ER Docs in Desirable Cities, What's Life Like?

[GeneralVeers]

The problem is the high-paying travel jobs have evaporated. The locums market is paying the same crap that full-time local positions pay: $180-250 per hour. The $300+/hr with paid travel gigs are gone.

Oh, and you don't get any retirement match or insurance, no benefits, and have to sleep in a hotel 1/3 the month. I did this last year and the pay was barely worth it, spending 14 days a month in an airport or hotel dealing with COVID in the Midwest was not. Some of these idiot firms don't even offer to pay travel any more, I had one recruiter even list that as a benefit (paying my own travel and deducing it as a business expense).

That's exactly why I quit locums. When the bonuses dried up, I could make almost as much working locally and sleep in my own bed.

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[emergentmd]

I am so glad I got out of the hospital. The stuff I hear and I am sure its worse not than when I was a hired gun. I don't think I would do locums now even if it was giving out big bucks.

 

[TheComebacKid]

Why are people so obsessed with locums? Like I get it, the pay was really good... But usually you have to fly in to work at some dumpster fire of a hospital in the middle of nowhere that can't staff their own ED... sounds like a nightmare.

How many locums jobs that were paying $400/hr were at places you enjoyed working at?

 

[GeneralVeers]

Why are people so obsessed with locums? Like I get it, the pay was really good... But usually you have to fly in to work at some dumpster fire of a hospital in the middle of nowhere that can't staff their own ED... sounds like a nightmare.

How many locums jobs that were paying $400/hr were at places you enjoyed working at?

Locums got me to Fire in 5 years. That's why. Granted it was the golden days and those opportunities don't exist now.

 

[Porfirio]

I would gladly work at a locum dumpster fire ED for $400 per hour. The direction now is all EDs will be dumpster fires for <$225 per hour.

 

[namethatsmell]

Locums got me to Fire in 5 years. That's why. Granted it was the golden days and those opportunities don't exist now.

Agreed. A few years of predominantly traveling around for work was one of the best financial decisions I've ever made. But all the things people have mentioned -- traveling, staying in hotels, being away from family/friends etc -- began to take a toll. And then there's the increased liability...never again, especially with staffing almost everywhere and rates being craptastic.

 

[lp430]

I am also one of those people who live in a "desirable" city, but travel for work. I am a couple years out. While it's not a long term solution, it enables me to live where I want and feel like I get a vacation every other week because I get to go home. I understand it's not for everyone but getting paid almost double the local rate doesn't hurt either.
Never imagined this is how I would be practicing medicine when I was in med school lol.

 

[The Knife & Gun Club]

I am also one of those people who live in a "desirable" city, but travel for work. I am a couple years out. While it's not a long term solution, it enables me to live where I want and feel like I get a vacation every other week because I get to go home. I understand it's not for everyone but getting paid almost double the local rate doesn't hurt either.
Never imagined this is how I would be practicing medicine when I was in med school lol.

How long is your “travel commute”? Like house to airport, flight, airport to target hospital? Does the hospital care that you don’t live there? Do they let you have any role in how things are run there?

 

[EctopicFetus]

Locums used to be the right fit for the right person in the right situation. Most of that has dried up as rates are terrible. I still get emails from time and time and honestly im unlikely to do locums ever but surely not anytime while my job is stable. That said I used to get rates of 300-350/hr. Now it is like travel 2-3 hours from home for 235/hr. Insanity.

 

[Fox800]

Locums used to be the right fit for the right person in the right situation. Most of that has dried up as rates are terrible. I still get emails from time and time and honestly im unlikely to do locums ever but surely not anytime while my job is stable. That said I used to get rates of 300-350/hr. Now it is like travel 2-3 hours from home for 235/hr. Insanity.

Agreed. Why would I spend half the month in an airport/hotel for the same pay I can get locally, and sleep in my own bed?

 

[bravotwozero]

Agreed. Why would I spend half the month in an airport/hotel for the same pay I can get locally, and sleep in my own bed?

Travel points.

jk

 

[GeneralVeers]

Locums used to be the right fit for the right person in the right situation. Most of that has dried up as rates are terrible. I still get emails from time and time and honestly im unlikely to do locums ever but surely not anytime while my job is stable. That said I used to get rates of 300-350/hr. Now it is like travel 2-3 hours from home for 235/hr. Insanity.

Yeah I'm at a loss who would take these jobs. Some people must be desperate for hours.

 

[Fox800]

Yeah I'm at a loss who would take these jobs. Some people must be desperate for hours.

Or they live in Denver or San Diego, where the going rate is <$150/hr at some places...

 

[MechEDoc]

Yeah I'm at a loss who would take these jobs. Some people must be desperate for hours.

Spouse...

 

[betamale]

Been thinking about this a lot. I was just presented an opportunity to work in Manhattan but this would mean a 33% pay cut and probably a 10% hike in taxes. I'd really like to do it as I'm still in my early 30s, however, I'd really like FIRE asap. Would you guys do it?

 

[skougess]

Spouse...

At what point does it makes more financial sense for a spouse to just quit and stay at home if the pay differential is so bad? So happy my spouse and I are following the money and not obsessed with any particular city.

 

[Mount Asclepius]

I think the key isn’t to search for 2 of the 3 (pay, job, location), but instead search for 90% of ideal in each of the 3. Eventually each one of the criteria may lose their luster in prioritization to you, or manage to vanish overnight. By finding close to ideal in each area, you maximize your likelihood of achieving some sense of longevity until you have more freedom through FIRE.

 

[Porfirio]

Been thinking about this a lot. I was just presented an opportunity to work in Manhattan but this would mean a 33% pay cut and probably a 10% hike in taxes. I'd really like to do it as I'm still in my early 30s, however, I'd really like FIRE asap. Would you guys do it?

Go FIRE and visit the city. Think of all the vacations you can do with 43% more pay. Why limit yourself to just NYC?

 

[DeadCactus]

Been thinking about this a lot. I was just presented an opportunity to work in Manhattan but this would mean a 33% pay cut and probably a 10% hike in taxes. I'd really like to do it as I'm still in my early 30s, however, I'd really like FIRE asap. Would you guys do it?

Personally, if I wanted to live in Manhattan and the job was one I wanted, I would do it. I'm all for living frugally and saving aggressively, but sacrificing your 20's to get into medicine and then sacrificing your 30's to get out of medicine never made sense to me. Some people are lucky and the lifestyle they want lines up with living in cities that pay well. But if the lifestyle you want involves living in a low pay area, I'd rather FIRE later and/or thinner than yet again sacrifice the present for incremental gains in the future.

 

[GeneralVeers]

Personally, if I wanted to live in Manhattan and the job was one I wanted, I would do it. I'm all for living frugally and saving aggressively, but sacrificing your 20's to get into medicine and then sacrificing your 30's to get out of medicine never made sense to me. Some people are lucky and the lifestyle they want lines up with living in cities that pay well. But if the lifestyle you want involves living in a low pay area, I'd rather FIRE later and/or thinner than yet again sacrifice the present for incremental gains in the future.

I'm not sure you can get to FIRE living in Manhattan. The low pay and extreme cost of living means your savings rate will be low. I'm sure it's fine for a couple of years, but living there for the long term would mean working into your 60's to retire.

 

[The Knife & Gun Club]

Personally, if I wanted to live in Manhattan and the job was one I wanted, I would do it. I'm all for living frugally and saving aggressively, but sacrificing your 20's to get into medicine and then sacrificing your 30's to get out of medicine never made sense to me. Some people are lucky and the lifestyle they want lines up with living in cities that pay well. But if the lifestyle you want involves living in a low pay area, I'd rather FIRE later and/or thinner than yet again sacrifice the present for incremental gains in the future.

I agree. I don’t think it’s unreasonable to chose a lower paying job as long as youre CHOOSING it. Some people find immense value in living in a cultural hub, near their family, or near their favorite outdoor activity. But you’ve gotta weigh that financial reality like the price of a car or a house or a boat.

If you run the numbers, $150 in Denver vs $220 in Dallas @ 120 clinical hours a month —> $216,000/year in Denver vs $316,000/year in Dallas, working the exact same amount of hours. Median home price per square foot in metro Denver is $275 vs $146 in metro Dallas. So your 3000 square foot home in Dallas coats $438,000, that same home costs $825,000 in metro Denver.

All this is not to say “moving to ___ desirable city is stupid” - it’s not - you just need to run the numbers and decide for yourself. Would you pay $100,000/year to have the PRIVILEGE of living in that particular city? How about paying twice as much for the same generic suburban house?

I’m not a huge FIRE guy. I would pay $100,000 to not be miserable if it came to that. And I could probably hit FIRE eventually making $200,000 grand a year. But I think there’s a lot of people out there who never actually sit down and figure out just what it costs to live in some of these places.

 

[elanmorin]

Great points, but honestly Manhattan kinda sucks now after COVID. Plus, how much do you really plan to be out in the city when you're working?

 

[thegenius]

I'm not sure you can get to FIRE living in Manhattan. The low pay and extreme cost of living means your savings rate will be low. I'm sure it's fine for a couple of years, but living there for the long term would mean working into your 60's to retire.

Unless pay has increased in NYC, most places you are making I reckon $250/year. maybe less. I went to residency in NYC and the full time academia was making $225/hr + benefits.

Cost of living in NYC is terribly high. You can live in the outskirts and commute 45 - 60 minutes a day but that is such a drag.

If you want to work in NYC that's fine but don't do it because of FIRE

 

[The Knife & Gun Club]

Unless pay has increased in NYC, most places you are making I reckon $250/year. maybe less. I went to residency in NYC and the full time academia was making $225/hr + benefits.

Cost of living in NYC is terribly high. You can live in the outskirts and commute 45 - 60 minutes a day but that is such a drag.

If you want to work in NYC that's fine but don't do it because of FIRE

Is that bad or good? A friend of mine just signed for $150/hr for full time academic in the south, but allegedly with good benefits.

My (admittedly limited) understanding of academic pay was that it usually sat in the ~$120-220/hr range. It’s much tougher to get a good idea of academic pay since they’re so rarely advertising with rates anywhere.

 

[thegenius]

Is that bad or good? A friend of mine just signed for $150/hr for full time academic in the south, but allegedly with good benefits.

My (admittedly limited) understanding of academic pay was that it usually sat in the ~$120-220/hr range. It’s much tougher to get a good idea of academic pay since they’re so rarely advertising with rates anywhere.

I'm sorry...they make $220K/year + benefits. It's not $220/hr!!!!!! I mistyped.

$220K/year + benefits which probably add up to 70-80K/year.

 

[bravotwozero]

Is that bad or good? A friend of mine just signed for $150/hr for full time academic in the south, but allegedly with good benefits.

My (admittedly limited) understanding of academic pay was that it usually sat in the ~$120-220/hr range. It’s much tougher to get a good idea of academic pay since they’re so rarely advertising with rates anywhere.

I got offered an academic job in Houston for $240k/yr plus benefits.

 

[EctopicFetus]

I got offered an academic job in Houston for $240k/yr plus benefits.

Why in gods name is anyone working for under 400k/yr. why work for under 225/hr? Its insane. If you love NYC or denver take a month or 2 off every year and go live there.

 

[bravotwozero]

Why in gods name is anyone working for under 400k/yr. why work for under 225/hr? Its insane. If you love NYC or denver take a month or 2 off every year and go live there.

While I did not accept that job, everyone knows thats the trade-off you take when going into academia. You take the pay cut, and in exchange you have residents and mid levels doing a lot of your grunt work, and a w-2 job that’s a lot more stable and secure.

 

[sylvanthus]

Been thinking about this a lot. I was just presented an opportunity to work in Manhattan but this would mean a 33% pay cut and probably a 10% hike in taxes. I'd really like to do it as I'm still in my early 30s, however, I'd really like FIRE asap. Would you guys do it?

heelllllll nooooo

 

[sylvanthus]

Why in gods name is anyone working for under 400k/yr. why work for under 225/hr? Its insane. If you love NYC or denver take a month or 2 off every year and go live there.

This, you could live near anywhere else in the US, make 400k, and then go back to ny for a month a year on vacay and live it up in the city.

 

[namethatsmell]

Before any med student reading this goes googly-eyed reading "400K" regarding EM jobs, recognize that these days this is well above average unless you're OK working close to 150 hours/month (hint: you won't be). Finding a job you'd actually want in that range is usually only possible if you get luckly with a unicorn gig or you're OK living anywhere.

At the same time, don't be the schmuck who takes a gig making 250k/yr (unless there's an insane pension or it's daytime/weekdays only).

 

[slchino]

Why in gods name is anyone working for under 400k/yr. why work for under 225/hr? Its insane. If you love NYC or denver take a month or 2 off every year and go live there.

I do and a lot has to do with family and culture.
I’ve lived in a place that isn’t as diverse and bc of that there is lack of food options, staring eyes and whispers. Having my child grow in a diverse city with extended family with ethnic groceries and restaurants is very important.

I could chase the $ and we could visit for a month or two at a time but the day to day living, spontaneous dinners, cousin birthdays, graduations, family sporting events make for memories that make it worth it even if i have to work to 70😆

 

[Mount Asclepius]

You often can live in nice small to medium sized cities within 1-3 hours of desirable large cities in desirable states significantly increasing your income, while still benefiting from living in a good location. Everyone gets dead set on every major city in the west half-ignoring why living in the west is popular.

 

[emperor tamarin]

Lij in NYC pays about 305k/yr, 34 clinical hours per week

NYU pays about 295k for 32 hours a week (28 if core academic faculty)

Sinai pays similarly

I'm not sure about presbyterian.

Pay in NYC has gotten much better since I was a resident

 

[bravotwozero]

Lij in NYC pays about 305k/yr, 34 clinical hours per week

NYU pays about 295k for 32 hours a week (28 if core academic faculty)

Sinai pays similarly

I'm not sure about presbyterian.

Pay in NYC has gotten much better since I was a resident

300K academic in NYC is probably the same as 240k academic in Texas, due to federal+state+city tax in the former region, and lack of state and local taxes in the latter.

 

[ERDude]

Lij in NYC pays about 305k/yr, 34 clinical hours per week

34 hours per week is way too much. If 8.5hr shifts that's 4/week or about 17/mo on average. Doable for the first 3-5 years out of residency but after that it's too much.

 

[Torsion]

34 hours per week is way too much. If 8.5hr shifts that's 4/week or about 17/mo on average. Doable for the first 3-5 years out of residency but after that it's too much.

34 hours per week is more than most academic physicians work clinically, but I would add that we are talking about academics here. At the place I am training and at every program I rotated at as a student there were faculty pushing 70. Having residents to do nearly all of the procedures and notes leads to greater longevity I would think.

 

[EctopicFetus]

I do and a lot has to do with family and culture.
I’ve lived in a place that isn’t as diverse and bc of that there is lack of food options, staring eyes and whispers. Having my child grow in a diverse city with extended family with ethnic groceries and restaurants is very important.

I could chase the $ and we could visit for a month or two at a time but the day to day living, spontaneous dinners, cousin birthdays, graduations, family sporting events make for memories that make it worth it even if i have to work to 70😆

There are plenty of diverse cities. Let’s be clear it’s not the diversity it’s your desire to be near family. I respect that but it’s a potentially costly decision. Money isn’t everything and family is more important imo as long as you are close to them and really take advantage of that.

 

[lp430]

How long is your “travel commute”? Like house to airport, flight, airport to target hospital? Does the hospital care that you don’t live there? Do they let you have any role in how things are run there?

Just started a new job, which is a touch over an hour flight for me. I live 30 min from the airport and the hospital I work at is 15 min from the other airport.
Hospital doesn't care. They are happy to have me (not because I'm special, but I'm young and will work lots of nights lol)
I am still expected to call into a meeting here and there, but that's not much time difference than listening to a recruiter tell me about a new job/fill out credentialing paperwork. Still feeling out how much of an admin role I'll have, not that I care that much.

 

[NRAI2001]

Before any med student reading this goes googly-eyed reading "400K" regarding EM jobs, recognize that these days this is well above average unless you're OK working close to 150 hours/month (hint: you won't be). Finding a job you'd actually want in that range is usually only possible if you get luckly with a unicorn gig or you're OK living anywhere.

At the same time, don't be the schmuck who takes a gig making 250k/yr (unless there's an insane pension or it's daytime/weekdays only).

Family med is making $300k + a year working 9-5..

 

[RustedFox]

Family med is making $300k + a year working 9-5..

People say this, but the FM average is far lower, especially in desirable areas.

 

[Rekt]

People say this, but the FM average is far lower, especially in desirable areas.

I think a big difference is what each specialty considers desirable area. Many of my classmates are signing in what I consider desirable areas making a killing where there are zero EM jobs to be found.

 

[RustedFox]

I think a big difference is what each specialty considers desirable area. Many of my classmates are signing in what I consider desirable areas making a killing where there are zero EM jobs to be found.

Classmates as in residency classmates ?
How are they making a killing where there are zero EM jobs to be found if they can't find a job?

 

[VA Hopeful Dr]

People say this, but the FM average is far lower, especially in desirable areas.

In super popular areas like SF or NYC that's probably true, but I'd bet that most areas (or immediately adjacent) can manage that.

That said, it does mean working pretty hard.

 

[NRAI2001]

People say this, but the FM average is far lower, especially in desirable areas.

Even in desirable location working average workload (15-25 pts per day) I haven’t seen an FM job for less than $220k a year. A lot of RVU based jobs are 300k to 400k-ish range.

 

[vm26]

Even in desirable location working average workload (15-25 pts per day) I haven’t seen an FM job for less than $220k a year. A lot of RVU based jobs are 300k to 400k-ish range.

devil is in the details

 

[NRAI2001]

devil is in the details

Just saying EM should be getting at least $100k or more than FM.. the work and schedules are more difficult and they deserve it. I think FM salaries being mid 200s is fair ( FM is difficult as well in its own ways).. but as an EM doc I would expect at least upper $300-mid $400s.

 

[VA Hopeful Dr]

Just saying EM should be getting at least $100k or more than FM.. the work and schedules are more difficult and they deserve it. I think FM salaries being mid 200s is fair ( FM is difficult as well in its own ways).. but as an EM doc I would expect at least upper $300-mid $400s.

EM still does make a fair bit more overall. I'm an outlier for FM in terms of money and across the year I still make under $200/hour.

 

[bravotwozero]

EM still does make a fair bit more overall. I'm an outlier for FM in terms of money and across the year I still make under $200/hour.

Do you work outpatient m-f 9am-5pm only or do more than that?

 

[CliveStaples]

If I had to guess, I would say a lot of the happy people in EM in desirable cities are going to be the major academic sites and the rare SDG.