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Looking for advice on some opportunities and better life balance


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Summary:

Due to burn out/desire to do more of what I love during my 30s, I'm trying to decide between:

1. Moving from FT FP (16, 9-10 hour days a month) to FT EM (Minimum of 18, 6-hour shifts a month)

2. Splitting my time 

     a. 30hrs FP + 1 day EM =3.5 day work week

     b. 20hrs FP + 1-2 day EM = 2.5-3.5 day work week *but lose insurance coverage

     c. Quit FP entirely + remain flexible PT EM and pickup as many or few shifts as I want each month

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Few things to know:

I'm in a long term relationship w/ someone who makes 30-50k/year and have no kids-no near future plans for them. I save half my take home pay. I'm on an IBR plan with student loans and have decided instead of aggressively paying them off, to remain on IBR until the end (If I worked 5-6 days a week for the next 4-5 yrs and saved nothing I could pay them off early-I dont want to do this anymore). I've used the savings to acquire 3 rental properties in a stable and growing market, pay no mortgage or rent myself, have $150k in equity in the properties and they bring in $1600/month of passive income currently. So at the end of the day, the passive income would feed us beans and rice and cover our mandatory expenses-but not leave room for anything else besides surviving. I plan to continue to invest in RE as part of my retirement portfolio. I've never wanted to work more than 3-4 days a week (always worked 3-12's alternating with 4-12s when EMS) with a goal to eventually work part time only and have passive income from rentals fill in the remainder.

I have been at an FQHC Family Practice for 3 years (just vested at 100%) full-time (4 days a week:9-9-9-12hrs) with 3 day weekends every week (Fri-Sat-Sun) and paid 75-80-85k(current)-90k(soon) annual salary with no bonus available. CME time and money is great. PTO is plentiful, but hard to take off (2 provider coverage at the clinic with no backup & pandemic restrictions still on PTO). We are scheduled 18-24 patients a day, 20min for everything no matter how complex the patient/complaint. No RNs, only MAs that are undertrained. I know we are helping people, esp. those without insurance, but the support for providers feels inadequate. I like the mission, but feel underpaid, bored, consumed with paperwork/mind numbing tasks and I rarely feel that I make a meaningful difference because of the number of patients who don't want to participate in their health and I'm just managing their symptoms for eternity rather than being able to actually fix the problem.

I was former EMS prior to PA school and always thought I wanted to work EM. Was hard to find a job fresh out of school in the Front Range (Colorado) so I took a Primary care job. I believe its served me quite well in terms of remaining a generalist. I also recognize the burnout rate with EM can be fairly high and I've enjoyed the less litigious nature of FP TBH.

I took a PRN job 2 months ago at the Emergency dept. that I formerly worked at as an ER Tech, located 1 mile from my house. I've been trying to get my foot in the door to EM for 3.5 years so I have been working 4-5 days a month in the ER on top of my FT FP job. I knew I couldn't do this forever and now am at a point where I need to make some decisions about my career moving forward.....Oh, and the ER just offered me FT position today (18, 6hour shifts a month at $60/hr w/ decent bennies and insurance;  breaks down to AGI of 87,480/year v. current FP at 16, mostly 9 hr shifts a month at $42/hr for AGI 90,000/yr)

Priorities: Time off, flexibility, more control over my own schedule, more fixing problems not managing chronic symptoms

ER gig pays $60/hr. 6 hour shifts 2-8pm w/ possible 2 hrs on either end if volume is up and we need to be called in-rarely happens with today's census. Current PT is whatever I want to pick up. FT would be minimum 18 shifts a month. RVU bonus structure. USACS-bennies seem pretty nice. I like and know the ER staff, providers and nurses alike and theyve been supportive so far. Worried about burnout and FT breaks down to alternating 4 day and 5 day work weeks, but half days.

FP will pay 90k/year. Goes up 5k every year I just remain employed. No bonus. reliable work schedule 4 days a week, Telehealth every thursday, off every Fri-Sat-Sun like clockwork. Like the MD I work with but mostly work solo coverage these days so I get lonely and bored haha.

I'm inclined to cut back to 2 days FP and 2 days ER a week but need to figure out insurance....SO doesn't get insurance through work and it would be $300-500/month for crappy marketplace insurance. I might be able to get myself on Medicaid buy-in program but only me.

I'm not in a bad position-just want to make smart decisions.

 

so....for anyone who actually read all that....THOUGHTS?! 🙂 What am I missing?

 

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flexibility is good. If you really like EM and really feel like you have maxed out the learning in FP then it sounds like the only thing keeping you there is benefits. So you are looking at a trade off: more free time or covered benefits? If you can afford to do per diem/PT EM (option C) and buy benefits that would give you the most flexibility to travel, etc

six hr shifts are really short. I imagine in a post-covid world those will become 8s or 10s.

I work 24s, 12s, and 10s. The 10s feel like they go by super fast. 

As an aside, $60/hr is on the low side for EM Pay for an experienced clinician. 

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I was hoping you would comment EMEDPA. Yes, $60/hr is low but in Colorado provider pay is quite suppressed by the desirable location and they weren't willing to negotiate given my lack of specific EM experience. I don't think I've maxed out my knowledge and learning in FP. I'm not sure I ever could. But I think an ideal mix would be EM and FP in some sort of blend for me. I do like the ER environment-those 6 hour shifts go fast. I really appreciate your input and thanks for taking  the time to read my post!

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What do you want to do with your time off? 6 hour shifts would allow you to work out, go grocery shopping, work on your rentals, eat dinner with your SO. These are much harder to fit into a work day if you’re working 9-12 hour shifts. Trade off is that you can’t go camping, take trips out of town as easily. 

I’ve worked 8s, 10s, 12s and find that 10s are my favorite for a balance between these trade offs. When working 12s, I can get a 30 min work out in and the rest of my time at home is eating and sleeping. 

You sound pretty financially savvy and could probably make any of the above options work. 

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First congrats on some great planning and decision making that is surely going to benefit you a great deal. In fact it already has because you have options...which many (most) people really don't.

I am a fan of list making. Start with a list of all the aspects of employement you can think of that matter to you. Pay, PTO, benefits, work-life balance, work environment, specialty etc etc.

Make a column for each of your options and plug them in based on where they fit. For instance a job with fewer hours would have work-life balance near the top of the list. You get the idea. Slide them up and down until you have them in the best order and start assigning a value to each item based on what matters to you. Then figure out which list gives you the most of what you want.

Personal currency changes over time. I used to be money money money so that would have been my highest valued work benefit. Now its lower stress and more time with family and friends.

Good luck!

Edited by sas5814
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My last ED gig I was initially hired at 6 hrs on F and M, and 10 hrs on S/S, so a four day weekend on and three days off in the middle.  I’d KILL if still working to work only six hour shifts.  Shoot I might even be able to be talked off my porch, hand over my firearm, let go of the cooler, and not even bother telling the kids to stay off my lawn.  It’s all about the bennies.  I could bum off my wife’s insurance and as long as they paid the malpractice then I’d be cool AT MY POINT IN LIFE.

At your age, consider a HDHP with a funded HSA for health insurance.  You probably don’t see your PCP, if at all so you really only need a major medical/catastrophic care policy.

Edited by GetMeOuttaThisMess
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