Convincing yourself to quit/walk away

Started by miacomet
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miacomet

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I've been working in the pit for 15 or so post residency years, and nearly 12 at my current job. My house is paid off and I've reached moderate FIRE. I can quit.
Eventually I probably should do something else somewhat financially remunerative, but I don't have to as long as I can accept a moderate standard of living.

My job has gotten much worse (insane patient sat metrics, corporate control) and my salary is no longer terribly competitive. I've cut down to part-time and it's not enough- the stress is still there. For my health, I need to quit. But I can't make myself pull the trigger because this is such a unicorn job and I don't really have anything lined up to grease the skids.

Any thoughts/suggestions/advice on convincing yourself to quit?
 
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alternatively, you can work yourself to death. That surely sounds more fun than not dying?

I can help you work longer if you want. If you could pay for my med school and a yacht, that'll reduce your savings enough to the point you'll want to stay at the job. But if you don't want to do that, shouldn't that say something about your true desires?
 
They say it helps to retire "to" something, but in my case, there wasn't another career, a family to raise, or a trip around the world. I just retired "to" not being stressed out, not being tired, and enjoying the way I spend each day, even if it's just a quiet day at home. I think sometimes we can almost convince ourselves that the bad shifts, or even the bad moments in a shift, aren't a big deal because we've done it for so long and we've conditioned ourselves to think that it's normal. When I imagined myself living the way I did when I was a student -- in a tiny apartment, camping for vacations, etc. -- and desperately wanted that over working one more shift, I knew I was ready. (I don't need to live that way, but the thought experiment showed me how crazy it was for me to keep working and that even if things took a terrible financial turn, I'd still end up happier.)

If you've run the numbers and everything checks out, and if you've been sitting on this and thinking about it for a long time, then it seems like you're ready. As they say, no one dies wishing they'd worked more.
 
Wait...how is this a unicorn job? I believe that it could suck and still be a unicorn. In my area, there might be two good jobs and about 15 soul sucking gigs that burn you out quick. I wouldn't call one of those jobs a unicorn, but I know if I burn a bridge there, I might be completely screwed later on. Is that the case here?
 
RustedFox said:
Its a unicorn job but it's gotten much worse? So it's no longer a unicorn job?
Click to expand...
It's in an insanely desirable area and the PPH used to be reasonable. The area is still desirable, but the salary is pretty low now and the PPR plus satisfaction metrics are a pain. Plus tons of micromanaging.
 
For what it's worth @miacomet I've been contemplating the exact same thing and have wanted to post something similar for a long long long time.

"Either **** or get off the pot"

The problem is my mind and my heart are constipated, so I'm stuck between a rock and a hard place!!
 
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miacomet said:
I've been trying to line something up to grease the skids for a year without success...hence the situation.
Click to expand...
What is your minimum requirement (not aspirational wish) for a job that greases the skids?

  • Full-time, part-time, or PRN?
  • In medicine or not?
    • If so, in EM or not?
  • As high-paying as EM or not?
 
Franzd'Epinay said:
What is your minimum requirement (not aspirational wish) for a job that greases the skids?

  • Full-time, part-time, or PRN?
  • In medicine or not?
    • If so, in EM or not?
  • As high-paying as EM or not?
Click to expand...
PT or PRN, I love seeing patients but it's too stressful in the US or in EM or both. Def not FT.
As long as I like it and it's low stress, I don't care. EM is always high stress ASFAIK
Doesn't have to be
 
miacomet said:
PT or PRN, I love seeing patients but it's too stressful in the US or in EM or both. Def not FT.
As long as I like it and it's low stress, I don't care. EM is always high stress ASFAIK
Doesn't have to be
Click to expand...
Have you considered Telemedicine or Occupational Medicine?
 
miacomet said:
PT or PRN, I love seeing patients but it's too stressful in the US or in EM or both. Def not FT.
As long as I like it and it's low stress, I don't care. EM is always high stress ASFAIK
Doesn't have to be
Click to expand...
Have you considered rural em. Low volume slightly lower pay usually it’s the commute that sucks but in many parts of the us you can get $150-200 for 1 pph. With that usually fewer metrics, less admin up your butt etc. it’s not for me but I’ve seen plenty of happy people do it.
Consider this you can work 5 -12s a month and make 10k or so a month. That leaves 25 or so days off a month and you still make good money. If you find the right spot and want it you could do 2-3 24s and make the same money and be off even more in a low stress job.
 
EctopicFetus said:
Have you considered rural em. Low volume slightly lower pay usually it’s the commute that sucks but in many parts of the us you can get $150-200 for 1 pph. With that usually fewer metrics, less admin up your butt etc. it’s not for me but I’ve seen plenty of happy people do it.
Consider this you can work 5 -12s a month and make 10k or so a month. That leaves 25 or so days off a month and you still make good money. If you find the right spot and want it you could do 2-3 24s and make the same money and be off even more in a low stress job.
Click to expand...

Never want to do nights again
Sick patients in small hospitals=stress
 
EctopicFetus said:
Have you considered rural em.
Click to expand...

When I hear stories of colleagues that have gone rural EM it always boils down to "lots of quick, and the random super sick"

And those random "super sick" are exactly that. Just actively trying to die on you, exhausting every hospital, local, and personnel resource, all while staring down the tunnel of trying to coordinate a 2+ hour dangerous transport to the nearest referral center while simultaneously dealing with minute-by-minute pushback across all fronts.

IMHO it takes a special kind of ER doc to thrive in that practice environment, and I can't imagine many recent grads (i.e. last 5 years or so) being chill with this even if they were down with a rural location.
 
EctopicFetus said:
Have you considered rural em. Low volume slightly lower pay usually it’s the commute that sucks but in many parts of the us you can get $150-200 for 1 pph. With that usually fewer metrics, less admin up your butt etc. it’s not for me but I’ve seen plenty of happy people do it.
Consider this you can work 5 -12s a month and make 10k or so a month. That leaves 25 or so days off a month and you still make good money. If you find the right spot and want it you could do 2-3 24s and make the same money and be off even more in a low stress job.
Click to expand...

Rural EM is often brought out as an antidote to people's stress and burnout. I imagine the only people who might suggest this are people who haven't actually worked in these environments.

I work a few rural shifts a month at a critical access hospital and they are far and away the highest stress and most difficult shifts I work.

I would never advocate working at a rural CAH to anybody who is already stressed or burned out by their job in a resource-rich tertiary care center or robust community hospital.

Rural EM has gotten orders of magnitude worse over the last 2 years now that transfers are totally f'd because all of the receiving hospitals are "at capacity," or "full" or "on diversion" at all times. Either way, they ain't helping you. Good luck calling 20+ hospitals and now trying to arrange for fixed wing aircraft to transport 2-3 states over while the patient actively dies and and drains every conceivable resource and staff your facility has. Now do this 2-3x a shift, every shift, while trying to take care of a fairly large number of PPH because you are the ONLY source of acute care in the entire county.
 
RoyBasch said:
Rural EM is often brought out as an antidote to people's stress and burnout. I imagine the only people who might suggest this are people who haven't actually worked in these environments.

I work a few rural shifts a month at a critical access hospital and they are far and away the highest stress and most difficult shifts I work.

I would never advocate working at a rural CAH to anybody who is already stressed or burned out by their job in a resource-rich tertiary care center or robust community hospital.

Rural EM has gotten orders of magnitude worse over the last 2 years now that transfers are totally f'd because all of the receiving hospitals are "at capacity," or "full" or "on diversion" at all times. Either way, they ain't helping you. Good luck calling 20+ hospitals and now trying to arrange for fixed wing aircraft to transport 2-3 states over while the patient actively dies and and drains every conceivable resource and staff your facility has. Now do this 2-3x a shift, every shift, while trying to take care of a fairly large number of PPH because you are the ONLY source of acute care in the entire county.
Click to expand...
I have worked rural em. I did it moonlighting and again recently to help in a pinch. RurAl em has a different pace. Fwiw the system I work in will take these transfers regardless of hospital capacity for our patients even if Ed to Ed assuming the Ed attending approves.
idk those shifts have been much less stressful than my main gig but they pay much less. My main site is my preference and within my own mind is a unicorn job.
i just can’t see how seeing under 1 pph with an admit rate of under 15% is super stressful. But maybe that’s me. To each their own. I think a change of scenery and fewer stupid ass metrics and actually being appreciated might be enough to cure burnout.
to me it’s the commute being an hour or more from home that sucks.
 
EctopicFetus said:
I have worked rural em. I did it moonlighting and again recently to help in a pinch. RurAl em has a different pace. Fwiw the system I work in will take these transfers regardless of hospital capacity for our patients even if Ed to Ed assuming the Ed attending approves.
idk those shifts have been much less stressful than my main gig but they pay much less. My main site is my preference and within my own mind is a unicorn job.
i just can’t see how seeing under 1 pph with an admit rate of under 15% is super stressful. But maybe that’s me. To each their own. I think a change of scenery and fewer stupid ass metrics and actually being appreciated might be enough to cure burnout.
to me it’s the commute being an hour or more from home that sucks.
Click to expand...
I think he's talking about something else. Rural ED and/or critical access hospital is in bumf*ck nowhere. You're talking about a smaller "community ED" 1 hour outside your metropolitan city hospital because if you're driving an hour outside from where you life, there's no way that's what I would term a rural ED. Two different animals.

I worked rural in VA and although acuity was lower on average, the PPH was high and all types of critical stuff would roll in all the time and transferring was a nightmare. I had a peds 2yo SDH one time where NSGY refused from nearest transfer center. Weather grounded every wing and I had to call multiple hospitals in 500 mile radius and finally got an academic place to take the kid 3.5 hours away by ground. I had to put a FM intern into he back of the ambulance with sticks of meds and walk him through the management en route. Another time I had a newborn code and no transports advanced enough to pick the kid up from local tertiary care. I had to get one of my nurses to jump in a BLS ambulance with me and I called up one of our hospitalists to come man the ED for a few hours while we drove this kid an hour away to the PICU.

That's the kind of cowboy nightmare **** you have to deal with in rural Eds and I don't miss it whatsoever. Some of the worse f'ing headache transfers I've ever had in my life. All the stuff you never have to deal with in a tertiary care/academic hospital. Ugh...never again.

I currently work several shifts in one of our smaller sister "community Eds" when I'm not at the academic hospital and although the shifts can be busy...it's MUCH less stressful. It is in no way comparable to that old rural ED in VA. Zero in common.
 
Apollyon said:
"Hospitalist" "FM intern". Nowhere close to these at my last, ****ty, rural **** job.
Click to expand...
I never quite understood how the FM interns rotated there. It was like their boondocks Appalachian elective or something. Where they sent people who misbehaved. The FM intern was a colorful character though. GQ looking guy, had like 9 kids or something and was sleeping with the respiratory therapist by rumor. Looked the part of a Tom Ford commercial until he smiled and had a large missing tooth that he apparently could care less about. My "charge nurse" had like 9 stents and a history of syncope in the ED from runs of afib RVR and gave any new doc a lecture about how they just needed to shock her and let her get back to work if she passes out on the job at any point. She was a chain smoker and took about 100 smoke breaks during any given shift. It was a weird place to work... The "hospitalist" was actually one of the ED docs who did hospitalist stuff on the side for what few pt's they had as inpatient.
 
Rural medicine is not a refuge for burnout. On the contrary, it will only exacerbate it. Most of these places are trainwrecks. No OB, prn gen surg, no cards, poor noncompliant pt population, hostile admin. When you've watched a patient slowly die in front of you because you can't transfer them, you'll begin staring at the bottom of the whiskey bottle with self-hate.
 
Kryptocoin said:
Rural medicine is not a refuge for burnout. On the contrary, it will only exacerbate it. Most of these places are trainwrecks. No OB, prn gen surg, no cards, poor noncompliant pt population, hostile admin. When you've watched a patient slowly die in front of you because you can't transfer them, you'll begin staring at the bottom of the whiskey bottle with self-hate.
Click to expand...

Sounds absolutely terrible!!!
 
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Kryptocoin said:
Rural medicine is not a refuge for burnout. On the contrary, it will only exacerbate it. Most of these places are trainwrecks. No OB, prn gen surg, no cards, poor noncompliant pt population, hostile admin. When you've watched a patient slowly die in front of you because you can't transfer them, you'll begin staring at the bottom of the whiskey bottle with self-hate.
Click to expand...
There’s a great country song called, “Staring at the bottom of the whiskey bottle with self-hate.” It was penned 7/10/22. For lyrics, see above.
 
thegenius said:
Sounds absolutely terrible!!!
Click to expand...


Yes, absolutely terrible. I only pick up those shifts now for >$350. Even then, it's not worth it. Your risk of a lawsuit exponentially goes up working at these facilities.

If you're a late-career physician looking to wind down, your best bet is probably something like the VA or leaving clinical medicine altogether.
 
Seems like two different types of 'rural' facilities being referenced here.
1. Low volume, critical access places w/ sub-5k yearly volume.
2. Moderate volume/poor coverage facilities, likely w/ mid-20k yearly volume.

They're pretty different. It's like equating an inner city county facility w/ an ivory tower university hospital under the banner of 'urban' (actually a lot more different).
 
RoyBasch said:
Rural EM is often brought out as an antidote to people's stress and burnout. I imagine the only people who might suggest this are people who haven't actually worked in these environments.

I work a few rural shifts a month at a critical access hospital and they are far and away the highest stress and most difficult shifts I work.

I would never advocate working at a rural CAH to anybody who is already stressed or burned out by their job in a resource-rich tertiary care center or robust community hospital.

Rural EM has gotten orders of magnitude worse over the last 2 years now that transfers are totally f'd because all of the receiving hospitals are "at capacity," or "full" or "on diversion" at all times. Either way, they ain't helping you. Good luck calling 20+ hospitals and now trying to arrange for fixed wing aircraft to transport 2-3 states over while the patient actively dies and and drains every conceivable resource and staff your facility has. Now do this 2-3x a shift, every shift, while trying to take care of a fairly large number of PPH because you are the ONLY source of acute care in the entire county.
Click to expand...

There’s also super low volume rural shops where you can literally watch netflix during your shifts.
 
turkeyjerky said:
Seems like two different types of 'rural' facilities being referenced here.
1. Low volume, critical access places w/ sub-5k yearly volume.
2. Moderate volume/poor coverage facilities, likely w/ mid-20k yearly volume.

They're pretty different. It's like equating an inner city county facility w/ an ivory tower university hospital under the banner of 'urban' (actually a lot more different).
Click to expand...

Yep exactly there are many different types of rural emergency departments.
 
I was referring to sites I worked at recently. Annual volume of 8k and 12k.

On one of my shifts I saw 5 patients in 12 hours. Everyone of them out of the Ed in under 2 Hours. 1 simple admit.

Unlike my main busy shop the ct tech and lab and x ray tech have nothing to do besides what I order. Things get done so quickly. Patients were all nice.

Other shifts were busier but simple.

I have done low Volume sites sporadically. Outside of the commute it’s like an off day and I can take care of other tasks while getting paid.
 
Birdstrike said:
A unicorn job is one that leaves you feeling you could be happy doing it as long as you need to.
Click to expand...
This is indeed my definition of a Unicorn job. I plan on working my unicorn job until it stops being a unicorn or I can't physically do it. Either way, once I walk away from medicine, I will have one foot in the grave.
 
miacomet said:
It's in an insanely desirable area and the PPH used to be reasonable. The area is still desirable, but the salary is pretty low now and the PPR plus satisfaction metrics are a pain. Plus tons of micromanaging.
Click to expand...
So it’s not a unicorn job and just a terrible gig with poor compensation and higher volume.

Just tell them to make you prn instead of part time. Then you can decide on how many shifts to do, even if that’s 0. But if you feel uneasy about the lack of income, you can always pick up more in that situation. You will have control of your life.
 
EctopicFetus said:
I was referring to sites I worked at recently. Annual volume of 8k and 12k.

On one of my shifts I saw 5 patients in 12 hours. Everyone of them out of the Ed in under 2 Hours. 1 simple admit.

Unlike my main busy shop the ct tech and lab and x ray tech have nothing to do besides what I order. Things get done so quickly. Patients were all nice.

Other shifts were busier but simple.

I have done low Volume sites sporadically. Outside of the commute it’s like an off day and I can take care of other tasks while getting paid.
Click to expand...

Both my rural sites are 8k annual volume. An average 12 hour day shift is 14 to 16 patients and a busy day shift is 20-24 patients. An average night shift is 6-10 patients.

It’s not bad.

I’ve worked about 8 or so hospitals now ranging from 3k annual volume to 70k annual volume. My favorite work environment by far was the place with 3k annual environment. It’s very relaxing and doesn’t feel like work.

Though all my rural sites have been within 1 hour of a major hospital. My current rural sites have 3 big hospitals within an hour and between the 3 of them I’ll usually be able to find a bed. It also doesn’t hurt that my rural critical access ERs are part of the largest healthcare system in my state.

Rural EM can be refreshing, it’s not as stressful as a busier gig if you are at a slow enough place, but it’s definitely not stress free. I’ve still had 10 people show up within the span of 90 minutes here. But if OP can find an environment with less than 4k annual volume, you might be able to pull off another couple of years without significant stress.
 
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cyanide12345678 said:
Just tell them to make you prn instead of part time. Then you can decide on how many shifts to do, even if that’s 0. But if you feel uneasy about the lack of income, you can always pick up more in that situation. You will have control of your life.
Click to expand...
This strategy only works if they can't fill their roster with a different full time doc and that their need >= shifts wanted by @EctopicFetus. If you're not able to retire yet, this is a very risky strategy unless you're completely willing to seek out PRN work elsewhere.
 
cyanide12345678 said:
Both my rural sites are 8k annual volume. An average 12 hour day shift is 14 to 16 patients and a busy day shift is 20-24 patients. An average night shift is 6-10 patients.

It’s not bad.

I’ve worked about 8 or so hospitals now ranging from 3k annual volume to 70k annual volume. My favorite work environment by far was the place with 3k annual environment. It’s very relaxing and doesn’t feel like work.

Though all my rural sites have been within 1 hour of a major hospital. My current rural sites have 3 big hospitals within an hour and between the 3 of them I’ll usually be able to find a bed. It also doesn’t hurt that my rural critical access ERs are part of the largest healthcare system in my state.

Rural EM can be refreshing, it’s not as stressful as a busier gig if you are at a slow enough place, but it’s definitely not stress free. I’ve still had 10 people show up within the span of 90 minutes here. But if OP can find an environment with less than 4k annual volume, you might be able to pull off another couple of years without significant stress.
Click to expand...

This is a good point. I worked at a critical access shop that had some sort of umbrella agreement w/ the biggest hospital in the closest metro area, where all transfers were taken w/o question. Psychs were also easy to dispo, they actually got taken to a local CSU for dispo after being medically cleared. Place was a breeze to work at, did 24s and I think I got woken up at night <10% of shifts. However, it coulda got pretty irritating if we were forced to board patients in a 5 bed ER.
 
cyanide12345678 said:
Both my rural sites are 8k annual volume. An average 12 hour day shift is 14 to 16 patients and a busy day shift is 20-24 patients. An average night shift is 6-10 patients.

It’s not bad.

I’ve worked about 8 or so hospitals now ranging from 3k annual volume to 70k annual volume. My favorite work environment by far was the place with 3k annual environment. It’s very relaxing and doesn’t feel like work.

Though all my rural sites have been within 1 hour of a major hospital. My current rural sites have 3 big hospitals within an hour and between the 3 of them I’ll usually be able to find a bed. It also doesn’t hurt that my rural critical access ERs are part of the largest healthcare system in my state.

Rural EM can be refreshing, it’s not as stressful as a busier gig if you are at a slow enough place, but it’s definitely not stress free. I’ve still had 10 people show up within the span of 90 minutes here. But if OP can find an environment with less than 4k annual volume, you might be able to pull off another couple of years without significant stress.
Click to expand...
Didn’t you go from a high volume high pay place to a lower volume gig?

What have your pay differences been at these places?
 
Backpack234 said:
Didn’t you go from a high volume high pay place to a lower volume gig?

What have your pay differences been at these places?
Click to expand...

Dropped from 260/hr IC to $200/hr W2 with quarterly bonuses around 4-5k. Any hours above 13 12 hour shifts per month are paid at $225/hr. So essentially went from 450k IC working 12 x 12 shifts a month to roughly 415k w2 of which 375k is w2 salary for 13 12 hr shifts, 16k ish bonuses, 15k or so 401k match, 5k cme, 2k for fees (licensing, organizations etc), 2.5k hsa employer contribution. Then obviously there are other benefits like health insurance, dental insurance, half of ficaa taxees, access to 457 for another 20k tax shelter, life insurance and disability insurance that I’m not putting a number on.

The income drop wasn’t terrible. But i went from averaging 1.8 to 2.0 pph to around 1.2 pph as an average between days and nights.

The previous job was also a nocturnist gig with 80 percent of volume seen in the first 4 to 6 hours of my shift. This is a ‘regular’ ER schedule.

Wife went from 55k resident salary to 230k FM attending salary so didn’t actually feel the pay cut because family income still went up as well, hitting 1M in net worth after being 3 years out either end of this month or next month despite the 20 percent drop in the stock market.
 
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Alright that’s not so bad. I’m looking at 350k/yr CMG vs 290k/yr with Va benefits and no nights. The money is tempting…
 
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TrailRun said:
Is the VA typically no nights? Is there a mini night ie 5p-3a or something?
Click to expand...

Sorry for the off topic detour here…
Probably depends on the VA. My father recently added a 1/4 time VA position (in the ED) and he only does nights. His main gig pays more for overnight shifts but is 1099 so he added the VA to get access to their benefits. He does 13 hour overnight shifts there but less than 9 hour nights at his main job. I think it depends on the site for how they structure their shift schedules so talk with the local VA for you if you’re interested.
 
TrailRun said:
Is the VA typically no nights? Is there a mini night ie 5p-3a or something?
Click to expand...
It depends on the VA. Only reason the job I’m looking at says no nights is because they have dedicated nocturnists. That goes away and I probably have to pick up some.

Other docs at other vas I’ve seen say they’ve work 0-2 nights in the last 4 years. Plus the Va is staffed differently, so nights are actually doable. Unlike CMG gig where you’re solo covered seeing 17 after midnight.
 
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