"Undesirable/Rural Locations" Pay?

[StraightShooter]

So I've been doing some research on EM. I recently shadowed one and he was telling me how someone working in places like Texas, or somewhere down south(away from larger cities) made close to $185/hour. But if you chose to go work somewhere rural, like North Dakota, or some, his words, "undesirable locations" you could easily pull $250/hour.

I thought this doc was pulling numbers outta his **s, so I wanted to ask you guys, are his numbers right? If so, why don't more people go out and work in those locations, its compensated a hell of a lot more. Or why not just do a few years(2 or 3) out there?

Anyway, just looking to get some real numbers out there.

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[Old_Mil]

Most community EM jobs through CMGs seem to pay 100-150 an hour. No benefits. Level II and I hospitals seem to be around 175-225 depending on location and desire to attract ABEM guys. I can't name a single place I could go and make 250+ an hour.

(I basically draw a line that excludes anything north or east of Illinois-Kentucky and west of the sierras)

 

[GeneralVeers]

Most community EM jobs through CMGs seem to pay 100-150 an hour. No benefits. Level II and I hospitals seem to be around 175-225 depending on location and desire to attract ABEM guys. I can't name a single place I could go and make 250+ an hour.

(I basically draw a line that excludes anything north or east of Illinois-Kentucky and west of the sierras)

I'm starting at a "rural" job in May for $250/hour + travel expenses. It's actually a big tertiary care center. These jobs are out there if you spend the time looking for them.

 

[zinjanthropus]

I can name multiple places in the 210-225/hour range and many of those are in urban areas
Old_Mil numbers are a little low for Southeast - not much down here paying less than 125/hour
rural areas in Florida seem to be closer to high 100s/low 200s per hour on avg
most CMGs do offer benefits as well

 

[DreamingTheLive]

So I've been doing some research on EM. I recently shadowed one and he was telling me how someone working in places like Texas, or somewhere down south(away from larger cities) made close to $185/hour. But if you chose to go work somewhere rural, like North Dakota, or some, his words, "undesirable locations" you could easily pull $250/hour.

I thought this doc was pulling numbers outta his **s, so I wanted to ask you guys, are his numbers right? If so, why don't more people go out and work in those locations, its compensated a hell of a lot more. Or why not just do a few years(2 or 3) out there?

Anyway, just looking to get some real numbers out there.

So many reasons, each personal, but all tied in some way to location, location, location.

 

[fahimaz7]

At some of the smaller facilities, the EM docs also cover the ICU beds (at the same time). Seems interesting to say the least!

 

[SaveTheDaleks]

Non Med side

I'm in a rural and undesirable area. The ER is insanely busy with stupid issues, Meth and alcohol problems, or very nasty trauma from farm equipment or animals and MVA.

ER staff also covers ICU from 6pm to 8am then all day Sunday.

It's poorly ran in my experience, if it's bad enough to need ER but not ambulance, we drive the 45 minutes into the city who is easier to work with, as they are far better with pediatrics and long term problems. If we go to the local ER, they call for Life Flight to transfer to another hospital.

Now granted, it's not as busy as highly urban areas and we don't have a lot of "That Guy" and SOCMOB. However, we make up for that with insane stupidity.

 

[deleted109597]

Most community EM jobs through CMGs seem to pay 100-150 an hour. No benefits. Level II and I hospitals seem to be around 175-225 depending on location and desire to attract ABEM guys. I can't name a single place I could go and make 250+ an hour.

(I basically draw a line that excludes anything north or east of Illinois-Kentucky and west of the sierras)

Whereas I haven't seen an advertised job in my state for less than $175/hr, and have seen plenty over $250/hr.
Even our moonlighting residents earn more than $150/hr. Some people make some interesting sacrifices to work in certain areas.

 

[DreamingTheLive]

Whereas I haven't seen an advertised job in my state for less than $175/hr, and have seen plenty over $250/hr.
Even our moonlighting residents earn more than $150/hr. Some people make some interesting sacrifices to work in certain areas.

Exactly.

 

[RustedFox]

Whereas I haven't seen an advertised job in my state for less than $175/hr, and have seen plenty over $250/hr.
Even our moonlighting residents earn more than $150/hr. Some people make some interesting sacrifices to work in certain areas.

I looked "hard" for Jobs in Florida a little under a year ago. The average on the gulf coast (excluding the panhandle; all bets are off there) seems to be 175-200/hour.

 

[FSU2013]

I looked "hard" for Jobs in Florida a little under a year ago. The average on the gulf coast (excluding the panhandle; all bets are off there) seems to be 175-200/hour.

All bets are off in a good or bad way?

 

[JShephard]

Whereas I haven't seen an advertised job in my state for less than $175/hr, and have seen plenty over $250/hr.
Even our moonlighting residents earn more than $150/hr. Some people make some interesting sacrifices to work in certain areas.

What are the top 5 states for EM?

 

[RustedFox]

All bets are off in a good or bad way?

Both. I've looked there too (largely because I had zero idea of the geography in Florida and I had to look up each site/location as I came upon them). Jobs there in the panhandle went from laughably low (100/hr) to ZOMGWOW (255/hr). Now that I've been here in FL for 8 months, I've heard enough people speak negatively about the panhandle that I'd never consider a job there. Besides, my personal list of "needs" in a place to live/work included a NHL team and an international airport within 1.5 hours, and the panhandle has neither.

 

[FSU2013]

Both. I've looked there too (largely because I had zero idea of the geography in Florida and I had to look up each site/location as I came upon them). Jobs there in the panhandle went from laughably low (100/hr) to ZOMGWOW (255/hr). Now that I've been here in FL for 8 months, I've heard enough people speak negatively about the panhandle that I'd never consider a job there. Besides, my personal list of "needs" in a place to live/work included a NHL team and an international airport within 1.5 hours, and the panhandle has neither.

Gotchya.....I'm hoping to end up back in FL after residency +/- fellowship.

 

[deleted109597]

What are the top 5 states for EM?

Based on Barb Katz, for 2012-2013, it's this.

 

[DreamingTheLive]

Gotchya.....I'm hoping to end up back in FL after residency +/- fellowship.

'Nole team doc.

 

[FSU2013]

'Nole team doc.

That's the dream.

 

[JShephard]

If you want to live in a specific state, does it give you a big advantage to train there? (For connections and knowing the landscape better?)

 

[glorfindel]

If you want to live in a specific state, does it give you a big advantage to train there? (For connections and knowing the landscape better?)

In my experience it does. However...

I also am of the opinion that EM docs overstate the difficulty of finding jobs in certain places. The key to getting a job even in the difficult places is availability. Be there, let everyone know you're there and are willing to fill "holes in the schedule."

Everyone, everywhere, has holes in the schedule to fill.

 

[JShephard]

In my experience it does. However...

I also am of the opinion that EM docs overstate the difficulty of finding jobs in certain places. The key to getting a job even in the difficult places is availability. Be there, let everyone know you're there and are willing to fill "holes in the schedule."

Everyone, everywhere, has holes in the schedule to fill.

Thanks for the input.

I guess I'm asking more about finding a desirable or great position instead of just finding work.

 

[Hercules]

If you want to live in a specific state, does it give you a big advantage to train there? (For connections and knowing the landscape better?)

Yes. It's obviously not mandatory but it helps from a networking standpoint. Especially if you get involved in the local groups.

 

[glorfindel]

Thanks for the input.

I guess I'm asking more about finding a desirable or great position instead of just finding work.

Like most fields, the demand for "great" positions exceeds the supply. Landing the great positions in EM is like every other field, and being known by the docs in a particular region is certainly better than if all they see is a CV mailed from some s***hole in South Carolina or Texas.

(Sorry, my biases are showing through.)

Y'all are free to hate me now. Don't worry; I can handle it.

 

[sylvanthus]

I have heard of people doing a week of 24 hour shifts in some podunk town in the midwest where there is generally time to sleep. They apparently can make bank doing that. Thoughts?

 

[joeDO2]

I have heard of people doing a week of 24 hour shifts in some podunk town in the midwest where there is generally time to sleep. They apparently can make bank doing that. Thoughts?

met someone at a conference that did that. VERY low volume place. single doc....FM boarded. locums 24 shift...place provided a house next door to the ED for the docs rotating through. only had to go across the street for the initial eval and later if the nurses requested it. otherwise the nurses and ancillary staff pretty much handled the treatment. pay was something ridiculous...7k/shift I think.

 

[DreamingTheLive]

Thanks for the input.

I guess I'm asking more about finding a desirable or great position instead of just finding work.

One man's garbage is another man's gold (or some **** like that). Your dream job could be viewed as something vastly different by others. Its really the same with residencies my friend. Beauty is in the eye of the beholder.

That being said, I do think that due to local connections, possible alumni, etc. that "in general" doing residency where you believe you may want to someday work is beneficial.

 

[RustedFox]

One man's garbage is another man's gold (or some **** like that). Your dream job could be viewed as something vastly different by others. Its really the same with residencies my friend. Beauty is in the eye of the beholder.

This. I think that my present job (minus the administrative climate, but that's everywhere) is my "dream job". My guess is that 80% of "newly graduating docs" would find this place boring as hell and hate "x, y, or z" about it.

 

[AlmostJesus]

A Level II Center in South Dakota is offering ~$200/hr in a city of 150,000
A Level III Center will bring you in $185/hr in a job where you can sleep in house.
The kicker... no state level income tax
If you do locum at the IHS hospitals, you can bring in bank for working a weekend, the downside is the working conditions, if they don't have someone to take your admit, you end up flying out simple medical admissions.

 

[StraightShooter]

Non Med side

I'm in a rural and undesirable area. The ER is insanely busy with stupid issues, Meth and alcohol problems, or very nasty trauma from farm equipment or animals and MVA.

ER staff also covers ICU from 6pm to 8am then all day Sunday.

It's poorly ran in my experience, if it's bad enough to need ER but not ambulance, we drive the 45 minutes into the city who is easier to work with, as they are far better with pediatrics and long term problems. If we go to the local ER, they call for Life Flight to transfer to another hospital.

Now granted, it's not as busy as highly urban areas and we don't have a lot of "That Guy" and SOCMOB. However, we make up for that with insane stupidity.

****. All I can say. How do you handle that kind of work? Do you think the money was worth it?

met someone at a conference that did that. VERY low volume place. single doc....FM boarded. locums 24 shift...place provided a house next door to the ED for the docs rotating through. only had to go across the street for the initial eval and later if the nurses requested it. otherwise the nurses and ancillary staff pretty much handled the treatment. pay was something ridiculous...7k/shift I think.

How do they even manage a 24 hour shift?

 

[deleted109597]

Like most fields, the demand for "great" positions exceeds the supply. Landing the great positions in EM is like every other field, and being known by the docs in a particular region is certainly better than if all they see is a CV mailed from some s***hole in South Carolina or Texas.

(Sorry, my biases are showing through.)

Y'all are free to hate me now. Don't worry; I can handle it.

Correct. However, if the market is saturated, you might move to an area and only get 5 shifts a month. If you can live on that while you're waiting to get "in" the group, and then waiting to make partner, it's workable.
If not, then it's not feasible to live somewhere and demand to have a job. You can't Occupy Salt Lake.
And your biases are ignorant at best, racist at worst. Take what you want from it.

How do they even manage a 24 hour shift?

At the low volume places it's probably easier than call. If you can convince yourself that being called by the nurses is acceptable.

 

[DB2013EM]

Highest I have seen was 280/hr in a fairly undesirable city. A friend rotated through there and understood why they were paid so much, apparently the docs were crazy stressed and unhappy.