
Potential new job: Also democratic. Multiple shops, would sometimes have to drive ~1 hour each way a few times a month, but mostly at one shop. Purely RVU based, with true potential for 350-400+/hr, but working like a dog for it, upwards of 3pph is not uncommon. I jived with the group when I visited. Options to cut down more aggressively after putting in the time/making bank for a few years, no real minimum, could coast into retirement well. Not a predatory setup. Almost certainly more nights. Very geographically different, slightly bigger town (has a costco/trader joe's/airport), closer to wife's fam but still a 1-ish hour drive and a shorter flight away. Wife isn't thrilled about the area (crime stats, etc., though probably overblown by those I've spoken to, is more brown compared to the green we're used to) but willing to give it a shot for the sake of the job if I want it, socially it's hard to say because we both knew church as our social safety net growing up, and we haven't figured out how to replace that yet, so it'll likely be starting from scratch again.
Honestly, I think I'm most afraid that I can't hack a higher acuity faster paced setup anymore. I'm only 3-4 years out of residency, but even in residency I can admit I wasn't the fastest (wasn't the slowest either). I get a bit flustered sometimes but in general run things smoothly. It's not uncommon to see 3-4pph for 2-4 hours on solo coverage hours at my current job, but every time I do, I find myself thinking "holy $#*%" and I need 30-60 minutes to catch up when my double coverage shows up. Thinking about doing that every hour for 90% of my shifts and having my income tied to that makes me a bit anxious, but I also keep thinking, I'm at work already, why not try and maximize the hours while I'm there anyway? But then I have a chill shift at my current job and I think "I'm getting paid WHAT to be here doing this amount of work?!" I can't seem to find internal peace about this one way or the other. I feel drawn to the money and I have aspirations of retiring early (read: ASAP), but I also am very aware that my current pay is above the mean (I'm pretty sure?) for EM, and I feel like I should be happy with what I have and keep what feels like a sustainable job, for now. I'm open to any thoughts/feedback, I don't feel like there are many people I can discuss this with in my life, obviously can't talk to my current partners about it. Feels like because of family geography that we are just in the wind and it's hard to really call somewhere home, but as above, jobs near family aren't really options.
