Introduction — Critique Welcome

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    Status: Physician
    Posts: 2155
    Joined: 05/01/2017
    Thanks again for all of the comments, everyone. I really appreciate it. Even though you are all “strangers,” I respect your opinions and your suggestions have changed the way I think about these things. This is info I don’t readily get from my attendings (I feel like they are all living pretty expensive lives, but that may be compared to my resident situation).

    I’m an APD in EM who spends a good part of my time advising our 4s on the job search.

    One thing I would tell your for sure is to not “chase the $$” when you are looking for a job. EM is pretty simple, if someone is going to pay you an over the top salary it’s for a good reason. Look at things like group stability, partner track, attrition, night shifts, etc. The name of the game in EM these days is mega groups which is my experience have variable quality even among them.

    In our job it’s better to take a job w/ 50th percentile comp that you can stay in for 10-15 years (or life) than to burn the candle at both ends. Part of the problem you realize pretty quickly is that you can’t have it all. Places where you have a lot of “fun” clinically (drop off GSW, stemis left and right) are generally going to have issues that make working there long term tough.

    I think the optimal job model for a new EM grad is to shoot for a dream job and then find your high paying side hustle in an area where they have a hard time attracting docs, bonus if this is a busy high acuity shop where you can fine tune your clinical skills, efficiency, airway management etc. Then as you stabilize your finances and life you just cut back on the side hustle and settle into your sustainable nice job. You are far less likely to burn out at a side hustle b/c you have far more control over it. You start to feel burned out? Just cut back for a month or 2, you might even find yourself missing it!

    It’s really tough as a young EM attending not to view a day off as wasted time “I could have made [insert shift compensation here] today.” Fight against that and go to the park with your kids — easier in TX or NC than in my beloved Great Lakes!.

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    Thanks for taking the time to write this–this is gold! Really makes me think about changing the way that I’ve been thinking about a job. I really like the idea of finding something I feel like I can do for a long time and supplementing that with higher volume/acuity. I think I’d definitely last longer doing something like that. I was hoping I’d hear from you as I’ve enjoyed some of your other comments, so thank you for the suggestions. As for the time at the park–summers here are incredible and cannot be beaten. Nothing like the time playing at the lake and the park, even the chilly pool in the summer. It’s these 6 months of clouds that seem so long.

    Want to do a quick introduction and invite any critique of my current situation/plans.

    The basics: PGY-3 in 4-year emergency medicine program in the cold and cloudy Great Lakes country. Stay-at-home spouse and two daughters (ages 4 and 8 mos).

    Current income: $59k – all W2 money (with nominal moonlighting <$1k)

    Current debt: total — $387k

    • $377k @ 6.25% –graduate ($8.5k) and medical school loans ($the rest); I estimate it will be about $430k by residency graduation. All are federal loans.
    • $8k (family loan for a car)
    • $2k medical bills (still paying off our 8-month old’s birth and our 3-year old’s broken arm last summer)

    Current cash on hand: $6k

    Retirement 403b (not Roth): $4k (100% in VSMPX)

    Budget: We track spending and budgeting using a spreadsheet.

    • Current take home is $3560/mo
    • Total spending about $2900/mo – We live in an apartment, didn’t buy a house
    • Gross savings 18.5%

    After residency plans: Family is all over the country, so not settled on any one location. I’ve started contacting employers, but still too early for some. Thoughts are to chase the $$, but don’t want to end up in a bad/unsafe environment. After not seeing the sun for half the year, we want to move somewhere that’s not by the Great Lakes. Thought about TX, but I’ve been told that jobs are drying up there. Also looking into the Cincinnati area, NC, but honestly are open to most places.

    Ideally we want to get rid of our loans ASAP (within 3 years) after residency. I am registered for PSLF but know it is less likely to work out since most EM groups are not non-profit. I’m hoping to sign early and then we will look into refinancing if not non-profit.

    Any critique is welcome.

    I am really thankful for the community I’ve found. I read White Coat’s website in med school (even got to meet him in St. Louis) but started reading the forum just recently. I’ve been really impressed by the stories I’ve read and the depth of knowledge of everyone who posts. Looking forward to eventually contributing my own success story down the road.

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    You know, it’s only that cloudy on the east side of the Great Lakes. We get more sun on the west side here in MN. It’s not Arizona, but it’s not as gray as the Pacific NW or rust belt.

    It sounds like you’re doing the right things with your finances. Your salary will be going up probably 6x or more when you finish residency. Keep the same mindset when you finish and your loans will be gone in short order.

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    Holy smokes! Physician on FIRE replied! My wife was also very impressed, haha. We’ve actually been looking at Minnesota a little. Wouldn’t mind a little of the “Minnesota nice” everyone talks about! Looks like a beautiful place to live. My wife’s parents are in AZ but will retire soon so they’re not sure where they will end up.

    “2k medical bills (still paying off our 8-month old’s birth and our 3-year old’s broken arm last summer)”

    Tangential, but is this typical for training programs to offer such horrible insurance coverage?


    Also, to the OP, somewhat contrarian advice, but I’d suggest not worrying about your savings rate now. Saving $600/mo is a noble effort, but you’re not really ‘saving’ since you’ve got massive debts at high interest rates accruing more than that in interest every month. The marginal utility of that $600 for you right now is far greater than it will be 5 years from now when you’ll make as much in a good month as you make in a year currently. Don’t blow it on useless stuff, but make sure your wife and young children are well taken care of.

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    Good observation–this is a sore subject as I missed the 30-day window to get our newest daughter enrolled in our decent insurance. Hopefully not a mistake I will ever make again. Costs should improve this year as she’s back on my insurance. As for the broken arm, little bills just keep trickling in even though we are 5 months out at this point. Ended up needing surgery, etc, so it ended up being pricey.

    It’s good advice about not going to crazy at this time. I think we feel fairly pinched for the time being, but are careful to make sure we aren’t being too crazy, i.e. we’re still eating, have a great apartment, reliable cars (although my check engine light did come on this morning). I have the lucky problem of a frugal wife, but like I said, not overly so. Honestly I can’t think of any “things” I want, just places I’d like to travel. We are looking forward to a great trip after residency, just don’t know where at this point. Right now there just isn’t much money or time for travel. .

    Drop it into MD  I got lucky ? and matched into a 4-year program. I think it will work out in the end. They say the ideal length is 3.5 yrs of training, so I’m sure I’ll feel pretty ready to spring the coop by the time 4 years is over. But for now I feel like I still have a lot to learn, so I’m fine with it.

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    Feel free to PM me and we can chat more about the job search offline and less publicly.


    #179702 Reply
    Avatar PocketChange 
    Status: Resident
    Posts: 11
    Joined: 08/07/2018

    @mpmd. Thanks, sent you a PM.

    #180123 Reply
    Avatar snowcanyon 
    Status: Physician
    Posts: 434
    Joined: 10/22/2018

    I’ve heard MN is great, but I have an acquaintance that was hosed in a medmal case in Minneapolis. Maybe this is only a problem in the bigger cities?

    Your kids are little, but they won’t be for long, so consider a part of the country where there will be opportunities for your wife in a few years.

    You sound like a great candidate for PSLF unless you are at a CMG residency.

    Agreed on avoiding CMGs (I really, really worry about the future of EM as they keep encroaching). It’s too bad you are in a four year, because it’s nice to do a fellowship so you have an exit strategy. Start thinking about nonclinical things you’ll want to do in a few years. Most people really, really want to cut down on shifts after a few years.


    #180157 Reply
    Avatar PocketChange 
    Status: Resident
    Posts: 11
    Joined: 08/07/2018
    Splash Refinancing Bonus
    @snowcanyon: Yeah, medmal is a worry of mine as it’s drilled into us in residency that we’re basically all going to be sued at some point. While I don’t think that’s totally true, I’m getting to the point that I realize it’s part of the job. I am employed in residency by a nonprofit hospital, so no CMG. I’ve definitely thought about the years down the road and a career I can run simultaneously as an “exit” strategy, but so far don’t have a good idea regarding that. I should have a wilderness med fellowship by the end of residency, but that’s basically just for fun–not many financial opportunities there. My wife and I are making this decision 100% together, so her needs are definitely part of the decision.
    #180674 Reply

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