EM in NYC?

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TSSVR4

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I'm a medical student interested in EM and have basically half my family in NYC. I have been told though that life as an EM doc in New York City is especially rough (nurses aren't too helpful, pay is nearly ~$100k less, patients are difficult).

Can anyone shed life on this? It's pretty important for me to do residency and eventually live in NYC. What should I expect?

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I'm a medical student interested in EM and have basically half my family in NYC. I have been told though that life as an EM doc in New York City is especially rough (nurses aren't too helpful, pay is nearly ~$100k less, patients are difficult).

Can anyone shed life on this? It's pretty important for me to do residency and eventually live in NYC. What should I expect?

I did my residency in NYC. There are advantages and disadvantages, as with anything. For me, the advantages way outweighed the disadvantages.

Yeah, the ancillary staff at many hospitals isn't the best/easiest to deal with. This may or may not have anything to do with the fact that many hospitals nursing staff is unionized. But its not anything you can't get used to or learn to work around. It will require you both to hone your people skills and to toughen up.

As a resident the income won't differ too much from residents elsewhere. You will pay a lot more in rent, but the salaries are slightly higher for residents in NYC and many hospitals offer subsidized housing. I was able to even put away some savings during residency while not really limiting myself in terms of entertainment or buying stuff. Having said that, I was single at the time. The calculus may change if I had been married with kids, but I know plenty of residents who are/were married with kids and survived just fine on their resident salaries. The attending income is lower than in many parts of the country, but that is true of the North East in general. Having said that, you can make significantly more if you are willing to commute out of the city a bit. It helps to think of living in NYC as a luxury, for which you have to pay a luxury tax.

I don't know if patients are any more difficult than elsewhere. There are difficult patients everywhere. It didn't really occur to me as an issue. The patients are New Yorkers. Once again, may have to toughen up if you want to make it here :)

There are lots of advantages though. On your limited time off as a resident, you are a short subway ride away from the best restaurants, bars and shows in the world. The city is really amazing (if you like big cities). No other place really compares in terms of energy and the sheer mass of things going on. If you are a foodie, this place can't be beat by any other place in the world. Also, if you don't try living in NYC now, then when are you going to do it?
 
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Thank you so much for your input. As a M4 about to start residency in NYC this coming July, this post gives me a more clear idea of what to expect. Not to hijack the original thread (but more like a follow up question about your NYC experience), did you encounter any language barrier when serving the patients from such a diverse background? I've heard that large % of patients in the city speak Spanish or Creole only, and as a person who speaks close to zero Spanish or Creole, I was about to rely on the nursing staff & translation phone service for taking history etc, but now I'm debating if I should start learning basic Spanish STAT as not doing so can hinder my efficiency? Or did you find this issue to be a minor problem that we can gradually overcome as we work? Thank you in advance!

I did my residency in NYC. There are advantages and disadvantages, as with anything. For me, the advantages way outweighed the disadvantages.

Yeah, the ancillary staff at many hospitals isn't the best/easiest to deal with. This may or may not have anything to do with the fact that many hospitals nursing staff is unionized. But its not anything you can't get used to or learn to work around. It will require you both to hone your people skills and to toughen up.

As a resident the income won't differ too much from residents elsewhere. You will pay a lot more in rent, but the salaries are slightly higher for residents in NYC and many hospitals offer subsidized housing. I was able to even put away some savings during residency while not really limiting myself in terms of entertainment or buying stuff. Having said that, I was single at the time. The calculus may change if I had been married with kids, but I know plenty of residents who are/were married with kids and survived just fine on their resident salaries. The attending income is lower than in many parts of the country, but that is true of the North East in general. Having said that, you can make significantly more if you are willing to commute out of the city a bit. It helps to think of living in NYC as a luxury, for which you have to pay a luxury tax.

I don't know if patients are any more difficult than elsewhere. There are difficult patients everywhere. It didn't really occur to me as an issue. The patients are New Yorkers. Once again, may have to toughen up if you want to make it here :)

There are lots of advantages though. On your limited time off as a resident, you are a short subway ride away from the best restaurants, bars and shows in the world. The city is really amazing (if you like big cities). No other place really compares in terms of energy and the sheer mass of things going on. If you are a foodie, this place can't be beat by any other place in the world. Also, if you don't try living in NYC now, then when are you going to do it?
 
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Thank you so much for your input. As a M4 about to start residency in NYC this coming July, this post gives me a more clear idea of what to expect. Not to hijack the original thread (but more like a follow up question about your NYC experience), did you encounter any language barrier when serving the patients from such a diverse background? I've heard that large % of patients in the city speak Spanish or Creole only, and as a person who speaks close to zero Spanish or Creole, I was about to rely on the nursing staff & translation phone service for taking history etc, but now I'm debating if I should start learning basic Spanish STAT as not doing so can hinder my efficiency? Or did you find this issue to be a minor problem that we can gradually overcome as we work? Thank you in advance!
It wont hurt, but pick the right language. Dont stress too much. Depends which hospital you will be at. PM me if you have questions.

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Consider upstate New York due to cost of living during residency.
 
Thank you so much for your input. As a M4 about to start residency in NYC this coming July, this post gives me a more clear idea of what to expect. Not to hijack the original thread (but more like a follow up question about your NYC experience), did you encounter any language barrier when serving the patients from such a diverse background? I've heard that large % of patients in the city speak Spanish or Creole only, and as a person who speaks close to zero Spanish or Creole, I was about to rely on the nursing staff & translation phone service for taking history etc, but now I'm debating if I should start learning basic Spanish STAT as not doing so can hinder my efficiency? Or did you find this issue to be a minor problem that we can gradually overcome as we work? Thank you in advance!

Your experience will highly depend on which hospital you will be doing residency at. There are hospitals where the overwhelming majority speak Spanish. There are some where it's Creole. There are a couple where it's Mandarin.

I highly enjoyed the diverse patient population. One of the hospitals I rotated at, close to 100% of the patient population spoke Spanish and >50% spoke it exclusively. When I started residency I did not speak any Spanish. Now I can take a basic history, at least for the simple stuff like chest pain. The rest of the time I use whatever resources are available to me: mostly hospital interpreters (several NYC hospitals have Spanish interpreters roaming around their ERs), patient family members (despite what unrealistic orientation videos will tell you, this is often unavoidable), phone interpretation (can work fairly well if you have either an interpreter phone or speakerphone), Spanish speaking staff, etc.

Is it a challenge? Sure. Is it something you should worry about? Nah. If you have the time and energy, it never hurts to pick up a little bit of a foreign language. You are going to get more bang for your buck with Spanish than with Creole though.
 
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I love NYC, but G-- damn that city is expensive. Used to live in Manhattan and,

f--k!


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Your experience will highly depend on which hospital you will be doing residency at. There are hospitals where the overwhelming majority speak Spanish. There are some where it's Creole. There are a couple where it's Mandarin.

I highly enjoyed the diverse patient population. One of the hospitals I rotated at, close to 100% of the patient population spoke Spanish and >50% spoke it exclusively. When I started residency I did not speak any Spanish. Now I can take a basic history, at least for the simple stuff like chest pain. The rest of the time I use whatever resources are available to me: mostly hospital interpreters (several NYC hospitals have Spanish interpreters roaming around their ERs), patient family members (despite what unrealistic orientation videos will tell you, this is often unavoidable), phone interpretation (can work fairly well if you have either an interpreter phone or speakerphone), Spanish speaking staff, etc.

Is it a challenge? Sure. Is it something you should worry about? Nah. If you have the time and energy, it never hurts to pick up a little bit of a foreign language. You are going to get more bang for your buck with Spanish than with Creole though.

When I was a senior resident, I would always assign the non-English speaking patients to the off-service intern or a medical student. Let them spend 40 minutes on the history and come back to me.
 
Your experience will highly depend on which hospital you will be doing residency at. There are hospitals where the overwhelming majority speak Spanish. There are some where it's Creole. There are a couple where it's Mandarin.

I highly enjoyed the diverse patient population. One of the hospitals I rotated at, close to 100% of the patient population spoke Spanish and >50% spoke it exclusively. When I started residency I did not speak any Spanish. Now I can take a basic history, at least for the simple stuff like chest pain. The rest of the time I use whatever resources are available to me: mostly hospital interpreters (several NYC hospitals have Spanish interpreters roaming around their ERs), patient family members (despite what unrealistic orientation videos will tell you, this is often unavoidable), phone interpretation (can work fairly well if you have either an interpreter phone or speakerphone), Spanish speaking staff, etc.

Is it a challenge? Sure. Is it something you should worry about? Nah. If you have the time and energy, it never hurts to pick up a little bit of a foreign language. You are going to get more bang for your buck with Spanish than with Creole though.

I figured even if I start learning Spanish from scratch, it won't be enough to take a thorough history anyway...so I'll probably be better off relying on different resource around me. It's really reassuring that some NYC hospitals have translators roaming around the ED. I'll follow the wise words of everyone who's been there done that and not stress too much. I'll try to focus on enjoying my couple months off before I get into serious business. Thank you for the advice!
 
For the amount you'd make working in Texas, and the amount you'd save on income taxes, you could spend at least 2 weeks per month in the best hotel in NYC and still come out financially ahead.
 
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I'm from New York originally and had no interest in training or living in NYC. The emergency departments I spent time in were a complete cluster****. No I don't plan on spending residency putting in peripheral IVs and drawing labs in all my patients, I'm not pushing patients to CT, I'm not interested in living my life in NYC traffic, nor am I interested in paying ungodly amounts of money for the privilege.

NYC pizza and bagels are the best in the world and are not replicated elsewhere. Its almost enough to make me want to live there, but then I go visit my parents every few months and sit in traffic for no god damn reason (Seriously? 1am and there's a backup on the Cross Bronx without there being an actual accident??)

I am training in a large city now, including at a busy urban ED in the ghetto with more than enough inner city patients to get my fill. There are plenty of other places in the country to gain experience.

I would recommend doing a rotation in NYC though. Experience it for yourself. Experience actually living in the city. People have this romanticized notion of the city but living in it is not easy (or cheap).

New York is always going to be the place I grew up, but I have no interest in living there full time or working there ever again.
 
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For the amount you'd make working in Texas, and the amount you'd save on income taxes, you could spend at least 2 weeks per month in the best hotel in NYC and still come out financially ahead.

It always blows my mind that people value living in a specific city (NYC, LA, SF, BOS, etc) enough to pay that kind of a "luxury tax". I get it for careers that really require living in a specific location and I get it if family is an issue. But to go out of your way to live there when better job prospect abound? Don't get me wrong, I love visiting NYC. And I'm not saying it's wrong, I get that everyone has their own things they value. It's just so disconjugate from the things I value that it seems crazy. Literally paying >$100k a year to live in a specific city and it's not like rural Idaho is the comparison...
 
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It always blows my mind that people value living in a specific city (NYC, LA, SF, BOS, etc) enough to pay that kind of a "luxury tax". I get it for careers that really require living in a specific location and I get it if family is an issue. But to go out of your way to live there when better job prospect abound? Don't get me wrong, I love visiting NYC. And I'm not saying it's wrong, I get that everyone has their own things they value. It's just so disconjugate from the things I value that it seems crazy. Literally paying >$100k a year to live in a specific city and it's not like rural Idaho is the comparison...

Especially during residency!
 
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I will echo that during an away rotation I did in NYC, the nursing was just awful. I was shocked. And it wasn't only bad because of the nursing unions, but because there are TONS of traveling nurses that descend on NYC for a month or two to live in the city with subsidized or free rent. They have nothing to lose since they will be gone in a few weeks anyway. It felt like every time I asked a nurse if they could help me find something, they would respond "I'm new here", ha. It was basically a work/vacation for them and it showed.
 
I just think of it as working 1 month for the state government if you live in CA or NY. As it is, in a tax-free state, I work until April 15th, just to pay the Federal government. I work until May to fund my retirement on top of that. If I lived in CA or NY, I would be working until the end of June each year before I started making money for myself.
 
I'm assuming it's not much better working in Long Island/Fairfield County CT?

I'm pretty boned family-wise. The other half of my family? LA.

I go to a very reasonable state school so loans are not super overwhelming. Still a bad idea to do residency in NYC (or hey, LA)? I admit, I am super enamored with the idea of spending my precious free time in an area where there is something always going on. I am currently in endless suburbia and although I recognize life is 'easier' here it is killing me...
 
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I'm assuming it's not much better working in Long Island/Fairfield County CT?

I'm pretty boned family-wise. The other half of my family? LA.

I go to a very reasonable state school so loans are not super overwhelming. Still a bad idea to do residency in NYC (or hey, LA)? I admit, I am super enamored with the idea of spending my precious free time in an area where there is something always going on. I am currently in endless suburbia and although I recognize life is 'easier' here it is killing me...

You have to put a monetary value on your priorities. Is it worth an extra $200,000 per year for you to live in NYC or LA? I'm calculating that as $100,000 (minimum) in salary differential, plus $50,000 for increased cost of housing, plus $50,000 in extra taxes.
 
I'm assuming it's not much better working in Long Island/Fairfield County CT?

I'm pretty boned family-wise. The other half of my family? LA.

I go to a very reasonable state school so loans are not super overwhelming. Still a bad idea to do residency in NYC (or hey, LA)? I admit, I am super enamored with the idea of spending my precious free time in an area where there is something always going on. I am currently in endless suburbia and although I recognize life is 'easier' here it is killing me...

Only you will be able to determine if it is worth it. Financially, no, you will take a big hit to do so. But there are other factors.
 
I'm assuming it's not much better working in Long Island/Fairfield County CT?

I'm pretty boned family-wise. The other half of my family? LA.

I go to a very reasonable state school so loans are not super overwhelming. Still a bad idea to do residency in NYC (or hey, LA)? I admit, I am super enamored with the idea of spending my precious free time in an area where there is something always going on. I am currently in endless suburbia and although I recognize life is 'easier' here it is killing me...
Everyone's priorities are different.

I'm doing my intern year in NYC and yes the nurses suck and it's annoying to have to transport a patient to CT, but overall I find it's been worth it living here and training at a hospital here.

You would literally have to pay me a million dollars to live somewhere rural. I highly value diversity, the opportunity to experience different things and a wide variety of good food, so I would be miserable in a rural location. Other people love it. 1 weekend I'm playing soccer with people from all over the world, the next I'm taking free W. African dance lessons, the next I'm going to a french language meet up....and the list goes on. I can't really put a monetary value on those things and those 3 things I listed were all free.

I also love not having to drive. I love my subway naps in the morning or after a long shift :)

As far as the cost...my hospital admittedly pays fairly well, so I've been pretty lucky. We don't get subsidized housing though. I get paid bi weekly and I think my rent is close to 40% of my take home. But still I've had enough money to save and I went on 2 international vacations last year and have 3 planned for this year. I'm not eating ramen or anything.

If you want to live in NYC I don't think during residency is a bad time to do it.
 
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Everyone's priorities are different.

I'm doing my intern year in NYC and yes the nurses suck and it's annoying to have to transport a patient to CT, but overall I find it's been worth it living here and training at a hospital here.

You would literally have to pay me a million dollars to live somewhere rural. I highly value diversity, the opportunity to experience different things and a wide variety of good food, so I would be miserable in a rural location. Other people love it. 1 weekend I'm playing soccer with people from all over the world, the next I'm taking free W. African dance lessons, the next I'm going to a french language meet up....and the list goes on. I can't really put a monetary value on those things and those 3 things I listed were all free.

I also love not having to drive. I love my subway naps in the morning or after a long shift :)

As far as the cost...my hospital admittedly pays fairly well, so I've been pretty lucky. We don't get subsidized housing though. I get paid bi weekly and I think my rent is close to 40% of my take home. But still I've had enough money to save and I went on 2 international vacations last year and have 3 planned for this year. I'm not eating ramen or anything.

If you want to live in NYC I don't think during residency is a bad time to do it.

Thanks, you sound similar to me in mentality. I would really love to have those experiences. I guess my best hope is to do NYC residency, get my fill, then pack up and work in Houston if recent posts are any indication. If you don't mind me asking, how are you only doing an intern year in NYC? Are you spending the other years in a long island community hospital?
 
Will never understand the infatuation with living in NYC. Grew up in NYC area. Love visiting. Did a Sub-I during med school there which was not very fun (poor nurses, pushed my own pt to imaging and had to wait there for ~ 2 hours - great to do when you're on an audition rotation right?). Scarcity of good trauma in NYC. Unless you are wealthy you will live in a shoebox or with 10 roommates. I don't need a choice of 23 different Thai restaurants that are open at 4am - I need 1 good Thai restaurant that is open during normal hours. I suppose during residency it'd be OK if you can go to a place with subsidized housing.
 
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Will never understand the infatuation with living in NYC. Grew up in NYC area. Love visiting. Did a Sub-I during med school there which was not very fun (poor nurses, pushed my own pt to imaging and had to wait there for ~ 2 hours - great to do when you're on an audition rotation right?). Scarcity of good trauma in NYC. Unless you are wealthy you will live in a shoebox or with 10 roommates. I don't need a choice of 23 different Thai restaurants that are open at 4am - I need 1 good Thai restaurant that is open during normal hours. I suppose during residency it'd be OK if you can go to a place with subsidized housing.

But but, you can get a sweet assed bagel after spending the day putting patients on comodes and transporting them to CT scan. Worth it!
 
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