By Lisa M. Sanders
Johns Hopkins Emergency Medicine Resident
- Location- This is a very important topic to take into consideration. There are over 4900 Emergency Rooms in the United States. 70% of physicians leave within the first 2 years of their first job. Also 85% of those people relocated to a place they hadn't considered. There are many types of environments in which to work- city vs. suburban, hot vs. cold, by the water vs. in the mountains.
- Academic vs. Community- You need to decide which type of setting would be good for you. There are some community hospitals in which residents may rotate, and they may be emergency medicine or other specialties. It may be harder to go back into academics if you start off in community.
- Clinical Setting- What kind of patient population does this hospital have? Is there a mix of patients- pediatrics, medical, surgical, trauma, psychiatric, obstetrics? How many patients are medicare, Medicaid, self-pay, or managed care? Is there a PICU, MICU, SICU, or a labor and delivery floor? Are all on-call specialties represented? How many Level 5's are there? Level 4's? Level 3's?
- Work Environment- How hard are you going to work? How sick are the patients? What resources are available to you? How is the physical facility- is it clean, happy, new? How has the nursing shortage affected your hospital? How many tech's are there?
How many secretaries? How much does the volume fluctuate during the day? How is the patient flow (is it chaotic or do patients move smoothly)? What is the coverage for physicians- single, double, triple coverage? What equipment is available to you (e.g. ultrasound machine)?
- The Schedule- This will determine how happy you are in your life. How do they assign coverage- is it lottery, first come/first serve, rotating? How flexible is the schedule? What is the vacation time offered? Will you be working nights? Sometimes "moles" are compensated but make sure that if you agree to working nights for a limited amount of time, this is written in your contract.
- Advancement Opportunities- Megagroups have a spectrum of Emergency Rooms- they may offer more or less opportunities. There are many ways to branch out into your job whether it be EMS director, Quality Assurance, Administration, Director of Sexual Assault programs, etc. If you have outside interests, ask if your department will help you or support you.
- Group Structure- There are many types of structures. In a megagroup, you are an employee of that group. You can be an independent contractor, an employee of the hospital, locum tenems, or part of a democratic group. How safe is your contract? How safe is the group contract with the hospital? Is there a noncompete clause in your contract?
- Longevity of the group- What is the turnover for the doctors and nurses? This can be a good indicator of what the working environment is like!
- Salary- Remember that often your lifestyle becomes adjusted to your salary so live within your means!!! And, don't judge a place by salary! What are the benefits? Do you get paid vacation, bonuses, retirement, business expenses, reimbursements? What is the disability and malpractice like? Are dues to ACEP, SAEM paid for? What is the dental and medical plan offered? Do they pay for your tail or do you have to buy it if you leave?
- Other issues- Who is your coder for reimbursement? Are they reliable? Remember that you are responsible for fraud if there are problems with coding. Also keep in mind that an emergency room that uses the T-system (a template charting product) may have a better compliance rate with coding.
Other options to consider when looking for a job are fellowships, part-time work, and locum tenems.
Remember that if a certain group does not have a job available now, they may have one available in 3 months so call again. Keep in mind that things are negotiable.
Finally, if you have any questions about the job search, you can call the Maryland ACEP chapter at 410-727-2237 or email questions to email@example.com.