Life changing decision... advice needed!

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Streptococcus
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Life changing decision... advice needed!

Post by Streptococcus » Wed Nov 26, 2014 1:12 am

Bogleheads,
I have to make a life changing decision and your inputs, advices, critiques are greatly appreciated.
After working for several years as a general practitioner, making >300K/year, I'm thinking about quitting my current job and pursuing a 3 year fellowship that will pay about 55K/year. I always thought that this decision would be straight forward but now that the match is upcoming, I have to admit that I'm torn.

Here are the pros for forgoing fellowship and staying at my current job:

- with my current income rising, I would be able to meet my investing goal in 8 years (my IPS tells me to pour 1.5M in the market, goal that would be met in 8 years, then forget about it for 15-20 years, meanwhile work part-time 2-3 days/week and enjoy life); going to fellowship, with the gross salary cut that would ensue would extend that projection by 3-5 years, maybe more.
- As a general practitioner, I enjoy a great relationship with my patients, low liability risk (knock on wood!!), great lifestyle, I live in a very safe area and the social aspect is great.
- When it comes to retirement, physicians are handicapped by their long education and late start in the work force. I started out late and I don't know if it would be wise to hold on 3 more years.
- The money that you make today is more important than the same amount of money made tomorrow because you can put it to work for a longer time.

Here are the pros for going to fellowship (emergency medicine) /quitting my job

- I love being a practitioner but I prefer my emergency medicine. So this is a typical case where my career fulfillment requires me to pursue a fellowship, but it may not be a sound financial decision.
- did I say that I love emergency medicine?
- It will be easier for me to work part-time (2 days a week) after I hit my number
- I would be more marketable than a general practitioner

I know this is a personal decision, but I think it will be inspiring and helpful to hear what you think and would do in my place.
Thanks

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celia
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Re: Life changing decision... advices needed!

Post by celia » Wed Nov 26, 2014 1:22 am

Please clarify: After a 3-year fellowship, will you be practicing as an emergency room doctor at a higher or lower salary than now? I look at the 3 years as a break for education during what otherwise is a high paying profession if I understand this correctly. If this is correct, will you be hitting "your number" after the same number of working years or before (not counting the 3 years of fellowship)?
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Re: Life changing decision... advices needed!

Post by lululu » Wed Nov 26, 2014 1:24 am

If emergency medicine is what you really love, I would go for it. The only job decision I regretted was once when I took one with a bundle of money over the more interesting one. You only live once, unfortunately.

You don't sound like you're that old - thirties, maybe? So another 3-5 years does not sound like a giant impact, esp. looking back at life from my seventies.

One caveat. I've been in the local ER a few times. The doctors there seem exhausted. My impression is that they work very long shifts and wind up exhausted. If that's standard, have you experienced that?

Streptococcus
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Re: Life changing decision... advices needed!

Post by Streptococcus » Wed Nov 26, 2014 1:30 am

celia wrote:Please clarify: After a 3-year fellowship, will you be practicing as an emergency room doctor at a higher or lower salary than now? I look at the 3 years as a break for education during what otherwise is a high paying profession if I understand this correctly. If this is correct, will you be hitting "your number" after the same number of working years or before (not counting the 3 years of fellowship)?
I'm not likely to make the same income as an emergency physician during the first couple of years post-graduation (5 years from now). I may not ever make the same money. If I stay at my current job, with all the bonuses and practice building I will likely hit 400K in 1 or 2 years. This is not income that pediatric emergency physicians make, unlike adult emergency physicians.
Therefore, money wise, It does not appear the best of the 2 options, but I value it as a better, more rewarding career. But it also extend my investment due date.

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dumbbunny
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Re: Life changing decision... advices needed!

Post by dumbbunny » Wed Nov 26, 2014 1:33 am

Streptococcus wrote: ...with my current income rising, I would be able to meet my investing goal in 8 years (my IPS tells me to pour 1.5M in the market, goal that would be met in 8 years}...When it comes to retirement, physicians are handicapped by their long education and late start in the work force. I started out late and I don't know if it would be wise to hold on 3 more years.
Is that what you mean to write - is it 3 or 8?
My knee-jerk advice is to follow your passion - life is short. You can always tweak your plan if it doesn't work out.
Last edited by dumbbunny on Wed Nov 26, 2014 1:48 am, edited 1 time in total.
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Streptococcus
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Re: Life changing decision... advices needed!

Post by Streptococcus » Wed Nov 26, 2014 1:36 am

lululu wrote:If emergency medicine is what you really love, I would go for it. The only job decision I regretted was once when I took one with a bundle of money over the more interesting one. You only live once, unfortunately.

You don't sound like you're that old - thirties, maybe? So another 3-5 years does not sound like a giant impact, esp. looking back at life from my seventies.

One caveat. I've been in the local ER a few times. The doctors there seem exhausted. My impression is that they work very long shifts and wind up exhausted. If that's standard, have you experienced that?
Yes, there is a lot of burnout in emergency medicine; mainly in adult emergency medicine as they are way busier than us. But there has been a trend to reduce the shift hours. Many peds EM now work 8 hours shifts instead of the 12 hours from a few years ago.

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celia
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Re: Life changing decision... advices needed!

Post by celia » Wed Nov 26, 2014 1:39 am

If married, your spouse's input should be strongly considered. He/she knows things about you that we don't know.
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bertie wooster
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Re: Life changing decision... advices needed!

Post by bertie wooster » Wed Nov 26, 2014 1:39 am

A bird in hand...

(and in this case the bird is worth potentially 400k/yr!)

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BolderBoy
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Re: Life changing decision... advices needed!

Post by BolderBoy » Wed Nov 26, 2014 1:43 am

How old are you?

basspond
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Re: Life changing decision... advices needed!

Post by basspond » Wed Nov 26, 2014 3:11 am

Ask yourself why didn't you pursue this path when you started your career? People are human so you will lose those personal relationships you have with your patients. But if this is your passion and you are not satisfied and your motivation is waning, than go with your heart.

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Sents
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Re: Life changing decision... advices needed!

Post by Sents » Wed Nov 26, 2014 3:19 am

When you are on your death bed will you regret not having the extra money or not following your passion?

You will be fine financially either way so do what you love.
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Re: Life changing decision... advices needed!

Post by IndexMD » Wed Nov 26, 2014 5:51 am

Some general practitioners moonlight or pick up shifts in EDs. Have you done this?

The reason I ask is the aspects of your career that you appreciate: a substantial (and rising) income, great relationships with your patients, and a great lifestyle may all be jeopardized by switching to Emergency Medicine (burnout rates in EM are real and you love your career as is). Furthermore, as you mentioned - your earnings will undoubtedly decrease as a pediatric EM doc. And probably even as an adult EM physician.

Plus, I'm not sure exactly what you said about the pros of switching are necessarily true: I don't think it's that difficult to work 2 days a week as a GP in the twilight of his/her career and both GPs and ED MDs are highly desired (I'm assuming you're in the US, of course).

You stated you love both being a GP and emergency medicine. So the two sides of the scale as I see it are: stick with a job you love, hit your number earlier, and retire earlier vs take a huge pay cut to specialize in something else you also love, take a pay cut down the road, and undoubtedly retire later. Obviously you seem to be like many of us and "retire" is more like "slow down slightly".

From a younger MD to a (slightly) older MD - I think you have a good thing going and would avoid switching. But, then again, I don't like Emergency Medicine (which is why I ask if you've spent much time in the ED), so it's safe to say you can take my advice with a grain of salt. Plus, I would have a hard time going from 300k+/yr to 55K/yr, even for three years. I say this as someone who has never been accused of lifestyle creep.
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Re: Life changing decision... advices needed!

Post by carolinaman » Wed Nov 26, 2014 6:36 am

It seems you have two good options. Whichever you choose, you will be fine. However, you have strong preference for emergency medicine. To pursue that will delay your reaching your investment goal by 3 to 5 years. Which is most important to you? It sounds like EM is but you must decide. I would advise you to take a long term view of this to decide which is best. How will you feel in 10 to 15 years with each of these choices. Once you decide, go for it and do not look back.

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Re: Life changing decision... advices needed!

Post by Jack FFR1846 » Wed Nov 26, 2014 7:06 am

Boy, you really have good options. Work where you are for 3 years (minimum) and your retirement is very well set. Then go to the ER and do what you *think* you really want to do. Be careful because the grass is always greener and all..... You may burn out from the ER work and long the easy, high pay of the GP work after some years.

I like the idea of taking on some part time ER work. Try that for a while....your weekends are free, right?

That being said......there are downsides to ER work. You'll likely start on weekends/nights until you build up seniority there. Doing per diem might be the way to go as you can always refuse shifts.
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Streptococcus
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Re: Life changing decision... advices needed!

Post by Streptococcus » Wed Nov 26, 2014 8:52 am

Thank you everyone for your replies. This is precisely what I needed: a different perspective from different people to get unstuck. I will greatly appreciate further comments.
Peterjens wrote:
Streptococcus wrote: ...with my current income rising, I would be able to meet my investing goal in 8 years (my IPS tells me to pour 1.5M in the market, goal that would be met in 8 years}...When it comes to retirement, physicians are handicapped by their long education and late start in the work force. I started out late and I don't know if it would be wise to hold on 3 more years.
Is that what you mean to write - is it 3 or 8?
My knee-jerk advice is to follow your passion - life is short. You can always tweak your plan if it doesn't work out.
3 years is the fellowship; 8 years is the projected time to hit my number and start working 2-3 days/week if I stay at my current job.
celia wrote:If married, your spouse's input should be strongly considered. He/she knows things about you that we don't know.
My spouse thinks that I should go to fellowship because we will be fine anyways, even if the goal is delayed. That is true, but money made today has more value than money made in the future. I am not likely to have the same income (300-400K/year) in the next 4-5 years. The investor in me sees many years of lost investing opportunities. But the physician in me sees a great career opportunity.
BolderBoy wrote:How old are you?
40
Sents wrote:When you are on your death bed will you regret not having the extra money or not following your passion?

You will be fine financially either way so do what you love.
I doubt I will have that type of regret on my dead bed whichever decision I make. I view both as acceptable options, hence, my indecision. Or maybe I'm wrong.

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Re: Life changing decision... advices needed!

Post by Zecht » Wed Nov 26, 2014 10:06 am

Some physicians choose to work very well into their retirement years (I know a few in their late 60s) simply because they love it and are still physically capable of doing that sort of work. Given that you are 40 and would be 43 getting into emergency medicine, you should consider how long you want to do that. Some people prefer slower work environments later on in life and others crave more action, you sound like the latter type.

I would recommend you looking at what your contributions would be from now until your target retirement age, and see what the difference is (assuming the standard retirement calculator methodology). Once you see that number, you should think if that's something you want to live with, or how many extra years of work you would want to do if you switched to emergency medicine. Hope this helps.

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Re: Life changing decision... advices needed!

Post by Artsdoctor » Wed Nov 26, 2014 10:40 am

Streptococcus,

As you probably are seeing, primary care is becoming increasingly onerous from an administrative point of view. You can buffer yourself with administrative assistants but there's no doubt in my mind that primary care will become increasingly burdensome as bureaucratic requirements increase. I doubt you will continue making that salary as reimbursements are certain to decrease, and if you do, you will almost certainly have to work harder for it. You sound like someone who truly likes spending time with patients, and this is sure to be challenged in the coming years.

Your financial situation sounds very secure. If you've completed your investment contributions by the time you're 50, you will be further ahead than most physicians (most people, for that matter).

If doing your fellowship is what you want to do, you should do it. Your ER shifts might be difficult (when I was 40, working at night didn't bother me but now that I'm in my mid-50s, no way!), but if you really want to do it, you'll have a lot more flexibility than you do now.

If your spouse supports your decision, I say go for it.

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Re: Life changing decision... advices needed!

Post by Lafder » Wed Nov 26, 2014 10:47 am

Wow, where do GPs make over 300k/year ? (You don't have to answer this! It just seems high compared to where I live)

I think the idea of picking up shifts in ERs to be sure you like the work is a good one.

Being an ER resident/fellow for 3 years puts you lower on the pecking order and the hours will suck. But, after 3 years you will have the certification and training to do what you seem to want to do.

My med school roommate did surgery first, switched to FP midway, then ended up being an ER doc who was able to take boards and be certified even though he had never done an ER residency. (I think this is no longer an option to just board in). He does a lot of locums work and makes more working half time than I do working full time.

Life is too short and you should do what you want. Just consider if there are ways to get what you want without making a 3 year full time commitment. And, if you end up not liking the residency, you can always quit midway with more ER training than you have now.

The impact on your family and free time will be huge. The 3 years pay difference will be made up over time and is not a good enough reason not to do it.

lafder

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Re: Life changing decision... advices needed!

Post by mpowered » Wed Nov 26, 2014 10:48 am

Emergency medicine would make your skills extremely desirable after the inevitable zombie apocalypse. If you haven't already considered that, maybe write that into the Pros column.

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Re: Life changing decision... advices needed!

Post by HomerJ » Wed Nov 26, 2014 11:00 am

johnep wrote:It seems you have two good options. Whichever you choose, you will be fine. However, you have strong preference for emergency medicine. To pursue that will delay your reaching your investment goal by 3 to 5 years.
Seems like it will be far more than that... More like 5-8 years.

OP, are you completely out of debt now with a decent nest-egg now? How long have you been making $300k? What are your expenses? Can you live on 55k without dipping into savings?
Last edited by HomerJ on Wed Nov 26, 2014 11:14 am, edited 1 time in total.

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HomerJ
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Re: Life changing decision... advices needed!

Post by HomerJ » Wed Nov 26, 2014 11:13 am

Streptococcus wrote:I would be able to meet my investing goal in 8 years (my IPS tells me to pour 1.5M in the market, goal that would be met in 8 years, then forget about it for 15-20 years, meanwhile work part-time 2-3 days/week and enjoy life); going to fellowship, with the gross salary cut that would ensue would extend that projection by 3-5 years, maybe more.
Okay,. you're 40... even at $300-$400k salary, it's going to take you 8 years to hit $1.5 million...

so that tells me you don't have much saved yet (compared to your salary)

Your original plan is to hit $1.5 million by 48, then work another 15-20 years part time (to 63-68)

If you take the fellowship, you won't hit $1.5 million until 53-55 probably... Are you still planning on working another 15-20 years part time after that (until 68-73)?

Like you said, doctors get a late start, and have to save hard off a high salary to make up for it... But you've just started saving, and now you want to delay saving for another 3 years, getting an even later start, and ending up with a lower salary to save from.

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Re: Life changing decision... advices needed!

Post by Streptococcus » Wed Nov 26, 2014 11:44 am

mpowered wrote:Emergency medicine would make your skills extremely desirable after the inevitable zombie apocalypse. If you haven't already considered that, maybe write that into the Pros column.
excellent point
HomerJ wrote:
johnep wrote:It seems you have two good options. Whichever you choose, you will be fine. However, you have strong preference for emergency medicine. To pursue that will delay your reaching your investment goal by 3 to 5 years.
Seems like it will be far more than that... More like 5-8 years.

OP, are you completely out of debt now with a decent nest-egg now? How long have you been making $300k? What are your expenses? Can you live on 55k without dipping into savings?
No school loans, no debt except for a mortgage with about 70K equity but we will sell the house when we move for the fellowship. We can definitely live and save off 55K. And my wife would be working too, making an additional 30-40K.
HomerJ wrote:
Streptococcus wrote:I would be able to meet my investing goal in 8 years (my IPS tells me to pour 1.5M in the market, goal that would be met in 8 years, then forget about it for 15-20 years, meanwhile work part-time 2-3 days/week and enjoy life); going to fellowship, with the gross salary cut that would ensue would extend that projection by 3-5 years, maybe more.
Okay,. you're 40... even at $300-$400k salary, it's going to take you 8 years to hit $1.5 million...

so that tells me you don't have much saved yet (compared to your salary)

Your original plan is to hit $1.5 million by 48, then work another 15-20 years part time (to 63-68)

If you take the fellowship, you won't hit $1.5 million until 53-55 probably... Are you still planning on working another 15-20 years part time after that (until 68-73)?

Like you said, doctors get a late start, and have to save hard off a high salary to make up for it... But you've just started saving, and now you want to delay saving for another 3 years, getting an even later start, and ending up with a lower salary to save from.
I spent the past few years building the practice and my income has been increasing steadily. I've been more established for the past 18 months and I have about 300K saved with a saving rate of 120-150K/year. So yes, I'm just starting.

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Re: Life changing decision... advices needed!

Post by mhalley » Wed Nov 26, 2014 12:15 pm

Many physicians work in the ED without being residency trained. While it is ideal to be residency trained, there are many more positions than there are residency trained, board certified physicians to fill them. While you would not be able to work in EVERY er out there, many ERs only require that you be board certified in a primary care specialty, plus have all of your merit badges (ATLS, ACLS and PALS).
The group I worked for in the past had a policy that they only hired board certified, residency trained physicians. They grandfathered me in because I was working there when the group came in (I am board certified in Family Practice). The result of this was that for the entire time they had the ER, we were understaffed. I had to work many more hours than I wanted, and they had to bring in people to moonlight, resulting in the ER never making enough money, to the point that they finally gave up and the hospital brought in another group with a less stringent hiring policy.
So I would suggest a third option: Get your merit badges, moonlight (either locally or as a Locums) for a year or so and see if you really like it enough to give up what sounds like a great practice. You can probably make about as much as you do now if you go full time. However, say goodbye to nights and weekends and holidays with your family.
O, you mention the word "fellowship". If this not an actual residency in emergency medicine, it is not worth it. You will do the job of an ER doctor and be payed like a resident. While you will get valuable training, you still will not be allowed to sit for the boards, and you still won't meet the criteria for those groups that want board certfied, residency trained ER docs.
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Re: Life changing decision... advices needed!

Post by lululu » Wed Nov 26, 2014 2:20 pm

Zecht wrote:Some physicians choose to work very well into their retirement years (I know a few in their late 60s) simply because they love it and are still physically capable of doing that sort of work.
I see a specialist who has to be 80 at least. It's quite nice seeing someone with that much experience.

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Re: Life changing decision... advices needed!

Post by Pajamas » Wed Nov 26, 2014 3:28 pm

My take is that this is not a financial decision but a life decision that has financial consequences. You will have an adequate income and can save for retirement in either outcome. The exact amounts may differ, but you will have enough either way.

So: Do what will make you happiest. If you don't do that, you will always regret it.

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Re: Life changing decision... advices needed!

Post by tallgirl1204 » Wed Nov 26, 2014 3:33 pm

Sents wrote:When you are on your death bed will you regret not having the extra money or not following your passion?

You will be fine financially either way so do what you love.
+1

Either way, your income will be very good compared to the general population, and you are apparently careful with your money, which also puts you ahead of the general population.

People who really like and are good at emergency medicine (although I know mostly ER nurses) seem to be a rare breed-- adrenaline junkies in a way. Is this what you're up for?

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Re: Life changing decision... advices needed!

Post by Streptococcus » Wed Nov 26, 2014 3:34 pm

Pajamas wrote:My take is that this is not a financial decision but a life decision that has financial consequences. You will have an adequate income and can save for retirement in either outcome. The exact amounts may differ, but you will have enough either way.

So: Do what will make you happiest. If you don't do that, you will always regret it.
good point

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Re: Life changing decision... advices needed!

Post by IndexMD » Thu Nov 27, 2014 9:50 pm

Did you see my post?
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Re: Life changing decision... advice needed!

Post by bubbadog » Fri Nov 28, 2014 12:08 am

I am a board certified ED physician with 18 years experience. I talk frequently with my friends from residency and the majority of us wish we had pursued other specialties. The reality of what we do most of the time is not "emergency medicine". Most of what we do is non urgent, primary care, chronic pain, and social work types of problems. I can go an entire shift without seeing anything that even remotely resembles a true medical emergency. I enjoy taking care of true emergency medical problems. The reality is that most of the time (>90%), that is not what you will be doing. I have worked at multiple different hospitals and the situation is the same at all of them. Please consider working some shifts before deciding on doing a residency. I worked for a group that would proudly announce that "We only hire board certified docs". The reality was that if we were short handed, which we almost always were, we would hire anyone who was board certified in primary care. The pay is fine. You would have no problem making 300k-500k. The other issue is the schedule. Most places I have worked nobody wants to do nights. The only fair way to handle this is to divide them up equally. A typical schedule of 16-18 shifts per month will be about 3-4 day shifts, 3-4 nights, and the rest afternoons (3-11pm). The nights would be in a row and the rest are randomly scattered throughout the month. It is very hard to go to bed and wake up at all different times of the day and night throughout the month. When I was thirty and no kids, not such a big deal. Now at age 48 and two kids, it is much harder. Another issue that my friends and I really did not appreciate when we we residents is that the ED is truly the "dumping" ground for the medical staff and the rest of the hospital. Go to the ER is the universal answer for every problem or problem patient regardless of whether or not they have a medical emergency. Please do not misinterpret my words as someone who does not love emergency medicine. I actually do for the 5-10% of the time that I am actually doing what I consider emergency medicine. You will have no problem finding opportunities part time working in the ED as a board certified primary care physician. I would strongly encourage you to work a bunch of shifts to see if the actual work matches your expectations. Emergency medicine is a truly noble profession. Taking care of patients for any problem, at any time day or night, regardless of their ability to pay is something to be proud of. Best of luck with your decision.

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kingsnake
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Re: Life changing decision... advice needed!

Post by kingsnake » Fri Nov 28, 2014 9:05 am

You spent the first bunch of years building up your practice...now that's it's full why not reap the rewards. You can certainly work in many EDs as is, so it sounds. Make hay while the sun shines!

In terms of finances though...to quote Taylor, there is more than one road to Dublin

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Re: Life changing decision... advice needed!

Post by desiderium » Fri Nov 28, 2014 9:16 am

Strep,

Think about this: How are you going to like doing a 3-year training program at this point in your career? You have lots of experience and will be under structured supervision, probably in many cases by people who have less clinical experience than you. I think you may suffer.

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Re: Life changing decision... advices needed!

Post by VictoriaF » Fri Nov 28, 2014 9:33 am

Jack FFR1846 wrote:Work where you are for 3 years (minimum) and your retirement is very well set. Then go to the ER and do what you *think* you really want to do. Be careful because the grass is always greener and all..... You may burn out from the ER work and long the easy, high pay of the GP work after some years.
That's my advice, too. Accept the current income and job satisfaction over the uncertainties of the alternative path's income and job satisfaction. You may even quantify the uncertainties of each path, for example as follows:

Remain in the current position:
1. Wealth
- Ability to provide financial security = 100%
- Certainty = 90%

2. Work Environment
- Satisfaction = 80%
- Proportion of good days = 60%

Total: 100% * 90% + 80% * 60% = 138%

Pursue emergency medicine:
1. Wealth
- Ability to provide financial security = 80%
- Certainty = 50%

2. Work Environment
- Satisfaction = 100%
- Proportion of good days = 50%

Total: 80% * 50% + 100% * 50% = 90%

You can tweak the labels, their meanings, and the corresponding numbers. You can also assign different weights to the categories of Wealth and Work Environment. The value of this process is not as much in that it will provide The Number, as that it will give you more clarity in what you really want.

This decision making approach is useful for all life changing decisions, including selection of the profession, educational path, employers, and dating and marriage.

Victoria
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Re: Life changing decision... advice needed!

Post by Watty » Fri Nov 28, 2014 10:49 am

A few things to think about;

1) How much disability insurance would you have during the years when you have the lower income? I am under the impression that insurers normally don’t like to provide disability insurance that is higher than your income but this might be a special case. If something permanent happened while your coverage was lower you could be in trouble.

2) Will you be able to meet all your expenses while your income is lower? If you have something like a large mortgage payment then you might have to dip into your retirement savings not just defer adding to it.

3) Will you be able to do Roth conversions while your income is lower? Is so that might help offset the reduced retirement savings.

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Re: Life changing decision... advices needed!

Post by Streptococcus » Fri Nov 28, 2014 11:31 am

IndexMD wrote:Some general practitioners moonlight or pick up shifts in EDs. Have you done this?

The reason I ask is the aspects of your career that you appreciate: a substantial (and rising) income, great relationships with your patients, and a great lifestyle may all be jeopardized by switching to Emergency Medicine (burnout rates in EM are real and you love your career as is). Furthermore, as you mentioned - your earnings will undoubtedly decrease as a pediatric EM doc. And probably even as an adult EM physician.

Plus, I'm not sure exactly what you said about the pros of switching are necessarily true: I don't think it's that difficult to work 2 days a week as a GP in the twilight of his/her career and both GPs and ED MDs are highly desired (I'm assuming you're in the US, of course).

You stated you love both being a GP and emergency medicine. So the two sides of the scale as I see it are: stick with a job you love, hit your number earlier, and retire earlier vs take a huge pay cut to specialize in something else you also love, take a pay cut down the road, and undoubtedly retire later. Obviously you seem to be like many of us and "retire" is more like "slow down slightly".

From a younger MD to a (slightly) older MD - I think you have a good thing going and would avoid switching. But, then again, I don't like Emergency Medicine (which is why I ask if you've spent much time in the ED), so it's safe to say you can take my advice with a grain of salt. Plus, I would have a hard time going from 300k+/yr to 55K/yr, even for three years. I say this as someone who has never been accused of lifestyle creep.
This is a great point. You are right that you can work 2 days a week as a GP. I have a colleague that does precisely that.

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Re: Life changing decision... advices needed!

Post by celia » Fri Nov 28, 2014 2:58 pm

VictoriaF wrote:. . .You can tweak the labels, their meanings, and the corresponding numbers. You can also assign different weights to the categories of Wealth and Work Environment. The value of this process is not as much in that it will provide The Number, as that it will give you more clarity in what you really want.

This decision making approach is useful for all life changing decisions, including selection of the profession, educational path, employers, and dating and marriage.
This is a terrific decision-making process. You can add more options to consider (eg, work part-time, volunteer in area of interest (low-income or 3rd world areas), build other sources of retirement income) and/or more categories to consider (although the original question is only comparing finances and job satisfaction, but maybe location, reputation, impact on family could be considered). Many of us have made lists of pros and cons, but not weighted the importance of each item.
A dollar in Roth is worth more than a dollar in a taxable account. A dollar in taxable is worth more than a dollar in a tax-deferred account.

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Re: Life changing decision... advice needed!

Post by A-Commoner » Fri Nov 28, 2014 4:00 pm

OP, you use the term GP to describe your field. Does this mean you finished med school but did not do residency training? If so, that would be very unusual anymore. It's very difficult to practice right out of med school without undergoing residency training (assuming you are in the US). Even primary care physicians (internists, family practitioners, pediatricians) have to go through residency training. The credentialing process to get on insurance provider networks and acquire hospital privileges forces one to be board-certified, and for that to happen, one must be residency-trained. The term GP is not used to describe these physicians. Just curious about your usage of terminology since I'm an internist myself and am aware of the distinction. Also, 300k income is high for a GP, you must have a high volume practice. I would not give that up to go to ER, but that's me. If your passion lies in ER work, go for it, compensation be damned.

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Re: Life changing decision... advice needed!

Post by letsgobobby » Fri Nov 28, 2014 4:04 pm

You've highlighted a lot of issues but one thing not discussed explicitly is: why, after years of training for general practice, and additional hard years building a practice: why after all those years are you wanting to change directions completely? I would ask yourself about the excitement of learning a 'new field' and the idea that you are ready to leave a budding and lucrative practice so soon after arriving.

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Re: Life changing decision... advices needed!

Post by letsgobobby » Fri Nov 28, 2014 5:10 pm

lululu wrote:
Zecht wrote:Some physicians choose to work very well into their retirement years (I know a few in their late 60s) simply because they love it and are still physically capable of doing that sort of work.
I see a specialist who has to be 80 at least. It's quite nice seeing someone with that much experience.
my dad is 79 and finally, finally retiring this year. He is extremely bright, and extremely sharp still, and his colleagues still turn to him for his experience and his advice. So I agree it's possible.

However I am 41 and already seeing that I am more tired than I was at 29 (when I finished residency). Kids growing up provide a huge competition for that most precious resource, time. I don't want to work as much as I used to. The opportunity to work part-time ASAP is very appealing to me. I'm trying hard to make it happen while letting the wife/family enjoy an enhanced lifestyle/fruits of our labors/ie, not depriving ourselves too much.

I agree the pie in the sky is working as a physician 2-3 days per week (or the equivalent - 7-10 days per month) forever. If I can do that, and have health care, I will drop full time work by 45.

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Re: Life changing decision... advice needed!

Post by Streptococcus » Fri Nov 28, 2014 5:20 pm

A-Commoner wrote:OP, you use the term GP to describe your field. Does this mean you finished med school but did not do residency training? If so, that would be very unusual anymore. It's very difficult to practice right out of med school without undergoing residency training (assuming you are in the US). Even primary care physicians (internists, family practitioners, pediatricians) have to go through residency training. The credentialing process to get on insurance provider networks and acquire hospital privileges forces one to be board-certified, and for that to happen, one must be residency-trained. The term GP is not used to describe these physicians. Just curious about your usage of terminology since I'm an internist myself and am aware of the distinction. Also, 300k income is high for a GP, you must have a high volume practice. I would not give that up to go to ER, but that's me. If your passion lies in ER work, go for it, compensation be damned.
I'm a pediatrician and emergency medicine is a fellowship in our specialty.
letsgobobby wrote:You've highlighted a lot of issues but one thing not discussed explicitly is: why, after years of training for general practice, and additional hard years building a practice: why after all those years are you wanting to change directions completely? I would ask yourself about the excitement of learning a 'new field' and the idea that you are ready to leave a budding and lucrative practice so soon after arriving.
I like to deal with non urgent issues but I love critical care, which represent 2-4% of my job. I practice inpatient and outpatient peds. EM fellowship is a way to sharpen my skills and maybe do more critical care. But is it worth doing 3 years of training? That's the dilemma?
VictoriaF wrote:
Jack FFR1846 wrote:Work where you are for 3 years (minimum) and your retirement is very well set. Then go to the ER and do what you *think* you really want to do. Be careful because the grass is always greener and all..... You may burn out from the ER work and long the easy, high pay of the GP work after some years.
That's my advice, too. Accept the current income and job satisfaction over the uncertainties of the alternative path's income and job satisfaction. You may even quantify the uncertainties of each path, for example as follows:

Remain in the current position:
1. Wealth
- Ability to provide financial security = 100%
- Certainty = 90%

2. Work Environment
- Satisfaction = 80%
- Proportion of good days = 60%

Total: 100% * 90% + 80% * 60% = 138%

Pursue emergency medicine:
1. Wealth
- Ability to provide financial security = 80%
- Certainty = 50%

2. Work Environment
- Satisfaction = 100%
- Proportion of good days = 50%

Total: 80% * 50% + 100% * 50% = 90%

You can tweak the labels, their meanings, and the corresponding numbers. You can also assign different weights to the categories of Wealth and Work Environment. The value of this process is not as much in that it will provide The Number, as that it will give you more clarity in what you really want.

This decision making approach is useful for all life changing decisions, including selection of the profession, educational path, employers, and dating and marriage.

Victoria
Awesome tip

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Re: Life changing decision... advice needed!

Post by Natsdoc » Fri Nov 28, 2014 5:56 pm

You're makimg > 300K as a general pediatrician and like your job?!?! Yes, by all means do the fellowship, and please let me know where I can send my CV to fill your vacancy! 8-)

I'm a little concerned when you say you are doing the ER fellowship to get more exposure to critical care. ER is a lot of non-emergent issues with less pay and difficult schedule. If you love ICU, then why not an ICU fellowship? With increasing trends to have in-house coverage and decreasing residency work hours there are places that hire general peds to cover at night in the ICU.

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Re: Life changing decision... advice needed!

Post by PoeticalDeportment » Fri Nov 28, 2014 5:59 pm

You haven't convinced me that after finishing a peds EM fellowship you won't think the grass is greener somewhere else (maybe even not as good as what you are doing now)!

If the honest truth is that you are a wanderer at heart, it would make sense to figure that out and indulge that side of your persona in less expensive ways than experimenting with you career.

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Re: Life changing decision... advice needed!

Post by Streptococcus » Fri Nov 28, 2014 7:20 pm

PoeticalDeportment wrote:You haven't convinced me that after finishing a peds EM fellowship you won't think the grass is greener somewhere else (maybe even not as good as what you are doing now)!

If the honest truth is that you are a wanderer at heart, it would make sense to figure that out and indulge that side of your persona in less expensive ways than experimenting with you career.
I will confess. I am a wanderer :D but this decision is part of a long term plan. I would like to work full time another 8-12 years (depending if I go to fellowship or not), accumulate all my retirement money, then let it grow a decade or two, meanwhile work 2 days a week till age 65-70, maybe later.

I currently work/live work in a small/medium size town and our family goal is to relocate to a larger city in a few years. Have a more metropolitan life. And as an EM it may be easier for me to work part time, make a decent living without overworking in a big city. I would be more marketable than a general pediatrician. GPs typically need to work more in big cities to make a decent living, and I will be at a preretiremen/part time stage of my life where I want to work for fun and enjoy life. But I agree with those who point out that I could do the same as a general pediatrician.

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Re: Life changing decision... advice needed!

Post by mhalley » Fri Nov 28, 2014 8:36 pm

Pediatrics is generally considered to be one of the lowest paid primary care specialties. I am amazed you can make so much money, so my hat is off to you. You must have a busy practice and are a great coder.My suggestion about the fellowship does change since you will get a board specialization from it, but you could still practice general emergency medicine without it. If indeed you wanted to pracice pediatric EM, then the fellowship would make a little more sense, but still would not be required. You might try calling the Hospitals at the citys you are thinking of moving to see what credentials they require. I still recommend a period of moonlighting or locums work to ensure this is truly what you want to do. Good luck.
Mike

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Babakhani
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Re: Life changing decision... advice needed!

Post by Babakhani » Fri Nov 28, 2014 9:31 pm

Big mistake. Don't do it.

Keep working on your current job and pick up ER shifts here and there to satisfy your desire to do ER.
Work an extra year after your 5-8 years of accumulation then if you still want to do ER, it will still be there.
This fellowship wont make you more marketable to a GP position and having a GP experience wont help you in a ER position since every ER guy has done medicine as well. So don't be fooled that you will be more marketable.

In fact, I am a partner with 2 other docs and we hire people for surgery jobs pretty regularly. The biggest red flags for us are indecisiveness (such as you are displaying by going back and forth between specialties) and multiple job switchings. Both show lack of stability in the past which is very predictive of future instability.

Good luck with your decision.
What is light without dark? | - the devil in "Legend" | What one man can do, another can do! | - Anthony Hopkins in "The Edge"

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Re: Life changing decision... advice needed!

Post by Babakhani » Fri Nov 28, 2014 9:41 pm

One more thing I forgot to mention. Your retirement plan is extremely poor.
Work 8-12 years and let it grow for 2 decades is your plan? What happens if your money doesn't grow as well as you wanted to in 2 decades? Will you rejoin the workforce at 70 when no one will want you?

Here is a better plan: 12-15 years working and 1 decade to grow.
Here is yet a better plan: Work 15-20 years and not only have the money when you retire, but you will realize that along the way it has been growing and you may not need to work more.
You have kids? College planned out for them? What if you get sick, lose a leg (God forbid), etc...
You are at a position to take chance (the market) out of your retirement planning and push your cart to retirement and what you want to do is push the cart a little and have it roll by chance the rest of the way.
What is light without dark? | - the devil in "Legend" | What one man can do, another can do! | - Anthony Hopkins in "The Edge"

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Re: Life changing decision... advice needed!

Post by Streptococcus » Fri Nov 28, 2014 10:39 pm

mhalley wrote:Pediatrics is generally considered to be one of the lowest paid primary care specialties. I am amazed you can make so much money, so my hat is off to you. You must have a busy practice and are a great coder.My suggestion about the fellowship does change since you will get a board specialization from it, but you could still practice general emergency medicine without it. If indeed you wanted to pracice pediatric EM, then the fellowship would make a little more sense, but still would not be required. You might try calling the Hospitals at the citys you are thinking of moving to see what credentials they require. I still recommend a period of moonlighting or locums work to ensure this is truly what you want to do. Good luck.
Mike
Pediatrics has perhaps the highest number of part-time physicians in medicine, hence its rank as the lowest paid specialty. I'm by no mean saying that we are among the top paid in medicine, but my understanding is that the ranking often published also reflect the large population of parttime pediatricians in this specialty.
Babakhani wrote:One more thing I forgot to mention. Your retirement plan is extremely poor.
Work 8-12 years and let it grow for 2 decades is your plan? What happens if your money doesn't grow as well as you wanted to in 2 decades? Will you rejoin the workforce at 70 when no one will want you?

Here is a better plan: 12-15 years working and 1 decade to grow.
Here is yet a better plan: Work 15-20 years and not only have the money when you retire, but you will realize that along the way it has been growing and you may not need to work more.
You have kids? College planned out for them? What if you get sick, lose a leg (God forbid), etc...
You are at a position to take chance (the market) out of your retirement planning and push your cart to retirement and what you want to do is push the cart a little and have it roll by chance the rest of the way.
Hmm :confused I did not get your post. I don't think that my retirement plan is poor. If i put 1.5M in the market and the growth is 0, I can retire with 1.5M. Or I can work part time till I'm 65, 75, 80. See, to me retirement means working less. Maybe 1, 2 or 3 days a week. It'll be enough to pay the bills. You stay young by staying active.

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Re: Life changing decision... advice needed!

Post by LowER » Fri Nov 28, 2014 11:15 pm

Strepto:

How many docs do you know who haven't changed jobs in the last 5 years? I don't know of many myself. We are all looking for safe haven when there may not be much left. It seems that you have found some grounds that many docs dream of, financially. I really don't know of any IM docs personally who have done so well, except one who manages a large IM group, and does so within a full-risk model with a multi-7-figure income, but his soul must have been buried long ago.

It's time for you to decide whether you are more strepto (chained to others) or more coccus (interpretation up to you), and to run with it, and the rest be damned.

There isn't much green grass left but the septic tank sure looks enticing, for now.

I understand your desire to run, and often contemplated the same, even with a bit higher compensation after a fellowship, but geez louise you make a ton of money and sticking it out a few more years could put you in a place of volunteering from there on out: doing good for the sake of doing good. Is there anything more rewarding?

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Re: Life changing decision... advice needed!

Post by Streptococcus » Fri Nov 28, 2014 11:25 pm

LowER wrote:Strepto:

How many docs do you know who haven't changed jobs in the last 5 years? I don't know of many myself. We are all looking for safe haven when there may not be much left. It seems that you have found some grounds that many docs dream of, financially. I really don't know of any IM docs personally who have done so well, except one who manages a large IM group, and does so within a full-risk model with a multi-7-figure income, but his soul must have been buried long ago.

It's time for you to decide whether you are more strepto (chained to others) or more coccus (interpretation up to you), and to run with it, and the rest be damned.

There isn't much green grass left but the septic tank sure looks enticing, for now.

I understand your desire to run, and often contemplated the same, even with a bit higher compensation after a fellowship, but geez louise you make a ton of money and sticking it out a few more years could put you in a place of volunteering from there on out: doing good for the sake of doing good. Is there anything more rewarding?
Thank you for your post LowEr. There is a lot of truth to what you wrote.

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Re: Life changing decision... advice needed!

Post by IndexMD » Sat Nov 29, 2014 2:06 am

The more I read, Streptococcus, from your posts the more convinced I am that you should absolutely not do this career change. I could go on and on but most of the posters above have already raised most of my points. Best of luck in your decision, regardless.
VTSMX VGTSX

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Re: Life changing decision... advice needed!

Post by Streptococcus » Sat Nov 29, 2014 10:24 am

IndexMD wrote:The more I read, Streptococcus, from your posts the more convinced I am that you should absolutely not do this career change. I could go on and on but most of the posters above have already raised most of my points. Best of luck in your decision, regardless.
Thanks indexMD

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