Help Me Rank My Job --- Poll

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I'm finishing residency this June and have 5 potential job options to choose from. Which one should I choose????

First, a little about me. I'm a resident in Chicago and I plan on continue living in downtown Chicago for at least 5-10 years. I like teaching residents, med students, but I also like being able to see most of my patients independently. Compensation is important as well as having benefits/retirement provided.

Choice A - Academic Teaching Employee
Academic Hospital, EM docs are employees, supervise residents/students in ER, lots of research requirements and non-clinical responsibilities, benefits/retirement included (total 160-210k annually)

Choice B - Community Democratic Group
Community Job, Private Democratic Group, no residents/students/PA's, All subspecialties available to consult. $125-$165/hr night differential + RVU bonus (total 300-400k annually)

Choice C - Academic/Community mix Democratic Group
Academic Hospital, EM docs belong to a Privately contracted democratic group, supervise residents/med students, $120/hr + RVU bonus, 40k/yr retirement, health/disability/life insurance included (total 250-350k annually)... but have to split time at Community Hospital 1.5 hrs away, No residents/students

Choice D - Community Independent Contractor
Small Inner city community Hospital, EM docs are Independent Contractors, no residents/med students, have PA's, no benefits/retirement, flat $140/hr (total 225-275k).

Choice E - Community Independent Contractor
Small Inner city community Hospital, EM docs are Independent Contractors, no residents/students, have PA's, wage is 100% RVU productivity, no benefits/retirement, $145-190/hr (total 300-350k)

 

[southerndoc]

You have a wide range of options, but the first should be the most important: community or academic?

That is something only you can decide. Once you make that decision, I believe you're 90% there. The remaining 10% is not as difficult, or at least it wasn't for me.

 

[GeneralVeers]

I chose option C as well for myself. Good luck with the job.

 

[docB]

You didn't say what benefits choice B offers. Still, I think that being happy in your practice setting is paramount so C gives you the mix of teaching and seeeing patients on your own. I know what you mean too. I teach residents (non-EM) and med students but sometimes when they're not there it's nice to just bust through patients and procedures on my own.

 

[GeneralVeers]

You didn't say what benefits choice B offers. Still, I think that being happy in your practice setting is paramount so C gives you the mix of teaching and seeeing patients on your own. I know what you mean too. I teach residents (non-EM) and med students but sometimes when they're not there it's nice to just bust through patients and procedures on my own.

DocB do you find that the residents help or hurt your RVUs?

 

[JackBauERfan]

DocB do you find that the residents help or hurt your RVUs?

i would think it depends on the resident somewhat but in general hurts the RVUS...based on my limited experience in community settings and now in residency..lets see what the expert says!

 

[Flopotomist]

A 3 hour round trip commute sounds brutal! How does that work exactly? eg. is there a "crash pad" or something?

 

[Dr. Dukes]

A 3 hour round trip commute sounds brutal! How does that work exactly? eg. is there a "crash pad" or something?

That would be a deal-breaker for me, no way I'm getting up 1.5 hours earlier than I have to so I can put miles on my car...

 

[docB]

DocB do you find that the residents help or hurt your RVUs?

It hurts productivity but not dramatically. I estimate (which means I had to glove up and use KY to pull this number from where I got it) 10-20%. I also like teaching so it makes my job better overall. We have some guys in the group who hate teaching and we a fortunate to have other hospitals where they can work so everyone's happy.

 

[WallowaWanderer]

I like teaching residents, med students, but I also like being able to see most of my patients independently.

Just curious how that would actually work, because you listed an academic job on your list. I know that as a student it really sucks working with someone who isn't passionate about teaching, and doesn't have time/desire to teach. Just something to think about. It seems like your primary motive for taking a teaching job should be your desire to teach.

 

[dchristismi]

I was torn between academic and community as well, and managed to find a job with a blend of exactly what I was looking for, and kept my options open for academics down the road. (B+C, if you will) I don't have your answer, but go with what makes you happy.

Isn't it great to have such a conundrum?

 

[GYN DOC]

are those average starting salaries?

 

[docB]

are those average starting salaries?

They're above average. In places like Chicago and other urban areas that are not huge draws based on their location like, for example, San Diego or Denver, the pay has to make up for the higher cost of living. One irony of EM is that places like San Diego pay less because they are so attractive docs will give up $$$ for location. The most money you can make in EM is (or was a few years ago last time I looked) in places that few people want to live like west Texas and Oklahoma.

Of note payor mix will always determine what you can be paid. A rich area of town will likely pay more than a poor area even though the poor area will likely have higher acuity.