Strongly Considering Going Back to Fellowship for Sports Medicine

[funnybanana]

Looking for some insight. I'm about 8 months out of a pretty solid academic EM program. I did well in residency, tried to see as many patients as I could and do as many procedures as I could in the limited 3 years I had there. I took a job back in my home town in a small community ED. I am busier than I ever was in residency, with actually much sicker patients. At my Level 1 academic center, EM consisted of taking a number of transfers and making a lot of consultants. Here in the community I'm doing a significant more amount of the leg work. And that's fine-- I actually love the work load, constantly learning, and the challenge (mostly).

My shop is staffed by TeamHealth. I'm finding so many frustrating aspects to this job-- everything from new grad nurses giving me pushback and sometimes flat out refusing to do my orders, complete disrespect from consultants/hospitalists, and other EM colleagues sitting around collecting a paycheck while I pick up their slack (we all get the same hourly rate). The majority of my patients are very chronically sick, as you might expect from adherence to a regular southern US diet, and I feel like each is in some way a landmine of liability and lawsuits waiting to happen.

All in all, this job isn't what I thought it would be. I always do my best for my patients, trying not to write off any complaint. After all, I grew up in this small town, and I love our population. Many of my patients are family friends or acquaintances, which can be somewhat challenging in its own regard, but I digress. I always knew about the specific challenges that the field of EM faced, but thought that returning home to work in our ED would make those challenges worth it. Sadly, that doesn't seem to be the case.

My father started an orthopedic surgery clinic and has been established in my town ever since 1987. His clinic has grown now to having about 8 total orthopedic surgeons, and while he's been in practice for 35 years now, I can't help but think how life would change as making a transition to outpatient sports medicine. While I might not make the money I currently do now in EM, I feel like lifestyle and my general happiness would be improved.

I'm kind of at a loss at this point. I really, really need some direction. What would you do if you were in my position? I know that's a tough question to answer, but any sort of guidance would greatly be appreciated.

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[Groove]

I think jumping ship would be premature at 8 months out. There are so many different types of gigs and a variety of variables that affect individual job satisfaction. Compensation model, PPH, work culture, % overnights, nursing culture, nursing admin, hospital admin, etc.. I've had some miserable jobs in my time that in hindsight had very little to do with EM and everything to do with a malignant environment. Sometimes, you really have to hunt around for that nice gig. I'm currently out of the larger tertiary care hospitals I had been working for years and in a single coverage community gig with 10+ beds, excellent nursing, great nursing management, occasional residents, etc.. It's glorious. It took me awhile to find this place though and it also took me a few years out of residency to really figure out what kind of environments make me happy. Sometimes, it's trial and error.

Although I think sports medicine would be a great gig, it's a little extreme to completely jump ship 8 months out and make a blanket judgement on all of EM. I think I'd give myself a good 2 years to make that decision. That being said, if it's only a 1 year fellowship and gives you a cushy clinic schedule, that might be worth it. I'd only consider it if say....I had only clinic hours and didn't have to sacrifice more than 100K but I bet it's an even steeper pay cut unless your dad intends to sell or give you the practice when he retires. If that's the case, then we are in a completely different scenario and I'd say your decision to jump into sports medicine and join your dad's practice makes perfect sense. Maybe if you did that you could pull 4 ED shifts a month somewhere to keep your feet wet. I doubt that would prevent sig skill atrophy with only 8 months under your belt though.

 

[betamale]

do it. I have sports med friends who are content with it. sounds like you're going to be rich eventually anyway. no point of suffering where you're at. EM is miserable and the volume and toxicity is not going to get better.

 

[always.chillin]

I would move and find a new job. I’d never want to treat people I knew, as that could and will cause issues if something is missed or if there’s a suboptimal outcome. Another issue is your site is staffed by TeamHealth which is a garbage company. They are so bad that I’d move cities if they’re the only option. Your experiences with nurses are also a bit unusual. In the 4 ERs I’ve worked at, I have never been disrespected by nurses. That leads me to think your site has issues. Try another job with a different company in a different region. If you still hate it, then by all means go for an exit plan. But in the right setting, EM isn’t bad and the money is good.

 

[Porfirio]

Ride the coattails of Daddy. Why struggle? I would take that option and you can always go PRN at your shop to keep your skills and likely make more money.

 

[sloh]

You’re sitting on a goldmine with your dad’s practice. Already have a patient panel and referral network. Do a sports med fellowship and do stem cells for cash.

 

[HemorrhagicShock]

You’re sitting on a goldmine with your dad’s practice. Already have a patient panel and referral network. Do a sports med fellowship and do stem cells for cash.

Is the cash for stem cells really that good?

This market seems saturated

Either way, I do agree that he should waltz onto Dad's practice and help become an operator/owner. He would be dumb not to.

 

[DeadCactus]

Treating family, friends, and acquaintances in a CMG ED sounds like a circle of hell. A year of fellowship to go into private practice at an established clinic with your family sounds great (assuming you have a good relationship with that family and can work together); you can always do PRN shifts if you miss the ED.

It's one year and a pretty fun year; the opportunity cost is real but overall it's a pretty low risk thing to try that will get much harder in the future.

 

[The Knife & Gun Club]

I would say you probably have the strongest indication to do sports med. You have a family owned private practice you could transition into and a good dynamic to get a fare shake in a practice with a bunch of orthos.

Fellowship is great. The $ loss hurts a bit but the confidence of knowing you never NEED to work another EM shift is amazing.

 

[sloh]

Is the cash for stem cells really that good?

This market seems saturated

Either way, I do agree that he should waltz onto Dad's practice and help become an operator/owner. He would be dumb not to.

The market is saturated but the OP has access to a patient panel already. Over 5k for less than 10 minutes for the procedure. He can make bank.

 

[Birdstrike]

Just being able to live a normal life by doing Sports Medicine would make it worthwhile by itself. If I was in your position, I'd consider myself a fool if I didn't do the Sports Medicine fellowship.

If you need to do EM to live, such that you develop psychologic pathology when you're not practicing EM, I suppose that change things. If you hated Sports Medicine that would change things. But I can tell you, after 10 years in EM, and now 10 years in an outpatient world (Pain), the improvement in my peace of mind is unmeasurable. Just people able to sleep when I want to sleep, eat when I want to eat, poop when I need to poop, is worth every minute I spent during my one year of fellowship.

You think you know how soul crushing EM is. But you won't really know, until you've been out about 6 weeks. Sports Medicine (like Pain) is one of those fellowships that buys you a new life out of EM (if you want it to) and that makes it especially sweet.

While you might not make the same hourly pain in Sports Medicine that you could in EM, you'll be psychologically able to work more hours with less psychological destruction and less havoc on your personal and family life. Also, assuming your father still has ownership in the practice he started, you would hopefully get a chance to get some ownership also, in the business and also if they have an ASC. It's at least something you could look into. That's a benefit of practice like Ortho, Pain and others, that aren't as common in EM.

 

[GatorCHOMPions]

Just being able to live a normal life by doing Sports Medicine would make it worthwhile by itself. If I was in your position, I'd consider myself a fool if I didn't do the Sports Medicine fellowship.

If you need to do EM to live, such that you develop psychologic pathology when you're not practicing EM, I suppose that change things. If you hated Sports Medicine that would change things. But I can tell you, after 10 years in EM, and now 10 years in an outpatient world (Pain), the improvement in my peace of mind is unmeasurable. Just people able to sleep when I want to sleep, eat when I want to eat, poop when I need to poop, is worth every minute I spent during my one year of fellowship.

You think you know how soul crushing EM is. But you won't really know, until you've been out about 6 weeks. Sports Medicine (like Pain) is one of those fellowships that buys you a new life out of EM (if you want it to) and that makes it especially sweet.

While you might not make the same hourly pain in Sports Medicine that you could in EM, you'll be psychologically able to work more hours with less psychological destruction and less havoc on your personal and family life. Also, assuming your father still has ownership in the practice he started, you would hopefully get a chance to get some ownership also, in the business and also if they have an ASC. It's at least something you could look into. That's a benefit of practice like Ortho, Pain and others, that aren't as common in EM.

To piggyback off of this, why not do a Pain fellowship @funnybanana? There's a lot of synergy between Ortho and Pain as well, and while the market is saturated in both it's slightly better in Pain from what I understand and you'll make more money should you not want to be tied down to your dad's practice.