u/im_throw

Current IM resident at a crossroads in choosing which fellowship I want. I like many things about critical care, but I don't know if I can handle the futility day in day out for the rest of my working life. I know for certain I don't want to work in academics (pay is too low), and my understanding is community ICUs get all the trach/peg LTACH type patients who have no hope and all the interesting cases are transferred out. I really do not want to have most of my census be those kinds of patients. If I wanted to do palliative care for most of my day I would be doing a palliative care fellowship instead.

Given that community MICU probably isn't something I would want to do, what else is there that doesn't pay academic rates? The specialized ICUs are all in academics and they seem to prefer non-IM trained intensivists so it's doubtful I'd be able to get a job there. There are a few larger non-academic hospitals around me who have specialized units, but they pay the same as academics based on their job postings.

Most of this post is probably hyper specific to medicine, but I'm hoping the people here not in medicine can provide some perspective.

For the purposes of this post, I'm considering only material factors (lifestyle/money) over personal interest. I'm having a difficult time deciding mostly because my two choices are at odds with regards to time off vs. money.

One thing that makes this decision more difficult is that I'm really only interested in living in my home state, which is a saturated HCOL east coast metro area. My parents, friends, and everything I want is there. This means that I can't have the best possible salary or best possible lifestyle, which is a trade off I will have to take.

That said, one thing I'm certain of is that I like time off and I don't want to work full time for very long. Probably a few years to invest heavily but no more. I've narrowed down my interest to critical care (CCM/PCCM) vs cardiology, but I'm having trouble choosing in part because I've been told that part time in cards is very hard to pull off.

With CCM:

• It seems like going 0.5-0.7 FTE won't be too difficult. Salaries in my state are low, so that FTE will pay as low as $200k and no more than $300k for 7-10 days a month respectively. At this salary considering COL, I'll be comfortable and not really stress about basic needs, and I'll also have much more free time than most others making the same salary. On the other hand, I won't have much space for luxuries: big house, fancy resorts, expensive hobbies, etc. Unless I decide not to save much, I'll probably be living a more middle class lifestyle. I'm not sure how okay I am with that. I feel like I'll want the ability to indulge more than what that salary will offer.

• If I burn out even on part time and want to FIRE completely, it might be difficult at that salary. So I'm basically required to work until retirement age if I want to keep my lifestyle.

• Since our salaries don't keep up with inflation, a $200k salary might not go very far later in my career. A lot of six-figure earners in other fields might actually be making more than me later on. Increasing costs will put a strain on my lifestyle even if I stay within my means.

• I have some concerns about the job market in the future especially with most CCM jobs now being done by midlevels.

With cardiology:

• Money will never be an issue, but I'll also be working 20-22 or more days a month. Days will be busy and I will also have after-hours admin and inbox work. Probably will be exhausted every day. But I'll be able to afford a decent amount of luxury and still save a good amount on top of that.

• On the other hand, I'll basically be forced to FIRE completely since part time might not be an option. I don't see myself doing full-time cardiology work for more than 5-10 years without burning out. Even if I go down to 4 days of clinic, I will still have to take full-time call and inpatient responsibilities, and I'll still never truly be "off" like in critical care. Call me greedy but 6 weeks off from work a year is just not enough for me, especially if I'm still having to check my inbox and everything.

• Like I said above, a $500k+ salary will give more of a buffer with inflation. Cards reimbursement increases also seem to outpace inflation, at least for the past few years.

My brain tells me that with how much I like time off, critical care part time is the best move. But I can't shrug off the lower salary compared to the 5-6 years of post graduate training it would require even though I get paid in free time. I definitely won't regret not working more, but will I regret having less money when I see all my higher paid peers living a better lifestyle?

For the purposes of this post, I'm considering only material factors (lifestyle/money). I'm having a difficult time deciding mostly because my two choices are at odds with regards to time off vs. money.

One thing that makes this decision more difficult is that I'm really only interested in living in my home state, which is a saturated HCOL east coast metro area. My parents, friends, and everything I want is there. This means that I can't have the best possible salary or best possible lifestyle, which is a trade off I will have to take.

That said, one thing I'm certain of is that I like time off and I don't want to work full time for very long. Probably a few years to invest heavily but no more. I've narrowed down my interest to CCM/PCCM vs Cards, but I'm having trouble choosing in part because I've been told that part time in cards is very hard to pull off.

With CCM:

• It seems like going 0.5-0.7 FTE won't be too difficult. Salaries in my state are low, so that FTE will pay as low as $200k and no more than $300k for 7-10 days a month respectively. At this salary considering COL, I'll be comfortable and not really stress about basic needs, and I'll also have much more free time than most others making the same salary. On the other hand, I won't have much space for luxuries: big house, fancy resorts, expensive hobbies, etc. Unless I decide not to save much, I'll probably be living a more middle class lifestyle. I'm not sure how okay I am with that. I feel like I'll want the ability to indulge more than what that salary will offer.

• If I burn out even on part time and want to FIRE completely, it might be difficult at that salary. So I'm basically required to work until retirement age if I want to keep my lifestyle.

• Since our salaries don't keep up with inflation, a $200k salary might not go very far later in my career. A lot of six-figure earners in other fields might actually be making more than me later on. Increasing costs will put a strain on my lifestyle even if I stay within my means.

• I have some concerns about the job market in the future especially with most CCM jobs now being done by midlevels.

With cardiology:

• Money will never be an issue, but I'll also be working 20-22 or more days a month. Days will be busy and I will also have after-hours admin and inbox work. Probably will be exhausted every day. But I'll be able to afford a decent amount of luxury and still save a good amount on top of that.

• On the other hand, I'll basically be forced to FIRE completely since part time might not be an option. I don't see myself doing full-time cardiology work for more than 5-10 years without burning out. Even if I go down to 4 days of clinic, I will still have to take full-time call and inpatient responsibilities, and I'll still never truly be "off" like in critical care. Call me greedy but 6 weeks off from work a year is just not enough for me, especially if I'm still having to check my inbox and everything.

• Like I said above, a $500k+ salary will give more of a buffer with inflation. Cards reimbursement increases also seem to outpace inflation, at least for the past few years.

My brain tells me that with how much I like time off, critical care part time is the best move. But I can't shrug off the lower salary compared to the 5-6 years of post graduate training it would require even though I get paid in free time. I definitely won't regret not working more, but will I regret having less money when I see all my higher paid peers living a better lifestyle?

How feasible is it to work part time as a general cardiologist? I've heard mixed things. Some people say you can make whatever schedule you want but others say groups will not want to hire you or let you switch to part time since it decreases their revenue.

For those who know any gen cards working part time, what's their schedule and salary like?

How feasible is it to work part time as a general cardiologist? I've heard mixed things. Some people say you can make whatever schedule you want but others say groups will not want to hire you or let you switch to part time since it decreases their revenue.

For those who know any gen cards working part time, what's their schedule and salary like?

Just wondering, what are some non-traditional paths you've heard of out of IM that are still clinical (so not consulting, MSL, etc.) and also not quackery? Either with IM alone or a short fellowship. Basically anything not hospitalist, PCP, or one of the common fellowships.

Just wondering, what are some non-traditional paths you've heard of out of IM that are still clinical (so not consulting, MSL, etc.) and also not quackery? Either with IM alone or a short fellowship. Basically anything not hospitalist, PCP, or one of the common fellowships.