Emergency Medicine - Now competitive?

[dog123an]

An older student told me yesterday, that the average EM step 1 is 245! That is pretty high. I am originally interested in lifestyle competitive specialties, but have always kept my eyes peeled for EM.

I have a lot of debt and want a decent lifestyle, I heard that in the south and rural areas, EM can go 500k+, has anyone else heard this or can elaborate.

I know that EM is male-dominated, does that change anything for a female applicant.

It seems like an awesome specialty, some what comparable for primary care lover, would you agree or disagree, depending on the setting. You get to see a mix of everything, all ages, when you're off, you are off, great pay, great lifestyle.

I just wonder why more people aren't going for EM, I could see it getting super competitive in the next few years.

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[emergentmd]

Yes
Yes but many women
Yes
More are going and more will come as people figure this out. 200+/hr is not bad when you can get a week off every month if you want. I currently work 10-12 shifts a month and pull in 400K/yr

 

[GTP]

I'm a female resident. Scored 250s on step one and 260s step two. Everyone kept telling me oh with your scores you can specialize in this that and the other thing. You will just be a glorified triage nurse blah blah. At the same time, EM isn't for everyone. I'm about to start final year, and I think I'm fairly busy during every shift. By the time I get home, I'm ready to eat and sleep (we do 10s). Yet, I don't get interrupted every 5 mins with ekgs, phone calls, ems calls, and midlevels. Also, trying to admit reject patients that nobody wants is def an issue. Last week I had an attending refuse a bipap who was retracting and such because she's a drug seeker and always leaves AMA when dilaudid gets d/c on the floor. So definitely has ups and downs.

 

[CliveStaples]

The good news is that some of the data for last year's Match is available for viewing: http://www.nrmp.org/wp-content/uploads/2017/04/Main-Match-Results-and-Data-2017.pdf

While Charting the Outcomes for the 2017 match is not yet available, here are the numbers from 2016: http://www.nrmp.org/wp-content/uploads/2016/09/Charting-Outcomes-US-Allopathic-Seniors-2016.pdf

Here's what you should glean:

1) Of US seniors who applied to EM in 2017, 7.3% went unmatched. For reference, this was a higher unmatched rate than Medicine, Pediatrics, FM, Neurology, Pathology, Radiology, or Anesthesiology, but is still a far cry from the 10+% unmatched specialties like Dermatology, Orthopedic Surgery, and Plastic Surgery. In addition, this was a better match rate than 2016, where 9% of applicants went umatched. There were no available EM positions in the SOAP. I would call EM "moderately competitive" based on these numbers.

2) In 2016 the mean Step 1 score was 233 and mean Step 2 score was 245.

As to your questions about pay and lifestyle, you're going to get a variety of opinions. In terms of pay per hour, EM does boast some of the highest compensation rates in medicine. That said, many experienced EM physicians would not necessary call the specialty a "lifestyle" specialty as EM requires frequent shifts on nights, weekends, and holidays. In particular, switching between days and nights oftentimes takes work to recover from and would lead to what I consider uncompensated hours "working." Burnout, which is rampant across medical specialties, is very high among EM physicians, especially if you are considering it a lifestyle specialty and comparing it to Dermatology and Ophthalmology.

Get some more exposure to the specialty and see what you think about the kind of work an EM doc does during a shift - you will probably find it much more rigorous than a lot of other rounding based specialties. You will stand a greater chance of having a fulfilling career if you come to EM because you love the environment, the personalities, and the medicine.

 

[DrWhozits]

The avg USMLE for matched USMDs was 233/245 (I/II). Avg USMLE for EM was 233/245 (I/II). As the above poster said, I think EM is pretty squarely in the middle, sort of like OB/GYN, Gen Surgery, etc.

The thing about EM is it seems to have its own value system with regards to SLOEs, away rotations, etc. which make it a little more difficult than some of the lower competitive specialties.

 

[sum dude]

An older student told me yesterday, that the average EM step 1 is 245! That is pretty high. I am originally interested in lifestyle competitive specialties, but have always kept my eyes peeled for EM.

I have a lot of debt and want a decent lifestyle, I heard that in the south and rural areas, EM can go 500k+, has anyone else heard this or can elaborate.

I know that EM is male-dominated, does that change anything for a female applicant.

It seems like an awesome specialty, some what comparable for primary care lover, would you agree or disagree, depending on the setting. You get to see a mix of everything, all ages, when you're off, you are off, great pay, great lifestyle.

I just wonder why more people aren't going for EM, I could see it getting super competitive in the next few years.

There's probably about 5000 other posts saying this, but do what you are interested in and enjoy the most, not what pays the most/has "best lifestyle." Otherwise you'll be here in 5 years wondering what "alternative EM" careers are available for highest money, and bitching about burnout. Shift work is nice, but flip-side we work nights/weekends/holidays when 90% other physicians at home.

Anyone making over 200k/yr should have no problem paying off debt, but you have to be disciplined and budget your money. Eg for 300k debt, you can pay off in 10 years at 3300/mo (yes, that number sucks, but doable on 200k salary--currently median EM makes 350k/yr, so even more doable).

 

[Venko]

The good news is that some of the data for last year's Match is available for viewing: http://www.nrmp.org/wp-content/uploads/2017/04/Main-Match-Results-and-Data-2017.pdf

While Charting the Outcomes for the 2017 match is not yet available, here are the numbers from 2016: http://www.nrmp.org/wp-content/uploads/2016/09/Charting-Outcomes-US-Allopathic-Seniors-2016.pdf

Here's what you should glean:

1) Of US seniors who applied to EM in 2017, 7.3% went unmatched. For reference, this was a higher unmatched rate than Medicine, Pediatrics, FM, Neurology, Pathology, Radiology, or Anesthesiology, but is still a far cry from the 10+% unmatched specialties like Dermatology, Orthopedic Surgery, and Plastic Surgery. In addition, this was a better match rate than 2016, where 9% of applicants went umatched. There were no available EM positions in the SOAP. I would call EM "moderately competitive" based on these numbers.

2) In 2016 the mean Step 1 score was 233 and mean Step 2 score was 245.

As to your questions about pay and lifestyle, you're going to get a variety of opinions. In terms of pay per hour, EM does boast some of the highest compensation rates in medicine. That said, many experienced EM physicians would not necessary call the specialty a "lifestyle" specialty as EM requires frequent shifts on nights, weekends, and holidays. In particular, switching between days and nights oftentimes takes work to recover from and would lead to what I consider uncompensated hours "working." Burnout, which is rampant across medical specialties, is very high among EM physicians, especially if you are considering it a lifestyle specialty and comparing it to Dermatology and Ophthalmology.

Get some more exposure to the specialty and see what you think about the kind of work an EM doc does during a shift - you will probably find it much more rigorous than a lot of other rounding based specialties. You will stand a greater chance of having a fulfilling career if you come to EM because you love the environment, the personalities, and the medicine.

Great advice well presented.

I would add that the majority of shifts are second shift which in itself can be a challenge for some.

Also, unlike most other specialties, you are likely to be an employee more than an employer as an EM doc. In addition, the number of decisions made per minute worked is generally much higher than any other specialty, which can be exhilarating at times and overwhelming at times.


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[Doctor_Strange]

Even working as an ED scribe these past several months EM certainly does not feel unique in being a "lifestyle specialty". One thing that I think EM has over just about any other specificity is the ability to travel more lol. Like every EM doc I work with travels to Europe or wherever like 3x year on two week vacations. Otherwise, as someone who is interested in EM, working in the ED has actually made me more realistic of the negative of shift works, i.e. night to day turnaround, constant worry of litigation, dealing with drug seekers back-to-back-to-back, ungrateful pts.

edit: also none of the docs I work with like working for TeamHealth, they just concede it is an unfortunate fact of their specialty. I don't know much about this other than literally no one has anything positive to say.

 

[witzelsucht]

Even working as an ED scribe these past several months EM certainly does not feel unique in being a "lifestyle specialty". One thing that I think EM has over just about any other specificity is the ability to travel more lol. Like every EM doc I work with travels to Europe or wherever like 3x year on two week vacations. Otherwise, as someone who is interested in EM, working in the ED has actually made me more realistic of the negative of shift works, i.e. night to day turnaround, constant worry of litigation, dealing with drug seekers back-to-back-to-back, ungrateful pts.

edit: also none of the docs I work with like working for TeamHealth, they just concede it is an unfortunate fact of their specialty. I don't know much about this other than literally no one has anything positive to say.

i used to scribe at an SDG. funny to think that if i had scribed at TH i might have been turned off the specialty altogether

 

[KinesiologyNerd]

i used to scribe at an SDG. funny to think that if i had scribed at TH i might have been turned off the specialty altogether

Seriously. Had the same experience. Mildly worrisome, but I guess you can pencil me in for fighting for SDGs.

 

[Angry Birds]

Every year this thread is reincarnated.

 

[takeurmeds02]

Even working as an ED scribe these past several months EM certainly does not feel unique in being a "lifestyle specialty". One thing that I think EM has over just about any other specificity is the ability to travel more lol. Like every EM doc I work with travels to Europe or wherever like 3x year on two week vacations. Otherwise, as someone who is interested in EM, working in the ED has actually made me more realistic of the negative of shift works, i.e. night to day turnaround, constant worry of litigation, dealing with drug seekers back-to-back-to-back, ungrateful pts.

edit: also none of the docs I work with like working for TeamHealth, they just concede it is an unfortunate fact of their specialty. I don't know much about this other than literally no one has anything positive to say.

Yea, I scribed too for about two years but I fell in love with it which is why I get anxious every time I hear that EM is becoming more and more competitive.

 

[neoevolution]

The avg USMLE for matched USMDs was 233/245 (I/II). Avg USMLE for EM was 233/245 (I/II). As the above poster said, I think EM is pretty squarely in the middle, sort of like OB/GYN, Gen Surgery, etc.

The thing about EM is it seems to have its own value system with regards to SLOEs, away rotations, etc. which make it a little more difficult than some of the lower competitive specialties.

I like the phrase "moderately competitive," which I think is what Winged Scapula used when someone said that gen surg wasn't competitive; answering yes or no to a question about competitiveness can make people think of the extremes, like a surgical sub-specialty or FM respectively, when it's really somewhere in the middle

 

[DetectiveAlonzo]

The students going into EM going into it for lifestyle are gonna be very disappointed.

FM has a backdoor into EM now as well.

 

[deleted109597]

The students going into EM going into it for lifestyle are gonna be very disappointed.

True

FM has a backdoor into EM now as well.

This isn't new.

 

[DetectiveAlonzo]

True

This isn't new.

I agree, but due to the severe shortage of docs and push for primary care, I'm finding a lot of places NEAR desirable cities (especially on the West Coast) are becoming more receptive to hiring FM docs with some experience working in emergency rooms.

Hell, I have family working as hospitalists that pick up shifts working in the ER.

 

[HooliganSnail]

I agree, but due to the severe shortage of docs and push for primary care, I'm finding a lot of places NEAR desirable cities (especially on the West Coast) are becoming more receptive to hiring FM docs with some experience working in emergency rooms.

Hell, I have family working as hospitalists that pick up shifts working in the ER.

a very large chunk of ED's in this country could not be run without Non-BC doc's working in the ED, this is not anything new. I think there are two reasons for this 1. Not enough BC EM docs in not enough places 2. BC EM docs command a certain hourly rate, and FM docs will work for significantly less than that.

 

[HooliganSnail]

The students going into EM going into it for lifestyle are gonna be very disappointed.

FM has a backdoor into EM now as well.

I know there are 14 EM fellowships offered for FM docs, but are they eligible to sit for ABEM/AOBEM exam afterwards?

Also, a full residency in family medicine with an additional year solely training in emergency medicine for 12 months is a great training regimen, better than say........and all online DNP program with 500 "clinical hours" (thats 12.5 weeks at 40hrs/wk)

 

[SpacemanSpifff]

I know there are 14 EM fellowships offered for FM docs, but are they eligible to sit for ABEM/AOBEM exam afterwards?

Also, a full residency in family medicine with an additional year solely training in emergency medicine for 12 months is a great training regimen, better than say........and all online DNP program with 500 "clinical hours" (thats 12.5 weeks at 40hrs/wk)

Initially though nope, but looks like I was wrong. Reading on here under 3C, if you trained at MMC, or one of the other recognized fellowship programs (after graduating from a primary care program) you could become BC.

 

[deleted109597]

Initially though nope, but looks like I was wrong. Reading on here under 3C, if you trained at MMC, or one of the other recognized fellowship programs (after graduating from a primary care program) you could become BC.

That's an alternate board though. It's not ABMS.
I mean, I could go make a board system and claim I'm an ophthalmologist if I wanted to. Getting people to recognize it? Not so much. You aren't allowed to advertise as board certified in my state if you have only ABPS. Of note, something like 90% of their board certs are for EM. Nobody does alternate boards for, say, cardiology, or surgery.

 

[SpacemanSpifff]

That's an alternate board though. It's not ABMS.
I mean, I could go make a board system and claim I'm an ophthalmologist if I wanted to. Getting people to recognize it? Not so much. You aren't allowed to advertise as board certified in my state if you have only ABPS. Of note, something like 90% of their board certs are for EM. Nobody does alternate boards for, say, cardiology, or surgery.

Ah, thanks for the clarification.

 

[HooliganSnail]

Initially though nope, but looks like I was wrong. Reading on here under 3C, if you trained at MMC, or one of the other recognized fellowship programs (after graduating from a primary care program) you could become BC.

That seems wild because there are combined EM/IM and EM/FM programs, but they are five years

 

[coachB]

That's an alternate board though. It's not ABMS.
I mean, I could go make a board system and claim I'm an ophthalmologist if I wanted to. Getting people to recognize it? Not so much. You aren't allowed to advertise as board certified in my state if you have only ABPS. Of note, something like 90% of their board certs are for EM. Nobody does alternate boards for, say, cardiology, or surgery.

You mean, like Rand Paul did?

 

[DetectiveAlonzo]

That's an alternate board though. It's not ABMS.
I mean, I could go make a board system and claim I'm an ophthalmologist if I wanted to. Getting people to recognize it? Not so much. You aren't allowed to advertise as board certified in my state if you have only ABPS. Of note, something like 90% of their board certs are for EM. Nobody does alternate boards for, say, cardiology, or surgery.

I say give it 5-10 years. It'll happen eventually. The bean counters control everything. It's only inevitable.

 

[deleted109597]

I say give it 5-10 years. It'll happen eventually. The bean counters control everything. It's only inevitable.

Give what 5-10 years?
ABPS has been around for longer than that already. And has already lost legal battles in many states, no matter how fluffy they make their boards look. The ABMS docs fight them every chance they get, and you should too. This is like optometrists wanting to do surgery, or psychologists wanting to prescribe meds. Or NPs to practice independently. In an ideal competitive world we could show we are better, but that doesn't exist. So them doing our job just serves to drive our wages down.

 

[DetectiveAlonzo]

Give what 5-10 years?
ABPS has been around for longer than that already. And has already lost legal battles in many states, no matter how fluffy they make their boards look. The ABMS docs fight them every chance they get, and you should too. This is like optometrists wanting to do surgery, or psychologists wanting to prescribe meds. Or NPs to practice independently. In an ideal competitive world we could show we are better, but that doesn't exist. So them doing our job just serves to drive our wages down.

I really think that we give FM docs 5-10 more years and they'll start staffing EDs in a majority of places and wages will be driven down. The supply of FM docs far outnumbers those of ED docs and if all it takes is some ER experience for a year or two to learn to manage extreme emergencies (which aren't that many as many use the ED as their primary care clinic)... then I don't see why the supply will not catch up with the demand. It's just misallocation is all. Then again... the ED isn't for everybody. We are at the will of the bean counters.

Bunch of FM docs are beginning and will have the last laugh.

Maybe just in rural places for now... but everything in medicine is a trend. It's only been going downward too.

I have no dog in this fight but it's surely interesting to see just how much opportunity there is out there.

And also why other starry-eyed med students looking at EM as a lifestyle specialty are going to be in for a world of hurt.

lulz

 

[DetectiveAlonzo]

I know there are 14 EM fellowships offered for FM docs, but are they eligible to sit for ABEM/AOBEM exam afterwards?

Also, a full residency in family medicine with an additional year solely training in emergency medicine for 12 months is a great training regimen, better than say........and all online DNP program with 500 "clinical hours" (thats 12.5 weeks at 40hrs/wk)

I'd say give it time.

 

[deleted109597]

I really think that we give FM docs 5-10 more years and they'll start staffing EDs in a majority of places and wages will be driven down. The supply of FM docs far outnumbers those of ED docs and if all it takes is some ER experience for a year or two to learn to manage extreme emergencies (which aren't that many as many use the ED as their primary care clinic)... then I don't see why the supply will not catch up with the demand. It's just misallocation is all. Then again... the ED isn't for everybody. We are at the will of the bean counters.
Bunch of FM docs are beginning and will have the last laugh.
Maybe just in rural places for now... but everything in medicine is a trend. It's only been going downward too.
I have no dog in this fight but it's surely interesting to see just how much opportunity there is out there.

You clearly have no concept of history. The reason FM docs can work in EDs is because they used to be the only option. Well that, and burnt out internists, and a few surgeons, and the random ophthalmologist. And then we made it a specialty. And allowed people to grandfather in, just like any other specialty. After the lawsuits about closing of the grandfather tract, and there were many, and it was open longer than it should have been, ABPS comes in and says "we will make a board". And they do, and it's mostly EM docs. But they don't have initial certification in EM, they're doing what's called a "practice track". And the wool was pulled over some state's eyes in allowing this. Then we started fighting again, and were successful in some states. Just like the current fights with independent practice of NPs.
Realize that if you don't fight this, it will devastate your career. We kind of shot ourselves in the foot by making hospitals have their ERs covered with docs in many places. There aren't enough ABEM docs out there to do it. So they fill it with what they've got. And they provide ****ty care, and cause things like ATLS to be created. The ABPS isn't out there arguing that the FM docs in those hospitals are cardiologists. Or intensivists. Or anesthetists. But for some reason, they've got a hair up their ass that they can be emergency docs. And the CMGs are paying them to do it.
Name any other part of the hospital that doesn't require board certification to do the job that you're doing. Maybe the ICU in some smaller hospitals, but we all know how good the care in the non-intensivist ICUs is.
Back to the original point, the medical boards aren't going to change their stance on ability to advertise as board certified. And the number of emergency residencies has skyrocketed in the last 10 years. So no, it isn't going to happen like you think it is. The nonboarded folk will always be stuck manning the rural hospitals, if they have any job. If we could convince EPs to sit on hospital boards and force them to hire only ABEM docs (which is true in many places), then it's a non-issue.
The bean counters could also use family docs for all the other specialties, but they don't. It's not because it wouldn't save money.

 

[DetectiveAlonzo]

You clearly have no concept of history. The reason FM docs can work in EDs is because they used to be the only option. Well that, and burnt out internists, and a few surgeons, and the random ophthalmologist. And then we made it a specialty. And allowed people to grandfather in, just like any other specialty. After the lawsuits about closing of the grandfather tract, and there were many, and it was open longer than it should have been, ABPS comes in and says "we will make a board". And they do, and it's mostly EM docs. But they don't have initial certification in EM, they're doing what's called a "practice track". And the wool was pulled over some state's eyes in allowing this. Then we started fighting again, and were successful in some states. Just like the current fights with independent practice of NPs.
Realize that if you don't fight this, it will devastate your career. We kind of shot ourselves in the foot by making hospitals have their ERs covered with docs in many places. There aren't enough ABEM docs out there to do it. So they fill it with what they've got. And they provide ****ty care, and cause things like ATLS to be created. The ABPS isn't out there arguing that the FM docs in those hospitals are cardiologists. Or intensivists. Or anesthetists. But for some reason, they've got a hair up their ass that they can be emergency docs. And the CMGs are paying them to do it.
Name any other part of the hospital that doesn't require board certification to do the job that you're doing. Maybe the ICU in some smaller hospitals, but we all know how good the care in the non-intensivist ICUs is.
Back to the original point, the medical boards aren't going to change their stance on ability to advertise as board certified. And the number of emergency residencies has skyrocketed in the last 10 years. So no, it isn't going to happen like you think it is. The nonboarded folk will always be stuck manning the rural hospitals, if they have any job. If we could convince EPs to sit on hospital boards and force them to hire only ABEM docs (which is true in many places), then it's a non-issue.
The bean counters could also use family docs for all the other specialties, but they don't. It's not because it wouldn't save money.

Hmmm.. I see what you're saying. I appreciate the input and your viewpoint. Cheers mate!

 

[LiamN0220]

I'm going into family medicine. In my state, family docs commonly staff 6k-60k/year emergency departments for $100-$400/hr. I'd say the average rate that I've seen is around $250/hr. These jobs are always with CMGs. They offer 100k+ in loan repayment/sign on bonus and stipends throughout residency.

Even though these jobs are tempting, I'm planning on doing a second residency in emergency medicine. It's only an extra two years since EM programs will give you one year credit for two years completed in any other specialty, and it's just the right thing to do if you want to be a good doctor. We went to medical school to be the experts. Let's keep the bar high and avoid taking the shortest route to the most money. That's what "providers" do.

My ideal practice is clinic 3-4 days/week with "my" patients and "my" practice and 1 x 24 hr ER shifts/week. This allows me to have a full time job with benefits (clinic) and supplemental income when I feel like it (ER). No call, no flipping from nights to days, no holidays, no weekends. Full time clinic, part time ER. Clinic gig should bring in around 250k in my state. ER gig should bring in an additional 250k. Not a bad lifestyle/income for five years of training.

 

[DetectiveAlonzo]

I'm going into family medicine. In my state, family docs commonly staff 6k-60k/year emergency departments for $100-$400/hr. I'd say the average rate that I've seen is around $250/hr. These jobs are always with CMGs. They offer 100k+ in loan repayment/sign on bonus and stipends throughout residency.

Even though these jobs are tempting, I'm planning on doing a second residency in emergency medicine. It's only an extra two years since EM programs will give you one year credit for two years completed in any other specialty, and it's just the right thing to do if you want to be a good doctor. We went to medical school to be the experts. Let's keep the bar high and avoid taking the shortest route to the most money. That's what "providers" do.

My ideal practice is clinic 3-4 days/week with "my" patients and "my" practice and 1 x 24 hr ER shifts/week. This allows me to have a full time job with benefits (clinic) and supplemental income when I feel like it (ER). No call, no flipping from nights to days, no holidays, no weekends. Full time clinic, part time ER. Clinic gig should bring in around 250k in my state. ER gig should bring in an additional 250k. Not a bad lifestyle/income for five years of training.

Shhh... don't want FM becoming super competitive now do we?

Nothing to see here folks... keep it movin'!

 

[deleted109597]

My ideal practice is clinic 3-4 days/week with "my" patients and "my" practice and 1 x 24 hr ER shifts/week. This allows me to have a full time job with benefits (clinic) and supplemental income when I feel like it (ER). No call, no flipping from nights to days, no holidays, no weekends. Full time clinic, part time ER. Clinic gig should bring in around 250k in my state. ER gig should bring in an additional 250k. Not a bad lifestyle/income for five years of training.

Two fulltime jobs per month is a bit much. You're doing 96 hrs of ER, and 128 of FM.
You gonna die.

 

[DetectiveAlonzo]

Two fulltime jobs per month is a bit much. You're doing 96 hrs of ER, and 128 of FM.
You gonna die.

Hmmm... I'd say that's pretty subjective.

36 hours in the ED can be somebody else's 80 hours.

I'm pretty sure it's not the same thing in terms of pace, acuity, and actual emergencies.....

 

[DetectiveAlonzo]

I'm going into family medicine. In my state, family docs commonly staff 6k-60k/year emergency departments for $100-$400/hr. I'd say the average rate that I've seen is around $250/hr. These jobs are always with CMGs. They offer 100k+ in loan repayment/sign on bonus and stipends throughout residency.

Even though these jobs are tempting, I'm planning on doing a second residency in emergency medicine. It's only an extra two years since EM programs will give you one year credit for two years completed in any other specialty, and it's just the right thing to do if you want to be a good doctor. We went to medical school to be the experts. Let's keep the bar high and avoid taking the shortest route to the most money. That's what "providers" do.

My ideal practice is clinic 3-4 days/week with "my" patients and "my" practice and 1 x 24 hr ER shifts/week. This allows me to have a full time job with benefits (clinic) and supplemental income when I feel like it (ER). No call, no flipping from nights to days, no holidays, no weekends. Full time clinic, part time ER. Clinic gig should bring in around 250k in my state. ER gig should bring in an additional 250k. Not a bad lifestyle/income for five years of training.

#BALLIN

 

[da8s0859q]

Hmmm... I'd say that's pretty subjective.

36 hours in the ED can be somebody else's 80 hours.

I'm pretty sure it's not the same thing in terms of pace, acuity, and actual emergencies.....

He and many of us here have experience after residency, though. It really is a lot when you look at it.

 

[LiamN0220]

I realize it would be a lot of work. That's why I would be able to drop/add ER as I burnout/rest up. Not having a full time ER gig also allows me to play 25 EDs in my state against each other to get the best desperation pay when coverage is short. I suppose EM only physicians could do this with a mix of urgent care but I'd like more continuity.

Real offers:

employed, clinic four days per week, no call, 8-4, six weeks vacation per year 200k base, some partners making 450k with RVUs from office procedures and seeing a lot of patients.

6k/year ER, 0.68 patients/hr, 24 hr shifts only, $230/hr, in the boonies, paid time to catch up on clinic notes.

Three day weekend every weekend and one week vacation every two weeks allows plenty of time to pick up 24 hr shifts at $5,500 each whenever I feel rested enough. Would still need time to recover like anyone else but might get to sleep through the night and at the very least am not flipping from days to nights.


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[RustedFox]

I gotta ask; what state is this?

 

[deleted109597]

Hmmm... I'd say that's pretty subjective.

36 hours in the ED can be somebody else's 80 hours.

I'm pretty sure it's not the same thing in terms of pace, acuity, and actual emergencies.....

Sorry. 128 hours of FM and 213 "equivalency hours" of FM vis EM. It makes more sense now?

 

[DetectiveAlonzo]

Sorry. 128 hours of FM and 213 "equivalency hours" of FM vis EM. It makes more sense now?

But he's not doing the constant day and night flipping either. I think most students really underestimate just how much sleep cycle flipping can eff you up in the ED world.

Probably not the right example... but I have family hospitalists that are doing 100+ hours a week (with call included) and they are paid handsomely for it.

You cannot do that with EM.

 

[LiamN0220]

I gotta ask; what state is this?

It's a really crappy state in the south. I'm lucky enough to have lots of family and friends here so I'll be able to have a pretty decent life with good jobs since no one else can stomach relocating to here. It's a jewel in the rough for the right person, but not the typical market. I have a feeling there are states with rural areas that are similar though.


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[Perfect Hair Day]

FM has a backdoor into EM now as well.

Can you elaborate?
Trying to strategize a back-up plan for EM in case I don't get ranked...

 

[InternistDO]

Can you elaborate?
Trying to strategize a back-up plan for EM in case I don't get ranked...

In more rural areas with a low (or no) supply of BC EM physicians, hospitals will hire FM and IM docs to staff EDs. It's not like a path to board certification though, just a consequence of low EM supply and high demand.

 

[Perfect Hair Day]

In more rural areas with a low (or no) supply of BC EM physicians, hospitals will hire FM and IM docs to staff EDs.

Is this a back-door to becoming board-eligible?

 

[InternistDO]

Is this a back-door to becoming board-eligible?

No, as far as I know there is no way to get board certified in EM without doing an EM residency.

 

[DetectiveAlonzo]

Is this a back-door to becoming board-eligible?

No you will not be board certified.

So unless you have no problem working in rural underserved EDs many EM docs cannot and do not want to work in... in locations that "suck" to many city slickers... then you will still be miserable.

So choose wisely.

 

[Perfect Hair Day]

No you will not be board certified.

So unless you have no problem working in rural underserved EDs many EM docs cannot and do not want to work in... in locations that "suck" to many city slickers... then you will still be miserable.

So choose wisely.

Looks like I'm choosing prelim as a backup then.

 

[DetectiveAlonzo]

Looks like I'm choosing prelim as a backup then.

U never know. Good luck.

 

[deleted109597]

U never know. Good luck.

It has as much chance as happening as cardiology will suddenly open up to FM residencies as well. Which is to say, it won't.