Academic EM in a large east coast city (say NYC)

[AnonymousDoctorGuyPerson]

Hey folks. As someone who has fallen absolutely in love with EM and can't get enough of it, who is also interested in teaching/research/leading, AND who wants to stay in their home city of NYC what does that career trajectory entail?

I've heard from some folks dual boarding like an EM/IM program is useful. I'm interested from hearing the folks currently in the field, thanks!!

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[DeadCactus]

1. Enter a reasonable quality EM residency
2. Do a fellowship
3. Accept low pay
4. Work in less desirable program until an opening occurs at a desirable program

 

[BoardingDoc]

Hey folks. As someone who has fallen absolutely in love with EM and can't get enough of it, who is also interested in teaching/research/leading, AND who wants to stay in their home city of NYC what does that career trajectory entail?

I've heard from some folks dual boarding like an EM/IM program is useful. I'm interested from hearing the folks currently in the field, thanks!!

Getting an attending gig in NYC shouldn't be difficult. You just have to be willing to accept one of the lowest EM salaries in the country while living in one of the most expensive cities in the country. Doing a fellowship will also help.

 

[AnonymousDoctorGuyPerson]

Getting an attending gig in NYC shouldn't be difficult. You just have to be willing to accept one of the lowest EM salaries in the country while living in one of the most expensive cities in the country. Doing a fellowship will also help.

1. Enter a reasonable quality EM residency
2. Do a fellowship
3. Accept low pay
4. Work in less desirable program until an opening occurs at a desirable program

Isn't that true for most salaries in NYC to be fair? They're relatively low across the board


Also
1) is there a particular fellowship that improves your chances?
2) any thoughts on EM/IM or EM/IM/CC?
3) How much does residency prestige help? What's considered a good residency?

 

[RustedFox]

Oh, Christ.

 

[AnonymousDoctorGuyPerson]

Oh, Christ.

Go on

 

[miacomet]

Working EM in NYC is hell. My suggestion is to look around and do a fellowship that will allow you to cut down clinical hours as fast as possible so you can work 16 or so hours a week and have the rest of your time "protected." Admin, maybe.

 

[RustedFox]

Go on

Posts like yours often bubble up on here from time to time.
Just like yours.
JUST . like . yours .

Here's how the thread usually progresses:

OP: I'm going to be the BEST ER (doc, program director, researcher, whatever) in my HOME CITY of (NYC/LA/SF), how do I Triforce ?

Attending A: That's a terrible idea because of (X), (Y), (Z), and (AA), (BB), (CC).....

OP: You're WRONG because REASONS ! I'm DIFFERENT.

Attending B: Okay, we all thought that we were different, too. Do you know about (DD), (EE), and (FF)?

OP: That won't matter because (generally the same) REASONS.

Attending C: No, you see... your REASONS aren't the way it actually works in the real world. Listen to us...

Attending B: Yeah, Attending C has it right on.

Attending A: ["Likes" attending B's post]

OP: I'm not listening; you guys are all burned-out and jaded.

....

....

....

Godwin's Law applies

....

Moderator: ALL YOUR BASE ARE BELONG TO US.


I could write a goddamned play.

Some of the things that you've already written are a dead giveaway. I'll let you wonder about which ones those are.

 

[AnonymousDoctorGuyPerson]

Posts like yours often bubble up on here from time to time.
Just like yours.
JUST . like . yours .

Here's how the thread usually progresses:

OP: I'm going to be the BEST ER (doc, program director, researcher, whatever) in my HOME CITY of (NYC/LA/SF), how do I Triforce ?

Attending A: That's a terrible idea because of (X), (Y), (Z), and (AA), (BB), (CC).....

OP: You're WRONG because REASONS ! I'm DIFFERENT.

Attending B: Okay, we all thought that we were different, too. Do you know about (DD), (EE), and (FF)?

OP: That won't matter because (generally the same) REASONS.

Attending C: No, you see... your REASONS aren't the way it actually works in the real world. Listen to us...

Attending B: Yeah, Attending C has it right on.

Attending A: ["Likes" attending B's post]

OP: I'm not listening; you guys are all burned-out and jaded.

....

....

....

Godwin's Law applies

....

Moderator: ALL YOUR BASE ARE BELONG TO US.


I could write a goddamned play.

Some of the things that you've already written are a dead giveaway. I'll let you wonder about which ones those are.

I said go on because idk what he's referring to here, if y'all tell me to stay clear I'm gonna stay clear. Just tryna hear from you guys.


What locations in the US are less malignant for EM?

 

[gro2001]

While my esteemed colleagues have a point, I would just say that I trained in NYC and know many attendings who love working there. Some even commute from other states. We even had one attending who lived in Hawaii who would fly in and do some shifts in a stretch. Many people stick around for years and don't want to leave. So some people clearly find it worthwhile. Maybe you will be one of them. Maybe not. Maybe you will for a while, then find you'd like to move elsewhere. Either way, don't let a bunch of bitter folks on here, most of whom have not trained or worked in NYC discourage you.

To be clear though, they are right in that it's some of the lowest pay, in an extremely expensive city, will largely dysfunctional, overcrowded ERs. Training in NYC will almost certainly involve some non-physician tasks (IVs, transport, etc).

As to what will set you up with that career:

-Residency, ideally at an academic institution in the area. Connections/networks matter, the best jobs aren't advertised, etc. And academic places tend to not want to hire from non-academic places. Most of the programs in the city are 4 year programs, so if you aren't going to pursue fellowship then that's a factor too, as most are reluctant to hire fresh grads from 3 year programs. Not that it's impossible to get a job here as a fresh grad from a 3 year community program in another part of the country, but it wouldn't be the easiest path.

-Fellowship would probably help. There isn't necessarily one that would make you a shoe in everywhere, and I wouldn't recommend doing it for that purpose alone. Generally most programs have at least one person in the common fields: ultrasound, tox, critical care, EMS, sim. It's hard to predict what needs any particular department will have when it's time for you to get a job. Do what you like, and if it's one of those areas it may give you a leg up.

-Whether you do a fellowship or not, finding a niche is important. The main advantage of a fellowship is that it's ready made way into a niche. There are people who make their own way without one, but it's harder, requires great mentorship, and could be harder to prove. But being able to point to something that you would bring to the table is huge. Just don't do admin. Everyone is doing admin. No one needs more admin people.

-I don't think EM/IM would particularly help. I haven't really seen it fulfill it's promise of building bridges between EM and IM, though that may be because very few EM/IM people do both EM and IM at the same institution. EM/CCM has done way more in recent years in that respect. CCM is a solid niche that is needed at many departments and could certainly be the way to further your career if you are interested in it. My biased opinion is that EM/IM/CCM is overkill and the extra IM time doesn't add that much worth either to your education or hirability.

 

[turkeyjerky]

Posts like yours often bubble up on here from time to time.
Just like yours.
JUST . like . yours .

Here's how the thread usually progresses:

OP: I'm going to be the BEST ER (doc, program director, researcher, whatever) in my HOME CITY of (NYC/LA/SF), how do I Triforce ?

Attending A: That's a terrible idea because of (X), (Y), (Z), and (AA), (BB), (CC).....

OP: You're WRONG because REASONS ! I'm DIFFERENT.

Attending B: Okay, we all thought that we were different, too. Do you know about (DD), (EE), and (FF)?

OP: That won't matter because (generally the same) REASONS.

Attending C: No, you see... your REASONS aren't the way it actually works in the real world. Listen to us...

Attending B: Yeah, Attending C has it right on.

Attending A: ["Likes" attending B's post]

OP: I'm not listening; you guys are all burned-out and jaded.

....

....

....

Godwin's Law applies

....

Moderator: ALL YOUR BASE ARE BELONG TO US.


I could write a goddamned play.

Some of the things that you've already written are a dead giveaway. I'll let you wonder about which ones those are.

Don't forget the post in several years when the OP comes back asking about locums, critical access hospitals, flying out of state, etc.

Then the post a few years after that where they've found a side gig and are transitioning out of clinical medicine entirely.

 

[AnonymousDoctorGuyPerson]

Don't forget the post in several years when the OP comes back asking about locums, critical access hospitals, flying out of state, etc.

Then the post a few years after that where they've found a side gig and are transitioning out of clinical medicine entirely.

Doubt it, I'd probably be in a different specialty.

 

[RustedFox]

Doubt it, I'd probably be in a different specialty.

That's the idea.

You say that you've "fallen absolutely in love with EM and can't get enough of it", which is the first indication that you don't know what EM is really actually about, especially in NYC.

The second item that gave it away was you asking: "How much does residency prestige help? What's considered a good residency?" See the threads on "Powerhouse residencies" to learn that there is no such thing in the world of EM as "prestige".

Let me make this brief: we're all telling you that EM is a nightmare and a sinking ship with a poor job market outlook - and NYC has probably the worst aspects of all of EM.

 

[thegenius]

Posts like yours often bubble up on here from time to time.
Just like yours.
JUST . like . yours .

Here's how the thread usually progresses:

OP: I'm going to be the BEST ER (doc, program director, researcher, whatever) in my HOME CITY of (NYC/LA/SF), how do I Triforce ?

Attending A: That's a terrible idea because of (X), (Y), (Z), and (AA), (BB), (CC).....

OP: You're WRONG because REASONS ! I'm DIFFERENT.

Attending B: Okay, we all thought that we were different, too. Do you know about (DD), (EE), and (FF)?

OP: That won't matter because (generally the same) REASONS.

Attending C: No, you see... your REASONS aren't the way it actually works in the real world. Listen to us...

Attending B: Yeah, Attending C has it right on.

Attending A: ["Likes" attending B's post]

OP: I'm not listening; you guys are all burned-out and jaded.

....

....

....

Godwin's Law applies

....

Moderator: ALL YOUR BASE ARE BELONG TO US.


I could write a goddamned play.

Some of the things that you've already written are a dead giveaway. I'll let you wonder about which ones those are.

LMAO

All your base are belong to us.

LMAO!!!!!

 

[thegenius]

Posts like yours often bubble up on here from time to time.
Just like yours.
JUST . like . yours .

Here's how the thread usually progresses:

OP: I'm going to be the BEST ER (doc, program director, researcher, whatever) in my HOME CITY of (NYC/LA/SF), how do I Triforce ?

Attending A: That's a terrible idea because of (X), (Y), (Z), and (AA), (BB), (CC).....

OP: You're WRONG because REASONS ! I'm DIFFERENT.

Attending B: Okay, we all thought that we were different, too. Do you know about (DD), (EE), and (FF)?

OP: That won't matter because (generally the same) REASONS.

Attending C: No, you see... your REASONS aren't the way it actually works in the real world. Listen to us...

Attending B: Yeah, Attending C has it right on.

Attending A: ["Likes" attending B's post]

OP: I'm not listening; you guys are all burned-out and jaded.

....

....

....

Godwin's Law applies

....

Moderator: ALL YOUR BASE ARE BELONG TO US.


I could write a goddamned play.

Some of the things that you've already written are a dead giveaway. I'll let you wonder about which ones those are.

Made me think of this:

“Roll the dice to see if I’m getting drunk!!”

 

[RustedFox]

Made me think of this:

“Roll the dice to see if I’m getting drunk!!”

I remember when this came out!

 

[AnonymousDoctorGuyPerson]

LMAO

All your base are belong to us.

LMAO!!

I remember when this came out!

Ah memories

(Yes I'm old)