What do I do instead?

[MedicineDawg]

In the wake of this week's match and the general future outlook, I'm not sure EM is my specialty of choice anymore. I've loved EM since before starting medical school and claimed I was doing XYZ "specialty of the month" I thought I could see myself doing only to end up back at EM because I've not loved anything as much as I've loved EM. Now I've submitted my away applications and have a gut feeling I'm making a mistake. My school and clerkship faculty have supported the idea of going into EM but sometimes I wonder if they're shielded against the reality of what EM is headed toward due to their role academics/admin. All say that they don't think the ACEP report projections will come to fruition, which is why I've gotten this far.

I'm drawn to the things that are "classically EM" but it looks like it's becoming a professional consult carousel and billing machine where you do anything but what you're trained to. I want to hold out hope because EM is full of the best people I know but I'm not sure if I'm really willing to risk not having a career in 4 years or being paid pennies with hundreds of thousands in debt.

It's hard to think of what makes me happy in medicine when I find something to love about almost every core rotation within a few weeks. However, nothing has ever been, "oh my gosh, I can't live without doing this forever". I love the hospital. I love variety. I love acuity. I particularly want a career where I don't need to sustain a patient base due to possibilities of moving frequently and having no control over where (which is why EM has continued to be so appealing despite the looming future).

I appreciate this community and all of your candid takes on these forums. I would love if y'all had thoughts or opinions you'd be willing to share.

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[bravotwozero]

If you have another specialty in mind, consider switching out and applying to it. You may or may not be successful. This should be step 1.

If that fails, finish residency and consider doing a fellowship in Pain or CCM, whatever appeals to you more. These are the only viable EM pathway fellowships where you can at least make as much, if not more, than EM. Yes, they have downsides, but so does the house of medicine, and their decline will likely come later, and not be as drastic as EM, giving you TIME to get finances in order.

Other options post residency:

- Open up an urgent care, and be content with the likelihood of skill atrophy from lower acuity.
- Move to a state where FSEDs are legal, either work in one or open one up on your own. Risks as above, but maybe a bit less, I still saw some sick patients in FSEDs when I worked in them.
-Disability examiner is an option, you'll take a pay cut but will work banker's hours, likely with jobs that offer good benefits

Telemed and chart/utilization reviews are options, but both are crappy in terms of pay, and job availability

Good luck.

 

[miacomet]

If you have another specialty in mind, consider switching out and applying to it. You may or may not be successful. This should be step 1.

If that fails, finish residency and consider doing a fellowship in Pain or CCM, whatever appeals to you more. These are the only viable EM pathway fellowships where you can at least make as much, if not more, than EM. Yes, they have downsides, but so does the house of medicine, and their decline will likely come later, and not be as drastic as EM, giving you TIME to get finances in order.

Other options post residency:

- Open up an urgent care, and be content with the likelihood of skill atrophy from lower acuity.
- Move to a state where FSEDs are legal, either work in one or open one up on your own. Risks as above, but maybe a bit less, I still saw some sick patients in FSEDs when I worked in them.
-Disability examiner is an option, you'll take a pay cut but will work banker's hours, likely with jobs that offer good benefits

Telemed and chart/utilization reviews are options, but both are crappy in terms of pay, and job availability

Good luck.

They aren't in residency yet....

 

[bravotwozero]

They aren't in residency yet....

dammit, I clearly have some reading comprehension issues.

In that case, apply to something else, whatever appeals to you! You've got nothing to lose. Keep EM as a backup at the bottom of your rank list, and if EM is all you get, read my post above lol

 

[RustedFox]

"My school and clerkship faculty have supported the idea of going into EM but sometimes I wonder if they're shielded against the reality of what EM is headed toward due to their role academics/admin."

 

[EctopicFetus]

If you plan on moving around a lot EM is a good choice. You will move from one mediocre job to the next though. I wonder how many of the “I have a great job” posts here and elsewhere are from people who lack perspective. I admit i can fall into this trap as well. There are aspects of my job that suck terribly bad but pay is top notch. I am a little more in the school of thought that I want to be able to maximize my income when i am at work. I dont think i could mentally take seeing 3-4/hr and making my hourly. Similarly, I dont think i would be happy seeing that extra patient per hour and getting $12/rvu for it. I found a good fit for me.

Bouncing around means you will find whatever is available in your location. Nothing more. The better jobs I have looked at recently essentially require a wait.

 

[miacomet]

One of the untenable problems with medical education is that we are forced to pick a career in our mid twenties and commit to it, unlike midlevels who can change on a whim. EM is problematic because it's highly, highly inflexible with few off-ramps. If you like EM, I would suggest you look at the off ramps- sports, palli, pain, addiction, and imagine if you could be happy in them if EM doesn't work out long-term. Would you be happy in administration, too? Many nonclinical jobs are hard to come by from EM- pharma, for example.

If you want to be a clinician, the things that will offer you the most opportunities are anything surgical, anything where you can easily hang your own shingle, or anything that requires a competitive fellowship (heme onc, cards, maybe GI). Would these work for you? You mentioned moving around a lot- this is less attractive as you get older, is there a reason you will be relocating frequently? Or is it just something you want?

I would cancel most/all of your away rotations- it's not like EM is going to skyrocket in popularity, use the time to explore other things. Anyone with a pulse and a US MD will match next year, so there's no reason to spend a ton of time pimping yourself out.

And yes, the academicians have no clue. I tried to explain to one of them that we received 50 applications for one part-time position at my job and he nearly fell over.

 

[JacobMcCandles]

As they say, shoot for the moon. Even if you miss you’ll still land an EM spot in the SOAP.

 

[FlaminHotER]

Go for Ortho
IR
Radiology
Anesthesiology
Sports Med

 

[MedicineDawg]

dammit, I clearly have some reading comprehension issues.

In that case, apply to something else, whatever appeals to you! You've got nothing to lose. Keep EM as a backup at the bottom of your rank list, and if EM is all you get, read my post above lol

Sorry, definitely should have made that more clear in my post but I'm an MS3. Thank you for the options for post EM! I've been considering an IM -> CCM instead since I'm finding that I don't really hate wards and rounding as much as I thought I would but I'm just now starting my medicine rotation. I was just always convinced I would hate it since it felt inherently opposite.

"My school and clerkship faculty have supported the idea of going into EM but sometimes I wonder if they're shielded against the reality of what EM is headed toward due to their role academics/admin."

Unfortunately for me, I'm the first physician in my family so this is all the information I've ever had to go off of. The only other EM docs I know have a fantastic private group and they're who I've wanted to be for years.

If you plan on moving around a lot EM is a good choice. You will move from one mediocre job to the next though. I wonder how many of the “I have a great job” posts here and elsewhere are from people who lack perspective. I admit i can fall into this trap as well. There are aspects of my job that suck terribly bad but pay is top notch. I am a little more in the school of thought that I want to be able to maximize my income when i am at work. I dont think i could mentally take seeing 3-4/hr and making my hourly. Similarly, I dont think i would be happy seeing that extra patient per hour and getting $12/rvu for it. I found a good fit for me.

Bouncing around means you will find whatever is available in your location. Nothing more. The better jobs I have looked at recently essentially require a wait.

Thanks for your reply! While I may not "have" to move, my spouse's job is in the hands of the wonderful and ever so thoughtful US government so they may stay in one place but who knows. They'll retire eventually but for now, I'm married to the government's demands. I bet there are wonderful jobs out there and I'd love to say "I'm definitely going to be one of the one's who finds them" but I'm trying to be realistic about myself. I definitely want to not hate coming to work because I'm trying to squeeze out another dollar.

 

[miacomet]

If you are moving around, don't overlook locums. Plenty of need for psych, gen surg, primary care, and ob gyn locums. I don't see the ob gyn issue going away, either.

 

[MedicineDawg]

One of the untenable problems with medical education is that we are forced to pick a career in our mid twenties and commit to it, unlike midlevels who can change on a whim. EM is problematic because it's highly, highly inflexible with few off-ramps. If you like EM, I would suggest you look at the off ramps- sports, palli, pain, addiction, and imagine if you could be happy in them if EM doesn't work out long-term. Would you be happy in administration, too? Many nonclinical jobs are hard to come by from EM- pharma, for example.

If you want to be a clinician, the things that will offer you the most opportunities are anything surgical, anything where you can easily hang your own shingle, or anything that requires a competitive fellowship (heme onc, cards, maybe GI). Would these work for you? You mentioned moving around a lot- this is less attractive as you get older, is there a reason you will be relocating frequently? Or is it just something you want?

I would cancel most/all of your away rotations- it's not like EM is going to skyrocket in popularity, use the time to explore other things. Anyone with a pulse and a US MD will match next year, so there's no reason to spend a ton of time pimping yourself out.

And yes, the academicians have no clue. I tried to explain to one of them that we received 50 applications for one part-time position at my job and he nearly fell over.

Unfortunately, that's so true. My spouse is military and I don't want to make unilateral choices for the both of us but he could go anywhere in the states or overseas. He's in far enough in his career I don't think it makes sense for him to quit as I'm still training. EM was also great since training would be 3 years but alas it looks like it all would require fellowship at this point which negates any time saved compared to other specialties.

While I'm not the most competitive as a medical student (state school, w/in top 1/3 and some research), I find cards interesting and especially CCM but I know nothing outside of how cool they are to consult and to read their notes lol. I hadn't even considered IM-based specialties until a week ago.

In terms of applications, I have my home EM scheduled enough to get one SLOE. I won't even know until April or later. I definitely can apply to other specialties and withdraw my application if I'm certain.

I hate how wishy washy this has made me all feel. Medicine has been a constant pool of uncertainty and anxiety.

 

[rokshana]

In the wake of this week's match and the general future outlook, I'm not sure EM is my specialty of choice anymore. I've loved EM since before starting medical school and claimed I was doing XYZ "specialty of the month" I thought I could see myself doing only to end up back at EM because I've not loved anything as much as I've loved EM. Now I've submitted my away applications and have a gut feeling I'm making a mistake. My school and clerkship faculty have supported the idea of going into EM but sometimes I wonder if they're shielded against the reality of what EM is headed toward due to their role academics/admin. All say that they don't think the ACEP report projections will come to fruition, which is why I've gotten this far.

I'm drawn to the things that are "classically EM" but it looks like it's becoming a professional consult carousel and billing machine where you do anything but what you're trained to. I want to hold out hope because EM is full of the best people I know but I'm not sure if I'm really willing to risk not having a career in 4 years or being paid pennies with hundreds of thousands in debt.

It's hard to think of what makes me happy in medicine when I find something to love about almost every core rotation within a few weeks. However, nothing has ever been, "oh my gosh, I can't live without doing this forever". I love the hospital. I love variety. I love acuity. I particularly want a career where I don't need to sustain a patient base due to possibilities of moving frequently and having no control over where (which is why EM has continued to be so appealing despite the looming future).

I appreciate this community and all of your candid takes on these forums. I would love if y'all had thoughts or opinions you'd be willing to share.

IM then pulm/CC.

 

[miacomet]

Unfortunately, that's so true. My spouse is military and I don't want to make unilateral choices for the both of us but he could go anywhere in the states or overseas. He's in far enough in his career I don't think it makes sense for him to quit as I'm still training. EM was also great since training would be 3 years but alas it looks like it all would require fellowship at this point which negates any time saved compared to other specialties.

While I'm not the most competitive as a medical student (state school, w/in top 1/3 and some research), I find cards interesting and especially CCM but I know nothing outside of how cool they are to consult and to read their notes lol. I hadn't even considered IM-based specialties until a week ago.

In terms of applications, I have my home EM scheduled enough to get one SLOE. I won't even know until April or later. I definitely can apply to other specialties and withdraw my application if I'm certain.

I hate how wishy washy this has made me all feel. Medicine has been a constant pool of uncertainty and anxiety.

Medicine is changing so quickly. We just don't know what the future will hold, be forgiving of yourself and remember it's an educated guess at best. It's unfair on first gen folks who have lots of debt, but if you do residency at a nonprofit you are building time to PSLF.

If you are open to longer training (five years) you could do EM/IM or EM/Peds, which would give you an out in a few years, if that interests you. I know one EM/IM person who ended up doing allergy. EM/IM/Critical care is also a 5-6 year program, and it seems like plenty of EM docs are doing critical care fellowships.

If you don't mind IM residency, there are a million fellowships, from cards to pulmonary to critical care. Pulm is nice because you could to crit care and then also do outpatient pulmonary. If you like critical care and the hospital, what about anesthesia? Some nice fellowships and niches there. Or general surgery, it's a beast, but there are a bunch of fellowships. There are Ob laborist positions too, and I have never ever heard of a surplus of OBs. Also some great fellowships if you want something cushier.

I wouldn't worry about the SLOEs too much- you have a pulse and are a strong US candidate. If nothing works out, EM will be there as a backup next year.

 

[MedicineDawg]

Medicine is changing so quickly. We just don't know what the future will hold, be forgiving of yourself and remember it's an educated guess at best. It's unfair on first gen folks who have lots of debt, but if you do residency at a nonprofit you are building time to PSLF.

If you are open to longer training (five years) you could do EM/IM or EM/Peds, which would give you an out in a few years, if that interests you. I know one EM/IM person who ended up doing allergy. EM/IM/Critical care is also a 5-6 year program, and it seems like plenty of EM docs are doing critical care fellowships.

If you don't mind IM residency, there are a million fellowships, from cards to pulmonary to critical care. Pulm is nice because you could to crit care and then also do outpatient pulmonary. If you like critical care and the hospital, what about anesthesia? Some nice fellowships and niches there. Or general surgery, it's a beast, but there are a bunch of fellowships. There are Ob laborist positions too, and I have never ever heard of a surplus of OBs. Also some great fellowships if you want something cushier.

I wouldn't worry about the SLOEs too much- you have a pulse and are a strong US candidate. If nothing works out, EM will be there as a backup next year.

Absolutely and there's no way to predict the future. I just feel like I need to pick something I know is stable rather than something I may find trouble with down the road. I need to sit down and think a bit more about what I can and can't see myself doing.
Thank you! I really appreciate yours and everyone's responses.

 

[JacobMcCandles]

I know one EM/IM person who ended up doing allergy.

Do they just sit in the ED and erase erroneous ‘allergies’ from the EMR because that’s sorely needed?

 

[Birdstrike]

Do anything where you don’t work nights, weekends or holidays. All medicine becomes routine with time. Very quickly you enter a phase where no amount of satisfaction from one’s work justifies the sacrifice of giving up the ability to have a normal life. Yet, the dissatisfaction from time away from friends and family, and chronic-circadian rhythm depression, never lessens.

Any satisfaction that might remain from an “interesting case” a 3 am, is outweighed by chronic-circadian rhythm dysphoria and it’s cancerous effect on one’s personal life and psychological state.

The least interesting specialty with bankers hours is far, far better than the most interesting one with rotating shift work, or night call.

 

[JacobMcCandles]

Do anything where you don’t work nights, weekends or holidays. All medicine becomes routine with time. Very quickly you enter a phase where no amount of satisfaction from one’s work justifies the sacrifice of giving up the ability to have a normal life. Yet, the dissatisfaction from time away from friends and family, and chronic-circadian rhythm depression, never lessens.

Any satisfaction that might remain from an “interesting case” a 3 am, is outweighed by chronic-circadian rhythm dysphoria and it’s cancerous effect on one’s personal life and psychological state.

The least interesting specialty with bankers hours is far, far better than the most interesting one with rotating shift work, or night call.

There are certainly trade offs but on a personal level EM can make sense. You do work evenings, nights, holidays, etc. but it’s tough to beat some of the schedule control when you know you need particular days off. Got a day you need off last minute? Make a trade. Need to be home for something during the week? No biggie. For the downsides regarding circadian shifts, I don’t think any other specialty has as much schedule flexibility.

 

[GatorCHOMPions]

There are certainly trade offs but on a personal level EM can make sense. You do work evenings, nights, holidays, etc. but it’s tough to beat some of the schedule control when you know you need particular days off. Got a day you need off last minute? Make a trade. Need to be home for something during the week? No biggie. For the downsides regarding circadian shifts, I don’t think any other specialty has as much schedule flexibility.

Trading used to be pretty difficult for me in all the EM jobs I’ve worked, 3 different sites in 5 years. Generally speaking you’re not asking to switch out of that Tuesday morning shift. In my current gig I can call out last minute and the clinic patients just get rescheduled. In fact it’s a lot less burden than asking a colleague to come in last minute to fill my EM shift that has to be staffed.

This goes to the common theme that EM “can” be great in theory, if you have the ideal schedule, in your ideal location, making ideal pay. How realistic is that now, and what about 5 years from now?

 

[JacobMcCandles]

Trading used to be pretty difficult for me in all the EM jobs I’ve worked, 3 different sites in 5 years. Generally speaking you’re not asking to switch out of that Tuesday morning shift.

This goes to the common theme that EM “can” be great in theory, if you have the ideal schedule, in your ideal location, making ideal pay. How realistic is that now, and what about 5 years from now?

I will say that I’m lucky in that I have a great group where trades typically aren’t an issue.

 

[Birdstrike]

There are certainly trade offs but on a personal level EM can make sense. You do work evenings, nights, holidays, etc. but it’s tough to beat some of the schedule control when you know you need particular days off. Got a day you need off last minute? Make a trade. Need to be home for something during the week? No biggie. For the downsides regarding circadian shifts, I don’t think any other specialty has as much schedule flexibility.

I did 10 years of EM and now I've done 10 years of Interventional Pain. If I want a day off now in Pain, I just tell my office manager I'm going to be out of the office and block my schedule and it's done. Even if I have patients scheduled, I can have them reschedule and "presto," a day off. It was much harder in EM. I could break a limb and they'd hand me crutches and say, "Work."

I'm glad it works for you, though.

 

[miacomet]

There are certainly trade offs but on a personal level EM can make sense. You do work evenings, nights, holidays, etc. but it’s tough to beat some of the schedule control when you know you need particular days off. Got a day you need off last minute? Make a trade. Need to be home for something during the week? No biggie. For the downsides regarding circadian shifts, I don’t think any other specialty has as much schedule flexibility.

I think this is harder than EM than in most other fields, and wow it's not group dependent in other fields. There's no mother may I, you just...have the day off.

 

[JacobMcCandles]

I did 10 years of EM and now I've done 10 years of Interventional Pain. If I want a day off now in Pain, I just tell my office manager I'm going to be out of the office and block my schedule and it's done. Even if I have patients scheduled, I can have them reschedule and "presto," a day off. It was much harder in EM. I could break a limb and they'd hand me crutches and say, "Work."

I'm glad it works for you, though.

How many days does that work for in a month?

 

[JacobMcCandles]

I think this is harder than EM than in most other fields, and wow it's not group dependent in other fields. There's no mother may I, you just...have the day off.

I think it’s much harder when you’ve got clinic and surgeries scheduled months out. In EM, you don’t own any patients. They’re not coming to see you. Somebody just needs to be available to work. You need a last minute day off you don’t have to reschedule patients, surgeries, etc.

 

[miacomet]

I think it’s much harder when you’ve got clinic and surgeries scheduled months out. In EM, you don’t own any patients. They’re not coming to see you. Somebody just needs to be available to work. You need a last minute day off you don’t have to reschedule patients, surgeries, etc.

So you can take off like a whole week at the drop of a hat?

 

[JacobMcCandles]

So you can take off like a whole week at the drop of a hat?

Nope but I can easily trade for last minute days off, if needed. I can also take multiple blocks off each month for vacations, if I wanted, that many other specialties wouldn’t have the opportunity to do. Again, it’s not a lifestyle specialty but it can work out well for people who value that kind of control. And you can basically do it without impacting patient care since nobody has to be rescheduled.

 

[GatorCHOMPions]

Nope but I can easily trade for last minute days off, if needed. I can also take multiple blocks off each month for vacations, if I wanted, that many other specialties wouldn’t have the opportunity to do. Again, it’s not a lifestyle specialty but it can work out well for people who value that kind of control. And you can basically do it without impacting patient care since nobody has to be rescheduled.

I’ll grant you multiple weeks off per month is unique to EM. Early on before kids I took a whole month vacation, once in a lifetime type trip. But now I just don’t need that and I’d much rather have nights/weekends/holidays off as a standard. I feel like the EM schedule is great long term only for those who remain childless.

I think it’s much harder when you’ve got clinic and surgeries scheduled months out. In EM, you don’t own any patients. They’re not coming to see you. Somebody just needs to be available to work. You need a last minute day off you don’t have to reschedule patients, surgeries, etc.

Yea it’s a hassle to reschedule…for my office staff. I don’t really feel any of that stress. I did, however, feel pressure to work sick and/or tired in EM.

 

[InternistDO]

Unfortunately, that's so true. My spouse is military and I don't want to make unilateral choices for the both of us but he could go anywhere in the states or overseas. He's in far enough in his career I don't think it makes sense for him to quit as I'm still training. EM was also great since training would be 3 years but alas it looks like it all would require fellowship at this point which negates any time saved compared to other specialties.

While I'm not the most competitive as a medical student (state school, w/in top 1/3 and some research), I find cards interesting and especially CCM but I know nothing outside of how cool they are to consult and to read their notes lol. I hadn't even considered IM-based specialties until a week ago.

In terms of applications, I have my home EM scheduled enough to get one SLOE. I won't even know until April or later. I definitely can apply to other specialties and withdraw my application if I'm certain.

I hate how wishy washy this has made me all feel. Medicine has been a constant pool of uncertainty and anxiety.

I switched from EM to IM at the beginning of my 4th year (now about to finish residency). I think rounds get a bad rap, yes, they're mind numbing as a med student but it's more interesting as a resident (and its only during training too). EM was my favorite rotation as a med student but I think that's because I felt like I got to do a lot of stuff. It was still enjoyable as an intern but you then realize how much un-fun stuff you're shielded from as a student.

There is still plenty of acuity in IM between hospitalist, pulm/crit, and cardiology and IM is incredibly flexible as a specialty--you can do pulm/crit and spend your day dealing only with very sick people in the ICU or you can do rheumatology and work a 9-5 dealing only with ambulatory patients in clinic, plus general IM itself gives you the ability to work both inpatient and outpatient.

I also think there's no one magic specialty for someone. If you like acute medicine I think you'd be happy in IM, EM, anesthesia, maybe even surgery.

 

[Birdstrike]

How many days does that work for in a month?

As many as I want it to. But I like to work and get paid. If I don’t work, I don’t get paid. To work 20 days per month doing what I do now, takes far less a toll than working much less in EM. Every hours in the ED, was like 1.5 - 2 hours doing anything else, for me.

Stay where you are, if it’s working for you. What I say, means little.

 

[Birdstrike]

There are certainly trade offs but on a personal level EM can make sense. You do work evenings, nights, holidays, etc. but it’s tough to beat some of the schedule control when you know you need particular days off. Got a day you need off last minute? Make a trade. Need to be home for something during the week? No biggie. For the downsides regarding circadian shifts, I don’t think any other specialty has as much schedule flexibility.

I’m glad EM works for you.

 

[WorkNoteEmergency]

Do anything where you don’t work nights, weekends or holidays. All medicine becomes routine with time. Very quickly you enter a phase where no amount of satisfaction from one’s work justifies the sacrifice of giving up the ability to have a normal life. Yet, the dissatisfaction from time away from friends and family, and chronic-circadian rhythm depression, never lessens.

Any satisfaction that might remain from an “interesting case” a 3 am, is outweighed by chronic-circadian rhythm dysphoria and it’s cancerous effect on one’s personal life and psychological state.

The least interesting specialty with bankers hours is far, far better than the most interesting one with rotating shift work, or night call.

That has been my experience as well. I still get some satisfaction from taking care of a "real" emergency patient but those are extremely few and far between. The regular high acuity patients are an AMS and/or sepsis with huge problem and medication lists, Most of them should be DNR but are full code so you do the full court press telling yourself "I hope nobody does this to me when I'm 88 years old". It is a grind, searching for the deadly needle in the ever increasing haystack.

If I was younger when I finished residency, I would have done a sports med fellowship. Cardiology was the other field I considered in med school, and it was the heart physiology I learned in paramedic school that got me interested in being a doctor to stat with. The cardiologists in my hospital system are the prima donnas and get paid the best, even the guys just doing office and consults. In my rural hospital they work bankers hours and take "phone call only" in the mornings on weekends, for inpatient only, not the ER.

Schedule swapping is a major annoyance for me and the only way to get two weeks off in my group is to straddle beginning and end of two months. Major vacation requests are done a year in advance and the popular times, like school spring breaks, go fast. Our schedules are made usually 3 months in advance, so if you want a specific weekend off on short notice that will often involve a lot wheeling and dealing.

MAny EM jobs are "no work, no pay" so if you're sick, you find a swap or suck it up and go to work. I've missed one day in 15 years. We all got a kick out of watching one of our partners roll around on one of those knee scooters after rupturing his quad tendon and taking care of patients looking for work notes for their stiff backs.

 

[miacomet]

That has been my experience as well. I still get some satisfaction from taking care of a "real" emergency patient but those are extremely few and far between. The regular high acuity patients are an AMS and/or sepsis with huge problem and medication lists, Most of them should be DNR but are full code so you do the full court press telling yourself "I hope nobody does this to me when I'm 88 years old". It is a grind, searching for the deadly needle in the ever increasing haystack.

If I was younger when I finished residency, I would have done a sports med fellowship. Cardiology was the other field I considered in med school, and it was the heart physiology I learned in paramedic school that got me interested in being a doctor to stat with. The cardiologists in my hospital system are the prima donnas and get paid the best, even the guys just doing office and consults. In my rural hospital they work bankers hours and take "phone call only" in the mornings on weekends, for inpatient only, not the ER.

Schedule swapping is a major annoyance for me and the only way to get two weeks off in my group is to straddle beginning and end of two months. Major vacation requests are done a year in advance and the popular times, like school spring breaks, go fast. Our schedules are made usually 3 months in advance, so if you want a specific weekend off on short notice that will often involve a lot wheeling and dealing.

MAny EM jobs are "no work, no pay" so if you're sick, you find a swap or suck it up and go to work. I've missed one day in 15 years. We all got a kick out of watching one of our partners roll around on one of those knee scooters after rupturing his quad tendon and taking care of patients looking for work notes for their stiff backs.

It's only one year for a sports fellowship. I would consider, do you think you are too old to be accepted??

 

[WilcoWorld]

I think it's great that the OP is keeping an open mind and considering other options. I just want to say that EM Docs are not a great source of advice on other fields, with the exception of posters like @Birdstrike and others who actually work non-EM jobs.

 

[GatorCHOMPions]

It's only one year for a sports fellowship. I would consider, do you think you are too old to be accepted??

Sports medicine is relatively saturated and doesn’t pay too well. I looked into it when debating on my next move. It seems the typical candidates are FM or PMR who use it to complement their outpatient clinic. Stand-alone SM is tough to find from what I understand. I know a few EM-SM docs who ended up in very unique combined jobs but that is the exception.

 

[miacomet]

Sports medicine is relatively saturated and doesn’t pay too well. I looked into it when debating on my next move. It seems the typical candidates are FM or PMR who use it to complement their their outpatient clinic. Stand-alone SM is tough to find from what I understand. I know a few EM-SM docs who ended up in very unique combined jobs but that is the exception.

Yep. Which brings us back to Pain, which is also saturated in many areas and really hard to get, palli, addiction.

I know @namethatsmell says EM docs are working in the ER because that's our choice, but I just never found an exit, and I looked hard.

 

[WorkNoteEmergency]

It's only one year for a sports fellowship. I would consider, do you think you are too old to be accepted??

Probably, but definitely too old to do full time fellowship training. I only want to work at most 5 more years anyway. Looking into some self taught concierge longevity type medicine now. Not as sexy as EM but definitely better for my longevity!

 

[CCM-MD]

I wouldn't recommend CCM. Things might be really good right now but it has all of the same issues as EM: midlevels, corporate staffing etc. Same with hospitalist and anesthesia - they have the same issues. Strongly recommend pursuing a specialty that is not totally dependent on the hospital and allows for self employment. I think surgical subspecialties and outpatient focused IM subspecialties will remain a good option long term.

 

[CoolWhipp]

anything with that can be kitchen scheduled is at risk.

 

[miacomet]

Wander over to the psych thread, they seem happy and remunerated

 

[Techmed07]

Psych has mid levels to deal with.

 

[miacomet]

Psych has mid levels to deal with.

So? You can still hang out your own shingle

 

[namethatsmell]

Yep. Which brings us back to Pain, which is also saturated in many areas and really hard to get, palli, addiction.

I know @namethatsmell says EM docs are working in the ER because that's our choice, but I just never found an exit, and I looked hard.

It doesn’t necessarily have to be clinical.
One option, that you can start tonight, is to go on indeed, ziprecruiter, LinkedIn etc and just apply to anything you could possibly find interesting/chill/fulfilling..force yourself to apply to 5-10 a day. Have no expectations and expect to be ghosted a lot. You can slowly expand your network, learn about new fields, and hopefully open some new doors. If nothing else, every time you put yourself out there it gets a little easier and you’ll feel more polished. And the more opportunities you get to sell yourself (and look at your skill set on paper), the more you’ll realize just how qualified you are do to LOTS of things outside the ED.