Anybody that's been out in the community for awhile miss working with residents?

[Groove]

I'm not sure if it's a case of "grass is greener" on the other side of the fence, but I find myself really missing working with residents and doing some teaching. Not enough that I would want an academic track with research obligations etc, but I definitely would be interested in an academic clinical track. The problem is that I don't know if I would hate it after a few months or not. I haven't worked in academics or a tertiary care center for over 6 years. Sometimes, I miss all the excitement and teaching. The problem is that I've got a pretty good community gig in a location close to family and friends but not necessarily where I want to spend the rest of my life. The pay is nice, colleagues are great, nursing...meh, it's ok (few rockstars mixed in with lazy) but all in all, I really have it pretty good. I like the stability of the group, the contract, and enjoy the years I've spent earning respect from our various specialists. We're all mostly on first name basis and they know when I call them that it's 100% legit. Plus, the job is literally 7 mins from my house.

Every few months though I'll search around in the region for academic jobs or "quasi" academic jobs (EDs where residents rotate through, etc..) and wonder what life is like on the other side. In the past, every time I've searched for a job in academics, the pay just sucks. I mean, so bad that it's not even an option anymore. I'm wondering if jobs in a CMG that has a residency might have higher pay. My current CMG has a resident contract I believe in another part of the state that I've thought about but then I get lazy thinking about new moves and new jobs, etc.. that it doesn't seem worth it anymore. We have a trauma center downtown that offered to privilege me for PRN and let me do a few shifts a month (EM residents rotate through the ED) and I may do this...but haven't decided yet.

I don't know if I'm just getting restless with my career complacency or if it's something else.

Anybody that works in academics want to give me some pros and cons or wish they worked in the community? Anybody that used to work in academics that has left and glad they did?

Up until now, I've always thought I'd sock away enough money to jumpstart my retirement and when I could consider less money then I might find a job with academics for the second half of my career but I'm not there yet.

Ironically, I just got a call from my old dept chief offering me a CMIO position in the hospital where I did residency which would have completely gotten me out of medicine entirely. 9-5, no weekends, no nights, pretty much all suit work that pulled on skills I had accumulated in my previous career but I turned it down. I didn't want to give up EM and the thought of wearing a suit all day long and not working at all in the ED except for maybe 1-2 shifts a month just didn't sound fun to me. I admit that in another 10 years I may regret that decision.

Maybe I'm just having a mid-life crisis. Thanks for letting me vent. Carry on.

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[Groove]

You would think that for people that all make 400K+/yr, we wouldn't all be so restless and unhappy with our careers, lol.

 

[southerndoc]

I'm core faculty and I make >400k/yr. All of our core faculty do. In general, core faculty CMG's will make more than core faculty at big academic facilities. We're paid a monthly stipend for reduced work hours and then get RVU-based pay with an hourly minimum.

Working with residents is fun, but it can be challenging sometimes especially with off-service rotators. Trying to explain to the OB intern why the 95 year old with chest pain/dyspnea can't just be labeled as GERD or anxiety gets old sometimes.

 

[Groove]

I'm core faculty and I make >400k/yr. All of our core faculty do. In general, core faculty CMG's will make more than core faculty at big academic facilities. We're paid a monthly stipend for reduced work hours and then get RVU-based pay with an hourly minimum.

Working with residents is fun, but it can be challenging sometimes especially with off-service rotators. Trying to explain to the OB intern why the 95 year old with chest pain/dyspnea can't just be labeled as GERD or anxiety gets old sometimes.

If you're RVU based during your clinical hours, doesn't teaching the resident slow you down and decrease your productivity?

 

[Birdstrike]

I recently started teaching residents after years of not doing any. They're off service transitional residents, so they're very green, but it's been enjoyable. I get paid for doing it, but it's not a huge amount of money. Teaching does slow you down, so I don't think it's a net monetary gain, but more likely a break even proposition. It's the kind of thing worth doing if you enjoy it, but not likely worth doing if you don't enjoy it.

I personally have enjoyed it and the interns seemed to have gotten a lot out of it. There is something about teaching people that early in their careers, people so devoid of the crispy, grizzled, bark-layer of burnout you gain after a while, that makes one a little more hopeful. Plus, the amount you can teach these people, if you really make an effort, is massive. By teaching, it also makes you realize the mountain of knowledge you've gained over the years and it's kind of nice to pass some of forward.

Haven't any EM residents come through yet, nor had any requests.

 

[Tenk]

I only work part time at a residency program although far less now that my bff is graduating in a month. RIP.

Working with most EM pgy-2 and above is like turning on god mode in Doom with unlimited ammo for the BFG. It’s so easy it’s ridiculous.

EM interns can be kinda hit or miss but generally ok.

Working with most off service residents is like playing Doom blindfolded without hands. You just end up smashing your face on the keyboard over and over again until you get to go home.

 

[southerndoc]

If you're RVU based during your clinical hours, doesn't teaching the resident slow you down and decrease your productivity?

Somewhat, yes. At the beginning of the year, you're slowed down. End of PGY-1 (and I supposed 2's and 3's) and you actually are more productive even with teaching. We still see patients on our own, too. Right now I probably see 25 per shift and the PGY-1 sees anywhere from 14-18 per shift depending on their level of comfort and how sick the patient is. The off-service rotators probably see 6-12 per shift.

Because of our extremely high acuity, we are staffed to only see about 1.9-2 PPH anyhow.

 

[Apollyon]

I recently started teaching residents after years of not doing any. They're off service transitional residents, so they're very green, but it's been enjoyable. I get paid for doing it, but it's not a huge amount of money. Teaching does slow you down, so I don't think it's a net monetary gain, but more likely a break even proposition. It's the kind of thing worth doing if you enjoy it, but not likely worth doing if you don't enjoy it.

I personally have enjoyed it and the interns seemed to have gotten a lot out of it. There is something about teaching people that early in their careers, people so devoid of the crispy, grizzled, bark-layer of burnout you gain after a while, that makes one a little more hopeful. Plus, the amount you can teach these people, if you really make an effort, is massive. By teaching, it also makes you realize the mountain of knowledge you've gained over the years and it's kind of nice to pass some of forward.

Haven't any EM residents come through yet, nor had any requests.

As pain, or EM?

 

[Birdstrike]

As pain, or EM?

Pain

 

[deleted547339]

I'm core faculty and I make >400k/yr. All of our core faculty do. In general, core faculty CMG's will make more than core faculty at big academic facilities. We're paid a monthly stipend for reduced work hours and then get RVU-based pay with an hourly minimum.

Working with residents is fun, but it can be challenging sometimes especially with off-service rotators. Trying to explain to the OB intern why the 95 year old with chest pain/dyspnea can't just be labeled as GERD or anxiety gets old sometimes.

Dang. When I get fed up with my current position I’m going to give you a call!

 

[GatorCHOMPions]

Just how crappy is the academic pay around you, OP? I’m at an academic site and, while not pulling 400k, think am doing fairly well at around $220/hour for 120 hours per month. How much are you expecting to make in academics?

Agree with the above about level of training impacting productivity and teaching moments. Overall I value the residents as a buffer to burnout for multiple reasons and so think it is worth the pay cut depending on regional circumstances. I don’t have very many academic/research obligations either.

It sounds like you have a pretty good job, though. I’m not sure I’d be in academics if I had a community job like you describe. I kind of defaulted into my job since I’m relatively restricted by location and it paid around the same as the community jobs in my area (mostly crappy CMG types).

 

[gamerEMdoc]

Our core faculty make about 350 at 12 nines a month. Not high end pay, but certainly not bottom barrel either. I'd personally rather make 350 than make north of 400k without residents. Working with residents completely rejuvenated my career and passion for medicine 7 years ago, there's no way I'd ever go back.

 

[deleted547339]

Just how crappy is the academic pay around you, OP? I’m at an academic site and, while not pulling 400k, think am doing fairly well at around $220/hour for 120 hours per month. How much are you expecting to make in academics?

Agree with the above about level of training impacting productivity and teaching moments. Overall I value the residents as a buffer to burnout for multiple reasons and so think it is worth the pay cut depending on regional circumstances. I don’t have very many academic/research obligations either.

It sounds like you have a pretty good job, though. I’m not sure I’d be in academics if I had a community job like you describe. I kind of defaulted into my job since I’m relatively restricted by location and it paid around the same as the community jobs in my area (mostly crappy CMG types).

Yea, I think people would laugh at my pay if they looked at what our “hourly rate” is. I think the number is something between 150 and 170. And I know a lot of academics overweight benefits, but when you actually calculate our cash value retirement, incentive/shift diff/bonus, I’m at low/mid 300s plus the indirect benefits. I’m more of a researcher and think I have an awesome job. Although I could probably approach 450-500 in private practice, I’m willing to pay a premium to love my job and work somewhere that’s not a grind.

 

[southerndoc]

I'm an independent contractor. I think the benefits with employment are overrated. When you do the calculations, IC's almost always come out ahead. No way I could get the retirement contributions I make with being an employee.

 

[Groove]

Working with most EM pgy-2 and above is like turning on god mode in Doom with unlimited ammo for the BFG. It’s so easy it’s ridiculous.

I want to personally thank you for putting this in an analogy that I can understand, lol. I TOTALLY got that. For some reason though it’s easier for me to remember the BFG from Quake 2 than from original Doom though I played both.

 

[Groove]

Just how crappy is the academic pay around you, OP? I’m at an academic site and, while not pulling 400k, think am doing fairly well at around $220/hour for 120 hours per month. How much are you expecting to make in academics?

Agree with the above about level of training impacting productivity and teaching moments. Overall I value the residents as a buffer to burnout for multiple reasons and so think it is worth the pay cut depending on regional circumstances. I don’t have very many academic/research obligations either.

It sounds like you have a pretty good job, though. I’m not sure I’d be in academics if I had a community job like you describe. I kind of defaulted into my job since I’m relatively restricted by location and it paid around the same as the community jobs in my area (mostly crappy CMG types).

Well, I’m probably whining a bit more than I should. Academic pay in my actual city is around $230/hr I believe, but they are full as I’ve checked in the past. (Others in the area seem to be paying roughly 300-325K/yr) They don’t have any room for FT and honestly I kind of enjoy my current job. I’d like to get PRN privileges at the trauma center to wet my feet so to speak and that would probably satisfy my desire to teach a bit. The trauma center pays $250/hr fixed. If I ever get restless, I’ll prob look for an academic site run by a CMG as terrible as that sounds. They just pay more.

 

[GonnaBeADoc2222]

Yeah I felt that itch too. I started picking up perdiem at a local academic shop. Pay isn't bad (200/hr for weekdays, 225 for weekends) considering that the local EM market suuuuuuucks. FT with them is around 170/hr. I like it a lot.

 

[carbonizedeyesockets]

My base is equivalent of 170/hr. We do get bonuses that can make pay close to 200/hr. However, we also get increases based on time board certified, which I think comes with an increase every 2 years or so. So those that have been board certified much longer get quite a bit more.

Yeah, it's garbage compared to what a lot of you make. But, it is what it is. I like teaching. With residents, I'm usually not seeing more than 2-2.5/hr, and if its a good group of residents, it's super easy work. Our site without residents, I see around 1-1.5/hr on my own and with the PA, its another 0.5-1 pt/hr that I see. I'd rather be here than any of the CMGs in the area. I sometimes think about going to an democratic group in the area, but my pay would drop until I were to make partner (if). My loans are high and I wouldn't able to take that kind of hit.

The scary thing is how much worse the pay used to be up until about 5 years ago. And there are still other academic departments in the area that get paid less.