Graduating EM resident - ask away, anything

[pinipig523]

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Are the residents at your hospital as miserable/cynical as many of the residents on this forum?

Was everyone chief resident at your residency or was it only saved for a special someone?

Did you see any URMz residents/attendings during your residency? And if so, what specialties were said URMz in?

What were some of the most exciting things you experienced as a resident?

When was the first time you dropped the ball and almost killed/maimed a patient? What happened?

And lastly, do you even lift?

1. Some are even more miserable and more cynical.
2. No, there are only 3 chiefs out of 15 of us seniors. I did not run for chief although I had several attendings ask me why I didn't run and that I should.
3. My PD is URM and he is awesome. ER is the specialty.
4. Most exciting is probably whenever I get to run a code, throw in a tube, toss in a central line, place a chest tube - basically any procedure. The most exciting time was probably when I was the ER senior on my trauma rotation - we had gunshot after gunshot come in. I think I was up for 30 hours that day.
5. Dropped the ball? As an intern, I gave a patient coumadin and then he died of a cardiac tamponade. It was not my fault since the patient's coumadin was indicated. But it was a sad sad side effect. I'll never forget it.
6. Lift weights? Yes I do. 3x/wk.

 

[JESSFALLING]

Do you feel adequately trained for psychiatric emergencies and how often to you request a consult for them?

Also....care to share what inspired your screen name?

Great thread, thanks!

 

[Sinfest]

Thanks for doing this 👍

 

[Bojack Horseman]

how do you manage to stay focused when you're tired, strung out, ridiculously hungry, etc. and you still have a lots of work to do?

 

[Dharma]

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

Statistically speaking. Take home: stay healthy and be in better shape than the youngsters. I'm close to 10 years older than most of the students in my SMP, but I can run circles around most of them and I doubt many could keep up with me on the 35+ miles I run weekly.

Thanks for the answering all these questions doc. Very cool of you.

 

[kautionwirez]

Take caution... that's just my perception of things.

We will always need cardiothoracic surgeons but not at the rate there were before. The market is probably already thinned out by now, if you want to pursue it... don't do EM, do CT surg and be happy man. They make more anyway.

Thanks!

CT has been my dream since I started thinking about becoming a physician.

 

[pinipig523]

Thanks!

CT has been my dream since I started thinking about becoming a physician.

Then by all means... we will still need CT surgeons. And if you like it and it's been a dream - chances are you'll be really good at it. Best of luck!!!

 

[pinipig523]

Statistically speaking. Take home: stay healthy and be in better shape than the youngsters. I'm close to 10 years older than most of the students in my SMP, but I can run circles around most of them and I doubt many could keep up with me on the 35+ miles I run weekly.

Thanks for the answering all these questions doc. Very cool of you.

Hey man... you can probably run circles around me (actually, you CAN). I barely run 6 mi a week. There's always an exception to the rule - and you are one. Props.

 

[pinipig523]

how do you manage to stay focused when you're tired, strung out, ridiculously hungry, etc. and you still have a lots of work to do?

That's still a tough thing to tackle. Usually, I burn out around 9 to 11 hours into a shift.

I've found a few things that help.
1. Coffee to get me through the first 2-3 hours of a shift.
2. A good meal before the shift (breakfast, lunch, or dinner) gets me through the majority of the shift. Probably the first 6-7 hours or so.
3. If I know I'm working beyond 8 hours, I would need some sort of a snack. Without a snack boost, I slow down significantly.
4. I work out 3-4x a week. I try to keep fit and I think it helps me be more efficient at work.
5. The last tip is probably mental health. You just have to do whatever it takes to get yourself mentally prepared and mentally ready for the challenge of a longer shift. Whether it be thinking about what you're going to do on your day off, etc... something is better than nothing.

 

[pinipig523]

Do you feel adequately trained for psychiatric emergencies and how often to you request a consult for them?

Also....care to share what inspired your screen name?

Great thread, thanks!

1. Yes. I do feel that I would like to really hone down on the psychiatric emergencies that lead to toxicological emergencies/nightmares/overdoses.
2. My screen name was inspired by an ice cream bar that I liked when I was a child. 😀

 

[kautionwirez]

Then by all means... we will still need CT surgeons. And if you like it and it's been a dream - chances are you'll be really good at it. Best of luck!!!

Do you think this will be an issue for me?

When I was 7-9, I broke my elbow and had surgery. I never did any rehab (I blame the doctor) and lost a good amount of rotation of my forearm. One arm I can hold a pencil horizontally and the broken one with a 45 degree. This has affected my ability to carry a football properly (became a linebacker instead of RB) , play guitar, and violin (with chords). I'm not saying it has limited my abilities to succeed in these activities but it has definitely limited my maximal potential

Would this effect my surgical skills in the future? I have done micro surgeries on mice and have done very well with those. I also seen a couple open heart surgeries which I thought was very doable.

 

[pinipig523]

Do you think this will be an issue for me?

When I was 7-9, I broke my elbow and had surgery. I never did any rehab (I blame the doctor) and lost a good amount of rotation of my forearm. One arm I can hold a pencil horizontally and the broken one with a 45 degree. This has affected my ability to carry a football properly (became a linebacker instead of RB) , play guitar, and violin (with chords). I'm not saying it has limited my abilities to succeed in these activities but it has definitely limited my maximal potential

Would this effect my surgical skills in the future? I have done micro surgeries on mice and have done very well with those. I also seen a couple open heart surgeries which I thought was very doable.

Hmm... I'm sure you can get around it but I think you know the answer to your question.

You know that you aren't at your max potential but that you can work around it and compensate for it. I would still keep a strong dedication to CT surg since that's your ultimate goal. I would not let anything short of an amputation detract you from reaching it.

 

[typicalindian]

so heres a couple questions, in your time working in the ER, what has been:
1.) the worst case you ever had to deal with?
2.) your favorite case thus far
3.) most challenging case up to date? (this may or may not be the same as #2 idk)

also,
-have you ever just completely froze and not know what to do? what do you do when this happens?
-do you like that your contact with a patient is basically until they are stable? do you ever wish you could follow up with certain people?
-have you ever done/seen something that made you "lose sleep"?
-what do you do with people who are drug seekers? feed the trolls or let them wait while you attend to more important things?
-have you ever had to attend to an emergency outside of the ER?
-have any of your patients in the ER ever approached you outside of a medical setting and asked you for medical advice etc? If yes, how do you respond to them?
(if anything strikes you as uncomfortable don't answer but i'd love to hear it if you can answer)

Thanks!

Couldnt help but notice you skipped these 🙁 I'm hoping that you may have just not seen them

 

[pinipig523]

Couldnt help but notice you skipped these 🙁 I'm hoping that you may have just not seen them

I'll get to that shortly... I missed it! Sorry!

Btw... just for full disclosure regarding salaries. Here is another prime example of a low salary ER job. I don't know much about WV and the location. I'm not sure how desirable or not desirable the location is but here's an email I just received today about a job in WV. The pay at approx 40h/wk is probably at 235K/y. Not the best.

A community hospital close to Pittsburgh, PA is seeking an Emergency Medicine physician. The location is Morgantown, WV--a highly-rated small city that is home to West Virginia University. This is a full-time, hospital-employed position. Compensation is highly competitive at a rate of $115/hour, with complete benefits

I don't know what they mean by complete benefits. If it means 401K included, that's pretty good. I don't know if it's just the area or what, but NOT ALL jobs are going to get you the 300K+ that I was talking about. I know my friends who went to DC got measly offers.

 

[Slack3r]

I'll get to that shortly... I missed it! Sorry!

Btw... just for full disclosure regarding salaries. Here is another prime example of a low salary ER job. I don't know much about WV and the location. I'm not sure how desirable or not desirable the location is but here's an email I just received today about a job in WV. The pay at approx 40h/wk is probably at 235K/y. Not the best.

A community hospital close to Pittsburgh, PA is seeking an Emergency Medicine physician. The location is Morgantown, WV--a highly-rated small city that is home to West Virginia University. This is a full-time, hospital-employed position. Compensation is highly competitive at a rate of $115/hour, with complete benefits

I don't know what they mean by complete benefits. If it means 401K included, that's pretty good. I don't know if it's just the area or what, but NOT ALL jobs are going to get you the 300K+ that I was talking about. I know my friends who went to DC got measly offers.

You may or may not know...

But any idea on the types of offers/opportunities available in the NY area? I've always heard that large, coastal cities (PARTICULARLY LA and NYC) paid on the lower end due to the vast number of people wanting to live/work in those areas. Thoughts?

 

[NickNaylor]

I'll get to that shortly... I missed it! Sorry!

Btw... just for full disclosure regarding salaries. Here is another prime example of a low salary ER job. I don't know much about WV and the location. I'm not sure how desirable or not desirable the location is but here's an email I just received today about a job in WV. The pay at approx 40h/wk is probably at 235K/y. Not the best.

A community hospital close to Pittsburgh, PA is seeking an Emergency Medicine physician. The location is Morgantown, WV--a highly-rated small city that is home to West Virginia University. This is a full-time, hospital-employed position. Compensation is highly competitive at a rate of $115/hour, with complete benefits

I don't know what they mean by complete benefits. If it means 401K included, that's pretty good. I don't know if it's just the area or what, but NOT ALL jobs are going to get you the 300K+ that I was talking about. I know my friends who went to DC got measly offers.

If $235k is the low end for 40 hrs/wk., that seems like a pretty awesome position to be in.

 

[DO1987]

I think he makes a lot. ER was a starting point, but it shows that it can be done. He did not come from money.

By the looks of it, I think he makes around 800K/year.

I know him as well (the garage guy) and his wife is a physician if I recall correctly.

 

[NickNaylor]

Also, a question (which may have been answered already - I haven't been following the thread closely): do you find that EM offers the opportunity to really use your diagnostic skills? Pretty basic question, I know, but for some reason I have this idea in my head that EM really doesn't use much diagnostic action other than determining who to refer to. I'm sure I'm completely wrong here, though.

 

[raltima07]

I know him as well (the garage guy) and his wife is a physician if I recall correctly.

What kind of physician is wife?

 

[DO1987]

What kind of physician is wife?

Rads

 

[YoungGregory]

If $235k is the low end for 40 hrs/wk., that seems like a pretty awesome position to be in.

Plus I feel like the cost of living in WV is so low you could live like a king with a 235k/year salary.


Great thread btw

 

[pinipig523]

What kind of physician is wife?

Rads

I know him as well (the garage guy) and his wife is a physician if I recall correctly.

Until this year, his wife was a radiology resident only. So her income should be a near non-factor in his success.

 

[pinipig523]

What kind of physician is wife?

Rads

Also, a question (which may have been answered already - I haven't been following the thread closely): do you find that EM offers the opportunity to really use your diagnostic skills? Pretty basic question, I know, but for some reason I have this idea in my head that EM really doesn't use much diagnostic action other than determining who to refer to. I'm sure I'm completely wrong here, though.

In EM, I feel like you do the majority of the diagnosis made in the hospital. Whether you're 100% spot on is a different story.

Sometimes you cannot find the diagnosis (i.e. abdominal pain), but you can rule out emergencies in that case.

 

[pinipig523]

You may or may not know...

But any idea on the types of offers/opportunities available in the NY area? I've always heard that large, coastal cities (PARTICULARLY LA and NYC) paid on the lower end due to the vast number of people wanting to live/work in those areas. Thoughts?

I would have to ask my co-seniors who are applying to those areas, they will tell me sheer numbers no problem.

We have some people in San Francisco as well, Kaiser, etc.

I figured Chicago would be a good barometer, I think NY pays similarly with some variation. And I think LA might pay a little higher especially in the suburb area.

Either way, I came into this field thinking I was looking to make 250K - that was my expectation. Anything beyond that is gravy.

 

[typicalindian]

Thanks a lot for doing this thread, I've had my eye on EM for quite some time now and I had no idea the pay was so well, which totally only adds to my interest 🙂 here's hoping you get to answering my questions soon 🙂)

 

[Prohok]

Cliche question, but when you have to give family members the bad news, what goes through your mind? What are your feelings about this?

I've been a nurse for four years working in long term care, I had to give bad news over the phone many times and unfortunately it still bothers me. I empathize with the family and do the best I can to assist them at the time being. But I wonder how it's gonna be when I'm a physician.

 

[deleted307836]

What do you think about the new EM----->Critical Care pathway? Know any residents doing this?

Do you enjoy ICU work?

 

[FrkyBgStok]

I am in Des Moines, ia and I am not going to ask if yu have any offers here, but did you interview at any hosipitals that seem to cater to a small city? And if so, how did they compare to the larger ones with regards to pay, benefits, and the job in general?

 

[Kate6058]

Btw... just for full disclosure regarding salaries...

Thanks for answering all these questions. I'm wondering, when you list these salary amounts, are they take home pay? If not, how much can an EM physician actually expect to make after taxes and fees and all that?

 

[raltima07]

Thanks for answering all these questions. I'm wondering, when you list these salary amounts, are they take home pay? If not, how much can an EM physician actually expect to make after taxes and fees and all that?

That's gross. C'mon man....

Get it, as in gross salary. I make myself laugh

 

[Caesar]

My very important question:

Can you hook me up with an away next year?

 

[jdok]

That's gross. C'mon man....

Get it, as in gross salary. I make myself laugh

what you did there, I see it.

 

[SeminoleVesicle]

Cliche question, but when you have to give family members the bad news, what goes through your mind? What are your feelings about this?

I've been a nurse for four years working in long term care, I had to give bad news over the phone many times and unfortunately it still bothers me. I empathize with the family and do the best I can to assist them at the time being. But I wonder how it's gonna be when I'm a physician.

Also wondering this. I watched this a few times while shadowing, very sad.

 

[druggeek]

Are the residents at your hospital as miserable/cynical as many of the residents on this forum?

Was everyone chief resident at your residency or was it only saved for a special someone?

Did you see any URMz residents/attendings during your residency? And if so, what specialties were said URMz in?

What were some of the most exciting things you experienced as a resident?

When was the first time you dropped the ball and almost killed/maimed a patient? What happened?

And lastly, do you even lift?

hi misc brah

 

[Got Em]

1) During your shifts, do you get breaks to eat? If so, does this count toward your hours? I've heard that places where there are more than 1 physician, you may actually get a 30 minute break that does not count toward your shift.

2) You've stated that you work night shifts as well. In your current job offer, are you allowed to work only days if you chose? I am very interested in EM, but not so much the overnight shifts. I have heard that overnight shifts pay at about a 20% shift diff and there were enough people that want to do this so you don't have to. Is this true?

 

[J0HNS0N]

Thanks for all this information. This is a real FAQ section.

 

[xfiretampa]

if you could go back in time to when you were a med student and say to yourself "Self look out for......, prepare for......do this instead of that....." , what advice would you give yourself, or things you didn't know that you wish you knew back then

Thanks for all the info! I hope to be as open as you whenever I am done with this long journey

 

[Flemon]

Thank you so much for this thread. I really appreciate it, as I'm sure everyone on here does as well.

 

[OzelloPiRat]

You need to go get a PO Box so we can all send you Starbucks gift cards for the free advice! I bet you wouldn't have to buy your own coffee for a long long time. Thank you for this!

 

[sibitrum]

I might be interested in pediatrics. What do you think about going into pediatric EM (through either pathway)?

 

[ADolefulDream]

I finnally decided to sign up because of this thread! Just had to say thank you for the insight!

 

[pinipig523]

I finnally decided to sign up because of this thread! Just had to say thank you for the insight!

You need to go get a PO Box so we can all send you Starbucks gift cards for the free advice! I bet you wouldn't have to buy your own coffee for a long long time. Thank you for this!

Thank you so much for this thread. I really appreciate it, as I'm sure everyone on here does as well.

Thanks for all this information. This is a real FAQ section.

Thanks a lot for doing this thread, I've had my eye on EM for quite some time now and I had no idea the pay was so well, which totally only adds to my interest 🙂 here's hoping you get to answering my questions soon 🙂)

Thank YOU fellas.

SDN has been good to me... if you guys need to know, one of the attendings I met on this thread helped me land a dream job. So you see... be nice to each other, you never know who will help you in the future (or who you may help).

 

[pinipig523]

I might be interested in pediatrics. What do you think about going into pediatric EM (through either pathway)?

If I recall correctly, it's 6 to 7 years total either way.

Two ways about it:
1. Do peds first (3 years) then peds ER fellowship (3 years).

OR

2. Do ER first (3 to 4 years) then peds ER fellowship (3 years).

I think you should know (for full disclosure)... that peds ER probably makes more than peds generalist. BUT, adult (regular ER) makes more than peds ER (in general). This is partially because pediatrics has lower reimbursement all across the board (peds cards, peds surg, etc).

I would suggest doing ER then peds ER. So you can do either one when you're done.

 

[pinipig523]

if you could go back in time to when you were a med student and say to yourself "Self look out for......, prepare for......do this instead of that....." , what advice would you give yourself, or things you didn't know that you wish you knew back then

Thanks for all the info! I hope to be as open as you whenever I am done with this long journey

I would say, "Self... keep reading, keep reading, keep reading, keep doing questions, keep furthering your knowledge."

It's that simple for me. I'd be smarter than I am now. I've been really reading a lot for the past year and I should've kept this pace up for much longer.

 

[pinipig523]

1) During your shifts, do you get breaks to eat? If so, does this count toward your hours? I've heard that places where there are more than 1 physician, you may actually get a 30 minute break that does not count toward your shift.

2) You've stated that you work night shifts as well. In your current job offer, are you allowed to work only days if you chose? I am very interested in EM, but not so much the overnight shifts. I have heard that overnight shifts pay at about a 20% shift diff and there were enough people that want to do this so you don't have to. Is this true?

1. If it's an 8 hour shift, I rarely ever get a break.
2. In my new job, there's a small 5% differential.

 

[pinipig523]

My very important question:

Can you hook me up with an away next year?

I would but I won't be there anymore.

But PM me at that time, I'll send you the email of the coordinator and give you some tips.

 

[pinipig523]

Thanks for answering all these questions. I'm wondering, when you list these salary amounts, are they take home pay? If not, how much can an EM physician actually expect to make after taxes and fees and all that?

Gross. Anyone who makes $300K net is MINTING money... that's tough to do.

http://www.paycheckcity.com/calculator/netpay/us/alabama/calculator.html

Use that to calculate a pretty good estimate using your state's taxes.

 

[pinipig523]

I am in Des Moines, ia and I am not going to ask if yu have any offers here, but did you interview at any hosipitals that seem to cater to a small city? And if so, how did they compare to the larger ones with regards to pay, benefits, and the job in general?

I went to Iowa to interview for residency.

I did not interview at small areas because I want to be near a metropolitan city (even if I chose to live in the suburbs).

The pay is generally lower in low volume areas unless they're really hurting for coverage then you will get hospital subsidy to bump your pay up. Remember that it's all about reimbursement, payer mix.

 

[pinipig523]

What do you think about the new EM----->Critical Care pathway? Know any residents doing this?

Do you enjoy ICU work?

I really thought long and hard about going into a critical care fellowship. I would've loved to do it if I was not married since I feel that I still have time on my side since I went straight through med school and residency.

One of my good co-seniors is doing a critical care fellowship.

And yes, I did enjoy the ICU. I enjoyed getting my butt handed to me on a regular basis... it helped me grow as a resident.

 

[pinipig523]

Cliche question, but when you have to give family members the bad news, what goes through your mind? What are your feelings about this?

I've been a nurse for four years working in long term care, I had to give bad news over the phone many times and unfortunately it still bothers me. I empathize with the family and do the best I can to assist them at the time being. But I wonder how it's gonna be when I'm a physician.

Tough stuff... always and forever for me.

It's something I dread doing.