Is Emergency Medicine genuinely that saturated, and should that still be my long-term goal?

[u1118933]

I am currently a pre-med nurse planning on applying to medical school within the next few years. My plan has been emergency medicine for a long time now and I've heard various times about the over-saturation of this field. I know it is ridiculous to think that I would consider different specialties if that's my true career goal, but will I be entering a job market with no jobs? I wouldn't be done with residency for about another 8 years. Where do you see the job market going? Is there any specific locations that would be better than others? Do fellowships in EM increase your chance of jobs?

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[RustedFox]

Does anyone else wanna tell'em to stay far away from medicine first?

 

[VA Hopeful Dr]

Does anyone else wanna tell'em to stay far away from medicine first?

Nope, plenty areas of medicine are still a good place to be.

 

[Porfirio]

Why not go to DNP school? Cheaper, easier, and less time. In 8 years it will have the same outcome.

You can also do it while you work as a travel nurse to pull in $$$.

 

[bravotwozero]

I am currently a pre-med nurse planning on applying to medical school within the next few years. My plan has been emergency medicine for a long time now and I've heard various times about the over-saturation of this field. I know it is ridiculous to think that I would consider different specialties if that's my true career goal, but will I be entering a job market with no jobs? I wouldn't be done with residency for about another 8 years. Where do you see the job market going? Is there any specific locations that would be better than others? Do fellowships in EM increase your chance of jobs?

read around some of the other threads on here. Barring major policy changes or unexpected demand surge/workforce loss, we're on track to have 10,000 unemployed EM grads in about 10 years time, which is likely where you'll end up by time you're done. Not a good place to be. As for avoiding medicine altogether, depends on a few factors. If you manage to get to residency with having minimal (<100k) to no loans, you'll end up coming out ahead financially in many specialties. Otherwise, being a nurse is a pretty good bet.

 

[Birdstrike]

I am currently a pre-med nurse planning on applying to medical school within the next few years. My plan has been emergency medicine for a long time now and I've heard various times about the over-saturation of this field. I know it is ridiculous to think that I would consider different specialties if that's my true career goal, but will I be entering a job market with no jobs? I wouldn't be done with residency for about another 8 years. Where do you see the job market going? Is there any specific locations that would be better than others? Do fellowships in EM increase your chance of jobs?

As SDN EM's Chief Professor of Doom and Gloom, I have something positive to say: 8 years is too far ahead in the future to make the determination you're trying to make. Most of us didn't even end up going into what we thought we wanted to be as pre-meds. I was 100% certain I'd be a General surgeon. That is, until I was 100% certain I was born to be an EM physician. That is, until I was 100% certain I was leaving the emergency department after 10 years, to do a Pain fellowship. Now I've been doing Interventional Pain Medicine for 10 years and it feels sustainable for the rest of my career. But in eight more years? Who knows. (The Pain doom-n-gloomers were predicting Pain would be dead 10 years ago, but here I am).

Think of these job market predictions like the weather forecast. You should be aware of the predicted trends, but don't put too much weight in them. There are too many things that could change in the next 8 years. Ten years ago, all anyone in EM could talk about was "There will always be too few ER doctors." Now it's, "There will always be too many ER doctors."

When it comes down to it, no one really knows. Just have a direction, go for it and make changes based on conditions along the way.

 

[u1118933]

Why not go to DNP school? Cheaper, easier, and less time. In 8 years it will have the same outcome.

You can also do it while you work as a travel nurse to pull in $$$.

I have a few reasons for avoiding the DNP route, the main ones being oversaturation (which is ironic because I want to be an EM doc), 2 is I want to have the deepest level of medical training I can get, three is non-standardized curriculum throughout the country which scares me

 

[u1118933]

read around some of the other threads on here. Barring major policy changes or unexpected demand surge/workforce loss, we're on track to have 10,000 unemployed EM grads in about 10 years time, which is likely where you'll end up by time you're done. Not a good place to be. As for avoiding medicine altogether, depends on a few factors. If you manage to get to residency with having minimal (<100k) to no loans, you'll end up coming out ahead financially in many specialties. Otherwise, being a nurse is a pretty good bet.

I've thought about CRNA school but it seems like all of the advanced practice RN positions are becoming filled.

 

[Groove]

Re-assess when you are in years 3 and 4 of med school. If market conditions remain the same or worse (and they probably will be worse...), then consider an alternate career path that provides similar mental stimulation and skill set...i.e. critical care.

The age old adage will tell you to "pick what you love and the money will take care of itself" and I used to sing this all day every day but 10 years in any given specialty will open your mind. You've basically mastered your specialty by that point (probably much sooner) and other specialties with new challenges and new concepts suddenly don't seem so bad. In fact, on certain days it becomes a chore imaging how you're going to stay motivated doing the same specialty for 30 years. That's the beauty of DNP school... you get good income with an enormous amount of flexibility over your career to work in multiple specialties. That being said, I understand the deeper rooted reasons for pursuing med school..the self perceived prestige and ego gratification followed by a deep personal sense of accomplishment. The appeal to persons of an obsessive compulsive nature who want the ultimate stamp of mastery in the medical sciences. (At the cost of pragmatism and sanity...)

The truth is that human beings are incredibly flexible and medicine is so varied and interesting to most physicians that you could probably reach equal degrees of career satisfaction in multiple specialties. I've said it before but I could have probably been equally happy doing CC and/or hospitalist medicine. I enjoy procedures but after 12 years of doing them...they aren't nearly as exciting anymore. Some days I even envy our hospitalist colleagues with their flexibility, "slower" pace, deeper understanding of pathology and 7on - 7off schedules (many of which don't require nights).

 

[nVictus]

On one hand, no one can predict the future but on the other hand, the math doesn't work out for EM.... there are simply too many docs/residencies and not enough jobs or docs retiring.... that doesn't change in the next 10 years. If 50% of my coworkers were 50-60+ years old, sure... but 80%+ are in their 30s/40s so no one is quitting for another 10+ years.

 

[RustedFox]

Re-assess when you are in years 3 and 4 of med school. If market conditions remain the same or worse (and they probably will be worse...), then consider an alternate career path that provides similar mental stimulation and skill set...i.e. critical care.

The age old adage will tell you to "pick what you love and the money will take care of itself" and I used to sing this all day every day but 10 years in any given specialty will open your mind. You've basically mastered your specialty by that point (probably much sooner) and other specialties with new challenges and new concepts suddenly don't seem so bad. In fact, on certain days it becomes a chore imaging how you're going to stay motivated doing the same specialty for 30 years. That's the beauty of DNP school... you get good income with an enormous amount of flexibility over your career to work in multiple specialties. That being said, I understand the deeper rooted reasons for pursuing med school..the self perceived prestige and ego gratification followed by a deep personal sense of accomplishment. The appeal to persons of an obsessive compulsive nature who want the ultimate stamp of mastery in the medical sciences. (At the cost of pragmatism and sanity...)

The truth is that human beings are incredibly flexible and medicine is so varied and interesting to most physicians that you could probably reach equal degrees of career satisfaction in multiple specialties. I've said it before but I could have probably been equally happy doing CC and/or hospitalist medicine. I enjoy procedures but after 12 years of doing them...they aren't nearly as exciting anymore. Some days I even envy our hospitalist colleagues with their flexibility, "slower" pace, deeper understanding of pathology and 7on - 7off schedules (many of which don't require nights).

On one hand, no one can predict the future but on the other hand, the math doesn't work out for EM.... there are simply too many docs/residencies and not enough jobs or docs retiring.... that doesn't change in the next 10 years. If 50% of my coworkers were 50-60+ years old, sure... but 80%+ are in their 30s/40s so no one is quitting for another 10+ years.

Groove hit on this awhile back, but it bears repeating:

"HEY ACEP: Give us an "outpatient" fellowship. Make it 1 year, maybe 18 months or so. Let us go and do so many of the jobs that only hire FM/IM, and watch as we go do them faster and better than a lot of FM/IM docs out there."

Reeling myself back in, I'll say this: No, the average EP isn't ready to go do outpatient work after 3 years of residency. We will need some more work and study; but given the way medicine is shaping up in this nation, it would be a great way to fill a big need. Also, enterprising EPs will find ways to make a lot of money doing this.

 

[sylvanthus]

Does anyone else wanna tell'em to stay far away from medicine first?

Ehh ive tried and it never works. Im just looked at as a disgruntled doc.

So, OP, go for it! Medicine is awesomesauce and well worth the sacrifice.

 

[gamerEMdoc]

As SDN EM's Chief Professor of Doom and Gloom, I have something positive to say: 8 years is too far ahead in the future to make the determination you're trying to make. Most of us didn't even end up going into what we thought we wanted to be as pre-meds. I was 100% certain I'd be a General surgeon. That is, until I was 100% certain I was born to be an EM physician. That is, until I was 100% certain I was leaving the emergency department after 10 years, to do a Pain fellowship. Now I've been doing Interventional Pain Medicine for 10 years and it feels sustainable for the rest of my career. But in eight more years? Who knows. (The Pain doom-n-gloomers were predicting Pain would be dead 10 years ago, but here I am).

Think of these job market predictions like the weather forecast. You should be aware of the predicted trends, but don't put too much weight in them. There are too many things that could change in the next 8 years. Ten years ago, all anyone in EM could talk about was "There will always be too few ER doctors." Now it's, "There will always be too many ER doctors."

When it comes down to it, no one really knows. Just have a direction, go for it and make changes based on conditions along the way.

Yeah I think you have the benefit of time to see what changes, if anything, and how bad the job market actually becomes if nothing gets improved. By the time you are applying for residency, our field will be in the midst of significant change in order to accommodate the expanded workforce, or it will be a dumpster fire of unemployment. Or maybe neither. 8 years ago most people were saying we may never get to EDs being staffed fully by EM docs. A lot changes with time. For all we know, the US healthcare system could look unrecognizable in eight years compared to today.

 

[Birdstrike]

Part of life is saying to yourself, "I've taken all the information in that I can and now it's time to say, 'F the naysayers. I'm doing what I want.'" I know that might not always be the best advice. But sometimes it is. You don't get your future self to consult. And other people further along, that think they know "how you should do it" because they think they knew what they "should have done' if they knew what they know now, didn't always make perfect decisions. They've proven that to you, by telling you they did something they regret. And they can't predict your future any better than you can.

Make whatever decisions you think are the best at the time and dive the hell in, to whatever that is. Change course as needed if conditions change or if you get new information along the way, but never waste time on regrets. Never. Regrets are nothing more than time wasted on an unchangeable past, that could be spent deciding now, how to make your best life today and in the future.

 

[Kryptocoin]

I am currently a pre-med nurse planning on applying to medical school within the next few years. My plan has been emergency medicine for a long time now and I've heard various times about the over-saturation of this field. I know it is ridiculous to think that I would consider different specialties if that's my true career goal, but will I be entering a job market with no jobs? I wouldn't be done with residency for about another 8 years. Where do you see the job market going? Is there any specific locations that would be better than others? Do fellowships in EM increase your chance of jobs?

Well ACEP have already answered that question. By 2030, so 9 yrs from now, we will have an oversupply of EM physicians. If all goes according to plan without much glitch, you will be entering the job market around that time (premed +med school + residency). If ACEP predictions are true, I definitely wouldn't want to be you.

However, unlike the rest of us , you do have the luxury of time to plan things out before you match into EM. I would look into CC, Pain, even palliative care fellowship if you do decide to pursue EM.

 

[Birdstrike]

Once upon a time, I made a decision to move to an apartment complex in Detroit at the city's rock bottom in the '90s. During that year, we had two homicides in the building, one of which I partially witnessed and was later called to testify about. I had my car broken into, witnessed a car repossession, and got many (well deserved) noise complaints due to being a normal 21-year-old idiot.

Was it the best decision moving there? No. Living in Detroit was nuts. You had the sense that you could lose your life at any minute. Do I 'regret' it? Not for a second. My year in that hellscape was the best year of education this naive boy from the suburbs ever got.

 

[Rekt]

Way too much text in this thread.

TLDR: if you're going into emergency medicine, you're making an extremely poor choice and your chance at severe underemployment or unemployment is very high.


As 100% completely expected and predicted we've had a few more jobs open in the past couple months which has made everyone forget about the job report and become complacent.

The workforce report is very real and will be the future. Especially as acep is still sitting with their fingers up their ass collecting more and more cmg money.

 

[RustedFox]

Way too much text in this thread.

TLDR: if you're going into emergency medicine, you're making an extremely poor choice and your chance at severe underemployment or unemployment is very high.


As 100% completely expected and predicted we've had a few more jobs open in the past couple months which has made everyone forget about the job report and become complacent.

The workforce report is very real and will be the future. Especially as acep is still sitting with their fingers up their ass collecting more and more cmg money.

I remember how much heat you caught when you first came around these parts.
I remember thinking to myself: "he's more right than he thinks he is."

 

[Franzd'Epinay]

I'm surprised people are unironically suggesting becoming an NP.

The quality control in their schooling is... nonexistent, to put it nicely. Could you become a good clinician if you become an NP? Absolutely. Are NP programs structured so that this is the most likely outcome? No way.

OP, if you like medicine but don't want to become a physician, consider becoming a PA instead.

 

[GeneralVeers]

I wouldn't recommend EM to anyone now, especially someone 4-5 years away from starting residency. The long-term outlook is catastrophic, and barring a major, unforeseeable shift, anyone going into this field is likely to be underemployed.

 

[Apollyon]

I remember how much heat you caught when you first came around these parts.
I remember thinking to myself: "he's more right than he thinks he is."

A broken clock is right twice a day. Even a blind squirrel occasionally finds an acorn.

 

[Birdstrike]

It's better to be at the top of the mountain dealing with the wind, than to be at the bottom looking up.

 

[RustedFox]

I wouldn't recommend EM to anyone now, especially someone 4-5 years away from starting residency. The long-term outlook is catastrophic, and barring a major, unforeseeable shift, anyone going into this field is likely to be underemployed.

Apart from the bolded (which is inarguably true), the work itself is REALLY COOL for like the first few years only.
After that, and you realize that 90% of Emergency Medicine is simply adult babysitting, it begins to eat your soul.

We all know this, but it needed to be re-stated here for the OP's sake.

 

[Birdstrike]

After that, and you realize that 90% of Emergency Medicine is simply adult babysitting, it begins to eat your soul.

100% devastating. 100% true.

 

[GeneralVeers]

Apart from the bolded (which is inarguably true), the work itself is REALLY COOL for like the first few years only.
After that, and you realize that 90% of Emergency Medicine is simply adult babysitting, it begins to eat your soul.

We all know this, but it needed to be re-stated here for the OP's sake.

And it's getting worse! We count each shift how many visits are simply a "failure to adult". For example, 19-year old male with viral illness who "can't swallow pills". I swear 2/3 of our visits are now simply about teaching the basics of living. Fully 90% of peds visits are failures at parenting.

 

[Ms Procrastinator]

Aside from pursuing something outside of medicine, what would you recommend someone pursue? What specialty is not suffering?

 

[RustedFox]

And it's getting worse! We count each shift how many visits are simply a "failure to adult". For example, 19-year old male with viral illness who "can't swallow pills". I swear 2/3 of our visits are now simply about teaching the basics of living. Fully 90% of peds visits are failures at parenting.

Seriously.

It blows my mind when the premeds and early med students say things like: "EM is the ONLY thing I can IMAGINE myself DOING."

I was one of those kids. It all seemed so awesome. Really did.

Then, you hit that point; where you realize... this is all nonsense. And you're in the middle of it, taking the abuse... from both patient, and admin.

 

[Sushirolls]

...and then Lawyer and Insurance Company walk into the bar, and say why the long face?

 

[GonnaBeADoc2222]

Aside from pursuing something outside of medicine, what would you recommend someone pursue? What specialty is not suffering?

-Private equity

-Cash only cosmetic plastics

 

[Kryptocoin]

-Private equity

-Cash only cosmetic plastics

I will add, any specialty where you have a large amount of control over the decision making (hiring and firing of staff, patient selection, insurance etc). Derm, Plastics, Ortho, ENT etc.

 

[GonnaBeADoc2222]

How many threads do we need on this topic? Like, honestly?

Not only is:
1) The job market saturated
2) The job basically sucks

I went from being a CMG cog (awful awful work environment), to a community academic cog where I can get away with seeing 1.5 pph (this is ABOVE average for the group lollll) and work zero overnights. And...it still kinda sucks. The nature of EM and what it attracts is just...bad.

 

[Birdstrike]

Aside from pursuing something outside of medicine, what would you recommend someone pursue? What specialty is not suffering?

Any specialty where you can work regular hours, no nights, no weekends, no holidays and no call, can be good. That's as long as you don't put yourself >6 mos salary in debt during your training. I did EM for 10 years. It was a mind-***king hellscape. I now do Interventional Pain medicine and have for 10 years. Though it's not perfect, it's much, much better. The schedule is perfect like Derm. You do cool procedures. It's low stress. The pay is reasonably good. The patients and chronicity can be challenging at times. But on balance, I feel like I've finally landed in a sub-world of Medicine that doesn't mentally, physically and psychologically destroy me. In fact, it's pretty good.

At your stage, the problem is you face 24 hours, 7 days per week of psychological gaslighting where your mentors, peers and self are all signalling to you that all the good specialties suck and all the soul-crushing, psychosocial life destroying specialties are all the good ones. It's a little bit like entering a psychedelic clockwork-orange world that tries to rearrange how and what your brain thinks like virus-malware. Coming out the otherside as true to yourself as you went in, is quite challenging.

Ten years from now, you're going to remember this very post from me, that you're now thinking is 100% nuts. And you're going to think, holy crap, that crazy Bird- what's-his-name guy was actually right.

 

[Ho0v-man]

Any specialty where you can work regular hours, no nights, no weekends, no holidays and no call, can be good. That's as long as you don't put yourself >6 mos salary in debt during your training. I did EM for 10 years. It was a mind-***king hellscape. I now do Interventional Pain medicine and have for 10 years. Though it's not perfect, it's much, much better. The schedule is perfect like Derm. You do cool procedures. It's low stress. The pay is reasonably good. The patients and chronicity can be challenging at times. But on balance, I feel like I've finally landed in a sub-world of Medicine that doesn't mentally, physically and psychologically destroy me. In fact, it's pretty good.

At your stage, the problem is you face 24 hours, 7 days per week of psychological gaslighting where your mentors, peers and self are all signalling to you that all the good specialties suck and all the soul-crushing, psychosocial life destroying specialties are all the good ones. It's a little bit like entering a psychedelic clockwork-orange world that tries to rearrange how and what your brain thinks like virus-malware. Coming out the otherside as true to yourself as you went in, is quite challenging.

Ten years from now, you're going to remember this very post from me, that you're now thinking is 100% nuts. And you're going to think, holy crap, that crazy Bird- what's-his-name guy was actually right.

There’s literally nothing that meets this criteria anymore. Those of us without help paying for school are all over $300k in debt. Most at my school are at about $400k on just med school alone.

 

[RustedFox]

There’s literally nothing that meets this criteria anymore. Those of us without help paying for school are all over $300k in debt. Most at my school are at about $400k on just med school alone.

Yep.
I was one of these kids.

330 something k in debt.
I got out in 8 years.

Timesink.

 

[bravotwozero]

I will add, any specialty where you have a large amount of control over the decision making (hiring and firing of staff, patient selection, insurance etc). Derm, Plastics, Ortho, ENT etc.

The most fundamental question that any young person trying to consider what career to pursue should try to answer would be: Do I want to be an employee, or do I want to be an owner, and accept all the liabilities and risks that come with either decision? Because the answer to that question will result in profound life altering consequences, be it within or outside of medicine.

 

[Birdstrike]

There’s literally nothing that meets this criteria anymore. Those of us without help paying for school are all over $300k in debt. Most at my school are at about $400k on just med school alone.

If that didn't exist anymore for me, I'd focus on controlling the part I can control, which is this part: Choosing a specialty where you can work regular hours, no nights, no weekends, no holidays and no call. Choose one of those and either find a job with some loan forgiveness program (rare, I know) or accept that you're going to have an extra house/car payment for the next 30 years. Because the other choice, which is to pick a specialty that makes you miserable for extra money, if a fool's errand. Many will still do it, though. The burnout rate in Medicine is high, for this among other reasons.

I was lucky to get out with $150,000 in debt. That was 20 years ago and I'm still paying on it. But I'm okay with it, because after a hard road of detours, I finally landed in a specialty that's relatively low stress and sustainable. It would obviously have been easier if I had rich parents that paid for my med school, but I didn't, and neither do most people.

 

[dchristismi]

I think you have to pick your poison too...

In residency, I hated call. Now that I am in a subspecialty where the practice has structured call well, it isn't really that bad. (Says the acting medical director who has been basically on backup call for everything the last week straight.) As long as your staff is trained well and expectations are set, it doesn't have to be terrible. Because of my background in EM, I really don't mind holidays or weekends either because it's not all of them.

Aside from pursuing something outside of medicine, what would you recommend someone pursue? What specialty is not suffering?

I read this wearing my HPM hat... because my specialty and expertise IS suffering. Ha. And HPM is exploding in a good way. You sort of have to be built for it, but it's definitely hurting for docs. EM is the perfect training ground, but I'm biased.

I've just finished 3 of the toughest, most complicated inpatient days I've done in a long time with some really tricky patients (I have one who would be a textbook EM nightmare and she's now one of my greatest successes... thanks to methadone, ketamine, and an obscure cardiac drug, among other things, that is an oral analog of lidocaine that I have found fantastic for refractory tenesmus, with my now N=2.) And I really love my work, because my worst day here is still better than the pit.

 

[EctopicFetus]

Simply you got to earn that money and get to FI. After that all the nonsense is either much easier to tolerate or you can bail when annoyed. I think the future is bleak. I also think there isnt enough that can be done to make those changes. Suggestions sure, there are tons. Actions that will be taken. NFW. ACEP wont allow it, CMGs will benefit, hospitals will benefit, docs will be screwed. Thats the story of 2030.

 

[namethatsmell]

There’s literally nothing that meets this criteria anymore. Those of us without help paying for school are all over $300k in debt. Most at my school are at about $400k on just med school alone.

You wrote this in response to @Birdstrike 's recommendation of: Any specialty where you can work regular hours, no nights, no weekends, no holidays and no call, can be good. That's as long as you don't put yourself >6 mos salary in debt during your training.

@Ho0v-man , while you're partially correct you're (possibly) also way off base.

You're spot-on that med school debts continue to grow and grow with each year. It sucks balls.

But you're potentially waayyy off base if you're convinced that you can't get into a specialty working regular hours, no nights, no weekend, no holiday and no call...and still pay off your loans. But I honestly can't tell from how your post is phrased. You may not be saying this in which case, my bad. But if you are...well dude you absolutely can.

And you don't have to be a super genius to do it. I tell med students to at least consider what have become the stealth "lowlies"-- Psych, IM and FM (lets call them PIF for brevity). Despite increasing awareness about how awesome PIF can be from a lifestyle and $ perspective, they still get crapped on all day long by ivory tower folks and subspecialists so med students stay primed to also look down on them. But I'm telling every med student who reads this...take a look at the trillions of job postings for outpatient jobs in these areas. No matter how desirable the city/location, there are always postings for 4d/wk no nights/weekends/holiday jobs in these fields paying in at least the mid 200s...yes that includes Denver, Austin (and other places EM folks who kill to work in). Many of these gigs offer loan repayment too. Many employed PIF docs make well into the 300s (and sometimes into the 400s). PIFs who start their own practice can make much more. PIF also offers a gigantic amount of varied work options to meet your life/financial needs and keep things fresh and reinvent your career (if you want that) over time. They also allow the lowest priced entry into a cash-only practice where patients don't get raked over the coals and docs get paid fairly and have total control.

And this is just for arguably 3 of the least competitive fields in medicine.

Will step off my soap-box now...but just because EM is imploding doesn't mean all of medicine is totally horrible. Within the overall sea of $hit medicine is currently resembling, there are still several bright spots if you look for them.

 

[dadaddadaBATMAN]

There’s literally nothing that meets this criteria anymore. Those of us without help paying for school are all over $300k in debt. Most at my school are at about $400k on just med school alone.

It can vary significantly depending where you go. Graduated within last 7 years from a middle of the road institution in terms of rank and cost. If you took out max cost of living and tuition you would have 280k. Most were closer to 240-250. Admittedly cost of living was a huge factor. Going to a public school could have taken off about 50k.

Go on East or west coast and you can add 100k minimum. Have a working spouse and you can also save substantially.

Many specialties make 400k at least on paper.

So no, it’s not “no specialty” and “no medical students”

I have a friend starting in psych who meets all his criteria without help from parents. Just gotta be willing to live in the Midwest

 

[Ho0v-man]

You wrote this in response to @Birdstrike 's recommendation of: Any specialty where you can work regular hours, no nights, no weekends, no holidays and no call, can be good. That's as long as you don't put yourself >6 mos salary in debt during your training.

@Ho0v-man , while you're partially correct you're (possibly) also way off base.

You're spot-on that med school debts continue to grow and grow with each year. It sucks balls.

But you're potentially waayyy off base if you're convinced that you can't get into a specialty working regular hours, no nights, no weekend, no holiday and no call...and still pay off your loans. But I honestly can't tell from how your post is phrased. You may not be saying this in which case, my bad. But if you are...well dude you absolutely can.

And you don't have to be a super genius to do it. I tell med students to at least consider what have become the stealth "lowlies"-- Psych, IM and FM (lets call them PIF for brevity). Despite increasing awareness about how awesome PIF can be from a lifestyle and $ perspective, they still get crapped on all day long by ivory tower folks and subspecialists so med students stay primed to also look down on them. But I'm telling every med student who reads this...take a look at the trillions of job postings for outpatient jobs in these areas. No matter how desirable the city/location, there are always postings for 4d/wk no nights/weekends/holiday jobs in these fields paying in at least the mid 200s...yes that includes Denver, Austin (and other places EM folks who kill to work in). Many of these gigs offer loan repayment too. Many employed PIF docs make well into the 300s (and sometimes into the 400s). PIFs who start their own practice can make much more. PIF also offers a gigantic amount of varied work options to meet your life/financial needs and keep things fresh and reinvent your career (if you want that) over time. They also allow the lowest priced entry into a cash-only practice where patients don't get raked over the coals and docs get paid fairly and have total control.

And this is just for arguably 3 of the least competitive fields in medicine.

Will step off my soap-box now...but just because EM is imploding doesn't mean all of medicine is totally horrible. Within the overall sea of $hit medicine is currently resembling, there are still several bright spots if you look for them.

It can vary significantly depending where you go. Graduated within last 7 years from a middle of the road institution in terms of rank and cost. If you took out max cost of living and tuition you would have 280k. Most were closer to 240-250. Admittedly cost of living was a huge factor. Going to a public school could have taken off about 50k.

Go on East or west coast and you can add 100k minimum. Have a working spouse and you can also save substantially.

Many specialties make 400k at least on paper.

So no, it’s not “no specialty” and “no medical students”

I have a friend starting in psych who meets all his criteria without help from parents. Just gotta be willing to live in the Midwest

Thanks guys but I’ve already matched and I know I’ll be fine. I was referring to awesome hours AND the whole part about not going into more debt than 6 months of salary. Nothing makes $800k and has no call and bankers hours.

 

[Frazier]

I think you have to pick your poison too...

In residency, I hated call. Now that I am in a subspecialty where the practice has structured call well, it isn't really that bad. (Says the acting medical director who has been basically on backup call for everything the last week straight.) As long as your staff is trained well and expectations are set, it doesn't have to be terrible. Because of my background in EM, I really don't mind holidays or weekends either because it's not all of them.


I read this wearing my HPM hat... because my specialty and expertise IS suffering. Ha. And HPM is exploding in a good way. You sort of have to be built for it, but it's definitely hurting for docs. EM is the perfect training ground, but I'm biased.

I've just finished 3 of the toughest, most complicated inpatient days I've done in a long time with some really tricky patients (I have one who would be a textbook EM nightmare and she's now one of my greatest successes... thanks to methadone, ketamine, and an obscure cardiac drug, among other things, that is an oral analog of lidocaine that I have found fantastic for refractory tenesmus, with my now N=2.) And I really love my work, because my worst day here is still better than the pit.

mexiletine?

 

[dadaddadaBATMAN]

Thanks guys but I’ve already matched and I know I’ll be fine. I was referring to awesome hours AND the whole part about not going into more debt than 6 months of salary. Nothing makes $800k and has no call and bankers hours.

Congratulations. My point was it doesn’t have to make 800k to meet his criteria for many students, could be closer to 400k and meet them. Have a good one

 

[dchristismi]

mexiletine?

Yep. Maybe it's not that obscure, but it's not really in the EM wheelhouse. My self-proclaimed junkie (with horrible metastatic badness FWIW) has now decided she feels so good she wants off her dilaudid PCA. Oy.

 

[Siggy]

"HEY ACEP: Give us an "outpatient" fellowship. Make it 1 year, maybe 18 months or so. Let us go and do so many of the jobs that only hire FM/IM, and watch as we go do them faster and better than a lot of FM/IM docs out there."

Could you imagine the horror on this forum if the FM forum had a thread going, "Do FM and then a 1 year EM fellowship... and you'll be better and faster than a lot of EM docs out there."

 

[RustedFox]

Could you imagine the horror on this forum if the FM forum had a thread going, "Do FM and then a 1 year EM fellowship... and you'll be better and faster than a lot of EM docs out there."

Unclear on whether you're mocking me, or remarking on how "you can work in the ER as FM, but you can't work FM as an EP" is actually in practice.

 

[deleted77919]

…

 

[Siggy]

Unclear on whether you're mocking me, or remarking on how "you can work in the ER as FM, but you can't work FM as an EP" is actually in practice.

Can you work in EM as FM?

Yes... and I agree that they shouldn't.

...but could you imagine the family physician (ignoring the ones who helped establish the field) proclaiming that they were better AND faster than many residency trained EM specialists?

 

[RustedFox]

Can you work in EM as FM?

Yes... and I agree that they shouldn't.

...but could you imagine the family physician (ignoring the ones who helped establish the field) proclaiming that they were better AND faster than many residency trained EM specialists?

Ah; I see.

I didn't mean to imply that "FM is slow, lulz, we R fastR".

That's not true across the board, and you and I both know that.

However, I'll point out that the ER expats around here that now do other things frequently remark that their background as an EP has made them faster at their new gig than their non-EM trained counterparts.

I recently started a side gig as "the EP in the room of FM", and that notion seems to be holding true for me as well.

To be clear, I'm not hating on FM as a field. I think FM can be awesome. I wish I had a lot of the FM skills in my set. What I'm saying is that EM-trained folks have the *move your ass* skill maxed-out, and it's a very useful and translatable skill.

 

[dadaddadaBATMAN]

Can you work in EM as FM?

Yes... and I agree that they shouldn't.

...but could you imagine the family physician (ignoring the ones who helped establish the field) proclaiming that they were better AND faster than many residency trained EM specialists?

I agree with you that this is obviously not true, but there are people who claim exactly this on the fm forums. One of the more recent threads I read had one fm doc claiming to be saving “countless patients” from the mismanagement of his em colleagues.

I find it interesting how as soon as we go to residency we all seem to forget we have near identical base training and a strong background in the same basic sciences. Any one of us can presumably learn the ins and outs of another ones job in a few years (residency). In jobs with overlap (em/fm/im/Peds), it realistically could be less, but due to our own institutions it won’t be. As a camp physicians need to start getting our crap together and ignoring the infighting. People have been eating our lunch a long damn time.