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$400K a year hospitalist gig or pulmonary / critical care fellowship

Home The Lounge $400K a year hospitalist gig or pulmonary / critical care fellowship

  • Avatar IMMD 
    Participant
    Status: Physician
    Posts: 7
    Joined: 09/08/2019

    The rational thing is of course given your age to continue on this path as You sort of have a great set up in terms of compensation and it is financially sound future—gigs like this are hard to find it seems which can lock you into the job. I have no idea though how typical this job is for your geographic area.

    A cynic would say however you could find something similar if needed plus How much more joy will you get for more work, more studying at your age with less pay for several years and only to again finish as a wet behind the ears attending in your new specialty settling into practice pattern in their 40s? You’re definitely introducing more work, more stress, without the guarantee of much more money. A relationship and/or kids wil demand more of your time and could make you happier than any job plus they they have their costs, own needs for possible relocation for SOs career, better schools, be near family etc. all your doing is switching the evil you know for novelty and then you’ll probably view your new job just like your old job more or less. Crit care has its own osh bombs, gomers, etc that can be fodder for burn out. Pulm Clinic can be full of chronic cough, unexplained Dyspnsa (ie obesity), gerd/aspiration you can’t fix, copd that you will never make better

    On the other hand, yolo. You didn’t come this far and work this hard to stop short of where you want to be. You don’t want to continually wonder what if. If work is going to be a big part of your life regardless for the next 20/30 years why not learn to do what you want? It may be hard to find a better gig but life events could force you into another hospitalist job that’s much more painful. You may be one of those docs who keeps working even when they don’t have to. You will have new skills you didn’t before and be able to help people in new ways. You can also still moonlight in fellowship so it’s not just 60k each year.

    7 on 7 off could be tough on a relationship and could get old. So can icu shifts. With Pulm you have the option of transitioning more towards OP if you desired which may be better for longevity. Pulm is tough with a lot to learn— to be good takes a lot of effort that can either invigorate you or may be exhausting in that you’re comfortable with hospital medicine and you’d have to again leave your comfort zone to learn a specialty . I Imagine you’d be general pulm ie not ild or phtn, cf, transplant focused? Are you open to OP work?

    Back to loans… If you stay in your current job have you calculated how much will be forgiven with your current payments? I forget if REPAYE has caps on monthly payments.

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    Thank you for the thoughtful reply. I’m not a huge fan of pulmonology but much prefer it over outpatient primary care. If I stay at my current job, I would have about $150K forgiven if PSLF goes through.

    #245165 Reply
    Liked by Duckworth
    Avatar IMMD 
    Participant
    Status: Physician
    Posts: 7
    Joined: 09/08/2019

    If you know you want to do critical care then I would skip the pulmonary portion. I’m a hospitalist and our critical care docs are critical care only. Our Pulmonary docs are critical care trained but don’t do it because they’re not always in the building like the Intensivists. 12 hours in house is not sustainable with a family. Imagine not having dinner with your family or seeing your kids for a week. Where I’m at every other day we get to leave at 3:30 but still have to answer our pager. Maybe that’s why the pay is so high. I’ve been doing this 11 years and it’s sustainable because I can have somewhat of a life during my week on. Just something to think about.

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    Very good points. If I decide against doing a fellowship and down the line I feel I’m getting burned out doing 7 on / 7 off in house 12 hour shifts, I’ll switch to 5 on / 5 off schedule which is currently an option at my hospital. Unfortunately, the earliest 1-2 of us could go home is around 5:30 pm few days a week since we don’t have a swing shift and late afternoons get busy with admits and talking with families. Our administration seems to be physician friendly, so if enough of us ask for a swing shift they would probably give it to us and we’ll probably get to leave earlier than 5:30 pm. We’ll see. I’ll eventually talk to my partners about it.

    #245169 Reply
    Avatar IMMD 
    Participant
    Status: Physician
    Posts: 7
    Joined: 09/08/2019

    Not to minimize your decision and the choices you’re comparing in any way, as I obviously can’t give you a physician’s perspective, but what you have asked violates my (personal) rec. for tax planning. I think it may also apply here.

    Never make an impactful decision based upon what “might” happen or what you “feel” may change in the future (cause you have no idea what else might also happen or how your feelings may change in the meantime). In regard to taxes, don’t do something now based on what Congress, the IRS, or your wealthy grandfather “may” do (hint – your wealthy grandfather’s decision is far more predictable than Congress – even the IRS is more predictable). Base your decision upon what you know right now rather than trying to predict (not only the future, but) the impact of what could change in the future. That’s the only truth. Otherwise, you are just trying to get lucky and, yes, a few people get lucky!

    Have you ever considered how many investors have been “sitting on the sidelines” for years because they were waiting for another big market drop ? (You’ll have to go back to 2009). Or how many homeowners have sold/purchased a home based on what they “feel” interest rates will fall? I have a pretty good idea of these answers because we’ve talked a good number of clients out of acting on inappropriate ‘feelings’ that are unreasonable. And these are people we have worked to educate and who say they agree with what we have discussed.

    This is, again, seriously JMPO but I hope it helps.

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    Thank you for the good post. The whole idea of preemptively doing a fellowship, especially given my age, may sound absurd to some people. Most of my friends tell me, “Dude, you should be thinking about retirement, not extra training!”. There is something to be said about money today is worth more than future money.

    #245172 Reply
    Liked by Tim
    Avatar pierre 
    Participant
    Status: Resident
    Posts: 178
    Joined: 02/01/2016

    PAYE caps your max payment at the 10 year standard repayment.

    REPAYE has no cap on the monthly payment.

    #245184 Reply
    Liked by IMMD

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