Why I used to love EM...and now I don't (6 years out)

[EvoDevo]

with the ridiculousness that is being pushed on us I will be joining AAEM. I havent been a member but I am convinced that ACEP is run and owned by the CMGs. Our own college is selling us out to the corporate raiders. While this isnt some panacea and I know they wont necessarily change a thing but at least they stand for what I believe in. I wish I could say the same for ACEP.

@EvoDevo Ill just say this, and it is something I firmly believe. We all make CHOICES and while I dont know your specifics I doubt many of us are stuck working at a CMG. You may choose to only live in one location. Your reasons may seem inflexible or they really may be inflexible. I live 2000+ miles from my parents and where I grew up. I chose not to work in a place with horrible job options.

Personally if my current job fell apart I would be on the lookout for another decent job. At some point I may choose to stay here in a crappy job but it wont be for any reason other than my choice which I will then live with.

Making a choice other than ACEP is still making a choice. Good one!

Of course we make choices. I choose to live in Texas (God Bless It) for financial, family, and entrepreneurial reasons (low taxes, homestead act, med mal protections, etc). The sad fact is that the CMGs are creeping in and making things difficult for SDGs. Now I know that the group in Houston pulled out of the hospitals and went to FSEDs and apparently are doing well. But being a SDG in this state is difficult (though don't know where emergentmd works, so it can be done). The downside to living here is that I have to put up with CMGs.

I know that in places in Virginia there are SEVERAL excellent SDGs that are doing well. Maybe after the kids are older we'll move away..

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[da8s0859q]

Of course we make choices. I choose to live in Texas (God Bless It) for financial, family, and entrepreneurial reasons (low taxes, homestead act, med mal protections, etc)...

Don't mean to hijack this thread, but it seems a good place to ask since it's a big part of finding our happy places. Does anyone have any experience they're willing to share as far as working in one of the other particularly doc-friendly states from a legal standpoint, at least going by the ACEP report card and the AAEM liability series? Colorado comes to mind. If you get far enough away from Denver, does the pay even start to approach some of the nicer Texas gigs?

Been thinking about Texas after residency and lived there for awhile, but open to options.

 

[barsoum.michael]

What's your opinion on tackling neurosurgery? I'm honestly gearing towards it

 

[deleted547339]

What's your opinion on tackling neurosurgery? I'm honestly gearing towards it

What???

 

[barsoum.michael]

I really want to be a neurosurgeon what's your opinion on the field?

 

[da8s0859q]

I really want to be a neurosurgeon what's your opinion on the field?

Okay, my post was at least tangentially related. Yours needs to be its own thread somewhere.

Either that or 0/10 trolling.

 

[Apollyon]

I really want to be a neurosurgeon what's your opinion on the field?

Do you go to Jets games and ask how people like the Rangers or Islanders?

In other words, why would you ask EM docs about neurosurgery? Doesn't that seem even just a bit odd - especially if you are considering doing that for a residency?

 

[EctopicFetus]

I wanna know where the heck I went wrong with my loans and why I, as a single guy, ended up with more loans than 90% of my peers?

I went to an average priced school, got some modest scholarships, lived within my means...and I have debt in the high 200s. Do most people just get a bunch of kick backs from their daddy that I never got, or what? Where did I go wrong?

I agree. I lived cheaply, worked etc. But my med school wasnt cheap. I owe a ton. Im 5 years out and have made a dent but I owe a ton. Im working on it. I have paid off 2 loans this year. Ill do 1 a year until im left with 1 whose interest is under 2%.

 

[EctopicFetus]

Making a choice other than ACEP is still making a choice. Good one!

Of course we make choices. I choose to live in Texas (God Bless It) for financial, family, and entrepreneurial reasons (low taxes, homestead act, med mal protections, etc). The sad fact is that the CMGs are creeping in and making things difficult for SDGs. Now I know that the group in Houston pulled out of the hospitals and went to FSEDs and apparently are doing well. But being a SDG in this state is difficult (though don't know where emergentmd works, so it can be done). The downside to living here is that I have to put up with CMGs.

I know that in places in Virginia there are SEVERAL excellent SDGs that are doing well. Maybe after the kids are older we'll move away..

I have heard that texas is getting ugly with the CMGs and some of the regional players. This is sad. I guess im lucky im flexible to move.

ACEP has really annoyed me lately. I dont know if the CMGs are the end of us or just a pendulum swinging one way. I hope in the long run we move back to SDGs but I will admit the future looks scary.

 

[emergentmd]

I am not going to even try to convince people on here that the income in the south is what I have stated. I have no reason to lie or even fabricate anything. I have a contract on my desk right now for 3900/12hr shift and the schedule for sept/oct with 15 opened shift in Sept still avail and in Oct over 60 open shift avail with ONLY one day that is fully covered. I could literally work 30 days in Oct and make 117K in October.

I have another contract in a nice city an hour drive from where I live for 3300/shift and they are begging me to pick up some shifts.

If I had to do it all over again, I would suck it up and act like a resident for 2 yrs, work 20 shifts and pull in close to 1 mil. Bank 1 mil and buy rental properties. You can then sit back, work a few shifts, and be able to live off the rental income. If I didn't have kids/married, I would absolutely work locums and do 15 shifts a month pulling in 60k a month.

I always scratch my head when I read the avg EM salary. From what I can surmise either or both.
1. The south pays substantially more than anywhere else and my view is skewed. If so, what are they paying in the west or northeast? Are you guys making 125/hr?
2. They must take into account all of the part timers. I bet the avg would go way up if they just include full time docs working 14 or more shifts a month. EM is one field where you can work part time easily vs something like surgery.

Anyhow, anyone who asks me if med school is worth it, I always tell them to go to the best state school for college and med school. Although 15 yrs ago, I went to a good state school for med school/college and without any family assistance, I left with less than 100k in loans. Paid it off in less than 1 yr.

I never understand why anyone would go to a private school vs a good public school when given the choice. I see really no good reason other than ego to take the private school route. I guess if having 3x the loan is worth having Harvard under your name, then by all means. But once you get out of residency, no one gives a crap about where you went to college/med school.

Now that I am in the middle of my career, I am realizing how lucrative EM medicine is. For me, the headaches are worth it. But EVERY field have their own headaches. Ask most specialists and you will find them complaining about something. No different than EM.

 

[EvoDevo]

Good point. If I'm pessimistic about the long term future of EM, in the short term I'm extremely happy. I now work fewer shifts per month than I did before and for 15 K more per month. Cannot complain at all. I'm much more in control of my life and practice than before.

 

[GeneralVeers]

Yes if you worked 30 days per month you could make $700K or more per year. But in reality most people are going to work 14-15 shifts which will still put you at 500K or less.

 

[GatorCHOMPions]

I always scratch my head when I read the avg EM salary. From what I can surmise either or both.
1. The south pays substantially more than anywhere else and my view is skewed. If so, what are they paying in the west or northeast? Are you guys making 125/hr?

What is considered the south in terms of these great salaries? Big cities in the south included or 100+ miles to the nearest major airport?

 

[Birdstrike]

I could literally work 30 days in Oct and make 117K in October.

Really? You present this as a feasible strategy for medical students and residents on this board?

I have a contract on my desk right now for 3900/12hr shift ....

At that rate, to make the $900,000 you claim you could, you're going to have to work 20, 12-hr shifts per month, likely traveling, every month with no vacation, flipping those shifts back and forth between nights and days, or 240 hr/month, all nights. All I can say is, "Good luck" to anyone that gives this a go.

You've said you are/were an ED director. You have written that working 30 days in a month and making 117K is a feasible plan, but as you mention, just not for you. You think working 20, 12-hr shifts year round to make $900,000 per year in EM is doable, and you just "don't get" anyone who thinks otherwise. You admit in a post above, you personally would never do it (for reasons mentioned: family, kids, life outside of work) but for everyone else, apparently unburdened with such distractions, this is what makes EM so great. It fits the formula perfectly. As long as there is new fresh meat that buys the hype, to fill the slot emptied by the guy that tried to give it a go and crashed and burned, the plan goes off without a hitch. At that point, we've come full circle. This is why we have threads like this, and why they are so valuable.

I think every med student and resident needs to decide if they want to work for ED directors who think there's nothing wrong with the idea to "literally work 30 days in Oct" or to work 240-hr per month (2880-hr per year) to make lots of money, in EM.

Pay special close attention medical students and residents. Pay very close attention.

 

[deleted547339]

Eh, I know a group where most people do 18+ 12's a month. Everyone seems to love their job. The group is probably 1/3 <5y grads, 1/3 >20 and 1/3 in the middle.

I don't get how they work that much, but they all seem to love it. I know it's not the norm, but it does exist.

Really? You present this as a feasible strategy for medical students and residents on this board?



At that rate, to make the $900,000 you claim you could, you're going to have to work 20, 12-hr shifts per month, likely traveling, every month with no vacation, flipping those shifts back and forth between nights and days, or 240 hr/month, all nights. All I can say is, "Good luck" to anyone that gives this a go.

You've said you are/were an ED director. You have written that working 30 days in a month and making 117K is a feasible plan, but as you mention, just not for you. You think working 20, 12-hr shifts year round to make $900,000 per year in EM is doable, and you just "don't get" anyone who thinks otherwise. You admit in a post above, you personally would never do it (for reasons mentioned: family, kids, life outside of work) but for everyone else, apparently unburdened with such distractions, this is what makes EM so great. It fits the formula perfectly. As long as there is new fresh meat that buys the hype, to fill the slot emptied by the guy that tried to give it a go and crashed and burned, the plan goes off without a hitch. At that point, we've come full circle. This is why we have threads like this, and why they are so valuable.

I think every med student and resident needs to decide if they want to work for ED directors who think there's nothing wrong with the idea to "literally work 30 days in Oct" or to work 240-hr per month (2880-hr per year) to make lots of money, in EM.

Pay special close attention medical students and residents. Pay very close attention.

 

[@JackShephard]

I agree with some of what you're saying, but you are missing half of the point.

Yes, writing anyone a check for 500k will solve a lot of problems. That being said, his problems aren't solely financial (although they are certainly complicated by debt and reliance on high income).

He is locked in a situation due to buying into a SDG and having kids where it is hard to move. His income has then been cut by 30% with constant threats for it to go down further. And then, HIS JOB IS THREATENED DAILY by administration making demands that are unreasonable and by reminding him that his is an easily replaceable cog in a machine.

When folks are complaining about patient satisfaction and admin demands, they're not just complaining that they have to keep the patients and bosses happy. That's true everywhere. What they are saying is the requests from SOME of the patients and admin are completely unattainable and are in a setting where everyone's contract reads "we can replace you without notice and for no cause". That is not standard at any job, even at Wendy's I'd get due process and unemployment.

This isn't to say EM is a bad gig. I am perfectly happy and would do absolutely nothing else. But, to claim it's all about money management mistakes that you won't make is utter hubris.

If you think it's sooo easy to pay off all your loans in a few years, why is it that 90% of EM docs haven't done this? They must all be much less enlightened than you. (For they record, mine are almost gone a few years out, but none of my partners are in that situation - it wasn't hard but it IS rare).

My point wasn't that "You made mistakes I won't." I was simply trying to state that, if you eliminate all the financial concerns (i.e. If I wanted to, I could not work for the next 12 months and I would be fine), then a lot of the stresses of life are more manageable. Secondly, it's a lot easier to handle the stresses of the work when you work < 32 hrs instead of 40-50 hrs a week. That's my only point. There's nothing arrogant about this stance, I think it's very reasonable. Whenever I've tried to focus on the litany of positives about this career, the counter idea is that there are challenges and difficulties. I agree. But I still look at this with all it's flaws and think I'm incredibly lucky and excited to take part in it. I don't know why or how this could be considered hubris.

If you like really like EM and want to do it, why do you care what anyone else thinks? I shouldn't really matter.

I'm making the opposing argument so that future medical students can see another opinion. I'm not trying to convince those who disagree. Just sharing another view. I think this is a good exercise in my thinking and for others. It forces me to develop my philosophy and challenge my perspectives. I stand unconvinced that this is a bad career or that I should worry about my future or only hope to break even. And I want to share that with the people who agree with me and those developing their thought process.

I am not going to even try to convince people on here that the income in the south is what I have stated. I have no reason to lie or even fabricate anything. I have a contract on my desk right now for 3900/12hr shift and the schedule for sept/oct with 15 opened shift in Sept still avail and in Oct over 60 open shift avail with ONLY one day that is fully covered. I could literally work 30 days in Oct and make 117K in October.

I have another contract in a nice city an hour drive from where I live for 3300/shift and they are begging me to pick up some shifts.

If I had to do it all over again, I would suck it up and act like a resident for 2 yrs, work 20 shifts and pull in close to 1 mil. Bank 1 mil and buy rental properties. You can then sit back, work a few shifts, and be able to live off the rental income. If I didn't have kids/married, I would absolutely work locums and do 15 shifts a month pulling in 60k a month.

I always scratch my head when I read the avg EM salary. From what I can surmise either or both.
1. The south pays substantially more than anywhere else and my view is skewed. If so, what are they paying in the west or northeast? Are you guys making 125/hr?
2. They must take into account all of the part timers. I bet the avg would go way up if they just include full time docs working 14 or more shifts a month. EM is one field where you can work part time easily vs something like surgery.

Anyhow, anyone who asks me if med school is worth it, I always tell them to go to the best state school for college and med school. Although 15 yrs ago, I went to a good state school for med school/college and without any family assistance, I left with less than 100k in loans. Paid it off in less than 1 yr.

I never understand why anyone would go to a private school vs a good public school when given the choice. I see really no good reason other than ego to take the private school route. I guess if having 3x the loan is worth having Harvard under your name, then by all means. But once you get out of residency, no one gives a crap about where you went to college/med school.

Now that I am in the middle of my career, I am realizing how lucrative EM medicine is. For me, the headaches are worth it. But EVERY field have their own headaches. Ask most specialists and you will find them complaining about something. No different than EM.

Good post.

People can talk about the practicality or feasibility of this plan - I won't attempt that line of thinking. Yet, the deeper point is this post is about solutions and possibilities. If you deconstruct a lot of the posts on here, you will see those critically analyzing and magnifying the terrors and injustices while other analyze or magnify the solutions or possibilities. Even if this scenario is too good to be true, the idea that one could earn 1 million in 2 years shows that there are many options out there.

Good luck everyone.

 

[two guys]

Jack, I don't mind your positivity. I appreciate it.

What I'm trying to point out (and you seem to keep missing), is that his problems aren't solely or even primarily financial. When you read his post and state that these are primarily financial issues, you are missing half of the point.

I don't remember if you're a medical student or resident. Let's assume you're a medical student. Imagine your school regularly expels students without notice, explanation or any appeals process. Now imagine they start scheduling multiple classes at the same time and demanding perfect attendance in all classes even if you can't phyisically be 2 places at once while also requiring that you always where a shirt and tie, always wear scrubs, and always wear tennis shoes while never exposing your hair. All of this must occur simultaneously. People regularly get expelled for breaking these rules.

Assuming you're someone who has worked hard and invested a lot of effort in getting into school and eventually being able to serve peoples health how does this make you feel?

Now imagine you discuss your concerns on a premed forum and mention that you're also understandably stressed about the student loans you've taken out and what will happen if you get expelled and can't pay the loans. Imagine the premeds say that all your problems are financially driven and you'd feel better if you had taken on less debt. They relate that most of them would give a kidney to be in your shoes. They don't understand how you could complain about having to go to class and follow a dress code. How would you feel?

 

[@JackShephard]

Jack, I don't mind your positivity. I appreciate it.

What I'm trying to point out (and you seem to keep missing), is that his problems aren't solely or even primarily financial. When you read his post and state that these are primarily financial issues, you are missing half of the point.

I don't remember if you're a medical student or resident. Let's assume you're a medical student. Imagine your school regularly expels students without notice, explanation or any appeals process. Now imagine they start scheduling multiple classes at the same time and demanding perfect attendance in all classes even if you can't phyisically be 2 places at once while also requiring that you always where a shirt and tie, always wear scrubs, and always wear tennis shoes while never exposing your hair. All of this must occur simultaneously. People regularly get expelled for breaking these rules.

Assuming you're someone who has worked hard and invested a lot of effort in getting into school and eventually being able to serve peoples health how does this make you feel?

Now imagine you discuss your concerns on a premed forum and mention that you're also understandably stressed about the student loans you've taken out and what will happen if you get expelled and can't pay the loans. Imagine the premeds say that all your problems are financially driven and you'd feel better if you had taken on less debt. They relate that most of them would give a kidney to be in your shoes. They don't understand how you could complain about having to go to class and follow a dress code. How would you feel?

I'm a medical student. I realize my status automatically invalidates all my opinions. I understand, although not completely buying into, the hierarchy of the world of medicine.

My assertion was that having no debt and working 50 hrs less per month would equate to less stress. Maybe this is a naive assertion.

Although I did comment briefly that one posters problems appeared to be primarily financial, I'm far from an expert on deciphering one man's discontent via an online post. Maybe most are destined to a dark and dreary fate. Nevertheless, I am determined to remain hopeful.

My purpose from the beginning was to shine a light for others, that there is much to be grateful for and we are all incredibly lucky. I stand by those sentiments.

Good luck to you two guys, and I also hope the poster before finds satisfaction. I will exit the thread now as I realize my status negates my contribution.

 

[emergentmd]

@ birdstrike - I think some reading comprehension is in order. I never said working 20, 12 hr shifts are for everyone. It is extremely difficult. But when I was a resident, i did 20-22 12 hr shifts with after shift rounding/lectures to boot. I did about about 18 months of this over the course of residency and I would say they were some of my easier months. I did residency before all of this hour capping craziness and did 100-120 hrs/wk on off service regularly.

So even difficult, I do not see doing 20-12 hr shifts impossible. I would definitely rather do this for 3-5 yrs after residency than do the crazy hours the surgical subspecialities were doing.

But my point is not that doing this is for everyone, but if you are in alot of debt, EM gives you a great opportunity to make alot of money in a short time. I would not do it now b/c I have 3 kids and a happy marriage that I would not jeopardize. But if I were single without any responsibilities, i definitely would do 15+ shifts a month as a locum.

15 shifts a month would still get me over 700K a year. Not bad in my opinion. I think this is very doable.

Also there wont be much flipping at these places. There are so many shifts open you could do 20 a month that were all days.

I do not want to paint EM as a rosy field. There are challenges and issues. But money should not be one of them.

 

[emergentmd]

What is considered the south in terms of these great salaries? Big cities in the south included or 100+ miles to the nearest major airport?

I know texas and Louisiana pays very well.

Big cities in texas would get you 250+/hr. go about 1-2 hrs from a big city and you will get 275-300+/hr.

 

[Birdstrike]

I never said working 20, 12 hr shifts are for everyone. It is extremely difficult.

We agree there.

...when I was a resident, i did 20-22 12 hr shifts with after shift rounding/lectures to boot. I did about about 18 months of this over the course of residency and I would say they were some of my easier months. I did residency before all of this hour capping craziness and did 100-120 hrs/wk on off service regularly.

I finished residency pre-work hour rules, also.

So even difficult, I do not see doing 20-12 hr shifts impossible. I would definitely rather do this for 3-5 yrs after residency than do the crazy hours the surgical subspecialities were doing.

I think most people finishing residency don't want to keep working residency hours. I didn't, and I still don't.

But my point is not that doing this is for everyone, but if you are in alot of debt, EM gives you a great opportunity to make alot of money in a short time. I would not do it now b/c I have 3 kids and a happy marriage that I would not jeopardize.

You think working those hours would jeopardize a marriage and family life? I agree.

I do not want to paint EM as a rosy field. There are challenges and issues. But money should not be one of them.

EM pays well. I never said it didn't. I do think it makes sense to quote industry averages, and percentiles, rather than regional outliers that are 3 times MGMA averages, and twice MGMA 90th percentile.

@ birdstrike - I think some reading comprehension is in order.

Thanks. I'll take that into consideration.

 

[two guys]

I'm a medical student. I realize my status automatically invalidates all my opinions. I understand, although not completely buying into, the hierarchy of the world of medicine.

My assertion was that having no debt and working 50 hrs less per month would equate to less stress. Maybe this is a naive assertion.

Although I did comment briefly that one posters problems appeared to be primarily financial, I'm far from an expert on deciphering one man's discontent via an online post. Maybe most are destined to a dark and dreary fate. Nevertheless, I am determined to remain hopeful.

My purpose from the beginning was to shine a light for others, that there is much to be grateful for and we are all incredibly lucky. I stand by those sentiments.

Good luck to you two guys, and I also hope the poster before finds satisfaction. I will exit the thread now as I realize my status negates my contribution.

Jack, one of the best things about this forum is that we get posts from all levels of training. If you read my post and think "this guy doesn't think my opinion counts because I'm a med student" then I need to do a better job writing my posts.

I didn't bring up your status to invalidate your positivity. I brought up your current experience to try to find some common ground that we've both experienced to draw a parallel and try to explain some folks frustration in a way that you could understand.

As I've said before, I love my job and couldn't be happier in EM. I worked a bunch before medical school and I can say definitively that overall, this is the best job I've ever had.

That being said, I do understand where these guys are coming from. This field is not what I thought it was in medical school and residency (this is true for most specialties). I wish I could dig up some of the posts on SDN from when I was training and what some posters said it would be like. I preferentially chose to believe the most positive outlier posts for satisfaction and pay. What happened? I was mildly disappointed to learn that things were not as I thought they'd be. Still a great job. Still happy. Just not exactly what I thought I was busting my tail for.

There's nothing wrong with being positive. It'd be real concerning if you weren't at this stage. But, try not to let that keep you from hearing what these guys are saying. Specifically, you don't seem to grasp the concept of "no due process" and how that really makes admin complaints and demands threatening and stressful.

You'll probably not end up burnt out and hating this field. Part of that is because you read on here and have a more accurate picture than most and have plans to have better financial independence. That being said, your job in 15 years will likely not be nearly as satisfying as you think it will be today. That's totally fine. You need something to look forward to.

 

[EctopicFetus]

I respect the opinions of those on here particularly those with more experience that me in EM. birdstrike and emergent in this thread have a lot of valuable insight.

I think finding jobs at 250+/hr is doable. I think one runs the risk of a terrible burnout working more than they are comfortable with.

I average 160 hours per month. I work all nights. It works well with my family. I try to be very efficient with my time outside of work on things I dont enjoy. What this means is I have a maid who cleans my home, a landscaper and a handyman to fix crap I dont enjoy.

I make time for my kids and their stuff, I do "date nights" with my wife and live a full life with my friends. I have colleagues who think anything more than 120 is crazy. I think it depends on the job.

I think maybe the disconnect between those much wiser than me is this.

1) you can make money in EM, a boatload and unlike other jobs you can kind of control your flow of income (more hours = more $$). This isnt always true in other fields. Most of us know that if I work X hours I will make at least y income.

I would caution those who are younger than me. I had great advice financially from my attendings. One was "dont ever think I can work x shifts and buy Y."

2) Birdstrike is correct in his assertion about PG scores, unrealistic expectations of C suite MBA types. While money doesnt make these ills better it makes the need to deal with them or tolerate them different if you are financially enslaved or financially free.

As I mentioned in a prior post in this thread I am convinced our jobs are more different than the same. I have a med school buddy who works in the NE for a hospital. He works abouot 15% fewer hours than I do. In that time he sees more patients (total) than I do in a given month. I make 3-3.5x what he does. My perks are better than his too.

For the students and residents. I will say again. Choose wisely.

 

[EctopicFetus]

I should say choose your job wisely.

Also I really believe that your finances play a huge role in your job satisfaction and therefore your life satisfaction when it comes to medicine and EM in particular. If you hate it you can work less (or not at all).

 

[Plectron]

Someone said, in response to my first post, that it is about sacrifices. I agree with that. I am willing to sacrifice and stay where I am in order for my kids to finish growing up. I love working in the department so it is not the medicine that burns me out. I could even deal with the BS from the c-suite but it is that trapped feeling that sucks. Even if I wanted to leave, I would still be taking a hit on my house as the market in my area has not come close to recovering to where it was in 2006. The last thing I want to do is take on more debt.

I would not discourage anyone from going into EM, just keep in mind the forces outside of the actual practice of medicine that you have to consider.

 

[RustedFox]

Adding on my two-cents.

I usually average around 135-140 hours/month, and I find that manage-able. Sure, there are some shifts where I'm pretty tired afterwards, but rest does come. There is a LOT of circadian rhythm stochasticity (not a word, yeah - I made that'n up) at my present job, but I'm leaving that one next month. We'll see if its any different at a bigger shop with more providers.

I have worked as little as 110 hours/month. I was bored. I've also clocked 160 hours in a month, I was toast.

The medicine itself is the best part. Still.

 

[EMedGrrl]

http://resus.me/emergency-medicine-a-great-job/

Great talk by Cliff Reid on why we do what we do, and what makes us happy. Can EM make you happy? Maybe.

 

[JeetKuneDo]

Most of the comments are about Texas and the Southern states. How's the hourly rate in the west coast (california, oregon, washington)? Am I right to assume that major cities (Portland, SF, LA, Seattle) are dominated by CMGs?

 

[GeneralVeers]

Most of the comments are about Texas and the Southern states. How's the hourly rate in the west coast (california, oregon, washington)? Am I right to assume that major cities (Portland, SF, LA, Seattle) are dominated by CMGs?

The hourly rates tend to be lower. There are fewer jobs in West Coast major metropolitan facilities available, so the the CMGs and hospitals know they can pay a lot less. Also the taxes (13% top income tax in CA) and the extraordinarily high cost of living make things difficult.

Washington is the only exception as they have no state income tax, though cost of living in Seattle can be expensive.

 

[GoBuckeyes913]

As I've stated time and time again, we are now factory workers turning out widgets.

I have become quite the professional data entry engineer for our immaculately complicated EHR. I wish we had scribes.


On a side note:
Some days, the light is sucked out of my soul (sadly, not really from patients). They are the easiest in this game to deal with. You're going to have jerk patients no matter what, you just can't let them get to you. Other days, it's fun and I enjoy it. I stopped being the Stepford-doctor a long time ago because frankly, I just couldn't do it anymore. It was exhausting. (Ironically, my PGs are in the 99% percentile) Medicine is evolving into, albeit a lot of B.S., but we just have to adapt right along with it... To a point. Being completely submissive gets you abused. I hate that walking-on-eggshells crap with administration, which is currently happening with my group. You get abused in fear of losing your contract, because to administration there is always another group willing to come in and "solve" your hospitals problems. Kudos to the ones who got out to find something better that worked for them. I can't imagine the courage it takes. If I have a Snuggie-like invention success or hit the lottery, I'd bail. For now, I'm not that unhappy.

 

[Birdstrike]

Some days, the light is sucked out of my soul...

Wow.

 

[RustedFox]

I have become quite the professional data entry engineer for our immaculately complicated EHR. I wish we had scribes.

What EHR do you use ?

 

[WilcoWorld]

I stopped being the Stepford-doctor a long time ago because frankly, I just couldn't do it anymore. It was exhausting. (Ironically, my PGs are in the 99% percentile).

Firstly, I think "the Stepford-doctor" is an excellent way to describe this phenomenon. It captures the individuality-sucking thoughtlessness of the recommended scripts.

Secondly, I have witnessed the same thing - when I stopped acting the way I was told to, my scores went up. (However, the stats on PG are so poorly done that I must admit that it was probably just coincidence.)

 

[EctopicFetus]

I came across this little nugget. Ill post it in its own thread because I think is summarizes what the future may have in store for us hospital based folks.

http://thehealthcareblog.com/blog/2014/09/18/how-to-discourage-a-doctor/

 

[GoBuckeyes913]

ED Pulsecheck/PICIS. Dragon also.

 

[GoBuckeyes913]

Wow.

Not kidding. A few months back I saw 62 patients in a 12 hour shift, because our CEO thought it would be cool to open an urgent care inside one of our free standing EDs AND offer sports physicals . . . To "beat the nearby competing hospital before they open one". And then advertised it all over gods green earth. All staffed by the same ED doc. Our group found out about 6 weeks before it happened, I suspect so that we would be purposely left out of the planning since none of that would fly. Oh, and we don't get to bill for the urgent care visits, yet do all the work. Admin holding over our heads that if we want to make our hourly rate at the free standings the same as we do downtown that we pretty much bend over and take it. I would rather put a campfire out with my face than relive that day again.

I love EM. And the patients aren't even that bad. It's the particular scenario above that literally defeats me some days.

 

[erdoc00]

Not kidding. A few months back I saw 62 patients in a 12 hour shift, because our CEO thought it would be cool to open an urgent care inside one of our free standing EDs AND offer sports physicals . . . To "beat the nearby competing hospital before they open one". And then advertised it all over gods green earth. All staffed by the same ED doc. Our group found out about 6 weeks before it happened, I suspect so that we would be purposely left out of the planning since none of that would fly. Oh, and we don't get to bill for the urgent care visits, yet do all the work. Admin holding over our heads that if we want to make our hourly rate at the free standings the same as we do downtown that we pretty much bend over and take it. I would rather put a campfire out with my face than relive that day again.

I love EM. And the patients aren't even that bad. It's the particular scenario above that literally defeats me some days.

I would've called in my resignation during the shift AND maxed out at 2 pts/hr. 62 patients in a 12 hour shift is not only abusive but it's also poor patient care. I don't think I could even have a scribe document that many visits per hour. Nor can you actually assess that many people even doing sports physicals.

No job or money is worth this. We are trained professionals dealing with peoples' lives, not moving parts through an assembly line. I seriously don't know how people allow themselves to be treated like this. I would rather deal cards at a casino or greet people in WalMart than be part of a system that operates like the above.

 

[EctopicFetus]

We think we deserve better but the C-suite guys and their mid level management minions see us like workers in a chinese factory.

Im lucky my shop isnt like this at all. I am one of the few who wishes my system was such where I could work harder (and make more money).

 

[Birdstrike]

Not kidding. A few months back I saw 62 patients in a 12 hour shift, because our CEO thought it would be cool to open an urgent care inside one of our free standing EDs AND offer sports physicals . . . To "beat the nearby competing hospital before they open one". And then advertised it all over gods green earth. All staffed by the same ED doc. Our group found out about 6 weeks before it happened, I suspect so that we would be purposely left out of the planning since none of that would fly. Oh, and we don't get to bill for the urgent care visits, yet do all the work. Admin holding over our heads that if we want to make our hourly rate at the free standings the same as we do downtown that we pretty much bend over and take it. I would rather put a campfire out with my face than relive that day again.

I love EM. And the patients aren't even that bad. It's the particular scenario above that literally defeats me some days.

Wow. I thought I had it bad when a couple 12 hours shifts, back to back, clocked in at 50 patients each, with some bacterial meningitis and other choice disasters thrown into the acuity mix. It's not even having to work your arse off, but having no control over anything after countless years of sacrifice and being told bend over said barrel, and insert rubber ball into mouth, like The Gimp. Painful. Let me guess: they constantly hint that if you don't like it, "You'll lose the contract"?

They're just going to keep getting bolder and more confident with this crap, until docs stand up and refuse to put up with this ----.







(By the way, love the face/campfire analogy: outrageously appropriate and hilarious at the same time. I may have to borrow that one, once in a while.)

 

[deleted547339]

Wow. I thought I had it bad when a couple 12 hours shifts, back to back, clocked in at 50 patients each, with some bacterial meningitis and other choice disasters thrown into the acuity mix. It's not even having to work your arse off, but having no control over anything after countless years of sacrifice and being told bend over said barrel, and insert rubber ball into mouth, like The Gimp. Painful. Let me guess: they constantly hint that if you don't like it, "You'll lose the contract"?

They're just going to keep getting bolder and more confident with this crap, until docs stand up and refuse to put up with this ----.


(By the way, love the face/campfire analogy: outrageously appropriate and hilarious at the same time. I may have to borrow that one, once in a while.)

Is there even a safe word?

 

[Birdstrike]

Is there even a safe word?

?

 

[da8s0859q]

Is there even a safe word?

Dilaudid.

 

[VA Hopeful Dr]

I would've called in my resignation during the shift AND maxed out at 2 pts/hr. 62 patients in a 12 hour shift is not only abusive but it's also poor patient care. I don't think I could even have a scribe document that many visits per hour. Nor can you actually assess that many people even doing sports physicals.

No job or money is worth this. We are trained professionals dealing with peoples' lives, not moving parts through an assembly line. I seriously don't know how people allow themselves to be treated like this. I would rather deal cards at a casino or greet people in WalMart than be part of a system that operates like the above.

Completely agree. My current UC job, during cold and flu season, often clocks in at 80 patients over 14 hours. This is with a population that can't self-triage worth a damn - MIs, CVAs, sepsis are not uncommon things we see here so its not like just 80 URIs over that day.

 

[Birdstrike]

Completely agree. My current UC job, during cold and flu season, often clocks in at 80 patients over 14 hours. This is with a population that can't self-triage worth a damn - MIs, CVAs, sepsis are not uncommon things we see here so its not like just 80 URIs over that day.

Gives new meaning to the concept of transitioning into urgent care to "slow down"

80 patients in 14 hours. That's work.

 

[Psai]

Reading the rape of emergency medicine makes me understand much more as I read this thread again

 

[xaelia]

Eh.

This thread looks like – yes, a few EPs have some anecdotal experience of getting fried on a shift, oh, but then a few EPs are out there making $250-300/hr, and then a few have found a way to invest in outside activities allowing them to scale back their clinical abuse, etc. Sounds like most professions. The world is not magic, we are not special and unique flowers, and we are not entitled to having our every vocational need met.

Our grandparents fought a friggin' World War or were drafted into Vietnam. Our parents worked plenty hard at jobs that weren't always fulfilling to help lay the foundation for us to go off to become doctors. Maybe we should just develop some coping skills and stop expecting fairy dust and rainbows. If you don't like your life (with apologies to William James):
1. Change it immediately.

2. Do it flamboyantly.

3. No exceptions.

 

[Birdstrike]

If you don't like your life (with apologies to William James):
1. Change it immediately.

2. Do it flamboyantly.

3. No exceptions.

And many on this thread have described doing exactly that. It is my hope that a thread like this can be inspiration those that still need to, and affirmation to those that don't.



#positivity

 

[LChristmas]

I was recently accepted to med school after spending 5+ years as an EMT so working in the ED seems like the natural progression of things. Being able to read all of the differing points of view is pretty interesting. The odds of me changing my mind a bunch of times in the next 4 years are pretty high, but this is all good information nonetheless.

 

[GoBuckeyes913]

Completely agree. My current UC job, during cold and flu season, often clocks in at 80 patients over 14 hours. This is with a population that can't self-triage worth a damn - MIs, CVAs, sepsis are not uncommon things we see here so its not like just 80 URIs over that day.

I would have climbed in your TARDIS. That's insane for one doc. Do you do your own documentation?

 

[Birdstrike]

"We can be Heroes,
Just for one day"

-David Bowie