555 EM spots did not fill in Match

[bravotwozero]

Most of the EM docs that work days at my site do not work night. I am guessing there must be a significant differential for working nights. Is it hard to find EM job in which one only work days?

EM might be able to solve this issue by providing a nice differential for night shift (eg., $40/hr extra).

Generally, yes, unless the group has a few dedicated nocturnists. I've been in those groups, but in my experience, that setup doesn't last long, and eventually the nocturnists end up deciding they don't want to work nights anymore, and either go back to days or leave. Even with the differentials.

Some of the VA shops though will hire nocturnists via staffing companies though, and all their own employed docs just end up working days. That's about as close to a permanent day shift gig as I have seen.

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[rokshana]

Why? Just wanted a different experience?

Because just because you are qualified to get into a U.S. med school doesn’t mean you get into a U.S. med school.

While, yes, many that go off shore have an issue…low gpa, low mcat,etc it is a common misconception that this represents everyone.
Plenty of students come from states ( NJ, Cali, texas, NY) where there simply are more applicants….qualified applicants than in state med schools with seats. Pt come from states that have no med school and are considered out of state as an applicant.
There are a number of reasons a person goes off shore that has nothing to do with performance or qualifications.

 

[Trousseau]

I talked to a buddy that graduated with me that stayed on as core faculty. He told me they only matched 3, then yesterday had to scramble to fill in the rest.

IMGs from the Caribbean with multiple red flags and board failures.

PD was told to fill or lose funding.

He said it was NOT a good week.

And this is a level 1 trauma center we’re we got amazing training. The area sucks but the type of place you go for great training and get out.

F CK. ACEP, ACGME, and all of the CMGs for what they have done to our field.

Man, I remember applying 6 years ago when EM was right under Ortho in competitiveness. How the turn tables…

 

[RustedFox]

Why? Just wanted a different experience?

Applied very regionally with my scores. Was told by people "Wow, you'll have no trouble."
Had trouble. I have an idea why. Didn't want to wait a year. My own family care doc then was a SGU grad who told me: "Don't wait... Go."

Glad that I did.

 

[hopefulgasman]

Another example of a “mighty program” that all of a sudden looks to be more “inclusive.” Kings County EM aka the Clinical Monsters. I count 99% USMDs and maybe one DO prior to this year. This year’s class has 8 IMGs from the Caribb and 2 DOs. USMDs aren’t dumb. 4 years to join a specialty on fire - hard pass. Literally.

This has nothing to do with IMGs or DOs, but rather a snotty program now realizing it’s worth.

 

[TooMuchResearch]

Avg em pay was like 380k. You may have to commute but there are a ton of super simple jobs around that pay 175-200/hr for minimal work and effort. Like 1 pph.

Or just find an SDG where PPH is about 1.3 at the high acuity place and there are rural sites where you can still occasionally sleep most of the night. Pretty sure we're past peak inflation adjusted hourly pay but I honestly have little to complain about. These jobs do exist. But probably nowhere near where CMGs roam free.

 

[miacomet]

Another example of a “mighty program” that all of a sudden looks to be more “inclusive.” Kings County EM aka the Clinical Monsters. I count 99% USMDs and maybe one DO prior to this year. This year’s class has 8 IMGs from the Caribb and 2 DOs. USMDs aren’t dumb. 4 years to join a specialty on fire - hard pass. Literally.

This has nothing to do with IMGs or DOs, but rather a snotty program now realizing it’s worth.

I can't find their list...really curious??

 

[TooMuchResearch]

If I know someone who is between IM and EM right now, I will tell that individual to do IM even for the sole purpose of becoming a hospitalist. I know things can change in medicine, I won't advise anyone to jump into a sinking ship .

I was surprised to learn what our hospitalists make. A busy overnight with 12 admissions and they're around par with what I make from a busy overnight. And I've already done about 90% of the overnight management and emergent consultation (don't get offended, that's at least half joke).

 

[TooMuchResearch]

Or just find an SDG where PPH is about 1.3 at the high acuity place and there are rural sites where you can still occasionally sleep most of the night. Pretty sure we're past peak inflation adjusted hourly pay but I honestly have little to complain about. These jobs do exist. But probably nowhere near where CMGs roam free.

Don't get me wrong. Sometimes we get absolutely smoked at the slow sites and there is an element of stress being the only doc in the facility after everyone else goes home for the day. But we trade stress/trauma for dollars. It's the job.

 

[JacobMcCandles]

Most of the EM docs that work days at my site do not work night. I am guessing there must be a significant differential for working nights. Is it hard to find EM job in which one only work days?

EM might be able to solve this issue by providing a nice differential for night shift (eg., $40/hr extra).

It isn’t like patients who come in at 3am reimburse more than someone coming in at 3pm. It’s all the same pot of money so in an SDG, the night shift differential is coming from those who work days/evenings. In a CMG, that money is typically coming from other docs and/or non-clinical people so it’s likely to be much less since they’re already typically paying the other docs less.

 

[Backpack234]

All this talk about saving and investing for 5 years and getting out. Probably worked from 2009 to 2021, but how's that been working out the last few years?

 

[The Knife & Gun Club]

Needs more context. What's the top half of your list? How many of them needed J-1 visa's?

IIRC gamer’s program has a very specific geographic area that they draw heavily from

 

[finalpsychyear]

To those who think they can not save 1M after residency or that its too much sacrifice, then I say you will be the 8 EM docs being dinner for the sharks. The ones who can have learned to swim faster than you.

I am not saying to go into EM but if you are or already starting, learn to outswim the 8 who can't teach themselves to swim fast.

Gen X would have agreed with this. The new guns are all about live in the moment and YOLO.

The 10 year FI goal should be a rule for those who are spending 4 years or less in residency. No guarantee mid levels wont gobble all the moonlighting gigs in future at the rate of pump.

FI when young ( <50) is the ultimate accomplishment imo not when nearing 60.

Point is everything worth having has its trade offs. I didn't want to spend 7-8 years in residency doing sub spec cards/rads, neurosurg, etc
So working 2 fte and investing 60% gross maybe till 10 years out with this approach vs these guys gets me close to them. Not easy but neither are the sacrifices those in these types of fields make.

 

[BoardingDoc]

Most of the EM docs that work days at my site do not work night. I am guessing there must be a significant differential for working nights. Is it hard to find EM job in which one only work days?

EM might be able to solve this issue by providing a nice differential for night shift (eg., $40/hr extra).

This is an extremely uncommon scenario. It does exist but the vast majority of shops have everyone working some nights.

 

[miacomet]

I can't find Kings County, although I'm looking, but wow Stony Brook. They were also full of themselves with their EMcrit etc. And now....

 

[GonnaBeADoc2222]

Lulz here we go with the intergenerational warfare.

Not everyone wants to grind themselves to a pulp and never enjoy anything.

2 FTEs lol stfu

 

[finalpsychyear]

Lulz here we go with the intergenerational warfare.

Not everyone wants to grind themselves to a pulp and never enjoy anything.

2 FTEs lol stfu

In my gigs this is 50ish clinical hours m-f only, no wknds/holidays/nights. 40 of them from home.

Not possible for all fields. Wish you the best in your long career ahead.

 

[Rekt]

All this talk about saving and investing for 5 years and getting out. Probably worked from 2009 to 2021, but how's that been working out the last few years?

It's not realistic at all.

The difference in debt alone from medical school is massive. Unless you're well off already, you're coming out with 250-350k in loans unless you went to TX. Pay isn't nearly as high. Everything is more expensive. Housing market is a joke. Car market is a joke. Stocks are a dumpster fire. The people who got into real estate just even 2-3 years ago got lucky and nothing like what happened will happen any time soon.

 

[miacomet]

Wow, at least the Clinical Monsters of Kings County had the foresight to interview a large group of applicants, and to rank them all. Seems like some programs knew this reckoning was coming....

 

[GonnaBeADoc2222]

It's not realistic at all.

The difference in debt alone from medical school is massive. Unless you're well off already, you're coming out with 250-350k in loans unless you went to TX. Pay isn't nearly as high. Everything is more expensive. Housing market is a joke. Car market is a joke. Stocks are a dumpster fire. The people who got into real estate just even 2-3 years ago got lucky and nothing like what happened will happen any time soon.

All you gotta do is find an SDG to pay you 400k, work 2 FTEs, buy 5 rental properties in 2019, and have connections!

 

[Franzd'Epinay]

All you gotta do is find an SDG to pay you 400k, work 2 FTEs, buy 5 rental properties in 2019, and have connections!

You forgot arguably the two most important points:

• Don’t live in a HCOL area
• Don’t have kids

Easy peasy.

 

[sylvanthus]

Maybe I missed it. I did not see anyone crapping on DO/IMG/FMG... People just acknowledged the reality of the match.

It is no secret that PDs have their preferences.

Ya Im not sure where the offense is comin from. Im a DO and wasnt offended by any of it. Its well known that in general the more DOs IMG FMGs the lower ranked the programs usually are.

 

[sylvanthus]

All this talk about saving and investing for 5 years and getting out. Probably worked from 2009 to 2021, but how's that been working out the last few years?

I havent earned jack in my retirement for the past 2 years. Its doin awesome!

 

[Backpack234]

It's not realistic at all.

The difference in debt alone from medical school is massive. Unless you're well off already, you're coming out with 250-350k in loans unless you went to TX. Pay isn't nearly as high. Everything is more expensive. Housing market is a joke. Car market is a joke. Stocks are a dumpster fire. The people who got into real estate just even 2-3 years ago got lucky and nothing like what happened will happen any time soon.

Exactly this. The generation before was fine. Graduate in 09. Market returns 20% per year. Houses are dirt cheap. Just shows how quickly things can change. Here’s hoping it changes again soon.

 

[bravotwozero]

I havent earned jack in my retirement for the past 2 years. Its doin awesome!

At least you can get away from nights if you wanted to.

 

[bravotwozero]

Exactly this. The generation before was fine. Graduate in 09. Market returns 20% per year. Houses are dirt cheap. Just shows how quickly things can change. Here’s hoping it changes again soon.

Not with those *****s at the federal reserve. Let’s wreck everyone’s life savings to get that inflation down!

 

[allantois]

Didn't know IM/EM was a thing

 

[sylvanthus]

Didn't know IM/EM was a thing

your mind will be blown when you learn EM/IM/CC is a thing.

 

[Splenda88]

I was surprised to learn what our hospitalists make. A busy overnight with 12 admissions and they're around par with what I make from a busy overnight. And I've already done about 90% of the overnight management and emergent consultation (don't get offended, that's at least half joke).

I dont know what you make. The nocturnists at my place make 382k/yr and I was told they are about to have a 15k raise. I think EM docs make more than that.

 

[Fecal_Occult]

Wow, at least the Clinical Monsters of Kings County had the foresight to interview a large group of applicants, and to rank them all. Seems like some programs knew this reckoning was coming....

Here's another program to shame for being snooty. Loma Linda. Formerly, an exclusive USMD only club. Now they are half DO's. As a California program, I think they should actually be happy with this match! These programs are all about equity and inclusivity. Now they get to spread the love to their non-USMD colleagues.

 

[EctopicFetus]

It isn’t like patients who come in at 3am reimburse more than someone coming in at 3pm. It’s all the same pot of money so in an SDG, the night shift differential is coming from those who work days/evenings. In a CMG, that money is typically coming from other docs and/or non-clinical people so it’s likely to be much less since they’re already typically paying the other docs less.

Depends. If u r 100% RVU based and your night volumes are lower you will earn less.

 

[EctopicFetus]

It's not realistic at all.

The difference in debt alone from medical school is massive. Unless you're well off already, you're coming out with 250-350k in loans unless you went to TX. Pay isn't nearly as high. Everything is more expensive. Housing market is a joke. Car market is a joke. Stocks are a dumpster fire. The people who got into real estate just even 2-3 years ago got lucky and nothing like what happened will happen any time soon.

I agree with some of this sentiment but people made out in RE post crash. People said housing will never pop like that again. My point is you never know. I am in the “keep firing” investment Plan. I put the same amount of money in the market every month no matter what it is doing. Stocks may go sideways for a while. Who knows. The experts are wrong as often as they are right which is why index investing has done so well.

 

[Splenda88]

It's not realistic at all.

The difference in debt alone from medical school is massive. Unless you're well off already, you're coming out with 250-350k in loans unless you went to TX. Pay isn't nearly as high. Everything is more expensive. Housing market is a joke. Car market is a joke. Stocks are a dumpster fire. The people who got into real estate just even 2-3 years ago got lucky and nothing like what happened will happen any time soon.

Many of these things have to do with where one lives and your goal. For instance, EM docs at my hospital make ~$250/hrs from what I was told. With that kind hourly rate, EM docs can easily make 450-500k. A typical middle class family home here is 300-350k. I just purchased new built here for 280k.

Even with having a 250-350k student loan, an EM doc here can be financially independent (FI) in 5-6 yr if this is the goal. FI is having no debt, your home paid off and have 1+ mil into investment IMO.

Honestly, that is why I am here. Goal is to make 375-425k every year as a hospitalist and then get the f*** out in 4-5 yrs.

I think people have to be a little bid more strategic about things.

 

[miacomet]

Many of these things have to do with where one lives and your goal. For instance, EM docs at my hospital make ~$250/hrs from what I was told. With that kind hourly rate, EM docs can easily make 450-500k. A typical middle class family home here is 300-350k. I just purchased new built here for 280k.

Even with having a 250-350k student loan, an EM doc here can be financially independent (FI) in 5-6 yr if this is the goal. FI is having no debt, your home paid off and have 1+ mil into investment IMO.

Honestly, that is why I am here. Goal is to make 375-425k every year as a hospitalist and then get the f*** out in 4-5 yrs.

I think people have to be a little bid more strategic about things.

A million plus a paid off house is a nice start, but it's far from livable retirement if you are single, forget it if you have kids.

 

[cyanide12345678]

All this talk about saving and investing for 5 years and getting out. Probably worked from 2009 to 2021, but how's that been working out the last few years?

Would have been nice graduating in 2010.

But graduating in 2019 wasn't that bad either. It hasn't been that bad. Just gotta save, invest, control expenses.

2008 - Moved to US with 2 suitcases and $5000.
2016 - Broke as hell, a lot of debt, graduated from med school.
2019 July - Still broke as hell graduated residency.
2022 August - Hit 1 M net worth.
2023 March - Sitting on 1.36M nest egg (that's after losing 50k these last 2 weeks -_- but they will come back )

Should have 2M by completion of year 5 post residency despite plans of both myself and my wife cutting down to 0.75 FTE.

10 years later, you'll look back and think 2023 was a nice time to buy real estate and stocks. If the market crashes, you're about to get some of the best buying opportunities of your life. Load up, work extra shifts and buy buy buy.

REITS have dropped 30+ percent. KBE, regional banking ETF, is crumbling, tech took a beat down with some amazing opportunities like meta touched a P/E ratio of < 10 (it was a once in a lifetime opportunity 2-3 months ago). I mean...just INCREDIBLE opportunities. BUY BUY BUY and hold through the turmoil, hold through the paper losses and come out wealthy - Eventually.

 

[Splenda88]

A million plus a paid off house is a nice start, but it's far from livable retirement if you are single, forget it if you have kids.

I said financially independent (not the retire early part)... Of course, I will continue to work. But in my mind that is f*** you money. Meaning, I can work on my own term.

The good think about medicine, most of us in this forum can make 150k+/yr working only 8 days/month. That is being in 90th percentile in term of income in the US.

I am ok being in the top 10% of any thing that is regarded as "good".

 

[cyanide12345678]

I said financially independent (not the retire early part)... Of course, I will continue to work. But in my mind that is f*** you money. Meaning, I can work on my own term.

The good think about medicine, most of us in this forum can make 150k+/yr working only 8 days/month. That is being in 90th percentile in term of income in the US.

I am ok being in the top 10% of any thing that is regarded as "good".

Most people with a 1M nest egg in their 30s theoretically have achieved coast fire. Most of us can do 4 shifts a month and make 100k+ and not touch retirement and just let it compound.

 

[Splenda88]

Most people with a 1M nest egg in their 30s theoretically have achieved coast fire. Most of us can do 4 shifts a month and make 100k+ and not touch retirement and just let it compound.

Sometimes we don't realize how fortunate we are. Imagine you tell the average person you make 100k+/yr working 4 days/month. It's crazy when you think about it.

I dont remember the exact context. But it was some clip on YouTube about dating and one of the female said she was dating a cardiologist; the host said do your best to keep that guy around because "you are dating a mini celebrity." Lol...don't know about that.

A few months ago, we were talking in the physician lounge about playing the Powerball when it was close to 1 billion $$$, one nephrologist said: 'We already won the lottery as physicians; we won't be that lucky to win it twice.'

 

[BoardingDoc]

Many of these things have to do with where one lives and your goal. For instance, EM docs at my hospital make ~$250/hrs from what I was told. With that kind hourly rate, EM docs can easily make 450-500k. A typical middle class family home here is 300-350k. I just purchased new built here for 280k.

500k at 250/hr = 38.5 hrs / wk in EM. That's 5 days a week of 8 hr shifts. Is this doable? Yes. Is this "easily making 500k?" Absolutely not. That schedule is not tenable. 16 shifts at 8hrs/shift is 29.53 hrs/wk which is a much more common comparison, which at 250/hr = 384k. Coincidentally, that's only 2k more than what your nocturnists are making.

 

[xaelia]

I'm sure it's way saner! Jealous!
Love to hear more about your job/lifestyle.

Well, saner – perhaps. We have a lot of the same problems:

Leaked email highlights staffing crisis at Christchurch’s Emergency Department — Chris Lynch Newsroom

Leaked email highlights staffing crisis at Christchurch’s Emergency Department

www.chrislynchmedia.com

Overall, it is indeed full of people – ODs, cow and eScooter trauma, old folks unable to safely be at home, and everyone whose back pain is unbearable. For most of the few years I've been here, it's been a pretty smoothly running department – we'd clear the WR when we got 240 a day, but now we're up to 340 - 370 a day, going as well as you could imagine.

But, just culturally, it's a lot more pleasant for working. Most folk are simply grateful for the time we spend trying to fix their issues. For the most part, our struggles are highlighted in the news enough they know it's not staff to blame for their waits or inability to access care – it's the administrators/government. So, most folks are quite patient with us, and it definitely goes a long way to have patients with realistic expectations for pace of care and the scope of care provided.

As far as work environment, I'm fairly lucky to be at the newest hospital in New Zealand, a major expansion of the only tertiary specialty care center on the South Island. One of the most fun things about working here is I've got colleagues trained all over the globe – Singapore, South Africa, the various bits of the British Isles, and the locals from AUS/NZ. The least fun thing, by far, is probably the derelict IT systems – I guess we'll see what we're able to improve with this next round of investment, but I still write orders on paper ...

I'd say the one thing most folks "complain" about the most down here is salary. I took a quick look back at my last 16 weeks or so, and seems like I cleared about $75k for 250 hours of clinical work. There's also expectation to do part of a day's worth of work as a hospital administrative portfolio. If you think about it as a part-time academic job, in a way, it works out OK – and factoring the perks of 9-odd weeks worth of time off (that accumulates faster than I can actually take it)(can get paid out in cash if you want, instead) – it ends up being overall sustainable.

Oh, and specialists (FACEM - their ABEM equivalent) don't work night shifts.

 

[BoardingDoc]

I'd say the one thing most folks "complain" about the most down here is salary. I took a quick look back at my last 16 weeks or so, and seems like I cleared about $75k for 250 hours of clinical work. There's also expectation to do part of a day's worth of work as a hospital administrative portfolio. If you think about it as a part-time academic job, in a way, it works out OK – and factoring the perks of 9-odd weeks worth of time off (that accumulates faster than I can actually take it)(can get paid out in cash if you want, instead) – it ends up being overall sustainable.

75k per 250hrs in USD or in kiwibucks? Cause 75k kiwibucks is 47k USD. (For those who hate math, that's either 300/hr or 188/hr depending).

 

[xaelia]

75k per 250hrs in USD or in kiwibucks? Cause 75k kiwibucks is 47k USD. (For those who hate math, that's either 300/hr or 188/hr depending).

... pacific pesos!

 

[VA Hopeful Dr]

Would have been nice graduating in 2010.

But graduating in 2019 wasn't that bad either. It hasn't been that bad. Just gotta save, invest, control expenses.

2008 - Moved to US with 2 suitcases and $5000.
2016 - Broke as hell, a lot of debt, graduated from med school.
2019 July - Still broke as hell graduated residency.
2022 August - Hit 1 M net worth.
2023 March - Sitting on 1.36M nest egg (that's after losing 50k these last 2 weeks -_- but they will come back )

Should have 2M by completion of year 5 post residency despite plans of both myself and my wife cutting down to 0.75 FTE.

10 years later, you'll look back and think 2023 was a nice time to buy real estate and stocks. If the market crashes, you're about to get some of the best buying opportunities of your life. Load up, work extra shifts and buy buy buy.

REITS have dropped 30+ percent. KBE, regional banking ETF, is crumbling, tech took a beat down with some amazing opportunities like meta touched a P/E ratio of < 10 (it was a once in a lifetime opportunity 2-3 months ago). I mean...just INCREDIBLE opportunities. BUY BUY BUY and hold through the turmoil, hold through the paper losses and come out wealthy - Eventually.

It's worth noting that your wife is also a doctor...

 

[GonnaBeADoc2222]

It's worth noting that your wife is also a doctor...

Shhhhhhhhhhhhh

 

[miacomet]

I said financially independent (not the retire early part)... Of course, I will continue to work. But in my mind that is f*** you money. Meaning, I can work on my own term.

The good think about medicine, most of us in this forum can make 150k+/yr working only 8 days/month. That is being in 90th percentile in term of income in the US.

I am ok being in the top 10% of any thing that is regarded as "good".

I have not found a way to work on my own terms in EM. Locums? It's all swings and weekends. Part time? You end up working more weekends and nights than your fair share. And the metrics never go away.

 

[JacobMcCandles]

Depends. If u r 100% RVU based and your night volumes are lower you will earn less.

That’s why any decent group can run some scenarios and give nocturnists different hourly, RVUs, whatever to ensure they’re not taking a pay cut. But that money would have to come from the other docs.

 

[GonnaBeADoc2222]

I have not found a way to work on my own terms in EM. Locums? It's all swings and weekends. Part time? You end up working more weekends and nights than your fair share. And the metrics never go away.

There's no real "working on your own terms" in EM.

Sure, you can do locums, but piss off the wrong person? Gone. Shop fills with FT folks? Gone.

The locums at my shop are essentially making the same as I do when you convert their 1099 to my w2 and consider my benefits.

 

[inspirationmd]

Unpacking the 2023 Match Week - ACEP Now

ACEP Now offers real-time clinical news, news from the American College of Emergency Physicians, and news on practice trends and health care reform for the emergency medicine physician. ACEP Now is an official publication of the American College of Emergency Physicians.

www.acepnow.com

This is an honest review of the issues.

 

[GonnaBeADoc2222]

I don't trust ACEP propaganda

 

[inspirationmd]

I don't trust ACEP propaganda

Fair point. ACEP News is usually lip service and nonsense. But the authors at least try to comment on most things and echo a lot of sentiment on this board. The very minimal commentary on CMG proliferation as a direct root cause is my biggest critique of it.