Starting school in August but know I want to do EM...what do I do?

[surfguy84]

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I'm starting school in August but have been doing some shadowing lately to get a better picture of different specialties. I've spent 50ish hours with a friend who is an EM physician. I'm addicted to the work and know it's what I want to do.

My question is..since I already have a career to shoot for, what exactly can I do to increase my competiveness come match time? I want to hit the ground running and do whatever I can to land a great EM residency position.

 

[Postictal Raiden]

At my school, everyone and their mother want to go into EM. I'm pretty sure that if you survey my class, 50%+ will say they want to do EM. Therefore, I wouldn't be surprised that the competitiveness of the field will skyrocket in the near future.

With that said, EM is a very DO friendly specialty and I don't see that changing despite the rise in competitiveness. Also from what I hear and read, the EM PDs value away rotations. Perhaps, in this field, your away rotations are even more important that your boards.

My advise to you is to focus on your preclinical education and try to incorporate some boards prep as early as you can. A high step I score will open a lot of doors for you. Also, keep an open mind as you will mostly likely change your specialty of interest a billion times.

Good luck

 

[Mr Kenobi]

At my school, everyone and their mother want to go into EM. I'm pretty sure that if you survey my class, 50%+ will say they want to do EM. Therefore, I wouldn't be surprised that the competitiveness of the field will skyrocket in the near future.

^haha totally. I was talking to my buddy the other day who is an EM attending (MD). I said it was funny, because it seemed like a ton of kids (including a lot of the gunners) at my school had their sights set on EM. He laughed and basically said thats because EM is to DO as say surgery is to MD. Somewhat attainable, yet competitive.

 

[surfguy84]

At my school, everyone and their mother want to go into EM. I'm pretty sure that if you survey my class, 50%+ will say they want to do EM. Therefore, I wouldn't be surprised that the competitiveness of the field will skyrocket in the near future.

With that said, EM is a very DO friendly specialty and I don't see that changing despite the rise in competitiveness. Also from what I hear and read, the EM PDs value away rotations. Perhaps, in this field, your away rotations are even more important that your boards.

My advise to you is to focus on your preclinical education and try to incorporate some boards prep as early as you can. A high step I score will open a lot of doors for you. Also, keep an open mind as you will mostly likely change your specialty of interest a billion times.

Good luck

Thanks for the tips. What about research? Will this give a leg up like in other fields?

 

[kenjixshadow]

Thanks for the tips. What about research? Will this give a leg up like in other fields?

Ahahahaha, it will look good to big academic programs, but in general EPs hate research. This isn't IM (for fellowship later on), derm, ENT, or ortho for god sake.

 

[Postictal Raiden]

Thanks for the tips. What about research? Will this give a leg up like in other fields?

I'm sure that, regardless of the field, having research is better than not having it. However, like the poster above mentioned, EM is not a research-heavy specialty.

Knowing that there's a good chance you may change your mind, you should always do whatever it takes to make your application competitive. What if you end up hating EM and liking something like Ophthalmology?

 

[Wolverines83]

Good grades, kill step 1. That way you're set if you change your mind. And you're also set if you don't change your mind.

 

[FrkyBgStok]

shadowing doesn't give a good idea of a specialty. you see little snippets of the best parts. and you will do yourself a disservice going into 3rd year with the such an EM mentality. Ive heard an attending say to another student, "oh you are doing EM? how original. hopefully you don't do like your other EM colleagues and half-ass this rotation." some students were so bad about it that the entire hospital hated them. plus you miss out on how awesome other fields are and what you can learn from them.

but like every school, it is ridiculous how many people here want to do EM because they are "addicted to the work" or because it "fits their personality." everyone says the same thing. do something to make you original......if possible.

 

[fingerscrossedpremed]

I'm starting school in August but have been doing some shadowing lately to get a better picture of different specialties. I've spent 50ish hours with a friend who is an EM physician. I'm addicted to the work and know it's what I want to do.

My question is..since I already have a career to shoot for, what exactly can I do to increase my competiveness come match time? I want to hit the ground running and do whatever I can to land a great EM residency position.

I'm in the exact same boat. I start at the end of July. I looked it up recently, and the average usmle for EM residencies is 230, which isn't horrible. I just hope it doesn't get super competitive during the next few years.

 

[Goro]

Do well in school, and then do well on your rotations, and do well on Boards.

My school sends grads into EM every year, so if they can do it, so can you.

In the mean time, just read up on Anatomy, OK? You'll need it.

I'm starting school in August but have been doing some shadowing lately to get a better picture of different specialties. I've spent 50ish hours with a friend who is an EM physician. I'm addicted to the work and know it's what I want to do.

My question is..since I already have a career to shoot for, what exactly can I do to increase my competiveness come match time? I want to hit the ground running and do whatever I can to land a great EM residency position.

 

[NontradCA]

OP I feel you. I had no interest in EM. I then saw the 175/hr. Now I like EM.

 

[Thought Crime Spree]

I wanted to do EM coming in, matched at my number one EM program. Get involved in EM things, clubs or national organizations. Go to conferences and here what matters from program directors. There is a lot of EM research going on but you won't find it at any DO programs (you won't fun any research really) but a case report or something doesn't hurt. Rock you boards and auditions and you can pick our spot. Easier said than done.

 

[hallowmann]

EM is one of those fields that I kind of wish I felt I was 100% compatible with, but I've been discouraged by the fact that many of the reasons people say they love the field are reasons that give me second thoughts about it... I guess I'll see in the coming months if its really for me or not.

 

[NurWollen]

Yeah there are so many people at my school who are 'sure' they want to do EM. It's kind of funny, for med students, emergency physicians are the fighter pilots of the medical world. In the real world, emergency physicians complain about the total lack of respect from other specialties.

 

[NurWollen]

EM is one of those fields that I kind of wish I felt I was 100% compatible with, but I've been discouraged by the fact that many of the reasons people say they love the field are reasons that give me second thoughts about it... I guess I'll see in the coming months if its really for me or not.

This. I really really want to love EM. But when I'm honest with myself, I'm not sure I'd be happy doing it. Luckily I am doing an EM rotation early enough 3rd year that I'll have plenty of time to plan ahead if I decide that is what I want to do. That is if Step 1/Level 1 don't preclude EM for me first, lol.

 

[surfguy84]

Are there any other specialities that allow for the lifestyle of em...not talking about pay...but the shift style work, lack of call, ease of finding locums work...

 

[235009]

Are there any other specialities that allow for the lifestyle of em...not talking about pay...but the shift style work, lack of call, ease of finding locums work...

Hospitalist. IM subspecialties. Peds subspecialties. Dermatology.

There is ALWAYS backup call no matter what field you're in.

Locums work is a nonissue. In the grand scheme barely anyone does it and it's a horrible/unpredictable lifestyle.

 

[NurWollen]

Are there any other specialities that allow for the lifestyle of em...not talking about pay...but the shift style work, lack of call, ease of finding locums work...

FM... you can find 9-5, 5 days per week, outpatient only jobs, or you could work as a full- or part-time hospitalist, or do urgent care work, etc. Or you could open your own full-spectrum practice, work like crazy and make a buttload of money. Lots of options in FM.

 

[AlbinoHawk DO]

At my school, everyone and their mother want to go into EM. I'm pretty sure that if you survey my class, 50%+ will say they want to do EM. Therefore, I wouldn't be surprised that the competitiveness of the field will skyrocket in the near future.

With that said, EM is a very DO friendly specialty and I don't see that changing despite the rise in competitiveness. Also from what I hear and read, the EM PDs value away rotations. Perhaps, in this field, your away rotations are even more important that your boards.

My advise to you is to focus on your preclinical education and try to incorporate some boards prep as early as you can. A high step I score will open a lot of doors for you. Also, keep an open mind as you will mostly likely change your specialty of interest a billion times.

Good luck

EM is just triage.

 

[kenjixshadow]

I'm in the exact same boat. I start at the end of July. I looked it up recently, and the average usmle for EM residencies is 230, which isn't horrible. I just hope it doesn't get super competitive during the next few years.

EM won't skyrocket into 250. Hell, even the most competitive residencies aren't there yet. EM won't be like derm where the money and lifestyle are good. EM lifestyle isn't age friendly. Hence, you rarely see any EP over age 50 working full time. Heck, the EPs on SDN think you're either crazy or dumb to work 40+ hours a week.

Are there any other specialities that allow for the lifestyle of em...not talking about pay...but the shift style work, lack of call, ease of finding locums work...

You need to seek wisdom from @cabinbuilder.

Yeah there are so many people at my school who are 'sure' they want to do EM. It's kind of funny, for med students, emergency physicians are the fighter pilots of the medical world. In the real world, emergency physicians complain about the total lack of respect from other specialties.

It's true though as I've seen it first-handed. The ED is the easy target, but whatever. A senior resident once told me, "Here in the ER, we take really sick patients, make them a little less sick and send them upstairs." I laughed more than I should.

 

[xBODOMx]

.

 

[cabinbuilder]

Are there any other specialities that allow for the lifestyle of em...not talking about pay...but the shift style work, lack of call, ease of finding locums work...

Family practice (me) is very versatile and flexible. There are more locums jobs out there than are doctors to fill. I easily get 10-15 emails a day asking for help. The schedule on locums is what you are able to give, not what they want you to do. If the job doesn't suit your needs then you don't take it.

I have worked ER - shift work, no call
I generally work urgent care- shift work, no call.
You can work hospitalist: 7 days on, 7 days off but have call during the week you work
FP clinic: can be just clinic, no call. Can be clinic with call. Can be clinic with call and hospital - just depends on the needs of the location.

 

[Mjolner]

^haha totally. I was talking to my buddy the other day who is an EM attending (MD). I said it was funny, because it seemed like a ton of kids (including a lot of the gunners) at my school had their sights set on EM. He laughed and basically said thats because EM is to DO as say surgery is to MD. Somewhat attainable, yet competitive.

My understanding is surgery was DO friendly. Is that not the case?

 

[fingerscrossedpremed]

My current program has third year EM residents that rotate through every month and I worked at another with a residency. I would say about 40% have told me they regret going into EM. About 30% of the leftover 60% are neutral about it.

Interesting find. A little outdated, but still applicable.

 

[Mr Kenobi]

My understanding is surgery was DO friendly. Is that not the case?

AOA surgery programs are super DO friendly.

 

[xBODOMx]

.

 

[Bea5T]

View attachment 192584
Interesting find. A little outdated, but still applicable.

Plastic surgeons make less than general surgeons? Always thought they were the most compensated due to cash only procedures.

 

[NurWollen]

Plastic surgeons make less than general surgeons? Always thought they were the most compensated due to cash only procedures.

I've never seen a physician salary list that didn't have issues passing the sniff test with a few specialties.

 

[kenjixshadow]

The other chart is out-of-date. Here are the ones from this year:

Source: Medscape

Source: http://www.beckershospitalreview.co...tatistics-on-physician-compensation-2015.html

Also this is the starting salary of each specialty if anyone is interested. https://www.aamc.org/download/399576/data/startingsalariesforphysicians.pdf

I'm more interested in the MGMA compensation 2015. If someone has it, please post it or PM me. Thank you

 

[surfguy84]

That aamc salary list seems kind of low, no?

 

[kenjixshadow]

That aamc salary list seems kind of low, no?

Nope, I heard it's quite right. That is the starting salary after residency, meaning you are not a partner. Once you are a partner, your compensation should be higher.

 

[Bea5T]

The other chart is out-of-date. Here are the ones from this year:

Source: Medscape

View attachment 192592

Source: http://www.beckershospitalreview.co...tatistics-on-physician-compensation-2015.html

Ok so everyone on SDN always goes on and on about Anesthesiology becoming a less desirable specialty due to lower compensation, but the data clearly shows that's not the case?

 

[IslandStyle808]

Ok so everyone on SDN always goes on and on about Anesthesiology becoming a less desirable specialty due to lower compensation, but the data clearly shows that's not the case?

They say the same thing about radiology, but in radiology's case it is because they increase the amount of cases they look over. Thus keeping their salary about the same. The same thing here might be happening for anesthesiology.

Well, @cliquesh will have a better idea of what is the main reason.

 

[cliquesh]

All I can tell you is that all graduating seniors from my program without fellowships took jobs for no less $300k starting. Peds, pain and cards fellows were in the $400+ starting.

Anesthesia seems fine for now. Who knows what it will be like when you guys finish your training in 8 or 9 years.

 

[SLC]

The other chart is out-of-date. Here are the ones from this year:

Source: Medscape

View attachment 192592

Source: http://www.beckershospitalreview.co...tatistics-on-physician-compensation-2015.html

View attachment 192593

Also this is the starting salary of each specialty if anyone is interested. https://www.aamc.org/download/399576/data/startingsalariesforphysicians.pdf

I'm more interested in the MGMA compensation 2015. If someone has it, please post it or PM me. Thank you

The plastic surgeon I know makes way more than either of the lists posted here, like more than double. And he basically doesn't do any cash only or cosmetic procedures. I know because I've seen the per-RVU payment he gets and have been in the room when he gets his RVU report.

We're talking north of $600K

 

[IlDestriero]

Ok so everyone on SDN always goes on and on about Anesthesiology becoming a less desirable specialty due to lower compensation, but the data clearly shows that's not the case?

Why do you say that? Anesthesia income can vary widely from low 200s with Cadillac academic benefits working 2-3 clinical days a week to eat what you kill work your a$$ off private practice in the sticks banking 700+. One average income data point tells you nothing. The problem is the greed. The greed of PP groups not accepting new partner track people anymore paying them 350 for a job that they do for 500+. The greed of selling out to an Anesthesia Management Company, or the sad reality of losing your contract to one. Now instead of a system you run and set up how you want, everyone is an employee making 350-400 while the corporate overlords and investors get rich on your work and billing.
Anesthesia is difficult field to evaluate because the jobs are so variable. 350 might be really great for a mommy track 7-3 no call no weekend or ambulatory only job doing your own cases, especially with benefits. Or, 350 might be comically bad covering 4:1 CRNAs all the time in a busy 7a-6p practice taking call Q5 or 6. I would need closer to twice that.

 

[IlDestriero]

Good and fair jobs are getting harder and harder to get every year especially in desirable areas, while predatory practices and anesthesia management companies are spreading like the cancer that they are driving down income while increasing workload. If the management company is paying you 350 to do what used to be worth 500 you just took a 30% pay cut.

 

[IslandStyle808]

Good and fair jobs are getting harder and harder to get every year especially in desirable areas, while predatory practices and anesthesia management companies are spreading like the cancer that they are driving down income while increasing workload. If the management company is paying you 350 to do what used to be worth 500 you just took a 30% pay cut.

So anesthesiologists are being forced into this workload by the management companies and don't really have a choice in the matter? Meaning even if anesthesiologists want to decrease their workload and let their salary take a hit, they can't.

 

[user3]

So anesthesiologists are being forced into this workload by the management companies and don't really have a choice in the matter? Meaning even if anesthesiologists want to decrease their workload and let their salary take a hit, they can't.

TBH, anesthesia's medicare problem and obamacare concerns seem more worrisome than the AMC's...

 

[IlDestriero]

So anesthesiologists are being forced into this workload by the management companies and don't really have a choice in the matter? Meaning even if anesthesiologists want to decrease their workload and let their salary take a hit, they can't.

If they don't like it they can quit or not take that job, but AMCs are a growing employer taking contracts that used to be private practice groups.
They want the most cost effective system to maximize their profit and have no need to work with you or anyone to give you a special arrangement.
Here's an example.
An 18 member group does all their own cases at a smaller hospital and surgery center. They are fair and have a $$ for call system, 3 of the older members don't take first call anymore "selling" it to the younger guys. They average 2 calls a month and take 12 weeks vacation each, accepting lower income for more time off. They also have a well planned benefit system that pays a generous retirement and all of their benefits pre tax.
They have 4 people off every day and cover 12 locations a day, and have the post call day off and a scheduler that helps with emergencies, pacu issues, breaks, difficult airways or blocks, etc. a real nice traditional group.
New management company takes over contract as they convinced the CEO they can do it better and cheaper as the old group took a stipend to cover low volume 24 hour call, and they they will accept the contract without any stipend. They also tell them that the 12 weeks vacation is crazy and a luxury they are paying for. Which may be true, but is actually irrelevant. They can staff any way they want.
Now they have the contract. They can cover 1 MD for 3 CRNAs so those 12 locations can be done by 12 CRNAs and 4 MDs. One more post call and another on vacation means 18 MDs are now 6 and 15or 16 CRNAs. They also cut Vaca to 6 weeks. As they are floating between rooms, they get rid of the scheduler position as well and hire one floater CRNA. The MDs can deal with emergencies.
They might make around the same money, but they're working much harder for 1/2 the vacation and the AMC is profiting off of everyone's work.
Don't like it, fine. Leave. They need to get rid of 12 anesthesiologists anyway.

 

[Thought Crime Spree]

These contract management groups started in EM, read The Rape of Emergency Medicine, a free copy is available online. They are quite prevalent, refer to the EM forums for more info.

 

[IlDestriero]

Oh yeah, your Cadillac benefits are now crap, no more big deductions, and the call is q6.
If you're lucky they keep the scheduler and you can be Q7.

 

[IslandStyle808]

If they don't like it they can quit or not take that job, but AMCs are a growing employer taking contracts that used to be private practice groups.
They want the most cost effective system to maximize their profit and have no need to work with you or anyone to give you a special arrangement.
Here's an example.
An 18 member group does all their own cases at a smaller hospital and surgery center. They are fair and have a $$ for call system, 3 of the older members don't take first call anymore "selling" it to the younger guys. They average 2 calls a month and take 12 weeks vacation each, accepting lower income for more time off. They also have a well planned benefit system that pays a generous retirement and all of their benefits pre tax.
They have 4 people off every day and cover 12 locations a day, and have the post call day off and a scheduler that helps with emergencies, pacu issues, breaks, difficult airways or blocks, etc. a real nice traditional group.
New management company takes over contract as they convinced the CEO they can do it better and cheaper as the old group took a stipend to cover low volume 24 hour call, and they they will accept the contract without any stipend. They also tell them that the 12 weeks vacation is crazy and a luxury they are paying for. Which is probably true.
Now they have the contract. They can cover 1 MD for 3 CRNAs so those 12 locations can be done by 12 CRNAs and 4 MDs. One more post call and another on vacation means 18 MDs are now 6 and 14 or 15 CRNAs. They also cut Vaca to 6 weeks. As they are floating between rooms, they get rid of the scheduler position as well and hire one floater CRNA. The MDs can deal with emergencies.
They might make around the same money, but they're working much harder for 1/2 the vacation and the AMC is profiting off of everyone's work.
Don't like it, fine. Leave. They need to get rid of 12 anesthesiologists anyway.

Very informative post, thank you. So it does look like a forced situation for anesthesiologists. With the AMCs increasing and their maximizing costs approach becoming more prevalent, this leaves anesthesiologist with most jobs that over work them. No options that let them take a hit in their salary if they want to work less. That's really bad.

 

[IlDestriero]

I ran out of time.
So to finish my example. This is a rough example.
Let's say they all made ~350 before the fall and the 500k stipend for the call bonuses. For simplicity lets assume 100k for malpractice and benefits are included so 18*450 + 500=$8.6m
They were making 8.6M with the old group, 8.1 million were patient care fees after collection costs, etc.
Lets be generous and say the new set up has 7 MDs and 18 CRNAs.
Their new benefits are only worth 50k.
New staffing costs.
7*400=2.8m
18*200=3.6m
So $6.4m in staffing costs.
But they are doing the same amount of work and collecting $8.1 million a year.
So the overlord is profiting $1.7m on your work. Maybe they throw you a bone and give you 50k more for the extra work. They still skim $1.3M a year out of your pocket, giving you more liability and accepting zero risk and liability themselves. You're a separate corporation they can just cut loose if there is a big disaster.
That's what you're up against, and why Wall Street and hedge funds invest in management companies. They actually make even more as their collection and benefit costs are lower because of their size and they can use size and penetration into the market to negotiate higher rvu rates.
And it's even worse as some will bid both EM and anesthesia contracts together so even if you are doing a great job and take no stipend, you still might lose the contract because they want to fix a money loser EM group and they won't bid separately. They need anesthesia profits to make the EM bid profitable.
The future is here, and it sucks more d%#k than a Mexican prostitute at a donkey show.

 

[burritowithgreensauce]

Purchase razorblades and shaving cream. Apply generous portion of shaving cream to genitalia. Use razorblade on said genitalia.
Purchase camera phone. Preferably one with an HD camera. download snapchat. open. Obtain snapchat of EM program directors. Place said genitalia in picture. Send to said PDs. Profit.

everything else is semantics and not worthy of your time.

 

[Postictal Raiden]

TBH, anesthesia's medicare problem and obamacare concerns seem more worrisome than the AMC's...

The CRNA thing is much more worrisome imo.

 

[surfguy84]

Well this all sounds wonderful. Can't wait to get started in medicine.

Thanks sdn!!

 

[kenjixshadow]

Destriero's posts are incredibly informative. I'd like to echo of the similar situation is happening with EM. You can read "The Rape of Emergency Medicine" - which is essentially about CMGs (contract management groups) are buying out democratic EDs. You can search more about about it by typing "CMG" on SDN.

$175/hr sure sound a lot and good to medical students & new attending physicians, but you'll be dealing with Press-Ganey, MBA, and bad administration who care nothing about patients and want you to quickly move the bodies. They alone have been sabotaging the profession. Btw, these are not my words. I'm simply reiterating what the EPs who have worked for CMGs said.

 

[TwinsFan]

Throwaway account.

It is quite surprising that more people are not talking about this. I was with a large private EM group (as a scribe) for a long time. It was bought out by a national CMG. Since I already had established relationships, they became pretty candid with me. Physician compensation was slashed by at least 50% on average (more for the faster/younger physicians). Benefits and retirement are still unknown and are in transition. Compensation aside, group moral is essentially non-existent. The CMG keeps boasting about how “you’re still your own group”, etc. But everyone knows they’re full of it. Partners, hell, even friends of many, many years have become fractured. People are leaving, trying to find any democratic position they can, while all the middle-to-older physicians are stuck. CMGs are a cancer to the physician world. .

It was a sad sight to witness. . .

Good luck everyone. . .

What part of the country was this in and how recently did it happen?

 

[IlDestriero]

I'm not sure why that needed a throw away account...
If it was bought out, the partners will likely have to remain there for 3-5 years to keep the money from the sale of their shares. If they just lost the contract, than they would be free to leave or try to negotiate a better deal, probably unsuccessfully. And, most importantly, got zero for their practice.
It's nice to see that one of the side effects is that academic practices seem to be having big growth in applicants as they are probably a safer long term bet than a lot of groups, particularly the systems that are financially strong.
We can't even interview all the truly qualified candidates anymore. There is an initial screen and a phone interview first.