I can't see myself enjoying anything but EM. Is the job market *that* sketchy?

[Franzd'Epinay]

What I don't get is all the negativity on here about EM. If people are that negative about it, they should find another career. I sure as heck would. I wouldn't want to be miserable and share my misery with other people and let it spill into other areas of my life.

A lot of it is just healthy venting.

If people are truly desperate, they will leave--even for a healthy paycut. No golden handcuff is worth being a shell of a human being for years on end.

---

Members don't see this ad.

 

[PikminOC]

Sounds like New Orleans or BR to me lol

Or any city really

 

[HemorrhagicShock]

Literally everything. You don't experience EM as a med student.
...
Literally a book could be written on why it's an extremely poor choice. Haven't even touched on all of it. The metrics. The drug addicts. The demanding googlers. The
...
It all comes down to what I'll call "THE DREAD". You'll have your own...

This is one of the greatest responses to the oft-asked med student question of "why does EM suck?"

It accurately codifies what you are protected from as a medical student when rotating through the ED.

Every medical student needs to scroll back up to the top and read Rekt's post. It should honestly be stickied. A truly impressive manifesto @Rekt

 

[Arcan57]

I have the same mindset.

What I don't get is all the negativity on here about EM. If people are that negative about it, they should find another career. I sure as heck would. I wouldn't want to be miserable and share my misery with other people and let it spill into other areas of my life.

Yes, EM has its problems, but I still enjoy helping people, teaching residents, doing cool EMS stuff, and no matter what people claim, getting paid quite well for it. No I may not be paid at the top 0.5% of the specialty nor make a baseball player's salary, but I'm not working for $15/hr and it pays the bills, allows me to do the things I want and buy the things I want, and to save for a good retirement.

As others have said, some of it is venting. I think a lot of it is that students' exposure to our field is purposely deceptive. You do a surgery rotation and you get a feel for what surgeons do. You do OB/GYN and it quickly becomes clear what that involves. Peds and IM are also pretty as billed, within the context of what setting you rotate.

EM clerkships lie to you from beginning to end. They lie that the job is exciting on a regular basis. They lie that you have the time and energy to do something approximating a comprehensive history and physical on the patients you see. They lie that 80% of what you do as an EM attending isn't keeping track of 6-12 separate timers as you are constantly trying to answer the question of how long your patients are going to be in the department and why they haven't left yet. They lie that the patient's pain and distress are somehow cool because it means we get to do stuff. They lie that positive feedback is common and negative feedback is vanishingly rare (when's the last time you saw an EM attending just destroy a student for being an idiot?). They lie about what the schedule does to you physically and socially.

I went into EM because I thought that my ability to retain a broad if not deep range of knowledge, comfort with uncertainty, tolerance of imperfection, and ability to stay calm when the world is crashing down would make me a comparatively "better" EM doc than I would be a neurologist. I see a lot of docs that don't have those attributes but liked the clerkship and didn't have anything better to do in mind. Working in the ED seems like a f@$#ing nightmare for them. But it's tough to get through to people about whether they're fundamentally suited for a specialty when they're focused on ancillary things. If a student is convinced the EM is easy and lucrative and that's their reason for signing up, they're likely going to be disappointed.

 

[RustedFox]

I wasn't affiliated with a residency until 5 years ago, and I still volunteer for plenty of shifts without residents (I still like to primarily see patients). I work every Thursday during conference day now that I'm in more of an administrative role instead of core faculty.

So, like I said.

Amigo, I love you - but that ain't community EM

 

[EctopicFetus]

I wasn't affiliated with a residency until 5 years ago, and I still volunteer for plenty of shifts without residents (I still like to primarily see patients). I work every Thursday during conference day now that I'm in more of an administrative role instead of core faculty.

I think we are in similar situations. I think the difference is we had plenty of good (not great years). The new ones wont even have those and the whole of EM and hospitals has gotten so much worse its like a different planet now.

once you have your financial feet under you if the job doesnt eat your soul you can focus on FI. once you hit FI (and I assume you have) it all gets so much easier. The advice I give all my residents and just gave one recently is that they have to pay off their debt aggressively. Couldnt imagine naything worse than owing 350k in debt and dreading work so bad I would rather do anything else. When you dont need to work (aka debt free you can choose) when you ahve FI you literally choose the option to work. it is so much easier to work.

 

[EctopicFetus]

So, like I said.

Amigo, I love you - but that ain't community EM

My 2 cents for all the newer docs is get involved and find your niche. I work a lot clinically still. About 20% more clinical shifts than my avg partner. This prevents burnout, find your niche. It will give you some purpose where the day to day grind can take that away. The counter to this is if you do this and the hospital / group you do this for sucks it is even more soul sucking than doing nothing.

 

[NITRAS]

I wasn't affiliated with a residency until 5 years ago, and I still volunteer for plenty of shifts without residents (I still like to primarily see patients). I work every Thursday during conference day now that I'm in more of an administrative role instead of core faculty.

You aren’t in Texas by chance . . . Or is Thursday just the normal conference day for EM residencies?

 

[southerndoc]

You aren’t in Texas by chance . . . Or is Thursday just the normal conference day for EM residencies?

No, Georgia.

 

[bravotwozero]

You aren’t in Texas by chance . . . Or is Thursday just the normal conference day for EM residencies?

It definitely was in Detroit.

 

[The Knife & Gun Club]

Look man, if you love it, do it. But go in knowing you may end up in a position where you can’t get a job in the city you want or make the amount of money you need to live super fancy.

I call it the Odessa Texas test: would you be ok doing EM if it meant having to live in Odessa, Texas to do it?

How about your current/future spouse, would THEY be cool with it?

You can have a decent house on 250-300k per year in a place like Odessa. Can drive new non-luxury cars. Take a couple of good vacations a year. Kids won’t have to pay for college as long as you plan to send them to state schools, which are pretty damn good 99 times out of 100. You’ll eventually pay back your debts, and if frugal will be able to build up a nice nest egg so you can eventually be financially independent around 55.

But if you’re looking for mansions, city life, fancy gadgets and BMWs Im not sure EM is the place to find that at least in the immediate future.

 

[cyanide12345678]

Not always. The biggest advantage we have is control. Someone shows at at my office, they get dismissed and can't come back. Someone is habitually noncompliant, they can be dismissed. I decide how many patients I see per day. If I'm really busy, I can stop taking new patients. I can turn people away at need. If my kid gets sick, I just call the office manage and she cancels my patients for the day.

The second biggest advantage is scheduling. I work banker's hours. No night, no weekends, no holidays. Lunch breaks are a thing.

Traditionally, EM made up for this by making way more money than primary care. This is starting to change. EM is getting less lucrative and primary care is becoming more so.

I can't speak for everyone, but all the "interesting pathophysiology" becomes way less interesting as time goes on. Plus, its time consuming. For example, I saw a new diagnosis crohn's disease patient a few weeks ago. Brand new to the area, had been diagnoses 3 weeks ago in another state but moved before she could start treatment. GI appointments here take 2-3 months. So I read up to make sure I was starting the right treatment, got her in with GI, had a long talk about symptoms that should warrant and ED visit, the whole shebang. Felt pretty proud of myself when she left cheered up since there was a solid plan in place.

Then I noticed that I'm now a hour behind.

There is so much truth to this post that really needs to be emphasized.

Control! ER doctors have no control.

I can have a patient threaten to punch me and be escorted outside and then if he checks in tomorrow again, stuck seeing him again. Heck if he checks in 1 hour later, he still needs a medical screening exam.

We Routinely get a patient in our ER every 2-3 days that undresses inappropriately in front of nurses and masturbates in the room. We only see him with security in the room now.

Would this EVER happen in a FM clinic?? Hell no. That guy would have been discharged from clinic long ago. It’s only the ER where he can be back every 2-4 days literally.

Had a guy threaten the nursing staff, cuss them out, but then they filed a patient complaint. Admin literally was buying the dude pizza -_-

This crap doesn’t fly in a FM clinic. When my daughter gets sick or we get a call from the day care to pick her up for a fever, i can never just leave work. My wife on the other hand, her clinic just calls her patients, reschedules them, and that’s it.

 

[RustedFox]

There is so much truth to this post that really needs to be emphasized.

Control! ER doctors have no control.

I can have a patient threaten to punch me and be escorted outside and then if he checks in tomorrow again, stuck seeing him again. Heck if he checks in 1 hour later, he still needs a medical screening exam.

We Routinely get a patient in our ER every 2-3 days that undresses inappropriately in front of nurses and masturbates in the room. We only see him with security in the room now.

Would this EVER happen in a FM clinic?? Hell no. That guy would have been discharged from clinic long ago. It’s only the ER where he can be back every 2-4 days literally.

Had a guy threaten the nursing staff, cuss them out, but then they filed a patient complaint. Admin literally was buying the dude pizza -_-

This crap doesn’t fly in a FM clinic. When my daughter gets sick or we get a call room the day care to pick her up for a fever, i can never just leave work. My wife on the other hand, her clinic just calls her patients, reschedules them, and that’s it.

This is the "stuff that he was shielded from" that OP was asking about.

And this is every day, dude.

We can do no right.
Patients can do no wrong.
AND, you're responsible for their behavior.

 

[cyanide12345678]

Look man, if you love it, do it. But go in knowing you may end up in a position where you can’t get a job in the city you want or make the amount of money you need to live super fancy.

I call it the Odessa Texas test: would you be ok doing EM if it meant having to live in Odessa, Texas to do it?

How about your current/future spouse, would THEY be cool with it?

You can have a decent house on 250-300k per year in a place like Odessa. Can drive new non-luxury cars. Take a couple of good vacations a year. Kids won’t have to pay for college as long as you plan to send them to state schools, which are pretty damn good 99 times out of 100. You’ll eventually pay back your debts, and if frugal will be able to build up a nice nest egg so you can eventually be financially independent around 55.

But if you’re looking for mansions, city life, fancy gadgets and BMWs Im not sure EM is the place to find that at least in the immediate future.

During October to December of 2020 - the days of volume drops, staffing cuts, and honestly a glimpse of the future EM job market, there were no jobs in odessa Texas either. I looked and didn’t find any.

USacs was not hiring for any of their hospitals - that’s most of San Antonio and austin.

Team health had one gig in el paso, 3 pts per hour 270/hr. No thank you. Everywhere else was full.

Vituity had one shop around el paso that was hiring.

There was one shop hiring in another border town with really terrible staffing ratios.

Otherwise after talking to 5-6 CMGs and numerous smaller groups throughout Dallas, austin, Houston, San Antonio, el paso, Lubbock, amarillo, midland, odessa etc, i literally found a handful of open positions - maybe 6-7 total in the entire state of Texas during the covid days. Couldn’t even get recruiters to call me back at some shops or respond to my emails.

I wish some of you had actively been job hunting during that time to really see what the future holds for emergency medicine. I had a good paycheck at that time so it wasn’t stressful, but i literally changed my entire plan of going back to Texas because i couldn’t find a reasonable job that didn’t feel like a massive downgrade from my current situation.

Eventually settled in the mid west. Literally changed my entire life plans because of the terrible job market in the second largest state in the US.

If you think you will have job security 5-6 years from now when you are a fresh graduate then you might actually be in for a surprise.

The covid volume drop was effectively a supply demand mismatch where all of a sudden a lot of ER doctors lost hours and there were almost no jobs even in a massive state like Texas. There’s a bigger supply demand mismatch that’s in the making.

Just think about this for a second. I started residency in 2016. There were 1750 or so open residency positions that year. In 2021, so 5 years, there were around 2850 or so spots. EM residency expansion is the LARGEST out of any other specialty. All economics is supply and demand, and we are truly in for a terrible couple of decades before some massive changes happen.

And just for the record, my parents were in Texas, my college was in Texas, my med school was in Texas, my brother was in Texas, i really wanted to be in Texas. I was literally willing to be in Amarillo or even Lubbock, and i really tried, responded to every single job posting i could find online. Most of them were shill listings to essentially put you in their database, they didn’t actually have jobs open when you talked to them on the phone. It was a very disheartening process and then after a couple of months i sat down with my wife and we started looking for a plan B.

I really don’t think you med students actually understand what’s about to come.

 

[Apollyon]

I call it the Odessa Texas test: would you be ok doing EM if it meant having to live in Odessa, Texas to do it?

Permian basin FTW!

 

[GatorCHOMPions]

Look man, if you love it, do it. But go in knowing you may end up in a position where you can’t get a job in the city you want or make the amount of money you need to live super fancy.

I call it the Odessa Texas test: would you be ok doing EM if it meant having to live in Odessa, Texas to do it?

How about your current/future spouse, would THEY be cool with it?

You can have a decent house on 250-300k per year in a place like Odessa. Can drive new non-luxury cars. Take a couple of good vacations a year. Kids won’t have to pay for college as long as you plan to send them to state schools, which are pretty damn good 99 times out of 100. You’ll eventually pay back your debts, and if frugal will be able to build up a nice nest egg so you can eventually be financially independent around 55.

But if you’re looking for mansions, city life, fancy gadgets and BMWs Im not sure EM is the place to find that at least in the immediate future.

I actually interviewed for an SDG and hospital employed job in Midland/Odessa several years ago out of residency! I was looking for the highest $$$ I could get at the time. The SDG was offering like $300/hour if I recall, but it was still a dealbreaker for my then gf now wife. I wonder what they can offer to new grads nowadays.

 

[Rekt]

During October to December of 2020 - the days of volume drops, staffing cuts, and honestly a glimpse of the future EM job market, there were no jobs in odessa Texas either. I looked and didn’t find any.

USacs was not hiring for any of their hospitals - that’s most of San Antonio and austin.

Team health had one gig in el paso, 3 pts per hour 270/hr. No thank you. Everywhere else was full.

Vituity had one shop around el paso that was hiring.

There was one shop hiring in another border town with really terrible staffing ratios.

Otherwise after talking to 5-6 CMGs and numerous smaller groups throughout Dallas, austin, Houston, San Antonio, el paso, Lubbock, amarillo, midland, odessa etc, i literally found a handful of open positions - maybe 6-7 total in the entire state of Texas during the covid days. Couldn’t even get recruiters to call me back at some shops or respond to my emails.

I wish some of you had actively been job hunting during that time to really see what the future holds for emergency medicine. I had a good paycheck at that time so it wasn’t stressful, but i literally changed my entire plan of going back to Texas because i couldn’t find a reasonable job that didn’t feel like a massive downgrade from my current situation.

Eventually settled in the mid west. Literally changed my entire life plans because of the terrible job market in the second largest state in the US.

If you think you will have job security 5-6 years from now when you are a fresh graduate then you might actually be in for a surprise.

The covid volume drop was effectively a supply demand mismatch where all of a sudden a lot of ER doctors lost hours and there were almost no jobs even in a massive state like Texas. There’s a bigger supply demand mismatch that’s in the making.

Just think about this for a second. I started residency in 2016. There were 1750 or so open residency positions that year. In 2021, so 5 years, there were around 2850 or so spots. EM residency expansion is the LARGEST out of any other specialty. All economics is supply and demand, and we are truly in for a terrible couple of decades before some massive changes happen.

And just for the record, my parents were in Texas, my college was in Texas, my med school was in Texas, my brother was in Texas, i really wanted to be in Texas. I was literally willing to be in Amarillo or even Lubbock, and i really tried, responded to every single job posting i could find online. Most of them were shill listings to essentially put you in their database, they didn’t actually have jobs open when you talked to them on the phone. It was a very disheartening process and then after a couple of months i sat down with my wife and we started looking for a plan B.

I really don’t think you med students actually understand what’s about to come.

People have no idea. I was extremely close with my seniors when they were job hunting during the pandemic. The entire country was desolate. Unless you were tracking it very closely or directly in those shoes then it just got shrugged off. People are oblivious to the storm that's coming.

 

[RustedFox]

During October to December of 2020 - the days of volume drops, staffing cuts, and honestly a glimpse of the future EM job market, there were no jobs in odessa Texas either. I looked and didn’t find any.

USacs was not hiring for any of their hospitals - that’s most of San Antonio and austin.

Team health had one gig in el paso, 3 pts per hour 270/hr. No thank you. Everywhere else was full.

Vituity had one shop around el paso that was hiring.

There was one shop hiring in another border town with really terrible staffing ratios.

Otherwise after talking to 5-6 CMGs and numerous smaller groups throughout Dallas, austin, Houston, San Antonio, el paso, Lubbock, amarillo, midland, odessa etc, i literally found a handful of open positions - maybe 6-7 total in the entire state of Texas during the covid days. Couldn’t even get recruiters to call me back at some shops or respond to my emails.

I wish some of you had actively been job hunting during that time to really see what the future holds for emergency medicine. I had a good paycheck at that time so it wasn’t stressful, but i literally changed my entire plan of going back to Texas because i couldn’t find a reasonable job that didn’t feel like a massive downgrade from my current situation.

Eventually settled in the mid west. Literally changed my entire life plans because of the terrible job market in the second largest state in the US.

If you think you will have job security 5-6 years from now when you are a fresh graduate then you might actually be in for a surprise.

The covid volume drop was effectively a supply demand mismatch where all of a sudden a lot of ER doctors lost hours and there were almost no jobs even in a massive state like Texas. There’s a bigger supply demand mismatch that’s in the making.

Just think about this for a second. I started residency in 2016. There were 1750 or so open residency positions that year. In 2021, so 5 years, there were around 2850 or so spots. EM residency expansion is the LARGEST out of any other specialty. All economics is supply and demand, and we are truly in for a terrible couple of decades before some massive changes happen.

And just for the record, my parents were in Texas, my college was in Texas, my med school was in Texas, my brother was in Texas, i really wanted to be in Texas. I was literally willing to be in Amarillo or even Lubbock, and i really tried, responded to every single job posting i could find online. Most of them were shill listings to essentially put you in their database, they didn’t actually have jobs open when you talked to them on the phone. It was a very disheartening process and then after a couple of months i sat down with my wife and we started looking for a plan B.

I really don’t think you med students actually understand what’s about to come.

I remember you going thru that and posting about it.
I was JOBLESS at the time.
Imagine how scary it was for me. I truly felt that "my career in EM was over".

 

[cyanide12345678]

People have no idea. I was extremely close with my seniors when they were job hunting during the pandemic. The entire country was desolate. Unless you were tracking it very closely or directly in those shoes then it just got shrugged off. People are oblivious to the storm that's coming.

I was moving by choice because my wife was graduating and we wanted to upgrade to a better city. It was nice job hunting while having a job that made 260/hr. I can’t imagine job hunting in a terrible environment with no income, 250k debt, and one after another recruiter just saying they are all full and not hiring.

Huge institutions, including the insurance lobby and the United States government is incentivized to drop ER volumes to decrease health care expenditure. I usually try not to bet against the US government.

Literally when volume dropped, thousands of ER doctors lost hours and income. I work with a guy who was unemployed for 1 year during covid - EM trained and has a fellowship under his belt.

Not to mention team health has started testing out rural ERs that are 100% PA/NP run during night shift. My friend was given notice that the doctors are essentially losing hours since they are no longer needed at night shift.

A storm is brewing like no other. If you are entering the job market in 6-7 years, Good luck to you.

 

[WildEMDoc]

During October to December of 2020 - the days of volume drops, staffing cuts, and honestly a glimpse of the future EM job market, there were no jobs in odessa Texas either. I looked and didn’t find any.

USacs was not hiring for any of their hospitals - that’s most of San Antonio and austin.

Team health had one gig in el paso, 3 pts per hour 270/hr. No thank you. Everywhere else was full.

Vituity had one shop around el paso that was hiring.

There was one shop hiring in another border town with really terrible staffing ratios.

Otherwise after talking to 5-6 CMGs and numerous smaller groups throughout Dallas, austin, Houston, San Antonio, el paso, Lubbock, amarillo, midland, odessa etc, i literally found a handful of open positions - maybe 6-7 total in the entire state of Texas during the covid days. Couldn’t even get recruiters to call me back at some shops or respond to my emails.

I wish some of you had actively been job hunting during that time to really see what the future holds for emergency medicine. I had a good paycheck at that time so it wasn’t stressful, but i literally changed my entire plan of going back to Texas because i couldn’t find a reasonable job that didn’t feel like a massive downgrade from my current situation.

Eventually settled in the mid west. Literally changed my entire life plans because of the terrible job market in the second largest state in the US.

If you think you will have job security 5-6 years from now when you are a fresh graduate then you might actually be in for a surprise.

The covid volume drop was effectively a supply demand mismatch where all of a sudden a lot of ER doctors lost hours and there were almost no jobs even in a massive state like Texas. There’s a bigger supply demand mismatch that’s in the making.

Just think about this for a second. I started residency in 2016. There were 1750 or so open residency positions that year. In 2021, so 5 years, there were around 2850 or so spots. EM residency expansion is the LARGEST out of any other specialty. All economics is supply and demand, and we are truly in for a terrible couple of decades before some massive changes happen.

And just for the record, my parents were in Texas, my college was in Texas, my med school was in Texas, my brother was in Texas, i really wanted to be in Texas. I was literally willing to be in Amarillo or even Lubbock, and i really tried, responded to every single job posting i could find online. Most of them were shill listings to essentially put you in their database, they didn’t actually have jobs open when you talked to them on the phone. It was a very disheartening process and then after a couple of months i sat down with my wife and we started looking for a plan B.

I really don’t think you med students actually understand what’s about to come.

Couldn't have summed it up any better. Was in the same exact position during that time coming from Texas as well. Even with a fellowship it was rough in both community and academics with nobody hiring at all. Almost ended tiny town community as the only BC doc in a group with 10 docs over 65, rate of 125/hr. Landed Midwest too. Now I have a great job but in a location I had no desire to be in with a family less than happy about the situation.

If the whole market becomes like what it was then in a few years, people need to be cautious. I love EM, and most days I like the ER as well. But this field is headed for a rough time, and people need to be realistic about it from the starry eyes of medical school.

 

[GonnaBeADoc2222]

I was moving by choice because my wife was graduating and we wanted to upgrade to a better city. It was nice job hunting while having a job that made 260/hr. I can’t imagine job hunting in a terrible environment with no income, 250k debt, and one after another recruiter just saying they are all full and not hiring.

Huge institutions, including the insurance lobby and the United States government is incentivized to drop ER volumes to decrease health care expenditure. I usually try not to bet against the US government.

Literally when volume dropped, thousands of ER doctors lost hours and income. I work with a guy who was unemployed for 1 year during covid - EM trained and has a fellowship under his belt.

Not to mention team health has started testing out rural ERs that are 100% PA/NP run during night shift. My friend was given notice that the doctors are essentially losing hours since they are no longer needed at night shift.

A storm is brewing like no other. If you are entering the job market in 6-7 years, Good luck to you.

Do y'all think if OP goes to a Powerhouse residency, it'll be different for them?

 

[cyanide12345678]

Do y'all think if OP goes to a Powerhouse residency, it'll be different for them?

I went to a top 20 med school, graduated top quartile, 99th percentile board scores, top 20 college, a 40+ year old residency program, one of the first in the country with a very large alumni network. My first medical director was also a regional director for team health and the previous founder and ceo of premiere health that had 78 hospital contracts. This was one of the largest buy outs for team. He sent some emails on my behalf to try to retain me within the team health system.

Nothing helped during covid days. There were some options but they were terrible.

Even right now i have the title of assistant professor at a healthcare system of what would be considered a top tier power house residency, though I’m not at their main residency shop. But i don’t think i would like to ever be job hunting 5-6 years from now, eventhough my resume and experience will be significantly stronger than any new grad.

 

[Lynx zwo drei vier]

Forget where we are today. When you finish residency and start working a job in summer of 2926 what will it look like. It’s a bad bad future that is predicted.
i think if you will be happy working without staff and supervising your CMG MLPs and making 150/hr with tremendous liability for their decisions then by all means.
if you think seeing high acuity patients and having time to actually manage them properly is in your future I would reconsider.
many of us have decent enough jobs for now. Is the future bright? No way. Look at all the recent info with insurers aggressively going after em pay. It’s mostly about CMGs but everyone will get cut. The CMGs have previously used insurers as an excuse to cut pay. Throw in the mid levels; the workforce issues and peer into the dark future. For anyone fresh out. Get your exit plans prepped.
the few semi decent jobs left (horrid location; decent work environment and decent pay) are filling as we speak. Once that’s full. Then what? When every job in Mississippi and Arkansas is full for $270-300/hr what comes next in a job market and job hunt. Not much will be left. Next is find the better cities and rates will drop there. Then the outlying cities of the good cities (1-2 hours out) then the crappy locations will see pay drop.
i like what i do. I would never advise my kids to do EM. No control and the factors above lead to a bleak future.

Even if the days of $300/hr in halfway-decent places are gone, haven’t FM/IM/Peds folks already been making disgracefully low pay in those places for years? I’ve seen stats (BLS, I think) saying that the median FM income in California(!) is barely 3 figures. Do you foresee EM getting that bad?

 

[GonnaBeADoc2222]

Was being sarcastic

 

[GonnaBeADoc2222]

Even if the days of $300/hr in halfway-decent places are gone, haven’t FM/IM/Peds folks already been making disgracefully low pay in those places for years? I’ve seen stats (BLS, I think) saying that the median FM income in California(!) is barely 3 figures. Do you foresee EM getting that bad?

This guy can't be helped.

Thread lock time?

 

[cyanide12345678]

Was being sarcastic

I know you were, but i want these young ones to understand that even an excellent resume may not mean much when there’s nothing available.

 

[cyanide12345678]

Even if the days of $300/hr in halfway-decent places are gone, haven’t FM/IM/Peds folks already been making disgracefully low pay in those places for years? I’ve seen stats (BLS, I think) saying that the median FM income in California(!) is barely 3 figures. Do you foresee EM getting that bad?

FM does not make that low income. Every FM gig becomes RVU only after 2 or so years after a period of guaranteed income. Guaranteed income is around 200-250k dependent on where you go. An average FM doctor generating 4800 annual RVUs makes around 230-270k once they are on productivity models depending on the formula for rvu conversion. Plus they have incentives and bonuses which can make a large part of their income - like a 20k annual bonus for having a panel of 3000 patients for example.

They also work weekdays only. Have a ridiculously amazing job market. Pcp shortages EVERYWHERE. My wife could literally throw a stone anywhere and get a job. She only works from 7:30 am to 3 pm as well, which is kind of nice.

And you know…. Once you account for paid time off, federal holidays off, weekends off, metrics related bonuses, an average FM doctor compensation is a lot closer to what an EM doctor makes without the nights, weekends, holidays, and most importantly without the job insecurity - which also is part of the dread that ER doctors will be facing -_-

 

[AD04]

I went to a top 20 med school, graduated top quartile, 99th percentile board scores, top 20 college, a 40+ year old residency program, one of the first in the country with a very large alumni network. My first medical director was also a regional director for team health and the previous founder and ceo of premiere health that had 78 hospital contracts.

I'm not sure if I should be impressed or sad. All that work you did matters significantly less than what specialty you ended up in.

 

[cyanide12345678]

I'm not sure if I should be impressed or sad. All that work you did matters significantly less than what specialty you ended up in.

Maybe that’s why i regret EM so much. I truly had options and could have picked several other specialties. Interviewing in 2015 for residency felt different. Attendings everywhere bragging about the 300/hr job options, and the ridiculous job prospects. It was a hot specialty, a lot of high caliber students were going in to the specialty. We all got suckered in.

Interviewing in 2018 for my first post residency job felt great. Since my wife was pgy1, i had to stay within a 50 mile radius. Had 5 job offers within that radius, essentially got an offer at every place i interviewed. Had so much negotiation ability, was able to negotiate an extra 30/hr, plus a sign on and ability to basically dictate my schedule.

Interviewing in 2020 was terrible. It really dawned on me then that i had made a mistake, this was before the acep report for the projected surplus, the writing was on the wall, i already was seeing the surplus and the increasing residency spots everywhere. When i finally got a job that felt an upgrade in quality of life compared to my previous job, I didn’t even try to negotiate, granted it was a university hospital affiliated job, so room for negotiation was less. But i just took what i got and was happy to end up in a very stable hospital employed system making reasonable income and seeing a low volume of patients.

 

[NITRAS]

Permian basin FTW!

I mean, there are a lot worse places than the Permian basin. I spent three years in Midland/Odessa.
-housing costs can vary extremely depending on boom/bust
-the restaurant selection actually has improved, but still. . . . .my wife and I kept joking that the 1-10 ranking only went up to 5 in midland/Odessa.
-its dry/flat with 7“ of rain a years, which you got in 3 days a years invariably with a foot of water in the streets. And your face crisping when you got in your car is something I don’t miss.
-I-20 is one of the most dangerous stretches of highway out there. Lots of big trucks, lots of drug use.
-It’s a geographically oddity, 5 hour drive from San Antonio, Dallas, El Paso.

Besides those things, it isn’t terrible. Never felt unsafe. The locals were generally sweet people. The single best ER doc I’ve worked with was there.

 

[VA Hopeful Dr]

Even if the days of $300/hr in halfway-decent places are gone, haven’t FM/IM/Peds folks already been making disgracefully low pay in those places for years? I’ve seen stats (BLS, I think) saying that the median FM income in California(!) is barely 3 figures. Do you foresee EM getting that bad?

BLS isn't accurate.

Outside of academics a full time FP isn't making under 200k unless they are lazy or slowing down for retirement.

 

[Arcan57]

2020 was a unicorn event. While it did feature a supply/demand mismatch, it felt like the driving factor in lack of jobs was the uncertainty regarding the revenue stream and the ability for a lot of shops just to make payroll. COVID spooked patients in a way that I don't see repeating anytime soon. I think there will still be a decent amount of geographic mobility in the future as jobs will be offered, just for significantly less pay.

 

[miacomet]

If you absolutely can't see yourself doing anything else, then it doesn't matter if the job market is sketchy- you have a choice of EM or unemployment. So your decision is made.

 

[cyanide12345678]

2020 was a unicorn event. While it did feature a supply/demand mismatch, it felt like the driving factor in lack of jobs was the uncertainty regarding the revenue stream and the ability for a lot of shops just to make payroll. COVID spooked patients in a way that I don't see repeating anytime soon. I think there will still be a decent amount of geographic mobility in the future as jobs will be offered, just for significantly less pay.

A supply demand mismatch none the less.

What do you think will happen when there is a surplus of 10,000 ER doctors in 7 years, essentially 20-25 percent of the ER work force?

What happens when CMGs keep increasing PA/NP coverage and reducing physician hours, decreasing your demand. That 30k volume ER with 36 hr MD/DO and 12 hrs PA coverage can easily be converted to a 24 hr MD/DO coverage model with 24 hours of PA/Np coverage. Staffing ratios are changing. A new grad who can’t find a job will happily replace you if you don’t accept these staffing changes.

And what happens when in 5 years we have 3500 residency spots and they fill up after Soap and with foreigners each year. Is this an impossible notion? Not really…we went from 1750 in 2016 to 2840 in 2021. And despite covid and the 2021 class struggling to find employment and some graduates losing their signed contracts and being unemployed, we still had 2920 spots in 2022, effectively an increase. The trend is obvious.

What happens when insurances push more and more for people to use tele medicine services and make it much more expensive to visit the ER? That’s happening. Teladoc signed a deal with Amazon 6 or so months ago as well. I don’t like betting against the world’s largest corporations either.

What happens when that level 2 50k volume shop ER with 48 hours doctor coverage and 24-36 hours PA/NP coverage adds a residency program and switches to 36 hours of MD/DO coverage, lots of residents, and PAs/Nps? This is also happening. This is how we’ve ended up with a surplus to begin with.

What happens when very large CMGs like team health start taking ERs with 8k annual volume or less and replace night shift with a PA/NP with a tele physician available for consultation. This is also already happening.

Money talks. Doctors are expensive. Our skills are only needed truly in 5 percent of ER cases. Most of them can survive long enough for a helicopter to fly them away. Corporations care about profits. We are not good for the bottom line.

I assure you, if covid had happened 10 years ago in the golden days, not a single ER doctor would have been unemployed, they would have still had plenty of options.

Covid wasn’t just a glitch, it exposed the weakness of the fundamentals of our job market. Supply and demand matters and it’s not looking favorable for us unfortunately.

 

[Arcan57]

A supply demand mismatch none the less.

What do you think will happen when there is a surplus of 10,000 ER doctors in 7 years, essentially 20-25 percent of the ER work force?

What happens when CMGs keep increasing PA/NP coverage and reducing physician hours, decreasing your demand. That 30k volume ER with 36 hr MD/DO and 12 hrs PA coverage can easily be converted to a 24 hr MD/DO coverage model with 24 hours of PA/Np coverage. Staffing ratios are changing. A new grad who can’t find a job will happily replace you if you don’t accept these staffing changes.

And what happens when in 5 years we have 3500 residency spots and they fill up after Soap and with foreigners each year. Is this an impossible notion? Not really…we went from 1750 in 2016 to 2840 in 2021. And despite covid and the 2021 class struggling to find employment and some graduates losing their signed contracts and being unemployed, we still had 2920 spots in 2022, effectively an increase. The trend is obvious.

What happens when insurances push more and more for people to use tele medicine services and make it much more expensive to visit the ER? That’s happening. Teladoc signed a deal with Amazon 6 or so months ago as well. I don’t like betting against the world’s largest corporations either.

What happens when that level 2 50k volume shop ER with 48 hours doctor coverage and 24-36 hours PA/NP coverage adds a residency program and switches to 36 hours of MD/DO coverage, lots of residents, and PAs/Nps? This is also happening. This is how we’ve ended up with a surplus to begin with.

What happens when very large CMGs like team health start taking ERs with 8k annual volume or less and replace night shift with a PA/NP with a tele physician available for consultation. This is also already happening.

Money talks. Doctors are expensive. Our skills are only needed truly in 5 percent of ER cases. Most of them can survive long enough for a helicopter to fly them away. Corporations care about profits. We are not good for the bottom line.

I assure you, if covid had happened 10 years ago in the golden days, not a single ER doctor would have been unemployed, they would have still had plenty of options.

Covid wasn’t just a glitch, it exposed the weakness of the fundamentals of our job market. Supply and demand matters and it’s not looking favorable for us unfortunately.

What happens is that MD pay craters to the point where it makes financial sense to hire us rather than midlevels. You’re also overestimating the labor pool of EM midlevels. Unlike us, they can switch fields or in the case of NPs go back to the bedside. There’s a relatively hard floor on what you can pay a midlevel and have them still be willing to work in our environment.

My point was that in 2020 there were no jobs. In 2028, it’s likely that pay will be depressed to the point that there will be shops hiring as non BC and midlevel only shops can suddenly afford BCEM.

I work in a system that has an extensive tele health component. In the absence of readily available PCPs, the majority of callers are directed to the ED. In general, anything that increases contact with any part of the healthcare system will increase ED visits.

 

[RustedFox]

A supply demand mismatch none the less.

What do you think will happen when there is a surplus of 10,000 ER doctors in 7 years, essentially 20-25 percent of the ER work force?

What happens when CMGs keep increasing PA/NP coverage and reducing physician hours, decreasing your demand. That 30k volume ER with 36 hr MD/DO and 12 hrs PA coverage can easily be converted to a 24 hr MD/DO coverage model with 24 hours of PA/Np coverage. Staffing ratios are changing. A new grad who can’t find a job will happily replace you if you don’t accept these staffing changes.

And what happens when in 5 years we have 3500 residency spots and they fill up after Soap and with foreigners each year. Is this an impossible notion? Not really…we went from 1750 in 2016 to 2840 in 2021. And despite covid and the 2021 class struggling to find employment and some graduates losing their signed contracts and being unemployed, we still had 2920 spots in 2022, effectively an increase. The trend is obvious.

What happens when insurances push more and more for people to use tele medicine services and make it much more expensive to visit the ER? That’s happening. Teladoc signed a deal with Amazon 6 or so months ago as well. I don’t like betting against the world’s largest corporations either.

What happens when that level 2 50k volume shop ER with 48 hours doctor coverage and 24-36 hours PA/NP coverage adds a residency program and switches to 36 hours of MD/DO coverage, lots of residents, and PAs/Nps? This is also happening. This is how we’ve ended up with a surplus to begin with.

What happens when very large CMGs like team health start taking ERs with 8k annual volume or less and replace night shift with a PA/NP with a tele physician available for consultation. This is also already happening.

Money talks. Doctors are expensive. Our skills are only needed truly in 5 percent of ER cases. Most of them can survive long enough for a helicopter to fly them away. Corporations care about profits. We are not good for the bottom line.

I assure you, if covid had happened 10 years ago in the golden days, not a single ER doctor would have been unemployed, they would have still had plenty of options.

Covid wasn’t just a glitch, it exposed the weakness of the fundamentals of our job market. Supply and demand matters and it’s not looking favorable for us unfortunately.

This guy moneys.

 

[cyanide12345678]

This guy moneys.

I like to money.

 

[JacobMcCandles]

Covid wasn’t just a glitch, it exposed the weakness of the fundamentals of our job market. Supply and demand matters and it’s not looking favorable for us unfortunately.

You're not comparing apples to apples here and COVID exposing the weakness of the fundamentals of our job market makes no sense. What weakness did it expose that was previously unknown? You have supply (physicians/midlevels) and demand (patients). Patient volumes dropped by nearly half for a lot of places overnight. I don't think anybody with half a brain would be surprised what happens when your demand drops by half overnight in any industry. Supply of physicians/midlevels isn't doubling overnight. The trend is definitely up but the trend of patient visits will likely continue to increase as well although not as much as the supply. There will still be good jobs out there but there will be a lot of subpar physicians who will find themselves working for pennies or out in BFE.

I get it. Most of the people here are burned out on EM. The job market won't be as good as students think it is but it won't be as bad as many here say it will be, either.

 

[Franzd'Epinay]

I wonder if the tightening labor market will meaningfully change the number of EM residents who go on to do (ACGME) fellowships. Is there data on current numbers?

 

[BoardingDoc]

You're not comparing apples to apples here and COVID exposing the weakness of the fundamentals of our job market makes no sense. What weakness did it expose that was previously unknown? You have supply (physicians/midlevels) and demand (patients). Patient volumes dropped by nearly half for a lot of places overnight. I don't think anybody with half a brain would be surprised what happens when your demand drops by half overnight in any industry. Supply of physicians/midlevels isn't doubling overnight. The trend is definitely up but the trend of patient visits will likely continue to increase as well although not as much as the supply. There will still be good jobs out there but there will be a lot of subpar physicians who will find themselves working for pennies or out in BFE.

I get it. Most of the people here are burned out on EM. The job market won't be as good as students think it is but it won't be as bad as many here say it will be, either.

Agreed. This is the exact same thing that happened in the airline industry. Airlines fired huge amounts of staff because demand for air travel went through the floor. Now they're getting murdered as demand is back and they literally can't hire fast enough. EM is doing the same thing and there are job offers galore as they scramble to get back to a steady state.

The big difference between the two industries is that there aren't 2000+ extra flight attendants being minted every year. Airlines will reach a steady state again and people will stop deciding to become a flight attendant if it's hard to get a job. Those unemployable/underemployed EM docs are just F*****.

 

[InternistDO]

BLS isn't accurate.

Outside of academics a full time FP isn't making under 200k unless they are lazy or slowing down for retirement.

Even academics in NYC pays more than that these days, thankfully.

UCLA was offering $250k base with most docs making in the mid 300s on production when I spoke to them. Obviously not peak EM money but not bad for 4 days a week in a big city.

 

[Brigade4Radiant]

Even academics in NYC pays more than that these days, thankfully.

UCLA was offering $250k base with most docs making in the mid 300s on production when I spoke to them. Obviously not peak EM money but not bad for 4 days a week in a big city.

Which is what EM makes in LA also they can get a job far easier. A lot of FM docs can also supplement with telehealth on their days off

 

[12jas]

Literally everything. You don't experience EM as a med student.

ALL OF THIS. Med student rotations are NOTHING like grinding EM every day. I love giving med students the fun stuff but I usually go out of my way to give them a few ****ty patient encounters or will put a difficult consultant or hospitalist on speaker so they can hear how I am spoken to. We are doing rotators a disservice by shielding them from the ****.

 

[The Knife & Gun Club]

During October to December of 2020 - the days of volume drops, staffing cuts, and honestly a glimpse of the future EM job market, there were no jobs in odessa Texas either. I looked and didn’t find any.

USacs was not hiring for any of their hospitals - that’s most of San Antonio and austin.

Team health had one gig in el paso, 3 pts per hour 270/hr. No thank you. Everywhere else was full.

Vituity had one shop around el paso that was hiring.

There was one shop hiring in another border town with really terrible staffing ratios.

Otherwise after talking to 5-6 CMGs and numerous smaller groups throughout Dallas, austin, Houston, San Antonio, el paso, Lubbock, amarillo, midland, odessa etc, i literally found a handful of open positions - maybe 6-7 total in the entire state of Texas during the covid days. Couldn’t even get recruiters to call me back at some shops or respond to my emails.

I wish some of you had actively been job hunting during that time to really see what the future holds for emergency medicine. I had a good paycheck at that time so it wasn’t stressful, but i literally changed my entire plan of going back to Texas because i couldn’t find a reasonable job that didn’t feel like a massive downgrade from my current situation.

Eventually settled in the mid west. Literally changed my entire life plans because of the terrible job market in the second largest state in the US.

If you think you will have job security 5-6 years from now when you are a fresh graduate then you might actually be in for a surprise.

The covid volume drop was effectively a supply demand mismatch where all of a sudden a lot of ER doctors lost hours and there were almost no jobs even in a massive state like Texas. There’s a bigger supply demand mismatch that’s in the making.

Just think about this for a second. I started residency in 2016. There were 1750 or so open residency positions that year. In 2021, so 5 years, there were around 2850 or so spots. EM residency expansion is the LARGEST out of any other specialty. All economics is supply and demand, and we are truly in for a terrible couple of decades before some massive changes happen.

And just for the record, my parents were in Texas, my college was in Texas, my med school was in Texas, my brother was in Texas, i really wanted to be in Texas. I was literally willing to be in Amarillo or even Lubbock, and i really tried, responded to every single job posting i could find online. Most of them were shill listings to essentially put you in their database, they didn’t actually have jobs open when you talked to them on the phone. It was a very disheartening process and then after a couple of months i sat down with my wife and we started looking for a plan B.

I really don’t think you med students actually understand what’s about to come.

Yup that’s exactly it. I was an intern in 2020. I remember watching our seniors attempting to graduate into the EM apocalypse and it scared the living crap out of me. This is from a residency that had never had anything but excellent job placement, where I’d been hanging out in the ED with their residents since 2016 when I was an M1.

Suddenly we had grads taking $60k/year educational positions at the VA so at least they’d have health insurance for their family. One guy uprooted his wife and 2 school aged kids to move to a town 2 hours outside of Lubbock Texas. Another was working PRN at the county jail to make ends meat until a job came along. Our alumni tried to help them but when people are fighting just to get enough hours for themselves so they don’t default on their house/car suddenly there’s not that much they can do for anyone else.

That’s why I’m heading to ICU fellowship. I like ICU and academics (I’d like to stay in it), but more than anything else ICU gives me a reason to do work I like without ever being beholden to the damn hedge funds which would gladly sell me and any other EP down the river to make a quick buck.

Have an exit strategy. It’s not acceptable to have the employment stability of a migrant farm worker after 10 years and a quarter-million dollars in debt.

 

[DeadCactus]

... but more than anything else ICU gives me a reason to do work I like without ever being beholden to the damn hedge funds...

I don't know if I would count on that....

 

[The Knife & Gun Club]

I don't know if I would count on that....

Sorry I should clarify. Corporate medicine is still alive and well in CCM. However there’s not a corporate residency mill generating a surplus of physicians in CCM the way there is in EM.

 

[bravotwozero]

Sorry I should clarify. Corporate medicine is still alive and well in CCM. However there’s not a corporate residency mill generating a surplus of physicians in CCM the way there is in EM.

…yet

 

[bky3c]

Have an exit strategy. It’s not acceptable to have the employment stability of a migrant farm worker after 10 years and a quarter-million dollars in debt.

Exactly. This is not even an exaggeration in so many cases.

 

[JacobMcCandles]

Exactly. This is not even an exaggeration in so many cases.

This is certainly a gross exaggeration.

 

[The Knife & Gun Club]

Exactly. This is not even an exaggeration in so many cases.

This is certainly a gross exaggeration.

Eh it’s an exaggeration for dramatic effect. Obviously no EM doc is living hand to mouth like an actual migrant farm worker.

There’s also people much older and wiser than me here and I’ll rightly cop to that.

But at least in my limited experience many of the attendings I’m friends with or have worked with have experienced significantly increased lability in their employment in the past few years. I know when I put out feelers for myself the waters were pretty icy.

Granted I’m in southern Florida, which is like ground zero for expansion/market saturation. It’ll take a while for the whole country to look like Miami/Dade/Broward. But its like a microcosm for the country. There’s still jobs paying $250 an hour but it’s mostly in fast paced corporate shops, or several hours outside of civilization in *shudders* north Florida, and people bounce around a lot.