Fellowships

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SunFlowerGirl48

SunFlowerGirl48

Full Member
5+ Year Member
What are some fellowships to do out of an EM residency, that gets you into more of a normal 9-5?

Pain
Palliative Care

What are some others?

How is ICU scheduling. Can you just do 7 on and 7 off of days?
 
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Pain, palliative, sports med,

ems if you become a full time ems Director (huge pay cut and more likely to be the ems guy for whatever job you’re at)

Toxicology and you can find a full time tox job (again, pay cut and probably gonna be the tox guy wherever you go)

As a side note: I would love to work in a wound care clinic but I’m not sure how to get started. There’s no EM fellowship as far as I know.
 
Keep in mind all of these things pay far less than emergency medicine (maybe not pain if you’re crazy good). You’d be better off doing locums with a pick your own dayshift only schedule and having way more time off than doing a fellowship just for the sake of working bankers hours.
 
CC pays about the same as EM, more in some areas/less in others. It’s a better job than straight EM community medicine, more sustainable and less nights and much less frustration at work. I don’t think you’ll find a 9-5 cc job but might be able too. I do only day shifts 7/7 model depending on the facility (acuity) 8-11 hr shifts.

Pain is probably what you are looking for if you want that 9-5 model and more/similar money. But you gotta do Pain (why do EM if you want to do outpatient pain management). Palliative Care isn’t really 9-5 in my experience it’s less than that. Good gig but big payout.
 
Tenk said:
Keep in mind all of these things pay far less than emergency medicine (maybe not pain if you’re crazy good).
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I make more doing Pain than I ever did in EM, with a much healthier lifestyle, pace & sleep schedule. Pain MGMA average salary is higher than EM and has been for as long as I've been looking at it (at least 8-9 years) so you don't have to be crazy good (whatever that means) to earn more. You only have to be average. A fair amount of procedures plus being able to pick and choose patients and insurances makes this pretty easy to do, like most procedural based sub-specialties.
 
EM vs Pain MGMA (note separate Anesthesia/Pain and non-anesthesia/Pain lines)

forums.studentdoctor.net

Updated MGMA?

Does anyone have the 2019 MGMA info representing 2018 for anes Pain? A friend had it for a different specialty so I know it’s out.
forums.studentdoctor.net forums.studentdoctor.net
 
Birdstrike said:
I make more doing Pain than I ever did in EM, with a much healthier lifestyle, pace & sleep schedule. Pain MGMA average salary is higher than EM and has been for as long as I've been looking at it (at least 8-9 years) so you don't have to be crazy good (whatever that means) to earn more. You only have to be average. A fair amount of procedures plus being able to pick and choose patients and insurances makes this pretty easy to do, like most procedural based sub-specialties.
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$/hr. Not salary.

If you worked 7-5, 5 days a week in EM at a non crap job, you’d clear over $600,000. Work at a great job and you’d make almost $800,000. It’s hard to beat EM $/hr in any specialty.

Feel free to show me the pain jobs that pay $250-300/hr though. I’m sure the people who have them are in fact, crazy good at what they do. Crazy good = good, fast work ethic and ability to do procedures fast and efficient btw. Just means you aren’t bad. Hope that clears that up for you.
 
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Tenk said:
Feel free to show me the pain jobs that pay $250-300/hr though.
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Some may beat it, but on average, the hourly is a wash. Do the math yourself, from the MGMA Pain: Non-anesthesia South Region: $480K divided by (40 hr/wk * 46 wk/yr) = $260/hr. And that's not even the highest paid region (Midwest is >$500k).

But here's the kicker. When I worked in EM, 30 hrs per week felt more like 45. And 48 hours per week in EM felt more like 78 per week. You might remember that I've posted several times to EM applicants that they should multiply the hours they think they're going to be working in EM x 1.5, because it'll take 50% greater a toll than a job with stable, non-schizoid, non-circadian scrambling hours. For that reason, the 36 hours per week I work now, feels more like 24 hr per week felt like in EM. But that's just me. That rule may not apply to everyone. Maybe I turned out to be more prone to circadian rhythm disruption than average, I don't know.

I make good money. I work less than 40 hr per week. My stress is 95% less than what it used to be and I have a peace of mind I couldn't find before when I felt like my schedule made my mind feel like it was tumbling around in a clothes dryer, shredding my circadian rhythms to bits, causing chronic dysphoria. And I'm completely okay with the fact that certain people think, from the outside looking in, that what I do wouldn't work for them. And EM works for you. So that's awesome. It's not about the money. It's what makes you happy. And as long as you are, that's what matters.
 
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The thing about pain is that it is competitive. Usually anesthesia has a strangle hold of those fellowships.

Hyperbarics is not an acgme fellowship so I doubt you can truly parlay that into something else like a wound care clinic that you couldn’t do as an attending
 
Hyperbarics looks like it is accredited. But also 2 years. 2 years of fellow income sounds rough!

Could swear I heard in residency you could get certified in hyperbarics in a 6 weeks course. Maybe that’s a simpler way to get in?
 
I stand corrected but I thought it was one year two years and no niche other than maybe wound care or academics makes it intolerable
 
Tenk said:
Keep in mind all of these things pay far less than emergency medicine (maybe not pain if you’re crazy good). You’d be better off doing locums with a pick your own dayshift only schedule and having way more time off than doing a fellowship just for the sake of working bankers hours.
Click to expand...

But...you will have greater longevity and possibly higher QOL working a regular schedule. Bird is wise on this one.

Ten years out, nights, weekends, and holidays are really taking their toll. If you have done locums where you can "pick your own schedule" that's great- usually hospitals want to give their full-timers a break and require locums to work a variety of shifts. I'm not seeing $250 an hour days-only locums jobs that last. Locums doesn't pay for the hours spent traveling, either, although for some reason people rarely take this into consideration. So locums really needs to pay a premium over a local EM job and a 9-5 gig, and I just haven't seen that in the offers currently out there.

EM pays BECAUSE of the antisocial hours. Give that up and you give up the pay.

Don't underestimate the impact of a nonstandard schedule on your longevity, satisfaction, and QOL. If it's not for you, accept that and pick one of the fields mentioned above, namely Pain, Palli, Occ Med, or Sports. I would avoid ICU if you are concerned about burnout and an antisocial schedule since the field is moving towards in-house call, although it pays and the schedule is better than EM.
 
It's still social you are only working 12 or so days and with the money made you can cut down to half and make 200k
 
miacomet said:
But...you will have greater longevity and possibly higher QOL working a regular schedule. Bird is wise on this one.

Ten years out, nights, weekends, and holidays are really taking their toll. If you have done locums where you can "pick your own schedule" that's great- usually hospitals want to give their full-timers a break and require locums to work a variety of shifts. I'm not seeing $250 an hour days-only locums jobs that last. Locums doesn't pay for the hours spent traveling, either, although for some reason people rarely take this into consideration. So locums really needs to pay a premium over a local EM job and a 9-5 gig, and I just haven't seen that in the offers currently out there.

EM pays BECAUSE of the antisocial hours. Give that up and you give up the pay.

Don't underestimate the impact of a nonstandard schedule on your longevity, satisfaction, and QOL. If it's not for you, accept that and pick one of the fields mentioned above, namely Pain, Palli, Occ Med, or Sports. I would avoid ICU if you are concerned about burnout and an antisocial schedule since the field is moving towards in-house call, although it pays and the schedule is better than EM.
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This is true if you get caught up having to make $400,000+ income. If you just work far less and are happy with $200-300,000 your life becomes amazingly better. A couple of years ago I was making almost $500,000. I was also working a ton. I cut my hours significantly after paying off all my loans and am now in the $300,000 range but I have so much time off right now it’s great. In all those other fellowship specialties you’re going to be working a ton more days which means you’ll have difficulty doing fun stuff on your off days because all those chores (house chores, doctor visits, finances, etc) all stack up. I also enjoy my job which is a plus. I know many of you don’t which is a bummer.

Lifestyle means different things for different people. For me it translates directly into days off. I’d rather work in an absolute hell hole for 7 days a month than a wonderful job 20 days a month and clear the same amount. For many they might want the 20 days a month job. You really can’t make absolute generalizations here because it’s different for everyone. It is why in my original post I didn’t touch on lifestyle and only talked about $/hr of which only pain can go toe to toe with EM on a reliable basis.
 
Birdstrike said:
Some may beat it, but on average, the hourly is a wash. Do the math yourself, from the MGMA Pain: Non-anesthesia South Region: $480K divided by (40 hr/wk * 46 wk/yr) = $260/hr. And that's not even the highest paid region (Midwest is >$500k).

But here's the kicker. When I worked in EM, 30 hrs per week felt more like 45. And 48 hours per week in EM felt more like 78 per week. You might remember that I've posted several times to EM applicants that they should multiply the hours they think they're going to be working in EM x 1.5, because it'll take 50% greater a toll than a job with stable, non-schizoid, non-circadian scrambling hours. For that reason, the 36 hours per week I work now, feels more like 24 hr per week felt like in EM. But that's just me. That rule may not apply to everyone. Maybe I turned out to be more prone to circadian rhythm disruption than average, I don't know.

I make good money. I work less than 40 hr per week. My stress is 95% less than what it used to be and I have a peace of mind I couldn't find before when I felt like my schedule made my mind feel like it was tumbling around in a clothes dryer, shredding my circadian rhythms to bits, causing chronic dysphoria. And I'm completely okay with the fact that certain people think, from the outside looking in, that what I do wouldn't work for them. And EM works for you. So that's awesome. It's not about the money. It's what makes you happy. And as long as you are, that's what matters.
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Yo man! I would choose another job if I made 10-20% less with 95% less stress and normal hours. Sounds appealing. Especially that you get to pick and choose your patients. 😎 And even better if you are making more than you used to as well.
 
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miacomet said:
But...you will have greater longevity and possibly higher QOL working a regular schedule. Bird is wise on this one.

Ten years out, nights, weekends, and holidays are really taking their toll. If you have done locums where you can "pick your own schedule" that's great- usually hospitals want to give their full-timers a break and require locums to work a variety of shifts. I'm not seeing $250 an hour days-only locums jobs that last. Locums doesn't pay for the hours spent traveling, either, although for some reason people rarely take this into consideration. So locums really needs to pay a premium over a local EM job and a 9-5 gig, and I just haven't seen that in the offers currently out there.

EM pays BECAUSE of the antisocial hours. Give that up and you give up the pay.

Don't underestimate the impact of a nonstandard schedule on your longevity, satisfaction, and QOL. If it's not for you, accept that and pick one of the fields mentioned above, namely Pain, Palli, Occ Med, or Sports. I would avoid ICU if you are concerned about burnout and an antisocial schedule since the field is moving towards in-house call, although it pays and the schedule is better than EM.
Click to expand...

Yeah a lot of the icu jobs are still day only though I see a lot of the 7/7 schedule where you may have a few weeks of nights a year but rest days.
 
As others have stated, ultimately it's about obtaining maximal happiness. For some, that's a 9-5 job after a pain fellowship. For me, if I had to go to pain clinic, you would find me at 8:30AM in the garage with the car running and a hose hooked up to the tailpipe. No amazing schedule could make me enjoy it. I think it's important to differentiate the trade off between "great schedule + doing what I hate" and "horrible schedule + doing what I love". For me, trying to find a balance between those two ends of the spectrum has always been challenging. Derm was appealing to me for many reasons, but I would do what I hate. Surgery was appealing to me for many reasons, but I wouldn't have lasted through the residency. For me, I think EM is more leaning towards the horrible schedule + doing what I love part of the spectrum. I think the constant goal is to find a way to pull you more towards the middle. Pain management/palliative care are definitely viable options, IF and only if you actually like the medicine. An overnight 12 hour shift in our resuscitation area for me flies by in the equivalent of 4 hours. A 9-5 in a pain clinic would be slow and painful torture for me.

For me, I see the appeal to academics. Many faculty in their 50s or 60s are working 6 clinical shifts a month (and no nights in our academic group). Sure, they work an additional 20 days a month. But depending on what they do, those days are a 9-5 job. Roll into the office at 9am, go to some meetings, do some research, give some lectures. Travel to some conferences. Grab lunch with your colleagues, go on an evening bike ride and then relax at home for the evening. Sure, there are pressures to publish, to get promoted, etc, so it's definitely not all rainbows and unicorns in the academic world.

Unlike the above poster, I would rather have 7 hectic clinical shifts and 20 days of work, than 7 hectic clinical shifts and 23 days off. I know that makes me crazy, but overall, I like medicine, I like the workplace, I like working with residents, students, etc. If I hate it after awhile, I'll leave and do something else.

I am also horrible at rock climbing. I mean what else do EM docs do outside of work? I would be bored out of my mind.

Critical care called to me awhile ago, but I don't think working in an ICU with mechanically ventilated patients of which roughly 1 in 3 will never leave your ICU is the key to solving the burnout problem. It's a phenomenal subspecialty that we have access to, but go into it for the right reasons. Nobody should be saying, "I'm going into CCM for the lifestyle".

Whatever you do, don't fall into the trap of making EM "just a job that pays the bills". While financial success is, IMO one of the many pillars of happiness and stability, it is only one pillar. If you hate your job, it won't be worth it. Strive for something within EM that makes you happy and gives meaning to your work.
 
TheComebacKid said:
A 9-5 in a pain clinic would be slow and painful torture for me.
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Maybe, maybe not. 2 days per week I do nothing but cool fluoro-guided spine and joint procedures. Those days are like working in the ED, but always feeling well rested, while working at your own pace without getting piled on by an avalanche of walk-ins or having codes crash in on top of you while you try to get your work done.

Admittedly, my 2 1/2 clinic days can drag at times, but not in the way you'd think. I'm not seeing "med abusing ER patients" those days. You do that. I used to do that. But I don't do that anymore. What I do on those clinic days is mostly evaluate new patients to see what procedures they may or may not need, see many non-opiate non-op ortho-type patients, and refill compliant little old ladies' gabapentin or 1-2 hydrocodone per day so they can walk and stay out of a nursing home. Focusing on the interventional aspect and de-emphasizing opiates as much as possible, is what makes it good. If you let it get out of balance in the other direction, yes, it would be miserable. I've been in practice long enough I get very few referrals involving the type of patients you'd fear most. Plus, I prescreen and decline those that come across my desk. Ironically, most of those end up being seen but in an ED by someone doing what I used to do, but not longer do.

But I get it. It something that 95% of people in the ED will always love to think would be the end of them. And I'll never convince them otherwise. But that's okay. I don't want or need to. To each his own.
 
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