Is EM really that competitive?

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No. IIRC, the Step 1 average is in the 230s.
 
Its becoming more competitive. But not THAT competitive yet. If you apply broadly enough, and your numbers aren't significantly below average (low 210s step 1, last quartile class rank) then you should be able to match somewhere. Even with really low numbers if you're able to shine on away rotations you might still be able to match, but it will be harder.

I think EM is as competitive as Anesthesia, and radiology right now.

Specialties like Derm, plastics, ENT, urology are really the most competitive specialties there are. At the end of the day, EM still has 1000+ spots available in the country.
 
Dr. Death said:
SDN is doom and gloom about every field. It's either too competitive or undesirable and the future job outlooks are always negative.
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That doesn't mean it's not true. But I agree, there's some inherent bias in the people who are more likely to post about these things.
 
Dr. Death said:
SDN is doom and gloom about every field. It's either too competitive or undesirable and the future job outlooks are always negative.
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That's because 100% of people on SDN are actually secretly gunners that are trying to drive people away from their field of choice 😉
 
twospadz said:
Is EM becoming that competitive? Or is just sdn that is being overly paranoid about the field?
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Nope, it's just SDN being overly paranoid, and for you asking the same thing several times, I guess.
 
Can somebody remind me why EM is so desirable these days?

I say this as an EM resident currently - by the time that you medical students are done with your EM residencies I don't believe the getting will be good. A big reason EM has hit a boom is because of the way our health system has fallen into place. There's a dearth of primary care docs/PAs/NPs/whatever and a relatively new glut of insured patients. This is a very simplified view of something way more complex, but you get the pic. Thus urgent cares and EDs are cleaning up.

The second that this changes, all the "wide-open" job markets you hear about will close tightly again.

And that doesn't even consider the actual day-to-day practice of EM. Generally some single digit percentage of my patients on any given day are TRUE emergencies. Otherwise it's a glorified and expensive family medicine clinic.

Add a few drunks, homeless, and entitled poor (not saying all of the needy are entitled, but interestingly a large percentage of the ones that I treat are far more entitled than the "richies), and boom you have a huge recipe for becoming jaded towards your fellow man, burnt out on your job, and chronically ill (poor health habits and self care).

Now add the constantly changing schedule, and you begin to wonder why this field is DESIRABLE...

All of this for what? A salary of 200k/year to be a replaceable cog in the corporate EM world?

Yet at the end of the day, I really love it. No joke, I just do everything I can to make sure medical students really truly know what they're getting themselves into.

And yes, I dabbled in derm, plastics, ortho for a while (I had the board scores, name brand school, etc), and I honestly think those specialties are popular PURELY because of their reimbursement potential. Nothing more.
 
exsanguination said:
Can somebody remind me why EM is so desirable these days?

I say this as an EM resident currently - by the time that you medical students are done with your EM residencies I don't believe the getting will be good. A big reason EM has hit a boom is because of the way our health system has fallen into place. There's a dearth of primary care docs/PAs/NPs/whatever and a relatively new glut of insured patients. This is a very simplified view of something way more complex, but you get the pic. Thus urgent cares and EDs are cleaning up.

The second that this changes, all the "wide-open" job markets you hear about will close tightly again.

And that doesn't even consider the actual day-to-day practice of EM. Generally some single digit percentage of my patients on any given day are TRUE emergencies. Otherwise it's a glorified and expensive family medicine clinic.

Add a few drunks, homeless, and entitled poor (not saying all of the needy are entitled, but interestingly a large percentage of the ones that I treat are far more entitled than the "richies), and boom you have a huge recipe for becoming jaded towards your fellow man, burnt out on your job, and chronically ill (poor health habits and self care).

Now add the constantly changing schedule, and you begin to wonder why this field is DESIRABLE...

All of this for what? A salary of 200k/year to be a replaceable cog in the corporate EM world?

Yet at the end of the day, I really love it. No joke, I just do everything I can to make sure medical students really truly know what they're getting themselves into.

And yes, I dabbled in derm, plastics, ortho for a while (I had the board scores, name brand school, etc), and I honestly think those specialties are popular PURELY because of their reimbursement potential. Nothing more.
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Seems action-packed, no rounding, lots of variety, mix of medical management and procedures, seems "chill", no call, shift work.

EM has some sizzle, but, personally, I hate the steak. As a med student, I had a really fun rotation at Advocate Christ. I basically only saw level 1s, did 2 chest tubes, multiple lines every shift, intubated, lacs, etc, etc. Seemed fun and I thought a pretty good gig.

As an intern, my EM rotation was honestly the worst month of the year. I'll just quote my thoughts from an earlier post:

"EM rotation as intern has been the low-point of the last 5 years for me (med school, internship).

I just can't take any aspect of it. Picking up a chart and seeing yet another 40-year-old female with weakness, dizziness, abdominal pain who's been here 3 times in the last month. The intractable back pain patient who is screaming and sobbing and can't get a word out except for, "They usually start with Dilaudid 2mg then 1mg every hour after that". Atypical chest pain over and over. Nausea and abdominal pain over and over. Sitting in the middle of our ED is like being in a glass bowl where there are 45 different useless alarms going off and every patient staring at you, with family members occasionally wandering up to ask me if they can have a food tray too. Waiting for consultants and primaries to call me back, wondering what I'm going to get yelled at for this time.

It's just incredibly unpleasant. There is no trust or relationship between physician and patient, or physician and consultant. I spend my entire day staring at the clock waiting to go home. I'm barely learning anything; we order the same shotgun labs and films on every with a given chief complaint. I see the chief complaint, put in my orders, then see the patient. Seeing the patient seems to change management a minority of the time. The big conundrum with every patient is not, "What's going on and how do we treat it?" but rather, "How can I get this patient out of the ED as quickly as possible (either to inpatient, obs, or home)?" I take no satisfaction or pleasure in nearly anything I do.

As a med student, I had a pleasant EM rotation. They didn't really care what I did. I just hung around the level 1s, tried to snag lacs and abscesses, etc. Very skewed look at the specialty. If I was unsure of what I wanted to go into at that point, I think the "sizzle" could have sold me on EM. The "steak" is like reheated truckstop meatloaf."
 
VisionaryTics said:
Seems action-packed, no rounding, lots of variety, mix of medical management and procedures, seems "chill", no call, shift work.

EM has some sizzle, but, personally, I hate the steak. As a med student, I had a really fun rotation at Advocate Christ. I basically only saw level 1s, did 2 chest tubes, multiple lines every shift, intubated, lacs, etc, etc. Seemed fun and I thought a pretty good gig.

As an intern, my EM rotation was honestly the worst month of the year. I'll just quote my thoughts from an earlier post:

"EM rotation as intern has been the low-point of the last 5 years for me (med school, internship).

I just can't take any aspect of it. Picking up a chart and seeing yet another 40-year-old female with weakness, dizziness, abdominal pain who's been here 3 times in the last month. The intractable back pain patient who is screaming and sobbing and can't get a word out except for, "They usually start with Dilaudid 2mg then 1mg every hour after that". Atypical chest pain over and over. Nausea and abdominal pain over and over. Sitting in the middle of our ED is like being in a glass bowl where there are 45 different useless alarms going off and every patient staring at you, with family members occasionally wandering up to ask me if they can have a food tray too. Waiting for consultants and primaries to call me back, wondering what I'm going to get yelled at for this time.

It's just incredibly unpleasant. There is no trust or relationship between physician and patient, or physician and consultant. I spend my entire day staring at the clock waiting to go home. I'm barely learning anything; we order the same shotgun labs and films on every with a given chief complaint. I see the chief complaint, put in my orders, then see the patient. Seeing the patient seems to change management a minority of the time. The big conundrum with every patient is not, "What's going on and how do we treat it?" but rather, "How can I get this patient out of the ED as quickly as possible (either to inpatient, obs, or home)?" I take no satisfaction or pleasure in nearly anything I do.

As a med student, I had a pleasant EM rotation. They didn't really care what I did. I just hung around the level 1s, tried to snag lacs and abscesses, etc. Very skewed look at the specialty. If I was unsure of what I wanted to go into at that point, I think the "sizzle" could have sold me on EM. The "steak" is like reheated truckstop meatloaf."
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I do think it's one of those jobs that sounds good on paper, but is an absolute hell to actually slog through.

Personally, I'd rather quit medicine than do EM.
 
The thing that makes EM unique among specialties is that your typical shift is highly dependent on your local patient population.

Some departments are basically glorified family medicine clinics while others see large numbers of extremely sick patients every day.
 
ciruji said:
Every specialty in these forums are getting competitive according to SDN.. go figure.
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Statistically, every specialty has gotten more competitive in recent matches save for a couple of exceptions. There's more apps than ever in the pile, and the prep materials have gotten so good that scores just keep climbing. It's a numbers game, and there's more competition than ever.
 
alpinism said:
The thing that makes EM unique among specialties is that your typical shift is highly dependent on your local patient population.

Some departments are basically glorified family medicine clinics while others see large numbers of extremely sick patients every day.
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Agreed. It is true that the vast majority of cases through the ED are total bull****, but I enjoy the challenge in trying to find that needle in the haystack of misery. In addition, letting those difficult patients get to you is a choice - if you let it happen, it will happen. It hard not to let them get to you, but look at it this way - they aren't there on a personal mission to make you hate your life; they are just on their own self-destructive spiral and we (as physicians in any specialty, really) can choose not to go with them.

I like being able to handle virtually anything that comes through the door. I like being the kind of doctor that people want for their family members on a plane when little Jimmy inhales a peanut. What is a dermatologist going to do for that? Working in a clinic where each and every pt has the exact same complaint with almost no chance of complications or weird problems would be the worst case scenario for me. I would rather not do medicine if I couldn't do EM. I am so grateful that some of you others are willing to deal with the BS of routine medicine.
 
I considered EM but after thinking about it more:
the shift work, patient population, and stress just did not appeal to as much as what I chose.

And, I agree the field will not see the demand it has now.

But, making only around 200K is low. Folks I know are pulling down 300K+

I do see the appeal overall over other specialties though. Good pay, no rounding, when you are off you are off, etc. It definitely is not the worst gig in medicine to me.
 
exsanguination said:
And yes, I dabbled in derm, plastics, ortho for a while (I had the board scores, name brand school, etc), and I honestly think those specialties are popular PURELY because of their reimbursement potential. Nothing more.
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All 3 have excellent lifestyles, that is what is driving it, whether that is during residency, after residency, or both. A student can't feel reimbursement potential as an attending, but can easily feel lifestyle. The same for the sudden interest in EM where you work in shifts for half the year and it feels great to get to run around as a med student, although those hours are very hard on mind and body when you're in your 40s, but most don't think that far out.
 
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GuyWhoDoesStuff said:
Moonlighting most likely, which is not allowed all places.
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Making 200k as a PGY-3 in EM sounds like absolute hell. I'm not even sure how there's enough time in the week for that; EM residency hours/week are not the same as EM attending hours/week.
 
Dave89 said:
Making 200k as a PGY-3 in EM sounds like absolute hell. I'm not even sure how there's enough time in the week for that; EM residency hours/week are not the same as EM attending hours/week.
Click to expand...

A lot of EM programs have you do fewer shifts as you become more senior. At my institution 3s+4s do 15 shifts/month. If you work in an extra 10-15 shifts in a month you can cake hard.
 
exsanguination said:
Can somebody remind me why EM is so desirable these days?

I say this as an EM resident currently - by the time that you medical students are done with your EM residencies I don't believe the getting will be good. A big reason EM has hit a boom is because of the way our health system has fallen into place. There's a dearth of primary care docs/PAs/NPs/whatever and a relatively new glut of insured patients. This is a very simplified view of something way more complex, but you get the pic. Thus urgent cares and EDs are cleaning up.

The second that this changes, all the "wide-open" job markets you hear about will close tightly again.

And that doesn't even consider the actual day-to-day practice of EM. Generally some single digit percentage of my patients on any given day are TRUE emergencies. Otherwise it's a glorified and expensive family medicine clinic.

Add a few drunks, homeless, and entitled poor (not saying all of the needy are entitled, but interestingly a large percentage of the ones that I treat are far more entitled than the "richies), and boom you have a huge recipe for becoming jaded towards your fellow man, burnt out on your job, and chronically ill (poor health habits and self care).

Now add the constantly changing schedule, and you begin to wonder why this field is DESIRABLE...

All of this for what? A salary of 200k/year to be a replaceable cog in the corporate EM world?

Yet at the end of the day, I really love it. No joke, I just do everything I can to make sure medical students really truly know what they're getting themselves into.

And yes, I dabbled in derm, plastics, ortho for a while (I had the board scores, name brand school, etc), and I honestly think those specialties are popular PURELY because of their reimbursement potential. Nothing more.
Click to expand...

You can say that about any field. Seriously, name me most fields and I can find you docs who says their job sucks. Neurosurg, anesthesiologist, hospitalists, surgeons. Everyone complains. Grass is always greener. Some people are just unhappy. I would say 99.9% of the world would trade for my Job and 99.9% of EM docs would not trade their job for others.

Your 200K a year shows how little you know about EM medicine. I make that in 6 months working 35 hrs/week. How many fields can you name that makes that much in such a short amount of hrs.

EM has flexibility too. Shift work is not great but not as bad as many describe

Everything you said
 
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emergentmd said:
You can say that about any field. Seriously, name me most fields and I can find you docs who says their job sucks. Neurosurg, anesthesiologist, hospitalists, surgeons. Everyone complains. Grass is always greener. Some people are just unhappy. I would say 99.9% of the world would trade for my Job and 99.9% of EM docs would not trade their job for others.

Your 200K a year shows how little you know about EM medicine. I make that in 6 months working 35 hrs/week. How many fields can you name that makes that much in such a short amount of hrs.

EM has flexibility too. Shift work is not great but not as bad as many describe

Everything you said
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still say you paint a rosy picture or at least a fleeting one. if everyone could make 400k working 35 hrs/week they would. you either work somewhere that is very undesirable or you know some magic tricks
 
Tenk said:
Not really, that's community EM pay.
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doesn't mean it isn't fleeting. 400k for 35hr/wk is the definition of a sweet deal, regardless of how high the avg acuity of patients you deal with is, or how tired/burnt out you feel. maybe this is a golden period for EM? gilded ages don't last forever.
 
PL198 said:
doesn't mean it isn't fleeting. 400k for 35hr/wk is the definition of a sweet deal, regardless of how high the avg acuity of patients you deal with is, or how tired/burnt out you feel. maybe this is a golden period for EM? gilded ages don't last forever.
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You don't know what you're talking about. They're actually getting underpaid at that. But why tear down your fellow physicians?
 
PL198 said:
doesn't mean it isn't fleeting. 400k for 35hr/wk is the definition of a sweet deal, regardless of how high the avg acuity of patients you deal with is, or how tired/burnt out you feel. maybe this is a golden period for EM? gilded ages don't last forever.
Click to expand...
Given the recent rescindment of the reasonable rate rules, it is quite likely that this will be the peak of EM salaries. Insurers will soon be able to pay whatever the hell they want for EM services rather than a reasonable rate as determined by the EM provider. Couple this with prohibitions against balance billing and EMTLA and you've got a recipe for disaster.
 
Mad Jack said:
Given the recent rescindment of the reasonable rate rules, it is quite likely that this will be the peak of EM salaries. Insurers will soon be able to pay whatever the hell they want for EM services rather than a reasonable rate as determined by the EM provider. Couple this with prohibitions against balance billing and EMTLA and you've got a recipe for disaster.
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i read something about that somewhere. So it sounds like EM is just going to plummet down the drain.... not to mention mid level encroachment.
 
asdf123g said:
i read something about that somewhere. So it sounds like EM is just going to plummet down the drain.... not to mention mid level encroachment.
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?? Plummet down the drain? When was the last time you heard of this happening to a specialty? There have been cuts to certain fields but what major cuts could happen in EM?
 
PL198 said:
still say you paint a rosy picture or at least a fleeting one. if everyone could make 400k working 35 hrs/week they would. you either work somewhere that is very undesirable or you know some magic tricks
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I say your wrong but what do I know. I am just an EM doc for 15 yrs, work in a very sought after city and Can go to many big cities making 400K working 35 hrs.

This was for the other poster.
 
emergentmd said:
I say your wrong but what do I know. I just work in a very sought after city and Can go to many big cities making 400K working 35 hrs.
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PL198 said:
doesn't mean it isn't fleeting. 400k for 35hr/wk is the definition of a sweet deal, regardless of how high the avg acuity of patients you deal with is, or how tired/burnt out you feel. maybe this is a golden period for EM? gilded ages don't last forever.
Click to expand...

I have contracts on my desk ranging from 275-350/hr IC. I can take one anytime I want. That works out to 500-635K per Year working 35 hrs/week.

400k for 35hr/week IC is underpaid in many areas. And the above are going rates for many BIG cities with many activities.

And what does fleeting mean? How can ANYONE predict the future? Decisions can only be made knowing what we know now. If you are making predictions on what will happen in 5 yrs, then your doomed to fail
 
Mad Jack said:
Given the recent rescindment of the reasonable rate rules, it is quite likely that this will be the peak of EM salaries. Insurers will soon be able to pay whatever the hell they want for EM services rather than a reasonable rate as determined by the EM provider. Couple this with prohibitions against balance billing and EMTLA and you've got a recipe for disaster.
Click to expand...

I actually hope EM becomes less competitive, spots dont fill, half the EM residencies close down. I just need another 5 yrs of EM shortage and I can retire in peace before 50.
 
emergentmd said:
I have contracts on my desk ranging from 275-350/hr IC. I can take one anytime I want. That works out to 500-635K per Year working 35 hrs/week.

400k for 35hr/week IC is underpaid in many areas. And the above are going rates for many BIG cities with many activities.

And what does fleeting mean? How can ANYONE predict the future? Decisions can only be made knowing what we know now. If you are making predictions on what will happen in 5 yrs, then your doomed to fail
Click to expand...

so you're saying it's fairly easy to make more money than a significant amount of surgeons, while working half the hours, doing a 3-4 year residency which is obviously much easier and a much better lifestyle? if that were true, people would be fighting tooth and nail for EM, like derm level competitiveness I'm talking.

I mean come on, basic sniff test says everything has its pros and cons. now you're saying 400k for 35 hr/ week is underpaid? avg doc is making almost half that working close to double the hours when you factor everything in. that doesn't strike you as odd?

maybe all of those things are true, but it seems highly unlikely for it persist. obviously everything isn't about money, but if people can make the kind of money you are talking about, by working 35 hours a week, after a 3-4 yr residency in which you work roughly 40 hours a week as well, while getting to do a bunch of cool procedures and see the broad array of stuff you see in EM, way more people would do it.

I like EM, I really do, but I just don't buy the picture you paint of it. if you doubled the salaries of hospitalists overnight, tons more people would do IM. so if the money was as good as you say, it would probably be the most competitive thing.

I'd love to hear what some other specialties think of what you're saying, because it basically means you're making 2x+/hr what they are making, with less training than a lot of them. Just doesn't seem logical.
 
@tymont12 what i meant was with increasing midlevel encroachment coupled with what mad jack said, is that not reason to be concerned about its future? Those sound pretty significant!
 
It's seems like a 1/4 of my class is suddenly interested in EM. I guess med students are starting to take notice... I have seen job listings offering 350k+ for 120 hrs/month in one of the most desirable locations in FL and I wonder if this salary trend in EM is here to stay for the next 10 years...
 
PL198 said:
so you're saying it's fairly easy to make more money than a significant amount of surgeons, while working half the hours, doing a 3-4 year residency which is obviously much easier and a much better lifestyle? if that were true, people would be fighting tooth and nail for EM, like derm level competitiveness I'm talking.

I mean come on, basic sniff test says everything has its pros and cons. now you're saying 400k for 35 hr/ week is underpaid? avg doc is making almost half that working close to double the hours when you factor everything in. that doesn't strike you as odd?

maybe all of those things are true, but it seems highly unlikely for it persist. obviously everything isn't about money, but if people can make the kind of money you are talking about, by working 35 hours a week, after a 3-4 yr residency in which you work roughly 40 hours a week as well, while getting to do a bunch of cool procedures and see the broad array of stuff you see in EM, way more people would do it.

I like EM, I really do, but I just don't buy the picture you paint of it. if you doubled the salaries of hospitalists overnight, tons more people would do IM. so if the money was as good as you say, it would probably be the most competitive thing.

I'd love to hear what some other specialties think of what you're saying, because it basically means you're making 2x+/hr what they are making, with less training than a lot of them. Just doesn't seem logical.
Click to expand...
Don't forget that EM has a LOT of space to absorb competition with its 1000+ spots or whatever. All the FMGS/IMGS/DOs will be kicked out first. Derm has exactly 0 space to absorb competition.
 
PL198 said:
so you're saying it's fairly easy to make more money than a significant amount of surgeons, while working half the hours, doing a 3-4 year residency which is obviously much easier and a much better lifestyle? if that were true, people would be fighting tooth and nail for EM, like derm level competitiveness I'm talking.

I mean come on, basic sniff test says everything has its pros and cons. now you're saying 400k for 35 hr/ week is underpaid? avg doc is making almost half that working close to double the hours when you factor everything in. that doesn't strike you as odd?

maybe all of those things are true, but it seems highly unlikely for it persist. obviously everything isn't about money, but if people can make the kind of money you are talking about, by working 35 hours a week, after a 3-4 yr residency in which you work roughly 40 hours a week as well, while getting to do a bunch of cool procedures and see the broad array of stuff you see in EM, way more people would do it.

I like EM, I really do, but I just don't buy the picture you paint of it. if you doubled the salaries of hospitalists overnight, tons more people would do IM. so if the money was as good as you say, it would probably be the most competitive thing.

I'd love to hear what some other specialties think of what you're saying, because it basically means you're making 2x+/hr what they are making, with less training than a lot of them. Just doesn't seem logical.
Click to expand...

Fine, I will shut up. Please all med students dont go into EM. Its a tough field. You get paid about 150/hr working your behind off. Everything sucks about EM. there is no way to make 350K working 35hrs/wk unless you are working in war zones.

Hopefully there will be a shortage to continue
 
Tri723 said:
All the FMGS/IMGS/DOs will be kicked out first.
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Trouble with that is that EM is one of the few fields where DOs have a substantial number of DO programs that will retain their DO leadership (and likely osteopathic focus) post-merger. It's unlikely they would shift to only taking MDs overnight, that's many decades out, if ever.
 
emergentmd said:
Fine, I will shut up. Please all med students dont go into EM. Its a tough field. You get paid about 150/hr working your behind off. Everything sucks about EM. there is no way to make 350K working 35hrs/wk unless you are working in war zones.

Hopefully there will be a shortage to continue
Click to expand...

not what I'm saying at all, just saying there's gotta be some realistic drawbacks that aren't readily apparent because the hourly pay and lifestyle appear to be insane. something that appears too good to be true generally is
 
PL198 said:
not what I'm saying at all, just saying there's gotta be some realistic drawbacks that aren't readily apparent because the hourly pay and lifestyle appear to be insane. something that appears too good to be true generally is
Click to expand...
the burn out i hear is very very high relative to other specialities due to the odd hours and the intensity of the 12 hrs (or so i think these are the reasons). Working night shifts when you're in your 40's doesnt sound fun either...
 
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