Job help

[watermanMD]

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Graduating EM resident here. May go back for Addiction vs. Tox fellowship after 1-2 years.

Currently debating between some jobs:

A) Mostly ideal coastal location, SDG with 4 year buy-in. Pre-partner pay is base rate + RVU incentive ($7$/hr bottom 75% vs 15$/hr top 25%) + quality (minuscule). Once partner, +profit share bonus Q4. Basically, making 15-20% less as non-partner to buy in, then are “up for partnership vote”, which I’m told is a shoe in. Good benefits. Hospital system is mix of well-off patients and low SES. Work mostly at one place but can rotate within county if desired. No FSED shifts in first 2-3 years. Not much trauma. Hospital system has good resources.

B) Undesirable coastal location (will have to drive minimum 2hrs for some hobbies) hospital-employed with good pay from day one. Pay is base + RVU + quality incentive. This adds up to essentially partner pay from day one as compared to job above, possibly slightly less. Sovereign immunity. Good benefits. Ability to take off large amounts of time (months) without penalty. Hospitals are mix of county, community. Essentially no peds. Good OB support. A few FSED shifts. Decent hospital resources. Level II trauma. Usually start people at part time, as seasonally slower when brought on in summer and transition to full time with option to remain part time if aligns with lifestyle.

C) Mostly ideal coastal location, hospital-employed with subpar pay (similar/ slightly higher to non-partner years in job A right now). Pay is base + RVU (15%) with looking to transition to higher % RVU in coming years (20-25% per director). Sovereign immunity. Good benefits. Mostly sick, county-type patients. Level II trauma. Some shifts at FSED or smaller community ER in county. Good OB support and peds.

D) Mostly ideal central location with local attending SDG with pre specified $ buy-in (usually takes partners 3-4yrs on avg). Amount is similar to $ withheld over 4 pre-partner years in job A. Overall appears to have highest compensation once partner. Most shifts will likely be at FSED and/or community, unfortunately. Good hospital resources/ support with easy transfers to mothership. Good benefits.

What benefits aside from compensation are there with joining a SDG for someone that is not really business-minded at the moment (maybe that will change)? Does anyone prefer hospital-employed positions over SDG? Is skill atrophy a real thing if I’m relegated to a FSED like some new grads have been? Thankfully have <100k in loans to repay and live like a dirtbag and have no plans on ever changing that, so plan to pay off quickly. Have no real ties or kids to care/support. Probably won’t do full time EM forever, hence the fellowship ideas. Any other thoughts? Tried talking to attendings but they are super pro-SDG and can’t give me much else—don’t know if they have grasp on real world. Recent grads all seemed to accept jobs in a COVID pinch so have been gathering their insight but looking for other insight. Appreciate any and all thoughts!

 

[Porfirio]

Why do a partner buy in if you want to go back to do a fellowship?

Also, if you plan to go back to fellowship focus on the money and not the location.

The most important decision you have is fellowship or no fellowship. That will determine everything.

 

[Zebra Hunter]

What are the base rates for these jobs? Also, an $8 difference for RVU incentive? What kind of incentive is that? It’d take you over a 1000 hours as a top 25% RVU earner to generate an extra $8k. The only way I see that as a real incentive is if the base pay is absurdly low.

 

[Groove]

Graduating EM resident here. May go back for Addiction vs. Tox fellowship after 1-2 years.

Currently debating between some jobs:

A) Mostly ideal coastal location, SDG with 4 year buy-in. Pre-partner pay is base rate + RVU incentive ($7$/hr bottom 75% vs 15$/hr top 25%) + quality (minuscule). Once partner, +profit share bonus Q4. Basically, making 15-20% less as non-partner to buy in, then are “up for partnership vote”, which I’m told is a shoe in. Good benefits. Hospital system is mix of well-off patients and low SES. Work mostly at one place but can rotate within county if desired. No FSED shifts in first 2-3 years. Not much trauma. Hospital system has good resources.

B) Undesirable coastal location (will have to drive minimum 2hrs for some hobbies) hospital-employed with good pay from day one. Pay is base + RVU + quality incentive. This adds up to essentially partner pay from day one as compared to job above, possibly slightly less. Sovereign immunity. Good benefits. Ability to take off large amounts of time (months) without penalty. Hospitals are mix of county, community. Essentially no peds. Good OB support. A few FSED shifts. Decent hospital resources. Level II trauma. Usually start people at part time, as seasonally slower when brought on in summer and transition to full time with option to remain part time if aligns with lifestyle.

C) Mostly ideal coastal location, hospital-employed with subpar pay (similar/ slightly higher to non-partner years in job A right now). Pay is base + RVU (15%) with looking to transition to higher % RVU in coming years (20-25% per director). Sovereign immunity. Good benefits. Mostly sick, county-type patients. Level II trauma. Some shifts at FSED or smaller community ER in county. Good OB support and peds.

D) Mostly ideal central location with local attending SDG with pre specified $ buy-in (usually takes partners 3-4yrs on avg). Amount is similar to $ withheld over 4 pre-partner years in job A. Overall appears to have highest compensation once partner. Most shifts will likely be at FSED and/or community, unfortunately. Good hospital resources/ support with easy transfers to mothership. Good benefits.

What benefits aside from compensation are there with joining a SDG for someone that is not really business-minded at the moment (maybe that will change)? Does anyone prefer hospital-employed positions over SDG? Is skill atrophy a real thing if I’m relegated to a FSED like some new grads have been? Thankfully have <100k in loans to repay and live like a dirtbag and have no plans on ever changing that, so plan to pay off quickly. Have no real ties or kids to care/support. Probably won’t do full time EM forever, hence the fellowship ideas. Any other thoughts? Tried talking to attendings but they are super pro-SDG and can’t give me much else—don’t know if they have grasp on real world. Recent grads all seemed to accept jobs in a COVID pinch so have been gathering their insight but looking for other insight. Appreciate any and all thoughts!

Your attendings are out of touch with the real world, like most ivory tower faculty. Personally, I don't really consider partnership tracks that are more than 2-3 years. 4 years is ridiculous, especially in this day and age when CMGs are basically Skynet, dropping in a few T1000s every now and then to blitzkrieg an SDG's "stable" hospital contract.

What's the PPH at these jobs? 25% pay cut is not such a big deal when it's working 1.6PPH and the higher paying job is 2.5 If they are both 2PPH then yes, it's a big deal.

I don't see why you are even considering SDGs if you are thinking about fellowship. You're the perfect person who should be picking a CMG job with a sign on loan repayment for a couple years at no loss in pay to help pay off your loans and give you some time to make up your mind about fellowships. I wouldn't even consider an SDG if I were you.

Yes, FSED fresh out of residency will result in skill atrophy. I would not advise it until you've worked 2-3 years.

I was going to vote on which job sounded the best out of the ones you listed but...I don't really like any of them. Just get a CMG job for a couple years, take the sign on if they are offering it and get your feet wet. Then decide what you want to do. Again, it's pointless to take an SDG job at less pay unless you have committed to FT EM and exorcised your ambivalence demons regarding fellowships.

I'm a little curious about your choice in addiction vs tox. Very different jobs. Both of which pay significantly less than EM will pay you, so just keep that in mind. I don't know your background but don't let your faculty attendings brainwash you into fellowships. Virtually all academic docs glorify fellowship training. Unless you truly hate EM or are planning on doing academics, I'd think long and hard before giving up the $$$ to go back for extra training. Better to just commit to the miserable world of EM as we know it today, punch in the final GPS destination of FIRE and hit cruise control.

 

[namethatsmell]

Graduating EM resident here. May go back for Addiction vs. Tox fellowship after 1-2 years.

Currently debating between some jobs:

A) Mostly ideal coastal location, SDG with 4 year buy-in. Pre-partner pay is base rate + RVU incentive ($7$/hr bottom 75% vs 15$/hr top 25%) + quality (minuscule). Once partner, +profit share bonus Q4. Basically, making 15-20% less as non-partner to buy in, then are “up for partnership vote”, which I’m told is a shoe in. Good benefits. Hospital system is mix of well-off patients and low SES. Work mostly at one place but can rotate within county if desired. No FSED shifts in first 2-3 years. Not much trauma. Hospital system has good resources.

B) Undesirable coastal location (will have to drive minimum 2hrs for some hobbies) hospital-employed with good pay from day one. Pay is base + RVU + quality incentive. This adds up to essentially partner pay from day one as compared to job above, possibly slightly less. Sovereign immunity. Good benefits. Ability to take off large amounts of time (months) without penalty. Hospitals are mix of county, community. Essentially no peds. Good OB support. A few FSED shifts. Decent hospital resources. Level II trauma. Usually start people at part time, as seasonally slower when brought on in summer and transition to full time with option to remain part time if aligns with lifestyle.

C) Mostly ideal coastal location, hospital-employed with subpar pay (similar/ slightly higher to non-partner years in job A right now). Pay is base + RVU (15%) with looking to transition to higher % RVU in coming years (20-25% per director). Sovereign immunity. Good benefits. Mostly sick, county-type patients. Level II trauma. Some shifts at FSED or smaller community ER in county. Good OB support and peds.

D) Mostly ideal central location with local attending SDG with pre specified $ buy-in (usually takes partners 3-4yrs on avg). Amount is similar to $ withheld over 4 pre-partner years in job A. Overall appears to have highest compensation once partner. Most shifts will likely be at FSED and/or community, unfortunately. Good hospital resources/ support with easy transfers to mothership. Good benefits.

What benefits aside from compensation are there with joining a SDG for someone that is not really business-minded at the moment (maybe that will change)? Does anyone prefer hospital-employed positions over SDG? Is skill atrophy a real thing if I’m relegated to a FSED like some new grads have been? Thankfully have <100k in loans to repay and live like a dirtbag and have no plans on ever changing that, so plan to pay off quickly. Have no real ties or kids to care/support. Probably won’t do full time EM forever, hence the fellowship ideas. Any other thoughts? Tried talking to attendings but they are super pro-SDG and can’t give me much else—don’t know if they have grasp on real world. Recent grads all seemed to accept jobs in a COVID pinch so have been gathering their insight but looking for other insight. Appreciate any and all thoughts!

Assuming you will actually do a fellowship after working 1-2 years...pick B if you can finagle a FT setup or at least ~.7FTE+full benes from the start.

 

[cyanide12345678]

Pick B. What's the point of A if you're doing a fellowship in a couple of years and won't become partner.

Need more information on salaries and how much you value being close/far from these hobbies of yours.

But id suggest picking the highest paying job if it's only a temporary gig, even if not ideal location.

Also the ambiguity of "base pay vs rvus" needs clarification. If the base for all these is 150 per hour then i don't like any of these jobs...

 

[NYEMMED]

I would go with B.

The problem with many SDGs is the sweat equity. Also they will likely sell to a CMG at some point anyway and you will lose your sweat equity.

Job B has what sounds like some hard to pass on benefits and pay.

 

[e30ftw]

southeast coastal by chance? don't have to answer the jobs just sound familiar. I passed on a unicorn SDG coastal gig with spreadsheet verified partner comp at $450k+ because they started new hires at $100/hr for the first two years and was a three year partnership. Honestly the main reason I passed was to stay a bit inland in the mountains nearer to home. Absolutely great gig though but due to location and the need to pay off my student loans asap I took the $220/hr CMG job instead and have no regrets. Now that I've been out 7 years I might pick job A out of your list but at the time with $300k/loans and concerns for contract stability I passed on the sweat equity.

 

[Groove]

southeast coastal by chance? don't have to answer the jobs just sound familiar. I passed on a unicorn SDG coastal gig with spreadsheet verified partner comp at $450k+ because they started new hires at $100/hr for the first two years and was a three year partnership. Honestly the main reason I passed was to stay a bit inland in the mountains nearer to home. Absolutely great gig though but due to location and the need to pay off my student loans asap I took the $220/hr CMG job instead and have no regrets. Now that I've been out 7 years I might pick job A out of your list but at the time with $300k/loans and concerns for contract stability I passed on the sweat equity.

That's hilarious. $100/hr for 2 years?! Man, who would be insane enough to take that gig. The irony is that most new grads in the SE probably have no idea that they can make $400-450K their first year out with a lot of CMG gigs in the same area. What an abusive partnership track. That's not sweat equity, that's blood equity.

 

[Rekt]

That's hilarious. $100/hr for 2 years?! Man, who would be insane enough to take that gig. The irony is that most new grads in the SE probably have no idea that they can make $400-450K their first year out with a lot of CMG gigs in the same area. What an abusive partnership track. That's not sweat equity, that's blood equity.

Dude that's fantasy land right there. Most CMGs in SE paying max 225 an hour as an IC so subtract 25-30/hr.

 

[Zebra Hunter]

That's hilarious. $100/hr for 2 years?! Man, who would be insane enough to take that gig. The irony is that most new grads in the SE probably have no idea that they can make $400-450K their first year out with a lot of CMG gigs in the same area. What an abusive partnership track. That's not sweat equity, that's blood equity.

I'm actually curious how they are only making $400-450k when the group is making $200/hr off of every new hire. I guess a ton of partners and only a few new hires at a time?

 

[Groove]

Dude that's fantasy land right there. Most CMGs in SE paying max 225 an hour as an IC so subtract 25-30/hr.

Not fantasy at all. I'm currently in a CMG gig that pays ~$250/hr +/- $10-15 in the SE. That's about market rate for all the CMGs in my area. My YTD gross was 443K for my mid December paycheck so it's not too far off base. I'll be roughly 450K for the year or slightly over. That's with no sign on, so the grads who are signing on with 100-150K are making even more. In your defense, most of the higher paying gigs in my state are in the western part. Eastern part pays $200-225/hr. But still...let's say they took $225 with 100-150K loan repayment. They are making what...~430K their first year out?

 

[Groove]

I'm actually curious how they are only making $400-450k when the group is making $200/hr off of every new hire. I guess a ton of partners and only a few new hires at a time?

I was thinking the same...that's a huge profit distribution for the partners. I would think they would be easily making 500-600K. They probably only showed the books for profits based strictly on collections and kept the partner bonuses private.

 

[GassYous]

southeast coastal by chance? don't have to answer the jobs just sound familiar. I passed on a unicorn SDG coastal gig with spreadsheet verified partner comp at $450k+ because they started new hires at $100/hr for the first two years and was a three year partnership. Honestly the main reason I passed was to stay a bit inland in the mountains nearer to home. Absolutely great gig though but due to location and the need to pay off my student loans asap I took the $220/hr CMG job instead and have no regrets. Now that I've been out 7 years I might pick job A out of your list but at the time with $300k/loans and concerns for contract stability I passed on the sweat equity.

That's insane. You're working for midlevel pay at the prime years of your life, when you need money most for a down payment, a car, student loans, credit card and compound interest on your investments. That hit is worse than the hundreds of thousands you see on the surface.

For the partner pay, it may be diluted out among a lot of partners. If you take a 300k from someone but divide it among 100 partners then that's only 3k.

 

[maxxor]

That's hilarious. $100/hr for 2 years?! Man, who would be insane enough to take that gig. The irony is that most new grads in the SE probably have no idea that they can make $400-450K their first year out with a lot of CMG gigs in the same area. What an abusive partnership track. That's not sweat equity, that's blood equity.

Blood equity is not limited to EM. I was in a radiology practice that paid the equivalent of 125/hr for 4 years.

They sold so I bounced. I make more in academics than I would had I continued in the fake partnership they were going to set up.

 

[Groove]

I can't get over that $100/hr 2 year blood equity. New grads listen up. So, the docs are losing 564K (over 2 years) based on what they could generate from a CMG in the same region. Let's assume that the partners are making...~100K extra each year through partnership bonus distributions from the blood equity culled from the non partner sheep. It would take 5.5 years to recoup the amount of money you lost. That's 7.5 years assuming, not a 3 year partnership track, but a 2 year partnership track. 7.5 years before you can recoup your money. You know how long 7.5 years is with an ED contract? It's an ETERNITY. Nobody on earth can guarantee a stable contract for 7.5 years. You'd have to be insane to assume it's still going to be around after 7.5 years of fighting off corporate equity with revolving hospital c-suite.

 

[maxxor]

I can't get over that $100/hr 2 year blood equity. New grads listen up. So, the docs are losing 564K (over 2 years) based on what they could generate from a CMG in the same region. Let's assume that the partners are making...~100K extra each year through partnership bonus distributions from the blood equity culled from the non partner sheep. It would take 5.5 years to recoup the amount of money you lost. That's 7.5 years assuming, not a 3 year partnership track, but a 2 year partnership track. 7.5 years before you can recoup your money. You know how long 7.5 years is with an ED contract? It's an ETERNITY. Nobody on earth can guarantee a stable contract for 7.5 years. You'd have to be insane to assume it's still going to be around after 7.5 years of fighting off corporate equity.

I’m in a neighboring state to you. Southeast boomer dominated practices are predatory.

 

[e30ftw]

I can't get over that $100/hr 2 year blood equity.

Yeah I probably couldn't hide the "wtf" expression when I saw that at the end of day during the interview with the business guy. To be fair the number I quoted earlier was probably lower end for their partner comp. Doing the math on the high end would be about $550k. Was a great group/location but the opportunity cost of delaying loan repayment and retirement saving was too hard to justify at the time.

 

[Mount Asclepius]

I picked a SDG with sweat equity years ago and would do again all day every day over working for a CMG. The calculus changes though depending upon how long you plan to be in the area. You also have to do your homework and find a fair group. Partnership track should be 1-2 years and 3 at the most. Prepartner and parter pay including profit sharing should be transparent and shared from the get go. You should ideally come out ahead within a total of 5 years over other comparable jobs in that geographic region. If it takes longer then you take on more risk as any contract’s stability becomes more difficult to forecast further out in time.

 

[emergentmd]

southeast coastal by chance? don't have to answer the jobs just sound familiar. I passed on a unicorn SDG coastal gig with spreadsheet verified partner comp at $450k+ because they started new hires at $100/hr for the first two years and was a three year partnership. Honestly the main reason I passed was to stay a bit inland in the mountains nearer to home. Absolutely great gig though but due to location and the need to pay off my student loans asap I took the $220/hr CMG job instead and have no regrets. Now that I've been out 7 years I might pick job A out of your list but at the time with $300k/loans and concerns for contract stability I passed on the sweat equity.

$100/hr? Sorry but this was not a unicorn but a predatory group. You are making less than many MLP with the risks of never making partnership. Imagine taking the job (someone will be holding the bag when they sell/bought out/kicked out) and 3 months from partnership they lose the contract?

 

[sylvanthus]

We need to start naming these groups so new grads know to steer clear.

 

[emergentmd]

I was extremely lucky when I started medicine and joined a SDG. 2 yr buy in, everyone treated the same, almost everyone made partnership.

Only difference was partners got yearly distributions which amounted to about 50K. Once you hit 2 yrs, you could buy in for 100K or just keep being a nonpartner.

So a partner made about $30/hr more than a nonpartner. the $100/hr scenario amounts to Partners making $170/hr more.

 

[random122893]

Not fantasy at all. I'm currently in a CMG gig that pays ~$250/hr +/- $10-15 in the SE. That's about market rate for all the CMGs in my area. My YTD gross was 443K for my mid December paycheck so it's not too far off base. I'll be roughly 450K for the year or slightly over. That's with no sign on, so the grads who are signing on with 100-150K are making even more. In your defense, most of the higher paying gigs in my state are in the western part. Eastern part pays $200-225/hr. But still...let's say they took $225 with 100-150K loan repayment. They are making what...~430K their first year out?

Mind if I ask where? Or private message?

 

[Dr Mantis Toboggan]

We need to start naming these groups so new grads know to steer clear.

No one ever names/shames on this board. Sucks.

 

[HoosierdaddyO]

Not trying to hijack this thread but seems silly to create a new one considering…This is kinda already a jobs thread.

But curious here if anyone has any background or thoughts on those Defense Healthy agency ER physicians contractor jobs that are on the GS-15 pay scale that are always posted, for military facilities/hospitals. Are these jobs legit, any upsides, and drawbacks… pay, liability, workflow, unforeseen issues, benefits etc?!

Any thoughts would be greatly appreciated 🙂).

 

[southerndoc]

GS-15 is around $110k/yr. That's an NP/PA rate.

 

[DeadCactus]

I'd personally probably pick C with B as second choice. Life is too short to live in undesirable cities just for extra money. Agree with others that SDG doesn't make much sense if you're just going to lose your buy-in when you leave in a year or two. Hospital employee is still better than CMG employee and either way, your first couple of years you are just figuring out what you want in life and your job. Tie yourself down with a SDG when you have a family or at least know you really want to stay in a certain area long-term.

 

[HoosierdaddyO]

GS-15 is around $110k/yr. That's an NP/PA rate.

So your salary will be 110k a year?? No bonus, no incentive… just literally 110 a year as a civilian physician employed by a DHA facility lol?!

If that’s the case then they are crazy!! Can anyone confirm or deny??

 

[DeadCactus]

GS-15 is around $110k/yr. That's an NP/PA rate.

My understanding is these jobs usually had some sort of modifier/bonus that increased the salary making it overall still lower than community jobs but more in line with academic medicine. I have no direct experience though.

 

[southerndoc]

My understanding is these jobs usually had some sort of modifier/bonus that increased the salary making it overall still lower than community jobs but more in line with academic medicine. I have no direct experience though.

A lot of physician jobs have that, but @HoosierdaddyO didn't mention any other pay/incentives.

Even with incentives I believe most DoD docs make less than $200k/yr. Pretty much malpractice free from what I hear.

 

[HoosierdaddyO]

A lot of physician jobs have that, but @HoosierdaddyO didn't mention any other pay/incentives.

Even with incentives I believe most DoD docs make less than $200k/yr. Pretty much malpractice free from what I hear.

Yes so all these jobs are always listed as a “GS15” but I would imagine that there has to be some sort of incentive or annual bonus to make this jobs someone more competitive in regards to salary… just was curious if anyone here has more direct experience or knowledge to what or how that’s calculated etc lol 🙂

 

[southerndoc]

Yes so all these jobs are always listed as a “GS15” but I would imagine that there has to be some sort of incentive or annual bonus to make this jobs someone more competitive in regards to salary… just was curious if anyone here has more direct experience or knowledge to what or how that’s calculated etc lol 🙂

You can get up to $160k as a GS-15 step 10.

I looked it up. Apparently EM is considered a higher paying specialty at least for the VA. Here's the link: https://www.va.gov/OHRM/Pay/2021/PhysicianDentist/PayTables_20210103.pdf

EM tier 3 maxes out at 385k. These numbers are from 2021.

The DoD physician incentive pay is around $50k for emergency physicians. I would think a civilian contractor would be paid on par with a VA doc, but I could easily be wrong. My experience with government pay has not been as a physician. Defense Finance and Accounting Service > MilitaryMembers > payentitlements > Pay Tables > HPO4

 

[namethatsmell]

Working as a civilian in a stateside military ER will land you far above GS15 pay. Can vary widely but have been offered ~210ish/hr as a contractor and another place was maybe 280k/yr as a direct employee. When you do the math on being a direct gov employee you realize how valuable actual benefits can be.

Edit for context: these #s are from several years ago and were in locations that are "desirable."

 

[DoctwoB]

$100/hr? Sorry but this was not a unicorn but a predatory group. You are making less than many MLP with the risks of never making partnership. Imagine taking the job (someone will be holding the bag when they sell/bought out/kicked out) and 3 months from partnership they lose the contract?

The only way someone should consider signing a job like this is with specific wording as to what happens if they are not made partner or if the group is bought or disbands. For example you make 100/hr for 2-3 years until partnership, but if not made partner you are owed an additional 100/hr that you worked during that time.

I haven't seen this done ER jobs, but I have had friends in fields with high rates of PE takeovers that have specifically added practice sale clauses to their contract. Namely if the practice sells to PE or someone else while they are in their partnership track they either get X amount of money, or X percentage of the payout (for example 50% of a partner level payout if they had completed half their partnership track)

 

[maxxor]

The only way someone should consider signing a job like this is with specific wording as to what happens if they are not made partner or if the group is bought or disbands. For example you make 100/hr for 2-3 years until partnership, but if not made partner you are owed an additional 100/hr that you worked during that time.

I haven't seen this done ER jobs, but I have had friends in fields with high rates of PE takeovers that have specifically added practice sale clauses to their contract. Namely if the practice sells to PE or someone else while they are in their partnership track they either get X amount of money, or X percentage of the payout (for example 50% of a partner level payout if they had completed half their partnership track)

You’re lucky if you can get this added. Maybe it’s changed since my first job search. When I tried, they laughed and said “we’ll never sell”

6 weeks in after starting, they were up for sale.

 

[DoctwoB]

You’re lucky if you can get this added. Maybe it’s changed since my first job search. When I tried, they laughed and said “we’ll never sell”

6 weeks in after starting, they were up for sale.

The answer to the "we'll never sell" is "well then it shouldn't be a problem to add this language then."

Of course everything depends on supply/demand for jobs. If a job has a ton of candidates they can tell you to take or leave it with respect to contract wording (or anything else).

 

[watermanMD]

Thanks for the replies, y’all.

A) base pay is 185 and ends up being ~210/hr. Avg PPH is somewhere around 2.1 without APPs and 2.7 with. Other details I’ve found is a non-compete clause in the contract and 20k sign on bonus for 2 year commitment.

B) base pay is 240 and ends up being ~270/hr. Avg PPH is 1.9 off-season, 2.2 in season.

C) Base pay is 165 and ends up being 200/hr. Avg PPH is 1.5, I believe.

D) Don’t know the nitty gritty details but somewhere between 200-230 base. Varying PPH depending on which site I work (FSED vs community site).

The hobby to which I’m referring is basically my favorite thing to do and important to me. Would have to drive minimum 2.5hrs to do it from job B…But I guess I could do or live wherever for a year or two…?

 

[watermanMD]

Your attendings are out of touch with the real world, like most ivory tower faculty. Personally, I don't really consider partnership tracks that are more than 2-3 years. 4 years is ridiculous, especially in this day and age when CMGs are basically Skynet, dropping in a few T1000s every now and then to blitzkrieg an SDG's "stable" hospital contract.

What's the PPH at these jobs? 25% pay cut is not such a big deal when it's working 1.6PPH and the higher paying job is 2.5 If they are both 2PPH then yes, it's a big deal.

I don't see why you are even considering SDGs if you are thinking about fellowship. You're the perfect person who should be picking a CMG job with a sign on loan repayment for a couple years at no loss in pay to help pay off your loans and give you some time to make up your mind about fellowships. I wouldn't even consider an SDG if I were you.

Yes, FSED fresh out of residency will result in skill atrophy. I would not advise it until you've worked 2-3 years.

I was going to vote on which job sounded the best out of the ones you listed but...I don't really like any of them. Just get a CMG job for a couple years, take the sign on if they are offering it and get your feet wet. Then decide what you want to do. Again, it's pointless to take an SDG job at less pay unless you have committed to FT EM and exorcised your ambivalence demons regarding fellowships.

I'm a little curious about your choice in addiction vs tox. Very different jobs. Both of which pay significantly less than EM will pay you, so just keep that in mind. I don't know your background but don't let your faculty attendings brainwash you into fellowships. Virtually all academic docs glorify fellowship training. Unless you truly hate EM or are planning on doing academics, I'd think long and hard before giving up the $$$ to go back for extra training. Better to just commit to the miserable world of EM as we know it today, punch in the final GPS destination of FIRE and hit cruise control.

Great advice.
I’ve thought a lot about it and really like thinking and talking about drug use and caring for this patient population. I think we have so much room for improvement when it comes to improving the lives of persons who use drugs. So much room for improvement for harm reduction in healthcare. They’re some of my favorite cases in the ED and I really enjoy the complexities of drug use—from the patient/ clinical side to the policy/ social side. Initiating treatment is coming to an ED near you (for more things than just opiate use disorder) and I enjoy the acute overdose side, as well as inpatient and outpatient work (I’ve done away rotations). I could see myself doing this stuff (and/or tele work) as a side-gig and eventually full time as I grow older. As far as Tox vs addiction goes—tox gives a broader knowledge of how drugs and the human body work, and is easily applied to addiction work. Many programs are now including addiction in the curriculum and there’s even been approval for a dual Tox/Addiction fellowship. But, tox can definitely overlook the social issues and bigger picture stuff (policy, etc) because those aren’t part of ACGME tox curriculum. But at the same time addiction medicine curriculum does not necessarily teach or accurately reflect how drugs work or the complexities of the molecules in the contaminated drug supply, etc. I like all the other stuff that Tox entails, but just not sure the additional year of fellowship would be worth it for me, as the idea of a traditional tox job (poison center call) doesn’t really get my juices going.

 

[turkeyjerky]

Dude, you need to consider whether or not you want to practice EM for the rest of your career or not. If yes, then for one of the SDGs, no question. If no, then go for one of the hospital employed ones, depending on the relative importance to you of money vs location. You can initiate MAT w/o having done a fellowship...

Know this, the working conditions and general happiness w/ respect to work life are almost universally higher amongst people working for SDGs then those working at hospital employed or CMGs. It's about more than just money.