INTRO TO LIFE AFTER RESIDENCY

Jun 17th, 2015

If Our Brain Was Like Homer Simpson’s Brain

OUR SOLE PURPOSE TO LIFE…

AND EVENTUALLY END UP LIKE…

HOWEVER, OUR BRAIN IS MORE COMPLEX…

• FAMILY/FRIENDS• EMERGENCY MEDICINE• LECTURES/CONFERENCES• HEALTH & LIFE INSURANCE

• CME ACTIVITY• EXAM/BOARDS• ELECTIVE• SOCIAL LIFE• MALPRACTICE• CAR, HOUSE• VACATION

• STATE LICENSE• TAXES/ LOANS

• FINANCIAL FUTURE

OUR OBJECTIVES:Organize Your Thoughts

THIS IS NOTHING NEW…

TODAY’S OBJECTIVES

• 1) Timeline to Graduation• 2) Licensing and Job related Expense

3) Curriculum Vitae Workshop • 4) Fellowships, Academic and Community

Positions, and Non-clinical Options• 5) Contracting Overview• 6) Life Insurance, Disability, Malpractice

TIMELINE FOR THE 3RD YEARS

JUNE Apply & register for USMLE Step 3 (if you have not done so)Consider your electives

JUNE - JULY Prepare your resumeGather all your documents together

JULY - AUG Start thinking about your ideal job/location

AUGUST - SEPTEMBER Approach people for letters

OCTOBER - MARCH Write to your respective director/chairmanInterview & Negotiate your contracts

NOVEMBER-FEBRUARY

Apply for medical licenseReview your contracts

JAN - DECEMBER Set up your finances, disability, life insurance

APRIL - JUNE Initial application for the ER Boards

JUNE Graduation!!!

LAR LECTURE SERIES FOR THE ACADEMIC YEAR 2015 - 2016

LAR LECTURE SERIES for 2015 - 2016• August 18th 2015 – CHAIRMEN’S DINNER FORUM

(Place TBD)• September –PGY2 EARLY PLANNING FOR THE

FUTURE (TBD, Pullout from conference)• NOVEMBER - ESSENTIALS OF CONTRACT REVIEW

(TBD, Daytime Meeting At/Near Christ or at Faculty Home)

• FEBRUARY - FINANCIAL PLANNING AND INSURANCE (TBD, Pullout from conference)

• APRIL OR MAY - MEDICOLEGAL CRASH COURSE TBD, All residency in conference)

LET’S BREAK IT DOWN YOUR TIMELINE EVEN FURTHER

GATHERING THE DOCUMENTS

JULY

JULY: Gathering the Documents• Birth Certificate or Current Original Passport• Official transcript

– College– Medical school– Graduate school

• Medical degree (notarized)– Translation if not in english– Letter from the Dean

• Residency postgraduate training– Diploma– Letter from the Chairman/Program director

• USMLE/FLEX Official Transcript• Verification of state licensure

Send in a Picture you Identify with

FINDING THE PERFECT JOBAUGUST - DECEMBER

CHOOSING THE RIGHT JOB:KNOWING THE FACTS ABOUT OUR

SPECIALITY

A Little about our speciality…

• 1789 - Dominique Jean Larrey during the French Revolution– Sometimes recognized as Father

of EM– Introduced the idea of “flying

carriages”– Transport wounded soldiers to a

central location

A Little about our speciality (cont’d)…

• 1961 – Very First 24/7 ER

A Little about our speciality (cont’d)…

• 1968 – First national EM meeting– 32 physician from 18 states

• 1970 –1st EM residency program (Univ of Cincinnati)• 1971 – 1st EM Department at a US Medical school– Univ of Southern California

• 1979 – EM became nationally recognized medical specialty by AMA and AOA

• 1988 – Last year for “grandfather clause”

WHAT DOES ALL THIS MEAN FOR YOU…

THERE IS A DEMAND FOR EP

• 2009 national report card on state of EM gave a D- grade for access to emergency care

THERE IS A DEMAND FOR EP

• Currently, the demand is ≥ 20,0000–Probably will not be

achieved till next century–Rural >>>

Urban/Suburban• Resorting to alternate staffing

models

Factors That the Demand for Emergency

Physicians1) Aging of US population2) General in US population3) Greater demand for ambulatory care services• Insufficient non-ED alternatives

4) Improved clinical outcomes assoc w/ EM physicians5) Expansion of out-of-care hospital services/systems6) Employment of physicians in emergency health care

facilities outside the US

Factors That Demand for Emergency

Physicians1) Closure of hospital EDs2) Use of “physician extenders” in place of EPs3) Refusal of payers to fund nonclinical duties by

EPs4) Transfer of ambulatory care cases currently

managed in ER to urgent care/walk-in clinics

Alarming Fact

• US government report–119 milion ED visits in 2006• 36% increase from 1996

–Decrease in #’s of ED• 4,019 (1996) to 3,833 (2006)

Goldstein, Jacobs (Aug 2008). Emergency Room Visits Hit Record High. Health Blog

ANOTHER ALARMING FACT ABOUT OUR SPECIALITY…

AGE-GROUP DISTRIBUTION FOR EPs

Why do they leave the Field… (1)

• AMA quotes the attrition rate for EM from 1.5% to >12%

• Ginde, et al (2010)– Highest attrition rate• <5 yrs post training AND > 40 yrs

– >18% after 20 years– >25% after 30 years

Why do they leave the Field… (2)

• Physicians who left the field– Long and irregular work schedule– Financial stability– Academic vs on your own– Single vs married– Board certification– STRESS

QUALITY OF LIFE RATINGS FOR

EMERGENCY PHYSICIANPersonal satisfaction A

Job security A

Future growth B

Benefit to society A

Low stress D

CHOOSING THE RIGHT JOB:HOW MUCH MONEY WILL I

MAKE???

US National Avg Salary for EP

$189,002 $212,295 $269,973 $298,769

10th% 25th% 75th% 90th%

CHOOSING THE RIGHT JOB:HOW MANY HOURS DO I WANT TO WORK?

Length of Shifts

“Length of the shift should depend on the physical and

mental load of the task”- Kanauth and Rutenfranz. J Human Ergol 1982 (11)

DEMOGRAPHICS OF MOST EDs

8 hrs 12 hrs 8 & 12 hrs Other 8, 12, and Other

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

11%

32%

18%

26%

13%

% of shifts worked

% worked

What Do We Prefer???8 hours vs 12 hours

8 hrs 12 hrs Other0%

100%

200%

300%

400%

500%

600%

700%

800%

900%

1000%

Series3Series2Preferred Shift

Length of Shifts (4): 8 hours vs 12 hours

• Advantages of 12 hrs– Fewer shift changes

• Fewer transfer of pt care– Longer time period for

patient care – Less time working after

shift change– Less commuting time– 1/3 more days

completely off

• Advantages of 8 hrs– More rest– alertness in the last 2-

4 hrs– Ability to participate in

personal activities on workdays

– Ability to apply circadian principles in rotating shifts

LICENSING, FEES, AND TIME FRAME…

NOV - JUNE

Expected Time Frame

• Depending on the state:– Arizona: 4 – 6 weeks– Illinois: 6 weeks – 12 weeks– Michigan: 6-8 weeks– Indiana: 6 weeks– Florida: 3 – 4 months– Texas, California: 6-9 months– Wisconsin: 3 months

HOW MUCH WILL IT COST?• Illinois License processing fee: $600.00

– California: $1298– Texas: $1002– Florida: $1227– Indiana: $250– Michigan: $150 ($230 w/ Controlled Substance)

• Illinois State Physician-controlled Substance License $5.00 and up to 8 weeks

• DEA application 6 weeks and $731.00

• Apply for NPI number (on line, a few minutes, free)

THOSE WHO WANT TO WORK IN MULTIPLE STATES….

FCVS

FEDERATION CREDENTIALS VERIFICATION SERVICES (FCVS)

• Permanent repository of primary-source verified credentials for physicians– Lightens the workload of credentialing staff– Reduces duplication of effort from physician– Reduces time period to get a license

• Good: those who wish to work in multiple states

• Bad: Another expense

FCVS

NOV – APRIL

Nov - April: What Else is There?• Financial Planning– Saving/ investing– Paying off loans– Starting practice– Insurance

• Malpractice Prep

• Other options?/Job Specific search

• Careers within EM and Fellowships

• Starting and running a business

• Wellness: tomorrow and beyond

ABEM EXAMINATIONAPRIL - JUNE

ABEM BOARD CERTIFICATION (1)INITIAL CERTIFICATION APPLICATION

Application fee if submitted onlineApril 15 - July 1,

2016

Application fee if submitted online July 2 - August 1,

2016

Application fee if submitted online

August 2 - October 1, 2016

Initial Certification Application

                     

$420* $575*(includes late fee)

$1,295*(includes late fee)

ABEM BOARD CERTIFICATION (2)QUALIFYING EXAMINATION

Examination Name                              

Register and pay onlineMay 1 - November 1, 2016

Register and pay onlineNovember 2 - 7, 2016

Qualifying ExaminationMonday - Sunday,

November 11 - 17, 2013$960* $1,965*

(includes late fee)

ABEM BOARD CERTIFICATION (3)ORAL BOARD EXAMINATION

• Notified by mid-January– Spring assignment• Registration by mid Feb ($1225)• Late Registration - 2 weeks later ($1515)

– Fall assignment• Registration by mid July ($1225)• Late Registration – 2 wks later ($1515)

BUT THAT’S NOT ALL FOLKS…

OTHER EXPENSES

• YOUR STUDENT LOAN• BUYING A NEW HOME– 20% down payment

• Buying a car??• Wedding/Marriage• Kids…• TAXES– Remember, you are in a higher bracket…

AVOID THE FRUSTRATION OF BEING A 1ST YEAR

ATTENDING

JULY 2016

CAVEATS FOR NEW ATTENDINGS• You are no longer the resident, the buck stops with you• You are the TEAM LEADER• Always be Nice and Always be Polite!• Resist the temptation to be vindicated!• Don’t publicly criticize any physician/hospital or other

physicians assessment• Your salary is dependent on your charting and biling• Don’t miss a shift and show up on time• Be careful with alcohol and other substance• You will be sued

WHAT DO YOUR FELLOW PEERS/

COLLEAGUES HAVE TO SAY?

Advice From Your Fellow Colleagues at ACH (1)

• Get the nurses on your side (D. Girzadas)– “it’s like starting residency all over again…”

• Show up early or on time (H. Zerth)– “or colleagues will resent you forever”

• Things move faster than ACH, have a plan before leaving the patient room (H. Zerth)– “adding on tests after tests will delay disposition

for 2-3 hrs and are generally frowned upon”

Advice From Your Fellow Colleagues at ACH (2)

• Don’t be afraid to ask your senior co-attending a question (D. Strasburger)– “asking for a second opinion is not forbidden”

• It’s not as hard to admit someone (H. Zerth)– “don’t fight tooth and nails, if you aren’t

comfortable discharging someone then admit”• You are going to be nervous (H. Zerth)– “just trust your training and you will do fine ”

Advice From Your Fellow Colleagues at ACH (3)

• Ask for an orientation of your ED (C Kulstad)– “never want to be in a situation where you have to

look around for something in a hurry (central lines, ET tubes, chest tubes, etc)”

• Become a “good citizen” by asking how you could contribute (M.Felder)– “allows you to find a nitche, both security and

longevity”

Advice From Your Fellow Colleagues at ACH (4)

• Say thank you a lot, act like you want the business (S Altman)– “when you are paid full salary, there is no such thing

as an ‘inappropriate’ ED Visit”• Be involved early and as much as possible(PJ

Konicki)– “get to know as many attendings outside the ED”– “attend social and charitable events run by hospital

and medical staff office” – “Make ED consultation friendly ”

Advice From Your Fellow Colleagues at ACH (5)

• Walk in the door calling your fellow attending by their first name (S Altman)– “if you act deferential, you will be treated as a

resident”• Try to accept all requests for shift trades when

possible, even if they don’t seem fair (S Altman)– “you will become known as a team player”– “just keep track of the shifts, beware of anyone who

tries to take advantage of you”

Advice From Your Fellow Colleagues at ACH (6)- Shadow Shifts -

• Do a shadow shift in a place you are not familiar (A. Kiernicki-Sklar)– “important to know how certain processes work before

you start (e.g. transfer, admission, running codes, etc)”– “allows you to be familiar with the kinds of equipment

they have available”• Need to know the competency of the staff around you

(A. Kiernicki-Sklar)– “ancillary staff may not know the medications you are

familiar with”– “will they be able to recognize a sick patient?”

Advice From Your Fellow Colleagues at ACH (7)- Watch your words-

• Listen first, talk last (T. Ross)• Give advice/opinion ONLY when asked (T. Ross)• Do not get in an argument for any reason – DO NOT

raise your voice (T. Ross)– “remember, you are under watch at all times”

• Never engage in any talk complaining about one of your colleagues (T. Ross)– If someone asks, respond back by saying: “you haven’t noticed

that, but how about them Bears”

Advice From Your Fellow Colleagues at ACH (8)- Watch your words-

“I think you will find that if you stop complaining you might not need to do it as much anymore. Once you start, it is hard to stop. Think of complaining like cigarettes and stay away... (Oh, how I would

love to have a smoke!!)” (T. Ross)

Advice From Your Fellow Colleagues at ACH (9)- Financial Help-

• Live like a resident for 2 more years (S Altman)– “a dollars saved today is worth more than one saved

tomorrow”– “put off that temptation of buying that Lexus/Porsche”– “ONLY EXCEPTION IS BUYING A HOUSE”

• Maximize tax deferred opportunities (S. Altman)– “money saved in this account is untouchable in case of

divorce, law suit, or even criminal activity”• Look for a good team to manage your

investments/retirements/disability (A Katiyar)

Advice From Your Fellow Colleagues at ACH (10)- AND AT LAST…-

• Remember this is your last year of training…– Start forming your “thinking process”• Ask yourself, “what will I do if I were on my own”?

– Get comfortable with as many procedures• EJs, central lines, chest tubes, LP, etc…

– Challenge yourself everyday with seeing pts• There is no limit, try to see as many pt as you can…

– Learn how to chart efficiently!!!• Don’t lose money!

MOST IMPORTANT NOTE:

DON’T FORGET ABOUT THE EMERGENCY MEDICINE

BOARDS

AND YOUR TAXES!!!

SO WHAT ARE MY OPTIONS…