Class of 2021 job market insights

[B52forU]

For what it's worth, I work in the phoenix market and it is tight especially during this covid era where everyone's hours are being cut so I doubt any groups are truly looking for new hires though I believe Tuba City infrequently has a need. My job compensation is in the ballpark that Ectopic cited for hourly including quarterly bonus and I do also receive benefits as well not included in that. Though it's my first job out from residency, I don't think that my job is in any way "crappy" all things considered compared to the hospitals where I trained in Chicago. Again the job market here is tight as it likely is across the country and even the Maricopa grads are having difficulty finding a job in the immediate area. Keep your options open, if you're open to Tucson there are better paying opportunities out there if they are still available.

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[EctopicFetus]

For what it's worth, I work in the phoenix market and it is tight especially during this covid era where everyone's hours are being cut so I doubt any groups are truly looking for new hires though I believe Tuba City infrequently has a need. My job compensation is in the ballpark that Ectopic cited for hourly including quarterly bonus and I do also receive benefits as well not included in that. Though it's my first job out from residency, I don't think that my job is in any way "crappy" all things considered compared to the hospitals where I trained in Chicago. Again the job market here is tight as it likely is across the country and even the Maricopa grads are having difficulty finding a job in the immediate area. Keep your options open, if you're open to Tucson there are better paying opportunities out there if they are still available.

Tucson is locked up. It’s gonna be an interesting next 3-5 years. My prediction is salaries dropping 10-20% in big cities.
Look at denver for a taste of the future.
2k em grads a year and a likely stake stock market will lead to locums getting destroyed, pay dropping under the guise of covid, decreases in Medicare reimbursement and other stuff. In reality it’s a supply demand question. Supply skyrocketing. Demand stagnant. Ask adam smith how this plays out.

 

[Dr Mantis Toboggan]

Tucson is locked up. It’s gonna be an interesting next 3-5 years. My prediction is salaries dropping 10-20% in big cities.
Look at denver for a taste of the future.
2k em grads a year and a likely stake stock market will lead to locums getting destroyed, pay dropping under the guise of covid, decreases in Medicare reimbursement and other stuff. In reality it’s a supply demand question. Supply skyrocketing. Demand stagnant. Ask adam smith how this plays out.

yup to make things worse decreased pay will cause late middle career guys like me (18 years out of residency) to stay longer to make enough to hit my number. so the supply stays higher longer making it worse for everyone. our loans are paid off and the mortgages about gone and we had the advantage of some nice years in the stock market, so we can hang out and tread water, not be as efficient and generally ruin things for the new crop.

 

[EctopicFetus]

It’s an amazing confluence of events. Where I am now it’s been an amazing change just in the last 18 months. em trained folks driving an hour plus for work. Nothing in the city. Even the hca sites are fairly full. Desperate times.

 

[Hercules]

yup to make things worse decreased pay will cause late middle career guys like me (18 years out of residency) to stay longer to make enough to hit my number. so the supply stays higher longer making it worse for everyone. our loans are paid off and the mortgages about gone and we had the advantage of some nice years in the stock market, so we can hang out and tread water, not be as efficient and generally ruin things for the new crop.

I think there will definitely be a large group in your situation. It may be (admittedly very mildly) offset by a separate mid career group, though. There will be some of us who basically say that once the pay gets bad enough, we’re not willing to work in the ED anymore. There’s most definitely a number for me where I wouldn’t do it.

 

[miacomet]

Locums never appealed to me. I look at the unpaid time with travel and it never made financial sense to me.

Curious where your friend is (what city or state) just curious. There are some good jobs around but they are becoming harder and harder to find. Phoenix went from a ton of SDGs to maybe 2 left.

It makes sense if, say, you are in a situation where one

-will really benefit from the tax advantages (although the last tax bill cut into those, big time)
-is planning a year or ten off and hotel/air miles really matter
-needs to lump shifts into a week a month, or a summer, or simply chooses not to work more than that
-wants to escape the family for extended periods of time

Agreed that financially it is rarely worth it, and certainly not now.

I've said it once and I'll say it again- pick a field where you own your patients, and with minimal midlevel encroachment

 

[EctopicFetus]

I think there will definitely be a large group in your situation. It may be (admittedly very mildly) offset by a separate mid career group, though. There will be some of us who basically say that once the pay gets bad enough, we’re not willing to work in the ED anymore. There’s most definitely a number for me where I wouldn’t do it.

Agree with this. I’m not too far from my FI number. I’m racing to get there. I’m not there yet but am at the point where I would be good if i never saved again but couldnt tap it to cover expenses. I do hope that i get another decade of having a “good” job.

 

[EctopicFetus]

It makes sense if, say, you are in a situation where one

-will really benefit from the tax advantages (although the last tax bill cut into those, big time)
-is planning a year or ten off and hotel/air miles really matter
-needs to lump shifts into a week a month, or a summer, or simply chooses not to work more than that
-wants to escape the family for extended periods of time

Agreed that financially it is rarely worth it, and certainly not now.

I've said it once and I'll say it again- pick a field where you own your patients, and with minimal midlevel encroachment

I think you are right. That being said I think in the right setup the tax things is minimal or non existent. For the time off many groups have a sabbatical in place (Unsure how locums helps with this). Agree that locums gives scheduling control.

Can’t argue with #4.. thats not a worry of mine.

I will say many groups will let you have a long period of time off. I had a partner of mine take all of July off. He made this decision pre COVID but it is doable. I am/did think about this in a year or 2. Thought about taking 4-6 weeks off and living elsewhere just because I can and think it would be a cool experience for my family.

 

[scoopdaboop]

Aren’t em jobs constantly available. US pop gets bigger every year and you can’t just have the same number of grads every year even though that might be beneficial for the grads that do come out.

 

[blue.jay]

I've said it once and I'll say it again- pick a field where you own your patients, and with minimal midlevel encroachment

What field is that? Midlevels are everywhere and almost everyone is employed these days (seems like every non-surgical field have no control over our their job)

 

[miacomet]

Maybe pain medicine? just spitballing here.

Thus I would pick a surgical field. Or perhaps interventional cardiology or GI.

 

[miacomet]

I think there will definitely be a large group in your situation. It may be (admittedly very mildly) offset by a separate mid career group, though. There will be some of us who basically say that once the pay gets bad enough, we’re not willing to work in the ED anymore. There’s most definitely a number for me where I wouldn’t do it.

Yeah, at a certain point no vale la pena, especially with nights/weekends/holidays. But most people are not as good a planner as you, Herk.

 

[blue.jay]

Thus I would pick a surgical field. Or perhaps interventional cardiology or GI.

Not every USMD can match into a surgical speciality and not all IM residents go into cardiology or GI. In fact a majority of us are in fields being encroached by midlevels. We all need to fight together and not apart.

 

[miacomet]

Not every USMD can match into a surgical speciality and not all IM residents go into cardiology or GI. In fact a majority of us are in fields being encroached by midlevels. We all need to fight together and not apart.

Sure. But I would suggest people look into those fields if they want a more stable career.

 

[EctopicFetus]

Aren’t em jobs constantly available. US pop gets bigger every year and you can’t just have the same number of grads every year even though that might be beneficial for the grads that do come out.

ED visits have been stagnant for a few years. Also, the growth of MLPs has made it where they are hiring them in lieu of docs.

 

[ER BlueBlood]

It could be worse, you could also own a restaurant as a side business while all this is going on...yea there are docs with those. Sadly I think this was to be expected for EM, wasn’t sustainable. If you aren’t doing surgery, good luck.

 

[alpinism]

Back in the day hospitals used to staff EDs with lots of MDs and a few MLPs to see the low acuity patients.

Nowadays hospitals have started to staff EDs with lots of MLPs and a few MDs to see the high acuity patients.

 

[blue.jay]

I guess the trend is changing like how ER is run in other countries where casualty doctors are MBBS grads without residency (like PAs) who triage patients for admission to medicine vs surgery or discharge simple stuff.

 

[Groove]

I'm not opposed to MLPs. I think we need them in our world. Otherwise, all of us would be stuck doing fast track stuff for a large part of the day as well as possible screening shifts. The MSE shifts can be ball busters and you might see 40 patients in a shift. I'm perfectly fine with sticking MLPs in FT areas and/or using them for MSEs. What I don't do is teach them procedures. I also don't co-manage higher acuity cases with them, I completely take over the case and manage them myself. The day you start giving them intubations and central lines, as well as walking them through the really difficult cases etc.. you are undermining your value to the department/hospital and eroding your specialty. I like plenty of them as persons but hey...this is business. I've taught zero procedures outside simple lac repairs and I&Ds in the past year alone to a MLP. We sequester them fairly well in our ED and they've accepted their role to soak up the lower acuity cases and adequately screen the complicated ones. The day we start incorporating them into the main ED and working with them side by side, empowering them to do all the same procedures and difficult management is the day we start killing ourselves. What message do you think that gives hospital administration and/or the medical specialists? You think they don't notice that the pt was managed just as well as the ABEM doc they spoke to during the last phone call? These are the same guys that sit on the MEC committee and help shape future hospital policy.

Let's please not make the same mistakes of anesthesia. We all know how that turned out for them.

 

[EctopicFetus]

I'm not opposed to MLPs. I think we need them in our world. Otherwise, all of us would be stuck doing fast track stuff for a large part of the day as well as possible screening shifts. The MSE shifts can be ball busters and you might see 40 patients in a shift. I'm perfectly fine with sticking MLPs in FT areas and/or using them for MSEs. What I don't do is teach them procedures. I also don't co-manage higher acuity cases with them, I completely take over the case and manage them myself. The day you start giving them intubations and central lines, as well as walking them through the really difficult cases etc.. you are undermining your value to the department/hospital and eroding your specialty. I like plenty of them as persons but hey...this is business. I've taught zero procedures outside simple lac repairs and I&Ds in the past year alone to a MLP. We sequester them fairly well in our ED and they've accepted their role to soak up the lower acuity cases and adequately screen the complicated ones. The day we start incorporating them into the main ED and working with them side by side, empowering them to do all the same procedures and difficult management is the day we start killing ourselves. What message do you think that gives hospital administration and/or the medical specialists? You think they don't notice that the pt was managed just as well as the ABEM doc they spoke to during the last phone call? These are the same guys that sit on the MEC committee and help shape future hospital policy.

Let's please not make the same mistakes of anesthesia. We all know how that turned out for them.

I think I'm with you on this. I think they are woefully unable to manage complex cases no matter how much I may help them. To suggest otherwise means that our time in training is not well utilized. I oversee a large number of MLPs who work seeing mostly FT and we get transfers from places where they are seeing people fairly independently. Some of them are smart but I think anyone who knows medicine knows they cant see moderate / high acuity patients alone.

They glide because the disease severity is low. If they 'miss" a case it is 1/1000 because the overall degree of illness in their patients is so low.

A hospital admin only sees $$$. We started to see this nonsense with the NPs on cardiology. They are terrible. They cant read EKGs and frankly are incredibly not helpful. A few were my former ED nurses and Ill just say I never thought that they were all that bright for bedside RNs.

Its disheartening to see what is happening. Just more reason to have a side hustle, save like an animal and plan for an exit when things get too crazy.

 

[scoopdaboop]

Back in the day hospitals used to staff EDs with lots of MDs and a few MLPs to see the low acuity patients.

Nowadays hospitals have started to staff EDs with lots of MLPs and a few MDs to see the high acuity patients.

This is true, but I remember an attending I worked with saying his salary has gone nothing but up since he was in practice since the mid 1990s. This is a guy in his late 50's-early 60s who also looked very good for his age, so I don't think he was overworked. Couldn't it be possible that if an ED has 2 MLP working "fast-track" area, and 3 docs running the more acute cases, that the docs working get their hourly boosted because they have to pay the MLP less, comapred to if they had 5 docs working at once. Yes, the hospital will pocket most of the savings.

 

[Mushdoc]

I think I'm with you on this. I think they are woefully unable to manage complex cases no matter how much I may help them. To suggest otherwise means that our time in training is not well utilized. I oversee a large number of MLPs who work seeing mostly FT and we get transfers from places where they are seeing people fairly independently. Some of them are smart but I think anyone who knows medicine knows they cant see moderate / high acuity patients alone.

They glide because the disease severity is low. If they 'miss" a case it is 1/1000 because the overall degree of illness in their patients is so low.

A hospital admin only sees $$$. We started to see this nonsense with the NPs on cardiology. They are terrible. They cant read EKGs and frankly are incredibly not helpful. A few were my former ED nurses and Ill just say I never thought that they were all that bright for bedside RNs.

Its disheartening to see what is happening. Just more reason to have a side hustle, save like an animal and plan for an exit when things get too crazy.

What do you guys do when you consult and its an NP or PA - and especially when you disagree or are actually needing help rather than just doing the basic cards consult on admit for CP rule out - are you asking them to have their attending call you back?

 

[Dr Mantis Toboggan]

This is true, but I remember an attending I worked with saying his salary has gone nothing but up since he was in practice since the mid 1990s. This is a guy in his late 50's-early 60s who also looked very good for his age, so I don't think he was overworked. Couldn't it be possible that if an ED has 2 MLP working "fast-track" area, and 3 docs running the more acute cases, that the docs working get their hourly boosted because they have to pay the MLP less, comapred to if they had 5 docs working at once. Yes, the hospital will pocket most of the savings.

Sure if a private group hires the MLPs they get the benefit. But in most cases now it’s the CMG who hires the MLP, you “supervise” them and assume their liability. And then they keep that money and pay you whatever they want.

 

[EctopicFetus]

What do you guys do when you consult and its an NP or PA - and especially when you disagree or are actually needing help rather than just doing the basic cards consult on admit for CP rule out - are you asking them to have their attending call you back?

So the CP rule out we admit to the hospitalists. We really only emergently consult the docs for emergent type stuff. MOstly STEMI but sometimes there is a clinical question. If I don't agree with them which has happened before I just tell them I want their attending to see the patient ASAP. Hasnt been an issue for me.

 

[EctopicFetus]

Sure if a private group hires the MLPs they get the benefit. But in most cases now it’s the CMG who hires the MLP, you “supervise” them and assume their liability. And then they keep that money and pay you whatever they want.

For the residents.. its not that they are paying you "whatever they want'. They are paying you the least amount possible to have you show up.

It is why Schumacher, APP and Teamhealth are cutting their costs right now. COVID is the excuse. the plan was there for a long time. Keep in mind TH started this pre COVID using their contract with UHC as an excuse. its all noise.. don't be foolish.

 

[texER]

Some on-the-ground feedback from a PGY3: Recruiters are pleasant but admit medical directors are not ready to look at hiring for 2021, and state that if so it will be very small number of positions this year as most folks are still dealing with wage cuts and hours cuts so they want to bring that back first.

We can't expect all 2400 of us graduating this year to get good jobs when the entire EM volumes nationwide took a 20-25% plunge. Can't add 6% to our workforce of new physicians when physician demand has stayed down 20%. The demand simply isn't back yet. Also seeing rates of $140-180 at the few busy sites that were previously advertised in the $250 plus range when I talked to them less than 12 months ago. They know we need jobs and the finances of EM suck right now. And to those of you saying, hold out don't settle for less, that's not reality. We have loans.

 

[namethatsmell]

I'm not opposed to MLPs. I think we need them in our world. Otherwise, all of us would be stuck doing fast track stuff for a large part of the day as well as possible screening shifts. The MSE shifts can be ball busters and you might see 40 patients in a shift. I'm perfectly fine with sticking MLPs in FT areas and/or using them for MSEs. What I don't do is teach them procedures. I also don't co-manage higher acuity cases with them, I completely take over the case and manage them myself. The day you start giving them intubations and central lines, as well as walking them through the really difficult cases etc.. you are undermining your value to the department/hospital and eroding your specialty. I like plenty of them as persons but hey...this is business. I've taught zero procedures outside simple lac repairs and I&Ds in the past year alone to a MLP. We sequester them fairly well in our ED and they've accepted their role to soak up the lower acuity cases and adequately screen the complicated ones. The day we start incorporating them into the main ED and working with them side by side, empowering them to do all the same procedures and difficult management is the day we start killing ourselves. What message do you think that gives hospital administration and/or the medical specialists? You think they don't notice that the pt was managed just as well as the ABEM doc they spoke to during the last phone call? These are the same guys that sit on the MEC committee and help shape future hospital policy.

Let's please not make the same mistakes of anesthesia. We all know how that turned out for them.

So much this.

I was once making my way out of the dept after a shift and was called back by some RNs asking me to eyeball a patient that a super-midlevel (who'd been blessed by admin to see all acuity levels) was evaluating as the other doc was doing a procedure in another room.

Midlevel seems annoyed I'm there. Pt has straightforward anaphylaxis. I ask midlevel what the plan is and don't get a definitive answer. I walk the midlevel through the case and what should be ordered and to prioritize epi. Midlevel and RNs in the room all agree. Then the other doc becomes free so I head out. Later on at home I log in and see the midlevel only ordered h1/h2/steroid but no epi because they felt the patient didn't look "bad enough to need it." Some time later the other doc sees the patient, realizes no epi was given, and orders it. In the note the midlevel states they discussed the entire case with me and sends it to me to co-sign.

How many aspects of this case are insane? I stopped counting when I got to 7 and my head exploded. I declined to sign that note and forwarded the case to the medical director.

 

[scoopdaboop]

So much this.

I was once making my way out of the dept after a shift and was called back by some RNs asking me to eyeball a patient that a super-midlevel (who'd been blessed by admin to see all acuity levels) was evaluating as the other doc was doing a procedure in another room.

Midlevel seems annoyed I'm there. Pt has straightforward anaphylaxis. I ask midlevel what the plan is and don't get a definitive answer. I walk the midlevel through the case and what should be ordered and to prioritize epi. Midlevel and RNs in the room all agree. Then the other doc becomes free so I head out. Later on at home I log in and see the midlevel only ordered h1/h2/steroid but no epi because they felt the patient didn't look "bad enough to need it." Some time later the other doc sees the patient, realizes no epi was given, and orders it. In the note the midlevel states they discussed the entire case with me and sends it to me to co-sign.

How many aspects of this case are insane? I stopped counting when I got to 7 and my head exploded. I declined to sign that note and forwarded the case to the medical director.

some of these low level providers (use this term now please, I think Rekt coined it), get a "i am actually depressed inside, and I have to seem like I have a big **** now" mentality once they think they do what physicians do, they get cocky.

 

[namethatsmell]

Some on-the-ground feedback from a PGY3: Recruiters are pleasant but admit medical directors are not ready to look at hiring for 2021, and state that if so it will be very small number of positions this year as most folks are still dealing with wage cuts and hours cuts so they want to bring that back first.

We can't expect all 2400 of us graduating this year to get good jobs when the entire EM volumes nationwide took a 20-25% plunge. Can't add 6% to our workforce of new physicians when physician demand has stayed down 20%. The demand simply isn't back yet. Also seeing rates of $140-180 at the few busy sites that were previously advertised in the $250 plus range when I talked to them less than 12 months ago. They know we need jobs and the finances of EM suck right now.

No doubt the job market sounds crappy for next year. Some food for thought:

1) The recruiters and CMGs are not your friends and will do everything they can to convice you that you'll be lucky to work for them at 140/hr. However, there's a pretty decent chance that covid's grip on our daily lives will relinquish significantly after this winter. And with that, people will start getting high in public again and hurt themselves and others...the "hold my beer" injuries will return in full force...and people with chest pain and focal weakness will feel comfortable coming to the ED again. While it's morbid it's kinda like field of dreams...these people will come and volumes will go up again. Don't lose the memory of the rates from pre-covid when negotiating in the future.

2) Don't feel boxed in. If you have geographic flexibility now is the time to try a bold move in exchange for a decent job. If not, you can live one place and work in another that will pay you fairly and bunch those shifts together.

3) Your EM background allows you to work in many settings outside the ED. Search the threads on this forum or EM Docs on fb for the multitude of discussions on this. If you can't find decent full time EM work that's agreeable to you then at least do 4 shifts/mo in a place that works and do other non-EM work. When/if the EM job market improves you can then grab a better gig. Or along the way you may find a gig you really like and not want to pull more shifts.

4) People change jobs all the time, which means jobs open up all the time. Network network network and be on the radar at places you'd like to eventually work.

5) If all else fails: binge watch every season of million dollar listing while getting a realtor license. That's my backup should the sky truly fall on all of medicine.

 

[Amazingmuzmo]

This is true, but I remember an attending I worked with saying his salary has gone nothing but up since he was in practice since the mid 1990s. This is a guy in his late 50's-early 60s who also looked very good for his age, so I don't think he was overworked. Couldn't it be possible that if an ED has 2 MLP working "fast-track" area, and 3 docs running the more acute cases, that the docs working get their hourly boosted because they have to pay the MLP less, comapred to if they had 5 docs working at once. Yes, the hospital will pocket most of the savings.

So in your scenario you've just unemployed 2 EM physicians and made the hospital a lot of money. How is this beneficial in the long run for the field of emergency medicine? You are missing the forest for the trees.

 

[scoopdaboop]

So in your scenario you've just unemployed 2 EM physicians and made the hospital a lot of money. How is this beneficial in the long run for the field of emergency medicine? You are missing the forest for the trees.

It's beneficial because there's enough jobs to go around currently... but with the new expansion that will rapidly go away.

 

[GatorCHOMPions]

Surprisingly I got a call from a local CMG today saying they’re hiring. A couple minutes into the call I understood why.

220 patients per day volume, 44h MD coverage and 16h MLP coverage. $160/hour base plus RVU. “Most docs per-COVID made around $200/hour which is nice”. Independent contractor. Bad malpractice climate to boot.

 

[CliveStaples]

Surprisingly I got a call from a local CMG today saying they’re hiring. A couple minutes into the call I understood why.

220 patients per day volume, 44h MD coverage and 16h MLP coverage. $160/hour base plus RVU. “Most docs per-COVID made around $200/hour which is nice”. Independent contractor. Bad malpractice climate to boot.

5pph I hope you laughed at them.

 

[GatorCHOMPions]

5pph I hope you laughed at them.

Even the guy from the powerhouse 4 year program wouldn’t be able to keep up.

 

[AlvinKamara]

Even the guy from the powerhouse 4 year program wouldn’t be able to keep up.

Okay so all this doom and gloom. Makes sense and I buy the warnings. But as a resident already in this field what the f*** can I do? Fellowship? Rural?

 

[bravotwozero]

Your options would be fellowship, depending on interest, if you really don't think you can land a decent ED job. This would include either Pain, Critical Care, or Tox-->academic position and being content with a paycut, but having a somewhat secure academic niche job. Of course, if you think you'd hate going into either subspecialty, then no point in doing or attempting any of it. Your critical care and tox rotations should give you a taste of the field, and see if you can squeeze in a pain elective.

 

[clibby]

Okay so all this doom and gloom. Makes sense and I buy the warnings. But as a resident already in this field what the f*** can I do? Fellowship? Rural?

Short Term: Same thing everyone else does in other fields. Network where you can. Leverage your faculty's network. Be willing to work on the fringe of the area you really want to work for awhile in order to network. Don't be too picky in the job search.

Medium term: Make sure you understand the business of EM so you meet your metrics and don't lose your job all while providing good care. Don't make enemies at your jobs either.

Long term: Advocate to ACEP and the ACGME-RRC to increase training requirements so mediocre to poor residencies close. Advocate to ensure every patient has access to a physician in a potential emergency. Don't tell your future group it is a good idea to open another residency.

There are no guarantees on what the field will look like in 10-20 years. Do what you like and do it well. If you think CCM, PEM, HPC, or PM is enjoyable, then do fellowship and jump ship. If you want academics, consider fellowship. Otherwise, only really do it if you are interested. Most won't help with most community jobs. You will be fine, you just might not experience the heyday of EM; or maybe you will, who knows?

 

[skougess]

On the other side of this issue is the EM Docs facebook group which I'm about ready to leave because its literally the same post over and over again. Is there really an EM job shortage or just an EM job shortage in Colorado/San Diego/Austin/Oregon/Seattle where apparently every single graduating resident in the country in 2021 wants to live.

 

[Porfirio]

Job shortage is in extremely rural areas of the country.

Editted because I messed up this post. Wrote this while on shift.

 

[Arcan57]

There is an EM job shortage everywhere, but it is most noticeable in high population centers.

First part is not true. There’s still a significant shortage of ED docs in the US, it’s just that there’s a shortage of well paying jobs in major urban centers. As that pool fills up (or maybe is already filled), the spillover goes to smaller urban areas, extended suburbs, and rural areas. That pool is much, much bigger but it’s one that most EM residents aren’t eager to swim in.

 

[emergentmd]

You can still find good jobs outside of big cities. Its not like in 3 yrs you went from Jobs everyone to jobs nowhere. I still get offers for crappy areas with still crappy pay relative to what I am used to.

 

[EctopicFetus]

First part is not true. There’s still a significant shortage of ED docs in the US, it’s just that there’s a shortage of well paying jobs in major urban centers. As that pool fills up (or maybe is already filled), the spillover goes to smaller urban areas, extended suburbs, and rural areas. That pool is much, much bigger but it’s one that most EM residents aren’t eager to swim in.

Suburban jobs are much more desireable than urban jobs. Pay is usually higher, hospitals better resources etc.

 

[Fox800]

On the other side of this issue is the EM Docs facebook group which I'm about ready to leave because its literally the same post over and over again. Is there really an EM job shortage or just an EM job shortage in Colorado/San Diego/Austin/Oregon/Seattle where apparently every single graduating resident in the country in 2021 wants to live.

Yep. The endless job posts of new grads looking for jobs in the PNW, Colorado, or California and acting surprised that there are few is getting old.

 

[Arcan57]

Suburban jobs are much more desireable than urban jobs. Pay is usually higher, hospitals better resources etc.

You know that, but many new grads don’t. A lot of new grads are trying to recreate their residency practice environment and are thrown off by the leaner coverage of suburban shops when picking their first job.

 

[EctopicFetus]

Yep. The endless job posts of new grads looking for jobs in the PNW, Colorado, or California and acting surprised that there are few is getting old.

People are foolish. Go train in New York and try to get a job in portland? Likely few if any connections. Em is a relationship business.

 

[EctopicFetus]

You know that, but many new grads don’t. A lot of new grads are trying to recreate their residency practice environment and are thrown off by the leaner coverage of suburban shops when picking their first job.

Why? Most residencies are under resourced and if you removed the cheap labor of the residents the hospitals would go down in flames.

 

[Arcan57]

Why? Most residencies are under resourced and if you removed the cheap labor of the residents the hospitals would go down in flames.

Residency is a team sport and new grads feel like if there’s a bunch of other attendings on at the same time that will make being an attending a team sport also. It doesn’t, but that’s the perception.

 

[Groove]

I love double/triple coverage shops. Especially when you've got a solid, mature and jovial crew. It's just fun working alongside other docs. The new grads asking for your advice on a case, etc.. bouncing cases off each other, not having to worry about a code rolling in while I'm in the bathroom or trying to get a sandwich out of the cafeteria with nobody to run it. Plus, I just get lonely working by myself. Sometimes, it's not that great...when you work in an RVU heavy productivity environment with a bunch of malcontents and loner types cherry picking and sniping chest pain and kidney stones from the WR and leaving the GOMERS and febrile newborns for you to pick up.

The main thing I miss about single coverage shops... The 12 hour shifts with a little less stress (not always though) where I could knock out 144 hours in 12 days with an enormous amount of time off. My current shift lengths are 8.5 hours and the new job is 9 hours which still requires me to work 16 shifts to get 144. Even when I worked 10s, I could knock out 16 for 160h and feel fine. I'd have to work 18 9's to get the same hours and 18 shifts....feels like 18 shifts, no matter how you cut it. Damn, I miss 10s and 12s.

 

[Apollyon]

I could knock out 144 hours in 12 days with an enormous amount of time off.

You were at a shop where they let you work 12 days in a row?

 

[Groove]

You were at a shop where they let you work 12 days in a row?

Nah, I meant 12 cumulative days or nights out of the month. That being said I don’t remember a restriction on sequential shifts but I def wouldn’t ever want to do 12, 12s in a row. I think we had some travelers that did 7 though.