I am 1 year out and already crispified by the BS. Been debating which exit(s) to take.
You’re actually in a pretty good spot careerwise to make a switch (coming from a guy who spent 15 years before starting a CCM fellowship). I say that because any good exit plan will take ~1-2 years to properly execute. That will give you 2-3 years of EM experience to buff out your CV, save your pesos, and make sure this is what you want to do. I know that an additional 1-2 years sounds unbearable. But believe me when I say that it goes by fast and there is an amazing weight lifted from your shoulders once you commit to an exodus and begin working on a plan. My wife said that I simply became a much happier person - I lost weight, enjoyed reading up on my future speciality, met new colleagues in CCM, etc.
Probably the first step is to decide if there is an aspect of clinical EM that you still enjoy or are you through with clinical practice in general. For me, I really, really loved taking care of sick as piss patients. So much so I have no problem spending 24+ hours straight in the ICU getting hammered with admissions. I literally spend waking hours and long runs letting my mind wander about vent settings, pressor/inotrope combination, ECMO, etc. You may like sports med, research, tox/occ med, etc.
If you plan on leaving clinical practice completely, the calculus changes. First, you need to decide how much you are willing to sacrifice in income since most alternative non-clinical careers play less. It could be a little less or way less.
Second, you need to identify what it is outside of clinical medicine you want to pursue, your existing skill set in that area, and how long it will take to meet the entry requirements. As you can see this will interact with the income sacrifice. For example, if you want to go to law school or get an MBA/MHA, you will have to save your pennies for tuition, cost of living, or consider part-time programs if money is tight. On the other hand, people considering operational medicine with the military or law enforcement may need 1-2 years to plan for the physical requirement, application process, background check, etc. Keep in mind that you will be starting at an entry level with entry pay - the Medical Director for NASA spend more than a decade getting to that position.
As you can see, the possibilities are endless. I know EM and FM colleagues who left clinical practice to work for NASA, DOD (Rgr BN Surgeon, SF Group Surgeon, AF CCATT), FBI (as both 1811 and contractor positions), Cleveland Browns, State Department, CIA, Rand Corp, USUHS, Pharma, Transportation and Safety Admin, FEMA, DC Fire, NYFD, GE, General Motors, University of Michigan Athletics, etc.
while NP/PA can rightfully say they aren't comfortable working nights.
