6. 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
9. 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
11. JUNE Apply & register for USMLE Step 3 (if you have not done
so)
Consider your electives
JUNE - JULY Prepare your resume
Gather 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/chairman
Interview & Negotiate your contracts
NOVEMBER-
FEBRUARY
Apply for medical license
Review your contracts
JAN - DECEMBER Set up your finances, disability, life insurance
APRIL - JUNE Initial application for the ER Boards
JUNE Graduation!!!
13. 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)
16. 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
20. 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
21. A Little about our speciality (cont’d)…
• 1961 – Very First 24/7 ER
22. 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”
24. THERE IS A DEMAND FOR EP
• 2009 national report card on state of
EM gave a D- grade for access to
emergency care
25. 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
26. Factors That the Demand for
Emergency Physicians
1) Aging of US population
2) General in US population
3) Greater demand for ambulatory care services
• Insufficient non-ED alternatives
4) Improved clinical outcomes assoc w/ EM
physicians
5) Expansion of out-of-care hospital services/systems
6) Employment of physicians in emergency health
care facilities outside the US
27. Factors That Demand for
Emergency Physicians
1) Closure of hospital EDs
2) Use of “physician extenders” in place of EPs
3) Refusal of payers to fund nonclinical duties by
EPs
4) Transfer of ambulatory care cases currently
managed in ER to urgent care/walk-in clinics
28. 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
32. 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
33. 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
34. QUALITY OF LIFE RATINGS
FOR EMERGENCY PHYSICIAN
Personal satisfaction A
Job security A
Future growth B
Benefit to society A
Low stress D
38. 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)
39. DEMOGRAPHICS OF MOST EDs
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
8 hrs 12 hrs 8 & 12 hrs Other 8, 12, and
Other
11.30%
32%
17.70%
26.10%
12.80%
% of shifts worked
% worked
40. What Do We Prefer???
8 hours vs 12 hours
0%
10%
20%
30%
40%
50%
60%
8 hrs 12 hrs Other
52%
20%
28%
Preferred Shift
41. 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
44. 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)
47. 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
50. 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
52. ABEM BOARD CERTIFICATION (1)
INITIAL CERTIFICATION APPLICATION
Application fee if
submitted online
April 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)
53. ABEM BOARD CERTIFICATION (2)
QUALIFYING EXAMINATION
Examination Name Register and pay online
May 1 - November 1, 2016
Register and pay online
November 2 - 7, 2016
Qualifying Examination
Monday - Sunday,
November 11 - 17, 2013
$960* $1,965*
(includes late fee)
54. 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)
56. 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…
58. 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
59. WHAT DO YOUR FELLOW
PEERS/ COLLEAGUES
HAVE TO SAY?
60. 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”
61. 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 ”
62. 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”
63. 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 ”
64. 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”
65. 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?”
66. 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”
67. 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)
68. 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)
69. 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!
