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

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Only if you don't mind doing a bad job at something important.
I do mind. But what I mind even more is that there is pretty much no way for an MD to retrain in another field. There is indeed a primary care psychiatry fellowship, but none for EM (as usual). But they are rare.

You can't tell me that basically any MD would do this better with a one or two year fellowship. Same for anything else midlevel. But they lock us (especially EM) into one field, while these ladies get to run wild. The reviews are funny "they prescribed me five medications in one month and then asked me if I wanted medication for anything else"

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I wonder how many people in the country hate their jobs. I bet it’s at least 50%, maybe significantly more. It seems pretty normal to dislike your job. I’m not sure why people in medicine feel that they have earned a right to love a job that pays them a large amount of money.
 
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I wonder how many people in the country hate their jobs. I bet it’s at least 50%, maybe significantly more. It seems pretty normal to dislike your job. I’m not sure why people in medicine feel that they have earned a right to love a job that pays them a large amount of money.
Well, then why go to med school instead of being an HVAC technician (my HVAC guy seems pretty happy FWIW, he actually helps people).

Because doctors in previous generations loved their jobs. Because half the reason we hate it is moral injury, and that's wrong and unnecessary.
 
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I don’t know, people told me way before I went to medical school way back when not to go into medicine. I think it’s been a while since doctors en masse have enjoyed their jobs. I was well aware this path sucks. A lot of my medical school classmates and residents I’ve seen over the years seemed to have ignored that advice.

What did you think emergency medicine was going to be?

I’ve had multiple co-residents that have gone back to do another specialty after we finished our EM residency. You should seriously look into that.
 
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I do mind. But what I mind even more is that there is pretty much no way for an MD to retrain in another field. There is indeed a primary care psychiatry fellowship, but none for EM (as usual). But they are rare.

You can't tell me that basically any MD would do this better with a one or two year fellowship. Same for anything else midlevel. But they lock us (especially EM) into one field, while these ladies get to run wild. The reviews are funny "they prescribed me five medications in one month and then asked me if I wanted medication for anything else"
There is no primary care psychiatry fellowship listed with the ABMS, so it won't count for very much. Think of it like the EM fellowship from FM.
 
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Theres nothing stopping you from doing the same.

You have a medical license.

Open a cash practice and sling SSRIs and ADHD meds like these ostriches.

You won't be as good as a psychiatrist but I'm sure much better than a psych NP.
 
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Theres nothing stopping you from doing the same.

You have a medical license.

Open a cash practice and sling SSRIs and ADHD meds like these ostriches.

You won't be as good as a psychiatrist but I'm sure much better than a psych NP.
And good luck getting medmal insurance for that.
I don't want to be a hack. I want a reasonable way to do this, or another field, safely.
It's so true, though. NPs are just useless at this point. As are all the LCSWs, LMHCs etc.
 
And good luck getting medmal insurance for that.
I don't want to be a hack. I want a reasonable way to do this, or another field, safely.
It's so true, though. NPs are just useless at this point. As are all the LCSWs, LMHCs etc.
I think a lot of people have given you multiple options for well defined pathways into other specialties (pain, sports med, occ health) or suggested opening your own practice where you could literally go in any direction you want.

You talk about how great being a psych NP would be and how a doc would do better with minimal training, but then shoot down that very same option when suggested.

At this point, it seems less like you're legitimately looking for a different clinical medicine job and are more upset at the lack of easy professional mobility as an MD compared to that of a mid-level.
 
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Yeh, once you exit the hospital/group clinical world, you can literally do whatever you want. You have an unrestricted medical license. The "limit", if anything, would be set by a malpractice carrier who may or may not insure you for your activities if you can't demonstrate competency in your scope.

There are also other clinical environments in which you might be able to practice emergency medicine; Canada, AUS/NZ, Fiji, Guam, USVI, etc. all have opportunities for 3/6/12 months or recurring locums etc. if your life affords you that flexibility.

If you're done with clinical medicine, they're recruiting at UnitedHealth:
 
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I think a lot of people have given you multiple options for well defined pathways into other specialties (pain, sports med, occ health) or suggested opening your own practice where you could literally go in any direction you want.

You talk about how great being a psych NP would be and how a doc would do better with minimal training, but then shoot down that very same option when suggested.

At this point, it seems less like you're legitimately looking for a different clinical medicine job and are more upset at the lack of easy professional mobility as an MD compared to that of a mid-level.

There's easier professional mobility as a midlevel if you want to continue to be a w2 /1099 cog...thats all theyre able to do.

You have limitless opportunities if you want to be an owner.
 
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A concierege Urgent Care type practice is perfectly within the EM wheelhouse and should be insurable.
 
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@miacomet , it’s clear you’re going through a tough time. I went through a similar time, felt trapped and powerless. Here are some realizations that either helped me get through it, or that I learned along the way.

Are we reactive or pro-active?

We sometimes act as if we’re a victim of external circumstances, that we’re a victim whose life is being determined by outside forces. That is the act being reactive, which is a choice.

We can choose to be proactive. We can choose how to react to our circumstance to move our future in a positive direction. We don’t have to remain a victim of our circumstances.

We must make a choice to be proactive and take initiative to move things to a better place. But we to have to choose it. We have to insist on it and be determined to make it happen.

We must choose whether to be proactive or not. If we don’t choose, the default, inferior choice is made for us. We are relegated to being reactive. We are responsible for this choice or lack of choice, whether we choose to be aware it it or not. We cannot change Emergency Medicine or its direction. We can change ourselves and our direction.

Reactive: I will remain unhappy until Emergency Medicine changes for the better

Pro-active: I will make changes in myself, my surroundings and my direction, so my life changes for the better.

We’ve all had to be proactive to accomplish to get this far. Why stop now?

Once we think the problem is external, that thought becomes the problem in and of itself. Once we realize our problem is in ourselves, that frees us to find the solution in that same place, within ourselves.

When we shift our focus away from the parts we cannot control, towards those we can control, better days are without reach.

Be proactive.


(Borrowed heavily from the book, 7 Habits of Highly Effective People and how it applies to us that have felt trapped in EM).
 
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I wonder how many people in the country hate their jobs. I bet it’s at least 50%, maybe significantly more. It seems pretty normal to dislike your job. I’m not sure why people in medicine feel that they have earned a right to love a job that pays them a large amount of money.

What a garbage take. Do most other jobs take 11 years and negative 200-400k to obtain? You’re damn right there’s a degree of entitlement to a certain threshold of money.
 
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I wonder how many people in the country hate their jobs. I bet it’s at least 50%, maybe significantly more. It seems pretty normal to dislike your job. I’m not sure why people in medicine feel that they have earned a right to love a job that pays them a large amount of money.
I'm skeptical of that. I think truly loving your job is quite rare, but I bet most people in the US at least tolerate or modestly enjoy their jobs. Also, I jumped ship from EM to a very different field, and for the first time I actually really started liking my job basically every day.
 
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I’ll say this docs often feel like we need to love our jobs. I think it is the romanticism we see on TV about medicine. Ill come out and say it.. I dont love EM. I like my job, i make it interesting for myself but I think the reality is most people who went into EM pursued much more as just a job. I see our neurosurgeons who are awesome and it is their life. It comes before their family, themselves etc. I have 0 interest in that.

If I could make EM money being a janitor and EM pay became current janitor pay, i would be a janitor. I dont put “Dr.” On anything i own and likely the only way my postman knows I am a doctor is because I get Acep trash and AMA trash in my mailbox.

I feel like i am good at it cause. I always put my best foot forward in anything i pursued. I committed Hard. I learned the stuff, i became a chief resident etc etc.

Again, it is just a job to me. It provides for me and my family. EM has given me so much that I am appreciative of it. The romanticism of EM left me a while ago whilst my eyes opened to the amount of nonsense we deal with and the CMG takeover.

As far as getting out, find something you like to occupy your time. Real estate, painting, fishing, golf whatever. If you find something that will let you earn some $$ good for you. Leave EM, dont do a fellowship. Move along and enjoy your FIRE life.
 
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@miacomet , it’s clear you’re going through a tough time. I went through a similar time, felt trapped and powerless. Here are some realizations that either helped me get through it, or that I learned along the way.

Are we reactive or pro-active?

We sometimes act as if we’re a victim of external circumstances, that we’re a victim whose life is being determined by outside forces. That is the act being reactive, which is a choice.

We can choose to be proactive. We can choose how to react to our circumstance to move our future in a positive direction. We don’t have to remain a victim of our circumstances.

We must make a choice to be proactive and take initiative to move things to a better place. But we to have to choose it. We have to insist on it and be determined to make it happen.

We must choose whether to be proactive or not. If we don’t choose, the default, inferior choice is made for us. We are relegated to being reactive. We are responsible for this choice or lack of choice, whether we choose to be aware it it or not. We cannot change Emergency Medicine or its direction. We can change ourselves and our direction.

Reactive: I will remain unhappy until Emergency Medicine changes for the better

Pro-active: I will make changes in myself, my surroundings and my direction, so my life changes for the better.

We’ve all had to be proactive to accomplish to get this far. Why stop now?

Once we think the problem is external, that thought becomes the problem in and of itself. Once we realize our problem is in ourselves, that frees us to find the solution in that same place, within ourselves.

When we shift our focus away from the parts we cannot control, towards those we can control, better days are without reach.

Be proactive.


(Borrowed heavily from the book, 7 Habits of Highly Effective People and how it applies to us that have felt trapped in EM).
All very wise, also shades of Viktor Frankl.

I'm just not sure what I want my direction to be. I was sure when i wanted my direction to be medical school, or various other things I've pursued. Now it's just not so clear.
 
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Direction. You are asking the right question.

When young, it’s all about finding the answers. Then it becomes about asking the right questions. Eventually the focus is on the journey.

Peace must come from within. It will not come from someone telling you their peace.
 
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There is a guy in my shop that left EM and went and did an optho residency in 3 years (they counted his EM as 1 year) He now works 4 days a week in optho and 1day in the ER. It is possible. He is board certified in both. He was about 40 when he went back and did optho residency, his wife was a little upset she a sthm and they have 3 kids but they made it work. So yes you can go back and do another residency
 
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There is a guy in my shop that left EM and went and did an optho residency in 3 years (they counted his EM as 1 year) He now works 4 days a week in optho and 1day in the ER. It is possible. He is board certified in both. He was about 40 when he went back and did optho residency, his wife was a little upset she a sthm and they have 3 kids but they made it work. So yes you can go back and do another residency

My god

that's incredible

the only ER doc in the country that won't mind when eye **** checks in
 
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There is a guy in my shop that left EM and went and did an optho residency in 3 years (they counted his EM as 1 year) He now works 4 days a week in optho and 1day in the ER. It is possible. He is board certified in both. He was about 40 when he went back and did optho residency, his wife was a little upset she a sthm and they have 3 kids but they made it work. So yes you can go back and do another residency
Damn, if only I were younger. How did he manage that? He's a god.

Honestly, I think EM as a field serves so few it needs to end, at least until there are better exit strategies. Or EM needs to be a fellowship after IM or FP or a combination residency with Peds, IM, or FP.
 
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Why don’t you just go back and do an IM residency? You’ll probably get 1 year credit for your prior residency training. The funding issue isn’t black and white as has been discussed ad nauseam previously. You said money isn’t the issue. So two years reduced income shouldn’t be a deal killer. IM will give you a lot of different options where you can continue to see patients.

My suspicion though is that you wouldn’t want to take on two years of longer hours at lower pay just to keep seeing patients in an alternative setting. I personally would rather find a non-clinical out, which for me is FIRE.
 
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Someone needs to answer this. The reality is usually depressing

Aren’t you PMR? You probably know the Sports market better than we do. I ran into an old friend who did FM to Sports, struggled mightily to find a job paying around 200k in HCOL area. I looked into it when I was debating my next move and all signs pointed to tough market and low reimbursement, much worse than Pain. Most sports jobs from what I understand expect you to split between SM and something else. With EM there are a couple split jobs out there but seem to be unicorns.
 
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Damn, if only I were younger. How did he manage that? He's a god.

Honestly, I think EM as a field serves so few it needs to end, at least until there are better exit strategies. Or EM needs to be a fellowship after IM or FP or a combination residency with Peds, IM, or FP.

Yes he's a very smart guy. He has a background in electrical engineering and has a couple patents related to medicine, although those did not make any money

And I agree I think it would be better if they could make a better exit strategy for EM. I was told years ago "once you are sick of EM you can always go into urgent care." Too bad most of the UC jobs have been taken over by MLPs
 
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And these are all yikes ways to see patients...msybe concierge, but what would I offer? Ketamine??

I’m officially working on my concierge medicine plan to get out of EM.

Will put a post in 2-3 months when everything is set up and running smoothly.

Will see how it goes. Time will tell.
 
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I’m confused, @miacomet . You say you dislike EM. Yet you’re financially independent enough to not need to work in EM, or work at all. That is what most people dream of. Yet you’re still unhappy.

I don’t understand.
 
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Agree with Birdstrike.
20+ opinions on what to do and the answer from OP is “well that’s hard”. Ok. Show me an easy path to something worthwhile that requires expertise, I haven’t seen it before.
 
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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.
Psych NP is probably one of the worst things to become they are essentially clueless most of the time when it comes to complicated patients…
 
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Aren’t you PMR? You probably know the Sports market better than we do. I ran into an old friend who did FM to Sports, struggled mightily to find a job paying around 200k in HCOL area. I looked into it when I was debating my next move and all signs pointed to tough market and low reimbursement, much worse than Pain. Most sports jobs from what I understand expect you to split between SM and something else. With EM there are a couple split jobs out there but seem to be unicorns.
Yeah I am, it was kind of a facetious comment haha. Sorry. But yes I see plenty of PM&R physicians chug the kool-aid about Sports Medicine fellowships. There aren't really any "Sports Medicine" specific jobs after fellowship and if there are they generally don't pay well. Ultrasound procedures reimburse garbage. My buddy who went to one of the top 3 PM&R residencies in the nation and then completed one of the top ACGME Sports Medicine fellowships is now working at a quite pathetic Kaiser job in SoCal seeing chronic pain-lite on the daily and getting paid a pretty pathetic salary. Can't really even entertain buying a home.
 
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I’m confused, @miacomet . You say you dislike EM. Yet you’re financially independent enough to not need to work in EM, or work at all. That is what most people dream of. Yet you’re still unhappy.

I don’t understand.

What [mention]miacomet [/mention] seems to be going through is extremely common when someone retires. Their struggle is something we all need to learn from, and I appreciate their openness in discussing it. It is exceedingly common for retirees to miss working, especially if they have worked for a long time in the field and/or their self identity is significantly tied to that career. As doctors, our training makes this a very common issue for us. We’re also by nature high achievers and “doers” so a life of recreation isn’t quite what we’re seeking.

To miacomet: Dan pink identified three things needed for job satisfaction, but they also are needed for life satisfaction - autonomy, mastery, and purpose. I could be wrong and this isn’t the reason for your struggle, but I suspect it is an issue of not having activities to satisfy those core needs we have as humans that work fulfills very well (medicine fills it too well). If you think it is seeing patients that you are missing and don’t need the money, try volunteering at a free clinic. See if it is patients you are missing. Or is it the complexity of cases in the ED? Or is it just having a sense of purpose, or one of those needs not being satisfied? None of that requires you to go do a residency. Just know that often these feelings are something you will wrestle with daily and for quite some time, but you need to figure out a way to give yourself a sense of direction. Anyone who retires needs to have a way to satisfy those three core needs in retirement. Until you know how you will satisfy those needs in retirement, any of us should try to delay or defer retirement. You’re already there, so just do your best to try to find ways to satisfy those needs and give yourself grace when you fall short. Good luck on your journey.
 
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What @miacomet is going through is actually pretty common for men not just in retirement but as early as their 30's:

"Levinson writes that this transition is often stressful. He calls it an “Age Thirty Crisis.”

This happens when a man’s current life structure is intolerable, but for whatever reason, they are unable to form a better one. A moderate or severe crisis is common during this period.

The Age Thirty Transition often begins with a vague uneasiness, a feeling that something is missing or wrong in your life. At this point, men sense that they must either find a new direction and make new choices or strengthen their commitment to the choices they’ve already made.
For some men, the process is smooth. By thirty, they feel their lives are reasonably complete. Still, it’s possible that they are not acknowledging flaws in their lives, which “often surface at a later time, when they exact a heavier cost.”

Sixty-two percent of the men interviewed in the book went through a moderate or severe age thirty crisis.

Many assume that people in their twenties have a good idea of what career they want. “This assumption,” the book states, “is erroneous.”

For some reason, it is a widely-held belief that people form their occupational paths in a steady, single-track manner.
Levinson writes that “this sequence was not the norm in any of our occupational groups.”

Levinson and his team discovered that it was the rule rather than the exception that young men faced setbacks, frustrations, and distractions when trying to decide on a career.

This was true regardless of their social class or occupational trajectory.

Young men often struggle for years to discover what they want to do for a living. It’s not uncommon to change one’s mind several times during this period of early adulthood.
It’s also a major step to commit to one particular line of work.

If men successfully complete the Age Thirty Transition—the final stage of young adulthood—they then enter what Levinson calls the “Settling Down” period.

This is a crucial step in adult development.

The main task of the Settling Down period is to commit to a few key choices and to invest yourself as fully as possible in your family, work, friendships, community, and personal interests.

As Levinson writes, by the early thirties, “A man has a stronger sense of urgency to ‘get serious,’ to be responsible, to decide what is truly important and shape his life accordingly.”

The Settling Down period typically extends from age 32-33 to age 39-42.

This phase of life involves assigning certain relationships, aspirations, and aspects of yourself to a more prominent place in your life. It also requires relegating other things to the back burner or ceasing them altogether.

In their mid-thirties and early forties, men who successfully enter the Settling Down period attain seniority at work. This brings money and prestige, but it also comes with burdens and responsibilities. Men in this phase let go of childhood conflicts which can sometimes plague early adulthood.
Levinson says there are two major tasks of the Settling Down period.

The first is to establish one’s place in society. It means to create a sufficiently orderly and stable life, to plant some roots and become a respected member of one’s community by contributing to young people the knowledge you have accrued in your own early adulthood. It means investing in existing romantic and social relationships.

The second major task is to advance in the workplace. At this point in a man’s career, “he has a sense of being on the low rung of the ladder, preparing to make his way to the top. Imagery of the ladder is an important part of life in this period.” The higher rungs might represent wealth, recognition, power, prestige, recognition, professional achievement, and so on.

Often, one of these tasks predominates at the expense of the other. If one task is overly neglected, though, it can create great difficulty in a man’s life.

Then there’s the second half—the culmination of the Settling Down as a man enters his forties.

It involves sufficient advancement on the ladder, becoming a senior member of his chosen occupation, wisely exercising authority, and mentoring young people.

If you have successfully made it to this stage, you spend less time relying on others and more time being relied upon by others.

Still, many men reach their late thirties and feel that they have not accomplished enough or achieved what they wanted.

This can involve a sense of being held back, of being restrained either by others or by one’s own inner conflicts and inhibitions.

For example, the book outlines how in their thirties, many men enter the managerial ranks at work. Even though their primary occupational interest was not in executive functions but in their original work (e.g., engineering or accounting), men will often get promoted into being a manager. At this point, many men get stuck in a role that does not interest them."
 
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Psych NP is probably one of the worst things to become they are essentially clueless most of the time when it comes to complicated patients…
Yeah, but their patients, insurers, and lcsws love them. And they are completely full of themselves and happy. So they win, even if everyone else loses!
 
I’m confused, @miacomet . You say you dislike EM. Yet you’re financially independent enough to not need to work in EM, or work at all. That is what most people dream of. Yet you’re still unhappy.

I don’t understand.
I guess I'm not most people! I come from folks that love their careers/jobs and do them for decades. I appreciate being FIRE-ish, I do, but I come from folks who love, love to work and love their careers, their careers being ophtho, ENT, urology, writing, design...they loved them. So while I've achieved what many want, and I'm grateful to be able to have flexibility and some security, it's not how I envisioned my life and it's strange and uncomfy and also guilt-inducing. I'm grateful, it just doesn't feel right on multiple levels.
 
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I guess I'm not most people! I come from folks that love their careers/jobs and do them for decades. I appreciate being FIRE-ish, I do, but I come from folks who love, love to work and love their careers, their careers being ophtho, ENT, urology, writing, design...they loved them. So while I've achieved what many want, and I'm grateful to be able to have flexibility and some security, it's not how I envisioned my life and it's strange and uncomfy and also guilt-inducing. I'm grateful, it just doesn't feel right on multiple levels.
I understand this. When I left EM it wasn’t what I envisioned. It felt like a failure. Although I was super relieved to be out and felt like I was freed from shackles, it also felt like the breakup of a long term love affair that I always tried to make work, but finally had to admit, wouldn’t work.

There was a mourning period. I felt I could never do anything as important as make a non-breathing person breathe or make a fibrillating heart beat again.

But I realized I didn’t need to do that, to be immensely valued. Having people give thanks for a year of pain free living after a nerve ablation, or seeing me in the hallway and saying, “Doc, I can walk because of you,” ended up being as equally as gratifying as anything I felt in EM.

One day, when I hang this up, I don’t intend on doing nothing. I see myself possibly volunteering at a med school, Doctors Without Borders or even something like habitat for humanity. Anything to remain useful in full retirement.

It took me some time stop being sad about my breakup with EM. At the same time, I never missed it or considered going back. I knew it was over, had to be over, and didn’t want to go back. I could have easily, if I wanted to. Although I didn’t go back, it took me awhile to morn the loss of what I dreamed as a teenager and pre-med student, would make me happy. It ended up being other things that made me happy.

I still use many of the skills I learned in EM, just in a different setting and different way. Whereas my job satisfaction in EM was a negative 20 out of 10, my current job satisfaction is a 6 out of 10. I can’t rave about it and say I feel like a kid walking into Disneyland every day. I don’t feel that way about anything, as I’m not that type. But it’s a solid 6 out of 10. Enough to sustain me and feel gratifying, but perhaps not enough to say I’d do it until I collapse on the job out of old age. Coming from EM which was immensely hard on me, a 6 out of 10 feels like a huge win.

I wrote about this quite a bit on here, circa 2011-2013.
 
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There is a guy in my shop that left EM and went and did an optho residency in 3 years (they counted his EM as 1 year) He now works 4 days a week in optho and 1day in the ER. It is possible. He is board certified in both. He was about 40 when he went back and did optho residency, his wife was a little upset she a sthm and they have 3 kids but they made it work. So yes you can go back and do another residency
There’s a guy that got so tired of waiting on ophtho to call back that he went out and just became an ophthalmologist. Honestly, it probably saved him time in the long run instead of trying to get a hold of them.
 
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My god

that's incredible

the only ER doc in the country that won't mind when eye **** checks in
Lol I like when I ask .. I mean have you done any welding or changed a UV bulb or anything .. and their bloodshot eyes light up and look at me like I’m a fortune teller 🤣

Other than that I also hate eye stuff
 
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There is a guy in my shop that left EM and went and did an optho residency in 3 years (they counted his EM as 1 year) He now works 4 days a week in optho and 1day in the ER. It is possible. He is board certified in both. He was about 40 when he went back and did optho residency, his wife was a little upset she a sthm and they have 3 kids but they made it work. So yes you can go back and do another residency
Sounds like Marius. He’s European though so it doesn’t count. 😝
 
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Things I tell my kids

#1. A job is called a job. If you somehow love your job, then you are a unicorn. Most people do not love their job, and this is ok,
#2. Some people, no matter what, just are not happy people. This does not mean you OP. But some people just are not happy people and you see this all the time with Docs. You need to soul search on what is making you unhappy, find a purpose, find a direction. Changing jobs many times is not the answer.
#3. The grass is not always greener. The only ones who tell you they are much happier will not be the many who are not happy with a career change. Spending another 3+ yrs to change specialty likely is not the answer. Look around, and most specialists do not love their job. Many will tell you its a job. Most surgeons, OB, Anesth, hospitalists I know do not love their job and seem more miserable than my EM partners.

With all of this said, if you are FIRE then you have plenty of time to search for what makes you happy. Not having the golden handcuffs makes changes less disruptive.

I probably have had more changes in careers in my life than most, with many that never were unintended. I just get that feeling and jump in.

In college, I hated medicine, and went into Engineering. Started as electrical/computer engineering -> mechanical engineering ->aerospace engineering ->Math major, ->then back to electrical/computer/Biomedical -> medical school. When I became an ER attending, I loved my job and thought I would work into my 60's which was not a bad path. Things changes and life is unpredictable. I got into RE, FSERs owner, and now for my 3rd career going into finances. Just passed my SIE exam and working towards my Private placement exams. Never in my life did I ever thought of these other 3 paths. So don't fear risks. Try it, and at worse you can go back being an ER doc which really isn't a terrible job for the pay.
 
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What a garbage take. Do most other jobs take 11 years and negative 200-400k to obtain? You’re damn right there’s a degree of entitlement to a certain threshold of money.

It’s not really a garbage take. Clearly our wages aren’t determined by how long we want to school or how much debt we have. Or else people would go to more schooling and take on more debt and feel entitled for more pay. Also, google sometime the share of the country that is getting multiple degrees or “doctorates” in this country. It’s a large number and increasing. And they have plenty of debt. Should society pay more because Timmy really likes early 18th century Tsarist Russian art and proved it by multiple degrees and hundreds of thousands of dollars in debt? Should he be paid more than the far lesser educated and far less indebted plumber? On what merit?

I don’t want to derail away too much, but we have a lot of self-importance and self-identify tied up in being doctors and that’s okay to an extent as long as we’re not having constant paralyzing identity crises and feel our self worth slipping away anytime someone insinuates we’re not there top of the food chain. That’s our insecurity there. Obviously I, like most here, wish medicine commanded that sort of respect, but that time seems to be gone. Traditions be damned.
 
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FWIW, it took me several years (easily 4-5) to transition my identity from that of an ER doc to a hospice doc.

When *who you are* is wrapped up in what you do, like us, I think it's probably a tougher transition. The above comment on retirees transitioning is a similar thing. I dipped my toes in and didn't switch abruptly but I did struggle with it mentally. The idea of loosing my skills was hard. When I realized I had to look up the HEART score, man, that was hard too. But now, I couldn't imagine going back.

But it WAS a transition and it WAS hard, and I struggled with it. And I will admit that.
And I will also admit that I do enjoy seeing patients and wasn't ready to give that up. I just see a lot less now with much less time pressure.
 
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What [mention]miacomet [/mention] seems to be going through is extremely common when someone retires. Their struggle is something we all need to learn from, and I appreciate their openness in discussing it. It is exceedingly common for retirees to miss working, especially if they have worked for a long time in the field and/or their self identity is significantly tied to that career. As doctors, our training makes this a very common issue for us. We’re also by nature high achievers and “doers” so a life of recreation isn’t quite what we’re seeking.

I’m an Occ Med doc and see this phenomenon all the time: from the 45-year-old police officer starting a new full-time security job after getting their pension, to the 60-year-old retired engineer signing up to drive the school bus for a bit, to the former teacher doing volunteer work at the hospital. It kinda surprised me at first (especially for people in professions/companies with great pensions), but I got used to it pretty quickly.

I couldn’t tell you what the denominator is (i.e., what percentage of retires this represents), but it’s common enough that I occasionally think about what my post-retirement job will be—or if I even will retire at all.
 
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Piano hit it on the head. Docs spend so much of their lives having very busy schedules and have a hard time with free boring times on their hands.

I have and still going through the same. When I went from full time hospital 15 shifts a month to Fser 6x12, you get really bored and feel the lack of purpose. I thought about going 4x12 but I fear the feelings will get worse.

It helps that I still have 3 teenagers, RE that takes about 10hrs/mo. Even with this, I’m picking up golf and starting to move into finances. I’m thinking about teaching at our kids schools now.

@50, I can’t Shake the feeling of lack of purpose.
 
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I love being ‘bored’ and never know where all the time goes. I certainly don’t feel bored even with nothing to do as rare as that ever occurs. Minutes turn into hours sipping coffee, reading (even free junk magazines in the mail), staring off into the horizon, listening to music or my backyard stream, running, a glass of wine, time with the family and dogs, on and on. Perhaps deep at heart I’m simpler than most. I like to think I’m just content with it all. This job has taught me it can all be unexpectedly gone in a second. Agree though that there can be a retirement identity crisis for some. I became a physician, but that’s not my identity or who I am. I’ll be comfortable leaving that part of myself behind. My exit from EM will be a little more time to myself, because I spent a lot of random time working outside of normal working hours.
 
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Piano hit it on the head. Docs spend so much of their lives having very busy schedules and have a hard time with free boring times on their hands.

I have and still going through the same. When I went from full time hospital 15 shifts a month to Fser 6x12, you get really bored and feel the lack of purpose. I thought about going 4x12 but I fear the feelings will get worse.

It helps that I still have 3 teenagers, RE that takes about 10hrs/mo. Even with this, I’m picking up golf and starting to move into finances. I’m thinking about teaching at our kids schools now.

@50, I can’t Shake the feeling of lack of purpose.

Nowadays I read books for free on archive.org. They have a huge selection. Going through the dark tower at the moment.
 
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Like I would love to do psych. But not being an NP, I cannot. I'd be okay with two or three years. But...the world wants psych NPs, not EM-Psych. We are not of value.
 
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Like I would love to do psych. But not being an NP, I cannot. I'd be okay with two or three years. But...the world wants psych NPs, not EM-Psych. We are not of value.

I would have killed for a EM-Psych residency personally. I liked both worlds a lot but they don’t exist together for obvious reasons even though like this whole thread stated there are a lack of good options for EM trained physicians wanting out of the ER. Still for you @miacomet I’m not sure where you live but a lot of states including even prominent ones like TX allow EMs to also do primary care. It’s a lot lower pay obviously but you’ve indicated money isn’t the issue. Just another thing to consider if you still miss the medicine and want more relationship/connection with the patients.
 
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Like I would love to do psych. But not being an NP, I cannot. I'd be okay with two or three years. But...the world wants psych NPs, not EM-Psych. We are not of value.
“We are not of value”. No. We just work in a different profession with different types of professional standards, regulation and organized turf protection. Apples and oranges.
 
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I would have killed for a EM-Psych residency personally. I liked both worlds a lot but they don’t exist together for obvious reasons even though like this whole thread stated there are a lack of good options for EM trained physicians wanting out of the ER. Still for you @miacomet I’m not sure where you live but a lot of states including even prominent ones like TX allow EMs to also do primary care. It’s a lot lower pay obviously but you’ve indicated money isn’t the issue. Just another thing to consider if you still miss the medicine and want more relationship/connection with the patients.
States don’t regulate what kind of medicine you can practice. It’s a facility/ insurance issue. Any physician can open up a primary care office. Whether you are opening yourself up to huge liability if something goes wrong will be for the court to decide.
States though do not determine scope of practice based on residency training.
 
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