Perspective

[yolo1]

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A little bit about me: Young, attending with physician spouse. No other big obligations. Don't spend much. Working 13 days a month. I like my job. Things I really love about this specialty: our hourly pay is relatively good AND our time wealth( LOVE LOVE having so much time off).

I am considering applying to Pain( I am prob not competitive) vs Palliative this cycle. As an outsider looking in, both offer better lifestyles than straight EM and comparable pay. H&P may be lower, but not by much when compared to what some EM docs make in parts of the country(looking at you MetroDetroit)

Again, I am a relatively young person and I am not sure what I want out of life(professionally and personally) so I was hoping for perspective.

From a practical stand point, I keep telling myself to crank out EM for 25-30 years and to save aggressively. I keep telling myself that I will be fine working the hours and that the days off are worth it. Also, I believe that I would be financially better off if I did straight EM. On the other hand, I feel although I would be working more days in Pain or Palliative, these options may offer a even better lifestyle then I have now with similar pay and deff less stress.

My questions:
1. Those that have done this job for more than 10-20 years how is your work life balance? I know the nights/evening become harder but are you happy that you are an EM doc? From a financial perspective was it worth it? (All the BS: admin, PE,mlps, increased residency spots, is not unique to EM)
2. Those that have done fellowship in pain or palliative: what are the cons about these fields that no one tells you about as an outsider looking in

I hope this thread will not turn into a bashing EM thread. Every EM attending/resident knows the ongoing threats to this field. I truly believe at the end of the day a job is a job-and they all become unpleasant in some way. Also full disclosure, the truth is I don't have much experience in Pain or Palliative. All I know is that I have an intrinsic interest in both and think they would gel well with the professional life I envision.

Sorry for the long threat. I hope most of it makes sense.

 

[Dr Mantis Toboggan]

A little bit about me: Young, attending with physician spouse. No other big obligations. Don't spend much. Working 13 days a month. I like my job. Things I really love about this specialty: our hourly pay is relatively good AND our time wealth( LOVE LOVE having so much time off).

I am considering applying to Pain( I am prob not competitive) vs Palliative this cycle. As an outsider looking in, both offer better lifestyles than straight EM and comparable pay. H&P may be lower, but not by much when compared to what some EM docs make in parts of the country(looking at you MetroDetroit)

Again, I am a relatively young person and I am not sure what I want out of life(professionally and personally) so I was hoping for perspective.

From a practical stand point, I keep telling myself to crank out EM for 25-30 years and to save aggressively. I keep telling myself that I will be fine working the hours and that the days off are worth it. Also, I believe that I would be financially better off if I did straight EM. On the other hand, I feel although I would be working more days in Pain or Palliative, these options may offer a even better lifestyle then I have now with similar pay and deff less stress.

My questions:
1. Those that have done this job for more than 10-20 years how is your work life balance? I know the nights/evening become harder but are you happy that you are an EM doc? From a financial perspective was it worth it? (All the BS: admin, PE,mlps, increased residency spots, is not unique to EM)
2. Those that have done fellowship in pain or palliative: what are the cons about these fields that no one tells you about as an outsider looking in

I hope this thread will not turn into a bashing EM thread. Every EM attending/resident knows the ongoing threats to this field. I truly believe at the end of the day a job is a job-and they all become unpleasant in some way. Also full disclosure, the truth is I don't have much experience in Pain or Palliative. All I know is that I have an intrinsic interest in both and think they would gel well with the professional life I envision.

Sorry for the long threat. I hope most of it makes sense.

If you have a physician spouse and no other obligations why would you need to work for 25 more years? Couldn’t you and your spouse just crank out another 10 then peace out?

 

[yolo1]

If you have a physician spouse and no other obligations why would you need to work for 25 more years? Couldn’t you and your spouse just crank out another 10 then peace out?

Yes. I believe if I work hard for the next 10-15 years in EM I could retire. I am more interested in the journey than the destination if that makes sense.

 

[Birdstrike]

2. Those that have done fellowship in pain or palliative: what are the cons about these fields that no one tells you about as an outsider looking in

...the truth is I don't have much experience in Pain or Palliative. All I know is that I have an intrinsic interest in both and think they would gel well with the professional life I envision.

I did EM for 10 years, and about 10 years ago I did a Pain fellowship. I'm glad I did. I've written extensively about my experiences in both Pain and EM on this forum, which you can do a search for if interested.

If you're lucky enough to get an accredited Pain fellowship spot, it's definitely worth considering, in my opinion. You don't have to think of it as "leaving EM" or a "career change," necessarily. Think of it as adding to your skill stack. You add a specialty. You're not quitting one specialty and replacing it with another (unless you want to).

Shadow a good Pain M.D. near you, particularly someone who focuses on the procedural aspect and minimizes the opiates. It could be eye opening. The 35-40 hours per week I work now in Pain takes a whole lot less out of me, than my old EM schedule did, even though EM amounted to less hours. YMMV

 

[dchristismi]

I did EM for 12 years and then gradually eased into hospice. (I'd recommend the fellowship though, especially if you're contemplating palliative.)
I'm also glad I did it that way. There's a lot to be said for the seasoning you get in the pit. As hard as it is, I wouldn't be nearly the doc I am now if I didn't have that experience. I also saved aggressively which allowed me to "retire" into it. (Har. I'm still working 0.8 FTE, but it's mentally retirement. It's still challenging, but in a different, much less full-on way. Also, people already have their awful diagnoses and I don't have to tell them. I often have to reiterate, especially to families, but it's not the "your child died" talk.) Also, being basically FI allowed me to have the financial liberty to walk away from EM. Which takes some guts, TBH. You get used to those big paychecks.

If you enjoy it, stick with it for now. See where it takes you. For me, it was a surprisingly natural transition. For some people it's more deliberate. You can decide not to decide and see where life takes you - that's ok. In fact, you can decide on what we (in HPM) would describe as a time-limited trial. Decide you'll see how the next 5 years go in EM. If you still like it, stick with it. If you don't still love it as much, then allow yourself to explore other options.

As far as HPM goes, you either don't mind the touchy-feeliness or you do. Kind of like EM, you sort of know if you can do it. You can be taught how to have goals of care discussions, but it helps if that doesn't bother you. I talk a LOT about death and suffering. And how we are going to minimize suffering. But there is a LOT of talking and not much DOING.

 

[Groove]

A little bit about me: Young, attending with physician spouse. No other big obligations. Don't spend much. Working 13 days a month. I like my job. Things I really love about this specialty: our hourly pay is relatively good AND our time wealth( LOVE LOVE having so much time off).

I am considering applying to Pain( I am prob not competitive) vs Palliative this cycle. As an outsider looking in, both offer better lifestyles than straight EM and comparable pay. H&P may be lower, but not by much when compared to what some EM docs make in parts of the country(looking at you MetroDetroit)

Again, I am a relatively young person and I am not sure what I want out of life(professionally and personally) so I was hoping for perspective.

From a practical stand point, I keep telling myself to crank out EM for 25-30 years and to save aggressively. I keep telling myself that I will be fine working the hours and that the days off are worth it. Also, I believe that I would be financially better off if I did straight EM. On the other hand, I feel although I would be working more days in Pain or Palliative, these options may offer a even better lifestyle then I have now with similar pay and deff less stress.

My questions:
1. Those that have done this job for more than 10-20 years how is your work life balance? I know the nights/evening become harder but are you happy that you are an EM doc? From a financial perspective was it worth it? (All the BS: admin, PE,mlps, increased residency spots, is not unique to EM)
2. Those that have done fellowship in pain or palliative: what are the cons about these fields that no one tells you about as an outsider looking in

I hope this thread will not turn into a bashing EM thread. Every EM attending/resident knows the ongoing threats to this field. I truly believe at the end of the day a job is a job-and they all become unpleasant in some way. Also full disclosure, the truth is I don't have much experience in Pain or Palliative. All I know is that I have an intrinsic interest in both and think they would gel well with the professional life I envision.

Sorry for the long threat. I hope most of it makes sense.

It sounds like you have a good gig. I would not switch to a new specialty unless you are burned out or sick of the field. You've barely experienced life as an attending. At the very least, get seasoned first and hard code your skill set.

I think if you can find some relative satisfaction in bread and butter EM, there's no reason to switch to anything else. You can always simply cut back and work fewer shifts. Things would have to get really dire for me including horrible job security combined with...probably 175/hr or less. I'd start considering other things at less than 200/hr. (In my region, that would be an average salary drop of about 50-75/hr)

Pain sounds miserable to me, I don't care how much @Birdstrike talks it up and sells it. I know he touts a procedure heavy practice but I'd shoot myself if I had to listen to chronic pain patients all day long. I'm glad he's happy but I have serious doubts that I would be.

Palliative does sounds gratifying. I enjoy listening to @dchristismi talk about it and can imaging actually enjoying that type of practice. However, according to all the statistics...the pay is atrocious compared to bread and butter EM. I simply can't imaging doing palliative unless I'm near retirement and income is no longer a requirement which begs the question why additional training and a new field would be preferable to simply working part time in EM? I'd have to really be sick of the field and/or want to do something entirely different.

 

[Birdstrike]

Pain sounds miserable to me, I don't care how much @Birdstrike talks it up and sells it. I know he touts a procedure heavy practice but I'd shoot myself if I had to listen to chronic pain patients all day long. I'm glad he's happy but I have serious doubts that I would be.

I respect this. What works for me, won't work for everyone. You need to do what's best for you.

But with all due respect, I can't think of a group of people, and I include my younger self in this group, worse at predicting future job satisfaction and prospects, than the EM community. We all told each other and believed that "burnout is a myth" "EM is sustainable" "EM is a lifestyle specialty," and believed it! We thought it would be what made us happy. As a group, we're terrible at predicting our own future job satisfaction.

The only reason I can say Pain will work for me, is because I have the advantage of looking to the past 10 years, where it did work for me. Only stepping out of the box of EM group-think, allowed me to take the leap of faith, which luckily happened to work, for me. Your experience may vary.

 

[bravotwozero]

If you can do EM for 25-30 years, you’re a better man than I am. That sort of time frame is certainly not in my career playbook, but I suppose anything is possible. There’s a reason you’ll be hard pressed to find EPs still working past their 50s.

 

[Apollyon]

If you can do EM for 25-30 years, you’re a better man than I am. That sort of time frame is certainly not in my career playbook, but I suppose anything is possible. There’s a reason you’ll be hard pressed to find EPs still working past their 50s.

But, if you're not working in the pit, you're dead to me!

/sarcasm

 

[GeneralVeers]

Year 13 for me. I am counting the days till I retire (Jan 1st is the goal). I've worked hard the last 5 years towards FIRE. Your goal should be to get 5-10K of non EM income either through a business or side job, and 5-10K of monthly investment income. If you are making 10-20K per month through non-EM sources you can retire. The goal is always to have enough income to not have to touch your savings or 401K to live, and maintain a good standard of living.

 

[yolo1]

Thanks everyone. Good insight from everyone.

Assuming money doesn't matter, up to what age do you all realistically think it is feasible to practice EM? Again barring no financial problems and health problems. I had planning on practicing as long as I can.

I anticipate that I might not be able to practice EM after 55 but I still want to practice something in medicine. This is partially why I am considering doing a fellowship today( or this foolish?) The last thing, I will have a family and who knows how present I will have to be and may need to cut down in my 40's. This is why I am considering fellowship while I have no obligations. Thoughts?

Thanks

 

[GeneralVeers]

Thanks everyone. Good insight from everyone.

Assuming many money doesn't matter, what age do you all realistically think it is feasible to practice EM? Again barring no financial problems and health problems. I had planning on practicing as long as I can.

The other thing is, I think I I personally might not be able to practice EM after 55 but I still want to practice something in medicine. This is partially why I am considering doing a fellowship today( or this dumb?) The last thing, I will have a family and who knows how present I will have to be and may need to cut down in my 40's.

Thanks

It really depends on the person. We had one doctor just have a heart attack at 50, and likely will not be doing full time any more. Other doctors are in their 70's and (for strange reasons) still practicing full time. Physically it does get harder in your 40's, especially night shift and circadian disruption.

 

[Apollyon]

Other doctors are in their 70's and (for strange reasons) still practicing full time.

Like the rare and obscure "I've been divorced twice"?

 

[Birdstrike]

Assuming money doesn't matter, up to what age do you all realistically think it is feasible to practice EM? Again barring no financial problems and health problems. I had planning on practicing as long as I can.

When I started, I thought my EM career-span would last until age 60. When I finished residency, I thought 55. When I turned 35, I thought 40.

By 37, I decided I couldn’t take the abuse anymore, and at age 38, I worked my last EM shift ever. That was 10 years ago. I never once considered going back.

 

[Groove]

I respect this. What works for me, won't work for everyone. You need to do what's best for you.

But with all due respect, I can't think of a group of people, and I include my younger self in this group, worse at predicting future job satisfaction and prospects, than the EM community. We all told each other and believed that "burnout is a myth" "EM is sustainable" "EM is a lifestyle specialty," and believed it! We thought it would be what made us happy. As a group, we're terrible at predicting our own future job satisfaction.

The only reason I can say Pain will work for me, is because I have the advantage of looking to the past 10 years, where it did work for me. Only stepping out of the box of EM group-think, allowed me to take the leap of faith, which luckily happened to work, for me. Your experience may vary.

Nothing but love for you Bird, but I'm waiting patiently for that inevitable post about all the things that annoy you about pain. I know it will show up on here eventually. Chronic pain...just CAN'T be all skittles and rainbows. 😉

 

[SeekerOfTheTree]

When I started, I thought my EM career-span would last until age 60. When I finished residency, I thought 55. When I turned 35, I thought 40.

By 37, I decided I couldn’t take the abuse anymore, and at age 38, I worked my last EM shift ever. That was 10 years ago. I never once considered going back.

This is exactly how I feel lol.

 

[GeneralVeers]

Like the rare and obscure "I've been divorced twice"?

Correct. That counts as strange. If you made the mistake of getting married and divorced, and losing half your stuff once, why would you repeat the same mistake? Doctors are stupid.

 

[gamerEMdoc]

If you can do EM for 25-30 years, you’re a better man than I am. That sort of time frame is certainly not in my career playbook, but I suppose anything is possible. There’s a reason you’ll be hard pressed to find EPs still working past their 50s.

We had a doc finally retire who was over 70. Was still working during COVID. Some people are just of a different breed. That... will not be me.

 

[Apollyon]

Correct. That counts as strange. If you made the mistake of getting married and divorced, and losing half your stuff once, why would you repeat the same mistake? Doctors are stupid.

In the words of Mickey and Sylvia, "Love Is Strange". The heart wants what it wants. Heck, with your other job, you know that!

 

[Birdstrike]

Nothing but love for you Bird, but I'm waiting patiently for that inevitable post about all the things that annoy you about pain. I know it will show up on here eventually. Chronic pain...just CAN'T be all skittles and rainbows. 😉

In Medicine, most people hate their jobs and are burned out. So, the bar isn’t very high. It’s simply a job. It just happens to be one that doesn’t make me tired and depressed all the time. If that is the definition of being “all skittles and rainbow,” then I guess it is.

 

[RustedFox]

In the words of Mickey and Sylvia, "Love Is Strange". The heart wants what it wants. Heck, with your other job, you know that!

Ohh, SYL-vi-aa?

(Yesss, Mickey?)

 

[GeneralVeers]

In the words of Mickey and Sylvia, "Love Is Strange". The heart wants what it wants. Heck, with your other job, you know that!

Yes people are irrational during that new relationship phase of infatuation. Since government is (inappropriately) involved in marriage, we should mandate a couple live together for 1 year before legally getting married. I suspect that would shake a lot of the divorces out of the system.

 

[Brigade4Radiant]

Yes people are irrational during that new relationship phase of infatuation. Since government is (inappropriately) involved in marriage, we should mandate a couple live together for 1 year before legally getting married. I suspect that would shake a lot of the divorces out of the system.

Nope divorce is a business lawyers make their money and do do the courts. Divorce lasts so long and is so expensive because there is no incentive to move quickly.

 

[deleted77919]

…

 

[Franzd'Epinay]

Yes people are irrational during that new relationship phase of infatuation. Since government is (inappropriately) involved in marriage, we should mandate a couple live together for 1 year before legally getting married. I suspect that would shake a lot of the divorces out of the system.

Marriage is essentially a type of contract and individuals are free to not sign up, even if they hold a ritual ceremony. You can also modify it with pre-nups, post-nups, etc. There's a lot of choice there. What's so inappropriate about that?

 

[Franzd'Epinay]

A little bit about me: Young, attending with physician spouse. No other big obligations. Don't spend much. Working 13 days a month. I like my job. Things I really love about this specialty: our hourly pay is relatively good AND our time wealth( LOVE LOVE having so much time off).

I am considering applying to Pain( I am prob not competitive) vs Palliative this cycle. As an outsider looking in, both offer better lifestyles than straight EM and comparable pay. H&P may be lower, but not by much when compared to what some EM docs make in parts of the country(looking at you MetroDetroit)

Again, I am a relatively young person and I am not sure what I want out of life(professionally and personally) so I was hoping for perspective.

From a practical stand point, I keep telling myself to crank out EM for 25-30 years and to save aggressively. I keep telling myself that I will be fine working the hours and that the days off are worth it. Also, I believe that I would be financially better off if I did straight EM. On the other hand, I feel although I would be working more days in Pain or Palliative, these options may offer a even better lifestyle then I have now with similar pay and deff less stress.

My questions:
1. Those that have done this job for more than 10-20 years how is your work life balance? I know the nights/evening become harder but are you happy that you are an EM doc? From a financial perspective was it worth it? (All the BS: admin, PE,mlps, increased residency spots, is not unique to EM)
2. Those that have done fellowship in pain or palliative: what are the cons about these fields that no one tells you about as an outsider looking in

I hope this thread will not turn into a bashing EM thread. Every EM attending/resident knows the ongoing threats to this field. I truly believe at the end of the day a job is a job-and they all become unpleasant in some way. Also full disclosure, the truth is I don't have much experience in Pain or Palliative. All I know is that I have an intrinsic interest in both and think they would gel well with the professional life I envision.

Sorry for the long threat. I hope most of it makes sense.

How do you like the actual medical part of EM (not thinking about hours, pay, etc.)?

If you don't hate it, you could stick it out until retirement. Like you said, it's just a job.

If you absolutely hate it, then get out ASAP.

 

[yolo1]

How do you like the actual medical part of EM (not thinking about hours, pay, etc.)?

If you don't hate it, you could stick it out until retirement. Like you said, it's just a job.

If you absolutely hate it, then get out ASAP.

I like the hours, money and the medicine equally tbh. I hope its not because i'm so green (attending less than 1 year).

When I got out of residency, I had the "now what?" feeling for the first 6 months but that has gotten much better.

Part of the problem is now that I have so much time to myself-I just keep thinking about the future. I like it now but i'm sure that can easily change with kids and/or inc life obligations.

Again, thanks for everyone's opinions.

 

[GeneralVeers]

Marriage is essentially a type of contract and individuals are free to not sign up, even if they hold a ritual ceremony. You can also modify it with pre-nups, post-nups, etc. There's a lot of choice there. What's so inappropriate about that?

Remember the no gay marriage thing? Government has finally corrected something that it had no business being involved with. Agree its a contract and should be done through legal means and not involve government.

 

[Franzd'Epinay]

I like the hours, money and the medicine equally tbh. I hope its not because i'm so green (attending less than 1 year).

When I got out of residency, I had the "now what?" feeling for the first 6 months but that has gotten much better.

Part of the problem is now that I have so much time to myself-I just keep thinking about the future. I like it now but i'm sure that can easily change with kids and/or inc life obligations.

Again, thanks for everyone's opinions.

Ok, I understand better now: you like your job but see everyone ahead being burned out and want to craft an exit plan now just in case.

I say go for it. You're young, have no kids, and just finished residency. This is the best time to do a fellowship. Just make sure to keep the door to EM open by working per-diem somewhere, especially since you do like the specialty.

A lot of people will tell you that it's a huge financial mistake. They're probably right when looking only at the numbers, but your net worth is likely only one of the factors affecting your happiness.