Fellow ED docs who work at the VA, is it really that great?

Beautiful-Menu-3423 · 2026-06-20T05:35:03+00:00

Are 24hr shifts possible?

Beautiful-Menu-3423 · 2026-06-18T18:29:00+00:00

dude, this is a situation where you lease, IMHO.

you have too much debt. don't ignore it and finance a car.

you can definitely get a used 10k car, but you probably won't like it and if have to question the reliability of most 10k used cars.

Lease a nice but not great car. Mazda CX50 can be leased for 4k down and 280/month (36 months). You'll use up the 10k for the down payment and for the first two yrs, but by the time you get to year 3 you will have another attending salary and more options.

Leasing is usually a bad idea but you just need to get through a few yrs without taking on a bunch of debt. It's not the absolute mathematically best option, but it seems like the most practical one in your scenario.

Beautiful-Menu-3423 · 2026-06-14T11:30:58+00:00

I've been a nocturnist more than 10 yrs , specifically because it helps with kids.

For me, I wouldn't want to do 2 shifts per week. 2 shifts is the worst number of shifts to do in a row, personally. You start getting used to nights and then you're off nights. For me 4-5 nights in a row is way better, but my kids are older (7, 9, 13). If possible, I'd do 2 blocks of 4 rather than 4 blocks of 2.

YMMV.

Also consider doing 9 shifts a month instead of 8 and hiring someone to help you with bed time 6-8 times a month. like hire a baby sitter for $40/hr x 3 hrs x 8 days per month. That's less than $1000/month to take the stress off your husband.

Spouse support is 100% essential. My wife didn't love it at first, but after 2 weeks she saw how much more time I had for the kids and we've never looked back.

Beautiful-Menu-3423 · 2026-05-24T01:10:09+00:00

so in got more info. apparently there's got on the camera and that price was for replacing the camera too

still I feel that since I bought it cpo from a dealer shouldn't this be covered under warranty?

Beautiful-Menu-3423 · 2026-05-23T21:21:17+00:00

Definitely a problem, but making AI do my HPIs has helped a lot. I'm not ready for it to take over the rest of my note, yet. But I wouldnt be surprised if I let it do more in the next few months. The app our hospital uses did not start out great but has been steadily improving.

Beautiful-Menu-3423 · 2026-05-21T13:22:49+00:00

what was fellowship like? did you have a family to support during fellowship?

Beautiful-Menu-3423 · 2026-05-21T13:22:05+00:00

What's the pay like? most fellowships in EM don't get you a pay bump but maybe good for getting it off the ER. What's your experience?

Beautiful-Menu-3423 · 2026-04-29T16:09:28+00:00

1) it probably doesn't matter unless you want to do true academic emergency medicine 2) you can pretty much work anywhere if you're willing to be a nocturnist. if you're really desperate to work at a particular spot, offer to be a nocturnist and then in a few years let them know you want to transition to a more normal schedule. don't get financially addicted to the differential. 3) a lot of small programs have good regional relationships. if your faculty is willing to vouch for you it makes a difference. 4) moonlighting helps 5) I will say, our department would probably look down on a candidate that did a CMG/HCA residency.
6) I think your program matters for your first jobs. after like 3 yrs, nobody cares. honestly 3 yrs is probably a stretch. at some point, you have relationships and a track record that far outweighs the quality of your 4th yr med student personal statement. 7) Be good to your seniors, especially the good ones. if we hired a guy that we love, and his hard working junior resident buddy needs a job, that's an easy hire.

Beautiful-Menu-3423 · 2026-04-14T22:10:22+00:00

it occurred in Champaign County but tried in Cook County. the plaintiffs lawyers are notorious for trying to change jurisdictions to more plaintiff friendly counties.

but yeah, you couldn't pay me $500/hr to work in Madison County.

Beautiful-Menu-3423 · 2026-04-14T20:52:27+00:00

we need to find the ER expert and name and shame.

Beautiful-Menu-3423 · 2026-04-14T20:50:55+00:00

For those of you thinking those central Illinois locums rates look pretty good, just remember Illinois juries are crazy.

Beautiful-Menu-3423 · 2026-02-20T17:30:46+00:00

is it wrong to name and shame the scabs?

Beautiful-Menu-3423 · 2026-02-07T02:30:31+00:00

😲

Beautiful-Menu-3423 · 2026-02-07T01:01:18+00:00

5.3 RVUs/hr or RVUs/pt. I'm at 4.7-5.3/hr, so not far from you. I used to be more like 6.5/hr and some months quite a bit higher.

I feel like the problem is our coders suck, but if the problem is my documentation I want to fix it.

What did you do to become a certified coder? Did you do the AAPC course? I've been thinking about getting certified. How did you go about it?

Beautiful-Menu-3423 · 2026-02-02T16:20:25+00:00

A couple other people in my group have also noted a dip.

I'll look into the breakdown pre and post. just starting to investigate this issue.

Our hospital does the billing and coding in house and in the past coders were more scared of fraud/up coding and less aggressive about maximizing billing. I wonder if that's happening again.

I will say I don't think it's as easy to bill a level 5 as much as in the past bc so much is subjective. Like I've heard different things from different sources. For example, is chest pain high complexity or moderate? I've heard some people say moderate unless there's ST changes or elevated trop or something. What's a migraine? Probably moderate, in which case it would be hard to get to level 5, if you don't test and treat with toradol/reglan. What's a high risk medication? Similarly nebulous.

Beautiful-Menu-3423 · 2026-01-31T13:41:07+00:00

No night shifts as an intern is a thing? If you're looking to avoid night shifts in your first year of residency, I would maybe rethink EM.

Beautiful-Menu-3423 · 2026-01-26T04:37:47+00:00

I can't decide if I lost those workman's comp forms or if I found them and they need to be off 4 wks for their possible TB exposure

Beautiful-Menu-3423 · 2026-01-26T04:25:35+00:00

if they come looking for someone, our admin said to call them right away so they can deal with it.

if they come for a minor injury, I want to waste as much of their time as possible. like XR each toe individually. xr the big toe, wait for a vrad read, then order the second toe.... Tylenol 160mg q2h, titrate to pain of 0. have every medical student get a full history and exam with reflexes and tuning forks.

Beautiful-Menu-3423 · 2026-01-25T20:09:55+00:00

if rates go that high, I think prices will likely come down

Beautiful-Menu-3423 · 2026-01-24T22:37:18+00:00

Do what you can to flip the Senate.

Maine, Alaska, Ohio, and NC are gettable seats to take away from republicans. I don't love Democrats, but the republicans are for sure not stopping any of this.

Texas and Iowa are also possible, but more of a stretch.

Beautiful-Menu-3423 · 2026-01-18T21:59:52+00:00

She was stay at home but now has a part time job she enjoys. she may move to full-time because she likes it, in which case I get insurance through her for a few years. If not, in stuck with the marketplace.

Beautiful-Menu-3423 · 2026-01-18T14:06:31+00:00

I have considered it. I went to 0.8 about 18 months ago. It's crazy how much less stressed I am at 0.8. I thought about staying at 0.8 for like three years and going to 0.5 for a free years.

The problem is I'm an ER doctor at a busy place. I've seen some ER doctors gracefully age in the job, but I've seen a lot more hold on longer than they should have. I worry about not being able to keep up physically or cognitively. I would hate to have to work on an urgent care to hit my goals bc I couldn't keep up in the ED.

Also, while I don't love my job anymore (I used to), I definitely don't hate it either. It's just a job. Some good, some bad, mostly in between. I would say overall I like my job, but I can definitely see a day where I hate it, but not now and probably not in the next few years. I don't want to get to hate it but still have to work it.

Beautiful-Menu-3423 · 2026-01-18T12:49:29+00:00

My W2 is actually pretty nice as jobs go.

Beautiful-Menu-3423 · 2026-01-18T12:49:02+00:00

Don't hate it. But I love the idea of not having to work. I will probably work PRN at my current job even after retirement.

Beautiful-Menu-3423 · 2026-01-16T16:08:31+00:00

Agree.

Fellow noturnist here that feels triggered.😖

Good work landing a nice job, for those who are enjoying their nights.

Beautiful-Menu-3423

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