I just wish there were better fellowships/exit strategies from EM

[miacomet]

I'm moderate FIRE and lucky in that I don't *have* to work. I'm surprised how much I miss seeing patients. I also have no desire to go back to EM. I can't believe I picked this field. It's such a waste, I like to work but there's just nothing after EM. Nothing.

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[doggydog]

Go back to residency a pick a different specialty

 

[miacomet]

Go back to residency a pick a different specialty

I'd love to, but isn't that insanely hard to do? What do you think the maximum age to do so would be? What specialties would be amenable? Why would they take me, with no CMS funding?

 

[Brigade4Radiant]

Doing a residency again is like saying go to law school or be a plumber

You have to go through match and as a seasoned attending you are non competitive and you work 60-80 hours for 50-60k

 

[miacomet]

Doing a residency again is like saying go to law school or be a plumber

You have to go through match and as a seasoned attending you are non competitive and you work 60-80 hours for 50-60k

Exactly. I don't mind the pay cut, well it's not a cut because my pay is currently zero, but why would anyone take a mid to late career doc?

 

[doggydog]

Most academic programs have spots that aren’t paid for with CMS funding.

 

[miacomet]

Most academic programs have spots that aren’t paid for with CMS funding.

Academic what field programs? And why the heck would they take a mid to late career EM doc?

 

[Brigade4Radiant]

Most academic programs have spots that aren’t paid for with CMS funding.

Yeah but they need those spots filled and they need to know that you are not just going to walk away. Plus any board certified doc at baseline has a 50% chance of matching

Non competitive fellowships that psych has are ideal

 

[Apollyon]

I'd love to, but isn't that insanely hard to do? What do you think the maximum age to do so would be? What specialties would be amenable? Why would they take me, with no CMS funding?

You would have CMS funding, but it's "indirect"; about which you are thinking is the "direct" payments. Indirect is about 70%, IIRC.

 

[miacomet]

Yeah but they need those spots filled and they need to know that you are not just going to walk away. Plus any board certified doc at baseline has a 50% chance of matching

Non competitive fellowships that psych has are ideal

????? Why a 50% chance?

 

[Brigade4Radiant]

????? Why a 50% chance?

Look at the match data for a US graduate in 2023

 

[miacomet]

Look at the match data for a US graduate in 2023

???? that's higher than 50%, but new grads are different, no?

 

[Brigade4Radiant]

???? that's higher than 50%, but new grads are different, no?

1647 graduates of US MD schools so a year or more after graduating in 2023 790 matched so 48%

 

[miacomet]

1647 graduates of US MD schools so a year or more after graduating in 2023 790 matched so 48%

I have no idea what you are saying....

 

[Mount Asclepius]

Perpetually dissatisfied. You need to let go of money and a certain lifestyle. Spend less and become content with little. I don’t often agree with @emergentmd, but I do agree with their ability to define happiness. There can be a lot after EM, but you pigeon hole yourself when you define something after EM as something after EM with money. I’m not saying money isn’t important, but it clearly seems to be to you. You may not like that idea, but I say that out of love from an anonymous internet stranger. There’s lots in this world. You can make lots of money in EM. If you don’t want to do that anymore that’s totally understandable. You can ask lots of questions and make lots of posts, but ultimately you need to personally grapple with what money means in your life. You’re not alone.

 

[The Knife & Gun Club]

I always wonder how long it would truly take to make someone who’s a board certified EM physician competent in another specialty.

Like how long would it take to make an EM doc an FM doc? What about an interventional radiologist or cardiologist? I doubt it would be a whole residency + fellowship worth, but probably would require a couple of years at least.

My guess is you could probably make someone a competent general internist, anesthesiologist, or FM with one year. Then allow them to access the subspecialties of whatever that new speciality is.

 

[GonnaBeADoc2222]

Yeah I mean we all know EM blows and conservatively 70% of us or so wouldn't do this again, but the only play now is to maximize what you can extract from it now, minimize the damage to yourself, and enjoy your free time doing other stuff.

 

[miacomet]

Perpetually dissatisfied. You need to let go of money and a certain lifestyle. Spend less and become content with little. I don’t often agree with @emergentmd, but I do agree with their ability to define happiness. There can be a lot after EM, but you pigeon hole yourself when you define something after EM as something after EM with money. I’m not saying money isn’t important, but it clearly seems to be to you. You may not like that idea, but I say that out of love from an anonymous internet stranger. There’s lots in this world. You can make lots of money in EM. If you don’t want to do that anymore that’s totally understandable. You can ask lots of questions and make lots of posts, but ultimately you need to personally grapple with what money means in your life. You’re not alone.

I'm not concerned about the money- we are fine financially; it's not a financial issue at all- what in my post made you think it was about money? I really thought I wouldn't miss seeing patients at all, or miss medicine at all, but I do. Like I get that we would all have to quit eventually, I just would love to see patients for another ten or fifteen years.

The finances are the least of it, much to my surprise.

 

[BoardingDoc]

I'm not concerned about the money- we are fine financially; it's not a financial issue at all- what in my post made you think it was about money? I really thought I wouldn't miss seeing patients at all, or miss medicine at all, but I do. Like I get that we would all have to quit eventually, I just would love to see patients for another ten or fifteen years.

The finances are the least of it, much to my surprise.

If you simply miss seeing patients there are a million ways you can see patients that might not make you a bunch of money.

Urgent care, occupational med doing disability evals or clearance for local govt agencies, prison medicine, opening your own concierge business, etc etc.

 

[miacomet]

If you simply miss seeing patients there are a million ways you can see patients that might not make you a bunch of money.

Urgent care, occupational med doing disability evals or clearance for local govt agencies, prison medicine, opening your own concierge business, etc etc.

And these are all yikes ways to see patients...msybe concierge, but what would I offer? Ketamine??

 

[VA Hopeful Dr]

I always wonder how long it would truly take to make someone who’s a board certified EM physician competent in another specialty.

Like how long would it take to make an EM doc an FM doc? What about an interventional radiologist or cardiologist? I doubt it would be a whole residency + fellowship worth, but probably would require a couple of years at least.

My guess is you could probably make someone a competent general internist, anesthesiologist, or FM with one year. Then allow them to access the subspecialties of whatever that new speciality is.

This comes up all the time around here.

For IM/FM, 2 years. Both specialties have a big longitudinal care aspect that you just can't get in a single year.

 

[miacomet]

This comes up all the time around here.

For IM/FM, 2 years. Both specialties have a big longitudinal care aspect that you just can't get in a single year.

And I would be so willing to do this....

 

[Brigade4Radiant]

I have no idea what you are saying....

https://www.nrmp.org/wp-content/uploads/2023/04/Advance-Data-Tables-2023_FINAL-2.pdf

 

[Rekt]

I'm not concerned about the money- we are fine financially; it's not a financial issue at all- what in my post made you think it was about money? I really thought I wouldn't miss seeing patients at all, or miss medicine at all, but I do. Like I get that we would all have to quit eventually, I just would love to see patients for another ten or fifteen years.

The finances are the least of it, much to my surprise.

Do you really though? I easily understand missing medicine. But the patients? Maybe you’re wearing some rose tinted goggles right now, but at least for emergency medicine, I think we’ve taken the spot for worst patient population by far.

 

[miacomet]

Do you really though? I easily understand missing medicine. But the patients? Maybe you’re wearing some rose tinted goggles right now, but at least for emergency medicine, I think we’ve taken the spot for worst patient population by far.

I have been lucky to work places with pretty great patients- a ski town hospital, the Indian Health Service, a few rural hospitals with ranchers and farmers as patients. Patient satisfaction, administration annoy me, patients less so, except for anti-vaxers.

 

[Waterlover]

Sports med and Pain med are 1 year long fellowships you can do from EM and completely get out of ER if you'd like and make as much as EM if you build up your practice. Palliative and Addiction are two other 1 year long fellowships that may not pay as much but will get you out.

 

[miacomet]

Sports med and Pain med are 1 year long fellowships you can do from EM and completely get out of ER if you'd like and make as much as EM if you build up your practice. Palliative and Addiction are two other 1 year long fellowships that may not pay as much but will get you out.

Yeah, I know. I've really tried to convince myself I like these, and tried to convince myself I could get them.
I'm just...not that interested in sports. My last gig had a high rate of sports injuries, it was...OK. My area has a ton of sports providers, too. I'd consider it, though. I wouldn't even know where to begin.
Pain is impossible to get and I get the impression there simply aren't that many jobs, although I may be wrong.
Palli is not my jam, I respect people who do it
Addiction- I always think these patients are better served by psychiatrists because so many have psych comorbidities.

I've thought about obesity medicine, but it seems not super scientifically based.

 

[Brigade4Radiant]

Pain is competitive and Anesthesia usually owns the pain department.

EM can do sports but then again a lot of departments are run by the FM faculty

 

[bravotwozero]

Yeah, I know. I've really tried to convince myself I like these, and tried to convince myself I could get them.
I'm just...not that interested in sports. My last gig had a high rate of sports injuries, it was...OK. My area has a ton of sports providers, too. I'd consider it, though. I wouldn't even know where to begin.
Pain is impossible to get and I get the impression there simply aren't that many jobs, although I may be wrong.
Palli is not my jam, I respect people who do it
Addiction- I always think these patients are better served by psychiatrists because so many have psych comorbidities.

I've thought about obesity medicine, but it seems not super scientifically based.

Occupational med? Don't even need a fellowship for that. See openings in my city all the time.

 

[Waterlover]

Pain is competitive and Anesthesia usually owns the pain department.

EM can do sports but then again a lot of departments are run by the FM faculty

Yes however that doesn't mean they won't hire EM. Literally sports has become so procedural that if you know how to use the US and do US guided injections, you can really get hired wherever.

 

[miacomet]

Yes however that doesn't mean they won't hire EM. Literally sports has become so procedural that if you know how to use the US and do US guided injections, you can really get hired wherever.

So just apply for fellowship? I wouldn't even know where to begin.

 

[Waterlover]

So just apply for fellowship? I wouldn't even know where to begin.

For sports you'll need to have demonstrated interest in it prior to applying. Sports is fairly competitive and harder to match from EM. Find a HS you can act as a team doc for a football fall season and do a couple of 2 week sports rotations at programs at minimum.

 

[doggydog]

It’s easier to get a residency in another speciality than to get into a pain medicine fellowship as an EM grad with no prior interest.

 

[Brigade4Radiant]

What is the avg rate for sports? I assume they can do 400k since they do a lot of injections

 

[doggydog]

Is sports really that easy? I have a coresident who did a sports fellowship straight out of residency and couldn’t get a sports job in the Midwest.

 

[miacomet]

For sports you'll need to have demonstrated interest in it prior to applying. Sports is fairly competitive and harder to match from EM. Find a HS you can act as a team doc for a football fall season and do a couple of 2 week sports rotations at programs at minimum.

Yeah, that sounds...so not for me. I like sports medicine like taking care of people with sports injuries, but I'm not super into high school teams etc. I'm certainly not into football. Sounds like it's not a good fit for me, nor would I get such a fellowship.

I would have thought working in a ski/mountain biking town and taking care of tons of recreational and also Olympic athletes would be more helpful than volunteering for a high school football team, which sounds like hell, but I guess sports fellowships are really narrowly focused.

Thanks for the info, I will cross it off my list!

 

[Birdstrike]

We recently hired a nurse who had previously worked for another Pain physician. She liked the physician, but didn’t enjoy the patients. After a few weeks, she said, “I’m surprised about your patients. Most of them are really happy. By and large, they’re great.”

I explained to her, it’s all depends on how you treat people, what you treat people with, and on who and what you accept.

 

[timpview]

I always wonder how long it would truly take to make someone who’s a board certified EM physician competent in another specialty.

Like how long would it take to make an EM doc an FM doc? What about an interventional radiologist or cardiologist? I doubt it would be a whole residency + fellowship worth, but probably would require a couple of years at least.

My guess is you could probably make someone a competent general internist, anesthesiologist, or FM with one year. Then allow them to access the subspecialties of whatever that new speciality is.

6 dedicated months for most non-procedure related specialties imo… at least for a baseline competency that can improve over time.

But if you have prescribing power than I also think there are some other things any MD could get into and figure it out in a relatively short period of time..(rehab/addiction, sleep medicine clinic, weight loss clinics, wellness clinics)

 

[Birdstrike]

So just apply for fellowship?

People message me all the time, “What should I do to make myself more competitive?” I make certain suggestions, as there are always things we can do to bolster our applications. But at the end of each of those messages, I conclude with, “But all I did, was just apply.”

That’s it. I just applied. I had never done a rotation, I hadn’t shadowed anyone, I hadn’t taken any courses. I just applied.

This was my plan, “I apply to all the fellowships. Hope for the best.”

Literally. That’s it!

No research. No connections. No special skills. No letters from anyone in the specialty. Just a very high volume of long-shots. And one went in. Only one!

 

[Birdstrike]

I also was self insecure about being older, or too “mature,” putting it more kindly. Later, my program director said, “The reason we liked you, was your ‘maturity.’”

The exact thing I was worried was my weakness, was my greatest asset at this program. It may have sunk me everywhere else, but this one program wanted (at least one of their 5 fellows) to be someone who was seasoned.

 

[GonnaBeADoc2222]

I dunno i think you have some intrinsic personal issues to sort out.

Your posts are all over the place.

Recently you were saying how being a nurse is so amazing and much better than physician .

I think you need a life coach / hobbies.

 

[miacomet]

I dunno i think you have some intrinsic personal issues to sort out.

Your posts are all over the place.

Recently you were saying how being a nurse is so amazing and much better than physician .

I think you need a life coach / hobbies.

I think psych NP is one of the best gigs ever! I will stand by that!

I have a million hobbies- skied for months this year, hike all the time, mountain bike. It's all great.

 

[Waterlover]

Yeah, that sounds...so not for me. I like sports medicine like taking care of people with sports injuries, but I'm not super into high school teams etc. I'm certainly not into football. Sounds like it's not a good fit for me, nor would I get such a fellowship.

I would have thought working in a ski/mountain biking town and taking care of tons of recreational and also Olympic athletes would be more helpful than volunteering for a high school football team, which sounds like hell, but I guess sports fellowships are really narrowly focused.

Thanks for the info, I will cross it off my list!

Oh yeah if you could get that experience with ski clinics or olympic athletes then that is great. I was assuming as if you had no sports background/ability to connect at baseline. It doesn't have to be high school, it's just the easiest thing to obtain if you couldn't get anything else for exposure.

 

[miacomet]

Oh yeah if you could get that experience with ski clinics or olympic athletes then that is great. I was assuming as if you had no sports background/ability to connect at baseline. It doesn't have to be high school, it's just the easiest thing to obtain if you couldn't get anything else for exposure.

Yeah, my last EM job, which was amazing until it wasn't, had a ton of sports medicine stuff- lots of Olympic athletes, lots of reductions. Huge percentage of our visits were ortho/sport. I saw more tibial plateau fx in a month than I saw in all of residency.

 

[Waterlover]

Yeah, my last EM job, which was amazing until it wasn't, had a ton of sports medicine stuff- lots of Olympic athletes, lots of reductions. Huge percentage of our visits were ortho/sport. I saw more tibial plateau fx in a month than I saw in all of residency.

You get with the right people and you can do that in sports med. There's literally ski clinic jobs where all you do is treat those injuries

 

[miacomet]

You get with the right people and you can do that in sports med. There's literally ski clinic jobs where all you do is treat those injuries

Yes, I know, I live near a bunch. You do realize those jobs are impossible to get, right?

 

[doggydog]

Pain is much more competitive now than it used to be, not sure when Birdstrike applied. People in EM residencies realized they made the wrong choice for them and are trying to get out. I have a friend who had to do a whole ultrasound fellowship before he was competitive for pain.

 

[miacomet]

Pain is much more competitive now than it used to be, not sure when Birdstrike applied. People in EM residencies realized they made the wrong choice for them and are trying to get out. I have a friend who had to do a whole ultrasound fellowship before he was competitive for pain.

Damn. Why ultrasound? More competitive for procedures?

EM is hell. And I stand by my assertion that Psych NP is a super lucrative gig with no standards and no ceiling on earnings.

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[VA Hopeful Dr]

I think psych NP is one of the best gigs ever! I will stand by that!

I have a million hobbies- skied for months this year, hike all the time, mountain bike. It's all great.

Only if you don't mind doing a bad job at something important.

 

[Waterlover]

Yes, I know, I live near a bunch. You do realize those jobs are impossible to get, right?

Haha I'm aware, my goal isn't to work in the mountains, I eventually just want to have a regular sports clinic, but if you do a sports fellowship at the Utah's, Colorado's, etc. and stay in the area it increases your chances of those types of jobs