Graduating EM resident - ask away, anything

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pinipig523 said:
1. I drive a 2008 Infiniti G37S coupe, black on black. Manual, 6 speed.

2. Yes, I am very happy I went straight through. I would've pushed myself through undergrad and completed it in 3 years since I had the AP credit to do so, if I could do it all over again. I am the youngest in my graduating residency class.
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Not only the brains, but the taste and style to match. Can't go wrong with a G37S...
 
mike1 said:
To what extent is your approach to medicine as an EM doc, as well as your personal life, affected by ruminating about messing up and being sued?
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I rule out stuff in the ER as a general principle. I make sure that the emergencies won't kill or harm the patient. I also practice good patient care and good customer service (this is key). Yes... it may involve some kissing up, but that's the field.

As for my personal life.... I'm not sure how this affects it. I can say that I'm fully prepared for anything that may happen in my day/day life. If I'm in a plane and someone has an arrest, I'm your man.

I don't ruminate about being sued... just yet. As a resident, you're pretty bullet proof.

As an attending, I plan on practicing safe and good medicine. It also helps that I'm moving to a state with good malpractice laws and tort reform. You'd have to be NEGLIGENT to be sued successfully.
 
mipp0 said:
Not only the brains, but the taste and style to match. Can't go wrong with a G37S...
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I hear ya. With the salary I'm getting, I can afford anything from an Audi R8 to a Bentley Continental GTC.

But that'd be stupid of me to do so.

I'd rather drive my car for another 4 years and then buy whichever replaces it so as to minimize my exposure to this particularly painful depreciating asset we call "cars".

👍
 
Don't forget she gets half if you divorce 😀
 
Chrome19 said:
Don't forget she gets half if you divorce 😀
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Touche... that'd be bad, my friend.

One of those things you really can't prepare for. :scared:

But in all seriousness, my wife and I have been together since junior year of high school. Hopefully, we can beat the odds. 👍
 
pinipig523 said:
I hear ya. With the salary I'm getting, I can afford anything from an Audi R8 to a Bentley Continental GTC.

But that'd be stupid of me to do so.

I'd rather drive my car for another 4 years and then buy whichever replaces it so as to minimize my exposure to this particularly painful depreciating asset we call "cars".

👍
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After your expected salary, what do you think your take home amount will be (after you take out the 401K)

And you never want to get a R8 or Continental? Ever? Which car do you think you will go for next?
 
How do EM practices work? Do you work at a hospital or what? And how long/what do you have to do to make partner?
 
raltima07 said:
After your expected salary, what do you think your take home amount will be (after you take out the 401K)

And you never want to get a R8 or Continental? Ever? Which car do you think you will go for next?
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It really depends. There's an offer for $320K base pay + $49,000 (employer contribution 401K - which is max btw) including benefits like health insurance. There's also another offer that pays $375K w/o 401K contribution. Keep in mind that 401K is a pre-tax contribution so you save on the high income tax bracket.

So approximately, I'd still take home a good amount. I'd probably clean approx $230K net (according to paycheck calculator - google it).

We haven't even dipped into the wife salary yet. Nor have we talked about the rise in compensation and making partnership. That's a WHOLE 'nother beast.
 
raltima07 said:
And you never want to get a R8 or Continental? Ever? Which car do you think you will go for next?
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Dude... you have no idea how badly I want an R8, a 911 Turbo, or something similar. But, it's just not financially sound. Not yet.

I will have to make partner and pay off my student loans first before I can dip into that type of toy. :thumb up:

Come back later and I'll show you the garage of an ER doc who played it right.
 
raltima07 said:
How do EM practices work? Do you work at a hospital or what? And how long/what do you have to do to make partner?
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EM practices work like this:

- The majority are groups with a president/ceo/owner. That president would own one or several groups. Each ER would have a medical director and if enough ERs exist, there may be a regional director.
- Each group has a contract with a hospital to provide that particular hospital with staffing for the ER.
- Each ER doc gets paid by the group based on production or based on a base salary rate.
- A partner is an ER doc who does not get much of the profits pulled away from him/her, but rather they make a portion of the profit (i.e. total profit divided by number of partners).

You make partner in various ways. Some groups don't have a partnership track, some do. Some make partner after 2 years, some after 4 years.

Just expect to make more as a partner. Don't be surprised if a partner makes $250-300/hr (approx $520 to 625K a year working 40h/wk).

Yes, it can be crapload.
 
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Great thread, thanks OP.

Do you see EPs being employed individually by hospitals as a growing trend in the future? (as opposed to group contracts)
 
I'm from rural WV...do you think your experiences in EM parallel at all to what could be expected here? I realize the nature of the work and frequency of bigger things happening are probably way different, correct?

Thanks a bunch for doing this, by the way. I've just been accepted to med school and have always thought I would like EM, but didn't know a whole lot about it.
 
pinipig523 said:
Dude... you have no idea how badly I want an R8, a 911 Turbo, or something similar. But, it's just not financially sound. Not yet.

I will have to make partner and pay off my student loans first before I can dip into that type of toy. :thumb up:

Come back later and I'll show you the garage of an ER doc who played it right.
Click to expand...

Get the aston - classy :laugh:

You better show me that garage of the ER doc that you promised.


New question: Do you think the medical school you went to matters in terms of getting a private practice job like this?
 
I don't think anyone's said this yet, but thank you for spending the time to answer all our questions. I know a lot of us think EM is the manly, cowboy way to go and every other specialty is wimpy sans surgery.

I work in the ED as as scribe, and even I can tell my faith in humanity slowly slipping away sometimes. The frequent fliers add up and get to you. I can only imagine 20 years of ED work can make a man bitter and cold.

Q. What are some options for ED physicians who want to slow down and pursue other avenues for income (say, after loans are paid off in 10 years)?
 
fri727 said:
I'm from rural WV...do you think your experiences in EM parallel at all to what could be expected here? I realize the nature of the work and frequency of bigger things happening are probably way different, correct?

Thanks a bunch for doing this, by the way. I've just been accepted to med school and have always thought I would like EM, but didn't know a whole lot about it.
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One of my classmates is going to join a more rural ER practice in Illinois. From my understanding, there are several differences.

1. Rural usually means somewhat low volume. This means that you get less people running though a day and this means that you will likely be working SINGLE coverage. This means that there will be only a SINGLE ER attending at a time. Compare that to an urban ER with a large volume of patients - you may be working as a double or triple coverage (2 or 3 attendings at one time).

The luxury of having another attending around is that you can bounce questions and you can divide and conquer the patient load. If you get slammed with an arrest, you know that the next cardiac arrest will likely go to your partner to take some load off of you.

2. Rural usually means a different demographic. There will likely be less penetrating trauma from GSW and more blunt trauma from MVC or farm equipment. You will get some penetrating trauma from farm tools but it's different from a gun shot. You may also have no nursing home patients, tertiary care patients - instead, you will have more bread and butter patients.

3. Rural also means you will be well known. You will be one of the 6 or so ER docs who cover that hospital. They'll know you when you run around town. Which could be a good thing or a bad thing.
 
dannydickman said:
I don't think anyone's said this yet, but thank you for spending the time to answer all our questions. I know a lot of us think EM is the manly, cowboy way to go and every other specialty is wimpy sans surgery.

I work in the ED as as scribe, and even I can tell my faith in humanity slowly slipping away sometimes. The frequent fliers add up and get to you. I can only imagine 20 years of ED work can make a man bitter and cold.

Q. What are some options for ED physicians who want to slow down and pursue other avenues for income (say, after loans are paid off in 10 years)?
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You are welcome! A lot of the stuff I've covered so far are stuff I did not even know as a 2nd or 3rd year resident, it's crazy how no one teaches us anything practical about our specialties... and I'm only covering ER. What about plastics, dermatology, ENT, urology, radiology, anesthesia, or even medicine and its subspecialties?

The answer to your question... there are options to pursue to start scaling back. You can become a medical director or associate medical director to cut back some shifts. Take my chairman - he works 4 clinical shifts a month and works the majority from the office. He makes more than any other attending at my program (no matter how many shifts they do).

Another route would be to save and pay off loans, then scale back as you peak.
 
CityLights said:
Great thread, thanks OP.

Do you see EPs being employed individually by hospitals as a growing trend in the future? (as opposed to group contracts)
Click to expand...

That is something I do not think will happen. There are some EPs who are employed by the hospital - think Kaiser Permanente.
 
raltima07 said:
Get the aston - classy :laugh:

You better show me that garage of the ER doc that you promised.


New question: Do you think the medical school you went to matters in terms of getting a private practice job like this?
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Tough question and tough answer. You need to go to a good medical school to position yourself into getting into a good residency.

That said, I think that the residency program is far more important in getting a private job. I may not be the best to ask about academic jobs, but I'm sure it's similar.

It does help though to have the word "Harvard Medical School" in your resume no matter what job you're looking for.
 
Could you compare your social life now compared to back when you were a pre med? (in terms of time not in terms of specific activities)--Also could you comment on the the learning curve from undergrad to med school to residency.

Btw was your undergrad - LUC? haha j/w
 
raltima07 said:
Get the aston - classy :laugh:

You better show me that garage of the ER doc that you promised.
Click to expand...

Alright... this guy and I kept in contact for a while. He told me his secret to accumulating wealth. Here is his garage and house. He just took delivery of 2 new cars this year. A Ferrari 599GTO and a Porsche RS.

Links to his thread on another forum:
http://www.teamspeed.com/forums/garage-forum/38204-moved-into-new-garage-pics.html

Here's a teaser pic of his garage. BTW, he is only 38.
RufMD.jpg


It goes to show you, be smart with your money initially out of residency, work hard - and you can get what you want. He's probably not the typical story, but it shows that it can be done.
 
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pmarank said:
Could you compare your social life now compared to back when you were a pre med? (in terms of time not in terms of specific activities)--Also could you comment on the the learning curve from undergrad to med school to residency.

Btw was your undergrad - LUC? haha j/w
Click to expand...

My social life now is a lot less busy. I am married so I like hanging out with my wife. In undergrad, it was mostly hanging with the guys and then my girlfriend (who is my wife now). The majority of what I did was take advantage of LANing. Call of Duty 1 had just come out, Counterstrike, StarCraft, Warcraft 3... so many games, so much hilarity! Beer and video games made for a hilarious nightly routine.

The learning curve is steep each step you take - from premed to med (you'll note what seems to be extreme volumes of information... the info is easy to understand but the sheer volume is what gets you). And again from med to residency (you'll note that what you learned doesn't really make you a doctor just yet).

It's an interesting experience. Sometimes you're like.... why am I an idiot? Other times you're like... I remember that from pharm!!

My undergrad was UIC. 🙂
 
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pinipig523 said:
The learning curve is steep each step you take - from premed to med (you'll note what seems to be extreme volumes of information... the info is easy to understand but the sheer volume is what gets you). And again from med to residency (you'll note that what you learned doesn't really make you a doctor just yet).
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i would say preclinical years --> clinical years was definitely a steeper learning curve than premed to med.

btw this is hands down the best thread on SDN right now, thank you very much for all the info
 
Great thread; lot's of very insightful information on here.

At the garage- Holy heaven I want to be an EM doc!
 
pinipig523 said:
Alright... this guy and I kept in contact for a while. He told me his secret to accumulating wealth. Here is his garage and house. He just took delivery of 2 new cars this year. A Ferrari 599GTO and a Porsche RS.

Links to his thread on another forum:
http://www.teamspeed.com/forums/garage-forum/38204-moved-into-new-garage-pics.html

Here's a teaser pic of his garage. BTW, he is only 38.
RufMD.jpg


It goes to show you, be smart with your money initially out of residency, work hard - and you can get what you want. He's probably not the typical story, but it shows that it can be done.
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Is this real life? sorry couldn't help myself 😀 Is this guy an EM doc too? looks more like a plastic Dude to me.
 
ozzi22 said:
Is this real life? sorry couldn't help myself 😀 Is this guy an EM doc too? looks more like a plastic Dude to me.
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100% EM doc, I've spoken to him.

Like I've said before, a little elbow grease goes a long way. Not to mention being frugal initially after residency.

A little motivation and desire for success helps as well.

Although a plastics dude would be able to swing this as well.
 
Stumpyman said:
Great thread; lot's of very insightful information on here.

At the garage- Holy heaven I want to be an EM doc!
Click to expand...

pinipig523 said:
100% EM doc, I've spoken to him.

Like I've said before, a little elbow grease goes a long way. Not to mention being frugal initially after residency.

A little motivation and desire for success helps as well.

Although a plastics dude would be able to swing this as well.
Click to expand...

This is a great thread! Thanks for all your descriptive responses. I'm pretty sure I have the personality for EM, but getting super jaded worries me. Do you find that a lot of the EM docs you know tend to have some of the same personality traits/characteristics?
 
pinipig523 said:
Alright... this guy and I kept in contact for a while. He told me his secret to accumulating wealth. Here is his garage and house. He just took delivery of 2 new cars this year. A Ferrari 599GTO and a Porsche RS.

It goes to show you, be smart with your money initially out of residency, work hard - and you can get what you want. He's probably not the typical story, but it shows that it can be done.
Click to expand...


Care to share? :meanie:

Thanks - I love this thread!!!
 
pinipig523 said:
2. Yes, I am very happy I went straight through. I would've pushed myself through undergrad and completed it in 3 years since I had the AP credit to do so, if I could do it all over again. I am the youngest in my graduating residency class.
Click to expand...

A lot of people on this board say that pushing through undergrad in 3 years is a bad idea - obvisouly, everyone has different opinions, but why do you say its something you would have done? Is it better on the outside after finishing?

Also, how old were you when you started med school, and residency?
 
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I have heard that the traditional big names (Harvard, Johns Hopkins, etc.) are not the "best" EM residencies. Is that true? What are some of the well-known "best" residencies, especially for getting a job where you want.
 
pinipig523 said:
Never rode in one. I wanted to rank Milwaukee MCOW high on my residency rank list but I ranked Cook number 1. MCOW had a good flight program.
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There's no cows there.

raltima07 said:
A lot of people on this board say that pushing through undergrad in 3 years is a bad idea - obvisouly, everyone has different opinions, but why do you say its something you would have done? Is it better on the outside after finishing?

Also, how old were you when you started med school, and residency?
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I think that people who pick a shorter residency track are less likely to wish they had more time off during their training. Doing seven years of neurosurgery probably makes you wish you had some time off.
 
What kind of research did you do in EM? Also, do you think the school you went to helped you land your residency? Was that your top choice (residency)?
 
DrMeowMeow said:
What is the average salary of a family practitioner? I often hear 120k-130k, but I figure you'd know more
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According to MGMA survery

Family Practice (without OB)
$201,512 -- mean
$151,207 -- 25th percentile
$183,999 -- Median
$233,948 -- 75th percentile
$297,760 -- 90th percentile
 
ilton said:
What kind of research did you do in EM? Also, do you think the school you went to helped you land your residency? Was that your top choice (residency)?
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1. EKG research, door-to-EKG times and how to reduce it to meet the 10 minute guideline.
2. I think the med school you go to helps you with the residency match.
3. Cook County was rank #1 on my list.
 
Renaissance Man said:
I have heard that the traditional big names (Harvard, Johns Hopkins, etc.) are not the "best" EM residencies. Is that true? What are some of the well-known "best" residencies, especially for getting a job where you want.
Click to expand...

Tough to say. If you go to the EM boards - more may be able to give you a better idea of which are the best.

I think going to a big name program is definitely going to help you get a job where you want. If you say Hopkins vs say... middle of nowhere community hospital, there's a high likelihood the medical director you interviewed with will remember you and offer you the job.

There are always exceptions to the rule, however.
 
raltima07 said:
A lot of people on this board say that pushing through undergrad in 3 years is a bad idea - obvisouly, everyone has different opinions, but why do you say its something you would have done? Is it better on the outside after finishing?

Also, how old were you when you started med school, and residency?
Click to expand...

1. Yeah, 3 years may not be ideal but I've had a few friends do it and plow through premed/med in 7 years. The only reason why I say that's what I would've done is because of time. I took a 4 year program for EM instead of a 3, so I "lost" 1 year.

2. Yes, it's better looking from the outside.
 
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kansaskid said:
This is a great thread! Thanks for all your descriptive responses. I'm pretty sure I have the personality for EM, but getting super jaded worries me. Do you find that a lot of the EM docs you know tend to have some of the same personality traits/characteristics?
Click to expand...

1. You should be a little concerned about the jaded view you may acquire in EM. I feel that a lot of my peers have the same perspective, so it's not just me.

Does everyone become jaded? Maybe not. But I'd bet the majority do, especially if you do a residency in an urban setting like mine.

2. I think a lot of EM docs are similar in that we tend to like to dabble into a lot of things at the same time rather than one thing at a time. The outdoors thing is also very true, I didn't want to believe it at first. We are also a little less into "titles" and less formal with our ancillary staff. We tend to work as a team rather than in a rank system, you have to be humble and you have to be ok with that.
 
Thanks for the responses thus far. Seeing as you can't choose which patients you see, how do you overcome the fear of contracting HIV, Hepatitis, etc...from one of them? Or is it something that never goes away?
 
jdok said:
Thanks for the responses thus far. Seeing as you can't choose which patients you see, how do you overcome the fear of contracting HIV, Hepatitis, etc...from one of them? Or is it something that never goes away?
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Just be very careful whenever you need to poke or do an invasive procedure in somebody. Everyone I see has HIV/HepC/Syphillis until proven otherwise.

I have not poked myself a single time yet (knock on wood). I just make sure I am careful and I know where the needle is at all time. When you become cocky and negligent because you've done a central line 50 times, that's when you get poked.

The fear I have is different seeing as I can't choose patients. My fear is a pediatric arrest rolling through the door. That's something I'm still working on (via reading and putting myself in positions where I get to see it more).
 
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Would you say EM is a lifestyle specialty?
Is there a 'ranking' system for patients in the order they're seen?
 
RavishingB said:
Would you say EM is a lifestyle specialty?
Is there a 'ranking' system for patients in the order they're seen?
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no, the full arrest has to wait in the waiting room for his or her turn.
 
pinipig523 said:
Alright... this guy and I kept in contact for a while. He told me his secret to accumulating wealth. Here is his garage and house. He just took delivery of 2 new cars this year. A Ferrari 599GTO and a Porsche RS.

Links to his thread on another forum:
http://www.teamspeed.com/forums/garage-forum/38204-moved-into-new-garage-pics.html

Here's a teaser pic of his garage. BTW, he is only 38.
RufMD.jpg


It goes to show you, be smart with your money initially out of residency, work hard - and you can get what you want. He's probably not the typical story, but it shows that it can be done.
Click to expand...

You have to take stuff like that with a grain of salt as well. Every dollar spent there is very little wealth accumulating for retirement. I know a ton of docs who do similar things. They end up divorced or in debt up to their eyeballs because of those spending habits. The 100-200k saved by being frugal doesn't mean you should go out and buy a new ferrari. If you want or have kids, then a significant chunk or change goes to that as well.
 
Would an MPH help you in your job search or residency placement at all?
 
You went straight through undergrad, med school, residency, now to a practicing ER doc.

Do you ever question your decision to go into medicine? Did you ever consider other professions outside of medicine or did you go into medicine because you didn't really know what else to do? If you were not in medicine what field would you be in?

Very nice thread btw.

-Crime
 
How often do employers offer loan repayment plans for first year EM graduates? Any idea on the average amount.
 
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