Are we tying our nooses w/ residency expansion?

[EctopicFetus]

Why do you think they’re going to be pulled from the SP500?

They were a bottom 10 company to begin with. Then their market cap dumped by 50%. Typically you have to have 5B in market cap. I think the bottom is 4B. They are barely above 4B.

Time will tell and I can hope..

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[EctopicFetus]

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[EctopicFetus]

EVHC current market cap is $4.1B... keep in mind the market has been on fire.. their stock.... well not so much!

 

[bravotwozero]

well I certainly hope they get booted from wall street. It means smaller doctor's groups won't have to compete with wall street money.

 

[coachB]

well I certainly hope they get booted from wall street. It means smaller doctor's groups won't have to compete with wall street money.

It doesn't mean they are delisted or "booted from wall street." Just that they are no longer part of that particular index. That may have a negative impact on share value in the short run but not some fundamental change that you imply.

 

[EctopicFetus]

It doesn't mean they are delisted or "booted from wall street." Just that they are no longer part of that particular index. That may have a negative impact on share value in the short run but not some fundamental change that you imply.

From a financial aspect this is a big deal. It will limit their ability to borrow money (which is how they are financing their operation). If you believe (and I dont) that they will contract with everyone then they will likely fail financially. They are starting to have a lot of trouble right now which i hope gets way worse. Many of their recent acquisitions arent going well.

 

[slurpy15]

This is why I have predicted we have 2-5 years left to make decent money before our salaries crater. My Australia exit plan is looking better every day.

Australia is projected to have an oversupply of ED docs shortly. What makes you think they would continue to have a shortage?

 

[slurpy15]

Ok. I don't think we need to worry that much about residency expansion. EM is a tough field and most people burn out after 5-15 years. The population is growing and aging, and I also think that the popularity of EM stems from the possibility for PT work. There are increasing nonclinical, lower stress jobs for docs, leading to an exodus from ER. Look at NYU's website- how many of their grads are still working in EM ten years out? Almost none.

 

[Money Moniker]

The 2018 Match data is in! There were a total of 2,278 PGY1 positions this year, up 11% from 2017 and 28% from 2014 when there were 1,786.

The accreditation of AOA programs into ACGME is muddying the waters somewhat in terms of how many "new" positions are actually new, so I did a little digging. Apparently there have only ever been 150 PGY1 AOA positions to begin with, so even assuming all the AOA slots have already been rolled into ACGME by now (doubtful), that would leave an increase of 342 genuinely new ACGME slots in just 4 years. Ouch.

 

[Restart13]

100% think that we need to limit the residency spots. Otherwise we will end up like pharmacists with decreasing/stagnant salaries with minimal full time positions open. If not, one as an individual will need to diversify and become more marketable. Getting into residency should be the limiting factor and bottleneck.

 

[slurpy15]

Ugh. I'm really worried. I think we have thus far been saved by increasing UCs, telehealth and FSEDs, but when that bubble pops, or when the PAs take these low-hanging fruit, who knows what we will be left with? I worry, too. Maybe we will be saved by high burnout? New nonclinical, non EM opportunities?

I'm mid-career- probably have ten more years in the game, and I am legitimately concerned.

 

[alpinism]

The only thing delaying the inevitable bubble is the ridiculously high rate of burnout among new grads.

Almost half of the EM docs I know who graduated in the past 10 years are either working part time or out of the game altogether.

 

[Frazier]

Many of the residents in my program are already thinking exit strategies.

And my residency is FAR from malignant. In fact I'd guess it is one of most supportive environments across the country.

EM is just tough, man.

 

[TheComebacKid]

Ugh. I'm really worried. I think we have thus far been saved by increasing UCs, telehealth and FSEDs, but when that bubble pops, or when the PAs take these low-hanging fruit, who knows what we will be left with? I worry, too. Maybe we will be saved by high burnout? New nonclinical, non EM opportunities?

If the only hope for our specialty is that more of us burnout more quickly, I think that illustrates we have a serious problem on our hands.

 

[emergentmd]

Burnout is not as big of a deal as most think IMO.

Are there EM docs that work into their 60's? I know of some
Are most EM docs out of the field before their 60's? Sure for the obvious reasons
Is burnout the only reason that you don't see docs in the ER into their 60s? Absolutely not.

The great thing about EM is you have alot of GOOD options outside of Hospital based ERs that pays well and is low stress.
UC, FSEDs, etc....

If you are in your 50's, and enough money in retirement (which you should), then why not work in a FSED/UC for 175/hr rather than a high stress ED for $250/hr?

If an Anesthesiologist could make $300k/yr doing 2 cases in a 12 hr shift, why would they make $400k/yr managing 4:1 all day?
If a radiologist could make $300k/yr reading 30 studies in a 12hr shift, why would they make $400k/yr reading 200 studies in a 12 hr shift?
If an orthopedic surgeon could make $300k/yr doing 1 case a day, why would they make $500k/yr doing 5 cases a day?

Thats right, I could work in a FSED seeing 5 pt/12 hrs at $175/hr. $175x12hrsx12shifts/mo = 302K/yr. Why would I work in a hospital based ED seeing 2pt/hr at $225? 4x the amount of pph, sicker patients, metrics, hospital admins, meetings for an extra $50/hr?

Give me the $175/hr job where I am watch TV, surfing the internet, sleeping, reading a book, working out 80% of the time.

 

[Money Moniker]

Burnout is not as big of a deal as most think IMO.

Are there EM docs that work into their 60's? I know of some
Are most EM docs out of the field before their 60's? Sure for the obvious reasons
Is burnout the only reason that you don't see docs in the ER into their 60s? Absolutely not.

The great thing about EM is you have alot of GOOD options outside of Hospital based ERs that pays well and is low stress.
UC, FSEDs, etc....

If you are in your 50's, and enough money in retirement (which you should), then why not work in a FSED/UC for 175/hr rather than a high stress ED for $250/hr?

If an Anesthesiologist could make $300k/yr doing 2 cases in a 12 hr shift, why would they make $400k/yr managing 4:1 all day?
If a radiologist could make $300k/yr reading 30 studies in a 12hr shift, why would they make $400k/yr reading 200 studies in a 12 hr shift?
If an orthopedic surgeon could make $300k/yr doing 1 case a day, why would they make $500k/yr doing 5 cases a day?

Thats right, I could work in a FSED seeing 5 pt/12 hrs at $175/hr. $175x12hrsx12shifts/mo = 302K/yr. Why would I work in a hospital based ED seeing 2pt/hr at $225? 4x the amount of pph, sicker patients, metrics, hospital admins, meetings for an extra $50/hr?

Give me the $175/hr job where I am watch TV, surfing the internet, sleeping, reading a book, working out 80% of the time.

But aren't those kinds of jobs precisely the sort of low hanging fruit that are already increasingly staffed by midlevels? Sure, FSEDs owned by EPs might be the domain of EM boarded docs only, but that's a relatively small fraction of the "non-ED EM jobs" out there. Hospital owned FSEDs and Urgent Cares I'd imagine are far more open to midlevel providers. However quickly the number of ED residencies is growing, the number of midlevels is growing several times faster, so I'm not sure how much longer the option of seeing a handful of low acuity patients a shift for $175/hr is going to exist. That is precisely the type of "workforce inefficiency" that corporate types ruthlessly seek and root out.

 

[emergentmd]

But aren't those kinds of jobs precisely the sort of low hanging fruit that are already increasingly staffed by midlevels? Sure, FSEDs owned by EPs might be the domain of EM boarded docs only, but that's a relatively small fraction of the "non-ED EM jobs" out there. Hospital owned FSEDs and Urgent Cares I'd imagine are far more open to midlevel providers. However quickly the number of ED residencies is growing, the number of midlevels is growing several times faster, so I'm not sure how much longer the option of seeing a handful of low acuity patients a shift for $175/hr is going to exist. That is precisely the type of "workforce inefficiency" that corporate types ruthlessly seek and root out.

I do not know of any FSED that has only Midlevels. You need a doc in these places b/c you actually will get really sick patients that are out of the scope of Midlevels. As long as there are FSEDs around, these jobs will be around. If they ever cease to exist, the EM market will get very tight and EM docs will lose any power against the hospitals/CMGs.

 

[evilbooyaa]

The 2018 Match data is in! There were a total of 2,278 PGY1 positions this year, up 11% from 2017 and 28% from 2014 when there were 1,786.

The accreditation of AOA programs into ACGME is muddying the waters somewhat in terms of how many "new" positions are actually new, so I did a little digging. Apparently there have only ever been 150 PGY1 AOA positions to begin with, so even assuming all the AOA slots have already been rolled into ACGME by now (doubtful), that would leave an increase of 342 genuinely new ACGME slots in just 4 years. Ouch.

Hopefully you guys (EM as a specialty) learn from the examples of multiple specialties before you (Radiology, Pathology, and most recently Rad-Onc) in regards to unchecked residency expansion and its effects on the job market.

They're not gonna pay 175/hr to babysit a UC if someone will work it for 125/hr.

 

[slurpy15]

FSEDs are a bubble that is bursting- look at Texas. A whole bunch have closed in both Houston and Dallas, and now there is an oversupply of physicians and salaries are trending down. Many states are looking to limit FSEDs and have restricted their operations or required (as in my state) that they be connected to a hospital system. Urgent cares are staffed by FPs and PAs, driving down salaries and increasing liability.

Agreed we need to be careful.

 

[deleted109597]

FSEDs are a bubble that is bursting- look at Texas. A whole bunch have closed in both Houston and Dallas, and now there is an oversupply of physicians and salaries are trending down. Many states are looking to limit FSEDs and have restricted their operations or required (as in my state) that they be connected to a hospital system. Urgent cares are staffed by FPs and PAs, driving down salaries and increasing liability.

Agreed we need to be careful.

Replace FSED with coffee shops and you'll begin to realize how wrong your statement is. Yes, some closed, in dense cities where they were on every corner. The ones that are closing are the corporate ones that were paying docs to fly in from other states. Those docs aren't coming anymore.
I haven't seen any depression of salaries outside of Austin.

 

[slurpy15]

Replace FSED with coffee shops and you'll begin to realize how wrong your statement is. Yes, some closed, in dense cities where they were on every corner. The ones that are closing are the corporate ones that were paying docs to fly in from other states. Those docs aren't coming anymore.
I haven't seen any depression of salaries outside of Austin.

I realize Texas is huge enough to be a country, but few states allow FSEDs. Most states require a parent hospital or simply don't license FSEDs. How will they save the rest of us? State of the Nation: Policy for Owning and Operating a Freestanding Emergency Department | JFSEM

 

[deleted109597]

I realize Texas is huge enough to be a country, but few states allow FSEDs. Most states require a parent hospital or simply don't license FSEDs. How will they save the rest of us? State of the Nation: Policy for Owning and Operating a Freestanding Emergency Department | JFSEM

I'm fully aware of state laws.
How does it help you? You're a commodity. You can move to a state with a better practice environment. Or, you can continue to languish where you are. Vote with your feet. Plenty of other people do (mostly Californians it seems).

 

[slurpy15]

I'm fully aware of state laws.
How does it help you? You're a commodity. You can move to a state with a better practice environment. Or, you can continue to languish where you are. Vote with your feet. Plenty of other people do (mostly Californians it seems).

And this attitude is why I would dissuade people from EM. First, moving is not an option for many people. Second, the few states with decent EM jobs cannot absorb all the EM docs in the country. Why would anyone go into a field where the only advice (from faculty, no less) is basically to move to one of two states with FSEDs? That's insane, and if that's truly the state of EM, we need to reevaluate what is going on with our profession and all of us who can't move to Texas or Colorado had better apply for a second residency.

Wow. So depressing.

 

[slurpy15]

And being a commodity sucks. I would recommend students pick a noncommodified field. Absurd.

 

[EctopicFetus]

We also need to consider how we water down the talent pool. Firmly believe that we need to really tighten up the resdencies. Certain residencies have their residents traveling all across the land to get their required rotations. The acuity is puny and now with HCA starting resdencies we have to be very nervous on how those HCA/EmCare residencies will churn out brainless sheep.

 

[slurpy15]

Personally, I think the ship has sailed. I wish I could change my career. But you can't go back....

 

[EctopicFetus]

Personally, I think the ship has sailed. I wish I could change my career. But you can't go back....

This doesn’t impact me in my SDG job. That being said you never know when a good thing will end. I save like a beast but it is easier because i do well.

 

[slurpy15]

Yes. But we need to explain the realities of EM to students. They should not be picking this field. Kids graduating with 200-400k in debt deserve an honest appraisal of the s***show that is EM in this day and age. It's not fair to point them in the direction of an unstable, imploding, liability and burnout ridden field. I can't speak to other fields in medicine, but I can say EM is a poor choice.

 

[EctopicFetus]

EM is great. I work with residents. I push them all to SDGs. I think those working with medical students need to explain the business to them, but of course they dont understand it since the majoritry simply work for the hospital / med school on a salary.

It is important to understand what you get into. That being said even working for an abusive CMG making $200/hr its not tough to make 300k. Thats way better than Peds, FP or IM.

I might be spoiled but I would struggle to do all I do on that money. Luckily I do well enough to max out my retirement and have a DB plan to boot and then backdoor IRAs, HSAs, and maxing out my wife’s retirement (she is self employed).

 

[slurpy15]

EM is great. I work with residents. I push them all to SDGs. I think those working with medical students need to explain the business to them, but of course they dont understand it since the majoritry simply work for the hospital / med school on a salary.

It is important to understand what you get into. That being said even working for an abusive CMG making $200/hr its not tough to make 300k. Thats way better than Peds, FP or IM.

I might be spoiled but I would struggle to do all I do on that money. Luckily I do well enough to max out my retirement and have a DB plan to boot and then backdoor IRAs, HSAs, and maxing out my wife’s retirement (she is self employed).

It's not all about the money for all of us. And the money is not that great. It's not finance great, or even cards, GI, or ENT great.

Many parts of the country have no SDGs. I can't think of any in Boston or New York, and I can't think of any in Portland or Seattle that are hiring. Sure, EM is great in Michigan, Texas, and Arkansas, but isn't every field? Some folks really, really care about patient care and want patient interaction, and supervising a bunch of PAs and giving crap care for a CMG would kill their souls. I'm not in an SDG, but I save a good six figures every year and the money doesn't make up for the hell of working for a corporation. And many SDGs are...work nights forever, then we'll see if we make you minions partner. They aren't all great.

Agreed it's important to know what you are getting into, and I don't think any medschools or residencies can or do explain this. I wish they would.

I would do anything to get out of what EM has become. But we set EM up so you have to do it (or Urgent Care) forever. And that's tough with CMGs etc.

 

[EctopicFetus]

It's not all about the money for all of us. And the money is not that great. It's not finance great, or even cards, GI, or ENT great.

Many parts of the country have no SDGs. I can't think of any in Boston or New York, and I can't think of any in Portland or Seattle that are hiring. Sure, EM is great in Michigan, Texas, and Arkansas, but isn't every field? Some folks really, really care about patient care and want patient interaction, and supervising a bunch of PAs and giving crap care for a CMG would kill their souls. I'm not in an SDG, but I save a good six figures every year and the money doesn't make up for the hell of working for a corporation. And many SDGs are...work nights forever, then we'll see if we make you minions partner. They aren't all great.

Agreed it's important to know what you are getting into, and I don't think any medschools or residencies can or do explain this. I wish they would.

I would do anything to get out of what EM has become. But we set EM up so you have to do it (or Urgent Care) forever. And that's tough with CMGs etc.

Money isn’t everything but it prevents burnout (I can work less). SDGs also give you some control. I have been lucky that both of my SDGs were very fair. Extra nights were optional etc. One of the SDGs in Seattle makes 270/pt. Thats a great job in a location even you would consider desireable. I am not saying it is easy but the jobs are out there. If you are tied to an area things will be tougher. I know EM docs in California and AZ who have made $1m+. I know plenty of EM docs making 600k+.

I also went to a “finance” heavy Ivy League school. You are right. My buddies who do private equity make more than I do and their careers will last longer than mine. One of my college buddies in finance just bought a house for 20M in SF.

That being said if you are flexible 500k in EM is doable. Thats a ton of money. You can make that working 120 hours a month. The mid levels will work for you and you will get a nice bonus from them without even needing to supervise many of them. When I “work” with them they may staff 1 pt per shift. I do sign their charts. I dont mind as the money goes right into my pocket.

I think many of the other fields have had their own issues. There are few cardiologists who are in independent groups around me. They either work for the hospital or another large multi specialty practice. Every field has its issues. It is important to know the challenges.

I finished residency in 2009. I still enjoy it. I look forward to my shifts. I also look forward to payday.

 

[slurpy15]

Money isn’t everything but it prevents burnout (I can work less). SDGs also give you some control. I have been lucky that both of my SDGs were very fair. Extra nights were optional etc. One of the SDGs in Seattle makes 270/pt. Thats a great job in a location even you would consider desireable. I am not saying it is easy but the jobs are out there. If you are tied to an area things will be tougher. I know EM docs in California and AZ who have made $1m+. I know plenty of EM docs making 600k+.

I also went to a “finance” heavy Ivy League school. You are right. My buddies who do private equity make more than I do and their careers will last longer than mine. One of my college buddies in finance just bought a house for 20M in SF.

That being said if you are flexible 500k in EM is doable. Thats a ton of money. You can make that working 120 hours a month. The mid levels will work for you and you will get a nice bonus from them without even needing to supervise many of them. When I “work” with them they may staff 1 pt per shift. I do sign their charts. I dont mind as the money goes right into my pocket.

I think many of the other fields have had their own issues. There are few cardiologists who are in independent groups around me. They either work for the hospital or another large multi specialty practice. Every field has its issues. It is important to know the challenges.

I finished residency in 2009. I still enjoy it. I look forward to my shifts. I also look forward to payday.

Thank you. These are all excellent points. I am perhaps annoyed with my current job because today I worked with a demented doc who keeps accidentally ordering things on my patients and blaming it on the "computer system" as opposed to dealing. And the director ignores it. So perhaps I am just crispy this week.

You make good points, and you sound like the kind of person who does well anywhere, is super flexible, and doesn't sweat the small stuff, which is a great combo for EM. Try getting a job at the $270/pt Seattle group, though! And woe to the Bostonians, NYers, and Mainers.

 

[EctopicFetus]

Yeah. There are crappy jobs out there. I know someone at that Seattle job but the NW is not my cup of tea. I have great friends in Bend and could get a job there too.

Plenty of crappy markets out there. Docs seem wed to those places. I went to school in the NE and lived in NYC before med school. Overall the NE has terrible pay.

 

[slurpy15]

Agreed. And terrible jobs. But some people have family reasons etc. Even weirder than NYC is CT, where they can't hire anyone, yet the jobs are still ****ty. I think it's important, though, for students to realize that EM + NE are incompatible.

 

[deleted109597]

And this attitude is why I would dissuade people from EM. First, moving is not an option for many people.

Yes it is. There is no absolute contraindication to moving for anyone. I get that it's tough, but what you're arguing is the same thing the Occupy Wall Street people argued. And it's asinine. What if your hospital closed? Would you move then or just retire?

Second, the few states with decent EM jobs cannot absorb all the EM docs in the country. Why would anyone go into a field where the only advice (from faculty, no less) is basically to move to one of two states with FSEDs?

There are more than a few states with decent EM jobs. And FSEDs aren't a)only in 2 states and b) the only thing that makes the state better. When I moved to Texas it was because of income tax, pay, and malpractice laws. FSEDs weren't a thing. There are other states with good malpractice laws now. I recommend looking at it that way. I wouldn't be a good faculty member if I didn't teach people how to think for themselves. I'm not arguing everyone needs to work in an FSED.

That's insane, and if that's truly the state of EM, we need to reevaluate what is going on with our profession and all of us who can't move to Texas or Colorado had better apply for a second residency.

See above. There are more than 2 states with good environments

Wow. So depressing.

Yes, so start looking at the bright side of things.

 

[Apollyon]

Yes, so start looking at the bright side of things.

I gotta play the lottery today. I thought this day would NEVER come - when @Dr.McNinja says something up, versus dark and snarky!

 

[slurpy15]

Yes it is. There is no absolute contraindication to moving for anyone. I get that it's tough, but what you're arguing is the same thing the Occupy Wall Street people argued. And it's asinine. What if your hospital closed? Would you move then or just retire?

There are more than a few states with decent EM jobs. And FSEDs aren't a)only in 2 states and b) the only thing that makes the state better. When I moved to Texas it was because of income tax, pay, and malpractice laws. FSEDs weren't a thing. There are other states with good malpractice laws now. I recommend looking at it that way. I wouldn't be a good faculty member if I didn't teach people how to think for themselves. I'm not arguing everyone needs to work in an FSED.

See above. There are more than 2 states with good environments

Yes, so start looking at the bright side of things.

[/QUOTE]

Sure. Anyone CAN move. But if that's not what they want, why would they pick a field that would force them to move and be unhappy? I just think prospective EM docs should know that the NE is out and that if living in a certain environment is important, or if they want/need to be near family, then maybe they should reconsider EM.

 

[Status Sciaticus]

Yes. But we need to explain the realities of EM to students. They should not be picking this field. Kids graduating with 200-400k in debt deserve an honest appraisal of the s***show that is EM in this day and age. It's not fair to point them in the direction of an unstable, imploding, liability and burnout ridden field. I can't speak to other fields in medicine, but I can say EM is a poor choice.

is this your feeling/opinion or do you have some proof to back up these claims?

It's not all about the money for all of us. And the money is not that great. It's not finance great, or even cards, GI, or ENT great.

Many parts of the country have no SDGs. I can't think of any in Boston or New York, and I can't think of any in Portland or Seattle that are hiring. Sure, EM is great in Michigan, Texas, and Arkansas, but isn't every field? Some folks really, really care about patient care and want patient interaction, and supervising a bunch of PAs and giving crap care for a CMG would kill their souls. I'm not in an SDG, but I save a good six figures every year and the money doesn't make up for the hell of working for a corporation. And many SDGs are...work nights forever, then we'll see if we make you minions partner. They aren't all great.

Agreed it's important to know what you are getting into, and I don't think any medschools or residencies can or do explain this. I wish they would.

I would do anything to get out of what EM has become. But we set EM up so you have to do it (or Urgent Care) forever. And that's tough with CMGs etc.

No one said it was going to be finance great. Most people know going into EM what their payscale is going to be. And complaining about income when comparing a 3 year residency program a 6 year residency program is silly.

I'm sorry you are not enjoying your career choice, but joining your corporation was your decision, one you can easily change. I believe you work for a CMG right? And given that you say CMGs are evil and horrible for future EM docs, perhaps you can lead us by example and switch over to a different job?

 

[slurpy15]

is this your feeling/opinion or do you have some proof to back up these claims?



No one said it was going to be finance great. Most people know going into EM what their payscale is going to be. And complaining about income when comparing a 3 year residency program a 6 year residency program is silly.

I'm sorry you are not enjoying your career choice, but joining your corporation was your decision, one you can easily change. I believe you work for a CMG right? And given that you say CMGs are evil and horrible for future EM docs, perhaps you can lead us by example and switch over to a different job?

I'm beginning to see that there is a reason you didn't match in EM. Stop assuming so much! You are going into a field where you need to listen....

 

[EctopicFetus]

I see this in other fields. If you do surgery you have to find a job. One of the breast surgeons I work with ended up here cause the market was over saturated in another part of the country.

I think docs are more comfortable with moving than most. How do people climb the corporate ladder? They move. I have friends in Shanghai, India and London who do finance. They went there for better opportunities.

No matter your career to find a “good” job you have to be flexible IMO.

The saying was you can have 2 out of 3. Good job, Location, or pay.

If you have 3 you are a unicorn, if you have 2 you are good. If you have one you need to keep looking.

 

[slurpy15]

I see this in other fields. If you do surgery you have to find a job. One of the breast surgeons I work with ended up here cause the market was over saturated in another part of the country.

I think docs are more comfortable with moving than most. How do people climb the corporate ladder? They move. I have friends in Shanghai, India and London who do finance. They went there for better opportunities.

No matter your career to find a “good” job you have to be flexible IMO.

The saying was you can have 2 out of 3. Good job, Location, or pay.

If you have 3 you are a unicorn, if you have 2 you are good. If you have one you need to keep looking.

All excellent points. I have to say EM jobs do seem to vary more than, say, Peds, IM, or neurology. I would say in NYC, Boston, and DC, you get one out of three in EM jobs. And you can get that without the headache of working...

 

[Status Sciaticus]

I'm beginning to see that there is a reason you didn't match in EM. Stop assuming so much! You are going into a field where you need to listen....

Oh and what reason is that? Good job at deflecting and not providing any evidence for all the things you are complaining about.

 

[slurpy15]

Learn to listen.

No, I don't work for a CMG. I actually have a decent job within what is normal for EM. That doesn't make it a great field.

 

[Brigade4Radiant]

So how far is reasonable to travel for another gig? Im thinking of credentialing in multiple places to pick up more shifts.

 

[slurpy15]

For me? A direct flight to a non-annoying airport and scheduling flexibility.

The best locums gigs are in undesirable areas. If you are looking at a locums gig in Manhattan, you know that job is bad!

 

[Rekt]

https://i.redd.it/py3ncok5cxm01.jpg

Another HCA grenade.

 

[slurpy15]

Ugh.

 

[Money Moniker]

https://i.redd.it/py3ncok5cxm01.jpg

Another HCA grenade.

WOW!

 

[engineeredout]

WOW!

15 PGY1 spots in a brand new program stinks of a search for free labor and not much else

 

[Money Moniker]

15 PGY1 spots in a brand new program stinks of a search for free labor and not much else

I know. My "WOW" was deeply sardonic in nature. It was a "so it has come to this" WOW.