Downshifting on the road to retirement...
Started by Groove
Get help with your application
Use all the free resources available to you from SDN: articles, guides, expert advising, forums discussions, and school research.
I think it is, especially the ones where you're just signing off on a midlevel
Advertisement - Members don't see this ad
But people do that in the ED all the time ED has more liability in most circumstances EMTALA is a liability incubator that is why there not that many lawsuits with telehealth in general.
Or you just show up to work not giving an F to voice your mind.
This is hilarious. I've had similar encounters.
Our guys take anything. Happy to see this new chapter in your life.
@Groove, Congrats. I have been there, a little scary to do, but you will not regret it. You are giving up a little $$ and perceived security for happiness. You older self will thank you, your family will thank you, your health will thank you.
I have been where you are now and those 6 shifts/month will likely keep dwindling down when you realize the scary choice was not scary at all.
I have easily given up 7 figures in salary the past 3 yrs and the loss $$$ has no tangible effect on my life. But being home with the kids, being less stressed, having more time for my health/working out, having time to play golf 3 times a week, traveling when I want have made my life many times better.
This summer we are doing a 1 wk trip to Costa Rica, 2 wk trip to Switzerland/Iceland, 1 wk trip to Orlando, Weekend trip to Chicago, a weekend lake trip, and a 4 dy golf trip to SLC. No way would I have been able to do this working full time.
Enjoy it when you are still young and healthy
I have been where you are now and those 6 shifts/month will likely keep dwindling down when you realize the scary choice was not scary at all.
I have easily given up 7 figures in salary the past 3 yrs and the loss $$$ has no tangible effect on my life. But being home with the kids, being less stressed, having more time for my health/working out, having time to play golf 3 times a week, traveling when I want have made my life many times better.
This summer we are doing a 1 wk trip to Costa Rica, 2 wk trip to Switzerland/Iceland, 1 wk trip to Orlando, Weekend trip to Chicago, a weekend lake trip, and a 4 dy golf trip to SLC. No way would I have been able to do this working full time.
Enjoy it when you are still young and healthy
Last edited:
Bittersteel
Full Member
I plan on almost fully retiring in about 6 years. Probably do 2 shifts / month just so I can keep my license and board cert active in case I need to fall back on it.
My wife is aghast and wonders what ill do with my time. My response: so many things; golf, ski, hike, read, garden, game, travel, etc etc etc.
Bittersteel
Full Member
Oh and #1 thing is reclaiming my sleep schedule. Unless you're someone who is lucky to have an all days schedule we are all some version of a half present zombie since we entered residency.
Mine would wonder what she's going to do with her time to not be around me so much. ROFL
Bittersteel
Full Member
EM is a field that takes mid career physicians who should be hitting their stride and makes them say "why the fuq am i doing this?." The smart ones then hyperaccelerate their savings and get out.
This was probably my primary motivator for going into pain med. Having a fixed daytime schedule is priceless.
Bittersteel
Full Member
My advice to residents here: find an SDG that knows what the fuq they're doing, make a shyt ton of money, save a ton on taxes, save most of it, get out.
Advertisement - Members don't see this ad
Finding the SDG is the hardest part. Likely, you will have to sacrifice location.
Bittersteel
Full Member
Could be, but not in my experience. I love where I live.
It's the same for EM and anesthesiology: location, lifestyle, pay. Pick 2 of 3.
Bittersteel
Full Member
I have all 3. Still gonna retire early though.
Aside from the soul suck... ok, never mind. That was my primary motivator.
But having a fixed daytime schedule is indeed priceless. A circadian rhythm is sometime I really, REALLY love.
Does anyone have any insight into these VA Tele-EC jobs? I can find enough about traditional telemedicine jobs but there's very little to find on these federal VISN Tele (Emergency Care) jobs. Does anyone know anybody that does it and if they do....pros? Cons?
Like....the one thing about telemedicine is the enormous flexibility and my understanding has always been that you can also choose which cases to do. The Tele-EC job listing is very vague. Are these VA patients calling from home? Is the goal to triage what's appropriate for the ER or is it to reduce ER visits? What's the expectation if you have a veteran calling in for chest pain, sob, palpitations and you have zero vitals and zero diagnostics? Can you send them nearby for vitals/EKG/imaging/labs? Are you supposed to send them to the ER? Like....the benefits look fantastic and it certainly looks low stress along with sovereign immunity but I've got zero interest in cutting corners or practicing bad medicine. What's the overall goal of these federal programs? Is the acuity similar to traditional telemedicine or is it higher acuity stuff? AI can't seem to find any information at all out there because it's so new. They've been growing the program since 2023.
Anybody have any friends/colleagues with additional insight?
On the same topic, does anyone know anybody who gave up EM clinical entirely for remote work (telemedicine in any variety?). The paranoid part of me thinks dialing down shifts as low as possible and feeling out remote work would make the most logical sense but at the same time these VA gigs seem almost too good to be true and I'm always suspicious when something is too good to be true.
Like....the one thing about telemedicine is the enormous flexibility and my understanding has always been that you can also choose which cases to do. The Tele-EC job listing is very vague. Are these VA patients calling from home? Is the goal to triage what's appropriate for the ER or is it to reduce ER visits? What's the expectation if you have a veteran calling in for chest pain, sob, palpitations and you have zero vitals and zero diagnostics? Can you send them nearby for vitals/EKG/imaging/labs? Are you supposed to send them to the ER? Like....the benefits look fantastic and it certainly looks low stress along with sovereign immunity but I've got zero interest in cutting corners or practicing bad medicine. What's the overall goal of these federal programs? Is the acuity similar to traditional telemedicine or is it higher acuity stuff? AI can't seem to find any information at all out there because it's so new. They've been growing the program since 2023.
Anybody have any friends/colleagues with additional insight?
On the same topic, does anyone know anybody who gave up EM clinical entirely for remote work (telemedicine in any variety?). The paranoid part of me thinks dialing down shifts as low as possible and feeling out remote work would make the most logical sense but at the same time these VA gigs seem almost too good to be true and I'm always suspicious when something is too good to be true.
What’s the harm in trying it out? You can always stop.
First Telehealth job offer landed. ~320K/yr FTE. Equates to about 40h/wk. You could do 3-4 days and higher rate one weekend day I suppose. No overnights. 100% flexibility. Pick your shifts in advance. 20 hour minimum. Zero nights. Mix of asynchronous, phone and video. The offers come out of the wood work depending on how many licenses you have. Once over about 12...it is very obviously advantageous gauging the interest. Several more Zoom interviews next week. Very reassuring for someone with zero experience outside bedside clinical EM.
IMLC is a complete game changer for anyone seeking this route. It's like shopping for state licenses through Amazon.
IMLC is a complete game changer for anyone seeking this route. It's like shopping for state licenses through Amazon.
Bittersteel
Full Member
Seems like a low rate for NP work slinging medrol dose packs.
Yeah, it's basically urgent care type stuff. The asynchronous visits are easy. You review the charts, history, med refill stuff, etc.. UC visits are the typical UC type stuff though filtered through the lens of telemedicine. Limited vitals, etc.. You can't exactly fill a Rx on a subjective fever, flank pain pt with dysuria requesting an abx for UTI, etc.. So, you have to be a bit more careful. At least, that's my impression so far. Monotonous? Sure. Low stress? Absolutely. 10 hours would probably equate to about 2 in the ED IMO. No codes. No consults. No screaming patients in hallway beds. No psych holds. Medical legal risk is ridiculously non existent compared to EM. It's nice to see a field for once that actively seeks EM. There are so many urgent care type tele jobs where they will list that as an advantage from the start. The whole weight loss HIMS stuff seems to be accelerating rapidly but I'm not particularly interested in that to be honest, even if it pays more. UC stuff seems doable. I'm estimating it roughly ~150-170/hr if you're productive. I won't know that for certain until a few months. It's not for everyone but it's nice to know that you have an alternative other than going back to residency, doing a fellowship or becoming a wound care doc. Oh, it's all 1099 of course.
Remain vaguely curious. The monotony of it actually sounds stressful to me, but that’s a personality thing.
I don’t think I’d be happy doing it for 40h a week even if I got to pick the hours.
I can see 20h a week if the rate is reasonable more as a slide into retirement move for me, especially if the days/hours are flexible. 1099 has its upsides.
I don’t think I’d be happy doing it for 40h a week even if I got to pick the hours.
I can see 20h a week if the rate is reasonable more as a slide into retirement move for me, especially if the days/hours are flexible. 1099 has its upsides.
I've done my time buddy. Looking for easier ways to practice without having to retire completely from medicine.
I'll have much more insight in a few months and will be sure to let you all know how it goes. I'm prepared to be extremely honest and open minded. If it sucks...I'll continue 6 shifts/mo for a few more years but I'm extremely curious to give it a shot. If it's a viable pathway for burned out bedside clinical EM docs, then we all deserve to know about it and there's just unfortunately not much info out there. Either way, I'll be honest about it.
Advertisement - Members don't see this ad
The difficult analysis is in choosing to continue EM while "trying out telemedicine/tele-urgent care". Tele-UC and Telehealth in general has an anaphylaxis level reaction to any current malpractice cases. They don't care if you've got one 10 years old but they very much care if you are in a current one. I don't have that to worry about (thank God) but the longer you work in EM with the highest malpractice risk next to OB, the more you shortchange any long term telemedicine ambitions if you truly desire to transition. Once you get named in a suit, even frivolously....you are absolutely screwed from getting hired form any of these companies until it's settled which could take years even if you are dropped. So, that creates a problem with long term planning. Most of us want to "try it out" for a few months to a year while also working EM which is the highest risk specialty that could absolutely screw you from future telemedicine work if you happened to get the unfortunate luck of being named in a suit.
I think the key is to realize early on that you are approaching burn out and to anticipate wanting to try out telemedicine and to really slow down during your cases, stop trying to be peak producer and focus on safe patient care with maximum defensive documentation. Hopefully, most of us do that all the time. I don't think this will be a good solution for docs who are close to burn out, get named in a malpractice suit and suddenly want to quit EM or move to something else. Telemedicine won't be an option for them for at least 4-6 years until their suit is settled. Just a brief insight I've had while going through this process.
I think the key is to realize early on that you are approaching burn out and to anticipate wanting to try out telemedicine and to really slow down during your cases, stop trying to be peak producer and focus on safe patient care with maximum defensive documentation. Hopefully, most of us do that all the time. I don't think this will be a good solution for docs who are close to burn out, get named in a malpractice suit and suddenly want to quit EM or move to something else. Telemedicine won't be an option for them for at least 4-6 years until their suit is settled. Just a brief insight I've had while going through this process.
You know what has zero lawsuits, easy hours, AND WFH/chill life?
UM. I carry no liability because there is nothing to be liable for. My notes I enter into the record are not a part of the "discoverable" record (back end of Epic)
*gets shot for plugging it again*
UM. I carry no liability because there is nothing to be liable for. My notes I enter into the record are not a part of the "discoverable" record (back end of Epic)
*gets shot for plugging it again*
Do you mind sharing how much you made with UM per yr once you started doing it full time? I honestly can't seem to find as much info on transitioning into UM from EM. It doesn't seem very easily navigated and I can't remember how you got into it honestly.
Last edited:
@Groove -- just be mindful of state laws. Like Georgia requires an in-person exam before you can prescribe or refill any controlled substance. I'm sure there are tons of nuanced laws in all states. I would be schizophrenic trying to keep up with them all.
Bittersteel
Full Member
Speaking as an obnoxious plugger of SDGs, the UM plugging is even more obnoxious as its even more inaccessible to most ER docs.
Oh. Well. Interesting. Yeah that could make it a non-starter. Thrice served over here. All resolved entirely in my favor, none made it all the way to trial (one got to the night before…). A different one made it to the Supreme Court of the Commonwealth! Yes, gentlemen, I’ve won a state Supreme Court case 😉
But hell ONE of those cases was a 7yr journey. I absolutely wouldn’t count on being case free in 5 years.
Frankly UM seems more my personality anyway. I’ve got a little rules lawyer bulldog in me…
this IS a valid AI use case, if it could be trusted!
Yeah, it’s a bit overwhelming. I have AI with read access to my work email keeping tabs on all the state licensing emails and giving me to do lists on my days off. Lots of hoops for sure. I don’t know how I would have done it otherwise. 31 fricken licenses!
I’ve got an entire Claude project devoted to licensing/telemedicine stuff.
I did a fair bit of telemed during COVID using teledoc. It was fine, but it was definitely slinging zpaks and writing work notes 80 percent of the time. Also, back then at least if you wanted 170/hr you needed to be seeing 7 patients per hour. Doable if there were patients waiting in the queue but it was definitely a grind for that amount of money.
@Groove definitely keep us posted on how "busy" you have to be during those work hours. If you have to be churning through patients during your work hours, my concern is you won't be able to tolerate how mind-numbingly boring it is for more than one to two hours at a time. or, knowing you, create a workflow through Claude to automate everything while you just sit back and do something else during your shifts while just kind of overseeing what Claude is doing.
Respectfully disagree sir
1) SDG work is location based, UM is typically remote, so access is limited by your internet rather than driving distance to an SDG
2) #1 speciality in UM is IM. #2 specialty is EM. Then a hodgepodge of others (peds, specialists, etc). I'm pretty sure 90% of new payor directors i talk to are burned out em docs. Sad they picked the wrong side, but i sort of get it, gets them out of ed
So I think its less accurate to say UM is "inaccessible" to EM docs and more, "I, bittersteel, have not attempted to access it"
I wish it were that easy here.
Can you give me the easy version of how to connect AI to my email and not have it somehow ruin my life
What AI are you using? In Claude, just go to settings or customize and then connectors. There's a gmail connector listed. You can give it 3 different types of access. I typically only give it read access so you never need to worry about it drafting or sending emails on your behalf.
Advertisement - Members don't see this ad
Update. 2 variants of jobs. Lots of opportunities btw. 85% are 1099 and those are the flexible ones. Maybe even 90% Those are the ones you can dabble in part time while working your clinical shifts to figure out whether you want to do tele-UC or not. 10% W2 positions. FTE. Benefits. Medical/dental/vision/retirement matching, etc.. PTO, holidays paid, sick pay, etc.. Mainly insurance companies but not all of them. The positions seem more stable. 4 days/wk. Daylight hours. Uncertain volume. Maybe one weekend out of the month. No nights. Set schedule. Possibility for admin/managerial promotion if you put in your time. Fairly good pay. Productivity bonuses end of year. Downside? Difficult to practice EM at the bedside and take one of those jobs at the same time so you are stuck making a decision to full on pivot/transition with a more stable job, good benefits, etc.. vs something you can dabble with in your part time with no worries at all if you decide to give it up. 40 hour average work weeks when you count in the single weekend/mo. (I only saw a few PT and those were 1099. Almost all the W2 were FTE.)
Spoke with a 1099 recruiter for one of the platforms and she said she had EM docs all over the place everywhere from logging in and doing calls during low volume ER shifts vs 50-75% part timers vs full timers. She said her top producer who kills it each month and works a ton pulled in 63K last month. She said most FTE productive types could pull in 23-30K/mo. She admitted they are very high producers. No clue whether any of this is legit or not but I asked. Eat what you kill type platform. Most high producers have 18-20 licenses and she said that's about what you'd need for no downtime and consistent high volume. Anything more would be cushion. It sounds like if you don't want to work nights/evenings, you need more licenses. This particular platform didn't pay more for weekends/nights but the rates seemed fairly decent. 85% phone calls. $25/call. $35/video. $10 if you signed up and they cancelled. She said most phone were 6-8 minutes. Video 10-12 minutes. You can do the math.
Every time I ask what the attrition rate is like for the docs, I get the same answer. "Everyone LOVES it here." So, I doubt I will be able to get any honest answers from that stand point.
I got the distinct feeling from one of them that she has some savvy nocturnists who basically log in while their night shifts after volume drops off and blast out some of these asynchronous visits and probably significantly add to their average hourly when you factor in everything. Very clever. They don't like it enough to do it full time but don't mind if it augments their income.
No clue on the EMRs. Most of the insurance people and larger 1099 tele-UC platforms seem to have some sort of proprietary system or they name systems I've never even heard of.
Spoke with a 1099 recruiter for one of the platforms and she said she had EM docs all over the place everywhere from logging in and doing calls during low volume ER shifts vs 50-75% part timers vs full timers. She said her top producer who kills it each month and works a ton pulled in 63K last month. She said most FTE productive types could pull in 23-30K/mo. She admitted they are very high producers. No clue whether any of this is legit or not but I asked. Eat what you kill type platform. Most high producers have 18-20 licenses and she said that's about what you'd need for no downtime and consistent high volume. Anything more would be cushion. It sounds like if you don't want to work nights/evenings, you need more licenses. This particular platform didn't pay more for weekends/nights but the rates seemed fairly decent. 85% phone calls. $25/call. $35/video. $10 if you signed up and they cancelled. She said most phone were 6-8 minutes. Video 10-12 minutes. You can do the math.
Every time I ask what the attrition rate is like for the docs, I get the same answer. "Everyone LOVES it here." So, I doubt I will be able to get any honest answers from that stand point.
I got the distinct feeling from one of them that she has some savvy nocturnists who basically log in while their night shifts after volume drops off and blast out some of these asynchronous visits and probably significantly add to their average hourly when you factor in everything. Very clever. They don't like it enough to do it full time but don't mind if it augments their income.
No clue on the EMRs. Most of the insurance people and larger 1099 tele-UC platforms seem to have some sort of proprietary system or they name systems I've never even heard of.
Last edited:
Telehealth sounds like the reason why I went into EM in the first place. I'm sure people out there love it but I don't think it'll ever be an option for me. Nothing about it sounds appealing.
I hear you, brother.
We went into EM with noble intentions.
We were wrong, as much as we felt like "grass-roots" change would impact society at-large.
You can still do good, for a small amount of people, every shift.
It's going to take a seismic-level societal change to achieve the things that we held as ideals when we went into EM.
We are not, and cannot be that force, lest we perish.
There's gotta be a serious disconnect between your brain and EM. DM me if you wanna talk about it. I don't wanna say that I have achieved Nirvana or anything silly like that; but my mindset now is as good as it gets (I think). If you don't DM me, I won't be upset about it, because I think that you already know what I'm going to say.
Bittersteel
Full Member
The key to sanity is having an end date on mind. Then it becomes a countdown instead of an endless slog.
You'll never change the culture of where you are.
Just make money and get out with your health intact.
Last edited:
That's really sad. But, it's really true.
What's actually bizarre is how immutable EM actually is, or more specifically, how little power EM physicians have to impact their environment. It's certainly the downside of the "clock-in, clock-out" "benefit" of EM, in the sense that you have all the authority of a punch card.
Making meaningful change is hard. I couldn't effectuate much in EM but in my new life I work closely now with the state hospital association to put up guardrails and educate other health systems on how to fight payors. So, the brain is fairly engaged. But how to translate this back to EM? I'm not sure I could. The ED exists in this very bizarre nexus between the hospital, the insurance company, and the rest of the world, and each of those will shift liability to the next, leaving you as the perpetual bag holder.
