EM is not a lifestyle specialty

[la gringa]

Old Mil: Are you sure its not just "my first job sucks" syndrome that's what's got you down?

I'm not asking to flame; I'm wondering what the details are that you hate.

I work for a large CMG in urban Florida. 175 hour. Employee position; full benefits.

Also *just thought* - maybe its the 1099 status that you hate. I'd hate having to deal with all the ins-and-outs of buying my own insurances, etc. That would suck me dry seeing all of "my" money go to the intangibles.

EF is dead-on, though. If I didn't "have" to work for a CMG (they own my area; there's two warring factions), I wouldn't. At all.

agree w/ RF about being a 1099... not for me at all.

i think it would help to say what you don't like about your current gig... there are warts in nearly EVERY job, you just have to figure out what warts you can tolerate and evaluate what you'd have to give up to get different warts.

i loved the location of my first gig out of residency, except for the crazy COL and i was underpaid. i have major student loans and had health issues... moved to where i am now (my hometown fwiw)... i now work fewer hrs for a bit more $$ and my COL is much, much lower. i can travel more and have more time to de-stress. still in a metro area but not a top 5 for COL anymore.

the metrics that were emphasized are different at these gigs too... gig 1 went goo goo ga ga over door to doc, total LOS, and pt satisfaction. they went to a hybrid base/RVU pay structure after i signed so that came into effect later.

gig 2 also has hybrid base/RVU pay but they care more about % dc'ed under 3 hrs but i never hear about door to doc. the pt satisfaction compensation is greater than in gig 1 and paid out monthly instead of yearly in a bonus.

there are also differences in partner structure and how you qualify, what business expenses are paid, how much directors work, how the schedule is done, how much call i take, etc etc...

---

Members don't see this ad.

 

[Arcan57]

Pay is highly dependent on your location. If you live outside of the big cities in Cali or the northeast or other pockets like Denver etc the money is there at 200/hr+.

I know I may be in the minority but the large CMGs will be the end of EM as a decent specialty.

EM will always be a decent specialty for those that can tolerate the circadian issues and the chaotic environment. The market forces that have led to the continue expansion of CMGs are going to effect everyone. The major separator in work environments isn't going to be CMG or democratic but whether the hospital admin understands that meeting metrics is more about creating a system that works then it is about flogging the doctor.

 

[SeekerOfTheTree]

How hard is it to be a dedicated nocturnist? Could I just work fri, sat, and sun nights if I wanted?

 

[Arcan57]

How hard is it to be a dedicated nocturnist? Could I just work fri, sat, and sun nights if I wanted?

Yes.

 

[DreamingTheLive]

Old Mil: Are you sure its not just "my first job sucks" syndrome that's what's got you down?

I'm not asking to flame; I'm wondering what the details are that you hate.

I work for a large CMG in urban Florida. 175 hour. Employee position; full benefits.

Also *just thought* - maybe its the 1099 status that you hate. I'd hate having to deal with all the ins-and-outs of buying my own insurances, etc. That would suck me dry seeing all of "my" money go to the intangibles.

EF is dead-on, though. If I didn't "have" to work for a CMG (they own my area; there's two warring factions), I wouldn't. At all.

RF, I got a few places for you....but you'd have to bust out that winter jacket you either burned or lost in the closet. Besides, winter is grossly underrated as a season.

 

[45408]

How hard is it to be a dedicated nocturnist? Could I just work fri, sat, and sun nights if I wanted?

We have a few intensivists who do this. No one wants to work those shifts usually, so they're open to someone who will.

 

[SeekerOfTheTree]

Thanks guys!

 

[la gringa]

at my shop - weekDAY nocturnist spots pop up now and then, but you could likely always sign on to be a weekEND nocturnist.

 

[SeekerOfTheTree]

How is the Michigan market for EM docs?

 

[RustedFox]

RF, I got a few places for you....but you'd have to bust out that winter jacket you either burned or lost in the closet. Besides, winter is grossly underrated as a season.

Eff you, maaan. (DTL and I know each other in real-life, so don't anyone get huffy)

Year-round golf, fishing, watersports, and beach life ? Florida >>>> what'choo got.

PM me with your final ROL. I gotta know.

 

[Loon]

How is the Michigan market for EM docs?

As I understand it, it's quite good, though compensation in Texas is better (per an attending at St. John). My understanding is that the EM market is fairly good wherever you go, save maybe Denver or a few other choice cities.

And if you want to live outside of the big city, odds are you can find a job just about anywhere. I think the UP is dying for docs of all sorts.

 

[deleted109597]

Year-round golf, fishing, watersports, and beach life ? Florida >>>> what'choo got.

I've got you beat. Best economy in the country? Malpractice reform? Same frost zone?

Also, highest point in Texas>>>>>>highest point in FL.

Hell, our capitol building is almost that tall.

 

[SeekerOfTheTree]

Sweet. You guys rock in providing responses.

 

[RustedFox]

I've got you beat. Best economy in the country? Malpractice reform? Same frost zone?

Also, highest point in Texas>>>>>>highest point in FL.

Hell, our capitol building is almost that tall.

Yeah, but.... its.... Texas. Haaa haaahaha.

(I kid).

Honest question: I heard that Texas has some screwball law on the books that prevents you from holding a license if you haven't done a family practice rotation whilst a student. No idea if that's true or not, or if it once was but now isn't - but I do remember lots of chatter about this from classmates back when I was a MS 3/4. I never did a FP rotation, so I would need to do... something ?

 

[RustedFox]

As I understand it, it's quite good, though compensation in Texas is better (per an attending at St. John). My understanding is that the EM market is fairly good wherever you go, save maybe Denver or a few other choice cities.

And if you want to live outside of the big city, odds are you can find a job just about anywhere. I think the UP is dying for docs of all sorts.

Markets that are generally regarded as "tight" (in no particular order):

1. Salt Lake City
2. Denver/Colorado at large
3. SoCal.
4. Oregon/Seattle/"Cascadia".

There was an article in ACEP news a year or so ago that listed the 10 "best" and "worst" markets for a new EP in terms of availability. They had a graphic of a flying pig next to Salt Lake City, which was a firm "#1" on the "worst markets" list.

 

[da8s0859q]

Yeah, but.... its.... Texas. Haaa haaahaha.

(I kid).

Honest question: I heard that Texas has some screwball law on the books that prevents you from holding a license if you haven't done a family practice rotation whilst a student. No idea if that's true or not, or if it once was but now isn't - but I do remember lots of chatter about this from classmates back when I was a MS 3/4. I never did a FP rotation, so I would need to do... something ?

I'm a Texas M4 -- match day in ten days and "did I match?" in six, woo -- and I've never heard anything like that over the past four years. I'd imagine I would've by now... maybe I'm just missing something.

 

[RustedFox]

I'm a Texas M4 -- match day in ten days and "did I match?" in six, woo -- and I've never heard anything like that over the past four years. I'd imagine I would've by now... maybe I'm just missing something.

No idea. Maybe you have a "built-in" FP rotation. We did not, and I remember plenty of classmates all stressing out over "... but if I can't get a FP rotation, then I'll never be able to work back home in _________ (Texas, California, New York, insert other screwball states here).

It'd be great if someone could give a firm answer on this.

 

[EMquest3]

No idea. Maybe you have a "built-in" FP rotation. We did not, and I remember plenty of classmates all stressing out over "... but if I can't get a FP rotation, then I'll never be able to work back home in _________ (Texas, California, New York, insert other screwball states here).

It'd be great if someone could give a firm answer on this.

I think the first page of this pdf answers your question. If I read it correctly board certification bypasses the requirement, but there's a lot of legalese so maybe someone else can take a look.

 

[deleted109597]

There was an article in ACEP news a year or so ago that listed the 10 "best" and "worst" markets for a new EP in terms of availability. They had a graphic of a flying pig next to Salt Lake City, which was a firm "#1" on the "worst markets" list.

Barbara Katz does them every year. It's in EMNews.
http://journals.lww.com/em-news/Fulltext/2012/10000/Career_Source__The_2012_2013_Job_Market_.14.aspx

No idea. Maybe you have a "built-in" FP rotation. We did not, and I remember plenty of classmates all stressing out over "... but if I can't get a FP rotation, then I'll never be able to work back home in _________ (Texas, California, New York, insert other screwball states here).

It'd be great if someone could give a firm answer on this.

Sure, if you're an IMG, you have to. It's form J.
Except for this part.

you are not eligible for physician licensure in Texas unless you are specialty board certified by a specialty board approved by the American Osteopathic Association or the American Board of Medical Specialties.

So you can't do residency in the state. But you can get licensed after BC status obtained. At least, that's my interpretation. I don't think there is a waiver either.
I didn't make the rule, so don't shoot the messenger.

 

[RustedFox]

Barbara Katz does them every year. It's in EMNews.
http://journals.lww.com/em-news/Fulltext/2012/10000/Career_Source__The_2012_2013_Job_Market_.14.aspx

Sure, if you're an IMG, you have to. It's form J.
Except for this part.

So you can't do residency in the state. But you can get licensed after BC status obtained. At least, that's my interpretation. I don't think there is a waiver either.
I didn't make the rule, so don't shoot the messenger.

EDIT: Thanks for that Katz link. I used to get both EM News and ACEP News as a resident. They're all kind of the same. Although; that article's focus is on compensation, not availability. I was shocked to see Ohio in the bottom ten.


Hmm. Interesting. I'd seriously consider it, once I'm BC and if all that legalese shakes out in my favor.

I'd have to live in/near Dallas, though. I need a hockey team within a 45 minute drive. Need.

 

[SeekerOfTheTree]

Umm how do I sign up for Tennessee one? Lol dude I would sign for se money during residency to pay down my loan.

 

[Loon]

A friend showed me an ad recently for a job somewhere outside Houston. Nonpartner track 400K in two years. Partner track was 750K after reaching partnership (2 years, they said).

I have a very good imagination and I can't imagine that much money. Sounded too good to be true.

 

[da8s0859q]

A friend showed me an ad recently for a job somewhere outside Houston. Nonpartner track 400K in two years. Partner track was 750K after reaching partnership (2 years, they said).

I have a very good imagination and I can't imagine that much money. Sounded too good to be true.

What the... what?

Wonder what the catch is.

 

[Arcan57]

What the... what?

Wonder what the catch is.

$400k is doable in Houston city limits even with the evil CMGs. $750k sounds high although there's a guy working with me that was the director of a shop pulling down $800k in his heyday.

 

[deleted109597]

Although; that article's focus is on compensation, not availability. I was shocked to see Ohio in the bottom ten.

Here's the location one.
http://journals.lww.com/em-news/Fulltext/2012/09000/Career_Source__The_2012_2013_Job_Market__Location.17.aspx

 

[Old_Mil]

Old Mil: Are you sure its not just "my first job sucks" syndrome that's what's got you down?

I'm not asking to flame; I'm wondering what the details are that you hate.

Well, I guess there are two separate questions really, one is the did I choose poorly when taking this position (absolutely). But that has more to do with this place than the general issues surrounding CMGs

I work for a large CMG in urban Florida. 175 hour. Employee position; full benefits.

The fact that you are in a CMG position is rare enough...but to compare see how your job compares to hospital employed positions in the southeast region which also have benefits. I think the discrepancy in hourly rates will shock you.

 

[RustedFox]

Well, I guess there are two separate questions really, one is the did I choose poorly when taking this position (absolutely). But that has more to do with this place than the general issues surrounding CMGs



The fact that you are in a CMG position is rare enough...but to compare see how your job compares to hospital employed positions in the southeast region which also have benefits. I think the discrepancy in hourly rates will shock you.

I don't get what you're saying: CMGs aren't rare at all around here, and I do have "employed" status.

 

[Arcan57]

I don't get what you're saying: CMGs aren't rare at all around here, and I do have "employed" status.

I was talking with the president of our branch of a big CMG and he said he didn't care whether the docs were IC or employee (they're employees in his region, IC in mine). The only difference is how they set up the shell corp that pays the salaries. The other condition was that everyone being payed by a particular shell corp had to have the same employment status (IC or employee). They're also creating an insurance product for their ICs as they realize an MD's inability to obtain private insurance due to pre-existing conditions is hurting their ability to recruit. CMGs are hungry for profits, but they're getting smarter everyday about how to get them.

 

[DreamingTheLive]

Eff you, maaan. (DTL and I know each other in real-life, so don't anyone get huffy)

Year-round golf, fishing, watersports, and beach life ? Florida >>>> what'choo got.

PM me with your final ROL. I gotta know.

Currently, lol, daily rain/snow mixed w/ pretty strong winds, a complete lack of nightlife, a barren restaurant scene, and continuous talk of the next big storm...of which ultimately ends up being a half-inch of snow....with a slight breeze....if that...Panzees.....However, at least the unemployment rate is really high.....wait a minute.

 

[DreamingTheLive]

A friend showed me an ad recently for a job somewhere outside Houston. Nonpartner track 400K in two years. Partner track was 750K after reaching partnership (2 years, they said).

I have a very good imagination and I can't imagine that much money. Sounded too good to be true.

I've heard of some pretty high salaries (albeit, not in the most desirable of places for most, obviously)....but this takes the cake. Theres something there that either your buddy isn't sharing or wasn't told. Or else you're averaging 5.7 trainwreck-type patients per hour. Minimum.

 

[EctopicFetus]

I've heard of some pretty high salaries (albeit, not in the most desirable of places for most, obviously)....but this takes the cake. Theres something there that either your buddy isn't sharing or wasn't told. Or else you're averaging 5.7 trainwreck-type patients per hour. Minimum.

Hard to imagine that kind of money. The devil is in the details. Now that being said depending on payer mix, how malignant their prepartner deal is it is possible.

I know of people who in AZ made 65k+ in one month. Another group I know of is making $350/hr.

my point is simple.. the jobs are out there but the details of those jobs may be highly unappealing. The job where my bud made 65+k in his month sees well over 3 per hour, is a killer environment and I doubt anyone would be happy at the end of their shift. Ill make less to have longevity and happiness in my job.

 

[Loon]

The job where my bud made 65+k in his month sees well over 3 per hour, is a killer environment and I doubt anyone would be happy at the end of their shift. Ill make less to have longevity and happiness in my job.

This is kind of along the lines of "You can do anything for a few years." Sadly, holding a job for just a few months would likely be a huge resume stain.

 

[StevieStud]

How hard is it to be a dedicated nocturnist? Could I just work fri, sat, and sun nights if I wanted?

Oh Hell Yes. And if you say the magic words "I will even work the SuperBowl, World Series, March Madness plus Christmas and New Years" then you will have a job for life no matter what your PG score says.

 

[SeekerOfTheTree]

Oh Hell Yes. And if you say the magic words "I will even work the SuperBowl, World Series, March Madness plus Christmas and New Years" then you will have a job for life no matter what your PG score says.

Honestly I wouldn't care to work those. I have no friends.

 

[Apollyon]

Oh Hell Yes. And if you say the magic words "I will even work the SuperBowl, World Series, March Madness plus Christmas and New Years" then you will have a job for life no matter what your PG score says.

People keep saying that over and over and over, but I just don't know how true it is. In my job, I offered to do that, coming in, and I got a flat "no" - that there was already a nocturnist that did every weekend night, and had been for years, and he has no interest in getting out of it. At my first job in Hawai'i, I offered to do that, and was rebuffed - bluntly. I was told "it can't be done" (then again, the place is somewhat cursed, so it all worked out in the end).

I'm just sayin'. My experience is affirmatively anecdotal, but it is an N of 2; it is not just a random thing.

 

[SeekerOfTheTree]

People keep saying that over and over and over, but I just don't know how true it is. In my job, I offered to do that, coming in, and I got a flat "no" - that there was already a nocturnist that did every weekend night, and had been for years, and he has no interest in getting out of it. At my first job in Hawai'i, I offered to do that, and was rebuffed - bluntly. I was told "it can't be done" (then again, the place is somewhat cursed, so it all worked out in the end).

I'm just sayin'. My experience is affirmatively anecdotal, but it is an N of 2; it is not just a random thing.

Dang that sucks! I want to do nights. I want to try to get more nights even in residency.

 

[Apollyon]

Dang that sucks! I want to do nights. I want to try to get more nights even in residency.

In residency, the biggest push is to get equal numbers of morning, afternoon, evening, and night shifts, both for equality's sake (for everyone) and for learning, as certain complaints have certain times where they are more prevalent (for your education).

10 years ago, Mt. Sinai had 2 dedicated blocks during residency of only nights. I don't know if they still do this. When I was a resident, I asked my PD about that, and she had a blanket "no", and said it couldn't be done. She did not give a reason.

Now, as a counterpoint, my second job in HI was nights only for a year. I loved it. LOVED it! LUUUUVVVVVVEEEEEDDDDD IT! Then, my hospital shut down and went out of business. The end.

 

[SeekerOfTheTree]

In residency, the biggest push is to get equal numbers of morning, afternoon, evening, and night shifts, both for equality's sake (for everyone) and for learning, as certain complaints have certain times where they are more prevalent (for your education).

10 years ago, Mt. Sinai had 2 dedicated blocks during residency of only nights. I don't know if they still do this. When I was a resident, I asked my PD about that, and she had a blanket "no", and said it couldn't be done. She did not give a reason.

Now, as a counterpoint, my second job in HI was nights only for a year. I loved it. LOVED it! LUUUUVVVVVVEEEEEDDDDD IT! Then, my hospital shut down and went out of business. The end.

Are you still in Hawaii? Nights are just so nice. I love it when the world is asleep. I remember you gave a long post about opportunities in Hawaii a while ago.

 

[Apollyon]

Are you still in Hawaii? Nights are just so nice. I love it when the world is asleep. I remember you gave a long post about opportunities in Hawaii a while ago.

Nah, sat around for 7 months, but then had to move back to the mainland. I am going back to get married, though, next month.

 

[SeekerOfTheTree]

Congrats man. I went to Kauai for the honeymoon. It is beautiful. Pick Hyatt over Marriott. Better beach.

 

[DreamingTheLive]

Congrats man. I went to Kauai for the honeymoon. It is beautiful. Pick Hyatt over Marriott. Better beach.

Sheraton for beach. Grand hyatt for hotel/laguna. Marriott if you want to be in Lihue.

Princeville hotels are overrated unless you're more into pure opulence vs. beach. Unless you really want to be next to Napali coast for hiking.

 

[SeekerOfTheTree]

Sheraton for beach. Grand hyatt for hotel/laguna. Marriott if you want to be in Lihue.

Princeville hotels are overrated unless you're more into pure opulence vs. beach. Unless you really want to be next to Napali coast for hiking.

I wanted to hike but was not able to convince SO. Such nice trails I hear.

 

[DreamingTheLive]

I wanted to hike but was not able to convince SO. Such nice trails I hear.

Some of the views are simply breathtaking and I've camped out at secluded coves/beaches along or off the trail with 100 year swells pounding away at the tiny beach under a full moon. The combination of sheer beauty and raw power is unexplainable so I won't even attempt it.

Such an underrated island...but alas, overdevelopment is coming...hard and fast.

 

[SeekerOfTheTree]

Some of the views are simply breathtaking and I've camped out at secluded coves/beaches along or off the trail with 100 year swells pounding away at the tiny beach under a full moon. The combination of sheer beauty and raw power is unexplainable so I won't even attempt it.

Such an underrated island...but alas, overdevelopment is coming...hard and fast.

That sounds awesome man. That sucks they are developing it so much. I am going to miss it. Hopefully one more trip after residency.

 

[dchristismi]

Agree with the Sheraton for the best beach. Love Kauai!

And if one of my docs said that they wanted to only work nights, we'd be happy to make that happen.
Fox, come work for me! Democratic, academic-affiliated, just a wee bit inland so out of the named-rain surge zone.

 

[RustedFox]

Agree with the Sheraton for the best beach. Love Kauai!

And if one of my docs said that they wanted to only work nights, we'd be happy to make that happen.
Fox, come work for me! Democratic, academic-affiliated, just a wee bit inland so out of the named-rain surge zone.

A "wee bit inland" needs to be less than one hour from Tampa. I need my sports and my airport.

 

[EctopicFetus]

This is kind of along the lines of "You can do anything for a few years." Sadly, holding a job for just a few months would likely be a huge resume stain.

Negative. I think this belief that any high paying job is unsustainable is a myth. There are great jobs with great pay out there. People seeing 2 pph, scribes etc.

 

[Hercules]

I'll second that this is a myth. There are lots of bad jobs out there, but there are some really great ones too.

 

[filhodeinferno]

Markets that are generally regarded as "tight" (in no particular order):

1. Salt Lake City
2. Denver/Colorado at large
3. SoCal.
4. Oregon/Seattle/"Cascadia".

There was an article in ACEP news a year or so ago that listed the 10 "best" and "worst" markets for a new EP in terms of availability. They had a graphic of a flying pig next to Salt Lake City, which was a firm "#1" on the "worst markets" list.

As someone who has a strong desire to live in the SLC area and who is most likely going into EM, this post depresses me quite a bit.

Anyone on here work along the Wasatch front, or in the West in general, that can shed some light on the job market out there these days?

 

[womp]

Don't listen to that Johnnydrama guy. This was the guy who threw a conniption fit when I told him that rads was going down the tubes in terms of salary and lifestyle a year ago. He clearly has a case of envy now that reality has dawned on him after the match.

All of medicine is getting the shaft though. I'm going into ortho, and reimbursements are going to come down on us hard next, and our hours are much less controllable outside of sports. What sucks more than making less money is making less money while working 70 hrs a week. EM is a good gig, I would have done EM if my research hadn't all been in ortho and unfortunately I hate seeing complicated new patients with no HPI, PMH or labs.