moonlighting at low volume ED for extra $$$

[usmle6969]

I'm a M4 likely going into Emergency Med. I'm trying to get a better sense of realistic economics of EM when it comes to those who work greater the average 36 hour week. Do most people who work above the normal just pick up more shifts in their hospital/group?

Is it reasonable to have a full time gig (36 hours per week earning, say, 275K in a busy, level 1 trauma) and an additional gig where you work, say, 1-2 12 hour shifts (or even 24 hour adding an additional 100-150K) in a low volume boonies hospital where you maybe see only <10 patients in 12 hours. (possibly I would envision living in a city for my main gig and commuting 2 hours one day a week to the "easy" low volume ED in podunkville . In theory doesn't this seem like a realistic way to make more money without burning out? Thoughts from anyone with similar gigs? Do these "easy" jobs existent in the first place,?

Also do most places have options to work 12 hours or is it usually 8 and 10? I figure many would much rather have 4 days off per week than 3, even if those 3 days of work are gonna be more brutal.

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[namethatsmell]

"Hard" does not always equal level 1 trauma center and "easy" does not always equal podunk ED. Varies widely based on staffing, pt populations, admin, access to/relationships with specialists, EMR, etc.

It's also generally accepted that for the vast majority of EPs the less hours you work the less likely you are to burn out.

 

[link2swim06]

I'm a M4 likely going into Emergency Med. I'm trying to get a better sense of realistic economics of EM when it comes to those who work greater the average 36 hour week. Do most people who work above the normal just pick up more shifts in their hospital/group?

Is it reasonable to have a full time gig (36 hours per week earning, say, 275K in a busy, level 1 trauma) and an additional gig where you work, say, 1-2 12 hour shifts (or even 24 hour adding an additional 100-150K) in a low volume boonies hospital where you maybe see only <10 patients in 12 hours. (possibly I would envision living in a city for my main gig and commuting 2 hours one day a week to the "easy" low volume ED in podunkville . In theory doesn't this seem like a realistic way to make more money without burning out? Thoughts from anyone with similar gigs? Do these "easy" jobs existent in the first place,?

Also do most places have options to work 12 hours or is it usually 8 and 10? I figure many would much rather have 4 days off per week than 3, even if those 3 days of work are gonna be more brutal.

I think you could work as many hours as you want. It's just going to get exhausting and might not be worth the extra 100K that is going is going to be taxed at nearly 50%. Run the marathon not the sprint. Find balance in your life and you will be more happy. The extra 50K isn't likely the magic ticket to it.

And to your last point, I don't think there are many easy jobs in the field of EM.

 

[usmle6969]

I think you could work as many hours as you want. It's just going to get exhausting and problem not worth the extra 100K that is going is going to be taxed at nearly 50%. Run the marathon not the sprint. Find balance in your life and you will be more happy. The extra 50K isn't likely the magic ticket to it.

And to your last point, I don't think there are many easy jobs in the field of EM.

Sorry, Easy was a loaded word. I just meant gigs that are low volume. I would imagine myself to be personally be less burned out picking up supplemental shifts where the pt volume is <50% less than my full time. I guess I was asking more if low volume ed gigs exist in more rural towns.

 

[shoal]

Ues it exists. Does it pay well, maybe but most dont

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[Vandalia]

Two things:

1) As other have pointed out, a low volume ED is not necessarily "easier" work than a high volume trauma center. It would be if you had equal resources at both places, but you won't. What might take 5 minutes to consult a sub-specialty resident, can easily take 45 minutes of your time at a solo ED.

2) All money is not equal. This might be the toughest thing to realize at your stage in the process. $25K can seem like a ton of money when you are a medical student, or even a young resident. However, when you are an attending that same $25K is a whole lot less tempting. When it comes to that decision of $25K or play with the kids, or work in the garden, or get some extra sleep (or all 3), your decision will be a whole lot different.

 

[The White Coat Investor]

Two things:

1) As other have pointed out, a low volume ED is not necessarily "easier" work than a high volume trauma center. It would be if you had equal resources at both places, but you won't. What might take 5 minutes to consult a sub-specialty resident, can easily take 45 minutes of your time at a solo ED.

2) All money is not equal. This might be the toughest thing to realize at your stage in the process. $25K can seem like a ton of money when you are a medical student, or even a young resident. However, when you are an attending that same $25K is a whole lot less tempting. When it comes to that decision of $25K or play with the kids, or work in the garden, or get some extra sleep (or all 3), your decision will be a whole lot different.

Amen. The first $25K a month is worth a lot more than the second $25K a month, both due to the extra taxes and the decreasing marginal utility of money.

 

[midweststudent1]

Ues it exists. Does it pay well, maybe but most dont

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Do small rural ED's pay significantly less? Don't they often already have a hard time finding physicians to staff their hospitals?

 

[Apollyon]

Do small rural ED's pay significantly less? Don't they often already have a hard time finding physicians to staff their hospitals?

I am in here before people use their local environment, and extrapolate it to nationwide (which isn't true).

In South Carolina, Pennsylvania, and Hawai'i, small rural EDs pay less. "Significantly" is debatable. And, yes, they DO have a hard time finding docs.

That is what makes it a head scratcher..."location, lifestyle, pay - pick two". They don't have location, lifestyle, OR pay, so you get nothing but the dregs. I make it work by working enough shifts, so it becomes financially tenable. What doesn't make sense is not paying full time guys more, but affording the idiotically expensive locums prices.

Now, as per usual on SDN, someone will say that Texas pays wonderfully. That is a great example, and, if you can make the move, do it. The more sanguine ones will say that they don't know for how long the largesse will last.

 

[Vandalia]

Do small rural ED's pay significantly less? Don't they often already have a hard time finding physicians to staff their hospitals?

Depends. The phrase "small rural ED" covers a wide range of places. I am sure there are people in New York City who consider Evansville, IN rural.

In some cases, it is a package deal. We are affiliated with a system that has one medical center and several smaller, "critical access" hospitals. As part of the "privilege" of our group having the contract, we agree to provide staffing at the smaller places. Everything is lumped together when salary is calculated and we have a fairly equal rotation to the rural places.

At the other extreme, some places staff solely with PA/ANP or minimally certified physicians - i.e., just enough training to have a valid license. They are obviously going to be paid a lot less.

You are not going to make more money working at an ED at a 5 bed hospital. However, I am fairly certain that you will make more at a town like Owensboro, KY than you will in Brooklyn, NY. Especially when you consider cost-of-living. Again, it depends what you consider rural, and what you consider small.

 

[Arcan57]

Depends. The phrase "small rural ED" covers a wide range of places. I am sure there are people in New York City who consider Evansville, IN rural.

In some cases, it is a package deal. We are affiliated with a system that has one medical center and several smaller, "critical access" hospitals. As part of the "privilege" of our group having the contract, we agree to provide staffing at the smaller places. Everything is lumped together when salary is calculated and we have a fairly equal rotation to the rural places.

At the other extreme, some places staff solely with PA/ANP or minimally certified physicians - i.e., just enough training to have a valid license. They are obviously going to be paid a lot less.

You are not going to make more money working at an ED at a 5 bed hospital. However, I am fairly certain that you will make more at a town like Owensboro, KY than you will in Brooklyn, NY. Especially when you consider cost-of-living. Again, it depends what you consider rural, and what you consider small.

This is actually something to be aware of when picking a hospital. Pretty much everybody is familiar with the concept of academic attendings being farmed out to work at community "affiliated" shops that have all the downsides of community medicine combined with academic pay. There are also a lot of groups that have one flagship hospital where everything is roses and all the specialties work in harmony and it's a 10 minute commute from your house but also 3 or 4 satellite hospitals that critical access, are 0.5-1.5 hrs away from the main center, and have with varying to non-existent levels of specialty coverage. There's nothing inherently wrong with that set-up but if the group is hiring, it's unlikely to be because they can't find docs to work at their Shangri-La location. If the other hospitals staffed by the group are a no-go for you, get that in writing or you're going to find yourself either working the majority of your shifts in the boonies or dealing with being given significantly fewer hours than promised.

 

[RuralEDDoc]

In regards to OP:
Yes, you can mix jobs to see different acuity levels, challenges, and pay.
My main job (~14 shifts per month) is a rural, high acuity hospital with less-than-ideal specialty back up. It's a great place to work but I promise I won't be working there 14 shifts a month forever - that's a recipe for burnout. It's just too high stress. I dig the adrenaline for now.
My second job (~2 shifts per month) is an urban, low acuity hospital (low acuity as there are bigger local hospitals that get the traumas, stemis, and strokes) that pays equally well as my first job, has better access to specialists, and I get out on time after my shifts (meaning my hourly is actually higher than my main gig). Its a nice break but I couldn't do it full time forever - too damn sleepy and at times just plain boring.
The combo works out for me. If I could do my main job twice less per month and my side job twice more, I think that would be a perfect mix.
Also, my 0wn experience above exemplifies the discussion of what is actually hard - my podunkville shifts are triple the stress and difficulty of my city job.

 

[emergentmd]

I actually like a main job + IC work for many reasons. Just don't get burned out.

My monthly goal is 12 shifts main job (100hrs) + 2 IC shifts (20 hrs) = $300K + $100K

 

[EM_Rebuilder]

I'm a M4 likely going into Emergency Med. I'm trying to get a better sense of realistic economics of EM when it comes to those who work greater the average 36 hour week. Do most people who work above the normal just pick up more shifts in their hospital/group?

Is it reasonable to have a full time gig (36 hours per week earning, say, 275K in a busy, level 1 trauma) and an additional gig where you work, say, 1-2 12 hour shifts (or even 24 hour adding an additional 100-150K) in a low volume boonies hospital where you maybe see only <10 patients in 12 hours. (possibly I would envision living in a city for my main gig and commuting 2 hours one day a week to the "easy" low volume ED in podunkville . In theory doesn't this seem like a realistic way to make more money without burning out? Thoughts from anyone with similar gigs? Do these "easy" jobs existent in the first place,?

Also do most places have options to work 12 hours or is it usually 8 and 10? I figure many would much rather have 4 days off per week than 3, even if those 3 days of work are gonna be more brutal.

Everything you described above is doable in EM. Others have pointed out some of the flaws in your thinking.

You concern of burnout is easily circumvented by not letting your desires outcost your means. In other words, in this field, its EASY to say "The Ferrari is ONLY 2 more shifts a month.. or I can join the Country Club for ONLY one shift a month... or the 5000 foot house is ONLY 1 more shift a month over the 3500 foot house...etc" When you do that, you become tied and stuck to your job, before long, you hate life and therefore you are burned out.

You can make a great living in EM working in various capacities and will make more than 90%+ of Americans (more than 98%+ in reality). Save money, work more when your young and its fun. Once you have a few million in the bank, work less, enjoy life, and go to work for the same reasons you signed up for it... to take care of patients.

 

[The White Coat Investor]

Everything you described above is doable in EM. Others have pointed out some of the flaws in your thinking.

You concern of burnout is easily circumvented by not letting your desires outcost your means. In other words, in this field, its EASY to say "The Ferrari is ONLY 2 more shifts a month.. or I can join the Country Club for ONLY one shift a month... or the 5000 foot house is ONLY 1 more shift a month over the 3500 foot house...etc" When you do that, you become tied and stuck to your job, before long, you hate life and therefore you are burned out.

You can make a great living in EM working in various capacities and will make more than 90%+ of Americans (more than 98%+ in reality). Save money, work more when your young and its fun. Once you have a few million in the bank, work less, enjoy life, and go to work for the same reasons you signed up for it... to take care of patients.

The amount of wisdom packed into this single post is unbelievable.