Switching From EM Into radiology?

[wamcp]

Depends where exactly. I grew up in Spartanburg which is smaller than Greenville but isn't a bad place to live. Much cheaper but still has the basics, plus a fair amount of non-chain restaurants that are surprisingly good.

I did residency in Anderson. Smaller still but in a good way (very Mayberry-ish) plus there's a big lake running right outside town to live on if that's your thing.

Anywhere else is going to be much less ideal for living there but might not be a bad commute.

Mind sharing the exact location so I can give more specific information?

This city:

Laurens, South Carolina - Wikipedia

en.m.wikipedia.org

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[VA Hopeful Dr]

This city:

Laurens, South Carolina - Wikipedia

en.m.wikipedia.org

Hard pass.

If you live in the nice suburb of Greenville on the south end (Simpsonville) that's a 30 minute drive which isn't too bad. Otherwise unless you like living with very little nearby, I wouldn't live there.

 

[YCAGA]

This city:

Laurens, South Carolina - Wikipedia

en.m.wikipedia.org

I grew up in the region...that location isn’t ideal if you don’t like rural but the counter point is you are still within 2 hours of Augusta, Asheville and Charlotte and within 3 hours of Charleston and Atlanta. All of these cities have a lot to do and are very popular for a reason. For nature/outdoors stuff, you are about 2-3 hours from arguably the best hiking and parks east of the Mississippi and 2-3 hours from a ton of beaches. Being close to Charlotte and Atlanta will also save you time and money on domestic and international flights because of the giant airports there. This seems like a fairly ideal location tbh if you are 7on 7off and don’t have much time to enjoy stuff during your work weeks, but have multiple days chunks free throughout the year. Just my 2 cents

 

[YCAGA]

370k for 15 night shifts a month, closed icu, at my city suburb hospital.

I opted for 10 a month which is still considered full time, so i get 250k.

400k should be very well within reason if open icu (even with no procedures) or in a more rural place

Thanks! Very informative. If those are 12 hour shifts, that is about $170/hr if I did the math right? Is the reason EM gets paid so much higher for nights the number of procedures?

 

[CCM-MD]

370k for 15 night shifts a month, closed icu, at my city suburb hospital.

I opted for 10 a month which is still considered full time, so i get 250k.

400k should be very well within reason if open icu (even with no procedures) or in a more rural place

Our nocturnists get $140/h in an open ICU with intensivist on call. Small southeast city with 65k population. Thats 305k for 15 shifts per month. Rate is lower than what is seen on SDN but interestingly they haven't had any trouble recruiting.

 

[Doctor_Strange]

I'm a current M4 pretty much done interviewing for Emergency Medicine this cycle who's having second thoughts about my choice based on the outlook for EM as has been discussed frequently online and also after more introspection, and considering potentially switching to Radiology in the future. It's obviously too late for this cycle, but how doable would this be during my EM intern year if I decided for sure that's what I wanted to do? I'm a US MD, >245 step 1 and around 250 step 2. Also, does anyone know if intern year in EM would count as my preliminary year? I understand this sort of switch is not as rare as I once thought, but still trying to get a better picture of how realistic it actually is and what barriers I'd be up against.

I had doubts after my second sub-i when I realized -- perhaps later than most -- that there were several aspects of EM I was not enjoying, and it all revolved mostly around one realization: the shift-work was destroying my body. Whether before or after a shift, I almost always felt groggy; I often times found myself eating unhealthy as a stress release and especially after night shifts (shout out to Taco Bell). I also found myself sleepy at the wheel for a few seconds on those night shifts. Basically, I just had so little energy to do anything other than recover. Seasoned EM docs don't mess around when they say you are "on" for 90% or so of shifts! I think while attractive at first such a work lifestyle is doomed to lead to burnout and chronic fatigue in one's later years and for me, I wanted a career that I could see myself in well into my late 50s and early 60s. I definitely want to find meaning in my work. And that was another consideration for me -- I wanted a career where I genuinely looked forward to the work and the patients. I'm not sure such a perspective is shared by many folks in EM -- they like the variety, boluses of adrenaline, but I honestly think there is a sense of apathy viewed towards the patients that come through the ED and I don't blame them mind you. Finally the disconnect between academic EM and community EM is night and day -- those academic folks do have relatively nicer lifestyles because they work so little while out in the community the burden and stress of working to meet your CMG or even SDG (they also can be bad per some EM doc friends) metrics can really damper your working environment. I will obviously concede no specialty is without metrics, but EM seems to be entrenched by them more so. But I digress.

I decided to dual-apply to IM as well and when I moved onto some other IM sub-specialty rotations after my sub-i it was a breath of fresh air ie Pulm/Crit and Cardiology. Patients coming to clinic who actually cared about their health. Lots of fun physiology in the ICU and on the inpatient side of medicine. Cath lab and Cardiology is applied physiology all the time. Basically, it's a lot of fun and there is an insatiable desire to be a master at one's craft. Again, I know that goes on in EM, but it's just different. Anyways, I mention all of this to say that I recently decided to withdraw my app from EM after taking stock of my own doubts on EM and frankly the widespread opportunities in other specialties (similar to Rads). Now, the current landscape of EM jobs, residencies, and the seemingly endless BS that EM docs appear to deal with admin-wise simply were tangential reasons or pluses for why I think ultimately I will have made the right decision. There's literally papers discussing how market saturation is an inevitability at the current pace. I won't go on, but I share this to tell you that I had similar thoughts. And by the way, there is plenty about EM I still love, but ultimately I realized I wanted something different in my career.

 

[rokshana]

So any idea what I'll be up against trying to switch out after intern year? I'm guessing the people at my program are going to hate me?

So why even rank? Find a prelim medicine, transitional year to soap into or lime up a research year in radiology for next year and reapply next year

 

[dadaddadaBATMAN]

So why even rank? Find a prelim medicine, transitional year to soap into or lime up a research year in radiology for next year and reapply next year

Because who gives a damn what the other people in his class think. Trying to match from an existing residency is coming from a position of strength: if you fail, you’re still on the road to being an attending physician.

If you do a prelim and you fail to match you’re either doing another prelim with no advancement or you’re unemployed. I guess you might be able to get insurance work or preventive med/occ med training, but no guarantees.

 

[rokshana]

Because who gives a damn what the other people in his class think. Trying to match from an existing residency is coming from a position of strength: if you fail, you’re still on the road to being an attending physician.

If you do a prelim and you fail to match you’re either doing another prelim with no advancement or you’re unemployed. I guess you might be able to get insurance work or preventive med/occ med training, but no guarantees.

Point being, of the OP doesn’t want to do EM, why do it? Better that he set himself up to have a better chance to get into a radiology than waste time doing an EM intern year...it’s not going to count towards radiology...at least not for a full year...has nothing to do with what other people think of him...but why waste a year in a specialty he doesn’t plan on going in?

 

[dadaddadaBATMAN]

Unless your existing residency plans to replace you if you match (which they will). Then if you don’t match and they fill your spot, you’ll be SOL

If that were the case you still would be no worse off than the transition student, and your residency might plan to soap someone instead. It depends on your program director and the program itself.

 

[Natremia]

If that were the case you still would be no worse off than the transition student, and your residency might plan to soap someone instead. It depends on your program director and the program itself.

Agreed. Fair points.

 

[123GO]

I'm a current M4 pretty much done interviewing for Emergency Medicine this cycle who's having second thoughts about my choice based on the outlook for EM as has been discussed frequently online and also after more introspection, and considering potentially switching to Radiology in the future. It's obviously too late for this cycle, but how doable would this be during my EM intern year if I decided for sure that's what I wanted to do? I'm a US MD, >245 step 1 and around 250 step 2. Also, does anyone know if intern year in EM would count as my preliminary year? I understand this sort of switch is not as rare as I once thought, but still trying to get a better picture of how realistic it actually is and what barriers I'd be up against.

Similar situation here, looks like EM does count as a prelim year for rads. DM me if you want.

 

[emergentmd]

OP should choose what he enjoys to do the most and this is what will make him happy. Bottom line is medicine is a job and there are unlimited pluses/minuses of any job. You find a job easier than 95% of Americans, you will make more than 95% of Americans, you will have job security more than 95% of Americans.

If you want are going into something solely for income, then no one will tell you what the market will be like in 5 yrs when you are done with Radiology.

When I went into EM, No one wanted to go into Rad or Anesthesiology.

I can tell you when I was working full time at a Hospital EM 5 yrs ago, most specialists was envious of ER docs. I went to work 14 dys a month, 8 hr shifts, and pulled in 350K/yr @ 225+/hr plus benefits.

Yes it is worse today and 5 yrs ago. No one knows what the next 5 yrs will be like. I can tell you 5 yrs ago, most specialist were miserable moreso than my EM partners. Anesthesiology, Hospitalist, surgeons, cardiologist were all unhappy. I can't speak for Rads b/c I never really saw them face to face.

Bottom line is do what you feel is right for you. If income/job security really scares you, then yeah go into radiology b/c their market is prob alittle better. But don't be surprised that in 6 yrs when you get out, most Radiology jobs will be predominately VC nighthawks and your pay is slashed in half as insurance companies/medicare slashes rates.

If you enjoy radiology enough to be paid $250K/yr instead of 500K then go into radiology. If you enjoy EM to be paid 250K/yr instead of 400K, then go into EM.

I don't share all the "I can't find a job anywhere in EM" b/c I just do not see it yet. Will I start getting these calls in the next few yrs, maybe but I just don't see it now and I live in one of the tightest markets.

 

[HemorrhagicShock]

Emergentmd, don't you own some freestanding ED and make triple what the average EP makes while seeing probably a third of the patients?

While your perspective is valued, I simply don't think you have a thumb on the pulse of what newly minted EPs are going through. Please correct me if I'm wrong.

FWIW you do give good advice ("do what you feel is right for you") but the EM you get to practice, both now and likely 10 years ago when you were in the grind is very different than what it is now. I'm making assumptions there, but I'm open to corrections.

Actual emergency medicine is less than 10% of what I do day-to-day in my current clinical practice, and I haven't even reached 5 years out of residency. The situation is dire without a doubt.

I write this post lovingly because you are a great example of the potential upsides of being an entrepreneurial physician, but I think the young ones and learners should know your current situation.

I do think your "abundance mentality" is absent among many of my generation, but it's admittedly tough to accomplish what you have and ultimately many fail at a variety of entrepreneurial efforts. One only hears of the successes due to survival bias. How many have failed and forced to return to employed/CMG drudgery?

 

[sloh]

You find a job easier than 95% of Americans

You think being an EM physician is easier than the jobs 95% of Americans have?

 

[clibby]

You think being an EM physician is easier than the jobs 95% of Americans have?

I believe he said finding a job. An EM physician can do urgent care, locums, telemedicine, etc. as a licensed physician in addition to the traditional work in the ED. Full time work in desirable locations is hard right now, but if you are willing to travel a bit you can find employment. In addition to fellowship, I work in 3 hospitals in a very desirable city that I could easily get >20 shifts per month if I wanted. Full time work at any given site is tough, though, but I am not hurting for shifts given I worked to get on at 3 sites PRN. Work is there; it isn't great and desirable markets are hard. What I have been seeing even compared to last year is lower pay for the PRN gigs, but nothing that will make me starve, and less full time options. I do worry that this is going to get worse with more grads, more urgent cares, and the rise of telemedicine.

We have enough ED docs, we just haven't distributed them equitably to rural areas and for now urgent cares have given people the option to live in desirable areas and work. I think the biggest challenge now is that it is getting harder and harder to live where you want and work close to home which is a huge burden on family life and the ability to live near those who support you. We shouldn't underestimate the impact this has on our quality of life. After all our training, I shouldn't have to relocate across the country to find a job because a group finally has an opening. We train people everywhere and we should be training people to fill a need that that exists in the region, not for cheap labor and to flood the market for Wall Street investors. Supply should meet demand this year and we are going to be oversupplied by close to 30% in less than 10 years: The Emergency Medicine Workforce: Shortage Resolving, Future Surplus Expected

Overall, I generally agree with this:

If you enjoy radiology enough to be paid $250K/yr instead of 500K then go into radiology. If you enjoy EM to be paid 250K/yr instead of 400K, then go into EM.

 

[sloh]

I believe he said finding a job. An EM physician can do urgent care, locums, telemedicine, etc. as a licensed physician in addition to the traditional work in the ED. Full time work in desirable locations is hard right now, but if you are willing to travel a bit you can find employment. In addition to fellowship, I work in 3 hospitals in a very desirable city that I could easily get >20 shifts per month if I wanted. Full time work at any given site is tough, though, but I am not hurting for shifts given I worked to get on at 3 sites PRN. Work is there; it isn't great and desirable markets are hard. What I have been seeing even compared to last year is lower pay for the PRN gigs, but nothing that will make me starve, and less full time options. I do worry that this is going to get worse with more grads, more urgent cares, and the rise of telemedicine.

We have enough ED docs, we just haven't distributed them equitably to rural areas and for now urgent cares have given people the option to live in desirable areas and work. I think the biggest challenge now is that it is getting harder and harder to live where you want and work close to home which is a huge burden on family life and the ability to live near those who support you. We shouldn't underestimate the impact this has on our quality of life. After all our training, I shouldn't have to relocate across the country to find a job because a group finally has an opening. We train people everywhere and we should be training people to fill a need that that exists in the region, not for cheap labor and to flood the market for Wall Street investors. Supply should meet demand this year and we are going to be oversupplied by close to 30% in less than 10 years: The Emergency Medicine Workforce: Shortage Resolving, Future Surplus Expected

Overall, I generally agree with this:

Thanks for the response. Do you know what the income is like for urgent care? Seems from what I read, it's significantly less than working full-time in the ED. And what about telemedicine?

 

[clibby]

Thanks for the response. Do you know what the income is like for urgent care? Seems from what I read, it's significantly less than working as a full-time in the ED. And what about telemedicine?

That entirely depends. For telemedicine, it is about volume. I see ~$30-$45 per patient through established companies. If you set up your own, you can bill more, but have to deal with billing just like setting up a solo practice. However, since I am only BE thanks to COVID and not BC, many companies don't want to hire me so my volume is only like 2-4 patients per day. If you did it full time it is likely similar to urgent care pay. It keeps me in the telemed space and covers my beer money.

Urgent care has a lot of other factors to consider. Do you own it? Are you part of a group running the UC or are you employed? Are you providing services or supervising midlevels? Few options pay what you get paid in the ED per hour as an employee, but the stress is often way less in UC.

 

[Backpack234]

What telemedicine companies are y'all working for? Even with an only-BCEM docs telemed system there's about 4-5 patients per day at $40/visit. Not nearly enough for anything more than beer money.

 

[emergentmd]

Even with the current EM market, I would say 95% of EM docs would not trade with their Non medical friends/family. I know I would not. I am still the envy of my friends/family, much better off financially, and have many more days off than most of them. I am taking 3-4 wks off in the summer for a road trip and still able to do all my shifts. Not many can do this without using up all of their vacations.

Looking back in the past yr even with covid, I took 2 wks off to go to destin. I took a week off in Thanksgiving to go skiing. Took 2 wks off in Christmas to just spend with the family. Took 10 dys off for spring break. Essentially every break my kids have, I take off. Not many other specialty can do this.

Compared to other attainable specialty, I don't think many of us would trade with Radiology, Anesthesiology, Hospitalist, cardiologist, surgery, Primary care when you take into account some of these specialist are 5 yrs vs 3 yrs.

 

[emergentmd]

Emergentmd, don't you own some freestanding ED and make triple what the average EP makes while seeing probably a third of the patients?

While your perspective is valued, I simply don't think you have a thumb on the pulse of what newly minted EPs are going through. Please correct me if I'm wrong.

FWIW you do give good advice ("do what you feel is right for you") but the EM you get to practice, both now and likely 10 years ago when you were in the grind is very different than what it is now. I'm making assumptions there, but I'm open to corrections.

Actual emergency medicine is less than 10% of what I do day-to-day in my current clinical practice, and I haven't even reached 5 years out of residency. The situation is dire without a doubt.

I write this post lovingly because you are a great example of the potential upsides of being an entrepreneurial physician, but I think the young ones and learners should know your current situation.

I do think your "abundance mentality" is absent among many of my generation, but it's admittedly tough to accomplish what you have and ultimately many fail at a variety of entrepreneurial efforts. One only hears of the successes due to survival bias. How many have failed and forced to return to employed/CMG drudgery?

I have/had it really good. Did EM in the golden years. Now doing FSEDs and able to make my own decisions. FSEDs in itself is not some printing machine and have their own risks. At least I have control of my own fate and able to make decisions without being lectured on how my standard of care for the past 20 yrs suddenly is not accepted anymore b/c the ACA said so.

I still know many of my old EM docs who still work at hospitals in a top 10 competitive/saturated city and they are still doing well with no drop in rate. Hours yes, but not rate. I would love to bring some of them on board but they are happy working at the hospital.

Even with CMGs, its really not that bad. Everyone needs to reset their perspective and not compare to what was 5-10 yrs ago. Those days are long gone. But EM docs still have it pretty good. The vast majority of specialties do not have it as good as 5-10 yrs ago. Go ask your cardiology/anesthesiology/Gen surg/radiology colleagues. They all will tell you the same.

Reset your perspective and you will be happy. Dwell on what you can not control, and you will make yourself miserable.

 

[Splenda88]

Looking back in the past yr even with covid, I took 2 wks off to go to destin. I took a week off in Thanksgiving to go skiing. Took 2 wks off in Christmas to just spend with the family. Took 10 dys off for spring break. Essentially every break my kids have, I take off. Not many other specialty can do this.

Compared to other attainable specialty, I don't think many of us would trade with Radiology, Anesthesiology, Hospitalist, cardiologist, surgery, Primary care when you take into account some of these specialist are 5 yrs vs 3 yrs.

Definitely not hospitalist... I am on the market now and the offers are not near what EM docs make... 220-300k ($110-135/hr working 15 days/month).

 

[emergentmd]

What telemedicine companies are y'all working for? Even with an only-BCEM docs telemed system there's about 4-5 patients per day at $40/visit. Not nearly enough for anything more than beer money.

You can make a decent living doing telemedicine. Busy during winter, slow during summer. Work your behind off during the winter and I bet you can make 100K doing just telemedicine quite easily.

 

[emergentmd]

Definitely not hospitalist... I am on the market now and the offers are not near what EM docs make... 220-300k ($110-135/hr working 15 days/month).

AND this is my point. Just because Locums was making 325-400/hr 5-10 yrs ago doesn't make the current rate bad. EM STILL in general makes more per hour than most specialties. There are not many that makes $200+/hr. The hospitalist 5 yrs ago were probably the most miserable group in the hospital. If you think the ER is a dumping service, Hospitalist are 10x worse. Atleast I get to go home and never see the pts again. The hospitalist has to deal with them for days.

 

[Splenda88]

AND this is my point. Just because Locums was making 325-400/hr 5-10 yrs ago doesn't make the current rate bad. EM STILL in general makes more per hour than most specialties. There are not many that makes $200+/hr.

I agree... EM is not probably what it was but still good compared to hospitalist.

 

[Taurus]

When I went into EM, No one wanted to go into Rad or Anesthesiology.

We probably started our respective residences around the same time about 10 years ago. Back then, there was a significant decrease in interest in radiology from med students because of what they were hearing from the frontlines. People couldn’t find jobs. People had to do 1-2 fellowships to get jobs. Etc.

At that time, there was increased interest in EM because of the shorter residency and high income potential. It was harder to match into EM than in rads back then. But, I did my research. There were no jobs for new rads because the stock market crash caused delayed retirements or some rads came back into the workforce because of depleted nest eggs. So there was no underlying structural changes. If anything, I felt imaging would be utilized and depended more in the future as midlevels became more common. So, I stuck with the radiology route and never regretted it. I believed that the rad job market would pick up again once the stock market recovered. It took a while but it did and so did the rad job market. I have so many opportunities in big desirable cities and at great pay in my rad subspecialty.

EM is facing structural changes that will permanently change the supply of jobs and the income potential, as you all have been referring to. It is in the best interests of CMG’s to open more residencies, pump out more BC EM docs, and drive down the salaries and bargaining power of EM docs. Unless you can stop or reverse that process, the field is in trouble. It will eventually reach a new equilibrium but not one many of you may like. Look at the pharmacy and law fields where there are oversupplies. Those people struggle mightily to find jobs and usually the income is below what they expected for having gone through the training process.

 

[MechEDoc]

You sit in your ivory tower of pain management telling the grunt docs down below not to worry, all while being out of clinical EM for....how long?
If you were working now you would realize there’s no pendulum anymore
The pendulum crashed and burned and now there just a pile of burning dog **** that is EM.

please tell me how the pendulum is going to swing back after CMG own the majority of the contracts , took away all cme funds, cut hrly pay, drop benefits (all before covid). This specialty is not controlled by docs anymore, but by private equity.

The pendulum always swings. Sure we might be the horse and buggies on the eve of the mass production of automobiles but I doubt that. There is no clear paradigm shift on the horizon just a supply-demand imbalance.

NPs are having a hard time finding jobs. PAs are having a hard time as well. Physicians aren't stupid, medical students will go into other specialties for a period of time, crappy residencies (especially ones that have a tight eye on profits) will close in a new equilibrium will be established. But I think it will take 5 to 7 years.

 

[Splenda88]

The pendulum always swings. Sure we might be the horse and buggies on the eve of the mass production of automobiles but I doubt that. There is no clear paradigm shift on the horizon just a supply-demand imbalance.

NPs are having a hard time finding jobs. PAs are having a hard time as well. Physicians aren't stupid, medical students will go into other specialties for a period of time, crappy residencies (especially ones that have a tight eye on profits) will close in a new equilibrium will be established. But I think it will take 5 to 7 years.

They will fill these spots with warm bodies (aka FMG/IMG with red flags). It's literally happening in pathology now.

 

[MechEDoc]

They will fill these spots with warm bodies (aka FMG/IMG with red flags). It's literally happening in pathology now.

What is happening in pathology? PE as well?

 

[Splenda88]

What is happening in pathology? PE as well?

Not PE. Saturated market due to overabundance in supply. Therefore, path grads have to do 1-2 fellowships to be competitive in the job market. As a result, it is not attracting a lot of AMGs, so PDs are forced to fill these spots with FMG/IMGs.

 

[MechEDoc]

Not PE. Saturated market due to overabundance in supply. Therefore, path grads have to do 1-2 fellowships to be competitive in the job market. As a result, it is not attracting a lot of AMGs, so PDs are forced to fill these spots with FMG/IMGs.

View attachment 332468

No kidding! Why does everyone want to do pathology now? I not trying to insult the field, but curious about the factors that lead to its saturation.

 

[CCM-MD]

No kidding! Why does everyone want to do pathology now? I not trying to insult the field, but curious about the factors that lead to its saturation.

You’re missing the point. Nobody wants to do path. There are too many spots and they are filling with FMGs that cannot get into anything else. Any residency is better than no residency. Your theory of “pendulum swinging” because students will go into other specialties does not work if the number of residency spots remain the same because there is an endless supply of FMGs that will gladly take any open position.

 

[turkeyjerky]

You’re missing the point. Nobody wants to do path. There are too many spots and they are filling with FMGs that cannot get into anything else. Any residency is better than no residency. Your theory of “pendulum swinging” because students will go into other specialties does not work if the number of residency spots remain the same because there is an endless supply of FMGs that will gladly take any open position.

Yeah, path was in the same spot when I was in med school 10 years ago. The only way the pendulum swings is towards having a bunch of subpar clinicians in our field.

 

[Backpack234]

What will it take for these sub-par EM residencies to close now that they've been opened? I can't imagine the ACGME admitting their mistake and closing some of these shops. If anything they'll probably double down.

 

[RadsRocks!]

Rad Onc is like this now as well. What used to be one of the most competitive fields in medicine 5-10 years ago is now the least for various reasons due to poor leadership and residency expansion.

 

[Rekt]

@emergentmd

Not sure why you continually say positive things about EM future when you're in the 99.99th percentile and aren't even looking at job opportunities. You have a very unique position and the over supply only benefits you even more. I really don't think you're in a spot to speak on how it's going and will be.

Was 350-500/hr a bubble? Absolutely. But it sounds like you think EM docs should be fine working for 140/hr or less.

 

[InternistDO]

@EmergDO

Not sure why you continually say positive things about EM future when you're in the 99.99th percentile and aren't even looking at job opportunities. You have a very unique position and the over supply only benefits you even more. I really don't think you're in a spot to speak on how it's going and will be.

Was 350-500/hr a bubble? Absolutely. But it sounds like you think EM docs should be fine working for 140/hr or less.

I think you have me confused with someone else, since my unique position in EM is that I did primary care IM instead.

 

[RustedFox]

@EmergDO

Not sure why you continually say positive things about EM future when you're in the 99.99th percentile and aren't even looking at job opportunities. You have a very unique position and the over supply only benefits you even more. I really don't think you're in a spot to speak on how it's going and will be.

Was 350-500/hr a bubble? Absolutely. But it sounds like you think EM docs should be fine working for 140/hr or less.

Psst. I'm pretty sure that's someone else as well. It was like EmergencyDO3 or something similar looking.

 

[Rekt]

I think you have me confused with someone else, since my unique position in EM is that I did primary care IM instead.

Fixed haha.

 

[Clean7795]

You’re missing the point. Nobody wants to do path. There are too many spots and they are filling with FMGs that cannot get into anything else. Any residency is better than no residency. Your theory of “pendulum swinging” because students will go into other specialties does not work if the number of residency spots remain the same because there is an endless supply of FMGs that will gladly take any open position.

Exactly. Once a field becomes dominated by FMGs, it becomes very easy to control the field because FMGs are dependent on visas to keep working (and most are just happy to have a job); thus leading to further diminished autonomy and pay.

If you enjoy radiology enough to be paid $250K/yr instead of 500K then go into radiology. If you enjoy EM to be paid 250K/yr instead of 400K, then go into EM.

I think this is generally good advice when things are relatively stable. Things aren't stable though. Continued expansion of residencies, increased corporate control and diminished physician autonomy, as well as competition from midlevels are very much real threats that are continuing to worsen.

Or how about this, imagine a nightmare scenario in radiology. Imagine AI reading 20% of imaging volumes causing reduced demand for new radiologists, and despite that corporate driven residences expand. Would you not warn medical students that things are looking pretty bad?

 

[RustedFox]

Fixed haha.

Saw your fix.
Oh yeah; THAT guy. 99.99 percenter with a unicorn position and zero idea of the current market.

 

[emergentmd]

Man, you guy sure gloom/doom. It must be miserable working a job in an Air conditioned place making 250K/yr and then not having to do work at home.

I will admit I have it really good but EM is nowhere near Path. I would also bet that if they asked all EM docs if would be willing to randomly wake up doing another specialty tomorrow, the majority would say NO.

I am sure most of you guys would be complaining why they are working so much as a surgeon, why they are dealing with social admissions/discharges as a hospitalist, why parents are so whinny as pediatricians, why they make so little as a FM, why they have to deal with CRNAs all day, why they are sitting in a dark room all day being second guessed, why they delivered babies all night with a full 8 hr clinic coming up.

Seriously, there are issues with EM just like every field has issues. You guys are stuck in this field. Either make the best out of it and make your 250+K/enjoy your non work life or wallow in self pity making 250K/hr. Some people just are born to be unhappy no matter what and should really self reflect on how good EM docs have it.

I am planning a 3wk summer vacation right now which I also did when I was working in the PIT. EM docs have the time and money to travel almost every month. Just be happy with the positives of EM, it will make you much happier.

You guys are depressing me.

 

[Rekt]

Man, you guy sure gloom/doom. It must be miserable working a job in an Air conditioned place making 250K/yr and then not having to do work at home.

I will admit I have it really good but EM is nowhere near Path. I would also bet that if they asked all EM docs if would be willing to randomly wake up doing another specialty tomorrow, the majority would say NO.

I am sure most of you guys would be complaining why they are working so much as a surgeon, why they are dealing with social admissions/discharges as a hospitalist, why parents are so whinny as pediatricians, why they make so little as a FM, why they have to deal with CRNAs all day, why they are sitting in a dark room all day being second guessed, why they delivered babies all night with a full 8 hr clinic coming up.

Seriously, there are issues with EM just like every field has issues. You guys are stuck in this field. Either make the best out of it and make your 250+K/enjoy your non work life or wallow in self pity making 250K/hr. Some people just are born to be unhappy no matter what and should really self reflect on how good EM docs have it.

I am planning a 3wk summer vacation right now which I also did when I was working in the PIT. EM docs have the time and money to travel almost every month. Just be happy with the positives of EM, it will make you much happier.

You guys are depressing me.

Still missing the forest for the trees.

 

[VA Hopeful Dr]

Man, you guy sure gloom/doom. It must be miserable working a job in an Air conditioned place making 250K/yr and then not having to do work at home.

I will admit I have it really good but EM is nowhere near Path. I would also bet that if they asked all EM docs if would be willing to randomly wake up doing another specialty tomorrow, the majority would say NO.

I am sure most of you guys would be complaining why they are working so much as a surgeon, why they are dealing with social admissions/discharges as a hospitalist, why parents are so whinny as pediatricians, why they make so little as a FM, why they have to deal with CRNAs all day, why they are sitting in a dark room all day being second guessed, why they delivered babies all night with a full 8 hr clinic coming up.

Seriously, there are issues with EM just like every field has issues. You guys are stuck in this field. Either make the best out of it and make your 250+K/enjoy your non work life or wallow in self pity making 250K/hr. Some people just are born to be unhappy no matter what and should really self reflect on how good EM docs have it.

I am planning a 3wk summer vacation right now which I also did when I was working in the PIT. EM docs have the time and money to travel almost every month. Just be happy with the positives of EM, it will make you much happier.

You guys are depressing me.

I'm FM and earning significantly more than 250k/year. My job is also way less stressful than even some of the best EM jobs out there.

So no, telling someone they should be grateful for 250k/year despite all the hardships that go with practicing emergency medicine really isn't the way to go.

 

[Splenda88]

I'm FM and earning significantly more than 250k/year. My job is also way less stressful than even some of the best EM jobs out there.

So no, telling someone they should be grateful for 250k/year despite all the hardships that go with practicing emergency medicine really isn't the way to go.

It's great that there are at least some senior docs who are not out of touch.

 

[sloh]

I'm FM and earning significantly more than 250k/year. My job is also way less stressful than even some of the best EM jobs out there.

So no, telling someone they should be grateful for 250k/year despite all the hardships that go with practicing emergency medicine really isn't the way to go.

Agreed, same with me and I’m PM&R

 

[MechEDoc]

I'm FM and earning significantly more than 250k/year. My job is also way less stressful than even some of the best EM jobs out there.

So no, telling someone they should be grateful for 250k/year despite all the hardships that go with practicing emergency medicine really isn't the way to go.

Enlighten me, how are you doing this? Direct primary care? Nice private practice, sole proprietorship, large corporate setting, rural, urban? So many questions…

 

[Birdstrike]

Man, you guy sure gloom/doom. It must be miserable working a job in an Air conditioned place making 250K/yr and then not having to do work at home...

...Seriously, there are issues with EM just like every field has issues. You guys are stuck in this field. Either make the best out of it and make your 250+K/enjoy your non work life or wallow in self pity making 250K/hr. Some people just are born to be unhappy no matter what and should really self reflect on how good EM docs have it...

You guys are depressing me.

It's great you're happy with your job. But not everyone has a situation as fortunate as you. For them to get from where they are to where you are, it's likely they have to do more than just pretend they're happy when they're not. Having a positive attitude helps, but no one is stuck in EM unless they choose to be. Sometimes a change in attitude helps. But sometimes a positive attitude plus taking action, helps more.

For me, the Jedi mind-trick of just willing myself into a better attitude when I wasn't happy taking mortar-fire in EDs, didn't work. I tried that for 10 years and failed. A positive attitude combined with taking action, worked. Once I made a real career change for the better, my attitude followed, and has been much better for many years now.

All the riches in the world cannot buy happiness. But happiness, can make the poorest man rich.

 

[skougess]

Enlighten me, how are you doing this? Direct primary care? Nice private practice, sole proprietorship, large corporate setting, rural, urban? So many questions…

It's 2021. FM makes close to $300k working 4-4.5 days per week. It's been on the uptrend for the past decade.

 

[namethatsmell]

Man, you guy sure gloom/doom. It must be miserable working a job in an Air conditioned place making 250K/yr and then not having to do work at home.

I will admit I have it really good but EM is nowhere near Path. I would also bet that if they asked all EM docs if would be willing to randomly wake up doing another specialty tomorrow, the majority would say NO.

I am sure most of you guys would be complaining why they are working so much as a surgeon, why they are dealing with social admissions/discharges as a hospitalist, why parents are so whinny as pediatricians, why they make so little as a FM, why they have to deal with CRNAs all day, why they are sitting in a dark room all day being second guessed, why they delivered babies all night with a full 8 hr clinic coming up.

Seriously, there are issues with EM just like every field has issues. You guys are stuck in this field. Either make the best out of it and make your 250+K/enjoy your non work life or wallow in self pity making 250K/hr. Some people just are born to be unhappy no matter what and should really self reflect on how good EM docs have it.

I am planning a 3wk summer vacation right now which I also did when I was working in the PIT. EM docs have the time and money to travel almost every month. Just be happy with the positives of EM, it will make you much happier.

You guys are depressing me.

I like many of your posts and think you talk about about a lot of stuff that's helpful for us all to read.

This is not personal, but the arguments made in this post miss the sentiment of what people are distressed about...

We get to work in "air conditioned place"...great, I also got my wisdom teeth pulled in an air conditioned place. It was still bad.

Many of the points made about the downside of other fields are valid...but comparatively people here feel that the downsides of EM have become untenable...and are suspecting that the immediate future is going to get even worse.

Nobody is saying ~250k is no money. But depending on the work environment (and how many hours are needed to work to get to that number)...it's very fair for people to assess their options. If you're working in a pleasant freestanding seeing 0.5 pph in a low liability state than maybe it's a fair deal. If you're making that seeing 2.5pph in a medmal hellhole while having to digest the crap the CMG overloads pulse your way...not so good. If you could make 6 figures doing non-clinical work or in another clinical field...and not being made to feel like garbage at work everyday...is 250k to do EM in a terrible setup still a good deal?

"You guys are stuck in this field." This is patently false. And the complete opposite mindset that anybody who's displeased being in EM should have. You. Have. Options. See the bajillion recent posts on this.

Focus on the "positives" -- on that I agree. In general this is a healthy way to frame one's work. And this forum has been gloomy recently. Perhaps neither is invalid?

I'm FM and earning significantly more than 250k/year. My job is also way less stressful than even some of the best EM jobs out there.

So no, telling someone they should be grateful for 250k/year despite all the hardships that go with practicing emergency medicine really isn't the way to go.

As I said elsewhere, I'm seriously happy for you guys. My pcp friends are pretty happy these days. Their market is terrific. In addition to the commentary on supply/demand etc I view it as a broader sign that patients still find value in their doctors. I honestly take it as a sign of hope that maybe, just maybe, the overall "system" can get a bit better.


Not to keep repeating myself...but primary care, psych, and any other field that allows you to own your own practice will always offer a shield from the torrents of **** that many hospital admins and PE groups expose their employed docs to. Not saying that it's easy to open and run your own practice, but to have it as an option at least gives you negotiating power. And many docs decide to do this and thrive.