Multiple Paths...Seeking Advice from the Elder Gods

[SeekerOfTheTree]

Hey Guys,

Need some advice here. I am in my 3rd year with the end in sight. I have started looking at jobs and need some help. I have 3 options and I can't figure out what to do and how it would be.

My home situation is got two kids one school aged and a wife with her family in this home state. So that gives background.

Options:

1) I stay in my current state with poor to ok malpractice environment and maybe make 250k-300k on the higher end.
2) Do multiple locums or travel options and make 400k for working around 10 days but I am gone
3) Move to Houston where they are paying great amounts of money and a great malpractice environment

I am leaning with option 3 eventhough it involves uprooting the family. Would Houston be worth it? The thought of the heat scares me but the pay off for the rest of my life seems worth it. The whole thought of starting all over again trying to make friends as an old man...have you guys gone through this struggle? What are your thoughts? What if I hate it down there and spontaneously combust due to the insane heat and humidity.

Option two seemed tempting because I have done consulting before but to be gone 10 days a month 120 a year 2400 over the span of a career seems like I am gone 6 and a half years over a 20 year career. 2 is tempting because things stay the same forever. I can go buy my plot in the cemetery right now and life is good forever.

Option one seems the most appealing but least profitable.

What are your guys thoughts? I need some help, I can't call on the quantum selves from the parallel worlds in the future so I thought I would seek your guys input.

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[Birdstrike]

Definitely #3, on one condition: If the wife is on board.

"If momma ain't happy, ain't nobody happy."-Some Guy

 

[GeneralVeers]

I work South of Houston and it's entirely liveable. God created a thing called "Air Conditioning".

 

[emergentmd]

Take #2 off your list. Don't even consider it if you want to stay married/see your kids growing up. I assume locums means flying somewhere and not driving less than 1 hr away

1 and 3 are a toss up depending on your situation. Don't even take the heat/humidity into the equation. After a year you will have no issues with it and never go to a cold place again.

I live in Texas so I would take 3 in a heartbeat. If money is a big deal, go to Houston. I live in texas and work 15 dys a month and on pace to pull in over 500k plus full benefits.

 

[vtucci]

Moved to Houston area after residency (in FL) and took job as an attending. Have 2 kids, great cost of living. Only downside for me is that I'm not a fan of bbq, tex-mex or spicy food.

 

[SeekerOfTheTree]

Thanks guys. Number 2 seemed tempting but you guys are right. I gotta brush up on my Spanish then. Thanks for the advice.

 

[Old_Mil]

1. Houston
2. Locums
3. Stay in your bad malpractice state

Unless you repeat your mistakes you can only get divorced from the same woman once.

There is no limit to the number of times malpractice lawyers can come after you.

 

[SeekerOfTheTree]

1. Houston
2. Locums
3. Stay in your bad malpractice state

Unless you repeat your mistakes you can only get divorced from the same woman once.

There is no limit to the number of times malpractice lawyers can come after you.

Lol I had to read this a few times. You are right.

 

[da8s0859q]

For those advocating Texas, a question (from a Texan finishing residency in less than a year far away):

If living in a state which is middle of the pack from a med mal standpoint -- think 20s-30s per ACEP report cards and AAEM's series on the same -- with how much conviction would you still want to move to a place like Texas (or Indiana, or some other medicolegal mecca)? Assume no family commitments or anything of the sort.

Curious about the feelings of those who have been out awhile.

 

[Old_Mil]

If moving from a middle of the pack malpractice state to texas results in your malpractice burden going from 3-4 lawsuits in a 25 year career to 0-1 is it worth it?

Sent from my awesome Ubuntu device using the Forum Browser app

 

[deleted109597]

Medmal, great climate for FSEDs if that's your thing (and it probably should be), awesome restaurants in some cities. I'm really not sure why some people have this huge hangup on Texas.
It's not like you're required to wear camo and carry a gun everywhere.

 

[fahimaz7]

How are those btw? I have a great opportunity at one (prime location) but have hesitation doing it right out of residency..

 

[MechEDoc]

Hi! I’ve got a similar question to the original poster and would love advice as well…

I’m a third and last year emergency medicine resident and long time SDN lurker who is starting to look for a post-residency job. I also happen to be community bound in a place that is strongly focused on academic medicine, as such there is little meaningful faculty assistance in making this next transition. Myself and the few other community bound residents are pretty much at a loss about how to go about finding good community jobs as well as the range of realistic opportunities for a new graduate.

As everyone has life factors that strongly influence what they’re looking for in a job, here are some of mine:

1. Single, have a dog and would be willing to travel for work.
2. Come from a long background of independent hard workers (family of entrepreneurs), I got my start in the lawn mowing business prior to having a educated profession (sadly cutting grass earned 4x per hour than I do as a resident!) - want to be in an environment where productivity matters a least somewhat!
3. Would love to live in the mountains (love mountain sports) but realize that jobs in those areas can be hard to come by, low paying, or both.
4. I’d be happy to commute (see #1). Ultimately I would like to find a community that I really like, put down roots, be part of a local democratic group, etc. but that is not something I’m shooting for inside of 3-5 years, I’d be happy if I found that on my first job, but that seems unlikely.

I think my ideal job would be a level II or III trauma center in a state with favorable liability laws, a patient volume of at least 20-30k, the ability to batch shifts (ten to twelve 12 hour shifts a month or something similar), and the opportunity to cut my teeth while really learning my new trade (residency has just given me a foundation - I feel like I have so much farther to go..!).

Any suggestions on where to get started? Where to turn to for contract negotiation advice? Any folks willing to act as a sounding board as to whether my hopes are even realistic?

Thanks!

 

[Doctor Bob]

Any suggestions on where to get started?!

Perhaps you'd be suited for a locums job.
You can batch your shifts, work as much as you want for as long as you want, then go vacation in the mountains for 1-2 weeks a month.
You'd be sacrificing point #4 (with the whole putting down roots thing), but you can establish your base of operations and put down your roots there. You just wouldn't be working there.


But I'll be honest.
My real reason for helping to answer your question is that now, having replied to this thread with advice, I can refer to myself as an Elder God.

 

[Birdstrike]

Hi! I’ve got a similar question to the original poster and would love advice as well…

I’m a third and last year emergency medicine resident and long time SDN lurker who is starting to look for a post-residency job. I also happen to be community bound in a place that is strongly focused on academic medicine, as such there is little meaningful faculty assistance in making this next transition. Myself and the few other community bound residents are pretty much at a loss about how to go about finding good community jobs as well as the range of realistic opportunities for a new graduate.

As everyone has life factors that strongly influence what they’re looking for in a job, here are some of mine:

1. Single, have a dog and would be willing to travel for work.
2. Come from a long background of independent hard workers (family of entrepreneurs), I got my start in the lawn mowing business prior to having a educated profession (sadly cutting grass earned 4x per hour than I do as a resident!) - want to be in an environment where productivity matters a least somewhat!
3. Would love to live in the mountains (love mountain sports) but realize that jobs in those areas can be hard to come by, low paying, or both.
4. I’d be happy to commute (see #1). Ultimately I would like to find a community that I really like, put down roots, be part of a local democratic group, etc. but that is not something I’m shooting for inside of 3-5 years, I’d be happy if I found that on my first job, but that seems unlikely.

I think my ideal job would be a level II or III trauma center in a state with favorable liability laws, a patient volume of at least 20-30k, the ability to batch shifts (ten to twelve 12 hour shifts a month or something similar), and the opportunity to cut my teeth while really learning my new trade (residency has just given me a foundation - I feel like I have so much farther to go..!).

Any suggestions on where to get started? Where to turn to for contract negotiation advice? Any folks willing to act as a sounding board as to whether my hopes are even realistic?

Thanks!

Assuming your program has been around a long time, get a list of alumni and where they've gone regionally. Then call people in places you'd like to go. Also, go to ACEP or other conference and meet as many docs as possible, and find out which are in groups that need people. Apply and fly around the country interviewing and checking places out. Avoid recruiters. These jobs usually suck and are so desperate they need to use recruiters.

You'll get a job, no problem. It just takes a lot of leg work, following leads and interviewing, to track down the right one for you.

 

[MechEDoc]

Perhaps you'd be suited for a locums job.
You can batch your shifts, work as much as you want for as long as you want, then go vacation in the mountains for 1-2 weeks a month.
You'd be sacrificing point #4 (with the whole putting down roots thing), but you can establish your base of operations and put down your roots there. You just wouldn't be working there.

Does anyone have experience with Locums... I'm concerned that taking one right out of residency might be bad for career development (both of my skills - i.e. being a lone ranger of sorts might not be wise and how future employers might perceive that chapter of my life). Ultimately I want to put down roots and work locally. Right now I have only the vaguest of ideas as to where that might be and would love the flexibility of being able to decouple my home base with work. Bad idea or reasonable?

 

[docdragon]

Hi! I’ve got a similar question to the original poster and would love advice as well…

I’m a third and last year emergency medicine resident and long time SDN lurker who is starting to look for a post-residency job. I also happen to be community bound in a place that is strongly focused on academic medicine, as such there is little meaningful faculty assistance in making this next transition. Myself and the few other community bound residents are pretty much at a loss about how to go about finding good community jobs as well as the range of realistic opportunities for a new graduate.

As everyone has life factors that strongly influence what they’re looking for in a job, here are some of mine:

1. Single, have a dog and would be willing to travel for work.
2. Come from a long background of independent hard workers (family of entrepreneurs), I got my start in the lawn mowing business prior to having a educated profession (sadly cutting grass earned 4x per hour than I do as a resident!) - want to be in an environment where productivity matters a least somewhat!
3. Would love to live in the mountains (love mountain sports) but realize that jobs in those areas can be hard to come by, low paying, or both.
4. I’d be happy to commute (see #1). Ultimately I would like to find a community that I really like, put down roots, be part of a local democratic group, etc. but that is not something I’m shooting for inside of 3-5 years, I’d be happy if I found that on my first job, but that seems unlikely.

I think my ideal job would be a level II or III trauma center in a state with favorable liability laws, a patient volume of at least 20-30k, the ability to batch shifts (ten to twelve 12 hour shifts a month or something similar), and the opportunity to cut my teeth while really learning my new trade (residency has just given me a foundation - I feel like I have so much farther to go..!).

Any suggestions on where to get started? Where to turn to for contract negotiation advice? Any folks willing to act as a sounding board as to whether my hopes are even realistic?

Thanks!

You have to do a lot of the legwork yourself. Pick your initial criteria and start narrowing down. Want mountains? Look near mountains. Does that include the Appalachians? The northwest? Etc. Pick an area or few and start calling about job opportunities. If you only want a SDG, that will narrow the options.

If there are a few alumns in the community, ask for their input. If you work at a community shop for experience, ask those docs. Read up on contracts. Garmel's book. AAEM. Etc. Barb Katz. Go to ACEP, maybe even check out the democratic group section,

Does that help?

 

[MechEDoc]

Thanks for all the quick replies... Just to answer some of the points above. I've reached out to alumni and even the guy I played hockey with in third grade who's now an ED doc in Oregon (I took a longer route to medicine). Some of those leads might be fruitful. Long term I'm looking for a SDG, short term I am open for anything. My areas of interest are Colorado followed by Washington and then perhaps Oregon. "docdragon" thanks for the tips on Barb Katz's and Garmel's books - I hadn't heard of them yet, but hopefully they'll help me come up to speed prior to signing on somewhere!

 

[EM Junkie]

MechEDoc, send me a PM if you're interested in hearing more about our SDG in Houston. We're hiring a full time doc now.