Resident Remediation

[sandiego1]

I am currently a PGY3 EM resident in a 3 year program and I have been on a remediation plan for all of my second year. Currently it looks like I'll likely be graduating 6 months late, around winter 2019. My remediation plan was related to evaluation scores, primarily related to identifying sick vs. not sick patients and lack of confidence in my decision making. I feel like those issues have improved significantly and I feel I am well liked by my attendings. I have never had any issues with professionalism.

I am concerned however about my impending job search as I will be applying off cycle and in a rather competitive job market. I was just wondering if anyone has experience with this type of situation or can offer any advice. I will be attending ACEP later this month and I am unsure how to approach potential employers.

I'd really appreciate any advice. Thank you

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[namethatsmell]

I am currently a PGY3 EM resident in a 3 year program and I have been on a remediation plan for all of my second year. Currently it looks like I'll likely be graduating 6 months late, around winter 2019. My remediation plan was related to evaluation scores, primarily related to identifying sick vs. not sick patients and lack of confidence in my decision making. I feel like those issues have improved significantly and I feel I am well liked by my attendings. I have never had any issues with professionalism.

I am concerned however about my impending job search as I will be applying off cycle and in a rather competitive job market. I was just wondering if anyone has experience with this type of situation or can offer any advice. I will be attending ACEP later this month and I am unsure how to approach potential employers.

I'd really appreciate any advice. Thank you

Provided you graduate from your program I promise you'll get a job, though you may need to be flexible on where it is. Start embracing this fact now.

You may actually benefit from coming into the job market at an off-peak time.

Focus like hell on becoming a good doc -- not only will it better serve your future patients, but it'll get you better recommendations from your faculty which will be very important for your first job hunt. Don't waste your energy worrying about job searching right now.

 

[WilcoWorld]

You may actually benefit from coming into the job market at an off-peak time.

I had the same thought.

 

[Groove]

I am currently a PGY3 EM resident in a 3 year program and I have been on a remediation plan for all of my second year. Currently it looks like I'll likely be graduating 6 months late, around winter 2019. My remediation plan was related to evaluation scores, primarily related to identifying sick vs. not sick patients and lack of confidence in my decision making. I feel like those issues have improved significantly and I feel I am well liked by my attendings. I have never had any issues with professionalism.

I am concerned however about my impending job search as I will be applying off cycle and in a rather competitive job market. I was just wondering if anyone has experience with this type of situation or can offer any advice. I will be attending ACEP later this month and I am unsure how to approach potential employers.

I'd really appreciate any advice. Thank you

Go to the ACEP job fair. Tons of potential employers along with the big CMGs looking for fresh meat, ahem... new docs. Even though I don't think it's a big deal, I wouldn't advertise the fact that you are graduating late due to remediation, just tell them you are graduating 2019 but won't be available to start work until Dec. If they ask why, just say you have personal business and other work lined up until then.

You shouldn't have any issues with finding a job unless you're limiting yourself to NYC, Denver, Hawaii or other highly saturated markets.

For the moment, just focus on finishing residency.

 

[Angry Birds]

There are a million jobs out there to be had.

 

[Tenk]

Should not be an issue. Don’t worry about it. The only thing you need to worry about right now is pushing yourself to see more patients.

 

[miacomet]

Go to the ACEP job fair. Tons of potential employers along with the big CMGs looking for fresh meat, ahem... new docs. Even though I don't think it's a big deal, I wouldn't advertise the fact that you are graduating late due to remediation, just tell them you are graduating 2019 but won't be available to start work until Dec. If they ask why, just say you have personal business and other work lined up until then.

You shouldn't have any issues with finding a job unless you're limiting yourself to NYC, Denver, Hawaii or other highly saturated markets.

For the moment, just focus on finishing residency.

NYC has tons of jobs.

 

[deleted109597]

Just graduate. Almost nobody will care that you're off cycle, and as long as you showed improvement you'll be fine. For the CMGs, they could care even less. They just want you to have a pulse.

 

[JAFERD]

Competitive job market? In EM? Maybe in Telluride or Park City. But anywhere else, you’ll get a job!


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[miacomet]

Competitive job market? In EM? Maybe in Telluride or Park City. But anywhere else, you’ll get a job!


Sent from my iPhone using Tapatalk

Telluride pays nursing wages. Don't think it's that competitive.... Jackson, OTOH, is impossible.

 

[Arcan57]

Off-cycle will probably help. If they’re hiring a bunch of docs, at least one will flame out/peace out in the first 3 months. And it’s a truism of being a medical director at a CMG that no matter how many docs you hire in July, you’re going to be short staffed and begging people to pic up shifts in February.

From a personal development standpoint, you have to have sick/potentially sick/ not-sick down to the point where you never confuse the two ends of that continuum. You can try and cheat by just lumping everybody into “potentially sick” but that way lies a full waiting room and being permanently behind the 8 ball while resuscitating.

It’s tough to evaluate your thinking while it’s happening and being whipsawed back and forth between attending recommendations that vary widely in terms of risk tolerance can make it tough to develop a coherent approach to decision making.

I’d recommend to start keeping a sticker sheet with every patient you see. When you walk out of the room, make a S, P, or N mark on the sticker. Sit down at the end of your shift and compare your initial impression to the patient’s clinical course. As a 3rd year, most of the initial impressions should be correct. If you admitted somebody for a valid medical reason (BS consultant/PCP convenience admits don’t count) that you marked as not sick or sent someone home you marked as sick, troubleshoot what happened.

Why did you make the decision that you did? And you don’t get to use ad hominem excuses. It’s not that you are stupid or lazy or suck at your job. Cognitive errors have causes and to a large extent those causes are going to be modifiable. It may be something simple like never having seen that disease process before. It may be something more deep seeded like not being confident in your procedural skills so you try to sell the patient as being less sick then they are to avoid the anxiety of a (perceived) difficult task. Maybe consultant X verbally abused you last time, so you know pt has the disease but you delay until you have autopsy proven confirmation before getting them involved. Whatever the systemic errors are , focus on how to fix them next time. Don’t use them as a measure of your self-worth or ability to be a successful physician in the future.

 

[JAFERD]

Telluride pays nursing wages. Don't think it's that competitive.... Jackson, OTOH, is impossible.

That’s true, but have you worked there? If you could write down all the things that would make an ideal EM job, other than pay, it would be that ED. Also, they only have 4 full time docs and last I was there, two of them are married. Not that hard to find 4 people willing to work in paradise, even for low pay.

 

[Angry Birds]

That’s true, but have you worked there? If you could write down all the things that would make an ideal EM job, other than pay, it would be that ED. Also, they only have 4 full time docs and last I was there, two of them are married. Not that hard to find 4 people willing to work in paradise, even for low pay.

Why on earth would anyone work for low pay

 

[miacomet]

Why on earth would anyone work for low pay

Seriously. And certainly not overnights in the ER. Telluride is NOT a cush job- fairly hard to transfer people, for example. For what they pay, you could do telehealth, exam prep, government work (less liability and higher pay).

 

[JAFERD]

Why on earth would anyone work for low pay

Great job, great pay, great location - you get two of the three. Depends on your priorities.

Seriously. And certainly not overnights in the ER. Telluride is NOT a cush job- fairly hard to transfer people, for example. For what they pay, you could do telehealth, exam prep, government work (less liability and higher pay).

Have you worked there? I was only there for a month, but seemed pretty damn cush to me. First off, it’s Telluride, which for some people is enough. They have almost no Medicaid population, no nursing homes, people are friendly and appreciative, did no pelvic exams, had not a single pain presenting with exacerbation of chronic pain, no one brought in their child at 3am for a cough, lots of ortho procedures, nurses are very experienced, etc. While I wasn’t making the phone calls, it didn’t seem at all difficult for them to transfer someone and it wasn’t something I heard any of them complain about.
I am aware that the pay sucks for ED, and you could do plenty other things for similar pay. However, I have about zero interest in exam prep, government prep, urgent care, or anything of the sort. The whole point though is that you’re in Telluride! You’re about a block away from one of the best ski resorts, in one of the most beautiful locations in the country. It’s certainly not for everyone, but I bet they don’t have too much trouble filling a spot, if one ever opens up.

 

[miacomet]

Great job, great pay, great location - you get two of the three. Depends on your priorities.

Have you worked there? I was only there for a month, but seemed pretty damn cush to me. First off, it’s Telluride, which for some people is enough. They have almost no Medicaid population, no nursing homes, people are friendly and appreciative, did no pelvic exams, had not a single pain presenting with exacerbation of chronic pain, no one brought in their child at 3am for a cough, lots of ortho procedures, nurses are very experienced, etc. While I wasn’t making the phone calls, it didn’t seem at all difficult for them to transfer someone and it wasn’t something I heard any of them complain about.
I am aware that the pay sucks for ED, and you could do plenty other things for similar pay. However, I have about zero interest in exam prep, government prep, urgent care, or anything of the sort. The whole point though is that you’re in Telluride! You’re about a block away from one of the best ski resorts, in one of the most beautiful locations in the country. It’s certainly not for everyone, but I bet they don’t have too much trouble filling a spot, if one ever opens up.

These are all excellent points, although I have to say doing all your own ortho procedures loses its luster pretty fast as an attending, as does low pay. It's still work.

 

[EctopicFetus]

Seriously. And certainly not overnights in the ER. Telluride is NOT a cush job- fairly hard to transfer people, for example. For what they pay, you could do telehealth, exam prep, government work (less liability and higher pay).

And live there lol.

 

[BoardingDoc]

These are all excellent points, although I have to say doing all your own ortho procedures loses its luster pretty fast as an attending, as does low pay. It's still work.

I think it loses its luster if you're not getting paid by productivity. If you are giving me $300 plus the value of the chart every time I pop a shoulder back in, I'm perfectly fine doing that until the cows come home.

 

[Angry Birds]

Great job, great pay, great location - you get two of the three. Depends on your priorities.
.

False. Black bear.

I pick all three.

It's a great time to be an ER doctor.

 

[Apollyon]

False. Black bear.

I pick all three.

It's a great time to be an ER doctor.

This brevity just does not help. Just what does "black bear" mean?

It's a long held thing - not something just made up. "Location, lifestyle, pay - pick 2 of three." If you can find 3/3, TAKE IT. That is all that can be said.

 

[Psai]

This brevity just does not help. Just what does "black bear" mean?

It's a long held thing - not something just made up. "Location, lifestyle, pay - pick 2 of three." If you can find 3/3, TAKE IT. That is all that can be said.

Bears. Beets. Battlestar galactica.

 

[Angry Birds]

This brevity just does not help. Just what does "black bear" mean?

It's a long held thing - not something just made up. "Location, lifestyle, pay - pick 2 of three." If you can find 3/3, TAKE IT. That is all that can be said.

Bears. Beets. Battlestar Galactica.

 

[Angry Birds]

Bears. Beets. Battlestar galactica.

LOL I read your post only after my own, which was identical (although I accidentally inverted "bears" and "beets"--just fixed it!).

MICHAEL!


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On a serious note, I understand and have heard the idea of "pick 2 of the 3: location, lifestyle, and pay." I just don't think it really holds up. I've worked in some crazy competitive markets--including California. You should always seek high pay.

The "pick 2 of the 3" thing can work if you change it to: "location, lifestyle, and cost of living." But, not pay. Always seek a high paying job. Always.

 

[Arcan57]

LOL I read your post only after my own, which was identical (although I accidentally inverted "bears" and "beets"--just fixed it!).

MICHAEL!


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On a serious note, I understand and have heard the idea of "pick 2 of the 3: location, lifestyle, and pay." I just don't think it really holds up. I've worked in some crazy competitive markets--including California. You should always seek high pay.

The "pick 2 of the 3" thing can work if you change it to: "location, lifestyle, and cost of living." But, not pay. Always seek a high paying job. Always.

High pay is better than low pay, but always seeking the highest salary starts becoming akin to always picking the lowest bidder on a contract. If it’s the highest paying gig in town and it’s hiring, there may be a reason for that.

 

[deleted109597]

High pay is better than low pay, but always seeking the highest salary starts becoming akin to always picking the lowest bidder on a contract. If it’s the highest paying gig in town and it’s hiring, there may be a reason for that.

Yeah but for 90% of the ER jobs out there it's simply a treadmill of patients and resistance for admission. So get your best rate. Those other 10% are divided between the 1% unicorn jobs that are amazeballs, and 9% that are more miserable than simply 3pph and no support.

 

[gro2001]

I wish there was a word to describe this phenomenon on SDN. Any time a poster says something reasonable about the job market (such as what a typical hourly rate is, or how many night shifts are common, or point out that you may have to sacrifice something to get something else), invariably a bunch of folks pop up saying that no, you can get paid $500/hour, work no nights, and have the best of everything because by golly, their SDG is doing it. And it's not that I don't believe these folks, or am jealous (my job is unusually cush in some ways too), but those posts pretend to ignore how rare those situations are. You got all three of job quality, pay, and location. Great! But it doesn't make the previous poster wrong to say that typically you get to choose 2/3.

 

[VA Hopeful Dr]

I wish there was a word to describe this phenomenon on SDN. Any time a poster says something reasonable about the job market (such as what a typical hourly rate is, or how many night shifts are common, or point out that you may have to sacrifice something to get something else), invariably a bunch of folks pop up saying that no, you can get paid $500/hour, work no nights, and have the best of everything because by golly, their SDG is doing it. And it's not that I don't believe these folks, or am jealous (my job is unusually cush in some ways too), but those posts pretend to ignore how rare those situations are. You got all three of job quality, pay, and location. Great! But it doesn't make the previous poster wrong to say that typically you get to choose 2/3.

Well and desirable location is a very subjective thing. If you have lots of family/friends in Wyoming or love skiing, it might be desirable for you. Probably less so for a single person who snorkels.

 

[BoardingDoc]

I wish there was a word to describe this phenomenon on SDN. Any time a poster says something reasonable about the job market (such as what a typical hourly rate is, or how many night shifts are common, or point out that you may have to sacrifice something to get something else), invariably a bunch of folks pop up saying that no, you can get paid $500/hour, work no nights, and have the best of everything because by golly, their SDG is doing it. And it's not that I don't believe these folks, or am jealous (my job is unusually cush in some ways too), but those posts pretend to ignore how rare those situations are. You got all three of job quality, pay, and location. Great! But it doesn't make the previous poster wrong to say that typically you get to choose 2/3.

Überjobenfreude

 

[Angry Birds]

I wish there was a word to describe this phenomenon on SDN. Any time a poster says something reasonable about the job market (such as what a typical hourly rate is, or how many night shifts are common, or point out that you may have to sacrifice something to get something else), invariably a bunch of folks pop up saying that no, you can get paid $500/hour, work no nights, and have the best of everything because by golly, their SDG is doing it. And it's not that I don't believe these folks, or am jealous (my job is unusually cush in some ways too), but those posts pretend to ignore how rare those situations are. You got all three of job quality, pay, and location. Great! But it doesn't make the previous poster wrong to say that typically you get to choose 2/3.

I feel ya. But I wasn’t saying to find a 500/hr job. I was just saying that one should never settle for a low paying job. 200/hr should be floor in my opinion.