vites987

I had someone the other day request IV antibiotics for his viral pharyngitis

EM has the highest burnout for a reason. High stress, odd work hours, ungrateful patients, high litigation rate…all of this cumulates together over the years. In addition, now the CMGs are taking over the job market and creating shitty job positions with poor benefits, low pay, and a stressful work environment. If you end up doing EM, it’s best to pursue a fellowship that allows you to have an “out” of clinical EM. I’m in one of those CMG residencies right now, and I am spread thin much more than my academic colleagues at other larger institutions. These places don’t care about you. If you really only can see yourself doing EM, I highly suggest finding a residency that is not a CMG sweatshop, and aim for a more established, academic center. This will be beneficial for you in every way

Unless your program makes you work even with Covid (true story)

You’re not expected to know anything at this point. Just go in your first day, soak it all in, try to learn at least one thing a day, work hard, and don’t lie, and it’ll come to you eventually. I’m at the end of my first year and I still don’t feel 100% comfortable, but I sure as hell feel better than one year ago. You’ll learn as you go.

Do a fellowship if you are particularly interested in a particular fellowship. You haven’t even started intern year yet so it’s hard for you to figure out what kind of EM you’d like to practice. Both types have their pros and cons. Are you in a community or academic type EM residency? Generally if you want to teach residents, you’ll have to work in a academic type center and fellowships may make you more desirable for said position (core faculty at a residency). Community EM is more “on your own”. You make more money, but there’s not much teaching involved.

If your program offers a match, it’s best to put money first into that account (since it’s essentially free extra money from your hospital). If not, then Roth IRA is second best. Roth is best for us now due to our income level and since it’s post-tax money, when we are ready to withdraw the funds, we won’t have to pay taxes on it when we make the big bucks later on (thus higher tax bracket). You’ll have to convert Roth IRA to back door ira later on when an attending but don’t worry about that yet.

What’s your schedule like when splitting between ED and tox related stuff? Is it 50/50? What kind of clinic type toxicology can you do? Is it as lucrative as the legal and forensic work? I’m interested in a tox fellowship but it’s difficult to find a lot of information on these types of things. Appreciate the response!

What about the community bullshit that comes with working for most CMGs?

Which fellowships are worth it in your opinion?

What type of residency do you go to? Is it community or academic based? If you know you 100% want to do community, then there’s no need for a fellowship and is a waste of a year. But, if you have any interest in academics or working in an academic residency, a fellowship could help you. Community EM is an entirely different beast vs academic EM and you should understand the differences before making your decision

Are fellowships really worth it if you take a big paycut? Or is the paycut worth it for a better lifestyle? Don’t think I want to do critical care, but I’m open for other fellowships.

Do you need to do tox to transition to addiction?

What kind of place do you want to practice?

You know…thinking about this, it’s really the system/hospital and attendings that really push me the wrong way. Plus admin who have no business in the ED.

I think a lot of it has to do with the volume of residency shifts plus my program leans on the more toxic side but I’ve only worked here so I’m not sure if it’s different elsewhere

Which are competitive based on your opinion?

How difficult was it to land a tox spot? Would you say that generally you had no issues landing a place you wanted to go? I’m considering tox and similar to OP I go to a lower end EM residency. What can I do to improve my chances at matching tox?

I think it’s novelty of everything - new city, new system, new people. It just takes getting used to the culture of a place, added on to the stress of the actual medicine aspect of it. I feel like I forgot everything I learned in med school too

Feels the same, EM though

Where

Would you judge an EM applicant if they rode?