How will you escape the pit (the ER)?

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TrailRun said:
Anyone else with a successful escape plan? Urgent care, palliative, interventional pain, occupational Med, addiction, etc? Need something to escape nights. So envious of our PA colleagues who can switch specialties so readily
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Addiction. Undecided on fellowship vs practice pathway. I like it though—def not for everyone. Generally, pay ain’t great.
 
TrailRun said:
Anyone else with a successful escape plan? Urgent care, palliative, interventional pain, occupational Med, addiction, etc? Need something to escape nights. So envious of our PA colleagues who can switch specialties so readily
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what is your definition of nights? overnight? how about ending at 10pm? is that still nights?
 
TrailRun said:
Anyone else with a successful escape plan? Urgent care, palliative, interventional pain, occupational Med, addiction, etc? Need something to escape nights. So envious of our PA colleagues who can switch specialties so readily
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0.5 FTE at a site I actually enjoy. 6x12 hr shifts a month, with benefits. Make up the difference with telemedicine and PRN ED work at my own discretion (sites I like - primarily cush low-volume FSEDs). Might consider pain in the future, or palliative.
 
emergentmd said:
So you own 300K NIO and yes Covered calls are profitable but I hope you got NIO recently b/c they are down over 50% from last Fall's high. I do covered calls on my Tsla stocks and still looking for a safe strike point. I essentially sell weekly covered calls for 1% premium so in theory can make 50% in a year. This is likely too aggressive and I should start to do 0.25-0.5% so would put me in the range of 12-25% range.
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Glad to see you doing this since we’ve had extensive conversations on the topic. Hopefully it’s been working well for you.
 
cyanide12345678 said:
Glad to see you doing this since we’ve had extensive conversations on the topic. Hopefully it’s been working well for you.
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Thanks. Tsla is doing well and I am very long on them. I think they are a fantastic company, learning to having higher strike so i don't have my stocks called. I think I was too aggressive and was called on some covered calls but its a good learning experience. Thanks for all the advice.
 
miacomet said:
I would love to know how you spend 300k/year.
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Lets see. last year I bought a new boat and a new jet ski = 100K. Kids private school = 30K. Kids club sports = 15K. Charity donations = 40K. vacations = 30K. That left me 85K to run a household of 5 with all the other costs.

Some years I spend only 200K but some years I will go over 300K. I just want income to allow me to cover even my most extravagant years. I am lucky enough to be able to afford this.

We had a spur of the moment Vegas trip planned yesterday for the family of 5 leaving on Friday. Total costs will be about 10K. I want to retire being able to not worry about paying for spur of the moment stuff.
 
The plan is to stack money, invest it etc. One other option is doing utilization work remotely. Thats for those of you who are looking for something else. Im gonna keep grinding my 100 hours a month along with some random other stuff i do to make money (Real estate, investments, side hustle, admin work).
 
hundreddaysoff said:
My gosh, I never imagined sports cost $5k/kid/year. Kinda hope my 2 little boys are drawn to couch potato-dom as I was. What sports do they play that cost so much?
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Don’t think that’s for usual sports.

Some niche sports have high entry fee: golf, anything involving horses, sailing, hockey, etc. some of them are to prevent the serfs from direct entry 🙂

If your kid is in track or something it could range from $0 to a few hundred (pay to play for bussing, coaches, etc) depending on school district
 
hundreddaysoff said:
My gosh, I never imagined sports cost $5k/kid/year. Kinda hope my 2 little boys are drawn to couch potato-dom as I was. What sports do they play that cost so much?
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I do not have children but I live in a suburban area where youth sports are considered sacrosanct.

You would be surprised, regular run of the mill sports like baseball, soccer, basketball can easily cost thousands with "club" teams that travel to other nearby cities/states to play. The coaches are privately paid by the team dues and the travel is covered by fees paid by parents, plus top-of-the line equipment/uniforms, I can easily see how it would be 5k/kid/year. Especially since many of these kids play a different sport every season so 3-4 different teams/year.

Mind you this is different than school sponsored sports where most of that stuff is covered by the school. That being said, you'll never make JV/varsity at any of the local high schools if you didn't play with competitive club teams as a younger kid and get coaching/experience/practice with other kids/families who take these sports very seriously.
 
RoyBasch said:
Mind you this is different than school sponsored sports where most of that stuff is covered by the school. That being said, you'll never make JV/varsity at any of the local high schools if you didn't play with competitive club teams as a younger kid and get coaching/experience/practice with other kids/families who take these sports very seriously.
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Haha... yeah, I endorse this statement. I played soccer through 3rd grade. Then Super NES came out. Then I had delusions of becoming a jock when I was 15 so I tried to join the JV team, since it was the only way to play in my small town. I lasted a total of 2 days in practice!

I read stuff from John T Reed and others about how the way to get my kid into Ivy League is to land a sports scholarship. With costs like these, I guess that's basically just a Richie Rich selection mechanism in disguise.
 
hundreddaysoff said:
Haha... yeah, I endorse this statement. I played soccer through 3rd grade. Then Super NES came out. Then I had delusions of becoming a jock when I was 15 so I tried to join the JV team, since it was the only way to play in my small town. I lasted a total of 2 days in practice!

I read stuff from John T Reed and others about how the way to get my kid into Ivy League is to land a sports scholarship. With costs like these, I guess that's basically just a Richie Rich selection mechanism in disguise.
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I’m probably biased. The sports I did growing up and that I’m expecting my kids to enjoy all essentially come down to shoes and other people.

I could see how baseball, hockey etc could add up quickly.

Less so in wrestling, cross country, soccer, track and field, maybe basketball.

I would argue that heavy conditioning and or lifting pays a long way in any of those, and doesn’t cost thousands to train in. You could easily blow a few thousand on “expert guidance” but it probably matters less than busting you behind. However, they do take a ton of time, which is its own marker of luxury

We’ll see, my kids aren’t that old yet, so I lack perspective
 
emergentmd said:
Lets see. last year I bought a new boat and a new jet ski = 100K. Kids private school = 30K. Kids club sports = 15K. Charity donations = 40K. vacations = 30K. That left me 85K to run a household of 5 with all the other costs.

Some years I spend only 200K but some years I will go over 300K. I just want income to allow me to cover even my most extravagant years. I am lucky enough to be able to afford this.

We had a spur of the moment Vegas trip planned yesterday for the family of 5 leaving on Friday. Total costs will be about 10K. I want to retire being able to not worry about paying for spur of the moment stuff.
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I agree it’s not at all hard to spend 300k/yr.

I probably average 250k/yr — mostly on kids activities (lessons, sports, medical), 3-4 amazing vacations a year (we love travel- the experiences are worth it), a few expensive hobbies (ie skiing), pretty nice primary house (maybe 1 expensive project/improvement a year), fully funding kids college (not sure this is considered “spending”)

No ridiculous cars, second home/wife, no drinking/gambling habit etc.

I have no plans to cut back lifestyle when retired (probably increase the travel/medical expenses and decrease the kids costs). And I plan to have a long retirement (although honestly will probably work a bit not to be bored).

That’s why 10 M is my FI number (in retirement accounts not residence). Honestly not sure even that is enough ~10 years from now with inflation being what it is.
 
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hundreddaysoff said:
My gosh, I never imagined sports cost $5k/kid/year. Kinda hope my 2 little boys are drawn to couch potato-dom as I was. What sports do they play that cost so much?
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We parent by allowing the kids decide what they enjoy. One Enjoys VB which is about 10K during the season. 6K for Club Dues. 4 away trips this yr is 1K/trip and they are all within driving distance. She does School VB too. I have no delusion that she will make money from VB, or even get a college scholarship. But 10K is well worth keeping her out of trouble, and in shape. I am happy to trade 10K rather than having all of the unhealthy, out of shape, social media, drug using, sex finding middle/high schoolers.

My youngest is starting Club BB so add another 2K. 3 K more for summer camps, etc.... keeps them out of trouble and we can afford it. Again better than having a lazy, overweight, depressed kid on my hands.

If you think 15K is crazy, I know parents who does private lessons at $110/hr, do national club teams that travels 4-5 times all over the country so that 1K trip becomes a 2-3K trip.

I have a partner that has their High schooler in a private tennis academy with private coaches that must be IVY school level tuition.

Now if you get into competitive golf, tennis, Horse anything, any individual sports, you will likely need private lessons if you want to be the best. I grew up playing lots of basketball and it was essentially shoes/ball then find a court for pick up games. Even BB has morphed from just going out and finding pickup games to club sport teams. Drive around and most basketball courts will not have pick up games and if you do find one, get ready to get your teeth busted up.
 
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I don‘t know. That seems like quite a bit of money.

I kinda assumed I’d take my kids to the gym with me when they get older. Been getting my tubby butt kicked with CrossFit recently. I did football, wrestling, in middle and high school. Seems crazy to spend so much on club sports. I had ample opportunity to get exposed to all the bad things in sports.
 
Apollyon said:
But, a grand? That's a few steps above "decent".
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I stayed at a reasonable hotel in Atlanta last month. $175/night. Let's say 3 nights for a big tournament. Used 3/4 of a tank of gas to get there, so 1.5 tanks just in interstate travel and let's say another .5 in travel around the city. I have an SUV so a tank is 20 gallons at $4 per gallon. Food for a family at non-fast food runs at least $50 per meal. We'll be generous and say only 3 meals.

That's $965 right there.
 
Apollyon said:
Volleyball? Although I don't understand how someplace you can drive to can cost $1k/trip.
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Volleyball. 1k is nothing. Lets be honest, we are all docs and I doubt many would book model 6 hotels. VB tourney are typically at a convention center, and the hotel connected is typically walking over a skybridge. These hotel runs 2-250/night for 2 nights min and sometimes 3. With taxes that is about $5-600 min. Gas for driving $100 min. Food for 2 is $200 and if the whole family of 5 goes that is $3-400.

The kids that fly to tourneys add $1-2K for plane tickets depending how many family members are going.

I do not see how anyone of decent taste can go anywhere for a weekend and spend less than 1K. I know there are motel 6 going for $60/night but I am not risking my family safety to save $200/night and the consequences of the rib/daughter when their teammates are staying walking across the sky bridge when we are spending an extra hr driving/finding parking/paying for parking.

I would say 1K/trip is about min for 2 nights.
 
NITRAS said:
I don‘t know. That seems like quite a bit of money.

I kinda assumed I’d take my kids to the gym with me when they get older. Been getting my tubby butt kicked with CrossFit recently. I did football, wrestling, in middle and high school. Seems crazy to spend so much on club sports. I had ample opportunity to get exposed to all the bad things in sports.
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It all depends on what you think is crazy spending. I rather spend 5-10k/yr for each child to be active and teach a healthy lifestyle than paying dearly later for them to be diabetic blobs playing video games all day
 
VA Hopeful Dr said:
I stayed at a reasonable hotel in Atlanta last month. $175/night. Let's say 3 nights for a big tournament. Used 3/4 of a tank of gas to get there, so 1.5 tanks just in interstate travel and let's say another .5 in travel around the city. I have an SUV so a tank is 20 gallons at $4 per gallon. Food for a family at non-fast food runs at least $50 per meal. We'll be generous and say only 3 meals.

That's $965 right there.
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The Tx tourneys we go to are 250/nt with taxes/fees. Even if we can get away at $50/meal for 2 people that is 6 meals. You forgot the souvenirs they peddle. The snacks at Starbucks.

I am sure we could get away with a $500 trip with $100 gas. Red roof in for $100/nt. Fast food for $100. Parking $100. But Spending a week watching VB all days, I like to go back and relax at a hotel where I can walk from the game rather than finding parking which would be about $100 for the weekend anyways.

Plus the girls like to stay at the same hotel which typically is the one connected by a sky bridge. Between games, we can go back to the hotel room and relax. If we had a red roof in a few miles away, we would just stay at the convention center which in itself is miserable.
 
Everything’s bigger in Texas.

No need to keep up with the Joneses.

You can raise kids with great values that have amazing experiences on very little.
 
Part of me became a doctor because I never wanted to worry about money. I’m going to leave being a doctor some day because it’s not about the money. We became Emergency Physicians over other seemingly boring specialities partially on the idea of ‘living.’ Money allows for opportunities, but possessions and the need for expensive experiences become limiting. My sense of identity is not as an EP. It was a significant part of my life, but I’m so much more. We all are. Don’t limit yourself to a list of non-clinical work on an anonymous forum. Rediscover your passion. Life is too short for means to an end. The end comes too soon.
 
Mount Asclepius said:
Part of me became a doctor because I never wanted to worry about money. I’m going to leave being a doctor some day because it’s not about the money. We became Emergency Physicians over other seemingly boring specialities partially on the idea of ‘living.’ Money allows for opportunities, but possessions and the need for expensive experiences become limiting. My sense of identity is not as an EP. It was a significant part of my life, but I’m so much more. We all are. Don’t limit yourself to a list of non-clinical work on an anonymous forum. Rediscover your passion. Life is too short for means to an end. The end comes too soon.
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Woof, this hit really hard to home.

I'm not crying, you're crying.
 
Think hospital employed gigs (non hca) are going to be the safest place to be compared to a cmg?
 
EMhawkeye said:
Think hospital employed gigs (non hca) are going to be the safest place to be compared to a cmg?
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I think so. I think they'll be a little less aggressive w/ pay cuts as the job market deteriorates, and are less likely to overstaff w/ midlevels. My guess is that the average cmg shop w/ devolve into 1 doc 'supervising' 4 midlevels at a time, begging them to staff patients so that they can get in on some of the RVUs to supplement their sub-$100/hr wage. And you'll get some modicum of job security and not have to deal w/ a constant shuffle of contract holders every 3 years.
 
Are we predicting pay cuts… or are we predicting just a very slow to no increase in salary over time and have inflation and cola eat away at that salaried number that remains constant for the next 5 to 10 years?!?
 
HoosierdaddyO said:
Are we predicting pay cuts… or are we predicting just a very slow to no increase in salary over time and have inflation and cola eat away at that salaried number that remains constant for the next 5 to 10 years?!?
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Former for CMGs, latter for hospital employed (and to a lesser extent sdgs)
 
Alternative: get a job at the Va. annual COLA increases and step up in pay.

Just starts with a lower base pay. But at least no cuts?
 
Man, this sounds like some great options. Young docs need to save early and then they will have quick FIRE money. Older docs, you screwed up and you just gotta work longer
 
emergentmd said:
Man, this sounds like some great options. Young docs need to save early and then they will have quick FIRE money. Older docs, you screwed up and you just gotta work longer
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Yup. The great options just aren’t there anymore. Personally, I’m planning to leave the 3+ per hour grindhouse rvu shop for the 1pph pace of the VA. Only a few years out but the market has been good so far (before this month) and the pension should help hedge against future volatility.
 
Anybody tried any of these "collaborative physician" jobs that I see from time to time? It seems to involve minor medical clinics where you are available for consult or do chart reviews.

I also have an opportunity locally to be a collaborative physician with one of those wellness clinics where they basically need a doc to sign testosterone prescriptions and want to pay me about $3K/mo for about 100 Rx monthly or so. I have no idea what kind of liability that would expose me to so I've been reticent to take it. In fact, now that I'm thinking about it I'm sure they have guys with 2-3K levels so I'm sure I would get sued eventually for a major MI or prostate cancer. So, I guess I have my answer on that second one.
 
Groove said:
Anybody tried any of these "collaborative physician" jobs that I see from time to time? It seems to involve minor medical clinics where you are available for consult or do chart reviews.

I also have an opportunity locally to be a collaborative physician with one of those wellness clinics where they basically need a doc to sign testosterone prescriptions and want to pay me about $3K/mo for about 100 Rx monthly or so. I have no idea what kind of liability that would expose me to so I've been reticent to take it. In fact, now that I'm thinking about it I'm sure they have guys with 2-3K levels so I'm sure I would get sued eventually for a major MI or prostate cancer. So, I guess I have my answer on that second one.
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Be careful. One online telemedicine platform was served a grand jury subpoena for overprescribing controlled substances. Signing those testosterone prescriptions may also be under scrutiny in the future.
 
Groove said:
Anybody tried any of these "collaborative physician" jobs that I see from time to time? It seems to involve minor medical clinics where you are available for consult or do chart reviews.

I also have an opportunity locally to be a collaborative physician with one of those wellness clinics where they basically need a doc to sign testosterone prescriptions and want to pay me about $3K/mo for about 100 Rx monthly or so. I have no idea what kind of liability that would expose me to so I've been reticent to take it. In fact, now that I'm thinking about it I'm sure they have guys with 2-3K levels so I'm sure I would get sued eventually for a major MI or prostate cancer. So, I guess I have my answer on that second one.
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Had a Friend many years ago offered a job on a clinic medical site. Said friend just had to go to the clinic, review charts, and sign off/review charts. Pay was something crazy like 10k/dy.

Said Charts were medicare pts, none of what was purportedly done, and the doc was tried/thrown in the fed pen for fraud. Poor guy, lost his license, lost his job, had a nice family.

Why would ANYONE sign off on anything where you did not see the pt. Ohhhhhhh, sorry forgot most ER docs do. 🙂

In all seriousness, I would never sign off on stuff.
 
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Poor Friend was completely ignorant, thought it was a dream job, didn't think much of just doing chart reviews and signing off. Well the FED looked at it completely differently.

Did you sign the chart - Yes
Then you approved of the orders - I guess
Did you do the procedures billed - No

Guilty....
 
Groove said:
Anybody tried any of these "collaborative physician" jobs that I see from time to time? It seems to involve minor medical clinics where you are available for consult or do chart reviews.

I also have an opportunity locally to be a collaborative physician with one of those wellness clinics where they basically need a doc to sign testosterone prescriptions and want to pay me about $3K/mo for about 100 Rx monthly or so. I have no idea what kind of liability that would expose me to so I've been reticent to take it. In fact, now that I'm thinking about it I'm sure they have guys with 2-3K levels so I'm sure I would get sued eventually for a major MI or prostate cancer. So, I guess I have my answer on that second one.
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I'd rather just work my day job another day or two
 
GassYous said:
I'd rather just work my day job another day or two
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Well, that's ultimately what I end up deciding every time but it sure would be nice to have something supplemental where I didn't have to deal with patients everyday. I'd even do chart review but no idea what that pays. Part of me thinks I might as well take advantage of these "collaborative" opportunities with midlevels while I can before they all are granted full autonomous practice without oversight in all 50 states. I always get cold feet about the liability which is ironic since I'm being forced to co-sign about 20 charts each shift for patients I never saw.
 
Groove said:
Well, that's ultimately what I end up deciding every time but it sure would be nice to have something supplemental where I didn't have to deal with patients everyday. I'd even do chart review but no idea what that pays. Part of me thinks I might as well take advantage of these "collaborative" opportunities with midlevels while I can before they all are granted full autonomous practice without oversight in all 50 states. I always get cold feet about the liability which is ironic since I'm being forced to co-sign about 20 charts each shift for patients I never saw.
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You've asked this question in a separate thread before, and received the same response...
 
emergentmd said:
Lets see. last year I bought a new boat and a new jet ski = 100K. Kids private school = 30K. Kids club sports = 15K. Charity donations = 40K. vacations = 30K. That left me 85K to run a household of 5 with all the other costs.

Some years I spend only 200K but some years I will go over 300K. I just want income to allow me to cover even my most extravagant years. I am lucky enough to be able to afford this.

We had a spur of the moment Vegas trip planned yesterday for the family of 5 leaving on Friday. Total costs will be about 10K. I want to retire being able to not worry about paying for spur of the moment stuff.
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I thought my expenses were getting out of control since building our ‘doctor home’. But compared to some of you guys it seems that my expenses are basically nothing lol. No wonder some of you guys have such a high FI number. I think I’ll technically hit FI when i hit 2M in net worth, that should be only another 3 or so years i think. Hopefully at least.
 
emergentmd said:
But 10K is well worth keeping her out of trouble, and in shape. I am happy to trade 10K rather than having all of the unhealthy, out of shape, social media, drug using, sex finding middle/high schoolers.
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I just ran across this and, well, hate to break it to ya but I alone have several middle/high school volleyball player patients. I guess I should mention I'm child psychiatry (which is why I hate to break it to ya).

From my personal experience with many many highschoolers, sports participation does not in any way guarantee or even lessen staying away from social media/drug using/sex finding (might be worse in many cases depending on what's going on in the sports crowd). I certainly encourage sports participation but not necessarily for those reasons. Think more along the unhealthy/out of shape parts, although some schools do random drug testing of athletes so that does act as a deterrence for drug use sometimes (definitely not all the time...). Certainly no linear correlation between amount of money spent vs likelihood of deterrence. I mean I think if you want to trade 10K for your daughter playing a sport she enjoys that's totally reasonable, but I'd just say that if that's the case.
 
cyanide12345678 said:
I thought my expenses were getting out of control since building our ‘doctor home’. But compared to some of you guys it seems that my expenses are basically nothing lol. No wonder some of you guys have such a high FI number. I think I’ll technically hit FI when i hit 2M in net worth, that should be only another 3 or so years i think. Hopefully at least.
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Ya im shooting for 2-2.5 ish with the house paid off. Think thatll be fine.
 
calvnandhobbs68 said:
I just ran across this and, well, hate to break it to ya but I alone have several middle/high school volleyball player patients. I guess I should mention I'm child psychiatry (which is why I hate to break it to ya).

From my personal experience with many many highschoolers, sports participation does not in any way guarantee or even lessen staying away from social media/drug using/sex finding (might be worse in many cases depending on what's going on in the sports crowd). I certainly encourage sports participation but not necessarily for those reasons. Think more along the unhealthy/out of shape parts, although some schools do random drug testing of athletes so that does act as a deterrence for drug use sometimes (definitely not all the time...). Certainly no linear correlation between amount of money spent vs likelihood of deterrence. I mean I think if you want to trade 10K for your daughter playing a sport she enjoys that's totally reasonable, but I'd just say that if that's the case.
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I am sure you know much more than I do but I am N=1. She enjoys VB, she likes the competition, it is organized, and yes it does keep her off media. If she didn't have something she is committed to, I see the extra time just doing unproductive stuff such as more social media. I have no idea if doing less social media now translates to anything in the future, but it gives her something to look forward to.
 
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