Second residency in Emergency Medicine (Part 2)

[IM.MD]

Hi everyone,

As I have previously posted, I'm interested in pursuing a second residency in Emergency Medicine. I completed an Internal Medicine residency in 2017 and I have been working as a hospitalist since then. I'm ABIM board certified. Although the hospitalist gig has been good to me financially, making $400K yearly with bonus + extra shifts, I would like to be a more versatile doc - peds, ortho, OB, performing lifesaving procedures, working up undifferentiated patients, etc. I'm planning to apply to many of the 270 EM residencies next month.
I would appreciate it if any of you, good folks, can give me some insight into which programs are willing to accept applicants who have completed another residency?
Thanks!

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[RustedFox]

JESUS CHRIST, NO!

Seriously, amigo - take your 400K and go do something awesome and forget that you ever had this terrible idea.

 

[Splenda88]

Not a good idea to get into sinking ship.

I hope OP is not serious.

 

[cyanide12345678]

Hi everyone,

As I have previously posted, I'm interested in pursuing a second residency in Emergency Medicine. I completed an Internal Medicine residency in 2017 and I have been working as a hospitalist since then. I'm ABIM board certified. Although the hospitalist gig has been good to me financially, making $400K yearly with bonus + extra shifts, I would like to be a more versatile doc - peds, ortho, OB, performing lifesaving procedures, working up undifferentiated patients, etc. I'm planning to apply to many of the 270 EM residencies next month.
I would appreciate it if any of you, good folks, can give me some insight into which programs are willing to accept applicants who have completed another residency?
Thanks!

I think you mistyped and what you should be applying for is a cardiology or GI fellowship.

 

[GonnaBeADoc2222]

It's amazing that despite all the objective badness that has happened to this field:

a) Residency expansion
b) Midlevel encroachment
c) Corporate takeover
d) Administrative indifference

people like this still choose to ignore it and peruse EM. It's like a fixed delusion that despite the countless stories of people not finding jobs where they want to be, toxic work environments, low compensation, people think they're the exception to the rule.

Sure, go into EM. Why should we save you from yourself?

 

[dadaddadaBATMAN]

Hi everyone,

As I have previously posted, I'm interested in pursuing a second residency in Emergency Medicine. I completed an Internal Medicine residency in 2017 and I have been working as a hospitalist since then. I'm ABIM board certified. Although the hospitalist gig has been good to me financially, making $400K yearly with bonus + extra shifts, I would like to be a more versatile doc - peds, ortho, OB, performing lifesaving procedures, working up undifferentiated patients, etc. I'm planning to apply to many of the 270 EM residencies next month.
I would appreciate it if any of you, good folks, can give me some insight into which programs are willing to accept applicants who have completed another residency?
Thanks!

in the spirit of actually answering the question, I think most residencies will be thrilled to have an im trained person. There is no question that a substantial portion of what we do is what you do already

I would imagine any program with em/im will be somewhat friendly as they believe in how the training can mesh.

The thing I would worry about and most programs probably would is not about internal medicine, but rather just that you’re an attending and have been for a while: are you teachable/will you do what you’re told.

No one wants to argue with their intern about whether an admission is warranted on every patient, though most would be willing to discuss it. Perversely, this is especially true when the intern is right.

to the posters above: you seem to have forgotten that this guy has an out from the field any time he wants. If it really starts to suck, he can go full im, either hospitalist or shingle

combining two super high burnout fields does feel a bit funny though

 

[Rekt]

in the spirit of actually answering the question, I think most residencies will be thrilled to have an im trained person. There is no question that a substantial portion of what we do is what you do already

I would imagine any program with em/im will be somewhat friendly as they believe in how the training can mesh.

The thing I would worry about and most programs probably would is not about internal medicine, but rather just that you’re an attending and have been for a while: are you teachable/will you do what you’re told.

No one wants to argue with their intern about whether an admission is warranted on every patient, though most would be willing to discuss it. Perversely, this is especially true when the intern is right.

to the posters above: you seem to have forgotten that this guy has an out from the field any time he wants. If it really starts to suck, he can go full im, either hospitalist or shingle

combining two super high burnout fields does feel a bit funny though

His best luck will be places that don't do with IM residents that rotate through the ED. Almost unanimously they are terrible at EM. FM is somewhat better, but still difficult to deal with. I think this and teachability are the biggest issues. I know my program would not consider a IM grad. Also you need to get SLOEs somehow.

But echoing above I think this would rank as a top 5 mistake in SDN history. This is a hugely dumb decision. Also he may have an out, but he'll lose 1.2million in the process.

 

[Birdstrike]

Whatever itch EM seems it might scratch for you, has got to also be present in some IM fellowship. Find an IM fellowship that allows you to build upon your IM training. Doing an EM residency seems like a near duplication and waste of your IM training.

Pick a cushy IM fellowship that allows you to have a normal life. Working nights, weekends and holidays has a toxic effect on personal lives, with no benefit, especially considering you're at a point at which a simple decision, could allow you to avoid it entirely. All the things that EM seems to have, that other specialties don't, get routine in time. You're left with nothing but terrible shifts, abusive patients, abusive administrators and the smell of your own frontal lobes burning out.

Choose a fellowship that allows you to have a normal life. Don't choose EM which is very similar to being a hospitalist, only worse. Choose EM and you're likely to be right here, 5 years from now asking, "What the hell was I thinking?" You'll have lots of company.

 

[dadaddadaBATMAN]

His best luck will be places that don't do with IM residents that rotate through the ED. Almost unanimously they are terrible at EM. FM is somewhat better, but still difficult to deal with. I think this and teachability are the biggest issues. I know my program would not consider a IM grad. Also you need to get SLOEs somehow.

But echoing above I think this would rank as a top 5 mistake in SDN history. This is a hugely dumb decision. Also he may have an out, but he'll lose 1.2million in the process.

I think this really depends on your relationship with the medicine department. For us it was the pgy2 that rotated with us. Some of the efficient ones were great.

they were generally slow but within their wheelhouse they were great, and I was pretty good friends with many of them already from intern rotations. I was rarely worried they were going to murder anyone unlike some of the psych and Ortho folks where I was double checking all the orders (especially overnight, 1 attending in house for an Ed that really required 2-3)

went to a place with pretty top notch im folks though, so it may vary.

edit: missed bit on opportunity cost. That’s true, but from the im perspective it’s about the same as any fellowship. It’s also about what you wanna do with life. Would I do it? Hell no, but it’s not my life

 

[namethatsmell]

OP, don't make this mistake. If you absolutely crave procedures than do cards, sports medicine, GI, or a pulm/cc fellowship..those 3 years will be SO much better rewarded than going into EM.

I would like to be a more versatile doc - peds, ortho, OB, performing lifesaving procedures, working up undifferentiated patients, etc.

OK, let's go through this from the EM point of view...

Seeing kids in the ED: will lose it's luster super fast (especially the 1 - 5yo group). While seeing a cute baby who bonked his head w/o red flags is admittedly a nice break from the rest of the ED...most other kid visits are meh. Non-toxic 2 year old with a fever? Yeah they'll be fine, but enjoy having the child scream in your ear and cough all over you during an exam...and then fighting with the parents about why little Billy doesn't need antibiotics . And if you get a truly sick or coding kid...it's the worst.

Seeing ortho stuff in the ED: OK, reductions are fun, but that's a small minority of the msk/ortho stuff you'll see. And having to corral orthopods into actually seeing a patient when needed is like pulling teeth.

Seeing OB/Gyn in the ED: Majority of OB you'll do is essentially r/o ectopic / dx miscarriage and delivering bad news...I've had to tell 100s of women they're miscarrying...sound fun to you? Only rarely will you actually get an eclamptic, precipitous delivery etc. The GYN stuff is almost always primary-care level stuff (that you as an internest can currently do in clinic), exceptions being eval for torsion / TOA.

Performing lifesaving procedures: Sure, we do this. But what's remarkable is how quickly you'll come to think you don't. For example the last 100+ patients I've tubed arguably all had a "life-saving" intubation...but it it doesn't really feel that way to me anymore. It's now just part of the job. But I'll grant you that the occasional pericardiocentesis, cric, transvensous pacer, etc is extremely gratifying...but depending on where you work + luck of the draw this will be a very very rare event for you (ie maybe every 6 mos to a few years, or never).

Working up undifferentiated patients: While being able to come up with a honed differential of possible emergent conditions (really the only conditions we care about) in the undifferentiated patient is a valuable skill...this type of thinking becomes ingrained in you after awhile and can color your thinking outside of work. Ie part-way through the pandemic my mom told me she'd lost her appitite due to "stress" and lost 15 lbs in 8 months. Is it pancreatic cancer? No. But that's where my EM brain took me for a week. Anyway, you can already work up undifferential pts in the clinic if you decide to do outpt IM. And as a hospitalist I'm sure you get patients all the time you think are still largely undifferentiated and get to go down some rabbit holes.

Do all these components of "versatility" still sound good to you? Look, the medicine of EM can be spectacular...but the general day-to-day becomes just that. And given the downfall of the EM market, there's no way any of us could in good consious recommend you "go for it."

 

[Pigg-O-Stat]

I don't have an answer to your actual question. But I will say, if you want to do it, do it. I predict the market will be better than people think. Check back in 10 years and let me know if I was wrong.

 

[RustedFox]

So much truth to what @namethatsmell wrote.

I have looked for far too long into the abyss of EM. The abyss does look back. I have seen it.

 

[Groove]

Hi everyone,

As I have previously posted, I'm interested in pursuing a second residency in Emergency Medicine. I completed an Internal Medicine residency in 2017 and I have been working as a hospitalist since then. I'm ABIM board certified. Although the hospitalist gig has been good to me financially, making $400K yearly with bonus + extra shifts, I would like to be a more versatile doc - peds, ortho, OB, performing lifesaving procedures, working up undifferentiated patients, etc. I'm planning to apply to many of the 270 EM residencies next month.
I would appreciate it if any of you, good folks, can give me some insight into which programs are willing to accept applicants who have completed another residency?
Thanks!

Don't do it. For all the reasons that the wise members of this forum have listed. Look, you already make the same salary. You have a respectable specialty and are a valuable member of the health care team. It's not worth sacrificing over a million dollars and incurring God knows how much debt in your search for an ephemeral pipe dream. Disillusionment with your specialty is normal and I would wager that the vast majority of docs struggle with it at some point or another.

A wise EM doc (who had gotten out of EM and into boutique, cosmetic medicine) told me one day: "Groove, I loved EM for 10 years...tolerated it for 10...and damn did I hate it for that last 10. I'd wager you'll have a similar experience. You may not think so now...but you will...with enough time spent in that God forsaken pit." The years are a little different in my case, but close enough and I'm well into the toleration phase. I'd love to do 7 on 7 off as a hospitalist. My quality of life would be so much better than it is now.

Pediatric codes suck. Most adult codes feel like you're a dancing witch doctor performing voodoo last rights and if you do somehow manage to get them back, they die within 48 hours or someone pulls the plug on them because they are brain dead. On very rare occasions do you manage to make a real "save" and even then the pt will never remember you and absolutely no-one will thank you for it. The very memory of the experience will quickly be drowned out by all the unsuccessful "saves". And if I didn't say it already...pediatric codes suck.

 

[RuralEDDoc]

I’ll add that I think this is a bad choice. If you want additional training, by all means seek it out, but with something that makes you a specialist. Don’t do additional training to only be a generalist.

 

[Birdstrike]

I propose we lock this thread on the grounds there's no rational reason to ever do a second residency in Emergency Medicine. File it where the threads about the benefits of drinking bleach, eating tide pods and smoke enemas are put. Either that or make it a sticky.

 

[RustedFox]

I propose we lock this thread on the grounds there's no rational reason to ever do a second residency in Emergency Medicine. File it where the threads about the benefits of drinking bleach, eating tide pods and smoke enemas are put. Either that or make it a sticky.

I propose the OP gives us the 400K and we will all forget that this thread was ever created.

 

[thegenius]

The thing I would worry about and most programs probably would is not about internal medicine, but rather just that you’re an attending and have been for a while: are you teachable/will you do what you’re told.

I worry that the IM training would come out while taking care of patients in EM....and the reality is that thought patterns of IM and EM treating undifferentiated sick patients would yield vastly different outcomes. You would have to go away from ordering tests and waiting for results to treat in favor of treating someone right away with very little information...e.g. you have vital signs, physical exam, and maybe an EKG before ordering life saving treatments like calcium gluconate, sodium bicarb, blood products, insulin drips, intubating, thoracostomy tubes, etc. EM is extremely good at fixing very sick people very quickly. Nobody else does it better (obviously). Not even critical care docs - at least the ones I've seen.

The IM doctors love ABGs, lab values, numbers they can fix. We often don't have that available to us for crashing patients. Note I'm not critical of IM in this fashion...they have time to consider these things and they are important. It's just two different universes.

 

[dadaddadaBATMAN]

I worry that the IM training would come out while taking care of patients in EM....and the reality is that thought patterns of IM and EM treating undifferentiated sick patients would yield vastly different outcomes. You would have to go away from ordering tests and waiting for results to treat in favor of treating someone right away with very little information...e.g. you have vital signs, physical exam, and maybe an EKG before ordering life saving treatments like calcium gluconate, sodium bicarb, blood products, insulin drips, intubating, thoracostomy tubes, etc. EM is extremely good at fixing very sick people very quickly. Nobody else does it better (obviously). Not even critical care docs - at least the ones I've seen.

The IM doctors love ABGs, lab values, numbers they can fix. We often don't have that available to us for crashing patients. Note I'm not critical of IM in this fashion...they have time to consider these things and they are important. It's just two different universes.

I would argue this comes back down to the two things I mentioned: are you teachable, will you do what you’re told.

they are not as good at that stuff as an em attending, but the comparison group isn’t ed Attendings but em interns.

not every internist could do it, but I bet the ones that want to are a self selecting group

 

[IM.MD]

Thank you all for the replies! The EM job market is getting tighter but that's true for other specialties too. Anesthesiology is an example but how many unemployed anesthesiologists are there? How many unemployed EM docs do you know? The Golden Age of EM (lots of locum jobs paying $300+/hr) may be over but I think EM will continue to pay higher per hour than hospital medicine and even CCM. Hence, I'll be able to resume making $400K / year after EM residency but I'll be working fewer shifts. Working three 12 hour shifts a week in EM seems more sustainable than seven 12 hour shifts in a row as a hospitalist which will improve longevity and in turn lead to greater financial gains over the course of my career. I don't need to make $400K a year. I'd be happy working three 24 hour shifts a month at $190-200 / hour at a low volume ED - my friend has a gig like this in WI seeing ~ 16 patients in 24 hours. I could work a similar job or six 12s a month until I'm physically and mentally able to and feel more professionally fulfilled in EM than in hospital med.

Cardiology and GI have clinic which I don't like and it's much harder to work part-time in those fields. It also takes time to build up adequate patient base and / or become a partner in Cards, GI, Heme-Onc, etc to be able get to the $500K+ yearly income. I'm 39 years old and I don't aspire becoming partner or working full time after age 50. I've thought about CCM but, ultimately, I'd be happier in EM. I truly enjoy the versatility of EM more than rounding on vented patients 7 days in a row while being on call at night. Scheduling in EM, although not ideal, seems more flexible and conducive to normal life than the 7 on / 7 off in hospital medicine and CCM. It's difficult on you and your family when you are working 84 hour stretches every other week.

I don't feel comfortable working in the ED with my current skill set. I think I'd be underprepared even if I go through the 1 year non-ABEM accredited EM fellowship available to FM and IM docs or the 6-12 months on the job training offered to non-EM boarded docs by TeamHealth, etc.

My EM letters of recommendation are from the ED docs I work with as a hospitalist, so not strong letters but it is what it is 😂. It is very difficult to set up EM clinical rotations as an attending. My requests to do so have been turned down several times. I had 3 months of EM rotations in residency but that was in 2015-2016, so I doubt the ED docs remember me and those letters would not be current. I know this is an uphill battle for me but I'll put those hosptialist $ to good use and apply to most of the 270 EM programs.

I'm teachable and I would think EM residency would change my mindset from IM to EM.

 

[thegenius]

Thank you all for the replies! The EM job market is getting tighter but that's true for other specialties too. Anesthesiology is an example but how many unemployed anesthesiologists are there? How many unemployed EM docs do you know? The Golden Age of EM (lots of locum jobs paying $300+/hr) may be over but I think EM will continue to pay higher per hour than hospital medicine and even CCM. Hence, I'll be able to resume making $400K / year after EM residency but I'll be working fewer shifts. (1) Working three 12 hour shifts a week in EM seems more sustainable than seven 12 hour shifts in a row as a hospitalist which will improve longevity and in turn lead to greater financial gains over the course of my career. I don't need to make $400K a year. (2) I'd be happy working three 24 hour shifts a month at $190-200 / hour at a low volume ED - my friend has a gig like this in WI seeing ~ 16 patients in 24 hours. I could work a similar job or six 12s a month until I'm physically and mentally able to and feel more professionally fulfilled in EM than in hospital med.

(1) Not so sure about this. EM shifts bounce around...you'll do morning, then evening, then an overnight...then back to an afternoon...etc. The varying shift work and night shifts cause a significant amount of burnout.

I'm willing to bet that 7 on, 7 off with a regular schedule beats 3, 12 hr shifts / week with varying times.

(2) You make 400K/year now. If you work 3 - 24 hr shifts at 200/hr....you'll make $172,800 / year. You want to take that much of an income drop? That's a 60% reduction!

Why don't you just work less hospitalist shifts? Instead of 7 on, 7 off, 7 on, 7 off (I presume you are doing that now...)...try doing something else. Work part time. Don't work 14 shifts/month, work 8.


This really doesn't make sense. You want to go through 3 years of hell doing another residency so you can make 60% less? No comprendo homey.

 

[RustedFox]

On top of the things that @thegenius mentioned... realize that the "interest level" per case is going to significantly drop.
Sniffles. Drunk. Abdominal pain. Too high to figure out why he's there. Drunk again. Chronic back pain for the 14th time this month.
A kid with nothing wrong with them. An adult with nothing wrong with them. An adult with nothing wrong with them. An adult with nothing wrong with them. An adult with nothing wrong with them. An adult with nothing wrong with them. An adult with nothing wrong with them. An adul-

 

[Apollyon]

Two very reasonable patients saying thank you with an Irish brogue was nice.

That reminds me of a story from, well, now, many years ago, with a pt that was Irish. Pt had an SVT (venous, not cardiac). There was was something "off" about the case (not the guy), so, I called the admit team. Unusually, the attending came down with the team, but, what the pt loved - and, I mean, f'n LOVED - was that the intern was named "Erin", and she had red hair and green eyes. Totally American, but, this guy may as well have seen a leprechaun. He was over the moon about that. And, for reasons still, to this day, I don't understand, the attending admitted him!

And I still, to this day, recall him saying her name, and just rolling off his tongue - "Erin". There was something magical about that moment in time.

 

[Groove]

Thank you all for the replies! The EM job market is getting tighter but that's true for other specialties too. Anesthesiology is an example but how many unemployed anesthesiologists are there? How many unemployed EM docs do you know? The Golden Age of EM (lots of locum jobs paying $300+/hr) may be over but I think EM will continue to pay higher per hour than hospital medicine and even CCM. Hence, I'll be able to resume making $400K / year after EM residency but I'll be working fewer shifts. Working three 12 hour shifts a week in EM seems more sustainable than seven 12 hour shifts in a row as a hospitalist which will improve longevity and in turn lead to greater financial gains over the course of my career. I don't need to make $400K a year. I'd be happy working three 24 hour shifts a month at $190-200 / hour at a low volume ED - my friend has a gig like this in WI seeing ~ 16 patients in 24 hours. I could work a similar job or six 12s a month until I'm physically and mentally able to and feel more professionally fulfilled in EM than in hospital med.

You don't get it. With your 7 on 7 off, you are ON THE SAME SCHEDULE with zero circadian disruption. Yes, you might be busy but you are still working at a much slower pace than your typical EM doc who's frenetically scrambling from room to room trying to find time to eat a meal and use the bathroom. You have zero flips because most hospitalist gigs have full time nocturnists. Your EM shifts are going to flip you all over the place. 6a-3, 9a-6, 11a-8, 2p-11, 3p-12, 5p-2, 9p-6, 10p-7, you get the picture. Now, imagine doing this all month. It doesn't matter if the number of shifts is smaller, what matters is that enormous amount of time lost while you flip from days to nights to days again. Nobody can do this very easily. You are 100% guaranteed to develop some sort of sleep disorder. Hell, I just came off late swings and tried to go to sleep at 8:30p other night after taking 12mg melatonin, 50mg Benadryl, 10mg ambien. How did that all turn out? Let me tell you... I laid there wide awake until 3am and then slept 2 hours and then got up to work my 6am shift. You can guess how crappy I felt all day. Those types of problems sleeping are incredibly normal for me when you start flipping all over God's creation on your schedule. Not to mention the stress it brings to interpersonal relationships when you are asleep during the daytime, or on a weekend, or on a holiday while your family and friends don't understand why you are never available. Looking for a slow 1.5pph job is going to take out out into the boonies somewhere 2 hours from any major city where you're loved ones are not going to want to live and they will probably pay you about 300K, so that's 100K less than what you make now and still with a much worse schedule than you probably find yourself working right now.

Plus, what a terrible time to go into EM with all the problems we're having. 10K too many docs in 2030 is the estimate! smh....The fixation some people get on our specialty is so irrational. But hey...remember...we warned you!

 

[namethatsmell]

Thank you all for the replies! The EM job market is getting tighter but that's true for other specialties too. Anesthesiology is an example but how many unemployed anesthesiologists are there? How many unemployed EM docs do you know?

I'm not sure where you're getting this from...the anesthesia job market is the opposite of tight. There are tons of open gas jobs in all major metros and so their salaries are going up again. I'm not saying anesthesia is all sunshine and rainbows, but in terms of their job market vs EM's right now it's night and day and probably will stay that way for the foreseeable future.

 

[RustedFox]

Yeah; we here in the ER sift thru all the *******ery and (mostly) only admit people who we really can't help from the ER; generally because there's something medically wrong with them (though social admits and such happen as well).

If I were IM, I would feel like I'm missing out on something - but ...

DUDE, YOU'D BE MISSING OUT ON 1.2 MILLION AND THREE YEARS.

 

[dadaddadaBATMAN]

Thank you all for the replies! The EM job market is getting tighter but that's true for other specialties too. Anesthesiology is an example but how many unemployed anesthesiologists are there? How many unemployed EM docs do you know? The Golden Age of EM (lots of locum jobs paying $300+/hr) may be over but I think EM will continue to pay higher per hour than hospital medicine and even CCM. Hence, I'll be able to resume making $400K / year after EM residency but I'll be working fewer shifts. Working three 12 hour shifts a week in EM seems more sustainable than seven 12 hour shifts in a row as a hospitalist which will improve longevity and in turn lead to greater financial gains over the course of my career. I don't need to make $400K a year. I'd be happy working three 24 hour shifts a month at $190-200 / hour at a low volume ED - my friend has a gig like this in WI seeing ~ 16 patients in 24 hours. I could work a similar job or six 12s a month until I'm physically and mentally able to and feel more professionally fulfilled in EM than in hospital med.

Cardiology and GI have clinic which I don't like and it's much harder to work part-time in those fields. It also takes time to build up adequate patient base and / or become a partner in Cards, GI, Heme-Onc, etc to be able get to the $500K+ yearly income. I'm 39 years old and I don't aspire becoming partner or working full time after age 50. I've thought about CCM but, ultimately, I'd be happier in EM. I truly enjoy the versatility of EM more than rounding on vented patients 7 days in a row while being on call at night. Scheduling in EM, although not ideal, seems more flexible and conducive to normal life than the 7 on / 7 off in hospital medicine and CCM. It's difficult on you and your family when you are working 84 hour stretches every other week.

I don't feel comfortable working in the ED with my current skill set. I think I'd be underprepared even if I go through the 1 year non-ABEM accredited EM fellowship available to FM and IM docs or the 6-12 months on the job training offered to non-EM boarded docs by TeamHealth, etc.

My EM letters of recommendation are from the ED docs I work with as a hospitalist, so not strong letters but it is what it is 😂. It is very difficult to set up EM clinical rotations as an attending. My requests to do so have been turned down several times. I had 3 months of EM rotations in residency but that was in 2015-2016, so I doubt the ED docs remember me and those letters would not be current. I know this is an uphill battle for me but I'll put those hosptialist $ to good use and apply to most of the 270 EM programs.

I'm teachable and I would think EM residency would change my mindset from IM to EM.

a couple of things: kudos regarding the self awareness on safety, I certainly wouldn’t be safe running an inpt service even if I could figure out routine chf, copd, aki, etc.

the schedule is the worst, and I do mean the worst reason to switch. There are gigs where you can have it good it terms of days off, but they are what is getting squeezed out by the tightened job market. Unless you *really* hate being a hospitalist you are probably better off negotiating a reduction in hours there than depending on a good part time gig in em

there are so many threads on this topic, I don’t feel the need to recount for the 10^9 time why the ed schedule sucks for anyone who isn’t young with no family.

almost every applicant I have ever talked to in em has this as a secret background reason for em. Almost universally we come to realize it isn’t what it is cracked up to be.

endocrine, rheum, palliative, or even primary care may have more days in the office but I guarantee you they have more quality time with their families than I do at the moment. Admittedly I work a fair amount for em (16-18 mo) but I think the gains from dropping to 11-12 are minimal due to the circadian swaps.

for the most part I have come to realize this discussion is futile, and you can only figure this out through lived experience. I hope you take the 1.2 million from working for three years, put it into real estate or the market, and back off on hospitalist shifts or do locums, but don’t do em for the schedule

 

[NITRAS]

OP might want to look into a different Hospitalist gig. I’d also remember that the last 12 months have basically sucked.

I’m at a pretty good place, with decent census, and I think I’ve decided everyone is basically simmering inside. Patients, families, consultants, nurses. Everyone.


I also know that the circadian issue is a big one, and why won’t plan on fellowship. (Goodbye PCCM/CCM dreams).

 

[Franzd'Epinay]

My EM letters of recommendation are from the ED docs I work with as a hospitalist, so not strong letters but it is what it is 😂. It is very difficult to set up EM clinical rotations as an attending. My requests to do so have been turned down several times. I had 3 months of EM rotations in residency but that was in 2015-2016, so I doubt the ED docs remember me and those letters would not be current. I know this is an uphill battle for me but I'll put those hosptialist $ to good use and apply to most of the 270 EM programs.

I think OP isn't going to be convinced, so we need to switch to harm reduction here.

My advice if you're intent on doing this:

1. Do not apply to all/most 270 programs. There have been a lot of terrible programs opening up lately that would love to use you as cheap labor and shortchange your education.

2. Apply to 3-year programs only.

 

[grt398]

If you're going to consider a 3 year residency...consider PCCM as a 3 year fellowship. Yes there's clinic in fellowship, but the job market after is wide open. You can find 0.4 FTE ICU (think small 10-12 bed open ICU)/pulm inpatient consult only jobs where you'll work 1 week/month of day shifts for ~180-200k, or do more ICU time if you want to get paid more, or even just covering clinic for your partners and not having a patient panel of your own if you want to stay inpatient only. There are also jobs out there that require as few as 4 days of clinic per month, aka you do 1 week ICU, 4 days clinic, then you're off for 2 weeks other than phone call 1:7 to 1:15 depending on the group. Because the majority of pulm docs are nearing retirement age, the demand is quite high and therefore job flexibility is as well. Just something to consider...

 

[Kryptocoin]

I was having a hellish last couple of shifts and was admitting lots of sick pts. I felt bad for my hospitalist so I actually cornered him in the hallway and apologized for admitting too many patients. He laughed. He said, "oh I don't mind. I have a cap . Once I hit that cap, I'm done taking anymore admissions."



I looked at my ER full of patients and a packed waiting room.....solo coverage, no cap for me. Sigh.

 

[Apollyon]

He laughed. He said, "oh I don't mind. I have a cap . Once I hit that cap, I'm done taking anymore admissions."

Was it just him on, though? Like, if he caps at 1am, is there no other hospitalist or admitting team? Who cares for the pts admitted at 3 or 4am?

 

[Kryptocoin]

Was it just him on, though? Like, if he caps at 1am, is there no other hospitalist or admitting team? Who cares for the pts admitted at 3 or 4am?

The hospitalist "on call" takes new admission from the ER and does the HP and orders. There is another hospitalist, not on call but is in the hospital managing admitted pts on the flr. Once the on-call guy hits his cap, the other guy starts taking new admissions while managing the floor too.

Pretty nice system if you ask me.

 

[Angry Birds]

I am gonna buck this thread and say I have an amazing almost criminally good schedule, make a good salary, and it couldn’t be done by any other speciality.
There. I said it.

i still wouldn’t do a second residency though. You can find a cush rural Er job as IM doc with some difficulty and extra training

 

[Brigade4Radiant]

Also the calculations for missed opportunity cost are on the lower bound.

You will be working more hours as an EM resident than you do. To have a true opportunity cost calculation you have to work the same as a resident for the next three years.

Plus studying and doing off-service rotations like trauma.

so at least 600k for three years so about 2 million.

Thats 80k a year forever. You would be better off doing a one year unaccredited EM fellowship to scratch this “EM itch”

 

[IM.MD]

I think OP isn't going to be convinced, so we need to switch to harm reduction here.

My advice if you're intent on doing this:

1. Do not apply to all/most 270 programs. There have been a lot of terrible programs opening up lately that would love to use you as cheap labor and shortchange your education.

2. Apply to 3-year programs only.

Thank you!

 

[IM.MD]

Also the calculations for missed opportunity cost are on the lower bound.

You will be working more hours as an EM resident than you do. To have a true opportunity cost calculation you have to work the same as a resident for the next three years.

Plus studying and doing off-service rotations like trauma.

so at least 600k for three years so about 2 million.

Thats 80k a year forever. You would be better off doing a one year unaccredited EM fellowship to scratch this “EM itch”

Yes, assuming one is able to stomach working that many hours as a hospitalist. I will enjoy my job more as an EM attending which will increase my longevity in medicine and my hourly rate will likely be at least $50 more per hour post-EM residency than typical hospitalist rates, so I'll eventually catch up financially especially if I work the same number of hours as I have as a hospitalist (about 2,400 hours a year).

 

[chocomorsel]

Yes, assuming one is able to stomach working that many hours as a hospitalist. I will enjoy my job more as an EM attending which will increase my longevity in medicine and my hourly rate will likely be at least $50 more per hour post-EM residency than typical hospitalist rates, so I'll eventually catch up financially especially if I work the same number of hours as I have as a hospitalist (about 2,400 hours a year).

How do you know you will enjoy a job “more” than you do now when you have never had that job?
That makes absolutely no sense. It’s the grass is greener argument. Stop being naive.

 

[thegenius]

How do you know you will enjoy a job “more” than you do now when you have never had that job?
That makes absolutely no sense. It’s the grass is greener argument. Stop being naive.

There doesn't appear to be any noteworthy insight by this man/woman.

 

[thegenius]

Yes, assuming one is able to stomach working that many hours as a hospitalist. I will enjoy my job more as an EM attending which will increase my longevity in medicine and my hourly rate will likely be at least $50 more per hour post-EM residency than typical hospitalist rates, so I'll eventually catch up financially especially if I work the same number of hours as I have as a hospitalist (about 2,400 hours a year).

You will NEVER EVER NEVER EVER EVER EVER work 2,400 hours a year being an EM doctor.

EVER!!!!!!

That's more than 20 shifts / month.


I work ~1,700 / year and that's 16-17 shifts / month.

 

[dadaddadaBATMAN]

You will NEVER EVER NEVER EVER EVER EVER work 2,400 hours a year being an EM doctor.

EVER!!!!!!

That's more than 20 shifts / month.


I work 1,700 / year and that's 16-17 shifts / month.

17 12s
20 10s
22 9s
25 8s

do you think Ed docs pass on making 500k + because we’re lazy? There’s a reason most ed docs work about 2/3 that much. It’s not sustainable. I’ve met a couple people who tried it. Universally burned out in 1-2 yrs

despite our supposed shift work we often end up staying late. This is true even for efficient folks depending on the site. For any of the above subtract 2-4 days of time due to circadian switches.

Our work pace is dramatically higher than most im services. if you’re like most ed docs, after a long stretch you’ll be worthless about two days. Which is probably as long as you’ll ever be off


I worked about that much for my intern year, and about 4/5 that my second /third year. i considered the micu a welcome break from the ed during residency. While working the limit of duty hours and call.


that plan is nonsense. If you’re willing to work like that (aka to the point of hating life) you will be better off making dough as a hospitalist.

 

[IM.MD]

How do you know you will enjoy a job “more” than you do now when you have never had that job?
That makes absolutely no sense. It’s the grass is greener argument. Stop being naive.

I did 3 months of EM rotations in residency. I guess, all med students and PGY 1-2s who do 1-2 months of specialty / subspecialty rotations and know they will enjoy a job they've never had are naive.

 

[RustedFox]

I did 3 months of EM rotations in residency. I guess, all med students and PGY 1-2s who do 1-2 months of specialty / subspecialty rotations and know they will enjoy a job they've never had are naive.

 

[IM.MD]

17 12s
20 10s
22 9s
25 8s

do you think Ed docs pass on making 500k + because we’re lazy? There’s a reason most ed docs work about 2/3 that much. It’s not sustainable. I’ve met a couple people who tried it. Universally burned out in 1-2 yrs

despite our supposed shift work we often end up staying late. This is true even for efficient folks depending on the site. For any of the above subtract 2-4 days of time due to circadian switches.

Our work pace is dramatically higher than most im services. if you’re like most ed docs, after a long stretch you’ll be worthless about two days. Which is probably as long as you’ll ever be off


I worked about that much for my intern year, and about 4/5 that my second /third year. i considered the micu a welcome break from the ed during residency. While working the limit of duty hours and call.


that plan is nonsense. If you’re willing to work like that (aka to the point of hating life) you will be better off making dough as a hospitalist.

I'm not planning to work that many hours as an EM attending unless I find a low volume rural ED seeing 1-1.5 pph which will still pay higher than a night hospitalist gig where you need to be "comfortable" with procedures and vent management

 

[thegenius]

Alright then man

Good luck with your career change

 

[Torsion]

Our work pace is dramatically higher than most im services. if you’re like most ed docs, after a long stretch you’ll be worthless about two days. Which is probably as long as you’ll ever be off

That's hyperbole. The longest I get off as a resident in the department is 2 days at a time and I'm working 180-200 hours per month + conference time. Most practicing EM docs are working 30-40% fewer hours. A lot can be said about circadian rhythm disruptions and the pace of the work causing burnout, but EM docs generally have some flexibility outside of work not afforded to a lot of other specialties.

 

[thegenius]

That's hyperbole. The longest I get off as a resident in the department is 2 days at a time and I'm working 180-200 hours per month + conference time. Most practicing EM docs are working 30-40% fewer hours. A lot can be said about circadian rhythm disruptions and the pace of the work causing burnout, but EM docs generally have some flexibility outside of work not afforded to a lot of other specialties.

I don't think so. The switching around shift work probably removes about 2 business days (and in some cases more) worth of time each month.

 

[dadaddadaBATMAN]

That's hyperbole. The longest I get off as a resident in the department is 2 days at a time and I'm working 180-200 hours per month + conference time. Most practicing EM docs are working 30-40% fewer hours. A lot can be said about circadian rhythm disruptions and the pace of the work causing burnout, but EM docs generally have some flexibility outside of work not afforded to a lot of other specialties.

1. He is saying 240 hrs, which is a world of difference from 180-200 (still not sustainable for any length of time)

2. Did lot of hiking and other active stuff as a resident outside work. There is an element of hyperbole, but honestly this stuff wears on you after a while and I have more trouble coping as an attending than I ever did as a resident.

3. We definitely have flexibility compared to any kind of surgery, a private practice im guy in the old sense (pt panel you follow inpt and outpt), or a number of other specialties. We do not by comparison to almost any outpt specialty. We don’t have much more than a hospitalist.

we absolutely don’t have enough more than a hospitalist to justify 2.5yrs-3 yrs residency, but that’s this guys call. I think it’s insane. Wish him/her luck. Rural ed might be more reasonable, still seems unwise to me.

 

[Torsion]

we absolutely don’t have enough more than a hospitalist to justify 2.5yrs-3 yrs residency, but that’s this guys call. I think it’s insane. Wish him/her luck. Rural ed might be more reasonable, still seems unwise to me.

Definitely agree here. I couldn't imagine going back to being an intern even as a PGY2, let alone someone who has years of experience as an attending in a different field.

3. We definitely have flexibility compared to any kind of surgery, a private practice im guy in the old sense (pt panel you follow inpt and outpt), or a number of other specialties. We do not by comparison to almost any outpt specialty. We don’t have much more than a hospitalist.

I'm not so sure. Patient panels tether you pretty tightly. Prior to medical school I worked for 2 separate private practice ophthalmologists, one who was near 70 and retiring and the next one who was in their 40s with young children. In both cases, having a patient panel that they were responsible for and an office staff that they had to pay kept their home life nice but relatively inflexible. They each probably took only 1-2 vacations per year, each no longer than 5-7 days. Otherwise many of their patients would go too long without being seen or their hourly employees (which was everyone) would take hits on their already meager salaries.

Large, corporate run group practices may have a scalability that allows easier cross coverage so that physicians can have a reprieve, but this is hard to achieve for solo or small group practices.

I would think a field like Rads probably has the best of all worlds - relaxing, quiet work environment, predictable schedule, high salary, lots of time off, no patient census. I just couldn't stare at a screen all day.

 

[Mad Jack]

Hi everyone,

As I have previously posted, I'm interested in pursuing a second residency in Emergency Medicine. I completed an Internal Medicine residency in 2017 and I have been working as a hospitalist since then. I'm ABIM board certified. Although the hospitalist gig has been good to me financially, making $400K yearly with bonus + extra shifts, I would like to be a more versatile doc - peds, ortho, OB, performing lifesaving procedures, working up undifferentiated patients, etc. I'm planning to apply to many of the 270 EM residencies next month.
I would appreciate it if any of you, good folks, can give me some insight into which programs are willing to accept applicants who have completed another residency?
Thanks!

If you would like to waste 3ish years of your life, this is a fine decision. By the time you're done you will be paid less than you're making now to work nights, weekends, and holidays while geograohically limiting yourself and putting your future deeper into the pocket of corporate overlords

 

[VA Hopeful Dr]

Definitely agree here. I couldn't imagine going back to being an intern even as a PGY2, let alone someone who has years of experience as an attending in a different field.



I'm not so sure. Patient panels tether you pretty tightly. Prior to medical school I worked for 2 separate private practice ophthalmologists, one who was near 70 and retiring and the next one who was in their 40s with young children. In both cases, having a patient panel that they were responsible for and an office staff that they had to pay kept their home life nice but relatively inflexible. They each probably took only 1-2 vacations per year, each no longer than 5-7 days. Otherwise many of their patients would go too long without being seen or their hourly employees (which was everyone) would take hits on their already meager salaries.

Large, corporate run group practices may have a scalability that allows easier cross coverage so that physicians can have a reprieve, but this is hard to achieve for solo or small group practices.

I would think a field like Rads probably has the best of all worlds - relaxing, quiet work environment, predictable schedule, high salary, lots of time off, no patient census. I just couldn't stare at a screen all day.

When I was PP, solo FM I took 3, week long vacations in per year and lots of 3 day weekends.

As an employed FP I take my full 30 days off every year.

The only real limiting factor is trying the make sure I plan vacations well in advance so we don't have to reschedule people. And even that is only because I feel guilty about doing it.