LotaPower

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so t minus 13.5 months until many of us are done with residency. I just wanted to get some advice from those who are more experienced on what type of job is the best for a new grad?

is it better to start at a place where you are getting your *** kicked on a daily basis? ( inner city, high volume acuity, less than perfect resourcs/ancillary staff/ difficult pt population etc.)....similar to some of the hospitals we currently train at...

... or is it a good idea to start out at a place in the community that might be a little slower in pace so that you can galvanize your skills, work more on your speed if needed and develop your own style?
 

docB

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The problem is more complex than just high or low acuity and volume. You also have to consider that in those high acutiy, high volume places you are likely to have more staffing, more available consultants and other resources (midlevels, residents, etc.) to help you out. The low volume places can seem less intimidating until you get some horrific disaster and you are totally alone with no where to turn.

Here's a moderately related thread about high vs. low volume centers.

I suggest trying to figure out which environment you like better and then finding a job that is a close to your ideal as possible. I don't think there's a lot of value in trying to "cut your teeth" in some situation you wouldn't want to work in long term. Learning the systems, politics and capabilities at every new job is difficult. Don't go through it more than necessary.
 

GeneralVeers

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In my opinion, if you are starting out, you want to be at a place with double coverage, and all the specialties on call. Those places will give you the support your need, as your skills may not be completely developed fresh out of residency.

Being single coverage in a small rural ED with no backup can be intimidating.
 

Egon

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It really depends on your confidence level coming out. Most prefer a double coverage... I found it really helpful my first year as an attending, especially when peds codes, etc, come in at night, you at least know someone is there with you just in case...

The biggest decision is area of the country and academic vs community. Those are the things which may dictate the tye of practice available.

Jobs are wide open in EM still. Just watch out for the contract groups coming out b/c they just want a warm body and could care less about your development as a physician. A lot of major contract groups are now owned by investment banks with people who never entered medical school making $ off your sweat equity. Very sad, don't feed in...
 

arctic187

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so t minus 13.5 months until many of us are done with residency. I just wanted to get some advice from those who are more experienced on what type of job is the best for a new grad?

is it better to start at a place where you are getting your *** kicked on a daily basis? ( inner city, high volume acuity, less than perfect resourcs/ancillary staff/ difficult pt population etc.)....similar to some of the hospitals we currently train at...

... or is it a good idea to start out at a place in the community that might be a little slower in pace so that you can galvanize your skills, work more on your speed if needed and develop your own style?
There are lots of university hospitals with a community affiliate. I interviewed at many jobs where you would work up to 50% at the community hospital. I think thats a great combo. Half the time working in the setting you are already comfortable with and then some time in a place where you are on your own. Its nice to get to do your own procedures once in a while. The residents seem to always manage to get the intubations done (with upper year assistance) so all I get to do is watch. And maybe I want to do a chest tube once in a while! Plus the frustrations you might feel at an academic center and community hospital are different. So its nice to have a bit of balance. I work half the time at a high acuity center with residents and then half at a lower acuity community hospital thats still gets its share of sick patients occasionally. You also pick up some additional skills at a community hospital, like when to transfer for specialist eval. In the beginning I found myself looking up a lot of ortho stuff....what can I splint and send to clinic and what goes to the main hospital immediately?

Hope that helps.
 

n2b8me

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I agree that practicing in a single coverage hospital is intimidating, especially if you have no experience with that as a moonlighter in residency. My philosophy was to be away from residents during my first few years out of residency... now it's been 5 years and still have not worked with any, only an occasional cardiology fellow on call. I don't know if thats a good thing, but its just what has happened.
I know that when I work at my single coverage gig I definitely have much more excitement... and at my HMO gig where there are 5 ER docs working together for 4 hours midday I have more boredom... but coming straight out of residency I might interpret the excitement as terror/panic, and the boredom as confidence building and having another doc to bounce ideas off.
if you aren't already... start moonlighting and see what things you like and what you don't.
 

Dr.McNinja

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if you aren't already... start moonlighting and see what things you like and what you don't.
I like money. I like having people to bounce ideas off of, but that is what the attending line at my residency is for if I'm by myself.
I honestly don't know where I want to go and what I want to do with myself after residency, so I guess it is a good thing it will be awhile before I go.