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Do gensurg or IM then. Lots of gensurg jobs that are not like residency (ie focus on non-acute gensurg) and GI/heme-onc/hospitalist jobs all viable from IM.
Income, benefits, compensation thread
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Do gensurg or IM then. Lots of gensurg jobs that are not like residency (ie focus on non-acute gensurg) and GI/heme-onc/hospitalist jobs all viable from IM.
Don’t become an anesthesiologist, hospitalist, intensivist, EM doc. Some of these may be doing well right now but the future is uncertain. All of these specialties share midlevel encroachment, predatory staffing groups, lack of control at work, and are viewed as an expense by hospital systems. What to do? Surgical subspecialties or procedural IM subspecialties. If you can’t get into those, do a non-procedural, outpatient focused IM subspecialty.
The love for hospitalist on this board stems from a handful of frequent posters. Maybe because they have great jobs or maybe they are new grads with rose colored glasses. For every 1 good job that someone is happy at, there are 4 bad ones. I know way too many unhappy hospitalists. You’re the absolute bottom of the totem pole in the hospital, some may tolerate the regular disrespect fine, but most don’t.
You’re not making a decision for the next 5 years, your decision is for the next 30+. I don’t have a crystal ball but the future of these 4 specialties looks pretty ****ty.
The love for hospitalist on this board stems from a handful of frequent posters. Maybe because they have great jobs or maybe they are new grads with rose colored glasses. For every 1 good job that someone is happy at, there are 4 bad ones. I know way too many unhappy hospitalists. You’re the absolute bottom of the totem pole in the hospital, some may tolerate the regular disrespect fine, but most don’t.
You’re not making a decision for the next 5 years, your decision is for the next 30+. I don’t have a crystal ball but the future of these 4 specialties looks pretty ****ty.
@CCM-MD is an alarmist.
EM might not have a bright future but I would not say the same for CCM, hospitalist medicine and anesthesia.
He is correct that there is occasional disrespect coming mostly from nurses (usually ICU nurses or nurse getting their NP based on my observation).
Maybe I am naive since I have been a hospitalist for only 2 years, or maybe I have an atypical gig. However, my co-residents who are at other facilities are ok with their gigs mostly because of the flexibility.
EM might not have a bright future but I would not say the same for CCM, hospitalist medicine and anesthesia.
He is correct that there is occasional disrespect coming mostly from nurses (usually ICU nurses or nurse getting their NP based on my observation).
Maybe I am naive since I have been a hospitalist for only 2 years, or maybe I have an atypical gig. However, my co-residents who are at other facilities are ok with their gigs mostly because of the flexibility.
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I have worked at least 16 shifts (192 hours, usually 204, sometimes as much as 240) every single month since I left residency (technically I did have vacation during residency) - so the last 6 years. The only exceptions were for 3 months where I was involuntarily dropped to 144 hours a month. I take vacations at the start and the end of months, so ive actually taken 10-11 days off in a row many times. Just front and back load consecutive months.
I think the way it was originally phrased was nobody is sustaining a 40 hour work week average. So that still applies. And months where I'm not taking European vacations I definitely do prefer the hours evenly split, but I have no problem punching out 16 shifts in 20 ish days to get time off to end and start two months.
Since EM docs regularly get disrespected by hospitalists, wouldn’t that make us the bottom of the totem pole?
I mean…. Don’t take that honor from us 🤣
Fair. I'm getting close to 40 as well and haven't felt the drop off yet but everything I do lately I do in the context of the fact that my wife is expecting (😁). We had two other coworkers both become first time dads in the last few years and they seem to be adamantly in favor of 12s, but both of their wives are full time at home and my wife is a professional as well - so I won't be surprised if my tune changes in a few months.
Lol. I was going to say the same because I see that all over the webs. Fortunately, we dont have that kind of BS at my place. I guess it's hospital culture.
One of my buddies who is CCM and works at what he describes a unicorn is extremely happy. Regular morning hours. No nights since mlp covers. 1 weekend a month. 700k a year now that he made partner and is on RVUs.
Apparently one bronch with biopsy is 10 rvus, takes him about an hour for everything, and he’s making $81/rvu generated.
FormerNFLQB
Full Member
I plan to do an elective in CCM to see if I like it but I hear horror stories about it not actually being high acuity cases and you are just a babysitter for the surgeons etc.
I have nice specialists actually.
The other day i had a third trimester pregnant lady with abdominal pain in my ER. It’s a critical access place, no OB.
The hospitalist who is FM trained randomly calls me and is like ‘hey you need help. I’ve delivered a lot of babies in my FM days’.
Yesterday i was presenting to an ortho attending, he wasn’t even mean or anything. He was actually pretty nice and detailed on the plan. Somehow he felt that he had cut me short a couple of times, so 10 minutes after we hang up, he calls me back just to apologize for being disrespectful….. and I’m like woah….i didn’t even think you were at all disrespectful. I thought he was actually very helpful on the phone, which i let him know.
ENT is often usually the biggest a**h*les in our system and my last hospital system. Completely toxic people on the phone. Talk to you like you’re just a dumb idiot.
You really don’t know what you’re talking about.
Most icu patients are medical patients. Surgeons have nothing to do with them. Respiratory failures, cardiac arrest, pulm edema, septic shock, severe GI bleeds etc. If there’s any post op intubate patient that is in the ICU, yes the surgeon’s opinion matters. It’s their patient!!!! They literally should be the people managing everything!!! The ICU doc should only be involved with vent management at that time. The surgeon is responsible for pretty much all surgery related complications. But that’s really not a majority of icu patients. Maybe 20 percent?
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FormerNFLQB
Full Member
Just want to clarify, it’s not I that thinks this way. It is what I have been told which is why I mentioned it here to get other’s opinions.
FormerNFLQB
Full Member
I obviously don’t know anything yet. Just what I’ve been told. Which I want to find out for myself. I’ve been told by a few people on here that things I am searching for are had in CCM which has sparked my interest
Yeah have to concur. Which is why I will still leave the ED for lunch breaks, even when busy for my own sanity.
FormerNFLQB
Full Member
Good point to make regarding the amount of patients in the ICU being surgical though. That makes more sense that what others have told me regarding CCM.
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As a hospitalist you will get ****ted on by everyone including administration and case managers. The stories I hear are terrible. Are there good jobs out there? Of course, especially in places most people don’t want to live in. But there are loads of bad ones.
CCM has less of the disrespect issue for various reasons, primarily because we are the last line of defense and can help some of the sickest of the sick. But we have many we can’t help. Surgical ICUs will have the most disrespect, and often you are just the surgeons vent managing bitch. My colleague here made close to 7 figures working 20ish shifts per month and a medical director stipend. Would advise you to do it? No because, again: midlevels, corporate staffing etc. as I stated before. Anesthesia is doing even better right now, but the field has a dismal future due to major CRNA encroachment.
CCM has less of the disrespect issue for various reasons, primarily because we are the last line of defense and can help some of the sickest of the sick. But we have many we can’t help. Surgical ICUs will have the most disrespect, and often you are just the surgeons vent managing bitch. My colleague here made close to 7 figures working 20ish shifts per month and a medical director stipend. Would advise you to do it? No because, again: midlevels, corporate staffing etc. as I stated before. Anesthesia is doing even better right now, but the field has a dismal future due to major CRNA encroachment.
FormerNFLQB
Full Member
So you would say to even stay away from CCM due to midlevels? Or did I read that wrong?
Nvm reread your initial comment.
That crna encroachment kept me from anesthesia. 7 years later, they are still going strong m. The doom and gloom for anesthesia has been going on for over a decade, but nothing seems to happen
I’m a realist. I think you have a good gig and are new.
Anesthesia and CCM are better options than EM or hospitalist IMO. But I would still avoid if I was a med student right now. There are better options.
FormerNFLQB
Full Member
What would you suggest I look into then? Obviously nothing is set in stone for me as of now.
People in SDN tend to exaggerate things.
It wasn't meant to be taken literally. There are usually a few in each group that work those kinds of hours for various reasons. The point I was getting at was for people not to expect that they're going to do that since those people are the exceptions to the rules.
Like I said earlier: surgical subspecialties (think ENT/urology/ortho) or procedural IM sub specialties (think GI). If that’s not your thing or can’t get in, the next best thing is a non procedural medical subspecialty (oncology/rheum/endocrine).
My wife is an endocrinologist works 4 days a week is paid 275k base, plus productivity. She has every weekend and public holiday off and additional gets 4-6 weeks in paid time off + CME. She has total control of her schedule and how she wants to do things - this is the biggest thing that prevents burn out. Lack of control is shared amongst all of the hospital based specialties mentioned earlier, and you should avoid them if possible.
FormerNFLQB
Full Member
I think I will have a decent shot at IM subspecialties as long as they are interesting to me (I have a decent application). I dont want to do something I dont love just to avoid the scope creep though.
If you ignore the scope creep you might end up in a specialty that you can’t actually “do” because of the scope creep. IMO it’s a real risk and if I was a medical student right now, this would be the biggest factor I would consider when selecting a specialty.
FormerNFLQB
Full Member
Point taken. I will look into those specialties you mentioned. Out of them I know I have an interest in oncology for sure just will have to give up my want of procedures.
You know many FM (few IM) docs work that kind of schedule without the addition al 2-3 yrs fellowship. They also make close to that. It is not unique to IM subspecialties. @VA Hopeful Dr has said here that he and his spouse (IM doc) make 300k+ working that kind of schedule.
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Yeah my wife has that exact life. I envy her schedule.
3 days a week. 200k. 11 federal holidays. 5 cme days. 4 weeks paid vacation. Those paid vacation days are basically 2.5 months of paid time off when you only work 3 days a week And only have to use 3 days of time off to get a whole week off.
It’s not just about the schedule. Primary care is a tougher job that has some big negatives, including being one of the bigger targets for midlevel encroachment. Being able to practice one organ system, avoiding the social issues and all of the paperwork make some of the IM subspecialties much better jobs than PC.
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Your life will definitely change. Congrats on becoming a first time dad! Like CoolDoc 12 hours becomes much harder when you miss those precious moments and time to help your partner. I've cried many times over not seeing my kids do small things like saying a word for the first time or reading bedtime stories. The 12 hour shifts really kills that depending on where you work and if your 12 hours really become 13 or 14 hours.
Its also hard when you and partner are like "ships passing in the night" you don't always get that time together to enjoy things with each other or the kid(s). At my shop we work 10s and I'm not the only one with littles which makes it a challenge. I joke with my husband that the rest of my crew doesn't care about staying late at the shop and occasionally staying for 12-13 because all they are missing is "yellowstone and their dogs" and yes they are all boomers
I think I misunderstood this as a student. Listen to this guy. A lot of high acuity patient's are going to have bad outcomes even if you do everything technically right. Getting a concrete win I think is more satisfying than watching a dying patient die.
A perfect 8 hr shift is 16 patients with last seen 2 hrs before leaving. 14 x 1 inch puts and 2 x 2 inch puts. The days of training in shock trauma and having 2+ feet puts all shift is not something an attending wants.
When you have kids/get older/get wiser, all you care about is going home refreshed and not feel like you went a round with Mike Tyson.
When you have kids/get older/get wiser, all you care about is going home refreshed and not feel like you went a round with Mike Tyson.
I don’t mind feeling that way coming out of the gym after a workout. The ED, not so much…
Yess.
Had a GREAT workout yesterday. Much chest. Very lift.
225 bench for 6 sets x 5 reps with no difficulty. Gonna attempt a 300 PB next week.
That’s good weight. Nice work. I’ve developed a phobia from FW chest press. I have a fitness trainer at home with a smith bar and got so used to unlocking/locking during COVID workouts that during one of my first visits back to the gym, I did chest press and was warming up with 180 and then 225 and I have no idea what happened but I think I tilted my hand from reflex on the smith bar (probably got used to overall bad form) and the next thing I know the thing was in free fall and landed on my chest. Bounced and I managed to catch it and rolled it off me. Sat up and immediately felt like I was about to lose consciousness but then the sensation passed. I’m fairly sure I had a sternal fracture and posterior rib fracture. I didn’t see anything on CXR at work but it took a good 4-6 weeks for the pain to subside and it was very slow progress getting back to bench to where I could withstand very much weight. I’ve been working out my entire life and have never dropped the bar. It freaked me out so much I haven’t done free weight chest since and will only do smith. I’m horrified that I could have easily dropped it on my neck and be dead or a quad. What’s more is that I generally have always prided myself on good form and safety.
Any peloton users in here? I’ve got the bike and row.
Damn dude, I’m impressed. Effing Hercules over here. That’s crazy strong for anybody, let alone someone your size.
Not funny but, that made me think, if you got an Xray, the radiologist reading would put out a call to Child Services.
(In case you don't recall, posterior rib fractures are child abuse, and an automatic board fail if you don't say that in your rads board exam. Or, at least it was.)
We have the tread and the bike, and enjoy them. I was already an avid indoor cyclist, because i ride road and thats what we do in poor weather, but the tread really changed how I enjoy treadmills… previously I loathed them and rarely did more than 3mi at 8min/mi pace and then jumped off just prior to dying of boredom. The coaches / talking / music / intervals on the tread are much more entertaining and I end up with much better workouts.
Got one at home that mostly the wife uses. I think it’s awesome though, had a good experience whenever I’ve used it, especially with access to live and recorded classes. Even better if you’ve got an Apple Watch so it can track your HR and calories burned.
It’s also a lot cheaper to buy since Pelotons stock took a nosedive from the pandemic days and they’re selling their bikes on Amazon.
Income benefits compensation and leg day thread
Thanks, bro.
5 foot 6. 165 pounds.
I tell you what: if I get a 300 press, I will post video on here and wear my full face bike helmet and shades to hide my face and such to maintain anonymity.
FormerNFLQB
Full Member
Make sure you use a spotter. Going from 225 repping it, to 300 is a jump. When I went from 295 to 315 it felt like a lot more than 20 pounds lol
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Admittedly I have not read every post in this thread but I did see some med student postings as well. I remember those days well and was also a bright eyed, naive med student looking into EM. I had worked in an ER for a few years prior to med school when I was in my early 20's and was convinced that was what I wanted to do. As I started getting older I was having second thoughts on that and ended up pursuing Psych. Soooooooooooooooooo glad I made that decision as now I'm in my late 30's and could not imagine working the schedule and dealing with what ya'll have to endure. I just separated from active duty so I haven't gotten to see the full fruits of my decision yet, just started my civ job less than 2 weeks ago. But so far, working 4 days per week, outpatient psych, good patient population, no nights, no weekends, no holidays, no call, 3 day weekends, lots of PTO, standard benefits. Hoping to make between 3-400K but have heard some working for this same group have cleared 5-600K so it's possible to make a bit more. For the med students out there, consider closely what has been said in this thread regarding EM. I respect you EM peeps as I know I couldn't do what you do.
I remember you during those early days, bro. I remember you.
Good on you for being smart.
Where were you guys to keep me from going astray 8 years ago when I decided on EM ?
Y'all failed me 😛
Ha, last fall, when I was still working regular shifts, I did an organized 62 mile gravel bike ride with a lot of climbing. It was hard but not soul sucking and felt fine at the end. Next day I was kind of sore and washed out feeling and I thought “holy ****e, this is exactly how I feel day after a hard shift!”
Now that I am almost completely out of EM, I more clearly recognize those days of feeling like crap, wondering if I was sick or not, out of shape or not, was just sleep disruption and being drained from work.
I swear the Psych/EM residency track would do so well today but there is a lack of enterprising PDs out there. Too many people on here and on the Psych forums and irl that have a hard time between those two. I know that’s not a good reason but still I feel that if you create one I bet it will get sufficient interest that more would follow. Assuming it would be 5 years I definitely would have applied for it. If it was like 6+years I could see the math being harder for it.
