Plan B if things go down the drain?

[cyanide12345678]

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So anyone here have a plan B for their lives if our field went down the sh** hole? Let's say the following happens over the next 5 years:

1) The law passes where out of network billing is at 125% of median in network and reimbursement starts to decline

2) 100+ new hca and cmg sponsored new residencies open and the market is flooded with new grads

3) CMGs continue taking over SDG contacts and replacing doctors with MLPs, leading to decreased physician demand.

Let's say our worst possible scenario happens and compensation drops to around 150/hour in most places.

What's next? Anyone with an exit strategy or plan B here? Or would you just suck it up and keep grinding?

 

[erdoc00]

Step one is to get your loans paid off. I got mine paid off a few years after residency and that freedom was worth more than anything else I could've bought with the money.

Without loans, you're free to actually make your own decisions and arent stuck being an exploited indentured servant to the healthcare machine.

Step two for me was living below my means so that i didnt actually have to make physician money to maintain my lifestyle. I dont have an "exit plan" per se but I'm not worried should I need to choose an alternative path.

 

[zurned]

Don't work and parasite off the system (food stamps and other gov't handouts). Just kidding.....but not really...

 

[bravotwozero]

I would seriously consider moving to Canada, or the Middle East. Job market is pretty tight for ED physicians in Canada, but not so in places like Dubai or Qatar. I’m a non drinker with kids so having a nightlife is not an issue for me, nor is cultural compatibility...

 

[GeneralVeers]

1. Run for Congress

2. If #1 fails move to Australia

3. If #1 and #2 fail, and the socialist revolution is successful, then do the minimum work and leech off the system like a good communist is supposed to.

 

[John Red]

150 / hr is already seen in some urban markets. I know many on this forum have said they wont work for anything under 200 / hr.

But, in your dooms day scenario of 150 / hr, if you work 140 hours a month that is still $250k a year. Where I come from that is more than enough to live comfortably. Rich? No. But roof on your head, food on the table, nice vacation should certainly be doable....

 

[southerndoc]

Quit emergency medicine and find something else to do.

 

[PikminOC]

Step one is to get your loans paid off. I got mine paid off a few years after residency and that freedom was worth more than anything else I could've bought with the money.

Without loans, you're free to actually make your own decisions and arent stuck being an exploited indentured servant to the healthcare machine.

Step two for me was living below my means so that i didnt actually have to make physician money to maintain my lifestyle. I dont have an "exit plan" per se but I'm not worried should I need to choose an alternative path.

Depends on the interest rate of the loans

 

[GeneralVeers]

Depends on the interest rate of the loans

Mine are at 2.75%. No reason to EVER pay them off unless a truck of money pulls up to my house

 

[GeneralVeers]

For $150/hr there are lots of other things that oculd be done. Working for pharma, or hospital admin pays $200-$300K with much less stress and exposure to liability.

 

[cyanide12345678]

I would seriously consider moving to Canada, or the Middle East. Job market is pretty tight for ED physicians in Canada, but not so in places like Dubai or Qatar. I’m a non drinker with kids so having a nightlife is not an issue for me, nor is cultural compatibility...

Are there really plenty of opportunities in qatar or Dubai? That's actually a legit backup plan then. What about the language barrier? Would be hard to do your job when every one around you spoke Arabic mostly.

 

[bravotwozero]

Are there really plenty of opportunities in qatar or Dubai? That's actually a legit backup plan then. What about the language barrier? Would be hard to do your job when every one around you spoke Arabic mostly.

Much of the population, Emirates/Dubai in particular, is made up of expat foreigners who speak English. I’m pretty sure they also have interpreters. There’s always people from there with a booth at ACEP every year

 

[cyanide12345678]

Much of the population, Emirates/Dubai in particular, is made up of expat foreigners who speak English. I’m pretty sure they also have interpreters. There’s always people from there with a booth at ACEP every year

Good to know. I didn't know there was a demand for EM docs in the middle East. I knew there was a huge demand for specialist physicians and they were offering 250k tax free with transportation and housing covered.

Uae, dubai, kuwait, qatar are actually very reasonable places to live in. Everywhere but saudi arabia -_- nobody should live in saudi arabia 😛

Most of the expats there will be Indians, Pakistanis, and bengalis. The labor class that has gone there, is probably not the most proficient in English though.

 

[BAM!]

1. Run for Congress

2. If #1 fails move to Australia

3. If #1 and #2 fail, and the socialist revolution is successful, then do the minimum work and leech off the system like a good communist is supposed to.

I think you're confusing socialism and communism, grandpa.

 

[Birdstrike]

I already triggered my exit plan. I spent all day today doing spine and joint injections, nerve blocks and ablations while listening to cool tunes in my in-office procedure suite. My stress is 90% less.

 

[GonnaBeADoc2222]

I already triggered my exit plan. I spent all day today doing spine and joint injections, nerve blocks and ablations while listening to cool tunes in my in-office procedure suite. My stress is 90% less.

I wish I could do this, but still get paid what I get paid now while training.

Sorta like how nurses "gain new skills" in np school yet still have time to work clinically as nurses.

 

[EctopicFetus]

I am FI now. Plan to fatFI. I like my job but I won’t be doing it for 150/hr. I have developed skills whereby I can move into straight admin. No liability, high pay and no weekends. Those meetings are sooooo tough.

 

[GeneralVeers]

I think you're confusing socialism and communism, grandpa.

There's a difference? Regardless of the route, the destination is the same....

 

[namethatsmell]

Great thread. I hope everyone on here has a plan B. I have a couple.

At a minimum, it will increase your value and ability to negotiate for work and jobs. But on the other end of the spectrum, it will allow you to exit a sinking ship and maintain your livelihood.

Even if you think EM is all buttercups and unicorns, you need to take some time to consider some plan Bs and have actionable steps to make one or two of them happen. Your future self will thank you.

 

[namethatsmell]

And here are some plan Bs I’ve not heard not the best things about in terms of pay, fulfillment, and quality of life:

-chart/billing review
-tele medicine
-urgent care

And here are some I’ve heard decent things about:

-wound care/hyperbarics
-Occupational medicine
-Pretty much all the fields under the public/preventative health umbrella
-Entrepreneural stuff

Feel free to add to this tiny list or change it or disagree.

 

[p1acebo]

And here are some plan Bs I’ve not heard not the best things about in terms of pay, fulfillment, and quality of life:

-chart/billing review
-tele medicine
-urgent care

And here are some I’ve heard decent things about:

-wound care/hyperbarics
-Occupational medicine
-Pretty much all the fields under the public/preventative health umbrella
-Entrepreneural stuff

Feel free to add to this tiny list or change it or disagree.

How does one transition from EM to occupational medicine?

 

[deleted109597]

There's a difference? Regardless of the route, the destination is the same....

Only one of them works theoretically in mental exercises. Other than that, they're the same.

 

[sylvanthus]

5 years in this scenario? Hope to God PSLF doesnt get axed in that time and that I get approved for it in 4 years. Then student loans are wiped out at least. Then:

1) Critical care as plan B
2) Telemedicine as plan C (tele ED, tele IM, tele ICU), hell do all 3 from my sailboat with satellite uplink? Might be a good plan A.
3) Hospitalist as plan D
4) Plan E. Locums work for the highest dollar in whatever field pays the most that I can do.
5) Plan F. Concierge medicine in a rich community, (do some Internal Medicine, some injections, botox, and other nonsense)
6) Plan G? Stay at home dad and let my wife work as a PA?

 

[cyanide12345678]

How does one transition from EM to occupational medicine?

I think, I'm not sure, but you should be able to do a fellowship in occupational medicine after EM.

 

[cyanide12345678]

And here are some plan Bs I’ve not heard not the best things about in terms of pay, fulfillment, and quality of life:

-chart/billing review
-tele medicine
-urgent care

And here are some I’ve heard decent things about:

-wound care/hyperbarics
-Occupational medicine
-Pretty much all the fields under the public/preventative health umbrella
-Entrepreneural stuff

Feel free to add to this tiny list or change it or disagree.

That's a good list but tele medicine is only paying around $30 per call. What sort of liability is one picking up by not being able to put your hands on the patient? You and i both know how a lot of patients are just terrible historians, i don't know how i feel about relying a lot on mostly patient history.

Chart review sounds like a good gig. No malpractice to think of. Work from anything in the world, that must be nice.

 

[gro2001]

Good to know. I didn't know there was a demand for EM docs in the middle East. I knew there was a huge demand for specialist physicians and they were offering 250k tax free with transportation and housing covered.

Uae, dubai, kuwait, qatar are actually very reasonable places to live in. Everywhere but saudi arabia -_- nobody should live in saudi arabia 😛

Most of the expats there will be Indians, Pakistanis, and bengalis. The labor class that has gone there, is probably not the most proficient in English though.

There's definitely a demand for western trained EM docs in the countries you mentioned. US, UK, Australian, Canadian EM boards should all get you a job in UAE or Qatar (probably Kuwait too, but I'm less familiar with Kuwait). Don't go to Saudi.

To be clear, "tax free" means that there is no income tax in UAE or Qatar. But US citizens and permanent residents still need to pay taxes on foreign earned income after the first $105,900. Hosing is typically paid for by the hospital, and it's nice. Overall, probably not the most amount of money you could make as an EM doc, but between the tax advantage and the other benefits its definitely at least decent.

 

[cyanide12345678]

There's definitely a demand for western trained EM docs in the countries you mentioned. US, UK, Australian, Canadian EM boards should all get you a job in UAE or Qatar (probably Kuwait too, but I'm less familiar with Kuwait). Don't go to Saudi.

To be clear, "tax free" means that there is no income tax in UAE or Qatar. But US citizens and permanent residents still need to pay taxes on foreign earned income after the first $105,900. Hosing is typically paid for by the hospital, and it's nice. Overall, probably not the most amount of money you could make as an EM doc, but between the tax advantage and the other benefits its definitely at least decent.

Any idea what the job is like? Volume of patients? You're not going to get sued, but do you have dozens and dozens of patients just waiting to be seen. I'm assuming there will be no death by charting either.

For example in New Zealand, once you become a "consultant EM physician" after some qualifying exam, you're seeing maybe 8 patients a day, mostly when your Junior doctors need you as a "consult". And if you think someone is at the end of their life, you can essentially decide to not pursue further workup. Here pushy family members don't even let the 90 year old Grandmas rest in peace.

 

[d2305]

There is no difference between communism and socialism, except in the means of achieving the same ultimate end: communism proposes to enslave men by force, socialism—by vote. It is merely the difference between murder and suicide. Ayn Rand

 

[Rekt]

Any idea what the job is like? Volume of patients? You're not going to get sued, but do you have dozens and dozens of patients just waiting to be seen. I'm assuming there will be no death by charting either.

For example in New Zealand, once you become a "consultant EM physician" after some qualifying exam, you're seeing maybe 8 patients a day, mostly when your Junior doctors need you as a "consult". And if you think someone is at the end of their life, you can essentially decide to not pursue further workup. Here pushy family members don't even let the 90 year old Grandmas rest in peace.

Yeah training in a country where sipping some alcohol will land you in a sandy hole for life sounds like a good place to work.

 

[EctopicFetus]

Palliative care, vein clinic, addiction medicine are all options. They aren't for me though. We all like to **** on admin for good reason but if I am gonna make BS money I want a BS job. Im not working holidays, weekends etc for crappy pay. Those of you saps who do I feel bad for. Just like the new grads job market is tight and when that happens your CMG is gonna drive your rates down. Already happening locally.

 

[EctopicFetus]

Another option is to spend a year in NZ or Australia doing EM. This is something I would consider doing when my youngest gets a little older. Also, I would advise all of you guys to strongly consider finding some side gig or passive income. This can be an Urgent Care, real estate, being a medical director for something. You have to finds what interests you and you can make some money.

I know Hercules on here does Urgent Cares. I have my own side gig which I think if I could put more time into it I could make into a nice side hustle with good income. Outside of my wife who makes good money I have 4 other sources of monthly income plus rental real estate and obviously investments in the stock market. Diversify, diversify diversify! Also live below your means by a lot and get your debts paid off.

If you can make 250k (low for an EM doc) and have no loans and a reasonable mortgage/rent payment you will stack money like its no ones business.

 

[namethatsmell]

How does one transition from EM to occupational medicine?

There are a some fellowships around the country to get boarded in it. I know one person who did it's supposedly super chill. It's two years with I think 1 being an MPH. I heard there's also a 1 year option for docs a few years out of residency.

However, based on recruiter emails I get you don't need to be boarded to work in this field. There seems to be a decent amount of options since there are few boarded occ med docs. I recently got a recruiting email from a big occ-med group (from Concentra I think?) wanting docs at a bunch of their clinics. I deleted it but IIRC it was 9-5, M-F, no call, no nights/weekends/holidays and 7 weeks of PTO a year. No idea what it's like to work for them, but it doesn't sound like a terrible lifestyle.

 

[namethatsmell]

That's a good list but tele medicine is only paying around $30 per call. What sort of liability is one picking up by not being able to put your hands on the patient? You and i both know how a lot of patients are just terrible historians, i don't know how i feel about relying a lot on mostly patient history.

Chart review sounds like a good gig. No malpractice to think of. Work from anything in the world, that must be nice.

Yeah tele and chart review were on my list of iffy plan Bs.

Pay is a bit low for both.

I've heard that chart review rates have dropped like a stone in the last 5 years as more docs have fled clinical medicine and the pool of applicants for these jobs is now much bigger.

Regarding your liability question for tele, not sure anybody knows the answer. When I last looked (about a year ago) there hadn't been any publicized suits from this. But of course, eventually, there will be given how our ridiculous med-mal system works.

 

[namethatsmell]

1. Run for Congress

2. If #1 fails move to Australia

3. If #1 and #2 fail, and the socialist revolution is successful, then do the minimum work and leech off the system like a good communist is supposed to.

You want to move to a country with universal health care?

Is this the real GV talking or has your account been hacked?

 

[EctopicFetus]

You want to move to a country with universal health care?

Is this the real GV talking or has your account been hacked?

I cant speak for GV but that is just one thing. Plenty of other great things. Reality is there isnt any one place that has everything. California is beautiful and tons to do but those taxes are a deal breaker for me.

 

[namethatsmell]

I cant speak for GV but that is just one thing. Plenty of other great things. Reality is there isnt any one place that has everything. California is beautiful and tons to do but those taxes are a deal breaker for me.

Yeah my comment was more tongue in cheek as while Veers and I don't always agree I like the guy.

The EM docs I know who've moved to Australia and NZ have all loved it and one is now permanently living there. It's a great option.

 

[cyanide12345678]

You want to move to a country with universal health care?

Is this the real GV talking or has your account been hacked?

Maybe Australians aren't as entitled 😛 ? 30-40 percent of my patients are great, reasonable human beings with intelligence. Those people are a joy taking care of. Another 30-40 percent are hypochondriacs, but still nice people, just don't know what the appropriate use of the ED. But i don't mind taking care of them at all. The remaining people are demanding, demeaning, entitled, rude -_- it gets old very fast when all you are genuinely trying to do is what is best for the patient.

 

[cyanide12345678]

Yeah my comment was more tongue in cheek as while Veers and I don't always agree I like the guy.

The EM docs I know who've moved to Australia and NZ have all loved it and one is now permanently living there. It's a great option.

I know one who moved to NZ. He loves it. Lower pay, he moonlights here so he can pay off his loans but loves it.

I know a pgy37 whose about to call it quits and leave for NZ soon as well.

 

[Angus Avagadro]

My plan B was to marry a specialist who makes more than I do. YOLO.

 

[cyanide12345678]

My plan B was to marry a specialist who makes more than I do. YOLO.

I failed at that. My wife is family medicine 😛 should have found myself a neurosurgeon sugar momma 😛

 

[Angus Avagadro]

Not sure about Australia. I was there recently and in Cairns, the Hawaii of Australia, they cannot recruit GPs for 185k Australian. Which is about 135k american. About 60% are Fly in docs. Gorgeous place to live. Australia is expensive, but economy is improving due to US tariffs with China Aussie increasing trade with China. Something to consider, be a Fly in Doc for a yr and check it out.

 

[Brigade4Radiant]

Ah yes the great teaches of HCA’s philosopher Ayn Rand

 

[Angus Avagadro]

I failed at that. My wife is family medicine 😛 should have found myself a neurosurgeon sugar momma 😛

Get her into addiction medicine. Lots of money with Suboxone practice. Or a paper route. Spend your free time thinking of ways for your wife to make more money. I have many disciples in my neighnorhood

 

[GonnaBeADoc2222]

What are the processes to get licensure in NZ/AUS?

How about work visas?

 

[TooMuchResearch]

Isn't your liability in part based on the standard for what you're doing? Of the standard is the history sucks and you can't examine the patient...

That's a good list but tele medicine is only paying around $30 per call. What sort of liability is one picking up by not being able to put your hands on the patient? You and i both know how a lot of patients are just terrible historians, i don't know how i feel about relying a lot on mostly patient history.

Chart review sounds like a good gig. No malpractice to think of. Work from anything in the world, that must be nice.

 

[Fox800]

1. Locums for the highest bidder in states with decent med-mal.
2a. Work in Australia, where they still pay ED docs a good living wage. Or Canada. Less likely the Middle East.
2b. Fellowship: critical care, ?pain
3. Marry a sugar mama.

 

[Groove]

Another option is to spend a year in NZ or Australia doing EM. This is something I would consider doing when my youngest gets a little older. Also, I would advise all of you guys to strongly consider finding some side gig or passive income. This can be an Urgent Care, real estate, being a medical director for something. You have to finds what interests you and you can make some money.

I know Hercules on here does Urgent Cares. I have my own side gig which I think if I could put more time into it I could make into a nice side hustle with good income. Outside of my wife who makes good money I have 4 other sources of monthly income plus rental real estate and obviously investments in the stock market. Diversify, diversify diversify! Also live below your means by a lot and get your debts paid off.

If you can make 250k (low for an EM doc) and have no loans and a reasonable mortgage/rent payment you will stack money like its no ones business.

I thought it was difficult and/or an arduous process to get licensed to practice in NZ or AU? Does anyone know someone who's gone through the process?

 

[GeneralVeers]

Australia has a robust private system as well (not the same for New Zealand). I see plenty of good jobs advertised in secondary cities like Brisbane with pay being $300K or more.

I go to Oz once or twice a year and it's an amazing place. I also did a rotation there, and it's incredible how much more reasonable the patients are, primarily due to their better general education, and insight into their disease processes.

Despite its flaws, it will certainly be a better place to practice than a "Medicare-For-All" Bernie Sanders nightmare that we might get in this country.

 

[deleted859535]

Australia has a robust private system as well (not the same for New Zealand). I see plenty of good jobs advertised in secondary cities like Brisbane with pay being $300K or more.

I go to Oz once or twice a year and it's an amazing place. I also did a rotation there, and it's incredible how much more reasonable the patients are, primarily due to their better general education, and insight into their disease processes.

Despite its flaws, it will certainly be a better place to practice than a "Medicare-For-All" Bernie Sanders nightmare that we might get in this country.

Never been. What's amazing about it?

 

[GeneralVeers]

Never been. What's amazing about it?

-Weather
-Cities (Sydney and Melbourne are some of the most liveable cities in the world)
-People
-Sane immigration policy
-Doctors are still paid decently, unlike most of the rest of the world

Cons
- Terrible food (and expensive)
- High taxes
- Expensive to get to