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  • Avatar Dilaudidopenia 
    Participant
    Status: Physician
    Posts: 214
    Joined: 05/22/2016

    Nuked for Rule 1 violation.  Keep it clean!

    in reply to: things to do in Chicago #249066 Reply
    Avatar Dilaudidopenia 
    Participant
    Status: Physician
    Posts: 214
    Joined: 05/22/2016

    I really like Chicago!

    Check out Kingston Mines if you like Jazz.  I try to go every time I’m in town.

    The International Museum of Surgical Science is really cool and unique.

    Girl and the Goat is another good restaurant.

     

    Have fun!

    in reply to: things to do in Chicago #248806 Reply
    Liked by Brains428
    Avatar Dilaudidopenia 
    Participant
    Status: Physician
    Posts: 214
    Joined: 05/22/2016

    Humans have this weird cognitive bias where we filter out all of the negative things of the past and worry about the future. It is actually a deeply rooted survival mechanism, as worrying about the future meant you saved food for the winter, patrolled your territory from roving bands of marauders, etc. By filtering out the negatives of the past, we avoided crippling depression while at the same time having some incentive to preserve social traditions, and thus a stable social order to things. The problem is that it’s not true, it’s just a filter we put on the world so our brains don’t explode. That said, medicine does feel very different to me now than it did 10-15 years ago. It’s better in some ways, and much worse in others, but it is still a wonderful career if you have the right temperament.

    There is no other job where you can make this kind of money AND have job stability. This combination just doesn’t exist in many other industries. If you are a competent doctor, you will have a job. Period. And not only that, you can probably find a job nearly anywhere you want one, and it will pay extremely well. And this shows no sign of changing anytime soon. There will likely be a physician shortage for the next 10-20 years, in pretty much every specialty. There will be as much work and as much income as anyone needs. The real problem will be learning to say no to too much work.

    This is exactly the opposite of what everyone was saying when I started. Almost every prediction about medicine since I’ve become a physician has been either wrong, or only partially right in ways that I probably would not have predicted (which ironically should make you instantly skeptical of my claim for long term physician shortages). Burnout is a real problem, but it is often manageable if we are extremely careful about putting up limits and simply learning to say no to ridiculous things. We have to do this collectively to some extent, and unfortunately some of our colleagues will be sociopathic workaholics…hopefully they aren’t the ones making the schedule 🙂

    Click to expand…

    A couple comments:

    -Plenty of jobs make great money and provide great stability.  My friends in chemical engineering working for big oil have highly specialized jobs making 200k+ plus full benefits, 401k matching, pension, paid maternity/paternity leave, fully funded masters degrees with just bachelor’s degrees when hired. They are not easily replaceable.

    -Being competent does not guarantee a job as a physician.  Just ask the ER doc working for a CMG that is told to pack it up and is taken off the schedule after pissing off the wrong person.

    in reply to: What do you think about the future of medicine? #248803 Reply
    Avatar Dilaudidopenia 
    Participant
    Status: Physician
    Posts: 214
    Joined: 05/22/2016

    My take as a young attending:

    Finances are great, can’t complain there.  Loans paid off in < 2 yrs after residency graduation and am stockpiling money.

    Work environment, pressure from govt/insurers/corporations….meh and declining.

    It is nice to get the occasional thank you.  Also cool to get the occasional interesting case.

     

    I think for me, the decision to enter medicine when I did was the correct decision.  It is difficult I will admit to think of the financial and time sacrifice I made to get to this point at 3am while getting screamed at by a narcotic seeker however.

     

    I don’t think I can recommend to my children.  The pressure is on.  Physicians have targets on their backs from multiple sources in 2019.  I don’t think the profession will be viable for those in high school and college at this time.  I am very scared for those already in medical school and somewhat committed.

    in reply to: What do you think about the future of medicine? #248562 Reply
    Liked by Dreamgiver
    Avatar Dilaudidopenia 
    Participant
    Status: Physician
    Posts: 214
    Joined: 05/22/2016

    On the flip side, if these power house 4 year programs are so great then how come they can’t produce well-trained EM physicians in 3 years like a majority of programs?

     

    Click to expand…

    I don’t think anyone does or would say that.

     

    If you’re paying your pgy4s less than a first year mid-level, or really any mid-level, then yes, it’s a scam.

    The majority of EM programs are by far and away 3 years

    EM is the only speciality with this crazy split in training length aside from some surg subs that can add a year or 2 for dedicated research time.

    If you want to do academics the right play is 3 yr program plus fellowship .

    Click to expand…

    The history on this is funny. EM was intended to be 4 years.

    Many programs used to be 2-3-4 where you did an actual internship and then did 3 years.

    It’s not really a crazy split, it’s the result of controversy and youth of the specialty.

    I would spin this another way, EM is the only acute care specialty that requires only 3 years. No one out there is advocating to switch anesthesia to a 1-3 format. OB/Gyn is 4, no one is really saying it should be 3. I actually can’t think of any other field in medicine where you are supposed to be ready to see the sickest patients in the hospital after 3 years of training. I really have nothing against 3 year shops, I have interviewed for jobs at several of them. I just think it’s a different strokes for different folks type of thing.

    I would also point out to you that I currently run around in a 4 year world and there is basically no dogging on 3 year shops that I hear. I hear a ton more hostility flowing from 3 to 4 such as how you are expressing yourself here. I would say that our cross-town rival 3 year program is badass, I have said many times before that I think they are one of the best programs in the country. You would describe my program as a scam. Kind of interesting that.

    On the pay point, resident pay is set by GME and based on Medicare and geography. It has literally nothing to do with midlevel pay. You are comparing two things that are completely unrelated and then making a really over-the-top statement based on said comparison.

    Click to expand…

    You’re an academic – give me data, not feelings. What is the value added???

    Are first time board pass rates different?  Are malpractice rates different?  Is career success different?

    Is there a regulation against the institution paying a PGY4 more than what they currently get? If so, why not just graduate all the PGY3s and guarantee them attending jobs for their PGY4 if you’re so concerned about keeping them in your environment for another year.

    Pay them their value.  An EM PGY4 is an attending.

    Click to expand…

    Again, the study would be nearly impossible to do actually do. If it existed no one would find it compelling.

    The goals of residency training cannot be reduced to things like board pass rates (which are almost always extremely high in good programs) and career success (nearly impossible to define).

    Again, PGY4 salaries are set across the institution by GME not the residency program. I think you can understand that your idea of just making them attendings for the year would be a massive amount of paperwork and would never fly from a contractual standpoint.

    It seems like you had a very negative experience in residency and I’m sorry about that. I didn’t, I enjoyed my training even my 4th year. I felt like I hit the ground about as ready as I possibly could and I have what I consider to be a great career.

    I think I’m going to invoke the forum policy here, we are not going to see eye to eye on this so I think we should leave it here.

    I would really encourage lurkers and students reading this to reject the idea that places such as Wash U, Denver, UCSF, Mt. Sinai, and Cook County are simply scamming their pgy4s for cheap labor.

    Click to expand…

    On the contrary, I had a very positive experience in residency.  Made good friends, got great training.  I just don’t think it needed to be 4 years.  BI in Mass has a model of 3 yrs + optional 4th year as an attending – they just grossly underpay them.

    Cook County as an example has more than one month of rotations on an internal medicine floor (in addition to ICU).  This is not a good use of time for an EM resident.

    in reply to: Just submitted EM residency application. #247882 Reply
    Liked by snowcanyon
    Avatar Dilaudidopenia 
    Participant
    Status: Physician
    Posts: 214
    Joined: 05/22/2016

    On the flip side, if these power house 4 year programs are so great then how come they can’t produce well-trained EM physicians in 3 years like a majority of programs?

     

    Click to expand…

    I don’t think anyone does or would say that.

     

    If you’re paying your pgy4s less than a first year mid-level, or really any mid-level, then yes, it’s a scam.

    The majority of EM programs are by far and away 3 years

    EM is the only speciality with this crazy split in training length aside from some surg subs that can add a year or 2 for dedicated research time.

    If you want to do academics the right play is 3 yr program plus fellowship .

    Click to expand…

    The history on this is funny. EM was intended to be 4 years.

    Many programs used to be 2-3-4 where you did an actual internship and then did 3 years.

    It’s not really a crazy split, it’s the result of controversy and youth of the specialty.

    I would spin this another way, EM is the only acute care specialty that requires only 3 years. No one out there is advocating to switch anesthesia to a 1-3 format. OB/Gyn is 4, no one is really saying it should be 3. I actually can’t think of any other field in medicine where you are supposed to be ready to see the sickest patients in the hospital after 3 years of training. I really have nothing against 3 year shops, I have interviewed for jobs at several of them. I just think it’s a different strokes for different folks type of thing.

    I would also point out to you that I currently run around in a 4 year world and there is basically no dogging on 3 year shops that I hear. I hear a ton more hostility flowing from 3 to 4 such as how you are expressing yourself here. I would say that our cross-town rival 3 year program is badass, I have said many times before that I think they are one of the best programs in the country. You would describe my program as a scam. Kind of interesting that.

    On the pay point, resident pay is set by GME and based on Medicare and geography. It has literally nothing to do with midlevel pay. You are comparing two things that are completely unrelated and then making a really over-the-top statement based on said comparison.

    Click to expand…

    You’re an academic – give me data, not feelings. What is the value added???

    Are first time board pass rates different?  Are malpractice rates different?  Is career success different?

    Is there a regulation against the institution paying a PGY4 more than what they currently get? If so, why not just graduate all the PGY3s and guarantee them attending jobs for their PGY4 if you’re so concerned about keeping them in your environment for another year.

    Pay them their value.  An EM PGY4 is an attending.

    in reply to: Just submitted EM residency application. #247833 Reply
    Avatar Dilaudidopenia 
    Participant
    Status: Physician
    Posts: 214
    Joined: 05/22/2016

    If you’re paying your pgy4s less than a first year mid-level, or really any mid-level, then yes, it’s a scam.

    The majority of EM programs are by far and away 3 years

    EM is the only speciality with this crazy split in training length aside from some surg subs that can add a year or 2 for dedicated research time.

    If you want to do academics the right play is 3 yr program plus fellowship .

    in reply to: Just submitted EM residency application. #246762 Reply
    Avatar Dilaudidopenia 
    Participant
    Status: Physician
    Posts: 214
    Joined: 05/22/2016

    As someone who graduated from a prestigious 4 year program, I can tell you it’s a scam.

    It was awesome running an entire pod as a pgy4 while the midlevels saw less than half my volume and got paid more than me.

    Of course a pgy4 grad will be somewhat better than a pgy3 grad. By that logic you should just train forever.

    Also….regional director of a CMG? Low bar lol.

    Avatar Dilaudidopenia 
    Participant
    Status: Physician
    Posts: 214
    Joined: 05/22/2016

    4000 per month on childcare?    good grief.     Like ya’ll said—-the HCOL area is what makes 350000 seem so paltry.   In my parts….that’s a very very good income and lifestyle afforded.

    Click to expand…

    These people need some geographic arbitrage.

    We live in what most on these forums would consider a HCOL city on the east coast (probably would be MCOL to most Americans, but I think it’s high).  I could get by VERY comfortably on this income.

    We have a kid, we max retirement, doing 529, we save on top of that, we killed my 200K of student loans 2 yrs out of residency, and we STILL do what we want in terms of vacations, dining, entertainment.

    If you’re living in a VHCOL city like SF, LA, NYC, Boston, then I can’t have much sympathy.

     

    in reply to: $350000 barely middle class #245562 Reply
    Liked by ddswifey
    Avatar Dilaudidopenia 
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    Status: Physician
    Posts: 214
    Joined: 05/22/2016

    I found this kind of astounding.

    Comments:

    1) Ditch the private pre-school (wtf? I went to public pre school. Why is preschool costing more than a year of state college tuition?)

    2) Child care expenses (move close to grandma and grandpa and get them to watch for even just 2 days a week.  offer them a small stipend which would be like 20% of what you’re paying now.  even better, with your million dollar house, build them an in law apartment to sweeten the deal in exchange for FT child care)

    3) Food –  Are you shopping at whole foods every day.  even if you are this food budget is nuts.

     

     

     

    in reply to: $350000 barely middle class #245557 Reply
    Avatar Dilaudidopenia 
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    Status: Physician
    Posts: 214
    Joined: 05/22/2016

    For the physician, this side hustle sounds great provided all the malpractice I’s and T’s are dotted and crossed.  I’d totally take $150/hr to do this at home while watching sports, feeding the baby, doing laundry, etc.  There are s*** hole EDs in NYC paying this for live coverage seeing 2+ pph.

    For the field of EM and medicine overall, this is a scam.  Not the telemedicine part.  “Provider in triage” as discussed above is just a way to tinker tinker with the metrics.

    I guess it’s cool to have an educated doc doing it rather than a midlevel who is ordering inflammatory markers for cough and plain films for back pain, oh and d-dimer on EVERYONE.

    in reply to: Emergency Medicine Telemedicine Job #244300 Reply
    Liked by wonka31
    Avatar Dilaudidopenia 
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    Status: Physician
    Posts: 214
    Joined: 05/22/2016

    Sigh…this again…more spreading of misinformation

    Avatar Dilaudidopenia 
    Participant
    Status: Physician
    Posts: 214
    Joined: 05/22/2016

    Just the other day I found out that a nurse that I know from our hospital is getting an NP degree.  She has about 10 years experience already.  I asked her if it has been hard securing rotations and she told me that it was not for her because of her experience she could draw on the physicians that worked with her on the floors.  She did say without prompting that her classmates with no experience are having a much more difficult time.

    Click to expand…

    No self respecting physician should be allowing any of these people to rotate with them.

    Avatar Dilaudidopenia 
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    Status: Physician
    Posts: 214
    Joined: 05/22/2016

    The Preferred is a great card.  Very versatile.  My wife and I both got one in residency.  When I became an attending, I then got a Reserve.  Been raking in the points through locums.

    in reply to: Which credit card? #237303 Reply
    Avatar Dilaudidopenia 
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    Status: Physician
    Posts: 214
    Joined: 05/22/2016

    I would not sign for 3 years.

    You are not “guaranteeing” anything by signing for 3 yrs, except being beholden to paying back a signing bonus. PE = CMG = 90 day without cause termination clause which can often be accelerated.  So you can sign for a billion dollars an hour and then they put you on notice and say you can either now work for ten dollars an hour or you can get lost.

    Signing for 140 / mo over 120 / mo just gives them more power.  Sign for less, let them have holes in the schedule, which you can then fill for negotiated shift bonuses.

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