Birdstrike

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This sounds like a perfect recipe for creating an environment where doctors won't want to move to work, and will strongly consider leaving if able.

"One Utah doctor shortage, coming right up as ordered!"
 
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Birdstrike

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PS-And people wonder why voters consider establishment politicians vile and worth abandoning for any choice other than them.
 
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bashwell

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Just wondering, what's EM like in Canada in terms of lifestyle (e.g. do attendings work rotating over night shifts, are there similar things to Press Ganey, etc.)?

I know in Australia and New Zealand lifestyle as an attending seems very good by comparison. For example, where I am attendings rarely if ever work past around midnight, they seem to generally work 4 days per week x 10 hrs per shift, and also rarely if ever work weekends. Press Ganey doesn't seem to be as ubiquitous. You don't seem to worry as much about getting sued as you do in the US. A slower pace and much less volume compared to the US, although maybe fast by Aussie/Kiwi standards. Patients are more grateful in general. It's considered a bit strange if a patient doesn't say thank you afterwards.

But on the negative side, pay is apparently a lot less (in general I've seen about a $350-$400k "package" but not all of this is strictly income). Also there's the hated 4 hour rule. It's a universal healthcare system, you have to see anyone and everyone and there's not really a whole lot of private work for EPs.
 
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WilcoWorld

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Just wondering, what's EM like in Canada in terms of lifestyle (e.g. do attendings work rotating over night shifts, are there similar things to Press Ganey, etc.)?

I know in Australia and New Zealand lifestyle as an attending seems very good by comparison. For example, where I am attendings rarely if ever work past around midnight, they seem to generally work 4 days per week x 10 hrs per shift, and also rarely if ever work weekends. Press Ganey doesn't seem to be as ubiquitous. You don't seem to worry as much about getting sued as you do in the US. A slower pace and much less volume compared to the US, although maybe fast by Aussie/Kiwi standards. Patients are more grateful in general. It's considered a bit strange if a patient doesn't say thank you afterwards.

But on the negative side, pay is apparently a lot less (in general I've seen about a $350-$400k "package" but not all of this is strictly income). Also there's the hated 4 hour rule. It's a universal healthcare system, you have to see anyone and everyone and there's not really a whole lot of private work for EPs.
What's the "hated 4 hour rule"?

edit: Nevermind, I looked hard and found the first link on Google.
 

bashwell

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What's the "hated 4 hour rule"?
Sorry about that. Here is a good explanation which tries to be objective, though the reality is most EPs here seem to really hate it.

By the way here is something (although there's some bias since it's from a recruiter) of what EM lifestyle is like in Australia. And here is something from an Irish EP working in Australia.
 
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Old_Mil

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Canada = work rotating overnight shifts like here.. Pay is equal to my current job.. Very little malpractice risk.. Annual malpractice premium is like $1k a year.. You incorporate and pay a fraction of the taxes you do here.. The physician doxumentatoon section of a chart is about the size of an iphone 6+ screen. To be fair the Canadian dollar has weakened significantly over the past two years though I think this is a temporary thing that will begin to reverse this afternoon.

Austrlia = pay is equal to here.

New Zealand = the pay is about half of what it is here but if you go in as a consultant you have no scheduled nights just on call nights to answer the phone and go in if your regiatrars get into trouble.. Like half the pph of a job here because with the registrars you have more warm bodies seeing patients.. This is a great way to ease in to retirement, if you aren't following in Birdstrike's footsteps.
 
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bashwell

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Canada = work rotating overnight shifts like here.. Pay is equal to my current job.. Very little malpractice risk.. Annual malpractice premium is like $1k a year.. You incorporate and pay a fraction of the taxes you do here.. The physician doxumentatoon section of a chart is about the size of an iphone 6+ screen. To be fair the Canadian dollar has weakened significantly over the past two years though I think this is a temporary thing that will begin to reverse this afternoon.

Austrlia = pay is equal to here.

New Zealand = the pay is about half of what it is here but if you go in as a consultant you have no scheduled nights just on call nights to answer the phone and go in if your regiatrars get into trouble.. Like half the pph of a job here because with the registrars you have more warm bodies seeing patients.. This is a great way to ease in to retirement, if you aren't following in Birdstrike's footsteps.
Awesome, thanks Old_Mil!

By the way, I know for Australia (at least where I am) it's the same or very similar to NZ where consultants don't have any scheduled or rostered nights, only on-call nights like you said, but that's usually taken care of by the registrars too. Vast majority of the time consultants seem to be at home in bed.

A few other little perks:
-CME (aka CPD in Australia = Continuing Professional Development) you're given $25k-$30k for CME per year (NZ is around $15k I've heard),
-10 days paid for CME/CPD (for example lots of Canadian doctors Down Under seem to use these 10 days + some of their vacation + the $25-$30k for CME to fly back to North America for a relevant conference)
-6 weeks vacation/holiday
-Paid sick leave
-Generous overtime pay (aka "salary penalty rates")
-Possibility of extra "allowance" if on call (depending on how bad call is) -- anywhere from $0 to $60k I've heard.
-Possibility of picking up extra locums for average $2000/shift to supplement income
-Staff specialist emergency physicians (similar to academic attendings in the US) schedules seem to be 4 day x 10 hrs shifts. But one of those days basically doesn't have to be clinical (seeing patients), but can be dedicated to "research" or teaching medical students.
-Overall "packages" I've seen range from about $350-$400k+.
 

Birdstrike

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I know in Australia and New Zealand lifestyle as an attending seems very good by comparison. For example, where I am attendings rarely if ever work past around midnight, they seem to generally work 4 days per week x 10 hrs per shift, and also rarely if ever work weekends.
This is an absolute ----ing tragedy for EM in the USA that we haven't found a way to make this happen, at the very least in a graduated way, as one progresses in seniority. I consider this a massive failure in EM leadership in the United States. They've been too content to move up their administrative chain knowing they can reduce to two shifts a month and leave the chum at the bottom to figure out how to fend for themselves or get chewed up by sharks, all while promoting lies like,

"Burnout isn't real in EM."

"You can just work part time."

"16 shifts a month is all you need to do."

"You can just get a job where you don't work nights."

And "EM is a lifestyle specialty."

For at least 60% of community EPs, these are stone faced lies.

It's also a massive failure of EPs not to demand what @bashwell describes, or at least some Americanized version of it. It's about time EPs get as demanding, and entitled and persistent as the rest of the country.

But it's unlikely to change in my lifetime, unless enough people leave for Canada, Australia, New Zealand and places like that (and maybe Texas), but I haven't been holding my breath in anticipation. So far, their strategy has been effective,

"Just keep pay high enough so there's warm bodies in the ED, push them until the breaking point, then fill shifts with bright eyed and hungry recruits ready to save the world each shift. Sell the sexy part of the specialty to new recruits. Rinse. Repeat."

But what do I know? I'm just a random on the Internet.
 
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