Struggling with post-fellowship career decision

[InFactotum]

I am finishing my fellowship in CCM via an anesthesia program in June, my residency training is EM. I am trying to find a 50/50 ICU/EM split.

Majority of my training has been in the cardiac ICU, and I think one day I'd like to end up in a cardiac ICU , but have not found a position in my region yet.

Current options:
1) Stay at home program working 50/50 EM/SICU (~7-8 EM shifts, 8 hours long; 7 days in mixed trauma/surgical ICU followed by week off)

Pros: Know the hospital well, money is decent for an academic center​

Cons: ~1 hour commute so would have to maintain a 2nd apartment away from my wife during the ICU shifts realistically, and probably during some ED shifts​

2) Major academic program in the same city as my wife working 50/50 EM/MICU (8 EM shifts, 8 hours long; nocturnist MICU position with 6 overnights in a row followed by week off)

Pros: I know the EM PD well and he is a great mentor and expect I can be involved significantly in the residency. Household name of hospital may benefit me in future jobs?​

Cons: Pay is poor compared to option 1, but average for the area in academics. Pure nocturnist MICU position sounds rough long term.​

3) 0.5FTE EM position at either of the above hospitals and find a locums ICU gig to cover the other 0.5FTE (eg 13 weeks of ICU)

None of the above options sound great, and none are ultimately what I think I want to do (EM/Cardiac ICU).

I am tempted towards option 3, and wait for a cardiac ICU position to open up in my city, but my major concern is if I work in a community ICU that I will have trouble getting hired into an academic position later on.

Any advice is appreciated.

---

Members don't see this ad.

 

[deleted547339]

How flexible is your wife’s job? Living away from my family would be a nonstarter for me, but to each his own.

 

[InFactotum]

How flexible is your wife’s job? Living away from my family would be a nonstarter for me, but to each his own.

At the moment, not flexible at all. Expect we will stay in this city for at least 3 years for her job. If we both still like our jobs at this time, probably will stay longer term. If she finds her position not worth it after that time period, we will likely move across the country closer to family.

In a way, all options result in being "away" from my wife for one week per month (nocturnist would mean not seeing her for a week because her hours would have her leaving the house before I get home, and vice versa).

 

[CCM-MD]

I have personally gone through living 1-2 weeks/month away from my wife and I strongly advise against it. I obviously don't know your exact circumstances. Perhaps you'll be better at it than my wife and I were.

 

[deleted171991]

I have personally gone through living 1-2 weeks/month away from my wife and I strongly advise against it. I obviously don't know your exact circumstances. Perhaps you'll be better at it than my wife and I were.

Depends on the wife.

 

[chessknt]

I think the only jobs I've seen get the seal of approval here are 8 weeks pto, 10x 8 hour shifts a month, 8 patient cap, 90% mgma with good weather. Everything else gets **** on.

I would open up the idea of only doing one or the other and see if new options open up with better pay and shift mix. The nocturnist might not be so bad but it depends on how you handle nights.

Are you on overnight call for the sicu job or why would you need to live somewhere else for a 1 hour commute? People commute an hour all the time..

 

[Justice4all]

1 hour commute is not bad . Stay at the hospital for those calls or shift. No need to expense an apartment . Cluster the ED shifts. Likely #1

 

[InFactotum]

I think the only jobs I've seen get the seal of approval here are 8 weeks pto, 10x 8 hour shifts a month, 8 patient cap, 90% mgma with good weather. Everything else gets **** on.

I would open up the idea of only doing one or the other and see if new options open up with better pay and shift mix. The nocturnist might not be so bad but it depends on how you handle nights.

Are you on overnight call for the sicu job or why would you need to live somewhere else for a 1 hour commute? People commute an hour all the time..

1 hour commute is not bad . Stay at the hospital for those calls or shift. No need to expense an apartment . Cluster the ED shifts. Likely #1

I think I undersold the commute. The commute is more like 1h20m non rush hour, and 2 hours rush hour, so ~3hours round trip. That means waking up at 4am to get to 6am sign out, leaving close to 7pm would have me arrive around 8:30-9pm. So, I would essentially just get home and go to bed and repeat, which doesn't make sense to me versus keeping a place.

 

[Dr.CCM]

I think I undersold the commute. The commute is more like 1h20m non rush hour, and 2 hours rush hour, so ~3hours round trip. That means waking up at 4am to get to 6am sign out, leaving close to 7pm would have me arrive around 8:30-9pm. So, I would essentially just get home and go to bed and repeat, which doesn't make sense to me versus keeping a place.

I’ve done similar commutes. Don’t do it. Not worth it. I’d factor in money/hr with the commute or money lost if renting an extra place. Wouldn’t do that job unless no choice.