How much difference does where you do residency make when job hunting?

[EMdupe2017]

4 year residency and then wants Orange County or Hawai'i?

That was the point of the question, I'd prefer to do a 3-year, but wanted to make sure I wasn't going to handicapping myself for finding a job later as all the big name shops in southern california are all 4-year programs. And yes, I realize that southern california and Hawaii are not the best in terms of finances for doctors, however there is more to life than money. I'm somewhat tied to these areas for personal reasons.

I appreciate all the responses and discussion in this thread. I'm not sure my original question was ever specifically answered, but what I'm taking away from the responses thus far is that I'll be fine going to really any of the CA programs and shouldn't worry about going to one of the "big names" unless I really want to work in academics in a big competitive city.

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[GeneralVeers]

I agree. With the exception of having an US (it's the only way I do lines), I don't care about trauma, backup, and all the rest. The most important things to ask are:

1. Scheduling, especially how many nights. How many days off per month can you have protected.
2. Median (not average) pay. I don't care what your top RVU producer is earning.
3. Salary structure, and length of time to get bonuses or distributions.
4. Termination process. Is there a "no cause" clause in the contract?

 

[hundreddaysoff]

When I was first job hunting 5 years ago, I interviewed at 7 shops in my area. I asked about US machines.

3 said "we don't use those".

Kthxbye.

I'm PGY3 and moonlight in places without US. It's not that bad, because like WCI says you just transfer out any potential emergency that needs US to dx. The hardest part is actually going back to the mothership and working a regular shift with my ultrasound director, who AFAICT has never worked an actual community shift in his life.

"You should be taking the time to do your own US DVT studies! When you're out in the community you won't always have a good US tech available."

"Yessir! Good point!" *silent rage*

 

[Old_Mil]

Maybe that's why they're asking. I didn't realize there were still EDs out there without an ultrasound in the department. I've been out of residency for 11 1/2 years and I have yet to work in a department where I didn't have a bedside US machine available to me. That includes four continents, academic medical centers, community EDs, glorified urgent cares, trauma centers, and tent hospitals. US is part of our core credentials. It's just assumed that you can do it because you're an emergency doc at our hospital.

If you are running an ED without an US, stop it. You're embarrassing the specialty.

While I wish that all EDs would have ultrasound, many still don't. As far as the EMR, that's a legitimate question. My former shop took their 5 year old hardware and network and pasted a new EMR on it which absolutely destroyed productivity. Not that the other questions you ask aren't important - they are - but there are an astounding number of hospital CEOs running lousy EDs out there...and ED directors/medical directors are for the most part powerless to stop it. Asking the really basic questions keeps assumptions from biting you in the butt later.

 

[alpinism]

When I was first job hunting 5 years ago, I interviewed at 7 shops in my area. I asked about US machines.

3 said "we don't use those".

Kthxbye.

If someone ever told me that I'd immediately get up and walk out of the interview.

US has been around for over 20 years now and every ED should have at least one machine.

 

[deleted109597]

If someone ever told me that I'd immediately get up and walk out of the interview.

US has been around for over 20 years now and every ED should have at least one machine.

EM has been a specialty for almost 50. Every ED should have EM trained physicians.
Hopes and dreams don't make it happen. I'm sorry you feel that way. You can always go buy your own butterfly.

 

[RustedFox]

If someone ever told me that I'd immediately get up and walk out of the interview.

US has been around for over 20 years now and every ED should have at least one machine.

Yeah, my feeling when I heard that was: "Seriously? What decade of medicine did this department stop in?"

I don't want to work anywhere that doesn't have a bedside US.

EM has been a specialty for almost 50. Every ED should have EM trained physicians.
Hopes and dreams don't make it happen. I'm sorry you feel that way. You can always go buy your own butterfly.

I was confused about what you meant by "butterfly". At first I thought you were just being creatively condescending. The "butterfly" pocket US is pretty sharp. I want one.

 

[Brigade4Radiant]

Very funny. But it's kind of true in a way. I mean, when residents come interview they're asking stupid questions. "Do you have an ultrasound machine? Do you have "good back-up? How much trauma do you see? How much peds? Which EMR do you use?" They care about all the wrong stuff. And when I say wrong, I mean different stuff than they will care about in just a few years. 5 years in they're going to care about how much they're paid (i.e. do they need to look for a different job in order to make what they're worth), whether there are toxic people in the group and medical staff, how shifts are divided up and compensated, how much control they have over who they work with and how they do their work etc. They're not going to care how ultrasounds are done in the hospital. They won't care whether you see 5% trauma or 10% trauma. In fact, they'll probably be sick of doing trauma at all by then. They'll be on their third EMR since they got there. They'll care much less about "back-up" because they'll just transfer crap that can't be taken care of at that place. The less your hospital can do, the more transfers you do, the easier transfers are to do etc. Whether I transfer you or admit you, one call does it all. It just doesn't affect your happiness at all.

It would be even worse talking to a medical student.

So yes, the subtleties of actually owning your job are lost on medical students, residents, and many new attendings. They just haven't realized yet that they should care about this stuff because it really will affect them for the rest of their careers.

You can't ask about "toxic" personalities also ultrasound is very important as well as back up. Sure you live in a location where people are relatively healthy and have insurance so transferring people isn't a pain. Transferring people in a poor southern area where you don't have tons of academic centers is painful. Also yes ultrasound is important I won’t work in a place that I can’t do an ultrasound guided IV also it’s good for first trimester bleeding and peritonsilar abscess.

Also as an attending on his first year out I’ve come to realize that you are in this by yourself and you shouldn’t put too much faith in any one group SDG, CMG, hospital groups will all abuse you. Always be credentialed at least two hospitals.

 

[The White Coat Investor]

You can't ask about "toxic" personalities also ultrasound is very important as well as back up. Sure you live in a location where people are relatively healthy and have insurance so transferring people isn't a pain. Transferring people in a poor southern area where you don't have tons of academic centers is painful. Also yes ultrasound is important I won’t work in a place that I can’t do an ultrasound guided IV also it’s good for first trimester bleeding and peritonsilar abscess.

Also as an attending on his first year out I’ve come to realize that you are in this by yourself and you shouldn’t put too much faith in any one group SDG, CMG, hospital groups will all abuse you. Always be credentialed at least two hospitals.

What good does being credentialed at two hospitals do if one SDG or CMG has the contract at both? You mean always have two jobs? That seems a bit of overkill given how easy it is to get another job in EM. I mean, where does it stop? Make sure you always have two state licenses? Three? Four? Never work anywhere full time?

I agree you can't ask "Are there any toxic personalities in the group?" Duh. But you can ask:

How well does the group get along?
What do you guys do together outside of work?
Do people in the group all look at work-life balance the same way
Are there any toxic personalities on the medical staff?
What are group meetings like?
How are decisions in the group made?
Are there any "senior" partners?
Is the buy out the same for everyone?
Can I meet for a few minutes with one of the nurses that has known all of you for years when I come to interview?

And when you find one of the pre-partners or younger guys and feel like you have a level of trust there or on a follow-up phone call you can ask "Are there any toxic personalities in the group?" Honestly, I wouldn't mind that question, but I can also answer it "no." Perhaps it could be phrased "Which doc is the most difficult to get along with and why?" but that one has to be asked pretty discretely. Hopefully to a friend or former residency mate in the group.

 

[Brigade4Radiant]

What good does being credentialed at two hospitals do if one SDG or CMG has the contract at both? You mean always have two jobs? That seems a bit of overkill given how easy it is to get another job in EM. I mean, where does it stop? Make sure you always have two state licenses? Three? Four? Never work anywhere full time?

I agree you can't ask "Are there any toxic personalities in the group?" Duh. But you can ask:

How well does the group get along?
What do you guys do together outside of work?
Do people in the group all look at work-life balance the same way
Are there any toxic personalities on the medical staff?
What are group meetings like?
How are decisions in the group made?
Are there any "senior" partners?
Is the buy out the same for everyone?
Can I meet for a few minutes with one of the nurses that has known all of you for years when I come to interview?

And when you find one of the pre-partners or younger guys and feel like you have a level of trust there or on a follow-up phone call you can ask "Are there any toxic personalities in the group?" Honestly, I wouldn't mind that question, but I can also answer it "no." Perhaps it could be phrased "Which doc is the most difficult to get along with and why?" but that one has to be asked pretty discretely. Hopefully to a friend or former residency mate in the group.

You are right it doesn't make sense to have two jobs if the CMG owns both of them. Yes it’s easy to get a job but if something goes south getting credentialed. Working full-time makes sense if you have a job that you love that pays well and gives you a decent amount of holidays and weekends off. This always makes sense if you are in a place that has many SDG which is why you your group is in the position its in. You guys are stable which means that it makes sense to work nights and weekends you guys have security.

However SDG have been phasing out the same way small hospital groups have been phasing out thats why I read you blog and work hard so I can have the most power in the situation I'm in. You said it yourself you can't hire all the grads for your site.

 

[yanks26dmb]

Couldn't one just do locums in the specific region they want to be in if they're having a hard time breaking in with a w-2 job? Build contacts, references, etc. then get out if locums isn't a desired long term option?

 

[DrfluffyMD]

To be fair, you have to have a very high IQ to understand SDGs. The benefits are extremely subtle, and without a solid grasp of EMTALA regulations most of the information will go over a typical medical student’s head. There’s also SDGs' nihilistic outlook, which is deftly woven into their sweat equity- their group philosophy draws heavily from Osler's literature, for instance. The attendings understand this stuff; they have the intellectual capacity to truly appreciate the depths of these groups, to realise that they’re not just profitable- they say something deep about LIFE. As a consequence medical students who don't understand SDGs truly ARE idiots- of course they wouldn’t appreciate, for instance, the truth in SDGs' existential catchphrase “this is a unicorn job,” which itself is a cryptic reference to Tintinalli’s epic Emergency Medicine. I’m smirking right now just imagining one of those addlepated simpletons scratching their heads in confusion as SDGs' genius wit unfolds itself on their job search. What fools.. how I pity them.

And yes, by the way, i DO have an SDG tattoo. And no, you cannot see it. It’s for the ladies’ eyes only- and even then they have to demonstrate that they’re within 5 RVUs of my own (preferably lower) beforehand. Nothin personnel kid

(Big fan of your work, WCI, but I just couldn't help myself)

Morty?

 

[DrfluffyMD]

You know, I agree with WCI on this one. EM right now is a buyer’s market, so let me give you an example of a field with a much tighter market: interventional radiology.

When I was interviewing for fellowship last year, practices are appearently so hungry for names, that where I am going (one of the big name many, many miles away from California) has an easier time placing into California compared to a local shop (think UCI, harbor, Loma Linda tier).

When a job is thought after, someone can literally say “I only want to hire UCSF grads” and they’ll be fine.

 

[Strider_91]

Let me see if I can help you reconcile those two statements. Admittedly, I can see why it would be hard for a medical student to do so.

# 1 You're not going to have trouble finding a job. If you complete an EM residency, you're going to get a job. If you pay attention, you'll likely get a good job. That's whether you're at a fancy pants residency, a "middle of the road" residency, or a residency on probation. So don't panic.

# 2 Since residency is 3 years long, you don't want to be somewhere you don't fit well, no matter how prestigious. So pick a residency primarily based on fit. Fit, location, quality of education, prestige is perhaps the order you should look at it.

# 3 There are some jobs in this country that are very hard to get. Not a lot, but a few. They are located in places like Portland, Denver, and Salt Lake City. They combine a great outdoorsy place to live, a moderate cost of living and tax situation, and the opportunity to own your job in a small democratic group (which is becoming more and more rare all the time). They are places where the patients and consultants are nice, there are no toxic partners, the pace is reasonable, and the pay is good. SDNers refer to these as "unicorn jobs." My job happens to be a unicorn job. Thus, it is highly desirable. Because it is highly desirable, we have a plethora of applicants who want to come work here. We don't go to ACEP and buy a booth. We don't buy ads in the back of the throwaways. In fact, we don't advertise at all. We hire one person every year or two and have our pick of about 50 CVs that people just send to us because they're out beating the bushes looking for the really good jobs. Now, if you've ever looked at a CV of a graduating resident, you would know there isn't much on there that is useful. There's a name and a phone number and an email address. The name of their college and maybe their major. The name of their medical school. The name of their residency. Maybe a few publications, presentations, and research crap that you don't care about because you're a 100% community shop. And now, unless you want to dedicate every afternoon for the next month to interviewing 50 people for one job, you've got to figure out a way to narrow them down. What would you use? Their name? Their major? The name of their college? Whether they did research or not? Their hobbies? I would submit that the most useful thing on that CV is the name of their residency. Second most useful? Probably their hobbies. You know why? Because that tells us whether they're going to be happy in Utah and stay here for the long term or not. Mountain biking, hiking, and backcountry skiing = good. Clubbing, political protesting, surfing = bad.

Hope that helps.

That last line had me actually laugh out loud. Also, I’ll be sending you my CV in 6 years. I’m going to put my SDN/ WCI handle on it so you remember me if you aren’t retired. How’s THAT for a standout CV?

 

[The White Coat Investor]

Couldn't one just do locums in the specific region they want to be in if they're having a hard time breaking in with a w-2 job? Build contacts, references, etc. then get out if locums isn't a desired long term option?

If there are locums jobs there, sure. But if it is tough to break in with a "w-2 job", they're not going to be using a lot of locums. You use locums when you can't hire permanent, so if they're hiring locums, they're probably hiring permanent.