EM docs that left medicine

[AlvinKamara]

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This thread is quite depressing to read as a first year that’s already starting to feel the herald symptoms of burnout. I already find myself dreading to go to work. I just finished a string of overnights and it legitimately took me 3 days to recover.

How much do you think the stressors of EM can be mitigated by just working less? I do have a high loan burden but my spouse is a high income earner so I don’t anticipate being pressed to make money hand over fist through my career, but who knows.


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[Boros]

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.

From someone far behind, aspiring to go into EM, thank you for this perspective.

 

[emergentmd]

To say that EM is a bad field to go into, it is a great exaggeration. Just from a monetary standpoint, there are few fields that makes as much per hour.

ALL fields are being squeezed. All Hospital Based fields are being micromanaged by the C suite. Ask a hospitalist, radiologist, anesthesiologist. They all will tell you the metrics, pressures they get. That is the one real mission of a for profit hospital. To make a PROFIT. Just like any other company, nothing unique to medicine.

All Non Hospital based fields are getting squeezed. Look at all of the Primary cares that are being bought or employed. It is very difficult for a PCP to open a private office. This is not restricted to primary care anymore. Cardiology, Orthopedics, Surgery, etc.... They all are being bought, employed, or "aligned" with a hospital. They all are a slave to their master just as EM is.

If you like EM, all of this doesn't matter. If you are getting burned out, this matters alot. But no different than any other field, they all have the same complaints.

If you ask Most EM docs and if they are true to themselves, EM would still be in their top 3 choices.

WHO on here would rather be a hospitalst? Pathologist? Anesthesiologist? General surgeon? Ob/Gyn? Radiologist?

Look, some might pick Radiology if they had to do it again, but that a 24 hr a day field now and have to churn out ER reads in 30 min. Plus you have to do 5 yrs of residency plus a fellowship to be competative which can be 7 Years!!!! Do EM and 3 yrs to make 300K.

 

[Birdstrike]

This thread is quite depressing to read as a first year that’s already starting to feel the herald symptoms of burnout. I already find myself dreading to go to work. I just finished a string of overnights and it legitimately took me 3 days to recover.

How much do you think the stressors of EM can be mitigated by just working less? I do have a high loan burden but my spouse is a high income earner so I don’t anticipate being pressed to make money hand over fist through my career, but who knows.


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Reducing your workload mitigates it a lot. The problem I had was getting my employer to let me cut back my hours. The response was always, "We're understaffed. Most ERs are understaffed. Everyone wants to cut back. If I let you cut back your hours, everyone will want to, then we're even more short staffed, wait times go up and we lose our contract." But, yes, if you can find and keep a job that allows you to work 120 hours per month or less, your stressors will be reduced greatly. Just make sure you don't get into a situation where your first year or two out, you get used to a lifestyle that requires you to work 180. Or, like I recommend to people starting out in EM, do a fellowship. Even the ones you don't think you'd be interested in give you options down the road, other people won't have.

Not too long ago I ran into a few guys I had done residency with. One guy did a hyperbarics fellowship and now only works 2 general EM shifts a month. Another did a EM cardiovascular fellowship and works only 8 general EM shifts per month. Another went into EMS and cut his general EM shifts in half. Another did a Pain fellowship and works zero general EM shifts per month (that's me). If you think you'll be happy working EM full time until you're 60, and you bounce back easily after those post night shifts, then don't plan for any need for a mid career change. But if you doubt you will be, diversify your skills so you have other options. It doesn't mean you have to abandon EM. But it may mean you'll be able to maintain your income easier, without having to work a full-time general-EM schedule at (or above) your maximum capacity.

When I was going into EM, the older folks told me "EM burnout is a myth." It was a lie.

 

[bravotwozero]

I don't think specialties like ortho are being 'squeezed'. They generate millions for the hospital, and hospital admins will literally build a new ward for ortho docs. They also have a lot of influence on hospital committees. How many ortho docs you know got canned by a hospital? I'm happy with my specialty choice, but some fields are definitely more squeezed than others...

 

[Birdstrike]

I don't think specialties like ortho are being 'squeezed'. They generate millions for the hospital, and hospital admins will literally build a new ward for ortho docs. They also have a lot of influence on hospital committees. How many ortho docs you know got canned by a hospital? I'm happy with my specialty choice, but some fields are definitely more squeezed than others...

I agree. To say ortho, derm, psych, pathology "all have the same problems as EM" is overly simplistic. Yes, we're all getting 'squeezed" to some extent by "the system" but to say the problems EM and derm, EM and ortho, EM and plastic surgery face, whitewashed a lot that's going on. Some are more isolated (non-hospital based, ASC based) and others are squeezed much harder (pure hospital-based, 24 hour, EMTALA affected specialties).

 

[miacomet]

Reducing your workload mitigates it a lot. The problem I had was getting my employer to let me cut back my hours. The response was always, "We're understaffed. Most ERs are understaffed. Everyone wants to cut back. If I let you cut back your hours, everyone will want to, then we're even more short staffed, wait times go up and we lose our contract." But, yes, if you can find and keep a job that allows you to work 120 hours per month or less, your stressors will be reduced greatly. Just make sure you don't get into a situation where your first year or two out, you get used to a lifestyle that requires you to work 180. Or, like I recommend to people starting out in EM, do a fellowship. Even the ones you don't think you'd be interested in give you options down the road, other people won't have.

Not too long ago I ran into a few guys I had done residency with. One guy did a hyperbarics fellowship and now only works 2 general EM shifts a month. Another did a EM cardiovascular fellowship and works only 8 general EM shifts per month. Another went into EMS and cut his general EM shifts in half. Another did a Pain fellowship and works zero general EM shifts per month (that's me). If you think you'll be happy working EM full time until you're 60, and you bounce back easily after those post night shifts, then don't plan for any need for a mid career change. But if you doubt you will be, diversify your skills so you have other options. It doesn't mean you have to abandon EM. But it may mean you'll be able to maintain your income easier, without having to work a full-time general-EM schedule at (or above) your maximum capacity.

When I was going into EM, the older folks told me "EM burnout is a myth." It was a lie.

Cutting down doesn't really help. I mean, it's better, but it doesn't solve the issue, and nights, weekends, and holidays need to be covered. I should add that being forced to work more due to a labor shortage is the third cousin of slavery, and that's deeply concerning.

I work 100 hours a month. It's still nights, weekends, and holidays. It's a bit better, but it's still a toxic stew on a Saturday overnight.

I don't know if fellowship can get you out of the ER- I quit a truly toxic one a decade ago, closing forever the fellowship path for me. I would recommend combined residencies over fellowship. You might be surprised how appealing peds and IM are later.

Burnout is terrible in EM, and we are squeezed like no one else. Escape is not easy, no matter how much you save.

 

[AlvinKamara]

Cutting down doesn't really help. I mean, it's better, but it doesn't solve the issue, and nights, weekends, and holidays need to be covered. I should add that being forced to work more due to a labor shortage is the third cousin of slavery, and that's deeply concerning.

I work 100 hours a month. It's still nights, weekends, and holidays. It's a bit better, but it's still a toxic stew on a Saturday overnight.

I don't know if fellowship can get you out of the ER- I quit a truly toxic one a decade ago, closing forever the fellowship path for me. I would recommend combined residencies over fellowship. You might be surprised how appealing peds and IM are later.

Burnout is terrible in EM, and we are squeezed like no one else. Escape is not easy, no matter how much you save.

I don’t mean to undermine your points but I’ve read a lot of your posts and you seem to be burned out from working in general, as suggested by your exit from fellowship as well. Correct me if I’m wrong of course. While I empathize with your plight, I don’t know how applicable it is broadly. I hope it’s not going to be so bleak for me, as someone who just started training.

Regarding reduction of clinical shifts, 100 hours a month still seems like a lot of work. Why not cut more significantly to like 70-80 hours a month*? I always read while applying that part of the appeal of EM is that you can really control how much or how little you want to work. Is this a total myth or is it workplace dependent?

I understand the job market and the jobs in the NYC area are lower paying and harder to control. Do you practice in this area? Are things better elsewhere?

Again, don’t mean to undermine your experience, I’m just hoping it doesn’t apply to me because if it does, the future looks very very bleak.


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[Apollyon]

@AlvinKamara you got a typo in there - I think you want 70 to 80 hours per month, not week.

 

[AlvinKamara]

@AlvinKamara you got a typo in there - I think you want 70 to 80 hours per month, not week.

Lol Freudian slip that betrays how much I’m working on my current rotation. Yea, I meant per month.


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[miacomet]

I don’t mean to undermine your points but I’ve read a lot of your posts and you seem to be burned out from working in general, as suggested by your exit from fellowship as well. Correct me if I’m wrong of course. While I empathize with your plight, I don’t know how applicable it is broadly. I hope it’s not going to be so bleak for me, as someone who just started training.

Regarding reduction of clinical shifts, 100 hours a month still seems like a lot of work. Why not cut more significantly to like 70-80 hours a month*? I always read while applying that part of the appeal of EM is that you can really control how much or how little you want to work. Is this a total myth or is it workplace dependent?

I understand the job market and the jobs in the NYC area are lower paying and harder to control. Do you practice in this area? Are things better elsewhere?

Again, don’t mean to undermine your experience, I’m just hoping it doesn’t apply to me because if it does, the future looks very very bleak.


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You make a great point- maybe medicine wasn't for me. Fellowship was truly toxic (residency sucked, but toxic it was not- just a ton of work).

I'm not in NYC because the jobs seem really crazy, although some really like doing all the nursing I guess. NY EM docs, feel free to chime in.

I could cut down to 80 hours a month, but you lose FMLA eligibility at less than 1250 hours a year. I actually have a decent job as EM goes, but working in a high stress environment with little control is icky no matter what the perks are. And that's what EM is.

 

[emergentmd]

I don't think specialties like ortho are being 'squeezed'. They generate millions for the hospital, and hospital admins will literally build a new ward for ortho docs. They also have a lot of influence on hospital committees. How many ortho docs you know got canned by a hospital? I'm happy with my specialty choice, but some fields are definitely more squeezed than others...

Every specialists are being squeezed. Some more and some less. It all depends on supply and demand, how much $$ they bring in. But the Bottom line is everyone is being squeezed.

Look at Texas and take S&W. They are employing everyone including Ortho. Look at all of the new Ortho grads that are choosing to align with hospitals rather than joining a Private group. This rarely happened 10 yrs ago, now it is happening more often. Many ortho docs are choosing immediate gratification and less admin headaches rather than going out an opening their own/joining a practice with the possibility of more $$$ down the road.

Don't kid yourself. Everyone is being affected. As more Government mandates comes down the road and more squeezing from insurers, you will start to see more surgical specialists being employed.

 

[emergentmd]

I agree. To say ortho, derm, psych, pathology "all have the same problems as EM" is overly simplistic. Yes, we're all getting 'squeezed" to some extent by "the system" but to say the problems EM and derm, EM and ortho, EM and plastic surgery face, whitewashed a lot that's going on. Some are more isolated (non-hospital based, ASC based) and others are squeezed much harder (pure hospital-based, 24 hour, EMTALA affected specialties).

I didn't intend to say everyone has similar problems as EM. I rather have EM problems than hospitalist problems. I rather have EM problems than the majority of fields if you take it as a whole. Give me 300K/yr working 14 dys a month over being a PCP making 200K working 20 dys a month any day. But that is another discussion.

but everyone is getting squeezed and will continue to be squeezed. Radiology had very little hospital over site when I started 20 yrs ago. Ask any radiologist, sit on any hospital committee and you will see they have metrics just like any other hospital based field.

When you sit in the EM playing field, you see ALL of the EM issues while you look at other Specialty playing fields and only see the BIG issues everyone is complaining about.

I am good friends with an anesthesiologist and a general surgeon (private practice). They would switch with my schedule in a heartbeat. The General surgeon, two doctor practice, almost never takes vacation and when they do it is for one week. They still have to pay staff!!

They both would kill for my schedule where I can take a week or two off anytime and still pull in 3-400K/yr.

 

[bravotwozero]

I am in texas, and I am not seeing that with ortho docs in my area.

 

[Paperman]

EM (or any medical specialty or industry for that matter) cannot be painted in black and white brush strokes.

Too many factors at play.

I understand if someone wants to leave EM or medicine in general. But, I think that EM is still one of the better gigs in medicine overall, recognizing that again there is a wide spectrum within each specialty.

Easy to blame it on external factors instead of recognizing how much control we have internally over how we feel.

I like EM and its outlook moving forwards within medicine/healthcare.

0.02

TPM

 

[emergentmd]

I am in texas, and I am not seeing that with ortho docs in my area.

The old established docs don't have many issues b/c their practice is set. Look at the Big cities in Texas. Look at S&W.

Private ortho groups will and are being squeezed. It is difficult competing with the scale advantage of hospitals. Watch HCA start owning private groups. They already are with Cardiology. This will accelerate once insurance companies start to squeeze payments.

 

[AlvinKamara]

What advice do you sage seasoned veterans of the trade have for a trainee early on? What areas/practice formats should I try to strive towards?


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[miacomet]

What advice do you sage seasoned veterans of the trade have for a trainee early on? What areas/practice formats should I try to strive towards?


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Try and minimize debt. Try and reach financial independence early. Try and learn some business skills or get an MBA. Contribute to a 401k or even just a Roth while you are in training.

It's REALLY hard to see what the future hold in medicine, so pick what you enjoy. It's entirely possible that ortho becomes an employed specialty, venture capital eats up ophtho and derm, and that EM gets thrown to midlevels. We don't know. But with no debt, passive income streams, and maybe a business degree, you will be better positioned than most.

 

[Paperman]

What advice do you sage seasoned veterans of the trade have for a trainee early on? What areas/practice formats should I try to strive towards?

You're a resident, intern it seems, so relax. I had a good residency experience but being an attending has still been 100x better. At least.

Learn as much as you can. Have fun as much as you can. Try to keep things in perspective (difficult in residency but think about this for a while). Use this time to think about what kind of environments, cases, patients, situations, relationships bring you satisfaction and think about how you can tailor your practice moving forwards. Ignore what others think is cool, prestigious or desirable. Think only about your true interests. Do you really like knife-gun clubs with acuity levels where nurses are actively bagging hallway patients waiting to be seen left and right...or do you like the idea of telling others about this because obviously it means you're a huge stud, right? Do you really want to do academics? Do you really want to work in a tiny rural hospital? Vice-versa with literally every potential practice situation in-between....Bravado is rampant in residency....

There is a lot of "sky is falling" mentality on these boards, but that is because that is what sells. Just like the news.

There are GREAT EM jobs out there still. I know this factually.

TPM

 

[Birdstrike]

What advice do you sage seasoned veterans of the trade have for a trainee early on? What areas/practice formats should I try to strive towards?


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Do any of the fellowships that allow you to offload as large a portion of the circadian-abusive general-EM shift work as you need to over time, and replace it with non-toxic subspecialty work.

 

[miacomet]

Do any of the fellowships that allow you to offload as large a portion of the circadian-abusive general-EM shift work as you need to over time, and replace it with non-toxic subspecialty work.

Bird, I agree.

This means, AFAIK, Pain; Occ Med; Preventive Medicine; maybe Addiction Medicine. Not very many. It does not mean ultrasound or tox.

 

[namethatsmell]

Add me to the group who have lessened burnout significantly by cutting hours. That's the one-liner...here's the longer, boring version:

After residency I was averaging 140-180 work-related hrs a month (shifts, charting, work travel). At first it was great. I was seeing great pathology, making a great salary, blah blah blah. Slowly but surely, things changed. I went from being happy and active outside of work to generally pessimistic and too exhausted to do much between shifts. Then a series of events played out which made me take a hard look at my work-life balance. While these events were bad at the time, I'm now mostly thankful they occurred as they caused me to refocus my priorities.

I cut way down to 3-6 shifts/mo for awhile and slowly the burnout faded. I now work 6-10 shifts/mo split between various shops. I decide how much I work each month and what days I make myself available. Instead of looking for the highest paying shops I look for ones that are well-staffed but still pay fairly. I don't work anywhere where I'm required to work overnights. I don't work anywhere where department decision makers--ie those who can actually determine things like scheduling and staffing levels--aren't working clinically. I don't work anywhere where I'm required to sign midlevel charts on patients I don't see. My level of stress has gone down considerably and my overall quality of life is SO much better.

There are certainly downsides of this work setup, can be tough to arrange, and it isn't for everybody...but it's something to consider if you need to change things up.

 

[emergentmd]

My 5 yr goal by age 50 is to be financial independent. Independence to me means no debt and work just to pay for living expenses. Keep retirement growing until I am 65

 

[Birdstrike]

Add me to the group who have lessened burnout significantly by cutting hours. That's the one-liner...here's the longer, boring version:

After residency I was averaging 140-180 work-related hrs a month (shifts, charting, work travel). At first it was great. I was seeing great pathology, making a great salary, blah blah blah. Slowly but surely, things changed. I went from being happy and active outside of work to generally pessimistic and too exhausted to do much between shifts. Then a series of events played out which made me take a hard look at my work-life balance. While these events were bad at the time, I'm now mostly thankful they occurred as they caused me to refocus my priorities.

I cut way down to 3-6 shifts/mo for awhile and slowly the burnout faded. I now work 6-10 shifts/mo split between various shops. I decide how much I work each month and what days I make myself available. Instead of looking for the highest paying shops I look for ones that are well-staffed but still pay fairly. I don't work anywhere where I'm required to work overnights. I don't work anywhere where department decision makers--ie those who can actually determine things like scheduling and staffing levels--aren't working clinically. I don't work anywhere where I'm required to sign midlevel charts on patients I don't see. My level of stress has gone down considerably and my overall quality of life is SO much better.

There are certainly downsides of this work setup, can be tough to arrange, and it isn't for everybody...but it's something to consider if you need to change things up.

This is great

 

[EctopicFetus]

What you see on this thread is what makes various folks unhappy with EM. I am paraphrasing from peoples posts but for some it is the lack of a circadian rhythm, for others it is the toxic waste dump of being in an ED and for others it is the lack of control, yet others it is working more than they want be it for purely $$$ reasons or being short staffed at work.

All of these are true in all EM jobs but they can be mitigated and you can pick which you can best tolerate and work your hours.

I know I beat this drum but a good functional SDG can fix this. We have folks who work about 64 hours a month in their non vacation months. Similarly we have folks in the 150 range. It’s all a choice. We make good money and have some control over our department. You can have a nocturnist etc.

All of this has to do with picking a good or the right job.

The flip side as mentioned is minimizing debt, living frugally and not needing to work. Working less of course will minimize burnout because taken to the extreme it means NO WORK. Maybe it isnt 3-6 shifts a month but rather 10 super easy super slow shifts in a rural setting.

I do think lots of people go into EM without understanding what they are looking for or knowing what to expect. I’m a pgy-13 and I still truly enjoy work. I averaged over 160 hours a month at a very busy job previously. My new job is busier but I work right at 100 clinical hours a month. I am happier, I enjoy it and it earns me enough whereby I can enjoy my life.

Pick your poison and choose wisely knowing what is best for you and your family. I think people who work more than they want at their shop for a CMG are complete idiots unless you get a large amount of bonus. Remember it isnt your problem to staff the place.

Good sdgs are plumply staffed. Most CMGs are going by the seat of their pants and just letting poorly performing locums make good money regardless of work ethic.

 

[AlvinKamara]

What you see on this thread is what makes various folks unhappy with EM. I am paraphrasing from peoples posts but for some it is the lack of a circadian rhythm, for others it is the toxic waste dump of being in an ED and for others it is the lack of control, yet others it is working more than they want be it for purely $$$ reasons or being short staffed at work.

All of these are true in all EM jobs but they can be mitigated and you can pick which you can best tolerate and work your hours.

I know I beat this drum but a good functional SDG can fix this. We have folks who work about 64 hours a month in their non vacation months. Similarly we have folks in the 150 range. It’s all a choice. We make good money and have some control over our department. You can have a nocturnist etc.

All of this has to do with picking a good or the right job.

The flip side as mentioned is minimizing debt, living frugally and not needing to work. Working less of course will minimize burnout because taken to the extreme it means NO WORK. Maybe it isnt 3-6 shifts a month but rather 10 super easy super slow shifts in a rural setting.

I do think lots of people go into EM without understanding what they are looking for or knowing what to expect. I’m a pgy-13 and I still truly enjoy work. I averaged over 160 hours a month at a very busy job previously. My new job is busier but I work right at 100 clinical hours a month. I am happier, I enjoy it and it earns me enough whereby I can enjoy my life.

Pick your poison and choose wisely knowing what is best for you and your family. I think people who work more than they want at their shop for a CMG are complete idiots unless you get a large amount of bonus. Remember it isnt your problem to staff the place.

Good sdgs are plumply staffed. Most CMGs are going by the seat of their pants and just letting poorly performing locums make good money regardless of work ethic.

How hard is it to find a good SDG?


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[deuist]

[QUOTE="miacomet]I would recommend combined residencies over fellowship. You might be surprised how appealing peds and IM are later.
[/QUOTE]

Yuck. I can't imagine someone doing EM for several years and then deciding to do IM, either hospitalist or outpatient. The only point in doing a combined EM/IM residency is to do an IM fellowship that you take an interest in. That way, you work part time in the ED and the ID clinic or whichever other specialty you choose. I certainly can't imagine why someone would want EM/FM. Every few months someone posts a thread about working in a rural area. I guess being the only doc in town might be an acceptable use for the combined training. But on the whole, going through the dual residences seems like a waste.

I do like the idea of doing a fellowship immediately after residency: toxicology, critical care, pain, etc...

 

[deuist]

Try and minimize debt. Try and reach financial independence early. Try and learn some business skills or get an MBA

An MBA will increase debt for most people. Business schools already post their courses on Cousera and EdX for free.

 

[EctopicFetus]

How hard is it to find a good SDG?


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Very.

 

[EctopicFetus]

[QUOTE="miacomet]I would recommend combined residencies over fellowship. You might be surprised how appealing peds and IM are later.

Yuck. I can't imagine someone doing EM for several years and then deciding to do IM, either hospitalist or outpatient. The only point in doing a combined EM/IM residency is to do an IM fellowship that you take an interest in. That way, you work part time in the ED and the ID clinic or whichever other specialty you choose. I certainly can't imagine why someone would want EM/FM. Every few months someone posts a thread about working in a rural area. I guess being the only doc in town might be an acceptable use for the combined training. But on the whole, going through the dual residences seems like a waste.

I do like the idea of doing a fellowship immediately after residency: toxicology, critical care, pain, etc...[/QUOTE]
The funny thing is doing em/fm is it’s a few more years of training and then you make even less money at those rural ed sites. Financially it’s a loser. To me the em fellowships are something worth considering after working as an attending if you can’t tolerate emergency medicine. None of the fellowships other than maybe pain will pay better than straight em.

If you live frugally and pay off your debt for the first few years of being an attending going back to do a fellowship won’t feel as big of a financial hit as you are used to living on say 100k since the rest went to debt service and you haven’t been living on 250k and the difference can be made up moonlighting. The opportunity cost is high and frankly rarely considered by people in medicine. People are too often focused on what feels good or seems easier.

 

[Paperman]

To the medical students and trainees reading this thread:

This forum represents a very vocal <1% of all Emergency Medicine physicians. Myself included. Take what you see on this forum with plenty of salt. My advice included.

Doing a fellowship or combined residency because you believe the sky is falling instead of being passionate about this additional niche of medicine is foolish.

Our urgent care docs earn far more than many EM fellowships without additional training. No late nights or overnights either. Low risk, low stress.

TPM

 

[EctopicFetus]

To the medical students and trainees reading this thread:

This forum represents a very vocal <1% of all Emergency Medicine physicians. Myself included. Take what you see on this forum with plenty of salt. My advice included.

Doing a fellowship or combined residency because you believe the sky is falling instead of being passionate about this additional niche of medicine is foolish.

Our urgent care docs earn far more than many EM fellowships without additional training. No late nights or overnights either. Low risk, low stress.

TPM

I agree. But I think it is foolish to not listen to a number of folks on here who have experience. I for one am not burned out. I am passionate about not taking a trash job with a CMG. I am happy to discuss the merits of an SDG vs CMG forever. Yes there are bad SDGs. The difference is unless you do locums or PT all the CMG jobs are trash. (I know not a popular opinion on here).

 

[MechEDoc]

I agree. But I think it is foolish to not listen to a number of folks on here who have experience. I for one am not burned out. I am passionate about not taking a trash job with a CMG. I am happy to discuss the merits of an SDG vs CMG forever. Yes there are bad SDGs. The difference is unless you do locums or PT all the CMG jobs are trash. (I know not a popular opinion on here).

I agree that pretty much all the CMG jobs are trash. All of the liability with no responsibility. No transparency and getting jerked around severely.

 

[KGflyboy]

My new job is busier but I work right at 100 clinical hours a month. I am happier, I enjoy it and it earns me enough whereby I can enjoy my life.

Do you work many non-clinical hours? Most jobs don't offer benefits for 100 hrs per month. I just signed at a place that requires 130 hrs for full time. I did see a few places that offer benefits for part timers, but they have to pay more out of pocket.

 

[miacomet]

Do you work many non-clinical hours? Most jobs don't offer benefits for 100 hrs per month. I just signed at a place that requires 130 hrs for full time. I did see a few places that offer benefits for part timers, but they have to pay more out of pocket.

My job requires 127.5 a month for FT (sweet bennies including a pension) and, wait for it, 85 hours a month for part-time. Still get health insurance, but it costs $200 a month for an individual as opposed to $40 FT. 8 hours a month can be non clinical including meetings etc. If you take a 24 hour paid call (about $600 in extra pay), you accrue a few hours of benefitted time.

 

[EctopicFetus]

Do you work many non-clinical hours? Most jobs don't offer benefits for 100 hrs per month. I just signed at a place that requires 130 hrs for full time. I did see a few places that offer benefits for part timers, but they have to pay more out of pocket.

I’m a partner so its a little different. In the end its my own money paying for my benefits. It’s hard to quantify my non clinical hours. I cant imagine 130 hours being the minimum for benefits. Seems crazy. Most commonly I have seen 100-120.

 

[WilcoWorld]

What advice do you sage seasoned veterans of the trade have for a trainee early on? What areas/practice formats should I try to strive towards?


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Live within your means, this will give you the freedom to leave a job that you don't enjoy.
Don't buy a home until you've worked at a job for long enough to know that you like it & want to stay there.
Don't change your principles to accommodate your job - change your job to accommodate your principles, and if your job can not be changed, get a different one.

 

[namethatsmell]

Live within your means, this will give you the freedom to leave a job that you don't enjoy.
Don't buy a home until you've worked at a job for long enough to know that you like it & want to stay there.
Don't change your principles to accommodate your job - change your job to accommodate your principles, and if your job can not be changed, get a different one.

Quoted for truth.

I did the first thing on this list which made it possible to do the third thing on this list. Telling a group you think is unethical to shove it is incredibly liberating. Having some fu money saved up so you can walk away from any job at any time and still pay your bills offers a healthy sense of autonomy and makes me less burned out.

 

[RustedFox]

Quoted for truth.

I did the first thing on this list which made it possible to do the third thing on this list. Telling a group you think is unethical to shove it is incredibly liberating. Having some fu money saved up so you can walk away from any job at any time and still pay your bills offers a healthy sense of autonomy and makes me less burned out.

Yep.
I have three months of "GTFO" money.
Some say this is on the light side.
They're probably right.

 

[AlvinKamara]

I’m a first year resident 6m in and not quite enjoying it very much because I feel constant unsure and unconfident. Does this bode ill for my job satisfaction down the road?


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[RustedFox]

I’m a first year resident 6m in and not quite enjoying it very much because I feel constant unsure and unconfident. Does this bode ill for my job satisfaction down the road?


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No.
This is how you should feel.
Right now, you shouldn't be sure, or confident.
Once you get it right, and you feel sure and confident, your satisfaction will skyrocket.
Then, you rescue the princess and win the game.

 

[KGflyboy]

I’m a partner so its a little different. In the end its my own money paying for my benefits. It’s hard to quantify my non clinical hours. I cant imagine 130 hours being the minimum for benefits. Seems crazy. Most commonly I have seen 100-120.

100-120 would be nice... For someone who just finished a job search, I can say that 120 is the lowest I found. 100 is rare outside of people chipping in to pay a bigger chunk of the premium themselves.

 

[RNtoMD87]

I think I could do anything for 4 days a month 144k a year. I live perfectly comfortably on 75k a year, could I work 2 days a month and make roughly what I make now? Id love to almost never have to go to work. Spend all my time hunting, fishing, etc.

 

[zurned]

If you actually thought about the amount we get paid per shift, it's actually kind of ridiculous. Assuming you work one 12 hour shift at 250/hr, that's 3,000 dollars. 3 grand to show up to work for ONE DAY. There are really very few other jobs that would match that. Even if you started your own business, a net profit of 3000 per day would be hard to achieve initially (if ever).

I can see myself pursuing something else on the side for intellectual stimulation or out of boredom, but probably would want to keep working at least part-time to keep my skills up. "Money is a little tight? I'll just work 2 shifts. Want to do a family trip? I guess I'll pull 3 shifts". It's a gold mine.

If you're burned out, just take some time off or scale back on hours. Lots of hospitals are so desperate that you basically get to make your own schedule.

Just don't become too attached to any individual job itself. I think that leads to burnout more than anything. If the administration and the way things are run starts to wear on you, just take your valuable skill and leave for greener pastures. Even with a salaried full time job, keep that mindset. If they are unwilling to cater to the hours or schedule you like, there are probably other hospitals nearby that will.

 

[miacomet]

If you actually thought about the amount we get paid per shift, it's actually kind of ridiculous. Assuming you work one 12 hour shift at 250/hr, that's 3,000 dollars. 3 grand to show up to work for ONE DAY. There are really very few other jobs that would match that. Even if you started your own business, a net profit of 3000 per day would be hard to achieve initially (if ever).

I can see myself pursuing something else on the side for intellectual stimulation or out of boredom, but probably would want to keep working at least part-time to keep my skills up. "Money is a little tight? I'll just work 2 shifts. Want to do a family trip? I guess I'll pull 3 shifts". It's a gold mine.

If you're burned out, just take some time off or scale back on hours. Lots of hospitals are so desperate that you basically get to make your own schedule.

Just don't become too attached to any individual job itself. I think that leads to burnout more than anything. If the administration and the way things are run starts to wear on you, just take your valuable skill and leave for greener pastures. Even with a salaried full time job, keep that mindset. If they are unwilling to cater to the hours or schedule you like, there are probably other hospitals nearby that will.

With nurses in some parts of the country earning $100 for a day shift and time and a half after eight hours, with differentials for nights/weekends/holidays, I'm not seeing $250 an hour as a particularly great ROI for all our training, liability, and stress although admittedly some of those are sunk costs and not really worth considering at this point. $250 an hour is a great hourly for days and weekdays, but it becomes increasingly not worth it for nights/weekends/holidays.

 

[Brigade4Radiant]

With nurses in some parts of the country earning $100 for a day shift and time and a half after eight hours, with differentials for nights/weekends/holidays, I'm not seeing $250 an hour as a particularly great ROI for all our training, liability, and stress although admittedly some of those are sunk costs and not really worth considering at this point. $250 an hour is a great hourly for days and weekdays, but it becomes increasingly not worth it for nights/weekends/holidays.

But even then you avg 36 hours a week if you had normal hours you would still work some weekends and 60+ hours if you converted to corporate.

You can get higher rate if you work prn in some hospitals. Also if you work full time it’s not like you work all holidays. To be honest it’s a great ROI other places in the nation have higher taxes. Also with 14 shifts a month and practically gauranted income and being able to work in any state and any hospital with an opening all it takes is time. There is just not many fields that come close to half the ROI.

Just do a FM office with low liability and no weekends or nights but then again if you are tight on money it’s difficult to raise your pay in EM it’s pretty easy just to work more shifts.

Even in Ortho you don’t have the job flexibility and the work more means more pay. EM isn’t rainbows and butterflies but as a job it’s a very good one.

 

[gro2001]

When I see some of these downer thoughts on SDN I can't help but think what kind of awesome lives these folks must have led prior to/outside of medicine to ever describe EM as anything but amazing. We get to work indoors, get paid hundreds of dollars an hour, doing cool things (literally saving lives). Many real world problems, like uneployment/underemployment, are essentially non existent to us. People here are describing jobs as not tolerable that pay $180 an hour because they may occasionally require you to do (heaven forbid) nursing duties. I am not saying everyone should take those jobs. I am saying that my dad installs billboards for a tiny fraction of the amount I am paid, and I can only imagine the look on his face if he saw some of these complaints.

 

[Psai]

When I see some of these downer thoughts on SDN I can't help but think what kind of awesome lives these folks must have led prior to/outside of medicine to ever describe EM as anything but amazing. We get to work indoors, get paid hundreds of dollars an hour, doing cool things (literally saving lives). Many real world problems, like uneployment/underemployment, are essentially non existent to us. People here are describing jobs as not tolerable that pay $180 an hour because they may occasionally require you to do (heaven forbid) nursing duties. I am not saying everyone should take those jobs. I am saying that my dad installs billboards for a tiny fraction of the amount I am paid, and I can only imagine the look on his face if he saw some of these complaints.

Maybe he should go to medical school

 

[EctopicFetus]

For those pitching the MBA route think long and hard what you hope to accomplish by doing this. Consider the debt you will take on and the opportunity cost. What will you do with an MBA? I think too many docs believe more education is the key to happiness as we have been conditioned to this.

I do a lot of business for my group. No MBA, I did learn a ton about running an EM practice. I have considered an MBA but I cant answer the question of what my ROI will be and what I hope to accomplish that taking some cheap classes at a local university or community college wouldn’t. I went to a solid undergrad with a top 5 undergrad business and MBA school. I have over 10 of my friends with MBAs from Harvard, Wharton, NYU, Michigan, NW, Chicago etc.

All tell me the biggest thing they got from MBA school was “networking”. Having an MD and a few $$ can open up many opportunities and as I have no plans of leaving clinical medicine its hard for me to justify the debt/opportunity cost.

It not hard to make 400k in EM but it is hard to get that fresh out of MBA school. The upside of MBA school may be higher but not until you work 80-100 hours a week, travel, work weekends etc.

It’s some medical fantasy that everyone else works less hard and makes more. Thats the exception and not the rule in business.

 

[EctopicFetus]

Reality is if you want to get out the more typical ways will work, start a side business (I have one) though this will take a lot of time and effort and training. The beauty is you can pick and choose.

I know guys doing laser hair removal, farming, urgent cares, and real estate. We all make enough where we can invest some startup capital and make money, we are all smart enough to read books and understand them. It can all be done. You will get a better ROI on this than getting an MBA or doing another residency. Can’t comment on fellowship as the spread is too wide.

My goal from day 1 was financial freedom by age 50, I should be there even earlier.