EM docs that left medicine

[iish]

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Anyone here leave medicine completely or know anyone that did? I don't mean leave EM for urgent care or hospice, but leave and pursue a whole different career?

I did this and every time I talk to a resident, new grad, or old grad for that matter, the large majority express the desire to do the same. This leads me to believe for many of us, our association with emergency medicine is just one of necessity.

I'd like to meet any other travelers on this journey and happy to answer any questions.

 

[Angry Birds]

What did you transition to and what’s your story? Lots of us would be interested in this.

 

[iish]

I'd like to say I left for some paradise on an island where I sell margaritas on a beach and surf, but I left to go into finance. Happy to go into specifics of the job if you DM me.

For me it was the decision of not wanting to be seen as a tool by those that work in corporate, whether they are executives at a hospital or staffing company. While we control our domains while at work, reality as we all know is that EM docs have no autonomy. The way I see it, without autonomy or proper oversight over our specialty, we are just well paid hourly employees. No different than driving for a ride share company. We plug in and plug out with no say in how our industry functions. We can fight this notion, but it's the sad truth. If I graduated residency into the world of SDGs and more friendly hospital admin, I'd probably still be an ED doc.

 

[PalmTreeDreamer]

I agree with Angry Birds, I'm sure there's lots of interest in your story. How did you transition into finance after residency? Did you already have a finance degree from before?

 

[Birdstrike]

...every time I talk to a resident, new grad, or old grad for that matter, the large majority express the desire to do the same. This leads me to believe for many of us, our association with emergency medicine is just one of necessity.

This is burnout, in a nutshell. The fact that you hear this "every time" you talk to a resident, new grad or old grad, is concerning, but not surprising. I used to feel that way, too, and I thought many times, about leaving Medicine entirely. But ultimately I realized I didn't hate using my knowledge and skills to help people as a doctor, I was just burned out on circadian-rhythm shift-work dysphoria, always being on a different schedule than my family, being treated like dog **** by patients and administration, and being chastised for my job because I didn't do my job plus the impossible. Having done an Interventional Pain Fellowship allowed me to have a normal life again, cure the oppressive circadian-rhythm shift-work dysphoria, get the boot of administration off my throat and work in a setting with reasonable expectations. The fact that I have to kick out someone who wants pills to sell, once in a while, is greatly outweighed by the drastic improvement in my well being and mental state. And when I have to do it, at least I'm not required by law to see that person over and over again, plus I never have to do it at 3:00 am on Christmas when I'm dysphoria and exhausted. Instead, I gladly do it at 2 pm on a Tuesday, with my sleep-tank on "full." Discharged, bye bye.

If I had found an easier way out of Medicine entirely, that also allowed me to have a normal life, sleep at night, be awake during the day and paid the same, I would have gladly taken it and skipped doing a fellowship which cost me a year's salary. But doing what I do now, I no longer feel the need to leave Medicine entirely, much at all. It's infinitely more sustainable. I know EM people find that hard to believe, but it's true. And if I ever get burned out on the very restricted, low dose prescribing I do, I'll just discharge all those patients with 30 days notice, and enact a policy that I'm taking referrals for procedures only.

Back to procedures...

 

[VA Hopeful Dr]

Pain is IMPOSSIBLE to get into now. Impossible. But fabulous story.

Really?

Because for this past match, there were 438 applicants for 335 positions, or 1.3 applicants per spot. Worked out for a 75% match rate which put it right at halfway between GI (65%) and endocrine (84%) on the IM spectrum, equal to peds EM for y'all, or the same as colo-rectal for the surgeons. To compare to the other main multi-disciplinary fellowship, sports med had a match rate of 65% this year.

Sure its not the 95% of child psych, but its also not the <50% of peds surgery.

I would think an EM resident who can get good LORs would have a decent shot at a fellowship (the data I could find doesn't break down results by specialty).

 

[iish]

I agree most folks are completely burned out. I think this burn out is largely due to doctors, especially EM docs, being treated like second class citizens by most people running healthcare establishments.

That said, I knowingly left EM for a job with longer hours, more unpredictability, and often times more stress in an industry with even higher burn out rates. Only difference is no one goes into this assuming it will be a 30 year career, which most EM docs imagine their career choice will be. Burn out here is due to different reasons, mostly lack of predictability and little to no work-life balance. Even though I contribute to society a fraction of what I did before, I still consistently feel like a valued member of the team. I understand I'll probably be burned out in 10 years and switch to a job that provides a more balanced life, but I'll never be disrespected by virtually everyone I work with.

 

[Vandalia]

I suppose the ones who are currently guests of the federal government don't count? There isn't a whole lot of stress pushing a lawnmower for 15 cents an hour.

 

[Groove]

I'm sorry, and don't mean this personal but without knowing more details, I'm extremely skeptical of your story. I would bet there is much more to your decision to jump ship than mere disillusionment with the field. I briefly took a look at your posts and your posts infer someone actively practicing up to 2018, or at least through 2017, so you couldn't have been in another field for very long or more than a few months. You are not really providing any details about your transition, your compensation level in the finance industry, your experience prior to transitioning (how many job environments did you try, etc..) or anything more than the typical disgruntlement heard from people that are usually working too many shifts or working too long at a malignant job site. Birdstrike is about the only person I've heard with a successful transition story and he/she has been incredibly open about the experience which has been well received in here and relevant IMO. Why do we have to PM you for details, why not share them openly on here? You should still be able to easily preserve your anonymity.

That being said, transitioning out of EM after almost a decade of training for another job in an entirely different field is beyond extreme and I would caution anyone considering it to think long and hard about the decision and to try everything in your power to avoid it. Sure, burnout is extremely common but I see people over analyze burnout instead of simplifying it down to some of the most common and most easily adjustable causes which are 1) working too many hours, 2) working at the wrong job. These are the most easy things to change and can make a drastic influence on day to day disillusionment with the field and burnout. 2 years ago, I almost considered jumping to another fellowship and getting out of EM entirely. This year, I feel like a new man. I'm happy, invested, energized and interested in the field again. What changed from then to now? Simple....I work 2-3 less shifts per month. Presto...no burnout. I used to think it was due to so many other factors when in reality....I was just working too much. It's that simple.

 

[Groove]

Just think about this....you can earn over 144K a year by working 4 twelve hour shifts a month. 4 shifts! If you are burned out from that light of a work load, there is something else going on in your life. I can't think of anything with a lighter or commensurate work load that will pay you that amount of money. Nor can I think of too many other specialties (other than ours) where that type of schedule would be attainable.

 

[miacomet]

I'm sorry, and don't mean this personal but without knowing more details, I'm extremely skeptical of your story. I would bet there is much more to your decision to jump ship than mere disillusionment with the field. I briefly took a look at your posts and your posts infer someone actively practicing up to 2018, or at least through 2017, so you couldn't have been in another field for very long or more than a few months. You are not really providing any details about your transition, your compensation level in the finance industry, your experience prior to transitioning (how many job environments did you try, etc..) or anything more than the typical disgruntlement heard from people that are usually working too many shifts or working too long at a malignant job site. Birdstrike is about the only person I've heard with a successful transition story and he/she has been incredibly open about the experience which has been well received in here and relevant IMO. Why do we have to PM you for details, why not share them openly on here? You should still be able to easily preserve your anonymity.

That being said, transitioning out of EM after almost a decade of training for another job in an entirely different field is beyond extreme and I would caution anyone considering it to think long and hard about the decision and to try everything in your power to avoid it. Sure, burnout is extremely common but I see people over analyze burnout instead of simplifying it down to some of the most common and most easily adjustable causes which are 1) working too many hours, 2) working at the wrong job. These are the most easy things to change and can make a drastic influence on day to day disillusionment with the field and burnout. 2 years ago, I almost considered jumping to another fellowship and getting out of EM entirely. This year, I feel like a new man. I'm happy, invested, energized and interested in the field again. What changed from then to now? Simple....I work 2-3 less shifts per month. Presto...no burnout. I used to think it was due to so many other factors when in reality....I was just working too much. It's that simple.

That's great cutting down worked for you.

I have already cut down my shifts to under 100 hours a month and for me, it wasn't enough to fix burnout. To each his or her own. Some people just can't take the circadian shifts, or they live in an area with terrible, underpaid EM jobs (hi, NYC). Why does everyone have to stay in EM? Why are you so against people looking at other fields? Because you think everyone can find balance in EM? Bird left, he's happy- why not others?

 

[Vandalia]

That's great cutting down worked for you.

I have already cut down my shifts to under 100 hours a month and for me, it wasn't enough to fix burnout. To each his or her own. Some people just can't take the circadian shifts, or they live in an area with terrible, underpaid EM jobs (hi, NYC). Why does everyone have to stay in EM? Why are you so against people looking at other fields? Because you think everyone can find balance in EM? Bird left, he's happy- why not others?

There is nothing wrong with that, provided that you are making a decision based on accurate information. The problem that I have found is that some very smart, very capable EM physicians don't have a clue what employment outside of medicine is actually like. I will be a grumpy old man and say that this generally - but not exclusively - appears to be the case for younger physicians. As an example, this spring a recent residency grad was saying that he should have been a plumber; the plumber charged $125/hr, so he obviously had to be taking home at least $200K/year. He was serious. (For the record, the median pay for a plumber in the US is $50,620/year.) I think a lot of the burnout from physicians is driven by the misconception that every guy and gal with a BA is making 6 figures working 40 hours a week with 6 weeks vacation.

It is a tough world out there: pharmacy is in horrible shape, dentists are in trouble, lawyers from top 10 law schools are working in sweatshops at night for $20/hour, small business owners are being squeezed.... Now, there ARE other options out there: if you love EM but just can't take the shiftwork, that is do-able. If you hate hospital bureaucracy, that can be dealt with to some extent. But if the burnout is due to the belief that everyone out there has a better job - and I know people like this - that is a recipe for disaster.

 

[miacomet]

There is nothing wrong with that, provided that you are making a decision based on accurate information. The problem that I have found is that some very smart, very capable EM physicians don't have a clue what employment outside of medicine is actually like. I will be a grumpy old man and say that this generally - but not exclusively - appears to be the case for younger physicians. As an example, this spring a recent residency grad was saying that he should have been a plumber; the plumber charged $125/hr, so he obviously had to be taking home at least $200K/year. He was serious. (For the record, the median pay for a plumber in the US is $50,620/year.) I think a lot of the burnout from physicians is driven by the misconception that every guy and gal with a BA is making 6 figures working 40 hours a week with 6 weeks vacation.

It is a tough world out there: pharmacy is in horrible shape, dentists are in trouble, lawyers from top 10 law schools are working in sweatshops at night for $20/hour, small business owners are being squeezed.... Now, there ARE other options out there: if you love EM but just can't take the shiftwork, that is do-able. If you hate hospital bureaucracy, that can be dealt with to some extent. But if the burnout is due to the belief that everyone out there has a better job - and I know people like this - that is a recipe for disaster.

"It is a tough world out there" is so completely true. As you say, look at the dentists and the lawyers.

 

[iish]

I'm sorry, and don't mean this personal but without knowing more details, I'm extremely skeptical of your story. I would bet there is much more to your decision to jump ship than mere disillusionment with the field. I briefly took a look at your posts and your posts infer someone actively practicing up to 2018, or at least through 2017, so you couldn't have been in another field for very long or more than a few months. You are not really providing any details about your transition, your compensation level in the finance industry, your experience prior to transitioning (how many job environments did you try, etc..) or anything more than the typical disgruntlement heard from people that are usually working too many shifts or working too long at a malignant job site. Birdstrike is about the only person I've heard with a successful transition story and he/she has been incredibly open about the experience which has been well received in here and relevant IMO. Why do we have to PM you for details, why not share them openly on here? You should still be able to easily preserve your anonymity.

That being said, transitioning out of EM after almost a decade of training for another job in an entirely different field is beyond extreme and I would caution anyone considering it to think long and hard about the decision and to try everything in your power to avoid it. Sure, burnout is extremely common but I see people over analyze burnout instead of simplifying it down to some of the most common and most easily adjustable causes which are 1) working too many hours, 2) working at the wrong job. These are the most easy things to change and can make a drastic influence on day to day disillusionment with the field and burnout. 2 years ago, I almost considered jumping to another fellowship and getting out of EM entirely. This year, I feel like a new man. I'm happy, invested, energized and interested in the field again. What changed from then to now? Simple....I work 2-3 less shifts per month. Presto...no burnout. I used to think it was due to so many other factors when in reality....I was just working too much. It's that simple.

Groove, I applaud your research and welcome the skepticism. To answer a few questions:
1) Continued practicing about 1/5 time through early this year so my posts would likely reflect this. I do enjoy it and hopefully can resume some part-time work again in the future.
2) My switch wasn't rooted in burnout. I was far from burning out. But you are right, I was disillusioned and for me this was enough to make a 180 degree change. The question is what do you want out of your career and I just didn't see EM providing what it was that I was looking for. I think this is a very reasonable reason to change careers, and a reason many actually go into medicine as a second career for.
3) Compensation is highly variable based on the economy, firm, personal performance, but I can say that I'm making as much as EM docs in my city, maybe marginally more. Not necessarily more than EM docs in other parts of the country. Again, this decision wasn't rooted only in money so not that important to me.

 

[Groove]

That's great cutting down worked for you.

I have already cut down my shifts to under 100 hours a month and for me, it wasn't enough to fix burnout. To each his or her own. Some people just can't take the circadian shifts, or they live in an area with terrible, underpaid EM jobs (hi, NYC). Why does everyone have to stay in EM? Why are you so against people looking at other fields? Because you think everyone can find balance in EM? Bird left, he's happy- why not others?

I hear you man and look...at the end of the day, you being happy with your life is all that matters. That being said....there have been a lot of studies on physician burnout and virtually all agree among a few common themes, usually involving personal and hospital specific factors that are completely changeable and reverse the feeling of burnout. It would be the rare occurrence for a physician to have no alternative but to leave the field of medicine entirely. I'm not saying it doesn't happen, but I would argue there's more going on with that individual than mere "burnout".

Look, what job are you going to find that pays you 144K for 4 days of work? I can't think of any... You think you are going to make that doing chart reviews or sitting in front of your computer doing telemedicine for 4 days out of the month? None of those jobs are going to pay you $250/hr. Plus, as soon as you leave EM, you are going to experience immediate skill atrophy. Let's say that field #2 doesn't work out to be the dream job that you thought and you start entertaining the idea of coming back to EM after say...a couple of years. I would feel VERY reticent and understandably fearful about jumping back into EM after 2 years having done no resuscitation whatsoever. I'm not saying you couldn't do it, but you'd be very rusty. I spoke with one well oiled and competent EM doc who took 6 months off for vacation and he said that although he didn't notice it at 3 months, 6 months he definitely noticed some atrophy and would find himself struggling with simple decisions that he wouldn't have had to think about before....

Here's a thought...why not just work 4 days a month and keep your EM skills and call it an early retirement with a 144K annual paycheck? That's 26 days give or take to devote to your mental/physical/spiritual well being and focus on the relationships that are important to you. You can do anything else in your free time but you haven't started to burn the bridge so to speak.

It's not that I'm not supportive of people doing other things, I'm just really skeptical that jumping fields is the real solution. I don't think people understand burnout very well and hence don't really know how to change it and are prone to look for extreme solutions for a simple problem. That being said, I'm not you nor am I the poster. I'm just posting food for thought. If it applies, consider it. If not, toss it. After all, I'm just some anonymous dude on an internet forum.

 

[iish]

There is nothing wrong with that, provided that you are making a decision based on accurate information. The problem that I have found is that some very smart, very capable EM physicians don't have a clue what employment outside of medicine is actually like. I will be a grumpy old man and say that this generally - but not exclusively - appears to be the case for younger physicians. As an example, this spring a recent residency grad was saying that he should have been a plumber; the plumber charged $125/hr, so he obviously had to be taking home at least $200K/year. He was serious. (For the record, the median pay for a plumber in the US is $50,620/year.) I think a lot of the burnout from physicians is driven by the misconception that every guy and gal with a BA is making 6 figures working 40 hours a week with 6 weeks vacation.

It is a tough world out there: pharmacy is in horrible shape, dentists are in trouble, lawyers from top 10 law schools are working in sweatshops at night for $20/hour, small business owners are being squeezed.... Now, there ARE other options out there: if you love EM but just can't take the shiftwork, that is do-able. If you hate hospital bureaucracy, that can be dealt with to some extent. But if the burnout is due to the belief that everyone out there has a better job - and I know people like this - that is a recipe for disaster.

Amen, you're 100% right. I actually think life is much easier in EM than outside.
1) There is little in the way of true career instability (outside CMGs cutting contracts)
2) We generally know what we are doing and while human physiology can be tricky, usually our actions have a pretty expected reaction
3) We make great money

Many of the folks that express wanting to leave don't realize how absolutely challenging, risky, and uncertain careers in these other fields can be. Although if you are OK with those downsides, the skills we learn as EM docs are easily transferable to other industries.

 

[Groove]

3) Compensation is highly variable based on the economy, firm, personal performance, but I can say that I'm making as much as EM docs in my city, maybe marginally more. Not necessarily more than EM docs in other parts of the country. Again, this decision wasn't rooted only in money so not that important to me.

What's your background? Did you have a degree in finance? MBA? Prior career to medicine? Do you mind giving more specifics on the type of finance job that you currently work? Again, you would have been making probably north of 300-400K/yr and you are inferring that you are making the same amount having jumped immediately to the finance sector which just seems incredible to me and certainly probably atypical for most.

 

[iish]

I hear you man and look...at the end of the day, you being happy with your life is all that matters. That being said....there have been a lot of studies on physician burnout and virtually all agree among a few common themes, usually involving personal and hospital specific factors that are completely changeable and reverse the feeling of burnout. It would be the rare occurrence for a physician to have no alternative but to leave the field of medicine entirely. I'm not saying it doesn't happen, but I would argue there's more going on with that individual than mere "burnout".

Look, what job are you going to find that pays you 144K for 4 days of work? I can't think of any... You think you are going to make that doing chart reviews or sitting in front of your computer doing telemedicine for 4 days out of the month? None of those jobs are going to pay you $250/hr. Plus, as soon as you leave EM, you are going to experience immediate skill atrophy. Let's say that field #2 doesn't work out to be the dream job that you thought and you start entertaining the idea of coming back to EM after say...a couple of years. I would feel VERY reticent and understandably fearful about jumping back into EM after 2 years having done no resuscitation whatsoever. I'm not saying you couldn't do it, but you'd be very rusty. I spoke with one well oiled and competent EM doc who took 6 months off for vacation and he said that although he didn't notice it at 3 months, 6 months he definitely noticed some atrophy and would find himself struggling with simple decisions that he wouldn't have had to think about before....

Here's a thought...why not just work 4 days a month and keep your EM skills and call it an early retirement with a 144K annual paycheck? That's 26 days give or take to devote to your mental/physical/spiritual well being and focus on the relationships that are important to you. You can do anything else in your free time but you haven't started to burn the bridge so to speak.

It's not that I'm not supportive of people doing other things, I'm just really skeptical that jumping fields is the real solution. I don't think people understand burnout very well and hence don't really know how to change it and are prone to look for extreme solutions for a simple problem. That being said, I'm not you nor am I the poster. I'm just posting food for thought. If it applies, consider it. If not, toss it. After all, I'm just some anonymous dude on an internet forum.

Groove, i see your point in its entirety. The thing to note is that everyone is looking for something different from their careers. While 4 days a month and 144k is great for some people, it may just not be what others want. Both are perfectly OK ways to approach career decisions.

 

[miacomet]

Amen, you're 100% right. I actually think life is much easier in EM than outside.
1) There is little in the way of true career instability (outside CMGs cutting contracts)
2) We generally know what we are doing and while human physiology can be tricky, usually our actions have a pretty expected reaction
3) We make great money

Many of the folks that express wanting to leave don't realize how absolutely challenging, risky, and uncertain careers in these other fields can be. Although if you are OK with those downsides, the skills we learn as EM docs are easily transferable to other industries.

Agreed that life outside EM is probably harder. Not everyone is looking for easier outside EM. Some are actually looking for a challenge, as you were 🙂. And not everyone is looking for 4 days a month for 144k. Some folks relish the challenge, as iish does, of excelling in a tough field where he will ultimately have more power to effect change.

 

[Birdstrike]

I agree most folks are completely burned out. I think this burn out is largely due to doctors, especially EM docs, being treated like second class citizens by most people running healthcare establishments.

That said, I knowingly left EM for a job with longer hours, more unpredictability, and often times more stress in an industry with even higher burn out rates. Only difference is no one goes into this assuming it will be a 30 year career, which most EM docs imagine their career choice will be. Burn out here is due to different reasons, mostly lack of predictability and little to no work-life balance. Even though I contribute to society a fraction of what I did before, I still consistently feel like a valued member of the team. I understand I'll probably be burned out in 10 years and switch to a job that provides a more balanced life, but I'll never be disrespected by virtually everyone I work with.

And what is it that you do now?

Edit: I see now, that you said above, you went into finance. Been skimming threads, lately.

 

[EctopicFetus]

I had an opportunity to go into finance. I did some work prior to med school and am decent with numbers. I have some of my closest friends who went to Harvard Biz, Wharton, etc. I feel like a f-in unicorn. I like what I do and often think I should work more clinically but I dont simply because of my kids. My new goal is to kick out CMGs and help proliferate SDGs. I have a plan.. will take a lot of time but even if I can create a single SDG site that used to be a CMG its a win.

I view burnout as a CMG related issue. It leads to a feeling of being out of control and being a cog. My interactions with leadership of various cmgs makes it clear they could give 2 poops about their docs. SDG life will get me FatFire before im 50.

 

[Hamhock]

I had an opportunity to go into finance. I did some work prior to med school and am decent with numbers. I have some of my closest friends who went to Harvard Biz, Wharton, etc. I feel like a f-in unicorn. I like what I do and often think I should work more clinically but I dont simply because of my kids. My new goal is to kick out CMGs and help proliferate SDGs. I have a plan.. will take a lot of time but even if I can create a single SDG site that used to be a CMG its a win.

I view burnout as a CMG related issue. It leads to a feeling of being out of control and being a cog. My interactions with leadership of various cmgs makes it clear they could give 2 poops about their docs. SDG life will get me FatFire before im 50.

This is a laudable goal and I hope you will share your plan, setbacks, progress -- and, ultimately, success!
Perhaps any successes could be duplicated elsewhere.
HH

 

[Brigade4Radiant]

So people hate CMGs but think finance and working for other corporations are better? Look Medicine isn’t for everyone but people make the error of thinking I passed standardized academic exams therefore I could be top of cuz field

Yes you do have the intelligence but the world outside of academic fields don’t care how high you scored on MCAT/STEP/GMAT they look for a pedigree and who you know and whose circle you are in.

Yes you could do a finance job doesn’t mean they would hire you plus people on sdn glamorize 9-5’s
Thinking that other people who make above 50k don’t work weekends and underestimate what being laid off sets you back financially

Medicine is pretty recession proof

 

[EctopicFetus]

So people hate CMGs but think finance and working for other corporations are better? Look Medicine isn’t for everyone but people make the error of thinking I passed standardized academic exams therefore I could be top of cuz field

Yes you do have the intelligence but the world outside of academic fields don’t care how high you scored on MCAT/STEP/GMAT they look for a pedigree and who you know and whose circle you are in.

Yes you could do a finance job doesn’t mean they would hire you plus people on sdn glamorize 9-5’s
Thinking that other people who make above 50k don’t work weekends and underestimate what being laid off sets you back financially

Medicine is pretty recession proof

People who think finance is 9-5 are insane. *Real* finance is backbreaking hour long work. I had a buddy of mine sleep in his office for a week while his company was arbitraging silver prices. They made a ton of money, sent him to puerto rico and set him and his colleague up with hookers (which I think is gross). Still he got a bunch of spending money and had a blast.

That being said he slept no more than 5 hours a day for a week and literally lived at work. He was working for someone else. Its commonplace for investment bankers to work 80-100 hours a week. Over time some get weeded out and some make out like bandits. But its not some cushy go to the coffee machine type job.

Making money isnt easy no matter the field.

 

[iish]

So people hate CMGs but think finance and working for other corporations are better? Look Medicine isn’t for everyone but people make the error of thinking I passed standardized academic exams therefore I could be top of cuz field

Yes you do have the intelligence but the world outside of academic fields don’t care how high you scored on MCAT/STEP/GMAT they look for a pedigree and who you know and whose circle you are in.

Yes you could do a finance job doesn’t mean they would hire you plus people on sdn glamorize 9-5’s
Thinking that other people who make above 50k don’t work weekends and underestimate what being laid off sets you back financially

Medicine is pretty recession proof

People hate CMGs because they treat you like a second class citizen, ie you do as you are told, when, where, and how. While these other corporations are very demanding, you are generally valued for your contribution.

 

[Brigade4Radiant]

People hate CMGs because they treat you like a second class citizen, ie you do as you are told, when, where, and how. While these other corporations are very demanding, you are generally valued for your contribution.

Corporations work for their bottom line employees and contractors cut into this other than maybe google most corps treat their corps rather poorly like Amazon. Nytimes did an article about corporate life there no thanks.

 

[miacomet]

So people hate CMGs but think finance and working for other corporations are better? Look Medicine isn’t for everyone but people make the error of thinking I passed standardized academic exams therefore I could be top of cuz field

Yes you do have the intelligence but the world outside of academic fields don’t care how high you scored on MCAT/STEP/GMAT they look for a pedigree and who you know and whose circle you are in.

Yes you could do a finance job doesn’t mean they would hire you plus people on sdn glamorize 9-5’s
Thinking that other people who make above 50k don’t work weekends and underestimate what being laid off sets you back financially

Medicine is pretty recession proof

It is not, however, immune to encroachment by midlevels, nor to oversupply due to the expansion of residency slots.

 

[Brigade4Radiant]

It is not, however, immune to encroachment by midlevels, nor to oversupply due to the expansion of residency slots.

You don’t have that protection in the first place. There is no great certificate in the corporate world plus some fields have protection like Surgery tech doesn’t need a certificate and you don’t need an MBA to run a business. Recessions greatly affect other fields which you have to consider.

 

[Old_Mil]

Anyone here leave medicine completely or know anyone that did? I don't mean leave EM for urgent care or hospice, but leave and pursue a whole different career?

I did this and every time I talk to a resident, new grad, or old grad for that matter, the large majority express the desire to do the same. This leads me to believe for many of us, our association with emergency medicine is just one of necessity.

I'd like to meet any other travelers on this journey and happy to answer any questions.

I bailed in 2016 after five years of full time practice. Since then, four other EPs that worked that shop walked away. When you lose five of eight docs in 2 years, you are doing something wrong, The job I had before that, zero of the original four EPs remain at that shop five years later.

First, let me say that whatever field you go into, you are going to work hard and put in long hours to be a success.

The issues that cause burnout in medicine are 100% related to taking intelligent, hard working, motivated people who have spent a decade or more training to do what they do and plugging them in to a system where they stil have 100% of the responsibility for good outcomes and 0% of the authority to make structural changes to ensure those good outcomes.

In the field I am in now, I have 100% responsibility for good outcomes, but about 99% of the authority to make whatever changes I see fit to ensure that they occur. How many physicians can say that? How many pit docs have any influence over their hospitals formulary, emr, the computers that run it, design of the department, equipment that the department stocks, or anything else that affects their life at work?

It was about a 50k a year pay cut to make the move. Considering every one if those dollars would have been taxed at a high marginal rate, it made sense.

For those of you saying you can work four shifts a month and make 144k a year, that is 250 an hour. Probably as a locums, probably as a 1099, probably paying retail for all your benefits. That's not a good deal. 99 percent of the jobs on practicelink.com don't pay 250 an hour. By way of comparison, the shop that has high school grads or associates degree holders fix your toys is in the 100-125 an hour range depending on where you live.

This having been said, I am actually going to start practicing part time this year again...mainly to put myself in a position where I can protect my loved ones from a system that is probably irreparably broken.

 

[miacomet]

I bailed in 2016 after five years of full time practice. Since then, four other EPs that worked that shop walked away. When you lose five of eight docs in 2 years, you are doing something wrong, The job I had before that, zero of the original four EPs remain at that shop five years later.

First, let me say that whatever field you go into, you are going to work hard and put in long hours to be a success.

The issues that cause burnout in medicine are 100% related to taking intelligent, hard working, motivated people who have spent a decade or more training to do what they do and plugging them in to a system where they stil have 100% of the responsibility for good outcomes and 0% of the authority to make structural changes to ensure those good outcomes.

In the field I am in now, I have 100% responsibility for good outcomes, but about 99% of the authority to make whatever changes I see fit to ensure that they occur. How many physicians can say that? How many pit docs have any influence over their hospitals formulary, emr, the computers that run it, design of the department, equipment that the department stocks, or anything else that affects their life at work?

It was about a 50k a year pay cut to make the move. Considering every one if those dollars would have been taxed at a high marginal rate, it made sense.

For those of you saying you can work four shifts a month and make 144k a year, that is 250 an hour. Probably as a locums, probably as a 1099, probably paying retail for all your benefits. That's not a good deal. 99 percent of the jobs on practicelink.com don't pay 250 an hour. By way of comparison, the shop that has high school grads or associates degree holders fix your toys is in the 100-125 an hour range depending on where you live.

This having been said, I am actually going to start practicing part time this year again...mainly to put myself in a position where I can protect my loved ones from a system that is probably irreparably broken.

Happy Thanksgiving! I'm pretty sure everyone wants to know what you went into...

 

[Birdstrike]

I bailed in 2016 after five years of full time practice. Since then, four other EPs that worked that shop walked away. When you lose five of eight docs in 2 years, you are doing something wrong, The job I had before that, zero of the original four EPs remain at that shop five years later.

First, let me say that whatever field you go into, you are going to work hard and put in long hours to be a success.

The issues that cause burnout in medicine are 100% related to taking intelligent, hard working, motivated people who have spent a decade or more training to do what they do and plugging them in to a system where they stil have 100% of the responsibility for good outcomes and 0% of the authority to make structural changes to ensure those good outcomes.

In the field I am in now, I have 100% responsibility for good outcomes, but about 99% of the authority to make whatever changes I see fit to ensure that they occur. How many physicians can say that? How many pit docs have any influence over their hospitals formulary, emr, the computers that run it, design of the department, equipment that the department stocks, or anything else that affects their life at work?

It was about a 50k a year pay cut to make the move. Considering every one if those dollars would have been taxed at a high marginal rate, it made sense.

For those of you saying you can work four shifts a month and make 144k a year, that is 250 an hour. Probably as a locums, probably as a 1099, probably paying retail for all your benefits. That's not a good deal. 99 percent of the jobs on practicelink.com don't pay 250 an hour. By way of comparison, the shop that has high school grads or associates degree holders fix your toys is in the 100-125 an hour range depending on where you live.

This having been said, I am actually going to start practicing part time this year again...mainly to put myself in a position where I can protect my loved ones from a system that is probably irreparably broken.

What did you go into? I spilled the beans and told what I went into. Your journey & thoughts could help many others.

 

[Old_Mil]

I've thought about discussing that. But if I did, I'd basically instantly identify myself to the world.

 

[RustedFox]

This having been said, I am actually going to start practicing part time this year again...mainly to put myself in a position where I can protect my loved ones from a system that is probably irreparably broken.

This is the reason why I will never quit. I may cut back. Way back. But I'll never quit.

 

[Birdstrike]

I've thought about discussing that. But if I did, I'd basically instantly identify myself to the world.

Yeah. I get it. I held out for that same reason for about 5 years. Then, once I realized what I had done was the right thing, I decided to share it with others to help people that might be in the same burned out, miserable, soul-crushing trap I had found myself in, and gotten out of. But do what you need to do. Retain as much anonymity as you need to, for as long as you need to. I get it.

But if at some point you can safely help others by sharing what you’ve done to find a better way, please do so. But not a moment sooner.

 

[Backpack234]

By way of comparison, the shop that has high school grads or associates degree holders fix your toys is in the 100-125 an hour range depending on where you live.

Where's this? Pretty sure my iphone repair guys don't make that much. Probably closer to 20/hr.

 

[Birdstrike]

Where's this? Pretty sure my iphone repair guys don't make that much. Probably closer to 20/hr.

He said "the shop," not the "guys." That's the rub. "The guy" doesn't get it. The top of the shop, always does.

 

[RustedFox]

Where's this? Pretty sure my iphone repair guys don't make that much. Probably closer to 20/hr.

Pretty sure he meant auto repair, with cars being the "toys" in question.

 

[GonnaBeADoc2222]

If you can get good health insurance from your spouse, going for one of those $250+/hour 1099 jobs is a pretty good way to go. Pretax retirement money is is a nice benefit you might be missing out on too, but a lot of times the fund choices they give you suck. Malpractice insurance is not a benefit. I don't consider group disability and life to be of any value either as they are not transportable.

I too have a lot of depressing thoughts regarding control of environment, etc. But I also think about how I make 400k and have almost complete control over my schedule...and that's pretty nice.

 

[iish]

I think the state of emergency medicine can in large part be attributed to the attitudes displayed on this forum. Most folks aren't thinking about the specialty, just how to optimize their own lives, hours, pay, benefits, etc. Nothing wrong with that, but in order to control our own specialty, we need to be less self-centered.

 

[W19]

Based on what people are saying in SDN in term of EM salary, a 2 days/wk job would certainly get most EM docs 180k+/yr. Not sure why it so difficult for many EM docs to transition to a 2 days/wk employment if they are feeling burnt out... Is it difficult to find a 2-day/wk job in EM?

 

[southerndoc]

Based on what people are saying in SDN in term of EM salary, a 2 days/wk job would certainly get most EM docs 180k+/yr. Not sure why it so difficult for many EM docs to transition to a 2 days/wk employment if they are feeling burnt out... Is it difficult to find a 2-day/wk job in EM?

Yes. It doesn't matter if a doc works 20 hours/month or 200 hours/month, his/her malpractice and administrative costs are the same. It's cheaper for the company to have people work more hours.

 

[GonnaBeADoc2222]

I think the state of emergency medicine can in large part be attributed to the attitudes displayed on this forum. Most folks aren't thinking about the specialty, just how to optimize their own lives, hours, pay, benefits, etc. Nothing wrong with that, but in order to control our own specialty, we need to be less self-centered.

Nah the reason for the state of the speciality is unchecked and unregulated residency expansion, unethical corporate practices and politicians who have sold patients and physicians down the river.

 

[BJJVP]

I think the state of emergency medicine can in large part be attributed to the attitudes displayed on this forum. Most folks aren't thinking about the specialty, just how to optimize their own lives, hours, pay, benefits, etc. Nothing wrong with that, but in order to control our own specialty, we need to be less self-centered.

I can see why things appear that way but I think you have it backwards. The attitudes you see are the result of the current state, not the cause of it. I think most went into medical school/residency with the goal of giving good patient care, while having a reasonable amount of control over their work environment and practice. I think the current attitude you see on the forum is the result of realizing the good fight is lost. These guys are just trying to get out with as little damage as possible. Once you realize your business is going bankrupt, you just try to sell off as much as you can. Trying to maintain your vision of a good business model is no longer relevant.

 

[iish]

Nah the reason for the state of the speciality is unchecked and unregulated residency expansion, unethical corporate practices and politicians who have sold patients and physicians down the river.

My point exactly. If some EM docs gave up some salary/time to fight those forces instead of worrying how to work as little as possible while still making good money, maybe we'd have some power.

These guys have figured it out. Pay us well enough that doing anything else seems implausible. Silence us while making us think we are getting a good deal.

 

[nimbus]

One of my best friends joined the FBI shortly after getting boarded in EM. He had a long and rewarding career as an FBI field agent, won the FBI directors award, and culminated
in his last few years as an instructor at the FBI academy in Quantico, Va. Throughout he maintained his medical licenses and CME, and worked shifts in various ERs. He is now retired from the FBI but still works part time in EM. He trained in LA and told me many of his fellow residents were working on screenplays so there may be a few of those too.

 

[iish]

One of my best friends joined the FBI shortly after getting boarded in EM. He had a long and rewarding career as an FBI field agent, won the FBI directors award, and culminated
in his last few years as an instructor at the FBI academy in Quantico, Va. Throughout he maintained his medical licenses and CME, and worked shifts in various ERs. He is now retired from the FBI but still works part time in EM. He trained in LA and told me many of his fellow residents were working on screenplays so there may be a few of those too.

That's phenomenal. Takes balls to take that leap. Out of curiosity, what propelled him to join the FBI? Pretty incredible to take a significant pay cut to do a more dangerous job in order to do what you feel is right.

 

[Brigade4Radiant]

My point exactly. If some EM docs gave up some salary/time to fight those forces instead of worrying how to work as little as possible while still making good money, maybe we'd have some power.

These guys have figured it out. Pay us well enough that doing anything else seems implausible. Silence us while making us think we are getting a good deal.

Lol sorry this forum holds a minority view and if more ER docs had the view of EM medicine then corporate mega groups would have less power.

This field would be a lot better off if doctors would focus more on themselves. So CMGs won’t have such a monopoly if you decided to work locums and refused to teach HCA residencies.

Most docs support ACEP no AAEM also my first priority will be me and my family. If I die the field won’t be affected in the slightest I support policies for AAEM because it’s in my best interest.

 

[nimbus]

That's phenomenal. Takes balls to take that leap. Out of curiosity, what propelled him to join the FBI? Pretty incredible to take a significant pay cut to do a more dangerous job in order to do what you feel is right.

He was a non traditional student and has a short attention span😉 He was always interested in law enforcement and liked shooting guns. While studying computer science as a college student in NYC, he joined the NYPD Auxiliary. After graduation he worked at IBM for a couple of years before he decided to attend med school. The FBI sent him all over the country and overseas to investigate abortion clinic bombings, embassy bombings, organized crime gangs, cyber crime, kidnappings, and a host of other things.

 

[Backpack234]

My point exactly. If some EM docs gave up some salary/time to fight those forces instead of worrying how to work as little as possible while still making good money, maybe we'd have some power.

These guys have figured it out. Pay us well enough that doing anything else seems implausible. Silence us while making us think we are getting a good deal.

Eek. Physicians giving up salary is absolutely not the answer to fighting these forces. Maybe giving up big paydays and selling out to large corporations would be an answer, but salary is one of the big things we're fighting for.

I didn't practice 20 years ago, but I don't imagine the goal back then was to work as little as possible to make the most money (although I'm sure 99% of humanity would love to work less for more money). It seems that back then, physicians were invested in their groups, benefitting their community while also pulling in big numbers. Now that they've sold to the corporations, we're one of the main expenses that these corporations have. Translation: Their goal is profit. Their expense is us. They achieve more profit by spending less on us. That's the formula now and why you see our fight is for our piece of the pie.

With that said, does an increase in EM doc salary of 50% nationwide solve the problems that EM is facing? Absolutely not. Personally, I'd argue that more docs in administrative roles, less rule by mega-corp, and a return to greater involvement by ED docs in their hospitals and their communities. (Cue plug for AAEM)

 

[iish]

With that said, does an increase in EM doc salary of 50% nationwide solve the problems that EM is facing? Absolutely not. Personally, I'd argue that more docs in administrative roles, less rule by mega-corp, and a return to greater involvement by ED docs in their hospitals and their communities. (Cue plug for AAEM)

Exactly. More docs in admin roles, greater involvement in hospitals and communities means people willing to give up some money/hours to do these things. CMGs know exactly how much to pay us so that doing anything else becomes illogical. They essentially pay us well to keep us on the sidelines.