Best big cities for EM?

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DeadCactus

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Considering moving. Family really wants to try the big city experience (LA, NYC, Chicago, etc) for a bit. Any thoughts on which cities are better options for EM in terms of job availability, salary, malpractice environment, etc? Ideal job would be academic with some independent shifts in a busy community hospital but I'm pretty flexible.

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I'm not saying you can't find it, but the more things you want that everyone wants, the less likely you are to find or get it. That's just the market dynamics at play.

So finding a job that:
1. Is in a decent city
2. Has tons of availability
3. With a good salary
4. In a state with tort reform
5. In a residency program

It's just highly unlikely. You will almost certainly have to give on several of those, so you may have to figure out your priorities of what's most important. Maybe that's the city itself. Maybe its the legal climate. Maybe it's the salary. You may have to compromise on several things.

I hope you find it though! If you do, let me know where it is (and don't tell anyone else)!
 
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Considering moving. Family really wants to try the big city experience (LA, NYC, Chicago, etc) for a bit. Any thoughts on which cities are better options for EM in terms of job availability, salary, malpractice environment, etc? Ideal job would be academic with some independent shifts in a busy community hospital but I'm pretty flexible.
NYC jobs are terrible. Would never work there.
 
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Considering moving. Family really wants to try the big city experience (LA, NYC, Chicago, etc) for a bit. Any thoughts on which cities are better options for EM in terms of job availability, salary, malpractice environment, etc? Ideal job would be academic with some independent shifts in a busy community hospital but I'm pretty flexible.

All the places you quoted have generally terrible salary, cost of living, and malpractice.
 
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Maybe live in Chicago and commute to nearby Indiana for shifts? There are good jobs in that state.
 
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Stay away from Chicago and NYC for liability reasons. Then stay away from NYC and CA for tax reasons. You guys like TX barbeque?
 
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All the places you quoted have generally terrible salary, cost of living, and malpractice.

Yea, I guess I'm looking more for damage control advise.

Stay away from Chicago and NYC for liability reasons. Then stay away from NYC and CA for tax reasons. You guys like TX barbaque?

We are considering major metro areas in Texas but the urban sprawl isn't quite the same experience.
 
I sympathize with you man. I love NY and CA. Best of luck
 
Sydney and Christchurch aren't bad. Melbourne either.
 
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Considering moving. Family really wants to try the big city experience (LA, NYC, Chicago, etc) for a bit. Any thoughts on which cities are better options for EM in terms of job availability, salary, malpractice environment, etc? Ideal job would be academic with some independent shifts in a busy community hospital but I'm pretty flexible.

This is an interesting move to make as a family--usually it's the other way around (from the city to the suburbs to look fore more space). I don't have any great advice other than to say NYC is not an ideal environment in which to practice EM (overcrowded, terrible ancillary services, etc.)
 
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Live in the city and fly out or drive out seems to be your options if you want to keep it open
 
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What is your biggest priority because that's really going to make a huge difference in what turns out to be the optimal location for you...

Is it really the city vibe - being able to walk or take public transit easily to work and attractions? Then Chicago, NYC, Boston, DC and Philly provide very different experiences than LA, Atlanta, Seattle or any place in Texas.

Is it being Academic? There are obviously more academic departments in LA, Chicago, NYC, Philly and DC than there are in Denver, Seattle, Atlanta, or Minneapolis.

Salaries and cost of living concerns? Doesn't require much explanation

Figure out what matters most and then narrow down your options
 
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I'm nearing the end of residency and have spent an awesome four years in Chicago for it. Training here has been excellent however practicing as an attending in this city would be anything but ideal. Different strokes for different folks.

For your points:
1. Is in a decent city
- It's Chicago. You have everything that you would ever want in your immediate area or just a short lyft ride away in the Northside. But with a big city comes big city problems. Traffic is unreal especially if you consider taking a job out of the city limits (better pay, better staffing, etc). For example, a commute to the south suburbs from Lakeview/Wrigleyville will net you an hour and a half minimum, possibly 2 hours during the rush hour times of 5-7 pm and 6-9 am. Even travelling within the city, 1 mile = 10 minutes depending on the day and time and area. I heard 4 gunshots nearby while staying atmy fiance's place last night further north around Devon. It depends on what you think is decent and worth it and whether you are coming with kids

2. Has tons of availability
- There are jobs available in the city. However the going rate is roughly in the 180-190s and more often than not (understatement) it will be at an understaffed (nurse and md) with limited backup (no anesthesia/obgyn/peds/gi/ent etc) with a county population. You will be looking at less at an academic site however true academics is limited to actually a few places, there are community academic sites available such as presence resurrection or midwestern which staffs multiple community sites through the chicago area. Commuting across the border to NW indiana is an option for jobs with substantially higher pay and better everything, except the commute is rough (long) and you would be better served living in the suburbs which defeats your entire purpose of living in a large city.

3. With a good salary
- Again.. 180-190 average with the low end being in the 160s. You may find higher rates as a nocturnist or as a 1099 IC, but understand that within the Chicago city limits, there is really no such thing as a free lunch . You're likely signing up for a dumpster fire that no one else wants. Your CMGs of choice in the city are Vituity and TH with USACS in the south suburbs.

4. In a state with tort reform
- This is cook county, the second worst county in the country for malpractice..

5. In a residency program
- Chicago has many residency programs. Loyola just opened up a new program out of their main site in Maywood. Presence residents staff Resurrection and St. Francis. UIC staffs multiple community sites such as Mercy and Advocate Lutheran/Masonic/Christ . Cook County residents staff Community first and Rush. Midwestern residents staff Swedish/Weiss/St. Bernards/Hammond/Crown Pointe/St. James etc. You can take jobs at sites that have residents, even easier for off service ones.

As everyone has stated above, it's priorities. I can tell you based on my own opinion, you will not achieve your entire list of must haves but you can check off 2-3 in Chicago and likely any other equivalent big city. Ask yourself why you want to move and have this "big city experience", is it for personal or professional reasons? For me, training here in Chicago was priceless but staying here for my first attending job out of residency was not practical for multiple reasons but it may be worth it for you
 
Have heard from several friends that metro areas in Texas are full. Austin has always been more difficult to find jobs and had generally lower pay. Houston/Dallas has been affected by freestanding ER closures. Houston also had 2 hospitals close due to the hurricane from a couple years ago. San Antonio may have some availability, but I'm hearing it's basically dried up as well.
 
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It's just too bad we don't have control over reimbursement. Geographic location would be irrelevant as far as pay. There's no reason that Austin TX pays significantly less than El Paso, except for greedy CMGs ripping off doctors who want to practice in a desirable city.
 
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It's just too bad we don't have control over reimbursement. Geographic location would be irrelevant as far as pay. There's no reason that Austin TX pays significantly less than El Paso, except for greedy CMGs ripping off doctors who want to practice in a desirable city.

Then by that logic, wouldn't the solution be to join an independent group or a hospital not owned by CMG?
 
Honestly I fell you would be better off live close by the big cities at a respectable rate an Airbnb to the cities when you have several days off in a row.

If you don’t have direct family members there or your spouse doesn’t have a job there think long and hard about the money you will give up and the extra shifts you would have to work to make the same.
 
I think it depends on what you want when you say a "big city". If you want a dense urban area where you don't need a car and can walk or take convenient transit to most places, then you're limited to the Boston-DC corridor, Chicago, and maybe SF. If you just want a city with a lot of people and things but are willing to accept something more sprawled out / drive more, then throw in Atlanta, LA, Houston, and Dallas.

The Northeast and West Coast cost a lot more. Lots of people want to live there. Most people on here will tell you you're crazy for taking less money, but frankly a lot of them would encourage you to take a gig in an ED that was literally on fire and the site of an ongoing gang war if it paid $500/hr. Live where it's going to make you happy. You'll make enough as a doc that you can be comfortable wherever you want. Not necessarily rich anywhere, but at least comfortable.
 
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It's just too bad we don't have control over reimbursement. Geographic location would be irrelevant as far as pay. There's no reason that Austin TX pays significantly less than El Paso, except for greedy CMGs ripping off doctors who want to practice in a desirable city.

I don't want to surrender us to the "infinite wisdom" of the federal government, but I do hope that someone does sooomething to correct this, in the same vein as "patients need to understand pricing upfront". You give them upfront pricing, and that's cool. On the back end, you give the docs what they're worth.

Is direct hospital employment the answer? I'm not sure.
 
Is direct hospital employment the answer? I'm not sure.
No. Ask yourself, who gets paid more, travel nurses or hospital nurses?
The hospital wants to pay as little as possible to have the services they desire to advertise. They only want to keep their name out of the news for bad things happening.
Just like any other job, a desirable city will pay less for the same job.
 
I don't want to surrender us to the "infinite wisdom" of the federal government, but I do hope that someone does sooomething to correct this, in the same vein as "patients need to understand pricing upfront". You give them upfront pricing, and that's cool. On the back end, you give the docs what they're worth.

Is direct hospital employment the answer? I'm not sure.

As I've said before the key is for all doctors to band together and demand to see how much is actually billed and collected in each of our names.
 
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No. Ask yourself, who gets paid more, travel nurses or hospital nurses?
The hospital wants to pay as little as possible to have the services they desire to advertise. They only want to keep their name out of the news for bad things happening.
Just like any other job, a desirable city will pay less for the same job.
The CMG wants to pay as little as possible to provide the services it is contractually obligated to provide.

Not sure I see the difference here.
 
The CMG wants to pay as little as possible to provide the services it is contractually obligated to provide.

Not sure I see the difference here.
Yes, but we already knew that. I was pointing out that the hospital won't be any different.
 
It's just too bad we don't have control over reimbursement. Geographic location would be irrelevant as far as pay. There's no reason that Austin TX pays significantly less than El Paso, except for greedy CMGs ripping off doctors who want to practice in a desirable city.

That's not true. The reason Austin pays less than El Paso is basic economics. There's a higher supply of doctors willing to live in Austin than in El Paso. That shifts supply curve to the right, meaning lower costs for a given demand (in this case, staffing company/ED groups). This explains why pay is so low in places like Denver or Hawaii--if there's a waiting list to get a job in a city, the pay will be less. The opposite is true for BFE Texas--groups have to pay higher rates to staff the given ED's b/c there's a shortage of supply (physicians).

It's also the reason why OP will never find a job with all the attributes she seeks above (or at very least, no one is going to advertise those unicorns for free). Big, desirable cities w/ great jobs will pay less in EM. Key is to find best balance...my vote would be Salt Lake City, Nashville, Atlanta, or Charlotte, though none of those are quintessential cities like NY or Chicago.
 
That's not true. The reason Austin pays less than El Paso is basic economics. There's a higher supply of doctors willing to live in Austin than in El Paso. That shifts supply curve to the right, meaning lower costs for a given demand (in this case, staffing company/ED groups). This explains why pay is so low in places like Denver or Hawaii--if there's a waiting list to get a job in a city, the pay will be less. The opposite is true for BFE Texas--groups have to pay higher rates to staff the given ED's b/c there's a shortage of supply (physicians).

I think you missed the point of my original post. If you staff for 2 pt/hour, the physician salary should be the same in Austin, El Paso, or NYC. The difference is CMGs being able to capitalize on high-demand areas and rip off physicians.
 
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