Emergency medicine in Arkansas

[premed_mamba]

3rd year med student interested in emergency medicine. I know all about the doom and gloom but I plan on staying in Arkansas to practice. Currently some of our EDs in the state are still being staffed by FM and IM. There’s 2 residencies in the state about 16 graduates per year none have ever had a problem finding a job here. What do you all think? Go for it or stay clear?

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[bravotwozero]

Please find something else to do.

 

[premed_mamba]

Please find something else to do.

Why do you say that

 

[RustedFox]

Why do you say that

He means "something else than EM".

Add me to that list of people that will tell you, in good conscience, to "find something else to do".

 

[premed_mamba]

He means "something else than EM".

Add me to that list of people that will tell you, in good conscience, to "find something else to do".

even in a rural area like Arkansas? I honestly thought that the talk was more so in more “desirable” areas. I literally saw a job today that was paying like $280 an hour.

 

[Apollyon]

A former friend is a PhD in education, and his field is dying out. He wrote an opinion paper that was published in an academic journal where he stated he was "a dinosaur". EM docs are on their way to becoming dinosaurs, with the new, small, agile mid-level mammals pushing out the reptilian carnivores.

 

[sylvanthus]

even in a rural area like Arkansas? I honestly thought that the talk was more so in more “desirable” areas. I literally saw a job today that was paying like $280 an hour.

Yaaa dude you wont finish for at leaat 4 years, in 2026 ish, there is an expected surplus of ED docs in the 9000 range by 2030. That doesnt mean 2029 all is well, 2030 things suck. Its a slow decent into suck. If people are unhappy in EM now with literally nothing improving. How do you think things will be when you graduate in 4 years from residency?

If one thing was looking up I could see a med student having optimism, But literally everything is going downhill.

Pay, increased “metrics”, continued hyperfocus on oatient satisfaction, increasing use of midlevrls and increasing midlevel independence, increased boarding in the ED, increases charting requirements etc etc etc. Literally, not one aspect of the job is improving.

But you do you man, after all, every med student thinks they are the exception until reality slaps them in the face.

 

[premed_mamba]

Yaaa dude you wont finish for at leaat 4 years, in 2026 ish, there is an expected surplus of ED docs in the 9000 range by 2030. That doesnt mean 2029 all is well, 2030 things suck. Its a slow decent into suck. If people are unhappy in EM now with literally nothing improving. How do you think things will be when you graduate in 4 years from residency?

If one thing was looking up I could see a med student having optimism, But literally everything is going downhill.

Pay, increased “metrics”, continued hyperfocus on oatient satisfaction, increasing use of midlevrls and increasing midlevel independence, increased boarding in the ED, increases charting requirements etc etc etc. Literally, not one aspect of the job is improving.

But you do you man, after all, every med student thinks they are the exception until reality slaps them in the face.

Thank you for this

 

[RustedFox]

Thank you for this

You're far better off doing FM or IM with fellowship.

Full stop.

Period.

 

[thegenius]

I will play devils advocate, somewhat.

First, I will never argue against the macro forces our field will experience. I believe there will be a surplus of jobs, and our salaries over time will go down. Frankly...except for concierge medicine, most practices that rely on insurance money will go down over time. Payments will go down. Not up. Doctors might make more over time but it's not due to increasing payouts.

However there are some that still like being a doctor. You have to accept the realities of EM. The good: We are the only diagnosticians for roughly 60-80 million people (out of 330 million). The rest, the roughly other 250 million or so get the majority of their diagnoses from outpatient doctors. For the ~80 million we (for better or for worse) are their doctors. I can't imagine a field where all you get are patients who regularly say "I have back pain, here is my MRI, what do you think?" And all you do is look at their MRI, talk to the patient for 2 minutes, and say "yes I can operate or no I can't operate." You get to know a little bit about every field. You don't need authorization to run tests (at least not yet).

The single worst thing about our field is the sense of entitlement that 80% of patients think they have. It's terrible. Not only do they get free health care, they expect and demand that you fix them, or call everybody that is needed to come into the ER or hospital to fix them.

It's important to think about the macro forces of the field...and they move slowly. Frankly all fields in medicine are changing. Every single one. The most important thing when choosing a field is enjoying what you do on a daily basis. I wouldn't do anything other than EM. Except perhaps Urology, ENT, or some other surgical subspecialty. EM is fun, fast paced, you get to do a lot of shiiit, you don't need authorization, and frankly we are simply the single most important doctors in our medical system. If a pestilence came over the land and wiped out entire specialties, our civilization would be most hurt if ER doctors got wiped out completely.

 

[HoosierdaddyO]

Haha so with all of this fear and concern about the future of jobs and job markets… what are some reasons why someone wouldn’t take a secure job would good benefits at a VA like hospital or work for the DoD at a military hospital as a civilian. I would imagine job security would be ideal even with the changing forces of EM at large lol?!

 

[Porfirio]

Do something where you have ownership and responsibility. EM is just responsibility.

Business respects ownership. If you have ownership, you have something of value.

I am replaceable and without ownership.

 

[bronx43]

Do something where you have ownership and responsibility. EM is just responsibility.

Business respects ownership. If you have ownership, you have something of value.

I am replaceable and without ownership.

This.

Certainly ownership of the business is ideal, but even “ownership” of a patient panel provides tremendous value. If patients come for you, then you’re not easily replaceable at the very least.

 

[turkeyjerky]

The notion that under-served or undesirable areas are going to be some oasis for EM seems to be a relatively common, but completely misplaced form of wishful thinking. In my thinking, there are several reasons why this won't be the case:
--Sure, non-boarded docs will likely get pushed out, but it'll happen gradually as they retire. Nobody's getting fired just because a recruiter has an in on some hotshot new grad who wants to move to Jonesboro. These guys have been working at these places for their entire career, and, despite the dumpster fire signouts we regularly get from the, they know how to keep admins happy (enough) not to get fired.
--CMGs dominate the market and can easily increase hiring for their travel teams, or people can commute. Denver has a direct flight to Little Rock. If I'm facing unemployment, you think I'm saying no to that sweet travel gig paying $175/hr? Hell, that's 50/hr more than they're paying locally.
--As above, ALL the general negatives about this field still apply. Midlevels, metrics, understaffing (which paradoxically will likely get worse as oversupply becomes more entrenched), etc. These are all getting worse year by year.

If you have literally any interest in another field, you should go for that one. The fact is that EM is not exactly fun to work in these days, is getting worse every year, and the fact is you'll be lucky to even get a job practicing emergency medicine in 4 years.

 

[Groove]

Do IM or FM. However, if you do EM, there are some decent jobs throughout the state of Arkansas and

3rd year med student interested in emergency medicine. I know all about the doom and gloom but I plan on staying in Arkansas to practice. Currently some of our EDs in the state are still being staffed by FM and IM. There’s 2 residencies in the state about 16 graduates per year none have ever had a problem finding a job here. What do you all think? Go for it or stay clear?

Do IM or FM and start pulling in 400K in an outpatient clinic working 4 days a week like most of the other FM guys in my neck of the woods. It's not that hard. Zero nights. Zero weekends. Zero Call. Busy work days but hey...only 4 of them.

 

[BigRhinoGuy]

Do IM or FM. However, if you do EM, there are some decent jobs throughout the state of Arkansas and

Do IM or FM and start pulling in 400K in an outpatient clinic working 4 days a week like most of the other FM guys in my neck of the woods. It's not that hard. Zero nights. Zero weekends. Zero Call. Busy work days but hey...only 4 of them.

I'm in a similar position as OP. @Groove, how is the market now in West TN? I've seen your comments on West TN pre-COVID. I'm planning on staying local during my career (Northwest TN specifically).

 

[RustedFox]

People need to stop this "I plan to stay local forever" thing.

You have ZERO idea where you want to be, or will end up.

Never in a thousand years did I think I would be where I am now.

Now, knock it off kids.

 

[premed_mamba]

People need to stop this "I plan to stay local forever" thing.

You have ZERO idea where you want to be, or will end up.

Never in a thousand years did I think I would be where I am now.

Now, knock it off kids.

This is false at least for me. I’ve lived where I live for 30 years and plan to be here until I die.

 

[RustedFox]

This is false at least for me. I’ve lived where I live for 30 years and plan to be here until I die.

....said the young RustedFox as well.

Point being: you may think that you're different, maybe exceptional.

You're not.

You're welcome.

 

[RustedFox]

Above that: if you're pre-med, as your username implies; then you truly have no idea what field of medicine you like.

I swore I was bound for FM, then IM, then about 2 other fields. I looked at EM like it was "people playing ambulance, without the ambulance".

For real. Know this:

Know that you don't know.

 

[premed_mamba]

Above that: if you're pre-med, as your username implies; then you truly have no idea what field of medicine you like.

I swore I was bound for FM, then IM, then about 2 other fields. I looked at EM like it was "people playing ambulance, without the ambulance".

For real. Know this:

Know that you don't know.

I’m a 3rd year med student as the first statement of the original post says. I’ve had this account for years. I’m on my last clinical rotation before 4th year. I’ve got a pretty good idea what I like it’s just the fear of the future which prompted this post.

 

[premed_mamba]

Do IM or FM. However, if you do EM, there are some decent jobs throughout the state of Arkansas and

Do IM or FM and start pulling in 400K in an outpatient clinic working 4 days a week like most of the other FM guys in my neck of the woods. It's not that hard. Zero nights. Zero weekends. Zero Call. Busy work days but hey...only 4 of them.

That sounds amazing other than Mgma has FM at 255k average in my area. 90th percentile is 415K how hard is it to get to that 400k mark? How
Many pts per day are they seeing? Are the employed vs pp owners?

 

[premed_mamba]

....said the young RustedFox as well.

Point being: you may think that you're different, maybe exceptional.

You're not.

You're welcome.

Give me advice on the specialty if you have more information on that than I do, that is why I posted on this forum. But I don’t understand how you can tell somewhere where they are going to end up based off the fact that you didn’t end up where you thought without knowing any other information. Nothing about me is exceptional but I do know that I have a very close knit large family who has been in this town that I live in for generations , I’m married to someone who also has a very close knit family who has been in this town for generations and all of our kids will probably end up living in this town. Some people just like the simple things and Im not looking for anything different.

 

[turkeyjerky]

This is false at least for me. I’ve lived where I live for 30 years and plan to be here until I die.

Then definitely do not apply to EM. If there's one thing that anyone deciding to enter this debacle needs, it's flexibility. You have no idea what the market in any specific locality will be in in 4-5 years.

 

[The Knife & Gun Club]

Look. Lots of people say they want to be in the same place forever. That’s normal. I moved back to my home town for Med school and residency. I get the draw.

But the reality is you have far less control over your employment prospects than you think as a physician. Getting a job isn’t “med school acceptance” level hard but it’s not a walk in the park either - in EM or otherwise. Some hospitals just aren’t hiring for the position you spent a decade training for, no matter how much you love the area. Sometimes they are but you realize only once they show you that secret contract on signing day that the terms they have you agreeing to are so absurd that you can’t possibly sign it.

Let’s take an example. True story. My buddy joe is born and raised in rural Georgia. He went to med school in rural Georgia. His home town had a nice little hospital, in rural Georgia. Joe loves rural Georgia and loves his community.

So after residency joe moves back to hometown Georgia, and takes a great gig with TeamGeorgia corporate physician group, that staffs their ED. He signs their standard, non-negotiable contract, which includes lucrative pay and a standard non-compete clause barring him from working for any ER in the state not run by TeamGeorgia.

Sadly Joe’s local hospital is acquired by a larger hospital system. This new parent hospital staffs all their EDs with another corporate physician group - United Georgia Acute Services (UGAS). Bummer because joe signed with TeamGeorgia, and has a non-compete. Now joe needs to leave his beloved home town to find a new job in a new state, because TeamGeorgia’s non-compete clause bars him from working for UGAS.

I’m not saying this will happen to you. I’m not saying you can’t have a happy long life in your home town - you probably can. But nothing is certain and intricacies in systems outside of your control can always change the game without warning.

 

[premed_mamba]

Then definitely do not apply to EM. If there's one thing that anyone deciding to enter this debacle needs, it's flexibility. You have no idea what the market in any specific locality will be in in 4-5 years.

This was helpful. Thank you

 

[premed_mamba]

Look. Lots of people say they want to be in the same place forever. That’s normal. I moved back to my home town for Med school and residency. I get the draw.

But the reality is you have far less control over your employment prospects than you think as a physician. Getting a job isn’t “med school acceptance” level hard but it’s not a walk in the park either - in EM or otherwise. Some hospitals just aren’t hiring for the position you spent a decade training for, no matter how much you love the area. Sometimes they are but you realize only once they show you that secret contract on signing day that the terms they have you agreeing to are so absurd that you can’t possibly sign it.

Let’s take an example. True story. My buddy joe is born and raised in rural Georgia. He went to med school in rural Georgia. His home town had a nice little hospital, in rural Georgia. Joe loves rural Georgia and loves his community.

So after residency joe moves back to hometown Georgia, and takes a great gig with TeamGeorgia corporate physician group, that staffs their ED. He signs their standard, non-negotiable contract, which includes lucrative pay and a standard non-compete clause barring him from working for any ER in the state not run by TeamGeorgia.

Sadly Joe’s local hospital is acquired by a larger hospital system. This new parent hospital staffs all their EDs with another corporate physician group - United Georgia Acute Services (UGAS). Bummer because joe signed with TeamGeorgia, and has a non-compete. Now joe needs to leave his beloved home town to find a new job in a new state, because TeamGeorgia’s non-compete clause bars him from working for UGAS.

I’m not saying this will happen to you. I’m not saying you can’t have a happy long life in your home town - you probably can. But nothing is certain and intricacies in systems outside of your control can always change the game without warning.

This puts things into great perspective! I really appreciate it!

 

[Groove]

I'm in a similar position as OP. @Groove, how is the market now in West TN? I've seen your comments on West TN pre-COVID. I'm planning on staying local during my career (Northwest TN specifically).

Market is about the same as pre-COVID in so far as EM compensation goes. ~$250-$265/hr. Chattanooga is ~$200/hr last I checked and East TN is ~$225/hr give or take. TH and Envision have most of the CMG contracts in West TN though Sound Physicians runs the Methodist contracts in Memphis. The field has gotten much more competitive with the glut of too many graduating residents and most sizable sign on bonus offers have dried up. It's becoming more difficult for residents to find jobs and in the last few years I've seen large numbers of EM docs move to TN from distant places in the US because they couldn't find a job back home. Feel free to PM me if you need more details.

Meanwhile, our FM guys are killing it in the outpatient practices with 4 day work weeks as long as they hire 1 or 2 NPs. The NPs alone are making ~200-250K. The FM partners are making 400+

If I was a 3rd year med student right now, I'd be looking at anything other than EM. I'd probably go FM and work outpatient or be an IM hospitalist. And if I really wanted to make bank and have the ultimate seal of job security?...psychiatry.

 

[premed_mamba]

Market is about the same as pre-COVID in so far as EM compensation goes. ~$250-$265/hr. Chattanooga is ~$200/hr last I checked and East TN is ~$225/hr give or take. TH and Envision have most of the CMG contracts in West TN though Sound Physicians runs the Methodist contracts in Memphis. The field has gotten much more competitive with the glut of too many graduating residents and most sizable sign on bonus offers have dried up. It's becoming more difficult for residents to find jobs and in the last few years I've seen large numbers of EM docs move to TN from distant places in the US because they couldn't find a job back home. Feel free to PM me if you need more details.

Meanwhile, our FM guys are killing it in the outpatient practices with 4 day work weeks as long as they hire 1 or 2 NPs. The NPs alone are making ~200-250K. The FM partners are making 400+

What is the role of an NP In a FM practice. Do they have their own panel of patients that we get a percentage off of or do they seem some of our lower acuity patients allowing more to be seen throughout the day etc?

 

[Groove]

What is the role of an NP In a FM practice. Do they have their own panel of patients that we get a percentage off of or do they seem some of our lower acuity patients allowing more to be seen throughout the day etc?

Same reason Anesthesiology groups hire CRNAs. They do the work of an MD for half the pay. Yes, we have a large FM practice here in town with multiple offices and each office is fully staffed with at least one NP that functions autonomously for the most part and has their own patients. The partners pay them a reduced salary with RVU incentives and the practice splits any additional profit/revenue amongst the physician partners.

 

[sylvanthus]

Market is about the same as pre-COVID in so far as EM compensation goes. ~$250-$265/hr. Chattanooga is ~$200/hr last I checked and East TN is ~$225/hr give or take. TH and Envision have most of the CMG contracts in West TN though Sound Physicians runs the Methodist contracts in Memphis. The field has gotten much more competitive with the glut of too many graduating residents and most sizable sign on bonus offers have dried up. It's becoming more difficult for residents to find jobs and in the last few years I've seen large numbers of EM docs move to TN from distant places in the US because they couldn't find a job back home. Feel free to PM me if you need more details.

Meanwhile, our FM guys are killing it in the outpatient practices with 4 day work weeks as long as they hire 1 or 2 NPs. The NPs alone are making ~200-250K. The FM partners are making 400+

If I was a 3rd year med student right now, I'd be looking at anything other than EM. I'd probably go FM and work outpatient or be an IM hospitalist. And if I really wanted to make bank and have the ultimate seal of job security?...psychiatry.

I wouldnt recommend hospitalist work. Same rule applies, you dont own a patient panel and they are starting to be replaced by midlevels.

 

[turkeyjerky]

I wouldnt recommend hospitalist work. Same rule applies, you dont own a patient panel and they are starting to be replaced by midlevels.

But better job market than EM. And, at least from what I’ve seen, it’s easier to mail it in. Plus exit options.

 

[RustedFox]

Give me advice on the specialty if you have more information on that than I do, that is why I posted on this forum. But I don’t understand how you can tell somewhere where they are going to end up based off the fact that you didn’t end up where you thought without knowing any other information. Nothing about me is exceptional but I do know that I have a very close knit large family who has been in this town that I live in for generations , I’m married to someone who also has a very close knit family who has been in this town for generations and all of our kids will probably end up living in this town. Some people just like the simple things and Im not looking for anything different.

Fair enough; but I'm also NOT "telling you where you'll end up", as you asserted.

So you've got roots in your country home. That's cool.

Five years down the line, life changes radically and you don't want to be within 5 states of your family, or you decide that you need to follow your destiny to (Iowa, Oregon, wherever), and you're divorced or something else awful happens.

"Awful and unpredictable" occurs more often than "nice and predictable" all day, every day.

 

[namethatsmell]

I'd probably go FM and work outpatient or be an IM hospitalist. And if I really wanted to make bank and have the ultimate seal of job security?...psychiatry.

Yup. If medicine keeps on spinning out of control, the likes of outpatient pcps and psych will be the only docs wanting to still show up for work. When you can charge cash for services which millions of people can/will gladly pay...you control your future.

Haha so with all of this fear and concern about the future of jobs and job markets… what are some reasons why someone wouldn’t take a secure job would good benefits at a VA like hospital or work for the DoD at a military hospital as a civilian. I would imagine job security would be ideal even with the changing forces of EM at large lol?!

If you're able to legit own your practice and are OK with the time needed to keep it going, go with that. Otherwise, being employed by a non-evil non-profit hospital or a federal/Kaiser job are the best options out there for the foreseeable future. The former will usually pay better but with more random red tape/landmines to deal with...while the latter is way more secure and usually less stress but with more predictable red tape and landmines. People who find their way into a dod/va/ihs/kaiser job at a shop with a decent workplace culture almost never leave...so these places almost never hire. Their salaries are often lower than other options, but when you factor in the cash value of their retirement options, benes, and paid time off along with the ratio of workload/stress: $$...you realize some of these are really sweet deals.

 

[EctopicFetus]

Point is you think you will want to work at the local rural hospital. It is possible they just wont be hiring. The smaller the hospital then potentially the same 5-8 docs are there and will stay. YOu will graduate residency in 2026.

As I said before while ACEP thinks there will be 10k too many EM docs by 2030 reality is well before that we will have docs underemployed which will put insane pressure on our wages.

See Denver colorado for proof. See its not that 10k docs wont have jobs but rather 30k docs wont get the hours they want all while saddled with crippling debt. We whine about anything under $200/hr but if you are a new grad with 300k in debt you will run that rate down on yourself because working 150 hours at $150/hr is better for you (since you dont value time yet) than making $225/hr for 50 hours a month.

On top of this dont think you will be able to find a job where you want. I didnt think I would go out west for residency, I didn’t think i would leave the city i did my residency in and I didnt think I would leave the first job out of residency. You just dont know. What will you do if the hospitals near you suddenly dont hire for 5 years or you can only get 20-30 hours a month? You gonna commute elsewhere from middle of nowhere Arkansas to middle of nowhere New Mexico? It’s not like a PCP where you can set up shop wherever you feel like.

 

[RustedFox]

Check back in 5 years.
I'll bet that you're nowhere near your hometown.

Your life sounds like a John Mellencamp song, and that's cool in a lot of ways.

But life is what happens while you were busy making other plans.

 

[Southpaw]

if you're absolutely set on living in a certain area then you need to go into a field you know will be needed in your area or something you could start up on your own. that's primary care.

 

[EctopicFetus]

if you're absolutely set on living in a certain area then you need to go into a field you know will be needed in your area or something you could start up on your own. that's primary care.

Also a bunch of surgical sub specialties too depending on how big/little that place is where you want to live. Some places are too small to support anything but a general surgeon.

 

[Brigade4Radiant]

first in EM it doesn’t matter where you went to residency most decent places don’t hire new grads regardless.

FM can get a job anywhere and can get 12 weeks of vacay which means a week off every month. If you have NPs and PAs you can make money.

FM with a few years can easily make 260k in Denver. Keep in mind with outpatient it depends on what insurance your patients get and how efficient you are.

 

[namethatsmell]

See Denver colorado for proof. See its not that 10k docs wont have jobs but rather 30k docs wont get the hours they want all while saddled with crippling debt. We whine about anything under $200/hr but if you are a new grad with 300k in debt you will run that rate down on yourself because working 150 hours at $150/hr is better for you (since you dont value time yet) than making $225/hr for 50 hours a month.

How recent is your info? Last I heard usacs started new Denver docs at 135/hr.

And don't worry, to get that princely rate all it takes is seeing 2.5/hr + "supervising" midlevel pts.

Race to the bottom there is quite impressive. What comes next?

 

[Lexdiamondz]

I’m a 3rd year med student as the first statement of the original post says. I’ve had this account for years. I’m on my last clinical rotation before 4th year. I’ve got a pretty good idea what I like it’s just the fear of the future which prompted this post.

You think you do, but medical school shields students from quite a bit of the day to day BS that goes into being a physician in any specialty.


There is a very good reason why general surgery has an attrition rate of 20%, why EM and CCM have the highest burnout, and why roughly half of all doctors wouldn't recommend medicine to their own children.


You know what you like today. Med students, unfortunately, are abysmal at knowing what's good for them in 5, 15 or 25 years and most of us learn that lesson the hard way.

 

[EctopicFetus]

How recent is your info? Last I heard usacs started new Denver docs at 135/hr.

And don't worry, to get that princely rate all it takes is seeing 2.5/hr + "supervising" midlevel pts.

Race to the bottom there is quite impressive. What comes next?

Depends on which site. USACS has all that debt they have to pay off at 6%+ interest.

 

[CoolDoc1729]

3rd year med student interested in emergency medicine. I know all about the doom and gloom but I plan on staying in Arkansas to practice. Currently some of our EDs in the state are still being staffed by FM and IM. There’s 2 residencies in the state about 16 graduates per year none have ever had a problem finding a job here. What do you all think? Go for it or stay clear?

I know you’ve heard from other posters that if you are geographically limited ER is a poor choice, and that primary care would be better. They are all 100% right.

One thing a lot of places near me are doing, is a primary care/urgent care setup. Much of what we do could also be done in this setting , and your patients will LOVE YOU if you’re willing to do minor procedures, X-rays, etc on site so they DON’T have to go to the ER. This is what I would have done, knowing everything I know now. Myself I’m working on a side gig so that (even though I’m one of the weirdos that really really likes my job) I’ll have a way out in 10 years if I need it. It is amazing how much worse the job market has gotten in the last decade.

 

[EctopicFetus]

I know you’ve heard from other posters that if you are geographically limited ER is a poor choice, and that primary care would be better. They are all 100% right.

One thing a lot of places near me are doing, is a primary care/urgent care setup. Much of what we do could also be done in this setting , and your patients will LOVE YOU if you’re willing to do minor procedures, X-rays, etc on site so they DON’T have to go to the ER. This is what I would have done, knowing everything I know now. Myself I’m working on a side gig so that (even though I’m one of the weirdos that really really likes my job) I’ll have a way out in 10 years if I need it. It is amazing how much worse the job market has gotten in the last decade.

Every wise em doc is looking for passive money. Went to a event and met a retinal surgeon who was 2-3 years older than me He quit what I assume was $1m a year job to focus on commercial real estate development.

 

[bravotwozero]

Every wise em doc is looking for passive money. Went to a event and met a retinal surgeon who was 2-3 years older than me He quit what I assume was $1m a year job to focus on commercial real estate development.

Strange. $1 mil per year will give you plenty of capital to start a passive income stream and hit FIRE in a few years.

 

[nimbus]

Haha so with all of this fear and concern about the future of jobs and job markets… what are some reasons why someone wouldn’t take a secure job would good benefits at a VA like hospital or work for the DoD at a military hospital as a civilian. I would imagine job security would be ideal even with the changing forces of EM at large lol?!

If the overall job market is terrible, won’t those jobs become scarce too?

 

[nimbus]

This.

Certainly ownership of the business is ideal, but even “ownership” of a patient panel provides tremendous value. If patients come for you, then you’re not easily replaceable at the very least.

The problem is that a lot of previously “ownership” specialties like derm and ophtho have sold out.

 

[RustedFox]

You think you do, but medical school shields students from quite a bit of the day to day BS that goes into being a physician in any specialty.


There is a very good reason why general surgery has an attrition rate of 20%, why EM and CCM have the highest burnout, and why roughly half of all doctors wouldn't recommend medicine to their own children.


You know what you like today. Med students, unfortunately, are abysmal at knowing what's good for them in 5, 15 or 25 years and most of us learn that lesson the hard way.

Oh my Gawd, this.

"I have a pretty good idea of what I like", he said.

If only I would have listened... to people like my future self....

 

[bronx43]

The problem is that a lot of previously “ownership” specialties like derm and ophtho have sold out.

One can always hang a shingle. It’s hard but possible… just depends how much one hates working for some corporate parasite.

 

[EctopicFetus]

Strange. $1 mil per year will give you plenty of capital to start a passive income stream and hit FIRE in a few years.

So he told me he started dabbling in it while working and was so successful he quit work. I think he wanted to keep working but retinal surgery became “boring” as he was doing the same thing day in and day out. I’m guessing based on the size of the deals he is hoping to make at least 3x that a year. Personally, it is hard to imagine given all the appreciation we have seen but what do I know.