Post EM career ideas

[miacomet]

Advertisement - Members don't see this ad

Kudos to Angry Birds for inspiring this post.

I've done EM for eleven years and I'm looking for my next career/job. We are in a decent position financially with a small pension starting this April, no mortgage, and a reasonable amount of savings- we can and will save further, but probably don't HAVE to.

My parents had jobs they did and loved into their seventies and eighties, and I'd ideally like to have the same. Leaving the nest is hard, and I'm not sure what to look into. I'd like to earn 80-150k a year with plenty of time off. I'm open to low-stress, circadian-friendly clinical, nonclinical, or something totally nonmedical.

Thoughts? What is everyone else going to transition to?

 

[Birdstrike]

Kudos to Angry Birds for inspiring this post.

I've done EM for eleven years and I'm looking for my next career/job. We are in a decent position financially with a small pension starting this April, no mortgage, and a reasonable amount of savings- we can and will save further, but probably don't HAVE to.

My parents had jobs they did and loved into their seventies and eighties, and I'd ideally like to have the same. Leaving the nest is hard, and I'm not sure what to look into. I'd like to earn 80-150k a year with plenty of time off. I'm open to low-stress, circadian-friendly clinical, nonclinical, or something totally nonmedical.

Thoughts? What is everyone else going to transition to?

What are your interests?

 

[BJJVP]

I am considering cruiseship medicine after the kids leave the home. However, I am still in the midst of researching the details.

 

[Dr Mantis Toboggan]

People **** on it, but I recently got into a situation where I own a small % of an urgent care and I’m finding the work enjoyable. Nice patients, low stress, and I think we provide some useful services (IVs, procedures, etc) for a very reasonable rate compared to ED charges. Fair number of cash pay patients and it feels like honest work. I’m just mixing into my ED work for now.

Or, two words: Ketamine. Clinic.


Trippy depression treatment? Hopes and hype for ketamine

Kudos to Angry Birds for inspiring this post.

I've done EM for eleven years and I'm looking for my next career/job. We are in a decent position financially with a small pension starting this April, no mortgage, and a reasonable amount of savings- we can and will save further, but probably don't HAVE to.

My parents had jobs they did and loved into their seventies and eighties, and I'd ideally like to have the same. Leaving the nest is hard, and I'm not sure what to look into. I'd like to earn 80-150k a year with plenty of time off. I'm open to low-stress, circadian-friendly clinical, nonclinical, or something totally nonmedical.

Thoughts? What is everyone else going to transition to?

 

[miacomet]

What are your interests?

Bird, that's a great question. I'm so crispy that my main interests are sleep and eating cheese. I like hiking, reading, hanging out with friends, and learning languages, but none of these is at all remunerative, sadly.

 

[namethatsmell]

People **** on it, but I recently got into a situation where I own a small % of an urgent care and I’m finding the work enjoyable. Nice patients, low stress, and I think we provide some useful services (IVs, procedures, etc) for a very reasonable rate compared to ED charges. Fair number of cash pay patients and it feels like honest work. I’m just mixing into my ED work for now.

I used to look down on all UCs...no longer. There's a clear difference between ones that docs own and operate vs the corporate UCs that are run by midlevels. In my experience the former tends to do well by patients and saves them money, thus creating actual value. The latter sends an unreasonable amount of patients from their UCs directly to the ED for things like asymptomatic HTN despite multiple attempts to re-educate said PAs/NPs. So now the patient gets two bills instead of one...hurts the patient but man the hospital systems gotta love it.

 

[namethatsmell]

Bird, that's a great question. I'm so crispy that my main interests are sleep and eating cheese. I like hiking, reading, hanging out with friends, and learning languages, but none of these is at all remunerative, sadly.

Great topic, thanks for starting this thread!

Here's a (lame) low hanging fruit answer: find a part-time EM job anywhere in the country that is easy/low stress by what whatever standards you use and pays decently. Work three 10-12hr shifts in a row if you have to travel and then be done for the month. Or put them back to back and do six straight shifts every two months if you want more time off in between. Or work them more spread out if you don't need to travel. Bottom line is if you work 36 shifts/year you should make 90-125k/yr and can devote the rest of your days to all those things you mention that don't pay.

 

[miacomet]

Great topic, thanks for starting this thread!

Here's a (lame) low hanging fruit answer: find a part-time EM job anywhere in the country that is easy/low stress by what whatever standards you use and pays decently. Work three 10-12hr shifts in a row if you have to travel and then be done for the month. Or put them back to back and do six straight shifts every two months if you want more time off in between. Or work them more spread out if you don't need to travel. Bottom line is if you work 36 shifts/year you should make 90-125k/yr and can devote the rest of your days to all those things you mention that don't pay.

Name, you are wise, and I'm definitely considering this or its lower stress, more circadian-friendly counterpart, urgent care, for three shifts a month. I'd honestly like to find something that pays and that's interesting and meaningful and that I can do into my eighties (I think UC might be a challenge at that age).

But thank you for your wise comment. It's probably the best path, at least for now. With the amount of taxes I pay as a W2 doc, I don't know how much my income would really decrease 😉. It's hard to pull the plug without another FT career sitting there, but your counsel is very wise.

 

[dchristismi]

I think we've briefly talked before, but I'm transitioning to hospice. (And we use that word a lot... in a different way. Ha!) I am enjoying medicine now, it fills the time well, such that I can see myself doing this for decades. I sure as hell couldn't manage in an ED full time at this point. And mostly, because I don't want to.

Definitely lower stress, much slower pace, still bedside (since I do inpatient) and now that I'm at "half" time (roughly 80 hours a month give or take), I'm in your projected goal range pay-wise. I was only doing about 10 hours a week for the first several months, and at first, it seemed like a glorified volunteer gig, but now could actually pay the bills. And that's without call or extra stuff I'm contemplating picking up.

I'm still doing roughly 3 EM shifts a month at a low-acuity FSED, and although it's getting harder on the ol' circadian system, as long as the money is good and it's only 3 overnights (seriously, 4 is when I have a really hard switching back... learned the hard way) I'm going to stick with it for a bit longer... Which is pretty much exactly what Name just described. It's totally worth it once you find the right gig.

I might give it up when the mortgage is gone, but I might just keep with it until the gig isn't as good as it is now. One never knows in these days of CMG buyouts...

Psychologically, it's taken me longer to get to the point of accepting that my identity is changing. Being an "ER doc" is a pretty awesome thing, and it's taken me a year to get used to the idea of moving away from the ED. (Bird in his infinite post-ED wisdom helped more than he might realize)

 

[miacomet]

I think we've briefly talked before, but I'm transitioning to hospice. (And we use that word a lot... in a different way. Ha!) I am enjoying medicine now, it fills the time well, such that I can see myself doing this for decades. I sure as hell couldn't manage in an ED full time at this point. And mostly, because I don't want to.

Definitely lower stress, much slower pace, still bedside (since I do inpatient) and now that I'm at "half" time (roughly 80 hours a month give or take), I'm in your projected goal range pay-wise. I was only doing about 10 hours a week for the first several months, and at first, it seemed like a glorified volunteer gig, but now could actually pay the bills. And that's without call or extra stuff I'm contemplating picking up.

I'm still doing roughly 3 EM shifts a month at a low-acuity FSED, and although it's getting harder on the ol' circadian system, as long as the money is good and it's only 3 overnights (seriously, 4 is when I have a really hard switching back... learned the hard way) I'm going to stick with it for a bit longer... Which is pretty much exactly what Name just described. It's totally worth it once you find the right gig.

I might give it up when the mortgage is gone, but I might just keep with it until the gig isn't as good as it is now. One never knows in these days of CMG buyouts...

Psychologically, it's taken me longer to get to the point of accepting that my identity is changing. Being an "ER doc" is a pretty awesome thing, and it's taken me a year to get used to the idea of moving away from the ED. (Bird in his infinite post-ED wisdom helped more than he might realize)

You are wise.

It's really hard to envision happiness in clinical medicine from my vantage point. I've cut down to about 100 hours a month, but the circadian issues are still getting me (and my waistline), even though I work in a reasonably functional ER with fairly nice patients and good staffing. Are three night shifts a month that much better? Maybe I need a cold turkey break from ER to clear my brain, but I worry I wouldn't be able to come back.

Identity issues are not a thing for me, luckily, it's the Benjamins each and every time. I realize I'm in an enviable position with no mortgage, even if it's neither my dream house nor my dream location, but it's hard for me NOT to keep going and saving more money for the inevitable rainy day.

It's just hard to cut the financial cord, especially when my job is a decent, desirable, less abusive job. If I leave, that door is closed, and I live in a tough, tough market.

 

[hundreddaysoff]

Kudos to Angry Birds for inspiring this post.

I've done EM for eleven years and I'm looking for my next career/job. We are in a decent position financially with a small pension starting this April, no mortgage, and a reasonable amount of savings- we can and will save further, but probably don't HAVE to.

My parents had jobs they did and loved into their seventies and eighties, and I'd ideally like to have the same. Leaving the nest is hard, and I'm not sure what to look into. I'd like to earn 80-150k a year with plenty of time off. I'm open to low-stress, circadian-friendly clinical, nonclinical, or something totally nonmedical.

Thoughts? What is everyone else going to transition to?

The most important questions I see here: do you actually need to keep working in order to eat at this point? And if so, exactly how much more cash do you need?

If you still need a lot of cash, I agree w/ low-stress ER/UC/whatever vs medical entrepreneurial stuff as your path of least resistance. But if you're now financially independent after 11 years, why worry about working at all? If you've won the game, why keep playing?

I love being an ED doc, and I could probably list about 500 things I'd rather do with my life than being an ED doc. It's just that none of them are likely to make very much money, and if they did they probably wouldn't be as much fun.

 

[thegenius]

This is already my second career. Was a software engineer for the first 7-8 years of my life.

I'm happy with the switch but did not anticipate, to the degree it has, the financial impact of not making any money for 4 years (medical school), and 4 years of residency making $60K/year. I'm married with two kids who are almost teenagers and have whittled down my 300K debt as an attending to 39K in 4.5 years. I don't even own a home.

I'm in ER for good. I'm not going to change anytime soon, unless I find a career programming and using medicine at the same time that pays $300K/year.

Jealous of those who have more independence than I!

 

[Tenk]

I used to think about changing but so few jobs can come close to the $/hr. If all you want is $80k a year, you could make that working like 3-4 shifts a month. That gives you 27 days a month to do whatever! I think the thing that gets a lot of docs trapped is living a lavish lifestyle that is actually not necessary when you look at the population at large.

 

[dchristismi]

100 hours a month is still too much as crispy as you are. Slash it to 60-80 for 2-3 months if you can. Call it a sabbatical if you will. You need a break.

Oh and read some of this:

This guy walked away from a Wall St career and went through a lot of the psychological struggles I did (and I think you are) about income.
You're thinking about "financial security" the wrong way | RadReads
There's another post about why successful people are afraid of being broke, also a good read. And anyway, those crystallized a lot for me.

I have never lived terribly lavishly and have a 7 figure nest egg saved. You probably do too. Yeah, I travel a lot, but I use sales and miles and still clip coupons and cook at home.

I suppose part of why I'm still doing those 3 EM shifts is in the above link. When you're used to $25000 paychecks (or more), half of that seems like a big drop. Once I actually thought about it and tracked my actual expenses, well... I don't *need* but a fraction of what I'm bringing in.
(although actually, I do enjoy a slow ED when I can actually spend time with my patients... which seems to be less and less the norm.)

 

[miacomet]

100 hours a month is still too much as crispy as you are. Slash it to 60-80 for 2-3 months if you can. Call it a sabbatical if you will. You need a break.

Oh and read some of this:

This guy walked away from a Wall St career and went through a lot of the psychological struggles I did (and I think you are) about income.
You're thinking about "financial security" the wrong way | RadReads
There's another post about why successful people are afraid of being broke, also a good read. And anyway, those crystallized a lot for me.

I have never lived terribly lavishly and have a 7 figure nest egg saved. You probably do too. Yeah, I travel a lot, but I use sales and miles and still clip coupons and cook at home.

I suppose part of why I'm still doing those 3 EM shifts is in the above link. When you're used to $25000 paychecks (or more), half of that seems like a big drop. Once I actually thought about it and tracked my actual expenses, well... I don't *need* but a fraction of what I'm bringing in.
(although actually, I do enjoy a slow ED when I can actually spend time with my patients... which seems to be less and less the norm.)

Perhaps you are right. Thank you for the article- not sure it applies to my circumstances, but very good reading.

Love hearing everyone's ideas- keep them coming!

 

[Birdstrike]

Bird, that's a great question. I'm so crispy that my main interests are sleep and eating cheese. I like hiking, reading, hanging out with friends, and learning languages, but none of these is at all remunerative, sadly.

Look into how you get a medical license in France. Google French Riviera. Do it for 1 year, work part time, eat cheese, sleep, travel Europe, hike the Alps, learn a language or two. That checks all your boxes. Plus its a big adventure you never thought you'd have.

 

[Birdstrike]

Or, two words: Ketamine. Clinic.


Trippy depression treatment? Hopes and hype for ketamine

A cash-for-controlled substance clinic. What could possibly go wrong...

 

[miacomet]

A cash-for-controlled substance clinic. What could possibly go wrong...

Back in my youth we used to call that a "crack house." Quaint, to be sure.

 

[RustedFox]

Practice IM.
90% of EM is IM anyways, so its not like it will be hard.

 

[emergentmd]

1. Work in a FSER 2, 24hr shifts a month. See 5-10 pts a day, sleep most nights, watch alot of TV, keep some resemblance of clinical medicine. - 100K/yr
2. Buy rental properties, When I pay all of mine off in 5 yrs - 100K/yr
3. Have a vacation home I rent, when I pay this off in 5 yrs - 50k/yr
4. Do some chart reviews about 10 hrs a wk - hope to pull in 50k/yr
5. Invest in Syndicated Apartment complexes 300K invested within 5 yrs - Hope to pull in 30k/yr

My 5 year plan is to bring in over 300K/yr with mostly passive income. If EM Armageddon occurs, I will get out of it completely and just live on rental properties, apt complexes, and chart reviews and live off 200k/yr.

 

[bbc586]

1. Work in a FSER 2, 24hr shifts a month. See 5-10 pts a day, sleep most nights, watch alot of TV, keep some resemblance of clinical medicine. - 100K/yr
2. Buy rental properties, When I pay all of mine off in 5 yrs - 100K/yr
3. Have a vacation home I rent, when I pay this off in 5 yrs - 50k/yr
4. Do some chart reviews about 10 hrs a wk - hope to pull in 50k/yr
5. Invest in Syndicated Apartment complexes 300K invested within 5 yrs - Hope to pull in 30k/yr

My 5 year plan is to bring in over 300K/yr with mostly passive income. If EM Armageddon occurs, I will get out of it completely and just live on rental properties, apt complexes, and chart reviews and live off 200k/yr.

What type of chart review work is this? And how did you get connected with it?

 

[Birdstrike]

What type of chart review work is this? And how did you get connected with it?

I think he's talking about medical-legal consulting, ie medical expert opinion work. You review charts that are from active medical malpractice, medical board or criminal cases. You can do this for either the defense or plaintiffs. It actually pays incredibly well and getting paid more than you normally make for reading someone else's chart and also billing an attorney for the privilege of allowing them to hear you talk, is pretty sweet. While everyone's fee schedule is different, it's generally easy to get twice your hourly income and even more for depositions or a day spent in court testifying. I've done a little bit of this, generally as a favor local attorneys I know and whom trust my opinion, and I do like the chart review and consultation part. The thing that prevents me from doing more of this, is the testifying part. Even though it pays incredibly well, getting cross examined by lawyers is never fun, not for me, at least. Incidentally, this is the work Peter Rosen was doing when he took money to testify against a fellow Emergency Physician, giving testimony that got him publicly censured by ACEP for violating ethics and expert witness guidelines, in a case involving a pediatric PE that many thought resulted in a very unjust outcome towards the emergency physician.

 

[southerndoc]

There are also companies that employee physicians to work from home doing chart reviews for either audits or for justifying inpatient admissions vs observation. (One does this in real time to guide admitting providers.) One of our former docs - who was a member of SDN, but I haven't seen him active in a while - was doing this. Pay was about $150k/yr I think. They provided their own secure laptop that you had to use to review the charts. Can't remember their name, but they were based in Pennsylvania.

 

[miacomet]

There are also companies that employee physicians to work from home doing chart reviews for either audits or for justifying inpatient admissions vs observation. (One does this in real time to guide admitting providers.) One of our former docs - who was a member of SDN, but I haven't seen him active in a while - was doing this. Pay was about $150k/yr I think. They provided their own secure laptop that you had to use to review the charts. Can't remember their name, but they were based in Pennsylvania.

I want this job.

 

[swamprat]

There are also companies that employee physicians to work from home doing chart reviews for either audits or for justifying inpatient admissions vs observation. (One does this in real time to guide admitting providers.) One of our former docs - who was a member of SDN, but I haven't seen him active in a while - was doing this. Pay was about $150k/yr I think. They provided their own secure laptop that you had to use to review the charts. Can't remember their name, but they were based in Pennsylvania.

Yes please remember [emoji106][emoji106]


Sent from my iPhone using SDN mobile

 

[Angry Birds]

I used to think about changing but so few jobs can come close to the $/hr. If all you want is $80k a year, you could make that working like 3-4 shifts a month. That gives you 27 days a month to do whatever! I think the thing that gets a lot of docs trapped is living a lavish lifestyle that is actually not necessary when you look at the population at large.

Tenk, I think you're right. The money is just too good to leave EM completely.

I think my goal is just to reduce clinical EM although supplementing my main income with a few shifts per month is probably unavoidable.

 

[miacomet]

Tenk, I think you're right. The money is just too good to leave EM completely.

I think my goal is just to reduce clinical EM although supplementing my main income with a few shifts per month is probably unavoidable.

Well, with all the posts talking about $160 an hour, the money may ultimately decline to the point that it's not worth it. What's up with your second career idea?

 

[deuist]

I signed up for SEAK many months ago to do chart reviews, but have never made any money off of it. Anybody know of any other chart review groups?

 

[jaeida8]

@miacomet and @deuist , I have been doing Radiology medical necessity review with Magellan, basically CT and MRI pre-authorizations. You can find the job for Physician Clinical Reviewer online. I signed up with other companies who send intermittent charts, but this is actually regular scheduled work with straight case review and peer to peer calls. Also the option to be an employee and get benefits. It's weekday hours, very easy to get time off. You can PM me for the details.