Advice Choosing Job

[HLxDrummer]

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Hey guys,

If this isn't permitted or needs to be moved/modified, please let me know.

I'm an upcoming PGY3 and I have narrowed down my prospects to two locations and need some help deciding.

Job 1:
-Has a bad reputation for beating up providers/being a meat factory, but under new management for the past two years. Currently phasing out locums docs
-Talking to docs there they didn't seem miserable but definitely not thrilled, either
-Work as IC
-$300/hr no RVUs
-30 some bed ED with full time scribes. High acuity level 2 trauma center. Has some issues with boarding. Read your own plain films at night. 40 hours physician coverage/day.

Job 2:
-Very stable staff, only reason they are hiring now is because they have some upcoming retirements
-Talking to docs here, they are all very happy. Literally they could not think of any downsides or complaints
-Work as employee
-Average $210/hr (base plus RVU- this number is based on the base pay plus average RVU)
- 30 some bed ED but you just run a 12 bed pod. Seems slightly lower acuity and minimal trauma. Scribes during busy shifts. Minimal to no boarding. 24/7 rads. 50 hours physician coverage/day.
-Can split your time between the main hospital and a 12 bed critical access hospital as you wish

Both have similar PPH and both have pros/cons in terms of location.

My main two concerns:
1. Seems like the first job pays way more but not sure how significant that is when you factor in insurance/taxes/etc. Can anybody weigh in on this? I have a wife and a kid I will need to get health insurance for.

2. The second job seems more sustainable and enjoyable but slightly worried about losing my skills straight out of residency (especially not having much trauma).

Overall just looking for some advice/input for those who have been through this before. I don't want to fall into the trap of picking the highest paying job and hating it but also don't want to lose my skills straight out of residency and regret not making more money early in my career. Thanks in advance!

 

[Apollyon]

Second job, hands down. The biggest steak isn't always the best. You won't lose your skills at either place. If they see 19k/year, that's what ACEP says (or said) is needed to not get bored.

 

[HLxDrummer]

Ya, that's what my gut is telling me. You don't think I'm getting taken advantage of at $210/hr? I see all these people posting online and it makes that offer seem low. Thanks for the input!

 

[deleted859535]

Ya, that's what my gut is telling me. You don't think I'm getting taken advantage of at $210/he? I see all these people posting online and it makes that offer seem low. Thanks for the input!

SDN is a skewed sample. While you can do better, in some ways, you "pay" for the kind of job / where the job is / benefits.

Second job, no question.

 

[HLxDrummer]

SDN is a skewed sample. While you can do better, in some ways, you "pay" for the kind of job / where the job is / benefits.

Second job, no question.

Ya I figured that was the situation. Honestly I'd rather have something enjoyable and sustainable and take a hit with pay. Just seemed like low pay (for clarification that $210 is base plus average RVU, not just base). Thanks again!

 

[carbonizedeyesockets]

Being happy is worth more than 90$/hr, IMO. Go with the place with happy people with low turn over.

 

[CliveStaples]

Yeah, make sure you realize that it’s really not a 90/hr difference in pay since you need to take into account the benefits you’ll receive as an employee. It won’t be 90/hr worth, but it will definitely narrow the gap.

Job 2 is probably the better position for most people. You just have to decide if it’s the right job for you. Don’t underestimate the fact that you talked to people who didn’t have complaints; including complaining about not being paid what they felt was competitive for their market.

 

[emergentmd]

90/hr=150k/yr. No one can answer the question if 150K is worth it or not as everyone has a price.

As a new grad, I prob would have taken the money given my ignorance. Where I am right now, I prob take neither. 210/hr seems quite slim for any real ER.

 

[enalli]

Job 2 all the way.

Quality of life is priceless. You'll still be clearing $300k, which is nothing to scoff at. If for some reason you regret it, there will always be vacancies at places like Job 1 (probably at that exact place too); the reverse may not be true.

 

[hundreddaysoff]

Both have similar PPH

To play devil's advocate, I think the actual pph should matter here. Eg, if the second job is paying 210/h to see 3pph when you could make 300/h seeing the same insane pph in the same market, I'd be concerned that someone is ripping you off, no matter how good the other benefits are. (See our recent famous "What are you REALLY worth???!!!" thread.) If they're both more like 2pph, that makes the second job look even better if your goal is long-term sustainability.

Maybe what I really mean to say is you should be suspicious of both jobs if pph turns out to be more than 2.5 or so.

FYI, I'm an R3 about to finish and I took my first attending job with features in between the two you're describing. 4 months of moonlighting later and I'm really happy with it.

One thing that surprised me this year is how little I ended up caring about overnight X-ray reads. You get better at X-rays really fast when you're forced to do your own reads. Although a lot of places don't automatically read X-rays overnight like they did in residency, most places will have a Nighthawk number you can call to get critical overreads as needed.

 

[link2swim06]

90/hr=150k/yr. No one can answer the question if 150K is worth it or not as everyone has a price.

As a new grad, I prob would have taken the money given my ignorance. Where I am right now, I prob take neither. 210/hr seems quite slim for any real ER.

Except it's not 150K

Benefits are probably worth $10-20/hr. So $70/hr really a spread.

Now those dollars are going to be taxed at 35-40+%.

So probably closer to ~$70,000 take home difference.

 

[dchristismi]

Another vote for job #2.
This is a no-brainer IME, having been there.

 

[HLxDrummer]

To play devil's advocate, I think the actual pph should matter here. Eg, if the second job is paying 210/h to see 3pph when you could make 300/h seeing the same insane pph in the same market, I'd be concerned that someone is ripping you off, no matter how good the other benefits are. (See our recent famous "What are you REALLY worth???!!!" thread.) If they're both more like 2pph, that makes the second job look even better if your goal is long-term sustainability.

Maybe what I really mean to say is you should be suspicious of both jobs if pph turns out to be more than 2.5 or so.

FYI, I'm an R3 about to finish and I took my first attending job with features in between the two you're describing. 4 months of moonlighting later and I'm really happy with it.

One thing that surprised me this year is how little I ended up caring about overnight X-ray reads. You get better at X-rays really fast when you're forced to do your own reads. Although a lot of places don't automatically read X-rays overnight like they did in residency, most places will have a Nighthawk number you can call to get critical overreads as needed.

PPH ends up around 1.7 for both.

Ps thank you everyone for the advice. My gut was telling me number 2 but it helps having some confirmation.

 

[Brigade4Radiant]

How many shifts do you have to work if its 120 job 2 easily you can always work prn at job 1 and work 1-2 shifts a month.

 

[HLxDrummer]

How many shifts do you have to work if its 120 job 2 easily you can always work prn at job 1 and work 1-2 shifts a month.

I think they're looking for 130 hours a month, so that is definitely an option!

 

[turkeyjerky]

PPH ends up around 1.7 for both.

Ps thank you everyone for the advice. My gut was telling me number 2 but it helps having some confirmation.

1.7 pph with a scribe is a piece of cake, imo.

 

[TooMuchResearch]

1.7 pph with a scribe is a piece of cake, imo.

Depends on the setup. Mixed acuity or all all the easy ones seen by PA in fast track?

 

[carbonizedeyesockets]

90/hr=150k/yr. No one can answer the question if 150K is worth it or not as everyone has a price.

Depending on the hours per year (e.g 1532), you could still be in the same income percentile (99th). I don't know, maybe it's because I worked low pay jobs for years before med school and because I once supported myself on 20$/hr, but I'll shed some $/hr for satisfaction and stability. I've worked crappy jobs with crappy management and in the long run it's not worth it (for me).

But, you are right, tolerance for that pay difference is going to vary from person to person and will also change depending on circumstances.

 

[emergentmd]

1.7 pph with a scribe is a piece of cake, imo.

1.7pph esp with a scribe is a nice day. In a 10 hr shift, thats 17 pts. Most places I work has all the easy stuff taken by the scribe. Most everything else is a bunch of labs, admit vs discharge anyhow.

 

[HLxDrummer]

Ya 1.7 isn't bad at all. Seeing more than that as a PGY2 with no scribe and at an academic place which slows things down. Not looking to get crushed every day as an attending though 🙂

 

[shoal007]

Ya 1.7 isn't bad at all. Seeing more than that as a PGY2 with no scribe and at an academic place which slows things down. Not looking to get crushed every day as an attending though 🙂

1.7 pph when you're the final decision is not as easy as it sounds. Add in poor or missing speciality coverage, difficult admission process and it can be much harder than your 1.7 pph in residency. In addition, the huge drive for patient satistifcation which you likely have been partially sheltered from. Either way, you'll be fine.

Sent from my Pixel 2 using Tapatalk

 

[GonnaBeADoc2222]

1.7 pph when you're the final decision is not as easy as it sounds. Add in poor or missing speciality coverage, difficult admission process and it can be much harder than your 1.7 pph in residency. In addition, the huge drive for patient satistifcation which you likely have been partially sheltered from. Either way, you'll be fine.

1.7 where I work would be a CAKEWALK. I'm routinely seeing 2 - 2.5 (with generally really good scribes). However, I do agree about the other points as listed above. My specialty coverage is pretty good, admits pretty easy, and I haven't been bothered about patient satisfaction literally at all.