EM after fifty

[miacomet]

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Expanding on the previous thread about lifestyle, how long are you all planning on working? What career transitions do you see ahead? What is your exit strategy from clinical EM, or do you think clinical EM is doable into your seventies?

I'm 45 and while I've maximized my savings and tailored my job as much as possible for longevity, I realistically have five more EM clinical years left in me. I'd like to transition to something else. I do like clinical medicine, but am open to pretty much everything else aside from admin. I'd need to make 125k a year and would like to make 150-200k.

Love to hear from other people's experiences/thoughts/ideas.

 

[bravotwozero]

While we’re on the subject, any attendings here still working EM age 50+ ? Would be interesting to find out...


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[Tenk]

My plan is 12 shifts a month starting end of this year as student loans will be gone. Ride that out a decade or so until dream house is built and paid for. Then go down to 8 shifts a month for hopefully two decades or so as I will have zero debt at that point. Then retire. I think a gradual shift reduction strategy is the best thing to do. It keeps your foot in the door in case something happens and you need to work more.

 

[miacomet]

While we’re on the subject, any attendings here still working EM age 50+ ? Would be interesting to find out...


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At least half my colleagues are over fifty. Oldest is 63. I just want to do something mellower!

 

[emergentmd]

Why not do urgent care or FSER? You just need to do 3 FSER shifts a month and pull in 150K.

Or be really passive and invest in real estate. I hope when I am 50, I will make 150K a yr in rental income.

 

[gro2001]

I am still early in my career, but I suspect that the best strategy for most is going to be a gradual shift reduction and gradual shift to working in lower acuity settings, whether that means urgent care, free standing ER, or just a quieter, smaller, community hospital, even if that means earning less per hour. I might not be able to continue seeing 3+ pts/hr 32-36 hrs/week when I am 60, but I hope and expect to be able to work 12-16 hours/week seeing 1.5 pt/hr long past that age.

 

[TheComebacKid]

One word: academics.

I plan on doing clinical medicine well into my 50s, then cut back and spend more time with resident and student education, research, lectures, etc.

I know many people cringe at that thought, but I believe that longevity in our specialty is important for long term happiness. I have some attendings that are in their mid 70s, sharp as blade, and who have a tremendous amount of experience and wisdom to share. They come into work every day excited, whether it's on their one of four to five shifts/month in the department, or at resident conference etc.

All of them have paid of their loans and have enough to retire, but they choose to work because they love it. I really think dementia starts to set in when you stop having something to get up for in the morning.

I don't know how it is in the community, but I think when you are 70 and work in shifts in the ED, you realize that you look sicker than your patients do. The metrics still apply, the "move the meat" never goes away. I find academics to allow you to stay involved in a different and more manageable capacity.

 

[miacomet]

Great suggestions!

My concerns are that Urgent Care is a really, really fast pace for an older doc, and academics or lower-acuity settings have just as many nights as any other ER job, and lower-acuity settings/UC also tend towards longer shifts. I work at a lower acuity site, and our fifty-plus docs have a rough time with our twelves. UC is also twelve hours.

Thoughts? Any other ideas?

 

[bravotwozero]

Find a FSED that is low volume with 24 hour shifts that pays 180-190/hr. Work 6 of those shifts out of the month, and you’ll be doing pretty good financially and be off 24-25 days out of the month.


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[miacomet]

Find a FSED that is low volume with 24 hour shifts that pays 180-190/hr. Work 6 of those shifts out of the month, and you’ll be doing pretty good financially and be off 24-25 days out of the month.


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Lol. No one after fifty wants to work 6 24s. Or any 24s. This is exactly the problem.

 

[bravotwozero]

You are OFF for 24 days out of the month! 24 days! That's about as cush as it gets, working a job where you'll likely get some sleep while you are on the job, and still make an amazing amount of money....

 

[miacomet]

You are OFF for 24 days out of the month! 24 days! That's about as cush as it gets, working a job where you'll likely get some sleep while you are on the job, and still make an amazing amount of money....

I don't think that's the issue for most docs after fifty- that's the dream of someone without family who wants to travel and who needs to make a ton of money. Are people not aware that circadian issues are worse with age, and that 24 hour shifts are hell on an aging body? Seriously?

 

[bravotwozero]

That sounds awfully complainy pants to me. 24 days off a month to sleep, recover, do what you want with family. Enough said.

 

[tarsuc]

but am open to pretty much everything else aside from admin. I'd need to make 125k a year and would like to make 150-200k..

Sorry, im not an attending yet. but Just wondering what's wrong with admin?

 

[miacomet]

That sounds awfully complainy pants to me. 24 days off a month to sleep, recover, do what you want with family. Enough said.

LOL! You must be young. I don't know any older docs who can handle that. Our 55 plus docs are having a legitimately hard time with twelve hour shifts, and really can't handle twelve hour nights. I don't think they are complaining. I think they are aging. You'll get there, too. Why so mean and unsympathetic? Why is it so hard to understand that people need different things?

 

[deleted109597]

Find a FSED that is low volume with 24 hour shifts that pays 180-190/hr. Work 6 of those shifts out of the month, and you’ll be doing pretty good financially and be off 24-25 days out of the month.
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Yeah, I work 8 24s a month at a FSED. In theory I have 20-23 days off per month. 8 are DOMA though, because I probably didn't sleep the night before. And, you can't work 8 in a row either. So let's call it 16 days of the month, giving me 12-15 days off. It still sucks some months, and I'm sub 40. It would have to be much, much slower than mine, and they probably don't pay 190/hr for those.

 

[deleted497653]

I am young (30s) and have worked at a small ED to make extra money. The 24 hour shifts were too draining. I slept some of the nights but it still was soul draining and I “didn’t feel right” after those shifts. It’s like being on call but not quite the same. Maybe do nights at a remote ED because at such a place it stops being busy at 10 p then picks up again at 4am. So you could sleep. But most EDs I’ve found are always trying to advertise and bring up the volume even at night so who knows how much sleep you’ll get. So I agree with @ miacomet that 24 hour shifts are not for 50 and older.

I would say, save your money and transition to a non clinical job at 50. Raise your kids and save your money while you’re still able. The people in my group who are older and still working are the ones with a lot of kids or an expensive lifestyle. Theoretically you’ll never have enough money to retire in America.

 

[miacomet]

I am young (30s) and have worked at a small ED to make extra money. The 24 hour shifts were too draining. I slept some of the nights but it still was soul draining and I “didn’t feel right” after those shifts. It’s like being on call but not quite the same. Maybe do nights at a remote ED because at such a place it stops being busy at 10 p then picks up again at 4am. So you could sleep. But most EDs I’ve found are always trying to advertise and bring up the volume even at night so who knows how much sleep you’ll get. So I agree with @ miacomet that 24 hour shifts are not for 50 and older.

I would say, save your money and transition to a non clinical job at 50. Raise your kids and save your money while you’re still able. The people in my group who are older and still working are the ones with a lot of kids or an expensive lifestyle. Theoretically you’ll never have enough money to retire in America.

Agreed 100%.

The question is what kind of nonclinical role? And how to transition? As to admin, it's just not for me. Too many meetings with...administrators.

 

[dchristismi]

I'm 41, been out just over 10 years.
Saving aggressively, just over 7 figures in the bank, and will have mortgage on 400K house paid off in 15 months.
Married into grown stepkids, so there's a huge savings there.

I cut back to 10 10h EM shifts about 3 years ago, am now down to about 6-8. There is no f-in way I could maintain the volume/acuity I used to. And I don't want to.

In the coming year, I plan to drop that to 3-4/month (at a cush freestanding no less) to cover the travel bills and pay off the mortgage.
Right now, I work 15-18 days/month doing HPM, and they are generally 4-6 hour days, plus afternoon phone coverage. And aside from the loooong family talks, I love it. Well, even those. I still sort of look at it as a volunteer gig, except on days when I have a lot of admissions. But I get paid based on billing, so I don't mind a new admission. Especially when I can actually relieve someone's suffering.

When the mortgage is gone, maybe I'll drop the EM altogether. Although for now, I really like this particular gig, but it's a 2h drive so I go in blocks.

I did a little bit of admin before. It's soul-sucking and miserable. You couldn't pay me enough to deal with that s#it again.

 

[miacomet]

I'm 41, been out just over 10 years.
Saving aggressively, just over 7 figures in the bank, and will have mortgage on 400K house paid off in 15 months.
Married into grown stepkids, so there's a huge savings there.

I cut back to 10 10h EM shifts about 3 years ago, am now down to about 6-8. There is no f-in way I could maintain the volume/acuity I used to. And I don't want to.

In the coming year, I plan to drop that to 3-4/month (at a cush freestanding no less) to cover the travel bills and pay off the mortgage.
Right now, I work 15-18 days/month doing HPM, and they are generally 4-6 hour days, plus afternoon phone coverage. And aside from the loooong family talks, I love it. Well, even those. I still sort of look at it as a volunteer gig, except on days when I have a lot of admissions. But I get paid based on billing, so I don't mind a new admission. Especially when I can actually relieve someone's suffering.

When the mortgage is gone, maybe I'll drop the EM altogether. Although for now, I really like this particular gig, but it's a 2h drive so I go in blocks.

I did a little bit of admin before. It's soul-sucking and miserable. You couldn't pay me enough to deal with that s#it again.

Thank you! Great info. I'm about where you will be in 4 years- house paid off, some more savings. I keep plugging away because my calculations show that I won't have enough to retire unless I keep socking it away. I'd love to cut down to one or two daytime shifts a month, but after calculating out my savings to quit working at 60 it just doesn't look like enough.

Did you do an HPM fellowship, or just transition? Is it worth it? If it's essentially a volunteer gig, I might hunt elsewhere. Thanks again for your post.

 

[Groove]

Just out of curiosity, for those that don't mind answering. What is your minimum goal for retirement savings where you would consider leaving medicine entirely?

Personally, I got a late start (2nd career) and I'm 43, 6 yrs out of residency, loans paid off (400K), aggressively saving for retirement (100K annually) and would like to have 4 mill to leave the field entirely (aiming for late 50s). I'm not sure if that is unreasonable or not? Need less? More? I think I might consider it at 3.5...

What about you guys?

I read WCIs article about multiplying your annual expenses by 25 and in that case I could probably do it for less than I originally thought....

 

[miacomet]

Just out of curiosity, for those that don't mind answering. What is your minimum goal for retirement savings where you would consider leaving medicine entirely?

Personally, I got a late start (2nd career) and I'm 43, 6 yrs out of residency, loans paid off (400K), aggressively saving for retirement (100K annually) and would like to have 4 mill to leave the field entirely (aiming for late 50s). I'm not sure if that is unreasonable or not? Need less? More? I think I might consider it at 3.5...

What about you guys?

I read WCIs article about multiplying your annual expenses by 25 and in that case I could probably do it for less than I originally thought....

I think about this daily. Ideally I would like 5 mm in 2018 dollars above and beyond a paid off house (mine is paid off but I would love to move). This will be tough for me, too. I would certainly cut down at 2.5 mm in 2018 dollars, and I think I would work just a few shifts a month at 3.5 mm. It's difficult, and a late start to retirement savings really shows the power of compounding, and how I missed out!

 

[bravotwozero]

5 mil does not seem doable to me even on an EM salary, but I really think myself and lots of people could live comfortably on much less. I’m thinking 2.5 mil would be enough after a paid off house.


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[bravotwozero]

Agreed 100%.

The question is what kind of nonclinical role? And how to transition? As to admin, it's just not for me. Too many meetings with...administrators.

Yeah, tough choices all around. Perhaps you can try your hand at becoming a parrot breeder....


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[coachB]

Just out of curiosity, for those that don't mind answering. What is your minimum goal for retirement savings where you would consider leaving medicine entirely?

Personally, I got a late start (2nd career) and I'm 43, 6 yrs out of residency, loans paid off (400K), aggressively saving for retirement (100K annually) and would like to have 4 mill to leave the field entirely (aiming for late 50s). I'm not sure if that is unreasonable or not? Need less? More? I think I might consider it at 3.5...

What about you guys?

I read WCIs article about multiplying your annual expenses by 25 and in that case I could probably do it for less than I originally thought....

It's a bit more complicated than a simple number. What's the allocation of your savings? Roth accounts? If you have a steady stream of expected tax-free income, obviously brings down the number, perhaps significantly. Tax deferred accounts? Taxable accounts? Expected tax burden?

 

[The White Coat Investor]

Just out of curiosity, for those that don't mind answering. What is your minimum goal for retirement savings where you would consider leaving medicine entirely?

I guess there is none. I hit my number (even once lifestyle inflation did its work on it) and I'm still practicing.

 

[deleted497653]

It's complicated but for the most part it depends on how addicted (or dependent) you are on your paycheck. What scares people about leaving medicine behind is that the steady paycheck and security will be gone.

The question is when to leave emergency medicine and what to do after. The first question for me doesn't mean leave emergency medicine to "retire". For me it means, leaving emergency medicine to do "other things". Now you might wonder what those "other things" are. I am always trying to answer those questions. For the most part, I do not want to work for someone else once I leave medicine or if I do work for someone else, I want it to be my passion or if not, something I can easily walk away from without a lot of consequences. I have hobbies and interests but don't want to sink my money into anything unless I know I can make any money invested back. Some of my interests are real estate (managing property), writing, teaching at a college/community college, start a small home based aesthetic practice. I have thought of hospice fellowship but at this time, I feel like it will only prolong my time in medicine and that is just not what I am aiming at right now.

So for me, I grew up low income but never missed a meal (although sometimes dinner was a piece of bread). I can pinch a penny.

Give me 2million with house paid off (400000) and I'm gone TODAY. (I will be done with my student loans 60,000 in 6 months. Original amount was $192,000 med school alone-had undergrad scholarship. My car is paid off). Wouldn't even look back. Now, like I said, I would be retiring from medicine but not from working. I still have young kids so I would need another gig until 65 when I can downsize and live off of....my retirement contribution- I will have made contributions into my savings for ~15 years.

I would like to add that part of my goal is to help my kids with partial college/professional school cost but they need to pay the rest with a part time job. I think it instills character to have to pay your way. I know colleagues paying for the whole cost. Hopefully, they can go to good state schools and cut the cost....or pause....get a scholarship.

 

[gro2001]

Just out of curiosity, for those that don't mind answering. What is your minimum goal for retirement savings where you would consider leaving medicine entirely?

Personally, I got a late start (2nd career) and I'm 43, 6 yrs out of residency, loans paid off (400K), aggressively saving for retirement (100K annually) and would like to have 4 mill to leave the field entirely (aiming for late 50s). I'm not sure if that is unreasonable or not? Need less? More? I think I might consider it at 3.5...

What about you guys?

I read WCIs article about multiplying your annual expenses by 25 and in that case I could probably do it for less than I originally thought....

For me, there are two meaningful thresholds when it comes to retiring:

$2M is the lowest threshold at which I would feel that I am financially independent. Using WCI's x25 rule (or the 4% rule), this would lead to an annual income of around $80k.

If I ever reach $5M, then I have to really consider whether any additional income is worth it. At that threshold I would probably continue working only on things that have nothing to do with making income.

 

[n2b8me]

1. concierge medicine
2. cosmetic dermatology
3. medical malpractice expert witness
4. physician consultant for medical devices

I would imagine any of these things need time to build up until you have an adequate client base... but you wouldn't need to deal with admins or insurances.

 

[dchristismi]

Thank you! Great info. I'm about where you will be in 4 years- house paid off, some more savings. I keep plugging away because my calculations show that I won't have enough to retire unless I keep socking it away. I'd love to cut down to one or two daytime shifts a month, but after calculating out my savings to quit working at 60 it just doesn't look like enough.

Did you do an HPM fellowship, or just transition? Is it worth it? If it's essentially a volunteer gig, I might hunt elsewhere. Thanks again for your post.

I didn't do a fellowship - just asked around and they jumped at the chance to get me. I've learned exactly 2 new things (that I use on a daily basis: the PPS scale and the Pain AD scale) and our skill set in EM is a perfect fit.

I sort of look at it as volunteering, but it's quite capable of paying the bills. I am part time, being roughly 3-6 hour days - however long it takes me to round on my patients. Full time brings benefits and roughly $200K. I don't want to work anywhere full time at this point. Maybe someday. Regardless, they do actually pay me, and it's still more than I made as a resident. (I started actually keeping track of how much time I actually spent last month, so will have better numbers soon. Last month, I made about 9K for 15 days, but some of those days were pretty short. Some weren't.)

Also, I don't think I'm going to need 5 mil to retire. I do plan on working for awhile yet, but transitioning to HPM is so much less stress. Besides, I need something to fill my time, or I'll spend too much of it buying airfare! I have thought about my FIRE number but I suspect I'll keep doing *something* - they just won't be 12h EM shifts. Also, husband will be inheriting some commercial real estate and we have a couple of rentals, so we'll have that income as well.

 

[The White Coat Investor]

If I ever reach $5M, then I have to really consider whether any additional income is worth it. At that threshold I would probably continue working only on things that have nothing to do with making income.

Why that restriction? There are lots of fun, enjoyable, fulfilling things to do that also provide an income.

 

[namethatsmell]

For the students and residents: pay your (future) self ASAP.

With discipline and a bit of luck EM only has to be a full-time job for 10 years.

Let's say you become an attending at 30.
Take the first two years and focus on killing your loans. You succeed. Great, let the Dom flow.
Now continue to work FT and now focus on saving/investing 100k/yr for 8 years.
Then at 40 your semi-retirement begins. You don't have to save ever again. Work 1-2 days/wk to cover your living expenses and enjoy your life. With a 7% ROI your savings from your 30s are worth $2.2mil at 50, $3mil at 55, or $4.2mil at 60 depending on when you decide to tap those funds.

And don't buy boats. But one boat is OK.

 

[miacomet]

I started late, so I'm going to have a rough time getting to $5 mm, but for those who are starting at 30 it should be doable by age 60. If you save 100k a year for 15 years, then 25k for the next 15, you will end up with over 8 mm at 60.

 

[hundreddaysoff]

It's complicated but for the most part it depends on how addicted (or dependent) you are on your paycheck. What scares people about leaving medicine behind is that the steady paycheck and security will be gone.

The question is when to leave emergency medicine and what to do after. The first question for me doesn't mean leave emergency medicine to "retire". For me it means, leaving emergency medicine to do "other things". Now you might wonder what those "other things" are. I am always trying to answer those questions. For the most part, I do not want to work for someone else once I leave medicine or if I do work for someone else, I want it to be my passion or if not, something I can easily walk away from without a lot of consequences. I have hobbies and interests but don't want to sink my money into anything unless I know I can make any money invested back. Some of my interests are real estate (managing property), writing, teaching at a college/community college, start a small home based aesthetic practice. I have thought of hospice fellowship but at this time, I feel like it will only prolong my time in medicine and that is just not what I am aiming at right now.

So for me, I grew up low income but never missed a meal (although sometimes dinner was a piece of bread). I can pinch a penny.

Give me 2million with house paid off (400000) and I'm gone TODAY. (I will be done with my student loans 60,000 in 6 months. Original amount was $192,000 med school alone-had undergrad scholarship. My car is paid off). Wouldn't even look back. Now, like I said, I would be retiring from medicine but not from working. I still have young kids so I would need another gig until 65 when I can downsize and live off of....my retirement contribution- I will have made contributions into my savings for ~15 years.

I would like to add that part of my goal is to help my kids with partial college/professional school cost but they need to pay the rest with a part time job. I think it instills character to have to pay your way. I know colleagues paying for the whole cost. Hopefully, they can go to good state schools and cut the cost....or pause....get a scholarship.

+1, $2M plus ~80ac paid-off land/house is the minimum I'm aiming for to FIRE. Anything extra is gravy and would allow me to have more expensive hobbies.

Mostly in retirement accounts, but account type doesn't actually matter so much since you only need 5y of living expenses in taxable before Roth conversion ladder would kick in.

 

[deleted547339]

On a similar note, I’m a new academician. Without getting into too many specifics, I always have the opportunity to pick up more shifts at the university hospital, as well as pick up other compensated work-related tasks. As a new grad, I kind of want to jump on every compensated activity I can in order to save up for a downpayment on a home. On the other hand, I don’t want to burn out. We’ll be saving about 82k/y +/- HSA. I figure we can be FI in 11 to 17 years depending on returns (using real returns from 3-10%).

Does anyone have any advice on how to decide 1) how much is enough and 2) when should I say yes or no. I’m kind of a workaholic. After training, I’m used to working a lot and part of me wants to keep my foot on the gas for the next 2-3y while I have the energy - rack up and extra 50-100k/y and slap down a 50% home downpayment. But obviously I want to spend time with family, too, and don’t want to burn out before FI.

 

[Groove]

On a similar note, I’m a new academician. Without getting into too many specifics, I always have the opportunity to pick up more shifts at the university hospital, as well as pick up other compensated work-related tasks. As a new grad, I kind of want to jump on every compensated activity I can in order to save up for a downpayment on a home. On the other hand, I don’t want to burn out. We’ll be saving about 82k/y +/- HSA. I figure we can be FI in 11 to 17 years depending on returns (using real returns from 3-10%).

Does anyone have any advice on how to decide 1) how much is enough and 2) when should I say yes or no. I’m kind of a workaholic. After training, I’m used to working a lot and part of me wants to keep my foot on the gas for the next 2-3y while I have the energy - rack up and extra 50-100k/y and slap down a 50% home downpayment. But obviously I want to spend time with family, too, and don’t want to burn out before FI.

I think that's an admirable retirement savings plan if you can keep it up.

1) General consensus seems to be 2.5 to 5 mill, depending on lifestyle and spending. That is, if you are asking how much retirement savings is enough.

2) I'm about 6 years out and my sweet spot is about 150 hrs per month. I can maintain my sanity, stay active in the gym and maintain my personal relationships while finding enough time for vacations with that schedule. There are a few years where I tried 160-180 and I felt horrible as well as had a terrible attitude at work. I felt like I was loosing my temper too often, so I backed it down and find myself much more relaxed and even tempered. (Though I would most assuredly work less if my retirement savings were better on target.)

Since you have a family, you might want to do less. Maybe 130-140 hours/mo.

 

[deleted109597]

Yeah, the idea of having multiple "income" properties appeals to me, but I'll wait until I pay off my house first. I don't want extra mortgages, especially if they don't generate as much income as I'd like.

 

[deleted547339]

I think that's an admirable retirement savings plan if you can keep it up.

1) General consensus seems to be 2.5 to 5 mill, depending on lifestyle and spending. That is, if you are asking how much retirement savings is enough.

2) I'm about 6 years out and my sweet spot is about 150 hrs per month. I can maintain my sanity, stay active in the gym and maintain my personal relationships while finding enough time for vacations with that schedule. There are a few years where I tried 160-180 and I felt horrible as well as had a terrible attitude at work. I felt like I was loosing my temper too often, so I backed it down and find myself much more relaxed and even tempered. (Though I would most assuredly work less if my retirement savings were better on target.)

Since you have a family, you might want to do less. Maybe 130-140 hours/mo.

When I say enough, I mean enough spending money per year.

 

[miacomet]

On a similar note, I’m a new academician. Without getting into too many specifics, I always have the opportunity to pick up more shifts at the university hospital, as well as pick up other compensated work-related tasks. As a new grad, I kind of want to jump on every compensated activity I can in order to save up for a downpayment on a home. On the other hand, I don’t want to burn out. We’ll be saving about 82k/y +/- HSA. I figure we can be FI in 11 to 17 years depending on returns (using real returns from 3-10%).

Does anyone have any advice on how to decide 1) how much is enough and 2) when should I say yes or no. I’m kind of a workaholic. After training, I’m used to working a lot and part of me wants to keep my foot on the gas for the next 2-3y while I have the energy - rack up and extra 50-100k/y and slap down a 50% home downpayment. But obviously I want to spend time with family, too, and don’t want to burn out before FI.

I would aim for 100-150k a year, and work as much as you can stand in whatever capacity until your mortgage is paid off. Everyone's work tolerance and daily needs are different. I think it's a great idea to pick up other compensated work-related tasks so you can find a niche when you want to slow down in a few years and also to avoid burnout. You sound like you are on the right track in any case.

 

[gro2001]

Why that restriction? There are lots of fun, enjoyable, fulfilling things to do that also provide an income.

Absolutely. What I meant is that at that point it becomes inconsequential whether what I am doing is generating an income or not. I may still do things that happen to make an income, but that would be of little consequence compared to what else I am getting out of it in terms of fulfillment, satisfaction, etc. At least that's how I imagine it.

 

[emergentmd]

Lol. No one after fifty wants to work 6 24s. Or any 24s. This is exactly the problem.

You got this all wrong. I work at FSED with volume 4-10 in 24 hrs and make more in that one shift than the avg american salary. Working 4 FSED shifts in a month is CAKE.

I sit around napping, reading, watch TV, catching up on paperwork for 90% of the time. I could be home doing the same but getting paid. Nice to have a break from the kids too so I can catch up on email/paperwork.

24 hrs seems long but its less work than being at home and doing housework, dealing with the kids, cleaning up. Plus most shifts you can get 4-8 hrs overnight and wake up refersh.

If FSEDs are standing for another 10 yrs, I will be one of the docs working 4-6 FSED shifts a month and pulling in 200K/yr.

 

[emergentmd]

Yeah, I work 8 24s a month at a FSED. In theory I have 20-23 days off per month. 8 are DOMA though, because I probably didn't sleep the night before. And, you can't work 8 in a row either. So let's call it 16 days of the month, giving me 12-15 days off. It still sucks some months, and I'm sub 40. It would have to be much, much slower than mine, and they probably don't pay 190/hr for those.

You haven't found the right FSED environment. You can get paid close to 190/hr with gigs less than 10/dy. I know of FSED gigs paying 225-250/hr but they are seeing 30+ in 24 hrs. That is not the FSED I would look for.

If your FSED saw 4-10 per 24 hrs, your 8 shifts is not 16 dys. You can get 4-10 hrs of sleep each shift so its not like doing a night shift and flipping back/forth.

 

[Groove]

You got this all wrong. I work at FSED with volume 4-10 in 24 hrs and make more in that one shift than the avg american salary. Working 4 FSED shifts in a month is CAKE.

I sit around napping, reading, watch TV, catching up on paperwork for 90% of the time. I could be home doing the same but getting paid. Nice to have a break from the kids too so I can catch up on email/paperwork.

24 hrs seems long but its less work than being at home and doing housework, dealing with the kids, cleaning up. Plus most shifts you can get 4-8 hrs overnight and wake up refersh.

If FSEDs are standing for another 10 yrs, I will be one of the docs working 4-6 FSED shifts a month and pulling in 200K/yr.

Emergentmd, where do you work man? What state? I'm insanely jealous. I wish we had gigs like that where I am located.

 

[Groove]

Also, are you invested in the FSED (Neighbors model, etc..), self owner, or are you simply employed to work shifts?

 

[emergentmd]

Obviously everyone has their own FIRE number but truthfully I think I will always do clinical medicine until health does not allow this. I just really enjoy work and EM work in general. I am in my mid 40's and doing difficult shifts becomes more difficult and really is a young person's game. But many hospital jobs are not difficult shifts (less than 2pph). I have had difficult jobs seeing 3+pph and crashing everywhere and this is definitely a young docs job b/c you getting more cynical as you get older.

My number for retirement is not actually any real number but more so when I don't have to take money from my retirement or savings. If I can get to 200k in passive income and all debt including home paid off, I would say I am retired.

Currently my rental income brings close to 200K/yr but most of that goes to paying off the deb. Once I get my rental income paid off and my home paid off, I would be monetarily retired.

At that point, I would have 2+mil in retirement account. 3 mil in rentals equity, 1mil in home equity.

It would be great never having to worry about touching my retirement to fund my retirement.

 

[emergentmd]

Also, are you invested in the FSED (Neighbors model, etc..), self owner, or are you simply employed to work shifts?

Both. And I would never go into a Neighbors model. I would only invest in a FSED where you truly are an owner with access to the books and decision making.

 

[namethatsmell]

Emergentmd, where do you work man? What state? I'm insanely jealous. I wish we had gigs like that where I am located.

IIRC he’s located in Texas which isn’t a big surprise given the rates he quotes.

By his math his FSED sees ~3k/yr. How many places with that volume pay what he gets? Very very few. He’s caught a unicorn.


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[emergentmd]

IIRC he’s located in Texas which isn’t a big surprise given the rates he quotes.

By his math his FSED sees ~3k/yr. How many places with that volume pay what he gets? Very very few. He’s caught a unicorn.


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You are wrong, very wrong.

 

[namethatsmell]

You are wrong, very wrong.

Then please correct me with specifics.



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[KGflyboy]

You got this all wrong. I work at FSED with volume 4-10 in 24 hrs and make more in that one shift than the avg american salary. Working 4 FSED shifts in a month is CAKE.

The math doesn't make sense to me. How can you possibly be bringing in this much money per patient to earn this much per shift.

How much do you think the average American makes? I assume it's between 30-40k.