The hardest part about hanging up the stethoscope was letting go of the ER doc identity. Indeed, it took a long time to get to the point where I could consider myself an expert at managing a high volume high acuity trauma/STEMI/stroke certified ED. There was meaning and satisfaction in knowing I was good at it.
But eventually, what I had to give up and deal with to maintain that persona, identity, and lifestyle was just too much. It's been over a year and I still haven't fully dropped the persona, especially since you get so much lay person cred for telling them you're an EM physician. You're a badass in their eyes. However...
I hate to say it, but EM is 100% blue-collar work, and I wish I realized that in medical school. I was more drawn to the sexiness of the field, particularly its potential to earn a substantial amount of money quickly through a 3-year residency. At the time, everything about it seemed exciting and interesting. As a medical student you're shielded from the day-to-day BS of being an attending EM physician, and you get to solely focus on bearing witness to the coolest cases, without having to deal with the negative aspects. I figured I wouldn't live past the age of 40, and so I didn't care much about the future (classic hubristic mid-20s male thought pattern).
It wasn't until I started investing my attending money that I realized there was a whole world of finance that interested me FAR more than medicine. And once I peeled back the surface, it was crazy to see how much money you could make simply by manipulating numbers on a screen in an intelligent way, rather than slave away physically and mentally at the bedside.
I wasn't designed to do blue-collar work, and by this point, EM was "easy" for me in specific ways, but tough in others. I will piss off a ton of people by saying this but EM wasn't intellectually challenging at all. It's a very algorithmic field, and the difficult parts all surround dealing with the personalities of the nurses, consultants, patients, and just about every other human obstacle that comes with providing care in a modern-day feces-fest that is the American ED. And then there's the mountains of charting and other secretarial work.
A difficulty Ludwig's airway? Go through your algo, if you have to cut, then cut. Get that airway by any means necessary. EASY.
But the hard part? Dealing with the dingus ENT on the other end. Dealing with the administrative fallout of having to do a cric. Going to peer review over saving a human being's life (which is what we trained to do). I could go on and on and on about these kinds of difficulties, which just wore me out. The road to hell is paved with good intention.
The medicine of EM is easy. It's, unfortunately, a tiny part of the job.
It was a waste of my talent and brainpower to be fighting with consultants, administrators, and sometimes even my own medical director.
I poured my intellect into learning how to invest, trade, scale, and, my goodness, has it been 1,000 times more fruitful. And get this. It's actually way more rewarding to me spiritually and mentally than being a physician ever was.
I now have a skill that allows me to support myself, my family, my kids, and even my extended family (if I become proficient enough) solely through my own skills. SOLOPRENEUR status. All I need is a computer and a great internet connection. I can do this from anywhere in the world. It keeps me informed about world events and macroeconomic factors, allowing me to stay ahead of 99% of human beings who are going about their lives when it comes to information flow.
I don't depend on nurses, assistants, bottom-of-the-IQ-barrel scribes, and a variety of other uncontrollable factors that we have to deal with as ER docs. That was a huge source of burnout for me. Zero control.
I genuinely think having to go through all that training is a complete waste for what the role is today, and I do think a well-trained PA can do a vast majority of the job, and could easily handle the more complex stuff if trained on the job. I've seen it before in some of the locums EDs. Experienced 20 year PAs who expertly placed lines and resuscitated patients intelligently. Managed traumas well. All of it. You're kidding yourself if you think you need an MD or DO to be a strong EM clinician in 2025. You just need good on the job training.
I think EM is full of people who truly can't see that our expertise isn't that valuable, isn't that difficult to obtain, and has minimal value-add to any healthcare system. And it's diluting faster and faster with the expansion of all these programs. It's an IMG specialty at this point.
I'm incredibly happy to be out of EM, and I'm also incredibly happy to be able to support myself with options income and risk-defined trading.
Though I'll end with this: I genuinely wish I could find some sort of way to still be a doctor as a side hustle, at my own pace. Perhaps see 5-6 patients per day, 2-3 days a week, assisting them with simple PCP-level tasks. Or even urgent care type stuff.
But a job like that doesn't exist, and you really can't create one and maintain a positive margin given what costs are these days, particularly in my VHCOL area. Any urgent care or similar clinical role effectively requires you to hustle out as much volume as possible - forget that.
And thus another physician withers away to the ether, pursuing something completely different, when I still have 20-30 years left in me to dedicate to some career or pursuit or whatever (I'm not even 40).
The best part is that I also received a half scholarship to attend medical school. What a societal waste if you think about it.
I'll leave you with this:
1. You can beat the market
2. It's pretty hard, but if you give it a residency-level effort (as you did with your clinical training) it's well within your reach
3. Invest in disruptive technology, learn how to pair trade with non-correlated assets, and SIZE UP
4. Learn options, this was such an unlock for me
5. "Diversification results in bips, concentration results in multiples."
Anyway, back to touching grass, taking my kid to a birthday party, followed by a stargazing event at the local observatory!
(Apologies for any mistakes, I just stream-of-consciousness typed this out)