Future job market

[MechEDoc]

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M2 here. Can I get some more advice on this?

I was thinking of doing just FM since it covers both EM, IM, Peds and OB and can get some of those positions in rural areas. Even OB jobs and hospitalist and ED and urgent care job opening have specific statements that they accept FM applicants. So FM appeals to me because of the security and wide-job market. Is this a bad idea to choose FM? I want to be a generalist because I don't like uncertainty and FM offers the most flexibility (and the international recognition of FM is massive compared to other specialties).

My interests: I love acute care, but I also love chronic care (I have experience being a scribe in both). So I can't exactly tell you I'm leaning EM. In fact, the appeal to EM for me was that I could work part time (a 7 shift stretch a month), have massive hobbies and still be pulling more than a full-time PCP/Hospitalist? Is this no longer true? Should I not consider EM?

EM here.

My take on it is as follows: FM is a good generalist for most common conditions. Being a jack of all trades they are a master of none. I would not seek out family medicine for OB care, emergency medical care, pediatrics, or dedicated internal medicine. There likely is an ongoing role for family medicine in very rural areas. However, most these rural areas aren't very desirable and FM winds up in more urban areas. In the emergency department, there is usually a significant gap between EM and FM trained physicians. The rate of Med Mal adverse outcomes reflects this as well. If you really want to do a bit of everything, you could aim for a FM/EM, IM/EM, or med/peds program. Alternatively, you can do FM with OB fellowship and be semi-passable at OB. Ask any L & D nurse and they know there is a difference.

 

[Mushdoc]

Really if you want to do family, it will depend on where you do it. If you are willing to live in a small town you could totally do family and admit your own patients, do minor procedures, OB, peds etc. You could also work some low volume ER shifts. I honestly wish I wanted to live in a small town and I would totally do that for the continuity and variety.

But if you are going to live in a big city, you will likely do hardly any OB, (maybe some gyn), some peds, and you might admit. You also can likely do some urgent care and maybe drive out to some EDs.

 

[Lexdiamondz]

M2 here. Can I get some more advice on this?

I was thinking of doing just FM since it covers both EM, IM, Peds and OB and can get some of those positions in rural areas. Even OB jobs and hospitalist and ED and urgent care job opening have specific statements that they accept FM applicants. So FM appeals to me because of the security and wide-job market. Is this a bad idea to choose FM? I want to be a generalist because I don't like uncertainty and FM offers the most flexibility (and the international recognition of FM is massive compared to other specialties).

My interests: I love acute care, but I also love chronic care (I have experience being a scribe in both). So I can't exactly tell you I'm leaning EM. In fact, the appeal to EM for me was that I could work part time (a 7 shift stretch a month), have massive hobbies and still be pulling more than a full-time PCP/Hospitalist? Is this no longer true? Should I not consider EM?

honestly your biggest source of job security in FM is your ability to work for yourself and hang a shingle. I wouldn't enter FM with the expectation of being able to reliably secure employment in EM, Peds or OB when there are thousands of grads leaving 3 and 4 year residencies who are more capable than an FM doc in those specific fields.

 

[MechEDoc]

honestly your biggest source of job security in FM is your ability to work for yourself and hang a shingle.

Agreed. Hospital systems are a cancer on cancer on American health care.

 

[ER BlueBlood]

Will point out that this whole covid thing has REALLY screwed over a lot of the income price points. It was a rube goldberg machine of driving down physician payments. Massive pandemic *actually* kept people home. Visits per day to the ED (particularly among worried well with insurance) dropped while the length of stay for admitted patients skyrocketed. This lead to massive costs for the hospital not being offset by shaking down the worried well for every penny insurance will give. Also elective surgery shut down so the hospitals other major source of income dried up. In areas *not quite* as hard hit, the hospitals laid off physicians or "asked" them to work fewer hours per month and/or at lower rates. In terribly hard hit areas, righteous white knights flew across the country to voluntarily work for little pay or free - leading to companies wondering what the point of paying the locals was when the out of towners wanted to do it for pennies on the dollar or simply for housing alone. As stuff has started to normalize the hospitals now dont want to raise the incomes and hours back to what they were before. The places that previously wanted traveling physicians now dont want them at all (the locums market is the hardest hit place in all of EM by all of this) because they realize that if the need gets really bad, people will volunteer.

All the while, new graduates who dont know what incomes they should be requesting (I know I didnt a few years ago) accept lower pay rates that their older coworkers would never dreamed of accepting and drive down the market price for the region.

optimistic silver lining: if you want to work rurally, the pay is still pretty great. And the good paying jobs still exist - but you're going to literally have to kill me or one of my coworkers in a fight to the death to get it. I am in a highly desired major city that also happens to pay well by any standard. I left a job paying (x +/- 15%) dollars a month in an incentive based model. I took this job making essentially exactly x dollars a month as well but now on a flat hourly model. This was just before covid by a few months. The old job 1) cut the hours per shift from twelve to ten. 2) they cut the number of physician shifts per day from five to four. and 3) they cut the average number of shifts per month from fourteen to ten; which is sort of an extension of having #2 occur. My current job still gives us the same hourly rate but we (lucky SOBs we are) got asked to work EXTRA shifts because our ICU cant recruit enough intensivists to cover its needs so we are doing extra shifts to cover some of the needs there.

The moral of that story is that good work is out there. But you have to read the tea leaves. I could never have predicted covid. but i knew this incentive based model was ripe for something ****ing with it, and the opportunity to make exactly the same money (in a slightly less nice hospital in the same city) on an hourly basis just felt infinitely more safe. Don't be afraid to move around a bit as you get experience and find the job that makes the most sense to provide you with lasting security and income. Or as lasting as anything is in EM

So you still made the best decision somehow right? Hmmm how should I extrapolate this post, I guess I’ll be fooled by randomness...

 

[scoopdaboop]

EM is done for. The specialty has been ruined by corporations. I predict in 8 years, the salaries for ER docs will fall to that of pediatrics.

 

[RustedFox]

EM is done for. The specialty has been ruined by corporations. I predict in 8 years, the salaries for ER docs will fall to that of pediatrics.

See; I understand the logic here - but I predict that the floor will be higher because then "nobody will do this job for that little" and the admins will have poisoned the well. Admins are smart; I don't think they'll poison the well; they'll just drain it to a certain depth.

 

[ConfusedAboutEverything]

"nobody will do this job for that little"

As the job market tightens, new EM grads will be desperate for jobs and that opens the door to compromise. Admin will take as much advantage of that and will hire those who accept/request the lowest salaries. Every time supply gets too high, salaries drop. Then it will become the norm for EM physicians to be paid like pediatrics, it will be accepted and other admins will follow suit.

 

[scoopdaboop]

luckily there’s a somewhat decent buffer because em is a pretty under staffed specialty, the new grads have to get jobs in the periphery of big cities and even more rural areas, but if this massive influx continues every year for The next 5 years then it’s over. ACEP or whatever group needs to lobby way harder than they are now.

 

[namethatsmell]

As the job market tightens, new EM grads will be desperate for jobs and that opens the door to compromise. Admin will take as much advantage of that and will hire those who accept/request the lowest salaries. Every time supply gets too high, salaries drop. Then it will become the norm for EM physicians to be paid like pediatrics, it will be accepted and other admins will follow suit.

This may be true except for the fact that working in the average ED becomes more and more difficult as time goes on as more "stakeholders" try to extract their pound of flesh from the department.

Consider that in pediatrics: the kids stay cute, the parents stay neurotic and you'll have to deal with both the anti-vaxers and the ones that want their kids put on ritalin because they don't mow the lawn in a perfect pattern, there's low(ish) pay for medicine, and work hours are generally 9-5 M-F. Things can be pretty static and predictable during the course of a peds career.

Whereas in more and more EDs: many of the patients remain completely unreasonable and/or violent, everybody wants you to fill in more gaps in our "health system" while also taking away resources you'd need to try to do it, you will constantly have to fight battles to convince said "system" to do it's job and take care of patients, and everybody (patients, hospitalists, consultants, pharmacy, the cafeteria guy, etc) will tell your boss how you should do your job and in order to stay employed you may very well have to say thank-you-sir-may-I-have-another. Oh and don't expect to have proper PPE in the next pandemic or to be compensated for taking on additional risks above those that already exist in normal times for an ED doc. And absolutely don't plan on having any meaningful administrative control over your job as an ER doc.

After those newly minted EM grads pay off their loans, how long do you think they'd hang around the ED continuing to get pummeled for the pay of a pediatrician? Most will not. They'll flock to a multitude of other gigs that would pay around the same wage and allow them to have their sanity back. So let's say you're right that one day admin tries to drop EM rates to a super low level..within a year or two demand will explode when nobody in their right mind will continue to work in an ED...and rates will have to come back up.

 

[ER BlueBlood]

Hair restoration and stem cells are where it’s at now for $$$

 

[ace_inhibitor111]

There will come a point where admins would rather keep the EM doctor with experience over the one straight out of residency, even if they have to pay them a little higher. So pay won’t drop quite as low as in Peds, but you’ll have a situation like in Pharmacy, Law or most other jobs where it will be very difficult for a new doctor to break into the field without a few years of experience on top of residency. Many grads will probably have to do random fellowships until they can get employed like in path.

 

[turkeyjerky]

This may be true except for the fact that working in the average ED becomes more and more difficult as time goes on as more "stakeholders" try to extract their pound of flesh from the department.

Consider that in pediatrics: the kids stay cute, the parents stay neurotic and you'll have to deal with both the anti-vaxers and the ones that want their kids put on ritalin because they don't mow the lawn in a perfect pattern, there's low(ish) pay for medicine, and work hours are generally 9-5 M-F. Things can be pretty static and predictable during the course of a peds career.

Whereas in more and more EDs: many of the patients remain completely unreasonable and/or violent, everybody wants you to fill in more gaps in our "health system" while also taking away resources you'd need to try to do it, you will constantly have to fight battles to convince said "system" to do it's job and take care of patients, and everybody (patients, hospitalists, consultants, pharmacy, the cafeteria guy, etc) will tell your boss how you should do your job and in order to stay employed you may very well have to say thank-you-sir-may-I-have-another. Oh and don't expect to have proper PPE in the next pandemic or to be compensated for taking on additional risks above those that already exist in normal times for an ED doc. And absolutely don't plan on having any meaningful administrative control over your job as an ER doc.

After those newly minted EM grads pay off their loans, how long do you think they'd hang around the ED continuing to get pummeled for the pay of a pediatrician? Most will not. They'll flock to a multitude of other gigs that would pay around the same wage and allow them to have their sanity back. So let's say you're right that one day admin tries to drop EM rates to a super low level..within a year or two demand will explode when nobody in their right mind will continue to work in an ED...and rates will have to come back up.

The problem is that the negatives of our specialty are far more hidden than those of many others specialties. The negatives of many other fields are pretty obvious to medical students:

Peds--annoying parents, snotty brats
Medicine--boooorrrrrrriiiiiinnnnnngggg
Gas--surgery's b*tch
Rads--sitting in the dark all day
Psych--ugh
Surgery--residents obviously miserable

EM is by far the best rotation for many students. Students get to do more, see cool ****, and don't get pimped by bow-tie wearing weirdos. Hell, I was thinking the other day about why I didn't go into gas--I think it basically came down to not wanting to be at the hospital before 6am every day. WTF? (well and the fact that I liked EM and didn't particularly like the general feel of the OR. but if I could go back I'd probably do Anes-->CC fellowship)

The negative aspects (irregular hours, ridiculous admin expectations, CMG gaslighting, etc) are almost completely hidden from students. And it'll take quite some time for news about reduced reimbursement and the crap market to trickle down. And where are all the current and future underemployed EPs supposed to go in the meantime? Plus, despite all the talk about the general career-span being short for EM, I sure see a lot of dinosaurs still practicing.

 

[thegenius]

EM is done for. The specialty has been ruined by corporations. I predict in 8 years, the salaries for ER docs will fall to that of pediatrics.

I think the bigger threat is the slow squeeze of profit margin from insurer contracts. That is....I don't think ER volume will change. In fact it will likely go up. But the percentage of patients with well paying insurers as a percentage will go down:

- Health Care costs continue to rise
- As a result, more costs will be pushed onto people
- As a result, it become less afforadable for people each year that goes by
- Jobs will be subsidizing healht care less and less as the years pass
- People will have less health care coverage
- As a result when they come to the ER....as a percentage there will be less people who have Aetna, BCBS, TenetHealth, etc, and more people who are on medicaid, medical, or self-pay.
- Thus...our pay goes down.
- Moreover....as health care becomes free for these people, they come to the ER more often...further diluting your pay. All free stuff in society gets abused. If you handed out free gut punches from Mike Tyson...he would be hitting people all the time.

 

[sloh]

The problem is that the negatives of our specialty are far more hidden than those of many others specialties. The negatives of many other fields are pretty obvious to medical students:

Peds--annoying parents, snotty brats
Medicine--boooorrrrrrriiiiiinnnnnngggg
Gas--surgery's b*tch
Rads--sitting in the dark all day
Psych--ugh
Surgery--residents obviously miserable

EM is by far the best rotation for many students. Students get to do more, see cool ****, and don't get pimped by bow-tie wearing weirdos. Hell, I was thinking the other day about why I didn't go into gas--I think it basically came down to not wanting to be at the hospital before 6am every day. WTF? (well and the fact that I liked EM and didn't particularly like the general feel of the OR. but if I could go back I'd probably do Anes-->CC fellowship)

The negative aspects (irregular hours, ridiculous admin expectations, CMG gaslighting, etc) are almost completely hidden from students. And it'll take quite some time for news about reduced reimbursement and the crap market to trickle down. And where are all the current and future underemployed EPs supposed to go in the meantime? Plus, despite all the talk about the general career-span being short for EM, I sure see a lot of dinosaurs still practicing.

Getting into the hospital before 6 am every day isn’t an insignificant concern though!

 

[acetylcholinesterasee]

which specialties??

While job security isn't the only thing you should think about when picking a specialty, it should be some part of your decision making. In the long run, a med student's best protection probably comes from either:
a) pursuing a surgical specialty with a grueling residency (ie neurosurgery) that drives away most students from going into it and keeps supply low or
b) going into something that you could do purely as an outpatient with the option to hang your own shingle.

While a specialty that fits either of these two attributes still isn't immune from forces like market saturation and private equity involvement, being in one of these specialties will generally allow for much more control over your own destiny. The job market and opportunities for other specialties (ie EM/radiology/anesthesia/hospitalist/CC etc) will be much more dependent on external forces you can never hope to control.

 

[Dr Mantis Toboggan]

which specialties??

based on my hospital’s call schedule and my buddies who are looking to hire docs for their groups, GI and pulm/critical care.

 

[cyanide12345678]

Bringing this thread back to life since I'm job hunting.

If there was any doubt about the terrible future for emergency medicine, then all those doubts should be gone. Emergency medicine is officially going down the sh**hole.

I sent out my resume to 6-7 different recruiters from large CMGs just to get a feeler for what's out there in Texas. Mind you, wasn't even looking in Austin, Houston, Dallas area. I was looking at the less desirable spots.

No spots in Lubbock or Amarillo, el paso has a couple hca hell hole spots with 24k vol single coverage without APC support. This particular site had 30 hours physician coverage and 36 hrs MLP coverage when volume was around 36k. Post covid they are down to 24 hours physician coverage only.

Even port Arthur in Texas didn't have spots.

IES in Houston seems to have 2-3 spots in Houston, but recruiter didn't pick up phone or respond to email.

Some jobs available 1.5 to 2 hours out of San Antonio and Dallas based on websites. Mostly usuck and envision website - the recruiters also didn't bother picking up phone or responding to emails.

Welcome to emergency medicine. Good luck everyone when 2000 people enter the job market soon.

Guess plan B is Indiana or kansas or maybe even sticking in Ohio - my 450k/yr job all of a sudden started appearing really attractive 😛 . Any other state recommendations if the only consideration is cost of living, low taxes, malpractice environment and compensation?

 

[CliveStaples]

I'd consider Tennessee from a COL and tax perspective; no idea about their malpractice environment, however.

I would also like to point out that a lot of the issue right now in finding a job is timing. I'd say that volume in ERs is still down 15-20% in many parts of the country, so staffing is taking a hit and places aren't hiring as a result. The question is what it will take to get back to life before COVID-19.

 

[Rekt]

I'd consider Tennessee from a COL and tax perspective; no idea about their malpractice environment, however.

I would also like to point out that a lot of the issue right now in finding a job is timing. I'd say that volume in ERs is still down 15-20% in many parts of the country, so staffing is taking a hit and places aren't hiring as a result. The question is what it will take to get back to life before COVID-19.

Step 1 is to stop blaming Covid. The residency expansion is the issue. Covid obviously will cause a small disruption, but people are just essentially giving ammunition to the RRC and EM organizations saying this is going to recover.

 

[cyanide12345678]

I'd consider Tennessee from a COL and tax perspective; no idea about their malpractice environment, however.

I would also like to point out that a lot of the issue right now in finding a job is timing. I'd say that volume in ERs is still down 15-20% in many parts of the country, so staffing is taking a hit and places aren't hiring as a result. The question is what it will take to get back to life before COVID-19.

It's in the list, worse malpractice reform laws than Ohio though.

 

[Porfirio]

If you have 450k/yr job and it is decently staffed, I would stay there.

 

[cyanide12345678]

If you have 450k/yr job and it is decently staffed, I would stay there.

18-19k volume, 24 hours doc and 8 hrs mlp with epic and dragon. So pretty decent staffing and gig compared to what I'm seeing.

Was 21k with 11 hrs mlp coverage prior to covid.

Don't care about the money as much anymore with my wife's second attending income salary starting 2021 and being completely debt free.

So I'm okay with a relaxing stress free life at a 10k vol place and 180-210 per hour single coverage.

 

[emergentmd]

If you go to a Powerhouse residency, then you have no worries. Everyone else take note of the above advice.🙂

I can remember the good old days 5 years ago when I would tell my wife exactly this,

"CMG won't leave me alone. I get text msgs daily to cover shifts for 2x rate = $550/hr"
"CMG just published their schedule and there are 30/90 open shifts. They are ONLY giving a 1K bonus. Ill just wait until they get desparate"
"Poor CMG scheduler. She just told me she can't go home until I cover the shift. Do you mind if I work it so she can go home? They are paying 2x rate"
"CMG just told me to name my price. I am going to ask for 5x rate=$1700/hr and see if they are willing"
"CMG just offered me the director position and I have been barely doing PRNs for them"

ohhhh... The good old days when I thought I was a rock star. A unicorn.

Those days sadly are Over. So Glad I landed softly and looking towards retirement in the next 5 yrs. Always thought I would die during my retirement years doing PRN shifts to keep my mind sharp. Things have changed so much in the 20 yrs since I started. Not only in pay, opportunities, but also control of your environment and feeling that I am needed.

Dont take this being down on EM. I still think it is one of the best fields to go into. I can cross 9/10 right off my list just b/c its 5+ yrs of residency. But when you lived through the golden EM years, you get alittle Jaded. Most EM attendings, rightfully so, should be happy with their income:work ratio that comes with EM. 350K is nothing to sneeze about.

 

[DeadCactus]

I'm all for self-interest and self-preservation but acting like EM is a doomed specialty because a 3 year residency no longer guarantees you a $350/hr job in any city you want to live in is ridiculous. It's crazy that anyone thought the market would sustain that kind of discrepancy compared to other specialties. Yes, things are worse today than they were 5 years ago. Yes, our professional organizations should be acting in our interest. That doesn't mean that EM is suddenly a bad deal.

 

[Fox800]

I'm all for self-interest and self-preservation but acting like EM is a doomed specialty because a 3 year residency no longer guarantees you a $350/hr job in any city you want to live in is ridiculous. It's crazy that anyone thought the market would sustain that kind of discrepancy compared to other specialties. Yes, things are worse today than they were 5 years ago. Yes, our professional organizations should be acting in our interest. That doesn't mean that EM is suddenly a bad deal.

How recently have you been job hunting?

3-4 years ago you could locum for $350/hr at a ton of places. Now it's $200 at a shop with inadequate staffing ("vOLuMeS aRe DoWn FrOm CoViD" despite rising volumes for months) in a crappy med-mal state. Residents are having contracts rescinded. People are being laid off.

One of my coworkers was just laid off (no shifts available after October). Another coworker had their travel reimbursement rescinded (it costs about $1500-2000 each time to get us out to work for a stretch of shifts), so they quit.

It's a very different deal at the moment.

 

[Rekt]

I'm all for self-interest and self-preservation but acting like EM is a doomed specialty because a 3 year residency no longer guarantees you a $350/hr job in any city you want to live in is ridiculous. It's crazy that anyone thought the market would sustain that kind of discrepancy compared to other specialties. Yes, things are worse today than they were 5 years ago. Yes, our professional organizations should be acting in our interest. That doesn't mean that EM is suddenly a bad deal.

Yeah you're quite clueless. Don't lose your job.

 

[DeadCactus]

How recently have you been job hunting?

3-4 years ago you could locum for $350/hr at a ton of places. Now it's $200 at a shop with inadequate staffing ("vOLuMeS aRe DoWn FrOm CoViD" despite rising volumes for months) in a crappy med-mal state. Residents are having contracts rescinded. People are being laid off.

It's a very different deal at the moment.

Do you think the current job market is unique to emergency medicine or even medicine?

 

[Fox800]

Do you think the current job market is unique to emergency medicine or even medicine?

Not similar to most of medicine. We don't have a clinic. We don't "own" our patients like clinic-based specialities or surgeons.

We're service-based and at the mercy of the hospitals/staffing groups. Similar to hospitalists, anesthesiologists, radiologists. We have to take what's out there, we can't just build our own practice.

And yes, the job climate is markedly different than just a few years ago.

 

[DeadCactus]

I don’t think the clinic doctors are out their high-fiving over how great the market is this year. I don’t think the FM folks are graduating and thinking what a great time to start a private practice. I think this forum puts starting a clinic up on a pedestal: it provides more control but it’s not going to magically adjust the market to create jobs and higher pay that corporations haven’t already gobbled up. I’m not sad that I can’t start a small business in the middle of the pandemic. I am glad I can pack up my belongings and immediately set up shop somewhere with a better market and then move on a whim to more desirable location when the situation improves especially compared to specialists who have to build up a practice.

The whole economy is bad this year and unusual in that medicine has actually been significantly affected. I wouldn’t want to be a new grad in any specialty. This year’s job market is not a symptom of an inherent flaw in emergency medicine. Outside of this year, I never said the market isn’t getting worse. The point is that the previous market was unsustainable and the current correction doesn’t make EM a bad career. I’m not against fighting for higher salaries as much as possible but the idea that EM is a doomed specialty because pay is adjusting to be more inline with other 3-4 year specialties is overly dramatic.

 

[emergentmd]

Owning your own patients or opening a truly independent practice is difficult with a lot of financial risks. All of the regulations, EMRs, staffing, delayed/poor reimbursement, large loan has made opening a new practice more the vast majority of fields impossible.

I can't think of any field where it would be easy to take out a loan, open up a single doc practice, and thrive. That is why most opening up a practice is joining an established vs group. The days of single doc practice is numbered. Maybe something like plastics.

Covid has hit docs hard. The small doc groups during Covid and even currently was hemorrhaging $$. I know some that took out loans just to pay staff out of the goodness of their heart b/c noone was seeing their doctor for 2-3 months. Not many single doc practice can close shop for 2-3 months and have literally zero income on top of all the insurance carrier barriers to payment.

Its super tough to open your own practice and even trying is a big financial risks. Like everything in life, most of the stories you hear are success stories. You don't hear of the failures like everything else in our current facebook life.

 

[JacobMcCandles]

Step 1 is to stop blaming Covid. The residency expansion is the issue. Covid obviously will cause a small disruption, but people are just essentially giving ammunition to the RRC and EM organizations saying this is going to recover.

Things can be multifactorial. I will say, I don't think residency expansion is why our volumes are 80-90% from pre-COVID days. Residency expansion will continue to make things more difficult but blaming this current environment all on residency expansion is ignoring many other driving factors.

 

[Frazier]

Heard recently from another coresident who moved out east after residency. Shifts got cut to 13/month working 8's. Could only get $180/hr in his city of choice. Also requires responding and running all codes on floor at one of the less-staffed satellite shops. 200-225k for EM? Tough.

 

[Lexdiamondz]

I don’t think the clinic doctors are out their high-fiving over how great the market is this year. I don’t think the FM folks are graduating and thinking what a great time to start a private practice. I think this forum puts starting a clinic up on a pedestal: it provides more control but it’s not going to magically adjust the market to create jobs and higher pay that corporations haven’t already gobbled up. I’m not sad that I can’t start a small business in the middle of the pandemic. I am glad I can pack up my belongings and immediately set up shop somewhere with a better market and then move on a whim to more desirable location when the situation improves especially compared to specialists who have to build up a practice.

The whole economy is bad this year and unusual in that medicine has actually been significantly affected. I wouldn’t want to be a new grad in any specialty. This year’s job market is not a symptom of an inherent flaw in emergency medicine. Outside of this year, I never said the market isn’t getting worse. The point is that the previous market was unsustainable and the current correction doesn’t make EM a bad career. I’m not against fighting for higher salaries as much as possible but the idea that EM is a doomed specialty because pay is adjusting to be more inline with other 3-4 year specialties is overly dramatic.

It's not the pay, it's the utter lack of jobs.

It's one thing if salaries are going down, but people aren't hiring at all. That is far more concerning than a drop in compensation.

 

[GeneralVeers]

It's not the pay, it's the utter lack of jobs.

It's one thing if salaries are going down, but people aren't hiring at all. That is far more concerning than a drop in compensation.

The problem came from anticipated increase in volumes. We had pretty steady increase in volume locally for the last 10 years. My current group hired up by about 20% over the last 2 years. We had a ton of new physicians/midlevels come online, or already in the pipeline and then COVID hit and the market collapsed. We are still overstaffed by about 10-15% and are looking for people to resign. We won't be hiring any new physicians for at least 2-3 years at the current rate, and this is a 70-physician group that staffs 8 sites.

 

[cyanide12345678]

Do you think the current job market is unique to emergency medicine or even medicine?

My family medicine PGY3 wife who is also job hunting with me is having a pretty different experience right now. Recruiters contacting her like crazy with jobs, even in desirable cities with fairly decent salaries for family medicine.

 

[JacobMcCandles]

Let’s look at a sister specialty, anesthesiology. Hit hard by COVID, surgical volumes down to 30-50% at its peak, dependent on the hospital, overrun by midlevels, CMGs, etc. etc. yet they’re not experiencing the same issues with jobs right now. The difference? An increase in only 8% residents compared to 33%+ in EM over the past 5 years. (The past 20 years is even worst, something like 3x more growth in EM)

I can't speak to the anesthesiology job market but I do know that surgical volumes, or at least the ones I am familiar with, are now way up as they are working to get caught up on previous elective surgeries that were put off. I don't see the previous elective ED visits that were put off in the spring coming in now. Again, don't get me wrong, residency expansion is a major issue but you've got blinders on and are missing the big picture if that's the only thing you want to focus on.

 

[DeadCactus]

My family medicine PGY3 wife who is also job hunting with me is having a pretty different experience right now. Recruiters contacting her like crazy with jobs, even in desirable cities with fairly decent salaries for family medicine.

Honest questions: Do you think it would be difficult to find a job in those same cities for the same salary as her? Do you think these are jobs in great practice set-ups?

 

[cyanide12345678]

Honest questions: Do you think it would be difficult to find a job in those same cities for the same salary as her? Do you think these are jobs in great practice set-ups?

Just starting the process, don't know yet about the practice set up quality.

And yes, i think it's going to be fairly difficult. Three recruiters have basically flat out said they have no full time openings at all for their region, they will connect me with other recruiters from other parts of Texas. I work for Team health. Their recruiter literally said that the only place available in her region is where the doctors are facing significant volume pressure because HCA is refusing to increase staffing. It was in response to my telling her that they had unsafe staffing, and she agreed.

I looked at jobs 2 years ago as a pgy 3 then. I had 5 offers in a 50 Mile radius then. Every group and hospital was hiring. Moonlighting was available every where as pgy3. Played one offer against the other. Two years later, I'm looking in the entire state of Texas, it's hard to find viable options in one of the largest states of the US. The entire conversation with recruiters is just different.... Instead of trying to sell you on something, they are just painting a dismal picture of not many options being available.

 

[Brigade4Radiant]

People keep saying only in your owning your own patients. The reality is that insurance owns your patient. Starting a practice means nothing because insurance can easily destroy you which is why practices are under hospitals now.

This is the reason cosmetic, psych and derm are the king.

 

[cyanide12345678]

It's not the pay, it's the utter lack of jobs.

It's one thing if salaries are going down, but people aren't hiring at all. That is far more concerning than a drop in compensation.

This is what I'm seeing now that I'm actively looking to move back to Texas. Maybe it's just Texas? But that's one damn big state.....

 

[JacobMcCandles]

This is what I'm seeing now that I'm actively looking to move back to Texas. Maybe it's just Texas? But that's one damn big state.....

Any available information on the state of freestanding EDs in Texas? I know they proliferated like crazy and I'm guessing more than a handful have met their demise this year. That, too, can affect jobs in an area.

 

[EctopicFetus]

This is what I'm seeing now that I'm actively looking to move back to Texas. Maybe it's just Texas? But that's one damn big state.....

Most big cities are full. Atlanta, Dallas, Houston , dc, nashville, Austin, phoenix etc. very few options. Em docs are mildly screwed the bad actors and non em trained Are about To be shown the door.

 

[cyanide12345678]

Any available information on the state of freestanding EDs in Texas? I know they proliferated like crazy and I'm guessing more than a handful have met their demise this year. That, too, can affect jobs in an area.

That market went bust a few years ago. One of the largest, adeptus health, parent company of first choice ER recently got sued even after they were buried to the ground. I got $18 from that for being a shareholder back in the day 😛

Very few remain.

 

[Torsion]

I think the current job market is more an acute symptom of COVID rather than a trend. There is a general hiring freeze due to the uncertainty of staffing needs going in to the winter. PGY3s are caught in a difficult situation given that the fall is usually the prime time to land a new job. Prior to COVID my hospital system was expanding and its associated SDG hired more graduates from the residency than they had in years and they were all able to keep their jobs through the pandemic. I'm hoping we'll get a clearer picture of the future come early spring.

 

[TheSingularity]

I think the current job market is more an acute symptom of COVID rather than a trend. There is a general hiring freeze due to the uncertainty of staffing needs going in to the winter. PGY3s are caught in a difficult situation given that the fall is usually the prime time to land a new job. Prior to COVID my hospital system was expanding and its associated SDG hired more graduates from the residency than they had in years and they were all able to keep their jobs through the pandemic. I'm hoping we'll get a clearer picture of the future come early spring.

Idealistic thinking.

Before COVID, we had the balance billing fiasco.

In the background is massive residency expansion.

Winter is coming, my friend.

 

[beebermd]

I have been working at the same site for various CMGs for the last 7 years. im the longest tenured doc here. I have seen many docs quit or let go. I also recently left a physician owed FSED due to a malignant work environment. after my departure I called around looking for other options. like other posters, I noticed a distinct difference in the conversations that i had with recruiters now, as opposed to 7 years ago when I first signed on. It was almost indifference. no sign on bonus, no rate negotiation, no relocation stipend. It was a take it or leave it proposition. drastic change from my pervious experience.

my biggest gripe has been after doing this for 7 years, is seeing how disposable we are. ive seen good docs let go because they piss off the neurosurgeon, or some admin. My cardiologist could probably throat punch my CEOs mother in the hospital parking lot, and still get a wing named after him. but heaven forbid if we want him to actually lay eyes on a pt that he wants us to send home. The job security, or lack thereof, really opened my eyes to the worst aspect of this specialty. CMGs and physician oversupply just makes us even more disposable.

I just opened aesthetic, hormone and regenerative (stem cell, prp, etc) practice. its my side gig. all cash based. its fun and im pretty damn good it. best thing is i am truly my own boss. I have no debt, so every time I work a shift at the ED, It is becoming more and more tempting to take a pay cut and do this full time and never worry about nights, weekends, and holidays again. but im also scared that if I scaled back my ED ****s to a couple of shifts a month, they may just let me go completely, because so many people are looking for full time.

Moral of the story....i believe in having options. EM in its current state makes it difficult to have options, but if you can find some, you'll be ahead if/when the bottom falls out

 

[GeneralVeers]

I just opened aesthetic, hormone and regenerative (stem cell, prp, etc) practice. its my side gig. all cash based. its fun and im pretty damn good it. best thing is i am truly my own boss. I have no debt, so every time I work a shift at the ED, It is becoming more and more tempting to take a pay cut and do this full time and never worry about nights, weekends, and holidays again. but im also scared that if I scaled back my ED ****s to a couple of shifts a month, they may just let me go completely, because so many people are looking for full time.

You've hit on a major problem. Doing a side business and going part-time in EM used to be a great option. In my area part-time isn't even an option anymore. Even before the pandemic, we had stopped giving shifts to all of the part-timers due to being overstaffed. Because we are W2, a part-time employee costs more per hour for the CMG than a full-time employee. At the moment EM is full-time or nothing in most major areas.

 

[alpinism]

You want to know how bad the job market is right now?

I'm in NYC and even a couple years ago people could literally get a job at almost every hospital in the city. Right now none of our senior residents can find any full time jobs in the city with the exception of a couple NYC Health Hospitals. These are the same places that are currently paying their physicians 120/hr for 1600/hr per year to work in horribly malignant and dysfunctional emergency departments.

 

[GeneralVeers]

You want to know how bad the job market is right now?

I'm in NYC and even a couple years ago people could literally get a job at almost every hospital in the city. Right now none of our senior residents can find any full time jobs in the city with the exception of a couple NYC Health Hospitals. These are the same places that are currently paying their physicians 120/hr for 1600/hr per year to work in horribly malignant and dysfunctional emergency departments.

It's interesting that people still want to work there, given the steep decline in quality of life. My understanding is that Midtown doesn't even exist anymore.