If you could go back in time, would you do EM again?

g3tb0mbed

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Hello, I am a rising M3 trying to get some insight from current EM physicians on how they view their choice to pursue EM. I personally have been aiming for EM since day 1. Currently still planning on applying EM. However, I am seeing so much doom and gloom that I am becoming a little unsure whether I am making the right decision. I greatly enjoy my time in the emergency department, but if job prospects are gonna be limited that definitely could be a deciding factor. I scored very well on Step 1 (260+) so I would have no problem applying to other competitive fields but this is currently where my heart is. If you could go back in time and choose another specialty, which would you pick and why or would you stick to EM. Thank you all in advance
 

hundreddaysoff

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EM sucks to the extent all jobs suck. I would still do it to the extent I am willing/obligated to work for a corporate master in any field. Search my posts to see way more discussion on this point.

EM is the only kind of medicine that doesn't bore the hell out of me. It's very possible to find a good job in a small town still; I just found two in fact. No applicants are pounding down these hospitals' doors despite having natural beauty, great weather, humongous beaches, and decent cost of living. If your heart is truly in it, be creative and persistent and don't listen to the hype on here.

If your heart isn't in it, there's no shame in trying for something less hospital-based. Keep in mind that the surgical subspecialties can involve ethical dilemmas for many including myself. Viz, you make most of your money charging patients/the health care system for fancy procedures they objectively may not need and according to the literature often don't help them in the long term and even have iatrogenic effects, eg tonsillectomies.

But maybe that's just sour grapes since my Step 1 in 2009 was only 217 :D
 
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TheSingularity

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EM at its core is a fantastic field. As hundreddaysoff says, it sucks to the extent that all jobs suck. However, it's all about finding the RIGHT job in EM. For example, when I worked for team health, I worked about 120 hrs/mo, made about 380k/yr (1099; no benefits), saw between 2-2.5 pph...and was MISERABLE. Leadership blew, the hospital I worked at was incredibly dangerous, I was a true cog.

Fast forward to now, where I work about 130 hrs/mo, make about 300k/yr (plus retirement contributions and health insurance)...but see about 1.5 pph, have great leadership/EMR, get to teach residents...and I'm soooo much happier. The system I work for is so supportive. During the height of COVID, when all my friends' hours at other hospitals were getting cut, we maintained the same level of staffing/pay and...got bonuses on top of it!

Now...I do worry about the youngins that are just setting off on their path in EM. I worry for the couple of my senior residents who were told by their future CMG employers that their start date was being pushed off until October of this year instead of Summer.

The market is really messed up right now because of COVID. It's somewhat scary to me that 3 months of interrupted volume caused such a catastrophe in the system financially. The market is really unstable right now. I'm not sure where it's heading, but I would imagine it will level off as we continue through the next year or two.
 
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cyanide12345678

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I battle with this frequently whether it was the right choice or not. The answer is yes and no.

Reasons for yes: no other 3 year residency would have had me making ~450k while working 12 days a month. I would have never paid off my debt within the first year as attending otherwise. I would have never had so much time off work to pursue other entrepreneurial ventures. So really... All the reasons for why i would do it again are purely financial. But if this changes in the future then no it's not worth it.

Reasons for no: no other specialty can you get 10 people drop in on your board within 30 minutes. The job is definitely more stressful than the average physician job. I mean... It is truly tiring when you're running around and the patients just don't stop coming in. There's no appointment or anything. If they keep on pouring in, you can on chugging along.

As others above have stated. A lot depends on the job. I'm sure i would be absolutely in love with my field if i started working at a 8-10k volume place, still making decent income at 170-180/hr. But it would be a massive paycut from current levels, but job satisfaction will be great. My next job will be like that mostly for career longevity. Otherwise i couldn't continue doing what I'm doing right now. I honestly don't know how people that average 2-2.5 pts per hour everyday, can do it long term consistently.

Other specialties i would explore include pm&r, derm, psychiatry, anesthesia, radiology.
 
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Porfirio

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Yes.

EM is headed the same direction all areas of medicine are. Our generation of physicians have less advantages and more disadvantages.

Eventually, corporate medicine will take over all fields of medicine. Medical school debt will continue to increase (be it increased cost or decreased salary to offset the cost). Residency programs will continue to increase in number. Mid levels will eventually get independent practice. Insurance companies and hospital CEOs/admin will continue to take in massive profits/income.

Even with all this EM will remain profitable for the applicant in our generation. But I would not tell my children to become a doctor.
 
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alpinism

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The job market is a disaster right now because of coronavirus.

Large numbers of graduating EM residents have had their hospital contracts outright cancelled. There are currently few to any jobs in major cities besides working at low paying free standing emergency departments. If you're seriously thinking of doing EM there's a good chance that by the time you graduate you'll have limited options for jobs besides working at rural hospitals a few hours from the nearest major city.
 
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deleted859535

I also scored highly on Step 1 and Step 2.

My answer is still "no" on somewhere between 1/3 and 1/2 of days worked.

SDN skews towards more critical of EM than many of my real-life partners and people I know outside of my own group actually are. All specialties have their share of bull****. That said, EM has the burnout stigma for a reason.

It does have some great perks, though. Some of them are alluded to above.

You just have to pick what gives you what you want and has the daily bull**** you think you can deal with for a career. With or without early retirement.
 
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Torsion

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SDN skews towards more critical of EM than many of my real-life partners and people I know outside of my own group actually are. All specialties have their share of bull****.

I communicated this thought several weeks ago on a different thread given real life discussions with attendings and graduating residenst in real life, suggesting that the 10-20 regular posters on this forum may not represent an adequate sampling of the breadth of perspectives among attending ER docs at large. I was very promptly criticized for proposing such a thought.
 
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RustedFox

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I communicated this thought several weeks ago on a different thread given real life discussions with attendings and graduating residents in real life, suggesting that the 10-20 regular posters on this forum may not represent an adequate sampling of the breadth of perspectives among attending ER docs at large. I was very promptly criticized for proposing such a thought.

This is why your post got discarded.
Graduating residents generally have limited to zero idea of what real-life community ED work is like.
Academic attendings are sometimes worse.
 
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Torsion

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This is why your post got discarded.
Graduating residents generally have limited to zero idea of what real-life community ED work is like.
Academic attendings are sometimes worse.

I can definitely understand how that can be the case, especially at Ivory Tower institutions. However, the interactions I'm referring to have largely been among partners in SDGs that have had associations with residencies. These SDGs have staffed large community health systems and frequently work in smaller suburban and rural EDs without resident support. It would think this group of docs would offer reasonable perspectives.
 

RustedFox

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I can definitely understand how that can be the case, especially at Ivory Tower institutions. However, the interactions I'm referring to have largely been among partners in SDGs that have had associations with residencies. These SDGs have staffed large community health systems and frequently work in smaller suburban and rural EDs without resident support. It would think this group of docs would offer reasonable perspectives.

Just so you know... 99% of the jobs you actually find out there will not be with affiliated SDGs. I say this in true precautionary fashion and not out of condescension.
 
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Torsion

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Just so you know... 99% of the jobs you actually find out there will not be with affiliated SDGs. I say this in true precautionary fashion and not out of condescension.

Certainly these kind of positions do not represent the norm nationwide and who knows what my practice environment will be in a few years. I think this would be my ideal practice environment, though, and it seems these types of groups frequently hire former residents or students when spots open up.
 
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deleted547339

It’s a good job, but it’s a hard job. It’s really just a very highly paid blue collar job. If you could tolerate plastics or derm or ent or ophtho, id probably do one of those, but it’s a good gig.
 
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TheComebacKid

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An important point regarding the "doom and gloom" on SDN... this place is an outlet for people. People have a bad shift, they want to vent and commiserate with their brethren. Sometimes, I agree it can get to the point of being toxic. But most people who have a great shift, will not come home and feverishly post about it online. The bias on this forum is real.

EM is subject to the same challenges of all specialties in the house of medicine. It comes down to your personality and interests in terms of which specialty you will fit better with.

In terms of the current poor job outlook... I would say EM is in the middle of the pack in terms of how hard we have been hit. The surgical folks got crushed too. Regardless, I think it says something when every surgeon I talked with was universally happier during the COVID shutdown while their caseload was more manageable and they could remember their kid's names again.

EM is a hard job. But it's rewarding. It's a team sport. The people generally have a pretty good sense of humor, even on this forum, which is why I keep coming back despite how crotchety some people sound (myself included).

I also can't emphasize enough what has already been stated... Two separate EM jobs across the street from each other can have vastly different experiences depending on the group/management. While certain patients can definitely be challenging, I don't think it's the drug seekers and borderline's that really crush your soul over the long haul. It's the folks in the executive suite, the nursing management breathing down your neck, the patient satisfaction surveys, etc. The corporate transformation of medicine is eating away at the very essence of what we do in terms of taking care of patients and getting satisfaction in our work. But that problem transcends all specialties and is not unique to EM.
 
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RPedigo

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Yes, 100%. I work in academics, but also moonlit in the community for six years. The opportunity to think about complex resuscitations, teach procedures, help residents become better physicians, and serve the underserved is a great combination. Would I have the same feelings if I did full time community medicine? I am not sure, but I do not think so since most of the things I mentioned are specific to working in a teaching environment. I was in a similar situation to you (AOA, very high board scores, etc.) and am glad I made the decision that I did. EDIT: another poster correctly pointed out that I should contextualize my position - I am very fortunate to work in a great place to live with a wonderful patient population and very desirable institution to practice emergency medicine, and it is likely my experience would be different if these were not true.
 
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GeneralVeers

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Yes, 100%. I work in academics, but also moonlit in the community for six years. The opportunity to think about complex resuscitations, teach procedures, help residents become better physicians, and serve the underserved is a great combination. Would I have the same feelings if I did full time community medicine? I am not sure, but I do not think so since most of the things I mentioned are specific to working in a teaching environment. I was in a similar situation to you (AOA, very high board scores, etc.) and am glad I made the decision that I did.

And $200K extra per year wouldn't help you feel better?
 
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SeekerOfTheTree

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This is why your post got discarded.
Graduating residents generally have limited to zero idea of what real-life community ED work is like.
Academic attendings are sometimes worse.

Exactly this.

I wouldn't have done it had I known more about the market and what it was going to become. With the tons of residencies popping up every year and the CMG squeeze the reward for the bull is getting less and less. There will be a saturation and for us younger attendings out there we are feeling it more and more. The older attendings or middle of the career on their way out are happy and really have lost touch with this.
 

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Yes. It’s complicated but yes.
EM is a tough gig with little control over the day to day, but it’s both more stable and respected than SDN gives it credit for. Mostly it’s a good gig. And while this is just my own preference showing through, it’s usually better than family practice or other clinic based specialty where a doc has to be both a business person and a physician. That’s hard to do.
Sometimes I yearn for IR or interventional cards. Then I take a step back and realize the call would kill me. If you get the chance, talk to these folks about their lifestyle- it’s not great.
 
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namethatsmell

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I see three viable options to be happy in EM going forward.

1) Be geographically flexible and work rural. You can find places that have way less administrative BS, collegial staff, grateful patients, and a reasonable workload.

2) Find a semi-unicorn or full-on unicorn job. This could be something like a spot with a legit SDG, a non-malignant academic group, Kaiser if you can tolerate the corporateness, or a decently-run VA if you can accept lower pay. These are tougher to land than option 1, but you can get into these spots by again being geographically flexible, having connections or niche skills, or by simply getting lucky and being in the right place at the right time. Most of these jobs will initially (or always) pay less than a typical CMG gig but they can have significant long-term payoffs that you won't see if you only stay for a few years.

3) Develop a IDGAF mentality for non-direct patient care headaches when at work (see recent thread on this). None of the regulars on here think the medicine of EM is lame. There are great cases and you'll get legit saves in EM each year that can carry you for months of mundaneness and disrespectful patients, admin, and consultants. But the challenge with EM (outside of the market now being flooded with new grads) is that everybody who is not an EM doc thinks they are in control of what you should do and how you should do it. The hospital admin wants you to both see all patients immediately on their arrival but also spend unlimited time with patients to get good patient satisfaction scores and make their metrics look good. The specialists think they can send their patient into you for non-emergent things and expect you to prioritize their patients over sicker patients. The CMG wants you to see tons of patients but also wants you to chart ASAP but they don't actually give you time to do this. I could go on and on, but the point is that there is simply no way to make everybody happy at many ED/hospital setups and at the end of the day you also need to make sure you leave your shift feeling like you did the right things for your patients in spite of these outside forces. You will likely get flak for doing the right thing and you have to learn how to brush it off and, when appropriate, call people out when they're putting patients at risk. The more you become OK with that, the more you can tolerate working at crappy places if you can't make option 1 or 2 happen.
 
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bravotwozero

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3) Develop a IDGAF mentality for non-direct patient care headaches when at work (see recent thread on this). None of the regulars on here think the medicine of EM is lame. There are great cases and you'll get legit saves in EM each year that can carry you for months of mundaneness and disrespectful patients, admin, and consultants. But the challenge with EM (outside of the market now being flooded with new grads) is that everybody who is not an EM doc thinks they are in control of what you should do and how you should do it. The hospital admin wants you to both see all patients immediately on their arrival but also spend unlimited time with patients to get good patient satisfaction scores and make their metrics look good. The specialists think they can send their patient into you for non-emergent things and expect you to prioritize their patients over sicker patients. The CMG wants you to see tons of patients but also wants you to chart ASAP but they don't actually give you time to do this. I could go on and on, but the point is that there is simply no way to make everybody happy at many ED/hospital setups and at the end of the day you also need to make sure you leave your shift feeling like you did the right things for your patients in spite of these outside forces. You will likely get flak for doing the right thing and you have to learn how to brush it off and, when appropriate, call people out when they're putting patients at risk. The more you become OK with that, the more you can tolerate working at crappy places if you can't make option 1 or 2 happen.

Great post! With regards to the last point, if you work at a place long enough, you will get a feel for which BS metric the admin cares the most about, and which ones don't matter to them. When you do, just pay attention to the ones that matter and ignore the rest. At my shop, admin is obsessed with patient satisfaction scores, and reducing complaints. They don't care about door to doc times, or throughput. The former can easily be manipulated by back timing anyway, but I digress. This might be because we're not a high volume ED. This is why admin likes our docs with high sat scores, even though they bring the ED to a grinding halt and make the nurses groan everytime they're on shift.
 
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I'm surprised by the number of "yes" responses here... but here's the critical point (medical students and PGY1s pay attention)

Do you notice the trend in the yes answer? It's ALL retrospective. Either they've been out for 10-15+ years and lived through the golden era of EM (and made their money, found that unicorn job, held on), or they've been an attending for 2-3 years and got in just before private equity really started the squeeze. Add in COVID19 market effects, and it's easy to see that if you are a CURRENT medical student, EM is a bad choice if you're going to be in debt and want some modicum of life beyond that of a middle class blue collar worker.

Already we've seen volumes start to creep up slowly, but surprise surprise, guess what ISN'T changing? There's no talk about increasing physician staff, there's no talk about hourly rates recovering, and there's no talk about reducing or maintaining mid-level coverage.

Granted I work with a national CMG, so my view is definitely skewed in that regard, but like many recent graduates, I didn't have fancy connections to contract holders of well-paying SDGs. These unicorn jobs are truly hard to find and break into.

I still enjoy the actual emergency medicine involved. However, my day-to-day practice involves at best 10% emergency medicine, and 90% secretarial work. Wrangling consultants, making sure patient satisfaction needs are met, documenting loads of BS (even with Epic and Dragon it's still a lot of work). Would I do this specialty again? Likely not, but I'm here and I'm now, and I'm overall positive on the current situation, but it's a bleak future no two ways about it.

Regarding that IDGAF post - it's hard to develop that mentality when you feel like your hours are threatened if you don't make your overlords happy.

Yes, 100%. I work in academics, but also moonlit in the community for six years. The opportunity to think about complex resuscitations, teach procedures, help residents become better physicians, and serve the underserved is a great combination. Would I have the same feelings if I did full time community medicine? I am not sure, but I do not think so since most of the things I mentioned are specific to working in a teaching environment. I was in a similar situation to you (AOA, very high board scores, etc.) and am glad I made the decision that I did.

Because you're very clear about where you work and because I remember your posts from back in the day you should be a little bit more clear about your situation. You work at a TOP TIER academic institution in one of the most desirable places in the United States. You are brilliant level in terms of your ability to bring academic value, and your reputation in the academic world is second to none. Your path is not accessible for 99.9% of graduating medical students or residents, plain and simple. I'm happy you found something that worked well for you, but nobody should make a decision on EM based on the idea that they'll be able to get to RPedigo's level.
 
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This is part of the reason I am strongly considering a dual FM/EM residency. I like EM, but I don't want to only do EM. I want to cherry pick when I do EM lol. With that being said, my back-up to a dual residency would be FM because then I could still work in a rural ED, which is what I'd want to do over a city ED anyways.
 
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Torsion

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EM is a bad choice if you're going to be in debt and want some modicum of life beyond that of a middle class blue collar worker.

I understand you are bearish on the future of EM as a specialty as we've hashed that out in another thread and I don't need to go through that again, but you've repeated this statement again and I really wonder what you think a middle class blue collar worker's life is like.

Even if the apocalypse occurred and EM salaries fell to 150k that would still offer a decent upper middle class life in most areas of the country even if your spouse did not work. I grew up under such circumstances, had plenty of privilege and opportunity, and my parents are now retired comfortably with a multi-million dollar nest egg without sacrificing much at all to save it. As a first year resident, I will be paid more than many "middle class blue collar workers" are paid throughout the country.
 
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Even if the apocalypse occurred and EM salaries fell to 150k that would still offer a decent upper middle class life in most areas of the country even if your spouse did not work. I grew up under such circumstances, had plenty of privilege and opportunity, and my parents are now retired comfortably with a multi-million dollar nest egg without sacrificing much at all to save it. As a first year resident, I will be paid more than many "middle class blue collar workers" are paid throughout the country.

Your point is well taken, but a large number of us simply would not take on the liability, workload, physical and emotional turmoil, and headaches of emergency medicine if asked to do the same (or more) for a fraction of current pay.
 
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Torsion

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Your point is well taken, but a large number of us simply would not take on the liability, workload, physical and emotional turmoil, and headaches of emergency medicine if asked to do the same (or more) for a fraction of current pay.

I fully understand and I certainly don't want to encounter such as situation either as a job applicant in a few years. I don't discount the threat that corporate medicine can have on our pay. I just wish I knew what to do about it.

My point was chiefly in regards to salary vs the details of the job itself. It's been apparent to me that a significant number of medical students, residents and attending physicians don't know what other professionals are earning and what type of lifestyle they have access to. For decades and perhaps longer, having an MD behind your name in the United States will earn you a more comfortable living than most people with a JD, DDS, or PhD and certainly more than your average American "blue collar worker". Even on the lowest end of physician salaries, I would eclipse if not double the annual earning of all of my non-medicine white collar peers by my early 30s.
 
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VA Hopeful Dr

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Your point is well taken, but a large number of us simply would not take on the liability, workload, physical and emotional turmoil, and headaches of emergency medicine if asked to do the same (or more) for a fraction of current pay.
That's key to this, I think. As an FP I can pull $150/hr fairly easily working 8-5, M-F. That's not good money for nights, weekends, and dealing with the work y'all do on top of the bad schedule.
 
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Torsion

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If EM pay went to 150K I’d quit without so much as a day’s notice. Wouldn’t even give it a second’s thought. I wouldn’t be able to continue in my current lifestyle with my student loans and continuing to save for retirement the way I want, so screw it. I’d sell my house, get a non-medicine Mon-Fri 8-4 job for 80K or 90K, go IBR on my loans, and chill with my fam and drink beer with my buddies on the evenings and weekends.

And this sentiment is exactly why I don't think that such a predicted salary apocalypse will occur. There is a number at which ER docs will refuse to work and its probably much higher thank 150k at this point. You could probably work as a 8-5 physician consultant for a number of companies and make a lot more than that 80-90k, too.
 
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RuralEDDoc

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If EM pay went to 150K I’d quit without so much as a day’s notice. Wouldn’t even give it a second’s thought. I wouldn’t be able to continue in my current lifestyle with my student loans and continuing to save for retirement the way I want, so screw it. I’d sell my house, get a non-medicine Mon-Fri 8-4 job for 80K or 90K, go IBR on my loans, and chill with my fam and drink beer with my buddies on the evenings and weekends.

I don’t know you but I call complete bullsh!t on this. You think EM is bad? Work an 80k per year job selling mortgages, or medical equipment, or whatever else you can get with no experience and academic over qualifications. You’ll be back in the ED before you can spit in the wind.
 
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I don’t know you but I call complete bullsh!t on this. You think EM is bad? Work an 80k per year job selling mortgages, or medical equipment, or whatever else you can get with no experience and academic over qualifications. You’ll be back in the ED before you can spit in the wind.
At least the level of liability is much lower then..
 
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cyanide12345678

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I don’t know you but I call complete bullsh!t on this. You think EM is bad? Work an 80k per year job selling mortgages, or medical equipment, or whatever else you can get with no experience and academic over qualifications. You’ll be back in the ED before you can spit in the wind.

I would never work at 150k either. I would have long packed my bags and either moved back to Pakistan and retired or started working in the middle East somewhere. My lower threshold sits at somewhere around 250k i believe.

I'm also only 3-4 years away from being financially at a point where i can just walk away anyday and retire for good in Pakistan if needed. And never work another day of my life while living in absolute luxury.

I would never put up with the crap of the emergency department for less than 250k. Ever.
 
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RPedigo

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And $200K extra per year wouldn't help you feel better?

I would love to have higher compensation, as would anyone. I understand that I am getting paid less by working for an underserved population despite living in a higher cost of living area than most. I am trading salary for high work satisfaction. This is a trade-off people make; I do feel that our compensation should be higher, and hopefully that is something that will happen with our next contract negotiations for the county.

Because you're very clear about where you work and because I remember your posts from back in the day you should be a little bit more clear about your situation. You work at a TOP TIER academic institution in one of the most desirable places in the United States. You are brilliant level in terms of your ability to bring academic value, and your reputation in the academic world is second to none. Your path is not accessible for 99.9% of graduating medical students or residents, plain and simple. I'm happy you found something that worked well for you, but nobody should make a decision on EM based on the idea that they'll be able to get to RPedigo's level.

Thank you - that is very nice of you to say. Academics is a funny world because I feel that all my colleagues are brilliant and consistently bringing more value than I am! But then realize that we all bring different skills to the table. You are completely correct that I live in a very desirable location and work at a very desirable institution to practice our specialty. That is important information for readers and I should have contextualized that more effectively. I will edit that into my post to clarify for others.
 
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Diagnostic Radiology, Critical Care, or a combined residency (EM/FM) seem attractive to me at this point when I look back... CC is probably a better fit for me but I don't think those guys get paid enough honestly. I'm shocked that they make so much less than us. I'm perpetually jealous of the diagnostic rads guys... You can literally work anywhere and it's good money. I like radiology...then again, I'm sure there are negatives d/t my lack of inside perspective.

EM...sigh. EM has been good to me. I'm just disappointed in how the field is evolving. It's nothing like what I thought it would be. I think we are being corralled into a role of "triage doctor" with the increasing emphasis placed on times and metrics. The lack of respect from specialists and hospital admin gets old after awhile. The increased litigation exposure as an EM doc gets old after awhile. That being said, it's fun on some days. I've essentially mastered my craft at this point and that feels good...you don't have to work as hard learning something new which makes me complacent. I'd probably continue doing this even if the sky fell out, but I do think current potential applicants need to think long and hard before pursuing EM. It made more sense for those of us who went in during the "golden years" but those days are long gone and I don't see them coming back anytime in the near future. I think a combined residency like EM/FM would be a safer choice these days and provide an easy out if EM imploded. The local PCP guys in my area make great money (400K) though they work hard.
 
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As for salary collapse....as much as it would gall me to work for significantly less pay, what options do any of us realistically have? I can remember making 65K working in IT. Even if EM paid 150K, what else can I do outside of medicine that would pay me 6 figures? I don't see that many of us would have much of a choice.
 
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Brigade4Radiant

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As for salary collapse....as much as it would gall me to work for significantly less pay, what options do any of us realistically have? I can remember making 65K working in IT. Even if EM paid 150K, what else can I do outside of medicine that would pay me 6 figures? I don't see that many of us would have much of a choice.

This is the fact sure you may have a “job “that may pay well however jobs you can be like oh and if you don’t have that job anymore you may have to move.

A better question would be would rather do PA or med school. Because with that you have a profession or you could do multiple jobs in. In fact I’ll probably steer my children to the NP or PA school.

Being in healthcare you could still work a wide variety of jobs. Sure no job is completely recession proof have her healthcare professions are more recession resistant than other fields. The only other equivalent that would do I’m gonna do I T for 60 5K would be doing nursing with three shifts a weekfor 68K.
 
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Hercules

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I would absolutely do it again. EM has been good to me. Most days I enjoy the work and it has afforded me a flexible schedule with a nice paycheck that has allowed me to start up several other business ventures that will enable me to be financially independent at an early age. I do not think I could have gotten to where I am while still being so available for my family in almost any other specialty.

As has been pointed out in this thread (and about 1000 other threads...), there are some commonalities noted for those that are happy in EM as well as those that are not. Part of my happiness in EM is related to the group I joined and I would have been miserable in some of the jobs I have seen described over the years. But guess what? I could say the same about every other specialty. There are some surgical groups in my town that I could have enjoyed working in. There are others that I would run screaming from the room if forced to join them. We sometimes forget that changing specialties would not have absolved any of us of the need to do our due diligence on potential jobs.
 
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Mushdoc

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I'm very glad I had other "adult jobs" before going to med school and still hang out with mostly non-doctors. I find office based jobs incredibly boring and see most of my friends making 80-120k/year. Its all about expectations. That said I miss regularly having weekends off, and night shifts suck. I also hate the OR and could never do hospitalist. I think something like pulm crit with a mix of clinic, procedures, consults and ICU might have been ok
 
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e30ftw

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Yes.

Five years out of residency and EM has been very good to me.

I'm a practical person. At this point almost every patient is kind of boring but I still like reducing fractures/joints, sewing someone's face back together (takes time but you actually get to help the patient) and being able to throw a PIV in anyone. (gotta have skills the nurses don't to stay ahead ;) .

So no I'm not constantly intellectually amazed by emergency medicine, but I'm more of a liberal arts person. I play and compose music, read literature, enjoy nature, etc for intellectual fulfillment.

Medicine is a job that pays very well and is beneficial to society. I enjoy helping people.

The existence of med-mal attorneys and dealing with whiny people will probably make it impractical to practice more than 10 or so more years however, so I'll enjoy the time I have left then retire.
 
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RustedFox

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What field of medicine would you enter if you had to choose all over again (if medicine again)?

I took a lot of time to think about an answer to this.

I don't think I would do medicine again. At all.
If it HAD to be medicine (like; if God came down and said - "Dude; I have been here all along. By the way... new rule - you can go back but you haaave to do medicine. AND the floor is lava.")

I think I would do FM and just do clinic-only stuff.

I'm a bit of a bizarre case study, though.
See; I got into medicine for two reasons.

(1) I was born into a medical family. Dad was a dentist (retired). Mom was an ER nurse. Uncle is a world-class pathologist (no joke; the guy is major-league level brilliant, holds patents, sits on boards of boards, he's 77 and still working). Aunt is/was (retired) an old cath-lab nurse. Ever since I was a kid, I was told that "biology is good; its how life is life". So [this sounds lame as hell, but its the truth], by the time I was in high-school, I really "knew the source material very well". For those who can remember, you used to be able to take SAT-II subject-specific tests. This was back in the day where an "800" was a perfect single-subject score, and a "1600" was a perfect score (math/verbal). I hear that a perfect score is like, 2400 now (or something). Anyways. I took two SAT-II subject-specific tests because I could. I scored a 760 on biology, and a 790 on molecular biology (yeah, that was a thing). I had a few scholarship offers from some big-name schools. Went to a state-school for my own reasons. I really, really, was one-track-minded.

(2) I had this idea of "nobility". Medicine of any variety (dentistry, podiatry, nursing, whatever) was "noble" because at the end of the day you were helping a fellow human being who needs help. This was "sacred" and was a "good thing to do", according to so many people who held so much influence over me.

Now, I don't care about people. Hardly at all.

I really don't.

If it was one thing that burned me out of medicine, its... people.

But hey, here I am. PGY-10.

I'm at a bit of a crossroads in life, too.
I don't have any kids. I'm not saving for the college educations of kids that I don't have.
I don't want kids.

My debts are all paid off. 330K+ for med school was a lot. Yay for me. Lulz. Gamer trophy, somehow.

I looked at my tax returns. I generally made (gross) in the neighborhood of 330K a year (plus/minus 10K or whatever).
I'd be just as happy with a lot less money.

I don't have a luxury car. A big house. A second home. Expensive watches. I don't buy "designer clothes". Sure, I like to travel; but a "good day off" for me is having some breakfast and going to the park to juggle a soccer ball or hit the batting cages, or just "playing like a kid would play". I don't head to the country club for 18 holes with "important executives". I hate those people and their pretentiousness. My wife said to me once: "I used to date this guy; he was in law school. One day, he said something like; 'when I'm a real lawyer, ALL of my clothes will be [designer name here]'." Lame sauce. She followed that with: "Yep. I knew right there and then that this wasn't going to work out." I don't need "status". In fact, I hate it.

We frequently go out to dinner, and not infrequently (because we generally sit at the bartop, we dont like tables), another patron or an employee will recognize me and say "Hey! Dr. Rustedfox! Thanks so much for x-and-y-and here's some follow-up that you didn't ask about!"

I hate that. I would rather just eat my chicken salad and drink my beer in silence.


I figure on making a big change.


I'm probably just going to go straight-part-time EM, and treat it like "radiation exposure". Its not that bad if your exposure isn't too long or or too heavy. This may or may not be tenable in the coming years. Who knows? Maybe EM will be nothing but PLPs. Everywhere. If that's it. I quit.
 
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I live in a ~650K with greater city area population of about 1.33 million in the deep South. Although the city is not small, it's not what I would call a very desirable place to live. There are roughly 11 or so realistic ERs to commute for work. When I moved here you could almost name your price. There have never been enough ABEM docs in the city to staff any of the EDs at 100%, so we've always relied on IM/FM with experience, etc.. People were begging you to work for them a few years ago. Well, our ED contract is more than likely ending after this year and I've been sending feelers out and it's crazy how tight the job market has become. One of TH's sites that has NEVER been able to staff 100% ABEM has now hired so many new grads that they are switching to hospital bylaws requiring ABEM and have zero spots available. The market is tight everywhere and nobody is currently hiring except for a couple of miserable EDs where nobody wants to work. Pay is ~$210-245/hr. TH has traditionally always had a mercenary team for this area that functions similar to the STRIKE team and get paid $275/hr. They are doing away with them since supply is quickly overcoming demand and there is no reason to pay those guys as much anymore so now they are telling me that their shifts are no longer being filled and they are being pushed to take on lower paying FT spots in some of the EDs.

It never occurred to me when I moved here 7 years ago that I would EVER entertain the thought of leaving to look for even less desirable places to live in order to have decent job security. Insane. I can't imagine what the market/salaries are going to look like in another 5 and even 10 years.
 
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bravotwozero

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I will probably get some flak for this, but if you're in our field, you need some kind of a back-up plan/side gig. I don't know how or what kind of alternative revenue stream I want to start, but have definitely resolved to do so in the past few days. It's difficult to come to work with the feeling that you always have a big target on your back.
 
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RustedFox

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I will probably get some flak for this, but if you're in our field, you need some kind of a back-up plan/side gig. I don't know how or what kind of alternative revenue stream I want to start, but have definitely resolved to do so in the past few days. It's difficult to come to work with the feeling that you always have a big target on your back.

Dude.

Our shifts have been cut to 6-7 hours because of COVID. Sure, the volume is coming back, albeit slowly.

Even at hour 6... I say to myself: "I want to get the hell out of here."
 
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GeneralVeers

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Dude.

Our shifts have been cut to 6-7 hours because of COVID. Sure, the volume is coming back, albeit slowly.

Even at hour 6... I say to myself: "I want to get the hell out of here."

I'm the same way. Still try to leave early even on my 6 hour shifts. There's just something about that last hour, regardless of shift length that makes me want to run away.
 
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