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Attending Anesthesiologist Returns to Training with Huge Debt

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  • Lithium Lithium 
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    I think we’re getting trapped into giving overly specific advice when we don’t have enough follow up info from the OP to steer him in the right direction.  Anne asked a very important question a few pages ago, which is what kind of advice he wants.  I’m not sure what the answer to that question is, but I don’t think it includes “What’s the best way to back out of my fellowship?” or “How soon can I get my wife back to work?” or “How can I find a more lucrative anesthesia job?”  That’s fine.  I’m okay with meeting people where they are.  But I’m going to hold off on posting again until I hear more specifics from the OP on what changes he’s willing to make.

    #228112 Reply
    MPMD MPMD 
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    Joined: 05/01/2017

    CC is full of tons of headaches, burnout, and bs [dealing with all kinds of difficult stuff such has end of life issues, surgeons /other docs who don’t want to let go and want to continue care that “might” (who can tell??) be futile, families dealing with terrible stuff, nurses who want to get done with the place and go on to NP school or CRNA school]. CC docs work hard or harder than any docs I know and they get crispy burnout.

    Anesthesia is a pretty good life man. Sure, you deal with some nonsense, but dude CC has a lifestyle that is worse in many ways.

    Also, in anesthesia, the dirty little secret is the strong docs will find themselves assigned the sickest of the sick cases and will be the last ones relieved in the afternoon and the first called when the excrement hits the ventilation system. Yes, for a while it is flatering but if you really think about it logically, it is essentially extra work and extra liability for no extra pay.

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    This wisdom and insight by Tangler is pure gold!  Having done CC after anesthesia, I could not have articulated this better.  Most will take a substantial pay cut to do CC or mix CC with anesthesia instead of 100% private practice anesthesia.  The burn out is EXCEPTIONALLY high in critical care (#1 in burn out among all specialities as reported at the 2018 SOCCA meetings in their talk on burnout).  I worked in a large CC group and didn’t know a single doc in our group of dozens of CC physicians who weren’t burned out – not one.  Personally, I find myself much less burned out and less fatigued after a day/week/month/year of anesthesia than CC, and my family agrees (for exactly the reasons Tangler stated above)!  It may be different for you and others of course.  If one doesn’t like the changes in modern medicine with anesthesia and mostly supervising CRNAs/AAs, one can always consider an MD-only group where you’re sitting cases.I

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    I seriously considered doing CCM fellowship after EM and am so glad I didn’t, I view it as one of the best decisions of my professional life. Obviously I don’t know the OP but it seems hard to imagine a person who doesn’t like anesthesia who is going to find professional satisfaction in CCM.

    Nothing against critical care it’s obviously a cool field. I just don’t think it revolutionizes your life compared to anesthesia or EM. You do some cool stuff, some procedures, there’s a fair amount of drudgery, you might have to work on Xmas morning, there are some big negatives, salary is basically the same.

    I get it when people drop gen surg for EM or do EM after peds — totally changes your life. Anesth –> CCM? Tough to imagine.

    q-school q-school 
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    Joined: 05/07/2017

    I think we’re getting trapped into giving overly specific advice when we don’t have enough follow up info from the OP to steer him in the right direction.  Anne asked a very important question a few pages ago, which is what kind of advice he wants.  I’m not sure what the answer to that question is, but I don’t think it includes “What’s the best way to back out of my fellowship?” or “How soon can I get my wife back to work?” or “How can I find a more lucrative anesthesia job?”  That’s fine.  I’m okay with meeting people where they are.  But I’m going to hold off on posting again until I hear more specifics from the OP on what changes he’s willing to make.

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    Anais Nin:

    “We don’t see the world as it is, we see it as we are.”

    #228151 Reply
    Liked by Anne
    q-school q-school 
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    As a spouse this isn’t the most welcoming forum. More so now that I just won’t stop participating.

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    😆

    It’s not you, it just never was meant for us. :p I had to ask WCI to include “Spouse” as a role when the forum started, so I feel like we’ve always been kind of secondclass citizens. But it’s cool, sometimes the good *doctor* isn’t the one with the time, energy, or inclination to worry about the nitty-gritty of financial decisions…plus I think it’s good for these fine folks to sometimes remember that the other half is more than just a body they’re dragging along through their own life, but instead might actually be a person of their own with their own perspectives and priorities! 😀

    I love your idea of reverse-engineering the finances. That way it becomes not “I would have to deprive my family of every luxury to gain the financial independence that y’all value — but I don’t,” but instead, “I honestly need to cut back a little even to achieve our most basic retirement and childraising goals.”

    This could also be a time for the OP to seek out a financial advisor to help with these calculations, to be honest. A neutral third party might be just what the…doctor ordered. (I crack myself up.)

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    I hear you.  But can you also understand how weird it seems to hear specific questions from the spouse and never hear from the physician?

    How can we get along with my spouse’s partners?  How do we manage the match?   Another fellowship or not?  How can we negotiate the contract?  How important is the no compete clause?  There are rarely one best answer and the flood of questions from us to try and help would honestly be best answered by the physician.   It does take time to provide a thoughtful response.  It is uncommon the spouse or the child or whoever the physician is to answer the questions, and ‘hearsay’ responses may not convey all the nuances or be wholly accurate.  It is perceived (by me) that the physicians don’t really want to be here/or at least they don’t feel it’s worth their time to make themselves available.  Otherwise they would have just posted themselves on the board.  Sometimes there is clear discord in the family/sometimes the spouse may have anxiety but not the physician, sometimes it seems to be used as a neutral third party.  Either way, this site may or may not be the best way to resolve the questions posed if (unintentionally limited or biased) information is presented.

    It cuts both ways.  🙂

    having said that, i often agree with you that busy people (myself included) trying to be good physicians, good business people, good parents, good children, good citizens, and good spouses, not necessarily in that order, tend to write quick and terse comments.  Physicians also tend to be used to giving recommendations.  The effect may be newcomers may not feel as welcome as they might.

    thanks for sharing.  Something for me to think about.

    #228156 Reply
    Avatar DCdoc 
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    Status: Physician
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    Joined: 06/14/2016

    Unlike many others here, I don’t view the decision to pursue a CCM fellowship as a poor choice. I’m anesthesia and have intermittently debated returning to do pain or cardiac, as I get bored at times signing off on charts while crnas do the cases. But this isn’t about me. CCM is merely 1 year with an anesthesia background. If you enjoy it more, and it gets you even one more year working in your career, it could be worth it. Only you can know if it’ll bring you an increase in your professional and personal satisfaction. It’s better to have a career you enjoy than one you do not. If the end-result money is comparable, which it likely is, then career-wise it could be a good option for you. I wish you the best of luck.

    #228163 Reply
    Avatar CharleyAnnMan 
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    Status: Physician
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    Again thanks for the responses. They were all excellent t and made me think about each facet of this financial disaster differently. Especially Tangler, Anne, and eye candy.
    Current thoughts:
    Fellowship: I backed out while in residency and don’t want to do that again and live with the regret . Yes it is just one year, and yes that’s still a huge financial impact. I know anesthesia is much easier and maybe that’s why I feel little job satisfaction and feel like I’m ‘not making a difference.’ Perhaps yes I should have explored other jobs outside of hometown, but there also continues to be the dilemma in the anesthesia world of CRNAs gaining more independent rights. Where does that leave my career 5, 10, 15 years from now? Fellowship is 2019-2020.
    Searching other jobs for when fellowship is completed.
    Trying to rid RV ASAP
    Mulling over housing options. Trying not to make another rash decision.
    Talking with wife about one car for at least a year
    She plans to go back to work. Let’s put that one to rest. I do like the comments about considering her career choices more as well. I try to be a good husband and do this and am very much appreciative of her willingness to move.
    What actual specific advice am I asking? I’m not sure if there’s anything one question. But you’ve all done a great job of making me thibk

    My head is spinning over here. Overwhelmed by the responses.

    #228165 Reply
    Avatar DCdoc 
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    Earnest refinancing bonus

    Rent out your current house for a year if you plan to return after fellowship, in hopefully a career path that is more fulfilling. The RV idea was dumb. A spouse with a high earning potential and high debt not working isn’t good. But I think a 1 year fellowship is a good idea if it brings more career happiness. I think many comments you received didn’t take into account how short an anesthesia CCM fellowship is…

    #228166 Reply
    Liked by EndoRobert
    fatlittlepig fatlittlepig 
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    Unlike many others here, I don’t view the decision to pursue a CCM fellowship as a poor choice. I’m anesthesia and have intermittently debated returning to do pain or cardiac, as I get bored at times signing off on charts while crnas do the cases. But this isn’t about me. CCM is merely 1 year with an anesthesia background. If you enjoy it more, and it gets you even one more year working in your career, it could be worth it. Only you can know if it’ll bring you an increase in your professional and personal satisfaction. It’s better to have a career you enjoy than one you do not. If the end-result money is comparable, which it likely is, then career-wise it could be a good option for you. I wish you the best of luck.

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    I didn’t realize it was 1 year vs 3 years. If it’s only a year I think it’s probably not a horrible decision- although the person who is unhappy after 2 years of practice is probably going to be unhappy after 2 years of practice in the next field and so on and so forth. During the fellowship year I would do a hard reset on lifestyle spending, and carry that forward to the next job.

     

    Avatar Kamban 
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    Status: Physician
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    Joined: 08/01/2016

    healthcare has evolved and the need for mid-levels has risen that pushes physicians, specifically anesthesiologists into other roles. I do not enjoy supervising and there are very few physician only groups left in the country f

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    Every field is getting taken over by midlevels, including CCM. So don’t kid yourself that doing CCM is going to give you those sweet interactions. In fact those interactions with depressed and sometimes resentful families of sick and often dying ventilated patients on 20+ drips, and staff that want your advice for the smallest things, might make you resentful and wish you were full time anesthesia. Many CCM attendings would love to have a full time anesthesia jobs and I know many dual nephrology/CCM and pulmonary CCM doing just nephrology or pulmonary and thankful they got rid of the CCM duties

     

    more diverse interactions with staff and families, more procedures, etc.) is the ability to plan my life around work. I’ve seen far too many older physicians with failed marriages and poor relationships with children to say that taking call every 3rd night and having unpredictable work schedules is worth it. With CCM it’s shift work and I know and my wife knows when I’ll be home.

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    You are more likely to have a burnout and failed marriage from the stressful CCM job than anesthesia. Drop those rose tinted glasses.

     

    Wife’s job: She is a certified P.E. She had an excellent job in the big city that I trained in, on track to make six figures yes like many have alluded to here. Moving to a smaller town, though, has limited her options tremendously, especially regarding pay.

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    You are one person who I would say who should not go to a LCOL area. Such areas may be great for physicians but terrible for engineers or people in fields that need sizable pool of skilled people. You should drop this idea of “hometown” and choose an area where you wife can find satisfying work and good pay and you have a good job with a good income.

    #228179 Reply
    Avatar Tangler 
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    Status: Physician
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    Joined: 08/23/2018

    OP, Awesomeness! Way to look past the criticism and look for helpful info! NOT easy.
    I feel much better about your prospects!
    Good job!!!!!

    #228205 Reply
    Liked by adventure, Zaphod
    Avatar MSooner 
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    .

    #228214 Reply
    Liked by spotty_dog
    SLC OB SLC OB 
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    Wow… lots of advice here. Good luck in fellowship, I hope it is all that you want it to be.

    1. I would sell the RV (as you are) and BOTH cars. They are too much for you. Use the cash to buy one or two reliable and safe old cars. Fellowship is the perfect place to drive a junky car. If equity in house, sell it and put towards loans.

    2. Sounds like your wife had some bad financial situations with her bankruptcy. I’d get her on the Dave Ramsey plan, I think she needs it. Gift her Financial Peace University and have her “work” at budgeting this year. Have her sell all the stuff you really don’t need (easy to take pics and post on Craigslist or Ebay while the baby is sleeping) and each and every dollar needs to go toward your debt. She can make a big difference in this area of your life, while she is a SAHM. Reduce your emergency fund and apply toward the debt. Probably need to actually do the “baby steps” which I usually don’t recommend for doctors but think you guys need it. She is a smart lady, to have a masters in engineering, she can do this!  This will be the most productive thing she can do while breastfeeding that sweet baby of yours. Have you make a “Spouse” account here… so she is motivated by hearing the success stories and by hearing others mistakes.

    3. Moonlight, only if you can legitimately. Put each of those dollars towards your debt.

    You CAN do this!

    #228217 Reply
    Zaphod Zaphod 
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    It takes some time to get over the initial “whoa” and actually consider the responses thoughtful and useful when someone kicks your view of the situation in the teeth. You’ve come round pretty quick.

    For others I think q school nailed the biggest part, docs are used to giving recs about very serious issues with little regard to how packaged (changing) so to normal socially versed folks it probably (and is) comes off very harsh.

    #228220 Reply
    Avatar farnorthtx 
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    I’ll note that this is spectacularly bad planning and implementation.

    But, I’ll offer something a bit different. Find a coach or mentor. Heck, if your insurance covers it find a therapist. You need someone to help you touch the brakes periodically and serve as a sounding board before you reach the end of the diving board. G’luck.

    #228481 Reply
    Liked by adventure
    One Wet Bandit One Wet Bandit 
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    It seems you made up your mind about the fellowship but just to change your perspective on anesthesia jobs- I work for an md only practice in the northeast, desirable area.  I work daytime until 430 pm m-f ( shift work u wanted). 315k/yr. no call. There are jobs out there in anesthesia that u can Tailor to your needs as long as your salary demands aren’t excessive.  I know people who make a lot more than me taking call, complain about taking call, but won’t take the paycut to work daytime hours.  Still, I’m pretty sure I make more than CC people in my area, and work less holidays and weekends (I work none).  But I also live frugally enough and value time over money for reasons I’ve discussed before and won’t get into now.  You’re free to choose whatever you want, and I wish you luck, but I personally would’ve looked for another job instead.  To each their own…

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