What's wrong with this calculation?

[b-real]

We have one the few ED's in the country with staggered acuity, where new oncoming docs pick up all the high-acuity patients, then proceed downward in acuity as their shift progresses and each successive oncoming doc pushes the ones ahead of him down. At the end of the shift, we're all just mopping up quickies. The guy who is next to leave is the one who does ALL the procedures (or supervises the students/residents/fellows who are doing them). So the first 3-4 hours is VERY stressful, but the second half of the shift is pretty easy.

Harris Methodist, no?

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[tymont12]

I feel like I see this a lot on here:

"Hey! give me your input!"

(volumes of opinions given, usually negative due to the naivety of the initial post)

"I don't need your opinion, I already KNOW the truth!"

 

[e30ftw]

OP the tone of your posts shows a desire to display your knowledge rather than take to heart the advice you are given.

If you already know the answer from your real-life experiences, why ask the question?

You can absolutely find a place who will let you work 200+ hrs / mo.

In 7 years, by all means, go for it.

 

[emergentmd]

Thanks for for the info, emd!

Are these $325/hr places tiny, low-volume, low-acuity ED's in the middle of Nowhere, West/East Texas? Because a 12-hour shift isn't that bad if you only see 10 patients in those 12 hours. Now, if you have to see 40 patients in those 12 hours, then that's a whole nuther story.

Low vol/low acuity? Try a nothing to do town working in a Trauma referral center. Thats a beat down 12 hrs that I would never do as a regular job but some can do it. Nothing I would do just out of residency but when you are a high flying confident ED doc.

 

[emergentmd]

OP the tone of your posts shows a desire to display your knowledge rather than take to heart the advice you are given.

If you already know the answer from your real-life experiences, why ask the question?

You can absolutely find a place who will let you work 200+ hrs / mo.

In 7 years, by all means, go for it.

I can show you places if you want to work 30 days a month and they would let you.

 

[Arcan57]

I can show you places if you want to work 30 days a month and they would let you.

That's the sign of a quality ED.

 

[goodoldalky]

OP you have an awful long way to go and a lot to learn still. I would worry less about how many shifts a month you will logistically be allowed to work and more about passing anatomy, taking the USMLEs, rotations, and trying to figure out if you even want to do emergency medicine... You can revisit this question in about 7 years when you are looking for a job. My .02.

 

[throckmortonDO]

I too work at a Level II trauma center where we average 30 charts per shift and I can count on one hand the number of patients that I have seen die in my 16 months of 20-shifts per month work. With the other hand and a few toes I can count of the number of cancer and terminal illness diagnoses. These things do happen but they're really not all that frequent.

This is a level II center? in my ACGME program we cover a level I, level II and rural hospital. At each hospital, on each shift I can count on both hands the number of deaths, traumas, critical care, and terminal illness patients I see. PA's see the low acuity in fast track.

The center you work in does not sound like a high acuity shop.

Can you elaborate more on what this 'progressive acuity' situation at the shop you work in consists of?

What is the group that staffs this shop?

 

[b-real]

This is a level II center? in my ACGME program we cover a level I, level II and rural hospital. At each hospital, on each shift I can count on both hands the number of deaths, traumas, critical care, and terminal illness patients I see. PA's see the low acuity in fast track.

The center you work in does not sound like a high acuity shop.

Can you elaborate more on what this 'progressive acuity' situation at the shop you work in consists of?

What is the group that staffs this shop?

If it's the place I'm thinking based on his description of DFW and a staggered acuity model, it's Harris Methodist in Fort Worth...I guarantee they have more than a handful of high acuity/deaths in the ED. I'm not sure why he's painting a picture of some wonderful
Utopian ED where nobody dies.

 

[The White Coat Investor]

I am a current ED scribe who will be attending medical school next year. EM is currently one of the top specialties on my list. I love working up patients with vague abd pain or CP. I even rather enjoy the crazy psych patients. I am not quite as fond of the social work aspects but that's what LCSW's are for.

Anyway, I will finish residency with approximately 400K in debt, so compensation is a real concern for me. I plan on working my ass off the first few years out of residency to pay off the debt and I am interested in how physically or logistically possible it is to make 500K+ per year in EM. I am not worried so much about the mental or psychological aspects of working a lot of hours as my other top specialty under consideration is neurosurgery.

TLDR: Let's say $250/hr for 10 hours; 20 shifts per month; 240 shifts per year x $2500 per shift = $600,000. What's wrong with this calculation? Is is unreasonable to expect at least $250/hr with malpractice included?

More info: I currently live in Texas, will attend medical school in Texas, and will practice in Texas. The group whose physicians I scribe for allow their docs to work a maximum of 20 shifts per month. I currently work this EXACT schedule as a scribe and feel as if I could work another 5 shifts a month without any ill effect.

What's the rush? Why would you want to work 25 shifts? Work your twenty 10s for two years and pay off your debt. Then move to a reasonable schedule like 12-15 tens and enjoy the rest of your financially awesome life.

$400K is a lot. You can do it as an EP without doing anything crazy as long as you control your spending. Earn $500K. Pay $150K in taxes. Put $50K toward retirement. Live on $100K. Pay $200K a year toward your debts. Out of debt in 2 years. What the heck is so hard about that?

 

[emememem]

OP, I have some experience with what you're describing though I am only halfway through it (intern!). I started out scribing, worked 50-60 hours a week, had the time of my life, felt well-rested and was making a comfortable income compared to anything I had known previously. I worked 2-3 shifts more than the attendings every month and was still super excited and energetic, and could not understand why they wouldn't just pick up more shifts at this awesome job. I still love all of Emergency Medicine (except peds, ugh) and look forward to going to work every day but there is no question that it is a different beast. More emotionally taxing, more intellectually exhausting. When **** goes wrong it is MY fault, and that is brand new and not something that I ever took to heart even as a medical student. Med school wears you out, and then residency wears you out more. I cannot tell your how many neurosurg or ortho hopefuls during med school had come-to-Jesus moments when they realized what that life actually entails. I think your goals and dreams are perfectly valid as long as you give yourself some wiggle room to change and adapt that plan as you move through this career.

Also, as an aside, my experience has been that telling people what their lives are like when you are not actually living that life does not usually go over well. You've got another professional degree so you certainly understand the rigors of postgraduate education, but medical school and beyond are different. Not better or worse, just very culturally different.

 

[shookwell]

Just wanted to add another slightly different perspective to this thread. My first year out of residency I worked a full time job at a higher paying community hospital where I worked pretty hard, plus a half time job at an academic center where I got paid less but worked with residents, and the work was less stressful and much more enjoyable. I ended up working at least 6 days a week, 7 days some weeks, and often worked longer shifts than most other docs so that I could fit in all the hours that I was being paid for.

I needed the money at the time, and although it was hard, I didn't really burn out because I was enjoying my work. It is not a solution for long term, I am currently cutting back and will probably transition to just one full time job in a few years, maybe with some locums on the side.

It's doable if you are willing to work hard, but not easy, and probably not for a very long time. PS even with that schedule I did not make close to 600k, although I'm sure Texas pays more than in the northeast.

 

[Brorthopedic]

Just wanted to say thanks to all those offering their inputs, even if it seemed to be in vain when addressing OP. A lot of people interested in EM, like myself, find value in the readings we come across while lurking here.

 

[cbrons]

Well, I will make sure to tell the half a dozen docs I scribe for who work 20 shifts per month that they hate their lives and that they should quit their job. In fact, they all love their jobs and think that it is the best job they have ever found.

Lol troll or...?

 

[cbrons]

Excuse me if my ideas of what it's really like to be an EP are gathered from what I see every single day.

You are excused. Goodbye.

 

[maniacmed]

Harris Methodist, no?

Gotta be. I scribed there years ago and it sounds dead on. While it's been a little while since I worked there I think OP is exaggerating a little here. There really were a few docs who were absolute beasts and worked in the 18-20 range. Hell one guy even worked more shifts at another hospital on his free time. But it was not the norm. And also keep in mind that with the staggered scheduling it was not uncommon for these shifts to really only last like 6 hours including charting and everything (thanks to us scribes.) But as I recall the happiest doc I knew there worked like 10 shifts a month and is without a doubt the smartest, most laid back doctor I ever met. Career goals.

 

[racerwad]

Do you work at a place that has the decreasing-acuity model? Because it seems to be a major component of why the physicians I work with are so happy. They only have to deal with high-acuity patients for the first half of the shift. The second half of the shift is all back pain, pregnant vag bleeds, sore throats, procedures, and signing charts. Also, the scribes on my team do ALL the manual labor. We handle all of the paperwork. Some of the doctors only touch a single of piece of paper if they have to pull out their triplicate pad to write Norco's. We even put in all the orders, do all the discharges and admits. All the doctors have to do (other than the mental work of being a physician of course) is talk to the patient, examine the patient, talk to consultants and hospitalists, and talk to RN's, PCT's, LCSW's, etc. The only time they have to interact with the EMR is to click "Sign" on each set of orders and click "Sign" again on each chart.

It sounds like you believe you, as the scribe, are doing the heavy lifting, and that the physician you are working for is just coasting along. You are wildly underestimating the amount of work those docs are doing while you are busy clicking in orders. Are the scribes the ones that run the codes, do the airways, place central lines/invasive monitoring, repair lacerations, perform procedural sedation, reduce all manner of orthopedic injuries, in addition to all the "easy" stuff you've mentioned like breaking bad news or talking to surgeons (basically the same). Not knowing the decisions that are being made behind the scenes makes what they do seem easy or straightforward.

I too work at a Level II trauma center where we average 30 charts per shift and I can count on one hand the number of patients that I have seen die in my 16 months of 20-shifts per month work. With the other hand and a few toes I can count of the number of cancer and terminal illness diagnoses. These things do happen but they're really not all that frequent.

Do you really think that in this short amount of time you have a handle on what life as an EP is like?

You asked in the title "What's wrong with this calculation?" I think it is pretty clear where the error lies.

 

[DarkHorse22]

this dude is a lock for chief resident at In-n-Out

 

[filhodeinferno]

Well, I will make sure to tell the half a dozen docs I scribe for who work 20 shifts per month that they hate their lives and that they should quit their job. In fact, they all love their jobs and think that it is the best job they have ever found.

Oh pardon us, sorry for doubting your knowledge of how many hours an EM doctor can work without burning out, scribe.

 

[Cytarabine]

I too work at a Level II trauma center where we average 30 charts per shift and I can count on one hand the number of patients that I have seen die in my 16 months of 20-shifts per month work. With the other hand and a few toes I can count of the number of cancer and terminal illness diagnoses. These things do happen but they're really not all that frequent.

I don't understand how this is possible. I did four 10 hr shifts in the adult ED as a 4th year, and just in those shifts - (1) trauma leading to leg amputation, (2) neurologic devastation 2/2 massive hemorrhagic stroke, (3) arrest in the field x2 with both dying, (4) likely bladder ca. These are only the ones I was aware of and that I can remember a couple of weeks after the fact. In what utopia do you not have dying patients coming into the ED?

 

[Arcan57]

I don't understand how this is possible. I did four 10 hr shifts in the adult ED as a 4th year, and just in those shifts - (1) trauma leading to leg amputation, (2) neurologic devastation 2/2 massive hemorrhagic stroke, (3) arrest in the field x2 with both dying, (4) likely bladder ca. These are only the ones I was aware of and that I can remember a couple of weeks after the fact. In what utopia do you not have dying patients coming into the ED?

He's probably talking about people that died in the ED which is comparatively rare. If you've never had to tell a family they don't have a dad or don't know that the CT shows mom has no chance of survival then it may seem pretty easy.

 

[CraftyMed]

All the doctors have to do (other than the mental work of being a physician of course) is talk to the patient, examine the patient, talk to consultants and hospitalists, and talk to RN's, PCT's, LCSW's, etc.

the mental work of being a physician+the mental anguish of having to talk to all those people=the reason I don't work 20 shifts/month

The only time they have to interact with the EMR is to click "Sign" on each set of orders and click "Sign" again on each chart.

The doc should be reviewing all the orders that are entered before signing them. He/she should also be reading each of the scribes' charts before signing. Even scribes are known to make mistakes.

 

[canigetawhatwhat]

This guy is a riot.

Hes got life figured out.

Lulz.

 

[Old Grunt]

I am a current ED scribe who will be attending medical school next year. EM is currently one of the top specialties on my list. I love working up patients with vague abd pain or CP. I even rather enjoy the crazy psych patients. I am not quite as fond of the social work aspects but that's what LCSW's are for.

Anyway, I will finish residency with approximately 400K in debt, so compensation is a real concern for me. I plan on working my ass off the first few years out of residency to pay off the debt and I am interested in how physically or logistically possible it is to make 500K+ per year in EM. I am not worried so much about the mental or psychological aspects of working a lot of hours as my other top specialty under consideration is neurosurgery.

TLDR: Let's say $250/hr for 10 hours; 20 shifts per month; 240 shifts per year x $2500 per shift = $600,000. What's wrong with this calculation? Is is unreasonable to expect at least $250/hr with malpractice included?

More info: I currently live in Texas, will attend medical school in Texas, and will practice in Texas. The group whose physicians I scribe for allow their docs to work a maximum of 20 shifts per month. I currently work this EXACT schedule as a scribe and feel as if I could work another 5 shifts a month without any ill effect.

Don't work somewhere where you have to cover your own malpractice. Also, as noted, don't forget you have to pay the government. I am just out of residency and have a significant amount of debt and am not willing to work 20 10s, but I have a family too.

I don't mean to sound like a jerk, but they physical/mental toll you are going to experience as an attending physician is much higher then what you experience as a scribe.

 

[Old Grunt]

Look, from my perspective, the most persuasive evidence I have of what is feasible or realistic are the real life physicians I work with every day. One of the docs that I work with who does 20 shifts per month tells me that the ONLY reason he doesn't work MORE shifts is because of the group 20-shift maximum rule. This guy is one of the most energetic, upbeat, enthusiastic EP's I work with. Hell, he even leads all his patients and family members in prayer after each H&P.

Excuse me if my ideas of what it's really like to be an EP are gathered from what I see every single day.

Wow. Nice troll. You got me.

 

[VA Hopeful Dr]

He's probably talking about people that died in the ED which is comparatively rare. If you've never had to tell a family they don't have a dad or don't know that the CT shows mom has no chance of survival then it may seem pretty easy.

That and working Christmas are why us 9-5 docs don't complain about you guys making too much money.

Now ortho on the other hand...

 

[TheBlueBlazer]

Wait, wait, wait, so the guy with $400k in debt from grad school in a field he's not even planning to have a career in is explaining to us how he KNOWS EXACTLY what his future is going to hold in career attempt #2? And how your particular brand of awesome far outshines all us lazy chumps, making it really just a matter of the Man with their stupid rules holding you back from your downside-free riches? To put it as nice as I possibly can, what you've just said is one of the most insanely idiotic things I have ever heard...may God have mercy on your soul. I have friends who stuck around to be attendings after residency who later told me that they had no idea what an job there actually was like, and you think you've got it all figured out because you were a SCRIBE?!?!

You seem to have run off, taken your ball mid-game and went home after people failed to reinforce your delirium, so I doubt you will even read this, but I hope you do come back so you can enlighten us some more about how things work in Magical Fairyland ED. Your persistent arguments and refusal to alter your worldview in the face of overwhelming evidence to the contrary, and your "you all just don't get it" mentality reeks of narcissistic tendencies. You'll do great in EM, homes.

 

[Auvelity]

OMG this post made my night.