Second year medical student asking about the field

[Brigade4Radiant]

Do what you love and follow your passion sounds like you are giving insightful advice but once you have lived experience as an adult you realise that money rules everything about work.

You should be focused on buying your time and making a good amount of money doing something you don't hate

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[emergentmd]

Two path in life.

1. Go with passion that will fade and go away. What are you left with
2. Go with the $$$ and what you can tolerate. You are left with $$$$ to cut down and work less, have more options outside of work.

Pick your path.

 

[Birdstrike]

In my opinion, it’s okay to chase dreams and passions. But its a big mistake not to fully consider what a career will feel like if and when the “passion” becomes routine and the “dream” begins to feel like a job. It can’t only be about passion. Passion has to be backed up with foresight and a plan.

Will intubation #1000 still feel the same as the first one did, at 4 am?

Will that shoulder reduction still feel “fun” after the gloom of chronic circaidian-rythm dysphoria gets more oppressive, not only during work time, but having to carry it during free, time, too?

Will you still feel like a “hero” working shifts in search of a life saved when you’re missing important moments in the life of the family?

That’s the mistake I made, the questions I didn’t fully explore.

EM worked out for me, just not in the way envisioned. I got to have my 10 years in EM when I was young and use it as a stepping stone to something that fits me better for the second half of my career.

Now, I still get to use my skills in a way that would have seemed “boring” to my younger self, but in a way that allows me to sustainably feel healthy, rested, positive and whole.

Everyone has to find their own path and mine is unlikely to work for most.

 

[dozitgetchahi]

That's fantastic. This will sound uneducated and silly, but how is it treating people with a wide variety of inflammatory conditions. Symptoms seem so vague, PE findings are vague, and my impression from the little I know is people with moderate to severe inflammatory conditions are just miserable all the time.

So - I love treating the actual rheumatologic/inflammatory conditions. For one thing, we can actually get those patients better the overwhelming portion of the time now. I actually enjoy a lot of the sleuthing and looking for patients’ symptoms with a long history as well as PE clues - but usually people with real rheumatologic conditions have findings that are fairly obvious, which is nice. You just have to go looking for them. When the clinic is full of sick complex rheum patients, I’m grooving…even if those visits are often long and complicated.

On the flip side…when the clinic is full of kooks and cranks complaining about a bunch of weird random functional symptoms that don’t make any sense, that can wear on you after a while. For whatever reason, over the last couple of months I’ve had a lot of these whiny folks with random pains and a negative workup come in (I personally think this may be CoVID-related myalgias/arthralgias - it’s going around again, and they seem to magically get better after a couple of months with no tx). It can get exhausting when the 5th person of the day with no clear diagnosis or etiology for their symptoms is looking at you intently for what I call “a magical solution to an unsolvable problem”. Also, another problem is that PCPs don’t seem to bother to do any meaningful workup or triaging of a lot of these patients anymore, so sometimes you get these “undifferentiated mess” situations where you’re doing a lot of the workup and then making referrals that honestly the PCP probably could have done themselves etc. I do my best to filter out as much of this nonsense as possible, but some of it gets through regardless.

Bottom line: actual rheumatology rocks. A lot of the rest of the nonsense that gets shipped to rheumatologists doesn’t. But you can filter out a lot of that nonsense before it ever gets to you, or at least get the patients referred to the proper doctors asap.

Furthermore, when I’m starting to get frustrated I remind myself I’m making $400k plus to work 4.5 days a week with zero call and zero hospital rounding, with more income potential going forward at my current PP job. That part definitely helps.

 

[oldtown]

Bottom line: actual rheumatology rocks. A lot of the rest of the nonsense that gets shipped to rheumatologists doesn’t. But you can filter out a lot of that nonsense before it ever gets to you, or at least get the patients referred to the proper doctors asap.

Furthermore, when I’m starting to get frustrated I remind myself I’m making $400k plus to work 4.5 days a week with zero call and zero hospital rounding, with more income potential going forward at my current PP job. That part definitely helps.

Sounds a lot like EM. Except for the good pay, good schedule, and upward future income potential part.

 

[emergentmd]

Everyone's Job in medicine is to use your big shovel and give yourselves bunch of options.

You have given up your 20's, you have 20 yrs to get to the point when you are 50 to be FIRE.

You make 300+K/yr. At 50, you should do what you want on your own terms. You have made more in 20 yrs than most make in 60 yrs.

 

[RustedFox]

"Eff" EM.
It's not at all what it used to be.
I can't wait to write my EM Eulogy like that one guy did not long ago.
Coming soon.

 

[Birdstrike]

EM gave me a lot. But the cost was astronomical.

 

[emergentmd]

EM gave me a lot. But the cost was astronomical.

Lets be real. IMO, 90% of jobs are worse than being a doc/EM.

I know partners in the Big 3 who prob make less than I do who travels 5 dys/week, never sees/have much relationships with their kids.

 

[RustedFox]

Lets be real. IMO, 90% of jobs are worse than being a doc/EM.

I know partners in the Big 3 who prob make less than I do who travels 5 dys/week, never sees/have much relationships with their kids.

What's the Big 3?

 

[emergentmd]

Big 3 accounting firms. Its prob the big 4 now.

 

[Birdstrike]

What's the Big 3?

As someone who grew up in Detroit, this makes me laugh.

 

[emergentmd]

As someone who grew up in Detroit, this makes me laugh.

Yeah, the big 3 Auto will be bankrupt 3 in 10 yrs unless the Gov does a huge voting push bailout

 

[Birdstrike]

Big 3 accounting firms. Its prob the big 4 now.

Oh...Lol. In Detroit, the "Big 3" stands for GM, Ford and Chrysler. I assumed you meant that.

Lets be real. IMO, 90% of jobs are worse than being a doc/EM.

I know partners in the Big 3 who prob make less than I do who travels 5 dys/week, never sees/have much relationships with their kids.

When I was referring to "costs," keep in mind not all costs are financial.

 

[Birdstrike]

Yeah, the big 3 Auto will be bankrupt 3 in 10 yrs unless the Gov does a huge voting push bailout

I think you're right. They're nudging them towards failure again, by pushing them to go all in on electric vehicles, which the majority of the public doesn't want. And yes, they (we the tax payers) will end up bailing them out again.

Example: Ford is projected to lose $4,500,000,000 on their electric car program this year alone. That's a staggering number: Four and a half BILLION dollars lost in one year alone. And the CEO has doubled down on moving forward with the program. And when they go bankrupt they'll cry, "Nobody saw this coming!"

OP, that means you should go to business school, where you can be a Fortune 500 CEO, lose billions for your company, still get paid $20 million and a raise for next year!

 

[emergentmd]

Oh...Lol. In Detroit, the "Big 3" stands for GM, Ford and Chrysler. I assumed you meant that.


When I was referring to "costs," keep in mind not all costs are financial.

No doubt but everyone in the house of medicine gives up a significant cost which is the decade of their lives. As I grow older, one regret was sacrificing my 20's

 

[emergentmd]

I think you're right. They're nudging them towards failure again, by pushing them to go all in on electric vehicles, which the majority of the public doesn't want. And yes, they (we the tax payers) will end up bailing them out again.

Example: Ford is projected to lose $4,500,000,000 on their electric car program this year alone. That's a staggering number: Four and a half BILLION dollars lost in one year alone. And the CEO has doubled down on moving forward with the program. And when they go bankrupt they'll cry, "Nobody saw this coming!"

OP, that means you should go to business school, where you can be a Fortune 500 CEO, lose billions for your company, still get paid $20 million and a raise for next year!

The Big 3 esp ford depends on their trucks/Pro division to make money. Everything else are loss leaders. Transitioning to Electric Truck will cannibalize their current main money maker at a loss. Now that Others are coming out with electric trucks, they are surly in for alot of trouble.

They will survive b/c they are too big to fail but they will not be the same in 10 years. The big 3 Auto are just not competitive in the EV space.

 

[Janders]

Interesting. I searched for your quote as I had remembered it as the version I posted and found this: .

That said, I also found your quote from 87 as you mentioned. It appears that Mike himself has been changing what he said over time.

In any event, all of this is largely a re-quotation of Helmuth von Molkte. "No plan of operations extends with any certainty beyond the first encounter with the main enemy forces." Or more succinctly: "No plan survives first contact with the enemy."

I’m told von Moltke the Elder’s words have a deeper meaning in their original German, but I’m not sure if that is true. His works on strategy are some of my favorites. He was basically repeating a Napoleonic maxim.

“The tactical result of an engagement forms the base for new strategic decisions because victory or defeat in a battle changes the situation to such a degree that no human acumen is able to see beyond the first battle. In this sense one should understand Napoleon's saying: "I have never had a plan of operations."
Therefore no plan of operations extends with any certainty beyond the first contact with the main hostile force”

Or a different, extended translation:
“The material and moral consequences of every major battle are so far-reaching that they usually bring about a completely altered situation, a new basis for the adoption of new measures. One cannot be at all sure that any operational plan will survive the first encounter with the main body of the enemy. Only a layman could suppose that the development of a campaign represents the strict application of a prior concept that has been worked out in every detail and followed through to the very end.”
“Certainly the commander in chief will keep his great objective continuously in mind, undisturbed by the vicissitudes of events. But the path on which he hopes to reach it can never be firmly established in advance. Throughout the campaign he must make a series of decisions on the basis of situations that cannot be foreseen. The successive acts of war are thus not premeditated designs, but on the contrary are spontaneous acts guided by military measures. Everything depends on penetrating the uncertainty of veiled situations to evaluate the facts, to clarify the unknown, to make decisions rapidly, and then to carry them out with strength and constancy.”

Clausewitz and Napoleon touched on similar themes in their writing, but didn’t quite say what Moltke said, and Tyson’s paraphrasing is, IMO, the most poetic version.

 

[Apollyon]

and Tyson’s paraphrasing is, IMO, the most poetic version.

One thing I would bet cash money against would be that barely literate Mike Tyson would be reading circa 1900 German military history. But that's just me.

 

[Janders]

One thing I would bet cash money against would be that barely literate Mike Tyson would be reading circa 1900 German military history. But that's just me.

Oh I enjoy the thought of Tyson in his leather chair, perusing his translation of Kriegsgeschichtliche Einzelschriften…

 

[endo]

I am 17 years out of residency and burned out. I recently left private practice (non-CMG group) for the VAMC, which has made me much happier. EM was good for me but if I had to chose a specialty today I wouldn't choose it. Not just because of the lack of future good jobs. The job itself isn't as fun anymore - when I started no one even knew what press ganey was. The job ground me down after 17 years but I think nowadays it would have been more like 5-10. For me it was:

1. constant grinding at 2+ pph, every shift
2. weird shift times, even after I got off nights
3. lawsuits (I've been involved and dropped from 2, but they each lasted 3 years). I couldn't imagine going through another.
4. rude, entitled, drunk, psychotic patients account for a large fraction of what you see. It eventually gets old.
5. BS: actual medicine ratio is much worse.
6. I worked at a high acuity center and always coming to work hyper-ready, like it's the superbowl wears you down.
7. Looking around at my partners and seeing how old & burned out they look

I think the best jobs are now rural ones, or where I work (VA). Funny, because those were always the ones looked down upon.

 

[GonnaBeADoc2222]

I am 17 years out of residency and burned out. I recently left private practice (non-CMG group) for the VAMC, which has made me much happier. EM was good for me but if I had to chose a specialty today I wouldn't choose it. Not just because of the lack of future good jobs. The job itself isn't as fun anymore - when I started no one even knew what press ganey was. The job ground me down after 17 years but I think nowadays it would have been more like 5-10. For me it was:

1. constant grinding at 2+ pph, every shift
2. weird shift times, even after I got off nights
3. lawsuits (I've been involved and dropped from 2, but they each lasted 3 years). I couldn't imagine going through another.
4. rude, entitled, drunk, psychotic patients account for a large fraction of what you see. It eventually gets old.
5. BS: actual medicine ratio is much worse.
6. I worked at a high acuity center and always coming to work hyper-ready, like it's the superbowl wears you down.
7. Looking around at my partners and seeing how old & burned out they look

I think the best jobs are now rural ones, or where I work (VA). Funny, because those were always the ones looked down upon.

Best patient populations are where there is high personal responsibility and accountability. Volumes will typically be low at night as the levels of co-morbid psych and substance abuse which lead to somatization are low. In addition, would be patients will self select to UC or primary care settings or...gasp...settle with "Hey maybe I'll just wait this little ache out for a few hours and see what happens..."

 

[Splenda88]

Lets be real. IMO, 90% of jobs are worse than being a doc/EM.

I know partners in the Big 3 who prob make less than I do who travels 5 dys/week, never sees/have much relationships with their kids.

I am pretty sure 95%+ of people out there would like to have a job in which they can work 10 days/month to make 270-300k/yr.

My job as a hospitalist is not perfect but I am damn sure it's better than 90% jobs out there.

I am going to reiterate that. Most of us in medicine do not realize how fortunate we are when it comes to salary and job security.

 

[wamcp]

I am pretty sure 95%+ of people out there would like to have a job in which they can work 10 days/month to make 270-300k/yr.

My job as a hospitalist is not perfect but I am damn sure it's better than 90% jobs out there.

I am going to reiterate that. Most of us in medicine do not realize how fortunate we are when it comes to salary and job security.

IM nocturnist, 12 shifts a month, closed ICU, PA does crosscover pages, typically 6-8 admissions a night. So 0.58 pph?
340K a year. No stupid meetings, conferences or admin breathing down the neck.

If I had to do EM…you need to pay me like at least 500/hr (so >1M a year?) for 2 pph shifts. I’m not gonna take on the risk of seeing totally undifferentiated patients all the dang time, critically ill patients, risk of discharging patients, having to know peds and obgyn knowledge, seeing the worried well but not knowing which is a ticking time bomb….not worth it for 200/hr. That’s burnout city.

I don’t know how you ER guys do it.

 

[Splenda88]

IM nocturnist, 12 shifts a month, closed ICU, PA does crosscover pages, typically 6-8 admissions a night. So 0.58 pph?
340K a year. No stupid meetings, conferences or admin breathing down the neck.

If I had to do EM…you need to pay me like at least 500/hr (so >1M a year?) for 2 pph shifts. I’m not gonna take on the risk of seeing totally undifferentiated patients all the dang time, critically ill patients, risk of discharging patients, having to know peds and obgyn knowledge, seeing the worried well but not knowing which is a ticking time bomb….not worth it for 200/hr. That’s burnout city.

I don’t know how you ER guys do it.

Yeah, EM is a tough job. I am pretty sure there are EM gig where these docs are seeing 1 pph.

6-8 admits for a 12 hr shift is extremely good. Wish I had the stamina to work night. I worked two night shifts the other day to cover for someone and I was like a zombie after night 2.

Hospitalist market has been good lately. Give the bean counter 5-7 years to turn it into hell.

 

[Mount Asclepius]

If I had to do EM…you need to pay me like at least 500/hr (so >1M a year?) for 2 pph shifts. I’m not gonna take on the risk of seeing totally undifferentiated patients all the dang time, critically ill patients, risk of discharging patients, having to know peds and obgyn knowledge, seeing the worried well but not knowing which is a ticking time bomb….not worth it for 200/hr. That’s burnout city.

I don’t know how you ER guys do it.

We don't. We burn out

There are some decent EM jobs out there. I think that's what keeps some of us still doing it instead of jumping ship.

Our personalities are perhaps better suited for the quick pace, but don't mesh well with a longer medical career.

 

[Dr Mantis Toboggan]

We don't. We burn out

There are some decent EM jobs out there. I think that's what keeps some of us still doing it instead of jumping ship.

Our personalities are perhaps better suited for the quick pace, but don't mesh well with a longer medical career.

Yeah plus some of us are probably too old for a career change (almost 50 in my case), just hoping to be able to get to half time by 55 or so. Then coast from there. Spent the first half of my career being underpaid in academics (first job was 150k/year) so can’t punch out just yet.