Newish attending: Ask me anything

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illegallysmooth

illegallysmooth

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Attended residency at UB in Buffalo, NY.
Practicing for 1.5 years in Dallas, TX.
One of my sites is is a large, busy "county" hospital with residency programs. I am part of private group staffed there, so while I deal with residents from other services I do not directly oversee residents.
My other site is more "community" however still Level 1 trauma, and many of my patients are from the same demographic group as the other site. Here, I supervise a 3rd year EM resident about once per month.

Any residents or med students with questions?

(always wanted to do one of these)
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Which people do you consider your "closest" colleagues, the staff and physicians you work with at your hospital sites or the other physicians in your group? Wondering what the professional/social dynamic looks like when you're not directly employed by the places where you work (as is common in EM). In other industries, even long-serving contractors are treated differently and have less influence at their workplaces than directly-hired employees. For instance, if you were interested, would you be eligible for an admin position (other than ED medical director; more like CMO/CMIO) at one of your hospital sites? If so, what would happen if your group were to move on from that site? Apologies if that's a naive question.

What attracted you to your current gig, especially geographically and in terms of the type of group/sites you work for? Has it lived up to your expectations?

What are your thoughts on dual residency training (EM/FM, EM/Anesthesia, EM/IM) vs. fellowship vs. straight EM in terms of attractiveness and usefulness for a practice setup like yours?

Thanks :)
 
How much of a factor was your residency porgram’s “reputation” and “prestige” a factor in your job search/recruitment after residency? Finalizing my rank list shortly and am leaning on ranking places more by fit vs reputation, but have been advised against that.
 
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Kind of similar to the above poster. I also hope to finalize my rank list shortly. I really liked some new programs I interviewed at due to fit/location/people. Just also curious on your thoughts about ranking based on fit vs reputation or new vs established.

In addition, I was wondering if you would be willing to talk a little bit about your experience at UB. I interviewed there, and I really liked the PD, faculty, and a lot of what the program has to offer (multiple training sites, scholarly tracks, new hospital, etc.). The only thing that really bothered me was the 12 hour shifts because the residents looked so exhausted. I expect to work hard wherever I go, but most places I interviewed at offered much shorter shifts with overlap and less total hours/month so I was kind of concerned about wellness about programs that do all 12s.

Do you mind talking a little bit about your experience there, what you think is most important in determining our rank lists, and how to survive working 12s? You can PM me if you feel more comfortable talking about your program privately.

Thanks!
 
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Advice for MS3s selecting away rotation sites? We have no home EM program in my state. Do rotations at target sites in your range or at reach sites out of your range to get letters from top programs? How do we determine which programs we're competitive for as MS3s?
 
zonule said:
Which people do you consider your "closest" colleagues, the staff and physicians you work with at your hospital sites or the other physicians in your group? Wondering what the professional/social dynamic looks like when you're not directly employed by the places where you work (as is common in EM). In other industries, even long-serving contractors are treated differently and have less influence at their workplaces than directly-hired employees. For instance, if you were interested, would you be eligible for an admin position (other than ED medical director; more like CMO/CMIO) at one of your hospital sites? If so, what would happen if your group were to move on from that site? Apologies if that's a naive question.

What attracted you to your current gig, especially geographically and in terms of the type of group/sites you work for? Has it lived up to your expectations?

What are your thoughts on dual residency training (EM/FM, EM/Anesthesia, EM/IM) vs. fellowship vs. straight EM in terms of attractiveness and usefulness for a practice setup like yours?

Thanks :)
Click to expand...

My fiancé and I are both EM docs and we've made friends with a few colleagues and their spouses. When it comes to socializing, no one cares what name or company is on your checks. The site which is the county hospital -- my group was basically brought in to help move the meat, we have no influence over policies or anything, and there's no opportunity for advancement. Maybe when the current medical director for our group at that site wants to give up the position, someone else will want it, but I can't imagine why. At my other site, we staff and control the entire ED. Our ED director became Chief of Staff for the hospital, and there's opportunities to work your way up.

I have some family in DFW, and Texas is a great state to practice in (looking at our income, lack of state sales tax, and tort reform). Our group was one of the last independent groups in the area (recently merged with a large national company) and has had great leadership, really friendly people, treated us very well. With working at the county/academic hospital I have an associate professor title on my CV, which may help me later if I want to go full academics.

I'm not sure if a fellowship would have helped me much. Maybe critical care, but I got plenty of CC experience in residency. Fellowships or dual residencies are useful if you actually picture yourself using it, and that's a very personal thing that completely depends on your professional goals.
 
DOtell said:
How much of a factor was your residency porgram’s “reputation” and “prestige” a factor in your job search/recruitment after residency? Finalizing my rank list shortly and am leaning on ranking places more by fit vs reputation, but have been advised against that.
Click to expand...

I don't really feel it was a factor at all. My fiancé and I have since learned that my job in particular was considered difficult to get, usually they only hire chiefs from the local residency. You should absolutely rank programs based on where you will be happy.
 
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TheOne13 said:
Kind of similar to the above poster. I also hope to finalize my rank list shortly. I really liked some new programs I interviewed at due to fit/location/people. Just also curious on your thoughts about ranking based on fit vs reputation or new vs established.

In addition, I was wondering if you would be willing to talk a little bit about your experience at UB. I interviewed there, and I really liked the PD, faculty, and a lot of what the program has to offer (multiple training sites, scholarly tracks, new hospital, etc.). The only thing that really bothered me was the 12 hour shifts because the residents looked so exhausted. I expect to work hard wherever I go, but most places I interviewed at offered much shorter shifts with overlap and less total hours/month so I was kind of concerned about wellness about programs that do all 12s.

Do you mind talking a little bit about your experience there, what you think is most important in determining our rank lists, and how to survive working 12s? You can PM me if you feel more comfortable talking about your program privately.

Thanks!
Click to expand...

An "established" residency compared to a new one may be a better choice, but not necessarily because of reputation.

I loved my residency. We actually took a poll during second year and we all voted on our shift lengths, 12 hr shifts got the most votes. More days off per month. If you have a working spouse with an inflexible schedule and your time before/after work doesn't overlap, that can be difficult for the relationship. I can't say enough nice things about Defazio, he's awesome. The majority of the attendings are great, a few are spectacular, and there's only one or two out of a large group that I didn't look forward to working with. My class bonded really well in the beginning of intern year, felt like a big family and they're probably the reason I loved my time there so much. I'm even going to marry one of them! In the time our class was there, we invented two new elective rotations for 3rd year, and they got approved. So the leadership are very willing to listen to residents and change the program if needed.

I think fit is most important in ranking programs. I didn't have a big problem with the 12 hr shifts, but I know one of my classmates who really wanted to change it - he's really into fitness and wanted to be able to go to the gym before or after work. Totally a personal thing. Have you worked 12s on rotations yet? Can PM if you'd like.
 
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20Hopeful16 said:
Advice for MS3s selecting away rotation sites? We have no home EM program in my state. Do rotations at target sites in your range or at reach sites out of your range to get letters from top programs? How do we determine which programs we're competitive for as MS3s?
Click to expand...

I had no "home" program either. In terms of figuring out where you are likely to be competitive, take an honest look at your grades so far and ask yourself how much weight the name of your school carries. You might want to look at the residency-specific application threads to get an idea of the stats of people who are/aren't getting interviews. If you're a DO you'll have a tough time applying to residencies that don't have many DOs.
I went to LECOM-Bradenton, had very good grades/Steps. Did one community ED rotation, then Palmetto in South Carolina (where I intended on applying), then Emory (which was the one "prestigious" name I picked), and then UB at the end of the reason (where I most wanted to go, so rotated there last). I think having the letter from Emory probably helped me, so I suggest trying to get one "reach" rotation. Hope that helps.
 
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What does your work schedule look like from week to week? Is there enough flexibility to work as much(or as little) as you want?
 
liveonthewater said:
What does your work schedule look like from week to week? Is there enough flexibility to work as much(or as little) as you want?
Click to expand...

yeah we generally tell them how many shifts we want (within reason). I was asking for 14, now 15.
Feb is a short month so a little light - last week I had 2 shifts, this week 3, next week one meeting plus 3 shifts, week after 4 shifts, week after 2 shifts.
I generally ask for no more than 3 in a row but to be honest I work 4 in a row sometimes, and my shifts are either 9 or 10 hrs depending on location. I usually leave a little late, occasionally a lot late.
 
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@illegallysmooth Thank you for doing this! Here's a question for those of us planning our rank lists now. Does prestige/reputation matter much in where you get jobs..like not just a decent paying job but one in ideal locations? For example, let's say an applicant has no interest whatsoever in fellowships..would he/she be making a mistake choosing a regular community EM with not much reputation if in case later down their career they decide to pursue academics. And at the same time if you don't want to do a fellowship..would a 4-year reputable place make up for the fellowship in helping you land an academic job if you pursue it down the line.

I guess what my question boils down to which sort of residency program..3 vs. 4..big name vs. small name helps you have lot of options down the line so you don't limit yourself?

Also, Kasier has a newish residency program in San Deigo..do you believe going to a Kaiser based residency might play a role in job prospects..because Kaiser is such a specialized system? Not sure if you'd know about this but thought I'd ask.

Thanks again!
 
What's your compensation like? Also what's your perception of the demand for EM docs? Has there been any notable changes in the field in recent years?
 
amonty144 said:
@illegallysmooth Thank you for doing this! Here's a question for those of us planning our rank lists now. Does prestige/reputation matter much in where you get jobs..like not just a decent paying job but one in ideal locations? For example, let's say an applicant has no interest whatsoever in fellowships..would he/she be making a mistake choosing a regular community EM with not much reputation if in case later down their career they decide to pursue academics. And at the same time if you don't want to do a fellowship..would a 4-year reputable place make up for the fellowship in helping you land an academic job if you pursue it down the line.

I guess what my question boils down to which sort of residency program..3 vs. 4..big name vs. small name helps you have lot of options down the line so you don't limit yourself?

Also, Kasier has a newish residency program in San Deigo..do you believe going to a Kaiser based residency might play a role in job prospects..because Kaiser is such a specialized system? Not sure if you'd know about this but thought I'd ask.

Thanks again!
Click to expand...

"Does prestige/reputation matter much in where you get jobs?" -- from my perspective it might have a small effect. I'm sure there's a difference between going to a big name, longstanding program and for instance a small community DO program. But apparently my job was hard to get and I went to Univ of Buffalo, which is not a name that knocks people's socks off (but maybe it should - it's a great program). If you're trying to go somewhere competitive for practice - like for instance Austin or Denver, it would probably help to go to a program that's widely respected. I wouldn't pick a residency based solely on that though, fit is more important than the name. What's probably more important when you go to look for jobs is how you performed in residency and what your attendings/PD/APDs have to say about you.

If you're planning to go into academics, want to work your way up, be a big name research type person, it's a good idea to do a 4 year program. It's not going to be IMPOSSIBLE to achieve that goal without it, just a little harder from what I've heard.

I always tell people to chose a fellowship based on your professional goals, not just to have it on your CV. Like if you love EMS and wanna be an EMS director some day, do that. Or you want to have some shifts in ICU, do critical care. Want to be an US fellowship director someday? You'll need an US fellowship then.

Using myself as an example, I have an interest in teaching so might want to go academic later, but I have no interest in being a dept chair or anything like that. I have a ton of loan debt, so going full academic was not really a smart choice for me. But I feel like it wouldn't be impossible for me to get back into academics, probably not at a hot-shot place full of academic gunners, but somewhere.

If you plan on practicing in a Kaiser system, future employers might like you having experience within the system just because it will be less confusing for you to start.

Hope that helps a bit!
 
Med_WannaBee said:
What's your compensation like? Also what's your perception of the demand for EM docs? Has there been any notable changes in the field in recent years?
Click to expand...

The county hospital is an hourly rate, somewhere around $230/hr, my other site is RVU based with no "basement" or minimum. I average 34k per month, before taxes.
My perception of the job market right now is that it's not difficult to find a job, but it may be getting a little harder. At least in DFW, getting a job here is definitely harder than it was a couple years ago. That's all likely to vary based on location. The job market will always be tougher in major cities that people want to live in, near the ocean and near the mountains. We EM docs like our hobbies and the outdoors, it seems. When I was starting to think about Texas, my perception of (and what I was told regarding) places like Austin is that I won't have any negotiating power and would be taking what I could get (i.e. I'd be lucky to get a job). Overall, I think graduating EM docs are not finding it too difficult to find jobs, but the amount of bargaining power and "choosiness" that we have might be starting to decline.
 
@illegallysmooth thank you so much for your thoughtful response? Just one question based on your last statement regarding Kaiser..what if you want to get a job at a place that isn't Kaiser..do you think they'll look at you differently or no?
 
amonty144 said:
@illegallysmooth thank you so much for your thoughtful response? Just one question based on your last statement regarding Kaiser..what if you want to get a job at a place that isn't Kaiser..do you think they'll look at you differently or no?
Click to expand...

No problem.
I've never been personally involved with the Kaiser system, but it seems like it's a little unique. Every site and city is different, you know, there's always going to be a learning curve when you start anywhere new (in terms of departmental protocols etc). I don't have the sense that it would ever be seen as a negative to be trained in a Kaiser system and seeking employment outside of that system. You learn the medicine and how to medically manage patients during residency, and when you go somewhere new you're always going to have to learn about how the specialist referrals work, which PCPs can be called, where you transfer which patients, etc.
When I first started I was a little jealous of my residency classmates who stayed in Buffalo at the facilities where we trained because their transition was easy and seamless, whereas I had to learn a completely different hospital system, community resources, etc. But that advantage disappears as soon as you have some experience in the new place, it just takes a few months to get comfortable.
 
What is the process like for finding a job straight out of residency? Is there a recruiter? Do you just send your CV around?
 
illegallysmooth said:
Attended residency at UB in Buffalo, NY.
Practicing for 1.5 years in Dallas, TX.
One of my sites is is a large, busy "county" hospital with residency programs. I am part of private group staffed there, so while I deal with residents from other services I do not directly oversee residents.
My other site is more "community" however still Level 1 trauma, and many of my patients are from the same demographic group as the other site. Here, I supervise a 3rd year EM resident about once per month.

Any residents or med students with questions?

(always wanted to do one of these)
Click to expand...
Where do you see yourself in 10 years?
 
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What are some myths about working in EM? The work seems interesting but I’m afraid I don’t have the full picture and my vision of what EM is has been clouded by tv shows
 
Restart13 said:
Looking back, what are your must haves, must NOT haves of attending jobs?
Click to expand...

Hard to say because these are my only two jobs so far lol. Maybe I can answer this a slightly different way. My biggest gripe about working as a private physician in a group brought into the county/academic site is that we have no control over anything. We have no say in policies that don't work for the patients or for us, and that's frustrating and a little demoralizing. Avoid that.

Must have...department leadership that has your back. For instance if there was a professional conflict between you and someone from another department, would your administration go to bat for you or throw you under the bus? That's important.

And it's hard to do these days with so many big corporate groups, but my group had a family-vibe to them, and I think that's really great.
 
Birdstrike said:
Where do you see yourself in 10 years?
Click to expand...

I want to own a decommissioned lighthouse. And I want to live at the top. And nobody knows I live there. And there's a button that I can press and launch that lighthouse into space.
 
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iforget2 said:
What are some myths about working in EM? The work seems interesting but I’m afraid I don’t have the full picture and my vision of what EM is has been clouded by tv shows
Click to expand...

I could probably answer that better if you told me what TV shows you're talking about lol.

Most of EM is pretty routine for us -- abdominal pain, dizziness, headache, minor (or major) injuries, shortness of breath (from CHF, COPD and less commonly pneumonia), chest pain, etc. There aren't as many "crazy" cases as you see on TV, although we do get them from time to time.
I find it interesting that you used the word interesting to describe EM work. I wouldn't call it "interesting" or "fascinating" per se, surely not more than other specialities with a narrower and more detailed practice. I think ophthalmology is very interesting, but I internally groan every time someone with an eye complaint stumbles in.
I find the speedy diagnosis and management of acute conditions to be the most ...fun? way to practice medicine, I guess that's why I chose EM. It's not fun all the time, but I couldn't sit in clinic or stand in the OR for most of the day. If those were my only options...I think I'd open a dog day care or something.
 
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Bea5T said:
What is the process like for finding a job straight out of residency? Is there a recruiter? Do you just send your CV around?
Click to expand...

Good question. First you'll probably want to narrow down a geographic region. From there, do some research online to find out who the major groups in town are, and reach out to your program coordinator so he/she can forward contact info for any graduates who may live in the area you're considering. Ask your faculty if they know anyone. You can email them, find out who they work for, how they feel about their jobs. I did that, plus looked at job listings on physician websites. Every major group will have a recruiter who can then talk to you about open positions and get the process started.
 
How big is your house (or future house) and how nice is your car?
 
Perfect Hair Day said:
Upon entry to the job market - did you find it mattered where you did residency?
Click to expand...

Not to my knowledge. I think Buffalo is the cat's meow but it's generally not a place people are impressed by, for any reason, unless you're entering a snow-shoveling competition.

By the way Buffalo is amazing, the city and the EM program.

Every ACGME-accredited EM program is going to have the same basic requirements. You get trained. I think it matters more if you made an impression while you were there.

(I like Buffalo)
 
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LebronManning said:
How big is your house (or future house) and how nice is your car?
Click to expand...

I have a lot of debt. My dad bought me a new Grand Am when I was 16 and I paid him monthly for years. I made plans to sell that car before I moved to Dallas 1.5 years ago and then it got totaled. I bought a 2016 Mazda 3. So I drove that Grand Am for like 14 years.

My fiancé is also an EM doc, he makes slightly less than I do (booyah) and we are planning to buy a house within the next 4 months. It will hopefully not be more than 600k, and have 4 beds, 2.5 baths.

(By the way in Buffalo you can buy a FREAKING MANSION for that much)
 
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illegallysmooth said:
My fiancé is also an EM doc, he makes slightly less than I do (booyah) and we are planning to buy a house within the next 4 months. It will hopefully not be more than 600k, and have 4 beds, 2.5 baths.
Click to expand...

~750k household income and you're buying a 600k house. America needs to take some lessons from you! Respect. At least get yourself like a porsche or something for being so responsible.
 
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illegallysmooth said:
I want to own a decommissioned lighthouse. And I want to live at the top. And nobody knows I live there. And there's a button that I can press and launch that lighthouse into space.
Click to expand...
Trolling SDN again, Stanley?
 
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How do you think your compensation/lifestyle would change if you moved out of the city?

I know people say rural docs make more, but curious if that is accompanied by an increase in work hours.
 
illegallysmooth said:
Attended residency at UB in Buffalo, NY.
Practicing for 1.5 years in Dallas, TX.
One of my sites is is a large, busy "county" hospital with residency programs. I am part of private group staffed there, so while I deal with residents from other services I do not directly oversee residents.
My other site is more "community" however still Level 1 trauma, and many of my patients are from the same demographic group as the other site. Here, I supervise a 3rd year EM resident about once per month.

Any residents or med students with questions?

(always wanted to do one of these)
Click to expand...

What's the job market like for Dallas/fort worth these days? Probably moving back in 2 years once my spouse finishes residency. One of my co residents who was looking in Texas this year said that it was getting very saturated.

On a side note, from the sound of things, your primary site was where I went to med school :)
 
Do you plan on having kids? If so, how do you think the EM lifestyle will work for you?
 
miacomet said:
It's hard to get off hours child care, work a lot of weekends, nights, and holidays. Have you found differently?
Click to expand...
You don't need a stay at home spouse to handle that as long as they work normal hours so that they can be responsible for pickup/dropoff during the hours that you're at work, but you can then return the favor on your random days off, random hours when you aren't working etc etc etc.

If your spouse is also in EM or works shift work, yes it can be difficult.
 
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BoardingDoc said:
You don't need a stay at home spouse to handle that as long as they work normal hours so that they can be responsible for pickup/dropoff during the hours that you're at work, but you can then return the favor on your random days off, random hours when you aren't working etc etc etc.

If your spouse is also in EM or works shift work, yes it can be difficult.
Click to expand...

Plus, if your spouse works, can’t you just work less?
 
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