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

[AlmostAnMD]

Yea, but the match rate into the Russian monarchy is pretty low and the burn out is terrible.

Sir you're going to need to take this high brow BS over to nephrology or something

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[Fox800]

Depends on the job. You don’t have to worry about that as a locums or PRN doc. I get that stuff at my prn gig, I just ignore it! They need me, not the other way around.

Same. I'm PRN at my job and I get a higher hourly than the full-timers but no benefits. I don't go to department meetings or really pay attention to any little nitpicking. There are constantly holes in the schedule and people are always trying to trade/give up shifts. No bonuses or incentives, so I only work 5 shifts a month. They briefly offered bonuses but those have been gone for months so they won't get any extra shifts out of me. I work M-F never after 1800, no evenings/nights and no weekends.

No benefits, no bonuses? I'll punch-in, and punch out.

This resonated with me - the burger flipper analogy:

 

[GonnaBeADoc2222]

My net worth has increased 1 mil (negative 200k to positive 800k) since residency graduation in June 2017 just by saving, paying off student loans, investing in index funds, and working my 13 days a month.

Hopefully I can eek out another 5 to 10 FT years before EM becomes truly intolerable.

 

[dchristismi]

Sir you're going to need to take this high brow BS over to nephrology or something

I caught it, and I actually laughed out loud. Brilliantly played, sir.
I think once there's a smart @ss reply, you can't go back and fix the typo. I hope it even becomes a legendary reference.

 

[miacomet]

There are LOTS of jobs right now, my e-mail inbox is blowing up every day. They just aren't that great.

Exactly. $210 doing nights in Florida? No thanks.
Locums isn't so easy. They have weird rules like you have to have worked at a 100k place to credential, or that you have to have worked 1500 hours a year or whatever to credential with them. It's not feasible unless you are a workhorse. Weirdly, they credential non ABEM docs, though.

 

[Jball43]

Exactly. $210 doing nights in Florida? No thanks.
Locums isn't so easy. They have weird rules like you have to have worked at a 100k place to credential, or that you have to have worked 1500 hours a year or whatever to credential with them. It's not feasible unless you are a workhorse. Weirdly, they credential non ABEM docs, though.

Minor thought, one of my closest friends is EM and wishes they never went into EM, let lone medicine. Oddly enough, now they’ve gone from a -20 out of 10 (to mirror another poster) life satisfaction to a 5/10 doing on demand telehealth and also prescribing weed to the good citizens of the state. This set up allows both souses to now be remote and to watch movies between patients, play video games if time allows, and work while traveling. The telehealth group paid for like a dozen licenses. Their pay is still solid and I think they don’t hate life anymore. Which is something. I’m not speaking from experience but I figured after reading this entire thing I should contribute 🥴

 

[xaelia]

Minor thought, one of my closest friends is EM and wishes they never went into EM, let lone medicine. Oddly enough, now they’ve gone from a -20 out of 10 (to mirror another poster) life satisfaction to a 5/10 doing on demand telehealth and also prescribing weed to the good citizens of the state. This set up allows both souses to now be remote and to watch movies between patients, play video games if time allows, and work while traveling.

Love to hearken back and contrast the premed idealism against actual life for those scorched by reality.

 

[Fox800]

Exactly. $210 doing nights in Florida? No thanks.
Locums isn't so easy. They have weird rules like you have to have worked at a 100k place to credential, or that you have to have worked 1500 hours a year or whatever to credential with them. It's not feasible unless you are a workhorse. Weirdly, they credential non ABEM docs, though.

Doesn't seem right. I haven't worked at a 100k+ place since residency and have had no problems getting locums assignments. No one is checking how many hours you work per year, how would they? Ask to audit your past paychecks? Yeah, no thanks. You're hiring locums because you're desperate and no one wants to work there as staff.

 

[GonnaBeADoc2222]

My net worth has increased 1 mil (negative 200k to positive 800k) since residency graduation in June 2017 just by saving, paying off student loans, investing in index funds, and working my 13 days a month.

Hopefully I can eek out another 5 to 10 FT years before EM becomes truly intolerable.

Everytime I log into a department meeting in reminded why I wanna go PT in 5 years or so.

 

[miacomet]

Doesn't seem right. I haven't worked at a 100k+ place since residency and have had no problems getting locums assignments. No one is checking how many hours you work per year, how would they? Ask to audit your past paychecks? Yeah, no thanks. You're hiring locums because you're desperate and no one wants to work there as staff.

It's not the hospitals, it's the locums companies.

Weatherby won't let you work at Level 1s unless you have worked at a Level 1in the last two years. Same with Level 2s. They also stratify docs (board certified or not) based on volume- I worked at a single coverage place with 13k volume for over a decade. They said they wouldn't credential me at anywhere more than 15k because "their malpractice wouldn't cover it."

CompHealth asked me to attest that I'd worked 1500 hours in the last two years (which I have done, but hey maybe it was 1400 hours) or their "malpractice wouldn't cover me." I said wow, I'd hate to be left bare with a lawsuit, why don't you call my old director and get an hours audit? They said, oh, just attest, it's casual, they don't check, meaning it's a bold face lie, for some reason they just demand this.

I've never had a medmal case. I have a stellar work history (who works at a place 12 years these days?)

I used to use these companies, but they've lost their minds.

 

[swamprat]

Do pain - I did. I made a little over 700 last year working M-F 9-4. Pain is your way out. End of thread.

 

[Birdstrike]

@swamprat is someone who started messaging me in 2014 asking about Pain, promptly took action, applied and got in. Swamprat is able to have a normal life now.

 

[Brigade4Radiant]

Do pain - I did. I made a little over 700 last year working M-F 9-4. Pain is your way out. End of thread.

I see why it’s competitive how many weeks of vacay?

 

[sloh]

Do pain - I did. I made a little over 700 last year working M-F 9-4. Pain is your way out. End of thread.

Location?

 

[emergentmd]

Do pain - I did. I made a little over 700 last year working M-F 9-4. Pain is your way out. End of thread.

Great Job. I don't mean doing pain and making 700K with bankers hours.

I mean willing to take the risks rather than waiting 5 yrs being in the same unhappy spot. I got out of hospital EM 5 yrs ago, work 4-6 dys a month, and make more than if I worked 3 full time EM jobs. Doing my next career in about a month not for the money but just because I want to which is the best feeling.

 

[GonnaBeADoc2222]

Yeah I think I'm slowly coming to terms with the fact that I can't do this full-time for a full career.

Pain is on the differential, unfortunately I am severely geographically strapped and can only really do one program.

Will explore.

 

[miacomet]

Yeah I think I'm slowly coming to terms with the fact that I can't do this full-time for a full career.

Pain is on the differential, unfortunately I am severely geographically strapped and can only really do one program.

Will explore.

What else are you considering?

 

[GonnaBeADoc2222]

What else are you considering?

1) part-time after a few more years

2) sucking it up

3) quitting.....jk....maybe

 

[miacomet]

1) part-time after a few more years

2) sucking it up

3) quitting.....jk....maybe

Crap options. Sorry.

 

[ScepticSkeksis]

For those under 40, OnlyFans is a good option. It allows you to work from home and control your own schedule.

 

[bravotwozero]

Everytime I log into a department meeting in reminded why I wanna go PT in 5 years or so.

I'm usually post night shift, mute my phone with headphones on, and go to sleep...

 

[JacobMcCandles]

I honestly don't think I could go back to a Monday through Friday job even if it were banker's hours.

 

[CoolDoc1729]

I honestly don't think I could go back to a Monday through Friday job even if it were banker's hours.

Same. Spent half the summer fishing on Wednesdays and Thursdays when it’s not crowded. It doesn’t work for everyone but I love my schedule. Even if I have to miss occasional events with my in laws 😜

 

[bravotwozero]

Same. Spent half the summer fishing on Wednesdays and Thursdays when it’s not crowded. It doesn’t work for everyone but I love my schedule. Even if I have to miss occasional events with my in laws 😜

N=3. I love being able to go to the gym and not have to wait for the cable machine or bench press.

Either I’m wired this way, or the job schedule just turned me into this person, not sure.

 

[Splenda88]

I honestly don't think I could go back to a Monday through Friday job even if it were banker's hours.

I don't think I could either as a hospitalist working on 7 on/off.

The people who work part time at my shop, do 7 days on and 21 days off.

 

[JacobMcCandles]

N=3. I love being able to go to the gym and not have to wait for the cable machine or bench press.

Either I’m wired this way, or the job schedule just turned me into this person, not sure.

I honestly think I stay in better shape working weird hours. I’m much more likely to get a workout in before an afternoon/evening shift than to come home from a day shift and workout and/or run.

 

[Brigade4Radiant]

Yeah, I don’t want to go back to a 9 to 5 Monday through Friday. I do telehealth as a side gig while doing my EM. shifts and the extra shifts I do for a bonus.

 

[Apollyon]

For those under 40, OnlyFans is a good option. It allows you to work from home and control your own schedule.

Why under 40? There's a niche for everything.

 

[GatorCHOMPions]

I honestly think I stay in better shape working weird hours. I’m much more likely to get a workout in before an afternoon/evening shift than to come home from a day shift and workout and/or run.

When you’re on a set 9-5 it’s pretty easy to workout in the morning. Wake up at 630, exercise, say hi to kids and eat breakfast, leave at 8-815.

Edit to add this is for those with enough equipment at home. If you go to the gym, yea it’ll be tougher.

 

[cyanide12345678]

The best of both worlds however would be Tuesday to Thursday fixed schedule - 8 am to 5 pm. 4 days off every weekend.

I envy my wife’s schedule which she starts after maternity leave.

Throw in 4 weeks paid vacation, 1 week paid cme, 10 or so federal holidays as additional paid time off.

Id be down for that.

Edit: 4 weeks paid vacation is still 20 days. So it’s basically almost 7 weeks off to travel for an entire week as she would only have to take 3 days of vacation time for a week off. It’s just incredible.

Edit again: the more i crunch the numbers and compare my job to hers the more i regret EM with some slight feeling of envy lol

Her part time job: 27 hrs per week. Number of days worked = (3 x 52 weeks) minus 20 days paid time off minus 5 cme days minus 10 fed holidays = 121.

Number of hours worked per yr = 121 x 9 = 1089

Salary = rvu based. Estimated to be around 220k for the part time gig extrapolated from the current rvu generation and seeing 16-18 scheduled patients per day. Salary continues to grow as patient panel increases in size especially as more Medicare advantage patients become part of her panel.

$/hr = 220000/1089 = $202. Grows over time.

Not bad at all when you start accounting for benefits like paid time off that EM doesn’t have.

 

[emergentmd]

When you’re on a set 9-5 it’s pretty easy to workout in the morning. Wake up at 630, exercise, say hi to kids and eat breakfast, leave at 8-815.

Edit to add this is for those with enough equipment at home. If you go to the gym, yea it’ll be tougher.

We have a gym at home with treadmill/weight machine. We have a membership to a high end gym. Docs make a good living, well worth it to spend alittle on your health. Its great to have a place where I can just go get a run/work out in anytime I have a free moment and get the urge.

I always loved the EM schedule even when I did 15 dys/month. I hate going to stores on weekends. Gives me lots of time to spend with my wife when kids are in school and avoiding the crowds are a great plus.

 

[miacomet]

Why under 40? There's a niche for everything.

Totally. Lots of elder workers in that particular industry and probably on video too. People just don't like to admit what they are ACTUALLY interested in.
Not all the Viagra crowd has thirty something partners.

 

[miacomet]

The best of both worlds however would be Tuesday to Thursday fixed schedule - 8 am to 5 pm. 4 days off every weekend.

I envy my wife’s schedule which she starts after maternity leave.

Throw in 4 weeks paid vacation, 1 week paid cme, 10 or so federal holidays as additional paid time off.

Id be down for that.

Edit: 4 weeks paid vacation is still 20 days. So it’s basically almost 7 weeks off to travel for an entire week as she would only have to take 3 days of vacation time for a week off. It’s just incredible.

Edit again: the more i crunch the numbers and compare my job to hers the more i regret EM with some slight feeling of envy lol

Her part time job: 27 hrs per week. Number of days worked = (3 x 52 weeks) minus 20 days paid time off minus 5 cme days minus 10 fed holidays = 121.

Number of hours worked per yr = 121 x 9 = 1089

Salary = rvu based. Estimated to be around 220k for the part time gig extrapolated from the current rvu generation and seeing 16-18 scheduled patients per day. Salary continues to grow as patient panel increases in size especially as more Medicare advantage patients become part of her panel.

$/hr = 220000/1089 = $202. Grows over time.

Not bad at all when you start accounting for benefits like paid time off that EM doesn’t have.

What's her gig?

 

[emergentmd]

Totally. Lots of elder workers in that particular industry and probably on video too. People just don't like to admit what they are ACTUALLY interested in.
Not all the Viagra crowd has thirty something partners.

I don't get Only fans. Is it essentially you pay for access and they do stuff you ask them to do for a price? Isn't this essentially free online anyhow?

 

[VA Hopeful Dr]

The best of both worlds however would be Tuesday to Thursday fixed schedule - 8 am to 5 pm. 4 days off every weekend.

I envy my wife’s schedule which she starts after maternity leave.

Throw in 4 weeks paid vacation, 1 week paid cme, 10 or so federal holidays as additional paid time off.

Id be down for that.

Edit: 4 weeks paid vacation is still 20 days. So it’s basically almost 7 weeks off to travel for an entire week as she would only have to take 3 days of vacation time for a week off. It’s just incredible.

Edit again: the more i crunch the numbers and compare my job to hers the more i regret EM with some slight feeling of envy lol

Her part time job: 27 hrs per week. Number of days worked = (3 x 52 weeks) minus 20 days paid time off minus 5 cme days minus 10 fed holidays = 121.

Number of hours worked per yr = 121 x 9 = 1089

Salary = rvu based. Estimated to be around 220k for the part time gig extrapolated from the current rvu generation and seeing 16-18 scheduled patients per day. Salary continues to grow as patient panel increases in size especially as more Medicare advantage patients become part of her panel.

$/hr = 220000/1089 = $202. Grows over time.

Not bad at all when you start accounting for benefits like paid time off that EM doesn’t have.

My wife is about the same except 4 days/week so 300k/year. Time off is about equal, we get 6 weeks total (we can take more but 30 days is a given) but that includes holidays.

 

[cyanide12345678]

What's her gig?

Family medicine. Regular out patient clinic.

 

[cyanide12345678]

My wife is about the same except 4 days/week so 300k/year. Time off is about equal, we get 6 weeks total (we can take more but 30 days is a given) but that includes holidays.

Yeah family medicine is such a hidden gem that no one actually appreciates. It’s a great specialty. Not to mention the value of actually owning your patients.

 

[JacobMcCandles]

The best of both worlds however would be Tuesday to Thursday fixed schedule - 8 am to 5 pm. 4 days off every weekend.

I envy my wife’s schedule which she starts after maternity leave.

Throw in 4 weeks paid vacation, 1 week paid cme, 10 or so federal holidays as additional paid time off.

Id be down for that.

Edit: 4 weeks paid vacation is still 20 days. So it’s basically almost 7 weeks off to travel for an entire week as she would only have to take 3 days of vacation time for a week off. It’s just incredible.

Edit again: the more i crunch the numbers and compare my job to hers the more i regret EM with some slight feeling of envy lol

Her part time job: 27 hrs per week. Number of days worked = (3 x 52 weeks) minus 20 days paid time off minus 5 cme days minus 10 fed holidays = 121.

Number of hours worked per yr = 121 x 9 = 1089

Salary = rvu based. Estimated to be around 220k for the part time gig extrapolated from the current rvu generation and seeing 16-18 scheduled patients per day. Salary continues to grow as patient panel increases in size especially as more Medicare advantage patients become part of her panel.

$/hr = 220000/1089 = $202. Grows over time.

Not bad at all when you start accounting for benefits like paid time off that EM doesn’t have.

I’m glad she enjoys it and feels well compensated but that wouldn’t come close to me being able to do clinic regularly.

 

[Anesthesia_Guy]

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

They wouldn't.

 

[miacomet]

They wouldn't.

Exactly! I think you can switch to another field within 5-7 years of graduating. I don't think you can switch much beyond that, it's really hard to do. Which is why EM sucks, among other things. The number of docs I know who simply...stopped practicing medicine because there were no exit strategies from EM is not small.

 

[BoardingDoc]

Location?

Based on other posts, southern Florida.

 

[TooMuchResearch]

I honestly think I stay in better shape working weird hours. I’m much more likely to get a workout in before an afternoon/evening shift than to come home from a day shift and workout and/or run.

Definitely...if I worked a 9-5, I'm strength training at 7 am? No thanks.

 

[Brigade4Radiant]

Definitely...if I worked a 9-5, I'm strength training at 7 am? No thanks.

Yeah I hate going to the gym early in the morning

 

[VA Hopeful Dr]

Yeah I hate going to the gym early in the morning

I love a good after work run

 

[sloh]

AM workouts are the best for me once I’ve been up for about 1 hr. Only took me 1-2 weeks to get used to it. Now I’m antsy to train in the AM. My mind is much clearer and I can do cognitive work much more efficiently after I train in the AM. And I feel zen’d the **** out for the rest of the day after I’ve had that release of aggression in the AM. Mood is much better.

The leaner and more ripped I am, the less sleep I need. I sleep at 1030-11 and wake up at 4. Eat first meal then drive out to gym near work. No traffic, gym is empty and no waiting on machines. Shower at the gym, dress for work, eat second meal I packed in my car, arrive at work by 830-9 am, round on patients for 1.5-2 hrs, head home after (I’m consultant not primary) and finish a couple hrs of documentation remotely at home.

In my case, a home gym would actually decrease my daily efficiency bc if I left for work after training at home, I’d hit traffic.

 

[bravotwozero]

I would love to start my day with a workout and on my days off, I usually do. But my day shift starts at 6am and lifetime doesn’t open till 5:30, so that doesn’t work. And I’m definitely not going to the gym when I’m post night shift in the morning.

 

[TooMuchResearch]

Yeah I hate going to the gym early in the morning

My joints don't feel mobile enough to even do light cardio until 45 minutes after I wake up. Moving any reasonable weight is minimum two hours after wake up, and I prefer early to mid afternoon. I guess I could take a 12-2 pm clinic lunch break, race home, train, shower, race back. I've tried strength work after a busy day shift, and it's alarming how little fatigue I feel during a set before I just can't move the weight. Also, I don't find that getting home and then disappearing to exercise helps me win any husband or father awards.
tl;dr: I'm a snowflake. Don't melt me.