RustedFox

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Hey all,

Nice to meet you all. I've been a fixture in the EM forum on here for a long time. Gotta admit it; I was really torn between EM and FM/IM when I matched.
Now, I'm 11 years down the line, and I'm pretty sure I'm burned out of EM for keeps.

Before anyone goes there (including myself), in no way do I think I can do an FP's job as well as any residency trained FP. I'm considering urgent care work, or maybe (some sort of) fellowship. The real jumping-off point here is: What could a smart doc do to better understand the outpatient/clinic world, and broaden his fund of knowledge to better dovetail in with your sphere of medicine?

I come in peace. No flames intended.
 
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smq123

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Hey all,

Nice to meet you all. I've been a fixture in the EM forum on here for a long time. Gotta admit it; I was really torn between EM and FM/IM when I matched.
Now, I'm 11 years down the line, and I'm pretty sure I'm burned out of EM for keeps.

Before anyone goes there (including myself), in no way do I think I can do an FP's job as well as any residency trained FP. I'm considering urgent care work, or maybe (some sort of) fellowship. The real jumping-off point here is: What could a smart doc do to better understand the outpatient/clinic world, and broaden his fund of knowledge to better dovetail in with your sphere of medicine?

I come in peace. No flames intended.

I don't know if this is what you're looking for, but you might look into volunteering at a free clinic. The time commitment is as much or as little as you want it to be, and it would give you a refresher of how an outpatient clinic runs.

What kind of fellowship are you interested in?
 
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Hey all,

Nice to meet you all. I've been a fixture in the EM forum on here for a long time. Gotta admit it; I was really torn between EM and FM/IM when I matched.
Now, I'm 11 years down the line, and I'm pretty sure I'm burned out of EM for keeps.

Before anyone goes there (including myself), in no way do I think I can do an FP's job as well as any residency trained FP. I'm considering urgent care work, or maybe (some sort of) fellowship. The real jumping-off point here is: What could a smart doc do to better understand the outpatient/clinic world, and broaden his fund of knowledge to better dovetail in with your sphere of medicine?

I come in peace. No flames intended.
Your training is plenty good as is for Urgent Care, you could safely start tomorrow.

For general primary care, this would be a good start: AAFP Family Medicine Board Review<br>Self-Study Package
 
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Link0358

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Fellowships... Hmm.

Critical care is out.
I think tox has very limited career options.

Would strongly consider anything that gets me away from a "hospital".
Any interest in a sports medicine fellowship?
It is open for EM to apply to, and is mostly outpatient.
 

smq123

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I guess the other question is, what about EM are you burned out on? The patients? The schedule?
 

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@RustedFox Few ED docs who burnt out in ED seem to like palliative care

 

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What about palliative care?

Urgent care would work. I will say though that I looked in to a per diem urgent care job and I thought it seemed like it was def the corporate mentality of crank through patients and quotas. So might be better than ED but might not be the "break" you’re looking for.
 

RustedFox

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I guess the other question is, what about EM are you burned out on? The patients? The schedule?

Both, and more.
Patients. Schedule. Admin. The fact that 75% of cases that come thru the ER aren't at all emergencies, but rather people who can't "adult". The fact that it's not an "emergency department" as much as it is an outpatient lab and 24-hour social services referral center. I could go on and on.

But in short; its not worth taking years off of my life in terms of its toll on my physical and mental health.
 
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RustedFox

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What about palliative care?

Urgent care would work. I will say though that I looked in to a per diem urgent care job and I thought it seemed like it was def the corporate mentality of crank through patients and quotas. So might be better than ED but might not be the "break" you’re looking for.

I know a Palliative Care doc (two, actually - one EM and one IM). They love it. I might find it depressing as all get-out, but I'm rolling that option around in my brain.
 

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Both, and more.
Patients. Schedule. Admin. The fact that 75% of cases that come thru the ER aren't at all emergencies, but rather people who can't "adult". The fact that it's not an "emergency department" as much as it is an outpatient lab and 24-hour social services referral center. I could go on and on.

But in short; its not worth taking years off of my life in terms of its toll on my physical and mental health.
Wow does every field have this? In psych personally, and I feel like this is very common. Would we have jobs if these pts weren’t around though?
 
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Both, and more.
Patients. Schedule. Admin. The fact that 75% of cases that come thru the ER aren't at all emergencies, but rather people who can't "adult". The fact that it's not an "emergency department" as much as it is an outpatient lab and 24-hour social services referral center. I could go on and on.

But in short; its not worth taking years off of my life in terms of its toll on my physical and mental health.

Urgent care is right up your alley. I say this as someone who does it regularly. In regards to the patient who can’t adult and managing their expectations, I believe it’s mostly mettled because it’s an urgent care and not an ER and most patients view it as same-day primary care rather than OMG-life-in-danger place. If its a true emergency, then the patient is referred to an ER ... and you get to bill usually a 99214-215 depending on craziness. No social services involved and by the nature of coverage and logistics of labs usually not on site, a lot of things can be (appropriately so) deferred to be done/ worked up with their primary care doc.
 
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RustedFox

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Wow does every field have this? In psych personally, and I feel like this is very common. Would we have jobs if these pts weren’t around though?

But you see, in psych... you're looking to solve that specific problem, and you get to turn them away.
In the ER, they just walk in whenever they want to, and admin demands that you see them in :10 minutes or less, and is primarily concerned with their satisfaction, rather than their safety or, even whether they should or should not be here.
 
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Look into the rules for states that don't have certificates of need for opening up hospitals.

If the rules look favorable, go to such a state that lacks CON and find a handful of other like minded burned out docs. Open up a small urgent care with an attached 10 bed general IM unit and a 6 bed psych unit. Have a basic imaging suite, and a mix used GI / ECT suite for the Psych.

Form a small doc group, where the IM/FM can admit their own patients, and with the basic procedure suite do all their own scopes etc. Then with you the ED doc doing your urgent care, you might even pick up a patient or 3 here and there that would be appropriate for this level of inpatient care the hospital can handle. Plus, you would be in house to field any urgent issues after hours on the 16 beds above.

Choose to only take the insurance that isn't a headache. Have big clear signs at entry to the urgent care warning people that these insurances you are OON for. Then have the disclaimer forms for it too if they still walk in.

Adjust things as necessary to make it viable.

Be the founding member, and keep more of one foot in the admin side of things making sure it stays a safe haven for burned out docs.
 
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Welcome to the FM side. Urgent care could be a pretty easy transition for you. No more nights, but much higher volume, typically.
In urgent care, it's not unusual to see >50 patients in a 12 hour shift. In primary care, it's non unusual to address 50+ problems in a day. Patient volume beats problem volume every time. At least, for now. 99213 x 50 > [(99214 x 17) + (99213 x 5)]

I have several FM colleagues locally who work 3-4 days/week. Most earn comfortably over $300,000. From what I understand, there are still "quality metrics" but not anything like what you describe.
 
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You should go back and become a psychiatrist. It is 3 years, and there will be hospital work in residency, but once done you don't ever have to set foot in a hospital again.
 
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We have EM, prev med, OBGYN, and former psych physicians working in general practitioners. I don't see why you cannot work in an FM clinic. I would recommend FM CMEs.

Good luck.
 

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We’re so supportive lol.
When FM goes over to the EM board the reaction is the exact opposite.

I was on a virtual panel recently with a different speciality that does similar to the work I do and it was a great reminder that FM docs are def my people!
 
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Many groups (including mine) won't hire you unless you're board certified in the specialty that you practice.
We just fired a guy because he let his BC lapse and refused to do anything about it. Really a shame, because his patients are massively drug addicted and poorly managed and now its everyone else's problem.
 
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We’re so supportive lol.
When FM goes over to the EM board the reaction is the exact opposite.

I was on a virtual panel recently with a different speciality that does similar to the work I do and it was a great reminder that FM docs are def my people!
You mean how an ED without BC EM doctors shouldn't even be called an ED anymore?

My wife is an internist so I see this every single day and completely agree with the bold.
 
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We just fired a guy because he let his BC lapse and refused to do anything about it.

Ditto. We also had a guy who let his BC lapse a few months before he was due to retire. He didn't get fired, but he was booted off most commercial insurance panels, as they also require you to be BC/BE. He didn't care, though, since most of his patients were Medicare anyway.
 

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Ditto. We also had a guy who let his BC lapse a few months before he was due to retire. He didn't get fired, but he was booted off most commercial insurance panels, as they also require you to be BC/BE. He didn't care, though, since most of his patients were Medicare anyway.
The guy I took over for in August did the same. BC lapsed Jan. 1 of this year, the hospital let him stay another 7 months so he could retire on his 65th birthday.
 

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Welcome to the FM side. Urgent care could be a pretty easy transition for you. No more nights, but much higher volume, typically.
In urgent care, it's not unusual to see >50 patients in a 12 hour shift. In primary care, it's non unusual to address 50+ problems in a day. Patient volume beats problem volume every time. At least, for now. 99213 x 50 > [(99214 x 17) + (99213 x 5)]

I have several FM colleagues locally who work 3-4 days/week. Most earn comfortably over $300,000. From what I understand, there are still "quality metrics" but not anything like what you describe.

Underrated post. For E&M specialties, including mine (PM&R), this is one way to make a lot of money without having to work long hours. A setting that lends itself to high volume.
 
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We’re so supportive lol.
When FM goes over to the EM board the reaction is the exact opposite.

I was on a virtual panel recently with a different speciality that does similar to the work I do and it was a great reminder that FM docs are def my people!

I’m starting to get this finding your people thing. We had a specialty week where every evening there were calls with program directors from different specialties and I felt the most relaxed and like I totally gelled with everyone was in the FM call lol.
 
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I’m starting to get this finding your people thing. We had a specialty week where every evening there were calls with program directors from different specialties and I felt the most relaxed and like I totally gelled with everyone was in the FM call lol.
That's how it starts...

 
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What about palliative care?

I know a Palliative Care doc (two, actually - one EM and one IM). They love it. I might find it depressing as all get-out, but I'm rolling that option around in my brain.

Some good news: no one ever regrets palliative medicine.

The doc that places the consult...
The patient...
Their family...
The actual palliative doc who subspecialized...

No one regrets palliative medicine. 😃
 
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Frazier

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Also, I bet you wouldn't find it depressing.

The actual practice isn't anywhere near as gloomy as many might perceive from outside the field.
 
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No sure if this is a troll, I assume not b/c his other posts are always legit.

But Urgent care would essentially be EM with 2x the pt/hr and 1/2 the pay. UC patients have the same "adult" issues as the ER. Actually most clinics have their own "adult" acting issues.

Why not just work 1/2 the amount of shifts, make same amount as full time UC?
 
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No sure if this is a troll, I assume not b/c his other posts are always legit.

But Urgent care would essentially be EM with 2x the pt/hr and 1/2 the pay. UC patients have the same "adult" issues as the ER. Actually most clinics have their own "adult" acting issues.

Why not just work 1/2 the amount of shifts, make same amount as full time UC?
I would disagree with this. You have to pay for UC visits, that keeps a lot of the nonsense out.

No IV pain meds so drug seekers are much more rare.

Can't usually admit people so you don't usually get NH dumps or patients wanting you to call their specialist.

If someone is too sick, you can send them to the ED.

And most importantly, you have the ability to turn away patients.
 
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RustedFox

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No sure if this is a troll, I assume not b/c his other posts are always legit.

But Urgent care would essentially be EM with 2x the pt/hr and 1/2 the pay. UC patients have the same "adult" issues as the ER. Actually most clinics have their own "adult" acting issues.

Why not just work 1/2 the amount of shifts, make same amount as full time UC?

In no way a troll post. Good looking out, though.
EM is no longer worth the:

1. Constant disruption to circadian rhythm.
2. Abuse from patients.
3. Abuse from administration.
4. Pointless transfers from nursing homes.
5. I could go on and on, but VA Hopeful doc hit the nail on the head.
 
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sloh

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There's a reason their forum is full of posts about retiring early, fellowships that don't involve working in the ED, and burn out.

The focus on pain fellowship as a plan B probably isn’t the wisest move as well. It’s a pretty high burnout sub specialty (while the schedule is more consistent than EM, the hours are still quite long; patients are emotionally draining) and I get a lot of DM’s from pain docs wanting to switch out of interventional pain and do SNF work (1099 SAR). Think about that for a second. Switching from pain to SAR work and basically throwing that fellowship training away.
 

VA Hopeful Dr

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The focus on pain fellowship as a plan B probably isn’t the wisest move as well. It’s a pretty high burnout sub specialty (while the schedule is more consistent than EM, the hours are still quite long; patients are emotionally draining) and I get a lot of DM’s from pain docs wanting to switch out of interventional pain and do SNF work (1099 SAR). Think about that for a second. Switching from pain to SAR work and basically throwing that fellowship training away.
I'm sure it can be. There's an EP who practices pain and is quite active in their forum talking about it.

I think many of us take for granted our jobs that don't involve night shifts or holidays, have the ability to fire/refuse to see patients, and allow for control of schedule (lunch breaks, max patients/day, that sort of thing).
 
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Matthew9Thirtyfive

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I think many of us take for granted our jobs that don't involve night shifts or holidays, have the ability to fire/refuse to see patients, and allow for control of schedule (lunch breaks, max patients/day, that sort of thing).

Can you eat regularly?
 
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We're required to work 36 hours/week and I'm not giving up my lunch break in exchange for Wednesday mornings.

Plus at my current level of busy, that Wednesday morning is worth about 40k/year.

Yeah, I could make quite a bit more if I worked 5 days/week rather than 4 (possibly as much as 50% more, assuming a full schedule). But, I'm happy with my income as-is, and I can't put a price on my sanity.
 
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I've toyed with the idea of taking Fridays off instead, but the mid-week break really makes the week fly by.

Wednesday is my admin day, so I agree!
It’s nice to see patients Mon & Tues, admin Wed and then patients again in Thurs.

To be fair, I do work my other job sometimes on Fri and Sat so don’t be too jealous (I pick my own schedule though)!
 

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Yeah, I'm super jealous of all y'all with a regular schedule.
The pay increase in EM be damned.
Looking at a clock from 2-7am while laying sleepless in bed isn't a "day off".
 
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