Graduating EM resident - ask away, anything

[jdok]

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Were you at the hospital when the shooting occured last night? Did you hear the gun shots? How did everyone react?

CHICAGO (AP) — Police have arrested a suspect in the fatal shooting of a woman at a Chicago hospital.
University of Illinois at Chicago spokesman Mark Rosati says UIC police pulled the 47-year-old man over for a routine traffic stop at 6:30 a.m. Friday. Rosati says the man, who has worked at the hospital for 15 years, fled the car and was arrested a few blocks away.The shooting happened late Thursday on the second floor of the hospital's parking lot. The Cook County Medical Examiner's Office says the woman who was shot later died.

http://news.yahoo.com/suspect-arrested-chicago-hospital-gun-death-131402274.html







And lastly....are you the shooter?

 

[NickNaylor]

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.

Go on...

 

[pinipig523]

How often do employers offer loan repayment plans for first year EM graduates? Any idea on the average amount.

This is not typical of most groups. I have seen a few, but these are usually in areas where you would not really think about practicing unless you had a connection (family, etc) with that area. Think of remote areas where they are hurting for ER docs.

 

[pinipig523]

Go on...

These are things I cannot say out on a public forum, I would rather go via PM. And even then, these require some holding back on some info on my part.

 

[pinipig523]

Were you at the hospital when the shooting occured last night? Did you hear the gun shots? How did everyone react?

http://news.yahoo.com/suspect-arrested-chicago-hospital-gun-death-131402274.html

And lastly....are you the shooter?

1. That's the hospital across the street.
2. I was not the shooter. 🙂

 

[Slowpoke]

These are things I cannot say out on a public forum, I would rather go via PM. And even then, these require some holding back on some info on my part.

 

[pinipig523]

You have to take stuff like that with a grain of salt as well. Every dollar spent there is very little wealth accumulating for retirement. I know a ton of docs who do similar things. They end up divorced or in debt up to their eyeballs because of those spending habits. The 100-200k saved by being frugal doesn't mean you should go out and buy a new ferrari. If you want or have kids, then a significant chunk or change goes to that as well.

Be careful. A lot of the cars you see in that pic are collectors. Take the Porsche Carrera GT - it does not depreciate and it only appreciates since it is no longer made. It lists at 400,000 now. The Ferrari F50 is also a collectors piece, that also appreciates and you can make 100% of your price paid in several years... there is not EVEN ONE for sale if you search the market. The Ferrari 599GTO is also a collectors piece and will not depreciate over time.

While you see cars, he and I see collector pieces.

He knows what he is doing and is not your typical "lets take an equity off the house and buy a car".

 

[pinipig523]

Would you say EM is a lifestyle specialty?
Is there a 'ranking' system for patients in the order they're seen?

1. I don't know if I'd classify EM as a lifestyle specialty. You work hard when you're in and you get placed into weird shifts. As you age, you still work odd shifts whereas the consultants stay home on a saturday night.

2. The triage system will assign a level to a patient. From 1 (low) to 5 (hyper acute). YOu see them based on acuity but be careful not letting the room back up as well.

 

[pinipig523]

Also, how old were you when you started med school, and residency?

I was 22 when I started med school.

I was 26 when I started residency.

I'll turn 30 a month before I become an attending.

 

[pinipig523]

Would an MPH help you in your job search or residency placement at all?

1. I think an MPH would help. It is something that is not easy to get on your resume (compared to an EMT course).

 

[pinipig523]

You went straight through undergrad, med school, residency, now to a practicing ER doc.

Do you ever question your decision to go into medicine? Did you ever consider other professions outside of medicine or did you go into medicine because you didn't really know what else to do? If you were not in medicine what field would you be in?

Very nice thread btw.

-Crime

1. Yes, I went straight through. Never regretted that route.

2. Yes, I did question my decision to go into medicine a few times. It sucks at times and there were a few times where I wondered why I did not go into dentistry and become OMFS. However, there are people doing worse than me (and people doing better). The grass is always greener at the other side.... or so it seems.

3. I thought about going into law or business/mba and becoming a junior exec.

4. If I was not in medicine, I'd probably be a dentist/OMFS... in a second.

 

[raltima07]

1. I think an MPH would help. It is something that is not easy to get on your resume (compared to an EMT course).

In a sense of being accepted to residency or a practice or actual use?

 

[45408]

Be careful. A lot of the cars you see in that pic are collectors. Take the Porsche Carrera GT - it does not depreciate and it only appreciates since it is no longer made. It lists at 400,000 now. The Ferrari F50 is also a collectors piece, that also appreciates and you can make 100% of your price paid in several years... there is not EVEN ONE for sale if you search the market. The Ferrari 599GTO is also a collectors piece and will not depreciate over time.

While you see cars, he and I see collector pieces.

I also see monstrous repair bills, insurance, storage and cleaning bills, and completely non-liquid assets. Also, you only get on the list for some of these vehicles (like an F50 or an Enzo) after buying a number of other Ferraris that aren't worth as much and won't appreciate, or you end up paying a vastly inflated price for the car, which makes it unlikely you'll ever see a return.

Unless you're restoring old, valuable cars with your own hands, I find it unlikely that you would really get any kind of reasonable return on these.

 

[pinipig523]

I also see monstrous repair bills, insurance, storage and cleaning bills, and completely non-liquid assets. Also, you only get on the list for some of these vehicles (like an F50 or an Enzo) after buying a number of other Ferraris that aren't worth as much and won't appreciate, or you end up paying a vastly inflated price for the car, which makes it unlikely you'll ever see a return.

Unless you're restoring old, valuable cars with your own hands, I find it unlikely that you would really get any kind of reasonable return on these.

Not true on many parts. There is great demand for some of these things, something maybe you or I are not privy to. Storage is simple if you have a garage, repair is ok if you don't use them everyday. You don't have to buy from the manufacturer if you want to avoid massive depreciation, you buy it from another person.

I think there's a good degree of fun in collecting these gadgets - it is not so much a depreciating asset as it is more a "stable" investment. You may probably break even in the end.

I would not suggest doing this if you are after money or ROI, but I would suggest something like this as a hobby if you have everything else in your financial life squared away.

Not something I would suggest taking an equity loan for.

It's the same thing with luxury timepieces or expensive audio equipment. Where one would see a complete waste of money, I see something where you can put some hobby money into and not necessarily take a bath if you intend on getting out.

 

[pinipig523]

In a sense of being accepted to residency or a practice or actual use?

Probably the acceptance sense.

 

[qbfyre]

Probably the acceptance sense.

Can you explain how an MPH (e.g global health) could help during/after residency?

 

[CaliGirl14]

How much does your friend with the garage make annually? Does he do stuff besides ER?

 

[45408]

Not true on many parts. There is great demand for some of these things, something maybe you or I are not privy to. Storage is simple if you have a garage, repair is ok if you don't use them everyday. You don't have to buy from the manufacturer if you want to avoid massive depreciation, you buy it from another person.

And if you buy a collector's item from another person, you're definitely going to be paying the mark-up I was just describing.

I think there's a good degree of fun in collecting these gadgets - it is not so much a depreciating asset as it is more a "stable" investment. You may probably break even in the end.

I would not suggest doing this if you are after money or ROI, but I would suggest something like this as a hobby if you have everything else in your financial life squared away.

Not something I would suggest taking an equity loan for.

It's the same thing with luxury timepieces or expensive audio equipment. Where one would see a complete waste of money, I see something where you can put some hobby money into and not necessarily take a bath if you intend on getting out.

Yeah, which was exactly my point when I said these aren't investments you'll get a return on. "Not taking a bath" is pretty different than having an appreciating investment.

 

[pinipig523]

Can you explain how an MPH (e.g global health) could help during/after residency?

It helps with certain fellowships from what I've been told. As to how much and the specifics, I'm not sure.

 

[pinipig523]

How much does your friend with the garage make annually? Does he do stuff besides ER?

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.

 

[pinipig523]

And if you buy a collector's item from another person, you're definitely going to be paying the mark-up I was just describing.


Yeah, which was exactly my point when I said these aren't investments you'll get a return on. "Not taking a bath" is pretty different than having an appreciating investment.

It depends. I can tell you that a Rolex Submariner was 4K in 2007 and now 8K. That's appreciation. If you know what you're doing, you can at least break even.

 

[sector9]

Great thread!!

I have considered EM but I don't really think I want to be at a community hospital ED. Is it competitive to work at a trauma center right after residency? What steps do you need to take to get a position like that?

 

[Wile]

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.

What do you mean ER was a starting point?

 

[pinipig523]

What do you mean ER was a starting point?

He used ER as a means to raising capital quickly for other opportunities.

 

[pinipig523]

Great thread!!

I have considered EM but I don't really think I want to be at a community hospital ED. Is it competitive to work at a trauma center right after residency? What steps do you need to take to get a position like that?

There are level I trauma centers in community hospitals - which means you'll staff it. If you're talking about academic level I trauma centers, it is difficult to enter the academic sector since you need to elevate your application above the other resident graduates.

 

[gettheleadout]

What do you mean ER was a starting point?

He used ER as a means to raising capital quickly for other opportunities.

The idea being that there probably aren't any ER docs that make $800k salary. 😛

pinipig, what specifics do you know about the EM salary comparison in the big academic centers you're referring to?

 

[Prohok]

I know you've touched on the topic of 3 years program being possibly undesired at some jobs. What is your opinion on a coveted facility like Vanderbilt Medical Center 3 years EM program?

I've spoke with some EM attending at my local hospital and they've always advise me that if I ever choose to go into EM, the best hospitals are those with only lvl 1 trauma serving for a major section of the state because you'll get to see a lot of varieties.

 

[Got Em]

I've heard of EMs making $250-300k for 40 hours in metro areas, but never heard of anybody doing $350-400k for 40 hours. Please tell me that 250-300 is the norm....if not EM residency spots will get increasingly more competitive in the next 10 years. I am very interested in EM because of the fast paced style and shift-based work, much like the schedule and environment of a retail pharmacist.

 

[pinipig523]

I've heard of EMs making $250-300k for 40 hours in metro areas, but never heard of anybody doing $350-400k for 40 hours. Please tell me that 250-300 is the norm....if not EM residency spots will get increasingly more competitive in the next 10 years. I am very interested in EM because of the fast paced style and shift-based work, much like the schedule and environment of a retail pharmacist.

My wife is a retail pharmacist, so I know your situation very well.

I'll get back to you guys with regards to salary and I'll display some examples of which areas have what. I'm in the middle of a CME course right now.

 

[HealthHare]

Will your job have you working nights? How do you and most EP's dealing with the circadian shifts? Does it have a major effect on family life?

Thanks!!!

 

[sector9]

There are level I trauma centers in community hospitals - which means you'll staff it. If you're talking about academic level I trauma centers, it is difficult to enter the academic sector since you need to elevate your application above the other resident graduates.

I see. The terminology I'm familiar with is that a "community hospital" just means a smaller hospital without any trauma center rating.

So working at a non-academic hospital with a level 1 trauma center is non-competitive? You'd just join the group that staffs the particular hospital and it would be no different than applying for any other type of open EM position?

 

[moosetracks]

Howdy,

Congratulations on almost finishing, must feel good. I'm a long way away

As I have shadowed at County this past summer, I may have seen you around!!

Just a question.

Looking back, was Chicago the best place to be?

 

[BurntFlower]

Thank you so much for making this thread! I'm also a pre-med who is highly interested in EM and you've answered a lot of questions that I've had, but had trouble finding the answers for. 😀

I do have questions of my own: Are you, or any other EM resident, interested in global health? If so, could you tell me more about the opportunities out there? And once you become an EM attending, how much time do you think one will have for leisure travel?

 

[pinipig523]

Thank you so much for making this thread! I'm also a pre-med who is highly interested in EM and you've answered a lot of questions that I've had, but had trouble finding the answers for. 😀

I do have questions of my own: Are you, or any other EM resident, interested in global health? If so, could you tell me more about the opportunities out there? And once you become an EM attending, how much time do you think one will have for leisure travel?

1. We've had some residents who went on to do fellowships in International Medicine and some who volunteer a great amount of time to clinics at 3rd world countries.

2. When I become an attending, my plan is to have ample vacation time to go and travel.

 

[pinipig523]

Howdy,

Congratulations on almost finishing, must feel good. I'm a long way away

As I have shadowed at County this past summer, I may have seen you around!!

Just a question.

Looking back, was Chicago the best place to be?

For me, yes... Chicago was the best place for me (us) to be. It has more to do than the academics of it, it had a lot to do with family.

 

[pinipig523]

I see. The terminology I'm familiar with is that a "community hospital" just means a smaller hospital without any trauma center rating.

So working at a non-academic hospital with a level 1 trauma center is non-competitive? You'd just join the group that staffs the particular hospital and it would be no different than applying for any other type of open EM position?

Working in a level 1 community hospital is the same as nearly any other community (non-academic) hospital. Some people like that, some people don't.

The competitiveness of a job depends more on the group and pay rather than the trauma level classification. This is a common mistake of less experienced students. Level 1 doesn't necessarily mean it's a coveted establishment.

 

[pinipig523]

Will your job have you working nights? How do you and most EP's dealing with the circadian shifts? Does it have a major effect on family life?

Thanks!!!

Yes, I will have to do nights. It does affect family life, but it depends on how you adapt to it. Working nights will take some time off the day prior and the day after for rest and recovery - no matter how you cut it.

You will need to figure out a deal with it on a regular basis.

Circadian is probably the best way to do it... start with days then pm then nights.

 

[pinipig523]

I know you've touched on the topic of 3 years program being possibly undesired at some jobs. What is your opinion on a coveted facility like Vanderbilt Medical Center 3 years EM program?

I've spoke with some EM attending at my local hospital and they've always advise me that if I ever choose to go into EM, the best hospitals are those with only lvl 1 trauma serving for a major section of the state because you'll get to see a lot of varieties.

I have a med school classmate who went there... Vandy is a good program for EM. You will still get a great job.

4 years is looked at as a positive to directors/groups hiring you, but that's not the only classification they look at. A solid place like Vandy is a fantastic line to place on your resume and the good training you get there will prepare you for attendingship.

 

[pinipig523]

The idea being that there probably aren't any ER docs that make $800k salary. 😛

pinipig, what specifics do you know about the EM salary comparison in the big academic centers you're referring to?

I've heard of EMs making $250-300k for 40 hours in metro areas, but never heard of anybody doing $350-400k for 40 hours. Please tell me that 250-300 is the norm....if not EM residency spots will get increasingly more competitive in the next 10 years. I am very interested in EM because of the fast paced style and shift-based work, much like the schedule and environment of a retail pharmacist.

The average made is dependent on payer mix. If you have a 100% insured rate, you're gold. If you have a 20% insured rate, omg... you're doomed. And the insured rate is inversely correlated with proximity to large cities/urban areas.

So with that said, if you want to live in the city of Chicago and work within the city limits - you will be looking at a 50/50 (insured/medicaid) reimbursement rate. You will probably only make 250-275K working 40h a week.

If you are looking to live in an average suburb and work there, you are probably looking at a 60/40 payer mix and you should be looking at approx 300K working 40h a week.

If you find yourself in a more affluent area (suburb), you are probably looking at a 80/20 mix and you are probably looking at 350-400K working 40h a week.

Now... if you find yourself in a very affluent area with a payer mix of 90/10 or more, then you're probably looking at 500K/year working 40h a week.

Keep in mind, jobs are tough to crack into when it comes to high paying ER jobs - just because there is low attrition and low turnover (basically, everyone likes working there and stays there).

Academics is a whole different beast. Most pay approx 200-220K only.

There are more aspects to this:
1. Patient volume of the ER department
2. Speed of the ER doc (in a productivity model, you can have speedy ER docs making a lot more... like 50K more than the average ER attending in the same facility).
3. Type of group (democratic vs large corporation)
4. State (TX vs IL) and the tort/malpractice reform of that particular state and how it affects overall costs of covering for liabilities. The less the cost of malpractice, the more money goes to the EP and the groups.
5. Location - sometimes a more competitive location can bring reimbursements down.

 

[thesauce]

Any big end-of-residency celebration planned?

 

[jdok]

Are there any specialties you thought might have been cool before entering med school, only to find out no way in hell you'd do them? If so, esplane!

 

[pinipig523]

Any big end-of-residency celebration planned?

I think that going home after my last residency shift will probably be anticlimactic. All that work in undergrad, mcats, getting into med school, going through med school, step 1-3, matching into a residency, going through residency.... and it'll be just another drive home that day.

I think that once I get home that day, I can just sit down and silently appreciate that I completed a good chapter of my life.

I think being able to smile at the end of that day is enough for me. Sometimes I don't need fireworks to appreciate the gravity of the situation.

👍

 

[pinipig523]

Are there any specialties you thought might have been cool before entering med school, only to find out no way in hell you'd do them? If so, esplane!

Cardiothoracic surgery was cool.

However, there are no jobs for those now because of the role of interventional cardiology (or so I was told by the surgeons).

 

[jdok]

How are the physical attributes of the nurses at your current hospital on scale of 1 to 10?

I don't know if you said this or not but what did you find were the most important factors in your application when you applied for residency that got you accepted?

How was your level of work hours stacked from PGY-1 to PGY-4?

Thanks for answering these and my previous questions 🙂

 

[pinipig523]

How are the physical attributes of the nurses at your current hospital on scale of 1 to 10?

I don't know if you said this or not but what did you find were the most important factors in your application when you applied for residency that got you accepted?

How was your level of work hours stacked from PGY-1 to PGY-4?

Thanks for answering these and my previous questions 🙂

1. Considering I work at Cook County Hospital, ancillary staff are very hit/miss (mostly miss). There are some good (great) nurses, but the majority are OK or subpar. I would rate it a 4/10.

2. Your personality and work ethic are probably up there (next to your numbers).

3. PGY1-4 at my program are the same hours worked. We work 40h/wk in the ER as residents. More at floor/icu/trauma rotations. More hours at outside ER rotations as well.

 

[Heavens Cloud]

How are the physical attributes of the nurses at your current hospital on scale of 1 to 10?

Lol, this reminds me of when I was scribing for an ER attending and he leaned over and said "Is it just me or are all of the nurses here really hot?"

I was like 😱

But it was so true... 😍

To OP: Do you have any information on how much more an ER doc makes for opting to work the overnight shifts only? I'm curious as to what the financial incentive is/will be for you guys. I would assume the night differential would be at least somewhat substantial.

 

[pinipig523]

Lol, this reminds me of when I was scribing for an ER attending and he leaned over and said "Is it just me or are all of the nurses here really hot?"

I was like 😱

But it was so true... 😍

To OP: Do you have any information on how much more an ER doc makes for opting to work the overnight shifts only? I'm curious as to what the financial incentive is/will be for you guys. I would assume the night differential would be at least somewhat substantial.

From the quotes I've seen, usually 20$/h more. That adds up to a lot if that's all you work. At 40h per week, ur looking at atleast $40K more per year.

 

[pinipig523]

How are the physical attributes of the nurses at your current hospital on scale of 1 to 10?

I answered your question earlier but I missed that you were asking about "physical" attributes.

I am revising my answer. I would say 2/10.

 

[One Hip Guy]

How often do you have high-stress cases like car-crashes where patients are critical, etc? Sorry if that sounds like a stupid question, television has probably ruined my perception of the ER. Also, can you describe how much of the diagnosis process you go through as an EM? Can you diagnose complex cases or is it mostly just general diagnosing and admitting difficult cases?

 

[Bojack Horseman]

Have you done any moonlighting during your residency? Does your program have any restrictions on moonlighting? Sorry if this has already come up.