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

[EctopicFetus]

Only hope is that if this does happen, the supply of ER docs will drop due to decreased student interest and attendings quitting or shifting to another specialty. Maybe after that, we'd eventually see the supply/demand ratio improve and things could be doable again. Obviously talking about time on the order of years.

Interest is dropping but only the quality of applicant has dropped. Less than 10 spots went up filled post scramble. We are screwed.

---

Members don't see this ad.

 

[Arcan57]

Zero chance this happens. The lower pay goes, the more desperate people get and the more they work.

Sure, guys like ectopic might be able to drop out of the workforce. But guys like me far outnumber them. We didn’t get as big a bite during the good times, and aren’t FIRE-ready (and every year that gets farther and farther away, I was projecting a 10-yr timeline 3 years ago. Now it’s 15+). When push comes to shove, you can bet your sweet ass I’ll be right there fighting tooth and nail for hours.

It's tough AF to cut down on expenses once they're in place. As illustrated by the higher paid specialties (looking at you, cards), doctors are willing to trash their lives in order to maintain income. In the absence of the ability to move to an area where a radically different expense profile makes sense, you're going to see docs working 18-20 shifts/month because they can'/won't cut their budget.

 

[EctopicFetus]

It's tough AF to cut down on expenses once they're in place. As illustrated by the higher paid specialties (looking at you, cards), doctors are willing to trash their lives in order to maintain income. In the absence of the ability to move to an area where a radically different expense profile makes sense, you're going to see docs working 18-20 shifts/month because they can'/won't cut their budget.

Yeah but if i am the contract owner I would overstaff with people and have them fight like hungry animals for the scraps i throw in the yard. This keeps them all hungry (and starving). Welcome to 2030. Thanks ACEP!

 

[Arcan57]

Yeah but if i am the contract owner I would overstaff with people and have them fight like hungry animals for the scraps i throw in the yard. This keeps them all hungry (and starving). Welcome to 2030. Thanks ACEP!

That's absolutely already happening. A close relative would be the grift of hiring for the main hospital at $x/hr FT then scheduling half of the shifts as FSED shifts at $(x-75)/hr. Doc starts making waves and suddenly you're working 75% FSED.

 

[bravotwozero]

That's absolutely already happening. A close relative would be the grift of hiring for the main hospital at $x/hr FT then scheduling half of the shifts as FSED shifts at $(x-75)/hr. Doc starts making waves and suddenly you're working 75% FSED.

Kelly Larkins group was doing this as far back as 2015, when she staffed St Luke’s

 

[EctopicFetus]

Kelly Larkins group was doing this as far back as 2015, when she staffed St Luke’s

Some of these practices have existed for some time. It’s spreading now and will accelerate the badness.

If you had 100 shifts to cover I would rather 20 docs get 10 each than have 10 that work 20 each.

If one leaves it is easier to push the 19 left to cover 10 than to ask 9 people to cover 20. The future looks bleak.

 

[avalon10]

I planned on going into Emergency Medicine when I started med school. Threads like this make so so unbelievably thankful that I changed plans during 4th year.
Truly scary stuff and not at all what I ever imagined a career as a doctor to be like.

 

[Brigade4Radiant]

I’m glad I convinced my brother not to do EM now he is doing FM and won’t have any problem getting a job in LA

 

[Dr Mantis Toboggan]

I’m glad I convinced my brother not to do EM now he is doing FM and won’t have any problem getting a job in LA

And they say we can’t make a difference!

 

[RustedFox]

I planned on going into Emergency Medicine when I started med school. Threads like this make so so unbelievably thankful that I changed plans during 4th year.
Truly scary stuff and not at all what I ever imagined a career as a doctor to be like.

So many of us on here would do FM/IM in a heartbeat now that this nonsense has come to pass.

Do you hear this, OP?

 

[avalon10]

So many of us on here would do FM/IM in a heartbeat now that this nonsense has come to pass.

Do you hear this, OP?

Or do PM&R. It’s pretty good.

 

[RustedFox]

Or do PM&R. It’s pretty good.

If it were only that easy, and didn't require... Oh, you know...

 

[alpinism]

Likely floor of 140-150/hr. The most you can reasonably work long term in this field is 130 hrs/mo. This amounts to 215 to 235k/yr. No benefits. High chance that you can't get this many hours due to 'flex staffing' arrangements and have to supplement w/ urgent care or telehealth work at a lower $/hr.

I'd go even further and say that it's likely 200K salary. For residents that's still a huge pay increase and many of them will happily accept that pay when it's their only choice if they want to stay in their hometown near family. That's a big reason why all the CMGs like USACS can get away with paying those low rates in highly desirable locations. I've talked with many of their current docs and when they get asked the question it's always the same answer that it sucks but it's worth the pay cut to be able to live near family.

 

[EctopicFetus]

I'd go even further and say that it's likely 200K salary. For residents that's still a huge pay increase and many of them will happily accept that pay when it's their only choice if they want to stay in their hometown near family. That's a big reason why all the CMGs like USACS can get away with paying those low rates in highly desirable locations. I've talked with many of their current docs and when they get asked the question it's always the same answer that it sucks but it's worth the pay cut to be able to live near family.

With more and more docs being minted in EM this will be exacerbated to locations that are even less desireable.

 

[Lynx zwo drei vier]

OP: Side gigs alone make this much hourly with no nights, weekends, abusive patients, or med mal risk.

This is why it's dumb AF to go into EM now.

What’s a good alternative? FM and then doing a fellowship to get gig work? Doing EM and then a fellowship in Sports so that I can have a plan B?

I’m open to neurology plus a stroke fellowship too. That’s narrower than what I liked about EM, but that site was still one of my favorites.

 

[Lynx zwo drei vier]

If you no longer recommend EM to medical students, what alternative fields would you suggest?

If someone's a competitive medical student who entered thinking about EM but is worried about the future, which specialties do you think would be better? Or would you still recommend EM to students passionate about the field?

forums.studentdoctor.net

I enjoyed this thread.

Speak for yourself, my guy. I've been told by one of SDN's powermembers to "go [Russian warship] yourself" 😬

 

[RustedFox]

Speak for yourself, my guy. I've been told by one of SDN's powermembers to "go [Russian warship] yourself" 😬

It's not just you, homey.
Ask any of us: "if we could go back..."

Just search that.

 

[EctopicFetus]

Buddy of mine em maybe 5 years left before retirement tells me he picked up a stray cat. He said the cat was an em doctor but would rather be homeless than spend another minute in the ED.

That’s him projecting. Buyer beware.

 

[EctopicFetus]

Good news is that as bad as em is you can still be an owner in usacs. /sarcasm

Also at least Acep has your back /2x sarcasm

Lastly midlevels won’t encroach cause they can’t differentiate sick from not sick and cmgs know this and CARE /more sarcasm

 

[DeadCactus]

It's sad that EM has essentially regressed back to the era where you did EM to pay the bills while you set up your long term practice. We've just shifted from building up a surgical or primary care practice to building up a practice based on an EM fellowship or non-clinical work.

 

[RustedFox]

What’s a good alternative? FM and then doing a fellowship to get gig work? Doing EM and then a fellowship in Sports so that I can have a plan B?

I’m open to neurology plus a stroke fellowship too. That’s narrower than what I liked about EM, but that site was still one of my favorites.

To give you an honest answer to your question: there are several "good alternatives" that are better than EM in so many ways.
If I had to do it all over, I would choose FM, then choose a fellowship that seriously interested me.

 

[Lynx zwo drei vier]

To give you an honest answer to your question: there are several "good alternatives" that are better than EM in so many ways.
If I had to do it all over, I would choose FM, then choose a fellowship that seriously interested me.

With all due respect, is there anywhere but rural areas where FM docs can assist in the ED? Everyone is predicting that EM will be dead everywhere but rural MAGA country (and if that’s the case then fine, you’ve convinced me), but from what I’ve heard it’s also only rural hospitals that call FM people into the ED anyway.

But what the hеll do I know. I’ve seen a couple FM attendings of mine rounding on the floor in a big city hospital.

 

[RustedFox]

With all due respect, is there anywhere but rural areas where FM docs can assist in the ED? Everyone is predicting that EM will be dead everywhere but rural MAGA country (and if that’s the case then fine, you’ve convinced me), but from what I’ve heard it’s also only rural hospitals that call FM people into the ED anyway.

But what the hеll do I know. I’ve seen a couple FM attendings of mine rounding on the floor in a big city hospital.

Bro, the "assist in the ED" thing... Makes limited sense.

If you mean "be the attending physician", then yeah - there are few if any FM attendings doing that in reasonably populated areas.

In the blink of an eye, they'll be gone. Doing better things, if you ask most of us here.

Do you hear that? That's opportunity knocking.

 

[cyanide12345678]

With all due respect, is there anywhere but rural areas where FM docs can assist in the ED? Everyone is predicting that EM will be dead everywhere but rural MAGA country (and if that’s the case then fine, you’ve convinced me), but from what I’ve heard it’s also only rural hospitals that call FM people into the ED anyway.

But what the hеll do I know. I’ve seen a couple FM attendings of mine rounding on the floor in a big city hospital.

Like fox said, you don’t ‘assist in the ED’ and plan to go through FM residency and fellowship. They have many options, and if the job market for EM boarded docs doesn’t look that great to work in the ER, why do you think FM trained doctors will have better luck getting an ER job. The FM doctor will however have an amazing job market for clinical outpatient medicine, so they won’t need to be in the ER. An ER doctor however will not have that luxury.

 

[RustedFox]

Like fox said, you don’t ‘assist in the ED’ and plan to go through FM residency and fellowship. They have many options, and if the job market for EM boarded docs doesn’t look that great to work in the ER, why do you think FM trained doctors will have better luck getting an ER job. The FM doctor will however have an amazing job market for clinical outpatient medicine, so they won’t need to be in the ER. An ER doctor however will not have that luxury.

Thanks. I'm coming of a nightshift and this is far better than my addled brain could come up with.

 

[voxveritatisetlucis]

Why not neuro and then neurocritical care? Job market in neurology looks very good. If you liked stroke, might be the safer option.

Obviously, all of this is dependent upon situation going into residency. Some med students/residents have trust funds that mean they never really have to work in medicine if worst comes to worst. EM is obviously safer in cases like this.

 

[GonnaBeADoc2222]

Bro, the "assist in the ED" thing... Makes limited sense.

If you mean "be the attending physician", then yeah - there are few if any FM attendings doing that in reasonably populated areas.

In the blink of an eye, they'll be gone. Doing better things, if you ask most of us here.

Do you hear that? That's opportunity knocking.

Reminds me of the time when I was working locums at this trash Team Health site.

There was an FM trained doc doing an "EM Fellowship" (aka shifts in the ED as an attending for crap pay and minimal didactics) working parallel to me.

Med Director to me "Just be there as a resource for him if he needs it."

Me "Nope. I'm literally a hired gun. If he's the attending, he will be the attending. Your circus. Your monkeys."

 

[Lynx zwo drei vier]

Why not neuro and then neurocritical care? Job market in neurology looks very good. If you liked stroke, might be the safer option.

Obviously, all of this is dependent upon situation going into residency. Some med students/residents have trust funds that mean they never really have to work in medicine if worst comes to worst. EM is obviously safer in cases like this.

No trust fund. I can't kick back and depend on my family's money. But I have almost no debt (thanks, Uncle Sam), an interesting CV, and some old contacts at the Bains/McKinseys/BCGs of the world. I'd rather not go corporate (if I'd wanted to be a consultant, I would've become one), but it wouldn't be hopeless if I tried. And I don't want to ask my partner to make an unreasonable move when she has a career of her own to worry about.

So yeah, your advice is well taken. Neurovasc might be what I'm looking for.

 

[alpinism]

No trust fund. I can't kick back and depend on my family's money. But I have almost no debt (thanks, Uncle Sam), an interesting CV, and some old contacts at the Bains/McKinseys/BCGs of the world. I'd rather not go corporate (if I'd wanted to be a consultant, I would've become one), but it wouldn't be hopeless if I tried. And I don't want to ask my partner to make an unreasonable move when she has a career of her own to worry about.

So yeah, your advice is well taken. Neurovasc might be what I'm looking for.

If you're geographically limited EM would definitely be a risky choice.

It's already tough finding jobs in many places and it will only get worse.

 

[Lynx zwo drei vier]

If you're geographically limited EM would definitely be a risky choice.

It's already tough finding jobs in many places and it will only get worse.

Even those notoriously malignant, burnout-factory hospitals in the NYC area? I’m not talking about Sinai, I’m talking about the ones you hear the real horror stories about.

 

[Arcan57]

Even those notoriously malignant, burnout-factory hospitals in the NYC area? I’m not talking about Sinai, I’m talking about the ones you hear the real horror stories about.

Yes.

But unless you're doing some kind of self-imposed penance, why aim for the worst possible experience you could have?

 

[cyanide12345678]

Even those notoriously malignant, burnout-factory hospitals in the NYC area? I’m not talking about Sinai, I’m talking about the ones you hear the real horror stories about.

There’s no hope for you. Just do EM.

Just do me a favor, report back in a few years when you are 2-3 years out as an attending. Then let us know if we were right or not in guiding you away from EM.

 

[Lynx zwo drei vier]

Like fox said, you don’t ‘assist in the ED’ and plan to go through FM residency and fellowship. They have many options, and if the job market for EM boarded docs doesn’t look that great to work in the ER, why do you think FM trained doctors will have better luck getting an ER job. The FM doctor will however have an amazing job market for clinical outpatient medicine, so they won’t need to be in the ER. An ER doctor however will not have that luxury.

Okay, that makes sense. I just asked because it would be nice to do something that I enjoyed, and I found the ED more enjoyable than OP clinic.

If reading that I liked ED work makes certain users want to “punch me in the face,” then it’s their right to fantasize about that.

 

[Lynx zwo drei vier]

Yes.

But unless you're doing some kind of self-imposed penance, why aim for the worst possible experience you could have?

Just wondered how all-consuming the decay is.

 

[RustedFox]

Okay, that makes sense. I just asked because it would be nice to do something that I enjoyed, and I found the ED more enjoyable than OP clinic.

If reading that I liked ED work makes certain users want to “punch me in the face,” then it’s their right to fantasize about that.

NO, no, no no no.

It was hearing that personality disorders make for interesting pathology that made everyone want to punch you in the face. Get it right.

 

[GonnaBeADoc2222]

No trust fund. I can't kick back and depend on my family's money. But I have almost no debt (thanks, Uncle Sam), an interesting CV, and some old contacts at the Bains/McKinseys/BCGs of the world. I'd rather not go corporate (if I'd wanted to be a consultant, I would've become one), but it wouldn't be hopeless if I tried. And I don't want to ask my partner to make an unreasonable move when she has a career of her own to worry about.

So yeah, your advice is well taken. Neurovasc might be what I'm looking for.

Can you hook me up with those Bain and McKinsey contacts?

 

[Apollyon]

NO, no, no no no.

It was hearing that personality disorders make for interesting pathology that made everyone want to punch you in the face. Get it right.

I said that, but, as I said, the first time, they're fascinating. Every time after that, it's like getting shot with a salt gun.

If the OP mentioned PDs, I missed that.

 

[Frazier]

Okay, that makes sense. I just asked because it would be nice to do something that I enjoyed, and I found the ED more enjoyable than OP clinic.

If reading that I liked ED work makes certain users want to “punch me in the face,” then it’s their right to fantasize about that.

I am not a huge fan of OP clinic (vs inpatient). That said, I only have 5 patients on my day schedule today. It will be a good day in clinic.

My big problem today will be what to fill my time with in office since it is raining and I can't take a 2 hour walk outside. The fact I'm posting on SDN sort of gives me my answer for chosen time sink.

That is not the sort of problem I ever found myself in while doing EM ("whatever shall I do with all this downtime and autonomy at work?").

Just about every setting is better than EM.

 

[cyanide12345678]

Just about every setting is better than EM.

Except general surgery. Now that’s another hell hole id never like to be a part of.

 

[BoardingDoc]

NO, no, no no no.

It was hearing that personality disorders make for interesting pathology that made everyone want to punch you in the face. Get it right.

You know how a 1/6 murmur is semi-jokingly described as "a murmur only a cardiologist can hear?" I feel like differentiating between a personality disorder and "you're just an a**h***" is something that only a psychiatrist can do.

 

[RustedFox]

I said that, but, as I said, the first time, they're fascinating. Every time after that, it's like getting shot with a salt gun.

If the OP mentioned PDs, I missed that.

You're right, but what OP is completely unaware of is this:

Every person in your department is a liability. You are responsible for their behavior. These people aren't well-behaved. In fact, they're LOOKING to cause trouble and almost never have any real, organic pathology. You all know that when you get "crazy", you watch that **** like a parent watches a child in public.

All OP knows is "How cool! A paranoid schizotypal. Interesting."

What we all think in the back of our mind is: "I'm watching you, MF'er. Make my day and I'll Haldol your ass, fast."

We've had the borderline PD female complain to admin that she wasn't getting enough attention and confabulate details. We've had the OCD (truly OCD, not what kids say "oh I cleaned my car, I'm so OCD") drag things out for hours because the nurse didn't clean the table to his specifications before drawing up a med.

Imagine if your patients exercised a smidgen of self-control, responsibility, or social awareness. Your shift would be so much better.

 

[Brigade4Radiant]

The thing about EM is you are in the premed mindset you want “competitive” but the thing is no one cares about your match after 1 year.

 

[EthylMethylMan]

If reading that I liked ED work makes certain users want to “punch me in the face,” then it’s their right to fantasize about that.

No one thus far has said that, man. We're objecting to the idea that you truly know what ED work is. Most of the EM residents and attendings here liked the medical school EM experience. It's why many of us applied to this specialty. Many of us then had buyer's remorse on July 1st, realizing we didn't have the full picture as students. The major point people in this thread have been trying to stress to you is that the EM that medical students see and the EM that physicians practice are two very different beasts. And not in a good way.

Good luck to you.

 

[Lexdiamondz]

Even those notoriously malignant, burnout-factory hospitals in the NYC area? I’m not talking about Sinai, I’m talking about the ones you hear the real horror stories about.

Those ****holes have been saturated for a couple years already. Many of them have been getting grads that wouldn't have sent them CVs 5 years ago.

I know grads from NYC EM programs that have been primarily working urgent care since graduation because they couldn't find EM gigs in the city

 

[Lynx zwo drei vier]

Can you hook me up with those Bain and McKinsey contacts?

I would if I could. Hard to network on an anonymous forum without doxxing myself though, sorry.

 

[Lynx zwo drei vier]

You're right, but what OP is completely unaware of is this:

Every person in your department is a liability. You are responsible for their behavior. These people aren't well-behaved. In fact, they're LOOKING to cause trouble and almost never have any real, organic pathology. You all know that when you get "crazy", you watch that **** like a parent watches a child in public.

All OP knows is "How cool! A paranoid schizotypal. Interesting."

What we all think in the back of our mind is: "I'm watching you, MF'er. Make my day and I'll Haldol your ass, fast."

We've had the borderline PD female complain to admin that she wasn't getting enough attention and confabulate details. We've had the OCD (truly OCD, not what kids say "oh I cleaned my car, I'm so OCD") drag things out for hours because the nurse didn't clean the table to his specifications before drawing up a med.

Imagine if your patients exercised a smidgen of self-control, responsibility, or social awareness. Your shift would be so much better.

I don't remember mentioning personality disorders once. I saw plenty of those on IP psych, and that's one reason that psych is wayyyy down on my list. The BPDs who can't function outside of the psych wing, the antisocial ones who are there to malinger their way into scoring benzos and three hots and a cot ... nope.

 

[Arcan57]

Just wondered how all-consuming the decay is.

If you need to do it, then do it. If you don't need to do it, find something else.

I got made assistant director 6 months out of residency (not a brag). I spent the next ACEP going to all these "How to be a director" type courses to try and get a handle on how to be good at the job. The guy that gave the "Dealing with Patient Complaints" lecture opened by saying, "The best feeling in the world [as a director] is when you stop banging your head against the wall". I had no idea what he was talking about at the time. In 2022 you can substitute [as an EM doc] in the above and you'd get a lot of knowing looks from the docs here.

 

[RustedFox]

I don't remember mentioning personality disorders once. I saw plenty of those on IP psych, and that's one reason that psych is wayyyy down on my list. The BPDs who can't function outside of the psych wing, the antisocial ones who are there to malinger their way into scoring benzos and three hots and a cot ... nope.

You said something close enough about "crazy people being interesting".

I already told you why this was a myopic statement.

EDIT: at least psych can turf these patients in private practice. Noncompliant? Byeee.

 

[RustedFox]

Fair point lol. I guess every FM doc or private-practice psychiatrist sees patients who are at least functional enough to know that they need a doctor.

But being dumb doesn’t disqualify you from getting healthcare, and sometimes the inability to act like a grown-up leads to interesting pathophysiology. There are the IVDU patients who’ve already ruined their veins, start getting creative about where they inject, and present with Lemierre’s. There are people who were too embarrassed to see a doctor for their pilonidal disease/perianal abscesses/etc and come in after trying home I&Ds. There’s the occasional patient who gets shot, doesn’t seek immediate attention because he doesn’t wanna show up on law enforcement’s radar, and finally comes in, bullet still in thigh, because the pain/fever/stench have gotten too bad to ignore.

And sometimes people are just sadly in denial. One such case was a guy who didn’t follow up on his HIV diagnosis for 3 years because he couldn’t accept it (and came from a culture where homosexuality is taboo). Without giving away specifics, his findings were hair-raising.

Here you go.
This is essentially it.

 

[JAFERD_MD]

You're right, but what OP is completely unaware of is this:

Every person in your department is a liability. You are responsible for their behavior. These people aren't well-behaved. In fact, they're LOOKING to cause trouble and almost never have any real, organic pathology. You all know that when you get "crazy", you watch that **** like a parent watches a child in public.

All OP knows is "How cool! A paranoid schizotypal. Interesting."

What we all think in the back of our mind is: "I'm watching you, MF'er. Make my day and I'll Haldol your ass, fast."

We've had the borderline PD female complain to admin that she wasn't getting enough attention and confabulate details. We've had the OCD (truly OCD, not what kids say "oh I cleaned my car, I'm so OCD") drag things out for hours because the nurse didn't clean the table to his specifications before drawing up a med.

Imagine if your patients exercised a smidgen of self-control, responsibility, or social awareness. Your shift would be so much better.

QFT.

Examples, with the med school ones being actual real things that happened and real thoughts I had, vs my reaction if the same patient were to come in now:
Med school me, on EM rotation: WHOA, this person got into a motorcycle accident and the paramedics are literally bringing him in a gurney, and his entire (detached) leg in a bag!

Post-residency, attending me: Oh god, this will be an interesting conversation with my spouse who is in medicine for tonight, but if I (but honestly, mostly the surgeons) don't do him right, we'll be getting hit with a lawsuit.

Med school me, on EM rotation: This elderly guy who was dehydrated just got a bag of fluids and he feels so much better and gave me a hug!

Post-residency, attending me: GTFO of my ER so I can clear out the 25 other people in the waiting room so my door to doc metrics don't fall and the admins don't breath down my neck

Med school me, on EM rotation: Oh neat, this 10" lac on this guy's leg that I get to close up! (Did this one with another med student)

Post-residency, attending me: Can I just staple this? This is going to waste me 45 minutes when I should be seeing another 2-3 more patients. Where's the half-competent medical student who can do it for me and not increase my liability?

I wrote the same empathetic personal statements to get into med school/residency and took the same humanistic touchy-feely classes in med school as OP and everyone else on this thread. I actually like my job too because I feel I'm relatively well-compensated, it's lower stress and there's low malpractice risk. But it doesn't stop me from getting QI/peer review requests in my inbox for s*** I missed, my bonuses being partially tied to how many patients left without being seen, and having 10 people find me to give me EKGs, give me the phone to a consultant, tell me about the crashing patient 3 doors down and say the chemistry panel on Bed 7 hemolyzed...all at once. As a medical student, you see none of those (except maybe the last example, but even so, you're not in the position of cognitive overload trying to triage all of these).