Help me decide: EM or Ortho

[Old_Mil]

Ortho.

In my opinion, Emergency Medicine is in a lot of trouble going forward. A system in which an ever expanding number of medicaid or government-insured patients have access to the ED under the terms of our malpractice and emtala legislation is a catastrophically bad place to work.

Also, I'm not sure what the terms of employment for Orthos are (W2 vs 1099 vs Group Owner) but an ever increasing number of EM jobs are 1099 positions where you pay both sides of social security and medicare and buy your benefits at retail.

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[Old_Mil]

I've said it a million times before on this forum... If I could go back in time, I wouldn't go into medicine at all. But, I would probably still pick Emergency Medicine if forced to decide specialties again. The key reason for me is that it is possible to do other things while being an ER doctor, although it is not easy. For example, I am currently getting a PhD and hoping it will lead to another career, with clinical EM being reduced significantly.

Premeds, this post is for you.

(while you still have time to do something about the soul-damning trajectory on which you find your life)

 

[Jabbed]

What is Urgent Care then? 90% of it is general bread and butter primary care. <b>The other 10% is what your unique EM training can fulfill, such as suturing etc</b>.

lol

 

[GandalfTheWhite]

All those taxes listed, are funds that go to a government, that you're not able to spend on yourself. It comes out of your take home pay. It doesn't matter what a tax is named, what government it goes to, or whether it's deducted from your paycheck, or paid to you, then paid out by you. Either way, it's money confiscated from you, that you can't spend on yourself or your family. Money paid to government for income, fica, sales, gas or any other tax, come out of funds you're paid, that you don't get to spend on yourself. Hidden taxes are no less "taxes" than the one you see on your pay stub or W-2. They all make you poorer, just the same. If it makes you feel better to to pretend they don't exist, aren't real, "don't matter," don't add up or don't reduce the amount of net take home pay at your disposal, then feel free to do so. That's okay by me.

But if you make a point to be aware of them, and add them up to the best of your ability (or at least estimate), then your net take home pay is a lot closer to the 50% number in my post, than it is to your 150k (or 75% of 200k). If your income is higher, >$400k, and you're in a high tax city in a high tax state, your tax home is likely even lower than 50%. This is even after maximizing 401ks, 529s, HSA and other deductions.
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Again, they're not CONFISCATED from you. Its the price you pay for living in this country. Stuff doesn't get handed to you for free. Roads, schools, security, and freedom all benefits you enjoy for which you pay your fair share of taxes. Don't make it out to be as if the government is stealing from you. If you dont like your city or state taxes, then move to one where its more affordable. I am entirely aware of sales taxes, property taxes, etc.. but no country lives in a tax free environment. IDK how you are saying that your take home is less than 50% on a 200k income.
14,000 - 529
5,500 - Roth IRA
54,000 - SEP IRA
12,500 Trad IRA
18,000 - 401k
6,750 - HSA

that's about 101,000.
So on a 100K net salary (assuming the low 200K) after contributions, you're telling me you're getting taxed at 50%? At most your all inclusive fed taxes are 26000, before any deductions or claiming any dependents.

 

[Birdstrike]

Again, they're not CONFISCATED from you. .

If you don't think taxes are 'confiscated' from you, try not paying them once. Let me know how it works out and how the tax authorities respond. Please film it too, and post it on this thread.

Its the price you pay for living in this country. Stuff doesn't get handed to you for free. Roads, schools, security, and freedom all benefits you enjoy for which you pay your fair share of taxes. .

"Taxes pay for stuff." I didn't know that.

Don't make it out to be as if the government is stealing from you. .

I never said stealing. Your brain autocorrected that into my post.

IDK how you are saying that your take home is less than 50% on a 200k income.
.

I make more much more than that. It's a whole different tax environment. It gets more punitive and confiscatory, the more you earn, and the more you achieve.

And as far as the deductions you mention. Thanks, but I maximize all of them. I have a very good and expensive account.

Let me ask you a question, are you on an attending a salary, resident salary, or student (i.e. no salary)?



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[GandalfTheWhite]

If you don't think taxes are 'confiscated' from you, try not paying them once. Let me know how it works out and how the tax authorities respond. Please film it too, and post it on this thread.
No I dont think they're confiscated from you. Confiscate implies a penalty which taxes are not. They're your membership dues for being in this country and in your given income bracket. I never said I wouldn't pay them. Your brain must've projected that into my post.


"Taxes pay for stuff." I didn't know that.
Clearly not, since you're implying your tax is being taken without just cause.

I make more much more than that. It's a whole different tax environment. It gets more punitive and confiscatory, the more you earn, and the more you achieve.
Most EPs do. The example the OP gave was a 200k income and I based the calculations on that, not on your undisclosed income.

And as far as the deductions you mention. Thanks, but I maximize all of them. I have a very good and expensive account.
OK?

Let me ask you a question, are you on an attending a salary, resident salary, or student (i.e. no salary)?
Oh I'm just a student, but I like how your brain just auto-corrected "no salary" into my post, without actually knowing if I earn any income (I do).

This is getting to be a waste of everyone's time so I'm not going to continue on this further but feel free to carry on with complaining about how the government is confiscating your money.
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[VA Hopeful Dr]

This is stupid.

I put 200k into a pay check calculator. No deductions, filing single.

Net pay is 125k. That's in a fairly tax friendly state. It's not exactly 50%, but it's not that far from it either.

 

[Birdstrike]

You enjoy paying taxes.

I don't.

But there's good news. That puts you in a much better place than me. It's much better to enjoy paying taxes, than to dislike it, since as a physician you're going to pay a tremendous amount of them, over your career.




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[GandalfTheWhite]

You enjoy paying taxes.

I don't.

But there's good news. That puts you in a much better place than me. It's much better to enjoy paying taxes, than to dislike it, since as a physician you're going to pay a tremendous amount of them, over your career.




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No one enjoys paying taxes. The difference is not to get worked up about what you cant change, at least for the time being.

 

[Birdstrike]

This is stupid.

I put 200k into a pay check calculator. No deductions, filing single.

Net pay is 125k. That's in a fairly tax friendly state. It's not exactly 50%, but it's not that far from it either.

Most of those tax calculators factor in Federal, State and (maybe city) income tax rates, because those are easy rates to factor in a quick online formula.

At risk of beating a dead horse, did the tax estimator you used ask you to enter the following, which are sometimes hidden taxes and more difficult to put in a quick, online tax estimate tool?

Property tax, real estate tax, federal gas tax, state gas tax, sales tax, social security tax, medicare tax, Obamacare tax (21 separate taxes), capital gains taxes, inheritance taxes, cigarette tax, alcohol taxes, luxury taxes on high end cars and jewelry, user fee-type taxes on airline tickets, rental cars, toll roads, utilities, hotel rooms, licenses, and financial transaction.

These all add up. They're all real. We're all paying them, in varying amounts and combinations. And they all ultimately come out of our gross income, albeit not withheld by employers.

Admittedly, the amounts are very difficult to estimate (that's the point, the government doesn't want you aware you're paying them on a daily basis) but the total number is not insignificant for a high earner and high spender.

Do the math and you'll find that your percent take home is a lot lower than you think, especially, if you live in a high tax, blue city or state.


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[VA Hopeful Dr]

Most of those tax calculators factor in Federal, State and (maybe city) income tax rates, because those are easy rates to factor in a quick online formula.

At risk of beating a dead horse, did the tax estimator you used ask you to enter the following, which are sometimes hidden taxes and more difficult to put in a quick, online tax estimate tool?

Property tax, real estate tax, federal gas tax, state gas tax, sales tax, social security tax, medicare tax, Obamacare tax (21 separate taxes), capital gains taxes, inheritance taxes, cigarette tax, alcohol taxes, luxury taxes on high end cars and jewelry, user fee-type taxes on airline tickets, rental cars, toll roads, utilities, hotel rooms, licenses, and financial transaction.

These all add up. They're all real. We're all paying them, in varying amounts and combinations. And they all ultimately come out of our gross income, albeit not withheld by employers.

Admittedly, the amounts are very difficult to estimate (that's the point, the government doesn't want you aware you're paying them on a daily basis) but the total number is not insignificant for a high earner and high spender.

Do the math and you'll find that your percent take home is a lot lower than you think, especially, if you live in a high tax, blue city or state.


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The calculator I used factored in federal and state income tax Medicare and Social Security.

Most of the other taxes you mentioned our consumption taxes, so those do not affect your net pay. By that I mean what hits your bank account. No one factors in gasoline tax or sales tax when determining take-home pay, colloquially that's just not how this works.

 

[Birdstrike]

The calculator I used factored in federal and state income tax Medicare and Social Security.

Most of the other taxes you mentioned our consumption taxes, so those do not affect your net pay. By that I mean what hits your bank account. No one factors in gasoline tax or sales tax when determining take-home pay, colloquially that's just not how this works.

It's money you have to give to a government, out of money you earn. It's money you can't save. It's money you can't spend on your kids college. It's money you can't use to buy a steak. It money you can't put towards a car. It's money that comes out of your bank account or wallet, which comes from your paycheck. Whether "no one" factors it in to "determine take home pay" or whether it's how "you think this works" it's dollars your state, local and federal governments are separating form you and your wallet. In fact, they've done such a good job hiding these taxes, some of you don't think they really even exist or matter. The government has been incredibly successful at extracting tremendous amounts of dollars from us, while much of the public remains blissfully unaware, and apparantly will work very hard to remain so. This thread is a great example of that.


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[VA Hopeful Dr]

It's money you have to give to a government, out of money you earn. It's money you can't save. It's money you can't spend on your kids college. It's money you can't use to buy a steak. It money you can't put towards a car. It's money that comes out of your bank account or wallet, which comes from your paycheck. Whether "no one" factors it in to "determine take home pay" or whether it's how "you think this works" it's dollars your state, local and federal governments are separating form you and your wallet. In fact, they've done such a good job hiding these taxes, some of you don't think they really even exist or matter. The government has been incredibly successful at extracting tremendous amounts of dollars from us, while much of the public remains blissfully unaware, and apparantly will work very hard to remain so. This thread is a great example of that.


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So you're right and almost literally everyone else is wrong?

Got it.

 

[Birdstrike]

So you're right and almost literally everyone else is wrong?

Got it.

No.

My point is simple: My personal opinion is that I am over taxed. And that as physicians we are over taxed. That includes all taxes we pay, not just the obvious ones, but the hidden ones as well. That's really all I've been trying to say.

 

[GandalfTheWhite]

No.

My point is simple: My personal opinion is that I am over taxed. And that as physicians we are over taxed. That includes all taxes we pay, not just the obvious ones, but the hidden ones as well. That's really all I've been trying to say.

Control your consumption if you want to control your taxes. Otherwise, just look at the cost as the subtotal and include the taxes as a grand total cost.
Otherwise, donate to your PACs and write your Congressmen. Tell him/her that you dont want taxes on anything at all; be sure to mention no taxes on steak, lambos/ferraris, jewelry, and airlines. And please record the conversation and post on this thread.

 

[Angry Birds]

No.

My point is simple: My personal opinion is that I am over taxed. And that as physicians we are over taxed. That includes all taxes we pay, not just the obvious ones, but the hidden ones as well. That's really all I've been trying to say.

Gandalf, as a fellow liberal, I must say that the above is not an unreasonable view of Birdstrike's.

 

[GandalfTheWhite]

Gandalf, as a fellow liberal, I must say that the above is not an unreasonable view of Birdstrike's.

Believe it or not, I am financially conservative. I dont like taxes either and I do wish they were lower. But the point being made here was how he was throwing in consumption taxes to justify a simple correction regarding post-tax income, not his belief that we are overtaxed.

 

[Jabbed]

So I'm not completely seeing the connection between 'EM vs Ortho' to this stimulating argument about effective tax rates..

 

[Birdstrike]

So I'm not completely seeing the connection between 'EM vs Ortho' to this stimulating argument about effective tax rates..

Here's the connection: If you go into ortho instead of EM you'll make so damn much money, you can buy a Ferrari and have money leftover to cover the sales tax on your Waygu steak and pay for @GandalfTheWhite 's, too, and not feel the least bit stressed or pressed for cash


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[Jabbed]

Here's the connection: If you go into ortho instead of EM you'll make so damn much money, you can buy a Ferrari and have money leftover to cover the sales tax on your Waygu steak and pay for @GandalfTheWhite 's, too, and not feel the least bit stressed or pressed for cash


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But mo' money mo' taxes

 

[GandalfTheWhite]

Here's the connection: If you go into ortho instead of EM you'll make so damn much money, you can buy a Ferrari and have money leftover to cover the sales tax on your Waygu steak and pay for @GandalfTheWhite 's, too, and not feel the least bit stressed or pressed for cash
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Here's the REAL connection: The extra 100K you make gets taxed in the 40% bracket. In exchange for that, you will work about 60 hours/week on average compared to the 40 hours/week in EM. You will have less flexibility on scheduling, you will work more, you will not have time for as many hobbies or friends/family as you would compared to EM. You will be rounding on a regular basis, seeing patients for follow-up, and you will be working in a high volume clinic 1-2 days per week. And you will be on call for the rest of your life. You will have much less free time to pursue anything non-medical such as outside business interests/ventures, hobbies, working out, taking multiple vacations, or any other leisure activity. If you want to earn more, you can add more shifts if you need to

However, you will have a more predictable schedule, you will be regarded in a more prestigious light, the best outcomes, and the most grateful patients.
And Wagyu beef is overrated. I'll take a Prime NY Strip or Porterhouse over it any day. Save all that extra money so the government cant tax my consumption and turn me into a grumpy old grouch who complains about taxes on goods.

 

[WilcoWorld]

Property tax, real estate tax, federal gas tax, state gas tax, sales tax, social security tax, medicare tax, Obamacare tax (21 separate taxes), capital gains taxes, inheritance taxes, cigarette tax, alcohol taxes, luxury taxes on high end cars and jewelry, user fee-type taxes on airline tickets, rental cars, toll roads, utilities, hotel rooms, licenses, and financial transaction.

Did you just cut and paste the same list of taxes twice in the same thread?

C'mon dude. That's boring.

 

[VA Hopeful Dr]

No.

My point is simple: My personal opinion is that I am over taxed. And that as physicians we are over taxed. That includes all taxes we pay, not just the obvious ones, but the hidden ones as well. That's really all I've been trying to say.

Oh.

Well that I can get behind 1000%.

 

[VA Hopeful Dr]

Here's the REAL connection: The extra 100K you make gets taxed in the 40% bracket. In exchange for that, you will work about 60 hours/week on average compared to the 40 hours/week in EM. You will have less flexibility on scheduling, you will work more, you will not have time for as many hobbies or friends/family as you would compared to EM. You will be rounding on a regular basis, seeing patients for follow-up, and you will be working in a high volume clinic 1-2 days per week. And you will be on call for the rest of your life. You will have much less free time to pursue anything non-medical such as outside business interests/ventures, hobbies, working out, taking multiple vacations, or any other leisure activity. If you want to earn more, you can add more shifts if you need to

However, you will have a more predictable schedule, you will be regarded in a more prestigious light, the best outcomes, and the most grateful patients.
And Wagyu beef is overrated. I'll take a Prime NY Strip or Porterhouse over it any day. Save all that extra money so the government cant tax my consumption and turn me into a grumpy old grouch who complains about taxes on goods.

Unless I'm woefully mistaken about EM pay, I think it's cute you believe Ortho only makes 100k more than you.

 

[GandalfTheWhite]

Unless I'm woefully mistaken about EM pay, I think it's cute you believe Ortho only makes 100k more than you.

On average in south central. Even if you look at the medscape report, theres about a 150K gap. After taxes, thats about 75-80K.
Unless you have some other numbers to push out thats not anecdotal evidence?

 

[VA Hopeful Dr]

On average in south central. Even if you look at the medscape report, theres about a 150K gap. After taxes, thats about 75-80K.
Unless you have some other numbers to push out thats not anecdotal evidence?

MGMA from last year (which I stupidly purchased) has Ortho in the South at 600 while EM is at 400.

 

[GandalfTheWhite]

MGMA from last year (which I stupidly purchased) has Ortho in the South at 600 while EM is at 400.

Looking at South Central, Medscape has EM at 395 and Ortho at 403. Its variable by state but their national avg was 489 vs 339.
But again, the point remains the same, would you work an extra 20 hours per week, remain on call, and give up on many of your hobbies just for that extra 60-100K post tax? Personally I would build up other streams of revenue in those 20 or so hours if I wanted, in addition to passive income generation. To me its about working smart over working hard.
Theres a lot of positives to ortho, but you do give up a lot to get it.

 

[VA Hopeful Dr]

Looking at South Central, Medscape has EM at 395 and Ortho at 403. Its variable by state but their national avg was 489 vs 339.
But again, the point remains the same, would you work an extra 20 hours per week, remain on call, and give up on many of your hobbies just for that extra 60-100K post tax? Personally I would build up other streams of revenue in those 20 or so hours if I wanted, in addition to passive income generation. To me its about working smart over working hard.
Theres a lot of positives to ortho, but you do give up a lot to get it.

Actually my position for many years now is to do what you enjoy.

That extra 100k won't be enough if you don't enjoy the work. It's the same reason I didn't do EM. The extra 150k or so isn't worth it to me. Making less but enjoying the work is almost always the better play in the long run.

 

[Birdstrike]

Why do you people keep talking about taxes & money?

Money doesn't matter and taxes are good because they help society.


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[Birdstrike]

Did you just cut and paste the same list of taxes twice in the same thread?

C'mon dude. That's boring.

Actually the first 2 times that list appeared on this thread it was actually quite interesting and titilating to amateur economists on the internet, worldwide. I'd show you all the direct messages thanking me, if they weren't mainly inappropriate bathroom selfies from overly thankful fans. Only when you made it appear a third time, by copying it in your quote, did it reach boring status. Just thought I'd clear that up.

 

[Old_Mil]

Unless I'm woefully mistaken about EM pay, I think it's cute you believe Ortho only makes 100k more than you.

Yeah, a 100k difference between Ortho and EM seems low. The number is probably closer to 200k given the trend in EM.

 

[GandalfTheWhite]

Yeah, a 100k difference between Ortho and EM seems low. The number is probably closer to 200k given the trend in EM.

And what trend would that be?
Also, the numbers are easily accessible. Google medscape's 2017 physician compensation report.

 

[VA Hopeful Dr]

Difference is 160k according to medscape but those surveys can be inaccurate. Also have to take into account ortho works at least 25 hours/week more than EM, if not more (mid 30s vs 60). EM salary also differs a lot by region- northeast EM averages less than 300k, whereas in texas 350k is common. A lot of female EM docs also work less than average hours, bringing average pay down. I've heard and seen $250/hr EM jobs in texas a lot, and if you work 40 hrs/week and 48 weeks a year youll hit 480k. Also EM residency is only 3 years, whereas ortho is minimum 5 years and then more for fellowship, so that's another thing if you are tired of training/studying.

I'm not disputing any of that. In fact its similar to one of the things no one thinks about regarding FM - banker's hours, no weekends/holidays, 3 year residency that is fairly low-stress compared to most - I think 200k+ is a pretty good deal for all of that. Sure its less money than almost everyone else, but money isn't everything.

Y'all have similar weekly hours, similar residency length, but the job is more stressful, you have to provide 24/7 coverage within the group, and you're stuck seeing everyone that comes in pretty much no matter what. I don't begrudge y'all making more than I do based on the lifestyle alone.

 

[MedLyfee]

I have a follow-up question, I apologize in advance if this is ridiculous to ask.

If I still can't decide by the end of the year, is it possible to set myself up to where I am able to apply to both?

My school allows me to do multiple aways and I thought perhaps I could do my first few aways in EM and then the rest of the aways in Ortho? I understand this lowers my chances of matching and i'll likely have to apply to many more programs to make up for the split, but is it possible?

I don't have a geographical preference nor do I care to be at a prestigious program as long as I'm able to practice what I enjoy, so i'll apply to lesser known "low-tier" programs to maximize my chances of matching. I believe after multiple aways in each speciality I'll have a better understanding of which is truly better for me. Cheers in advance, fellas.

 

[Osteoth]

I have a follow-up question, I apologize in advance if this is ridiculous to ask.

If I still can't decide by the end of the year, is it possible to set myself up to where I am able to apply to both?

My school allows me to do multiple aways and I thought perhaps I could do my first few aways in EM and then the rest of the aways in Ortho? I understand this lowers my chances of matching and i'll likely have to apply to many more programs to make up for the split, but is it possible?

I don't have a geographical preference nor do I care to be at a prestigious program as long as I'm able to practice what I enjoy, so i'll apply to lesser known "low-tier" programs to maximize my chances of matching. I believe after multiple aways in each speciality I'll have a better understanding of which is truly better for me. Cheers in advance, fellas.

Ortho is too competitive for that. You need to choose.


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[MedLyfee]

Ortho is too competitive for that. You need to choose.


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I appreciate the response, it can play out two different ways:

1) I realize that EM is for me and i'll still have a solid chance at matching that year
2) I realize that Ortho is for me and perhaps, most likely, I'll need to do a research year and re-apply.

Honestly I wouldn't mind taking that chance, which is why i'm asking if it's possible? I know numerically my chances aren't great, but i'm willing to take the risk if I at least have some sort of shot.

 

[Osteoth]

I appreciate the response, it can play out two different ways:

1) I realize that EM is for me and i'll still have a solid chance at matching that year
2) I realize that Ortho is for me and perhaps, most likely, I'll need to do a research year and re-apply.

Honestly I wouldn't mind taking that chance, which is why i'm asking if it's possible? I know numerically my chances aren't great, but i'm willing to take the risk if I at least have some sort of shot.

People who apply ortho a second time around have a much worse chance than those who apply straight out. On my phone so if someone else has that data.

The real question is would you be ok doing gen surg if you decide ortho late then dont match the 2nd time.


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[RoyBasch]

I appreciate the response, it can play out two different ways:

1) I realize that EM is for me and i'll still have a solid chance at matching that year
2) I realize that Ortho is for me and perhaps, most likely, I'll need to do a research year and re-apply.

Honestly I wouldn't mind taking that chance, which is why i'm asking if it's possible? I know numerically my chances aren't great, but i'm willing to take the risk if I at least have some sort of shot.

This is a very bad idea. Both EM and ortho are sufficiently competitive that you need to commit to one or the other. Furthermore, both specialty application processes heavily weight away rotations and evals from them. If you don't have enough aways (which you will not realistically be able to to do before application's open--and being right on time with applications as soon as they open is critically important when applying to a competitive specialty!) your match prospects will suffer. Furthermore, having sat on a residency admissions committees I can tell you that re-applicants and people applying a second time is almost always viewed negatively and as a considerable "red flag." You don't want any red flags when there are 1000 applicants just like you without any red flags. The programs do not have and do not need the patience to given anybody a second shot.

 

[MedLyfee]

This is a very bad idea. Both EM and ortho are sufficiently competitive that you need to commit to one or the other. Furthermore, both specialty application processes heavily weight away rotations and evals from them. If you don't have enough aways (which you will not realistically be able to to do before application's open--and being right on time with applications as soon as they open is critically important when applying to a competitive specialty!) your match prospects will suffer. Furthermore, having sat on a residency admissions committees I can tell you that re-applicants and people applying a second time is almost always viewed negatively and as a considerable "red flag." You don't want any red flags when there are 1000 applicants just like you without any red flags. The programs do not have and do not need the patience to given anybody a second shot.

Thanks for clearing that up!

 

[Osteoth]

Thanks for clearing that up!

So now what?

 

[MedLyfee]

So now what?

I guess it'll have to be one or the other. I'm leaning more towards EM, what are you in/pursuing, if you don't mind me asking?

 

[Osteoth]

I guess it'll have to be one or the other. I'm leaning more towards EM, what are you in/pursuing, if you don't mind me asking?

I haven't got my STEP score back yet but I'm between EM & Gen Surg/Urology depending on score.

Can't really tell how much respect/pride is worth, because EM is great on paper but in the hospital hierarchy EM docs get constantly shafted and **** on by every other service...

 

[Angry Birds]

I haven't got my STEP score back yet but I'm between EM & Gen Surg/Urology depending on score.

Can't really tell how much respect/pride is worth, because EM is great on paper but in the hospital hierarchy EM docs get constantly shafted and **** on by every other service...

Last time I checked, EM and surgery were similar competitiveness. But yeah, I think urology is highly competitive, right?

I agree that we EM docs are low on the hospital hierarchy, but I think we are highly regarded amongst the general public, thanks to George Clooney et al. I was watching a comedy show the other day, and the comedian was ripping on an orthopedic surgeon in the crowd, mocking him saying he "wasn't a real doctor." I think this was because the orthopedic surgeon just said "orthopedist" instead of "orthopedic surgeon." The comedian didn't realize that orthopedic surgery is highly competitive and definitely "a real doctor", lol. He must've confused "orthopedist" with "chiropractor" or "podiatrist", lol.

Ultimately though, I think these are all really minor reasons and should only sway a decision minimally. Don't let your life be dictated by what others think.

 

[Osteoth]

Last time I checked, EM and surgery were similar competitiveness. But yeah, I think urology is highly competitive, right?

I agree that we EM docs are low on the hospital hierarchy, but I think we are highly regarded amongst the general public, thanks to George Clooney et al. I was watching a comedy show the other day, and the comedian was ripping on an orthopedic surgeon in the crowd, mocking him saying he "wasn't a real doctor." I think this was because the orthopedic surgeon just said "orthopedist" instead of "orthopedic surgeon." The comedian didn't realize that orthopedic surgery is highly competitive and definitely "a real doctor", lol. He must've confused "orthopedist" with "chiropractor" or "podiatrist", lol.

Ultimately though, I think these are all really minor reasons and should only sway a decision minimally. Don't let your life be dictated by what others think.

Yeah but through Gen surg you can get into trauma, CT, plastics etc, which are all competitive/respected.

I used to think that way until I got into the wards and people started to compare each other based on what specialty they're going into. It gets very tiring to constantly get **** on when you go to work, especially if you're working 60+ hours a week.

 

[GandalfTheWhite]

Yeah but through Gen surg you can get into trauma, CT, plastics etc, which are all competitive/respected.

I used to think that way until I got into the wards and people started to compare each other based on what specialty they're going into. It gets very tiring to constantly get **** on when you go to work, especially if you're working 60+ hours a week.

The traditional plastics programs are going the way of integrated programs. Very soon, there wont be many trad programs left. But do you really want to do a 7-8 year residency to get into plastics?

If someone is ****ting on your chosen specialty, **** on theirs. I had a fellow MS4 going into IM try to put down EM as triage docs and that IM does the real work, and I responded with the fact that EM makes the diagnosis and IM has to manage them. Also threw in how we dont waste 4 hours per day rounding, staying on call every 3-4 nights, and getting subpar pay for the amount of hours worked. Seemed to shut him up real quick.

 

[Osteoth]

The traditional plastics programs are going the way of integrated programs. Very soon, there wont be many trad programs left. But do you really want to do a 7-8 year residency to get into plastics?

If someone is ****ting on your chosen specialty, **** on theirs. I had a fellow MS4 going into IM try to put down EM as triage docs and that IM does the real work, and I responded with the fact that EM makes the diagnosis and IM has to manage them. Also threw in how we dont waste 4 hours per day rounding, staying on call every 3-4 nights, and getting subpar pay for the amount of hours worked. Seemed to shut him up real quick.

Thats true but at the same point all general surgeons + fellowships off of general surgery will make more money and carry more respect to both the medical community and society at large. I'm not saying its the most important thing, but for me I'm coming to see that it might be in the top 5.

 

[GandalfTheWhite]

Thats true but at the same point all general surgeons + fellowships off of general surgery will make more money and carry more respect to both the medical community and society at large. I'm not saying its the most important thing, but for me I'm coming to see that it might be in the top 5.

This is blatantly false. Respect for EM varies based on hospital culture. Most community hospitals are very cordial with their ED because they feed them their patients and hence more $$$ for them.
Secondly, salary is dependent on hours worked. Most salary data you see for EM is based on a 35-40 hour work week, compared to a surgeons 60-70 hour work week. So keep that in perspective when you are comparing two separate fields.

 

[Osteoth]

This is blatantly false. Respect for EM varies based on hospital culture. Most community hospitals are very cordial with their ED because they feed them their patients and hence more $$$ for them.
Secondly, salary is dependent on hours worked. Most salary data you see for EM is based on a 35-40 hour work week, compared to a surgeons 60-70 hour work week. So keep that in perspective when you are comparing two separate fields.

I'm course. I'm just going off the net sum from what I've been exposed to and told.

And to an extent, yes it is but from what I've seen/experienced there's a reason most EM docs only work ~40 hours a week. Shifting from days to nights and back again plus the weird late-PM shifts in-between takes a toll on your body.

Furthermore, in my state (California) there are no FSED but there are surgical centers, which means you can more viably go into private practice as a general surgeon than you can as an emergency medicine physician, further increasing your potential autonomy & salary via ownership.

 

[TheOther]

And to an extent, yes it is but from what I've seen/experienced there's a reason most EM docs only work ~40 hours a week. Shifting from days to nights and back again plus the weird late-PM shifts in-between takes a toll on your body

And those 40 hours are packed with dense decision-making, seeing 4-5 pts/hr, while trying to find room to admit.

 

[GandalfTheWhite]

And those 40 hours are packed with dense decision-making, seeing 4-5 pts/hr, while trying to find room to admit.

Again, false... most docs steadily see 2 - 2.5 pts/hr. lets not stretch hyperbole to ridiculous extent.