What else can I do as a board certified EM Doc?

[tenfootsilence]

I used to lurk around here constantly as a medical student and learned alot... Now I am 3 years into my career, passed boards, love where I live and just realize that EM is just not a lifestyle I want to grind for 30+ years. Yes, I knew what I was getting into (family and friends as EM docs), but honestly you just cant really know until you do it for a bit.

Dont get me wrong, I DONT hate it, but now that im getting over my post residency jitters, I am just being honest with myself and realize its not for me in the long term. I really hope im not whining cause I dont mean to at all, and am happy to continue doing it for a time, but just want to start working at an exit strategy.

MY QUESTION IS:

What other options are out there as reasonable alternatives.... and what is the best way to pursue them. I know there is urgent care, but that seems like the only real option without further residency training (although I saw that Birdstrike did pain after reviewing a thread lower down which I have considered).

I am sure there are PLENTY of threads on here about this but the search function seems to bring up some outdated stuff/difficult focusing just on what other jobs are available. I am happy to stay in medicine in some capacity and would actually like to continue a few shifts a month for quite a while, but am interested in working my way out of it completely in 7-10 years and figure now is the time to start.

Any thoughts or links to other helpful threads appreciated.

For the record I am located in the southeast if that helps with advice. Thanks for any advice in advance!

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[deleted497653]

1. Administration - non EM admin jobs (not medical director) in the hospital- some admin positions require as little as 25% clinical duties with the rest admin. They will require you have prior supervisory experience so would need about three years lead time prepping for this. Can PM me if you need an example.

2. Academic such as medical school dean - a lot of these jobs seem like they never get advertised because they are good cush jobs that rarely become vacant. You could work fewer shifts as part of the job.

3. Work less shifts and be satisfied with less money

4. Do a fellowship and develop other non ER skills.

I am kinda in the same boat as far as realizing EM lifestyle and scheduling will not work long term. It’s not about pleasing those around you by staying in something you feel is not right for you. I used to look at colleagues and wonder if they can make it work, why can’t I? The answer is that we are all different. What matters is that you figure out a way to make a living with the skills you have or gaining otger skills. It’s your life.

 

[RustedFox]

Great original post.

Wow.

 

[deleted497653]

Great original post.

Wow.

 

[RustedFox]

I mean this sincerely.
Once you get into this game, its hard to get out.

In no part of my keystrokes do I mean mockery, sarcasm, or whatever.

Good on you, OP.

 

[Tenk]

Work less.

 

[Birdstrike]

without further residency training (although I saw that Birdstrike did pain after reviewing a thread lower down which I have considered).

It's the only thing I could come up with, where I could keep the same or better income and have a completely normal life (i.e. not working a single night, weekend or holiday shift ever again) while sacrificing only 1 year (fellowship). I, like you, knew I was going to have to get out far before retirement time, I just didn't know how and had trouble getting past the inertia of making a change.

I went into Interventional Pain with a leap of faith not knowing how it would turn out. It could have failed and I might have been on to plan B, C or D. But despite the challenges and bumps in the road, and the fact that it's clearly not for everyone, it's worked out well for me. My life is much better and I feel I can work as long as I need to or am physically able to.

The biggest thing I needed, and it looks like you're very close to getting, is the courage to make a change. It's a very scary thing to do. But once you realize that even if your escape plan fails, you always have your EM training and board certification to fall back on, there's not nearly as much risk as you think. Mainly, it's the fear of the unknown. Also, I needed the determination to push past the inertia of staying in my comfort zone and to force myself to decide what that change was going to be.

I was very lucky to get a fellowship spot, to begin with. Then, when I did, there was tremendous stress leading up to it, mostly financial and trying to figure out how to move my family to an expensive city, pay for a new life in a new city, while paying for our home back home, during a year I took an 80% pay cut. Once I found a way to make the finances work (barely) it started to come together, but I'll admit, it was incredibly heartburn inducing. Then, once I realized that if I hated it, even a few weeks or a month in, that I could just say, "F--- it," quit and move back home to my old job and start making EM money again until I came up with plan B, then I took the leap.

Think about it. It's scary when you're hundreds of thousands in debt, in mid residency, the thought of quitting medicine is horrifying, knowing you have the debt with no way to pay it back and no high-income potential. But if you're leaping from a springboard of already having a specialty, board certification and a six figure income to fall back income, your options are much, much greater, than you realize. Your own comfort zone and inertia, are your biggest obstacles.

You just need the courage and determination to make the change you know you need to make, whatever that happens to be. If you're not sure you can do it, watch this interview (warning, salty language). It's an interview with a guy named David Goggins. He grew up poor and was beaten by his pimp father. By all odds, he should have failed and become a statistic. Yet somehow he found the courage and determination to become a Navy Seal, ultra-endurance athletic beast, best selling author and world record holder despite an unknown congenital heart defect which ended up requiring surgery. Aside from this thread, it's just a super cool story, from a super interesting person. Everyone should watch it. If Goggins can do it, you can do it.

 

[deleted547339]

Research? Work at an academic medical center and pursue a graduate degree, then transition into that role slowly.

 

[tenfootsilence]

Thanks for all of your input so far. I have thought about working less, and thought about the academic route but not sure I want to take the pay cut when im not sure I really even want to stay in EM in the long run. Probably will cut back in hours, but hoping to do so in order to spend some time pursuing other opportunities (once I decide what that may be). Grass isn't greener, I know that, but maybe a different shade that I can appreciate more is kinda my thought.

Birdstrike- I think you nailed it. My biggest problem right now is the fear/inertia of starting something new.... I mean I have essentially worked my entire adult life towards this goal of becoming a physician, so to think of possibly getting out already seems kind of asinine, ha. Thanks for your thoughts.... Once I decide what direction to go, its good to know it can be done.

 

[tenfootsilence]

Also- I thought about the just cutting back option..... but inevitably that prolongs my career if thats the only thing I try. Seems somewhat counterproductive and not to mention you lose alot of benefits doing that. But like I mentioned above, I probably will cut back some once I have an idea what else I want to work towards.

 

[precisiongraphic]

Ideas:
- Pain as Birdstrike outlined
- Hospice/palliative as @dchristismi has discussed
- Starting a Botox clinic and eventually hire NPs to work for you which you could do while continuing to work shifts as EM doc
- Insurance company work
- Legal firm work
- ELectrinic health records consulting - I have an MD friend who did this and now runs a consulting firm helping Doctors start new careers. Let me know by PM if you want contact information.
- MPH and research, admin or similar
- Pharmaceutical company consultant
- Sports medicine perhaps or occupational medicine
- Medical director for large corporation advising on expatriate medical care, emergency evacuation etc.
- Direct primary care or concierge doc

You have time to plan and to save up for transition costs, do research, work locums while working on side gig etc. You can engage a small business consultant or research start up options in your state/municipality. Decide if you really want to work for yourself and be an entrepreneur or if you want to work for someone else.

 

[Brigade4Radiant]

Without a fellowship nothing much that another board certified doctor in Family or Internal Medicine couldn’t do.

 

[d2305]

Family physicians don't have to work nights or treat derelicts, unless they want to.

 

[deleted206819]

Ideas:
- Pain as Birdstrike outlined
- Hospice/palliative as @dchristismi has discussed
- Starting a Botox clinic and eventually hire NPs to work for you which you could do while continuing to work shifts as EM doc
- Insurance company work
- Legal firm work
- ERM consulting - I have an MD friend who did this and now runs a consulting firm helping Doctors start new careers. Let me know by PM if you want contact information.
- MPH and research, admin or similar
- Pharmaceutical company consultant
- Sports medicine perhaps or occupational medicine
- Medical director for large corporation advising on expatriate medical care, emergency evacuation etc.
- Direct primary care or concierge doc

You have time to plan and to save up for transition costs, do research, work locums while working on side gig etc. You can engage a small business consultant or research start up options in your state/municipality. Decide if you really want to work for yourself and be an entrepreneur or if you want to work for someone else.

ERM or EMR consulting?

Would you mind if I sent you a PM as well?

 

[precisiongraphic]

ERM or EMR consulting?

Would you mind if I sent you a PM as well?

Electronic Medical records or EHR

Yes feel free to PM me.

 

[Porfirio]

I always laugh on the inside when I read these posts.

OP: I am tired and the work is hard. It is also not as interesting as it once was.
Others: Cut your hours.
OP: But I can’t take the pay cut.
Others: ...

OP, you ever work a job outside of medicine making $10-$20 per hour for more than two years? With the only prospects of going up to $20-$25 per hour? I am just curious.

 

[deleted859535]

I always laugh on the inside when I read these posts.

OP: I am tired and the work is hard. It is also not as interesting as it once was.
Others: Cut your hours.
OP: But I can’t take the pay cut.
Others: ...

OP, you ever work a job outside of medicine making $10-$20 per hour for more than two years? With the only prospects of going up to $20-$25 per hour? I am just curious.

Yes, we are in a fortunate position.

While we're being curious, just how early in your EM career are you?

 

[emergentmd]

EM medicine, like every other med field, Job, and essentially everything in life, is a pick 1 or 2 out of 3.

You want nice house in a nice neighborhood that is cheap? Not going to happen. Pick 2 of 3. Maybe get a nice house and cheap but won't be in a nice neighborhood.

You want a nice car, new, and cheap? Pick two of 3. You could get a nice car and cheap but it may be 20 yrs old.

Same with EM medicine. You want a good lifestyle, high pay, and control of your work schedule? Pick two of 3.
Give up high pay and I can tell you how to get a 9-5 job where you can control your work schedule.
Want High pay, then you may just be able to pick 1.

Why would anyone expect to Pick all 3? These jobs tend not to exist.

I make 400-500K for the past 15 yrs. I have to work alittle more hours and work some days/shifts that are not desirable.
If I wanted to make 100K, I could work 20 hours a week and avoid all weekends and nights.

99.9% of the world population would kill for out job/pay. KILL.

 

[miacomet]

We are, although I'm having a tough time with nights as I head to fifty, and an even harder time figuring out how to cut down on clinical.

I keep picking up more and more shifts to stash more and more cash, which doesn't help with finding an exit or a career sustainable into my sixties or seventies. Always impressed by Birdstrike, although that's not my path.

Sorry OP is feeling this way so early in their career.

 

[miacomet]

EM medicine, like every other med field, Job, and essentially everything in life, is a pick 1 or 2 out of 3.

You want nice house in a nice neighborhood that is cheap? Not going to happen. Pick 2 of 3. Maybe get a nice house and cheap but won't be in a nice neighborhood.

You want a nice car, new, and cheap? Pick two of 3. You could get a nice car and cheap but it may be 20 yrs old.

Same with EM medicine. You want a good lifestyle, high pay, and control of your work schedule? Pick two of 3.
Give up high pay and I can tell you how to get a 9-5 job where you can control your work schedule.
Want High pay, then you may just be able to pick 1.

Why would anyone expect to Pick all 3? These jobs tend not to exist.

I make 400-500K for the past 15 yrs. I have to work alittle more hours and work some days/shifts that are not desirable.
If I wanted to make 100K, I could work 20 hours a week and avoid all weekends and nights.

99.9% of the world population would kill for out job/pay. KILL.

Yes, tell us how to make 100k and no nights or weekends, or 9-5 with control of my work schedule...dying here...

 

[Apollyon]

I make 400-500K for the past 15 yrs.

$7million? And you're still working? That is anesthesia level scratch.

And, you have passive income still inbound from rental properties? Dude - what IS the end game, here?

 

[emergentmd]

Yes, tell us how to make 100k and no nights or weekends, or 9-5 with control of my work schedule...dying here...

There are locum sites that will schedule me am shifts only and no weekends. Not consistent, some months more and some less. But to achieve 100K is low for ER work - about 3 shifts a month.
There are Quick Care clinics opened 9-5 that I could work at.
You can do Workers comp clinics that are 9-5.

 

[emergentmd]

$7million? And you're still working? That is anesthesia level scratch.

And, you have passive income still inbound from rental properties? Dude - what IS the end game, here?

7 Mil is not alot of $$ when you consider 30% goes to uncle Sam. That leaves about 5 mil over 15 yrs. With kids, house, activities, private school, etc.... it snot like I have a brinks truck in my backyard.

If I sold all of my properties/home and live in an apt, I would prob have 3 mil in the bank but don't think my wife would go for that.

My end game is to have 300K in passive income so I won't have to touch any of my investments.

 

[Apollyon]

7 Mil is not alot of $$ when you consider 30% goes to uncle Sam. That leaves about 5 mil over 15 yrs. With kids, house, activities, private school, etc.... it snot like I have a brinks truck in my backyard.

If I sold all of my properties/home and live in an apt, I would prob have 3 mil in the bank but don't think my wife would go for that.

My end game is to have 300K in passive income so I won't have to touch any of my investments.

Well, good luck, and God bless. It's a lot better than the opposite!

 

[cyanide12345678]

7 Mil is not alot of $$ when you consider 30% goes to uncle Sam. That leaves about 5 mil over 15 yrs. With kids, house, activities, private school, etc.... it snot like I have a brinks truck in my backyard.

If I sold all of my properties/home and live in an apt, I would prob have 3 mil in the bank but don't think my wife would go for that.

My end game is to have 300K in passive income so I won't have to touch any of my investments.

I want to be like you when I grow up

My personal end game is a rental real estate empire, a diversified stock portfolio|, and early retirement in my 50s. EM is essentially the source of capital for my bigger entrepreneurial goals in life.

As for OP, I don't know why anyone would consider an urgent care over a very low volume ER. You still decent number of patients in UC, which means you still do a lot of charting which slowly sucks your soul. Now a 2k - 8k volume ER, now that's a vacation. I moonlight at a 3.5K Volume ER personally that pays $130/hr. Very good number for the volume. It doesn't feel like work. Every time I do a 24 hr shift there, I come home refreshed, well slept, energized, and amazed at how much I made for how little I did (for example - on my last shift I saw 7 pts in 24 hrs. I basically made $445 per patient). In the grand scheme, there may be a pay cut, but the happiness factor may increase significantly with such a relaxing job.

I personally will work at a busier higher paying place for a few years, set up side income streams during the time, and then transition into a relaxing 2k-6k volume ER.

 

[Porfirio]

Yes, we are in a fortunate position.

While we're being curious, just how early in your EM career are you?

Took me 11 years to get to where I am. Hard work, long hours, sacrifice, and only more to go. You might be on a different part of the road than me, but it’s the same road - brother/sister.

I only hope I never get into a position where I forget how grateful I am to be able to say “I worked hard, and I made X million(s) of dollars.”

 

[TheComebacKid]

OP: personal question that you can answer or not answer if you so choose. What are your expenses? Loans? Mortage? Kids?

Many, MANY people go the academic route, take a pay cut and still live comfortably. They may not have all the bells and whistles, but working in academics often comes with lots of benefits that you may not get in other settings i.e. independent contractor/CMG. That includes tuition benefits, matching retirement accounts etc. Will it all add up to what you make in the community? Not even close, but it may be worth it for a better quality of life.

Academicians work hard, but it's not the level of exhaustion that comes with working in the community and churning through patients. While fellowship is slowly becoming more and more a requirement for working in academics, plenty of people still find jobs in academics without a fellowship (depending on the program). Having residents write your notes, call consultants etc makes the work easier in some ways, but it still can be challenging feeling responsible for all the work that they do.

We have had many community attendings come back to the academic world and train residents/students, and overall they are very well received, bring a lot of expertise from their community experience, and they overall seem fairly happy to me.

Even if you come back to academics though, you still won't get the 9-5 job. If that's what you are seeking, the pain/palliative route is probably the way to go.

 

[namethatsmell]

Took me 11 years to get to where I am. Hard work, long hours, sacrifice, and only more to go. You might be on a different part of the road than me, but it’s the same road - brother/sister.

Uh huh. I wouldn't get too comfortable simplifying things. By your logic, we could say all humans are on the same road. Does that mean we all have the same levels of experience and insight?

To your earlier point, I agree that if you develop a lifestyle that requires working a ton to support it you're digging your own grave. But that's different than what people are talking about on this thread.

 

[Birdstrike]

99.9% of the world population would kill for out job/pay. KILL.

No, 99.9% of the world population would not kill for our jobs. Because our job requires thousands of hours of extremely difficult and brutally competitive school & studying foreplay they don't want to go through. That 99.9% of the population has already said, "No thanks. I'll take the quickie."

 

[Birdstrike]

I only hope I never get into a position where I forget how grateful I am to be able to say “I worked hard, and I made X million(s) of dollars.”

I hope you don't either. Some work is emotionally & physically taxing enough, that no amount of money can put water on the burn. The whole point of this forum is to take what other people are saying and use that information to avoid certain pitfalls and make a better future for yourself than you'd otherwise have without that information. If you just dismiss what they're saying out of hand as ridiculous and without merit, you'll often miss very valuable insights that you can use to your advantage. You don't have to agree with everything everyone posts on everything, and not every post is great, but try to look a little deeper. You can learn a lot from what people are posting here, especially from the ones you disagree with.

 

[miacomet]

No, 99.9% of the world population would not kill for our jobs. Because our job requires thousands of hours of extremely difficult and brutally competitive school & studying foreplay they don't want to go through. That 99.9% of the population has already said, "No thanks. I'll take the quickie."

Exactly. People think we are privileged. Maybe, but we also work hard and work at night. And no one says thank you. I would kill to be enabled, but sadly some of us have to enable everyone else.

 

[GonnaBeADoc2222]

Exactly. People think we are privileged. Maybe, but we also work hard and work at night. And no one says thank you. I would kill to be enabled, but sadly some of us have to enable everyone else.

I feel pretty privileged to be born into the situation I was where I didn't have to worry growing up, and had the time and support to succeed academically. I think that was absolutely crucial to me getting to the point I am at now.

However, like all of us, I worked my butt off in college and medical school, and sacrificed a lot during residency. I took on debt and deferred income while my college friends took high paying jobs directly after graduation.

Like most of us, I work nights, weekends, and holidays. We are responsible for a lot. I don't sit around and passively collect 400k, I work for a living, and I think we deserve the level of income we generate.

In terms of "finding something else do do with EM," I think sometimes it's easy to fall into the trap that the grass will be greener elsewhere just because your current job isn't perfect. After looking around a bit at a couple different groups (albeit in a crappy paying city) and even thinking about fellowship, I've realized that my current gig is actually really nice. It's not perfect, but the pay and schedule are great. When it comes down to it, a job is a job...they call it a job because they have to pay you to do it.

Sent from my SM-G928V using SDN mobile

 

[GatorCHOMPions]

OP, do not underestimate the effects of academics on wellness. I get paid just about the average salary for the region (~220/hour) and have residents for 90% of my shifts. Not only do they take care of many of the mundane and annoying tasks in the ED, but they're fun to have around to teach and be a role model to. You may find being in an academic environment is reinvigorating. If you're concerned about being roped into research/non-paid activities, there are jobs out there where the only non-clinical work expected is a few lectures per year. Plus most of these jobs have great benefits (401k match, big CME dollars) with lower hours to be considered full time. Mine is about 124 hours per month which is around the average. You just need to search and find the right fit.

You say you love where you live, so there is certainly a disconnect between your job and the rest of your environment. Being a physician is a career for the long haul. We didn't waste our 20s/30s wading in mounds of debt only to bow out after a few years. I think a major cause of (your) EM burnout is the lack of control over working conditions and the "clock in, clock out" shift work mentality. I suggest you find an EM job where you feel more inspired and emotionally invested. Hint: not a CMG. If academics doesn't suit you, look for small democratic groups. They are working for the greater goal of their group's success. You never hear these guys as frustrated as most on this forum (until they're bought out by the CMG). If none of those exist around you, consider true locums where you just work when you want to. Don't give up on EM just yet.

 

[emergentmd]

No, 99.9% of the world population would not kill for our jobs. Because our job requires thousands of hours of extremely difficult and brutally competitive school & studying foreplay they don't want to go through. That 99.9% of the population has already said, "No thanks. I'll take the quickie."

OP is an attending, likely makes 300K working 35-40 hrs/wk.

I am not taking into account what he sacrificed to get to this point b/c its already done. Also, you have no clue what others have to go through in the world to just put food on their table/survive constant violence. But what he sacrificed is not relevant. My point is 99.9% would kill to make 300K working 35-40 hrs.

300K/yr puts Op in the 99% of the US population. 300K/yr would put him in the 99.999% of the world income (50K is 99% in this world).
And this is to work 35-40 hrs.

If OP walked through Asia, Africa where most of our population is, I would bet he would not find 1 in 1000 that he would trade jobs with.

I would not trade my job for any of my childhood friends or anyone I am close with today. Its extremely difficult to make 300K working 35 hrs a week.

 

[deleted497653]

OP is an attending, likely makes 300K working 35-40 hrs/wk.

I am not taking into account what he sacrificed to get to this point b/c its already done. Also, you have no clue what others have to go through in the world to just put food on their table/survive constant violence. But what he sacrificed is not relevant. My point is 99.9% would kill to make 300K working 35-40 hrs.

300K/yr puts Op in the 99% of the US population. 300K/yr would put him in the 99.999% of the world income (50K is 99% in this world).
And this is to work 35-40 hrs.

If OP walked through Asia, Africa where most of our population is, I would bet he would not find 1 in 1000 that he would trade jobs with.

I would not trade my job for any of my childhood friends or anyone I am close with today. Its extremely difficult to make 300K working 35 hrs a week.

What people are saying is that despite Emergency medicine being a good way to make a lot of money while not having to work much, it is not what they want to do until they retire. Telling someone to be satisfied with something they aren't satisfied with is not helpful either. Everybody values different things as far as quality of life. However, we all value a roof over our heads and to take care of out families. The OP and others like myself are trying to find a respectable way out of or around Emergency medicine that can still afford a normal lifestyle. It doesn't make us bad people that we are making 300K and still want something "better".

 

[miacomet]

What people are saying is that despite Emergency medicine being a good way to make a lot of money while not having to work much, it is not what they want to do until they retire. Telling someone to be satisfied with something they aren't satisfied with is not helpful either. Everybody values different things as far as quality of life. However, we all value a roof over our heads and to take care of out families. The OP and others like myself are trying to find a respectable way out of or around Emergency medicine that can still afford a normal lifestyle. It doesn't make us bad people that we are making 300K and still want something "better".

Totally. Although (pain aside) most non-EM jobs are a bit of a pay cut. Unfortunate, but true. If it's easier, it's probably going to pay less. Not sure how to address that.

 

[deleted547339]

OP, do not underestimate the effects of academics on wellness. I get paid just about the average salary for the region (~220/hour) and have residents for 90% of my shifts. Not only do they take care of many of the mundane and annoying tasks in the ED, but they're fun to have around to teach and be a role model to. You may find being in an academic environment is reinvigorating. If you're concerned about being roped into research/non-paid activities, there are jobs out there where the only non-clinical work expected is a few lectures per year. Plus most of these jobs have great benefits (401k match, big CME dollars) with lower hours to be considered full time. Mine is about 124 hours per month which is around the average. You just need to search and find the right fit.

You say you love where you live, so there is certainly a disconnect between your job and the rest of your environment. Being a physician is a career for the long haul. We didn't waste our 20s/30s wading in mounds of debt only to bow out after a few years. I think a major cause of (your) EM burnout is the lack of control over working conditions and the "clock in, clock out" shift work mentality. I suggest you find an EM job where you feel more inspired and emotionally invested. Hint: not a CMG. If academics doesn't suit you, look for small democratic groups. They are working for the greater goal of their group's success. You never hear these guys as frustrated as most on this forum (until they're bought out by the CMG). If none of those exist around you, consider true locums where you just work when you want to. Don't give up on EM just yet.

You’re making 330k doing 124h/mo in academia?? Need more docs??

Or is that including all of your benefits?

 

[miacomet]

You’re making 330k doing 124h/mo in academia?? Need more docs??

Or is that including all of your benefits?

Ugh. 124 a month is too much, unless there are minimal nights and weekends.

 

[GatorCHOMPions]

You’re making 330k doing 124h/mo in academia?? Need more docs??

Or is that including all of your benefits?

Ugh. 124 a month is too much, unless there are minimal nights and weekends.

Slightly less than 330k but I include some vacation when I say 124 hours. And yea less than average nights/weekends.

 

[alpinism]

Have to agree with emergent on this one.

Its surprisingly easy to find locums day shifts at good rates.

Pick up 5 shifts per month and you can make 100K with literally 25 days off every month.

 

[chudat]

Have to agree with emergent on this one.

Its surprisingly easy to find locums day shifts at good rates.

Pick up 5 shifts per month and you can make 100K with literally 25 days off every month.

wowzers

 

[miacomet]

Have to agree with emergent on this one.

Its surprisingly easy to find locums day shifts at good rates.

Pick up 5 shifts per month and you can make 100K with literally 25 days off every month.

Wow. I must be doing it wrong. Everywhere, I mean everywhere, has insisted on nights.

 

[thegenius]

MY QUESTION IS:

What other options are out there as reasonable alternatives.... and what is the best way to pursue them. I know there is urgent care, but that seems like the only real option without further residency training (although I saw that Birdstrike did pain after reviewing a thread lower down which I have considered).

You can be a cosmonaut.

 

[Old_Mil]

I always laugh on the inside when I read these posts.

OP: I am tired and the work is hard. It is also not as interesting as it once was.
Others: Cut your hours.
OP: But I can’t take the pay cut.
Others: ...

OP, you ever work a job outside of medicine making $10-$20 per hour for more than two years? With the only prospects of going up to $20-$25 per hour? I am just curious.

To be pretty blunt about it, people with the intelligence and drive to get though medical school aren't people who are going to sit around earning 10-20 dollars an hour. Some retraining or another degree may be required.

Heck, take the LSAT, go to law school, and instantly become the best med Mal lawyer in town.