Post-residency options

[visceral0775]

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After I graduate, I would like to supplement my time working in the ED with another job to prevent burnout. What other types of clinical roles are available that don't require a fellowship? Palliative, pain, wilderness, etc?

 

[thegenius]

Not sure what you are talking about. The number of jobs is potentially infinite?

You are graduating from an ED residency and don't want to practice ER medicine fulltime?
If that is the case, you can do
- urgent care
- work somehow for a private company as their urgent care doctor (like for Boeing)
- any biotech firm
- any health care firm
- sales
- research
- plumber
- statistician and make our COVID-19 models more accurate
- minor league baseball player
- average adult porn actor
- cement layer
- musician, play the guitar, do some drugs and try to be like Jerry
- scribe
- ER Scribe
- EMT
- nurse

the list is endless

 

[Angry Birds]

After I graduate, I would like to supplement my time working in the ED with another job to prevent burnout. What other types of clinical roles are available that don't require a fellowship? Palliative, pain, wilderness, etc?

You really don't know that pain requires a fellowship?
This sounds like a troll account, the equivalent of catfishing.
I don't get what people get out of this.

 

[deleted547339]

After I graduate, I would like to supplement my time working in the ED with another job to prevent burnout. What other types of clinical roles are available that don't require a fellowship? Palliative, pain, wilderness, etc?

Easiest way to not get burned out: live like the average American, work like a half time ER doc.

 

[thegenius]

After I graduate, I would like to supplement my time working in the ED with another job to prevent burnout. What other types of clinical roles are available that don't require a fellowship? Palliative, pain, wilderness, etc?

You edited your first post. Now my response doesn't make as much sense.

 

[visceral0775]

You really don't know that pain requires a fellowship?
This sounds like a troll account, the equivalent of catfishing.
I don't get what people get out of this.

As a matter of fact, no I really didn't know, and this is not a troll account.

People have said mixed things about needing fellowships for palliative and even wilderness, for example, so I wasn't sure if pain was included in this or not.

 

[visceral0775]

Easiest way to not get burned out: live like the average American, work like a half time ER doc.

Thank you 🙂

 

[docB]

One thing that may help you curate your list of possibilities is to divide them into things that pay and things that don't.
Things where you're billing patients tend to pay while others don't. For example, urgent care, pain (extra training) and palliative (extra training) pay a significant amount. By "significant amount" I don't mean get super rich money. I don't even mean = to what you'd make as a full time EP. I mean enough money to cut your full time EM commitment to say half hours with the sideline making up the difference. And for that you'll probably be doing more total hours.
Stuff like sports, EMS and wilderness don't pay. People tend to do these for personal interest rather than money. Doing something for personal interest is important and can really help with burnout. I really enjoy doing EMS and it's probably the only reason I haven't chucked the whole industry at this point.
And before you mention various docs who have really sweet gigs they most likely have years of experience and networking in their respective communities and fields. Very few docs fall into those jobs without paying dues first.
One extra note about sports med. The sports med jobs that pay involve working in a clinic seeing school and weekend warrior sprains, strains and ouchies and billing those patients. It's more like working urgent care or fast track. If you're seeing yourself hanging out with pro athletes and running onto the field with the champs those jobs don't pay. In fact many pro teams want you (or your institution) to pay them for the privilege of taking care of them. I'm not putting that down and it is fun but don't think there's money in it.

 

[Torsion]

In fact many pro teams want you (or your institution) to pay them for the privilege of taking care of them.

Do self-respecting physicians actually do this? I might not even mind volunteering my time if its something I enjoyed doing but the idea of a professional paying the recipient of service "for the privilege" sounds ridiculous.

 

[RustedFox]

I'm a little unclear on the original post. No snark intended; I do mean to help as a guy who has been totally burned out.

You plan on working FT in the ED, and also working PT in another tangentially-related field to prevent burnout?
I don't think that's what you mean; because that would be a faster-track to burnout.

You plan on working PT in the ED, and also working PT in another tangentially-related field '' '' ?
If that's what you mean (I think this is more likely), then you've got to figure out what income level you'll accept, and how to "bridge the gap".

I'll stop here for now.

 

[docB]

Do self-respecting physicians actually do this? I might not even mind volunteering my time if its something I enjoyed doing but the idea of a professional paying the recipient of service "for the privilege" sounds ridiculous.

It usually comes with advertising rights. You get to bill yourself as "The Official Whatever of the City Mascots." I know os some big ortho groups that do it and for EM the deal is usually with the hospital or system.

 

[visceral0775]

I'm a little unclear on the original post. No snark intended; I do mean to help as a guy who has been totally burned out.

You plan on working FT in the ED, and also working PT in another tangentially-related field to prevent burnout?
I don't think that's what you mean; because that would be a faster-track to burnout.

You plan on working PT in the ED, and also working PT in another tangentially-related field '' '' ?
If that's what you mean (I think this is more likely), then you've got to figure out what income level you'll accept, and how to "bridge the gap".

I'll stop here for now.

Hello,
Yes PT in the ED and PT in a related field. As you mentioned yourself being burnout out (and as many ED docs do), what are your plans for yourself in the long-run? That was basically all I was asking in the post.
thanks!

 

[visceral0775]

One thing that may help you curate your list of possibilities is to divide them into things that pay and things that don't.
Things where you're billing patients tend to pay while others don't. For example, urgent care, pain (extra training) and palliative (extra training) pay a significant amount. By "significant amount" I don't mean get super rich money. I don't even mean = to what you'd make as a full time EP. I mean enough money to cut your full time EM commitment to say half hours with the sideline making up the difference. And for that you'll probably be doing more total hours.
Stuff like sports, EMS and wilderness don't pay. People tend to do these for personal interest rather than money. Doing something for personal interest is important and can really help with burnout. I really enjoy doing EMS and it's probably the only reason I haven't chucked the whole industry at this point.
And before you mention various docs who have really sweet gigs they most likely have years of experience and networking in their respective communities and fields. Very few docs fall into those jobs without paying dues first.
One extra note about sports med. The sports med jobs that pay involve working in a clinic seeing school and weekend warrior sprains, strains and ouchies and billing those patients. It's more like working urgent care or fast track. If you're seeing yourself hanging out with pro athletes and running onto the field with the champs those jobs don't pay. In fact many pro teams want you (or your institution) to pay them for the privilege of taking care of them. I'm not putting that down and it is fun but don't think there's money in it.
[/

Thank you fot the feedback/advice!

 

[RustedFox]

Hello,
Yes PT in the ED and PT in a related field. As you mentioned yourself being burnout out (and as many ED docs do), what are your plans for yourself in the long-run? That was basically all I was asking in the post.
thanks!

My plan is one of the two:

1.) Work only the minimum required (generally 120) hours/month at whatever hospital I choose to work at, and be VERY choosy about where I work/live. I can figure out a way to live on 250K+ a year; for realsies.
2.) Go locums and work as much or as little as I so please.

 

[visceral0775]

My plan is one of the two:

1.) Work only the minimum required (generally 120) hours/month at whatever hospital I choose to work at, and be VERY choosy about where I work/live. I can figure out a way to live on 250K+ a year; for realsies.
2.) Go locums and work as much or as little as I so please.

That sounds like a good plan 🙂

 

[TheComebacKid]

I may sound like a complete d-bag for saying this, but Wilderness Medicine is not a fellowship. It's for EM docs who like the outdoors and don't want to pay off their loan debt. You should not pursue this fellowship, IMO, barring some very rare/specific circumstances that I can't even think of.

Palliative care pays.
Critical care pays.
Toxicology pays.
Pain pays. But you have to do pain. Shoot me now.

EMS doesn't really pay well at all (much of it is volunteer depending on the agency). Lots of EMS is government work, so even the positions that do pay, they come with all the crap that involves being a government employee, and very little money, and likely years of paying your dues working for free. I'm starting EMS fellowship this summer, and with the exception of possibly being more competitive for academic positions which don't pay much to begin with, nobody at any community shop will likely care about my additional training. It's more for me.

Regardless, if anyone is going to pay you for doing anything, doing additional training in said area is beneficial. For EMS, the age of non fellowship trained medical directors is likely coming to an end, and the expectation for new jobs is that people complete fellowship training and sit for the boards.

 

[RustedFox]

I may sound like a complete d-bag for saying this, but Wilderness Medicine is not a fellowship. It's for EM docs who like the outdoors and don't want to pay off their loan debt. You should not pursue this fellowship, IMO, barring some very rare/specific circumstances that I can't even think of.

Palliative care pays.
Critical care pays.
Toxicology pays.
Pain pays. But you have to do pain. Shoot me now.

EMS doesn't really pay well at all (much of it is volunteer depending on the agency). Lots of EMS is government work, so even the positions that do pay, they come with all the crap that involves being a government employee, and very little money, and likely years of paying your dues working for free. I'm starting EMS fellowship this summer, and with the exception of possibly being more competitive for academic positions which don't pay much to begin with, nobody at any community shop will likely care about my additional training. It's more for me.

Regardless, if anyone is going to pay you for doing anything, doing additional training in said area is beneficial. For EMS, the age of non fellowship trained medical directors is likely coming to an end, and the expectation for new jobs is that people complete fellowship training and sit for the boards.

You're not a D-bag. At all.
At the risk of me reciting my own joke:

"Wilderness Medicine: Chapter 1"
- Get the hell out of the wilderness, then do the medicine.

"Wilderness Medicine: Chapter 2:
- See Chapter 1.

See: Sports Medicine, Chapters 1 and 2, replace "... out of the wilderness" with "... off of the field".

The only difference is whether you want to wear boots and carry a leatherman, or whether you want to wear a Team Polo and carry a clipboard.
Give the "discerning look" (requires fellowship training to unlock) and carry on.

 

[RustedFox]

Aside from that funny analogy, can you explain what is so bad about sports med? Just curious. Is it possible to still work a decent number of shifts in a month and do some sports med clinic time, procedures, and events to diversify and stave off burnout while still taking home some good coin?

No.
That job doesn't exist.

 

[TheComebacKid]

Aside from that funny analogy, can you explain what is so bad about sports med? Just curious. Is it possible to still work a decent number of shifts in a month and do some sports med clinic time, procedures, and events to diversify and stave off burnout while still taking home some good coin?

There's no such thing as "make good coin" and "stave off burnout" in EM. If you want to stave off burnout, you will be making less. If you want to make more money, you will suffer from burnout.

It's the trade off you make going into a specialty that purchases vacation homes for malpractice attorneys, working nights/weekends/holidays, circadian rhythm disruptions, and dealing with some of the least pleasant people society has produced. It's precisely because you do the things that cause burnout when nobody else will do them, that people will pay you nicely for it.

 

[RustedFox]

Thanks Y’all. Would going Sports Med FT then be a mistake since you could have done the same thing post-FM and essentially let all your resus skills go to waste?

Re-read my post.

 

[RustedFox]

Can we have a filter (I know it works; because we did it awhile ago on this forum where on April Fools Day that all posts were translated into "PirateSpeak!") where all posts about "Sports Medicine" be retranslated as "Sspornts MEDazzine" (or some agreed upon bastardization of the phrase) to break it to the med-students that their dreams of wearing a Team Polo and standing on the sidelines and giving a Discerning Look can be fulfilled by wearing a Team Polo and giving a Discerning Look without a residency in EM?

 

[DeadCactus]

You avoid burnout by making sound financial decisions and having a coherent career plan for the next 5 years, 10 years, and 20 years to get you where you want to be in life. It's fine to talk to other people and see what direction they've taken their career but there is a constant stream of burn-out avoidance threads from people barely entering the field. It's like their running down some graduation checklist of buy life insurance, buy disability insurance, build career escape pod, find a job, etc.

Either you have some interest that you've entertained turning into a part-time and maybe eventually full-time career or you don't. If you did, you wouldn't be fishing for random ideas from strangers so I have to assume you don't. Since you don't, your path forward should be simple. Take the best job you can find by whatever metrics you decide to prioritize and go work that job. Learn to be an attending, make some money, get your finances handled, and enjoy life. In a year or two you'll figure out what you like and hate about your job and can come up with a more concrete plan for how to adjust your career trajectory to minimize the things you hate and maximize the things you love. There are tons of options but it doesn't make sense to start listing them without having some problem we're trying to solve that is more specific than not practice emergency medicine. There is no point in building a parachute before you know if you're on a crashing plane or a boat with a small leak that needs to be plugged...