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SeekerOfTheTree

SeekerOfTheTree

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Random question. I've been doing locums for the past year and it has been pretty good. Thinking about moving down to Texas with the fam for the next year and giving it a shot. Make some good money without sleeping in a hotel. When you do locums you realize some of the places you work (Missouri, Illinois) have horrible malpractice laws. So Texas is pretty tempting to sleep better at night. Any thoughts on towns that would be nice and not too mean to a brown man and his family? Missouri (minus St. Louis) can be pretty dicey on the racism. Any good jobs?
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Houston is a very diverse city, and my group is hiring. If you're interested, send me a PM. Austin and Dallas are likewise, but the pay and cost of living is better in Houston.


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Twice I've had to use this today.
Hate by State
Texas is not more racist than many states. Part of that is because it's significantly (ie, nearly half) brown/black. It only looks snowy white because the census lumps hispanics in with whites.
The far eastern border is probably the most "southlike" of the state. While there are likely pockets of racism in some areas, it's the one that makes state and national news.
If you're black, you'll have a higher percentage of black people in the major cities, if that's something you're looking for.
 
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Some parts of Texas are pretty damn racist. I somehow ended up in the wrong part of Houston a few years ago and felt like I was lucky to escape from there with my life. It felt good to be back in Missouri (well, outside of St Louis), let me tell you.
 
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Brahnold Bloodaxe said:
Some parts of Texas are pretty damn racist. I somehow ended up in a heavily Hispanic part of Houston a few years ago and felt like I was lucky to escape from there with my life.
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You can always find dark places everywhere, its not just Texas
 
Brahnold Bloodaxe said:
Some parts of Texas are pretty damn racist. I somehow ended up in the wrong part of Houston a few years ago and felt like I was lucky to escape from there with my life. It felt good to be back in Missouri (well, outside of St Louis), let me tell you.
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I've lived/worked in some of the roughest areas of Houston. They don't bother me at all. Now when I worked in Memphis....that bothered me.


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Makati2008 said:
I've lived/worked in some of the roughest areas of Houston. They don't bother me at all. Now when I worked in Memphis....that bothered me.
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giphy.gif

It's completely valid. I had a guy try to bum money off me literally 2 minutes after I stopped for gas in Memphis once. The only place worse? West Memphis.
Although I once had a cop in Birmingham tell me that I shouldn't be getting gas in the area of town we were in. He proceeded to get back into his car while it pumped. Wasn't sure how to proceed, since I was across the street from my extended stay.
LA, Chicago, Newark, Philadelphia? Those have areas that scare me. Houston? Maybe in the Third Ward. But that's where Frenchy's and Cream Burger are.
 
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Race relations are funny.

Newark. Dear god, man. Newark.

I was "corrected" in LA by my good buddy (father of my goddaughter) for being my hypersocial/ebullient self with the local Chinese population. (I'm a loud, small white guy).
Long story made short: GoodBuddy is Chinese, and we're all in a Chinese shopping area doing simple stuff (buying cheap stuff, drinking bubble tea, etc). I was otherwise engaging strangers in conversation as we all hung out and waited for (whatever) to happen. He looks at me and says: "Dude, you freak out yellow people when you do stuff like that; just going up and talking to them and playing with their kids and stuff." I'm just being me. No harm intended; but I learned that its otherwise gauche to chat up people that you don't know, etc in the local Chinatown.

Baseball fans will enjoy this one. Another goodbuddy of mine (OldWhiteGuy) is the ultrasound chief at one of my local hospitals. He was very familiar with the Pittsburgh Pirates of the 1970s (the "We-are-Family" crew) because they all had houses locally and spent spring training/etc. here in the area. Willie "Pops" Stargell was an outstanding diabetic vasculopath who was frequently an inpatient at our shop. As OldWhiteGuy once put it: "I knew Pops Stargell well... breakfast was fried chicken and mashed potatoes. Lunch was cigarettes." Pops was also one of the nicest guys on the planet; would sit and talk with anyone for hours about (whatever). One day, goodbuddy walks up to the floor to visit Pops. He just about hits the doorway to Pops' room when he gets distracted for a second, and turns around to say hi to the gal at the RN desk or whatever. He turns back to walk into pops room, and BOOM, standing silently there in the doorway (not there before) was an absolute giant of a man. OldBuddy is startled by the sudden appearance of the tall African-American right fielder and lets out a yip. From behind the mammoth of a man, he hears another voice yell: "Dave! You can't just stand in the doorway... you scare white people when you do things like that!" The guy in the doorway was of course, Dave (The Cobra) Parker, and the wiseguy behind him mouthing off was Kent Tekulve.
 
Speaking of Texas...it seems to be physician 'Mecca' in that it has the highest salaries, lowest taxes, and best legal environment. It is early days but I think it is the state I would like to practice in.

For those who live and work there and are familiar with the trends: do you foresee the state turning democrat in the next 10 years? Demographically speaking, I think it's down to only 40% non-hispanic white and that's the only group that votes Republican. Trump won the place with only 51% of the vote which is scary. Texas flipping blue has dire repercussions both on the state level and national level, for obvious reason$.
 
I will be a new EM grad in June 2018 and obtained my full Texas medical license last month- heard that was the hard part and finding a job was the easy part. Doesn’t seem to be the case... I’m moving to Houston with no ties to the area. Emailed Emcare a few months ago and they only had two sites hiring and said to email them back later in the year- it’s now December and I’m again essentially told to contact them in a few months. Getting late in the job hunt and just emailed recruiters from TeamHealth as random googling showed they are also heavy in Houston region. USACS emailed me randomly today and after a quick search doesn’t look like that have any Houston sites.

Yes I understand everyone hates CMGs, but I need a job. Talked to faculty in my program and most have friends in other cities in Texas, but not Houston.

Would love to get some advice from all the experienced EM docs here.

tldr: graduating June 2018. Just got My full Texas medical license. Moving to Houston, Texas with no ties to region. Any sites hiring? :) Thanks.
 
Gither said:
I will be a new EM grad in June 2018 and obtained my full Texas medical license last month- heard that was the hard part and finding a job was the easy part. Doesn’t seem to be the case... I’m moving to Houston with no ties to the area. Emailed Emcare a few months ago and they only had two sites hiring and said to email them back later in the year- it’s now December and I’m again essentially told to contact them in a few months. Getting late in the job hunt and just emailed recruiters from TeamHealth as random googling showed they are also heavy in Houston region. USACS emailed me randomly today and after a quick search doesn’t look like that have any Houston sites.

Yes I understand everyone hates CMGs, but I need a job. Talked to faculty in my program and most have friends in other cities in Texas, but not Houston.

Would love to get some advice from all the experienced EM docs here.

tldr: graduating June 2018. Just got My full Texas medical license. Moving to Houston, Texas with no ties to region. Any sites hiring? :) Thanks.
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Yeah the market in Houston has changed...my group is not hiring anymore. After Harvey, 1-2 HCA hospitals got shut down, so those docs got funneled out to other HCA hospitals. I would try St Joseph’s in downtown Houston, which is staffed by Schumacher. They have had a hard time in the past retaining people. If they’re not hiring, then that’s a good indication IMO that the Houston market is now very tight.

That being said, if you went an hour outside the city you’d have no trouble finding a job.


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bravotwozero said:
Yeah the market in Houston has changed...my group is not hiring anymore. After Harvey, 1-2 HCA hospitals got shut down, so those docs got funneled out to other HCA hospitals. I would try St Joseph’s in downtown Houston, which is staffed by Schumacher. They have had a hard time in the past retaining people. If they’re not hiring, then that’s a good indication IMO that the Houston market is now very tight.

That being said, if you went an hour outside the city you’d have no trouble finding a job.


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Click to expand...

Thanks for the heads up, really appreciate it- Just left a message for the recruiter at Schumacher. Almost seems like a red flag for a first attending job if they have a hard time keeping docs.

Regards to going an hour outside the city, I’m definitely not opposed to it. You recommend just finding a hospital on google maps and cold calling the director or going through a recruiter with one of the big CMGs in the Houston region?
 
Cold calling is always the way to go. That’s how I landed my first job.


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Houston just got much, much tighter. Between Harvey hospital closures, and First Choice closing 8 sites, there's a lot more docs than needed.
If you're willing to go to Dallas, Ft Worth, San Antonio, or even the outskirts of Houston, you will fare better.
Or go to the Valley. You'll make a killing.
 
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The Dallas and Fort Worth markets seem to be tighter as well. I spoke w/ EM Consultants a month back and they essentially had only a single position available, and it was fire fighter position that did not sound like the best gig. QuestCare I believe had 1-2 positions open, as well. San Antonio is indeed, wide open though. Every group in town seems to be hiring: USACS, VEA, GSEP, EMCare.
 
Dallas/Houston are super saturated. DFW has spots if youre willing to drive 30min outside of city limits. There are tons of people looking for work in Houston.
 
The ED volume in one of the big hospital systems in Houston had been growing by 7-15% year over year since at least 2011. Shops that used to be 4 docs and an APP are now 6 docs and 4 APPs. The rate of expansion seems to have died off in 2017. A lot of places hired for 2017 expecting that growth and are now dealing with being slightly to heavily overstaffed. It's also created a market where a lot of docs are less than 5 yrs out from residency. The evolution from "I want 12 shifts a month and to travel outside the country every 2 months) with "I got married and just had a kid, pre-K is how much$!#?" is increasing the desired shifts/month (effect usually is negated by older attendings slowing down but the FSEDs siphoned off most of them) leading more than one staffing group to realize they've actually overhired and aren't getting their docs the hours they expected. I wouldn't be surprised to see the pay in Houston start to fall as Team and Envision realize they don't have to pay 15% above market rate to attract docs. Houston has a great Medicare and private payor environment so I don't see our income cratering but I wouldn't be surprised if collectively we averaged an income $25-50k less than last year.
 
Its very interesting how things have changed in a few years and I never thought I would see the day when the Texas market gets saturated.

Supply and demand always equalizes but its much sooner than I would have expected.
 
emergentmd said:
Its very interesting how things have changed in a few years and I never thought I would see the day when the Texas market gets saturated.

Supply and demand always equalizes but its much sooner than I would have expected.
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The playing field was so unlevel that you had to have a compelling reason not to be here.
 
There is more than one "Texas" out there folks. Just look around and you'll find them.

Low cost of living, low/zero state taxes, good liability protections, and good pay. If, like most who go to Texas, you're willing to not have great weather or the best in cultural amenities, there are many nice places to practice.

The people who have it tough are those who want to be in really outdoorsy places. Always competitive and often without those four things noted above that people going to Texas are trying to get.
 
As a new texan, I will say our summers are brutal, but our winters are beautiful - We had sweltering hot humid 108 degrees in the summer in Houston, but it's low humidity 50s-60s bay area kind of weather here right now, and I can't wait to get on my bike.
 
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As a long time Texan, I would not go anywhere else. Its hot in the summer but I still get out in my shorts, jump into my garaged car, and drive wherever I want to another air conditioned building. I jump in the pool when its hot.

In the winter (like today), I still leave in my shorts and light Jacket. Its 60's and can do anything outside.

I doubt there are many states with as much cultural experience, outdoor experience, sports experience, Music experience, Tech experience as Texas.
 
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emergentmd said:
As a long time Texan, I would not go anywhere else. Its hot in the summer but I still get out in my shorts, jump into my garaged car, and drive wherever I want to another air conditioned building. I jump in the pool when its hot.

In the winter (like today), I still leave in my shorts and light Jacket. Its 60's and can do anything outside.

I doubt there are many states with as much cultural experience, outdoor experience, sports experience, Music experience, Tech experience as Texas.
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I'm not sure you travel much. I'm not sure which of those to begin with. Let's start with outdoors stuff, since that's what I know best.

Texas is the second biggest state in the country. The largest has 8 national parks. Texas? 2. And that's counting Guadalupe Mountains. Denali....Kenai Fjords....or Big Bend and Guadalupe... tough choice.

Utah has 5. There are state parks in Utah that are cooler than the national parks in Texas.

Most of Texas is private land. Can't hike on it, camp on it, bike on it, hunt on it etc without permission. More than 95%. Alaska? 96% public. Utah 75% public. Oregon, 60% public. I could keep going.

Number of ski resorts in Texas. Well, I guess if you count the Bearfire in Dallas. Which isn't built yet. And is indoor. Then you get one.
Number of ski resorts in Utah: I count 14 off the top of my head. "But Utah is a lot further North." Okay. Arizona has two. New Mexico has nine.

Texas rock climbing routes per Mountain Project: 2,323
Utah Texas rock climbing routes per Mountain Project: 11,509 (Remember this state is like 1/4 the size of Texas

Ice climbing routes in Texas: None

Number of peaks over 9,000 feet in Texas: Zero (and all the 8000 footers are practically in New Mexico)
Number of peaks over 13,100 feet in Colorado: 55

Number of surfers who live on the West Coast who go to Galveston to surf: Zero
Number of surfers who live in Galveston who go to the West Coast to surf: >>> zero

Number of miles of mountain bike trails in Texas per MTB Project: 1529
Number of miles of mountain bike trails in Utah per MTB Project: 3065

Number of acre-feet of water in all Texas lakes and reservoirs: 13 Million
Number of acre-feet of water in a single lake in Utah: 15 Million. It's second biggest lake also has 15 Million.

Number of species of mosquitos in Texas: 85
Average humidity in Houston: 75%
Average humidity in Utah: 55% (and less in summer)

I look at all that and I wonder what you do when you go outdoors in Texas besides sweat and swat mosquitoes.

I'm sure someone from NYC could compile a similar list for culture and someone from the Bay Area could compile a similar list for tech.

I do hear Austin has a pretty cool music scene though and I hear the sports scene is very good. But an outdoor paradise it is not.
 
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What WCI is trying to say is that if you like the Rocky Mountains, ice climbing, or the great salt lake, Utah would be preferable to Texas.
 
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LOL WCI just put Texas in its place...


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Someone compare Texas to California or Washington now.
 
How hard would it be for a Texan doing an OOS residency to come back into Texas for practice?
 
While WCI is mostly correct regarding Texas outdoors, I have to defend Big Bend and Guadalupe Mountains National Parks, as both are amazing spots. Yes, we only have two national parks, but they are awesome and unique. I feel they hold their own among the other NPs. But don't visit Big Bend in summer, haha.
 
Cinclus said:
While WCI is mostly correct regarding Texas outdoors, I have to defend Big Bend and Guadalupe Mountains National Parks, as both are amazing spots. Yes, we only have two national parks, but they are awesome and unique. I feel they hold their own among the other NPs. But don't visit Big Bend Texas in summer, haha.
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Fixed that for you.
 
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It's not difficult, just expensive, and a lengthy process to get a TX license. You have to take this jurisprudence exam, which is easy and a waste of time and money. It takes a good 4-6 months to get licensed. It will also run you about 2 grand.
 
GandalfTheWhite said:
Its that easy? I heard lots of people complaining about how difficult it was to get licensed in TX but I wasnt sure as to why.
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Just got my license beginning of November. Started application process mid August, but did not really start turning things in until mid September as I had no time to go to fed ex every few days to mail random things. Finger prints took the longest if you’re not from Texas. Jurisprudence exam required the most effort.
 
Have a TX license. Took me upwards of six months from application acknowledgement to issuance (within last year).
 
goodoldalky said:
What WCI is trying to say is that if you like the Rocky Mountains, ice climbing, or the great salt lake, Utah would be preferable to Texas.
Click to expand...

To be fair, nobody actually likes the Great Salt Lake (which is NOT the biggest lake in Utah by the way.) Here's a review from Trip Advisor:

Either you have a great time, or you have a good story...
The story......Having read all the reviews here on trip advisor, I still wanted to see the Great Salt Lake. This was my second time to Salt Lake City and I didn't want to miss it again.
The experience went as follows: First we pulled into the free parking lot at the Saltair which houses bathrooms and a tiny gift shop. The Saltair was very disappointing and rundown.
The Salt Lake itself was so low that it resembled an extreme low tide at the beach and as a result it was quite a walk (see pics) to even reach the water. Luckily we had a nice breeze when we headed out.
By the time we had almost reached the water the breeze had started to die down. It was at that point that we got a whiff of the "Great Smell". Considering all the dead bird carcasses we passed on the way out, we should not have been surprised. Still, I was determined to stick my fingers in the water so we continued onward.
Next the bugs came into play since there was no breeze to keep them at bay. At this point my family began to make a retreat, but we were so close to the water that I kept going. By the time I reached the water the swarm of bugs was so thick it was like the ground was moving with each of my steps. I quickly stuck my finger in the water and then ran back to the parking lot with the bugs in pursuit. Although we got into the car as fast as possible, we couldn't keep the bugs from getting in with us. Once we got on the highway we had to roll all the windows down to try to get them back out.
The Great Salt Lake should be a unique attraction, instead its like a trip to the dump on a hot summer day.

Here's another:

Fun, if you like swimming in an outhouse
The Great Salt Lake is a wasteland. I suppose there is some value in being able to say you tried it - but not enough value to outweigh the absolute disgustingness of the place.

Of course that means ONE of us loved it.

The ten year old thought floating in the lake was "amazing," which I guess is true, if your idea of amazing is swimming in lukewarm brine with billions of gnats and trillions of sea monkeys. The rest of us thought it was like taking a dip in a hot outhouse hole.

First of all, the bathroom/shower facility is about 200 yards from shore - it's a hike with little kids, and it's not worth it.

The black clouds moving over the lake were visible from 600 yards out. They were swarms of gnats - and they were everywhere.

The seven year-old reluctantly followed me in, high footing the entire time. I didn't have the heart to tell her that her Russian goose-stepping wasn't going to protect her from the infinite number of brine shrimp carousing in the water. The lake was actually orange from all of the shrimp, and the whole place smelled like semi-decayed cat food. I did manage to get her in deep enough for both of us to float, but that was about it. When we returned to shore to pick up our bag and shoes, it was a scene of Amityville proportions. We couldn't see our shoes, or the bag - they were black, absolutely covered in gnats. I had to grab each item and do the Olympic hammer throw just to get the bugs off - and then we had to pick them up quickly, before they settled down again. I have not seen anything so vile in a long time.

It was on the bucket list - and now it's off. I would advise others to never put it there in the first place.

Seriously, makes the great outdoors of Texas seem appealing.
 
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There is plenty to do in Texas. Yes, it's not Colorado, Utah, or NM. It's certainly not Alaska.
But the overwhelming majority of states don't have peaks above 8000. They're in the Rockies alone. Texas is 14th by highest peaks. Yes, nearly all of Colorado is higher, but Texas has a higher mountain than 2/3rds of the nation.
Also, "mountains" aren't the only things outdoors. You like watersports? Lots of lakes. Plenty of hunting and fishing to be had here. We have the only F1 course in the US. Houston has one of the best food scenes in the US, if not the world at this point. Yes, that's an opinion, but it's one based on actual food writers.
I mean, if you want to talk about California, then beyond the fires, mudslides, and earthquakes, there's the fact that the water there is brutally cold year round. Yes, surfing the gulf is difficult, but at least I don't have to wear a dry suit to do it.
I mean, to each there own, but it's not like Texas is a miserable place where you have to wear camouflage, vote Republican, and carry a gun everywhere.
 
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