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Any transient hope I had for this field is evaporating lol.
Any transient hope I had for this field is evaporating lol.
I got a rock.I get a not-insignificant number of PMs from people on SDN saying something along the lines of: "Either me or my spouse/SO is a [2nd/3rd year] EM resident and is absolutely distraught about what to do because EM is not at all what they thought it would be for all the reasons that you and others have described and we're looking for something, anything else."
IMGs now know EM is easy to match to so of course they will still apply to all community IM and FM programs EM is now in that teir.
This is concerning (for them) because unlike IM or FM where you can specialize or significantly tailor your practice settings, emergency medicine is really not a good specialty for people that don’t LOVE emergency medicine - because you’re on a one track train doing a very specific job that is both physically and emotionally not easy. Especially if you hate the job and are just doing for the green card/visa.Yes. I know at least a handful of Pakistani applicants putting EM as a backup after IM - since last year’s match meant that it was the easiest specialty to get in.
I think that doctor money and coming from another country you can learn to tolerate a lot.This is concerning (for them) because unlike IM or FM where you can specialize or significantly tailor your practice settings, emergency medicine is really not a good specialty for people that don’t LOVE emergency medicine - because you’re on a one track train doing a very specific job that is both physically and emotionally not easy. Especially if you hate the job and are just doing for the green card/visa.
I got a rock.
This is concerning (for them) because unlike IM or FM where you can specialize or significantly tailor your practice settings, emergency medicine is really not a good specialty for people that don’t LOVE emergency medicine - because you’re on a one track train doing a very specific job that is both physically and emotionally not easy. Especially if you hate the job and are just doing for the green card/visa.
I think that doctor money and coming from another country you can learn to tolerate a lot.
Serious question for this group. Would you be as burnt out if you worked 130 hours a month and made 900k a year? I would argue no you wouldn’t.
It’s the trash pay, trash environment for “standard” pay that makes em so painful.
But it is worth it especially if we’re talking about what they would make in their country and their lifestyle. Most immigrants from other countries would work 90 hours consecutively if they were making 250 K.
I was in this exact position by the end of PGY-1. You feel absolutely trapped because fellowshipping out is hard. Genuinely dread-inducing.I get a not-insignificant number of PMs from people on SDN saying something along the lines of: "Either me or my spouse/SO is a [2nd/3rd year] EM resident and is absolutely distraught about what to do because EM is not at all what they thought it would be for all the reasons that you and others have described and we're looking for something, anything else."
There is always the option of online penis pills.I can't help but feel that a sizable percentage of these new applicants and new spots simply either (1.) won't graduate, (2.) if they graduate, won't pass their boards and find meaningful employment, or (3.) will go urgent care or some other route altogether.
There is always the option of online penis pills.
Currently fellowship-ing out and the hours are pretty painful (this month I had a week of 100 in-hospital hours worked, and a “home” call shift that was 82 hours long), but I’d do it again in a heart beat.I was in this exact position by the end of PGY-1. You feel absolutely trapped because fellowshipping out is hard. Genuinely dread-inducing.
It will be interesting to see how it translates to fill rate.I think the numbers are artificially inflated because more people are now applying to EM as a back-up. The numbers are not up because more people organically want to go into EM.
Currently fellowship-ing out and the hours are pretty painful (this month I had a week of 100 in-hospital hours worked, and a “home” call shift that was 82 hours long), but I’d do it again in a heart beat.
My wife just remarked the other day that I seem happier and less tired now than when I was an EM senior working 50-60 hrs/week.
I think it’s tough to know how you’ll respond to the EM lifestyle until you’re really in it. It’s tough to simulate constant circadian flipping and being treated like dog poo by your hospital ademons and patients.
Currently fellowship-ing out and the hours are pretty painful (this month I had a week of 100 in-hospital hours worked, and a “home” call shift that was 82 hours long), but I’d do it again in a heart beat.
My wife just remarked the other day that I seem happier and less tired now than when I was an EM senior working 50-60 hrs/week.
I think it’s tough to know how you’ll respond to the EM lifestyle until you’re really in it. It’s tough to simulate constant circadian flipping and being treated like dog poo by your hospital ademons and patients.
Not CCM but I agree it's program dependent. I still vividly remember my ICU time as a resident. One MICU rotation was easier than the ER (but boring). One MICU rotation was easier in terms of work done per hour there but the hours there definitely started to outweigh that benefit. My trauma ICU rotation was significantly more hours AND sometimes more work than the ER. That place was a **** show.From my ICU rotations in residency (which seems like ages ago) and hearing from current friends who have completed CCM fellowship I get the idea that even on those deep hell weeks during CTICU/CVICU/surgeon-infested-ICU you still get the opportunity to sit down, take a dump, and grab a coffee when you want. There's meaningful downtime that makes 100 hour weeks sound like magic compared to a 50-60 hour week with balls to the wall patient volume/idiocy and switching circadian rhythms.
Any truth to this? I am heavily looking into a CCM fellowship but my current hang-up is whether I'd be able to deal with the workload of fellowship. Most of my friends tell me it was easier than the workload of EM residency, but that also seems program-dependent.
Thoughts?
I completely agree - I’m in an anesthesia program but by virtue of the setup most of my rotations are surgical ICUs and co-fellows are surgeons. It’s busy for sure - you’re responsible for 27 intubated vented clusterF’s - but there’s no real dispo issues and it’s rare that more than 1-2 will be actively crashing at a given time.From my ICU rotations in residency (which seems like ages ago) and hearing from current friends who have completed CCM fellowship I get the idea that even on those deep hell weeks during CTICU/CVICU/surgeon-infested-ICU you still get the opportunity to sit down, take a dump, and grab a coffee when you want. There's meaningful downtime that makes 100 hour weeks sound like magic compared to a 50-60 hour week with balls to the wall patient volume/idiocy and switching circadian rhythms.
Any truth to this? I am heavily looking into a CCM fellowship but my current hang-up is whether I'd be able to deal with the workload of fellowship. Most of my friends tell me it was easier than the workload of EM residency, but that also seems program-dependent.
Thoughts?
One big thing I considered is how the programs structured their hours. I chose a place that uses a call system (Q2 home call) rather than a 7a-7p type of gig. Because with call you only are sticking around if stuff is happening, in which case I want to be there anyway.Not CCM but I agree it's program dependent. I still vividly remember my ICU time as a resident. One MICU rotation was easier than the ER (but boring). One MICU rotation was easier in terms of work done per hour there but the hours there definitely started to outweigh that benefit. My trauma ICU rotation was significantly more hours AND sometimes more work than the ER. That place was a **** show.
Grass isn't always greener.
I don't know if I agree with that.I think the numbers are artificially inflated because more people are now applying to EM as a back-up. The numbers are not up because more people organically want to go into EM.
I don't know if I agree with that.
EM may be less competitive than in previous years, but it's still a somewhat labour-intensive application process relative to other uncompetitive specialties (FM, IM, Peds, etc) Having a viable application in EM still requires doing away rotations, obtaining SLOEs and other LORs. While some may be applying as a back up, I don't think they make up anywhere near a majority of the increase from last year.
I don't know if I agree with that.
EM may be less competitive than in previous years, but it's still a somewhat labour-intensive application process relative to other uncompetitive specialties (FM, IM, Peds, etc) Having a viable application in EM still requires doing away rotations, obtaining SLOEs and other LORs. While some may be applying as a back up, I don't think they make up anywhere near a majority of the increase from last year.
I agree. Anecdotally, I see it happening with new residents, but sometimes it's hard to determine "Am I turning into the douchebag attending". I often wonder what the medium to long term trends will be. Will the bad docs bring down the common denominator and decrease wages but increase staffing as no one is equipped to run an ER adequately? Will the good groups keep compensation high while attracting the true EM docs who want to work hard/make more money? I think rural locums will only proliferate as the new docs don't want to/are unable to work at the 'top of the skillset' shops.There's that.
But for real; I genuinely think there's going to be a non-ignorable percent of "failures to launch".
10/10 head exploding but I do think for some of the ultra-rural jobs FM may make a bit more sense. I see postings from time to time for these 5 bed ED and 8 bed inpatient hospitals in the way way critical access territory where you’re the Hospitalist and the ED doc at the same time.i saw someone on the physician community FB page post that they thought that an FM trained doc made a better emergency doc in a rural ED than EM...all i could think is that there would be a lot of heads exploding over here in SDN...but that certainly may be the mentality of those that are applying to EM right now.
...who is a glorified triage nurse who directs patients to ‘specialists’ while caring for minor urgent care like things themselves.
I work in a 4 bed ED. But we get plenty of days of 10 patients at a time and overflow to a nearby unit. We also get our fair share of two critically ill patients at once. If you want dedicated ED coverage, there is one true choice.10/10 head exploding but I do think for some of the ultra-rural jobs FM may make a bit more sense. I see postings from time to time for these 5 bed ED and 8 bed inpatient hospitals in the way way critical access territory where you’re the Hospitalist and the ED doc at the same time.
You could make a case for some of these ultra-rural places being better served by one FM who can have a clinic and see some peds and OB, do some very slow moving EM, admit the occasional low acuity inpatient. Not because they’d do the EM part particularly well but because it’d probably be better for the community overall to have one person that can offer all of that rather than someone who’s trained (albeit more thoroughly) only for EM.
That’s super interesting- how do you have the resources to do 2 rooms at once? What does the staffing model look like for an ED that small?I work in a 4 bed ED. But we get plenty of days of 10 patients at a time and overflow to a nearby unit. We also get our fair share of two critically ill patients at once. If you want dedicated ED coverage, there is one true choice.
Trust me, it's not. I know you're squared away and on top of your game, but, this is like the med students that think EM is so active all the time. Rural has their sick pts, with essentially no support. It's not sleep all night. It's a post stroke 65 year old guy coming in at 4am with a STEMI (true case). It's a VERY fat retired nurse, hammered, at 2am, who fell, struck the bed, fractured rib, and got a pneumo, who I had to cut twice to get a chest tube in (true case).I’ve always thought it’d be interesting to pick up some shifts in a tiny ED like that.
ICU is far easier. It has all of the plus sides of the ED and far fewer downsides. There is a barrier to entry, and I don’t have to be the final dispo of the patient. On my busiest days when I’m getting pulled in 10 directions, I’m still not run as ragged as I was in the ED.From my ICU rotations in residency (which seems like ages ago) and hearing from current friends who have completed CCM fellowship I get the idea that even on those deep hell weeks during CTICU/CVICU/surgeon-infested-ICU you still get the opportunity to sit down, take a dump, and grab a coffee when you want. There's meaningful downtime that makes 100 hour weeks sound like magic compared to a 50-60 hour week with balls to the wall patient volume/idiocy and switching circadian rhythms.
Any truth to this? I am heavily looking into a CCM fellowship but my current hang-up is whether I'd be able to deal with the workload of fellowship. Most of my friends tell me it was easier than the workload of EM residency, but that also seems program-dependent.
Thoughts?
“Less soul crushing” than EM always gets a thumbs up from me.I am in a much better place physically, emotionally, and spiritually that I was in the ED. I work about the same number of shifts each month, but I’m paid more, and the work is more enjoyable and less soul crushing. 10/10, I’d recommend.
That’s super interesting- how do you have the resources to do 2 rooms at once? What does the staffing model look like for an ED that small?
Also curious how far out you are from the nearest city and if you travel to work there or live there full time?
I’ve always thought it’d be interesting to pick up some shifts in a tiny ED like that.
96 hour shifts, and you had GSx, anesthesia, and OB/GYN? I had a surgeon from Tuesday evening to Thursday 5pm sharp. Gas was CRNAs on call, but, without a surgeon, what did they do? But, I have to say, in 7 years, one birth.You weren't asking me specifically, but I'll throw in my 2 cents in case it helps. I did a handful of critical access shifts in addition to my urban shifts for most of the years of my career. They were a nice break sometimes, and when they did get busy/high acuity, it felt like time traveling to when there were no specialists and every doctor was just a doctor. Patients tend to be nicer, and staff tend to be rock stars because they don't last if they're not. That includes physicians. Some of the nicest surgeons I've ever met were at these places.
They were 2-5 hours from the nearest major airport. I went for a few days at a time. At night, I was the only physician in the hospital, and gen surg, anesthesia, and Ob/gyn were on call. They had 1-2 nurses (and sometimes a tech) both day and night in the ED, and if they got busy, they could usually pull in another nurse or two from the floor.
Shifts were 12-96 hours. The longer ones provided a call room with a mini kitchen. I once had 4 major traumas at the same time, from the same incident, and we got them stabilized and transferred without a problem. You just hop from room to room and do what you can with the resources you have, and you get them out asap. I don't think anyone expects the care to be identical in the middle of nowhere compared to a Level 1 trauma center, a stroke center, etc., but you do the best you can.
I wasn't implying that your experience didn't happen. I just had different experiences. I can certainly believe that some places are (or at least were) decent and others are terrible.96 hour shifts, and you had GSx, anesthesia, and OB/GYN? I had a surgeon from Tuesday evening to Thursday 5pm sharp. Gas was CRNAs on call, but, without a surgeon, what did they do? But, I have to say, in 7 years, one birth.
We lost the majority of nurses due to a toxic nurse manager. The "rock stars" ALL left. The only ones left were garbage.
If I had 4 traumas at once, more than one would suffer.
No hospitalists, no intensivist (which was fine, because there was no ICU), no neuro, no ENT. Had Ortho M-F.
Now, it looks like the hospital is down to 2 doctors TOTAL. They booted docs from the ED, and replaced them with NPs.
Times, they changed. The pts I had were people unable to "adult" (hat tip to @RustedFox ). Not gracious, not good people (for the most part), just poor and rural. Bad decisions, no options in life.
The barrier to entry thing is such a game changer honestly compared to the ED. It’s the reason I actually like the surgical units more than i thought I would.ICU is far easier. It has all of the plus sides of the ED and far fewer downsides. There is a barrier to entry, and I don’t have to be the final dispo of the patient. On my busiest days when I’m getting pulled in 10 directions, I’m still not run as ragged as I was in the ED.
Everything is better in the ICU (this is obviously my own perspective). The patients are sicker, the pathophysiology is fascinating, and I have acquired a much deeper understanding of it.
I’m not a big fan of procedures, but I do far more in the ICU than I ever did in the emergency department. I actually feel like I get to help people through a difficult time instead of shuffling them along and my chances of meeting expectations are significantly better than the emergency department. There’s also a level of respect, given to me by fellow physicians of all specialties, which should not be the case, but it is. People value your opinion, they respect your time and abilities, and often lean on you for help.
One complaint, I often see from medical students and residents is that they don’t want to spend “six hours rounding“. But that is really only in academic centers run by inefficient attending. I work in a busy community hospital, my patient census is typically around 15 and I generally round in about 30 minutes. I come in, review the labs, start my notes, make my plan, talk to the overnight nurse and rounding is really just so I can touch base with the pharmacist.
On my busiest day, I have still had time to get lunch, use the bathroom if I need to and drink water. I remember countless emergency shifts where I never use the bathroom, never had a drink of water and barely sat down at all. There is still disruption of the circadian rhythm, but it is not nearly as often as it was in the emergency department.
For me, the fact of the matter is that my worst day in the ICU is better than my best day in the emergency department. But it is taxing work, and watching a patient decline day after day despite all of your best efforts hurts in a way that is difficult to describe to people who do not work inpatient medicine. It does bring a dread that is different than the emergency department, but still painful.
All in all, it’s a much better specialty in my opinion, but it certainly has its drawbacks, limitations and painful realities. There are still people and families with unrealistic expectations, but the longer I do this the less I care. I’ll give it my all, but my self worth is no longer tied to outcomes.
I am in a much better place physically, emotionally, and spiritually that I was in the ED. I work about the same number of shifts each month, but I’m paid more, and the work is more enjoyable and less soul crushing. 10/10, I’d recommend.
250-600k, depending on location and hours worked. Works out to 150ish/hr low end and 400/hr upper end. Some outliers above and below, for sure. I think avg is 210/hrHow much does EM make ? I’m glad I didn’t pick this speciality
I'm NCC and you summarized it perfectly. Yes, you have emergencies (codes, airways, etc.) but you can largely plan out your rounds and procedures. You get to poop, eat, go to the cafeteria, and even to local restaurants. It is nowhere near the insanity of the ED where anything can come in at any second.From my ICU rotations in residency (which seems like ages ago) and hearing from current friends who have completed CCM fellowship I get the idea that even on those deep hell weeks during CTICU/CVICU/surgeon-infested-ICU you still get the opportunity to sit down, take a dump, and grab a coffee when you want. There's meaningful downtime that makes 100 hour weeks sound like magic compared to a 50-60 hour week with balls to the wall patient volume/idiocy and switching circadian rhythms.
Any truth to this? I am heavily looking into a CCM fellowship but my current hang-up is whether I'd be able to deal with the workload of fellowship. Most of my friends tell me it was easier than the workload of EM residency, but that also seems program-dependent.
Thoughts?
Is this all 1099?250-600k, depending on location and hours worked. Works out to 150ish/hr low end and 400/hr upper end. Some outliers above and below, for sure. I think avg is 210/hr
Many, but not all. Some are W2. Fewer are K1.Is this all 1099?
That’s super interesting- how do you have the resources to do 2 rooms at once? What does the staffing model look like for an ED that small?
Also curious how far out you are from the nearest city and if you travel to work there or live there full time?
I’ve always thought it’d be interesting to pick up some shifts in a tiny ED like that.