Splitting time with EM/CC

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
K

kdade

New Member
7+ Year Member
Joined
Aug 12, 2014
Messages
10
Reaction score
3
Members don't see this ad.
Hi all,
I have a question here that has a couple components.
1) I am a current IM resident (PGY2) looking to pursue CCM. From the IM route, I know it is most feasible to go the PCCM route (or nephrology, ID...), and am told it's easier to get hired that way. Also, I know many people prefer an alternate work environment to the ICU.
2) I am finding myself not as interested in pulm, and don't foresee wanting to do clinic
3) I had a much better EM experience as a resident (absolutely loved it), than I did as a medical student. I am heavily considering going back for EM after I finish out IM.
All this being said, my main question is: does anyone have experience with splitting time between the ED and ICU? I know many people who do fellowship (either from IM or EM), and then choose not to work in the ED or wards. However, my ideal would be to split my time, though I don't know how realistic that really is.
 
It’s hard to split.

I would recommend doing pulm/CCM. That route at least allows you to have a specialty that is not tied to a hospital. In this current environment of midlevel encroachment and expansion of training positions, it is crazy to do a second residency in a hospital based specialty, followed by a fellowship in a hospital based specialty. 8 years of GME, only to face the possibility of potentially not finding a decent job in your location of choice.
 
I had a pretty good setup. I was doing ICU fulltime as a w-2 position while picking up ED shifts as an independent contractor. This let me have 2 401ks. and a 457, and a bunch of “business” writeoffs. Was an awesome setup. However, ED shifts have all dried up. Now I likely have to look at icu locums as an independent contractor.
 
sylvanthus said:
I had a pretty good setup. I was doing ICU fulltime as a w-2 position while picking up ED shifts as an independent contractor. This let me have 2 401ks. and a 457, and a bunch of “business” writeoffs. Was an awesome setup. However, ED shifts have all dried up. Now I likely have to look at icu locums as an independent contractor.
Click to expand...
How does ICU locums work in this situation? Are you working 7 on 7 off and then a week of locums in between? Because that sounds crazy. Or is your schedule a little different, or do the locums gigs not need you for 7 days at a stretch. Also what salary are you seeing for locus? Most of the offers I've seen are around $240/hr. I wouldn't mind picking up a few locums gigs here and there to open a second 401k.
 
Tipsy McStagger said:
How does ICU locums work in this situation? Are you working 7 on 7 off and then a week of locums in between? Because that sounds crazy. Or is your schedule a little different, or do the locums gigs not need you for 7 days at a stretch. Also what salary are you seeing for locus? Most of the offers I've seen are around $240/hr. I wouldn't mind picking up a few locums gigs here and there to open a second 401k.
Click to expand...
Why is there any benefit to a second 401k? IRS caps the combined total together per calendar year at 19500

you would only benefit if there is 457b
 
wamcp said:
Why is there any benefit to a second 401k? IRS caps the combined total together per calendar year at 19500

you would only benefit if there is 457b
Click to expand...

Not correct, second 401k is not effected by the first one. Also the limit is much higher for the second one as your are both an employee and employer.

Just as an example, this last year, I tossed 19500 into my w-2 401, 19500 into a 457, and 31000 into a solok.
 
wamcp said:
Why is there any benefit to a second 401k? IRS caps the combined total together per calendar year at 19500

you would only benefit if there is 457b
Click to expand...
I think the benefit of a second 401k is you can maximize contributions from two different companies. Even thou your max is still 19500, you can get more match $$. Although I am guessing at MD salary - this is not as big of a deal. For example for me
Job 1 - they match the first 5% dollar for dollar - I put in 8k, then put in 8k
Job 2 (my moonlighting gig) matches dollar for dollar up to 8 % - I put in 2k, then put in 2 k

Then I qs my primary job up to the max of 19.5 - that being said, it only gives me an extra match on my moonlighting gig of 2k - not worth the hassle of a second job for just that benefit - but if you get a better match, it may be.
 
Tipsy McStagger said:
How does ICU locums work in this situation? Are you working 7 on 7 off and then a week of locums in between? Because that sounds crazy. Or is your schedule a little different, or do the locums gigs not need you for 7 days at a stretch. Also what salary are you seeing for locus? Most of the offers I've seen are around $240/hr. I wouldn't mind picking up a few locums gigs here and there to open a second 401k.
Click to expand...


Not sure yet, just starting to look into it. From what Ive seen the rates are about 250/hr. I work a week on, week off, but also have vacation time in addition. So currently work 70 shifts in 6 months. This results in random stretches of three weeks off. So figure ill either do a 3 day stretch on weeks off or a random week here and there.
 
Dred Pirate said:
I think the benefit of a second 401k is you can maximize contributions from two different companies. Even thou your max is still 19500, you can get more match $$. Although I am guessing at MD salary - this is not as big of a deal. For example for me
Job 1 - they match the first 5% dollar for dollar - I put in 8k, then put in 8k
Job 2 (my moonlighting gig) matches dollar for dollar up to 8 % - I put in 2k, then put in 2 k

Then I qs my primary job up to the max of 19.5 - that being said, it only gives me an extra match on my moonlighting gig of 2k - not worth the hassle of a second job for just that benefit - but if you get a better match, it may be.
Click to expand...

What I said was not entirely correct, its a tad more complicated. Its 19500 total betweem all as an “employee”, but you are also an “employer”. so can do roughly 20% of your business income up to like 57k ish.
 
Just fyi, if you live in certain states you can do “qualified joint ventures” and have your spouse do your scheduling, finances, etc and toss some money into a solok for him/her also. Look into it as it gets complicated.
 
sylvanthus said:
Not sure yet, just starting to look into it. From what Ive seen the rates are about 250/hr. I work a week on, week off, but also have vacation time in addition. So currently work 70 shifts in 6 months. This results in random stretches of three weeks off. So figure ill either do a 3 day stretch on weeks off or a random week here and there.
Click to expand...
hmm. How much vacation do they give you each year?
 
sylvanthus said:
Not correct, second 401k is not effected by the first one. Also the limit is much higher for the second one as your are both an employee and employer.

Just as an example, this last year, I tossed 19500 into my w-2 401, 19500 into a 457, and 31000 into a solok.
Click to expand...
That makes sense regarding solo 401k. I thought you meant two w2
 
I’m not ICU but EM and Pain and it’s been 1 year since I’ve been in the ED now due to horrid EM job market - I guess you can’t consider me an unemployed ER doc as I have a FT job but yeah as a BC EM doc I can’t find work in the field. I was picking up a lot of per diem weekend shifts and making good extra money. I would not touch EM if I was a med student - you would be crazy to finish IM only to go do EM and then CC. The field was going down hill before covid hit anyway - now there’s just no question about it.
 
sylvanthus said:
What I said was not entirely correct, its a tad more complicated. Its 19500 total betweem all as an “employee”, but you are also an “employer”. so can do roughly 20% of your business income up to like 57k ish.
Click to expand...
ya - i wasn't taking into consideration if you have your own LLC and pay yourself so you get to contribute on both sides - I used to have my own small LLC and worked contract work here and there before that all dried up due to the saturation of my field.
 
sylvanthus said:
Not sure yet, just starting to look into it. From what Ive seen the rates are about 250/hr. I work a week on, week off, but also have vacation time in addition. So currently work 70 shifts in 6 months. This results in random stretches of three weeks off. So figure ill either do a 3 day stretch on weeks off or a random week here and there.
Click to expand...
I currently work 7 on 7 off (work 70 hours get paid for 80)- and get 320 hours of PDO (been here a long time). so I work 150 shifts a year (1500 hours). The 3 weeks off are awesome if you love to travel - ya - I am exhausted by the end of it- but if you are young and looking to make some extra $$ - it is a great schedule to do so. I personally am at a point in my life the time off is worth more than the extra $$.
 
You must log in or register to reply here.

Similar threads

petomed
EM part time
2
Replies
57
Views
7K
Arcan57
Arcan57
B
EM Alliance
Replies
1
Views
919
RustedFox
RustedFox
E
Houston EM forum
Replies
3
Views
1K
HemeOncHopeful19
H
Boatswain2PA
Best EM podcasts?
2
Replies
64
Views
4K
Janders
J
G
EM Match 2025
2
Replies
90
Views
10K
RustedFox
RustedFox
Top