EP looking to broaden scope, maybe purse some FM, maybe not.

[PunkRockMD]

Good friend of mine opened a vasectomy clinic. He is not fully out of the ED yet but he's getting close. Definitely location dependent though.

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[SLC]

Can you eat regularly?

I take a 2hr lunch break.

 

[Reboa]

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!

Exactly this. 51 posts and not one person dissuading someone without the proper training from working in family med. Whereas any of us residents ask a question about any work that infringes on someone’s turf, i.e. Em fellowships, and we get shut down immediately. It sure would be nice if our em colleagues would give us the same respect we give them or even the same respect they give their Ed pas/nps

 

[deleted87716]

Exactly this. 51 posts and not one person dissuading someone without the proper training from working in family med. Whereas any of us residents ask a question about any work that infringes on someone’s turf, i.e. Em fellowships, and we get shut down immediately. It sure would be nice if our em colleagues would give us the same respect we give them or even the same respect they give their Ed pas/nps

Technically, I’m not advocating EM working as FM. That requires BC, same as EM. Primary care is a big umbrella, however, and we can use all the qualified (and, yes, in making that distinction, I’m looking at you, independent NP/PA folks) help we can get.

 

[nowaysanjose]

Technically, I’m not advocating EM working as FM. That requires BC, same as EM. Primary care is a big umbrella, however, and we can use all the qualified (and, yes, in making that distinction, I’m looking at you, independent NP/PA folks) help we can get.

Can you define qualified? Would rads, path, or psych count?

 

[deleted87716]

Can you define qualified? Would rads, path, or psych count?

Not in my opinion. I've seen some serious mismanagement in urgent care by semi-retired specialists who clearly had no idea what they were doing.

 

[turkeyjerky]

Exactly this. 51 posts and not one person dissuading someone without the proper training from working in family med. Whereas any of us residents ask a question about any work that infringes on someone’s turf, i.e. Em fellowships, and we get shut down immediately. It sure would be nice if our em colleagues would give us the same respect we give them or even the same respect they give their Ed pas/nps

To be fair, the OP all but bent over backwards to say they weren't looking to practice FM. People don't come over to the EM forum to ask for advice on getting jobs working the FT section of an urban ER.

Also, not sure you want the same respect we give to the midlevels....

 

[RustedFox]

To be fair, the OP all but bent over backwards to say they weren't looking to practice FM. People don't come over to the EM forum to ask for advice on getting jobs working the FT section of an urban ER.

Also, not sure you want the same respect we give to the midlevels....

OP here.

Yeah; in no way am I going to hang my own shingle or join a FM practice and do straight-up FM.
My sentiment is rather: "I would like to learn how I can best broaden my skill set so as to be better functioning in a world outside of the ER. There's far more to medicine than the ED."

Oh yeah; and the "respect" that we give the MLPs is more "we have to work with you because the CMG says so; so don't eff everything up, mmkay?"

 

[RustedFox]

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.

So much this.
"Pay up front and be cooperative; if not - there's the door."

The one thing that really used to crush me is when I was single-coverage, and got hit with 2-3 of the "turbo-frequent-flyers" within an hour, knowing full well that it was going to be a mess that only took me away from running the department and put me behind on finishing my charting.

That would really blow my top.

One hospital that I worked in even asked us not to use the term "frequent flyers", as it sounded unkind. We were told to use the term "high-utilizers" because "feels". Yep. No matter how disruptive these people are, their feelings were more important than anything else, including "doing the right thing".

 

[door_to_balloon_knot]

So much this.
"Pay up front and be cooperative; if not - there's the door."

The one thing that really used to crush me is when I was single-coverage, and got hit with 2-3 of the "turbo-frequent-flyers" within an hour, knowing full well that it was going to be a mess that only took me away from running the department and put me behind on finishing my charting.

That would really blow my top.

One hospital that I worked in even asked us not to use the term "frequent flyers", as it sounded unkind. We were told to use the term "high-utilizers" because "feels". Yep. No matter how disruptive these people are, their feelings were more important than anything else, including "doing the right thing".

I think the overall theme of CHOICE and the ability to say no seems like it would make UC really attractive for you.

Join us on the dark side. >

 

[deleted87716]

One hospital that I worked in even asked us not to use the term "frequent flyers", as it sounded unkind. We were told to use the term "high-utilizers" because "feels". Yep. No matter how disruptive these people are, their feelings were more important than anything else, including "doing the right thing".

 

[sloh]

View attachment 324742

Much more important to know what sort of patient has all the diseases

 

[DocHoliday84]

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".

This is exactly where I'm at. Been an EM attending for 7 years at this point, and the circadian disruption is already so much harder to deal with than it was in the beginning. I'm pretty sure its real bad for one's health to live this way, so the fact that we feel horrible doing this is our body trying to tell us something. I'm going to stay with EM a bit longer to meet some financial goals I set for myself/my family, but as soon as that is done, I'm going to do hospice. No more nights. Can you imagine? Most exciting thought in the world to me right now.

 

[Frazier]

This is exactly where I'm at. Been an EM attending for 7 years at this point, and the circadian disruption is already so much harder to deal with than it was in the beginning. I'm pretty sure its real bad for one's health to live this way, so the fact that we feel horrible doing this is our body trying to tell us something. I'm going to stay with EM a bit longer to meet some financial goals I set for myself/my family, but as soon as that is done, I'm going to do hospice. No more nights. Can you imagine? Most exciting thought in the world to me right now.

Just to set you up for realistic expectations, as a hospice medical director you will still be at risk of interrupted sleep at night...

Hospice nurses will call you if needed to provide guidance with refractory/unexpected symptom crises. That said, I imagine you meant no more nights as in "night shift circadian rhythm destruction" -- in which case, you're right on.

 

[RustedFox]

This is exactly where I'm at. Been an EM attending for 7 years at this point, and the circadian disruption is already so much harder to deal with than it was in the beginning. I'm pretty sure its real bad for one's health to live this way, so the fact that we feel horrible doing this is our body trying to tell us something. I'm going to stay with EM a bit longer to meet some financial goals I set for myself/my family, but as soon as that is done, I'm going to do hospice. No more nights. Can you imagine? Most exciting thought in the world to me right now.

I'm 8 years out of residency.
It's awful; more so when the ER is flooded with neither emergent nor urgent complaints from midnight on.
Then, you're just babysitting.

I'm on the Urgent Care job hunt right now. I expected a pay cut, but it will be worth it to my sanity.

 

[RustedFox]

This is exactly where I'm at. Been an EM attending for 7 years at this point, and the circadian disruption is already so much harder to deal with than it was in the beginning. I'm pretty sure its real bad for one's health to live this way, so the fact that we feel horrible doing this is our body trying to tell us something. I'm going to stay with EM a bit longer to meet some financial goals I set for myself/my family, but as soon as that is done, I'm going to do hospice. No more nights. Can you imagine? Most exciting thought in the world to me right now.

I don't have the citation handy right now; but it's recognized as a CV risk factor, yes.
Simple Google-Fu will do it.

 

[RustedFox]

Okay, amigos - I'm on the urgent care train. Gonna dip my toes in the water. Still staying on the roster at a few ER sites just because I can. I'll "pinch hit" at those sites if and when I can, or feel like it.

As a generality; I know I'm taking a (welcome) paycut; but if anyone can give me an approximate hourly rate, that'd be great. I don't want to just have "zero idea" that I'm being lowballed and foolishly miss the opportunity to negotiate.

 

[door_to_balloon_knot]

Okay, amigos - I'm on the urgent care train. Gonna dip my toes in the water. Still staying on the roster at a few ER sites just because I can. I'll "pinch hit" at those sites if and when I can, or feel like it.

As a generality; I know I'm taking a (welcome) paycut; but if anyone can give me an approximate hourly rate, that'd be great. I don't want to just have "zero idea" that I'm being lowballed and foolishly miss the opportunity to negotiate.

Southern CA location here. Anecdotal info, but no **** ~$150+/- 25/hr as per diem. Some places are that-ish plus productivity as staff. Salaried is some where around $250-280k but I’m not as in touch anymore as salaried is the worst position to be in. Residents moonlighting were making $90-110/hr. Someone correct me if they are seeing different. Obvi going to less than ER no matter which way you slice it unless I’m just really out of touch with ER compensation. Tbh would use something like a physician contract negotiator who has access to MGMA data for the local area and pay them the whatever couple of hundred/ grands to sort it out for you; more than likely you’ll make that back and then some within the first few months if they can negotiate a higher compensation.

 

[AMEHigh]

Okay, amigos - I'm on the urgent care train. Gonna dip my toes in the water. Still staying on the roster at a few ER sites just because I can. I'll "pinch hit" at those sites if and when I can, or feel like it.

As a generality; I know I'm taking a (welcome) paycut; but if anyone can give me an approximate hourly rate, that'd be great. I don't want to just have "zero idea" that I'm being lowballed and foolishly miss the opportunity to negotiate.

In my area it’s $125-$150 for one large local chain that I briefly interviewed at. I’m in a city that typically doesn’t pay super higher for physicians in general. I think that was a standard rate regardless of specialty, so I don’t think EM got paid more.

Good luck!

 

[sloh]

Southern CA location here. Anecdotal info, but no **** ~$150+/- 25/hr as per diem. Some places are that-ish plus productivity as staff. Salaried is some where around $250-280k but I’m not as in touch anymore as salaried is the worst position to be in. Residents moonlighting were making $90-110/hr. Someone correct me if they are seeing different. Obvi going to less than ER no matter which way you slice it unless I’m just really out of touch with ER compensation. Tbh would use something like a physician contract negotiator who has access to MGMA data for the local area and pay them the whatever couple of hundred/ grands to sort it out for you; more than likely you’ll make that back and then some within the first few months if they can negotiate a higher compensation.

Are the productivity goals easy to hit for these jobs? I'm curious if it's possible to make 350-400k with urgent care if the physician is really efficient.

 

[DocHoliday84]

Just to set you up for realistic expectations, as a hospice medical director you will still be at risk of interrupted sleep at night...

Hospice nurses will call you if needed to provide guidance with refractory/unexpected symptom crises. That said, I imagine you meant no more nights as in "night shift circadian rhythm destruction" -- in which case, you're right on.

Yeah, I figured there would be some call. A week of call q6 weeks is common I am guessing?

How has your experience with these calls been? as far as middle of the night goes, best case scenario for me is to be able to talk to the nurse and answer the question on the phone without having to break out the computer and look at a screen. Not sure if this is a realistic expectation though...I guess as long as I can stay at home and not go in in the middle of the night that is probably the main thing.

 

[Frazier]

Yeah, I figured there would be some call. A week of call q6 weeks is common I am guessing?

How has your experience with these calls been? as far as middle of the night goes, best case scenario for me is to be able to talk to the nurse and answer the question on the phone without having to break out the computer and look at a screen. Not sure if this is a realistic expectation though...I guess as long as I can stay at home and not go in in the middle of the night that is probably the main thing.

That's a pretty good summary. The frequency of call as you know will depend on how many docs are on the team to rotate. If you are at a more robust hospice, Q6-8 weeks is possible. If it is a small operation, Q2-3 weeks might be their reality.

When it comes to frequency of actual phone calls, that will have a lot to do with your hospice nurses. The acuity of the patient is there no matter what... they all have serious illness, they are all dying, they all have potential to have symptoms become a crisis. Your team of nurses will be the ones fielding initial calls and going to the homes at all times of day and night. If your nurses are good at putting out fires, or better yet, anticipating fires before they turn into a conflagaration, then the patient will have an excellent plan heading into the night as the nurse and yourself will have put together plan A, B, C etc during the day. You might not need to be called at all... Or maybe you do, whatever is best for the patient. However many many seasoned hospice nurses are superb at managing end-of-life needs at bedside for the patient and their family. When the plan gets hairy, or something arises that wasnt prepped for, they will need your medical direction.

Another facet is the census, if you have 20 patients in your territory it will be a different call burden than if you have 200 patients.

Lastly, you will have a pretty good idea about these folks between either certifying them yourself or reviewing them all during weekly IDT -- so there shouldn't be a large number of surprise patients that require you to open the computer at 2am to learn about them. Also your nurses will be able to provide you a nice summary over the phone -- PMH blurb, current sxs burden, what has been tried, what they are hoping to achieve. Some might perhaps even have some reccs in mind already, and will just need a verbal order that can be signed in the AM.

Call is not terrible by any means compared to the rest of the medical world-- but I suppose it could be if you had frequent call, with a huge census, and all brand new/unfriendly/lazy nurses. This has not been my experience. The nurses that choose this line of work tend to do so for good reason.

 

[DocHoliday84]

That's a pretty good summary. The frequency of call as you know will depend on how many docs are on the team to rotate. If you are at a more robust hospice, Q6-8 weeks is possible. If it is a small operation, Q2-3 weeks might be their reality.

When it comes to frequency of actual phone calls, that will have a lot to do with your hospice nurses. The acuity of the patient is there no matter what... they all have serious illness, they are all dying, they all have potential to have symptoms become a crisis. Your team of nurses will be the ones fielding initial calls and going to the homes at all times of day and night. If your nurses are good at putting out fires, or better yet, anticipating fires before they turn into a conflagaration, then the patient will have an excellent plan heading into the night as the nurse and yourself will have put together plan A, B, C etc during the day. You might not need to be called at all... Or maybe you do, whatever is best for the patient. However many many seasoned hospice nurses are superb at managing end-of-life needs at bedside for the patient and their family. When the plan gets hairy, or something arises that wasnt prepped for, they will need your medical direction.

Another facet is the census, if you have 20 patients in your territory it will be a different call burden than if you have 200 patients.

Lastly, you will have a pretty good idea about these folks between either certifying them yourself or reviewing them all during weekly IDT -- so there shouldn't be a large number of surprise patients that require you to open the computer at 2am to learn about them. Also your nurses will be able to provide you a nice summary over the phone -- PMH blurb, current sxs burden, what has been tried, what they are hoping to achieve. Some might perhaps even have some reccs in mind already, and will just need a verbal order that can be signed in the AM.

Call is not terrible by any means compared to the rest of the medical world-- but I suppose it could be if you had frequent call, with a huge census, and all brand new/unfriendly/lazy nurses. This has not been my experience. The nurses that choose this line of work tend to do so for good reason.

Cool. Nice to hear that about the nurses, that makes such a big difference. Very helpful response. Much appreciated.

Here is a question that I have been curious about as well. Anyone know of someone who did an FM residency after being an attending in another specialty like EM? Would they let you start as a PGY2?

 

[VA Hopeful Dr]

Cool. Nice to hear that about the nurses, that makes such a big difference. Very helpful response. Much appreciated.

Here is a question that I have been curious about as well. Anyone know of someone who did an FM residency after being an attending in another specialty like EM? Would they let you start as a PGY2?

In my program we took on someone as a PGY-2 who finished 3 years of an OB residency and then practiced as a GP for 14 years before coming to us.

So it does happen.

 

[Sushirolls]

I've got Natropaths peddling hyperbaric chambers in my area.

I suppose EM could do a hyperabaric fellowship and then open up an outpatient clinic and sell the snake oil of the chamber.

 

[RustedFox]

I've got Natropaths peddling hyperbaric chambers in my area.

I suppose EM could do a hyperabaric fellowship and then open up an outpatient clinic and sell the snake oil of the chamber.

I refuse to ever be a snake oil salesman. My area has a LOT of FM docs peddling expensive vitamins, "chelation therapy", platelet rich plasma, etc.

Cool. Nice to hear that about the nurses, that makes such a big difference. Very helpful response. Much appreciated.

Here is a question that I have been curious about as well. Anyone know of someone who did an FM residency after being an attending in another specialty like EM? Would they let you start as a PGY2?

Glad someone else is asking this, as well. If it weren't a full 3-year time commitment, I would also consider a FM residency. However, there is zero sense in me spending 100 hours a week doing admissions or other scutwork.

 

[VA Hopeful Dr]

I refuse to ever be a snake oil salesman. My area has a LOT of FM docs peddling expensive vitamins, "chelation therapy", platelet rich plasma, etc.



Glad someone else is asking this, as well. If it weren't a full 3-year time commitment, I would also consider a FM residency. However, there is zero sense in me spending 100 hours a week doing admissions or other scutwork.

There's almost no way you'd have to do all 3 years.

And new duty hour rules, no more than 80 these days. Plus if you get to skip intern year you escape a lot of scut work.

 

[Doc Doc Doc Goose]

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".

Are you sure that it’s just EM that has you burnt out? Or maybe just the practice of medicine in general?

 

[Make Or Break]

Okay, amigos - I'm on the urgent care train. Gonna dip my toes in the water. Still staying on the roster at a few ER sites just because I can. I'll "pinch hit" at those sites if and when I can, or feel like it.

As a generality; I know I'm taking a (welcome) paycut; but if anyone can give me an approximate hourly rate, that'd be great. I don't want to just have "zero idea" that I'm being lowballed and foolishly miss the opportunity to negotiate.

I’m at 110/hr as a resident moonlighting

 

[scharnhorst]

why are some FPs doing allergy medicine ? I thought only IM can go into that field ?

 

[VA Hopeful Dr]

why are some FPs doing allergy medicine ? I thought only IM can go into that field ?

Any examples of this?