555 EM spots did not fill in Match

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Once a LONG time ago considered EM but was turned off by the lifestyle. Matched FM this cycle. Super happy I didn’t do EM.

Anyone who has an interest in EM should just do FM at this point. If you’re THAT interested, a fellowship is always an option.

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The only way to “save” the specialty at this point is to shut down some residencies.
 
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Once a LONG time again considered EM but was turned off by the lifestyle. Matched FM this cycle. Super happy I didn’t do EM.

Anyone who has an interest in EM should just do FM at this point. If you’re THAT interested, a fellowship is always an option.

I wish i could just go back and do FM.

I’d be so much happier. It’s just a better gig.
 
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I wish i could just go back and do FM.

I’d be so much happier. It’s just a better gig.
I couples matched and didn’t match EM my first time around.

The second time, got fewer EM interviews,
Applied to FM and IM as backup, and matched EM.

Lol.
 
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I struggled with psych vs EM. I combed these forums as a Med student. I buried the advice of various posts I read over the years recommending to avoid EM. Now, I’m an attending and have a really good job. BUT, I’ve realized I should’ve chose Psych (or hell, anything else). Have regretted it almost monthly since intern year. Never had the balls to switch. Regret it probably even more now. To the indecisive Med students reading these posts: heed our advice. That’s all I can say. EM is some ****. I don’t hate my life, I quite like it. But it didn’t have to be this way for me. I could’ve had a cush psych gig and not lost years of my life to stress and circadian dyssynchrony. I could’ve not spent my days in the flaming dumpster fire that is the hospital ED. I didn’t fully believe all the EM negativity but…it is, in fact, reality.

Even as a resident, I didn’t realize how messed up the schedule can be as an EM doc. Med students and anyone who doesn’t do this type of schedule has no clue (even other shift workers): Monday 0700-1900, Tuesday 1900-0100, Thursday 0600-1800, Friday 1900-0700, Sunday 0700-1900. Random flips with barely 24 hours off. If you’re scheduler does it by hand, it might actually be logical or reasonable. But if it’s done partially or fully by computer… ugh… I managed with schedules like that above for a year (far more nights and evenings though, and most of my days were 24 hours after coming off a night shift) but decided the steady nature of just being straight nocturnist without the weird random day here and there, while getting a slight pay differential, was worth it. Been doing nocturnist for 8 or 9 months and I see my kids more somehow and while the flips back and forth suck, and I feel jet lagged a lot, it overall is better than the quasi dream state I was in the year before. Steady but ****ty schedule for me>chaotic schedule.

The amount of circadian rhythm disruption cannot be overstated: unless you’re a cyborg, you will have some amount of it and your cortisol levels will be completely out of whack. This is something I completely underestimated and didn’t fully understand, despite working as a tech then paramedic in an ED before med school and shadowing hospital employed community EM docs.

Birdstrike’s post above fully encapsulates most of the crap that is EM today. I just felt the need to really hammer home to anyone who is thinking “oh I’ve done shift work, I can handle the swings” that they truly have no clue how they’d handle it unless they’ve worked that kind of schedule with it’s randomness and chaos before. I voluntarily decided to only work nights because it was better than the chaos of the “normal schedule”. I’d guess a lot of groups do it better than ours with this. But there are loads of groups who do it like this. This is not a lifestyle specialty, unless your lifestyle fits a random schedule.
 
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What would all you salty ****ers' advice be to a 4th year who just matched to EM? Listened to the warnings, decided **** it, we ball. Interested in maybe crit care or ultrasound.
 
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What would all you salty ****ers' advice be to a 4th year who just matched to EM? Listened to the warnings, decided **** it, we ball. Interested in maybe crit care or ultrasound.
Don’t do US. Thats a dime a dozen. Welcome to a great specialty. I would also say if you wanted to do CC probably should have gone the IM route. But Em is still functional for now. Start sorting out your career ASAP. Be it a fellowship or a job. It’s gonna be tough out there.
 
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We could write about the negatives of EM until we're blue in the face, but if people don't believe it, it won't make a difference. The fact that 2,500 people are still going into it is proof the lies, the sales pitch, the swindle, are still working by and large.

But the facts remain the same. EM is a lie from the very name. Emergency Medicine is NOT emergency medicine. It's 90% something else. It should be renamed for what it is mostly, not for what it was supposed to be.

1) Lifestyle specialty - Lie
2) When you're off, you're off - Lie
3) Emergency Medicine is the medicine of emergencies - 90% Lie

4) You'll be the most rested of all specialties because days off - Lie
5) You won't be backstabbed and treated worse than dirt by administrators you'll never meet - Lie

It's biggest recruiting features and the reason most people go into it, are all false. Yet they still sell it that way, and enough bodies are showing up and buying in.

NO ONE should go into EM. No one. No EM grads, not foreign grads. NO ONE, until there is radical change focused on physician fairness, physician wellness and physician respect.

Until doctors are given carte blanche to rewrite the rules of the specialty, and administrators, regulators and step aside, NO ONE should.

They should tear up the textbooks and rewrite them. Start by taking the NAME off any textbook written by backstabbing EM physicians who testify against their own with testimony so bad they're sanctioned for it.

Entire chapters should be written about how you MUST do what administrators tell you or you'll be fired.

If the specialty was HONEST without it's recruits, honest with itself, at least that would be fair. But honest, they won't be. Because it would paint a picture so dark, so grim, so discouraging, they'd fear no one would every go into EM. Rather than take a stand, unionize, band together and fiercely use their leverage to make radical change for the better, they'd just rather lie.

Entire chapters should be written about you'll be depressed, groggy and snapping at your family when you're "off" because you worked till 7 am on your day "off." Jet-lag will be your life.

Entire chapters should be written about how your ED director will force/pressure/gaslight you into gaming the numbers of "door to doctor" times and 50 other metrics to please some administrator, while sick patients need you.

Entire chapters should be written explain how previous entire chapters should be ignored because "patients will demand you do X, Y, Z and you'll be fired if you don't 'please' the patients."

Entire chapters should be written on the fact that you'll be sued for NOT committing malpractice multiple times, for something you didn't do, that somebody else did or didn't do, no matter how defensive you practice medicine and that one of your colleges or bosses will make a big paycheck to ensure it happens.

All Emergency Medicine books should be retitled as "Mostly Data Entry & Corporate Profits Disguised as Urgent Care, with Some Emergencies" Seriously. I'm not joking. It's not okay to start lying already on THE COVER OF THE BOOK. Fix the specialty or RENAME IT!

Entire chapters should be written about using a computer on wheels, mouse, finger pad, clicking boxes, checking boxes, meaningful use, useless meaning, and data entry will be >50% of time spent.

Entire chapters should be written about how to pull yourself out of the inevitable psychosocial crisis the specialty will drive you to within 5 years or less through emotional exhaustion, while you're blamed for it by those that caused it.

Entire chapters should be written about being verbally abused by admitting doctors, consulting doctors, drunk/psychotic/violent patients 100 times to every 1 time you're thanked.

An entire chapter should be written on how the specialty was specifically designed so that you're trapped in it, with scarce exit plans. This was no accident, when EM was formed as a residency as opposed to a fellowship after IM, FM or peds. If it was a fellowship, then every EP would be able to easily move in and out of EM, based on working conditions, whereas residency is a one-way street without room to turn around or exit laterally).

But...but...but...NONE of that really matters even a bit, in comparison to the fact that chronic circadian rhythm dysphoria, and working nights, weekends and holidays takes such a big toll on a person's personal and family life, it's just not worth it when there are so many other choices less onerous. EVERYTHING pales in comparison to that fact that EM takes away one's ability to have a normal life. The impact of losing that, cannot be overstated.
Lol…. Came here to see the reaction to the match. My password is somehow still saved on my computer! I logged in just to say how excellent and true all of this is. 20 years later and I’m still at it, but the cost has been high over the years. I wrote a post on here in 2003 about the dangers of opening too many training programs…. It just took a while to come true, I guess. This should be required reading for all med students.
 
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I am not going to sugarcoat or disagree with much said about EM. EM is much more difficult than what it was last decade. I still do not think EM is nearly as bad as many other specialists, some will disagree which I understand the reasons.

But you, I, or anyone else is not going to change the fact that there are too many EM residencies and even if it is not filled by AMG it will be filled by FMGs. I mean, create 7K spots and Caribbean grads will fill it. Every field could be threatened with an oversupply of residencies.

Everyone in EM should find cheat codes because there are always cheat codes in life. If you know you will be on a boat with 9 other and there are 8 hungry sharks then instead of hoping to not eaten, then learn to swim fast.

If I were an EM resident, this would be my mindset.

1. I will do 3 yrs of residency.
2. 5 yrs post grad, I would have made 700K vs a surgeon who just graduated.
3. After taxes, living expenses you should bank 300K.
4. EM docs still work 12-14 dys a month. You have lots of off days and a 300K head start to do something with it.
5. Think about a business you can make money from because 300K is alot of money and if used correctly can produce alot of money.
6. In 5 yrs work less if you like b/c you have used the money wisely.

Compare this to the surgeon who finished in 5 yrs. They have to start out making no more than what an ER doc made working way more than 40 hrs a wk. They are working all weekdays, call on some weekends, calls at night to build their practice. They have less money and less time to create cash flow b/c they are working alteast M-F when business transactions are made.

Who would you rather be? Obviously it depends how you treat the extra time and 300K head start. Give me the ER doc any day b/c I can create alot with 300K.

Its not all roses in EM, but use the positive to your advantage. Train to be the guy who can swim fast and let the sharks eat the other 8 EM docs. There is alot of luck in life but you have to create your own luck and be ready to turn that luck into success.
 
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Ooh, finance? As an employee or something else? Finance means many things. This is interesting.
Never would I be an employee again. Once you taste the apple of being an owner, it is hard to go back working for someone else. I met a guy about 5 yrs ago introduced to me by one of our kids teachers. Kept in touch, reached out, and he needs a "partner" to work with him in commercial real estate properties. I have lots of time on my hand and its good money working from home. If it works out, it will dwarf my current EM income. If it doesn't, no biggie other than some lost time which I have alot of right now.
 
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Never would I be an employee again. Once you taste the apple of being an owner, it is hard to go back working for someone else. I met a guy about 5 yrs ago introduced to me by one of our kids teachers. Kept in touch, reached out, and he needs a "partner" to work with him in commercial real estate properties. I have lots of time on my hand and its good money working from home. If it works out, it will dwarf my current EM income. If it doesn't, no biggie other than some lost time which I have alot of right now.
Impressed. I can't stand being an employee- it's not my nature- but I'm not seeing an out, at all. I can't believe I wasted my time and life energy on EM.
 
Impressed. I can't stand being an employee- it's not my nature- but I'm not seeing an out, at all. I can't believe I wasted my time and life energy on EM.
When you have $$$ and time, there is always an out. You prob are or can make 400K/yr. Live off 100k, save 200K. Thats alot of money to start being your own boss. Find something you are passionate about because you have time/money.

You either take a leap now or look back in 20 yrs wondering why you didn't take a leap.

If you do not have any passions that can make money, then put that money into the S&P, and in 10 yrs you can work part time.
 
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Been awhile, but came to comment on this.

Birdstrike’s post is on point.

Everyone I know in EM is trying I get out of working full-time, except for one new grad, who still has rose colored glasses on.

In an area where there’s only CMGs. It’s all true.

Good riddance. I hope this all leads to a massive change in the specialty. I hope AAEM’s lawsuit is successful. All the private equity stuff is why I never renewed my ACEP membership after residency. Nobody cares except the docs working. Unless we unionize, I don’t see anything getting better.

My strategy? Make money, pay off loans, keep my non-clinical gig. Never see a patient again. Never work a weekend or holiday again. Never deal with the drunk guy causing a scene. Never have to deal with jerk consultant again. I hate peds and peds sedations. No, I don’t have time to spend starting a USGIV. Gaming worthless metrics that don’t actually improve patient care. Yeah, I’m excited.

All I can think of is that Pikachu meme. What did you expect releasing a report saying we have a massive oversupply of docs in the future, then a pandemic where we just suck it up in our reused PPE, where corporate medicine takes priority over patients, and admin does not care about the ED?

Well, well, well, if it’s not the consequences of my actions…
 
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This was a hard thread to read. Hopefully the match is a wakeup call to the powers that be -- not only that they need to decrease the number of training programs (for-profit programs, FFS, that should never be allowed), but also that the field as a whole is experiencing an existential crisis.

I remember matching EM 10 years ago alongside some of the best and brightest from med schools around the country. The fact that we have taken those people and turned them into burned-out husks or forced them out of medicine entirely is a ****ing tragedy.

I mostly came to post this, though, for the residents reading this thread: it's not too late. I switched out of EM during residency because I recognized that it wouldn't or couldn't make me happy (mostly, I think that I didn't want to exist in a world where my worth was defined by how many pph I could see -- and I didn't even know about Press Gainey). My field has its own issues (anesthesia), but I can genuinely say I love my job and I never dread going into work. It sucks to go back through the match as a resident, and it may mean giving up a year or two of your life - but that's nothing when it comes to a hopefully 30+ year career.
 
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Once a LONG time ago considered EM but was turned off by the lifestyle. Matched FM this cycle. Super happy I didn’t do EM.

Anyone who has an interest in EM should just do FM at this point. If you’re THAT interested, a fellowship is always an option.

Actually, it's not lol. ABEM is the new gold standard. Being not-ABEM will be significantly limitiing.

I wish i could just go back and do FM.

I’d be so much happier. It’s just a better gig.

Hey. Guess what? You can. You have a license. There is nothing stopping you from hanging a shingle, charging cash, and providing whatever service you want. Whether it be obesity, management of basic HTN / HDL / DM, TRT, basic psych meds, etc etc. You can find a market that's lacking, and fill it.

Will malpractice insurers insure you?...maybe.

Will the practice be successful?...maybe.

Now, the IM / FM folk will run in here screaming HEY YOU DIDN'T DO A RESIDENCY IN XYZ YOU CAN'T DO THISsSsSsS (apparently residency training in EM meant nothing when all the IM / FM / surgeons were / still are moonlighting in our EDs).

Guess what? You can. You won't be able to do it as well as them, but hey, we live in 2023, where we allow online NPs to do ALL of the above, and CRNAs intubate, throw lines, and manage vents.

If an NP can do it, why not you?
 
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@emergentmd solid advice above. I recommend alternative cash flows. Save aggressively, if you can enjoy some of it you can really accelerate your finances. It’s why I like RE, I enjoy surfing for properties in my free time and the returns have been nuts cause the housing market happened to pop. But there are other options. Use your time wisely. If you just want to work your shifts and spend all the free time just hiking it wont get you the $$ freedom you deserve and if you are fine with that then it works. I have spread my $$ around, syndication, stock market, RE I own etc. If you are a person who likes to socialize you will likely meet people doing all sorts of interesting financial things and would likely be happy to have you on board.

I know EM docs who have done DPC, addiction medicine, ketamine clinics, med spas, obesity, Botox, urgent care owners as side gigs. There are tons of options you have to jump in. I would avoid the 30-50k courses as it is frankly not that complicated.

if you are scared cold call someone outside of your area. They will likely be happy to help. If RE scares you invest with a syndicator then buy an inexpensive property with little risk and you will learn a lot. Read books, listen to podcasts. The info is all out there and if you can get thru med school this other stuff isnt terribly complex.
 
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Actually, it's not lol. ABEM is the new gold standard. Being not-ABEM will be significantly limitiing.



Hey. Guess what? You can. You have a license. There is nothing stopping you from hanging a shingle, charging cash, and providing whatever service you want. Whether it be obesity, management of basic HTN / HDL / DM, TRT, basic psych meds, etc etc. You can find a market that's lacking, and fill it.

Will malpractice insurers insure you?...maybe.

Will the practice be successful?...maybe.

Now, the IM / FM folk will run in here screaming HEY YOU DIDN'T DO A RESIDENCY IN XYZ YOU CAN'T DO THISsSsSsS (apparently residency training in EM meant nothing when all the IM / FM / surgeons were / still are moonlighting in our EDs).

Guess what? You can. You won't be able to do it as well as them, but hey, we live in 2023, where we allow online NPs to do ALL of the above, and CRNAs intubate, throw lines, and manage vents.

If an NP can do it, why not you?

Because they can't.
Not well enough to be reasonable, functional, and .... what was it? Oh yeah, SAFE.
 
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Actually, it's not lol. ABEM is the new gold standard. Being not-ABEM will be significantly limitiing.



Hey. Guess what? You can. You have a license. There is nothing stopping you from hanging a shingle, charging cash, and providing whatever service you want. Whether it be obesity, management of basic HTN / HDL / DM, TRT, basic psych meds, etc etc. You can find a market that's lacking, and fill it.

Will malpractice insurers insure you?...maybe.

Will the practice be successful?...maybe.

Now, the IM / FM folk will run in here screaming HEY YOU DIDN'T DO A RESIDENCY IN XYZ YOU CAN'T DO THISsSsSsS (apparently residency training in EM meant nothing when all the IM / FM / surgeons were / still are moonlighting in our EDs).

Guess what? You can. You won't be able to do it as well as them, but hey, we live in 2023, where we allow online NPs to do ALL of the above, and CRNAs intubate, throw lines, and manage vents.

If an NP can do it, why not you?
If you want to be supervised like an NP, have at it.

Right out of residency I turned down an ED job because I didn't think I was trained well enough for it. Same reason I didn't moonlight in the ED in residency when I was asked.

The only FPs I have known personally to do ED work were either super rural or had been working in that same ED since the 80s. So no, I'm not exactly supportive of FPs working in the ED unless there is no one else willing to work there.

You're right, you legally can do exactly what you've described. I don't see why you'd want to do something you're aren't trained in but its no skin off of my back if you do it. There are more than enough primary care patients to go around.
 
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What would all you salty ****ers' advice be to a 4th year who just matched to EM? Listened to the warnings, decided **** it, we ball. Interested in maybe crit care or ultrasound.
To those who just matched to EM, I’d say, “Congratulations and welcome to the club.” You’re one of a great, great group of people.

Maybe the experience will be better for you than it was for us. Or maybe you’re one of those people born and bread for EM and will always wonder, “I just don’t see what all the complaining is about.”

But if not, there are ways to make your way through it, or out of it, if you choose. We can help you with that along the way. Either way, you are going to do some amazing work through it all, that you can very proud of. Whether it’s 1 year, 10 years or 30, you’re going to do and see some amazing things very few people can say they’ve ever done or seen.

I chose EM, just like you. It didn’t kill me. My life is good. Just take care of yourself. Listen to your body. Listen to your mind. And if changes are needed, make them.

These salty **** ***ers are here to help you through whatever path you choose. We’re also here to be mocked and ridiculed if what we’ve written turns out to be total BS. Feel free to tell it like it is, for better or for worse.
 
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When you have $$$ and time, there is always an out. You prob are or can make 400K/yr. Live off 100k, save 200K. Thats alot of money to start being your own boss. Find something you are passionate about because you have time/money.

You either take a leap now or look back in 20 yrs wondering why you didn't take a leap.

If you do not have any passions that can make money, then put that money into the S&P, and in 10 yrs you can work part time.
Oh, I can work part-time. I'm there. It's still miserable!! The emails still never end. The micromanaging never ends.
 
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Will the practice be successful?...maybe.

Now, the IM / FM folk will run in here screaming HEY YOU DIDN'T DO A RESIDENCY IN XYZ YOU CAN'T DO THISsSsSsS (apparently residency training in EM meant nothing when all the IM / FM / surgeons were / still are moonlighting in our EDs).

Guess what? You can. You won't be able to do it as well as them, but hey, we live in 2023, where we allow online NPs to do ALL of the above, and CRNAs intubate, throw lines, and manage vents.

If an NP can do it, why not you?
I actually think ED docs should not have a hard time practicing hospital medicine; though it might take them a year to be ok at it.

Just my opinion as an IM doc
 
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Actually, it's not lol. ABEM is the new gold standard. Being not-ABEM will be significantly limitiing.



Hey. Guess what? You can. You have a license. There is nothing stopping you from hanging a shingle, charging cash, and providing whatever service you want. Whether it be obesity, management of basic HTN / HDL / DM, TRT, basic psych meds, etc etc. You can find a market that's lacking, and fill it.

Will malpractice insurers insure you?...maybe.

Will the practice be successful?...maybe.

Now, the IM / FM folk will run in here screaming HEY YOU DIDN'T DO A RESIDENCY IN XYZ YOU CAN'T DO THISsSsSsS (apparently residency training in EM meant nothing when all the IM / FM / surgeons were / still are moonlighting in our EDs).

Guess what? You can. You won't be able to do it as well as them, but hey, we live in 2023, where we allow online NPs to do ALL of the above, and CRNAs intubate, throw lines, and manage vents.

If an NP can do it, why not you?
But that’s the problem. We have a specialty that has a supposed certification but we have widespread allowance of people to practice without that certification. You wouldn’t dare find an EM doc trying to do an appy, no matter how rural an ED is. If that hospital didn’t have a GS, they would do whatever it takes to get one and stay open because that means $$$. Because we say, sure, yeah, any Tom Dick or Harry can do EM, even those we have ABEM and our specialty has been around for 60 years, sure, let an FM doc run an ED. We wouldn’t let an ER doc be a hospitalist, so why do we allow EDs to be staffed by non-ED docs? It’s insane.
 
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I said this before. If you don’t have an em trained or ABEM boarded doc then you don’t get to bill as an ED. Problem solved.

Bill like the urgent care you are.
 
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The family doctor thing is true however, the NP really only need to be billing 60% and it needs to be an urgent care unless the doctor puts a little note in it should not be billed like an emergency care visit
 
M1 - 7 years away from having an attending job.

Let’s see …. That’s 3000 x 7 = 21000 graduates ahead of them.

Does anyone see 21000 ER doctors retiring in the next 7 years? Or does anyone see 21000 jobs opening up in 7 years?

Your total ER workforce in the US is 46k. Literally based on current residency expansion number, you will increase work force by 50 percent in less than 8 years.

I mean sure…the guy can do EM. If he/she doesn’t find a job, oh well then.
Well EM is one of the few specialties that I see where residents( nevermind attendings) that are thinking about FIRE and how to accomplish it…
 
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IR is very competitive to match directly. However, it is very non competitive fellowship after DR residency.
Not exactly true. Solid IR fellowship spots are pretty competitive.
 
Hospitalists are on the verge of collapse. I would not bet on the "specialty" 10 years, let alone 30 years down the road.

A lot of CEO's are figuring out you can live without them.

Have a NP/PA cover the basic stuff and discharges, EM cover emergencies, and consult for everything else.

The fundamental rule of medicine: If you don't "own" patients, or are able to provide something that literally no one else can (radiology, pathology, neurosurgery) you are in trouble. Even if you are in one of those criteria you still may be in trouble.

Corollary of the fundamental rule: Arbitrage does not work in medicine. Arbitrage is a big fancy word that means make a lot of money for not much work. Eventually supply and demand and pressure from other specialties will even things out. Sure neurosurgeons will make a lot of money because they are crazy, but length of training and hours worked will always even out.

So if you are picking a specialty, don't bet on the one that is "hot" right now in terms of pay and lifestyle.
Yea, medicine is pretty bad. Would not pick again. I did two fourth year aways in EM after reading all about EM being the best specialty and how you work 8 days a month and make $450k from guys like WCI. Thankfully I also took note of Birdstrike’s warnings and avoided EM. Flipping my circadian rhythm constantly would be catastrophic for my health and no $$$ is worth that.

Surgical subspecialties, heme onc, cardiology, and maybe GI are the only reason somebody should go to med school going forward.

I’m in path and have an incredible lifestyle and lovely attending job at the moment, but outsourcing and CMS cuts make it difficult to recommend to anyone. Good luck to all of us stuck in this mess.
 
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Wonder how many spots left after SOAP ended today. Seems like all the failed GAS and Ortho applicants SOAPed into EM.
 
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Yea, medicine is pretty bad. Would not pick again. I did two fourth year aways in EM after reading all about EM being the best specialty and how you work 8 days a month and make $450k from guys like WCI. Thankfully I also took note of Birdstrike’s warnings and avoided EM. Flipping my circadian rhythm constantly would be catastrophic for my health and no $$$ is worth that.

Surgical subspecialties, heme onc, cardiology, and maybe GI are the only reason somebody should go to med school going forward.

I’m in path and have an incredible lifestyle and lovely attending job at the moment, but outsourcing and CMS cuts make it difficult to recommend to anyone. Good luck to all of us stuck in this mess.
There is alot of EM specific bashing which is well warranted and partly because most knew how good it was 10-20 yrs ago. It all depends on your perspective. If you are coming from someone working 120hrs/mo making 450K with little admin oversight running their own group, then year EM sucks. But 90% of people in the US would kill to make 200/hr.

What is going on in EM is not EM specific but medicine specific. Medicine has become corporate medicine. Ask any surgeon you know and see how they like their job. Ask any hospitalist taking call and see how they like their job. I can't think of many hospital based specialities where the majority like their job. Again its all perspective.

10 yrs ago, I would put EM up against most field. Today, I still think EM is still better than many fields.

I have a surgeon mom/dad couple, Anesthesiologist, and Cardiologists couple I know well whose kids go to our school. We just had a week long school camping trip and neither the Surgeon nor the anesthesiologist could go but I went. I actually chaperoned all of my 3 kid's 5th grade trip. I coached my 5th grader's basketball team this yr. Kids talk. The Surgeon's kid tells my son that dad/mom is never home and they were picked up for after school day care + Nanny. Anesthesiologist wife complains all the time that husband is either on call/at work/post call and can't make it to many events. Cardiologist kid's tells my daughter that her parents are never home and SHE confides in my daughter when she has problems.

I would trade being an ER doc with all its warts than other specialists who work/on call all the time.
 
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There is alot of EM specific bashing which is well warranted and partly because most knew how good it was 10-20 yrs ago. It all depends on your perspective. If you are coming from someone working 120hrs/mo making 450K with little admin oversight running their own group, then year EM sucks. But 90% of people in the US would kill to make 200/hr.

What is going on in EM is not EM specific but medicine specific. Medicine has become corporate medicine. Ask any surgeon you know and see how they like their job. Ask any hospitalist taking call and see how they like their job. I can't think of many hospital based specialities where the majority like their job. Again its all perspective.

10 yrs ago, I would put EM up against most field. Today, I still think EM is still better than many fields.

I have a surgeon mom/dad couple, Anesthesiologist, and Cardiologists couple I know well whose kids go to our school. We just had a week long school camping trip and neither the Surgeon nor the anesthesiologist could go but I went. I actually chaperoned all of my 3 kid's 5th grade trip. I coached my 5th grader's basketball team this yr. Kids talk. The Surgeon's kid tells my son that dad/mom is never home and they were picked up for after school day care + Nanny. Anesthesiologist wife complains all the time that husband is either on call/at work/post call and can't make it to many events. Cardiologist kid's tells my daughter that her parents are never home and SHE confides in my daughter when she has problems.

I would trade being an ER doc with all its warts than other specialists who work/on call all the time.

Your sleep schedule is worse/sporadic compared to those fields.

Prospects for cards/gas/surgery are better than EM. Less saturation. Less decline in pay.

They also don't deal with the worst parts of society everyday. No one is taking a dump in the middle of their clinic like your ER.

They can refuse to see whoever, you can't.

They have more options, more outs than you if they don't like their situation.

Calling it warts is a huge fracking understatement.
 
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Your sleep schedule is worse/sporadic compared to those fields.

Prospects for cards/gas/surgery are better than EM. Less saturation. Less decline in pay.

They also don't deal with the worst parts of society everyday. No one is taking a dump in the middle of their clinic like your ER.

They can refuse to see whoever, you can't.

They have more options, more outs than you if they don't like their situation.

Calling it warts is a huge fracking understatement.
Certain types of freestandings are exempt from EMTALA, so they do have some control over who they can see.
 
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A big problem with docs is b/c most are high earners, they get trapped in the cycle of overworking to keep up with their lifestyle. Lets be honest, if EM doc work 70 hrs a month making 200K, they are better off than 90% of Americans and would be much happier. Not much would bother you if you were working 2x9 hr shifts a wk.

Again, we will not be able to fix most of EM's problems. If you are a typical doc, Graduate at 28, work 5yrs save 1M and at 33 you have many options. Put that 1M in the S&P, forget about it and cut back to half time living off 200k. When you turn 60, you will have around 10M.

Seems simple but most docs can't do it which traps them into working full time past their 50's.
 
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a lot of docs get out with 300-500k in loans.... so it's not realistic to save 1 million in 5 years... especially if you factor in those loans, finally buying a house, and starting a family.

Can it be done? Yes. You'll live like a resident for even longer. Overall, imo, an unfair ask for someone that went through all that schooling.

"Honey, I know you stuck with me for a decade while I did this doctor thing but do you mind if we continue to pause our lives for another half decade because i chose the wrong specialty?"

Also, companies don't generally provide benefits for docs working 70hrs/mo.

I agree with your general principles though... save a lot then work less/get out. But I think that says a lot about the specialty when the "solution" is to just do less of the thing you trained 7+ yrs for

I am cognizant to not sugar coat this for any readers out there when other people try to cover up the "warts" of EM. EM was painted as a rosy picture to me and my classmates, no one told us the warts (or maybe they did but we didnt listen). Now all of us are trying to get out. I don't want this to happen to my future colleagues, they can/should pick something else.
 
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I don't know who is graduating at 28, either.
Graduate high school at age 18.
18 + 4 years undergrad = 22
22 + 4 years med-school = 26
26 + 3-4 years residency = 30.

I was almost 31 when I settled into my first attending gig. Moved with only what we could fit in two cars. Start-up costs are big. Health insurance ain't cheap. No, I wasn't keen on working 180+ hours a month anymore; I just worked my ass off for 7 years. Let me breathe for a touch.
 
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No one is graduating at 28 u less you did an accelerated MD program or skipped grades. I went straight through and graduated residency at 30 (if i did 3 year would have been 29).

Similarly almost no one is amassing 1M net worth 5 yrs out of residency unless they have no loans, live in LCOL area, making 300/hr off the rip in a W2 setting where health insurance provided (or working spouse), saving aggressively.
 
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No one is graduating at 28 u less you did an accelerated MD program or skipped grades. I went straight through and graduated residency at 30 (if i did 3 year would have been 29).

Similarly almost no one is amassing 1M net worth 5 yrs out of residency unless they have no loans, live in LCOL area, making 300/hr off the rip in a W2 setting where health insurance provided (or working spouse), saving aggressively.
Let's say an EM doc with a non-physician spouse is bringing in $480k/year (let's say $400k for the doc at 1750 hours is about $230/hr) straight out of residency. Looking back, federal effective rate is about 25% + $20k in state taxes.

$480k - $140k taxes = $360k

Live off of $100k = $260k for student loans and investing.

Take a buy and hold approach assuming even very average market returns and you've paid off $200k in student loans and you've got well over $1M in investable assets. It's pretty easy to do but most people don't want to do it.
 
Who is making 480k / yr out the gate with a sustainable number of monthly hours??

Assuming a healthy number of hrs (about 120/mo), that's 310/hr.

That's not the average new grad job right now. Prob a 90th percentile job.
 
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Who is making 480k / yr out the gate with a sustainable number of monthly hours??

Assuming a healthy number of hrs (about 120/mo), that's 310/hr.

That's not the average new grad job right now. Prob a 90th percentile job.

Look at the post. That's $400k for the doc working 1750 hours/year or 145 hours/month (which is the number of contracted hours for many employed jobs) which is about $230/hr with a non-physician spouse making $80k. This isn't a hypothetical scenario and this isn't an unusual situation.
 
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It’s really sad to see a field with so much potential going down in flames like this. I’ve loved EM since I was a premed. The My first year of residency we watched the entire speciality begin to implode.

I’m so glad I acted quickly and picked up a CCM slot early. This should be a lesson to any other med students thinking EM - if you have to do EM residency (I would’ve never forgiven myself if I didn’t), have an exit strategy.

If EM ever wants to return to its former glory I’ll be back to pick up shifts and get my hands dirty in the pit.
 
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CCM is not the escape you think it will be.

Many hospitals are content to staff w NP overnight.

Lots of burnout.

Do CCM if you love it, not because you want to escape EM.
 
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Pretty funny to see the new "solution" is to save 60%+ of your paycheck and then use the other 40% for loans/mortgage/insurance/food/etc... so you can do less emergency medicine for less money per year and no benefits.

You're talking about a top tier savings rate. I do this but I don't think it's fair that this "solution" is presumed applicable for everyone.
 
Look at the post. That's $400k for the doc working 1750 hours/year or 145 hours/month (which is the number of contracted hours for many employed jobs) which is about $230/hr with a non-physician spouse making $80k. This isn't a hypothetical scenario and this isn't an unusual situation.

Sorry, yes I see now.

The math works.

But is it practical?

After flogging yourself for 11 years through college, med school, residency, who is really excited to "live like a resident?"

To your point tho, i do think it's relatively easy to increase net worth after graduation.

I've increased my NW about 900k in my
first 6 years out while living a nice lifestyle, despite a divorce and a kid and working a series of "average" jobs.
 
Sorry, yes I see now.

The math works.

But is it practical?

After flogging yourself for 11 years through college, med school, residency, who is really excited to "live like a resident?"

To your point tho, i do think it's relatively easy to increase net worth after graduation.

I've increased my NW about 900k in my
first 6 years out while living a nice lifestyle, despite a divorce and a kid and working a series of "average" jobs.
Honestly, I overestimated the spending. I don’t think we ever spent $100k/year then. That still got us a nice house we still live in today along with any vacations we wanted, etc. Our expenses have gone up a bit with the addition of kids but our income has gone up more. We’re also not big with keeping up with the paycheck to paycheck Joneses or being jealous of fake Instagram posts that show people living lifestyles they don’t really lead.

To both of our points, EM still allows for great financial success if you let it.
 
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It was even better 7+ years ago when the starting hourly was 300. Those docs got their money.

Now the rate is 20% less with worse work place environment. Still, you can be financial successful.

But that doesn't fix EM. What happens when the new grads come out in 5 years and the starting hourly is 180? Then 150? And so on. This "solution" may allow current docs to be just ok, but new EM grads will suffer with worse prospects/working conditions.

Increasing your savings rate and sticking your head in the ground helps nobody but yourself.
 
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No one is graduating at 28 u less you did an accelerated MD program or skipped grades. I went straight through and graduated residency at 30 (if i did 3 year would have been 29).

Similarly almost no one is amassing 1M net worth 5 yrs out of residency unless they have no loans, live in LCOL area, making 300/hr off the rip in a W2 setting where health insurance provided (or working spouse), saving aggressively.
I could have. Though I would have turned 29 literally 1 week after residency so not sure that really counts.
 
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No one is graduating at 28 u less you did an accelerated MD program or skipped grades. I went straight through and graduated residency at 30 (if i did 3 year would have been 29).

Similarly almost no one is amassing 1M net worth 5 yrs out of residency unless they have no loans, live in LCOL area, making 300/hr off the rip in a W2 setting where health insurance provided (or working spouse), saving aggressively.
You could if you live like a resident for another 5 yrs. Just pretend you are a neurosurgery resident. Lol

@Nocturnist has done it without living like a resident
 
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