Class of 2021 job market insights

[Porfirio]

How close is the next hospital with OB and Peds? What relationship does your hospital have with a larger hospital?

Most of the time these types of patients are instantly accepted for transfer if you have a close by academic hospital. Additionally, EMS might not stop at your hospital with these sick patients because they know you do not have these services.

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[Apollyon]

Additionally, EMS might not stop at your hospital with these sick patients because they know you do not have these services.

Except, if you are the only game in town, and next hospital is 30 miles away, they ain't passing you to go there. If the pt is approximately midway between hospitals, then they might go to that one that had the resource.

 

[Rekt]

back to jobs...

Am in final year of residency, have an offer for a small community shop with limited resources (no OB, peds, etc). Am hesitant to accept realizing residency has prepared me very well for work in an academic setting but less so for community, although would prefer community (ideally with OB/peds/ a couple residents or med students to teach). Have applied to a dozen locally and this is the only opening right now. Northeast.

Do I:
a) accept the offer
b) decline and hope something else opens up in the next 8 months

No Ob even? This must be an incredibly rural place. This will be so different than an academic setup. I think you will greatly struggle to be honest.

 

[Mushdoc]

Just focus on learning those things really well the last half year, have a low threshold to call the transfer line for advice and transfer if concerns

 

[turkeyjerky]

back to jobs...

Am in final year of residency, have an offer for a small community shop with limited resources (no OB, peds, etc). Am hesitant to accept realizing residency has prepared me very well for work in an academic setting but less so for community, although would prefer community (ideally with OB/peds/ a couple residents or med students to teach). Have applied to a dozen locally and this is the only opening right now. Northeast.

Do I:
a) accept the offer
b) decline and hope something else opens up in the next 8 months

Unless you went to a really weird residency, you should be prepared to work in a community shop. No peds service is pretty typical for real-life and shouldn't be a sticking point. No OB points to either a super-small hospital, or another place in town that handles all of that. Definitely not ideal.

It sounds like this is not even close to your ideal job, but you're geographically limited and graduating into a depressed market so you don't have many options. You could take the job and then bounce to another shop once something opens...

 

[The Knife & Gun Club]

What are the risks associated with going somewhere without OB? Is it just a medicolegal problem since you could be on the hook for potential bad OB outcomes?

 

[Mr Bitterness]

back to jobs...

Am in final year of residency, have an offer for a small community shop with limited resources (no OB, peds, etc). Am hesitant to accept realizing residency has prepared me very well for work in an academic setting but less so for community, although would prefer community (ideally with OB/peds/ a couple residents or med students to teach). Have applied to a dozen locally and this is the only opening right now. Northeast.

Do I:
a) accept the offer
b) decline and hope something else opens up in the next 8 months

Every place I’ve worked with no OB coverage, I’ve had multiple terrible experiences. I would never work in a place without OB again. Even if there is a hospital across the street with in house OB, if they walk into your shop, you’re stuck with them until they’re stable for transfer, and you have an accepting doc.

No peds is not that big of a deal.

 

[LostinLift]

I've done a few interviews so far, some of the places are interviewing 10-15 people per spot. Most people seem to think more jobs will open up closer to January-March.

 

[TrailRun]

All good points! The nearest level 1/ OB is 30 mins away so not super rural. There is "auto-accept" with the OB at least. Was hoping for a place with a little more support straight out of residency. They have about 130 beds so fairly small hospital. Feels risky to give up this offer hoping something else will open up, although if a vaccine is truly on the way in the spring, then theoretically ER volumes will go back up and jobs will open up? But who knows. Thanks for the thoughts

 

[Porfirio]

Do what is best for right now. You are too young in your career to wait for the later.

 

[Rekt]

All good points! The nearest level 1/ OB is 30 mins away so not super rural. There is "auto-accept" with the OB at least. Was hoping for a place with a little more support straight out of residency. They have about 130 beds so fairly small hospital. Feels risky to give up this offer hoping something else will open up, although if a vaccine is truly on the way in the spring, then theoretically ER volumes will go back up and jobs will open up? But who knows. Thanks for the thoughts

Or people can stop using this excuse and realize the issue was here long before COVID.

There's too many residencies and too much supply of EM docs. Full stop.

 

[The Knife & Gun Club]

Or people can stop using this excuse and realize the issue was here long before COVID.

There's too many residencies and too much supply of EM docs. Full stop.

Look dude, I know you’ve got some strong opinions and I respect that you come on here to consistently tell it like it is.

But beating you chest about too many residencies is not a helpful answer to this posters question.

...

Regarding the above predicament, I’m clearly not in a position to speak from experience...but can inquire...

@TrailRun how much exposure to this kind of environment have you had? Are you at a big academic center where Peds and OB are always just upstairs and a phone call away? Or have you spent any time at a community place where they have to come from home/you’re managing the show until they arrive?

That may color the decision a bit

 

[GatorCHOMPions]

General job market insight - choose the right setting, if possible. Fair SDG >>>> Hospital Employed/Academic >> CMG/Predatory SDG.

Tale of two jobs:

1.) Full-time hospital employed W2 job which is like 50/50 base salary and RVU. Over the last few months with volumes dropping I went from about $225/hour pre-COVID to $160/hour at the lowest point to about $180/hour nowadays. We're also staffing a bunch of lower acuity areas more and more (lower RVU) because "that's where the need is". Could they afford to subsidize us in some way and really thank us for our service during these times? Sure they could. I know they have to be making big $$$ on us, but they won't ever do that.

2.) Per-diem SDG job has held steady throughout the year at $250/hour days and $300/hour nights, also W2 by the way. They cut a few midlevel hours, but none for the physicians. I already had much respect for this group before, but it's even more crystal clear how much better it is to work with fellow EM physicians in control.

 

[TheComebacKid]

Really elementary question, I apologize ahead of time.

But why are SDGs that much more preferable to Hospital employed/academic jobs? I mean I understand the benefits of an SDG and being on a partnership track, etc. But to me it seems like those working for many hospital/academic groups are treated fairly well without much in terms of predatory practices.

 

[ERDude]

Really elementary question, I apologize ahead of time.

But why are SDGs that much more preferable to Hospital employed/academic jobs? I mean I understand the benefits of an SDG and being on a partnership track, etc. But to me it seems like those working for many hospital/academic groups are treated fairly well without much in terms of predatory practices.

Several reasons IMO:
- Opportunity for partnership money (300+/hour) while still having a quality job (1.5pph, good support, etc)
- Ability to make practice and business decisions easily as a group (eg. change staffing levels, adjust shifts, adjust pay rates, etc)
- Potential for more engaged doctors that are involved with the hospital, committees, leadership, etc (win-win for hospital and SDG)

 

[partypantss]

So in the current market climate, is it even more advantageous than before to pick a residency program that is associated with a democratic group? Especially if they say a large portion of their grads end up getting into democratic groups?

 

[RustedFox]

So in the current market climate, is it even more advantageous than before to pick a residency program that is associated with a democratic group? Especially if they say a large portion of their grads end up getting into democratic groups?

Stahhhhhhpp.

 

[Rekt]

So in the current market climate, is it even more advantageous than before to pick a residency program that is associated with a democratic group? Especially if they say a large portion of their grads end up getting into democratic groups?

Yes.

As long as you realize that you'll be competing with most of the current residents for spots, if there are even any available. If you do, keep studying, be involved with the program, be likable, aka be a (really) good resident.

 

[TheComebacKid]

It's a good question because there isn't a clear answer readily available anywhere. It simply boils down in my opinion to more control over your work environment and improved billing because there isn't a layer between you and the payers. There are outliers on either side (some good hospital employed/academic jobs versus some malignant SDGs), but in general it otherwise holds true.

I have a huge appreciation for SDGs because, at least as an outsider, it seems like each of the individual physicians in the group contribute to overall success. You ride and die together.

That being said, one of the appeals of CMGs, and why they were so attractive to so many EM docs is because you punch in/punch out and get paid. There are people who don't want to sit on committees or manage their own billing.

I wonder if hospital/academic groups are a balance between the two...

 

[EctopicFetus]

I’m a big pro sdg guy. As with owning any business you have trade offs.
Unlimited financial upside vs risk of losing your contract.
YOU profit off the mlps not your boss. You control mid level practice not your boss

it does require some uncompensated time for meetings and such but even with counting meeting time you make way way more than a cmg. Also, when there is a glut of new grads it doesn’t impact you financially at all. You are playing a different game.
Said another way, if tomorrow the market dropped 60k new em docs my pay wouldn’t be altered by 1 penny. Those who are employed by others won’t be able to say the same.

 

[CliveStaples]

A SDG is not always the right job for somebody; I.e. they may have insane pre-partner buy-ins or have a horrible attrition rate.

But SDGs are very important for establishing the "floor" of what an EP makes. By being paid directly from billed care, they ensure that no matter how much the supply increases, their compensation remains the same. By simply having the option out there of SDG jobs, it ensures that other work models (CMGs, hospital employed groups, etc.) cannot drop their pay too precipitously. If all SDGs go the way of the dinosaur and EPs are all no longer aware of what they are billing for, then the "doom and gloom" concerning salary drops could actually be realized.

 

[sum dude]

Honest Truth - you're either going to work for a hospital/CMG, or you better think outside the box to provide care and make money. Whatever you think EM doctors make, cut it by 1/3 at that's more accurate to what you'll make. 95% of the grads here will not find their "dream job" or even a good/great in next 5 years. You're going to have to settle. Take whatever job you can get, start paying off loans, live within your means.

Get multiple part-time positions (and hospital privileges) if good groups are offering--this is how you will get a good/great job when the market picks up. The solid SDG's or highly desirable groups have a line of 10 people working at their place where if they need a full-time hire, they'll pull from there. I wouldn't recommend locums at this time--too risky given the dips in revenue. I don't recommend doing a Fellowship unless you "love it" or it gets you an in if you want to work academics. Good luck guys--this job market is the most brutal I've ever seen in medicine. The pendulum will swing back to normal, but it might take some a few years.

 

[The Knife & Gun Club]

So in the current market climate, is it even more advantageous than before to pick a residency program that is associated with a democratic group? Especially if they say a large portion of their grads end up getting into democratic groups?

Yes.

As long as you realize that you'll be competing with most of the current residents for spots, if there are even any available. If you do, keep studying, be involved with the program, be likable, aka be a (really) good resident.

Yea. Our program is affiliated with a high functioning SDG in a tough market. The SDG Leadership is great at helping people land jobs at other SDGs, but even for our own grads they’re very picky about who would get an offer.

The reality is when you only have +/- 1 position opening up a year, those slots are worth their weight in gold and not given out lightly.

Overall it helps with jobs to be affiliated with an SDG, but landing a gig at a SPECIFIC one is still equal parts luck, skill, and politics.

 

[sum dude]

back to jobs...

Am in final year of residency, have an offer for a small community shop with limited resources (no OB, peds, etc). Am hesitant to accept realizing residency has prepared me very well for work in an academic setting but less so for community, although would prefer community (ideally with OB/peds/ a couple residents or med students to teach). Have applied to a dozen locally and this is the only opening right now. Northeast.

Do I:
a) accept the offer
b) decline and hope something else opens up in the next 8 months

Every resident on this forum needs to read this and get comfortable with this setting. You should take job but keep looking around. Program directors need to allow moonlighting or teach rural ED medicine

 

[The Knife & Gun Club]

Florida FCEP listserv is horrifying right now.

Lots of the PDs openly taking about how they can’t find jobs for their residents and their attempts to stop the expansion in the state was stonewalled by the ACGME. It’s all pretty grim.

Dr Farcy, former president of AAEM, said out of their 7 PGY3 residents they’ve been “able” to place 2 into fellowship - the other 5 remain jobless. Not one of their graduating residents has a community job yet.

Damn.

 

[Lexdiamondz]

Florida FCEP listserv is horrifying right now.

Lots of the PDs openly taking about how they can’t find jobs for their residents and their attempts to stop the expansion in the state was stonewalled by the ACGME. It’s all pretty grim.

Dr Farcy, former president of AAEM, said out of their 7 PGY3 residents they’ve been “able” to place 2 into fellowship - the other 5 remain jobless. Not one of their graduating residents has a community job yet.

Damn.

That's terrifying.

If the former head of a national organization can't pull strings to get you a community gig in fxcking Florida (aka America's wang) I don't know what more to say re: the future of this specialty.

 

[sum dude]

Florida FCEP listserv is horrifying right now.

Lots of the PDs openly taking about how they can’t find jobs for their residents and their attempts to stop the expansion in the state was stonewalled by the ACGME. It’s all pretty grim.

Dr Farcy, former president of AAEM, said out of their 7 PGY3 residents they’ve been “able” to place 2 into fellowship - the other 5 remain jobless. Not one of their graduating residents has a community job yet.

Damn.

FCEP, ACEP, AAEM, AMA--none can do anything or that's racketeering. This is exactly what govt/private hospitals wanted

 

[HemorrhagicShock]

Maybe those 7 PGY3s who have yet to find a job could band together and open up a CMG-based residency program. Automatic jobs, automatic cheap source of labor, automatic medicare money per spot!

 

[blue.jay]

Maybe those 7 PGY3s who have yet to find a job could band together and open up a CMG-based residency program. Automatic jobs, automatic cheap source of labor, automatic medicare money per spot!

Now that's how a pyramid scheme starts!

 

[sum dude]

Maybe those 7 PGY3s who have yet to find a job could band together and open up a CMG-based residency program. Automatic jobs, automatic cheap source of labor, automatic medicare money per sot

Better yet, call yourself the ACGME accrediting body, who accredits ACGME. Then grade them, and make them pay you dues so that they can function as ACGME. When they ask who gave you that authority, say it's part of our charter, as the accrediting body, accrediting body--then they'll have no choice.

 

[Frazier]

Florida FCEP listserv is horrifying right now.

Lots of the PDs openly taking about how they can’t find jobs for their residents and their attempts to stop the expansion in the state was stonewalled by the ACGME. It’s all pretty grim.

Dr Farcy, former president of AAEM, said out of their 7 PGY3 residents they’ve been “able” to place 2 into fellowship - the other 5 remain jobless. Not one of their graduating residents has a community job yet.

Damn.

Yeah, I'm not sure how to interpret the usage of "able" there. Pretty much every fellowship, sans perhaps pain, is 100% attainable to EM grads if they apply broad enough.

 

[EctopicFetus]

A SDG is not always the right job for somebody; I.e. they may have insane pre-partner buy-ins or have a horrible attrition rate.

But SDGs are very important for establishing the "floor" of what an EP makes. By being paid directly from billed care, they ensure that no matter how much the supply increases, their compensation remains the same. By simply having the option out there of SDG jobs, it ensures that other work models (CMGs, hospital employed groups, etc.) cannot drop their pay too precipitously. If all SDGs go the way of the dinosaur and EPs are all no longer aware of what they are billing for, then the "doom and gloom" concerning salary drops could actually be realized.

This is the talk of 5-7 years ago. The updated version of this is that those predatory SDGs long sold out. SDGs have 20+ applicants per spot with 0 ads in ACEP monthly, EPM or EMN. It’s all word of mouth.

SDGs make way more than CMG docs.. I am sure you knew that though.

 

[YungDoc2018]

PGY3 in Southern US. Been on job hunt for 6+ months without ever talking to a CMG. Have received offers from well respected groups/hospital systems ranging from w2 $250/hr with benefits in big city to 1099 jobs $320/hr at shops outside big city. Some good jobs still out there but you must network and research.. doesn’t happen overnight.

 

[doggydog]

Florida FCEP listserv is horrifying right now.

Lots of the PDs openly taking about how they can’t find jobs for their residents and their attempts to stop the expansion in the state was stonewalled by the ACGME. It’s all pretty grim.

Dr Farcy, former president of AAEM, said out of their 7 PGY3 residents they’ve been “able” to place 2 into fellowship - the other 5 remain jobless. Not one of their graduating residents has a community job yet.

Damn.

How many residencies have opened up in Florida in the last 3-5 years?

 

[Mushdoc]

PGY3 in Southern US. Been on job hunt for 6+ months without ever talking to a CMG. Have received offers from well respected groups/hospital systems ranging from w2 $250/hr with benefits in big city to 1099 jobs $320/hr at shops outside big city. Some good jobs still out there but you must network and research.. doesn’t happen overnight.

When you say big city do you mean like Atlanta sized big city or Birmingham sized big city. Not trying to be rude or anything I’ve just found that we all seem to have pretty varied definitions of “big city.”

There also seems to be a big difference between small-medium sized cities (how I would define birmingham) with residencies and those without. The ones that don’t have residencies seem to have much better opportunities than those that do. I would recommend people specifically look for places without residencies to find jobs if they can

 

[blue.jay]

Are Columbus, Cincinnati, Pittsburgh considered desirable cities (very competitive for jobs with lower pay) ?
How about Phoenix, Tucson, Albuquerque, Las Vegas ?

 

[bravotwozero]

Are Columbus, Cincinnati, Pittsburgh considered desirable cities (very competitive for jobs with lower pay) ?
How about Phoenix, Tucson, Albuquerque, Las Vegas ?

Yes to all.

 

[CliveStaples]

This is the talk of 5-7 years ago. The updated version of this is that those predatory SDGs long sold out. SDGs have 20+ applicants per spot with 0 ads in ACEP monthly, EPM or EMN. It’s all word of mouth.

SDGs make way more than CMG docs.. I am sure you knew that though.

Locally, there's a SDG (which nearly sold out a few years ago but enough of their younger partners held it together) which offers a 2-3 year pre partner track paying well below local CMG rates and requires working all night shifts. The local CMG docs did not apply.

I spoke with a soon-to-be graduating resident just a few months ago that told me about an even worse SDG somewhere in the midwest. I told him to stay far away. There are still bad actors in the SDG world.

 

[sum dude]

When you say big city do you mean like Atlanta sized big city or Birmingham sized big city. Not trying to be rude or anything I’ve just found that we all seem to have pretty varied definitions of “big city.”

There also seems to be a big difference between small-medium sized cities (how I would define birmingham) with residencies and those without. The ones that don’t have residencies seem to have much better opportunities than those that do. I would recommend people specifically look for places without residencies to find jobs if they can

Substitute "Big" w/ "desirable". California, NYC, Denver, Miami, Chicago...you're going to be sub $200/hr if not already

 

[YungDoc2018]

When you say big city do you mean like Atlanta sized big city or Birmingham sized big city. Not trying to be rude or anything I’ve just found that we all seem to have pretty varied definitions of “big city.”

There also seems to be a big difference between small-medium sized cities (how I would define birmingham) with residencies and those without. The ones that don’t have residencies seem to have much better opportunities than those that do. I would recommend people specifically look for places without residencies to find jobs if they can

I’m talking about DFW.. but I totally agree with you about mid size cities vs large metropolitan areas.

 

[EctopicFetus]

Locally, there's a SDG (which nearly sold out a few years ago but enough of their younger partners held it together) which offers a 2-3 year pre partner track paying well below local CMG rates and requires working all night shifts. The local CMG docs did not apply.

I spoke with a soon-to-be graduating resident just a few months ago that told me about an even worse SDG somewhere in the midwest. I told him to stay far away. There are still bad actors in the SDG world.

Where is locally?? Curious.. there will always be bad actors.. my first SDG which IMO wasnt a bad actor associates made literally 1/4 of what partners made Unless you worked nights. Everything was out in the open meaning your partnership track.

IMO if they are transparent thats being fair. People can choose if they want to pursue the path they lay out. I do agree thats a very undesirable setup but if you make 2-3x CMG pay after maybe its not that bad.

 

[CliveStaples]

Where is locally?? Curious.. there will always be bad actors.. my first SDG which IMO wasnt a bad actor associates made literally 1/4 of what partners made Unless you worked nights. Everything was out in the open meaning your partnership track.

IMO if they are transparent thats being fair. People can choose if they want to pursue the path they lay out. I do agree thats a very undesirable setup but if you make 2-3x CMG pay after maybe its not that bad.

I'm in the southeast. For reference, the setup was to pay about 40-50 dollars less per hour (relative to comparable CMG) as a pre partner for 2-3 years, working exclusively nights, and when you became partner earned all-RVU pay which generally amounted to about 75 dollars more per hour than a comparable CMG for the day shift partners - I think they subsidize the night shifts so they aren't horribly underpaid. Then of course the CMGs are offering bonuses so that ups the early year(s) pay gap more, too. You also remained the nocturnist until a new pre-partner took your position. 5 years on average.

All that to say, it wasn't 2-3x CMG pay, but it was certainly a pay bump. But an indefinite period of time being the nocturnist, a not insignificant pay cut in important earning years in terms of investing, and the worry that the group dissolves before you make up for the opportunity cost, all for working a few less night shifts and 75 more per hour was not necessarily a no brainer decision.

 

[turkeyjerky]

I'm in the southeast. For reference, the setup was to pay about 40-50 dollars less per hour (relative to comparable CMG) as a pre partner for 2-3 years, working exclusively nights, and when you became partner earned all-RVU pay which generally amounted to about 75 dollars more per hour than a comparable CMG for the day shift partners - I think they subsidize the night shifts so they aren't horribly underpaid. Then of course the CMGs are offering bonuses so that ups the early year(s) pay gap more, too. You also remained the nocturnist until a new pre-partner took your position. 5 years on average.

All that to say, it wasn't 2-3x CMG pay, but it was certainly a pay bump. But an indefinite period of time being the nocturnist, a not insignificant pay cut in important earning years in terms of investing, and the worry that the group dissolves before you make up for the opportunity cost, all for working a few less night shifts and 75 more per hour was not necessarily a no brainer decision.

Yeah, that's a ****ty buy-in. Moneywise, not insane but all nights even after your a partner? F those guys.

It's set ups like that that allowed CMGs to dominate the market.

 

[Backpack234]

That’s a pretty awful deal. Must be florida

 

[RustedFox]

Yeah, that's a ****ty buy-in. Moneywise, not insane but all nights even after your a partner? F those guys.

It's set ups like that that allowed CMGs to dominate the market.

Identical to one of the shops that I interviewed with, and wanted to run screaming from halfway thru the interview.

 

[skougess]

Florida FCEP listserv is horrifying right now.

Lots of the PDs openly taking about how they can’t find jobs for their residents and their attempts to stop the expansion in the state was stonewalled by the ACGME. It’s all pretty grim.

Dr Farcy, former president of AAEM, said out of their 7 PGY3 residents they’ve been “able” to place 2 into fellowship - the other 5 remain jobless. Not one of their graduating residents has a community job yet.

Damn.

I cross checked it and the guy on there saying he recruits for Envision and that there are zero openings isnt telling the truth....because they are currently hiring for a program director for a new residency program! What. A. Joke.

Job here if you don’t believe me.

EDphysician.com Mobile Site Job Details

EDphysician.com displays Emergency Medicine, Urgent Care and ER jobs, including staff and directorship positions; more than 2,000 jobs; updated daily

www.edphysician.com

 

[EctopicFetus]

Yeah, that's a ****ty buy-in. Moneywise, not insane but all nights even after your a partner? F those guys.

It's set ups like that that allowed CMGs to dominate the market.

Agreed. Thats a terrible setup and likely done by the old farts in power. IMO once a partner all has to be equal. Til then so be it. My first job out the pay was so low as an associate that they basically forced you into nights. And the only way to get night pay was to work “all nights”. I did this for 5 years. I am truly curious about the SDGs who aren’t crushing the CMG pay. Makes me wonder why their business is so inefficient.

 

[RustedFox]

Agreed. Thats a terrible setup and likely done by the old farts in power. IMO once a partner all has to be equal. Til then so be it. My first job out the pay was so low as an associate that they basically forced you into nights. And the only way to get night pay was to work “all nights”. I did this for 5 years. I am truly curious about the SDGs who aren’t crushing the CMG pay. Makes me wonder why their business is so inefficient.

The "all nights until partner" thing is a dealbreaker in the same capacity as: "I sacrificed all this during school and residency to... work all nights? Uhh... no."

 

[EctopicFetus]

The "all nights until partner" thing is a dealbreaker in the same capacity as: "I sacrificed all this during school and residency to... work all nights? Uhh... no."

Agreed but there are a number of residents who are prima Donnas. I think in the end the upside matters. I knew the upside of my old group. I made well under market til I got there. Job was easy, low volume, great location. No regrets. There is something special about working in an SDG where all your well beings are tied and almost everyone pulls in the same direction.

 

[RustedFox]

Agreed but there are a number of residents who are prima Donnas. I think in the end the upside matters. I knew the upside of my old group. I made well under market til I got there. Job was easy, low volume, great location. No regrets. There is something special about working in an SDG where all your well beings are tied and almost everyone pulls in the same direction.

There are some residents who are Primadonnas, but there are more who just want the normal job they were promised.