M4 considering EM - job avaliability and lifestyle in rural or suburban areas

[okudasai]

Hello all, I am an M4 who is currently in the bargaining stage of grief regarding my desire to do EM. My story is the usual one; scribed as a pre-med, loved my third year EM rotations, am a very good personality fit, enjoy acuity and dealing with the undifferentiated patient, etc. I also enjoy doing interventions and seeing them have an effect fairly quickly and initial stabilization of the very sick. I am also interested in crit care, and I had some notion of doing EM and go into a fellowship based on how bad the job market looks by the time I am graduating.

My question regarding the EM job market is how possible is it to live in a coastal city and commute to rural or suburban EDs, assuming that is where most/all of the jobs will be in the next few years? Is there any hope regarding jobs in big cities for EM, especially within the next 3-5 years? The actual care in rural areas does appeal to me in that you get to do more stuff and have more autonomy, but I think that living in a rural area might not be for me. My hope was that I could continue to live in a metropolitan area and commute 1-2 hours and work 1 week out of the month. Do most ED docs who work in the suburbs or rural areas end up having to either live in the area or have a hotel 2 weeks out of the month? If the above sounds like a pipe dream, and if the end conclusion is that to do EM in the future means being okay with living in rural/midwest/suburban areas in order to have a job, I am not sure if I can stomach that for the sake of doing EM. Any and all advice is extremely appreciated!

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[e30ftw]

My question regarding the EM job market is how possible is it to live in a coastal city and commute to rural or suburban EDs, assuming that is where most/all of the jobs will be in the next few years? Is there any hope regarding jobs in big cities for EM, especially within the next 3-5 years?

Yes, it is possible to live in a coastal city and practice EM. There are many coastal cities in the US. Whether you can get the specific job you want at the specific time you want it in four hypothetical years, no one can answer. What do you mean by suburban? I live in the suburbs and practice at a community ED but downtown of a mid-sized outdoorsy city is only like 18 minutes away.

Do most ED docs who work in the suburbs or rural areas end up having to either live in the area or have a hotel 2 weeks out of the month?

Most emergency physicians live near their practice location, like most people. Your questions are very vague, it sounds like by coastal you specifically mean SF/LA/NYC. I'm sure it's possible to have a $5k/mo 600sq/ft apt in midtown and fly to a rural area to work but I don't know anyone who does it. (sure some do, just saying personally..) When I graduated (7 years ago) I only went to one interview other than my home institution; a desirable SDG in a nice city on the East Coast with partner compensation in the mid-400s. They offered me the job but I chose to stay at my inland location, for many reasons and am very happy with the gig so far. A quick search on edphysician.com shows multiple jobs advertised in LA/SF/SD. They're probably not unicorn gigs but the jobs are out there..

If the above sounds like a pipe dream, and if the end conclusion is that to do EM in the future means being okay with living in rural/midwest/suburban areas in order to have a job, I am not sure if I can stomach that for the sake of doing EM. Any and all advice is extremely appreciated!

I can confidently say that there will still be emergency physicians working in large cities in 2025. There are enough large cities in the US that it's reasonably confident to say if you are a good applicant you are likely to get a job in *a* large city. If you're dead-set on LAC-USC or something no one knows.. again, suburbs (and rural areas sometimes) are often like minutes from downtown in many cases, if having to live in a suburb is a deal-breaker then yes you may want to reconsider EM.

 

[okudasai]

Yes, it is possible to live in a coastal city and practice EM. There are many coastal cities in the US. Whether you can get the specific job you want at the specific time you want it in four hypothetical years, no one can answer. What do you mean by suburban? I live in the suburbs and practice at a community ED but downtown of a mid-sized outdoorsy city is only like 18 minutes away.



Most emergency physicians live near their practice location, like most people. Your questions are very vague, it sounds like by coastal you specifically mean SF/LA/NYC. I'm sure it's possible to have a $5k/mo 600sq/ft apt in midtown and fly to a rural area to work but I don't know anyone who does it. (sure some do, just saying personally..) When I graduated (7 years ago) I only went to one interview other than my home institution; a desirable SDG in a nice city on the East Coast with partner compensation in the mid-400s. They offered me the job but I chose to stay at my inland location, for many reasons and am very happy with the gig so far. A quick search on edphysician.com shows multiple jobs advertised in LA/SF/SD. They're probably not unicorn gigs but the jobs are out there..



I can confidently say that there will still be emergency physicians working in large cities in 2025. There are enough large cities in the US that it's reasonably confident to say if you are a good applicant you are likely to get a job in *a* large city. If you're dead-set on LAC-USC or something no one knows.. again, suburbs (and rural areas sometimes) are often like minutes from downtown in many cases, if having to live in a suburb is a deal-breaker then yes you may want to reconsider EM.

Apoligies for being vague; yes I was referring to SF/LA, etc. sorts of cities, also places like DC, Seattle, Portland. I am not sure that living in the suburbs would be a deal breaker per se, but I think I would want to stay in a metropolitan sort of area for at least a few years after graduating. I think being forced to live in a rural would be a deal breaker for me, however.

Thank you for your response! I am concerned that the oversupply would make the job market (in bigger cities especially) more competitive, and that you would have the possibility of being forced to move to where the jobs end up being. My main concern with EM would be that I would be limited by location more so than I would be in a different speciality, such as IM which I am also considering.

 

[skougess]

Apoligies for being vague; yes I was referring to SF/LA, etc. sorts of cities, also places like DC, Seattle, Portland. I am not sure that living in the suburbs would be a deal breaker per se, but I think I would want to stay in a metropolitan sort of area for at least a few years after graduating. I think being forced to live in a rural would be a deal breaker for me, however.

Thank you for your response! I am concerned that the oversupply would make the job market (in bigger cities especially) more competitive, and that you would have the possibility of being forced to move to where the jobs end up being. My main concern with EM would be that I would be limited by location more so than I would be in a different speciality, such as IM which I am also considering.

Keep in mind you can’t lump suburban with rural. Suburban is actually very competitive. Because who wouldn’t want to work 10 minutes from their home?

As another point, it’s reeaaally easy to say “I’m just gonna fly/drive out to work shifts in rural USA”, it’s another thing to actually be facing that and the expense, hassle, and major disruption to your life that that all entails (e.g. “Sorry, sweetie/kids, daddy’s gotta go **** around in West Virginia and live in a long term Airbnb rental again this week!”). People talk about commutes as being one of the major things that can make you miserable in life. Imagine THAT commute.

 

[okudasai]

Keep in mind you can’t lump suburban with rural. Suburban is actually very competitive. Because who wouldn’t want to work 10 minutes from their home?

As another point, it’s reeaaally easy to say “I’m just gonna fly/drive out to work shifts in rural USA”, it’s another thing to actually be facing that and the expense, hassle, and major disruption to your life that that all entails (e.g. “Sorry, sweetie/kids, daddy’s gotta go **** around in West Virginia and live in a long term Airbnb rental again this week!”). People talk about commutes as being one of the major things that can make you miserable in life. Imagine THAT commute.

Gotcha, if the jobs end up being rural, than I would have to make peace with the disruption the long commutes would have to my life. I personally don't mind long commutes as of now (plenty of time to listen to podcasts) but I have no doubt it gets exhausting after a while. And I don't think I would like having to live away from family 1-2 weeks out of the month. Do you know of any ED docs who do long commutes for their jobs, and how/if they make it work?

 

[cyanide12345678]

Gotcha, if the jobs end up being rural, than I would have to make peace with the disruption the long commutes would have to my life. I personally don't mind long commutes as of now (plenty of time to listen to podcasts) but I have no doubt it gets exhausting after a while. And I don't think I would like having to live away from family 1-2 weeks out of the month. Do you know of any ED docs who do long commutes for their jobs, and how/if they make it work?

Only almost fell asleep on the wheel 4-5 times in the last two years driving an hour back after my 12 hour night shifts 😂😂😂

Probably slept in the parking lot of a gas station 8-10 times in the last 2 years when i realized halfway i couldn't make it without needing a nap.

 

[okudasai]

Only almost fell asleep on the wheel 4-5 times in the last two years driving an hour back after my 12 hour night shifts 😂😂😂

Probably slept in the parking lot of a gas station 8-10 times in the last 2 years when i realized halfway i couldn't make it without needing a nap.

I was told that the rural shifts would be 12 hours long. Do you feel that the longer commutes essentially makes it so that you can't do much on shift days other than work and sleep? How is the lifestyle generally when it comes to long commutes, would you recommend it or is it something that wears on you as time goes on? I suppose I wouldn't mind doing long commutes a week out of each month but 2 weeks or more would be my breaking point. Thank you for the input!

 

[cyanide12345678]

I was told that the rural shifts would be 12 hours long. Do you feel that the longer commutes essentially makes it so that you can't do much on shift days other than work and sleep? How is the lifestyle generally when it comes to long commutes, would you recommend it or is it something that wears on you as time goes on? I suppose I wouldn't mind doing long commutes a week out of each month but 2 weeks or more would be my breaking point. Thank you for the input!

I'm burned out and switching jobs, 10 shifts left. That's the short answer to your question.

 

[okudasai]

I'm burned out and switching jobs, 10 shifts left. That's the short answer to your question.

Man, I am sorry to hear that, it sounds brutal. Don't think I'd fare much better. Well, I think that if the EM job market ends up with most jobs being rural, it might end up being a deal breaker for me. Thanks so much for your responses!

 

[RustedFox]

I was told that the rural shifts would be 12 hours long. Do you feel that the longer commutes essentially makes it so that you can't do much on shift days other than work and sleep? How is the lifestyle generally when it comes to long commutes, would you recommend it or is it something that wears on you as time goes on? I suppose I wouldn't mind doing long commutes a week out of each month but 2 weeks or more would be my breaking point. Thank you for the input!

Dear God, man.
Listen to yourself.

Pick a different field of medicine.

 

[okudasai]

Dear God, man.
Listen to yourself.

Pick a different field of medicine.

Honestly should have thought about the lifestyle more before making the post, but hearing everyone's responses has helped a great deal. Will hopefully be able to move on to the acceptance stage of grief soon.

 

[cyanide12345678]

Honestly should have thought about the lifestyle more before making the post, but hearing everyone's responses has helped a great deal. Will hopefully be able to move on to the acceptance stage of grief soon.

Why grief? You're not missing out on much. The biggest thing that was going for emergency medicine was that it was one of the best $$/hour after a 3 year residency and had an amazing job market 5 years ago where you could do whatever you wanted. This is no longer true of the specialty. The only other benefit is you don't take work home.

Everything else gets old pretty soon.... The nights, the weekends, the holidays, the drunks, the disrespectful, the demeaning and the demanding patients. The volume stressors, the replacement by MLPs, the increasing pressure of signing mlp charts for patients you haven't seen. There's no scheduled patients in emergency medicine, it sucks when they just keep on coming. Last shift i walked in 7 pm, between 7 and 9 pm 13 patients came in. There's no schedule, if they keep pouring in, you just keep chugging along and hating your shift. Wouldn't it be nice if you had a patient come in every 20 minutes instead of 5 come in 10 minutes at the same time? Oh and you'll love the 4 for 1 ER specials, if one kid has the sniffles, they all get checked. I wish these people had to pay their ER bill -_-

So what are you grieving? The fact that you are in a position to never be a part of a specialty that seems to increase your risk for htn, obesity, CAD and other health disorders due to circadian rhythm disruptions and shift work disorder?

I'm the one grieving because i can't turn back time and be where you are and go into urology or something 😂😂😂

 

[Tenk]

Hey I work at a critical access hospital that somehow has 21 ed beds and mid 20,000 annual visits. It used to be fine because anyone sick I could ship easily. But the aftermath of Covid has caused a nationwide bed shortage that I don’t see being solved anytime soon (in fact will probably get worse). Would probably recommend against limited resources at the moment. It’s getting quite unsafe. I’ve actually seen people die waiting for beds.

 

[e30ftw]

Apoligies for being vague; yes I was referring to SF/LA, etc. sorts of cities, also places like DC, Seattle, Portland. I am not sure that living in the suburbs would be a deal breaker per se, but I think I would want to stay in a metropolitan sort of area for at least a few years after graduating. I think being forced to live in a rural would be a deal breaker for me, however.

Thank you for your response! I am concerned that the oversupply would make the job market (in bigger cities especially) more competitive, and that you would have the possibility of being forced to move to where the jobs end up being. My main concern with EM would be that I would be limited by location more so than I would be in a different speciality, such as IM which I am also considering.

If your criteria is to live in a US coastal city with a >1m metropolitan statistical area population to include the Atlantic and Gulf Coasts, and you are an appropriately competitive applicant who ranks his/her match list based on geographical proximity to desired practice location, I think it's very reasonable to expect to be able to find an ABEM job somewhere in the country that meets your criteria upon graduating, assuming no issues during residency. Again probably the most import factor is matching into a residency near your desired practice location. If you are a poor applicant or underperform in residency, all bets are off..

The way your question is structured kind of makes me think IM +/- subspecialties may be a better fit..

Tenks above post is very accurate as well and one reason why I would not jump into a rural/critical access job. The sweet spot in EM is all-ABEM group, 1099/SDG (or fair compensation otherwise), 100-130hrs/mo, 8/9/10 hr shifts (12s will ruin you), and mid volume (40-60k) community (no residents, sorry academic guys, can't deal..) in a system where you have backup (OB, gen surg, etc) and can easily transfer trauma/nsgy type stuff. When you go too rural you are at the mercy of other hospitals when it comes to getting your patient definitive care so will inevitably get involved in some sort of OB disaster or neurosx/trauma decompensating patient. This happens everywhere just much more likely at a critical access hospital and tends to be a medico-legal-ethical disaster..

To be clear though I am very happy in EM and would choose the same specialty again.

 

[okudasai]

If your criteria is to live in a US coastal city with a >1m metropolitan statistical area population to include the Atlantic and Gulf Coasts, and you are an appropriately competitive applicant who ranks his/her match list based on geographical proximity to desired practice location, I think it's very reasonable to expect to be able to find an ABEM job somewhere in the country that meets your criteria upon graduating, assuming no issues during residency. Again probably the most import factor is matching into a residency near your desired practice location. If you are a poor applicant or underperform in residency, all bets are off..

The way your question is structured kind of makes me think IM +/- subspecialties may be a better fit..

Tenks above post is very accurate as well and one reason why I would not jump into a rural/critical access job. The sweet spot in EM is all-ABEM group, 1099/SDG (or fair compensation otherwise), 100-130hrs/mo, 8/9/10 hr shifts (12s will ruin you), and mid volume (40-60k) community (no residents, sorry academic guys, can't deal..) in a system where you have backup (OB, gen surg, etc) and can easily transfer trauma/nsgy type stuff. When you go too rural you are at the mercy of other hospitals when it comes to getting your patient definitive care so will inevitably get involved in some sort of OB disaster or neurosx/trauma decompensating patient. This happens everywhere just much more likely at a critical access hospital and tends to be a medico-legal-ethical disaster..

To be clear though I am very happy in EM and would choose the same specialty again.

I enjoyed EM immensely and think I would do well in residency, however, I am leaning towards IM slightly more as of now, since location is pretty important to me, and I feel that the flexiblity/stability it offers is something to think about before making my desicion. I have been sucessfully dissauded away from rural EM after thinking more carefully about the impact it would have on my life in general. Thank you for all the advice!

 

[cyanide12345678]

Hey I work at a critical access hospital that somehow has 21 ed beds and mid 20,000 annual visits. It used to be fine because anyone sick I could ship easily. But the aftermath of Covid has caused a nationwide bed shortage that I don’t see being solved anytime soon (in fact will probably get worse). Would probably recommend against limited resources at the moment. It’s getting quite unsafe. I’ve actually seen people die waiting for beds.

I feel your pain. Usually have to call 4-5 hospitals before finding a place with a bed these days, often times just end up on waiting lists with critical patients just sitting.

 

[Birdstrike]

Hello all, I am an M4 who is currently in the bargaining stage of grief regarding my desire to do EM. My story is the usual one; scribed as a pre-med, loved my third year EM rotations, am a very good personality fit, enjoy acuity and dealing with the undifferentiated patient, etc. I also enjoy doing interventions and seeing them have an effect fairly quickly and initial stabilization of the very sick. I am also interested in crit care, and I had some notion of doing EM and go into a fellowship based on how bad the job market looks by the time I am graduating.

My question regarding the EM job market is how possible is it to live in a coastal city and commute to rural or suburban EDs, assuming that is where most/all of the jobs will be in the next few years? Is there any hope regarding jobs in big cities for EM, especially within the next 3-5 years? The actual care in rural areas does appeal to me in that you get to do more stuff and have more autonomy, but I think that living in a rural area might not be for me. My hope was that I could continue to live in a metropolitan area and commute 1-2 hours and work 1 week out of the month. Do most ED docs who work in the suburbs or rural areas end up having to either live in the area or have a hotel 2 weeks out of the month? If the above sounds like a pipe dream, and if the end conclusion is that to do EM in the future means being okay with living in rural/midwest/suburban areas in order to have a job, I am not sure if I can stomach that for the sake of doing EM. Any and all advice is extremely appreciated!

Makes sense at 26. Will have you feeling trapped, hating your life and beggin' for momma by 36.

 

[sylvanthus]

Get him boys.

 

[Angry Birds]

I was told that the rural shifts would be 12 hours long. Do you feel that the longer commutes essentially makes it so that you can't do much on shift days other than work and sleep? How is the lifestyle generally when it comes to long commutes, would you recommend it or is it something that wears on you as time goes on? I suppose I wouldn't mind doing long commutes a week out of each month but 2 weeks or more would be my breaking point. Thank you for the input!

I do this. It's not bad.
Just stack your shifts and sleep in the call room. That's what I do.
I have a sweet schedule and am paid well. Yes, things are tightening up in the job market and it might be just that I've had this gig for a long time (before any COVID sort of crash).
But, for me, things are still rosey.
If I could go back in time, I'd probably not pick medicine due to how long/difficult/soul-sucking med school and residency are, but now that I've done it, I'm actually glad. I look around at my friends in other professions and thank my lucky stars. I make a crap ton of money for the few days a week I work. Very grateful.

Sorry, I know this is currently an unpopular view here.

 

[okudasai]

I do this. It's not bad.
Just stack your shifts and sleep in the call room. That's what I do.
I have a sweet schedule and am paid well. Yes, things are tightening up in the job market and it might be just that I've had this gig for a long time (before any COVID sort of crash).
But, for me, things are still rosey.
If I could go back in time, I'd probably not pick medicine due to how long/difficult/soul-sucking med school and residency are, but now that I've done it, I'm actually glad. I look around at my friends in other professions and thank my lucky stars. I make a crap ton of money for the few days a week I work. Very grateful.

Sorry, I know this is currently an unpopular view here.

What does your typical schedule look like? Do you essentially do all your shifts 1-2 weeks out of the month and than commute home? Or do you just take fewer shifts so you don't have to away from home for very long?

 

[Angry Birds]

What does your typical schedule look like? Do you essentially do all your shifts 1-2 weeks out of the month and than commute home? Or do you just take fewer shifts so you don't have to away from home for very long?

I'll message you but you have the gist of it.