ER scheduling

[scoopdaboop]

I was a scribe before entering med school (im going to be a first year this august), and drank the Er kool-aid and like it. The only issue I see with the ER is the hours. TBH, i'm one of the peoples that would randomly pull all nighters anyways (gaming etc), and i was wondering how difficult it is it to get a job where you work days and mornings later in your career but no nights.

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[wolverine10k]

Depends on the specific SDG/CMG/hospital you work for. It’s certainly possible. My current group has a couple docs that take the majority of the night shifts. Some of my friends’ gigs are evenly distributed. All of this can change if your group is bought out by a CMG, docs in the group no longer want to do nights only, etc.

 

[RustedFox]

If my group can get ONE more nocturnist, then I am 90% nightshift free.

 

[AlgernonMed]

If my group can get ONE more nocturnist, then I am 90% nightshift free.

Do groups let new grads be nocturnists or do they want you to do a couple months of traditional rotating shifts first?

 

[hundreddaysoff]

Do groups let new grads be nocturnists or do they want you to do a couple months of traditional rotating shifts first?

Depends how bad they need nocturnists. I made the decision to do nights only 3 months out of residency. If I had wanted to on Day 1, my boss would've been fine with it, because no one else was doing it. Ask at the job interview, but maybe don't ask right away if you're interested in using it as a chip to get a bit more hourly.

 

[Groove]

Look, the reality is that this specialty has a "shop" open 24/7/365. Now, if you owned a business that's open 24/7/365...How realistic do you think it would be to expect to never work nights, weekends and/or major holidays? Not very.

Sure, anything is possible and your best bet would be to land a gig with dedicated nocturnists, but don't count on it. Yes, if you pursue EM you're going to work nights. It's just in the cards. If you can't deal with that, then honestly....what specialty are you going to pick? That cuts out surgery, IM (hospitalist), EM, Anesthesia, Ortho, etc.. You do realize all these specialties work nights when they are on call, right? You'll be fine. You get used to it.

To more specifically answer your concerns about having to work nights later in your career... Yes, you're going to still have to work them. Especially if you work for a CMG. The beauty (or curse?) of a CMG is that everyone is on an equal playing field insomuch as compensation, hours, schedule, etc.. So, you get to hit the ground running as a new hire and are making just as much as Dr. Moses who's in his late 60s. Then again, when YOU are in your late 60s, you'll be expected to "pull your weight" and that includes working your share of nights, weekends and holidays. I'm always extremely fair with all of our docs when making the schedule and I run a statistical report every few months and adjust nights accordingly to make sure everyone has the same percentage. Ironically, the only ones who complain are the younger ones.

You might have better luck as a senior partner in a SDG where you can cash in on seniority perks but I wouldn't count on them still being around for too much longer. Alternately, I suppose you could find a CMG that was really desperate for a new FTE and negotiate limited or no nights into your contract, but I wouldn't recommend it as the rest of your colleagues are bound to find out and that won't exactly make you the popular kid on campus. We had one guy like that who insisted on no nights after he had a heart attack and was given a pass for "health reasons". It used to give me such an attitude because he smoked like a chimney and I would have to give his nights to everyone else including one of our docs who was early 70s and has since retired (thank God...That's what 4 divorces will do to you!)

 

[deleted836128]

In my group we literally just have a handful of docs who like nights, and they work all the nights. They get their regular schedules and everyone else is happy because they don’t have to work nights (unless there’s like a once in a blue moon situation). The PAs don’t work nights because we just don’t have the volume. There are plenty of new docs we have hired that have never worked more than a couple nights here or there.

 

[The Knife & Gun Club]

I guess as another annoying med student follow up...

How easy is it to cluster the nights? I don’t mind being nocturnal for a week or two at a time every month but the “day, evening, overnight, repeat” schedule really they use for SubIs messes with my head.

I’m going to do it regardless because EM is awesome but 2 circadian cycles a week seems brutal long term.

As always thanks to all the professionals who come on here to repeatedly answer our questions again and again.

 

[thegenius]

The places I’ve worked at try to cluster the nights for everybody. Schedulers try hard to make good schedules for ER docs (at least the ones I know).

 

[gamerEMdoc]

I guess as another annoying med student follow up...

How easy is it to cluster the nights? I don’t mind being nocturnal for a week or two at a time every month but the “day, evening, overnight, repeat” schedule really they use for SubIs messes with my head.

I’m going to do it regardless because EM is awesome but 2 circadian cycles a week seems brutal long term.

As always thanks to all the professionals who come on here to repeatedly answer our questions again and again.

Most good schedulers cluster your night shifts. It’s not only something to ask about when you’re looking for a job (do you have nocturnists, how many nights do I have to work a month, how are night scheduled, etc), but if this is something that is important to you and it maybe worth asking on the residency interview trail as well.

I’m a nocturnist though, I hate flipping back and forth and prefer staying up all night. Honestly, I generally don’t get tired until I see sunlight. Its a marketable skill.

 

[Tenk]

Plan on doing some nights always. If you find a job with little to no nights that’s great but if you go into EM with the expectation of working no nights you may find yourself stuck with locums only.

 

[RustedFox]

Do groups let new grads be nocturnists or do they want you to do a couple months of traditional rotating shifts first?

We have a doc starting next month who is fresh out of residency who is signed to do all nights.

 

[scoopdaboop]

any thoughts on the new pay cap? one of the docs i scribed with who has been in practice since the early 90's says his salary has gone up consistently, and i'm worried about choosing EM because if they do "cap" salaries then I'm afraid EM might not be worth it.

 

[Groove]

any thoughts on the new pay cap? one of the docs i scribed with who has been in practice since the early 90's says his salary has gone up consistently, and i'm worried about choosing EM because if they do "cap" salaries then I'm afraid EM might not be worth it.

What pay cap? If you want to earn more, you simply sign up to work more shifts each month. EM has one of the highest $$$/hr ratio among all specialties.

Everyone was screaming that the sky was falling for Anesthesia after the 90s and the influx of CRNAs but last time I checked, those guys are still doing quite well. EM may see some fluctuations but I don't see it drastically changing in the long term but that may be wishful thinking.

Here's some realistic compensation information. Compare pay in the SE to Colorado, Washington or NY...yikes!

2017–2018 Compensation Report for Emergency Physicians Shows Steady Salaries - ACEP Now

ACEP Now offers real-time clinical news, news from the American College of Emergency Physicians, and news on practice trends and health care reform for the emergency medicine physician. ACEP Now is an official publication of the American College of Emergency Physicians.

www.acepnow.com

 

[deleted109597]

any thoughts on the new pay cap? one of the docs i scribed with who has been in practice since the early 90's says his salary has gone up consistently, and i'm worried about choosing EM because if they do "cap" salaries then I'm afraid EM might not be worth it.

?
New pay cap?
ER is the same as any other "eat what you kill" specialty. You get paid for working, not for time served.

 

[scoopdaboop]

?
New pay cap?
ER is the same as any other "eat what you kill" specialty. You get paid for working, not for time served.

oh okay, i was just talking about the new senate bill proposal that's been floating around in the ER forum. if there's nothing to worry about then I won't.

also, how do the ER docs here feel about being a middle man a lot of the times? While ER docs obviously save lives, do you guys regret not being experts at some field like say cardiologists, GI etc. I only ask because one of the docs I scribed with would always follow up with his patients' charts the next shift and it seems like he did miss not being able to follow up with people.

 

[deleted109597]

oh okay, i was just talking about the new senate bill proposal that's been floating around in the ER forum. if there's nothing to worry about then I won't.

also, how do the ER docs here feel about being a middle man a lot of the times? While ER docs obviously save lives, do you guys regret not being experts at some field like say cardiologists, GI etc. I only ask because one of the docs I scribed with would always follow up with his patients' charts the next shift and it seems like he did miss not being able to follow up with people.

Anybody you admit to the hospital you work at you can follow up with. Most of us do with interesting cases at some point.
We are experts in emergencies. I don't regret not being an expert at managing outpatient diabetes or hypertension, but I can manage the emergent episodes of those and other conditions.

Surprise billing legislation will affect every specialty, not just emergency medicine.

 

[namethatsmell]

also, how do the ER docs here feel about being a middle man a lot of the times? While ER docs obviously save lives, do you guys regret not being experts at some field like say cardiologists, GI etc. I only ask because one of the docs I scribed with would always follow up with his patients' charts the next shift and it seems like he did miss not being able to follow up with people.

May be more helpful to think of it like this...fewer and fewer doctors today will evaluate patients with literally any complaint imaginable and with a wide differential. We do. Our differential tends to be focused on emergent/very urgent conditions. If you go into EM, chances are good you'll be more facile in how to quickly diagnose, resus, and initiate treatment for most of these conditions than the relevant specialists who's turf the patient's condition lands on. You'll also learn to do this far more efficiently than other docs. The specialists will know more about the definitive and longer term management of illness in their wheelhouse.

Another thing to consider is what part of the patient's course you want to see them in. In EM you're acting on limited/no information and by the time they see the specialist that doc will have plenty of info to work with and also the luxury of time to see a patient's condition play out. Also, in EM being thanked will be a rare occurrence. As a specialist you'll get far more gratitude. If you think you'll have trouble with these things than EM may not be for you.

 

[Groove]

also, how do the ER docs here feel about being a middle man a lot of the times? While ER docs obviously save lives, do you guys regret not being experts at some field like say cardiologists, GI etc.

Sure, it bothers me. But it bothers me less when I see my paycheck every month.

 

[deleted859535]

oh okay, i was just talking about the new senate bill proposal that's been floating around in the ER forum. if there's nothing to worry about then I won't.

also, how do the ER docs here feel about being a middle man a lot of the times? While ER docs obviously save lives, do you guys regret not being experts at some field like say cardiologists, GI etc. I only ask because one of the docs I scribed with would always follow up with his patients' charts the next shift and it seems like he did miss not being able to follow up with people.

This does occasionally bother me - the "middle man" as you put it - but as I've learned to embrace what I'm for and what I'm not, it bothers me less and less.

I follow up on what I want to follow up and don't have to follow what I don't want to follow. That's also nice.

And:
1. My expertise is in a different sense as already described by others earlier in this thread;
2. I don't have to deal with a lot of things I don't want to deal with, but at the expense of our own unique nonsense in the ED;
3. I work fewer - but often more intense - hours than many;
4. We continue to enjoy good pay and job security in the house of medicine.

I'm no idealist, but there is some truth to "anything, anywhere, anytime."

 

[Backpack234]

Being the middle man can be rough. One of my main sources of stress is the attitude I get from consultants. Stuff like:

“Why are you admitting this 80 year old with chest pain and an elevated troponin?”

It’s annoying and consultants could learn a lot about professionalism and manners. But with that said, I still love my job and get over stuff like that fairly quickly.

 

[thegenius]

also, how do the ER docs here feel about being a middle man a lot of the times? While ER docs obviously save lives, do you guys regret not being experts at some field like say cardiologists, GI etc. I only ask because one of the docs I scribed with would always follow up with his patients' charts the next shift and it seems like he did miss not being able to follow up with people.

Dude...we follow-up on our patients all the time. I watch over 50% of the patients I admit to see what happens to them.

Overall you have to want NOT want to be a specialist … to go into ER. If you want to know everything about Cardiology or Allergy or stuff like that, then don't go into ER.

Basically...we do primary care 90% of the time and real emergency care 10% of the time. Even that ratio is debatable. But when you do save someone's life because you order calcium gluconate 3g IVP STAT based on EKG findings and THAT's it...no lab values...and pt's become hemodynamically stable...you will be patting yourself on the back. Or you decide to do a lateral canthotomy JUST based on physical exam findings and nothing else and you save their eyesight...you'll be bragging about that s&#t for a week!

 

[GonnaBeADoc2222]

Things that suck about EM:

1) The lack of respect / recognition from patients, consultants, admin. "Oh you tubed that patient that the attending anesthesiologist couldn't tube? Whatever." The 2% of the time you get genuine recognition feels awesome though.

2) The "fishbowl" effect. Everyone is watching you. Every mistake, minor grievance will be elevated to admin. Trust me, all the subspecialists are making the same minor mistakes here and there but they can hide it better.

3) Dumping ground for every other specialty / PCP.
-Labor "ruled out" up on L&D? Send em to the ED with their abdominal pain at 32 weeks gestation.
-Social disaster shows up at PCP after years of lost to followup? Straight to the ED.
-Can't be bothered to send patient to pre-op for their non emergent surgery? The ED will do the pre-op scut!

4) Potentially (very) needy nurses (seriously, when will they learn how to put in an ultrasound guided IV line or do a simple EJ?)

5) Some abusive, manipulative patients. Most of my documentation time is spent on these in anticipation of a possible admin complaint, rather than the sick / complex patients. Exhausting.

Things that are good about EM:

1) The pay (right now)

2) The schedule (depending on the job...mine is great)

3) The short residency

4) Procedures. I've intubated hundreds of times and it still excites me. There's also nothing like the clunk of a shoulder or a hip and the gratitude the patient expresses afterwards.

5) The ability to walk away at the end of the day and wash your hands of it

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I would advise medical students to carefully choose a specialty that can be somewhat independent from the hospital or one that is a huge money generator for the hospital. They only care about you if you make them $$$. Ortho with a specialization in joints comes to mind. Spine is huge too. I'm sure there are a few others. Mohs surgeon? Retina specialist? Cataract remover factory? Facial plastics? EM is getting flooded with new residencies and the ACGME and professional societies are doing nothing to curtail this. Midlevels with online degrees are effectively practicing independently in shops where there is no time to supervise. Who knows what the future holds.

 

[hundreddaysoff]

also, how do the ER docs here feel about being a middle man a lot of the times? While ER docs obviously save lives, do you guys regret not being experts at some field like say cardiologists, GI etc. I only ask because one of the docs I scribed with would always follow up with his patients' charts the next shift and it seems like he did miss not being able to follow up with people.

In addition to being an expert in emergencies, I am an expert in quickly figuring out what my patients and referring clinicians want and what they actually need and then giving them one or both of those things in a way that hopefully won't make their life any worse going forward. That is 90% of my job and I take pride in that. It is a specialized skill and depends a lot on your locality and the resources available to you in your shop.

For me, for now, doing this depends a lot on getting around corporate BS, but there are also some good aspects to corporate BS. Eg, HCA will never refuse a pt admit, presumably because money, and they hire hospitalists to that goal. So I will never get any pushback about an admit. I also rarely get pushback from specialists, again because consultations and procedures = money for the specialists. It seems that the lower our pt census goes, the more grateful my hospitalists and specialists are to me.

Not really anything they teach you in med school, but if you like this sort of stuff, then EM might be a good fit for you. I've always been fascinated with customer service and quickly establishing rapport with people and getting them to trust me, but I was never very good at it until I learned all this stuff in residency.

Mind you, as much as I love my job there are about 50 things I'd rather be doing in my life, and none of them involve clinical medicine or even necessarily making money. So if I'm still doing this full-time in my 60s, something has gone terribly wrong.

 

[GatorCHOMPions]

What's everyone's percentage of evenings (shift ending past 9 pm) and overnights? I feel like I am getting shafted at my shop with 65-75% of shifts either evening or overnight - or is this the norm? I recognize by simple math if you have three shifts (day, evening, night) that it seems logical to work 2/3rd evening and night, but staffing level is different at different times where I and most people work.

 

[Dr Mantis Toboggan]

We have 7 shifts between 2 sites. I work 14 a month and will pretty much almost always have 2 of each a month.

What's everyone's percentage of evenings (shift ending past 9 pm) and overnights? I feel like I am getting shafted at my shop with 65-75% of shifts either evening or overnight - or is this the norm? I recognize by simple math if you have three shifts (day, evening, night) that it seems logical to work 2/3rd evening and night, but staffing level is different at different times where I and most people work.

 

[TooMuchResearch]

It really depends on your coverage. About 55% of our shifts end after 9 pm (includes overnights).

What's everyone's percentage of evenings (shift ending past 9 pm) and overnights? I feel like I am getting shafted at my shop with 65-75% of shifts either evening or overnight - or is this the norm? I recognize by simple math if you have three shifts (day, evening, night) that it seems logical to work 2/3rd evening and night, but staffing level is different at different times where I and most people work.

 

[wolverine10k]

I'm all evenings/nights now, but 2/5 of our shifts are true day shifts. The other 3 are evening/night shifts. There is a pretty fair rotation between the group, it was just easier for me to stay on nights.

 

[Groove]

What's everyone's percentage of evenings (shift ending past 9 pm) and overnights? I feel like I am getting shafted at my shop with 65-75% of shifts either evening or overnight - or is this the norm? I recognize by simple math if you have three shifts (day, evening, night) that it seems logical to work 2/3rd evening and night, but staffing level is different at different times where I and most people work.

Our "night" shifts are 5p-3a and 9:30p-6:30a. We have 5 physician shifts/day for 150-155 shifts/mo. We have 2 nocturnists, one of which works 12-14 (9:30-6:30a) and another that works 14 (5p-3a). That leaves:

77.5 "night shifts" - (12+14) = 51.5 / (11 docs) = 4.6 nights/mo

This translates to about 25-31% nights among our "day" docs each month currently.

My last gig was about 6 overnight shifts/mo on average or roughly 37-40%

 

[scoopdaboop]

How many shifts a month do you think is doable? Where I worked there was a night doc who worked a **** ton and saw 30-40 patients every night probs and didn’t miss a beat. Is it that difficult to do say 20-24 shifts a month?

 

[Groove]

How many shifts a month do you think is doable? Where I worked there was a night doc who worked a **** ton and saw 30-40 patients every night probs and didn’t miss a beat. Is it that difficult to do say 20-24 shifts a month?

20-24 is not sustainable. It's dangerous for your health and dangerous for the pt's. EM shifts are reliably higher stress with a significantly faster pace and higher baseline stress level d/t the nature of the work that we do and the overall mechanics of the ER. Humanly possible? Sure..but I wouldn't recommend it. In a busy ED on a Monday, there's virtually no downtime.

The longest stretch I've worked was 3 weeks of 12 hours shifts and I never want to do that again. Ever.

I knew a guy who worked 20 shifts a month routinely and had a thriving real estate business on the side. He was very calm, cool and collected. These types of docs are anything but the norm and I have no idea how he sustained that kind of schedule for so long.

Normal seems to be about 120-130 hours a month or 13-14 shifts/mo. The most I've worked was 17-18/mo routinely and it really wore me down over the years to the point that I've backed off now and am glad that I did. I'll make about 100K less this year, but I'm happier.

 

[GatorCHOMPions]

It really depends on your coverage. About 55% of our shifts end after 9 pm (includes overnights).

I guess what I forgot to mention in my post above was I suspect the shift distribution is not equal among physicians in my group. I know some of the heavy admin types work 0-2 evenings/nights per month. Do these people get as many preferential shifts where you guys work?

How many shifts a month do you think is doable? Where I worked there was a night doc who worked a **** ton and saw 30-40 patients every night probs and didn’t miss a beat. Is it that difficult to do say 20-24 shifts a month?

I think it's better to think of things in hours per month. I work at a normal to high acuity type shop seeing 2-2.5 pph and get pretty crispy after I've worked over 160 hours in a month. My happiest place is 100-120 hours per month.

You also need to consider the shift length. It is not the same to work 20 8-hour shifts as it is to work 20 12-hour shifts, although both are very crappy nonetheless. I'd rather work 12-12's than the equivalent 18-8's, or even 17-8's, but that is more of a personal preference. I like having complete days off more than I like going into work more often.

 

[Groove]

I guess what I forgot to mention in my post above was I suspect the shift distribution is not equal among physicians in my group. I know some of the heavy admin types work 0-2 evenings/nights per month. Do these people get as many preferential shifts where you guys work?

In general, yes. Just about every medical director I've worked with does their own scheduling and preferentially gives themselves a.m. shifts. One thing you need to realize though is the amount of administrative tasks they perform outside of the ED. This includes committee meetings, interdepartmental meetings, QA, chart review and dodging peer review complaints, being available for c-suite, etc.. For instance, it's tough to be available to meet suddenly with c-suite who phones you up at 9a.m. (remember, you're expected to always be available for hospital admin as director) for an impromptu meeting because of a complaint they've received from a surgeon regarding a case last evening when you've just worked 2 nights in a row and are trying to sleep on a Monday. These things routinely happen, especially in a larger and busier ER.

That being said, our current director is the first I've worked with that routinely works nights. He currently works 30% night shifts to be exact and is tied for the most night shifts with me. I've told him in the past that none of us really expect him to work all those nights but he does it anyway. It has definitely not gone unnoticed among the rest of the docs. I'm not sure it's a great idea though as a director and if I was ever a medical director, I probably wouldn't do it unless it was a weekend shift for the reasons listed.

Plus, they're the medical director. That's worth a few perks IMO for a leadership role that nobody typically wants.

 

[TooMuchResearch]

Our people who are doing a lot of administrative stuff get more of a preferential/set schedule to accommodate frequent meetings but still work the same proportion of days/evenings/nights.

I guess what I forgot to mention in my post above was I suspect the shift distribution is not equal among physicians in my group. I know some of the heavy admin types work 0-2 evenings/nights per month. Do these people get as many preferential shifts where you guys work?






I think it's better to think of things in hours per month. I work at a normal to high acuity type shop seeing 2-2.5 pph and get pretty crispy after I've worked over 160 hours in a month. My happiest place is 100-120 hours per month.

You also need to consider the shift length. It is not the same to work 20 8-hour shifts as it is to work 20 12-hour shifts, although both are very crappy nonetheless. I'd rather work 12-12's than the equivalent 18-8's, or even 17-8's, but that is more of a personal preference. I like having complete days off more than I like going into work more often.

 

[TooMuchResearch]

Our people who are doing a lot of administrative stuff get more of a preferential/set schedule to accommodate frequent meetings but still work the same proportion of days/evenings/nights.

I guess what I forgot to mention in my post above was I suspect the shift distribution is not equal among physicians in my group. I know some of the heavy admin types work 0-2 evenings/nights per month. Do these people get as many preferential shifts where you guys work?






I think it's better to think of things in hours per month. I work at a normal to high acuity type shop seeing 2-2.5 pph and get pretty crispy after I've worked over 160 hours in a month. My happiest place is 100-120 hours per month.

You also need to consider the shift length. It is not the same to work 20 8-hour shifts as it is to work 20 12-hour shifts, although both are very crappy nonetheless. I'd rather work 12-12's than the equivalent 18-8's, or even 17-8's, but that is more of a personal preference. I like having complete days off more than I like going into work more often.

 

[thegenius]

How many shifts a month do you think is doable? Where I worked there was a night doc who worked a **** ton and saw 30-40 patients every night probs and didn’t miss a beat. Is it that difficult to do say 20-24 shifts a month?

That guy is going to get a heart attack and die very early if he’s doing, on average, 22 shifts/month seeing over 30 pts/shift. That sounds so outrageous that I almost don’t believe it.

It’s beyond un-sustainable.

 

[GonnaBeADoc2222]

A couple responses to the above:

1) I had an attending in residency who pulled something like 24 night shifts / month. Had a gaggle of kids and a wife who loved to spend money. Also lived in an expensive house in a HCOL area. I actually really like the guy. However, he would frequently fall asleep on shifts and once got into a car accident on the way home from a shift secondary to falling asleep at the wheel. After that, he only took the train. I would not recommend this.

2) The chair / director of an ED should be a leader, not just a boss. My chair in residency worked maybe 2 shifts / month, never a weekend / holiday / night, never on the lower acuity side of the ED, never with interns. One of my directors at a TH site worked maybe 5-6 shifts / month, again never a weekend / holiday / night. It's pretty tough to take these types of "leaders" seriously and be motivated to comply with whatever edicts they throw down. Directors are often getting a nice little stipend to do director work - it's your job to figure out how to balance your admin duties with clinical obligations and you shouldn't be allowed to (or even feel like you should be entitled to) dump all the undesirable shifts onto your colleagues.

 

[GatorCHOMPions]

2) The chair / director of an ED should be a leader, not just a boss. My chair in residency worked maybe 2 shifts / month, never a weekend / holiday / night, never on the lower acuity side of the ED, never with interns. One of my directors at a TH site worked maybe 5-6 shifts / month, again never a weekend / holiday / night. It's pretty tough to take these types of "leaders" seriously and be motivated to comply with whatever edicts they throw down. Directors are often getting a nice little stipend to do director work - it's your job to figure out how to balance your admin duties with clinical obligations and you shouldn't be allowed to (or even feel like you should be entitled to) dump all the undesirable shifts onto your colleagues.

Cannot like this post enough. Unfortunately doubt the effective leader as defined above exists at most shops.

 

[Old_Mil]

I would advise medical students to carefully choose a specialty that can be somewhat independent from the hospital or one that is a huge money generator for the hospital. They only care about you if you make them $$$. Ortho with a specialization in joints comes to mind. Spine is huge too. I'm sure there are a few others. Mohs surgeon? Retina specialist? Cataract remover factory? Facial plastics? EM is getting flooded with new residencies and the ACGME and professional societies are doing nothing to curtail this. Midlevels with online degrees are effectively practicing independently in shops where there is no time to supervise. Who knows what the future holds.

This is very good advice. If you're a current medical student you need to really think about where medicine in the US is going to be in another decade or two.

 

[scoopdaboop]

This is very good advice. If you're a current medical student you need to really think about where medicine in the US is going to be in another decade or two.

As long as em makes 350,000 not including benefits per year while working around 14 shifts a month I don’t mind

 

[hundreddaysoff]

As long as em makes 350,000 not including benefits per year while working around 14 shifts a month I don’t mind

Well, that's the gamble you're taking. Will it still in 6-7 years or will the crony capitalists drive us down to primary care money? No one knows.

The benefit of picking a primary care specialty would be that you'd have a bit of flexibility to pick another job if hospitalist compensation or whatever were to tank. The downsides of primary care are of course legion.

I happened to agree with you when I was in your shoes 4 years ago, and it's paid off for me so far. I just need this status quo to hold for another 4-5 years and then I win. Just understand that it's probably a risk/reward thing and thus a decision you should make for yourself based on your risk tolerance.

I like that you're going into this eyes wide open. You're ahead of at least 90% of med studs in doing so.