EM Match 2025

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RustedFox said:
Over 9000.
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WhatJobDoIPick said:
@RustedFox Did you throw your controller through the wall?

Omg speaking of metroidvanias, I recently played Ori and the Will of the Wisps. Amazing.
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I'm not big into Ori, but that's precisely the genre that will have me seated and playing for hours.

Nah. The very specific reasons (unique to me) are:

1. As soon as you put the camera above and behind the player character and make it THAT third person view, I'm out.

2. Do that, AND make me control the camera separately?? I'm double out. Too much of a task.

3. Don't give me an "open world". Keep it simple and direct.

It's gotta feel like a game. With a set of play rules. I need boundaries.
 
RustedFox said:
I'm not big into Ori, but that's precisely the genre that will have me seated and playing for hours.

Nah. The very specific reasons (unique to me) are:

1. As soon as you put the camera above and behind the player character and make it THAT third person view, I'm out.

2. Do that, AND make me control the camera separately?? I'm double out. Too much of a task.

3. Don't give me an "open world". Keep it simple and direct.

It's gotta feel like a game. With a set of play rules. I need boundaries.
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I hear that. It's definitely TOO open at times. I like tighter narratives.
 
Time will tell if mediocre students really are a detriment to the specialty. If they can pass their boards, they deserve a seat at the table. Pass rate was what, 80%? If it drops further then yes, spots should remain unfilled. It’s just laughable that academic programs which were once elite MD only powerhouses are now filling with virtually anyone with a pulse. Look at Yale EM’s resident backgrounds as they go from Ivy League med school grads to DO and IMG over the years. This is absolutely not a knock on DOs or even IMGs, just telling of the “enthusiasm” med students have for that mighty program these days.
 
TooMuchResearch said:
I just want to double my income without doubling my hours worked but haven't stumbled on the free money opportunity I guess haha.
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It involves work and risk. I try to find opportunities where I have to put in work up front and then let it cruise afterwards. Real estate can be this way.. The returns arent quite as good but it is doable to get 10%+ returns. I only invest in real estate that gets me 10% cash on cash returns and the appreciation is gravy.
 
I have been on this forum for over 20 years and these thread seem to be the same but a different year. It also seems to be some of the same who continue to complain about EM but do nothing about it.

I teach my kids how to handle problems. If you have a problem, you have 2 choices in life.
#1 - If you can do something about it, then fix it
#2 - If you can't, then stop complaining and move on.

Continuing to complain and not doing anything about it, serves very little purpose. Continuing to complain when you can't do anything about it, just makes you miserable. Sometimes if you can't do something about the problem, it is best to look for the silver lining and move on.

I worked in the Pit for 15+ years and heard the same complaints. I Just found all of the silver linings of EM and continued to look forward to going to work. Once our SDG was taken over by a CMG, I saw the writing on the wall. Shifted to #1 and did something about it.

Now I pivoted to managing medical facilities. Added on managing my real estate properties. Added on working in finance. I have many more businesses that I could start tomorrow but have found peace working 3-4 dys/month and being essentially retired.

I told everyone this 10+ years ago on similar threads. If you were complaining 10 yrs ago and continue to be in the same spot, then it was a choice to not choose #1. Sucks, but #1 requires some risks but as an EM doc, you have the time/money that should make the risk tolerance minimal.
 
emergentmd said:
I have been on this forum for over 20 years and these thread seem to be the same but a different year. It also seems to be some of the same who continue to complain about EM but do nothing about it.

I teach my kids how to handle problems. If you have a problem, you have 2 choices in life.
#1 - If you can do something about it, then fix it
#2 - If you can't, then stop complaining and move on.

Continuing to complain and not doing anything about it, serves very little purpose. Continuing to complain when you can't do anything about it, just makes you miserable. Sometimes if you can't do something about the problem, it is best to look for the silver lining and move on.

I worked in the Pit for 15+ years and heard the same complaints. I Just found all of the silver linings of EM and continued to look forward to going to work. Once our SDG was taken over by a CMG, I saw the writing on the wall. Shifted to #1 and did something about it.

Now I pivoted to managing medical facilities. Added on managing my real estate properties. Added on working in finance. I have many more businesses that I could start tomorrow but have found peace working 3-4 dys/month and being essentially retired.

I told everyone this 10+ years ago on similar threads. If you were complaining 10 yrs ago and continue to be in the same spot, then it was a choice to not choose #1. Sucks, but #1 requires some risks but as an EM doc, you have the time/money that should make the risk tolerance minimal.
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Agree. What I have seen people do is cut working back a little (or some people work the same), spend their free time on their new idea, I have also seen people work more to fund the effort of these new ventures if early on in career and savings are small.

This way if your attempt doesnt succeed you just go back to EM. Interestingly, other than real estate I havent seen anyone fail and go back to FT EM. Literally every single person I know found a way.

The one guy I am thinking about in real estate bought some properties that were at the top of the market and I told this person not to buy as the “numbers” didnt jive. fast forward a few years and it isnt going well for them.

Of the people I know who I can assure you are not special or particularly geniuses at business have all found their way. I think the physician mindset of minimal risks comes into play. Docs are not big risk takers for the most part. Even in EM who is viewed as cowboys in medicine are really not big risk takers IMO. Ct this, admit that.. all of that is risk mitigation.

I think perhaps the issue is that people want to find something that is of particular interest and to do a deep dive in the topic. As mentioned real estate takes some education, it’s not sexy. I also said if it were me and I was younger and wanted out I would look into the Rx and management f weight loss. No shortage of options, can make money on the meds as well as your time and labs and perhaps most importantly, new meds will continue to come out.

Create a full “program” for people a diet, workout routine that is customized for your patients. Hard to imagine you couldnt do this and charge 500-1k a month. Not hard to find 30-50 patients. Then you can upsell testosterone, vitamin D and all the other lifestyle stuff people are craving. Do half your work online via zoom How many hours do you think you need to work to manage 50 patients a month? I would suggest it is under 60 hours a month including labs and everything else.

That after expenses would get you to 600k a year in revenue (on the low end) and expenses would be under 200k for sure. Startup costs would be 10k or less. It’s about your time and desire to dive deep into the topic.

This is one specific item i have thought about but isnt for me. Again, Urgent cares are an option, home health is an option, running IV therapy clinics is an option. There is truly no shortage of options for people.

Again, options exist for everyone.
 
EctopicFetus said:
Agree. What I have seen people do is cut working back a little (or some people work the same), spend their free time on their new idea, I have also seen people work more to fund the effort of these new ventures if early on in career and savings are small.

This way if your attempt doesnt succeed you just go back to EM. Interestingly, other than real estate I havent seen anyone fail and go back to FT EM. Literally every single person I know found a way.

The one guy I am thinking about in real estate bought some properties that were at the top of the market and I told this person not to buy as the “numbers” didnt jive. fast forward a few years and it isnt going well for them.

Of the people I know who I can assure you are not special or particularly geniuses at business have all found their way. I think the physician mindset of minimal risks comes into play. Docs are not big risk takers for the most part. Even in EM who is viewed as cowboys in medicine are really not big risk takers IMO. Ct this, admit that.. all of that is risk mitigation.

I think perhaps the issue is that people want to find something that is of particular interest and to do a deep dive in the topic. As mentioned real estate takes some education, it’s not sexy. I also said if it were me and I was younger and wanted out I would look into the Rx and management f weight loss. No shortage of options, can make money on the meds as well as your time and labs and perhaps most importantly, new meds will continue to come out.

Create a full “program” for people a diet, workout routine that is customized for your patients. Hard to imagine you couldnt do this and charge 500-1k a month. Not hard to find 30-50 patients. Then you can upsell testosterone, vitamin D and all the other lifestyle stuff people are craving. Do half your work online via zoom How many hours do you think you need to work to manage 50 patients a month? I would suggest it is under 60 hours a month including labs and everything else.

That after expenses would get you to 600k a year in revenue (on the low end) and expenses would be under 200k for sure. Startup costs would be 10k or less. It’s about your time and desire to dive deep into the topic.

This is one specific item i have thought about but isnt for me. Again, Urgent cares are an option, home health is an option, running IV therapy clinics is an option. There is truly no shortage of options for people.

Again, options exist for everyone.
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You and @emergentmd are 100% correct and your "tough love" has inspired me to start the push to get a business idea I've been mulling around in my head going.

I do agree with @RustedFox that we can both look for other opportunities and complain lol. It is cathartic.
 
EctopicFetus said:
Agree. What I have seen people do is cut working back a little (or some people work the same), spend their free time on their new idea, I have also seen people work more to fund the effort of these new ventures if early on in career and savings are small.

This way if your attempt doesnt succeed you just go back to EM. Interestingly, other than real estate I havent seen anyone fail and go back to FT EM. Literally every single person I know found a way.

The one guy I am thinking about in real estate bought some properties that were at the top of the market and I told this person not to buy as the “numbers” didnt jive. fast forward a few years and it isnt going well for them.

Of the people I know who I can assure you are not special or particularly geniuses at business have all found their way. I think the physician mindset of minimal risks comes into play. Docs are not big risk takers for the most part. Even in EM who is viewed as cowboys in medicine are really not big risk takers IMO. Ct this, admit that.. all of that is risk mitigation.

I think perhaps the issue is that people want to find something that is of particular interest and to do a deep dive in the topic. As mentioned real estate takes some education, it’s not sexy. I also said if it were me and I was younger and wanted out I would look into the Rx and management f weight loss. No shortage of options, can make money on the meds as well as your time and labs and perhaps most importantly, new meds will continue to come out.

Create a full “program” for people a diet, workout routine that is customized for your patients. Hard to imagine you couldnt do this and charge 500-1k a month. Not hard to find 30-50 patients. Then you can upsell testosterone, vitamin D and all the other lifestyle stuff people are craving. Do half your work online via zoom How many hours do you think you need to work to manage 50 patients a month? I would suggest it is under 60 hours a month including labs and everything else.

That after expenses would get you to 600k a year in revenue (on the low end) and expenses would be under 200k for sure. Startup costs would be 10k or less. It’s about your time and desire to dive deep into the topic.

This is one specific item i have thought about but isnt for me. Again, Urgent cares are an option, home health is an option, running IV therapy clinics is an option. There is truly no shortage of options for people.

Again, options exist for everyone.
Click to expand...
I actually started a deep dive into a health and lifestyle type clinic offering mostly virtual visits, even registered the LLC, bought domains, etc.

I just couldn't figure out what to do after that. All the "practice startup" things I found online are people who broke out of traditional medicine by...selling courses. Hard to find good information.
 
WhatJobDoIPick said:
You and @emergentmd are 100% correct and your "tough love" has inspired me to start the push to get a business idea I've been mulling around in my head going.

I do agree with @RustedFox that we can both look for other opportunities and complain lol. It is cathartic.
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We complain because it never used to be this way. It shouldn't be this way now. And it will be this way in the years to come if everyone is quiet about it.
 
TooMuchResearch said:
I actually started a deep dive into a health and lifestyle type clinic offering mostly virtual visits, even registered the LLC, bought domains, etc.

I just couldn't figure out what to do after that. All the "practice startup" things I found online are people who broke out of traditional medicine by...selling courses. Hard to find good information.
Click to expand...

I know someone who literally graduated from psych residency, said F you to the academic faculty who screwed him over and started an all cash concierge psych practice.

Lots and lots of word of mouth, on the ground networking and self advertising, but now he has more business than he can service.

I think the nuts and bolts of setting up a cheap EMR, lab portal, prescribing platform, malpractice are relatively simple.

The hard part is getting the patient panel.

I agree with the above sentiment that we have tons of spare time as ER docs to dedicate to launch something like this.
 
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RustedFox said:
We complain because it never used to be this way. It shouldn't be this way now. And it will be this way in the years to come if everyone is quiet about it.
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Complaining can be cathartic for many so go ahead if it makes you feel better. But if docs continue to complain, and do nothing about it, then they are setting themselves up to be miserable when it doesn't have to be.

A Janitor making 50K a year have little time or money to pivot. If they risk 100K and fail, that is a 2 year mistake. They have a giant hole with small shovel.
A Em doc making 500K/yr have a lot of time and money to pivot. If they risk 100K and fail, that is a 2.5 month mistake. We have a small hole with a giant shovel.

I have ideas of a business that is high margin, low startup that you could build up in 5 years and prob sell for 5 million if you get revenue up to 1-2mil/year. I am in retirement mode but if I get bored, I will definitely look into it.
 
USCDiver said:
They've done a good job keeping the list under wraps. It's usually leaked by now. I guess because it wasn't as egregious as last couple years it's less exciting.
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It was posted almost immediately on the Reddit spreadsheet.
 
doggydog said:
It was posted almost immediately on the Reddit spreadsheet.
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I don’t know where the Reddit spreadsheet is. I’m way too old to be browsing the med student subreddits, Can you link to it?
 
emergentmd said:
I teach my kids how to handle problems. If you have a problem, you have 2 choices in life.
#1 - If you can do something about it, then fix it
#2 - If you can't, then stop complaining and move on.

Continuing to complain and not doing anything about it, serves very little purpose. Continuing to complain when you can't do anything about it, just makes you miserable. Sometimes if you can't do something about the problem, it is best to look for the silver lining and move on.
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Pointing out problems is often a valid third option, though, both for internal and external issues.

I see all the negativity on this forum as providing a valuable service to two groups of people: 1) people unhappy in EM with no one to talk to about it and 2) students considering EM who are often shielded from the negatives of the field. If everyone who was ever unhappy with the field just quietly quit without talking about it, the first group would think they're the odd one out and the second would go in thinking it's all rainbows and butterflies. You just have to keep in mind this is a (relatively) small group that is not necessarily reflective of the entire EM experience.

emergentmd said:
It also seems to be some of the same who continue to complain about EM but do nothing about it.
...
I told everyone this 10+ years ago on similar threads. If you were complaining 10 yrs ago and continue to be in the same spot, then it was a choice to not choose #1. Sucks, but #1 requires some risks but as an EM doc, you have the time/money that should make the risk tolerance minimal.
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I get what you're saying, but I think some people are unhappy yet simply not burned out enough (yet) to make the jump.
 
hopefulgasman said:
Pass rate was what, 80%? If it drops further then yes, spots should remain unfilled.
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The simple ask: publish 5-year rolling average pass rate by program

Whether it's applicant-related or training-program related, the fastest way to kill bad programs will be to name and shame ones who can't get their trainees over the bar

Which means it'll never happen
 
WhatJobDoIPick said:
I know someone who literally graduated from psych residency, said F you to the academic faculty who screwed him over and started an all cash concierge psych practice.

Lots and lots of word of mouth, on the ground networking and self advertising, but now he has more business than he can service.

I think the nuts and bolts of setting up a cheap EMR, lab portal, prescribing platform, malpractice are relatively simple.

The hard part is getting the patient panel.

I agree with the above sentiment that we have tons of spare time as ER docs to dedicate to launch something like this.
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Hmm. I know someone that has done the setup process for urgent care. Maybe they'll help me out for a fee though I wouldn't need as big of a setup as they did.

I am a bit hesitant as to how my partners would react to me starting a practice outside of EM that contains a dash of snake oil though. Not that most of what we do isn't snake oil anyway.
 
WhatJobDoIPick said:
You and @emergentmd are 100% correct and your "tough love" has inspired me to start the push to get a business idea I've been mulling around in my head going.

I do agree with @RustedFox that we can both look for other opportunities and complain lol. It is cathartic.
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I mean i love to whine as well but congrats to you.. I have done a few things outside of EM for money.. i have another idea I am working on but keeping it under very tight wraps.
 
TooMuchResearch said:
I actually started a deep dive into a health and lifestyle type clinic offering mostly virtual visits, even registered the LLC, bought domains, etc.

I just couldn't figure out what to do after that. All the "practice startup" things I found online are people who broke out of traditional medicine by...selling courses. Hard to find good information.
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Figure out your niche.. Men’s health? Low T clinic? Functional medicine? Weight loss? I would find someone else ideally in another part of the country that is doing it.. Poeple have to advertise on their websites. You can get a ton of info. If you arent a competitor (different geographic area) I would reach out to them. I have found that people are super helpful if you arent viewed as direct competition. I would avoid the snake oil salesman.

But there are docs doing DPC.. etc.. talk to them.. ask them the detailed questions. 90% will tell you literally everything including the pitfalls.
 
TooMuchResearch said:
Hmm. I know someone that has done the setup process for urgent care. Maybe they'll help me out for a fee though I wouldn't need as big of a setup as they did.

I am a bit hesitant as to how my partners would react to me starting a practice outside of EM that contains a dash of snake oil though. Not that most of what we do isn't snake oil anyway.
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I think most people dont care.. one of my old partners started an early version of teledoc. He actually sold his company to teledoc and worked for them for a while. I was offered the chance to invest. The idea seemed stupid to me then and what he was doing was dumb. The opportunity cost led the investors to at best break even.. at worst they lost some money. I always commended the guy for risking it and leveraging what he had going for him to make it happen. Even though he sold he didnt make much.
 
Just looked at my alma mater's match list

So many EM matches in so many places that can't possibly have a residency program. Places that I know that absolutely can NOT have adequate pathology or entire categories of things like trauma, peds, etc.

This "$pecialty" now belongs to corporations .
 
My bad, I didn't read all the way through this thread and someone beat me to the meme I sent
 
EctopicFetus said:
Agree. What I have seen people do is cut working back a little (or some people work the same), spend their free time on their new idea, I have also seen people work more to fund the effort of these new ventures if early on in career and savings are small.

This way if your attempt doesnt succeed you just go back to EM. Interestingly, other than real estate I havent seen anyone fail and go back to FT EM. Literally every single person I know found a way.

The one guy I am thinking about in real estate bought some properties that were at the top of the market and I told this person not to buy as the “numbers” didnt jive. fast forward a few years and it isnt going well for them.

Of the people I know who I can assure you are not special or particularly geniuses at business have all found their way. I think the physician mindset of minimal risks comes into play. Docs are not big risk takers for the most part. Even in EM who is viewed as cowboys in medicine are really not big risk takers IMO. Ct this, admit that.. all of that is risk mitigation.

I think perhaps the issue is that people want to find something that is of particular interest and to do a deep dive in the topic. As mentioned real estate takes some education, it’s not sexy. I also said if it were me and I was younger and wanted out I would look into the Rx and management f weight loss. No shortage of options, can make money on the meds as well as your time and labs and perhaps most importantly, new meds will continue to come out.

Create a full “program” for people a diet, workout routine that is customized for your patients. Hard to imagine you couldnt do this and charge 500-1k a month. Not hard to find 30-50 patients. Then you can upsell testosterone, vitamin D and all the other lifestyle stuff people are craving. Do half your work online via zoom How many hours do you think you need to work to manage 50 patients a month? I would suggest it is under 60 hours a month including labs and everything else.

That after expenses would get you to 600k a year in revenue (on the low end) and expenses would be under 200k for sure. Startup costs would be 10k or less. It’s about your time and desire to dive deep into the topic.

This is one specific item i have thought about but isnt for me. Again, Urgent cares are an option, home health is an option, running IV therapy clinics is an option. There is truly no shortage of options for people.

Again, options exist for everyone.
Click to expand...

FYI I tried doing something exactly like this when I left EM last year (lifestyle-type concierge practice - was hoping to advise on fairly basic stuff like this and help manage easy chronic conditions etc) and I did not in anticipate how difficult it would be.

The competition for this kind of practice is EXTREMELY fierce in my VHCOL area. The entire thing is a marketing game, and it takes you down so many rabbit holes of how to create funnels, leads, and all sorts of other marketing jargon that you realize it's no longer a game of medicine, but purely a game of optics and sentiment. And being able to provide enough value to maintain subscription services is WAY more difficult than you realize. People don't want to pay for medical care, the ethos is so baked into our culture.

What was surprising to me, though, was how easy it was to get medmal via shopping through insurance brokers, and what was remarkable was that there are already piecemeal EMR services out there that allow you to pay per patient per month (or year, depending on what you want).

The possibilities to create a niche practice are effectively endless. Still, you subject yourself to something with pretty much ZERO moat and something that PAs, NPs, and other much larger corporate organizations have already started and scaled, and are way more efficient than you.

Ultimately I decided it was a ~$20k experiment/tuition in a lesson that starting a niche outpatient concierge clinical business isn't easy at all. I am extremely thankful I didn't go harder into it (e.g. putting down money for an actual brick-and-mortar operation).

I went back to subsisting on real-estate income and selling covered calls on my stock positions, which is a much much much easier and chiller life.
 
HemorrhagicShock said:
FYI I tried doing something exactly like this when I left EM last year (lifestyle-type concierge practice - was hoping to advise on fairly basic stuff like this and help manage easy chronic conditions etc) and I did not in anticipate how difficult it would be.

The competition for this kind of practice is EXTREMELY fierce in my VHCOL area. The entire thing is a marketing game, and it takes you down so many rabbit holes of how to create funnels, leads, and all sorts of other marketing jargon that you realize it's no longer a game of medicine, but purely a game of optics and sentiment. And being able to provide enough value to maintain subscription services is WAY more difficult than you realize. People don't want to pay for medical care, the ethos is so baked into our culture.

What was surprising to me, though, was how easy it was to get medmal via shopping through insurance brokers, and what was remarkable was that there are already piecemeal EMR services out there that allow you to pay per patient per month (or year, depending on what you want).

The possibilities to create a niche practice are effectively endless. Still, you subject yourself to something with pretty much ZERO moat and something that PAs, NPs, and other much larger corporate organizations have already started and scaled, and are way more efficient than you.

Ultimately I decided it was a ~$20k experiment/tuition in a lesson that starting a niche outpatient concierge clinical business isn't easy at all. I am extremely thankful I didn't go harder into it (e.g. putting down money for an actual brick-and-mortar operation).

I went back to subsisting on real-estate income and selling covered calls on my stock positions, which is a much much much easier and chiller life.
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IMO this practice is a mix of selling your soul for money and marketing as you noted. Why do patients like PAs.. hint.. it’s not cause they are smart. If you want to have a concierge type cash practice I would advise that you have to acquiesce to the clientele. The closest thing to this that comes to the top of my head is cosmetic Plastics. I am familiar with the DPC / concierge practice as I helped a friend deep into this world. He ended up finding some incredibly odd niches. Find a business with little to no insured employees and often times the owner of the business will pay a subscription for what is effectively basic medical care for the employees as it makes the employees less likely to leave said employer. It wont make. You rich but it will get you some constant steady income from which you can hustle and make a real business. It isnt easy.. i never promised that.. But you can make 3-400k if you hustle and have some connections. There is 0 moat.. you offer nothing special that the next ED doc cant do as well. It’s about your marketing.
 
I am working on an idea.. huge moat.. it may work it might not.. big moats require big complex ideas or unique relationships or some other very unique thing about your business (huge start up costs etc). Not a lot of big moats out there. If you can find one and scale properly you can have a near monopoly.
 
HemorrhagicShock said:
FYI I tried doing something exactly like this when I left EM last year (lifestyle-type concierge practice - was hoping to advise on fairly basic stuff like this and help manage easy chronic conditions etc) and I did not in anticipate how difficult it would be.

The competition for this kind of practice is EXTREMELY fierce in my VHCOL area. The entire thing is a marketing game, and it takes you down so many rabbit holes of how to create funnels, leads, and all sorts of other marketing jargon that you realize it's no longer a game of medicine, but purely a game of optics and sentiment. And being able to provide enough value to maintain subscription services is WAY more difficult than you realize. People don't want to pay for medical care, the ethos is so baked into our culture.

What was surprising to me, though, was how easy it was to get medmal via shopping through insurance brokers, and what was remarkable was that there are already piecemeal EMR services out there that allow you to pay per patient per month (or year, depending on what you want).

The possibilities to create a niche practice are effectively endless. Still, you subject yourself to something with pretty much ZERO moat and something that PAs, NPs, and other much larger corporate organizations have already started and scaled, and are way more efficient than you.

Ultimately I decided it was a ~$20k experiment/tuition in a lesson that starting a niche outpatient concierge clinical business isn't easy at all. I am extremely thankful I didn't go harder into it (e.g. putting down money for an actual brick-and-mortar operation).

I went back to subsisting on real-estate income and selling covered calls on my stock positions, which is a much much much easier and chiller life.
Click to expand...

People don't want to pay for traditional healthcare. They are very happy to pay for quackery like chlorophyll tablets from naturopaths however. Furthermore, they feel entitled to your labor to provide it, for free. They all want their specific silo funded (Medicaid, medicare, military benefits, private) but think the funding of any other silo is "socialist." Furthermore, the expect to walk into an ER at midnight with a cough and not pay a convenience fee of 1k or more. All shocked Pikachu if they wait 2 hours or more. They are maximum resource extractors, with minimum reciprocal contribution. Main character syndrome to the extreme.

Then the hospitals and groups say to see all these losers quickly and perfectly, but btw there's no plain film reads at peak volume times, all the patients will be in the hallway, and you'll have close to zero consultant support.

I'm on track to save about 100k to retirement and another 15 to 30k to extra mortgage principal this year. I think this is my quickest way to coast fire and freedom. After which I can do a few weekday shifts a month in some ER or telehealth or something to cover expenses. Maybe real estate if the opportunity presents. But I have no intention to do a lifetime of high intensity evening and weekend and holiday swing shifts for close to no thanks.
 
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HemorrhagicShock said:
FYI I tried doing something exactly like this when I left EM last year (lifestyle-type concierge practice - was hoping to advise on fairly basic stuff like this and help manage easy chronic conditions etc) and I did not in anticipate how difficult it would be.

The competition for this kind of practice is EXTREMELY fierce in my VHCOL area. The entire thing is a marketing game, and it takes you down so many rabbit holes of how to create funnels, leads, and all sorts of other marketing jargon that you realize it's no longer a game of medicine, but purely a game of optics and sentiment. And being able to provide enough value to maintain subscription services is WAY more difficult than you realize. People don't want to pay for medical care, the ethos is so baked into our culture.

What was surprising to me, though, was how easy it was to get medmal via shopping through insurance brokers, and what was remarkable was that there are already piecemeal EMR services out there that allow you to pay per patient per month (or year, depending on what you want).

The possibilities to create a niche practice are effectively endless. Still, you subject yourself to something with pretty much ZERO moat and something that PAs, NPs, and other much larger corporate organizations have already started and scaled, and are way more efficient than you.

Ultimately I decided it was a ~$20k experiment/tuition in a lesson that starting a niche outpatient concierge clinical business isn't easy at all. I am extremely thankful I didn't go harder into it (e.g. putting down money for an actual brick-and-mortar operation).

I went back to subsisting on real-estate income and selling covered calls on my stock positions, which is a much much much easier and chiller life.
Click to expand...
Lol ya way easier said than done. When I look at LA/SoCal, how do physicians even compete against companies like this? I looked at their careers page and it doesn't even seem like they hire MD/DO's. Just midlevels.

www.next-health.com

Next Health | Longevity, Health Optimization & Wellness Center

Next Health offers personalized wellness plans including NAD+ & IV therapy, hormone treatments, regenerative aesthetics and more. Elevate your health today!
www.next-health.com www.next-health.com

"Plasma exchange, executive physical, hormone optimization, EBOO therapy, ozone therapy, NAD+, labs, IV therapy, Functional Med, advanced medical services, weight optimization, vitamin shops, peptide therapy, wellness technology, next beauty aesthetics"

West Hollywood, Century City, Studio City, Woodland Hills, Newport Beach, Montecito
 
sloh said:
Lol ya way easier said than done. When I look at LA/SoCal, how do physicians even compete against companies like this? I looked at their careers page and it doesn't even seem like they hire MD/DO's. Just midlevels.

www.next-health.com

Next Health | Longevity, Health Optimization & Wellness Center

Next Health offers personalized wellness plans including NAD+ & IV therapy, hormone treatments, regenerative aesthetics and more. Elevate your health today!
www.next-health.com www.next-health.com

"Plasma exchange, executive physical, hormone optimization, EBOO therapy, ozone therapy, NAD+, labs, IV therapy, Functional Med, advanced medical services, weight optimization, vitamin shops, peptide therapy, wellness technology, next beauty aesthetics"

West Hollywood, Century City, Studio City, Woodland Hills, Newport Beach, Montecito
Click to expand...
I fundamentally don’t understand how medically unindicated commercial transfusion of blood products (in this case albumin) is legal.
 
sloh said:
Lol ya way easier said than done. When I look at LA/SoCal, how do physicians even compete against companies like this? I looked at their careers page and it doesn't even seem like they hire MD/DO's. Just midlevels.

www.next-health.com

Next Health | Longevity, Health Optimization & Wellness Center

Next Health offers personalized wellness plans including NAD+ & IV therapy, hormone treatments, regenerative aesthetics and more. Elevate your health today!
www.next-health.com www.next-health.com

"Plasma exchange, executive physical, hormone optimization, EBOO therapy, ozone therapy, NAD+, labs, IV therapy, Functional Med, advanced medical services, weight optimization, vitamin shops, peptide therapy, wellness technology, next beauty aesthetics"

West Hollywood, Century City, Studio City, Woodland Hills, Newport Beach, Montecito
Click to expand...
You don't compete for the rich worried well. There just aren't that many of them to go around.

Go the DPC route. When I did that probably 80% of my patients were uninsured blue collar/small business people.
 
sloh said:
Lol ya way easier said than done. When I look at LA/SoCal, how do physicians even compete against companies like this? I looked at their careers page and it doesn't even seem like they hire MD/DO's. Just midlevels.

www.next-health.com

Next Health | Longevity, Health Optimization & Wellness Center

Next Health offers personalized wellness plans including NAD+ & IV therapy, hormone treatments, regenerative aesthetics and more. Elevate your health today!
www.next-health.com www.next-health.com

"Plasma exchange, executive physical, hormone optimization, EBOO therapy, ozone therapy, NAD+, labs, IV therapy, Functional Med, advanced medical services, weight optimization, vitamin shops, peptide therapy, wellness technology, next beauty aesthetics"

West Hollywood, Century City, Studio City, Woodland Hills, Newport Beach, Montecito
Click to expand...

You hit the nail on the head my man.

A single/solo doc without very specific access to a very specific high-margin niche of medicine with a wide, wide, wide moat is essentially forced into two options:

1) Accept wage ****ery working as some employee of said corporate wellness clinic chains or Kaiser or Optum or whatever. And yea, they don't even hire MDs or DOs anymore.

2) Join extremely predatory grindhouse private practices that even the owners are looking to dump to the ever-growing corporate sphere in that desirable location, thus always living in a slight state of anxiety

I feel truly blessed to have got out at the right time in FIRE mode, it almost seems impossible now
 
HemorrhagicShock said:
You hit the nail on the head my man.

A single/solo doc without very specific access to a very specific high-margin niche of medicine with a wide, wide, wide moat is essentially forced into two options:

1) Accept wage ****ery working as some employee of said corporate wellness clinic chains or Kaiser or Optum or whatever. And yea, they don't even hire MDs or DOs anymore.

2) Join extremely predatory grindhouse private practices that even the owners are looking to dump to the ever-growing corporate sphere in that desirable location, thus always living in a slight state of anxiety

I feel truly blessed to have got out at the right time in FIRE mode, it almost seems impossible now
Click to expand...

It's trash all around, just different flavors.

I feel most bad for the residents graduating or matching now that have 300-500k of student debt
 
WhatJobDoIPick said:
It's trash all around, just different flavors.

I feel most bad for the residents graduating or matching now that have 300-500k of student debt
Click to expand...
I sort of do.. but being around a bunch of them from multiple residencies I truly have found that many are plenty happy with what I think are mediocre jobs. They want to take no risk, be given a smooth path and want to work more “manageable” hours. Few wants to work more than 120/month.

We can argue back and forth whether that is good. I think there is some wisdom in working less though I tend to tell mentees that the real wisdom is sprinting for 3-5 years and maximizing earnings and then settling into more normal numbers. This recommendation is based on everyone’s personal situation (kids/no kids, married, not married, goals get to FI, coast forever).

All that being said you could work 125 hours a month at a fairly mediocre job and earn 200/hr. You could wallow in a mediocre career and I think thats fairly doable long term and while you may have to commute you could find a non malignant job. I think it is also quite doable to find a “harder” job making 300/hr and work those same 125 hours a month and suddenly you are earning 450k.

Much of all this depends on the COL of where you live, state taxes, renting vs buying a home. You can earn 450k and rent a decent enough place for 3-4k.. Leaves a ton of money for saving, investing etc.

So I dont feel bad.. I actually will feel the worst for those who are the very recent grads. The ones who were in residency during covid or just after. The expectation for those was a long term stable job and stable to slightly rising income. I suspect pay will very shortly drop in all but the crappiest metro markets. Those same docs who want comfort and convenience will accept it. They wont leave and partially there is nowhere to go that doesnt suck. I know some will mention locums but depending on your personal situation that could really suck. Some people hate travel, travel includes delays and loss of time with family. Locums and that lifestyle is right for some folks.. It’s horrid for others. I have a EM buddy who is licensed in nearly 50 states. NO idea why he does it. He likes to text me to say hey im here in the upper Midwest in December.. The high today is -14. He is away from his family, pay is good but not great. He has had some insanely good years. He made $1M+ pre-covid for a year or 2. Worked a lot but had some insanely good jobs including some working things like 2am-6am for 1k/hr. He also had some horrific work environments especially some that Sound Physicians staffs. That has dried up for him. I assume much of that has dried up for others since I will hear some $400/hr opportunities but even those seem to be fewer and further between.

All that to say if you are a current medical student or a current resident you have entered a path that is bleak. Not only will pay go down but hours will drop with it. There are far too many residents for the even 20% who might do a fellowship or something else we will still have too many. Moving to 4 year residencies which seems like a foregone conclusion will just mean we will have dumber and weaker students going into EM. We are on par with FP in terms of competitiveness right now. It didnt used to be this way. Perhaps thats another reason I dont feel bad. EM is no longer a bunch of docs who could have done another good field. Instead it is a lot of scraping the bottom of the barrel.
 
EctopicFetus said:
I sort of do.. but being around a bunch of them from multiple residencies I truly have found that many are plenty happy with what I think are mediocre jobs. They want to take no risk, be given a smooth path and want to work more “manageable” hours. Few wants to work more than 120/month.

We can argue back and forth whether that is good. I think there is some wisdom in working less though I tend to tell mentees that the real wisdom is sprinting for 3-5 years and maximizing earnings and then settling into more normal numbers. This recommendation is based on everyone’s personal situation (kids/no kids, married, not married, goals get to FI, coast forever).

All that being said you could work 125 hours a month at a fairly mediocre job and earn 200/hr. You could wallow in a mediocre career and I think thats fairly doable long term and while you may have to commute you could find a non malignant job. I think it is also quite doable to find a “harder” job making 300/hr and work those same 125 hours a month and suddenly you are earning 450k.

Much of all this depends on the COL of where you live, state taxes, renting vs buying a home. You can earn 450k and rent a decent enough place for 3-4k.. Leaves a ton of money for saving, investing etc.

So I dont feel bad.. I actually will feel the worst for those who are the very recent grads. The ones who were in residency during covid or just after. The expectation for those was a long term stable job and stable to slightly rising income. I suspect pay will very shortly drop in all but the crappiest metro markets. Those same docs who want comfort and convenience will accept it. They wont leave and partially there is nowhere to go that doesnt suck. I know some will mention locums but depending on your personal situation that could really suck. Some people hate travel, travel includes delays and loss of time with family. Locums and that lifestyle is right for some folks.. It’s horrid for others. I have a EM buddy who is licensed in nearly 50 states. NO idea why he does it. He likes to text me to say hey im here in the upper Midwest in December.. The high today is -14. He is away from his family, pay is good but not great. He has had some insanely good years. He made $1M+ pre-covid for a year or 2. Worked a lot but had some insanely good jobs including some working things like 2am-6am for 1k/hr. He also had some horrific work environments especially some that Sound Physicians staffs. That has dried up for him. I assume much of that has dried up for others since I will hear some $400/hr opportunities but even those seem to be fewer and further between.

All that to say if you are a current medical student or a current resident you have entered a path that is bleak. Not only will pay go down but hours will drop with it. There are far too many residents for the even 20% who might do a fellowship or something else we will still have too many. Moving to 4 year residencies which seems like a foregone conclusion will just mean we will have dumber and weaker students going into EM. We are on par with FP in terms of competitiveness right now. It didnt used to be this way. Perhaps thats another reason I dont feel bad. EM is no longer a bunch of docs who could have done another good field. Instead it is a lot of scraping the bottom of the barrel.
Click to expand...

Yes...the ones who graduated peri-covid are the ones I feel the most bad for. If you chose this field after 2021 you're really not too bright.

Crazy about your locums friend. What's the end game? If I made over a mil for a couple years I'd probably just retire.
 
WhatJobDoIPick said:
Yes...the ones who graduated peri-covid are the ones I feel the most bad for. If you chose this field after 2021 you're really not too bright.

Crazy about your locums friend. What's the end game? If I made over a mil for a couple years I'd probably just retire.
Click to expand...
The irony is he is older than me, has really had some horrid luck (heavy into real estate before the collapse) but then bought a home currently worth well over $2m for about 400k. I know a lot about his finances and know his thinking very well. I truly dont understand the end game, or the point. He is basically someone who i think will never feel like he has enough. He could retire by my measure but who knows. He is not too far from 60, youngest kid is about to finish college.
 
EctopicFetus said:
I sort of do.. but being around a bunch of them from multiple residencies I truly have found that many are plenty happy with what I think are mediocre jobs. They want to take no risk, be given a smooth path and want to work more “manageable” hours. Few wants to work more than 120/month.

We can argue back and forth whether that is good. I think there is some wisdom in working less though I tend to tell mentees that the real wisdom is sprinting for 3-5 years and maximizing earnings and then settling into more normal numbers. This recommendation is based on everyone’s personal situation (kids/no kids, married, not married, goals get to FI, coast forever).

All that being said you could work 125 hours a month at a fairly mediocre job and earn 200/hr. You could wallow in a mediocre career and I think thats fairly doable long term and while you may have to commute you could find a non malignant job. I think it is also quite doable to find a “harder” job making 300/hr and work those same 125 hours a month and suddenly you are earning 450k.

Much of all this depends on the COL of where you live, state taxes, renting vs buying a home. You can earn 450k and rent a decent enough place for 3-4k.. Leaves a ton of money for saving, investing etc.

So I dont feel bad.. I actually will feel the worst for those who are the very recent grads. The ones who were in residency during covid or just after. The expectation for those was a long term stable job and stable to slightly rising income. I suspect pay will very shortly drop in all but the crappiest metro markets. Those same docs who want comfort and convenience will accept it. They wont leave and partially there is nowhere to go that doesnt suck. I know some will mention locums but depending on your personal situation that could really suck. Some people hate travel, travel includes delays and loss of time with family. Locums and that lifestyle is right for some folks.. It’s horrid for others. I have a EM buddy who is licensed in nearly 50 states. NO idea why he does it. He likes to text me to say hey im here in the upper Midwest in December.. The high today is -14. He is away from his family, pay is good but not great. He has had some insanely good years. He made $1M+ pre-covid for a year or 2. Worked a lot but had some insanely good jobs including some working things like 2am-6am for 1k/hr. He also had some horrific work environments especially some that Sound Physicians staffs. That has dried up for him. I assume much of that has dried up for others since I will hear some $400/hr opportunities but even those seem to be fewer and further between.

All that to say if you are a current medical student or a current resident you have entered a path that is bleak. Not only will pay go down but hours will drop with it. There are far too many residents for the even 20% who might do a fellowship or something else we will still have too many. Moving to 4 year residencies which seems like a foregone conclusion will just mean we will have dumber and weaker students going into EM. We are on par with FP in terms of competitiveness right now. It didnt used to be this way. Perhaps thats another reason I dont feel bad. EM is no longer a bunch of docs who could have done another good field. Instead it is a lot of scraping the bottom of the barrel.
Click to expand...

Yet another required reading post from @EctopicFetus

EVERY medical student needs to read this.

DO NOT GO INTO EM!!!

The specialty is now meant as a backup for those who cannot match into anything else and can't see themselves being an FP (the only thing easier to get than EM).

And even the 10% of masochists that somehow still want to do EM despite knowing and UNDERSTANDING this realities of the profession need to go in with an exit plan in mind since you will be lucky to survive more than 10 years, ESPECIALLY if you want to live in any desirable to semi-desirable location.
 
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