Burning Down a Fiery Path (1st Year EM attending)

[deleted813736]

any advice

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[LostinLift]

I am a single male, graduated from medical school a little quicker at age 23, went to a three year residency in the midwest and took a job in Rural MIdwest for one year.
I received my income statement and netted 396K from July to Now from this job. I worked over 200 hours a month consistently. There were days where I was unmotivated and felt I picked the wrong line of work, other days are ok. I have been considering my exit plan from EM soon and dont know what route to take. I have a contract until June 30th that I will finish one way or another. Wont have any debt ..its been paid off already. I am not sure what to do but I am lost in what route to take. Maybe business? Maybe armed forces? Would taking a few months off an getting back into it work? I fully intend to become board certified (took written exam and hopefully oral early next year) before making any drastic changes. Wondering if anyone is feeling this way. And Yes I am aware the job I took reflects on borderline dangerous for mental health/physical health/etc.

I am working about the same hours in residency and I'm feeling the burn. Once loans are paid off why not drop the hours down to 100/month and see how you feel? As our toxicologists say, it's all about the dose. I feel like I could do 8-10 shifts a month for 30 years. If I had to keep working 200 hours a month for even one more year I would want to call it quits.

 

[gamerEMdoc]

200/mo is a lot. Our residents don't work that. Work a reasonable schedule (144 hrs/mo) and see how you feel first. If still too much, cut back a little more.

 

[Tenk]

The fact that you have no debt at such a young age is great! Since you’re debt free and single now, you can easily find a better job only working 100 hours or so a month. 200 is far too much. I work about 100-120 hours a month and it’s far more relaxing.

 

[deleted547339]

EM isn’t all sunshine and rainbow, but I can promise you 95%+ of EM folks who even really like EM will hate it if they work 200h/mo doing it.

You’re in a really great position. Cut back.

 

[UrbanEM2]

@medschool2cool feel free to PM me

 

[KGflyboy]

I am a single male, graduated from medical school a little quicker at age 23, went to a three year residency in the midwest and took a job in Rural MIdwest for one year.
I received my income statement and netted 396K from July to Now from this job. I worked over 200 hours a month consistently. There were days where I was unmotivated and felt I picked the wrong line of work, other days are ok. I have been considering my exit plan from EM soon and dont know what route to take. I have a contract until June 30th that I will finish one way or another. Wont have any debt ..its been paid off already. I am not sure what to do but I am lost in what route to take. Maybe business? Maybe armed forces? Would taking a few months off an getting back into it work? I fully intend to become board certified (took written exam and hopefully oral early next year) before making any drastic changes. Wondering if anyone is feeling this way. And Yes I am aware the job I took reflects on borderline dangerous for mental health/physical health/etc.

I hope you find something fulfilling. I suspect that you are miserable because you are working far too much. I don't think anybody would like working that much.

Do you have many hobbies? What do you do outside of work? If all you do is work and sleep, you are going to hate every job. Find some balance in life.

Life is too short. Enjoy it before it's it's gone.

 

[cyanide12345678]

200+ hrs per month is just ridiculous. Try a reasonable schedule first, then reassess how much you like/hate EM.

I'm guessing you worked far more than 200 since the last i checked there weren't that many rural sites paying ~330/hr for you to make 400k working 1200 hrs in 6 months.

 

[The Knife & Gun Club]

Are you working 24s? Otherwise 200/month is 17 12s or 25 8s.

like others said above - I don’t even work that much as a resident, and we have the benefit of not having to bear the full cognitive load of the department.

Why not just try a lower shift load and maybe look into ECs outside of medicine? You could try real estate/rentals, investing, or even consult for industry. I’ve got a buddy who’s making great money helping a device company design central line equipment.

You could cut your income in half and still be on the fast track to FIRE.

 

[d2305]

Read the military posts before you raise your right hand.

 

[JacobMcCandles]

You need a hobby.

 

[Porfirio]

Find a significant other to spend time with. Work less and live more. Spend more time on yourself.

 

[door_to_balloon_knot]

How about the dirty world of urgent care?

Join us, we have regular work hours and can punt to the ED

 

[turkeyjerky]

Yeah, agree with the others. Cut back to a normal schedule and see how you actually feel before leaving the field. This has been the toughest, weirdest year for us all.

 

[AlbinoHawk DO]

200/mo is a lot. Our residents don't work that. Work a reasonable schedule (144 hrs/mo) and see how you feel first. If still too much, cut back a little more.

Your residents must be very lucky. When I rotated in the ED I had to do 65-85 hours a week for the entire month

 

[Rekt]

Your residents must be very lucky. When I rotated in the ED I had to do 65-85 hours a week for the entire month

I 100% doubt this. Almost every program does 19-22 shifts a month/block unless you're Denver.

 

[gamerEMdoc]

Your residents must be very lucky. When I rotated in the ED I had to do 65-85 hours a week for the entire month

Well for residents, there is a hard cap of 60 hrs/week while in the ED. So nobody should be breaking that. Although, IMO, that's still pretty brutal.

I 100% doubt this. Almost every program does 19-22 shifts a month/block unless you're Denver.

Hours/week really is heavily influenced by shift hours. 20 shifts/month is very different depending on the shift hours. For instance, in a four week period, 20 shifts comes down to:

12 hr shifts - 60 hrs a week
10 hr shifts - 50 hrs a week
9 hr shifts - 45 hrs a week

Also, the other thing to factor in is whether shift counts are based on a 4 week block vs month block. That has a small difference as well. For instance, our interns work 20 9's in a month. So in a 31 day month that's 40.6 hrs/week, as opposed to 45 hrs/week in a 4 week block schedule.

 

[Groove]

As everyone has already stated, you’re simply working too much. It’s nothing more complicated than that so stop anguishing over an imagined pyrrhic epiphany where you’re about to step out into the rain, kneel down and put on your best Shawshank Redemption or Platoon movie poster pose + Braveheart freedom scream. We’d hate to see you ride off into the sunset when it was something as simple as clocking in fewer hours

 

[ERDude]

I work ~ 90 clinical hours a month (and ~ 20 admin hours/mo) and basically never feel like I have too many days off. I also try to never work more than 3 shifts in a row exception being holiday blocks. I've incrementally cut down on shifts over the past 4-5 years and found this to be my sweet spot. Agree with others in that you should at least *try* a reasonable workload before deciding to make a complete exit from EM.

 

[RuralEDDoc]

You might find you’re enamored by the big paycheck and resistant to cutting down. Try decreasing even 10% to 15%; 170-180 hours a month will still net big paychecks but will feel a lot better.

 

[Brigade4Radiant]

Congrats on being able to work like a resident after residency. It makes the transition to attending easier since the learning curve is steep.

Invest and get a six month emergency fund and next year do 140 a month which is full time and see how you feel.

 

[Fox800]

I'm also a newer attending. I'm having similar blues - trying to work a lot, not having a ton of luck (my 140-150 hrs/mo has been cut to 90-110 due to overstaffing). COVID has everything closed and I'm unmarried, so it's impossible to socialize...and I live in a very sociable city full of young people. So it's been a very isolating year. Work/home/work/home lather rinse repeat.

I think having a hobby is key. Do something - get into books, learn to cook (Home Chef is good). I'm planning on taking SCUBA lessons, buying an ocean kayak, and I'm seriously considering taking getting my private pilots license. Do something, anything! Astronomy, start a garden and grow some spicy peppers, get in to making cocktails. Get into some new board games with family. Foster a pet. Go skiing, get a new bike, etc.

Take some time to care for yourself (massages do a world of good).

Now's the time to start exercising so you can look your best when travel opens up again.

Someone recommended a physician career coach - I'm having a bad case of "is this it? I'm at the top? What do I do now"?

Your loans are gone. It's time to slow down. Max out your HSA, back-door Roth IRA, your 401k and any 403b/457 plans, and stash away 4-6 months of living expenses as an emergency fund. For me, I have 1 month in checking to cover cash flows, and the rest in a Vanguard taxable account that's been doing well this year. You can invest it to your risk tolerance - all cash, a high yield savings account, bonds, a mix of bonds/stocks, or all stocks (like me). Vanguard makes this easy.

 

[AlbinoHawk DO]

I 100% doubt this. Almost every program does 19-22 shifts a month/block unless you're Denver.

You can doubt it all you want. In 4 weeks, I only got 4 days off, and some days were BS because I was getting out at 4 am to transition back to days. The first push was 9 days straight of 12-hour shifts. Maybe this was different for me because I am not an EM resident and we don't have an EM residency here

 

[bravotwozero]

I've been averaging 180-200 hours per month. However, most of my shifts are now in lower volume/acuity freestanding ERs. Not exactly a picnic, but end up with long stretches of downtime, which makes the hours doable. No way in hell I'd survive 200 hours of busy hospital ED shifts per month.

 

[Franzd'Epinay]

You can doubt it all you want. In 4 weeks, I only got 4 days off, and some days were BS because I was getting out at 4 am to transition back to days. The first push was 9 days straight of 12-hour shifts. Maybe this was different for me because I am not an EM resident and we don't have an EM residency here

The bolded point is the key here. Those hours would be a huge no-no for anyone aware of the EM ACGME rules.

 

[Franzd'Epinay]

I am a single male, graduated from medical school a little quicker at age 23, went to a three year residency in the midwest and took a job in Rural MIdwest for one year.
I received my income statement and netted 396K from July to Now from this job. I worked over 200 hours a month consistently. There were days where I was unmotivated and felt I picked the wrong line of work, other days are ok. I have been considering my exit plan from EM soon and dont know what route to take. I have a contract until June 30th that I will finish one way or another. Wont have any debt ..its been paid off already. I am not sure what to do but I am lost in what route to take. Maybe business? Maybe armed forces? Would taking a few months off an getting back into it work? I fully intend to become board certified (took written exam and hopefully oral early next year) before making any drastic changes. Wondering if anyone is feeling this way. And Yes I am aware the job I took reflects on borderline dangerous for mental health/physical health/etc.

Take a few weeks off (if you can), drop your hours to the bare minimum needed to get benefits, then see if you feel the same way near the end of your contract.

 

[dadaddadaBATMAN]

I'm planning on taking SCUBA lessons, buying an ocean kayak, and I'm seriously considering taking getting my private pilots license.

Fox you sure you’re ok? The hobbies above are like a fast track to stereotypical physician death. Perhaps add skydiving, mountaineering, caving, and cliff diving into the mix for max effect.

 

[RustedFox]

Fox you sure you’re ok? The hobbies above are like a fast track to stereotypical physician death. Perhaps add skydiving, mountaineering, caving, and cliff diving into the mix for max effect.

Someone please start a thread where we can all 'fess-up to having EM-stereotype traits.

Myself:

Mountain bike ? Check.
Skiing? Check.
Guitar ? Check.
Fleece vest? Check.

 

[turkeyjerky]

Fox you sure you’re ok? The hobbies above are like a fast track to stereotypical physician death. Perhaps add skydiving, mountaineering, caving, and cliff diving into the mix for max effect.

Don't forget the cocaine (but I guess that's more NSG than EM)

Someone please start a thread where we can all 'fess-up to having EM-stereotype traits.

Myself:

Mountain bike ? Check.
Skiing? Check.
Guitar ? Check.
Fleece vest? Check.

Fleece vests are the worst! Lol

 

[RustedFox]

Fleece vests are the worst! Lol

Guilty as charged.

 

[Franzd'Epinay]

Someone please start a thread where we can all 'fess-up to having EM-stereotype traits.

Myself:

Mountain bike ? Check.
Skiing? Check.
Guitar ? Check.
Fleece vest? Check.

No microbrewery tours?

 

[dadaddadaBATMAN]

No microbrewery tours?

No he brews his own

 

[Angry Birds]

Someone please start a thread where we can all 'fess-up to having EM-stereotype traits.

Myself:

Mountain bike ? Check.
Skiing? Check.
Guitar ? Check.
Fleece vest? Check.

I don't fit any of these nor do I engage in extreme sports.
I'm a quiet, anti-social bookworm who hates anything physical... hardly the ER stereotype.

 

[RustedFox]

No microbrewery tours?

No he brews his own

For the record, I think that most microbrews aren't very good.
I want beer flavored beer. I don't want to drink a beer and taste perfume, hints of corriander, and whatever.
But I haven't had a beer since October. Haven't been in the mood.

 

[Cinclus]

I have been guitar-slinging and outdoors-loving since I was a wee child. The child version of me would have told you that you're nuts if you suggested the adult version would be a physician. Child version of me was smart and knew better. Child Cinclus wanted to be a race car driver or field biologist or some combination of the two. I actually knew better until I was in graduate school for something else and hated it. And then I was like, "Why not medicine? These other things seem to suck, too." Oops?

 

[blue.jay]

Someone please start a thread where we can all 'fess-up to having EM-stereotype traits.

Myself:

Mountain bike ? Check.
Skiing? Check.
Guitar ? Check.
Fleece vest? Check.

I guess that's why EM grads among all other specialities look for jobs in Colorado, Utah, Pacific Northwest

 

[Brorthopedic]

I love to play video games but I would hate them if I had to play 200 hours/month. I'm not sure why people think it's any different for a job and it's specific to the specialty lol. Lower your hours, there are more important things than money.