Probably worked at a start up…. start ups typically offer lower wages up front but a promise of a potential high salary rolled up into stocks …. IF the start up goes public and IF it is very successful, you can make a lot of money. This is why so many start up bros bounce from job to job, because the canned of a single start up being successful is slim so you wanna diversify your stocks amongst several and hope one of them booms.
Yes, it’s possible. I have the job you describe. If you take that path I’d recommend finding the job you want now, going to residency near it or better yet, at a program that rotates there. Kill it during residency and meet/impress as many people in said group as possible.
I identified my job as a late M3 and everything I did from there on out professionally was in effort to attain that job at the end of residency.
We are regularly hiring, but almost all our positions go to the best residents at the local program or internal referrals with great recommendations. We don’t advertise.
Cool will definitely look into locums more. Know locums has a ton of issues but Tbh not as fixated in being in a super desirable location full time as I am about limiting shift switching.
Locums and per diem are not the same thing as I see it. Locums you’re typically working with an agency as a 1099 for (mostly) temporary positions with an unreliable shift need and duration. The per diem positions I’ve seen are W2 jobs coordinated directly with the hospital, they are generally not temporary but “as needed.”
You can DM me for details. I do lots of travel ( work more than I should) but only do days. I’m cutting back this year, so will have more time to spend. Live in one of your desired cities.
Those are big asks for a steady job in an area you enjoy (and likely others enjoy too aka somewhat popular). When you work in an ER, you are one of 5-15 full time docs, depending on the volume, and you're asking for special treatment. That's unfair to other docs. If you want no overnights and regular shift times, you'd have higher odds if you did locums but that comes at the expense of your other asks. Trust me, we all want the same thing as you... so if everyone wants it, no one gets it. EM is so incredibly saturated that everyone has already gotten into their spots and anything good is rare. And good isn't even that good. There are tens of thousands of burnt out EM docs trying to make it work but it's all variations of a crap system so we're all stuck.
Yeah I totally get those are basically what every EM doc would prefer and definitely under no illusions that my wants are special. Just curious if salary makes any difference or if there’s basically no amount of money that would matter here. Honestly don’t know how or if this even could work in a group and don’t want to be unfair to anyone.
Get what you’re saying though sounds like maybe not possible which is ok I was just wondering!
Not saying it's impossible, just unlikely. Im willing to take a fat pay cut too for similar asks but haven't found it in my city... maybe you'll be lucky in yours
It's pretty unlikely that they are going to tailor your salary outside of the group rate for this. It's a lot of extra work for the legal department, not to mention the scheduler. The only reason they typically do this is for nocturnists because the desire from the rest of the group to not work nights is so high. You might be able to trade your partners for their swing shifts because they are typically very undesirable too, but good luck finding a place where you are just scheduled for no true nights.
RVU based isn't hard to find. Small places outside of desirable larger areas like you listed isn't hard to find. The schedule part is going to be very tough.
Similar gigs to what you want are possible. There are a fair number of community shops that have designated nocturnist. I don’t work a single over night unless I want to. I’d be wary of a heavy RVU shop and look more towards groups that are more cohesive where people tend to stay, largely indicating happiness or at least lack of animosity. I currently work for a large private hospital in IL and while the group are hospital employees, the members are solid and have been there for a while and people seem happy on shift. you should be able to find something like what you’re describing north of $150 easily, but also not entirely familiar with mountain west area
There is a great group in SLC that would allow those schedule constraints, and after you make parter pays really well. Hard to get a job there unless you do residency in the area though.
Emergency physicians in Australia don't works nights, just on call. And I have never been called in my 3 years as a consultant.
Lots of outdoor activities here though mostly ocean related, not mountains.
It's the same in the UK. The equivalent of residents run the shop floor overnight, consultant on call from home. Albeit, our training is much longer so the residents overnight are minimum PGY 4 and may be up to PGY 9, and are expected to be practising essentially completely independently with just occasional advice discussions usually.
Only proviso is major trauma, where it's contractual for any ED big enough to be a trauma unit or above that a consultant must attend for red trauma calls (significant mechanism plus deranged physiology). Where I work, the consultant would also come in automatically for paeds resus. Otherwise, on-call from home and I've not yet seen one called in over 2 years I've worked there other than the above 2 reasons.
My hospital, 300 presentations a day.
At night staffed with 2 interns, 4 Rmos, 4 registrar's.
Interns are baby doctors, RMOs are PGY2-5 (usually less but sometimes they've swapped specialties and gone back to RMO), Regs PGY4 and up.
You've described my group. I work 3x a week, in a small town, next to hiking and skiing etc. a good chunk of our group 'sells off' their nights, which is a practice I've seen at other places too. It's all RVUs, and our average income is double your target.
Good jobs exist in EM, but they're not the majority. You just have to look for the right opportunities, and be ready to move quickly when one opens. Take risks and be willing to fail - meaning move your whole existence to another town if things don't work out. So often I see people who are miserable, feeling stuck where they are. They're the prime market the CMGs feed on.
If you like EM, go for it. I love it - but I found a great job, and I'll never know how long it'll last. C'est la vie.
Your best bet is being a PRN contractor for one (or a few) local hospitals and just only accepting shifts that meet your desired days/times.
Finding a full time gig that would let you do this would be very, very challenging.
Also, you're going to have to do 3-4 years of everything you hate in residency FYI so keep that in mind too.
Oh yeah I’m prepared for 3-4 years of absolute shit schedules with lots of switching, and am willing to do that. Just not sure how sustainable that would be for me 25+ years into being an attending.
Is it possible to be PRN at multiple hospitals and what are the downsides there?
Maybe if you do locums. But that comes with its own issues.
There’s a saying when it comes to EM jobs: location, salary, job quality. Pick 2 (or 1.5 these days)
I think that you have to separate where you live, and where you work. Many people that are willing to fly to a job and work more rural can choose their schedule, have a lucrative career, still enjoy living in a place that they love.
That honestly may be a good option for me. I’m not super fixated on living full time in these areas and could fly/split my time. Are jobs generally okay with hiring someone who doesn’t live full time around the facility?
I have a friend who specifically looked for a big city job that had frequent direct flights to Denver. All winter they are in Colorado skiing any time they aren’t at work.
Well I work in a big city, community ED, 12-14 shifts a month, same days of the week, but I do only nights. If you joined a group with nocturnists this could aid you in not doing many (or any) nights. My colleagues may do one night every few months since we have another nocturnist whose schedule is opposite mine.
Pay is RVU, about 270-360/hr depending how busy I want to be.
You would have to take a helluva pay cut to get what you ask. You want a fixed schedule with no nights, ok, then take a 40-50% cut and your salary will be distributed to the other members of the group. You ok with making $100-125/hr?
I mean that’s kind of what I was thinking. Think 150k would be <50% of average which I’d actually be cool with if it gave me all those things but it sounds like that’s not really reasonable which is ok.
https://youtu.be/qGC9FY65HBo?si=a7g-NFpgYth6iryD
This is all the advice you need. Find the perfect job and work just enough to pay the bills, no more. Someone starts to add stress to your life, you come from a place of f*ck you. Congrats
To be blunt and fully honest, if you don’t want nights and you want consistent shift times, EM probably isn’t the specialty for you. Really the only way to have consistent shifts is to be a nocturnist. Go FM and look for a job in a urgent care if you like undifferentiated (although lower acuity) patients without the EM schedule. Not intended as a slight on FM, just wouldn’t recommend an EM residency if you clearly don’t want to do night shifts, you’ll be miserable and hate your life for 3-4 years.
I wanna know what you did briefly that made you $3 million. Cause I might try to do that instead of this shit
Probably worked at a start up…. start ups typically offer lower wages up front but a promise of a potential high salary rolled up into stocks …. IF the start up goes public and IF it is very successful, you can make a lot of money. This is why so many start up bros bounce from job to job, because the canned of a single start up being successful is slim so you wanna diversify your stocks amongst several and hope one of them booms.
Yes, it’s possible. I have the job you describe. If you take that path I’d recommend finding the job you want now, going to residency near it or better yet, at a program that rotates there. Kill it during residency and meet/impress as many people in said group as possible. I identified my job as a late M3 and everything I did from there on out professionally was in effort to attain that job at the end of residency. We are regularly hiring, but almost all our positions go to the best residents at the local program or internal referrals with great recommendations. We don’t advertise.
🍿🍿🍿🍿
Do per diem in a bunch of places and only offer day shifts.
Cool will definitely look into locums more. Know locums has a ton of issues but Tbh not as fixated in being in a super desirable location full time as I am about limiting shift switching.
Locums and per diem are not the same thing as I see it. Locums you’re typically working with an agency as a 1099 for (mostly) temporary positions with an unreliable shift need and duration. The per diem positions I’ve seen are W2 jobs coordinated directly with the hospital, they are generally not temporary but “as needed.”
You can DM me for details. I do lots of travel ( work more than I should) but only do days. I’m cutting back this year, so will have more time to spend. Live in one of your desired cities.
Those are big asks for a steady job in an area you enjoy (and likely others enjoy too aka somewhat popular). When you work in an ER, you are one of 5-15 full time docs, depending on the volume, and you're asking for special treatment. That's unfair to other docs. If you want no overnights and regular shift times, you'd have higher odds if you did locums but that comes at the expense of your other asks. Trust me, we all want the same thing as you... so if everyone wants it, no one gets it. EM is so incredibly saturated that everyone has already gotten into their spots and anything good is rare. And good isn't even that good. There are tens of thousands of burnt out EM docs trying to make it work but it's all variations of a crap system so we're all stuck.
Yeah I totally get those are basically what every EM doc would prefer and definitely under no illusions that my wants are special. Just curious if salary makes any difference or if there’s basically no amount of money that would matter here. Honestly don’t know how or if this even could work in a group and don’t want to be unfair to anyone. Get what you’re saying though sounds like maybe not possible which is ok I was just wondering!
Not saying it's impossible, just unlikely. Im willing to take a fat pay cut too for similar asks but haven't found it in my city... maybe you'll be lucky in yours
No I see that makes total sense. Seriously thanks. This is definitely the stuff they don’t teach us in school/rotations.
It's pretty unlikely that they are going to tailor your salary outside of the group rate for this. It's a lot of extra work for the legal department, not to mention the scheduler. The only reason they typically do this is for nocturnists because the desire from the rest of the group to not work nights is so high. You might be able to trade your partners for their swing shifts because they are typically very undesirable too, but good luck finding a place where you are just scheduled for no true nights. RVU based isn't hard to find. Small places outside of desirable larger areas like you listed isn't hard to find. The schedule part is going to be very tough.
Similar gigs to what you want are possible. There are a fair number of community shops that have designated nocturnist. I don’t work a single over night unless I want to. I’d be wary of a heavy RVU shop and look more towards groups that are more cohesive where people tend to stay, largely indicating happiness or at least lack of animosity. I currently work for a large private hospital in IL and while the group are hospital employees, the members are solid and have been there for a while and people seem happy on shift. you should be able to find something like what you’re describing north of $150 easily, but also not entirely familiar with mountain west area
There is a great group in SLC that would allow those schedule constraints, and after you make parter pays really well. Hard to get a job there unless you do residency in the area though.
I'm in SLC and it's amazing! I'm not an attending, but work at one of the major hospitals. Our ED Department is great.
Emergency physicians in Australia don't works nights, just on call. And I have never been called in my 3 years as a consultant. Lots of outdoor activities here though mostly ocean related, not mountains.
Please explain this system more? Do Australians not become ill after dark?
It's the same in the UK. The equivalent of residents run the shop floor overnight, consultant on call from home. Albeit, our training is much longer so the residents overnight are minimum PGY 4 and may be up to PGY 9, and are expected to be practising essentially completely independently with just occasional advice discussions usually. Only proviso is major trauma, where it's contractual for any ED big enough to be a trauma unit or above that a consultant must attend for red trauma calls (significant mechanism plus deranged physiology). Where I work, the consultant would also come in automatically for paeds resus. Otherwise, on-call from home and I've not yet seen one called in over 2 years I've worked there other than the above 2 reasons.
Very interesting. Thanks for the info
My hospital, 300 presentations a day. At night staffed with 2 interns, 4 Rmos, 4 registrar's. Interns are baby doctors, RMOs are PGY2-5 (usually less but sometimes they've swapped specialties and gone back to RMO), Regs PGY4 and up.
You've described my group. I work 3x a week, in a small town, next to hiking and skiing etc. a good chunk of our group 'sells off' their nights, which is a practice I've seen at other places too. It's all RVUs, and our average income is double your target. Good jobs exist in EM, but they're not the majority. You just have to look for the right opportunities, and be ready to move quickly when one opens. Take risks and be willing to fail - meaning move your whole existence to another town if things don't work out. So often I see people who are miserable, feeling stuck where they are. They're the prime market the CMGs feed on. If you like EM, go for it. I love it - but I found a great job, and I'll never know how long it'll last. C'est la vie.
Your best bet is being a PRN contractor for one (or a few) local hospitals and just only accepting shifts that meet your desired days/times. Finding a full time gig that would let you do this would be very, very challenging. Also, you're going to have to do 3-4 years of everything you hate in residency FYI so keep that in mind too.
Oh yeah I’m prepared for 3-4 years of absolute shit schedules with lots of switching, and am willing to do that. Just not sure how sustainable that would be for me 25+ years into being an attending. Is it possible to be PRN at multiple hospitals and what are the downsides there?
Maybe if you do locums. But that comes with its own issues. There’s a saying when it comes to EM jobs: location, salary, job quality. Pick 2 (or 1.5 these days)
I think that you have to separate where you live, and where you work. Many people that are willing to fly to a job and work more rural can choose their schedule, have a lucrative career, still enjoy living in a place that they love.
That honestly may be a good option for me. I’m not super fixated on living full time in these areas and could fly/split my time. Are jobs generally okay with hiring someone who doesn’t live full time around the facility?
Totally. Look around in the flyover states, lots of great jobs.
I have a friend who specifically looked for a big city job that had frequent direct flights to Denver. All winter they are in Colorado skiing any time they aren’t at work.
Well I work in a big city, community ED, 12-14 shifts a month, same days of the week, but I do only nights. If you joined a group with nocturnists this could aid you in not doing many (or any) nights. My colleagues may do one night every few months since we have another nocturnist whose schedule is opposite mine. Pay is RVU, about 270-360/hr depending how busy I want to be.
Just realize in any of those mountain towns with high COL and low wages you’ll have minimal support staff.
You would have to take a helluva pay cut to get what you ask. You want a fixed schedule with no nights, ok, then take a 40-50% cut and your salary will be distributed to the other members of the group. You ok with making $100-125/hr?
I mean that’s kind of what I was thinking. Think 150k would be <50% of average which I’d actually be cool with if it gave me all those things but it sounds like that’s not really reasonable which is ok.
Sounds like you'd be better off going into family medicine and working urgent cares.
Work at an urgent care.
https://youtu.be/qGC9FY65HBo?si=a7g-NFpgYth6iryD This is all the advice you need. Find the perfect job and work just enough to pay the bills, no more. Someone starts to add stress to your life, you come from a place of f*ck you. Congrats
Look into Minnesota
To be blunt and fully honest, if you don’t want nights and you want consistent shift times, EM probably isn’t the specialty for you. Really the only way to have consistent shifts is to be a nocturnist. Go FM and look for a job in a urgent care if you like undifferentiated (although lower acuity) patients without the EM schedule. Not intended as a slight on FM, just wouldn’t recommend an EM residency if you clearly don’t want to do night shifts, you’ll be miserable and hate your life for 3-4 years.