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  • Specialty Switch

    I am a boarded internal medicine doc who has practiced as a hospitalist for several years, unhappy with career. I am thinking of going through ER residency for a lot of different reasons, probably should have done it to begin with.   I would have to give up about 500-600k in opportunity cost to go through another residency. This is an important consideration, but I think the financials would work out in the long run as ER seems to pay quite a bit better.   Sometimes it seems like the idea is too crazy.  Has anyone known of anyone who has done this?   Yes I have considered fellowship in pulm crit, but would prefer to do ER.

  • #2
    I know of several physicians (clients) who have either done, are doing, or are planning the same. Clients who have made the change early in their careers are happier and it has worked out financially but it depends upon your situation and your goals. Going from a lower-income position to a higher-income position, in general, works out ok. Again, in general, it is better to make a change than to be unhappy in your career. This assumes, of course, that your happiness with your current work isn't fixable any other way (i.e. by changing employers).

    You might want to have a session with Dr. Heather Fork at Doctor's Crossing before you make up your mind (NOTE: I get no compensation or in-kind referrals for mentioning her name). Her practice offers career transition advice to physicians just like you.

    Financially, you might want to consider a limited purpose (as opposed to ongoing planning) financial checkup with a fee-only financial planner to map out your future financial picture both with and without making a change.
    Our passion is protecting clients and others from predatory and ignorant advisors. Fox & Co CPAs, Fox & Co Wealth Mgmt. 270-247-6087


    • #3
      I know a handful of people that have made career switches. This is done all the time imho, though rarely discussed during medical school studies. One of my ophto attendings as a med student had been an IM attending who realized he really wanted to do Opthalmology after already being in practice.
      I have friends that have changed careers.
      To your question, I know of an oncologist who realized he really wanted to pursue EM—the hospital recognized one year of training or so. He is now an ER attending. You can read his bio here
      Opportunity cost should not be a big factor if the alternative is quitting medicine for good because you are miserable in your current job.


      • #4
        I wouldn’t think twice if that’s what you want to do

        3 years is less than many IM sub specialties

        Just look at it like you’re doing a fellowship.


        • #5
          is the ED pay that much better than hospitalist where you are?  are you sure it's a career thing versus a specific job thing?

          what is it about ED that is so enticing versus critical care or staying in hospitalist?

          i know people who have done it, to answer your question.  i don't think they were specifically as unhappy in their job as you describe, but rather had a passion to do something else.

          do you have interests outside of medicine?  can you just cut back your hours a little and find some happiness outside hospital?   sabbatical?

          600k is a lot to give up during your accumulation years.  it's probably like committing to work 3 extra years after compounded interest considerations.   burnout rates in ED on surveys remain high.

          but i'm a fan of doing what makes you happy.  i just hope you are happier with this plan than currently.

          good luck.




          • #6
            Depending on where you are, if you're rural enough you can get ER jobs as FM/IM. Just need ATLS. You'd have to probably brush up on some bedside procedures though.


            • #7
              Can't you cross apply some of your IM training and maybe finish in 2 years? Basically eliminate MICU months and a couple others. I'm not sure when you trained or how long the training years are good for certification.


              Here is another boarding way to go about it. You could get certified after practicing ER after 5 years. Certainly that would limit where you could practice, though.

              Also, I'm wondering if you could pick up weekend hospitalist work to support your income during training years.


              • #8
                I'm guessing youre burnt out. Can't you find a different job that you would enjoy?


                • #9
                  In a rural setting, I've worked with ED docs who were trained in FP, IM, CT Surg, Anesthesia, and Rheum.  Only the Rheum had re-trained before starting work in ED.  I'm not recommending it and would never do it; just noting the precedent.


                  • #10

                    Depending on where you are, if you’re rural enough you can get ER jobs as FM/IM. Just need ATLS. You’d have to probably brush up on some bedside procedures though.
                    Click to expand...

                    They would have to do much more than "brush up" on some bedside procedures.


                    • #11
                      This is never going to make financial sense, the opportunity cost is too great.

                      If you need to do this to be happy then that's a different story.

                      Keep in mind you're trading hospital-based shift work for hospital-based shift work. Not exactly sure that's the recipe for success. Just remember the paraphrased words of WCI, you'll work longer, have less stuff, or retire with less. There's no magic in this equation.

                      A word of wisdom from an APD who actually looks at residency applications -- assuming this is indeed the case, make sure that you present yourself as a happy warrior who has decided that IM just isn't for them. Occasionally we see one of 2 things: someone who is just miserable who appears on a trajectory to continue that way no matter where they work or (even more galling) someone who has decided that they need to get down to the ED and fix it.


                      • #12
                        I've always thought of ER shift work as much harder then hospitalist shift work.  The ER is busy when you would rather be home (dinner time, overnight) whereas hospitalists can arrange most of their shifts during the daytime (they are busy 9-5 pm).    There will always need to be more ER docs working on the weekends and nightime then 9-5, I think that gets old as you get older.  Plus all the social issues you deal with as a hospitalist show up in the ER but can even more difficult to manage without a case manager/social worker all  motivated to discharge the patient somewhere.   I agree with looking for another hospitalists job if you are unhappy in your current one.   Working for an urgent care center would be another way to see if you really like that er working environment.


                        • #13

                          I am thinking of going through ER residency for a lot of different reasons, probably should have done it to begin with
                          Click to expand...

                          It would be easier to give specific, concrete advice if you were able to share what these reasons were.

                          ED can certainly pay better, but the burnout rate is probably higher. If money were the most important consideration, you can almost always work more shifts/see more pts as a hospitalist for more money. Sounds like that's not really feasible though.

                          I agree that it'd be much easier to find a different hospitalist job, than go through a whole new residency. Be aware that residency programs probably can't shave an entire year off for prior experience in IM - expect maybe 3-6 months at most, which is still better than nothing.


                          • #14
                            There isn't enough money in the world to make me repeat residency but to each their own. One of the best psych attendings started out in family medicine for a few years before going back to do a psych residency. She has been very happy with the switch, going on about 15 years now. Do what makes you happy.


                            • #15
                              More then half our ER docs are IM or FP trained.

                              Residency again would be tough.

                              Maybe a job switch is all you need.

                              Urgent care?