Your first EM attending job experience

[EMgig]

Anyone willing to share their first EM attending job experience? I have somewhat of a convoluted story of how I got this current job, essentially pressured into signing a contract at a place that had difficulty recruiting (now i'm figuring out why) at a location I didn't want to be in, but needed a job, and blindly signed the contract hoping for the best but it didn't turn out that way.

It's possible the problems in this hospital system might be encountered anywhere else so i'm wondering if others have had a similar experience or if this is just an isolated malignant environment- is it common to have a large amount of bureaucracy forcing you to have frequent meetings, chart reviews, nurses who complain for unfounded reasons but have a significant amount of weight in your perception as a clinician (but you can't file complaints about them because they are protected by a union)? It's possible I just don't fit in and am thinking I want to leave and find a better environment (i've only been here for a few months to know I just don't like coming to work).

I'm debating whether I should leave or ride out my current job hoping it will become better? I've often thought about locums as I would have greater control over my schedule (i'm already becoming burned out because as the new person, i'm being forced to work more shifts), and the ability to decide not to return to places I do not like.

Any thoughts anyone? Is what i'm experiencing common or uncommon?

---

Members don't see this ad.

 

[Dr Mantis Toboggan]

Not common. Sounds horrible. It’s the job of medical director to run interference and keep much of that BS away from his team. Doesn’t sound like that happens at your site at all.

 

[EMgig]

Not common. Sounds horrible. It’s the job of medical director to run interference and keep much of that BS away from his team. Doesn’t sound like that happens at your site at all.

Thank you for your reply. We also are on call which I don't like because it's another day that I might tentatively have to come in and cannot leave for a trip, I wish I had other jobs to compare this place to, but i'm wondering if anyone else has any experiences they would like to share so I can compare?

 

[TooMuchResearch]

Thank you for your reply. We also are on call which I don't like because it's another day that I might tentatively have to come in and cannot leave for a trip, I wish I had other jobs to compare this place to, but i'm wondering if anyone else has any experiences they would like to share so I can compare?

The job sounds bad.

Our group has a backup/call system, I have one day on average less than once per month. We get paid for it, it gets used rarely. I don't like being on call, but I do like that if I ever need to utilize it, someone will cover my shift, no questions asked

Sent from my Moto G (5) Plus using SDN mobile

 

[Brigade4Radiant]

Where is this job at? In the southeast? I’m an attending the first year out I signed to a place that has very high acuity and low resources but I’m starting at a new hospital next month which seems to be a better fit. They had me working a lot of weekends and nights.

You need to find another job and leave your current gig in the next few months. We are preyed upon because we often don’t know our worth. Your gig sounds like a group close to me but I refused because you have to be on call for 3 or 4 days a month and you don’t get paid unless you are called in. I refused to sign to such a malignant group especially since they kept on using “we’re a small democratic group.”

 

[OccupyTheED]

OP quit that job immediately. You are marketable, you have options. That place sounds like a real s*ithole. Your best leverage is to vote with your feet.

 

[The White Coat Investor]

Read your contract so you know how much notice to give. Start looking for another job. Do it right this time.

 

[joeDO2]

Anyone have some tips for things to look out for on the job hunt? When interviewing is there any flexibility to negotiate or are rates/schedules pretty much set in stone with the big CMGs? What has been your experience with standard rate vs rate + RVU jobs? With the SDGs what is a reasonable buy in ? Anyone familiar with the tampa bay market? Thanks!

 

[shoal007]

Anyone have some tips for things to look out for on the job hunt? When interviewing is there any flexibility to negotiate or are rates/schedules pretty much set in stone with the big CMGs? What has been your experience with standard rate vs rate + RVU jobs? With the SDGs what is a reasonable buy in ? Anyone familiar with the tampa bay market? Thanks!

There is little room for negotiation for rate, hours, schedule in most groups. If you want all weekend or nights or evening then it is easier. You may have negotiation power for contract and bonus if not in a highly competitive market.

Sent from my Pixel 2 using Tapatalk

 

[WilcoWorld]

It’s the job of medical director to run interference and keep much of that BS away from his team. Doesn’t sound like that happens at your site at all.

I never thought about it that way before - you're spot on.

 

[namethatsmell]

There is little room for negotiation for rate, hours, schedule in most groups. If you want all weekend or nights or evening then it is easier. You may have negotiation power for contract and bonus if not in a highly competitive market.

Sent from my Pixel 2 using Tapatalk

This is probably true if you’re looking in a very competitive market and even then there could be some wiggle room. But there are very few of those in the country (maybe Utah, Denver, SF, Portland, Seattle, Austin, Raleigh, a few other spots). Basically anywhere else, I’d negotiate pretty hard. Especially if multiple places are advertising for the same market...if there were enough EPs there they wouldn’t have to. Don’t be afraid to say no to an offer if you’re getting low-balled, you may be pleasantly surprised when they come back with a higher offer.


Sent from my iPhone using SDN mobile

 

[triplehog22]

This is probably true if you’re looking in a very competitive market and even then there could be some wiggle room. But there are very few of those in the country (maybe Utah, Denver, SF, Portland, Seattle, Austin, Raleigh, a few other spots). Basically anywhere else, I’d negotiate pretty hard. Especially if multiple places are advertising for the same market...if there were enough EPs there they wouldn’t have to. Don’t be afraid to say no to an offer if you’re getting low-balled, you may be pleasantly surprised when they come back with a higher offer.


Sent from my iPhone using SDN mobile

Raleigh is very competitive? I've never seen it lumped in with those other markets

 

[PDTY]

Raleigh is very competitive? I've never seen it lumped in with those other markets

A lot of NC, particularly in the triangle, is competitive. The pay may not match Charlotte though.

Jump ship, and either get in with a stable private group or regroup your personal aim in a hospital-employed-group (usually less headache and bureaucracy as that is covered by admin)

 

[triplehog22]

A lot of NC, particularly in the triangle, is competitive. The pay may not match Charlotte though.

Jump ship, and either get in with a stable private group or regroup your personal aim in a hospital-employed-group (usually less headache and bureaucracy as that is covered by admin)

Huh, TIL. thanks!

 

[Old_Mil]

[QUOTE="EMgig, post: 19494383, member: 801662] Any thoughts anyone? Is what i'm experiencing common or uncommon?[/QUOTE]

In general, a bad EM job will never get better. A good EM job may, however, get worse. This is typically because the ROE for any shop are set by a hospital management team that typically survives any turnover in groups, CMGs, or docs.

You can further classify bad jobs into bad jobs (too little pay) or dangerous ones (terrible malpractice environments, lack of admitting/speciality support, understaffing).

My first attending job was awful for both of the above reasons. It was actually worse than residency. I quit after two months, but had a six month out clause that I mistakenly tried to fulfill.

Second job was better but got bad after a year and half when the ACA unleashed the medicaid hounds and our local offices all stopped accepting new patients.

Walk away. If it's a pay issue fulfill the terms of your contract before you leave. If it's a dangerous job, give them a two week notice or just walk away.

 

[EctopicFetus]

Find a locums position to fill some of the income and quit. Find a good fair group. This sounds super bad. You should have sought guidance from your faculty or an alum before being “pressured”. Unless the job is for $400/hr or one of the tightest markets what’s the pressure? Those jobs are always gonna be available.

 

[EMgig]

Thank you everyone, it's nice to hear advice from those who are more seasoned/experienced. I heard it was common for newbies to change jobs within the first few years out but I never thought it would be me, I've never quit anything in my life and kind of feel like a failure for doing so soon after I just started. I wish I didn't ignore the red flags to begin and I hope those who are job hunting now don't do the same.

Right now i'm trying to cope with a malignant environment and attempting to make it work out. Not particularly tied to this location so not sure why I'm choosing to stick around...maybe because part of me wonders if I would deal with the same sort of problems elsewhere or if it is in fact isolated to the environment I'm in. Sounds as though many of you have actually found a functional work environment and that they do exist.

Anyway, thank you everyone for the insight. I guess i'm working on my plan B at the moment, I do feel uneasy leaving a job I just started, I guess I just fear any potential repercussions for leaving.

 

[EMgig]

Not common. Sounds horrible. It’s the job of medical director to run interference and keep much of that BS away from his team. Doesn’t sound like that happens at your site at all.

Just wanted to reply to this- I never thought about it this way since i've never seen that happen (the only comparison I have was my experience in residency)....it just seems as though those in a higher positions of power tend to abuse that power, but maybe this is not the norm across the board.

 

[GonnaBeADoc2222]

Not sure why you are choosing to stick it out in what sounds like a terrible job in a location you don't like. Are you making $400/hr? They say you can choose to optimize 2 out of 3 factors through any given job - pay, schedule, or work environment/location. I'm in my first attending job too, and even though it's definitely not 100% ideal, I still feel like I am close to optimizing two out of three of those factors. There's no shame in leaving a toxic environment in a location that you don't even want to be at. Unless there is a major shake up in the ED medical director or hospital CEO position, this place isn't going to get better. Put in your notice and run far away - try out locums or a travel position. Or use your leverage to negotiate for better pay / schedule.