Graduating EM resident - ask away, anything

[pinipig523]

Hey guys,

I figured it would be good to get an idea of what it's like to go through residency and the field of Emergency Medicine. I recall my premed and med school years, it's tough to weed through the information especially when your sources are other premeds or med students.

This is stuff I wish I knew as a premed student - so ask away.

A little about myself:
- Born and raised in the Chicagoland area
- Went to a Chicago undergrad, med school, and residency program - I pretty much went to where I wanted to go
- I am a traditional student. Went straight, no breaks.
- Age: 29, male
- Job will be in another state - contract at hand

Anything is fair game - why, what, when, pros/cons, what I wish I knew, what I would've done otherwise, pay, etc...

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[flatearth22]

Guess I'll start:

1) Why EM?

2) What other specialties did you consider?

3) When did you "officially" decide on EM?

4) Would you have still done EM if you had gotten a 250+ on your Step 1 and honored all of your 3rd year rotations (assuming you didn't)?

5) How do you feel about the future of EM especially with regards to EC's losing tons of money and shutting down as well as the [possible] encroachment by mid-level providers.

6) What would you have changed about your medical school experience (academic, personal, otherwise)?


Thanks for doing this!

 

[RavishingB]

Most memorable case?

 

[theseeker4]

1) I see you are a PGY-4. Are you in a 4-year program, or did you do something else the first year? If in a 4-year program, would you rather have trained in a 3-year program, or do you feel the year of lost attending salary was worth the additional training? If you did something else before starting a 3-year program, what was it and why did you change?
2) How much of your residency was spent in away rotations outside the ED (such as in OB/GYN, surgery, etc.)? Is that typical for EM residencies as far as you know?
3) What is making you leave the Chicago area? If it won't reveal too much about your identity, what state are you going to practice in and why? Political climate, liability climate, etc.?
4) Most obvious question, would you choose to go into EM again, and would you recommend it to others? What do you think are important characteristics of a new doctor to be successful in EM?

 

[kpcrew]

about how much do you still have to pay in terms of loans?
how was medical school and what's the best piece of advice that you can give about it?
what's next in your future?

Thanks for the answers.

 

[pinipig523]

1. I like the variability. I guess I ended up liking everything in med school from OB to psych. I have a very short attention spam and I like starting workups but I don't have the patience to finish every single one of them.
2. I seriously considered anesthesia and surgery.
3. I officially decided around August of my M4 year. That said, I was president of EMIG for 2 years prior, I did research in EM my M3 year so I was already heavily invested in EM. Anesthesia was my curve ball.
4. I wish I could say I honored everything and got a 250+ steps. I did well but not that well. If I had gotten that score, I'd be lying to myself if I didn't say that I'd probably do plastics.
5. I don't know about pay going down... To be honest with you, the pay I've been offered is really good and it really depends on payer mix of that particular ER. Midlevels will ne'er run the ER, they are there to help with flow and because we cosign PA charts, we bill for t as well. They help us.
6. If there was anything I would've done, I would've been more studious and probably treated every clinical rotation like my residency dependent on it.

Guess I'll start:

1) Why EM?

2) What other specialties did you consider?

3) When did you "officially" decide on EM?

4) Would you have still done EM if you had gotten a 250+ on your Step 1 and honored all of your 3rd year rotations (assuming you didn't)?

5) How do you feel about the future of EM especially with regards to EC's losing tons of money and shutting down as well as the [possible] encroachment by mid-level providers.

6) What would you have changed about your medical school experience (academic, personal, otherwise)?


Thanks for doing this!

 

[pinipig523]

about how much do you still have to pay in terms of loans?
how was medical school and what's the best piece of advice that you can give about it?
what's next in your future?

1. Loans = 190K includes undergrad and med.
2. Medical school was fine. Lots of studying and missing out on stuff. But other than that, I found that if you find a really good buddy or a new best friend, med school becomes easy.
3. Next up? I gotta sign my job contract. We start looking for jobs around August of your senior resident year and sign before the new year, typically.

 

[pinipig523]

Most memorable case?

It was not a single case but a constellation of cases on my first call night as the MICU senior.

1. Massive hemoptysis, filled the ET tube with blood. Could not ventilate, died.
2. Hypertensive encephalopathy, resistant to iv meds.
3. AIDS pt who developed bilateral pneumothoraces while on the vent.
4. AIDS pt who developed ARDS and needed a tube, fluid overload and renal failure.

This happened my first call, first day as a 3rd year resident in the MICU. Nearly crapped in my pants that night. There was no ICU fellow or ICU attending in the hospital... Just me, a 3rd medicine resident, and a medicine intern. Total insanity.

 

[tiedyeddog]

How do you guys handle prescription drugseekers?

 

[ShireCheshire]

I realize this is still a little bit further down the road for you, but what are the typical schedules like for EM docs?

 

[RogueUnicorn]

i know you said your salary offer was very good, but can you be more specific in terms of ballpark figure and practice setting?

 

[mipp0]

It was not a single case but a constellation of cases on my first call night as the MICU senior.

1. Massive hemoptysis, filled the ET tube with blood. Could not ventilate, died.
2. Hypertensive encephalopathy, resistant to iv meds.
3. AIDS pt who developed bilateral pneumothoraces while on the vent.
4. AIDS pt who developed ARDS and needed a tube, fluid overload and renal failure.

This happened my first call, first day as a 3rd year resident in the MICU. Nearly crapped in my pants that night. There was no ICU fellow or ICU attending in the hospital... Just me, a 3rd medicine resident, and a medicine intern. Total insanity.

Wow...

 

[lkthlttr]

3. I officially decided around August of my M4 year. That said, I was president of EMIG for 2 years prior, I did research in EM my M3 year so I was already heavily invested in EM. Anesthesia was my curve ball.

What type of research activities do people typically do for EM?

 

[pinipig523]

i know you said your salary offer was very good, but can you be more specific in terms of ballpark figure and practice setting?

For a 40 hour workweek, what do you think it is? I want to see if your expectations are in line with the reality, first.

 

[pinipig523]

What type of research activities do people typically do for EM?

It's going to be less bench work and more practical applications of things or protocols in the ER. My research revolved around EKG times in the ER and how to break the 10 minute barrier. Published.

 

[pinipig523]

I realize this is still a little bit further down the road for you, but what are the typical schedules like for EM docs?

Actually it is only 7 months away... Not too long.

The schedule on my contract asks for approx 40 hours a week. However you can break it down depends on the length of shifts. If you do 10h shifts, that's 16 in a month. If you do 12h shifts then you're looking at 12-13 a month.

Not bad.

 

[pinipig523]

How do you guys handle prescription drugseekers?

Tough question. You will learn your own way to approach this.

For me, I think 5 pills can pacify even the most angry patient who really wants some pain meds. But you have to be very careful not to potentiate further abuse. Something like "I will give you a few pills now, but you really need to followup with your primary or a pain clinic. We cannot prescribe more next time."

 

[Heavens Cloud]

Do you plan on using medical scribes? Not sure if where you work will offer them, but if it did, would you? Assume... $16 a hour.

If you're not familiar, scribes write up the HPI/ROS/Physical Exam/Medical Decision Making, give it to you for editing & signing. Makes your documentation much easier.

 

[JESSFALLING]

Do you think obtaining EMT cert/experience, prior to medical school, would be worth the investment if you have a potential interest in EM?

 

[pinipig523]

Do you plan on using medical scribes? Not sure if where you work will offer them, but if it did, would you? Assume... $16 a hour.

If you're not familiar, scribes write up the HPI/ROS/Physical Exam/Medical Decision Making, give it to you for editing & signing. Makes your documentation much easier.

I'm familiar but it depends on the group and practice. I don't dictate how the ER runs. I interview and accept an offer if I like it.

Would I like scribes? A resounding HELL yes.

 

[pinipig523]

Do you think obtaining EMT cert/experience, prior to medical school, would be worth the investment if you have a potential interest in EM?

Very minimally. If you could only hear what goes on in the post interview (for residency) meetings with the program director and other attendings, you'd be surprised what really matters in a candidate.

 

[flatearth22]

Very minimally. If you could only hear what goes on in the post interview (for residency) meetings with the program director and other attendings, you'd be surprised what really matters in a candidate.

That's a teaser if I ever heard one. Please expand.

 

[EBTrailRunner]

What's a typical day for you? For someone looking to get into EM, how many hours per week should they expect to work as a resident? Thanks!

 

[mike1]

To what extent is your approach to medicine as an EM doc, as well as your personal life, affected by ruminating about messing up and being sued?

 

[fzwarrior]

for a 40 hour workweek, what do you think it is? I want to see if your expectations are in line with the reality, first.

200k (+/- 20k)

 

[CeeEstee0]

How much time have you spent in a helicopter? what was your most memorable experience in the air?

 

[pinipig523]

200k (+/- 20k)

Nice guess. Way off. Double that. That's what is written on my contract.

Even inner city, 200 is very low.

 

[RogueUnicorn]

For a 40 hour workweek, what do you think it is? I want to see if your expectations are in line with the reality, first.

200k (+/- 20k)

Nice guess. Way off. Double that. That's what is written on my contract.

Even inner city, 200 is very low.

WOW. My guess would have been ~150k

 

[chidoman]

what is the level of patient gratitude in the ED compared with other specialties? In general.

 

[pinipig523]

How much time have you spent in a helicopter? what was your most memorable experience in the air?

Never rode in one. I wanted to rank Milwaukee MCOW high on my residency rank list but I ranked Cook number 1. MCOW had a good flight program.

 

[deleted307836]

What specifically made you pick EM over anesthesia?

 

[pinipig523]

what is the level of patient gratitude in the ED compared with other specialties? In general.

From my experience:

Surgery > ER > medicine

 

[pinipig523]

What specifically made you pick EM over anesthesia?

Anesthesia had this whole midlevel provider issue and they do not diagnose or treat patients.

 

[TXKnight]

1-In your experience (provided you ever worked alongside an older non-trad), do you consider "their" performance just as good as younger doctors? and I mean it in the physical sense. Working 17 shift a month -or whatever it is in residency- many of them 12 hrs night shift, my guess is that it takes a toll on older (say 35-40) than younger docs, and eventually could hamper performance at some level?. I'm older myself, so my question.
2-you seem to have gotten a good contract i wonder whether that's common? Are you going to the southwest for your practice? I hear they pay better.
3- most important factor to match well into EM: step scores/class rank/letters of rec OR all of them?

I wish you the best of lucks! I hope I never have to meet you as my doctor in an ER, otherwise, it's awesome you decided to answer all these questions!

 

[pinipig523]

What's a typical day for you? For someone looking to get into EM, how many hours per week should they expect to work as a resident? Thanks!

Surprisingly... Better than most residencies, but this is dependent on program. Some programs do 12h shifts x 20 in 1 month (that's ROUGH!).

My program was sweet. 4 years but 8h shifts x 5 shifts a week.

I work 40h weeks + lectures. Not bad for a resident.

But that's in the ER... I pull call when I'm on trauma, icu, floors.

 

[pinipig523]

WOW. My guess would have been ~150k

That's way too low bud.

I mean location has some influence on your pay. DC pays the worst but Wisconsin pays the best. However, the payer mix is most influential.

In a community hospital with a 80/20 (insured/uninsured) mix... It is not uncommon to make between 350K to 400K right out of residency at 40h a week.

 

[RogueUnicorn]

That's way too low bud.

I mean location has some influence on your pay. DC pays the worst but Wisconsin pays the best. However, the payer mix is most influential.

In a community hospital with a 80/20 (insured/uninsured) mix... It is not uncommon to make between 350K to 400K right out of residency at 40h a week.

thanks, the issue of salaries and such are so rarely discussed in the open, at least at my school, it's hard to get a good sense. could you also expand on what you were saying about your experience with candidate qualifications for residencies? thanks a lot for doing this btw

 

[curveball617]

What's the worst part about EM? I'd imagine the lifestyle is good, but do you think EM docs burn out relatively quickly?

 

[ozzi22]

What's the worst part about EM? I'd imagine the lifestyle is good, but do you think EM docs burn out relatively quickly?

I would like to know this too?

 

[raltima07]

What car do you drive?

Are you happy with your decision to go straight through?

 

[pinipig523]

1) I see you are a PGY-4. Are you in a 4-year program, or did you do something else the first year? If in a 4-year program, would you rather have trained in a 3-year program, or do you feel the year of lost attending salary was worth the additional training? If you did something else before starting a 3-year program, what was it and why did you change?
2) How much of your residency was spent in away rotations outside the ED (such as in OB/GYN, surgery, etc.)? Is that typical for EM residencies as far as you know?
3) What is making you leave the Chicago area? If it won't reveal too much about your identity, what state are you going to practice in and why? Political climate, liability climate, etc.?
4) Most obvious question, would you choose to go into EM again, and would you recommend it to others? What do you think are important characteristics of a new doctor to be successful in EM?

1. Yes, I am in a 4 year full categorical program. All 4 are ER. If I were to do it over again, I would still do a 4 year despite the prevalence of 3 year programs. When I went out job hunting, they love 4 year grads much more than 3 year grads. They would even tell me outright.

Plus, the extra year of training is great for someone who isn't into doing a fellowship year.

2. Approx 30% of residency is spent on away rotations. I think this is pretty typical for most residencies that I applied to 4 years ago.

3. I am leaving Chicago because of I hate the political climate, I don't like the litigation and malpractice that goes on in this state, I hate that the state tax has gone up 66%. I also have been here for way too long. This is my 12th year in the city itself... from undergrad through residency. It's time for a change.

If you asked me 4 years ago, where would I see myself? I would say, I'd like to have a nice condo in the city. Now? I'd rather be in the suburbs and these condos don't appeal to me like they once did.

Clubbing and bar hopping is no longer my scene. Interestingly enough, you do grow up someday. Even at 29.

4. Would I go into EM again? Yes. Over and over again. It's a solid field as long as you like this kind of stuff. It's very challenging as you can never master everything but you can hope to be comfortable with most things.

EM is a field for those who are ok not being DEFINITIVE care. You are not the last line of defense, you are usually the most crucial or first line of defense. If you understand your role in the medical chain, you'll be ok.

 

[jessiemsy]

Question - EM seems perfect to me now but I wonder how I'll feel about it when I'm 50. Do you work with any older docs? How do they feel about their jobs at that point in their lives? Also, what about people with families (especially women, I think you're a guy, but anyone ones you work with)?

 

[pinipig523]

What car do you drive?

Are you happy with your decision to go straight through?

1. I drive a 2008 Infiniti G37S coupe, black on black. Manual, 6 speed.

2. Yes, I am very happy I went straight through. I would've pushed myself through undergrad and completed it in 3 years since I had the AP credit to do so, if I could do it all over again. I am the youngest in my graduating residency class.

 

[pinipig523]

Question - EM seems perfect to me now but I wonder how I'll feel about it when I'm 50. Do you work with any older docs? How do they feel about their jobs at that point in their lives? Also, what about people with families (especially women, I think you're a guy, but anyone ones you work with)?

1. EM is perfect for me but I also wonder how I'll be when I'm... say... 60. I think 50 is ok, you don't burn out then. You just have to live with the idea that unlike those who take on a less rigorous job, you peak out earlier.

Here's how I'd do it. Take a good paying job in the community. Make approx 375K, put in 64K into the 401K, invest VERY conservatively to avoid pitfalls. At age 59, I'd have approx$ $6,000,000 at avg return of 4%/yr.

In the meantime, I'd live in an apartment the first year as an attending, and save $120,000 for a rainy day fund. Buy a house a year later and mortgage it at 15years (take a doctors loan w/ down payment of 5%). Pay it off by age 45.

Take all my student loans and pay it in 10 years.

By age 45, I should have a 6 figure bank account, no more student loans, no more house payments and have nearly 2mil in the 401K account. Not only that, but I should have no credit card debt and I should still be driving nearly any car I want for the past 15 years ($60K and under).

After 45, I can do whatever I want. I can drop my hours from 40h/wk to approx 24-32/wk. I can still afford anything I want, I'd be financially bulletproof.

That's how you beat the age factor.

2. As for families, I just got married last year. And yes, my wife likes my job. It affords me time to spend at home and make a good living. Just don't work too much.

 

[pinipig523]

What's the worst part about EM? I'd imagine the lifestyle is good, but do you think EM docs burn out relatively quickly?

1. Worst part is not the burn out. I think that the worst part is that you become jaded and you see the scum of the earth walk through your doors. You begin to wonder if humanity is truly good or somewhat selfish/greedy/abusive/evil.

That's the worst part about EM. It took me halfway through my intern year to realize that my perception of people in general had changed for the worse.

 

[pinipig523]

I would like to know this too?

The burn out phenomenon is possible, I don't know because I haven't gone that far out yet. But there are ways to beat it.

You cannot work as much as you did when you were younger as you can if you were older - that's plain and simple.

The burn out happens if you think you can sustain a lavish lifestyle all the way until near retirement age... unless you become a partner in an ER group, no way.

You have to live within your means (and the means are good, my friends)... but don't cross that line.

Once you buy a ferrari... you're screwed. You're a slave to your material possessions and you will have to work for it and you will notice a burn out factor.

My 2 cents.

 

[jdok]

Can you expand on the preferences of your PD when choosing a resident? You mentioned them preferring a 4yr to a 3yr resident. Anything else like this?

 

[pinipig523]

thanks, the issue of salaries and such are so rarely discussed in the open, at least at my school, it's hard to get a good sense. could you also expand on what you were saying about your experience with candidate qualifications for residencies? thanks a lot for doing this btw

1. Yes, salaries are always hush-hushed... as if a doctor talking about the money he earns is intrinsically evil. Hey... this is how I look at it. Yes, we're here to help people. Yes, we like the challenge that medicine presents to us. But come on! You slave yourself for over a decade, accumulate an absurd amount of debt + interest!

And you can't talk about salary?? Please.

2. Candidates need to be well rounded. Yes, an EMT history may help but it may also hurt (straight from an attending in the ranking council) depending on how you used it or not used it at all.

The gist is that you need to be able to hold a conversation during the interview and have some sort of personality. You also need to display that you have a good work ethic. Those 2 are enough to get your foot in the door and into a rank list.

When you interview, if you BS your way through it and are caught, you strike out. If you seems off, you strike out.

If you seem normal and can be fun to be around when working in the ER (for the next 3-4 years), you've jumped the first hoop and you will be ranked.

 

[pinipig523]

Can you expand on the preferences of your PD when choosing a resident? You mentioned them preferring a 4yr to a 3yr resident. Anything else like this?

You mean a medical director of a practice you are trying to join when you get out of residency?

Yes, it seems to me that they prefer 4 year graduates over 3 year ones. And this also goes the same for academic institutions. The extra year of training is worth it, to me.

Other things that would help you out:
1. If you were chief resident during your final year as a resident.
2. If you did a fellowship.
3. If you came from a strong program. Directors have preferences and contacts go a loooong way.

DO NOT PISS ANYONE OFF! Do not piss your residency program director, do not piss of your chairman (may God help you if you do). Don't even think about pissing off anyone in medical or premedical school. You NEVER know who you'll need to go to bat for you when looking for a job.

That guy who sits next to you in Orgo? Yeah, the weird kid who never showers? Yes, he may become an attending at a place you want to work at and he may be the one who can seal the deal for you (or against you). Yes, this happens.

 

[pinipig523]

1-In your experience (provided you ever worked alongside an older non-trad), do you consider "their" performance just as good as younger doctors? and I mean it in the physical sense. Working 17 shift a month -or whatever it is in residency- many of them 12 hrs night shift, my guess is that it takes a toll on older (say 35-40) than younger docs, and eventually could hamper performance at some level?. I'm older myself, so my question.
2-you seem to have gotten a good contract i wonder whether that's common? Are you going to the southwest for your practice? I hear they pay better.
3- most important factor to match well into EM: step scores/class rank/letters of rec OR all of them?

I wish you the best of lucks! I hope I never have to meet you as my doctor in an ER, otherwise, it's awesome you decided to answer all these questions!

1. Older guys work just as fast as the younger guys because I have not seen anyone older than 37 in my program. So that's still young.

One caveat though... if you are older, you have less work years left and you'll peak earlier.