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Starting M4 Year – Seeking Some Advice on Residency for Career Goals

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  • Avatar SandorClegane 
    Participant
    Status: Student
    Posts: 5
    Joined: 05/25/2019

    If you are agnostic to specialty, and your goals are as simple as you outline, it’s easy.

    I’m still not convinced you shouldn’t be a Hospitalist with one week one and one week off.  Pick an underserved area to work since you will be traveling half the year and you can be a multimillionaire by 45 easily.  You will have 26 weeks of the year to travel.  If you want to work less, those jobs typically allow part time work even.  If you want to be a multimillionaire by 43 do nighttime hospitalist.  Easy.

    to scratch the entrepreneurial side, do a non medical side hustle that you can run from the internet anywhere.  Problems solved.

    Not getting why you don’t want to do adult medicine.  What specifically is turning you off to it?   But it doesn’t matter if i get it or not.  Pick ED then.  This shift work is what will allow you to run out the door and travel when you want.  If you have long term relationships with patients, it gets harder and harder to do that as the years go by.

    i’m not sure whether you are trolling us.  Why would you ever write that your wealthy family member thinks physicians are frauds and then say he wants you to open a clinic with your medical license?  So you can commit said fraud and s/he can get rich?

     

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    During my gen IM wards, specifically university based hospitalist services, I felt like I was running in a hamster wheel. This is basically the same as whey I’m not super crazy about general adult medicine. Many (but certainly not all) of the patients had many chronic medical problems that were a result of their own choices at least in part and wanted the physicians to “fix” it.  Pts with DM1 or kidney failure who would be discharged with plans for placement/dialysis/insulin, and then show up a few days later in DKA/uremia and we’d have to do an admission for literally the same thing. chronic pain/drug seekers, sequelea from poorly self-managed diseases, Not being able to solve anyone’s problem without a consult. Just felt very bureaucratic and running in a wheel. That’s just me though, because I enjoyed inpatient peds even though it was respiratory distress all day everyday. And since I don’t know what fellowship I’d want to do….  EM+OB = too many nights for me. I worked in an ER before medical school and realized that the toll to my circadian rhythm, wasn’t worth it for me. But I appreciate you giving me your thoughts, something I’ve definitely thought of. If I still can’t decide between Psych and IM, I don’t know what I’d do for my backup after combined Peds-psych and combined med-psych. The other part is, there are noncompetitive med-psych programs in not very good programs and I’d almost rather just do psych in a cool city like Austin or Chicago.

     

    Appreciate the tip about leaving patients hanging when you leave, and that getting harder to do as time goes by.

    Anyway, no I’m not trolling you, just giving some context to my understanding/experience of entrepreneurialism in healthcare. To clarify, he doesn’t think that all physicians are frauds. I am of south asian origin and born and brought up here in the states. This family member was born in India, and the culture of corruption is so deep there, that it seems obvious/natural to him that any business endeavor, including health-related, would have some level of corruption. These physician friends of his that apparently are multimillionaire clinic owners I am sure of south asian origin also. My point in mentioning this, was that I have heard from him that it is possible to make money opening up clinics with the physician as a supervisory role. The point of my original post was in part to ask the WCI community of the practicality of me doing this from scratch.

    #217242 Reply
    MPMD MPMD 
    Participant
    Status: Physician
    Posts: 2483
    Joined: 05/01/2017

    There has already been a lot of quality advice here.

    What I tell every student with a dream (e.g. OP, 1/2 usa practice 1/2 mission work, etc) is that the tough part is finding other people who want to either hire you, work with you, or work for you.

    You couldn’t throw a rock at an American med school w/o hitting an M3 or M4 who says something like “I’m going to do EM/IM then a CCM fellowship. I’m going to do 2 shifts/mo in the ED, 2 weeks in the ICU, then have a follow up clinic where I see all of my own patients for continuity. Of course this will be for the half of the year that I’m not running a free clinic in [insert developing nation here].” I always try to very gently burst their bubble with 2 points: The first is that they will have a very hard time finding a group that wants to change all of the rules to support the plan, the second is that they are going to be staring down the fact that the way doctors make money is by going to work early in the morning and doing what they trained to do.

    Dream set ups aren’t impossible as a doc, but they are tough.

    Avatar Brains428 
    Participant
    Status: Physician
    Posts: 392
    Joined: 11/09/2017

    I say go anesthesia. You can take an employed shift type position in the Midwest and have a ton of freedom. I would say radiology if it weren’t for 2-3 extra years of training. I also feel like it would be less taxing on the soul than nocturnist or even a daytime hospitalist for 10 years.

    I know a couple people who went straight into business after med school. I don’t really know how much they make, but I’m assuming they did it to escape medicine.

    #217266 Reply
    Liked by SandorClegane
    Avatar AR 
    Participant
    Status: Physician
    Posts: 846
    Joined: 03/10/2016

    There has already been a lot of quality advice here.

    What I tell every student with a dream (e.g. OP, 1/2 usa practice 1/2 mission work, etc) is that the tough part is finding other people who want to either hire you, work with you, or work for you.

    You couldn’t throw a rock at an American med school w/o hitting an M3 or M4 who says something like “I’m going to do EM/IM then a CCM fellowship. I’m going to do 2 shifts/mo in the ED, 2 weeks in the ICU, then have a follow up clinic where I see all of my own patients for continuity. Of course this will be for the half of the year that I’m not running a free clinic in [insert developing nation here].” I always try to very gently burst their bubble with 2 points: The first is that they will have a very hard time finding a group that wants to change all of the rules to support the plan, the second is that they are going to be staring down the fact that the way doctors make money is by going to work early in the morning and doing what they trained to do.

    Dream set ups aren’t impossible as a doc, but they are tough.

    Click to expand…

    Yeah this is so true.  The other complicating thing is having a family.  I’m at a point now where I could essentially do above if I wanted to and still have a very reasonable income.  But throw a spouse and a few kids into the mix and suddenly a stable, predictable schedule with minimal required travel becomes far more appealing.

    #217268 Reply
    Vagabond MD Vagabond MD 
    Participant
    Status: Physician
    Posts: 3469
    Joined: 01/21/2016

    There has already been a lot of quality advice here.

    What I tell every student with a dream (e.g. OP, 1/2 usa practice 1/2 mission work, etc) is that the tough part is finding other people who want to either hire you, work with you, or work for you.

    You couldn’t throw a rock at an American med school w/o hitting an M3 or M4 who says something like “I’m going to do EM/IM then a CCM fellowship. I’m going to do 2 shifts/mo in the ED, 2 weeks in the ICU, then have a follow up clinic where I see all of my own patients for continuity. Of course this will be for the half of the year that I’m not running a free clinic in [insert developing nation here].” I always try to very gently burst their bubble with 2 points: The first is that they will have a very hard time finding a group that wants to change all of the rules to support the plan, the second is that they are going to be staring down the fact that the way doctors make money is by going to work early in the morning and doing what they trained to do.

    Dream set ups aren’t impossible as a doc, but they are tough.

    Click to expand…

    In medicine, there are vision people and grinders. I am a grinder, and most docs are grinders. Being a vision person is high risk and high reward, but without vision people, we would not have many of the advancements in science, technology, and systems.

    "Wealth is the slave of the wise man and the master of the fool.” -Seneca the Younger

    #217278 Reply
    Avatar AR 
    Participant
    Status: Physician
    Posts: 846
    Joined: 03/10/2016

    In medicine, there are vision people and grinders. I am a grinder, and most docs are grinders. Being a vision person is high risk and high reward, but without vision people, we would not have many of the advancements in science, technology, and systems.

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    I would agree with this.  But that’s doesn’t mean the vision people don’t have to grind.  It’s a different kind of grind though.  And at least for some period of time it is even more time consuming.

    #217320 Reply
    Avatar jacoavlu 
    Moderator
    Status: Physician, Small Business Owner
    Posts: 2374
    Joined: 03/01/2018
    Splash Refinancing Bonus

    with radiology you can travel and work at the same time, but you’d almost certainly be an employee and not an owner doing this and you really have to grind to make money and it wouldn’t be very much fun, to me

    someone who was really adventurous in a field conducive to telemedicine could set up shop at least part time in Puerto Rico, take advantage of Acts 20/22, spend at least 183 days per year on the island to be a resident, provide telemedicine services to the mainland, save a bunch in taxes

    The Finance Buff's solo 401k contribution spreadsheet: https://goo.gl/6cZKVA

    #217347 Reply
    Liked by SandorClegane
    CM CM 
    Participant
    Status: Physician
    Posts: 1168
    Joined: 01/14/2017

    There has already been a lot of quality advice here.

    What I tell every student with a dream (e.g. OP, 1/2 usa practice 1/2 mission work, etc) is that the tough part is finding other people who want to either hire you, work with you, or work for you.

    You couldn’t throw a rock at an American med school w/o hitting an M3 or M4 who says something like “I’m going to do EM/IM then a CCM fellowship. I’m going to do 2 shifts/mo in the ED, 2 weeks in the ICU, then have a follow up clinic where I see all of my own patients for continuity. Of course this will be for the half of the year that I’m not running a free clinic in [insert developing nation here].” I always try to very gently burst their bubble with 2 points: The first is that they will have a very hard time finding a group that wants to change all of the rules to support the plan, the second is that they are going to be staring down the fact that the way doctors make money is by going to work early in the morning and doing what they trained to do.

    Dream set ups aren’t impossible as a doc, but they are tough.

    Click to expand…

    In medicine, there are vision people and grinders. I am a grinder, and most docs are grinders. Being a vision person is high risk and high reward, but without vision people, we would not have many of the advancements in science, technology, and systems.

    Click to expand…

    Sure, but daydreams and fantasies aren’t the same as vision.

    Erstwhile Dance Theatre of Dayton performer cum bellhop. Carried bags for Cyd Charisse (gracious). Hosted epic company parties after Friday night rehearsals.

    #217351 Reply
    CM CM 
    Participant
    Status: Physician
    Posts: 1168
    Joined: 01/14/2017

    someone who was really adventurous in a field conducive to telemedicine could set up shop at least part time in Puerto Rico, take advantage of Acts 20/22, spend at least 183 days per year on the island to be a resident, provide telemedicine services to the mainland, save a bunch in taxes

    Click to expand…

    .

    Erstwhile Dance Theatre of Dayton performer cum bellhop. Carried bags for Cyd Charisse (gracious). Hosted epic company parties after Friday night rehearsals.

    #217352 Reply
    Avatar wideopenspaces 
    Participant
    Status: Physician
    Posts: 1137
    Joined: 01/12/2016

    Definitely don’t plan on outpatient psychiatry. You can’t up and leave your patients on a regular basis. Even a week off has you coming back to a ton of patient calls and tasks. Plus if I’m being perfectly honest you don’t seem to have the personality type for outpatient. Inpatient psych pays better and gives you much better flexibility. Triple board is a waste of your time given your goals as is med peds. I have a friend who did family medicine. He runs a home health service with PA and APRNs and also has some cosmetic stuff he does on the side- his wife runs the business and he is medical director. So I’d do psych if you just want to work a ton for a few years and then do locums, or family medicine if you want to do more of a business type thing. But for now you should really just focus on becoming a good doctor, you have a ways to go before anything else matters.

    #217372 Reply
    Avatar BCBiker 
    Participant
    Status: Physician
    Posts: 235
    Joined: 01/10/2016

    Being skeptical of this family member is smart. Sometimes successful ventures are pure luck so don’t count on riding coattails unless 100% by the book. Losing license would be hard to recover from. I have a feeling you are quite different from this family member so appreciate the help she/he gave you and move on. I know the type and they aren’t generally the type that go to med school. Just reading between the lines in your post.

    #217398 Reply
    Avatar SandorClegane 
    Participant
    Status: Student
    Posts: 5
    Joined: 05/25/2019

    with radiology you can travel and work at the same time, but you’d almost certainly be an employee and not an owner doing this and you really have to grind to make money and it wouldn’t be very much fun, to me

    someone who was really adventurous in a field conducive to telemedicine could set up shop at least part time in Puerto Rico, take advantage of Acts 20/22, spend at least 183 days per year on the island to be a resident, provide telemedicine services to the mainland, save a bunch in taxes

    Click to expand…

    Definitely don’t plan on outpatient psychiatry. You can’t up and leave your patients on a regular basis. Even a week off has you coming back to a ton of patient calls and tasks. Plus if I’m being perfectly honest you don’t seem to have the personality type for outpatient. Inpatient psych pays better and gives you much better flexibility. Triple board is a waste of your time given your goals as is med peds. I have a friend who did family medicine. He runs a home health service with PA and APRNs and also has some cosmetic stuff he does on the side- his wife runs the business and he is medical director. So I’d do psych if you just want to work a ton for a few years and then do locums, or family medicine if you want to do more of a business type thing. But for now you should really just focus on becoming a good doctor, you have a ways to go before anything else matters.

    Click to expand…

    Just want to say thanks everyone for the great advice on many aspects of this discussion!

    #217420 Reply
    Liked by BCBiker

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