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I hope to work all nights or overnights. The only time I like to see the sunrise is on the backend of it. 
Fantasies of EM vs the Reality: common Misconceptions of EM Hopefuls
- Thread starter Chris Knight
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As a practicing EM doc I find this post most useful and wish it had existed back when I was a med student.
A couple of other things to be aware of:
The ER job market is not "wide open". It is ROUGH to get a job in Utah (even in the middle of nowhere), Oregon (except very rural), Washington, parts of California. I know people in Utah from great programs who have tried for YEARS to find a job. Obviously less desirable areas of the country do not have this issue. Unlike other fields, in EM you can't start your own practice, so if you want to live somewhere desirable, think twice about EM as a field. I know alot of people who are stuck doing locums in crappy places with no benefits and no hope of a permanent job. Other places that are "hard" to get a job (NYC) are actually not so bad...but the jobs do not pay well there and are pretty abusive.
You forgot to add in "drug seekers"
And what if they patient with back pain has a dissection? Don't forget to add that in!!
EM does not have high job satisfaction. Look hard at where you want to live. If it is somewhere with no jobs (Utah) DO SOMETHING ELSE unless you literally want to be unemployed.
A couple of other things to be aware of:
The ER job market is not "wide open". It is ROUGH to get a job in Utah (even in the middle of nowhere), Oregon (except very rural), Washington, parts of California. I know people in Utah from great programs who have tried for YEARS to find a job. Obviously less desirable areas of the country do not have this issue. Unlike other fields, in EM you can't start your own practice, so if you want to live somewhere desirable, think twice about EM as a field. I know alot of people who are stuck doing locums in crappy places with no benefits and no hope of a permanent job. Other places that are "hard" to get a job (NYC) are actually not so bad...but the jobs do not pay well there and are pretty abusive.
You forgot to add in "drug seekers"
And what if they patient with back pain has a dissection? Don't forget to add that in!!
EM does not have high job satisfaction. Look hard at where you want to live. If it is somewhere with no jobs (Utah) DO SOMETHING ELSE unless you literally want to be unemployed.
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I'm in Colorado, so think I'm safe. I can't imagine ANYONE would want to work here! I mean, it's always really cold and it snows all the time.
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I don't know about Utah, but last year one of our grads got a job in portland and was offered one in Seattle. (Her fiance ended up with a job in portland so she took that one.)
NYC is a pretty tight market if you aren't from nyc (ie know people). I have no idea what programs you are talking about, in terms of being abusive, but I have friends at *most* of the programs and none have complained about it being abusive. The pay varies, depending on if you are in manhattan vs bronx or queens.
Other than that, I think the field is pretty 'wide' open if you are a residency trained graduate with good letters. In the last few years our residents have all gotten jobs where they wanted: manhattan, Washington DC, texas, florida, vegas, northern california, oregan, chicago, hawaii, new jersey......
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I'm in Colorado, so think I'm safe. I can't imagine ANYONE would want to work here! I mean, it's always really cold and it snows all the time.
Totally off-topic, but someone has to do it in every thread. People from Colorado have come here and said it felt colder here than there, which is just ironic to me. We don't get as much snow most years though. ("here" is about 10 hours straight east from Denver I think)
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No idea.
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World-class skiing thirty minutes away.
Air density. As you go down in altitude, the heavier air is better at convection cooling/heating.
WW - CO is a terrible place to live! I don't know why anyone would want to work there!
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That's an interesting post from erdoc1234. If anything I have heard the exact opposite though. i might be engaging in a little bit of wish-thinking but I still feel like I haven't met a graduating EM resident who wasn't doing pretty much whatever they wanted.
Granted most of these residents were at pretty awesome programs, cuz that's how I roll.
Granted most of these residents were at pretty awesome programs, cuz that's how I roll.
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Denver and the Front Range cities have a pretty mild climate. It's usually warm and sunny, and then every once and a while it snows. The next day after a big snow the sun comes out and the snow melts. High up in the mountains (like in Leadville) it's a different story and can get really cold, but Denver is on the high plains and not really "in" the mountains at all.
Now back to this nice and uplifting thread . . .
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I think overall shift work is a blessing and a curse. I was going to go into EM until I had a child and then couldn't imagine the irregularity of shifts along with nights, weekends and holidays for the rest of my life. However, I can see where if one works mostly nights it could afford more time with the kids during the day before and after school. The caveat here is that you have to be ok with working consistent nights, and the toll this might take after many years could be significant.
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Because all the mormons that went away for med school want to go back to the motherland regardless of any other factors.
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But you know, I sent a casual email to a hospital in my hometown where I wanted to work. Just sort of a "HihowareyaIstillhaveayearleftbutifyouhaveajobthenIwouldliketobeconsidered" you understand, and an hour later my phone rang and I was invited for an interview. The Vice President and their recruiter gave me an hour-long presentation, took me around, arranged to have me tour and talk with some of their EM physicians, and essentially offered me a job three hours after our first meeting for well above the national average in salary, a really nice signing bonus, and they will pay to move us next July.
It's at one of the best hospital systems in the South in an area with a very low cost of living. It's nothing spectacular, the same old same old as far as patients but we wanted to move there so location was the most important factor. Maybe it's not San Diego but I prefer to live in flyover country anyway.
Number of calls: 1
Number of job offers: 1
Contract Signed: 1
Number of Interviews I Have to Go On Now: 0
Cost to Me of Applying for Jobs: 0
All I had was a rough draft of my CV straight from ERAS, by the way, and they offered me a job without asking for any references or talking to anyone at my program. (But they will for credentialing, obviously)
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If you've been out for a few years and haven't had any major problems you have pretty good portability. I get job offers here and there from people I know via residency and ACEP. I'm confident I could get a job in any region of the country I want. I couldn't get most academic jobs and I'm not saying I could go to any city right off the bat but with some time and work I probably could get close.
I have 2 points here. First, some places don't need to hire new grads and can hold out for veterans. Once you've got some years under your belt you are a little more attractive. Second, the field has pretty good portability. As a BC/BE EP you can expect to be able to get near where you want to go but you may not get your first pick.
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docB - You coudl get a job anywhere cause you're a bada$$.
Actually, now that I am board certified, I kind of snooped around and interviewed at a few places (some local, some out of state), and had NO difficulty whatsoever in getting job offers quickly. I do agree iwth docB - once you get a few years under your belt (I have two), are BC, and dont' have any major F-ups (i.e. your medical director likes you and gives you a good reference), you probably could get a job almost anywhere.
Tough market areas it is a bit easier if you "know someone" but I don't think it would be too impossible. EM is a small world, and its really more of just putting your feelers out there.
When I was interviewing for a job, our dearly departed friend ERMudPhud got me a contact in the DC area and got me a job interview at a community job, no problem.
Q
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To: Panda, Quinn, and docB
From: Amory
Subject: A faux pas on behalf of my fellow medical students.
Not to turn this into a debt thread, but I know alot of us are looking at our bottom lines as we graduate with some trepidation. I know asking about salary is frowned upon in this world, but will you give us the over/under on 200k for the jobs you have.
Thank you,
AB
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Way over.
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In terms of job offers for this just about to graduate from a 3 year program resident:
Academic - Just a bit under
Non-academic - Over
Academic - Just a bit under
Non-academic - Over
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Over.
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That's true. I walked into one group's monthly meeting where I wanted a job and ripped off my shirt and yelled "You don't offer me a job! I offer you not kicking your butts!" But then the senior partner walked in and unfortunately for me he was Chuck Norris. The next thing I remember I woke up on the floor of a truck stop bathroom in Nebraska.
Seriously though this is an important point about EM that I don't recall ever seeing here before: As an EP you get more marketable in the 2 to 10 years after residency. Some groups will not hire new grads. They just don't want to have to deal with the break in period which is tough. After your boards and 2-3 years you will find a lot more open doors, especially at the little democratic groups that so many grads want. Once you get farther down the road and especially if you have some experience that a group wants (admin, US, etc.) you might be able to negoiate a better join. For example I have seen experienced docs join groups as full partners rather than having to go through the partnership track.
I think that the take home message for residents is that if you really, really want to wind up in a particular job and you don't get it when you're fresh out keep your contacts fresh, keep letting them know you're interested and it might open up after a few years.
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academic job, over.
docB is right, as usual. If you can't find that "perfect" job in that "hard to work" city, take a decent job. Get some experience under our belt. Then keep trying to find that hard job. DC was a tough market a few years ago. There were a lot of other jobs around, none that paid super great, seemed to have bad backup coverage. Nothing near what I would consider a solid job. Ended up going academic and have loved it since, but now that I have two years I have been approached by several small democratic groups with some sweet gigs (nice community hospital IN DC that you actually sleep at night).
Q
docB is right, as usual. If you can't find that "perfect" job in that "hard to work" city, take a decent job. Get some experience under our belt. Then keep trying to find that hard job. DC was a tough market a few years ago. There were a lot of other jobs around, none that paid super great, seemed to have bad backup coverage. Nothing near what I would consider a solid job. Ended up going academic and have loved it since, but now that I have two years I have been approached by several small democratic groups with some sweet gigs (nice community hospital IN DC that you actually sleep at night).
Q
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That's true. I walked into one group's monthly meeting where I wanted a job and ripped off my shirt and yelled "You don't offer me a job! I offer you not kicking your butts!" But then the senior partner walked in and unfortunately for me he was Chuck Norris. The next thing I remember I woke up on the floor of a truck stop bathroom in Nebraska.
I hope no one tries to do this for residency interviews! Although would not fault said person for major cajones...Seriously, thanks for the encouraging info about the job market!
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1st job out of residency, large HMO group at around 200k.
Now at FFS democratic group at well over double that....
Agree with above posters that many groups want a couple of years of experience.
Now at FFS democratic group at well over double that....
Agree with above posters that many groups want a couple of years of experience.
The customer satisfaction aspect of an ER doc was pretty new to me out of residency things like: Press Ganey scores, performing patient call backs, consultant complaints, patient complaints. Then there is dealing with consultants that will not see patients. In residency this was pretty easy, as an attending it can be extremely frustrating. In residency I felt a genuine collegiality with residents from other departments, plus they were as naive as me and we got along pretty well. Now they're wiser and don't want the extra headache for me, I feel like sometimes we don't share the common interest of the patient anymore... especially since it's not their patient yet.
The market is wide open. They need EM everywhere and most hospitals are trying to get IM and FP out of the ER for legal reasons. Looking for a job after the academic year has started is the easiest way to get hired at a desirable place, people always leave, and they will need to fill shifts. It's tough having the rest of the staff pick up the slack for 9 months.
Salaries will vary from about $175 to $300K starting for average amount of hours. The academic jobs are on the lower side and private democratic groups on the upper. There are a few good groups to get into where you will make $500k as partner, but they are in the middle of nowhere. Highest paid ED doc I know is $800K, director of a group in a rual area.
I also know people who will fly out to do shifts and live wherever they want. Not much different than if you did consulting at Mckinsey, but a lot less hours.
Finally, you can start your own practice/group. It will take a lot of credibility, a good group of friends, but if a hospital has a bad ER with a lot of complaints, they welcome a new group coming in that can provide true Emergency care. You not going to do it right out of residency unless you go to one of these rual areas. It's high risk and high reward.
Salaries will vary from about $175 to $300K starting for average amount of hours. The academic jobs are on the lower side and private democratic groups on the upper. There are a few good groups to get into where you will make $500k as partner, but they are in the middle of nowhere. Highest paid ED doc I know is $800K, director of a group in a rual area.
I also know people who will fly out to do shifts and live wherever they want. Not much different than if you did consulting at Mckinsey, but a lot less hours.
Finally, you can start your own practice/group. It will take a lot of credibility, a good group of friends, but if a hospital has a bad ER with a lot of complaints, they welcome a new group coming in that can provide true Emergency care. You not going to do it right out of residency unless you go to one of these rual areas. It's high risk and high reward.
