555 EM spots did not fill in Match

[Splenda88]

Any unfilled spots after the SOAP?

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Members don't see this ad.

 

[alpinism]

Word on the street is about 50 were unfilled left after SOAP finished.

 

[HemorrhagicShock]

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.

If you had 300k cash now, and a schedule where you're only working 12 shifts a month and thus free time to start some side hustles and business what would you do in 2023?

I understand the generic answer you may give us "real estate" or "syndications" or "FSED" but if it's not too much trouble, I'd appreciate it if you could be more descriptive.

Would you take 50k of that and find a rental that you can cash flow? Would you put another 50k of that into some dividend-earning equity? Would you take 100k of that and start urgent care or FSED? Maybe consider starting some other para-medicine business after doing some market research and finding an edge? How much would you keep as cash if any of the ventures above fails?

 

[hopefulgasman]

Laughing out loud at “top academic” EM programs that use to turn their noses up at lesser “name brand” candidates now completely filled with DOs and IMGs based on their incoming class photos.

How the “mighty” have fallen. This specialty is a dumpster fire.

 

[WorkNoteEmergency]

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.

I cut back to 80-90 hrs/month a few years ago. Interestingly I did that when I proved to myself I could live just fine on $250k working (for only 9 months) for a CMG. Took a part time gig an hour away for $275k/yr which is now $245k after Covid “Health Care Hero, Good Luck and Hope you Don’t Die Using the Not Soiled Enough Yet N95 We Gave You” pay cut.

At any rate it seemed like the answer in the 6 months before Covid hit but it has become untenable for me as I’ve aged. Every shift involves some disruption of sleep, whether forcing myself to try to sleep early to get up at oh dark hundred or staying up later than my mid 50’s body and brain want. The work is much more complex and really the kicker for me, leadership is apathetic, often hostile, incompetent (well beyond the BITD “look what that nimrod VP did again”), grasping and lazy. I have more self respect than to shorten my life expectancy for people like that.

When I made the switch to part time, I fairly aggressively pursued non-clinical career pathways without a lot of success. Pharmaceutical and med device consulting seems to me the most fertile ground but an older EM doc, on paper, is poorly qualified for that. 20 year ago foresight I would have laid some framework for that. There are some Pharma companies that offer fellowships in drug development. Even though I’m a late bloomer, started med school age 31 and served as Navy GMO before residency, I managed my money fairly well so that now I can tell my employers to f CK off and I am just working to meet most expenses and preserve my nest egg a little bit longer. BTW the wealthiest physicians I know personally are the one who sold his group to a CMG and made millions and another who graduated med school and then went to work in a VC firm, now an exec at a Pharma company making base $700k per year.

 

[Mount Asclepius]

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.

I graduated residency at 28. Turned 29 a little over a month into attendinghood. I skipped a grade. So you weren’t wrong

I hit 1M net worth at 5 years post-residency after paying off 300K in student loans. Did pay sweat equity for partnership, but moonlighting during pre-partnership, living like a resident for a few years, aggressively saving, and the accelerating ahead with partnership profit sharing got me there.

So essentially I agree with you, and you aren’t wrong. Just want others to know that it can be done and there is a path to do it.

Back to dumpster fire ranting 🔥

 

[Nocturnist]

Geriatrics in the ED is:
1) Fell down 2 AM.
2) Weak. But why is my mom weak?
3) Dizzy. Which means anything.
4) Altered from SNF. Nope just the dementia that the new nurse didn’t know about.
5) Want to send them all home, but their family knows something is wrong and last time they were sent home they had to come back and were admitted. Can’t they just be admitted for a day so you can watch them? 🤦‍♂️
6) I don’t know why I’m here?
7) What are my medications? It’s in the compuder.
8) No we didn’t talk about a DNR/DNI. She was so healthy with her end stage cancer and a very active 90 year old. Can’t you do something more?
9) I’m still weak!
10) Whoops, I fell again.

Are you excited yet?

And from your friendly neighborhood hospitalist POV:

1) UA has 9 WBCs. Admit for UTI!
2)Daughter adamant mom's UTIs always present with weakness. Admit!
3) 2+ leuk esterase you say? Gotta be a UTI! Admit.
4)No she's not having any urinary symptoms, but still has 100+ WBCs like the last 48 UAs that keep growing polymorph flora. Gotta be the UTI this time tho- admit!
5)of course we can but what kind of a watch would it be without some ceftriaxone for good measure?
6)neither do I, but it's not going to stop us from diagnosing you with that UTI!
7)that compuder would have told you in 2 seconds I'm currently on invanz through a PICC for my real ESBL uti but that's not going to stop you from rocephin'ing me anyway, is it?
8)F ya we can, we can always check another UA!
9)well it's pretty obvious, you still have pyuria. Duh. Admit!
10) you fell...right into that uti! Admit!

Jk love all ya ED docs, and thanks for the job security 😉

 

[JacobMcCandles]

Who’s got the list on which programs didn’t fill their spots?

 

[miacomet]

I cut back to 80-90 hrs/month a few years ago. Interestingly I did that when I proved to myself I could live just fine on $250k working (for only 9 months) for a CMG. Took a part time gig an hour away for $275k/yr which is now $245k after Covid “Health Care Hero, Good Luck and Hope you Don’t Die Using the Not Soiled Enough Yet N95 We Gave You” pay cut.

At any rate it seemed like the answer in the 6 months before Covid hit but it has become untenable for me as I’ve aged. Every shift involves some disruption of sleep, whether forcing myself to try to sleep early to get up at oh dark hundred or staying up later than my mid 50’s body and brain want. The work is much more complex and really the kicker for me, leadership is apathetic, often hostile, incompetent (well beyond the BITD “look what that nimrod VP did again”), grasping and lazy. I have more self respect than to shorten my life expectancy for people like that.

When I made the switch to part time, I fairly aggressively pursued non-clinical career pathways without a lot of success. Pharmaceutical and med device consulting seems to me the most fertile ground but an older EM doc, on paper, is poorly qualified for that. 20 year ago foresight I would have laid some framework for that. There are some Pharma companies that offer fellowships in drug development. Even though I’m a late bloomer, started med school age 31 and served as Navy GMO before residency, I managed my money fairly well so that now I can tell my employers to f CK off and I am just working to meet most expenses and preserve my nest egg a little bit longer. BTW the wealthiest physicians I know personally are the one who sold his group to a CMG and made millions and another who graduated med school and then went to work in a VC firm, now an exec at a Pharma company making base $700k per year.

So does this mean you quit? What is the solution you have found?

 

[JacobMcCandles]

Laughing out loud at “top academic” EM programs that use to turn their noses up at lesser “name brand” candidates now completely filled with DOs and IMGs based on their incoming class photos.

How the “mighty” have fallen. This specialty is a dumpster fire.

The few announcements I saw didn't post MD or DO and didn't post their medical school. Hilarious.

 

[JacobMcCandles]

If you had 300k cash now, and a schedule where you're only working 12 shifts a month and thus free time to start some side hustles and business what would you do in 2023?

I understand the generic answer you may give us "real estate" or "syndications" or "FSED" but if it's not too much trouble, I'd appreciate it if you could be more descriptive.

Would you take 50k of that and find a rental that you can cash flow? Would you put another 50k of that into some dividend-earning equity? Would you take 100k of that and start urgent care or FSED? Maybe consider starting some other para-medicine business after doing some market research and finding an edge? How much would you keep as cash if any of the ventures above fails?

For most docs, the best way to make money is doing doctor stuff while buying and holding a US Total Market or S&P 500 fund. That's why it's important to do what you can to not burnout so you can prolong your career if you want. I'd rather work less and make more doing EM than work more and make less doing something else at this point. I also understand that may not be true for everyone.

 

[Nocturnist]

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 live in one of the highest cost of living areas in the country, never made over $250/hr, never lived like a resident (bought 2 homes, super car, traveled every month) and was a millionaire a little before 4 years out of residency.

If you've just owned a house in a the last five years, you're likely added a few hundred thousands in equity to your net worth. If you've just maxed out your retirement and employer match the last five years and bought a house, you're practically doing something wrong if you're not a millionaire.

I'm not some high end specialist. I just pick up enough extra shifts to out earn my spending. And I'm just a hospitalist.

You'll be surprised how many MDs are millionaires within 5 years.

 

[bravotwozero]

Ok millionaire as in cash/stocks plus house is one thing, but millionaire in pure liquid assets cash/stocks is another.

The former - I accomplished in about 6 years time by buying a house. The latter, is more difficult and I’m not there yet

 

[nVictus]

Imo, pure liquid assets are the only thing that counts, especially if you want to cut down shifts and let it compound. Home equity doesn't mean much since you have to live in it or take out a loan against it.

My brokerage account doesn't make me feel any better on shift though

 

[GonnaBeADoc2222]

Eyeroll to millionaire including what Zillow says about your home.

Congrats. You bought right before best market ever. Can you time it again?

Agree with above about cash/equities/whatever else liquid is what counts.

 

[TrailRun]

Some of the numbers you all are getting are impressive. I made 280 for full time including RVU/bonuses last year, and paid at least 80 in taxes. Paying for childcare, student loans, a new 26k car to get to work, don’t see myself becoming a millionaire anytime soon. Not complaining, but 400k isn’t realistic nowadays, at least in my area. Given that, I would’ve chosen another specialty to at least save nights and weekends… but am applying pain so will see

 

[Interpolfanclub]

Guess I'll jump in. Agree with what has been said about the crisis in EM. I have been out 13 years now and am very realistic about the field. I've worked and trained in some toxic ERs and probably could not work another 13 in those places. I'm lucky that I practice in an area where patients are mostly realistic. I really like my partners, the pace is humane and the pay is good. That being said the circadian swings, pediatric codes, and angry patients will wear even the strongest docs out eventually. I've listened to these lectures and "modules" about energizing docs and developing "resilience" etc and just roll my eyes because it doesn't change the fact that the work is just exhausting. Nobody in the US workforce is more resilient than ER staff. Patients don't understand, admin doesn't understand, we're the only ones who "get it." The work is just an absolute grind and will wear you out in ways other fields don't.

I don't know if the answer to what ails EM is to continue to live like a resident after residency, save a ton, then get out as soon as possible although maybe that's the path for some. I think it's a huge loss to society if someone with a decade of experience in the pit walks away, but I get it. I'd rather split the difference and work a sustainable amount, stay married and have a life outside of medicine. That being said, I invest in real estate and hopefully will be in a place to cut back to half time in my late 40s, 5 years away and punch out completely by 52-53. I think it's doable but I still really enjoy the good cases and saving lives and will probably keep working even if I don't have to. I really enjoy RE, and the math, and the relationships so it's a pretty natural fit. I've actually slashed my retirement contributions so I have more cash for RE. Having a ton of money in a 401k doesn't get my out of shifts, but cash flow does.

Aside from totally ignoring patient comments and sat , I don't break my neck to see everyone ASAP. They can wait. I see the sick people quickly but everyone else can wait for me to think, document, eat, educate etc etc. I'm also nicer when I'm not redlined and think that comes across. That is worth more to me and the patient than flogging myself to another 0.3 pph.

So I'm trying to walk a middle road. I still work hard, but sustainably, while developing other interests and income streams, and ignoring the admin and patient experience noise has helped me a lot. Also dropped all of my admin duties. Will close by saying the expansion of residencies is an enormous mistake but I'm not sure how it could've been avoided with CMGs driving most of it.

 

[WorkNoteEmergency]

So does this mean you quit? What is the solution you have found?

I’ve spent a lot of time using FIRE and other retirement calculators, met with a Schwab advisor to crunch numbers to confirm that if I wanted, I could mostly retire right now, albeit a little uncomfortably. For now, I’m still working out what my regular income will be but I’m staying on prn in the current job, 1-2 shifts per month while I sort things out. The last measure fall back will be 4 shifts/month locums. I only need to cover expenses for about 2-3 years for an almost completely worry free retirement. Ideally I would have worked this out over a year or two while still doing my regular work schedule but it became clear to me last summer/fall I had to get out fast.

One lesson learned trying to plan this out was getting a good handle on expenses. I thought I did initially but once I paid close attention I realized the monthly spend has gone up quite a bit recently with inflation.

 

[miacomet]

I’ve spent a lot of time using FIRE and other retirement calculators, met with a Schwab advisor to crunch numbers to confirm that if I wanted, I could mostly retire right now, albeit a little uncomfortably. For now, I’m still working out what my regular income will be but I’m staying on prn in the current job, 1-2 shifts per month while I sort things out. The last measure fall back will be 4 shifts/month locums. I only need to cover expenses for about 2-3 years for an almost completely worry free retirement. Ideally I would have worked this out over a year or two while still doing my regular work schedule but it became clear to me last summer/fall I had to get out fast.

One lesson learned trying to plan this out was getting a good handle on expenses. I thought I did initially but once I paid close attention I realized the monthly spend has gone up quite a bit recently with inflation.

Thanks for the info. I struggle with my exact exit strategy, too. I could retire now if I stay in my current house, but we'd like to move and keep both houses.

I've settled into 3-4 shifts a month of locums, no nights, no weekends, although all late swings, of which I'm not a huge fan. It's a lot of stress, would be nice if the RE market took a tumble, which it might.

 

[xaelia]

Amazing to see how little of this is "Emergency Medicine" problems, but "U.S. Emergency Medicine" problems. A few things – circadian rhythm disruptions, pediatric codes, etc. – are universal, but nowhere receives literal abuse (rather than just lack of support) from so many angles.

Not everything is great overseas, but it's at least sustainable in mid- to late-career.

 

[miacomet]

Amazing to see how little of this is "Emergency Medicine" problems, but "U.S. Emergency Medicine" problems. A few things – circadian rhythm disruptions, pediatric codes, etc. – are universal, but nowhere receives literal abuse (rather than just lack of support) from so many angles.

Not everything is great overseas, but it's at least sustainable in mid- to late-career.

Ooh, where are you?

 

[xaelia]

Ooh, where are you?

Christchurch, New Zealand.

 

[miacomet]

Christchurch, New Zealand.

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

 

[alpinism]

Damn Yale EM has 5 IMGs in their class.

 

[JacobMcCandles]

Some of the numbers you all are getting are impressive. I made 280 for full time including RVU/bonuses last year, and paid at least 80 in taxes. Paying for childcare, student loans, a new 26k car to get to work, don’t see myself becoming a millionaire anytime soon. Not complaining, but 400k isn’t realistic nowadays, at least in my area. Given that, I would’ve chosen another specialty to at least save nights and weekends… but am applying pain so will see

Where are you at in the US?

 

[miacomet]

Damn Yale EM has 5 IMGs in their class.

Wow. And many DOs.

 

[Splenda88]

Damn Yale EM has 5 IMGs in their class.

It will get worse next year. Every AMG who was skeptical has gotten the warning now.

EM will be what psych was from 1990-2010.

 

[JacobMcCandles]

Crazy that Yale got 19 of their top 20…

 

[miacomet]

Orlando. Wow.

 

[miacomet]

Wow. Few US-trained MDs...anywhere:

 

[miacomet]

This was 100% SOAP/scramble. Wild.

 

[Splenda88]

Orlando. Wow.

Not too bad... Only 2 are IMG

 

[miacomet]

Not too bad... Only 2 are IMG

Was it a DO residency originally?

 

[Splenda88]

Was it a DO residency originally?

probably not.

 

[miacomet]

This was another SOAPy program:

 

[Prehealth1011]

I'd be interested to see the % FMG matched. I have pccm fellows from med schools in Pakistan who wanted but couldn't do EM because of the whole mandatory US rotation/SLOE thing.

 

[bravotwozero]

So, all spots filled post soap last year, it’s all but 50 this year. Small number, but not nothing. I suspect that number is also going to grow every year.

 

[JacobMcCandles]

I wish just one program would just post “Damn it…” followed by a picture of their class.

 

[RustedFox]

Doesn't matter where they're from.
It matters (to us) that the slot is filled.
The numbers....

 

[miacomet]

I wish just one program would just post “Damn it…” followed by a picture of their class.

I confess to schadenfreude regarding privileged academicians who will now have to pick up the slack of resident who really wanted, I dunno, psych or peds!

 

[miacomet]

Doesn't matter where they're from.
It matters (to us) that the slot is filled.
The numbers....

It matters in that some will flee EM for palli, sports, pain if they can get it, addiction ASAP. And that some will transfer out. Half these folks don't want to be pit docs, or won't be able to tolerate it

 

[Brigade4Radiant]

Yale is understandable if it’s 4 year program

 

[WilcoWorld]

BTW the wealthiest physicians I know personally are the one who sold his group to a CMG and made millions and another who graduated med school and then went to work in a VC firm, now an exec at a Pharma company making base $700k per year.

So, the wealthiest docs you know are business men!

 

[calvinhobbes]

This was another SOAPy program:

Damn and to think this program used to take mostly NYCOM DOs. Wonder who SOAP’ed

 

[Splenda88]

EM docs can work 7 days/month and still make > 200k/yr. Not a bad gig if your student loan is paid off.

Only 5% of individuals in the US make that much and almost all are working 40+ hrs/wk and 20+ days/month.

 

[Splenda88]

Things are more bleak than I thought. There are IMGs with multiple failures who matched.

I can't wait to see how many US MD students will apply to EM next cycle.

 

[WorkNoteEmergency]

So, the wealthiest docs you know are business men!

Exactly! Neither one works very hard right now, although both put in some hard work in the past.

 

[southerndoc]

Yale is understandable if it’s 4 year program

Yale didn't match? Must've missed it on the list.

 

[EMhawkeye]

The constant digging and craping on img/ do’s and inferior choices for residents is getting exhausting and is a really ugly look for ya’ll.

 

[GonnaBeADoc2222]