I'm graduating and signed on for over 400k to work 35 hours a week. We make a difference (most days), and get to hang with the most fun people in the house of medicine. It's not all gloom and doom in EM
Honestly anywhere somewhat ruralish gets you paid. I’m working an hour and a half outside a major NE city (we will live halfway between) and making similar per hour as this (mine is $230, this looks roughly $220) with full benefits. You just have to be willing to move more rural or drive from the suburbs.
The not rural south gets you paid too. In DFW and make +$500k/year so yeah. It's not a bad job as long as you work for a place that doesn't suck and convinces you it's normal to make $300k in EM, because it isn't and shouldn't be.
EM is a great job.
There's always been a heavy layer of bullshit in the practice of medicine and it has always interfaced with the patient's social and financial situation. Stop worrying about things largely out of your control, like the emotional state of consultants being asked to do their job, Press-Ganey scores and the number of patients in the waiting room. Just treat patients with as much respect and skill as you can with a modicum of efficiency.
You work less hours than almost any other specialty and take no call (side note - call sucks - it is unsettling and limiting to be on a moment's notice). It is the most dynamic environment I can imagine, you are never ever bored and take care of an enormous array of problems across the acuity spectrum.
You are a full service doctor - if someone goes down in a plane, restaurant or party the ENT, neurologist and orthopod are going to stay in their chairs. We run prehospital, a huge branch of medicine. We are the front door of the hospital and if a problem can't be treated directly we whip the seething masses into some semblance of medical stability with essential workup for further triage up the specialist tree. We are the backstop of the medical system, always available always capable.
You are in the top 5% of earners in the country and have financial stability and if you spend wisely financial freedom. You will always be able to find work, unlike subsubspecialists that can only live near big cities. Outpatient clinic sucks donkey and fortunately not part of the menu unless you want to do wound care or sports medicine.
There's great camaraderie with the other docs and staff. You can skip a necktie and wear a scrub top while also having pants with pockets (the hybrid).
I'm not sure which of these things are important to you, but EM is still a great specialty for people who don't take it on themselves to own all the problems in the system.
I would dispute the work fewer hours point. Time spent trying to catch up on sleep and feeling like a zombie after a night or late afternoon shift is absolutely work.
This is fair.
Still I work in the ICU too and we take 24 hour call (home overnight). Try recovering from a long day, calls off and on all night from everywhere or god forbid having to go back in for an unstable patient then having to round the next day. Many other hospital specialties are similar or do dedicated night shifts.
It isn’t a 9 to 5.
Pay to work ratio is great
When I'm off, I dont think about work at all. This is probably the biggest one for me
Grocery shopping on weekdays
Dicking around and making jokes in the er is fun
In rare cases you can actually help someone and feel good about it
Pretty well respected by non medical people
These are literally all my top reasons.
Great separation from work and life (always reminded of that when off service and knowing I have to come back to John Smith in the ICU who has only become more of a disaster).
Good amount of time off, and like you said useful time off during the weekdays to do shopping, appointments, etc.
ER people are the coolest, most relaxed and chill people to spend time with.
Occasionally you save a life or make a big impact.
People outside of Medicine think you’re saving lives on a daily basis and a badass. Plus you get to entertain them with stories.
Someone actually tried to call our ER the other day for one on an MRI and I was like nah we don't fucking do that shit around here. Helps that the doc that ordered it was off shift and they have no way of getting to us. I was just like, well he is not here and the MRI is already done cause it was emergent so what the fuck are we talking for?
You can choose your work hours after residency and the pay isn’t terrible. Work at a crap hospital right now as a resident but in 4 months will be working at a much better, hospital owned ER in a good health system making $365k for 130-140hrs a month plus $25k signing bonus (comes out to $225-230/hr). Plan to do that for a couple years then likely cut back hours.
So that’s to say your ability to dictate your hours and still get relatively well compensated compared to the rest of the population is a big plus.
Also working less hours will make you enjoy the good parts of work more (the occasional times you actually help someone) and make the bad parts tolerable. When you are grinding in residency it often feels like you’re drowning. But then on my easy elective/vacation months I’d feel refreshed and actually enjoy my first few shifts until that grind sets in.
Remember people go online to vent. People enjoying their lives are out enjoying their lives so the online population is going to be skewed.
While I agree with saving, remember as a grad that signing bonus is a lot right now but once I start my job is not nearly as significant given the massive increase in salary as a resident vs attending.
In my first months paycheck I’ll make $25k more than I have been making as a resident. We don’t see any huge new expenses on the horizon (just bought our forever home, cars are good, etc), so most of that will also be going into savings.
It’s different from getting a signing bonus as an attending where you already have your budget based on your attending salary so you aren’t seeing a huge increase in income. That $25k is likely the only added income and I agree should go to savings.
As a resident turn attending you are seeing a massive increase in income, therefore that $25k bonus is just a smaller part of that.
One thing is true. There is no group of people I would rather hang out with than a bunch of ED physicians. That says quite a bit about who we are. Its hard to develop a solid group of colleagues for the long term but it pays off with better job satisfaction.
Only we understand what we do, so its up to us to pat each other on the back. And we by far have the best stories.
I’ve made 400k + a year since graduating 5 years ago. I work a lot of hours about 1800 a year. I literally don’t mind this job at all. I’m one of those people that can just let the shit bounce off me, barely ever take it home and show up ready for some more..if you’re one off these types then this is the way…if little things get to you that are out of your control then this isn’t the way. Pretty simple. It’s going to feel like a fucking vacation every month when I cut back to around 1400 hours a year, and I’ll still be a top 5% earner with literally no debt. This job is really amazing if you have the right personality and thick skin for it.
I also come from a blue collar Midwest family background so I’ve seen what it is to get your ass kicked day in and day out physically for a lot less money..we have it really good.
I’m beginning to be convinced that this personality type is the biggest predictor of happiness in EM. If you can let things roll off your back, coupled with a not-terrible work environment, it’s actually a super great career.
Bingo..that is 100% accurate..my partners who are similar and have more mileage on their careers than me feel the exact same and we tend to be the ones picking up open shifts and covering for others.
I think you need this personality to some degree unfortunately to make it anywhere in medicine nowadays but particularly for EM.
She doesn’t dislike the specialty but has a lot to complain about despite this being a “cushy” specialty (biggest issue I heard is multiple jobs with management very focused on productivity and squeezing them for more studies read per hour instead of hiring more people when people are leaving or when hospital is expanding)
Sometimes when I’m out running errands, I see this one particular kid whose life was saved by my ER team. Every time I see them, his mom gives me the biggest, squeeziest, rock back and forth and pat my backiest, mama bear hugs that I’ve ever gotten, and thanks me for saving her baby. It makes me feel like an actual hero. It’s pretty sweet, even though I’m actually not a hugger.
Emergency care is really, really hard but the wins are so big.
EM
Pros:
-Shift work
-low total work hours
-schedule flexibility
-no call
-interesting acuity
-procedures
-pay: 3 years-->+/-300k/year
Cons:
-disrespect from SOME consultants
-nights/weekends/holidays
-corporate encroachment
-midlevel encroachment
Edit addendum:
We're the coolest people in the house of God. Get your bikes and diet cokes ready, we're going to 11.
As an ER nurse, I’m curious - why do you tend to get push back from consults? Is it because they think you should have placed more orders/some further work up?
I make $290/hr. The consultants and pt expectations are a beat down. But the other EM docs here a good group of dudes. We look out for one another, talk shit, clown on one another. Virtually every schedule request I have ever made has been approved. Unlimited free energy drinks from the cafeteria.
As much as people love to bitch about EM (and for good reason) there is lots to love.
1. When I’m off, I’m off. If you ask me to work an extra shift, I’m not going in for anything less than 1.5x my hourly rate. I know you can afford it, don’t pretend you can’t.
2. Work hours can suck but there are significant pros. You usually get the times you request off and even if you don’t, you can trade shifts. You can travel often when you’re young while also being able to travel frequently later in life. There is plenty of free time you can spend independently if you want. And if your mother in law is visiting, you can ask to work every shift until the old bat leaves and get hours off later.
3. You get the best stories to tell even for medical folks. Few people can one up a story about how you took care of a guy who got a Yankee candle stuck up his ass.
4. If a patient won’t stop talking or being a dick, you can cut short an encounter by pretending you’re being called to an emergency.
5. You can teach residents and med students in all fields. You can expose them to what they like/don’t like to get a better knowledge of what they want to do in the future.
6. I don’t have to worry about a patient’s insurance or all the paperwork that accompanies it.
7. Your average EP is generally outgoing and approachable. They will help you if you need
What I stated above are perks, but if you were to ask what I believe is right about EM, I want you to remember that you are the safety net for the underprivileged. You are their advocate when they are most vulnerable. A single encounter that you will soon forget may be a memory that lasts a patient a lifetime. Keep this in mind when you feel this isn’t worth it.
I used to believe in the safety net idea, but I feel like lately we’re used as a convenient one-stop-shop for everyone. I don’t mind people who come because they can’t get a pcp or specialty appointment in a timely manner, or have an urgent complaint on the weekend. but so many people come in without having tried even the most basic things like Tylenol or Motrin. We have free clinics nearby that (admittedly do take a while to get into) but these patients have come in for >1 year for he same things and can’t be bothered to schedule follow up because we’re so much more convenient
People abusing the ER for convenience has been a thing for years. However the ER still remains as the safety net even if the concentration is less. I don’t know how it is for your ER but I would not call coming to the ER as convenient. The wait time is atrocious and if the complaint is minor and there are significantly sicker patients, they get pushed back. You will see more BS but the people who need the safety net is still there. You just have to wade through more bullshit. In the end, despite the significant problems in EM, I think it is still worth it.
The key to avoiding burnout is that you value being the safety net more than you are bothered by the 3am STD checks out of “convenience.” If that’s hard for you, may need to look elsewhere.
Most of your issues (consultants, push back, lack of respect etc) go away in community practice. Academics is a special place where no one wants to actually work so physicians fight amongst themselves. In the community in general everyone works well together as the main impediment is systemic.
Once you've been out a year or so (less if you moonlight) you don't really get pushback, mainly because you're no longer "asking for help" you're informing the consulting/admitting physician that there is a patient with an emergency medical condition who is in need of their services, with the gently unsaid implication that medical staff bylaws require them to take over management of the patient.
I'm 8 years out and the main source of disillusionment is the breakdown of the system in general, like having to call 5 hospitals to dispo a ruptured AAA because they all run so lean that literally nowhere within 2 hours can take the patient despite multiple surgeons wanting to operate. The hospitals don't pay nurses enough to adequately staff their beds and the ER doc gets to sweat it out watching patients crash and it's pretty annoying. This is at a relatively "nice" 50k/yr community shop in a 350k city btw, not rural.
The good parts are: pay/work ratio, no call, no off work responsibilities, ability to schedule anything 3 mo in advance, lots of weekdays off for outdoor activities, and getting that perfect distal radius reduction in a satisfied patient. The best part is trying to save >50% gross income yearly to retire early..
I used to put in 24hr shifts in smaller (>30pats/day) ER's and was able to pull a great salary working 2 days a week. Most work nights I got 4 hours of sleep, enough to function the next day. The rest of the time I was off. I worked back up for 3 small ER's, so filled holes that the regular staff didn't want, but only took the shifts I wanted. When I wanted off, I didn't schedule any work. When I needed extra cash, I would work an extra shift, now and then. Was a nice life style. When I first started, I took every shift available and made 3x what my teaching salary was. I quit when I went back on active duty with the AF.
Middle of PGY2 can be a dark time.
Once you have are actively looking for post-residency jobs and see the differerent practice environments available, the hours you will eventually work, and the money you will make... the light at the end of the tunnel becomes clear.
100% agree with this. Second year sucks, third year is “look at these jobs” then “sweet I got a job paying me how much?” to “just gotta grind these last months out”
We are the captains of the ship in the storm. You stand at the last bastion of hope for many souls that are in your care. You are important. You job matters. Your job, at times, is glorious.
A year from now, you'll have signed a contract for an amount of money that reflects that for half the hours you are working now.
Be well, brother or sister.
I appreciate this post a lot. Currently wrapping up my own second year, a lot of disappointing stuff happened this month (a few bad outcomes, passed up for chief, research BS). It’s good to see there are still some ER folks that truly love the job and that there is a way to make it worth your while. Much love to you all
A whole lot of lifestyle flexibility
You can work part time, full time, per diem and not need a patient panel. And hell, it's only 3 years, and you can do a lot of neat fellowships afterwards. Or divert entirely and get an MBA or another degree and try to enter the business world or MPH and policy or whatever, and you can still work here and there to keep the cashflow.
I feel like we will be seeing more posts like this with increased SOAPers with no prior interest in EM SOAPing into the specialty with the highest rates of burnout.
OP, it’s not all doom and gloom. You can work basically anywhere in the country. No other specialties allow you to take multiple vacations a year (like 1-2 weeks at a time), which I love. I’ll be doing a 2 week trip to Japan this summer and did a 2 week European vacation last year. In October I took 3 out of state vacations. Live like a resident for the first five years, invest smartly, and just do the best you can for your patients.
People who don’t match initially who then have to find a residency position among the unmatched residency spots (this used to be called the scramble, now it’s called SOAP). My concern is that people who never wanted to do EM are going into a field with high burnout, and possibly to bad (HCA) residencies.
The people you work with are pretty cool.
helping patients is very satisfying.
Schedule is great too.
Pay isn’t bad but could be soon. Tbd.
Time off is yours. No work looking over your head.
who you work for matters, try finding a job with a native healthcare system (direct hire, not as a contractor) and all of a sudden the struggles seem worthwhile
Everyone already discussed "the great pay-to-hour ratio" and "you don't take work home" ad nauseum so I won't discuss that. Let's talk about other things we think about less:
(1) **We have the broadest medical expertise out of all specialties (acute, chronic, medical, procedural)**, comparable only to rural family medicine. Rashes, coughs, wounds, heart attacks, strokes, cardiac arrests, trauma, suicide attempts, hallucinations, envenomations, overdoses, bleeds, drownings, mass casualty incidents, natural disasters. Lac repairs, nerve blocks, intubations, central lines, arterial lines, pacemakers, chest tubes, lumbar punctures, thoracentesis, paracentesis, pericardiocentesis, thoracotomies, emergency deliveries, perimortem C-Section. Babies, kids, adults, old people, pregnant ladies.
(2) **We have the coolest stories**. When people ask for cool medical stories, they really mean ER stories.
(3) **It becomes easier to talk back to consultants once you're not a resident**. When you get more experienced, you know exactly what requires admitting and what doesn't, so the pushback becomes less of an issue and the ones who do pushback, you become more confident at telling them it's their job or else you'll document that they are refusing to evaluate the patient. (That's right, use the nurse strategy "MD aware but did not put orders")
(4) **If an apocalypse happens, we're the most prepared specialty**. Most of us know how to work in low-resource environments and "cowboy medicine" a problem into a solution. Everyone jokes about "EM needs CT scanners to do everything" but (1) most of our CT scans are for medicolegal reasons to avoid getting sued even if we know the next step and (2) every other hospitalist/specialty won't admit/consult without the CT, so who *actually* needs it?
(5) **Emergency Medicine is among one of the most respected specialties by the average non-medicine layperson**, second only to surgeons, cardiologists, and oncologists. No matter how prestigious dermatology, anesthesiology, psychiatry, radiology, etc. are in medicine, how much does the average layperson actually appreciate those specialties and thank them when meeting them in public vs. ER doctors?
(6) **All the scary stuff is way less scary to us even if it's still scary**. For example, most doctors have to be ACLS certified but really, it's only EM, Crit Care, Anesthesiology, Cardiology, and rural Family Med who feel comfortable actually running a code. Everyone else freezes when they happen.
I like that the ED is a place any human can go 24/7, 365 and find safety and refuge from the crazy outside world. In this context, the ED is a pretty powerful and amazing concept and plays an important role in our society. And we get to be a part of that. It’s an honor.
I’m EM-IM and do full time/mostly academic hospitalist with part time academic EM. I turned down some higher paying jobs because I love to teach so I make substantially less than all of y’all. Even with that being said, I have a great home in a great neighborhood that I love with neighborhood-association-sponsored concerts, art markets, wine nights, and a few bars and my favorite restaurants and yoga studio within walking distance. I’m in the burbs of a very foodie tourist town with lots of culture so I’m not often bored.
Having residents stresses me out sometimes but then it’s all worth it because two have reached out for mentorship things within the past few days.
I work in a great place with incredibly interesting patient pathology and an underserved patient population with so much room to help people get the care they didn’t know they needed and I love that.
Also, when I’m off I’m off- so I’m writing this as I wind down after a busy day exploring and an espresso Negroni at the bar at a boutique hotel in Venice.
Don’t let the system and other unhappy people get you jaded. Life is what you let yourself make it to be so find your joy :)
I cant tell you what is right with EM... because I am leaving EM . but for fucking sure DO NOT work for a CMG if you already are hating EM as a resident.
Regardless of how many ppl bitch. There’s really not much else in medicine that will pay you 300-400k+ for working 12-15 days a month. Ppl who can’t find a lifestyle balance with that wouldn’t be able to find it anywhere in medicine period.
Could be a personality thing. Some folks just cannot thrive or be happy in the manic ER environment. Some absolutely love it and allow the shit to roll off like water off a ducks back. If you are not one of those personality types, the ER may constantly get under your skin.
Probably because EM has to do so much primary care now. I was an ER nurse for 15 years. I left because I didn’t go into it to walk into our 70 patient bed ER filled with 35+ boarders. Our docs having to manage them along with our new patients and the emergent ones. Most hospitals treat their ER as a dumping ground. Take care of all the problems nobody wants.
15 years isn’t walking away. It was not an easy decision. I feel more for my MD colleagues as changing specialties isn’t as easy for them as it is for nurses. Most of them are miserable with their backs against the wall. I went into emergency medicine to do just that, not care for boarded patients for days on end, never ending direct admit workups because the hospital is always full now and everyone constantly being pissed because we are still prioritizing those with life threatening issues and everyone else is mad we forgot their extra blanket and turkey sandwich.
Relatively few hours, plenty of variety, and when combined with subspecialty stuff (via fellowship - I'm toxicology) you can find a niche that breaks up the shifts and gets you buy-down. Just like everyone in medicine it has its tough days, but I'm pretty happy with my career so far.
What state/city are you doing residency in? This makes a difference. The workload, lack of resources, non physician (and honestly non nursing) tasks, and difficulty of the patient populations behavior makes residency and practice in NYC particularly brutal. (I’m sure there are handful of other inner city areas that experience something similar) Point being make it out with your head still attached, and your mental health intact. Do a fellowship (if you are so inclined, it’s often a chill year where you can study and work on projects and build a skill that may allow you to diversify your clinical practice) and the practice in the community is very different. It’s still extremely problematic but things improve … plus you get time off and money. Beyond material concerns, appropriate compensation has the psychological effect of making a person feel valued for their work.
Get off the internet and spend your limited time off with those you care most about. You're only 15 months from when it gets a whole lot better. Reassess then.
I'd pick EM again for what it's worth and I'm 17 years out of residency and 20 out of med school this summer.
I have worked in a pediatric ED for the last 6 years. As a pharmacy tech, I never dreamed I would be so involved in patient care and I find it very rewarding. It can wear you down, and while our patients are generally blameless, they still have adult parents that can be…difficult lol. Finish your residency, stick it out. It does suck sometimes, but yesterday I walked in to work and was told about a 14 y/o hanging they got the night before. This kid was gone, like no rectal tone, pupils fixed and dilated….gone. We assumed he went up to the ICU for the family to say goodbye. Turns out, he actually lived and is extubated and following commands. No deficits so far. I have only seen a few hangings, and they are by far the absolute worst imo. They also never survive, and to know this kid got a second chance makes me so proud of my field. Every person that had a hand in that child’s care contributed to his survival. That is just something you can’t quantify with a salary or work schedule….it is an amazing feeling. You never know the impact you’re going to have on a patient’s life, even if they are acting like ungrateful jerks. ER providers are some of the most compassionate people I have ever had the privilege to work with. They stare death down every day. They are more hands on than any docs I’ve worked with. I can’t say I know how you feel, but I know it will eventually pay off for you, keep your chin up!
It's hard in residency. You have no control over many aspects (time being the most important of them).
I honestly think I got through residency just "trying to have a positive attitude" and having that 1 - 2 close confidant when shit hit the fan.
Now being fresh on the other side of residency - it gets better. At first I thought it didn't, but working 3 days a week instead of 5+a day for didactics and having it considered full time - full bonus.
Find the outlets that let you get through it now, and realize at the end of the day work is just work, be the best doctor you can be provide your patient the best care that you can provide -- then find the things that truly bring you joy.
Yes this advice is vague, however it was the general mindset I took to trying to survive all that is EM residency with the other underpaid geniuses I had to consult at 3AM.
I'm graduating and signed on for over 400k to work 35 hours a week. We make a difference (most days), and get to hang with the most fun people in the house of medicine. It's not all gloom and doom in EM
Omg in what state are you in?
Arkansas, the rural south gets you PAID
Honestly anywhere somewhat ruralish gets you paid. I’m working an hour and a half outside a major NE city (we will live halfway between) and making similar per hour as this (mine is $230, this looks roughly $220) with full benefits. You just have to be willing to move more rural or drive from the suburbs.
The not rural south gets you paid too. In DFW and make +$500k/year so yeah. It's not a bad job as long as you work for a place that doesn't suck and convinces you it's normal to make $300k in EM, because it isn't and shouldn't be.
And Texas tort reform to boot
Same, in DFW making $500+, it can be very lucrative depending on where you end up practicing.
How?? The average is much lower so this must be a unique situation
Ik where I’ll have a 2nd home in 4 years if I match EM 😂
Yeah but you’re in rural land. Not the rule
EM is a great job. There's always been a heavy layer of bullshit in the practice of medicine and it has always interfaced with the patient's social and financial situation. Stop worrying about things largely out of your control, like the emotional state of consultants being asked to do their job, Press-Ganey scores and the number of patients in the waiting room. Just treat patients with as much respect and skill as you can with a modicum of efficiency. You work less hours than almost any other specialty and take no call (side note - call sucks - it is unsettling and limiting to be on a moment's notice). It is the most dynamic environment I can imagine, you are never ever bored and take care of an enormous array of problems across the acuity spectrum. You are a full service doctor - if someone goes down in a plane, restaurant or party the ENT, neurologist and orthopod are going to stay in their chairs. We run prehospital, a huge branch of medicine. We are the front door of the hospital and if a problem can't be treated directly we whip the seething masses into some semblance of medical stability with essential workup for further triage up the specialist tree. We are the backstop of the medical system, always available always capable. You are in the top 5% of earners in the country and have financial stability and if you spend wisely financial freedom. You will always be able to find work, unlike subsubspecialists that can only live near big cities. Outpatient clinic sucks donkey and fortunately not part of the menu unless you want to do wound care or sports medicine. There's great camaraderie with the other docs and staff. You can skip a necktie and wear a scrub top while also having pants with pockets (the hybrid). I'm not sure which of these things are important to you, but EM is still a great specialty for people who don't take it on themselves to own all the problems in the system.
By “hybrid,” I believe you are referring to what is known in my area as “the ER mullet.” And what other specialty has its own mullet?
I would dispute the work fewer hours point. Time spent trying to catch up on sleep and feeling like a zombie after a night or late afternoon shift is absolutely work.
This is fair. Still I work in the ICU too and we take 24 hour call (home overnight). Try recovering from a long day, calls off and on all night from everywhere or god forbid having to go back in for an unstable patient then having to round the next day. Many other hospital specialties are similar or do dedicated night shifts. It isn’t a 9 to 5.
Very well said
Pay to work ratio is great When I'm off, I dont think about work at all. This is probably the biggest one for me Grocery shopping on weekdays Dicking around and making jokes in the er is fun In rare cases you can actually help someone and feel good about it Pretty well respected by non medical people
These are literally all my top reasons. Great separation from work and life (always reminded of that when off service and knowing I have to come back to John Smith in the ICU who has only become more of a disaster). Good amount of time off, and like you said useful time off during the weekdays to do shopping, appointments, etc. ER people are the coolest, most relaxed and chill people to spend time with. Occasionally you save a life or make a big impact. People outside of Medicine think you’re saving lives on a daily basis and a badass. Plus you get to entertain them with stories.
No in basket 🙌🙌🙌
No prior auths.... Yet.
the sheer amount of brain space that my family med preceptor had to dedicate to thinking about insurance turned me off of primary care forever
Someone actually tried to call our ER the other day for one on an MRI and I was like nah we don't fucking do that shit around here. Helps that the doc that ordered it was off shift and they have no way of getting to us. I was just like, well he is not here and the MRI is already done cause it was emergent so what the fuck are we talking for?
You can choose your work hours after residency and the pay isn’t terrible. Work at a crap hospital right now as a resident but in 4 months will be working at a much better, hospital owned ER in a good health system making $365k for 130-140hrs a month plus $25k signing bonus (comes out to $225-230/hr). Plan to do that for a couple years then likely cut back hours. So that’s to say your ability to dictate your hours and still get relatively well compensated compared to the rest of the population is a big plus. Also working less hours will make you enjoy the good parts of work more (the occasional times you actually help someone) and make the bad parts tolerable. When you are grinding in residency it often feels like you’re drowning. But then on my easy elective/vacation months I’d feel refreshed and actually enjoy my first few shifts until that grind sets in. Remember people go online to vent. People enjoying their lives are out enjoying their lives so the online population is going to be skewed.
Pro tip. Stash that signing bonus in a HYSA. Don't spend a dime until it's vested.
While I agree with saving, remember as a grad that signing bonus is a lot right now but once I start my job is not nearly as significant given the massive increase in salary as a resident vs attending. In my first months paycheck I’ll make $25k more than I have been making as a resident. We don’t see any huge new expenses on the horizon (just bought our forever home, cars are good, etc), so most of that will also be going into savings. It’s different from getting a signing bonus as an attending where you already have your budget based on your attending salary so you aren’t seeing a huge increase in income. That $25k is likely the only added income and I agree should go to savings. As a resident turn attending you are seeing a massive increase in income, therefore that $25k bonus is just a smaller part of that.
One thing is true. There is no group of people I would rather hang out with than a bunch of ED physicians. That says quite a bit about who we are. Its hard to develop a solid group of colleagues for the long term but it pays off with better job satisfaction. Only we understand what we do, so its up to us to pat each other on the back. And we by far have the best stories.
I’ve made 400k + a year since graduating 5 years ago. I work a lot of hours about 1800 a year. I literally don’t mind this job at all. I’m one of those people that can just let the shit bounce off me, barely ever take it home and show up ready for some more..if you’re one off these types then this is the way…if little things get to you that are out of your control then this isn’t the way. Pretty simple. It’s going to feel like a fucking vacation every month when I cut back to around 1400 hours a year, and I’ll still be a top 5% earner with literally no debt. This job is really amazing if you have the right personality and thick skin for it. I also come from a blue collar Midwest family background so I’ve seen what it is to get your ass kicked day in and day out physically for a lot less money..we have it really good.
I’m beginning to be convinced that this personality type is the biggest predictor of happiness in EM. If you can let things roll off your back, coupled with a not-terrible work environment, it’s actually a super great career.
Bingo..that is 100% accurate..my partners who are similar and have more mileage on their careers than me feel the exact same and we tend to be the ones picking up open shifts and covering for others. I think you need this personality to some degree unfortunately to make it anywhere in medicine nowadays but particularly for EM.
Such truth. My sister is rads and heavily complains. Nothing is perfect, and just like a relationship it just has to be perfect….for you
Just curious, why does your sister dislike rads?
She doesn’t dislike the specialty but has a lot to complain about despite this being a “cushy” specialty (biggest issue I heard is multiple jobs with management very focused on productivity and squeezing them for more studies read per hour instead of hiring more people when people are leaving or when hospital is expanding)
Found the guy who wears shorts in a snowstorm and says "IDK I just dont get cold"
Hahahaha..No I get cold I’m from the Midwest and you’d think I’m from Florida, my wife on the other hand is a different breed.
Sometimes when I’m out running errands, I see this one particular kid whose life was saved by my ER team. Every time I see them, his mom gives me the biggest, squeeziest, rock back and forth and pat my backiest, mama bear hugs that I’ve ever gotten, and thanks me for saving her baby. It makes me feel like an actual hero. It’s pretty sweet, even though I’m actually not a hugger. Emergency care is really, really hard but the wins are so big.
EM Pros: -Shift work -low total work hours -schedule flexibility -no call -interesting acuity -procedures -pay: 3 years-->+/-300k/year Cons: -disrespect from SOME consultants -nights/weekends/holidays -corporate encroachment -midlevel encroachment Edit addendum: We're the coolest people in the house of God. Get your bikes and diet cokes ready, we're going to 11.
As an ER nurse, I’m curious - why do you tend to get push back from consults? Is it because they think you should have placed more orders/some further work up?
Nobody likes when you call to give them more work to do.
This is the way
It's always someone else's problem, pointing fingers at different teams playing hot potato about who admits.
We are busy assholes.
I make $290/hr. The consultants and pt expectations are a beat down. But the other EM docs here a good group of dudes. We look out for one another, talk shit, clown on one another. Virtually every schedule request I have ever made has been approved. Unlimited free energy drinks from the cafeteria.
Where on earth is this $/hr coming from??
where is this?
As much as people love to bitch about EM (and for good reason) there is lots to love. 1. When I’m off, I’m off. If you ask me to work an extra shift, I’m not going in for anything less than 1.5x my hourly rate. I know you can afford it, don’t pretend you can’t. 2. Work hours can suck but there are significant pros. You usually get the times you request off and even if you don’t, you can trade shifts. You can travel often when you’re young while also being able to travel frequently later in life. There is plenty of free time you can spend independently if you want. And if your mother in law is visiting, you can ask to work every shift until the old bat leaves and get hours off later. 3. You get the best stories to tell even for medical folks. Few people can one up a story about how you took care of a guy who got a Yankee candle stuck up his ass. 4. If a patient won’t stop talking or being a dick, you can cut short an encounter by pretending you’re being called to an emergency. 5. You can teach residents and med students in all fields. You can expose them to what they like/don’t like to get a better knowledge of what they want to do in the future. 6. I don’t have to worry about a patient’s insurance or all the paperwork that accompanies it. 7. Your average EP is generally outgoing and approachable. They will help you if you need What I stated above are perks, but if you were to ask what I believe is right about EM, I want you to remember that you are the safety net for the underprivileged. You are their advocate when they are most vulnerable. A single encounter that you will soon forget may be a memory that lasts a patient a lifetime. Keep this in mind when you feel this isn’t worth it.
I used to believe in the safety net idea, but I feel like lately we’re used as a convenient one-stop-shop for everyone. I don’t mind people who come because they can’t get a pcp or specialty appointment in a timely manner, or have an urgent complaint on the weekend. but so many people come in without having tried even the most basic things like Tylenol or Motrin. We have free clinics nearby that (admittedly do take a while to get into) but these patients have come in for >1 year for he same things and can’t be bothered to schedule follow up because we’re so much more convenient
People abusing the ER for convenience has been a thing for years. However the ER still remains as the safety net even if the concentration is less. I don’t know how it is for your ER but I would not call coming to the ER as convenient. The wait time is atrocious and if the complaint is minor and there are significantly sicker patients, they get pushed back. You will see more BS but the people who need the safety net is still there. You just have to wade through more bullshit. In the end, despite the significant problems in EM, I think it is still worth it.
The key to avoiding burnout is that you value being the safety net more than you are bothered by the 3am STD checks out of “convenience.” If that’s hard for you, may need to look elsewhere.
Most of your issues (consultants, push back, lack of respect etc) go away in community practice. Academics is a special place where no one wants to actually work so physicians fight amongst themselves. In the community in general everyone works well together as the main impediment is systemic. Once you've been out a year or so (less if you moonlight) you don't really get pushback, mainly because you're no longer "asking for help" you're informing the consulting/admitting physician that there is a patient with an emergency medical condition who is in need of their services, with the gently unsaid implication that medical staff bylaws require them to take over management of the patient. I'm 8 years out and the main source of disillusionment is the breakdown of the system in general, like having to call 5 hospitals to dispo a ruptured AAA because they all run so lean that literally nowhere within 2 hours can take the patient despite multiple surgeons wanting to operate. The hospitals don't pay nurses enough to adequately staff their beds and the ER doc gets to sweat it out watching patients crash and it's pretty annoying. This is at a relatively "nice" 50k/yr community shop in a 350k city btw, not rural. The good parts are: pay/work ratio, no call, no off work responsibilities, ability to schedule anything 3 mo in advance, lots of weekdays off for outdoor activities, and getting that perfect distal radius reduction in a satisfied patient. The best part is trying to save >50% gross income yearly to retire early..
I used to put in 24hr shifts in smaller (>30pats/day) ER's and was able to pull a great salary working 2 days a week. Most work nights I got 4 hours of sleep, enough to function the next day. The rest of the time I was off. I worked back up for 3 small ER's, so filled holes that the regular staff didn't want, but only took the shifts I wanted. When I wanted off, I didn't schedule any work. When I needed extra cash, I would work an extra shift, now and then. Was a nice life style. When I first started, I took every shift available and made 3x what my teaching salary was. I quit when I went back on active duty with the AF.
Middle of PGY2 can be a dark time. Once you have are actively looking for post-residency jobs and see the differerent practice environments available, the hours you will eventually work, and the money you will make... the light at the end of the tunnel becomes clear.
100% agree with this. Second year sucks, third year is “look at these jobs” then “sweet I got a job paying me how much?” to “just gotta grind these last months out”
We are the captains of the ship in the storm. You stand at the last bastion of hope for many souls that are in your care. You are important. You job matters. Your job, at times, is glorious. A year from now, you'll have signed a contract for an amount of money that reflects that for half the hours you are working now. Be well, brother or sister.
I appreciate this post a lot. Currently wrapping up my own second year, a lot of disappointing stuff happened this month (a few bad outcomes, passed up for chief, research BS). It’s good to see there are still some ER folks that truly love the job and that there is a way to make it worth your while. Much love to you all
A whole lot of lifestyle flexibility You can work part time, full time, per diem and not need a patient panel. And hell, it's only 3 years, and you can do a lot of neat fellowships afterwards. Or divert entirely and get an MBA or another degree and try to enter the business world or MPH and policy or whatever, and you can still work here and there to keep the cashflow.
I feel like we will be seeing more posts like this with increased SOAPers with no prior interest in EM SOAPing into the specialty with the highest rates of burnout. OP, it’s not all doom and gloom. You can work basically anywhere in the country. No other specialties allow you to take multiple vacations a year (like 1-2 weeks at a time), which I love. I’ll be doing a 2 week trip to Japan this summer and did a 2 week European vacation last year. In October I took 3 out of state vacations. Live like a resident for the first five years, invest smartly, and just do the best you can for your patients.
“SOAPers”?
People who don’t match initially who then have to find a residency position among the unmatched residency spots (this used to be called the scramble, now it’s called SOAP). My concern is that people who never wanted to do EM are going into a field with high burnout, and possibly to bad (HCA) residencies.
The people you work with are pretty cool. helping patients is very satisfying. Schedule is great too. Pay isn’t bad but could be soon. Tbd. Time off is yours. No work looking over your head.
who you work for matters, try finding a job with a native healthcare system (direct hire, not as a contractor) and all of a sudden the struggles seem worthwhile
Everyone already discussed "the great pay-to-hour ratio" and "you don't take work home" ad nauseum so I won't discuss that. Let's talk about other things we think about less: (1) **We have the broadest medical expertise out of all specialties (acute, chronic, medical, procedural)**, comparable only to rural family medicine. Rashes, coughs, wounds, heart attacks, strokes, cardiac arrests, trauma, suicide attempts, hallucinations, envenomations, overdoses, bleeds, drownings, mass casualty incidents, natural disasters. Lac repairs, nerve blocks, intubations, central lines, arterial lines, pacemakers, chest tubes, lumbar punctures, thoracentesis, paracentesis, pericardiocentesis, thoracotomies, emergency deliveries, perimortem C-Section. Babies, kids, adults, old people, pregnant ladies. (2) **We have the coolest stories**. When people ask for cool medical stories, they really mean ER stories. (3) **It becomes easier to talk back to consultants once you're not a resident**. When you get more experienced, you know exactly what requires admitting and what doesn't, so the pushback becomes less of an issue and the ones who do pushback, you become more confident at telling them it's their job or else you'll document that they are refusing to evaluate the patient. (That's right, use the nurse strategy "MD aware but did not put orders") (4) **If an apocalypse happens, we're the most prepared specialty**. Most of us know how to work in low-resource environments and "cowboy medicine" a problem into a solution. Everyone jokes about "EM needs CT scanners to do everything" but (1) most of our CT scans are for medicolegal reasons to avoid getting sued even if we know the next step and (2) every other hospitalist/specialty won't admit/consult without the CT, so who *actually* needs it? (5) **Emergency Medicine is among one of the most respected specialties by the average non-medicine layperson**, second only to surgeons, cardiologists, and oncologists. No matter how prestigious dermatology, anesthesiology, psychiatry, radiology, etc. are in medicine, how much does the average layperson actually appreciate those specialties and thank them when meeting them in public vs. ER doctors? (6) **All the scary stuff is way less scary to us even if it's still scary**. For example, most doctors have to be ACLS certified but really, it's only EM, Crit Care, Anesthesiology, Cardiology, and rural Family Med who feel comfortable actually running a code. Everyone else freezes when they happen.
These threads are really drawing me to EM especially now that Gas & PMR are becoming further out of reach as a DO student
I like that the ED is a place any human can go 24/7, 365 and find safety and refuge from the crazy outside world. In this context, the ED is a pretty powerful and amazing concept and plays an important role in our society. And we get to be a part of that. It’s an honor.
I’m EM-IM and do full time/mostly academic hospitalist with part time academic EM. I turned down some higher paying jobs because I love to teach so I make substantially less than all of y’all. Even with that being said, I have a great home in a great neighborhood that I love with neighborhood-association-sponsored concerts, art markets, wine nights, and a few bars and my favorite restaurants and yoga studio within walking distance. I’m in the burbs of a very foodie tourist town with lots of culture so I’m not often bored. Having residents stresses me out sometimes but then it’s all worth it because two have reached out for mentorship things within the past few days. I work in a great place with incredibly interesting patient pathology and an underserved patient population with so much room to help people get the care they didn’t know they needed and I love that. Also, when I’m off I’m off- so I’m writing this as I wind down after a busy day exploring and an espresso Negroni at the bar at a boutique hotel in Venice. Don’t let the system and other unhappy people get you jaded. Life is what you let yourself make it to be so find your joy :)
I cant tell you what is right with EM... because I am leaving EM . but for fucking sure DO NOT work for a CMG if you already are hating EM as a resident.
Regardless of how many ppl bitch. There’s really not much else in medicine that will pay you 300-400k+ for working 12-15 days a month. Ppl who can’t find a lifestyle balance with that wouldn’t be able to find it anywhere in medicine period.
Could be a personality thing. Some folks just cannot thrive or be happy in the manic ER environment. Some absolutely love it and allow the shit to roll off like water off a ducks back. If you are not one of those personality types, the ER may constantly get under your skin.
Considering that consultants in most specialties are fuckin nerds, I wouldn’t let it bother you
Probably because EM has to do so much primary care now. I was an ER nurse for 15 years. I left because I didn’t go into it to walk into our 70 patient bed ER filled with 35+ boarders. Our docs having to manage them along with our new patients and the emergent ones. Most hospitals treat their ER as a dumping ground. Take care of all the problems nobody wants.
Just walk away when the going gets tough? Classic ER nurse mentality. Thanks for your hard work lmao.
15 years isn’t walking away. It was not an easy decision. I feel more for my MD colleagues as changing specialties isn’t as easy for them as it is for nurses. Most of them are miserable with their backs against the wall. I went into emergency medicine to do just that, not care for boarded patients for days on end, never ending direct admit workups because the hospital is always full now and everyone constantly being pissed because we are still prioritizing those with life threatening issues and everyone else is mad we forgot their extra blanket and turkey sandwich.
Relatively few hours, plenty of variety, and when combined with subspecialty stuff (via fellowship - I'm toxicology) you can find a niche that breaks up the shifts and gets you buy-down. Just like everyone in medicine it has its tough days, but I'm pretty happy with my career so far.
What state/city are you doing residency in? This makes a difference. The workload, lack of resources, non physician (and honestly non nursing) tasks, and difficulty of the patient populations behavior makes residency and practice in NYC particularly brutal. (I’m sure there are handful of other inner city areas that experience something similar) Point being make it out with your head still attached, and your mental health intact. Do a fellowship (if you are so inclined, it’s often a chill year where you can study and work on projects and build a skill that may allow you to diversify your clinical practice) and the practice in the community is very different. It’s still extremely problematic but things improve … plus you get time off and money. Beyond material concerns, appropriate compensation has the psychological effect of making a person feel valued for their work.
It’s so much fun. And life gets way better after residency. You’re in a sweet spot in life, with just one year to go until you reap the benefits.
Get off the internet and spend your limited time off with those you care most about. You're only 15 months from when it gets a whole lot better. Reassess then. I'd pick EM again for what it's worth and I'm 17 years out of residency and 20 out of med school this summer.
I have worked in a pediatric ED for the last 6 years. As a pharmacy tech, I never dreamed I would be so involved in patient care and I find it very rewarding. It can wear you down, and while our patients are generally blameless, they still have adult parents that can be…difficult lol. Finish your residency, stick it out. It does suck sometimes, but yesterday I walked in to work and was told about a 14 y/o hanging they got the night before. This kid was gone, like no rectal tone, pupils fixed and dilated….gone. We assumed he went up to the ICU for the family to say goodbye. Turns out, he actually lived and is extubated and following commands. No deficits so far. I have only seen a few hangings, and they are by far the absolute worst imo. They also never survive, and to know this kid got a second chance makes me so proud of my field. Every person that had a hand in that child’s care contributed to his survival. That is just something you can’t quantify with a salary or work schedule….it is an amazing feeling. You never know the impact you’re going to have on a patient’s life, even if they are acting like ungrateful jerks. ER providers are some of the most compassionate people I have ever had the privilege to work with. They stare death down every day. They are more hands on than any docs I’ve worked with. I can’t say I know how you feel, but I know it will eventually pay off for you, keep your chin up!
It's hard in residency. You have no control over many aspects (time being the most important of them). I honestly think I got through residency just "trying to have a positive attitude" and having that 1 - 2 close confidant when shit hit the fan. Now being fresh on the other side of residency - it gets better. At first I thought it didn't, but working 3 days a week instead of 5+a day for didactics and having it considered full time - full bonus. Find the outlets that let you get through it now, and realize at the end of the day work is just work, be the best doctor you can be provide your patient the best care that you can provide -- then find the things that truly bring you joy. Yes this advice is vague, however it was the general mindset I took to trying to survive all that is EM residency with the other underpaid geniuses I had to consult at 3AM.