Class of 2021 job market insights

[Rekt]

Damn, well, as a MS4 going into EM that was feeling excited about all of the interview invitations I've been getting so early in the cycle, reading through this whole thread definitely killed my good mood.

Don't worry, you can feel even worse three years from now when looking for a job.

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[partypantss]

Don't worry, you can feel even worse three years from now when looking for a job.

Planning to do tox or crit care so I can split my time and have another option to segue to, so I have 5 more years to burry my head!

 

[AlmostAnMD]

I picked one up from the Heaven Hill gift shop this year. Let me know how you like it.

For the price I think definitely not my best but still a good flavor profile. I got mine at a charity auction, man I'd love to go to their gift shop! I'm not near the bourbon trail at all. Once it opens back up for tours/tastings again I wanna go down there and raid a whole bunch of stuff, this place included.

 

[EctopicFetus]

Damn, well, as a MS4 going into EM that was feeling excited about all of the interview invitations I've been getting so early in the cycle, reading through this whole thread definitely killed my good mood.

welcome to the new reality.

 

[EctopicFetus]

Easy to say. When the change was made to require approval by directors, I told the docs that worked for me that I would NEVER turn down their overtime requests in shift admin, and to please put in every minute they worked. At other sites it was very different. We all know plenty of docs who stay hours late to document, and won’t bill for it. They either bought into the BS about “you’re the owner of a business”, or they were terrible docs that wanted to keep their jobs, or they were young and are afraid to bill extra. Either way a big percentage of the docs at the sites would never bill for staying late. Incredible abuse of the time and worth of the docs, (and this didn’t start til Dominic sold out to private equity.)

And to those who say to sue. . . . Good luck. You’re going to quit your job, and sue a massive PE backed company/ your employer for denying you a few hours of pay?

2 words. Class action.

 

[Fox800]

Those critical care jobs are drying up faster than a 95 year olds vagina. And tox? Day late dollar short.

Agreed a toxicology fellowship to get a better job seems like a long-shot. There may be 200 of these jobs in the entire US, and most folks stay there for the long haul.

Critical care still seems hot - can you provide numbers about the job field drying up? Because I understand that this is not the case.

 

[EctopicFetus]

Agreed a toxicology fellowship to get a better job seems like a long-shot. There may be 200 of these jobs in the entire US, and most folks stay there for the long haul.

Critical care still seems hot - can you provide numbers about the job field drying up? Because I understand that this is not the case.

I can only speak based on anectdotes but basically most private groups don’t want them as they don’t do pulm or sleep. Stuck at niche hospitals or academics. The number of cc folks has grown steadily for a decade. I don’t believe there are tons of jobs around.

 

[Buckeye1992]

I am a PGY3 from a small community program in the Midwest. I had already signed for a 1099 at 235/hr (min 140 hr/avg 1.6pph) prior to Covid hitting. The rest of the residents in my class are actively looking for jobs and are finding/interviewing at places paying more than what I signed for even in desirable places. There is occasionally a lot of doom and gloom on this website but the experience for finding jobs in my residency has not changed from previous years even with COVID.

 

[Rekt]

I am a PGY3 from a small community program in the Midwest. I had already signed for a 1099 at 235/hr (min 140 hr/avg 1.6pph) prior to Covid hitting. The rest of the residents in my class are actively looking for jobs and are finding/interviewing at places paying more than what I signed for even in desirable places. There is occasionally a lot of doom and gloom on this website but the experience for finding jobs in my residency has not changed from previous years even with COVID.

So you're essentially making effectively 205/hr in an undesirable location. Kind of speaks to the market imo. And anecdotes are anecdotes. We all got them. From what I've been seeing your program must be an exception. Must be a secret powerhouse program.

 

[Buckeye1992]

Coastal city of 75k. With a signing bonus adding 15$/hr.

 

[Fox800]

I am a PGY3 from a small community program in the Midwest. I had already signed for a 1099 at 235/hr (min 140 hr/avg 1.6pph) prior to Covid hitting. The rest of the residents in my class are actively looking for jobs and are finding/interviewing at places paying more than what I signed for even in desirable places. There is occasionally a lot of doom and gloom on this website but the experience for finding jobs in my residency has not changed from previous years even with COVID.

So $205-215/hr because no benefits.

 

[alpinism]

I am a PGY3 from a small community program in the Midwest. I had already signed for a 1099 at 235/hr (min 140 hr/avg 1.6pph) prior to Covid hitting. The rest of the residents in my class are actively looking for jobs and are finding/interviewing at places paying more than what I signed for even in desirable places. There is occasionally a lot of doom and gloom on this website but the experience for finding jobs in my residency has not changed from previous years even with COVID.

I'd be very surprised if everyone in your class was getting offers for 250/hr jobs in desirable coastal cities.

 

[EctopicFetus]

I'd be very surprised if everyone in your class was getting offers for 250/hr jobs in desirable coastal cities.

Yeah.. thats not happening. Covid screwed up the job market real bad.

 

[Frazier]

So $205-215/hr because no benefits.

This is an excellent point. Can't stress it enough.

You hear about the importance of considering benefits, but it didn't quite hit home until I actually sat down with my attending contract and added up everything... from 401k/403b/457/XYZ matching, malpractice, CME, option to sell generous PTO, insurance, tuition reimbursement, etc etc... it all added to to 90k-100k extra on top per year beyond base+bonus.

Granted I speak from the standpoint of my subspecialty position, not EM -- perhaps the world is different there with benefit profiles? But still, the 1099 route needs to be framed carefully for new grads, no doubt!

 

[Fox800]

I'd be very surprised if everyone in your class was getting offers for 250/hr jobs in desirable coastal cities.

They aren't. People aren't getting $250 in Texas at the moment.

 

[turkeyjerky]

I am a PGY3 from a small community program in the Midwest. I had already signed for a 1099 at 235/hr (min 140 hr/avg 1.6pph) prior to Covid hitting. The rest of the residents in my class are actively looking for jobs and are finding/interviewing at places paying more than what I signed for even in desirable places. There is occasionally a lot of doom and gloom on this website but the experience for finding jobs in my residency has not changed from previous years even with COVID.

Coastal city of 75k. With a signing bonus adding 15$/hr.

Coastal midwest? Where is this Gary? Get ready for them to cut the production formula--you might be averaging 190/hr before you know it.

This is an excellent point. Can't stress it enough.

You hear about the importance of considering benefits, but it didn't quite hit home until I actually sat down with my attending contract and added up everything... from 401k/403b/457/XYZ matching, malpractice, CME, option to sell generous PTO, insurance, tuition reimbursement, etc etc... it all added to to 90k-100k extra on top per year beyond base+bonus.

Granted I speak from the standpoint of my subspecialty position, not EM -- perhaps the world is different there with benefit profiles? But still, the 1099 route needs to be framed carefully for new grads, no doubt!

Yeah, imho people way overestimate the tax deductions for 1099 work.

 

[EctopicFetus]

Coastal midwest? Where is this Gary? Get ready for them to cut the production formula--you might be averaging 190/hr before you know it.



Yeah, imho people way overestimate the tax deductions for 1099 work.

It is as if people dont understand basic economics. Unless you work for a private group or a benevolent group the PE and hospital employed jobs will drive your rate as low as possible. Thats how it works. If the other poster wants a more detailed explanation i am happy to provide it.

 

[turkeyjerky]

It is as if people dont understand basic economics. Unless you work for a private group or a benevolent group the PE and hospital employed jobs will drive your rate as low as possible. Thats how it works. If the other poster wants a more detailed explanation i am happy to provide it.

And when they change the formula, it's always presented as "under the new formula, many of us will actually experience an increase in reimbursment". Yeah right.

 

[Buckeye1992]

Coastal midwest? Where is this Gary? Get ready for them to cut the production formula--you might be averaging 190/hr before you know it.

Residency in Midwest. Attending job starting next summer on east coast.

 

[askamsky51]

Just wanted to throw my hat in the ring for more data. Intentionally vague.

Just took a job. W2 employee, ~200/hr in mid-sized city in pnw. +100/hr night differential. Quarterly bonus. No Rvu.

Stemi/stroke/lvl2. Double coverage.

1.5 pph officially.

Benefits are good. Additional amenities i will again be intentionally vague about.

Jobs are out there.

 

[EctopicFetus]

And when they change the formula, it's always presented as "under the new formula, many of us will actually experience an increase in reimbursment". Yeah right.

Indeed. This has been seen time and again. They are moving more and more to RVUs. Takes away their risk if volumes drop/we shut down again.

Also telling someone you are taking a $10/hr cut sounds worse than we are cutting your per RVU reimbursement by $1. Games, games and games. Remember they dont make changes because it benefits docs. They do it to protect themselves and their bottom lines.

 

[EctopicFetus]

Residency in Midwest. Attending job starting next summer on east coast.

I wish you the best but cant wait to hear how it is going 6 months after you start. I hope it all works out. I am super skeptical though.

 

[Fox800]

Just wanted to throw my hat in the ring for more data. Intentionally vague.

Just took a job. W2 employee, ~200/hr in mid-sized city in pnw. +100/hr night differential. Quarterly bonus. No Rvu.

Stemi/stroke/lvl2. Double coverage.

1.5 pph officially.

Benefits are good. Additional amenities i will again be intentionally vague about.

Jobs are out there.

Jobs in the PNW as a whole are tough. You may have found a needle in the haystack - lots of docs on FB trying to end up there and not having much luck.

It's a warning sign for me that two of the residents in this years graduating class from my "powerhouse" program in the heartland are having trouble finding jobs. The usual MO was to graduate and slot into one of the democratic local groups and make bank, but now they are scrambling and considering full-time locums out of the gate.

 

[EctopicFetus]

Jobs in the PNW as a whole are tough. You may have found a needle in the haystack - lots of docs on FB trying to end up there and not having much luck.

It's a warning sign for me that two of the residents in this years graduating class from my "powerhouse" program in the heartland are having trouble finding jobs. The usual MO was to graduate and slot into one of the democratic local groups and make bank, but now they are scrambling and considering full-time locums out of the gate.

Except there are not a ton of locums out there at all.. or PT work. It isnt the end of the line yet but in 3-5 years it might be..My residents have found decent gigs. Nothing exciting. Typical above avg give and take type positions. But in the last cycle some of the people i know from other programs got pushed back start dates etc. I consider every month lost working especially early on to cost you about 30k/month. So pushing back 2 months is a 60k hit.

 

[Alvarez13]

Jobs in the PNW as a whole are tough. You may have found a needle in the haystack - lots of docs on FB trying to end up there and not having much luck.

It's a warning sign for me that two of the residents in this years graduating class from my "powerhouse" program in the heartland are having trouble finding jobs. The usual MO was to graduate and slot into one of the democratic local groups and make bank, but now they are scrambling and considering full-time locums out of the gate.

Locums is dead

 

[EctopicFetus]

Locums is dead

This is exactly the sentiment of people i know who did it for a while. The job market is regional. More and more regionals are very ugly. As we pour a bunch of new grads in and the old guard doesnt leave basic economic principles will hold true. Plan for the worst and hope for the best!

 

[Fox800]

Locums is dead

Compared to 2 years ago, yeah. You can still find some gigs, but like 10% of what was out there before.

If you're willing to work in Alaska, Iowa, Wisconsin, Minnesota, or the Dakotas, you'll find work.

They all pay $175-250 per hour to stay in a Hampton Inn in a small town instead of your own bed at night and you'll spend 1/3 of the month in a hotel or an airport...not worth it IMHO.

Folks need to consider non-traditional options like the VA, DOD civilian contractor jobs, hospital employed positions (sometimes these aren't as easy to find), etc. Get a DECENT job, pay off your loans, then you have freedom.

 

[turkeyjerky]

Compared to 2 years ago, yeah. You can still find some gigs, but like 10% of what was out there before.

If you're willing to work in Alaska, Iowa, Wisconsin, Minnesota, or the Dakotas, you'll find work.

They all pay $175-250 per hour to stay in a Hampton Inn in a small town instead of your own bed at night and you'll spend 1/3 of the month in a hotel or an airport...not worth it IMHO.

Folks need to consider non-traditional options like the VA, DOD civilian contractor jobs, hospital employed positions (sometimes these aren't as easy to find), etc. Get a DECENT job, pay off your loans, then you have freedom.

Having done locums (mix of mostly local per-diem and some travel) for the past 2 years or so, I think it would be an absolutely horrible idea for a new grad to consider it now. Not only have volume cuts and 'adjusted hours' decreased the need, but it's caused a lot of people to come out of the woods and sign on full time to achieve security. Shops I work at are fully staffed for the first time in years. Only the crappiest, lowest paying locums jobs are still out there, and even those are filling up within a few days of being posted (which means you'll have to go through a recruiter rather than direct to get in, and they're even less willing to negotiate on rate than before).

My advice to new grads would be to leverage your alumni network as much as possible and contact every small group in your region of choice. If nothing's open (which it probably won't be unless your looking in the midwest) make it clear that you're flexible and willing to wait until off-cycle. Then sign w/ whatever CMG or Hospital you can find, with the intention of dropping as soon as you find something better. Whatever you do, stay flexible, don't put down roots, don't take any signing bonuses.

 

[Backpack234]

Woof. Residents from my program in the Midwest struggling to find gigs. Hearing from friends planning to move back home that they’re stuck in the city they trained in. It’s rough out there all over. Probably time to hunker down, build a nest egg and develop some other skills.

 

[EMhopeful2]

Hopefully all this doom/gloom will discourage students from going into EM. I graduate in 2022, not too worried.

 

[blue.jay]

Hopefully all this doom/gloom will discourage students from going into EM. I graduate in 2022, not too worried.

Looking at ERAS 2021 prelim data 2,336 US-MDs (2,138 last year) and 1,168 DOs (982 last year) applied to EM. Students still find EM very desirable. Job market might get very saturated by 2030.

 

[alpinism]

That's almost FOUR HUNDRED more applicants.

 

[EMhopeful2]

Looking at ERAS 2021 prelim data 2,336 US-MDs (2,138 last year) and 1,168 DOs (982 last year) applied to EM. Students still find EM very desirable. Job market might get very saturated by 2030.

It's a cool field where you get to treat basically everything with a short residency. But I should have done anesthesiology.

 

[ace_inhibitor111]

People taking advantage of the 1 SLOE rule to dual apply. I know several doing the EM/ortho combo

 

[EctopicFetus]

It's a cool field where you get to treat basically everything with a short residency. But I should have done anesthesiology.

Anesthesia having its issues too.

 

[miacomet]

Anesthesia having its issues too.

Better fellowships from anesthesia- easier to get pain, still have critical care

But I would have chosen psych- all the crazy of the ED with none of the bureaucrats

 

[EctopicFetus]

Better fellowships from anesthesia- easier to get pain, still have critical care

But I would have chosen psych- all the crazy of the ED with none of the bureaucrats

Their fellowships way better and can be more protective. Higher risk cases etc. but Private equity is going after psych too. Surgical sub specialties are the only safe ones (for now). Low risk of AI disruption and low risk of Noctors.

 

[EMhopeful2]

You can do pain and critical care from EM. Have a couple friends doing it, not difficult to get.

 

[EctopicFetus]

You can do pain and critical care from EM. Have a couple friends doing it, not difficult to get.

Critical care doesnt get you more money and I’m not sure it gives you a ton of options. Most of the EM CC jobs (not all) are in academics. Private groups want you to do clinic. The ROI on the 2 years is essentially 0 or negative. It may extend the length of your career which is the only argument for a positive ROI.

 

[blue.jay]

You can do pain and critical care from EM. Have a couple friends doing it, not difficult to get.

I would guess pain is competitive as the programs prioritize anaesthesia > PMR > others

 

[zyx189]

Just wanted to throw my hat in the ring for more data. Intentionally vague.

Just took a job. W2 employee, ~200/hr in mid-sized city in pnw. +100/hr night differential. Quarterly bonus. No Rvu.

Stemi/stroke/lvl2. Double coverage.

1.5 pph officially.

Benefits are good. Additional amenities i will again be intentionally vague about.

Jobs are out there.

Congrats! Mind PM'ing me the location? Just curious... I'm an ATTG physician in FL, just curious about the location/rates in areas of the PNW.

 

[calvnandhobbs68]

I am a PGY3 from a small community program in the Midwest. I had already signed for a 1099 at 235/hr (min 140 hr/avg 1.6pph) prior to Covid hitting. The rest of the residents in my class are actively looking for jobs and are finding/interviewing at places paying more than what I signed for even in desirable places. There is occasionally a lot of doom and gloom on this website but the experience for finding jobs in my residency has not changed from previous years even with COVID.

I was just looking at this thread (and am not in EM) but also noticed the "min 140/hr" part of this and agree with the people who are talking about RVUs above. This sounds more like a job where they're telling you you'll average 235/hr based on RVUs/pph but minimum is actually 140/hr...which sounds awful for EM.

 

[Buckeye1992]

I was just looking at this thread (and am not in EM) but also noticed the "min 140/hr" part of this and agree with the people who are talking about RVUs above. This sounds more like a job where they're telling you you'll average 235/hr based on RVUs/pph but minimum is actually 140/hr...which sounds awful for EM.

Not 140/hr. I am guaranteed 140 hrs per month at 235/hr

 

[calvnandhobbs68]

Not 140/hr. I am guaranteed 140 hrs per month at 235/hr

Ah that makes wayyyy more sense

 

[CliveStaples]

Just as an fyi, I don't think a single person I know that had hours reduced because of COVID got to play the "but I'm contracted for a minimum number of hours" card. If a place was fully staffed to begin with, nobody had their hours guaranteed.

Hopefully that doesn't happen again.

 

[bravotwozero]

I don't think Biden, or anyone else for that matter, is going to do that. Nor does any president have the power to.

 

[EctopicFetus]

I don't think Biden, or anyone else for that matter, is going to do that. Nor does any president have the power to.

Well, let me say to the last poster. Read your contract. You arent guaranteed 140 hours. There is usually language that says something about good faith. With regards to shutting things down, public health concerns give state and federal leaders a lot of leeway. If Biden wins and you have a democratic governor governor it is more likely. If you have a repub governor they are less likely to shut it down. That being said if the numbers stay as they are that might be the wisest move.

 

[The Knife & Gun Club]

Well, let me say to the last poster. Read your contract. You arent guaranteed 140 hours. There is usually language that says something about good faith. With regards to shutting things down, public health concerns give state and federal leaders a lot of leeway. If Biden wins and you have a democratic governor governor it is more likely. If you have a repub governor they are less likely to shut it down. That being said if the numbers stay as they are that might be the wisest move.

I would be really surprised if full “March-April” style lock downs occur anywhere in the country at this point in the game. Maybe some increasing or decreasing restrictions on large gatherings and indoor dining/bars but the blanket closures Of businesses, parks, restaurants etc just don’t seem to be the things anyone (regardless of party) wants to do in this moment.

 

[GeneralVeers]

They might try a national lock down or mask mandate but it would immediately be challenged in the Supreme Court and lose. One of the few things I'm not worried about.

 

[TrailRun]

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