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dchristismi

dchristismi

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Just felt the need to share with people who get it.

I wired the mortgage payoff today.
Debt Free.
It's possible. And I'm 42. (Paid off my pile of student loans and $100K in alimony years ago. Paid for my car with cash. Rolled the equity of the last 2 homes into this one)


As many of you know, I have "retired" from general EM now, and have a 90% hospice practice, 10% dedicated oncologic EM... which together might be full time, but are probably closer to 3/4. If that. I do need something to keep me busy - I can't quite afford to travel all the time - but what I do is exceptionally satisfying. It's fulfilling. Sometimes it's emotionally challenging, sometimes I really have to ponder options, but it's nothing like what you all still do every day.

I have time to exercise. I get plenty of sleep. (oh sleep, you sweet, sweet thing.)
And I don't stress near as much as I used to. Having stepped away, it's easy to see that the ED is a damn stressful place.

I suppose I could FIRE at this point, but I enjoy medicine again. (Even doing just part time HPM, which is a rather low paying field, is still better than the majority of Americans make, so life is very good.) I don't know that I have an actual FIRE number, although I do have a pile of FU money, which allowed me to walk away from TeamHealth and most recently, Envision.

Freedom is priceless.
 
Welcome to the club. Just sold my big house and downsized to high-rise for which I paid cash. I could work 4-5 shifts a month now, keep a good standard of living, and not touch any savings.

This is essential for anyone in EM right now. Earnings are still high, so pay off debt, and sock away money. You will be future-proofed against all the economically ignorant politicians who want to sabotage us.
 
dchristismi said:
Just felt the need to share with people who get it.

I wired the mortgage payoff today.
Debt Free.
It's possible. And I'm 42. (Paid off my pile of student loans and $100K in alimony years ago. Paid for my car with cash. Rolled the equity of the last 2 homes into this one)


As many of you know, I have "retired" from general EM now, and have a 90% hospice practice, 10% dedicated oncologic EM... which together might be full time, but are probably closer to 3/4. If that. I do need something to keep me busy - I can't quite afford to travel all the time - but what I do is exceptionally satisfying. It's fulfilling. Sometimes it's emotionally challenging, sometimes I really have to ponder options, but it's nothing like what you all still do every day.

I have time to exercise. I get plenty of sleep. (oh sleep, you sweet, sweet thing.)
And I don't stress near as much as I used to. Having stepped away, it's easy to see that the ED is a damn stressful place.

I suppose I could FIRE at this point, but I enjoy medicine again. (Even doing just part time HPM, which is a rather low paying field, is still better than the majority of Americans make, so life is very good.) I don't know that I have an actual FIRE number, although I do have a pile of FU money, which allowed me to walk away from TeamHealth and most recently, Envision.

Freedom is priceless.
Click to expand...

Congrats, same boat here, 32, but I still need to build my nest egg. Goal is $2 mil, will probably quit at 42.
 
Congrats. Though to the MS folks, its not all bad. Im in my early 40s, could surely retire now if I wanted even with wife and kids. I still truly enjoy what I do. Avoiding the CMGs has been a major key for me. Working for myself in decent EM SDGs that are fair has given me so much freedom. I work clinically less than 3 shifts a week and do very well financially. I could cut back even further but I still enjoy my job and I can get off for any life event. My sleep hygeine has always been poor but I am off enough I can go to the gym whenever I want.

I applaud Drchristismi but dont want people to think you have to stop practicing EM in your early 40s. I think we both finished residency around the same time. Choose well with who you work for, though options are dwindling. I got my financial house in order years ago and its what I tell any resident/young attending. Make hay while the sun is shining. Worst case scenario you have a pile of cash.

also, i do not advocate for living like you make 20k a year. Enjoy your money but save first. I vacation as often as possible (more limited by my kids school than anything else), enjoy your time with your family and splurge on a few things. Pay off debt like a crazy person (after you save your money).

As I said before any new grad even taking a standard super crap EM job with a CMG can make 400k. 60k to retirement leaves you at 340k. Taxes will eat up less than a third in most states so lets call it 110k. That leaves you 230k or we will call it 19k a month. live on 8k a month which is more than double what you had as a resident. 11k a month to debt. That should get all but the most dire young em docs debt free in 3-5 years which will also make you feel stupid rich. I dont think I have seen an EM doc contract paying much less than 400k for FT work. assuming 1700 hours a year its not exactly crushing it to make $235/hr. If you are then you need to work more or find a better job.
 
Just to add on to the above. I applaud the OP for getting her (from my prior memory) financial house in order. My post was in no way meant as a swipe at that or leaving EM. I think too many jobs suck the life out of us. In particular those managed and run by PE firms. Namely, USACS (the worst), APP (small player but growing and almost as terrible as USACS), Envision, Team, Shumacher.

These rent seeking leeches will take. Learn to say no to them they are experts at abusing you with no guilt or care.
 
Yup I have a wife and a few kids, and I still paid 2-3x my monthly debt payment every month (like 6-10K/month), and paid 300K off in 4.7 years. I don't make crazy money either, certainly not ectopic rates. Feels good to be debt free. I basically lived paycheck to paycheck after maxing out my SEP-IRA and HSA every year. It can be done. Congrats christismi!
 
Congratulations. That must be a great feeling. I can't wait to join the club soon *fingers crossed*.
 
1 kid so far and paid off my medical school loans less than 2 years out of training.

Mortgage to come tho....
thegenius said:
Yup I have a wife and a few kids, and I still paid 2-3x my monthly debt payment every month (like 6-10K/month), and paid 300K off in 4.7 years. I don't make crazy money either, certainly not ectopic rates. Feels good to be debt free. I basically lived paycheck to paycheck after maxing out my SEP-IRA and HSA every year. It can be done. Congrats christismi!
Click to expand...

Sent from my Pixel 3 using SDN mobile
 
dchristismi said:
Just felt the need to share with people who get it.

I wired the mortgage payoff today.
Debt Free.
It's possible. And I'm 42. (Paid off my pile of student loans and $100K in alimony years ago. Paid for my car with cash. Rolled the equity of the last 2 homes into this one)


As many of you know, I have "retired" from general EM now, and have a 90% hospice practice, 10% dedicated oncologic EM... which together might be full time, but are probably closer to 3/4. If that. I do need something to keep me busy - I can't quite afford to travel all the time - but what I do is exceptionally satisfying. It's fulfilling. Sometimes it's emotionally challenging, sometimes I really have to ponder options, but it's nothing like what you all still do every day.

I have time to exercise. I get plenty of sleep. (oh sleep, you sweet, sweet thing.)
And I don't stress near as much as I used to. Having stepped away, it's easy to see that the ED is a damn stressful place.

I suppose I could FIRE at this point, but I enjoy medicine again. (Even doing just part time HPM, which is a rather low paying field, is still better than the majority of Americans make, so life is very good.) I don't know that I have an actual FIRE number, although I do have a pile of FU money, which allowed me to walk away from TeamHealth and most recently, Envision.

Freedom is priceless.
Click to expand...
Congratulations!
 
Thanks guys. And yes, I'm female. No kids, but married into 2 "adult" steps and a grand, which also makes life a LOT cheaper.

And FWIW, I do think there are plenty of EM docs who love what they do, are damn good at it, and will do it until they drop dead. I've had the honor of working with many of them.

Learn to say "no." That's huge. I also regained a lot of independence after going through a very stressful loss of contract and going 1099. Make hay while the sun shines, sock as much as you can away, but make as many memories as you can while you do it.
 
EctopicFetus said:
Congrats. Though to the MS folks, its not all bad. Im in my early 40s, could surely retire now if I wanted even with wife and kids. I still truly enjoy what I do. Avoiding the CMGs has been a major key for me. Working for myself in decent EM SDGs that are fair has given me so much freedom. I work clinically less than 3 shifts a week and do very well financially. I could cut back even further but I still enjoy my job and I can get off for any life event. My sleep hygeine has always been poor but I am off enough I can go to the gym whenever I want.

I applaud Drchristismi but dont want people to think you have to stop practicing EM in your early 40s. I think we both finished residency around the same time. Choose well with who you work for, though options are dwindling. I got my financial house in order years ago and its what I tell any resident/young attending. Make hay while the sun is shining. Worst case scenario you have a pile of cash.

also, i do not advocate for living like you make 20k a year. Enjoy your money but save first. I vacation as often as possible (more limited by my kids school than anything else), enjoy your time with your family and splurge on a few things. Pay off debt like a crazy person (after you save your money).

As I said before any new grad even taking a standard super crap EM job with a CMG can make 400k. 60k to retirement leaves you at 340k. Taxes will eat up less than a third in most states so lets call it 110k. That leaves you 230k or we will call it 19k a month. live on 8k a month which is more than double what you had as a resident. 11k a month to debt. That should get all but the most dire young em docs debt free in 3-5 years which will also make you feel stupid rich. I dont think I have seen an EM doc contract paying much less than 400k for FT work. assuming 1700 hours a year its not exactly crushing it to make $235/hr. If you are then you need to work more or find a better job.
Click to expand...
Curious to why you picked 60k for pre tax retirement?
 
Probably because if you have an i401K and max both your employee portion (19k) and employer profit-sharing portion (37k) plus a backdoor Roth (6k) that’s about $60k. It’s actually 62 this year, up a bit from last year.
 
People talk smack about Dave Ramsey all the time, but his principles work. If people avoid putting charges on credit cards, pay with cash, and concentrate on getting out of debt (i.e., that means budgeting even for the wealthy), then they can become debt free.
 
dchristismi said:
Probably because if you have an i401K and max both your employee portion (19k) and employer profit-sharing portion (37k) plus a backdoor Roth (6k) that’s about $60k. It’s actually 62 this year, up a bit from last year.
Click to expand...
Yep. Not everyone has access to other vehicles like 529, DB plans etc.
 
EctopicFetus said:
Congrats. Though to the MS folks, its not all bad. Im in my early 40s, could surely retire now if I wanted even with wife and kids. I still truly enjoy what I do. Avoiding the CMGs has been a major key for me. Working for myself in decent EM SDGs that are fair has given me so much freedom. I work clinically less than 3 shifts a week and do very well financially. I could cut back even further but I still enjoy my job and I can get off for any life event. My sleep hygeine has always been poor but I am off enough I can go to the gym whenever I want.
Click to expand...

As an MS3 interested in EM, how realistic is it to find a job in a SDG? Is it a matter of networking? How do I even go about finding such jobs? Do they typically require things beyond being board certified in EM? I guess like a special contribution that you bring to the group, maybe covering more night shifts than average or something. Does being fellowship trained help land a spot?

I really don't like the idea of working for a CMG and am happy to take a pay cut for the sake of longevity, fairness, and respect.

Thank you
 
My opinion: a good SDG will give you equitable scheduling from day 1. If you're doing all nights, make sure you get paid more and get to pick your schedule. Most of community EM doesn't care if you're fellowship trained. That said, our group has grown large enough that we've acquired a few fellowship trained people to fill some fellowship appropriate roles.
Clockdoc89 said:
As an MS3 interested in EM, how realistic is it to find a job in a SDG? Is it a matter of networking? How do I even go about finding such jobs? Do they typically require things beyond being board certified in EM? I guess like a special contribution that you bring to the group, maybe covering more night shifts than average or something. Does being fellowship trained help land a spot?

I really don't like the idea of working for a CMG and am happy to take a pay cut for the sake of longevity, fairness, and respect.

Thank you
Click to expand...
 
It you can swing it financially as a new grad, it would be great to join an SDG as a pre partner.

I certainly understand the pressures to make more money as a fresh grad though.

If you can afford it, avoid CMGs at all costs.
Clockdoc89 said:
As an MS3 interested in EM, how realistic is it to find a job in a SDG? Is it a matter of networking? How do I even go about finding such jobs? Do they typically require things beyond being board certified in EM? I guess like a special contribution that you bring to the group, maybe covering more night shifts than average or something. Does being fellowship trained help land a spot?

I really don't like the idea of working for a CMG and am happy to take a pay cut for the sake of longevity, fairness, and respect.

Thank you
Click to expand...

Sent from my Pixel 3 using SDN mobile
 
dchristismi said:
Just felt the need to share with people who get it.

I wired the mortgage payoff today.
Debt Free.
It's possible. And I'm 42. (Paid off my pile of student loans and $100K in alimony years ago. Paid for my car with cash. Rolled the equity of the last 2 homes into this one)


As many of you know, I have "retired" from general EM now, and have a 90% hospice practice, 10% dedicated oncologic EM... which together might be full time, but are probably closer to 3/4. If that. I do need something to keep me busy - I can't quite afford to travel all the time - but what I do is exceptionally satisfying. It's fulfilling. Sometimes it's emotionally challenging, sometimes I really have to ponder options, but it's nothing like what you all still do every day.

I have time to exercise. I get plenty of sleep. (oh sleep, you sweet, sweet thing.)
And I don't stress near as much as I used to. Having stepped away, it's easy to see that the ED is a damn stressful place.

I suppose I could FIRE at this point, but I enjoy medicine again. (Even doing just part time HPM, which is a rather low paying field, is still better than the majority of Americans make, so life is very good.) I don't know that I have an actual FIRE number, although I do have a pile of FU money, which allowed me to walk away from TeamHealth and most recently, Envision.

Freedom is priceless.
Click to expand...

Congrats!

Can you please expand on what "dedicated oncolgic EM" is and how it works? Sounds super interesting.
 
TheSingularity said:
It you can swing it financially as a new grad, it would be great to join an SDG as a pre partner.

I certainly understand the pressures to make more money as a fresh grad though.

If you can afford it, avoid CMGs at all costs.

Sent from my Pixel 3 using SDN mobile
Click to expand...
I think the old paradigm of less money working for sdgs is wilting away. Pre partners in my group have equitable scheduling day 1 and make considerably more than any cmg locally.
The bad actors have not surprisingly been the first to sell.
I’ll be honest in that there are incredibly few decent groups left. I think the only hope for em is for groups of docs to take over local contracts. It’s not easy but it’s doable.
 
Care to quote a ballpark hourly figure?
EctopicFetus said:
I think the old paradigm of less money working for sdgs is wilting away. Pre partners in my group have equitable scheduling day 1 and make considerably more than any cmg locally.
The bad actors have not surprisingly been the first to sell.
I’ll be honest in that there are incredibly few decent groups left. I think the only hope for em is for groups of docs to take over local contracts. It’s not easy but it’s doable.
Click to expand...

Sent from my Pixel 3 using SDN mobile
 
EctopicFetus said:
I think the old paradigm of less money working for sdgs is wilting away. Pre partners in my group have equitable scheduling day 1 and make considerably more than any cmg locally.
The bad actors have not surprisingly been the first to sell.
I’ll be honest in that there are incredibly few decent groups left. I think the only hope for em is for groups of docs to take over local contracts. It’s not easy but it’s doable.
Click to expand...

The only hope is to get a bill or rights and force CMGs to be more transparent. I believe that if every CMG was forced to report to every employed physician monthly how much was collected in their name, and how much was paid out as salary it would open people's eyes and make people more aware of how much they are worth.
 
dchristismi said:
Just felt the need to share with people who get it.

I wired the mortgage payoff today.
Debt Free.
It's possible. And I'm 42. (Paid off my pile of student loans and $100K in alimony years ago. Paid for my car with cash. Rolled the equity of the last 2 homes into this one)


As many of you know, I have "retired" from general EM now, and have a 90% hospice practice, 10% dedicated oncologic EM... which together might be full time, but are probably closer to 3/4. If that. I do need something to keep me busy - I can't quite afford to travel all the time - but what I do is exceptionally satisfying. It's fulfilling. Sometimes it's emotionally challenging, sometimes I really have to ponder options, but it's nothing like what you all still do every day.

I have time to exercise. I get plenty of sleep. (oh sleep, you sweet, sweet thing.)
And I don't stress near as much as I used to. Having stepped away, it's easy to see that the ED is a damn stressful place.

I suppose I could FIRE at this point, but I enjoy medicine again. (Even doing just part time HPM, which is a rather low paying field, is still better than the majority of Americans make, so life is very good.) I don't know that I have an actual FIRE number, although I do have a pile of FU money, which allowed me to walk away from TeamHealth and most recently, Envision.

Freedom is priceless.
Click to expand...
Sorry to be a noob.... what is “FU” money?
 
Dr Mantis Toboggan said:
search for John Goodman’s speech from The Gambler on YouTube.
Click to expand...
I just reviewed that. Actually cool concept. Seems enough money for 2 years would be my f u money. Almost enough time to retrain in something else if I had to...(retrain not necessarily in medicine)...

I always thought 6 months emergency money wouldn’t be enough but could not put my finger on why...(not referring to FIRE. Talking about when one unexpectedly needs to walk away from a bad situation job wise).

Personally I wouldn’t be able to quit working until kids out of high school. I don’t want my kids to suffer because I had to have things my way...
 
FU money is exactly what it sounds like.

And oncologic EM is basically an ED embedded in a cancer center, usually dedicated to those patients only. That's how mine is, although it's not a true ED, and not EMTALA-bound. Stuff the center can't handle (ie STEMIs, stroke alerts in people without known brain tumors, vascular emergencies etc) get 911ed down the street to an actual Big Hospital ED. Each center is different, but there aren't many. FWIW, this is at a big cancer center in Tampa. MD Anderson in Houston I think actually has a fellowship.

I interviewed at MD Anderson years ago and I've always been interested in these super-sick patients, and was toying with joining their faculty then. You lose some of the fun stuff (Nursemaid's elbows!) but it's really geared to the problems that impact oncology patients vs all-comers. Lots of neutropenic fevers, cord compression, crazy immunologic side effects, etc.
 
If it wasn't for the kids I'd probably still be in an apartment and much closer to FI. But I agree, wouldn't trade them.
emergentmd said:
Congrats. Kids are what keeps Fire from happening quickly. If not for the kids, I would be at Fire in my late 30's.

But I would not trade.
Click to expand...
 
If I were single, not married I would be doing locums. Do travel assignments.
Work 3 months locums.
Live abroad for 3 months.
Rinse and repeat at a different locums/abroad.

Easily make 200K/yr and living expenses would be almost zero with the locums paying for room/board.

Spend 100K abroad, pocket 100K.

I have had hawaii 3-6 months assignments that I have turned down. I am sure the hospitals and pay sucks but nothing I can't do for 6 months. There are so many decent places that need short term coverage when docs take leave of absence.
 
EctopicFetus said:
As I said before any new grad even taking a standard super crap EM job with a CMG can make 400k. 60k to retirement leaves you at 340k. Taxes will eat up less than a third in most states so lets call it 110k. That leaves you 230k or we will call it 19k a month. live on 8k a month which is more than double what you had as a resident. 11k a month to debt. That should get all but the most dire young em docs debt free in 3-5 years which will also make you feel stupid rich. I dont think I have seen an EM doc contract paying much less than 400k for FT work. assuming 1700 hours a year its not exactly crushing it to make $235/hr. If you are then you need to work more or find a better job.
Click to expand...

Sadly there are plenty of us making less than 400k. I've looked around at at least three states (CO, FL, and VA) paying 140, 170, and 190 respectively. Crazy to see these low rates. I figured everywhere was hitting at least 225. However, you're giving great advice here!

And Congrats to OP! Well deserved!
 
EctopicFetus said:
I think the old paradigm of less money working for sdgs is wilting away. Pre partners in my group have equitable scheduling day 1 and make considerably more than any cmg locally.
The bad actors have not surprisingly been the first to sell.
I’ll be honest in that there are incredibly few decent groups left. I think the only hope for em is for groups of docs to take over local contracts. It’s not easy but it’s doable.
Click to expand...

Just been reading through the thread and surprised I'm quoting you again! I think you're very fortunate for finding the dem groups that you've found. I agree that the best hope is for smart docs to take over local contracts. However, plenty of places are owned by companies like HCA, who I doubt will ever hire a local group of docs over a CMG. Might be time for docs to start owning entire hospitals and managing it themselves.
 
There's huge selection bias here on SDN. Someone quotted somewhere that the avg EM compensation nationally is something like 225/hr. I think that's grossly inflated.

If you can find 200/hr in a nice place to work I say go for it.

I've done the CMG / locums thing and ya it's nice money and I killed off my debt, but in the long run it sucks, believe me.
 
You can’t make a blanket statement that 200 is a good rate not everyone lives in Cali for the Midwest and southeast that is a low offer
 
So, $2.3 million and a paid off house for an ED doc who makes 400k/yr in ten years. Doable goal?
 
TheSingularity said:
There's huge selection bias here on SDN. Someone quotted somewhere that the avg EM compensation nationally is something like 225/hr. I think that's grossly inflated.

If you can find 200/hr in a nice place to work I say go for it.

I've done the CMG / locums thing and ya it's nice money and I killed off my debt, but in the long run it sucks, believe me.
Click to expand...

You're right about SDN selection bias, but going by the ACEP compensation report, I figure most places (where I'm looking) would be >200.

www.acepnow.com

2018-2019 Compensation Report for Emergency Physicians - ACEP Now

ACEP Now offers real-time clinical news, news from the American College of Emergency Physicians, and news on practice trends and health care reform for the emergency medicine physician. ACEP Now is an official publication of the American College of Emergency Physicians.
www.acepnow.com www.acepnow.com
 
Backpack234 said:
You're right about SDN selection bias, but going by the ACEP compensation report, I figure most places (where I'm looking) would be >200.

www.acepnow.com

2018-2019 Compensation Report for Emergency Physicians - ACEP Now

ACEP Now offers real-time clinical news, news from the American College of Emergency Physicians, and news on practice trends and health care reform for the emergency medicine physician. ACEP Now is an official publication of the American College of Emergency Physicians.
www.acepnow.com www.acepnow.com
Click to expand...

Grossly inflated across the board.
 
Who you think if more likely to respond, someone who makes 300/hr or someone who makes 150/hr?
Backpack234 said:
You're right about SDN selection bias, but going by the ACEP compensation report, I figure most places (where I'm looking) would be >200.

www.acepnow.com

2018-2019 Compensation Report for Emergency Physicians - ACEP Now

ACEP Now offers real-time clinical news, news from the American College of Emergency Physicians, and news on practice trends and health care reform for the emergency medicine physician. ACEP Now is an official publication of the American College of Emergency Physicians.
www.acepnow.com www.acepnow.com
Click to expand...

Sent from my Pixel 3 using SDN mobile
 
Backpack234 said:
Sadly there are plenty of us making less than 400k. I've looked around at at least three states (CO, FL, and VA) paying 140, 170, and 190 respectively. Crazy to see these low rates. I figured everywhere was hitting at least 225. However, you're giving great advice here!

And Congrats to OP! Well deserved!
Click to expand...
I will say there are sdgs in Virginia paying $300/hr. Florida you can get $225+.

maybe city dependent. From what I hear SoFla is a disaster.
 
Backpack234 said:
Just been reading through the thread and surprised I'm quoting you again! I think you're very fortunate for finding the dem groups that you've found. I agree that the best hope is for smart docs to take over local contracts. However, plenty of places are owned by companies like HCA, who I doubt will ever hire a local group of docs over a CMG. Might be time for docs to start owning entire hospitals and managing it themselves.
Click to expand...
Hca has been dumping envision. Plenty of the private equity guys know this.
 
bravotwozero said:
So, $2.3 million and a paid off house for an ED doc who makes 400k/yr in ten years. Doable goal?
Click to expand...
Yes. Depends on the house and lifestyle you want to get there. IMO that’s a lofty goal though. Net worth of 2.7m (assuming 400k house which would be far below an avg em docs house imo) would require saving 200k or so a year.
 
TheSingularity said:
Yeah? Why? Are they directly employing their docs?

Sent from my Pixel 3 using SDN mobile
Click to expand...
Some are and some are giving those contracts to SDGs in their system. It is an interesting time. Just got word of a new sdg forming in the Southeast. Slowly but surely I hope we get our specialty back!
 
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