[hundreddaysoff]

You're welcome! Basic answer: $250/h + benefits and 4 days/week "off". Plus, working in the ER at night is the most fun job I've ever had or probably ever will have. (Programming is second.)

Despite this, I plan to pivot to my telemedicine business full-time within the next year. I know I am not invincible and the older I get, the more mistakes I am likely to make and the more working nights will become a risk factor for heart disease, diabetes, and the like. Plus, working nights wreaks havoc on the family, but it's the only option to work stable days each week in the ER. (Ie, most ER docs either work all nights or work a random rotating schedule of first, second, and third shifts.)

[ibatindev]

Having worked as an MSI (Medical Specialized Interpreter) at $4/h, I've noticed that patients are still very reluctant to accept telemedicine for anything other than reviewing lab results.Do you possess a strategy to overcome this challenge?

LATAM Subcontractor for Teleperformance/LanguageLine Solutions/Pacific Interpreters.

[hundreddaysoff]

The strategy I possess is to use telemedicine in novel and directed ways when it suits the purpose.

Most telemedicine roles I have interest in start with a very directed patient population and a limited set of interventions. Patients at risk for HIV, obese patients, etc. In this context, these subsets of patients are happy to accept special-purpose telemedicine, in my experience.

I personally would not want to see a primary doctor or surgeon over the Internet, and if I needed follow-up testing in the lab right next door anyway, I would prefer to go in person to both places in one "quick" trip rather than dicking around with the Internet before going out to the lab anyway.

Patients are right to be reluctant. Telemedicine offers a lot of benefits, but it can never be as thorough as time in person with a primary doctor. (But this in-person time is just not possible to get for your average patient in my experience.)

[el_benhameen]

Completely understand if you don’t have the time or desire to answer questions, but I’m curious whether you went programming -> MD or the other way around, and how you made the transition.

[hundreddaysoff]

1. Grow up in the 90s and play too many video games and read the Extropians list too much.

2. Decide I want to be, like, the Hagbard Celine of pharmaceuticals and cure death, or something.

3. Learn programming because I still need a job if I fail at (2) and anyway programming is fun and people are scary.

4. Double major in CS and Bio, do bioinformatics research for minimum wage.

5. Move to Berkeley, learn more programming working at a random startup for minimum wage.

6. Get a job as a bioinformatics programmer at a lab; learn lots more programming and some bench biology and publish papers, under the theory that I need papers and a PhD to start a pharmaceutical company.

7. Look around and decide I don't want to be postdocking in SF for $40k/y when I'm in my 40s and have kid(s).

8. Enter an MD/PhD program (MSTP, ie combined and debt-free degrees) as a lowish-resistance hedge even though I dislike premeds and also the entire bloated medical system.

9. (8 years later) Do residency in Emergency Medicine because it's really fun and all the other specialties bore me. (Except radiology, but that's no fun with chronic sciatica.)

[p1esk]

Why do you say emergency medicine is fun? I imagine you often see people in pain, life degrading injuries, and all kinds of other sad things.

[hundreddaysoff]

Well, here's how an ideal night goes for me.

https://forums.studentdoctor.net/threads/patients-per-hour.1...

(Writing this in the middle of the night from that critical access ER I mention.)

I just don't think there's any other medical specialty that has a job as action-packed and gratifying as my job is for me. Surgery would be gratifying, for sure, but also I hate formal clinic and I have a weak bladder, so no.

Yeah, I guess I see lots of sad things. But (1) often patients are sad about things that could've happened but didn't actually happen, and I can cheer them up just by telling them the truth. (2) Often I can make patients happier if actual sad things happen to them, at least in the moment, and that makes me happy too. And (3) if I got sad every time I saw a sad thing, I'd be too sad to do my job and then I'd get fired. So, like, these things don't really make me sad because I'm here to do my job, not to get big feelings?

Does that make sense, or too facile?

[p1esk]

Action-packed and gratifying? Sure. Fun? No.

Some of the people you see in ER are having the worst time of their lives (I was once), so it would be great to be viewed as more than “pph”.

Btw, that forum you linked to, it’s depressing. Yes, the system is broken, but it also seems everyone has just given up.

[sangnoir]

> Fun? No

Maybe not for you. If I had a medical emergency, I wouldn't want to be attended to by a mopey physician - no matter how dire my circumstances. The same goes for therapists and first responders. Yes, those people don't always see people at their best, and they've seen some shit - but it's just a job, and society works best if that job is done well.

ER doctors are the SREs of physicians - some folk are wired to enjoy the same high-tempo/unpredictability aspects that repels others.

[liotier]

> Action-packed and gratifying? Sure. Fun? No.

I looked up the etymology of "fun" and you are right - Middle English fonne, fon (“foolish, simple, silly”).

That said, I'll take action-packed and gratifying over fun any day.

Also, emergency medical doctors are extremely foolish people during their down time - medicine has an old tradition of utter silliness when it is time to blow off steam from the job's pressure. So there, fun too !

[lukan]

When I was in ERs as patient, I did enjoy doctors with a good mood. People with a good mood are also usually doing a better job and if they have fun fixing my mess, good for them and for me. Optimism is quite helpful for recovery.

I mean, I am also a fan of black humor, so mixing jokes with blood works for me, even if it is my own blood.

[hundreddaysoff]

Of course I view you as more than pph. My job would not be very fun if I only viewed you as pph. And another part of keeping my job involves minimizing patients complaining about me to admin, which they would a whole lot more if I only [acted like I] viewed them as pph.

And, in order to allow myself to continue viewing patients who are not you as more than pph as well (and thus keep my job), I also consider a lens of pph. Because if I'm talking to you for an hour about low-carb diets or whatever and you feel like I'm the best doctor in the world, but there are 5 more people in the waiting room in pain that I haven't seen yet because I'm totally focused on you... also not doing my job.

The fact that I use this lens does not limit the services I provide to you or the empathetic positive feelings I share with you as a fellow human. (Or not, if you don't want those feelings. As a certified weirdo, I distrust people who come onto me w/ big outward empathy, personally. But most patients like it in my experience. So I tailor it really depending on who you are.)

Agree that forum is very depressing. Bunch of old ER docs who aren't looking for a way out for whatever reason. Part of the goal of my posts in that thread was to get them to smile a little, but they're too crusty. If I hated my job as much as some of them, I would just quit immediately and go back to programming.

[tomcam]

Wait you think ER is fun but also radiology? I feel like they are on opposite poles of the excitement spectrum. And are you saying you have sciatica?

[hundreddaysoff]

Yes, I think many things are fun or exciting, often for diverse reasons.

ER is fun because, eg, https://forums.studentdoctor.net/threads/patients-per-hour.1...

I do some radiology in the ER. I do find this fun. The core skill of radiology is to find stuff in pictures and then communicate these findings to others. Just like I did as a scientist, which I also found fun and exciting.

I also find it fun to do research in molecular imaging. I suspect I would further have fun researching AI techniques that may allow us to replace some or all of the human work of radiologists with computers. (I suspect "all" will never happen, for the same legal reasons that I suspect we'll never have real self-driving cars. Humans need, um, human scapegoats.)

However, yes, I also have chronic sciatica, or back pain. It gets worse the longer I sit. I don't like standing still enough to use stand desks and treadmills are distracting. Clearly being a radiologist and sitting in a dark room for hours at a time would not be good for this pain.

This is yet another reason I got out of full-time programming.

[tomcam]

I love the way you love life. Yours are some of the most interesting answers I’ve ever read on this site.

[i_am_proteus]

Thanks for sharing all of this. Your account of a night shift gives me hope that there are still micro-cultures out there that want to get it done. Reminds me of the best parts of active duty.

[fuzzfactor]

>there are still micro-cultures out there that want to get it done.

My impression as well.

And I admire it way more when the attitude is maintained even when surrounded by those having lesser motivation.

[Sparkyte]

250/h thats solid.

[leaferino]

What's your telemedicine business?

[hundreddaysoff]

Main telemedicine gig right now is diagnosing and managing HIV and other STDs. Patients love it as it's super private, and even testing can be done discreetly at home with a mailed kit.

Currently completing an online fellowship in obesity medicine and plan to start my own online practice or collaborate with midlevels who do so. Will probably get into tele-urgent care as well.

I've learned a little about all aspects of medicine as an ER doc, and it's exciting to apply that knowledge to telemedicine. Telemedicine is the Wild West right now. COVID-19 just opened it up a couple years back. We don't really know how to maximally benefit patients with it, but there are all kinds of new models being tried. When it works, it really works, without all the bloat and entrenched rentiers that can make brick & mortar medicine awful for both doctors and patients.

Reminds me of the state of the Internet around 2000. Wide open.