Anybody do IM locums during fellowship? Also logistics/mentorship for subspecialty locums

[IM_to_ortho_hopeful]

Anybody have any tips/guides on how to get set up for IM locums during fellowship?

Also, I'm a current GI fellow but trying to get some mentorship regarding both IM and GI locums. Trying to figure out what to learn during fellowship to maximize locums and also trying to figure out how to schedule locums so I can work as much as possible during my first three years out; I know sometimes there may be some dead time between contracts, trying to learn how to avoid that. Also trying to learn how to navigate working with vendors/direct to hospital vs starting my own locums company to cut out the other locums companies. And then there's the navigation of contracts, attempting to max out total hours worked (24hrs/day at hourly rate) vs simply 8hrs/day rate - in the anesthesia side they say to max out hours instead of hourly rate to take home the most. I do see posts for 4k-5k/day or $500+/hr rate for locums (links below); but I want to learn how to cut out the middle man to maybe get a $500/hr rate to 600-700/hr or get the 5k daily rate to 6k or 7k. Then there's the clerical logistics of it; how to navigate IMLC, how to balance credentialing, how much of this can be done during fellowship to hit the grind hard day 1 of attendinghood.

I don't really know how I can do this without mentorship, there's very few resources online for this, and specifically for GI locums.

I didn't match my preferred specialty so I ended up in IM-->GI so I want to max out locums so I can retire within 3 years of attendinghood. Doing some research grind for my preferred specialty now during fellowship, then planning to keep applying to my preferred specialty during retirement. Hoping to make enough money to hit coastFIRE and then let the money work for me while continuing to apply to residency and when hopefully one day I can become a resident again. Just doing the math of 300 days * 4500/day = 1.35M/year, which should be 700k-800k post tax which should let me hit my coastFIRE numbers within 3 years, but unsure how realistic this goal is. I'm happy to move anywhere in the country and make the trade of 3 years of my life for coastFIRE, but again not really sure whether this would be realistic financially in the middle of nowhere either, as in why don't we see other IM/GIs doing this/talking about this/maybe I'm in an academic bubble.

The anesthesia forum is very open about numbers and mentorship with regards to locums, so I wanted to ask the IM/GI guys on this forum for mentorship, hopefully someone is willing to provide some guidance.

Links to aforementioned jobs:

Locum-to-Perm Gastroenterologist – Iowa – $525/Hourly! (Gastroenterology) in Iowa at PRN Healthcare · DocCafe

Apply for Gastroenterology Physician jobs in Iowa on DocCafe

www.doccafe.com

Locum Gastroenterology Physician job in Seneca, SC - Make $4,000/day - $4,500/day in Seneca, South Carolina at Aya Locums · DocCafe

Apply for Gastroenterology Physician jobs in Seneca, South Carolina on DocCafe

www.doccafe.com

Locums in Columbus GA/$4400 Day (Gastroenterology) in Columbus, Georgia at Aya Locums · DocCafe

Apply for Gastroenterology Physician jobs in Columbus, Georgia on DocCafe

www.doccafe.com

---

Members don't see this ad.

 

[dozitgetchahi]

Anybody have any tips/guides on how to get set up for IM locums during fellowship?

Also, I'm a current GI fellow but trying to get some mentorship regarding both IM and GI locums. Trying to figure out what to learn during fellowship to maximize locums and also trying to figure out how to schedule locums so I can work as much as possible during my first three years out; I know sometimes there may be some dead time between contracts, trying to learn how to avoid that. Also trying to learn how to navigate working with vendors/direct to hospital vs starting my own locums company to cut out the other locums companies. And then there's the navigation of contracts, attempting to max out total hours worked (24hrs/day at hourly rate) vs simply 8hrs/day rate - in the anesthesia side they say to max out hours instead of hourly rate to take home the most. I do see posts for 4k-5k/day or $500+/hr rate for locums (links below); but I want to learn how to cut out the middle man to maybe get a $500/hr rate to 600-700/hr or get the 5k daily rate to 6k or 7k. Then there's the clerical logistics of it; how to navigate IMLC, how to balance credentialing, how much of this can be done during fellowship to hit the grind hard day 1 of attendinghood.

I don't really know how I can do this without mentorship, there's very few resources online for this, and specifically for GI locums.

I didn't match my preferred specialty so I ended up in IM-->GI so I want to max out locums so I can retire within 3 years of attendinghood. Doing some research grind for my preferred specialty now during fellowship, then planning to keep applying to my preferred specialty during retirement. Hoping to make enough money to hit coastFIRE and then let the money work for me while continuing to apply to residency and when hopefully one day I can become a resident again. Just doing the math of 300 days * 4500/day = 1.35M/year, which should be 700k-800k post tax which should let me hit my coastFIRE numbers within 3 years, but unsure how realistic this goal is. I'm happy to move anywhere in the country and make the trade of 3 years of my life for coastFIRE, but again not really sure whether this would be realistic financially in the middle of nowhere either, as in why don't we see other IM/GIs doing this/talking about this/maybe I'm in an academic bubble.

The anesthesia forum is very open about numbers and mentorship with regards to locums, so I wanted to ask the IM/GI guys on this forum for mentorship, hopefully someone is willing to provide some guidance.

Links to aforementioned jobs:

Locum-to-Perm Gastroenterologist – Iowa – $525/Hourly! (Gastroenterology) in Iowa at PRN Healthcare · DocCafe

Apply for Gastroenterology Physician jobs in Iowa on DocCafe

www.doccafe.com

Locum Gastroenterology Physician job in Seneca, SC - Make $4,000/day - $4,500/day in Seneca, South Carolina at Aya Locums · DocCafe

Apply for Gastroenterology Physician jobs in Seneca, South Carolina on DocCafe

www.doccafe.com

Locums in Columbus GA/$4400 Day (Gastroenterology) in Columbus, Georgia at Aya Locums · DocCafe

Apply for Gastroenterology Physician jobs in Columbus, Georgia on DocCafe

www.doccafe.com

I’m so confused.

You successfully matched GI - which most people would see as a big prize - and yet you still want to apply to another specialty later, after you “FIRE” retire in 3 years from doing some sort of hardcore campaign of burning yourself out with as much locums work as you can possibly get?

Wtf.

What is the other specialty and why do you want to do this. What happens if you don’t match this other specialty down the road? How do you hope to do a bunch of research in that specialty if you’re working like a pack mule doing locums for 3 years?

Starting your own locums company as a GI fellow sounds insane.

My advice: forget about all this locums nonsense. Forget about the other specialty. Just go be a successful GI doc. A lot of people would kill to be in your shoes. Being GI already sets you up to be very well off. You don’t need anything else here. If you want to FIRE, GI sets you up well for that, working a regular job with reasonable hours.

 

[IM_to_ortho_hopeful]

I’m so confused.

You successfully matched GI - which most people would see as a big prize - and yet you still want to apply to another specialty later, after you “FIRE” retire in 3 years from doing some sort of hardcore campaign of burning yourself out with as much locums work as you can possibly get?

Wtf.

What is the other specialty and why do you want to do this. What happens if you don’t match this other specialty down the road? How do you hope to do a bunch of research in that specialty if you’re working like a pack mule doing locums for 3 years?

Starting your own locums company as a GI fellow sounds insane.

My advice: forget about all this locums nonsense. Forget about the other specialty. Just go be a successful GI doc. A lot of people would kill to be in your shoes. Being GI already sets you up to be very well off. You don’t need anything else here. If you want to FIRE, GI sets you up well for that, working a regular job with reasonable hours.

Thanks for the advice I appreciate it.

To answer your questions it ultimately comes down to what I want to do for the rest of my life. I want to be an orthopedic surgeon out of passion. I never wanted to be an internist. I see both IM and GI as a means to an end and hope I can retire 3 years into attending hood. 2.5M by age 35 should grow to 10M by 55 naturally sitting in VTI. I will feel less pressure to make money if I hit my coast fire number by age 35.

This allows me to keep applying to orthopedic surgery for the rest of my life, even if I don’t match. In terms of research I’m continuing working with mentors I’ve worked with since medical school so it streamlines the research grind a bit during fellowship.

If I don’t get into orthopedic surgery I would just work a few weeks of Gi locums a year while I keep applying every year, so I wanted to set up the locums pipeline from an early stage.

Blame the system not me man, I never wanted to be an internist but was forced to be, is it so wrong to try to escape and pursue my passions? I’m okay with sacrificing my life and time to pursue this strategy, if it seems realistic, what’s so wrong about that?

 

[dozitgetchahi]

Thanks for the advice I appreciate it.

To answer your questions it ultimately comes down to what I want to do for the rest of my life. I want to be an orthopedic surgeon out of passion. I never wanted to be an internist. I see both IM and GI as a means to an end and hope I can retire 3 years into attending hood. 2.5M by age 35 should grow to 10M by 55 naturally sitting in VTI. I will feel less pressure to make money if I hit my coast fire number by age 35.

This allows me to keep applying to orthopedic surgery for the rest of my life, even if I don’t match. In terms of research I’m continuing working with mentors I’ve worked with since medical school so it streamlines the research grind a bit during fellowship.

If I don’t get into orthopedic surgery I would just work a few weeks of Gi locums a year while I keep applying every year, so I wanted to set up the locums pipeline from an early stage.

Blame the system not me man, I never wanted to be an internist but was forced to be, is it so wrong to try to escape and pursue my passions? I’m okay with sacrificing my life and time to pursue this strategy, if it seems realistic, what’s so wrong about that?

You can do whatever you want with your life. However, the rate of matching these competitive specialties like ortho declines dramatically the further out you get from medical school. I’m not sure it’s very realistic. Also, nobody forced you to be an internist and now gastroenterologist - you chose these things as a “backup” (especially GI, which itself is often a challenging match. Nobody unintentionally falls into a GI fellowship as a “backup”).

I also think it’s a bit crazy that you took a GI slot from someone who may have really wanted to make a lifetime career out of it. The time to do this whole “ortho or bust” game was probably at the end of IM residency, not at the end of a GI fellowship on top of that.

Do you really want to continue applying to ortho residencies when you’re like 55 or something? Do you have any other plans in life? Do you have debt? Want a family?

 

[Redpancreas]

Don’t feed the troll.

@dozitgetchahi I think OP may have just started GI. The best time for this would have been after med school. OP should have taken a gap year, super productive with research, and applied to every program in the country. Eventually the grind would have got him matched.

This whole thread reads like a 2/10 troll attempt. 2 because I could sympathize with lack of money as a PGY 4-6 when OPs in his 30s, but it’s not like OP’s late to attending hood and would have 30+ years to practice in a fairly good field with minimal burnout.

 

[IM_to_ortho_hopeful]

Don’t feed the troll.

Not really sure how I'm trolling... these are genuine questions I think are applicable to all fellows interested in locums, and applicable to general IM community. I admit my life trajectory is not normal, but I have my passions

 

[IM_to_ortho_hopeful]

You can do whatever you want with your life. However, the rate of matching these competitive specialties like ortho declines dramatically the further out you get from medical school. I’m not sure it’s very realistic. Also, nobody forced you to be an internist and now gastroenterologist - you chose these things as a “backup” (especially GI, which itself is often a challenging match. Nobody unintentionally falls into a GI fellowship as a “backup”).

I also think it’s a bit crazy that you took a GI slot from someone who may have really wanted to make a lifetime career out of it. The time to do this whole “ortho or bust” game was probably at the end of IM residency, not at the end of a GI fellowship on top of that.

Do you really want to continue applying to ortho residencies when you’re like 55 or something? Do you have any other plans in life? Do you have debt? Want a family?

As for choosing GI, it seemed like the easiest escape from IM. Scoping all day is tolerable to me, so I can do it if needed; unfortunately I had to take a spot because the alternative would have been practicing as an internist, which I know I would not have been able to tolerate

I'll probably give up before I'm 55 - but mid 30s, why not? I don't really have much else going on in my life, no debts; I do want a family eventually but I'll have to move to the middle of nowhere to hit coastfire ASAP so that eliminates any social life or ability to meet a significant other; I'm okay with making these sacrifices to retire early and at least make the attempt to chase my dreams and pursue my passions for the rest of my life.

 

[Redpancreas]

Not really sure how I'm trolling... these are genuine questions I think are applicable to all fellows interested in locums, and applicable to general IM community. I admit my life trajectory is not normal, but I have my passions

Why’d you bust your butt to go through 3 years of IM to match GI with a plan for fellowship for 3 years to work in a field for 3 years. Initial GI take home doesn’t pay that well to where that’s worth it. You could literally have just done IM, gone locums, and paid for your unlimited ortho attempts after.

 

[dozitgetchahi]

Don’t feed the troll.

@dozitgetchahi I think OP may have just started GI. The best time for this would have been after med school. OP should have taken a gap year, super productive with research, and applied to every program in the country. Eventually the grind would have got him matched.

This whole thread reads like a 2/10 troll attempt. 2 because I could sympathize with lack of money as a PGY 4-6 when OPs in his 30s, but it’s not like OP’s late to attending hood and would have 30+ years to practice in a fairly good field with minimal burnout.

I don’t think OP is trolling. A very common scenario on SDN goes something like this:

Poster: “I want to do this really weird/stupid/crazy thing in medicine!”

SDN: “Nah bro, that’s not a good idea, don’t do that.”

Poster: “But I think it’s a great idea! And I intend to do it no matter what!”

Sometimes the poster comes back later to fill us in on how it went. It usually doesn’t go well.

 

[IM_to_ortho_hopeful]

Why’d you bust your butt to go through 3 years of IM to match GI with a plan for fellowship for 3 years to work in a field for 3 years. Initial GI take home doesn’t pay that well to where that’s worth it. You could literally have just done IM, gone locums, and paid for your unlimited ortho attempts after.

Thanks for the response. Well to answer your question, with IM I saw most hospitalist positions max out around 2k a day, from a time standpoint GI can get around 4-5k a day from locums was my rationale for going into GI. I hope this can help with some discourse, is it true that initial GI take home doesn't pay that well even in the middle of nowhere? Especially with the direction that facility fees are going for hospital outpatient, it seems that employed positions are outpacing private offers. Maybe you can help me understand the income potential for GI because I don't have any mentors that are willing to talk to me about this.

For example, I will link below job offers for several GI hospitalist 7 on 7 off positions, with guaranteed income not income potentials. I've also spoken to the recruiters directly, and one practice directly and the jobs seem real. I have seen South Dakota 850k, North Dakota 750k, West Virginia 700k, Tennessee 800k, Pennsylvania 700k. Would it not be possible to work two of these, or do a combo W2 GI hospitalist + 1099 locums to essentially double pretax earnings to perhaps 1.4M - 1.6M? If I wanted to grind, no days off, would it not be possible to work 2+ FTEs?

Now maybe I'm missing something that you can better inform me on, but is there something I'm missing when I see these jobs? In terms of energy and drive I'm very driven to keep grinding for a few years to build a nest egg to coastfire immediately after fellowship - I also don't have any family or SO to hold me back.

To contrast, I have not seen as many lucrative private practice (true PP, avoiding PE) starting salaries, I've only found 1M guarantee in texas, 900k guarantee Missouri, 800k base guarantee Minnesota, and a few others around this range; but most jobs advertise as potential which I'm wary of. It seems like a 2-3 year partner track at 400k-600k income, on top of standard buy in of EBITDA * 3 / percent share (for ASC/practice/path/other entities) would put you behind several years financially compared to the above employed positions. Moreover, those private practice gigs that are offering high take home guarantees in fact have contracts with local hospitals that subsidize their pay - i.e. the hospital is providing some of the facility fee from use of their facilities over to the GI docs now. Which makes me wonder - will this be a trend in the GI market going forward, practices negotiating subsidies from local hospitals for coverage/call? If hospital employed positions are more lucrative, what would be the incentive for a young trainee to join a private practice, especially with PE gobbling up so many of the previous true PP?

Additionally what are your opinions for how to find the most lucrative gigs? I hear these are word of mouth

I'll post some links below to provide evidence of the income numbers I'm working with for calculations, with a decent sample size, seen similar offers through other sites; doccafe, practice link, etc. These are all W2/K1 positions and no 1099 locums.

GI hospitalist positions:

800k+ | 100K Sign On | North of Nashville | GI Dayshift 7 on 7 off job in Kentucky

Find your next 800k+ | 100K Sign On | North of Nashville | GI Dayshift 7 on 7 off job located in Kentucky. Apply Now for this great 800k+ | 100K Sign On |

jobs.jacksonphysiciansearch.com

GI Hospitalist | $720K Salary - 14 Days Per Month | Mountain West Region job in South Dakota

Find your next GI Hospitalist | $720K Salary - 14 Days Per Month | Mountain West Region job located in South Dakota. Apply Now for this great GI Hospitali

jobs.jacksonphysiciansearch.com

7 on/7 off GI Hospitalist Opening | Northeast | $800K+ Income job in Pennsylvania

Find your next 7 on/7 off GI Hospitalist Opening | Northeast | $800K+ Income job located in Pennsylvania. Apply Now for this great 7 on/7 off GI Hospitali

jobs.jacksonphysiciansearch.com

GI | West Virginia | Six Figure Sign on Bonus | $1 Million+ Comp Potential job in West Virginia

Find your next GI | West Virginia | Six Figure Sign on Bonus | $1 Million+ Comp Potential job located in West Virginia. Apply Now for this great GI | West

jobs.jacksonphysiciansearch.com

GI private practice positions:

Gastroenterology | Private Practice | Partnership Track | Texas Metro job in Texas

Find your next Gastroenterology | Private Practice | Partnership Track | Texas Metro job located in Texas. Apply Now for this great Gastroenterology | Pri

jobs.jacksonphysiciansearch.com

Gastroenterology | $1MM+ Year 1 | 11,000+ wRVUs Annually | Minneapolis job in Minnesota

Find your next Gastroenterology | $1MM+ Year 1 | 11,000+ wRVUs Annually | Minneapolis job located in Minnesota. Apply Now for this great Gastroenterology

jobs.jacksonphysiciansearch.com

Gastroenterology | Bustling Missouri Town | 900k Earnings Potential job in Missouri

Find your next Gastroenterology | Bustling Missouri Town | 900k Earnings Potential job located in Missouri. Apply Now for this great Gastroenterology | Bu

jobs.jacksonphysiciansearch.com

 

[Ubba]

If I were an Ortho residency interviewer and a GI-trained doc walked through the door as an applicant, I'd structure my interview as closely along the lines of a psych exam as i could remember from med school, and take a good look at your pupils for good measure.

 

[dozitgetchahi]

Thanks for the response. Well to answer your question, with IM I saw most hospitalist positions max out around 2k a day, from a time standpoint GI can get around 4-5k a day from locums was my rationale for going into GI. I hope this can help with some discourse, is it true that initial GI take home doesn't pay that well even in the middle of nowhere? Especially with the direction that facility fees are going for hospital outpatient, it seems that employed positions are outpacing private offers. Maybe you can help me understand the income potential for GI because I don't have any mentors that are willing to talk to me about this.

For example, I will link below job offers for several GI hospitalist 7 on 7 off positions, with guaranteed income not income potentials. I've also spoken to the recruiters directly, and one practice directly and the jobs seem real. I have seen South Dakota 850k, North Dakota 750k, West Virginia 700k, Tennessee 800k, Pennsylvania 700k. Would it not be possible to work two of these, or do a combo W2 GI hospitalist + 1099 locums to essentially double pretax earnings to perhaps 1.4M - 1.6M? If I wanted to grind, no days off, would it not be possible to work 2+ FTEs?

Now maybe I'm missing something that you can better inform me on, but is there something I'm missing when I see these jobs? In terms of energy and drive I'm very driven to keep grinding for a few years to build a nest egg to coastfire immediately after fellowship - I also don't have any family or SO to hold me back.

To contrast, I have not seen as many lucrative private practice (true PP, avoiding PE) starting salaries, I've only found 1M guarantee in texas, 900k guarantee Missouri, 800k base guarantee Minnesota, and a few others around this range; but most jobs advertise as potential which I'm wary of. It seems like a 2-3 year partner track at 400k-600k income, on top of standard buy in of EBITDA * 3 / percent share (for ASC/practice/path/other entities) would put you behind several years financially compared to the above employed positions. Moreover, those private practice gigs that are offering high take home guarantees in fact have contracts with local hospitals that subsidize their pay - i.e. the hospital is providing some of the facility fee from use of their facilities over to the GI docs now. Which makes me wonder - will this be a trend in the GI market going forward, practices negotiating subsidies from local hospitals for coverage/call? If hospital employed positions are more lucrative, what would be the incentive for a young trainee to join a private practice, especially with PE gobbling up so many of the previous true PP?

Additionally what are your opinions for how to find the most lucrative gigs? I hear these are word of mouth

I'll post some links below to provide evidence of the income numbers I'm working with for calculations, with a decent sample size, seen similar offers through other sites; doccafe, practice link, etc. These are all W2/K1 positions and no 1099 locums.

GI hospitalist positions:

800k+ | 100K Sign On | North of Nashville | GI Dayshift 7 on 7 off job in Kentucky

Find your next 800k+ | 100K Sign On | North of Nashville | GI Dayshift 7 on 7 off job located in Kentucky. Apply Now for this great 800k+ | 100K Sign On |

jobs.jacksonphysiciansearch.com

GI Hospitalist | $720K Salary - 14 Days Per Month | Mountain West Region job in South Dakota

Find your next GI Hospitalist | $720K Salary - 14 Days Per Month | Mountain West Region job located in South Dakota. Apply Now for this great GI Hospitali

jobs.jacksonphysiciansearch.com

7 on/7 off GI Hospitalist Opening | Northeast | $800K+ Income job in Pennsylvania

Find your next 7 on/7 off GI Hospitalist Opening | Northeast | $800K+ Income job located in Pennsylvania. Apply Now for this great 7 on/7 off GI Hospitali

jobs.jacksonphysiciansearch.com

GI | West Virginia | Six Figure Sign on Bonus | $1 Million+ Comp Potential job in West Virginia

Find your next GI | West Virginia | Six Figure Sign on Bonus | $1 Million+ Comp Potential job located in West Virginia. Apply Now for this great GI | West

jobs.jacksonphysiciansearch.com

GI private practice positions:

Gastroenterology | Private Practice | Partnership Track | Texas Metro job in Texas

Find your next Gastroenterology | Private Practice | Partnership Track | Texas Metro job located in Texas. Apply Now for this great Gastroenterology | Pri

jobs.jacksonphysiciansearch.com

Gastroenterology | $1MM+ Year 1 | 11,000+ wRVUs Annually | Minneapolis job in Minnesota

Find your next Gastroenterology | $1MM+ Year 1 | 11,000+ wRVUs Annually | Minneapolis job located in Minnesota. Apply Now for this great Gastroenterology

jobs.jacksonphysiciansearch.com

Gastroenterology | Bustling Missouri Town | 900k Earnings Potential job in Missouri

Find your next Gastroenterology | Bustling Missouri Town | 900k Earnings Potential job located in Missouri. Apply Now for this great Gastroenterology | Bu

jobs.jacksonphysiciansearch.com

Ok so here’s a few more questions.

Have you ever lived in any of these “BFE America” places before? I have (rural Alabama and now semi rural Midwest). They’re not for everyone. I only lasted 10 months in Alabama before bailing out. (I quite like my current Midwest location). If you’re not white, straight and ideally male (or even if you’re not from there originally), you may find a lot of these places to be inhospitable.

Working 2+ FTE sounds like a good way to die on duty, like some of those Wall Street bankers have been doing lately. When I was a resident, there was a general IM attending that was trying to FIRE as fast as possible by basically picking up every single shift he possibly could. It wasn’t clear when he slept. He was careless and wasn’t being a good doctor at all (probably on account of sleep deprivation, and probably also on account of not liking being a doctor). Eventually the guy started having hallucinations on shift and got reported to the state PHP.

This plan is crazy. I would seriously reconsider the whole thing, dude. If you don’t like GI that much, work part of the year as GI locums and then spend the rest traveling or discovering other passions. There’s more to do in life than continually reapplying to ortho residency, especially when you will be a GI doc.

 

[sloh]

Inb4 many scope perfs haha

 

[IM_to_ortho_hopeful]

Inb4 many scope perfs haha

I don’t really understand how being a good doc and maxing income are mutually exclusive? Especially for locums where you are a wage worker and are not incentivized by scoping as fast as possible?

 

[dozitgetchahi]

I don’t really understand how being a good doc and maxing income are mutually exclusive? Especially for locums where you are a wage worker and are not incentivized by scoping as fast as possible?

There’s a point after which a doc is working too much to possibly be well rested etc. 2+ FTE is definitely there.

 

[IM_to_ortho_hopeful]

Ok so here’s a few more questions.

Have you ever lived in any of these “BFE America” places before? I have (rural Alabama and now semi rural Midwest). They’re not for everyone. I only lasted 10 months in Alabama before bailing out. (I quite like my current Midwest location). If you’re not white, straight and ideally male (or even if you’re not from there originally), you may find a lot of these places to be inhospitable.

Working 2+ FTE sounds like a good way to die on duty, like some of those Wall Street bankers have been doing lately. When I was a resident, there was a general IM attending that was trying to FIRE as fast as possible by basically picking up every single shift he possibly could. It wasn’t clear when he slept. He was careless and wasn’t being a good doctor at all (probably on account of sleep deprivation, and probably also on account of not liking being a doctor). Eventually the guy started having hallucinations on shift and got reported to the state PHP.

This plan is crazy. I would seriously reconsider the whole thing, dude. If you don’t like GI that much, work part of the year as GI locums and then spend the rest traveling or discovering other passions. There’s more to do in life than continually reapplying to ortho residency, especially when you will be a GI doc.

Thanks, to answer your questions I’ve lived in BFE areas my entire life. Unfortunately have never been able to live where I wanted and constricted by med school acceptances and match. But I’m okay with living in these places.

I guess what’s so crazy about the plan? I don’t really understand why one wouldn’t be able to work daily with no breaks for a couple of years, haven’t we all done it during training? I don’t really have much passions outside of specific parts of medicine either. So I guess what do you recommend me to do? Should I drop out of GI fellowship?

 

[IM_to_ortho_hopeful]

There’s a point after which a doc is working too much to possibly be well rested etc. 2+ FTE is definitely there.

Did something change between generations? Old school docs used to work every day this 7 on 7 off culture didn’t exist. Why can’t we grind like they did?

Frankly I don’t feel tired after doing 15+ scopes a day, mentally or physically, not sure if grinding GI is comparable to a cognitive field, I hated IM so it was much more emotionally exhausting than scoping, but maybe someone else can comment on the realities of fatigue in GI

 

[hotsaws]

This has got to be either trolling or mania. If you're trolling, good on you, 8/10 for almost being believable. If your serious, the most alarming thing is that you don't seem insightful as to just how crazy this sounds.

 

[IM_to_ortho_hopeful]

This has got to be either trolling or mania. If you're trolling, good on you, 8/10 for almost being believable. If your serious, the most alarming thing is that you don't seem insightful as to just how crazy this sounds.

How is it crazy? You see other threads like it all the time.. how can I make the most as a nocturnist/hospitalist, etc; this is just as a GI doc

Also why is it so difficult to talk about salary with internists, anesthesiologists and radiologists are so open about salary and how to maximize their time for maximum return lol

 

[hotsaws]

It’s not crazy to maximize earnings as a gi doc post fellowship. It sounds like a grind and those of us with families or other priorities might just choose “normal” high earnings that come with routine practice in that field. But it’s not crazy to finish training and then want to secure a huge nest egg quickly. That’s a common stated desire, perhaps less commonly pursued after the fatigue and aging of training. But not crazy at all. What is crazy…is thinking you’re going to do this while applying and then potentially reentering training in a completely unrelated field for another 5 or 6 years. The crazy part starts when you say oh and I’m applying for ortho.

Not sure what you mean by difficult to talk about salary. There are plenty of threads -- I think there's an entire multipage hospitalists thread -- discussing how to make money, structure a career, and negotiate contracts. I think you'll find open sharing from internists in all aspects of practice from locums beasts to suburb round and go homers.

 

[IM_to_ortho_hopeful]

It’s not crazy to maximize earnings as a gi doc post fellowship. It sounds like a grind and those of us with families or other priorities might just choose “normal” high earnings that come with routine practice in that field. But it’s not crazy to finish training and then want to secure a huge nest egg quickly. That’s a common stated desire, perhaps less commonly pursued after the fatigue and aging of training. But not crazy at all. What is crazy…is thinking you’re going to do this while applying and then potentially reentering training in a completely unrelated field for another 5 or 6 years. The crazy part starts when you say oh and I’m applying for ortho.

Not sure what you mean by difficult to talk about salary. There are plenty of threads -- I think there's an entire multipage hospitalists thread -- discussing how to make money, structure a career, and negotiate contracts. I think you'll find open sharing from internists in all aspects of practice from locums beasts to suburb round and go homers.

Thanks for your post. With regards to trying to maximize earnings as a GI doc, this is my goal, I don't have any family, or frankly many friends really, so I wanted to maximize income because I don't have anything holding me back. I, like the others you mention, want to build up a nest egg as soon as possible; I feel that when you hit your coastfire number you can start to unplug from the matrix, you no longer need to work for money, but rather can pursue your passions. I have no family or friends so why not attempt to max out money to unplug? I don't really know what I would do with my time off. I understand that for someone who has a family they have other priorities, but unfortunately I haven't been blessed with a family. With regards to fatigue and aging of training, I don't feel fatigued right now, I actually thought IM and GI are both pretty easy, my hours are like 7:30-5 in GI fellowship... it's not particularly physically exhausting; the fatiguing part for me is moreso the lack of interest and passion. Neurosurgeons are the least burnt out physicians per surveys, imo because they tend to be the most passionate about what they do.

With regards to applying for another specialty after hitting coastfire numbers and unplugging from the matrix, I understand this is atypical, but it ultimately comes down to what do I want to do for the rest of my life? I'm an internist already but I hate the work, why would I do it if I financially reach a point where the growth of assets outpace my spending? GI is tolerable, and endoscopy is a nice skillset to have, but I see it as more of a means to an end. I want to learn a new skillset that not many people have, and focus on disease that I'm passionate about, is that so wrong? If I don't match again, I don't match but at least I gave it a shot to pursue my dreams. If I don't match I would likely attempt to apply for radiology residencies, maybe I will apply simultaneously, to access the ability to work from home, and the ability to titrate work down to 3-4 hours a day whenever I want.

With regards to difficulty talking about salary, it comes down to me posting this thread and not a single response has been about the nuts and bolts of locums and GI income maxxing logistics - I even posted links to several jobs to facilitate discussion, and the majority of the comments have been people calling me crazy for wanting to not be an internist lol. To contrast, I actually posted a similar comment on an anesthesia locums thread and they, were actually pretty helpful, but did not know the specifics of the IM and GI markets so redirected me here.

 

[IM_to_ortho_hopeful]

Why’d you bust your butt to go through 3 years of IM to match GI with a plan for fellowship for 3 years to work in a field for 3 years. Initial GI take home doesn’t pay that well to where that’s worth it. You could literally have just done IM, gone locums, and paid for your unlimited ortho attempts after.

Any thoughts on maximizing initial GI income per the prior links I posted for GI gigs? Since you're a GI doc thought I'd ask

 

[geniusindisguise]

Thanks for your post. With regards to trying to maximize earnings as a GI doc, this is my goal, I don't have any family, or frankly many friends really, so I wanted to maximize income because I don't have anything holding me back. I, like the others you mention, want to build up a nest egg as soon as possible; I feel that when you hit your coastfire number you can start to unplug from the matrix, you no longer need to work for money, but rather can pursue your passions. I have no family or friends so why not attempt to max out money to unplug? I don't really know what I would do with my time off. I understand that for someone who has a family they have other priorities, but unfortunately I haven't been blessed with a family. With regards to fatigue and aging of training, I don't feel fatigued right now, I actually thought IM and GI are both pretty easy, my hours are like 7:30-5 in GI fellowship... it's not particularly physically exhausting; the fatiguing part for me is moreso the lack of interest and passion. Neurosurgeons are the least burnt out physicians per surveys, imo because they tend to be the most passionate about what they do.

With regards to applying for another specialty after hitting coastfire numbers and unplugging from the matrix, I understand this is atypical, but it ultimately comes down to what do I want to do for the rest of my life? I'm an internist already but I hate the work, why would I do it if I financially reach a point where the growth of assets outpace my spending? GI is tolerable, and endoscopy is a nice skillset to have, but I see it as more of a means to an end. I want to learn a new skillset that not many people have, and focus on disease that I'm passionate about, is that so wrong? If I don't match again, I don't match but at least I gave it a shot to pursue my dreams. If I don't match I would likely attempt to apply for radiology residencies, maybe I will apply simultaneously, to access the ability to work from home, and the ability to titrate work down to 3-4 hours a day whenever I want.

With regards to difficulty talking about salary, it comes down to me posting this thread and not a single response has been about the nuts and bolts of locums and GI income maxxing logistics - I even posted links to several jobs to facilitate discussion, and the majority of the comments have been people calling me crazy for wanting to not be an internist lol. To contrast, I actually posted a similar comment on an anesthesia locums thread and they, were actually pretty helpful, but did not know the specifics of the IM and GI markets so redirected me here.

Personally, I don't think it's crazy to pursue an orthopedic residency if that is your true passion and goal in life, even if it's a terrible idea from a pragmatic and financial standpoint. Money isn't everything and I have come across folks who have traveled similar paths. However, the bolded does not make any sense. This would be a >$2.5 million opportunity cost with the added risk of skills atrophy as a GI doc to gain another set of skills that pays similar as a gastroenterologist to work a job you have no passion for. Why would this be a back up plan?

 

[chessknt]

Why not become a general surgeon, that way when you perf the colon you can just flip them over and to an exlap and fix it, add modifier 25 and get full payment. Double dip that $hit then have them follow up with your 100 NPs you hired to see all your patients to feed your endless scoping clinic.

 

[dozitgetchahi]

Personally, I don't think it's crazy to pursue an orthopedic residency if that is your true passion and goal in life, even if it's a terrible idea from a pragmatic and financial standpoint. Money isn't everything and I have come across folks who have traveled similar paths. However, the bolded does not make any sense. This would be a >$2.5 million opportunity cost with the added risk of skills atrophy as a GI doc to gain another set of skills that pays similar as a gastroenterologist to work a job you have no passion for. Why would this be a back up plan?

I agree. Furthermore, why go through all the trouble of matching and training for GI if you don’t actually want to do it?

 

[AlbinoHawk DO]

I agree. Furthermore, why go through all the trouble of matching and training for GI if you don’t actually want to do it?

OP said that they find doing scope more tolerable than general IM, which I suppose makes some sense. However, tolerating 3 years of fellowship sounds quite brutal to me when you don't like that fellowship and you could be making cash. I suppose some people have higher tolerability for dealing with being in training

 

[Doctor_Strange]

This is one of the most ridiculous posts I have ever read in my life. There is so much fremdschämen here I cannot even hold it together lol.

 

[Konigstiger]

None of this really makes any sense. If your goal was simply to make as much money as possible after failing to match orthopedics, your backup residency should have been psychiatry or something else that makes a decent amount of money but doesn't require heavy hours. Choosing IM and then GI is the "path of most resistance" in order to achieve what you want. I also don't understand why you chose to grind for the brutal GI match and then be a fellow for three years and miss out on three years of attending income instead of working as a hospitalist and focusing on ortho research/connections while also making attending money and having a lot more free time. The path you chose seems to cost you quite a bit of money and definitely costs you significantly more time and stress.

Also, whatever program that accepted you has incredibly bad interviewing skills since you're exactly the type of person they should not want. This isn't meant as an insult, as you're probably quite intelligent and hardworking given you matched GI, but it's crazy to me that a GI program accepted someone who has no desire to actually do GI.

 

[dozitgetchahi]

None of this really makes any sense. If your goal was simply to make as much money as possible after failing to match orthopedics, your backup residency should have been psychiatry or something else that makes a decent amount of money but doesn't require heavy hours. Choosing IM and then GI is the "path of most resistance" in order to achieve what you want. I also don't understand why you chose to grind for the brutal GI match and then be a fellow for three years and miss out on three years of attending income instead of working as a hospitalist and focusing on ortho research/connections while also making attending money and having a lot more free time. The path you chose seems to cost you quite a bit of money and definitely costs you significantly more time and stress.

Also, whatever program that accepted you has incredibly bad interviewing skills since you're exactly the type of person they should not want. This isn't meant as an insult, as you're probably quite intelligent and hardworking given you matched GI, but it's crazy to me that a GI program accepted someone who has no desire to actually do GI.

All of this x100.

 

[hotsaws]

This dude has to be trolling. If not, it's a cringey illustration of discontent and escapism.

 

[dozitgetchahi]

This dude has to be trolling. If not, it's a cringey illustration of discontent and escapism.

I have encountered a lot of doctors with fanciful, unusual, “out there” beliefs, and a disproportionate number of these kinds of people seem to post on SDN. So I don’t necessarily think OP is trolling, because I’ve heard so much wild/weird/stupid stuff come out of the mouths of people in this profession that I don’t think anything is outside the realm of reality anymore.

 

[IM_to_ortho_hopeful]

None of this really makes any sense. If your goal was simply to make as much money as possible after failing to match orthopedics, your backup residency should have been psychiatry or something else that makes a decent amount of money but doesn't require heavy hours. Choosing IM and then GI is the "path of most resistance" in order to achieve what you want. I also don't understand why you chose to grind for the brutal GI match and then be a fellow for three years and miss out on three years of attending income instead of working as a hospitalist and focusing on ortho research/connections while also making attending money and having a lot more free time. The path you chose seems to cost you quite a bit of money and definitely costs you significantly more time and stress.

Also, whatever program that accepted you has incredibly bad interviewing skills since you're exactly the type of person they should not want. This isn't meant as an insult, as you're probably quite intelligent and hardworking given you matched GI, but it's crazy to me that a GI program accepted someone who has no desire to actually do GI.

Well I did IM because I had no other option, I don't like IM. GI was the easiest way out of IM, I'm not super passionate about constipation but I'd rather be scoping all day than doing IM work; i.e. GI is much more tolerable (to me, personally) and has less bull**** (for me) to deal with than IM, that's why I went into it. At this point it's more about what I'd rather do for the rest of my life. Unfortunately with more years as an IM attending it becomes more difficult to match into fellowship so I thought I might as well apply. Monetarily I didn't really see much difference, a lot of fellows make 100k base nowadays; if you moonlight 75 shifts a year you get to the 250k a hospitalist makes anyway, you'd be surprised how much free time you actually get in fellowship, at least in GI and heme/onc. Can't argue with you about losing time, that's for sure, and unfortunate because time is our most valuable resource.

What I find interesting about this thread is all posts are critiquing my life choices, which is fair as they are atypical, but not a single post has actually responded to the actual question of how to maximize locums logistics for GI/IM lol.

I have encountered a lot of doctors with fanciful, unusual, “out there” beliefs, and a disproportionate number of these kinds of people seem to post on SDN. So I don’t necessarily think OP is trolling, because I’ve heard so much wild/weird/stupid stuff come out of the mouths of people in this profession that I don’t think anything is outside the realm of reality anymore.

Is it so strange to want to pursue your passions? I don't mean to disparage you by this comment, but I think I remember in another thread you posted something about preferring to be a radiologist than an IM/rheum? Isn't my situation analogous to yours? I do agree with you that I have seen some other outlandish posts on SDN.

 

[hotsaws]

There are a number of threads out there regarding locums, albeit probably not GI specifically. The useful information is about contracts, predatory employers, poor working conditions, support staff, excessive liability exposure, etc. That is universally applicable. There is no free lunch. If someone is offering you significantly above average compensation for a job, there's always a catch. Perhaps the catch is just a crappy location or bad hours. That seems fine with you. Sometimes the catch is a terrible job, regardless of location and hours. That would be what to look out for. I'm sure you could look through those threads and then DM posters (with specific questions) who might have some helpful experience.

The reason you're getting so much push back is because of how obscene your overall plan is and the general discordance you seem to have in it. It's not atypical, it's nonsensical.

 

[eyeeye_captain]

OP, good luck and Godspeed.

I started to write about how stacking multiple locums/recruiter jobs in BFE is a logistical nightmare, and how that ortho ship already sailed, hit an iceberg, and sank, but I thought the Simpsons would be more eloquent.

 

[IM_to_ortho_hopeful]

OP, good luck and Godspeed.

I started to write about how stacking multiple locums/recruiter jobs in BFE is a logistical nightmare, and how that ortho ship already sailed, hit an iceberg, and sank, but I thought the Simpsons would be more eloquent.

View attachment 393324

Haha thanks for the post. Yes I understand locums stacking in rural areas would be a logistical nightmare so I was looking for tips or a guide on what to do. The anesthesia guys are definitely doing it, but they referred me to you guys to figure it out.

I agree I’m out of touch with reality. But I have a dream, and what happens to a dream deferred?

I understand there is low probability I match again, but if I don’t match I’ll have my retirement stack ready as my backup plan.

 

[dbdnt]

I realize this is probably a troll post, but I think what’s sad is you have said multiple times how you don’t have a personal life, family, or friends to “hold you back.” I think this says a lot about your mindset right now. If I knew you personally, I would tell you to take a good long break before embarking on any of these schemes.

 

[dozitgetchahi]

Well I did IM because I had no other option, I don't like IM. GI was the easiest way out of IM, I'm not super passionate about constipation but I'd rather be scoping all day than doing IM work; i.e. GI is much more tolerable (to me, personally) and has less bull**** (for me) to deal with than IM, that's why I went into it. At this point it's more about what I'd rather do for the rest of my life. Unfortunately with more years as an IM attending it becomes more difficult to match into fellowship so I thought I might as well apply. Monetarily I didn't really see much difference, a lot of fellows make 100k base nowadays; if you moonlight 75 shifts a year you get to the 250k a hospitalist makes anyway, you'd be surprised how much free time you actually get in fellowship, at least in GI and heme/onc. Can't argue with you about losing time, that's for sure, and unfortunate because time is our most valuable resource.

What I find interesting about this thread is all posts are critiquing my life choices, which is fair as they are atypical, but not a single post has actually responded to the actual question of how to maximize locums logistics for GI/IM lol.


Is it so strange to want to pursue your passions? I don't mean to disparage you by this comment, but I think I remember in another thread you posted something about preferring to be a radiologist than an IM/rheum? Isn't my situation analogous to yours? I do agree with you that I have seen some other outlandish posts on SDN.

I didn’t prefer to be a radiologist to IM/rheum, I realized I didn’t really want to be a human slide reader in a dark room all day (and that I want to see patients). I didn’t like in patient general IM work either, but I did really like outpatient clinic work and found that I really enjoyed my rheumatology rotation. Rheumatology fellowship largely sucked, but that had a lot to do with my program (which was pretty brutal) and not the actual practice of rheumatology. I quite like my current job as a rheumatologist, and I am not secretly pining to bail out of rheumatology to apply to radiology residencies. (I *chose* IM/rheum.) Even if I was, there is no way that I would give up my current income as a physician to go be treated as a scut worker trainee again. That **** was miserable.

If you don’t currently have friends, family or “anything else” in life, why not spend some time pursuing those things? Meet people, meet friends, date. Expand your life. Do hobbies. Find passions other than orthopedic surgery. Put your energy in other places and directions. Medical training has a way of making people put the blinders on, and think there’s nothing else to do but study and work. This isn’t even remotely true, but you wouldn’t be the first doc to get towards the end of training and look around and wonder “is this it”? The solution to this isn’t doing more training…that would be like getting out of jail, and trying to go back because you don’t know how to live in the real world. The solution is to establish a life.

 

[IM_to_ortho_hopeful]

I realize this is probably a troll post, but I think what’s sad is you have said multiple times how you don’t have a personal life, family, or friends to “hold you back.” I think this says a lot about your mindset right now. If I knew you personally, I would tell you to take a good long break before embarking on any of these schemes.

I didn’t prefer to be a radiologist to IM/rheum, I realized I didn’t really want to be a human slide reader in a dark room all day (and that I want to see patients). I didn’t like in patient general IM work either, but I did really like outpatient clinic work and found that I really enjoyed my rheumatology rotation. Rheumatology fellowship largely sucked, but that had a lot to do with my program (which was pretty brutal) and not the actual practice of rheumatology. I quite like my current job as a rheumatologist, and I am not secretly pining to bail out of rheumatology to apply to radiology residencies. (I *chose* IM/rheum.) Even if I was, there is no way that I would give up my current income as a physician to go be treated as a scut worker trainee again. That **** was miserable.

If you don’t currently have friends, family or “anything else” in life, why not spend some time pursuing those things? Meet people, meet friends, date. Expand your life. Do hobbies. Find passions other than orthopedic surgery. Put your energy in other places and directions. Medical training has a way of making people put the blinders on, and think there’s nothing else to do but study and work. This isn’t even remotely true, but you wouldn’t be the first doc to get towards the end of training and look around and wonder “is this it”? The solution to this isn’t doing more training…that would be like getting out of jail, and trying to go back because you don’t know how to live in the real world. The solution is to establish a life.

You guys are right for sure. I definitely prioritized profession and studying over making genuine connections and friendships. One day you just turn thirty and realize you have no friends, and you realize you haven’t been building a life filled with people you want to surround yourself by. Oh well, friendships are difficult to make in your thirties, people with kids have other priorities, understandably so. So I keep focusing on maxing reimbursement per unit time, not much else for me to do tbh.

 

[hotsaws]

The last two posters hit the nail on the head. I had actually typed out some similar stuff but every time I put effort into a post on this thread, I keep thinking it's troll food.

I will just further reinforce what has been said. If you spend your 30s in perpetual training or grinding away doing locums or taking every extra shift, you will miss out on much of what makes the whole early retirement thing worth it in the 1st place. If you do not have much else in terms of relationships and hobbies right now, it will only get worse. Medicine takes these things away from us, almost a guarantee during training and sometimes during the career itself (depending on what kind of lifestyle you choose). This is probably why med schools look fondly on applicants that are a little older than average and have done more than just highschool, undergrad, med school, etc. straight through. Not only does med school and training take up a significant amount of time, but it also often has us uprooting ourselves geographically every couple years at the mercy of some effed up match system. Once you finally finish training, and especially if you have a career that offers the potential for a good lifestyle, you are now back in control of your personal life to a far greater degree. You can work normal hours, you can live where you want, you can pursue hobbies and relationships. If you just keep grinding and training, you won't have that. It won't matter how much money you make.

You said "Oh well, friendships are difficult to make in your thirties, people with kids have other priorities, understandably so." This is not false but an even more accurate/relevant statement would be "...friendships are difficult to make when you're perpetually training or working crazy hours doing locums." You could finish your fellowship and pretty much move to the city of your choice and pursue whatever you want. Whether you're artsy, nerdy, athletic, musically inclined....whatever, there is probably plenty of groups in decent sized city that are looking to expand their friend circle. Plenty of single doctors have ended up marrying pharma reps, nurses, PTs, other docs, etc. You meet at work but you need the normal hours to cultivate those things further. Then you will find that the medicine thing can just be a job. Give yourself a chance at happiness, man. I'm not trying to be a dick by critiquing all your plans, I genuinely hope you take a look at all these responses and reconsider. If you think building relationships is hard in your 30s, how do you think it's going to be in your 40s? More money can just be isolating at that point anyway.

 

[sloh]

Oh well, friendships are difficult to make in your thirties, people with kids have other priorities, understandably so. So I keep focusing on maxing reimbursement per unit time, not much else for me to do tbh.

Don’t double down on isolation. You can change course and when you become an attending you’re actually a more attractive potential mate.

 

[hopefulraddaddypls]

Take this with a massive grain of salt... Im an IM prelim going into rads, from what I've seen, the GI fellows and docs are by far the happiest in IM with heme/onc close second. The fellows I talked to mentioned signing w pp for 800k-900k when they get to partner status in 2-3 years, stick with GI lol, man this thread is entertaining

 

[hopefulraddaddypls]

Thanks for your post. With regards to trying to maximize earnings as a GI doc, this is my goal, I don't have any family, or frankly many friends really, so I wanted to maximize income because I don't have anything holding me back. I, like the others you mention, want to build up a nest egg as soon as possible; I feel that when you hit your coastfire number you can start to unplug from the matrix, you no longer need to work for money, but rather can pursue your passions. I have no family or friends so why not attempt to max out money to unplug? I don't really know what I would do with my time off. I understand that for someone who has a family they have other priorities, but unfortunately I haven't been blessed with a family. With regards to fatigue and aging of training, I don't feel fatigued right now, I actually thought IM and GI are both pretty easy, my hours are like 7:30-5 in GI fellowship... it's not particularly physically exhausting; the fatiguing part for me is moreso the lack of interest and passion. Neurosurgeons are the least burnt out physicians per surveys, imo because they tend to be the most passionate about what they do.

With regards to applying for another specialty after hitting coastfire numbers and unplugging from the matrix, I understand this is atypical, but it ultimately comes down to what do I want to do for the rest of my life? I'm an internist already but I hate the work, why would I do it if I financially reach a point where the growth of assets outpace my spending? GI is tolerable, and endoscopy is a nice skillset to have, but I see it as more of a means to an end. I want to learn a new skillset that not many people have, and focus on disease that I'm passionate about, is that so wrong? If I don't match again, I don't match but at least I gave it a shot to pursue my dreams. If I don't match I would likely attempt to apply for radiology residencies, maybe I will apply simultaneously, to access the ability to work from home, and the ability to titrate work down to 3-4 hours a day whenever I want.

With regards to difficulty talking about salary, it comes down to me posting this thread and not a single response has been about the nuts and bolts of locums and GI income maxxing logistics - I even posted links to several jobs to facilitate discussion, and the majority of the comments have been people calling me crazy for wanting to not be an internist lol. To contrast, I actually posted a similar comment on an anesthesia locums thread and they, were actually pretty helpful, but did not know the specifics of the IM and GI markets so redirected me here.

putting in 6 years into IM then GI to then apply rads (with no background on how competitive you are, not a slam dunk match) is just crazy talk, that's easily 5 more years (gen rads plus fellowship ir/neuro/msk etc)

 

[IM_to_ortho_hopeful]

If I were an Ortho residency interviewer and a GI-trained doc walked through the door as an applicant, I'd structure my interview as closely along the lines of a psych exam as i could remember from med school, and take a good look at your pupils for good measure.

Would it really be that weird to apply? I dislike being an internist, is that so wrong?

 

[IM_to_ortho_hopeful]

If you don’t currently have friends, family or “anything else” in life, why not spend some time pursuing those things? Meet people, meet friends, date. Expand your life. Do hobbies. Find passions other than orthopedic surgery. Put your energy Medical training has a way of making people put the blinders on, and think there’s nothing else to do but study and work. This isn’t even remotely true, but you wouldn’t be the first doc to get towards the end of training and look around and wonder “is this it”? The solution to this isn’t doing more training…that would be like getting out of jail, and trying to go back because you don’t know how to live in the real world. The solution is to establish a life.

This is actually very good advice, thanks

 

[Ubba]

Would it really be that weird to apply? I dislike being an internist, is that so wrong?

So I keep focusing on maxing reimbursement per unit time, not much else for me to do tbh.

You are giving off a number of mixed messages. Is it more about disliking being an internist or trying to maximize reimbursement/time? Because if the latter is remotely important, the very easy answer here is to work as a GI. The opportunity cost of training afresh in a new (surgical) specialty would be enormous. A terrible investment except in the most unusual circumstances (e.g., family-owned ortho shop).

 

[Meerkatology]

im wondering why u didnt go into another field of surgery.

i never understood whats so magical about ortho that so many people want to so bad. seems ortho or bust is a recurrent theme im seeing alot here

to me a surgeon is a surgeon, but im not one so what do i know🤣

 

[hotsaws]

I get the ortho or bust thing. I don't think surgical fields are comparable across the board. If I went the surgical route, it would have been ortho or bust. Maybe knowing what I know now, ENT would also be in play. Zero interest gen surg, thoracic, vascular etc.

There is a big difference in practice settings, lifestyle, patient types, outcomes, compensation

Nothing the OP has done or suggested makes any sense to me.

 

[collegestud2013]

If OP wanted ortho so badly, it should have been attempted during a gap year after graduating from med school (ie research year and broad application). This is want most deans/advisers will recommend med students who don't match into a competitive specialty, assuming the rest of their app that they cannot change, like grades and USMLE scores, are within reach of the specialty.

If OP was already was an IM resident at that point, he should have attempted to match ortho after IM residency while working as a hospitalist, and not do a GI fellowship as he does not plan on doing either long-term. Hospitalist locums definitely does not cap at at $2k per day, especially if you want to grind and work multiple nocturnist shifts, which should pay closer to $3k/night in the middle of nowhere. This would have allowed OP to FIRE earlier than spending another 3 years of GI fellowship. Also don't forget the tax brackets you'll be in as an attending so the extra pay you make with GI will be taxed at 40-50% depending on which state you're in.

At this point, assuming OP is not trolling, I would recommend him dropping out of GI fellowship and giving the spot to someone else, and doing hospitalist locums while attempting the above.