Pursue a second residency after FM?

[PteFabulous]

Hi SDN,

I am a FM resident considering pursuing a second residency in IM when I'm done. Ever since med school, I wanted to be an intensivist, that was my original goal. I started residency in gen surge, but transferred after a year to FM. I transferred for multiple reasons; crazy hours, unsupportive work environment, and being long distance was taking a toll on my marriage. Now I have a year left of FM and have to look for jobs, but I can't say I'm excited about any particular practice opportunity.

I'm considering applying for IM with the goal of sub specializing in CCM. If I don't get it, then I would do GIM. The thought of more training doesn't bother me, but I am worried that I may not be happy in IM either.

I have felt a little lost after switching from gen surge, I used to have a plan that was working out well, and now I am just confused.

Any perspective and advice is greatly appreciated!

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[Gastrapathy]

Why not practice as a hospitalist for a while before committing to that?

 

[doc05]

just do FM. it's a good field.

 

[PteFabulous]

I have a hospitalist rotation coming up, so I'll see how that goes.

I also wonder if it'll get better when I'm an attending, and not a resident anymore...

 

[ThoracicGuy]

I have a hospitalist rotation coming up, so I'll see how that goes.

I also wonder if it'll get better when I'm an attending, and not a resident anymore...

It always gets better... usually.

 

[deleted480308]

Ever since med school you wanted to be an intensivist......so you matched general surgery for a year and then went fm?

 

[ThoracicGuy]

Ever since med school you wanted to be an intensivist......so you matched general surgery for a year and then went fm?

Looks like he's a Canadian IMG matching in the US.

 

[PteFabulous]

FM was originally my second choice if I didn't in to gen surg. FM was a easy transfer, open spot in my hometown, quick transfer within 1 month of my request. It's very difficult to keep the end goal in mind when you're sleep deprived and angry all the time.

I hope it does get better! Maybe practicing for at least a year first might help give me some perspective.

Thanks for all your advice!

 

[BW15]

CCM is a stressful field and you would be adding at least 5 years to your training. Also keep in mind that there are many fellowships that are Pulmonary/CCM (3 years), so if you were to match one of those you would have to like the Pulmonary aspect. Being a pulmonary doc is not a pleasant experience, these patients are extremely sick people, most with neurological injury that prevents them from breathing on their own.

Family medicine is a good specialty, you get a 9-5 job and you get to converse with fairly healthy patients.

If I was in your shoes, I would most likely stick with family medicine and move on with my life. There is more to life than medicine, another 5-6 years of training is like giving up another 5-6 years of your life.

 

[NRAI2001]

I think you may enjoy being a hospitalist? How would being a general IM doc be any better than FM? IMO as a general doc FM would be a much better gig? Can see Peds, women, ob in addition to adult PTs... Doing an IM residency to "maybe do GIM.." Doesn't make sense.. Maybe you have a case of the "too good for FM-itis" seen that over and over again... Person that was actually probably a good fit for a certain field but just felt like they could do better or were too good for certain fields..

IMO FM is waaay under-rated... Good lifestyle, good mix of patients, can actually feel like normal person from time to time and is not unreasonable to make $300-$400k a year.. Good deal IMO

 

[NRAI2001]

But just as a question... Anyone know of people who went on to do a second residency after fm or any other field?

 

[bashwell]

IMO FM is waaay under-rated... Good lifestyle, good mix of patients, can actually feel like normal person from time to time and is not unreasonable to make $300-$400k a year.. Good deal IMO

I agree FM is underrated. I think it's a great specialty. But "not unreasonable to make $300-$400k a year" - where are these jobs? Please tell!

But just as a question... Anyone know of people who went on to do a second residency after fm or any other field?

I know there are a couple of anesthesiologists here on SDN who are former FM physicians. I also met an orthopedic surgeon who did FM first.

 

[BobBarker]

Anesthesia plus ccm fellowship would be 4 years extra.

 

[deleted480308]

I'm calling bull on 3-400k being easy to attain in a normal FM situation

 

[DocBlin]

Maybe just maybe if you worked 80 hrs/week in FM you 'might' hit $300 in your 3rd or 4th year. Just maybe but very doubtful. More realistic is hoping for $200K/year as a goal.. Usual yearly gross average for 40hrs/week Urgent Care++ $190K. So go figure if you can reach that first.

 

[bashwell]

I've heard of some rural FMs getting like $200/hr to work rural EDs. I suppose if you did only that for a year, then you could be $300-$400k. However this isn't exactly a normal or "not unreasonable" situation for FM, at least as far as I'm aware.

 

[deleted480308]

I've heard of some rural FMs getting like $200/hr to work rural EDs. I suppose if you did only that for a year, then you could be $300-$400k. However this isn't exactly a normal or "not unreasonable" situation for FM, at least as far as I'm aware.

I know @cabinbuilder pulls that kind of money but she does a lot of 24/7 locum gigs....it's not really a normal situation

 

[cabinbuilder]

I've heard of some rural FMs getting like $200/hr to work rural EDs. I suppose if you did only that for a year, then you could be $300-$400k. However this isn't exactly a normal or "not unreasonable" situation for FM, at least as far as I'm aware.

Most I have ever made in a rural ED is $115/hr. Usually it's the EM docs who make that. But I guess it comes down to how desperate the place is to stay open then you can name your own price but the schedule would be brutal.

 

[galactus]

But just as a question... Anyone know of people who went on to do a second residency after fm or any other field?

Yup. I personally know of people who went from FM to ob/gyn, FM to ER, and FM to Peds.

In terms of the FM people making $300k+, it's not unreasonable, because I graduated with them. Mind you they are doing outpatient/inpatient/ER/surgical OB and working their tails off, but still.

 

[bashwell]

In terms of the FM people making $300k+, it's not unreasonable, because I graduated with them. Mind you they are doing outpatient/inpatient/ER/surgical OB and working their tails off, but still.

Thanks, that's interesting. Do you think it's possible to work ~50hrs in FM and make ~$300k, such as by maximizing whichever pays the most (e.g. working all rural EDs; all outpatient in areas with great payor mix; whatever)?

 

[gutonc]

Thanks, that's interesting. Do you think it's possible to work ~50hrs in FM and make ~$300k, such as by maximizing whichever pays the most (e.g. working all rural EDs; all outpatient in areas with great payor mix; whatever)?

Anything is possible. But the reason that every FP isn't making that kind of money is because it's not easy. In fact, probably really hard.

 

[pulmoblast]

Being a pulmonary doc is not a pleasant experience, these patients are extremely sick people, most with neurological injury that prevents them from breathing on their own

You have absolutely no idea what a pulmonologist does do you?

We treat LUNG disease like COPD, Asthma, Sarcoidosis, ILD etc. diagnose and stage some lung cancers. Bronchoscopy +- EBUS is the bread butter procedure.

Some people do additional training in pulmonary hypertension, interventional pulmonology and sleep medicine.

 

[DocBlin]

Reply to 'bashful'; My son 1 year out, boarded FM in Urgent Care in NYC. Hourly rate $120. So 50 hrs/week = 200 hrs/month @ $120/hr = $24,000/month. 11 months gross would be $264,000./ But remember the 'taxes'.... So work more make more but burn out faster...

 

[bashwell]

Most I have ever made in a rural ED is $115/hr. Usually it's the EM docs who make that. But I guess it comes down to how desperate the place is to stay open then you can name your own price but the schedule would be brutal.

Reply to 'bashful'; My son 1 year out, boarded FM in Urgent Care in NYC. Hourly rate $120. So 50 hrs/week = 200 hrs/month @ $120/hr = $24,000/month. 11 months gross would be $264,000./ But remember the 'taxes'.... So work more make more but burn out faster...

FM working urgent care in NYC makes slightly more than FM working rural ED? That's surprising to me, but then again probably because I know next to nothing about economics. The $115/hr in rural ED would probably go a lot further than the $120 in NYC.

 

[NRAI2001]

FM working urgent care in NYC makes slightly more than FM working rural ED? That's surprising to me, but then again probably because I know next to nothing about economics. The $115/hr in rural ED would probably go a lot further than the $120 in NYC.

How much do board certified ed docs make?

 

[cabinbuilder]

FM working urgent care in NYC makes slightly more than FM working rural ED? That's surprising to me, but then again probably because I know next to nothing about economics. The $115/hr in rural ED would probably go a lot further than the $120 in NYC.

True, you have to factor in cost of living. I work locums so all my housing, travel, and rental car at the site is no cost to me. I do have housing bills at my home base, just not where I am working.

 

[bashwell]

True, you have to factor in cost of living. I work locums so all my housing, travel, and rental car at the site is no cost to me. I do have housing bills at my home base, just not where I am working.

Thanks cabinbuilder. You sound like you do amazingly well, which is very cool. But is it traveling around a lot like this? I think I'd like it but might have difficulty if I start to have a family, get older, etc. Tons of respect for FPs though. You guys do it all!

 

[cabinbuilder]

How much do board certified ed docs make?

From the jobs that I have seen come across my email $200-$250/hr but their level of expertise warrants that.

 

[cabinbuilder]

Thanks cabinbuilder. You sound like you do amazingly well, which is very cool. But is it traveling around a lot like this? I think I'd like it but might have difficulty if I start to have a family, get older, etc. Tons of respect for FPs though. You guys do it all!

Doesn't have to be but when you have multiple licenses it makes for more opportunities and I can pick and choose what jobs pay the most and decide where I want to go. Remember that NO ONE forces me to a site. I have the final say ALWAYS.

 

[bashwell]

Doesn't have to be but when you have multiple licenses it makes for more opportunities and I can pick and choose what jobs pay the most and decide where I want to go. Remember that NO ONE forces me to a site. I have the final say ALWAYS.

By the way, you might've already answered this somewhere in the past, so apologies if you have, but just wondering why you chose FM over EM as you seem to do a lot of work in rural EDs, and also temporary or short term rather than permanent or long term work, like a few months here, a few months there, etc. which wouldn't seem to need chronic management of disease as much? But I guess FM always has the possibility of going into a more regular schedule someday if needed, whereas I don't think that's as likely for EM?

 

[evilbooyaa]

I echo what other people said that if you're considering GIM at all, just do a year of hospitalist. FMs can still become hospitalists or nocturnists at a lot of hospitals.

 

[cabinbuilder]

By the way, you might've already answered this somewhere in the past, so apologies if you have, but just wondering why you chose FM over EM as you seem to do a lot of work in rural EDs, and also temporary or short term rather than permanent or long term work, like a few months here, a few months there, etc. which wouldn't seem to need chronic management of disease as much? But I guess FM always has the possibility of going into a more regular schedule someday if needed, whereas I don't think that's as likely for EM?

I didn't choose FM, it chose me. I scrambled into FM when I didn't match. I never wanted to be an ER doctor and work rural ER because it's a stabilize and ship type of scenario mostly. Stop the bleeding, get the line in, hang fluids, stabilize pressure and call the plane.

I do mostly urgent care any more because I don't like dealing with trauma, cardiac emergencies, or stroke management. I don't see kids under 6 months. I don't do OB. I don't do chronic medical management in urgent care. I don't refill narcotics. I like the fast pace of urgent care and how it's different every day but if there is anything that needs higher care I can send them to the ER.

I have tried many times to do a permanent job (5) and have quit everytime. Just don't like someone telling me how to practice medicine. On a locums job they treat me well or I walk out the door.

 

[BW15]

You have absolutely no idea what a pulmonologist does do you?

We treat LUNG disease like COPD, Asthma, Sarcoidosis, ILD etc. diagnose and stage some lung cancers. Bronchoscopy +- EBUS is the bread butter procedure.

Some people do additional training in pulmonary hypertension, interventional pulmonology and sleep medicine.

You're right now that I think of it. I did a 1 month rotation at a pulmonology clinic at a county rehabilitation hospital, so my experience was most likely skewed toward those with neurological injuries.

Good to hear that these are not the majority of patients you guys see, because it was a difficult patient population to work with.

 

[styphon]

Family medicine is a good specialty, you get a 9-5 job and you get to converse with fairly healthy patients.

That's odd, I see very few healthy patients <-sarcasm

I've heard of some rural FMs getting like $200/hr to work rural EDs. I suppose if you did only that for a year, then you could be $300-$400k. However this isn't exactly a normal or "not unreasonable" situation for FM, at least as far as I'm aware.

I was offered anywhere from 100 to 130$/hr for rural ers which is 200-260k/year if you work 40hr/week.

 

[Kahreek]

.....

 

[cabinbuilder]

are you married or/and with children? How is it living like a rockstar in tour?
Do you go homebase often? Is your radius of practice very large? Like plane trip large?

Hmm interesting perspective: Yes I am married. Yes I have 2 kids ages 16 and 19. I have been doing locums for 5 years. As my kids got older my radius got bigger and the assignments longer. Many times when I am on a long assignment (4 months or more) the company will fly me home once a month and I will take 3-4 days to be home and restock the house, do the mail, any projects, etc. My husband stays home. Not quite rockstar as I am the relief help and generally work 60-75 hours a week when I am there so it's just another clinic mostly.

Yes, it's plane trip large. I practice in 5 states: Oregon, Alaska, Nevada, Wyoming, and Texas.

I work big chunks so I can take big chunks off and do something fun. I do find time to fit in some Vegas stuff too.