Working more shifts as an attending

[C8H11NO2]

I am a 4th year who was previously set on General Surgery but am now strongly considering making the switch to EM. Currently doing my EM rotation and loving it. Plus the hours aren't too bad. One question though... as a new attending out of residency, is it relatively easy to negotiate working more shifts (beyond the 40-some hours/week)? Or are groups more controlling of your hours? I could see myself working maybe 55 hours/week for 2-3 years to help with my massive debt. Thanks!

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[Arcan57]

I am a 4th year who was previously set on General Surgery but am now strongly considering making the switch to EM. Currently doing my EM rotation and loving it. Plus the hours aren't too bad. One question though... as a new attending out of residency, is it relatively easy to negotiate working more shifts (beyond the 40-some hours/week)? Or are groups more controlling of your hours? I could see myself working maybe 55 hours/week for 2-3 years to help with my massive debt. Thanks!

Depends on the group. 55 hrs per week is 5 11hr shifts which is 20/month. Probably doable in most groups. If the shop is lushly staffed, maybe not.

 

[EM4life]

I think it depends on the structure of the group which can vary vastly. Many groups will let you negotiate more hours. I can tell you though that I've never heard of an attending doing a 55 hour week. Conceivably you could do 4 12 hour shifts in 1 week - but I can't see doing more than that because as you will figure out in residency, EM is nonstop, often chaotic, often without any real food/bathroom break, and often staying late to tidy up and chart. If you continue working 55 hours per week - even for more than 1 week you will get burned out real fast and I don't think it can safely be done, just my 2 cents.

 

[FMtoEM]

You can also moonlight. Also not every EM job is non stop and chaotic.

 

[jbar]

Remember you are looking at a 30 year career. So looking backwards when you retire, working 55 hours a week for 2 years isn't going to make that big an impact in your lifetime earnings. Are you going to care when you are 65 that it took an extra 2 years to pay off your debt? I think you run the risk of burning out working that much as an attending.

Also I'm not a financial planner, but it seems to me that it's much easier to cut $50,000 from your spending than it is to try to earn an extra $50,000. So you might want to plan more on living somewhere afforadable and driving an old car for a few years rather than planning to work yourself to death. Furthermore, you could find a place no one wants to work and go there for a few years. I would rather live in the middle of nowhere texas for 2 years and work 40 hours a week and catch up on my reading, making $300,000 a year rather than living somewhere I want and working more.

 

[The White Coat Investor]

I wouldn't recommend 20. You could probably swing 17-18 for a while though.

But your question isn't should you, it's could you, and yes you could, unless your group actually likes you and wants you to keep from burning out. You might need a second gig to get all those shifts in, but I'm sure you could get them if you really wanted them.

How much debt do you have that you need to make more than a half million?

$225 per hour x 12 hours per shift x 20 shifts per month x 12 months per year = $648K

Even if you're doing 8s you're talking $432K.

$225 per hour x 55 hours per week x 52 weeks per year = $644K

Even if you took 4 weeks vacation you'd still be grossing nearly $600K.

You really have that much debt?

According to a recent survey the average partner emergency physician makes $326K working 1620 hours per year (that works out to $201 per hour). 1620 hours = 135 per month. That's eleven 12s or seventeen 8s.

P.S. Most people go into EM because they want to work a little less (not more) and pursue some other interests on the side. You sure you fit in? If you want to work a bazillion hours general surgery will be happy to oblige.

 

[C8H11NO2]

Thanks for all your very thorough (like wow) and helpful input. When the numbers are actually crunched, I realize that my thought process is quite naive. But then again I'm still young, dumb, and full of... inexperience.

 

[da8s0859q]

I wouldn't recommend 20. You could probably swing 17-18 for a while though.

But your question isn't should you, it's could you, and yes you could, unless your group actually likes you and wants you to keep from burning out. You might need a second gig to get all those shifts in, but I'm sure you could get them if you really wanted them.

How much debt do you have that you need to make more than a half million?

$225 per hour x 12 hours per shift x 20 shifts per month x 12 months per year = $648K

Even if you're doing 8s you're talking $432K.

$225 per hour x 55 hours per week x 52 weeks per year = $644K

I realize that there's a lot of regional variance in salary, and I might be showing my inexperience as an M4 on this side of residency, but at what sorts of jobs in any given region are people likely to have higher hourly pay? Level 1 places, smaller community/rural places with lower volume that have a harder time attracting staff, ...?

Besides the academic practice difference, I mean.

But then again I'm still young, dumb, and full of... inexperience.

 

[docB]

Several guys in my group pull >200 hrs a month. I think that most groups out there will let you work more and primarily get testy when you want to work less. Couple that with moonlighting and I'd say the rule is that it's very possible to work almost as much as you want.

The question about can you vs. should you is valid. If you're looking to burn the candle at both ends for a few months to make some extra money though it's very possible.

 

[EctopicFetus]

I realize that there's a lot of regional variance in salary, and I might be showing my inexperience as an M4 on this side of residency, but at what sorts of jobs in any given region are people likely to have higher hourly pay? Level 1 places, smaller community/rural places with lower volume that have a harder time attracting staff, ...?

Besides the academic practice difference, I mean.

Depends. Its not as simple as you make it out to be. The higher pay has more to do with payer mix and who you work for. Do you work for the hospital, a managed care group, or for yourself.

The democratic (partners) make the most according to the surveys.

 

[jbar]

One thing I'd also throw out there for all the students. I'm a resident, and as a med student I remember thinking "wow, being in the ER is pretty laid back, this shifts aren't that bad." But most of the places I rotated as a med student we worked 8 or 9 hour shifts, seeing probably about .5-1 patient an hour. During the last year while a intern I was working 12 hour shifts, seeing about 1.2-1.5 patient an hour, and it's a whole other world. Attendings are probably seeing 2 or more patients an hour, depending on the mix of complexity (ie fast track or not).

All this is worth keeping in mind as a med student because it's dangerous to project what life as an attending will be like based on what you are doing during a med student shift. (this goes for all fields of medicine, you might like having derm patients, but can you see yourself handling 50 patients in a half day? Could you do 4 surgeries a day as an attending? etc)

So I think it's easy to say as a med student "man, these shifts are cake, I could do 25 of these a month," but it's a different story when you are carrying 12 patients at once.

 

[EM_Rebuilder]

You can almost always find 'more shifts' espically if you look around and credenital at more than just your primary hospital. You will literally have people blowing up your phone and your inbox.

I usually work 12-12s a month.. I took on some new EMS duties so I asked for my hours to be CUT to 10-12s a month starting in August. I usually have moonlit (meaning to work a shift at somewhere other than the primary job) anywhere from 0-4 shifts a month.

The two places I mainly moonlight at sent me there open shifts.. one has 7 the other 2. I could almost work every single one of them if I wanted to....

At the end of the day, make certain that there is time for family and such. If you really want to bank first out of residency, go somewhere that pays very well although it may not be your choice of living at all. That way you do well and still work a managable amount.

 

[anonymousEM]

Remember that not all jobs are created equal either. Single coverage, volume, your support within the hospital all play into your longevity in both a career hospital and moonlighting. Getting paid a little less and not being up to your eyeballs every shift might be worth it to some.

In my first job I didn't think about whether I'd supervise PAs, random off-service residents etc in our ER and I was put in a position of covering super-sick folks with a less than ideal physician coverage ratio and constantly felt unsupported and at a huge risk. That job wasn't worth it for what I was getting paid or even twice that. A few weeks ago I got an ad from a recruiter to moonlight at the same site for more than I was ever paid...and I would still not consider working there. When you look for moonlighting, learn plusses and minuses from the folks working there and not just the recruiter before committing. A few extra bucks isn't worth a lawsuit if you're under-supported. Some of the high paying jobs are because no one wants to go to timbuktu but there are others that people who understand are avoiding too.

 

[Doctor Bob]

I'm fresh out of residency and the job I'm going to at the start of August will have me working 12 8's a month (for the military).

Since I had a month gap, I figured I would I work as much as possible during July at the place I graduated from in order to pad my savings. The scheduler was happy to accommodate me and has me working 22 shifts this month (9-12 hours apiece depending on the shift).

After only a little over 3 weeks at this pace I'm getting pretty salty from time to time when some of the less tolerable patients come in. If it were longer than a month this would be pretty inadvisable.