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4 hours ago, SerpentineNino said:

Seems like so many people this year have applied for EM, and the competition is fierce. The question is, why are so many people picking EM over specialities with much higher earning potential like Derm and Ophthalmology? How much can a new EM grad expect to make? 

Is it about the money or is it about the lifestyle? 

I mean they as I understand it earn less than many other 5 year specialists (say 250-300K if you are motivated) but they have some significant lifestyle advantages. Plus it is considered perhaps "exciting" compared other areas. The shift work for some can be draining but that can be also minimized in many cases. Still fixed 8-9 hour shifts, absolutely no post shift responsibilities, very flexible field.... 

(they may also not be doing derm or ophtho because the odds of getting that field for them and in general is relatively low. ).

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It's definitely in large part about the lifestyle Emerg and the appeal of medical emergencies. PM&R has been similarly competitive lately due to the lifestyle despite the lackluster salary.

I do wonder though whether emerg have lower overhead? They might make less but if they're making 350k with little overhead it might not be that much of a salary gap.

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If I remember correctly, a cfpc ER physician  said during a presentation that he easily made 300 000+. I presume they don’t pay overhead? If so, that’s a hefty amount that  they save vs most specialities that require offfice space and staff for outpatient visits.

if you can deal with shift work and broad scope, emerg is the best speciality in my opinion: Fast pace, no on call. When you’re done your shif,  you’re completely off. No need to follow lab work for patients (or find a collegue to) when you’re on vacation. You can live in rural or urban settings, great mobility (don’t have to deal with transferring patients and building a new patient load if you need to move).

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40 minutes ago, F508 said:

If I remember correctly, a cfpc ER physician  said during a presentation that he easily made 300 000+. I presume they don’t pay overhead? If so, that’s a hefty amount that  they save vs most specialities that require offfice space and staff for outpatient visits.

if you can deal with shift work and broad scope, emerg is the best speciality in my opinion: Fast pace, no on call. When you’re done your shif,  you’re completely off. No need to follow lab work for patients (or find a collegue to) when you’re on vacation. You can live in rural or urban settings, great mobility (don’t have to deal with transferring patients and building a new patient load if you need to move).

yup no or extremely little overhead, high prior in the hospital, they seem to move around as much as they want and can take months off at the right centres occasionally for special projects. 

I was wondering if some of it was that surgery wasn't as popular re job market and maybe there was some transfer from people interested in that as a result. I am not really sure on that point. 

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There is also a "cool" factor to it that may be a bigger deal than people think.  You have a lot of contact with the general "healthy" public, and you are sort of doing what the public imagines a doctor as doing.  Also its fast paced, no bs.  In Ontario I think they make ~300$/hour with no overhead.  That's pretty great.

3 hours ago, zizoupanda said:

PM&R has been similarly competitive lately due to the lifestyle despite the lackluster salary.

I did neurology and had some contact with PM&R during my residency.  They make a lot through med legals and insurance work.  Like their staff made way more than my neuro staff.  The posted salary that only takes into account ohip billings for them is really deceptive.

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24 minutes ago, goleafsgochris said:

There is also a "cool" factor to it that may be a bigger deal than people think.  You have a lot of contact with the general "healthy" public, and you are sort of doing what the public imagines a doctor as doing.  Also its fast paced, no bs.  In Ontario I think they make ~300$/hour with no overhead.  That's pretty great.

I did neurology and had some contact with PM&R during my residency.  They make a lot through med legals and insurance work.  Like their staff made way more than my neuro staff.  The posted salary that only takes into account ohip billings for them is really deceptive.

Do they really make 300 hourly? I thought it was more 200ish. 

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I almost did EM. Picked against it because I did not like the match % and I did not want to do family, not get the plus one, and be stuck doing office FP work.

 

(Thats a lesson for you people too. If you think its gonna be unlikely youre going to get into something then try harder to get into it. dont settle for the lower thing because its easy to get into. youre in medicine and are a type A personality so youre gonna regret it.)

 

I think EM is so popular because it is incredibly flexible, and it is a very sought after credential that allows you to work in big cities. Though Toronto and Vancouver do have emergency departments, the majority of their new hires are FRCPC only. 

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11 minutes ago, GrouchoMarx said:

I almost did EM. Picked against it because I did not like the match % and I did not want to do family, not get the plus one, and be stuck doing office FP work.

 

(Thats a lesson for you people too. If you think its gonna be unlikely youre going to get into something then try harder to get into it. dont settle for the lower thing because its easy to get into. youre in medicine and are a type A personality so youre gonna regret it.)

I agree to an extent with what you're saying - but on some level, one has to accept that things may not work out as one wants.  EM has a very low match ratio - it's simply a fact.  

It doesn't mean jumping to the conclusion that things won't work out..  In your case, you chose to minimize your worst-case loss in terms of doing FM by not pursuing EM.  In exchange, you ended up with a specialty which at the time seemed like a better choice than your worst case loss, but far from your best-case / optimistic gain.      

Being prepared to accept all eventualities I think avoids excess stress and anxiety, and as long as one does seek and follow up on all available opportunities, I think is a more rational strategy.   

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Just now, marrakech said:

Apparently in Québec, there's a pay difference - but the number of FRCPCs is regionally limited.  Aside from that, there's slight fellowship/academic advantages, but otherwise not much (source). 

absolutely ha - not to be flippant at all, the differences do appear to be relatively small and I am sure it is not that surprising to anyone that academically the longer training is looked at a bit more favorably.  

I was always surprised out programs are 5 years for EM, when even the US is only 4 if I am recalling things correctly. 

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1. Good lifestyle -- you spend fewer overall hours working than most other specialties, even considering the circadian disruption and extra sleep needed

2. Decent pay -- middle of the pack overall, which is really attractive when you consider the above

3. Jobs -- plenty of jobs across each province

4. Medical & procedural with patient interaction -- you get to do a decent amount of everything

 

5. No patients after hours -- once you're done your shift, you're done (except for the rare 1-2 hours you might stay to handover or finish up)

6. Flexibility -- ties in with the above; you can switch shifts with someone else in your group if you want vacation time

7. Scheduling -- shifts, no call unlike many other hospital based specialties

8. General appeal -- EM is definitely one of the sexier specialties

 

Key are #1, 2, 3, and 4. Good lifestyle, pay, and job/location availability is appealing to everyone. On top of that, EM is one of the few specialties that doesn't "own" patients yet still has a decent amount of actual patient contact. Other specialties that don't own patients (e.g. anesthesia, radiology, path/lab specialties) have minimal to no interaction with patients.

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Anesthesia has "minimal to no interaction" with patients? 

I think EM has some nice advantages, but it's also one of the highest burnout specialties. I don't think that's a trivial issue. It's certainly appealing to the more adrenalin-junkies among us, but the odd high intensity emergency situation is always outnumbered by mundane abdo pain and - of course - getting that CTA because it might possibly maybe be a dissection. And having consultants shit on your decisions. Sure you get into some interesting procedures but you're rarely the expert in any of them. 

In the end it's a hard job but has been endlessly glamourized by TV. 

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31 minutes ago, A-Stark said:

Anesthesia has "minimal to no interaction" with patients? 

I think EM has some nice advantages, but it's also one of the highest burnout specialties. I don't think that's a trivial issue. It's certainly appealing to the more adrenalin-junkies among us, but the odd high intensity emergency situation is always outnumbered by mundane abdo pain and - of course - getting that CTA because it might possibly maybe be a dissection. And having consultants shit on your decisions. Sure you get into some interesting procedures but you're rarely the expert in any of them. 

In the end it's a hard job but has been endlessly glamourized by TV. 

The burn out aspect is really under emphasized - people area always saying well they work 16-18 shifts a month, why don't they just push it up to a more standard 22 or so shifts per month (average for a 5 day a week job give or take per month) - after all it is only relatively short shifts after all.  That would increase their income by 25-35%  and they are still working much less than most doctors. 

....and yet even at the more typical shift rates people implode with surprising frequency. There are very few "old" EM docs it seems to me - at least at major centres. 

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I agree with the burnout - speaking to some of the older staff who don't take as many shifts as they did, they said that the shiftwork really takes a toll on them emotionally and physically. 

one of them joked to me that shift work is, can be a carcinogen: https://www.elsevier.com/about/press-releases/research-and-journals/rotating-night-shift-work-can-be-hazardous-to-your-health

I think it's a great specialty, I definitely enjoyed it when I was working in the ER. 

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16 hours ago, rmorelan said:

absolutely ha - not to be flippant at all, the differences do appear to be relatively small and I am sure it is not that surprising to anyone that academically the longer training is looked at a bit more favorably.  

I was always surprised out programs are 5 years for EM, when even the US is only 4 if I am recalling things correctly. 

haha, yah its interesting. In the US most programs are actually 3 year EM programs, with the more "academic" programs being 4 years.  The 3 year EM programs are intense in their own right.

Interestingly enough, with EM programs and FM programs both 3 years in the US, its really the EM specific training that differs them.  There is a transition of sorts of more 4 year programs being opened, or converted etc. 

 

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On 2/28/2018 at 2:15 PM, goleafsgochris said:

There is also a "cool" factor to it that may be a bigger deal than people think.  You have a lot of contact with the general "healthy" public, and you are sort of doing what the public imagines a doctor as doing.  Also its fast paced, no bs.  In Ontario I think they make ~300$/hour with no overhead.  That's pretty great.

I did neurology and had some contact with PM&R during my residency.  They make a lot through med legals and insurance work.  Like their staff made way more than my neuro staff.  The posted salary that only takes into account ohip billings for them is really deceptive.

no bs? You make it sound like an emerg is non stop traumas and resus, when really >50% is "I have chest pain" that turns out to be nothing, "I have belly pain" that turns out to be nothing, "Ive had ___ symptom for months but never seen a family doctor or tried anything for it"...theres definitely a lot of "bs" that doesnt belong in the emerg that you see every day.

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2 hours ago, goleafsgochris said:

I meant no bs in terms of paperwork, more following up after you’re done, time not spent on direct patient care etc. Of course no one would dispute that emerg deals with patients with nonsense complaints figuring that out is a lot of the job 

 

Man, it sounds like youve had a way better experrience in the ED than me lol. Theres definitely paperwork (charting, WSIB forms, referrals, etc), followups (calling for culture results, although I would agree with you mostly on this one), and time spent not on patient care and just standing around (bed lock, anyone? and waiting for BW, imaging, consults you called hours ago to see your patients, pushback from said consults, triage, etc).

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Maybe is my bias and my specific experience?  I did neuro where theres a bigass dictation on every patient you see (often taking over an hour at the end of a clinic day).  No dictation and just scribbling notes was like a dream.  And ya my experience was wayyyy more direct patient care and less paperwork than any other in or out-patient rotation ive ever been on haha

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On 2/28/2018 at 4:19 AM, SerpentineNino said:

Seems like so many people this year have applied for EM, and the competition is fierce. The question is, why are so many people picking EM over specialities with much higher earning potential like Derm and Ophthalmology? How much can a new EM grad expect to make? 

There's also the very simple fact that some people just like EM, but couldn't possibly imagine spending their lives doing derm or ophthalmology :) As simple as that 

Also, for people saying people are off when they are off, kinda.... There are physicians who are often put on call, and if the regular staff at that time calls in sick, the one on call will have to go. At least, that's how the schedules are made at the MUHC. 

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On 2/28/2018 at 11:15 AM, goleafsgochris said:

I did neurology and had some contact with PM&R during my residency.  They make a lot through med legals and insurance work.  Like their staff made way more than my neuro staff.  The posted salary that only takes into account ohip billings for them is really deceptive.

A small minority of PMR does legals and insurance work, and while very lucrative, it is utter shit paper work - far removed from the ideals of what PMR is all about (advocacy for the disabled). And doing medical-legal is not an any way exclusive domain of PMR. Pretty much everyone else can do it, as it doesn't require any special tools. A GP with a sports medicine interest, orthos, neuro, etc.

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On 2/28/2018 at 3:14 PM, rmorelan said:

I think the running is joke is the difference is about 2 years of residency.

Exactly. The pay is exactly the same, and they can get jobs just about anywhere that a FRCPC EM would.

You could argue it is even superior in terms of flexibility, as a CFPC EM can open up a primary care clinic, do walk-ins and locums anywhere, while the other can't.

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