I want to sacrifice location to maximize pay in my first attending job (anywhere in the country) - I don't know where to start

[theWUbear]

The long and short of this post is that I'd work anywhere in the country (from Anchorage to North Dakota to Texas to FL, etc.) for a decent quality of job and >>$300/hr and I don't know how to comprehensively search for jobs on a national scale other than reading classified ads
----

I'm a rising third year resident in a new three-year program, candidate for chief resident. If not named chief, will still be graduating with research/leadership positions/awards that demonstrate I was more than just a resident who coasted through. I am the type of physician that can't not get involved in making a system better and taking on more than just clinical responsibilities.

I have been told that there are three qualities in a job and you can't have them all: great location, great quality of job, and great pay. I am not tied down geographically at this time, and would like to sacrifice location to an extreme to get a decent quality of job with great pay that represents the difficulty of attracting a candidate to the area based on undesirable location. I'm not considering locums - I want to hone my practice in a hospital system for the next few years the right way. I'm therefore at this job for at least 3 years if I have a good experience. Part of my desire to live 'anywhere' is that it jives with my personality - I've lived all over the US and have a passion for exploring new places and learning from new people.

All I know how to do for this is use websites such as www.edphysician.com and find the jobs that advertise >$300/hour pay, to start. But most jobs do not advertise their hourly rate off the bat, perhaps it is tacky to do so. Are there national recruiters I should get in contact with? How would you go about such a national search? Are there markets you recommend I look into other than Texas at large? Thank you for your recommendations.

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[Merely]

No one is going to pay a brand new grad 300/hr lol..

 

[theWUbear]

No one is going to pay a brand new grad 300/hr lol..

I was unaware that the online advertised rates for jobs seeking BC/BE physicians do not apply to new grads - should I take into account that advertised offers do not apply to me or is that post incorrect? As I continue to receive cold call/email/letters, should I presume the offers made to me do not apply and when I express interest a lower number will be given because I am a new grad?

 

[MechEDoc]

I do not have definite answers for you on where to go for $300 or more per hour, however I might have some insights...

I'm a rising third year resident in a new three-year program, candidate for chief resident. If not named chief, will still be graduating with research/leadership positions/awards that demonstrate I was more than just a resident who coasted through. I am the type of physician that can't not get involved in making a system better and taking on more than just clinical responsibilities.

That's great that you're a rising star, but I don't think any employers will care. Being the type of physician that "can't not get involved in making a system better" will work against you. Systems that will pay you $300 an hour or more for starting are probably dysfunctional and will not be super excited to have your brand-new attending feedback. There are well-run private groups that will pay over $300 per hour, these jobs or word-of-mouth, the salaries are not easy to discern without firsthand knowledge, and you will not start at this pay. Again, I'm sure they'd be thrilled to get some pointers (no matter how valid they are!).

I have been told that there are three qualities in a job and you can't have them all: great location, great quality of job, and great pay. I am not tied down geographically at this time, and would like to sacrifice location to an extreme to get a decent quality of job with great pay that represents the difficulty of attracting a candidate to the area based on undesirable location. I'm not considering locums - I want to hone my practice in a hospital system for the next few years the right way. I'm therefore at this job for at least 3 years if I have a good experience. Part of my desire to live 'anywhere' is that it jives with my personality - I've lived all over the US and have a passion for exploring new places and learning from new people.

If you are hoping to start a $300 per hour you are likely going to find yourself in a terrible location and a suboptimal emergency department. You can really cut your teeth there and hone your training, however it's unlikely you will find a "decent quality of job".

All I know how to do for this is use websites such as www.edphysician.com and find the jobs that advertise >$300/hour pay, to start. But most jobs do not advertise their hourly rate off the bat, perhaps it is tacky to do so. Are there national recruiters I should get in contact with? How would you go about such a national search? Are there markets you recommend I look into other than Texas at large? Thank you for your recommendations.

You might be able to find a $300 per hour job in Texas, however this will be harder with the implosion of freestanding emergency departments which lead to an excess of physicians. There was a private group in Abilene Texas that was consistently advertising jobs around $300 per hour. They were taken over by Envision who continues to offer a "*NEW RATE** Avg $300/hr" for the last 4 years. I visited that ER and it seems like a decent place. They have an aviation boneyard outside of town, meth, and sagebrush.

Other decent paying places are the deep South and the frigid rural northern Midwest. To consistently hit $300 per hour you need to find a place where very few other people want to live, a good payer mix, and utilization of PAs and NPs. The reason for the latter requirement is that a typical ED physician at 2 patients per hour will likely bring in $150 gross professional fees per patient, this will lead to a gross of $300 per hour, out of this needs to come profits for the managing entity (you will likely be working for contract management group), malpractice, and all of your other overhead expenses. Unless you work for a very lean group (in which case you will not be offered $300 per hour) you are looking at a likely overhead of at least 30%. As such, you will be unable to see $300 per hour unless your work is subsidized or you are utilizing cheaper providers and you are profiting off their labor.

Best of luck!

 

[BoardingDoc]

No one is going to pay a brand new grad 300/hr lol..

Yes they will. If you're working at a dumpster fire of an ED that can't get anyone else that is.

 

[namethatsmell]

If you don’t want the risk/reward of working your way up in an SDG or and don’t want to work in a hellscape-like environment, consider adjusting your expectations to a rate that begins with a 2.

 

[hundreddaysoff]

The long and short of this post is that I'd work anywhere in the country (from Anchorage to North Dakota to Texas to FL, etc.) for a decent quality of job and >>$300/hr and I don't know how to comprehensively search for jobs on a national scale other than reading classified ads
----

I'm a rising third year resident in a new three-year program, candidate for chief resident. If not named chief, will still be graduating with research/leadership positions/awards that demonstrate I was more than just a resident who coasted through. I am the type of physician that can't not get involved in making a system better and taking on more than just clinical responsibilities.

I have been told that there are three qualities in a job and you can't have them all: great location, great quality of job, and great pay. I am not tied down geographically at this time, and would like to sacrifice location to an extreme to get a decent quality of job with great pay that represents the difficulty of attracting a candidate to the area based on undesirable location. I'm not considering locums - I want to hone my practice in a hospital system for the next few years the right way. I'm therefore at this job for at least 3 years if I have a good experience. Part of my desire to live 'anywhere' is that it jives with my personality - I've lived all over the US and have a passion for exploring new places and learning from new people.

All I know how to do for this is use websites such as www.edphysician.com and find the jobs that advertise >$300/hour pay, to start. But most jobs do not advertise their hourly rate off the bat, perhaps it is tacky to do so. Are there national recruiters I should get in contact with? How would you go about such a national search? Are there markets you recommend I look into other than Texas at large? Thank you for your recommendations.

Here's how I found a great job paying $275/h. It was pretty easy and if I had looked in a few more states and been a bit more anal I'm sure I would've bagged a $300er. Caveats of this system: this was in 2016, I had no way of knowing a priori it was a good job, and it entails CMGs.

1. Figure out what states you want to search. For me in 2016 it was TX. If you just go by MGMA, for you in 2019 it might be like MS, NM, and NV.

2. Find the Envision and Teamhealth rep assigned to your residency's area. They're usually the attractive young people who advertise the free dinners. Don't bother w/ USACS; their whole business model is based on lowballing new grads.

3. Tell the reps you're interested to work in these states and you want to talk to the local reps. Often reps are randomly assigned to different states.

4. Email the local reps and tell them you're super-excited to work in their state and would like to see a list of all their jobs.

At least in my case, they sent me a spreadsheet with all the compensation and other numbers. Now, just get the rep to send you contact info for medical director etc and try to figure out if it's a good-quality job (easier said than done as a new grad). But I agree w/ other posters that if you sound too idealistic on the phone, they might peg you as annoying and not hire you, so try to keep it low-key.

I don't know how to do this w/ SDGs. Probably a lot more time-intensive.

 

[Porfirio]

You can find it (even as a new grad). Honestly, many residency programs are dumpster fire EDs and worse lifestyle. Talk to recruiters to get a baseline of what they are offering if they are offering $220 per hour there is no way to get close to $300 per hour. Find a place that offers $250 then negotiate up. Remember sign on bonus, student loan repayment, CME, moving reimbursement can be negotiated.

 

[gro2001]

The long and short of this post is that I'd work anywhere in the country (from Anchorage to North Dakota to Texas to FL, etc.) for a decent quality of job and >>$300/hr and I don't know how to comprehensively search for jobs on a national scale other than reading classified ads
----

I'm a rising third year resident in a new three-year program, candidate for chief resident. If not named chief, will still be graduating with research/leadership positions/awards that demonstrate I was more than just a resident who coasted through. I am the type of physician that can't not get involved in making a system better and taking on more than just clinical responsibilities.

I have been told that there are three qualities in a job and you can't have them all: great location, great quality of job, and great pay. I am not tied down geographically at this time, and would like to sacrifice location to an extreme to get a decent quality of job with great pay that represents the difficulty of attracting a candidate to the area based on undesirable location. I'm not considering locums - I want to hone my practice in a hospital system for the next few years the right way. I'm therefore at this job for at least 3 years if I have a good experience. Part of my desire to live 'anywhere' is that it jives with my personality - I've lived all over the US and have a passion for exploring new places and learning from new people.

All I know how to do for this is use websites such as www.edphysician.com and find the jobs that advertise >$300/hour pay, to start. But most jobs do not advertise their hourly rate off the bat, perhaps it is tacky to do so. Are there national recruiters I should get in contact with? How would you go about such a national search? Are there markets you recommend I look into other than Texas at large? Thank you for your recommendations.

I did a far and wide search of rural jobs back in 2015. Here are a couple of lessons I learned:

1) You often don't know what the actual rate is going to be. Many many places will have, for example, a $180 base + % RVUs +/- bonuses/penalties set by the group (satisfaction, meeting attendance, other group 'citizenship' issues, etc). Even if they are being completely transparent, at best they can give you a range of what most people end up taking home as an hourly rate, and that rate can be pretty wide (with the example I gave, anywhere from $200 - 275). Even in that scenario, you don't know how you will fit in with that range. A lot of people end up making a lower rate initially until they figure out the charting game and other ways of maximizing their RVUs. Then again, maybe their docs are all older/slower/lazier and you will start within that range or higher. Or maybe they are older but more savvy and will pick up all the charts with the highest bang for buck. So even if they are being completely transparent (like show you the actual anonymized rates for every doc in the group for the last quarter), you don't really know. Most will not be that transparent. While not trying to actively fool you will be perhaps overly optimistic. And then there will be those who will outright lie to you. Unfortunately those last two groups of recruiters/admins will be very hard to tell apart.

2) There are very few (non partner) jobs that are sustainable that will earn you over $250/hour. Vast majority of places higher than that are either dumpster fires no sane person will last more than a year at or just don't usually have openings. I've interviewed all over (Appalachia, South, Midwest, North East) and didn't see a single place that I would risk signing with that was offering much more than $250/hr. Some decent jobs got to the (low) 300 range, but those were few, far between, and come through a personal connection. Given that, I highly doubt the goal of >300 and a somewhat decent place is doable, even completely sacrificing location.

 

[Uranium678]

You can definitely find it without doing locums. I have heard of places in MS still offering that rate. Check out emrecruits . com for a couple as well. I’d also recommend contacting a national recruiter like comphealth and asking what they have for that rate.

 

[Birdstrike]

No one is going to pay a brand new grad 300/hr lol..

Oh, y e s they will. If it's enough of a post-apocalyptic, dirt-sniffing, colonscape.

 

[GonnaBeADoc2222]

so much lol in this thread

-No one cares if you're a chief
-There's nothing wrong with locums
-No chance of finding a "decent quality" job at that rate

 

[alpinism]

A few points.

1) Sorry to say but for community jobs no one really cares about all your research or leadership experience and if anything they're looking for doctors who will keep their head down work hard and not make any waves.

2) If you're willing to sacrifice location your best bet will be undesirable locations in southeastern states. Basically look at locations where most people would never want to live as a young successful professional. Think places like rural Western Texas hours from the nearest major city.

3) Having said the above your 2 choices are basically SDG and CMG hospitals. SDGs will usually pay less initially until you make partner so if you're looking for a high paying jobs right off the bat you're stuck with CMGs like ApolloMD, TeamHealth, and Envision.

4) Once you've figured this out its actually pretty simple. Go on their website and contact one of their regional recruiters and basically tell them what you're looking for and what's their current availability. They'll send you a list of openings with details including compensation.


Depending on where you're willing to work you can probably pull 250-300/hr as a new graduate.

 

[theWUbear]

I greatly appreciate all the advice in this thread - it's provided me some good direction. Of note, after 3-4 years in the community my plan is to head to the northeast where family is and rejoin academics, teach, and make far less money. hence my mentioning my residency projects. I will have no problem putting my head down and just focusing on clinical medicine the next few years.

 

[Groove]

I greatly appreciate all the advice in this thread - it's provided me some good direction. Of note, after 3-4 years in the community my plan is to head to the northeast where family is and rejoin academics, teach, and make far less money. hence my mentioning my residency projects. I will have no problem putting my head down and just focusing on clinical medicine the next few years.

Just move home near family and sign on as a firefighter with one of the big CMGs. Contact a few of them and tell them your requirements. I think TH still pays $300/hr for their strike team, at least in my area. Take their 50K sign on and do the work for a couple years, then reassess. Academics in the NE is going to be quite the pay cut.

New grads and their mothers are the only ones who think they are extra special coming out of residency. The rest just see you as a new grad. No offense. What I mean is that nobody really cares whether you were chief or what research you did in residency.

 

[RustedFox]

/b/ *fast forward*

OP meets girl.
OP moves to PNW to be with her, because of reasons.
OP proposes marriage.
OP has son, who is rising baseball star.
OP moves to midwest/southeast so son can be scouted and/or go to good baseball school on scholarship.
OP never took that 300+ dollar/hour job in EastCan'tStandIt, nor did he go into academics in the NE.

Life is what happens while you were busy making other plans.

 

[Druggernaut]

If I was just looking to make the most money possible, I'd move to one of a few cities in the southeast, credential at 3-4 hospitals in a 2 hour diameter from my home base, agree to a 2-4 shifts a month at each facility, then pick up additional time when they're short staffed for bonus pay. There's plenty of jobs down there in cities with over 100,000 population that'll pay $280/hr, but $300 base pay gets more difficult.

You may find some difficulty going from a little rural ED to a big name academic center without some sort of academic activity for several years. My experience in doing medical school and residency in places I didn't want to live has me convinced it's not worth it to chase the big money to the exclusion of all else, but it's your decision. There are also academic places paying $230-250/hr too, so you don't need to take a vow of poverty to teach residents.

 

[TooMuchResearch]

Here's how I found a great job paying $275/h. It was pretty easy and if I had looked in a few more states and been a bit more anal I'm sure I would've bagged a $300er. Caveats of this system: this was in 2016, I had no way of knowing a priori it was a good job, and it entails CMGs.

1. Figure out what states you want to search. For me in 2016 it was TX. If you just go by MGMA, for you in 2019 it might be like MS, NM, and NV.

2. Find the Envision and Teamhealth reps affiliated with your residency. They're usually the attractive young people who advertise the free dinners. Don't bother w/ USACS; their whole business model is based on lowballing new grads.

3. Tell the reps you're interested to work in these states and you want to talk to the local reps. Often reps are randomly assigned to different states.

4. Email the local reps and tell them you're super-excited to work in their state and would like to see a list of all their jobs.

At least in my case, they sent me a spreadsheet with all the compensation and other numbers. Now, just get the rep to send you contact info for medical director etc and try to figure out if it's a good-quality job (easier said than done as a new grad). But I agree w/ other posters that if you sound too idealistic on the phone, they might peg you as annoying and not hire you, so try to keep it low-key.

I don't know how to do this w/ SDGs. Probably a lot more time-intensive.

Residencies have affiliated CMG reps?

 

[hundreddaysoff]

Residencies have affiliated CMG reps?

Not formally on the residencies' end. Reps formally assigned by the CMGs to specific residencies/areas, yes. Fixed for clarity in original.

 

[GeneralVeers]

Residencies have affiliated CMG reps?

Best advice to you is that when you start at any new job, don't give any advice or thoughts on anything. You are a new attending and no one cares what you think. Just keep your head down, do your job, learn the system and don't make waves. Maybe once you've been practicing awhile people will value your opinion.

The best way to get fired from a job, especially a CMG one is to ask questions that management are uncomfortable answering.

 

[thegenius]

You being a new grad...and me being out 4.8 years...I'm telling ya it is really nice working for a job where you are supported by your peers and don't have a lot of pressure to churn out patients during your initial months / years.

It's going to take time for you to figure out how you are going to practice ER medicine. You don't learn that in residency. You learn that after working in the real world.

There is nothing wrong trying to make $300/hr, but if you could work at a place and make $260/hr and you are given support, guidance, and are not doing single coverage (for instance) in the first few weeks, and you aren't seeing 2.4/hr, all of these things make a difference.

It probably took me 2-3 years to figure out how to practice ER medicine. Even now...I work at two different hospital systems and I treat chest pain differently at both.

Also, COL (cost of living) will go a long way towards achieving your financial goals. If you make $260 / hr in Alabama, or make $310 / hr in urban California, your money will go so much farther in Alabama.

 

[thegenius]

If I was just looking to make the most money possible, I'd move to one of a few cities in the southeast, credential at 3-4 hospitals in a 2 hour diameter from my home base, agree to a 2-4 shifts a month at each facility, then pick up additional time when they're short staffed for bonus pay. There's plenty of jobs down there in cities with over 100,000 population that'll pay $280/hr, but $300 base pay gets more difficult.

You may find some difficulty going from a little rural ED to a big name academic center without some sort of academic activity for several years. My experience in doing medical school and residency in places I didn't want to live has me convinced it's not worth it to chase the big money to the exclusion of all else, but it's your decision. There are also academic places paying $230-250/hr too, so you don't need to take a vow of poverty to teach residents.

Working at a little rural ED fresh out of residency, with little support, having to transfer patients, this and that....just doesn't seem like the way one should enter ER medicine. I'm sure it's possible...I bet there are stories where new ER docs thrive...but they are probably not common.

Problem with residency is that most (from what I hear) have admitting privileges. Ours did. We could admit anything. I think the biggest single adjustment I had coming out of residency was learning that I couldn't just admit anything I wanted.

 

[TooMuchResearch]

Working at a little rural ED fresh out of residency, with little support, having to transfer patients, this and that....just doesn't seem like the way one should enter ER medicine. I'm sure it's possible...I bet there are stories where new ER docs thrive...but they are probably not common.

Problem with residency is that most (from what I hear) have admitting privileges. Ours did. We could admit anything. I think the biggest single adjustment I had coming out of residency was learning that I couldn't just admit anything I wanted.

Why not? Aren't you the expert in emergency disposition?

 

[thegenius]

Why not? Aren't you the expert in emergency disposition?

A fresh graduate doesn't have experience dealing with tricky dispos. In residency you basically did what your attending wanted to do. You get this false sense of security that if you just don't know you can admit the patient and you cannot get push back. Every day we get patients where we just don't know what to do. They are not super sick...those are easy. They are not well, those are also easy. It's these in-between patients. You are always taught never to send someone home with unexplained tachycardia. As a brand new attending, you are going to admit a young person who has a HR 106 and everything you've done doesn't point to a diagnosis? You've given 2L, you've done this and that.

We are experts on emergency disposition but it does take experience to develop that. We have new guys at our work and they are doing night shifts...and the other night they signed out 6 patients and there were an additional 8 to be seen by the morning doc. That has everything to do with experience and efficiency. There are lots of nuances to our work, to all work.

 

[Hercules]

A fresh graduate doesn't have experience dealing with tricky dispos. In residency you basically did what your attending wanted to do. You get this false sense of security that if you just don't know you can admit the patient and you cannot get push back. Every day we get patients where we just don't know what to do. They are not super sick...those are easy. They are not well, those are also easy. It's these in-between patients. You are always taught never to send someone home with unexplained tachycardia. As a brand new attending, you are going to admit a young person who has a HR 106 and everything you've done doesn't point to a diagnosis? You've given 2L, you've done this and that.

We are experts on emergency disposition but it does take experience to develop that. We have new guys at our work and they are doing night shifts...and the other night they signed out 6 patients and there were an additional 8 to be seen by the morning doc. That has everything to do with experience and efficiency. There are lots of nuances to our work, to all work.

It sounds like your residency experience was different than mine. As an upper level my attendings were not really sitting over my shoulder. I have an easier time admitting now than I did in residency. I also don’t do a lot of soft-I-don’t-know-what’s-going-on-but-I-don’t-want-to-send-them-home admissions. I think that should be a pretty rare occurrence, and if you’re getting pushback then you may have played that card too often.

 

[EMDOC17]

I work in a job that pays about $315/hr depending. I am not quite 2 years out and its a hospital employee gig with no RVU's but full benefits. All new hires start at the same so I started at this rate (well not really we got a raise a year out). We actually have really good consultants and partners. Decent pph with a group avg of 1.56 pph. No true partnership track so no graduated pay. Actually a good gig.

The catch you need to be willing to work nights/evenings to get that. Its also in the frigid midwest. Days are paid at a lower rate. We are hiring and need some more docs. You can PM me if you want.

 

[GonnaBeADoc2222]

I work in a job that pays about $315/hr depending. I am not quite 2 years out and its a hospital employee gig with no RVU's but full benefits. All new hires start at the same so I started at this rate (well not really we got a raise a year out). We actually have really good consultants and partners. Decent pph with a group avg of 1.56 pph. No true partnership track so no graduated pay. Actually a good gig.

The catch you need to be willing to work nights/evenings to get that. Its also in the frigid midwest. Days are paid at a lower rate. We are hiring and need some more docs. You can PM me if you want.

You must have an incredible payer mix to get that rate at such a low pph. What is the day rate? How far away is the nearest major airport?

 

[EMDOC17]

You must have an incredible payer mix to get that rate at such a low pph. What is the day rate? How far away is the nearest major airport?

I don't know the payer mix since I show up and get paid by the hour. If I am an hour after my shift I get paid for it. The nearest major airport is 2-2.5 hours south depending where you live. The day rate is 225/hr. Any hour after 10 pm is $315/hr no matter when you start.

 

[GonnaBeADoc2222]

I don't know the payer mix since I show up and get paid by the hour. If I am an hour after my shift I get paid for it. The nearest major airport is 2-2.5 hours south depending where you live. The day rate is 225/hr. Any hour after 10 pm is $315/hr no matter when you start.

That's a nice night differential

 

[EMDOC17]

That's a nice night differential

We have a stable group of "older docs" and a few newer ones. The older docs don't want to work the evenings and nights so they agreed to the differential. It allows us to either opt in or out of nights. Works for all of us. I have loans to pay so I take the nights. The other docs just want to sleep during the night so they take the pay cut. Works for us currently.

 

[Birdstrike]

My advice is to go somewhere you think you'll be happy, from the start. Any extra amount of money you earn going somewhere you're knowingly sacrificing your happiness, even short term, is unlikely to be enough to be worth it in the long run. If you go somewhere you're happy, and stay, that's one less time you have to move, find a new place to live, plant then uproot new roots, do a new job search or get used to a new place to live. It's also one less time you have to shake off the accumulated emotional exhaustion of taking on something so soul sucking, no one else wants to do it, even for the highest of wages. There is a cost to all of that one needs to consider. On the other hand, if you simply want a new adventure, then maybe that's maybe it's worth it if you can remain unattached with an easy exit strategy. But putting yourself in the best overall situation as soon as possible is usually best, even if the pay may not be the absolute highest of all available jobs.

 

[Groove]

Now that's what I call a night diff! Damn. Last time we visited the topic at my gig, everyone was all pumped about a night diff, then the CMG offered $20/hr diff and stipulated that it would come out of the day doc's pocket at the end of the day. They weren't so excited at that point and the night diff died a quick death.

 

[EMDOC17]

Groove, the more gray hairs the more you don't want to work nights. If you incentivize the new docs then you don't have to do the ****ty hours. Doc gray hair doesn't have to do a single overnight because I offered to work them at a big incentive. I pay off my loans; gray hair can works longer. I pay off my loans they continue working. Its a win win as I am seeing. I think more places should adopt it. If you want to control what you work than money talks. If our system keeps in place then I can pay my loans off in another 3 years, be financially independent, and pass the torch on to the next new grad that wants to do the same and work daytime bankers hours.

 

[Groove]

Groove, the more gray hairs the more you don't want to work nights. If you incentivize the new docs then you don't have to do the ****ty hours. Doc gray hair doesn't have to do a single overnight because I offered to work them at a big incentive. I pay off my loans; gray hair can works longer. I pay off my loans they continue working. Its a win win as I am seeing. I think more places should adopt it. If you want to control what you work than money talks. If our system keeps in place then I can pay my loans off in another 3 years, be financially independent, and pass the torch on to the next new grad that wants to do the same and work daytime bankers hours.

Hey man, I'm totally for it. You guys have a good system. I'm 45 with some serious salt and pepper action going on, so I don't know where that puts me in the classification scheme, lol. I'm nursing a right supraspinatus tendinopathy and just pulled my left lower back picking up some dumbbells yesterday so I don't feel too spry this morning. I'm shuffling around like I've got a hemorrhoid. That being said, I think I'd still gladly pull nights a few more years for that kind of diff. Glad they are making it worth your while!

At my current gig, I split the nights up evenly, no matter how long someone has been there. I just think that's fair when there is no differential. The funny thing is that my older docs never complain. I literally never hear from them. It's the brand new docs that belly ache and moan about having to work nights. If we could get a decent night diff going that everyone would support, I'd probably hear a lot less whining.

 

[EctopicFetus]

A few important items. 1) these high paying Eds will put you at high risk of med Mal and may break you.
2) if you want to make more money offer to work all nights. Many places pay $50/hr for nocturnists
3) if going the CMG route I would get credentialed at all the hospitals for all cmgs near you.
4) they will try to get you to commit. DONT beyond 4 shifts a month or something
5) if you get $300/hr and you are the highest paid person there you will be the first whose shifts they cut (after they offer to let you cut your pay first if they like you)
6) they won't commit to a number well above their advertised rate for a year (or longer).

Re new grads you won't get that money right out of the gate. Instead find a job in a location that needs docs and then be available. There is a local new grad who was making $400/hr 3 months out of residency. It didn't last long but he made the money.

Gettgin $300+/hr from a CMG is a grind. If you understand that and are flexible you can get it. $350-400 is there too. I had a buddy who would fly to BFE TX and do overnights for $600/hr.

With the overwhelming growth in residencies fewer and fewer of these jobs are around.

Also as mentioned the SDGs who pay well usually won't hire someone they don't know and yes there are SDGs where day 1 you can make $300+/hr.

 

[HLxDrummer]

I'm graduating this year and was looking at jobs this past year in the NE. Ranged between $180/hr to $300/hr. Most were low $200s. The $300/hr sounded like a **** show and despite thinking hard I actually passed on it and have no regrets (keep in mind I haven't actually started my attending job, but when you are seeing over 2PPH of high acuity patients spread over 35 beds in residency plus sign out patients with no scribe, etc it makes you really excited to see 1.6PPH with a scribe in a 12 bed pod and still make low to mid $200s).

 

[thegenius]

It sounds like your residency experience was different than mine. As an upper level my attendings were not really sitting over my shoulder. I have an easier time admitting now than I did in residency. I also don’t do a lot of soft-I-don’t-know-what’s-going-on-but-I-don’t-want-to-send-them-home admissions. I think that should be a pretty rare occurrence, and if you’re getting pushback then you may have played that card too often.

I guess our experiences were different, sounds like it.

Even then...an ER doc with 5-10 years of experience is better equipped to run solo with limited ER resources than a doc fresh out of residency. You think so? Equipped meaning everything including making a disposition.

 

[thegenius]

I work in a job that pays about $315/hr depending. I am not quite 2 years out and its a hospital employee gig with no RVU's but full benefits. All new hires start at the same so I started at this rate (well not really we got a raise a year out). We actually have really good consultants and partners. Decent pph with a group avg of 1.56 pph. No true partnership track so no graduated pay. Actually a good gig.

The catch you need to be willing to work nights/evenings to get that. Its also in the frigid midwest. Days are paid at a lower rate. We are hiring and need some more docs. You can PM me if you want.

Dude that is a great gig. 1.6 pt/hr, making > $300K/hr, and you get full benefits to boot? That job is a keeper provided it's a functional ER.

So you are somewhere in the land of...
Montana / Wyoming / Colorado / Kansas / Nebraska / South Dakota / North Dakota / Minnesota / Iowa / Illinois / Wisconsin

 

[thegenius]

Now that's what I call a night diff! Damn. Last time we visited the topic at my gig, everyone was all pumped about a night diff, then the CMG offered $20/hr diff and stipulated that it would come out of the day doc's pocket at the end of the day. They weren't so excited at that point and the night diff died a quick death.

F'ing CMGs.

They are so awful

 

[RoyBasch]

I don't know the payer mix since I show up and get paid by the hour. If I am an hour after my shift I get paid for it. The nearest major airport is 2-2.5 hours south depending where you live. The day rate is 225/hr. Any hour after 10 pm is $315/hr no matter when you start.

That's a huge differential.

To the OP (and new grads in general) Night-Day differentials are usually less than that, my group is on the low side, but its +5% per hour for nights.

To the OP: If you are really hunting huge salary, volunteering as a nocturnist could definitely help. When people cite rates that's usually the day shift. A group with say a decent 250/hr base pay could easily average above 300s over night with a decent differential. Groups always want nocturnists in general so it could definitely help break into a group that is "not hiring right now."

That being said, there are a million pros/cons of night shift besides money that have been discussed ad nauseum on this board.

 

[TooMuchResearch]

I guess our experiences were different, sounds like it.

Even then...an ER doc with 5-10 years of experience is better equipped to run solo with limited ER resources than a doc fresh out of residency. You think so? Equipped meaning everything including making a disposition.

Our group does some rural coverage, but new grads get a few month grace period (and some prefer the busy places only).

I feel very comfortable out by myself with limited specialty backup (unless I transfer).

 

[Hercules]

We have a stable group of "older docs" and a few newer ones. The older docs don't want to work the evenings and nights so they agreed to the differential. It allows us to either opt in or out of nights. Works for all of us. I have loans to pay so I take the nights. The other docs just want to sleep during the night so they take the pay cut. Works for us currently.

In my SDG we pay a $100/hr night diff. That has still led to the 8 of us splitting the nights evenly. We’re always looking for a nighthawk though who wants to take advantage of our gray hairs...

 

[deleted941485]

Lol. In 5 years, None of this is gonna matter.

 

[TooMuchResearch]

Lol. In 5 years, None of this is gonna matter.

Okay...

 

[sum dude]

... I'm not considering locums -

Then as a new grad, you're sure as hell not getting $300/hr. You might find a solid democratic group that pays that to partners, but not new grads.

 

[sylvanthus]

Agree with those saying live where you want and do locums. Probably the best way to make a decent amount of money and not live in a ****hole. Also agree with those saying leadership experience and other nonsense on the CV doesn't matter at all. I was chief, Ill be triple boarded, sat on several boards including a chapter of ACEP and AAEM, held leadership positions in the AMA, state medical society, EMRA, wrote book chapters for EMRA pubs, got my FAWM, mostly done with DIMM etc etc. NOONE CARES! You know what I am offered in the ED in the town ill be living in? 180/hr with NO benefits and these bastiches now have me double scheduled on thanksgiving with my other job and I cant find coverage. They don't realize I would drop that 180/hr no benefit job in a heartbeart as the other position pays more per hour, offers benefits, and has the possibility of loan forgiveness. Im likely going to have to quit a bloody job this early because I cannot physically be in two places at the same time. Ahhh! Kk rant off.

 

[Apollyon]

Agree with those saying live where you want and do locums. Probably the best way to make a decent amount of money and not live in a ****hole. Also agree with those saying leadership experience and other nonsense on the CV doesn't matter at all. I was chief, Ill be triple boarded, sat on several boards including a chapter of ACEP and AAEM, held leadership positions in the AMA, state medical society, EMRA, wrote book chapters for EMRA pubs, got my FAWM, mostly done with DIMM etc etc. NOONE CARES! You know what I am offered in the ED in the town ill be living in? 180/hr with NO benefits and these bastiches now have me double scheduled on thanksgiving with my other job and I cant find coverage. They don't realize I would drop that 180/hr no benefit job in a heartbeart as the other position pays more per hour, offers benefits, and has the possibility of loan forgiveness. Im likely going to have to quit a bloody job this early because I cannot physically be in two places at the same time. Ahhh! Kk rant off.

It's May. You can't find coverage for the end of November? That's almost 7 months away.

 

[Groove]

Agree with those saying live where you want and do locums. Probably the best way to make a decent amount of money and not live in a ****hole. Also agree with those saying leadership experience and other nonsense on the CV doesn't matter at all. I was chief, Ill be triple boarded, sat on several boards including a chapter of ACEP and AAEM, held leadership positions in the AMA, state medical society, EMRA, wrote book chapters for EMRA pubs, got my FAWM, mostly done with DIMM etc etc. NOONE CARES! You know what I am offered in the ED in the town ill be living in? 180/hr with NO benefits and these bastiches now have me double scheduled on thanksgiving with my other job and I cant find coverage. They don't realize I would drop that 180/hr no benefit job in a heartbeart as the other position pays more per hour, offers benefits, and has the possibility of loan forgiveness. Im likely going to have to quit a bloody job this early because I cannot physically be in two places at the same time. Ahhh! Kk rant off.

Just tell them you can't work on Thanksgiving because you're working somewhere else and offer to work Christmas and/or NYE. They'll either fly in a traveler or the AFMD/FMD will work it. It's part of the job description. I'm a little confused though, are you working a FT job and scalping moonlighting shifts on the side? If you're scalping a high dollar holiday shift on the side and therefore not making yourself available for your FT gig, that's going to be a problem.

 

[sylvanthus]

Both are part time gigs, one in the ICU one in the ED, both worked on schedules at same time, both scheduled me thanksgiving. Harder to drop the ICU shift as I work the night before and night of thanksgiving while its day shift on thanksgiving in the ED.

 

[Apollyon]

Both are part time gigs, one in the ICU one in the ED, both worked on schedules at same time, both scheduled me thanksgiving. Harder to drop the ICU shift as I work the night before and night of thanksgiving while its day shift on thanksgiving in the ED.

Again, though - are those people such humongous dinguses that, again, 7 months beforehand, are rigid in being unable to switch? Honest question.