Second residency

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I am a midcareer EM doc (age 45) and I loathe it and have always loathed it. I tried doing a fellowship to make it better, but it wasn't for me. I would be happier in onc or pulmonary or Gi. Is it crazy to try and do an IM residency? Where do I even start? I can't see myself doing EM for much longer. I need to work for twenty more years. Where do I begin?

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I am a midcareer EM doc (age 45) and I loathe it and have always loathed it. I tried doing a fellowship to make it better, but it wasn't for me. I would be happier in onc or pulmonary or Gi. Is it crazy to try and do an IM residency? Where do I even start? I can't see myself doing EM for much longer. I need to work for twenty more years. Where do I begin?
I'd start by contacting IM PDs and asking what they think. A local IM PD in your area. And there are IM PDs here on SDN that you could contact.

It comes down to how much the opportunity costs are worth it to you and your family. I'm sure you know you'd be spending the next 5-6 years on a resident and fellow's salary and living a resident and fellow's life to become an oncologist, pulmonologist, or gastroenterologist.
 
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Which fellowship did you do?

An additional 5 years of training would be a hard pill to swallow for most. What is it about the fields you mentioned that interest you so much? What about doing one of the fellowships that can take you completely out of the ED such as pain, sports medicine, or palliative care?
 
Which fellowship did you do?

An additional 5 years of training would be a hard pill to swallow for most. What is it about the fields you mentioned that interest you so much? What about doing one of the fellowships that can take you completely out of the ED such as pain, sports medicine, or palliative care?

Would rather not discuss the fellowship because it's a rare one for ED docs and I don't want to out myself. I didn't finish it. I don't like sports or palliative care. Nothing about the fields interest me. I guess it would get rid of night shifts, but then I could just do UC. I don't mind 5 years of training if it gets me to a place where I am happy. I really like the science of oncology, and I like onc patients.

I guess I could consider pain, but it seems impossible to get. Is it possible? Can you really get a job as a pain doc from EM? I'd like to be in NYC ideally.

I am fairly embarrassed I did EM. What a stupid field for a bright med student with good grades! It's basically a high-paying blue-collar field. I guess I didn't get the memo.
 
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Consider addiction medicine, I see a lot of EM docs transition to that given their experience already with drug addiction in the ED.
 
I am a midcareer EM doc (age 45) and I loathe it and have always loathed it. I tried doing a fellowship to make it better, but it wasn't for me. I would be happier in onc or pulmonary or Gi. Is it crazy to try and do an IM residency? Where do I even start? I can't see myself doing EM for much longer. I need to work for twenty more years. Where do I begin?

What was it about the fellowship that caused you not to finish? Would those or similar issues arise with a new residency program?
 
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What was it about the fellowship that caused you not to finish? Would those or similar issues arise with a new residency program?

I doubt it. I was well-liked in residency. It was more that I wasn't getting anything out of the fellowship and it was the wrong field for me. Fellowship in EM is highly optional and often doesn't add much- it's not like a cardiology or vascular fellowship. But I am concerned that people always assume that leaving fellowship is for a negative reason.
 
Consider addiction medicine, I see a lot of EM docs transition to that given their experience already with drug addiction in the ED.

Maybe. What kind of jobs are there? I confess I've never thought about it and the medicine doesn't really appeal to me.
 
In my opinion you should just learn to like EM or find a completely different career. You will lose so much money going back through residency and fellowship.
 
I doubt it. I was well-liked in residency. It was more that I wasn't getting anything out of the fellowship and it was the wrong field for me. Fellowship in EM is highly optional and often doesn't add much- it's not like a cardiology or vascular fellowship. But I am concerned that people always assume that leaving fellowship is for a negative reason.

That's not what I was getting at. I'm wondering more if it was the fact of going through training again and everything that goes with it that caused you not to want to finish and if those same feelings would show up if you were doing a residency+fellowship in IM+cards for example.
 
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That's not what I was getting at. I'm wondering more if it was the fact of going through training again and everything that goes with it that caused you not to want to finish and if those same feelings would show up if you were doing a residency+fellowship in IM+cards for example.

Hmm. I do see your point- I already have a remunerative career, so why would I stick it out? I guess that's the case for any second residency, right?
 
In my opinion you should just learn to like EM or find a completely different career. You will lose so much money going back through residency and fellowship.

I don't mind EM, although I hate the lack of continuity. I have a really, really rough time with the circadian issues. I can't seem to find much outside medicine...DOC is all clinical jobs or jobs not for docs!
 
Another option is critical care. You can now do a critical care fellowship from EM. You might still have some of the shift issues, but you'd have more continuity of care (although not like pure IM).

You could certainly apply to IM residencies, and see what happens. You might get 6 months of credit for all of your prior training, but this would be completely up to the program. GI is rather competitive, so there's no guarantee you'd get a spot. Pulm is less competitive. You also mentioned Onc, which is mis-competitive.

If you hate what you're doing, continuing to do it for another 20 years is painful.
 
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Another option is critical care. You can now do a critical care fellowship from EM. You might still have some of the shift issues, but you'd have more continuity of care (although not like pure IM).

You could certainly apply to IM residencies, and see what happens. You might get 6 months of credit for all of your prior training, but this would be completely up to the program. GI is rather competitive, so there's no guarantee you'd get a spot. Pulm is less competitive. You also mentioned Onc, which is mis-competitive.

If you hate what you're doing, continuing to do it for another 20 years is painful.

Agreed. I hate it. I like critical care, but the circadian issues are a huge deal for me, and if I'm going to undertake further training, that is one thing that has to be addressed. Mis-competitive? I'm confused. I would be more interested in pulm or onc, honestly, than GI.
 
Neurology is your answer. You are guaranteed a fellowship in a field of your choosing afterwards.
 
Its ironic considering EM is a competitive specialty..
Med students think, hey, short residency, pay is currently great, in demand market, some procedures, shift work so good separation between life and work, and telling non-medical people you are an “emergency physician” sounds cool.

But they don’t consider the negatives. Circadian rhythm changes are hard, don’t underestimate them, especially as you get older, and increase risks for certain health issues. EM isn’t as sustainable longer term if you continue full time, at least you’d have to work at a lower level ED like level 4 vs. 1 or lower volume ED, but that might not make hospitals happy with you. Having to work a lot of nights and weekends. Having to work holidays. This doesn’t seem like a big deal when single, but spouses and children won’t necessarily be on board when you are regularly missing family events. Press Ganey scores and keeping patients and admin happy. Often dealing with the frequent flyers, psychiatric type patients, drunks, opioid seekers, and dregs of society. Having to work with hospitals and dealing with hospital politics. Read the infamous rape of EM.

But some people think the positives outweigh the negatives, so they still enjoy EM. Some EM transition into other roles like less EM shifts and more admin so their careers last longer. EM can be a fulfilling career for people, but it is person dependent.
 
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Em was not competitive a few years ago.
 
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As an EM doc, I say, "ouch"!


LOL. Everyone, thank you so much for the suggestions. They really mean a lot and have given me a ton of hope. I think it will be hard to match in a second residency, but no harm trying, I suppose. I don't see myself in admin, and those jobs are few and far between. I guess I'm debating between an exit from within EM (sports, pain, palli, occ med, public health/preventive medicine) vs IM plus fellowship. I think the latter carries greater risk but also potentially greater reward as I would be happiest with pulm, ID, or onc. I realize there are pitfalls either way and that one of the great lessons of life is that you have to leap and then make a good life of whatever the results are. But easier said than done!

Apollyon, what are your plans for an eventual exit from EM/night shifts?
 
When I retire. I finished residency 12 years ago, and am doing well. Either I am not burned out, or I am too dopey to realize it! But I feel fine right now. (Actually, dry and hung over!)

How do you deal with circadian issues? How do you plan on dealing in the future?
 
At 45, there is no chance I would embark on retraining in an IM sub. You could retire on the lost income alone.

You could do CC and get a job in a BMT ICU.
 
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At 45, there is no chance I would embark on retraining in an IM sub. You could retire on the lost income alone.

You could do CC and get a job in a BMT ICU.

Yeah I can't even fathom doing another residency and fellowship at 45.
 
At 45, there is no chance I would embark on retraining in an IM sub. You could retire on the lost income alone.

You could do CC and get a job in a BMT ICU.

I like CC, but don't you have to work nights? A huge part of the issue for me is nights. I looked over on the CC forum, and nights seemed to be a big issue.
 
Yeah I can't even fathom doing another residency and fellowship at 45.

I know. I could work in UC and pull in 250k a year, but I think my soul would die. Perhaps it would die in another residency, too.

Trying to find a non soul-killing option I can do until 70. My parents retired at 77 and 83 and loved their jobs, and I'd like to be in a similar spot.
 
I know. I could work in UC and pull in 250k a year, but I think my soul would die. Perhaps it would die in another residency, too.

Trying to find a non soul-killing option I can do until 70. My parents retired at 77 and 83 and loved their jobs, and I'd like to be in a similar spot.
How about teaching?
 
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I know. I could work in UC and pull in 250k a year, but I think my soul would die. Perhaps it would die in another residency, too.

Trying to find a non soul-killing option I can do until 70. My parents retired at 77 and 83 and loved their jobs, and I'd like to be in a similar spot.
What did your parents do if you don't mind saying?
 
Doing pain to work in NYC is probably one of the worst decisions you can make.
 
Doing pain to work in NYC is probably one of the worst decisions you can make.

Why? I haven't chatted with any NYC pain docs, so I don't know. Love more insight.
 
If you like critical care, but you don't want nights, then you could do a second residency in anesthesiology. If you can get credit for your intern year, then it's three years and you are done.
 
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Mis-competitive? I'm confused. I would be more interested in pulm or onc, honestly, than GI.

I meant "mid-competitive". It's more competitive than rheum, and less than GI/Cards.

I like CC, but don't you have to work nights? A huge part of the issue for me is nights. I looked over on the CC forum, and nights seemed to be a big issue.

I don't know, but maybe not. We've seen the world of hospital medicine shift from everyone doing nights to nocturnists. Smaller ICU's (community based) are starting tele-ICU coverage to manage nights. You might well be able to get a day only job, or get paid less to work only days. And it's only 2 years of training on top of what you have, so it's a reasonable option.
 
I am deleting my post. Read that you dont like palliative care.


Hope you find an area you are happy with. Maybe move into admin?
 
I am deleting my post. Read that you dont like palliative care.


Hope you find an area you are happy with. Maybe move into admin?

Not sure about palli. Have to think about it. I don't really have a sense of what one's day is as a palli doc.
 
Lots of flexibility with palliative. You could be doing inpatient consults (9-5 hours), or outpatient clinic hours. You could be doing some hospice (inpatient unit rounding, home hospice telephone, home visits) .
You could be involved in education, admin
You could even do it part time with ER.


It would be something that is sustainable into your 70s (not at all physically taxing and hours are reasonable) if you like the work, and dont mind talking to patients and families. You work in a team. Call structure will depend on how big the group and hospital is, most small programs dont even have call requirements.

I know three ER docs who moved into palli, 2 still do Er on the side and love the balance

Your experience in ER is very valuable, but if you dont enjoy the work then i wouldnt recommend it.
.
 
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International Post Doctoral Fellowship

Really not sure what you are looking for but this sounds interesting and can be from em. I know tox is a common em fellowship but this is more of a epidemiology/ public health level option.

Good luck finding what you are looking for!
 
International Post Doctoral Fellowship

Really not sure what you are looking for but this sounds interesting and can be from em. I know tox is a common em fellowship but this is more of a epidemiology/ public health level option.

Good luck finding what you are looking for!

That actually looks amazing! Not sure if Atlanta is in the cards, but wow. Although it appears to be funded by countries in the Middle East for their own grads. No Americans :(

BTW, has anyone heard of this: Residency Program
 
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I can't tell you how useful everyone's answers have been. They've really clarified what's important to me and what I can and can't put up with and what kind of opportunity costs are worth it and aren't. I feel like the blind man and the elephant- you are all helping it come into focus for me.

I still don't have answers, and keep the comments coming, but I am profoundly grateful.
 
That actually looks amazing! Not sure if Atlanta is in the cards, but wow. Although it appears to be funded by countries in the Middle East for their own grads. No Americans :(

BTW, has anyone heard of this: Residency Program

Oops! Not sure if there is a similar program at Emory for us grads. Talked to a friend in em who was specifically going for a public health tox fellowship there and is us grad so not sure. Just googled to find.

Anyways looks like there may be a similar closer program. I'm sure there may be something similar on east coast if you look hard.
 
Oops! Not sure if there is a similar program at Emory for us grads. Talked to a friend in em who was specifically going for a public health tox fellowship there and is us grad so not sure. Just googled to find.

Anyways looks like there may be a similar closer program. I'm sure there may be something similar on east coast if you look hard.

Thank you! Looks like a fun couple of years, but not sure if it would actually get me out of the ER.
 
There is no way I would do another residency.

Have you thought about another career path? Most likely a pay cut, but money isn't everything.
There are plenty of places that a career in medicine can fit in to...teaching, admin, IT, education, non-profit work, public health, etc.
 
There is no way I would do another residency.

Have you thought about another career path? Most likely a pay cut, but money isn't everything.
There are plenty of places that a career in medicine can fit in to...teaching, admin, IT, education, non-profit work, public health, etc.

Yes, I will have to give up my pulmonary and heme onc dreams, I think. I love to teach, but I don't see many opportunities to get PAID for teaching- it seems to be one of those things docs have to do for free. Admin seems really, really hard to get. I'd like public health or non-profit, but I'm still trying to find what's out there.
 
Agreed. I hate it. I like critical care, but the circadian issues are a huge deal for me, and if I'm going to undertake further training, that is one thing that has to be addressed. Mis-competitive? I'm confused. I would be more interested in pulm or onc, honestly, than GI.
I suspect that was a typo for "Mid-competitive".
 
There are some prolific/regular posters in the EM forum that have made the transition to both interventional pain and Palliative Care, from EM. Just keep your eyes open there, they talk about it quite a bit.

For CCM (a relatively easy move from EM these days), the circadian stuff can still be an issue, but nothing like in EM (or like you experienced in residency, or will experience as a fellow). 3 of the hospitals I work at (1 of which is the university with a large CCM fellowship and 2 of which are Level 1 trauma centers, relevant only to the size and acuity of the patient population) have no overnight in-house attending in the MICU. Sure, they're available by page overnight, but I only recall 1-2 middle of the night calls a week to the attending when I was a resident, and I never saw a MICU attending in the hospital after 9pm. Bottom line, I think your view of what a CCM career would mean may be a bit tainted by your residency experience.

As for starting over completely, this is certainly do-able. Your prior experience will be a positive in some places and a negative in others...and there's no way for you to know which will be which.

If Onc really is your passion, I don't really see a major harm in going for it (other than the money issue in the short term, which as you know, everyone on the EM forum will tell you is a terrible idea and you should just suck it up and power through another 10 years and save all your money so you can retire early). Best case scenario, you match, get a fellowship, and move on in your career. There are 2 worst case scenarios, and which is the actual worst, is something only you can decide:
1. You don't match IM and have to stay in EM
2. You match IM but fail to match a fellowship you're interested in and have to stay in General IM (PCP or hospitalist), or just go back to EM

Either way, you won't end up any worse off than you currently are.

Finally, you mention wanting to stay in NYC. While that's certainly possible, if you're really going to go all in on this, you're going to have to take off those blinders and see the 98% of the country that's across the Hudson.
 
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Post moved to EM forum
 
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There are some prolific/regular posters in the EM forum that have made the transition to both interventional pain and Palliative Care, from EM. Just keep your eyes open there, they talk about it quite a bit.

For CCM (a relatively easy move from EM these days), the circadian stuff can still be an issue, but nothing like in EM (or like you experienced in residency, or will experience as a fellow). 3 of the hospitals I work at (1 of which is the university with a large CCM fellowship and 2 of which are Level 1 trauma centers, relevant only to the size and acuity of the patient population) have no overnight in-house attending in the MICU. Sure, they're available by page overnight, but I only recall 1-2 middle of the night calls a week to the attending when I was a resident, and I never saw a MICU attending in the hospital after 9pm. Bottom line, I think your view of what a CCM career would mean may be a bit tainted by your residency experience.

As for starting over completely, this is certainly do-able. Your prior experience will be a positive in some places and a negative in others...and there's no way for you to know which will be which.

If Onc really is your passion, I don't really see a major harm in going for it (other than the money issue in the short term, which as you know, everyone on the EM forum will tell you is a terrible idea and you should just suck it up and power through another 10 years and save all your money so you can retire early). Best case scenario, you match, get a fellowship, and move on in your career. There are 2 worst case scenarios, and which is the actual worst, is something only you can decide:
1. You don't match IM and have to stay in EM
2. You match IM but fail to match a fellowship you're interested in and have to stay in General IM (PCP or hospitalist), or just go back to EM

Either way, you won't end up any worse off than you currently are.

Finally, you mention wanting to stay in NYC. While that's certainly possible, if you're really going to go all in on this, you're going to have to take off those blinders and see the 98% of the country that's across the Hudson.


Great advice! Thank you. I have lived outside of NY for 10 years, but my parents are old and I really need to live closer. I've lived most of my adult life outside NYC, and it hasn't brought me joy.
 
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