First job advice

[Brigade4Radiant]

I'm looking for jobs as a third year resident I'm just curious about some of your guys thoughts.

Taking call? (one job I'm looking at you will be on "call" three days a month for a 24 hour period each day.

Employer vs I.C

What are some thing that you can negotiate on? A lot of the places I looked at don't give signing bonuses.

I know full time is 120 hours but it seems like 130-140 is what places are offering for full time.

I was thinking about moving closer to a big city but a mid size city in the midwest gives you 250 base plus RVU while in the southeast it is mostly 200 base.

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[deleted109597]

Talk to the rest of the employees and find out how often call is used. Is it only to cover for call outs? Or is it for busy times?
The second has been discussed ad nauseum.
You can negotiate anything you want, but you may also not get the job.
Full time is whatever the contract writer says it is.
Live wherever you want.

 

[bravotwozero]

I wouldn't work at a place where you have to 'take call'. That sounds like total BS.

I negotiated for moving expenses to be paid for. Other people have asked for licensing fees to be covered. If there's something you want, do not hesitate to ask, since you have nothing to lose.

My gig required a minimum 120 hrs for full time, 140 sounds brutal.

If you can get health insurance through your wife, I would go IC since your pay will be higher, and you can deduct more things from your taxes.

250 plus RVUS sounds great IMO, especially if you like where you live.


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[TooMuchResearch]

3 call days per month is a lot. That sounds like more of a sick call + come to work it's busy call.

I think a sick call system is okay - wouldn't you want your shift covered by a partner if you or a family member (kid) was sick?

But getting called in because the ED is busy is just thin scheduling. I wouldn't do it, but lots of people do.

 

[fahimaz7]

It's all about where you want to live and what you want to be doing. Some like inner city hospitals, some like rural hospitals, and some like a mix. Some prefer 1099 where some prefer to be W2. There's no simple answer.

I took a pay cut and moved to the area I want to be and couldn't be happier. You couldn't pay me enough money to work (and live) in a lot of the places in this country.

 

[Brigade4Radiant]

3 call days per month is a lot. That sounds like more of a sick call + come to work it's busy call.

I think a sick call system is okay - wouldn't you want your shift covered by a partner if you or a family member (kid) was sick?

But getting called in because the ED is busy is just thin scheduling. I wouldn't do it, but lots of people do.

Yeah I would like some of my days covered if my kid was sick but other places you just call the scheduler and then they call all the EM physicians and see who can cover. I mean what if your kid is sick and you're on call you're in the same position.

 

[RustedFox]

I took a pay cut and moved to the area I want to be and couldn't be happier. You couldn't pay me enough money to work (and live) in a lot of the places in this country.

I took a 15-20 dollar/hour pay cut to move between HOSPITALS in my city. I couldn't be happier.

 

[WilcoWorld]

Sick call is good. Even better than having it when your kid's sick is having it in the case that the doc who's relieving you gets sick.

Call-in for busy times is lousy. It seems more common for shops that like to chronically understaff while still cracking the metrics whip.

 

[RustedFox]

Sick call is good. Even better than having it when your kid's sick is having it in the case that the doc who's relieving you gets sick.

Call-in for busy times is lousy. It seems more common for shops that like to chronically understaff while still cracking the metrics whip.

This was the exact, precise reason that I left my HCA job (mentioned above).

 

[HunterGatherer]

I had sick call in residency and there was always that one person who abused the system. Ours got me 2x. I'm not a fan of sick call. Maybe people become very professional once residency is over.

sign up for 120 hours and also get credentialed with 1-2 other gigs. that way you can work more when needed and have easy months when needed.

 

[namethatsmell]

Unless there's something amazing about the job with 3 on call days, walk away.
I hate this system but can see how people taking 1 day per month isn't unreasonable if everybody has the same amount and it's only for call outs not volume.

As for hours, I walk away from any place that requires more than 130. Really, 120 or less for full time is ideal. You can always choose to work more in months you feel like it. Don't get locked in.



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[Groove]

I'm also not a fan of call unless its a SDG group with partnership benefits, equity and personal buy in that makes such sacrifices worthwhile and are obligatory in nature.

IC would benefit you with the commencement of the Trump administration seeing as how it appears that you will benefit significantly under corporate status filing with taxes at 15% if this indeed turns out to be true.

There are two sides of the "minimum hours for FT" clauses in contracts. Negotiate for lower hours if you value your downtime and don't anticipate working much more than your negotiated hours. Negotiate higher hours if you have a bottom line for how much income you need each month to sustain your lifestyle and have a higher tolerance for greater workloads. The reality is that most jobs will let you work as much as you want if you let them know your needs up front but if you come in negotiating 110h and 6 months later decide that you need to work 180h to generate your goal income, don't expect to be able to get the extra shifts. The employer is going to staff the ED appropriately (slightly overstaffed). If you end up needing extra shifts, and didn't negotiate an optimal number in the beginning, you may be stuck picking those up PRN at another ED.

Signing bonuses are becoming more standard these days and I would negotiate for one in any location that is even remotely undesirable. Don't sign for more than 2 years. It will take you at least 6 months to get a feel for whether the job is going to work out long term or not. Negotiate your bonus with a 50% forgiveness after 1st year and each month pro-rated during your second year. That's a reasonable request and will both provide your employer with adequate incentive to keep you there long term while providing you an emergency out that's less financially punitive.

As for the geography, that's very personal. Many people are completely willing to sacrifice significant salary for location. I, however, am not. Proximity to family, friends and an airport can make the worst of locations very tolerable.

 

[Brigade4Radiant]

I'm looking at areas around in the Southeast Apollo has the locations I'm interested in but I guess I'll negotiate for below 140

 

[emergentmd]

I'm looking for jobs as a third year resident I'm just curious about some of your guys thoughts.

Taking call? (one job I'm looking at you will be on "call" three days a month for a 24 hour period each day.

Employer vs I.C

What are some thing that you can negotiate on? A lot of the places I looked at don't give signing bonuses.

I know full time is 120 hours but it seems like 130-140 is what places are offering for full time.

I was thinking about moving closer to a big city but a mid size city in the midwest gives you 250 base plus RVU while in the southeast it is mostly 200 base.

Most jobs I have applied for or worked at states that 120 hrs/mo is full time and that includes administrative time.

If They put me on Call, I would take minimum 100/hr and then 200/hr to come to work. Seriously. If not, I would not sign up.

On Call is CRAP. I might as well just go to work. If the place is on call for 24 hr periods, you bet they would call you in when someone calls in sick, there is a hole to fill (jobs sounds crappy), or if there is a SURGE.

3 days a month is ALOT. That is 72 Hrs of "being at work" on top of the 130 hrs you got to be at work.

There has to be a disincentive to be called in for the company otherwise you will be called in all the time

 

[emergentmd]

I'm also not a fan of call unless its a SDG group with partnership benefits, equity and personal buy in that makes such sacrifices worthwhile and are obligatory in nature.

IC would benefit you with the commencement of the Trump administration seeing as how it appears that you will benefit significantly under corporate status filing with taxes at 15% if this indeed turns out to be true.

There are two sides of the "minimum hours for FT" clauses in contracts. Negotiate for lower hours if you value your downtime and don't anticipate working much more than your negotiated hours. Negotiate higher hours if you have a bottom line for how much income you need each month to sustain your lifestyle and have a higher tolerance for greater workloads. The reality is that most jobs will let you work as much as you want if you let them know your needs up front but if you come in negotiating 110h and 6 months later decide that you need to work 180h to generate your goal income, don't expect to be able to get the extra shifts. The employer is going to staff the ED appropriately (slightly overstaffed). If you end up needing extra shifts, and didn't negotiate an optimal number in the beginning, you may be stuck picking those up PRN at another ED.

Signing bonuses are becoming more standard these days and I would negotiate for one in any location that is even remotely undesirable. Don't sign for more than 2 years. It will take you at least 6 months to get a feel for whether the job is going to work out long term or not. Negotiate your bonus with a 50% forgiveness after 1st year and each month pro-rated during your second year. That's a reasonable request and will both provide your employer with adequate incentive to keep you there long term while providing you an emergency out that's less financially punitive.

As for the geography, that's very personal. Many people are completely willing to sacrifice significant salary for location. I, however, am not. Proximity to family, friends and an airport can make the worst of locations very tolerable.

Signing bonus is nice only if attached to a 6 month contract. The most I would sign is 1 year in any job b/c if you read the fine print, they can fire you in 3 months even if you just signed a 3 yr contract.

Why give the owners/CMG all the leverage.

 

[shoal007]

We do call. Thankfully it's not abused. I've been called in twice in 1.5 yrs. once doc forgot shift and other 2 codes going on at the same time. It totally depends on the gig,


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[emergentmd]

I understand why Call would be helpful. But IMO its not a great idea if abused or not.

Even if you are only called in 1-2 times every year, then you essentially had a cloud over your head for 36 dys/yr when you are off. Not worth it.

Our SDG tried it, didn't like it after people rarely was called in. If there is an emergency, someone in the group would come in, or the people on would extend their hours.

 

[Brigade4Radiant]

We do call. Thankfully it's not abused. I've been called in twice in 1.5 yrs. once doc forgot shift and other 2 codes going on at the same time. It totally depends on the gig,


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So how long did you stay when you were called in? Other places I was looking at the would just ask the next doc to come in early and compensate them for it.

 

[Groove]

Good luck finding a 6mo contract with worthwhile bonus. I've never heard of one. Most contracts have 60-90d notice and that's like putting your notice in 3mo after you took a sign on and committed. Hope that relationship is not needed in the future because that's a guaranteed burned bridge now. 1yr is pretty standard and 2y for anything remotely interesting which is usually on the order of 50K in this area. Obviously if you don't like commitment then don't take a sign on.

 

[Groove]

I think if you have official sick call, it will absolutely be abused at some point. I guarantee if you raise the hourly rate enough for those rare staffing emergencies someone will def fill the shift.

The problem with being on call is that you're not getting paid and that's an emergency shift you could have picked up for another ED willing to pay you for your time.

 

[MackandBlues]

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[emergentmd]

Good luck finding a 6mo contract with worthwhile bonus. I've never heard of one. Most contracts have 60-90d notice and that's like putting your notice in 3mo after you took a sign on and committed. Hope that relationship is not needed in the future because that's a guaranteed burned bridge now. 1yr is pretty standard and 2y for anything remotely interesting which is usually on the order of 50K in this area. Obviously if you don't like commitment then don't take a sign on.

I understand why groups give sign on bonuses and make you sign a 2 yr contract. They want to hook you in with the early $$$ and makes it hard to leave after it turns out to be different than promised.

I know you can't find bonuses with short contracts. I just don't think 50K bonus (30-35K after taxes) is worth being locked in for 2 yrs.

EM docs are relatively rare. Bonuses are given by groups that are not desirable otherwise they don't need to offer it. If said place gives bonuses/not desirable, then you have leverage. Why get locked in for 2 yrs at a place that is not desirable?

But at the end of the day, at worse you pay back the bonus and quit the job. Contacts are meant to be broken and the CMGs know this. Why would any owner want an unhappy doctor coming to work? They rather make you pay back the bonus and let you go.

 

[emergentmd]

I think if you have official sick call, it will absolutely be abused at some point. I guarantee if you raise the hourly rate enough for those rare staffing emergencies someone will def fill the shift.

The problem with being on call is that you're not getting paid and that's an emergency shift you could have picked up for another ED willing to pay you for your time.

If you work 15 dys a month, add on 3 call Days then you have made scheduling vacations infinitely more difficult. Our group has never had an issue covering an emergency (early births, really sick doc). At just my hospital, I would say this has happens 1-2 times a year and we cover it without any extra $$$$. Docs just step up b/c we are in the Pit together and No One abuses it.

Surge? No way anyone should be on call for this. Docs who are on just need to suck it up until the new doctor comes.

 

[deleted109597]

I got a call last night. Christmas ****ing night. From one of my sites.
"It's really busy can you come in for a few hours and help clean up?"
No, but I can tell the people there that I've never needed help on shifts I work. I wonder why that is?

 

[Hercules]

I got a call last night. Christmas ****ing night. From one of my sites.
"It's really busy can you come in for a few hours and help clean up?"
No, but I can tell the people there that I've never needed help on shifts I work. I wonder why that is?

You've got to be kidding me.


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[emergentmd]

I got a call last night. Christmas ****ing night. From one of my sites.
"It's really busy can you come in for a few hours and help clean up?"
No, but I can tell the people there that I've never needed help on shifts I work. I wonder why that is?

Calling in for Surges, for the most part, is just a crutch for slow docs. There are slow docs and even the slightest busy days starts to become a surge. If you were on call, you then are committed to coming in. That is why being on Call as an ED doc sucks.

They have directors and assistant directors that are paid for doing admin stuff. Let them come in.

I was the director for years and I knew if there were surges, and I was in town, I would come in first. I would never call another doc up to come in.

I would never take a job with forced call unless I am getting paid atleast 100/hr

 

[Groove]

I understand why groups give sign on bonuses and make you sign a 2 yr contract. They want to hook you in with the early $$$ and makes it hard to leave after it turns out to be different than promised.

I know you can't find bonuses with short contracts. I just don't think 50K bonus (30-35K after taxes) is worth being locked in for 2 yrs.

EM docs are relatively rare. Bonuses are given by groups that are not desirable otherwise they don't need to offer it. If said place gives bonuses/not desirable, then you have leverage. Why get locked in for 2 yrs at a place that is not desirable?

But at the end of the day, at worse you pay back the bonus and quit the job. Contacts are meant to be broken and the CMGs know this. Why would any owner want an unhappy doctor coming to work? They rather make you pay back the bonus and let you go.

In my experience, it's more common to see sizable sign ons with CMGs vs SDGs because with the SDG it's felt much more pointedly. The partners have to cough up a sizable bonus to the new guy starting out on the partnership track that could have otherwise gone to the rest of them that year or spent on operations and let's face it, that's never an easy sell. It's much easier to convince the new partner that he's joining a gem of a group where quality of life/work and long term earning potential outweighs any benefits the local CMG could possibly offer. (Caveat Emptor) The money in a CMG comes from the company and isn't felt so personally by the local docs or leadership. Just about all the CMGs in my area offer sign ons as an incentive in an area that has a paucity of quality EM docs. It doesn't mean the site sucks, it's just supply and demand. I think all EM docs should evaluate their personal risk tolerance and take advantage of those offers when available. That's why I think negotiating 50% forgiveness after a year (who can't put up with a new place for a year?) with pro rata is by far the easiest way to go if you want that extra $$$. It's a great time for our specialty and I think all the new grads should probably take advantage of the proliferation of sign ons because let's face it, statistically most of them are changing jobs after 2 years anyway. It's a personal thing I suppose. I don't seem to see sign ons for any SDG groups I've ever interviewed for in desirable locations or even where I'm at. If it was offered, it was offered with resistance after persistence on my part. That being said, the decision to not offer a sign on can lose you a good doc to a competing group. Hell, I remember when I graduated residency in poverty wanting to take a job with an SDG and they wouldn't even give me enough of a sign on to handle moving expenses. I went with a CMG that paid me 50K, then went with another one not long after that that paid me another 40K and never looked back. New grads need the cash and CMGs are capitalizing on that because they know it's difficult to resist.

 

[Brigade4Radiant]

The call is only for call in's and never for busy days. The amount of calls in a year is around 8-9.

 

[emergentmd]

The call is only for call in's and never for busy days. The amount of calls in a year is around 8-9.

So are each doctor called in 8-9 times a year or 8-9 total for the group? Either way its ridiculous. 8-9 times per doc means people are not showing up for a bunch of reason or you have a MASSSIVE group. We had 100+ docs and you might have 8-9 times a yr when a doc doesn't show.

8-9 times a group would mean a Massive amount of call days for a very occasional need.

Either way, I would not do call unless I get paid.

Doctors working that day can stay later, do a double shift, etc... their day is likely shot anyhow.

 

[shoal007]

So how long did you stay when you were called in? Other places I was looking at the would just ask the next doc to come in early and compensate them for it.

4 hours. got paid 8

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[TooMuchResearch]

I understand why groups give sign on bonuses and make you sign a 2 yr contract. They want to hook you in with the early $$$ and makes it hard to leave after it turns out to be different than promised.

I know you can't find bonuses with short contracts. I just don't think 50K bonus (30-35K after taxes) is worth being locked in for 2 yrs.

EM docs are relatively rare. Bonuses are given by groups that are not desirable otherwise they don't need to offer it. If said place gives bonuses/not desirable, then you have leverage. Why get locked in for 2 yrs at a place that is not desirable?

But at the end of the day, at worse you pay back the bonus and quit the job. Contacts are meant to be broken and the CMGs know this. Why would any owner want an unhappy doctor coming to work? They rather make you pay back the bonus and let you go.

Counterpoint: Our community standard is a signing bonus, so in some places it just what happens and can't help you pick the good from bad jobs.

 

[swamprat]

Call sounds absolutely terrible, especially if its if the ED gets busy. Even for sick days, what do groups do if there isn't an "on call" person and someone is truly sick and calls out?

 

[deleted77919]

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[namethatsmell]

I realize this money comes from a slush fund that could otherwise be used to bump everyone's pay a couple of bucks an hour, but I would not trade a few dollars an hour for the possibility of being called in on an involuntary basis.

Completely agree. This is the way to do it.

 

[The White Coat Investor]

I'm looking for jobs as a third year resident I'm just curious about some of your guys thoughts.

Taking call? (one job I'm looking at you will be on "call" three days a month for a 24 hour period each day.

Employer vs I.C

What are some thing that you can negotiate on? A lot of the places I looked at don't give signing bonuses.

I know full time is 120 hours but it seems like 130-140 is what places are offering for full time.

I was thinking about moving closer to a big city but a mid size city in the midwest gives you 250 base plus RVU while in the southeast it is mostly 200 base.

We have call. You're technically on call for 4 hours after the 6 pm to 2 am shift and for 4 hours before the 10 am to 6 pm shift. Very rare to be called in. Haven't called someone in in years. Never on call on days you're not working already. So worst case scenario your 8 becomes a 12.

In EM, you need to be paid something like 10% more for an IC to be equivalent to an employee salary, and that assumes a very skimpy benefits package for the employee.

The key to negotiation is having another job offer in your pocket. When you're willing to walk away and go somewhere else, then you have negotiating power. But how much really depends on the job and what they need and what other options they have. Technically you can negotiate anything. Bear in mind to the employer, money is money, whether it goes for your salary, your benefits, your signing bonus etc. All the same.

Full time is whatever you decide it is. If you only want to work 120, then don't go to a job that requires you to work 140. But there are many places that would consider 140 or more full time. 12 twelves is 144. 15 tens is 150. I don't want to work that much (that's why I work 96) but you may very well want to (and should) right out of residency.

 

[gman33]

When looking at hourly rates, try to figure out how many hours you will be actually working for each shift.
Some places may tell you that you will work 8's, but the docs are always stuck an hour late and all charting is done at home.
So that 8 hour shift is really 11 hours of work.

Pretty hard to figure out.

If at all possible try to talk to some people who have left a job and figure out why.

 

[GatorCHOMPions]

I'm also about to be a new grad this coming summer. I've locked down my full time gig at a place in the northeast due to family situation. The requirement is only 120 hours per month, so I'm considering doing locums in some place like Texas a few days per month here and there to supplement income. Any thoughts on how doable this is in the midst of studying for boards, learning how to be an attending, etc.?

People on these boards talk about obtaining figures like $400/hour or more, but I have only been offered $300/hr in very remote locations. With the travel and time away from family, I don't see it as worthwhile for less than $350/hr. Are these offers because I'm new and don't know the ropes? Is it best to start out with one of these locums companies who find places for you? Any recommendations on how to go about this are welcome!

 

[hypnix]

I'm also about to be a new grad this coming summer. I've locked down my full time gig at a place in the northeast due to family situation. The requirement is only 120 hours per month, so I'm considering doing locums in some place like Texas a few days per month here and there to supplement income. Any thoughts on how doable this is in the midst of studying for boards, learning how to be an attending, etc.?

People on these boards talk about obtaining figures like $400/hour or more, but I have only been offered $300/hr in very remote locations. With the travel and time away from family, I don't see it as worthwhile for less than $350/hr. Are these offers because I'm new and don't know the ropes? Is it best to start out with one of these locums companies who find places for you? Any recommendations on how to go about this are welcome!

As a recent grad myself (6 mos as an attending), I would spend your first 6 mos learning how to be an attending, taking and passing your boards, learning your hospital system, nurses, EMR, etc and then start as locums. I am going through the credentialing process for my first ML gig now. To me, the money is more money that I have ever seen and I don't think there is a rush to spend time away from your family situation to work in Texas to make $400/hr. In regards to how to get that rate, I am not sure how one goes about that. Maybe your residency has some alums working in Texas who can provide you more information.