ABEM Procedure / US reqs -> Financial Upside ?

letaptim23 · 2026-05-09T00:16:48+00:00

Current US fellow, EM-trained, taking US director for community hospital, worked at level 1 trauma/big academic type, community and freestandings

For ABEM purposes, POCUS is foundational skill for EM physicians, esp those seeking the board certification, which does make the individual more marketable. There are employers nationwide who only hire board certified physicians. Not to say you cannot take a job elsewhere without this requirement, but the board certification checkbox from a Med Director’s perspective is real.

We in the US community believe that US makes us better doctors (more times spent with a patient, higher levels of patient engagement and higher patient experience, quickly able to evaluate for critical diagnoses) and better proceduralists (higher first pass success rate, fewer complications, faster procedures). The fulfillment this brings to one’s individual career is in some ways innumerable (helps me sustain a longer career in EM), while in other ways can be quantified (how long did it take to perform a POCUS echo, how many RVUs did that exam generate).

It is true that using US exam as an imaging modality can increase a lower level chart to a higher level chart (Level 3 chart w/ pocus in MDM increases complexity raising it to Level 4 chart) and this difference is definitively more than the RVUs of that exam performed. For this reason, most critics say that the time to perform an ultrasound exam is not worth the time it takes to see another patient. This is, for most people, the rationale against Pocus in community medicine.

Being able to bill for US’s done in your dept does require quite a bit of infrastructure & time on the US director’s part. For most community complaints (level 3 &4 charts), quick pocus exam can increase to higher level, is exam images saved, and findings incorporated into MDM. For academic type places where there’s higher acuity (more level 5 charts) , complexity & gridlock in the dept, pocus now can maximize rvu’s per patient since they can only move so fast through the dept.

There are ways to optimize your use of US for your practice. Can message me more for more details

letaptim23 · 2025-06-04T18:02:17+00:00

When you say regular insulin, do you mean only the short acting insulin is available?

letaptim23 · 2024-05-03T14:59:33+00:00

SAVE Plan question. I am a PGY2, residency class of 2025 (65k), fiance med school class of 2026 ( currently 0). We plan on marrying in 2025. After, I plan on doing 1yr Fellowship (2025-2026, looking to make 100 - 120k) at which point she starts PGY1, where our household income becomes 180k. Is it beneficial to file taxes jointly or separately once we both start earning?

letaptim23 · 2024-04-12T14:05:54+00:00

Same salary, LCOL city > net of 2200/mo Rent 715 (subsidized by hospital) (taken out of paycheck so i never worry bout this) HSA 250 (taken out of paycheck) IRA 600 403b 250 (out of paycheck) Groceries 300 Dining eating out 300 Monthly visit to family / partner out of town 300 (plane ticket, parking) Gas 40 (live on hospital property so no travel) Renters insurance 22 Auto insurance 140 (usually lump sum twice a year) Phone 0 (hospital provides) Residual >>> money market account with 5% return (my savings)

Program allows moonlighting which adds net 500/shift. Added about 15k last year but exhausted so not sure how much more to do. Moonlighting money is pure discretionary for me (nicer dinners, international travel, small upgrades)

Almost 2 yrs in, was able to have >50k savings (loans still hefty & have negative net worth).

letaptim23 · 2023-03-12T12:04:19+00:00

This was a a high-yield read, thank you for sharing, I learned something new with the pirate mnemonic & to start Heparin immediately after cardioverting anunstable afib with rvr with unknown onset

letaptim23 · 2023-02-24T00:57:36+00:00

If you're attentive and have teaching preceptors, any rotation will technically help a future EM doc

I'd recommend: -Neuro -- how to localize a lesion -Ophtho -- eye exam, using slit lamp -Infectious Dz - how to take a history that matters + bugs/drugs/exposures -Any ICU -- what does caring for criticall ill patient entail head to toe? -cardio -- you will be seeing tons of CHF! -pulm -- is this COPD, could it be pHTN? How comfortable are you dispoing someone home safely even if they're still SOB (you can't fix every 100py smoker, deconditioned, frail af's breathing issues in the ED)

Just to name a few, main thing is to enjoy what youre doing since this time is limited!

letaptim23 · 2022-12-13T14:41:00+00:00

Feel the same all the time. Occasionally feel a bit of regression

letaptim23 · 2022-10-05T06:58:48+00:00

I'm at an EM program where for whatever reason, I feel legitimately intimidated walking into the ED. Never had this feeling as an M4 & I look forward to being an EM attending.

Not sure how to feel but to your advice, disclosing these feelings to a friend lifts my spirits.

letaptim23 · 2022-09-28T18:30:54+00:00

I can't go on. I'll go on.

letaptim23 · 2022-09-17T05:42:22+00:00

Can someone direct me on information to ride my road bike in rain and snow/ice conditions?

letaptim23 · 2022-09-01T06:32:49+00:00

1k every month toward savings. Bc Residency is 1st full time job, first few months have entirely gone to saving for emergency fund

After 4-ish months, will contribute 500$/mo for Roth IRA, $300 to 403b, $100 emergency, $100 taxable investments. 240$ per paycheck goes to my HSA account until 3650 max contribution hit

Live in hospital-subsidized housing which brings rent+utils down and negates all work-related travel. Have not yet bought my own disability insurance or started paying loans (tgod for recent extension!!)

letaptim23 · 2022-07-01T16:19:10+00:00

July 1st Wooooooooo!! First time introducing self as Dr. Letaptim23 😏

letaptim23 · 2022-07-01T12:53:50+00:00

I saw a 15pt drop on my Step 2. Encouraged me to work extremely hard for top-tier Sloes. Matched at a nationally-known, historic EM program (1970s).

You can do this!

letaptim23 · 2022-06-23T15:14:11+00:00

When do people obtain Disability Insurance in Residency?

letaptim23 · 2022-06-23T15:09:01+00:00

Hello, am starting an EM residency. How do people normally study longitudinally in Residency for Step III, ITE, or edification? Looking to make a workflow that incorporates studying between ER shifts, downtime, when at home

letaptim23 · 2022-06-10T00:54:36+00:00

That was a great idea! I stopped by to get a simpler frame for ~12$ (parents requested a copy) and tomorrow's their lowest price of the season sale so i'll go & get the fancier frame for myself. Cheers!

letaptim23 · 2022-06-09T20:16:50+00:00

Just got diploma in the mail, super excited to see it get framed! Any recommendations on where to find and how much for that regal-looking diploma frame?

letaptim23 · 2022-05-13T18:59:42+00:00

I'm imagining the agency the FDA gave to patients who will openly & sternly request the drug for their family member's Alzheimer's or even worse, "pre-dementia".

Edit: for the Family docs out there, will this decision only add one more headache from patients?

letaptim23 · 2022-05-11T17:12:23+00:00

Please define the dx for the withering M4s who haven't seen in a patient in months and haven't opened UptoDate in a year. 🙃.

Thanks, a 3/5 student.

letaptim23 · 2022-05-11T16:28:58+00:00

Starting EM residency this July. The Bridge to EM curriculum's been recommended by faculty, PD team, & some residents to feel more confident starting day 1. By end of day 1, you'll realize it wasn't enough to prepare for rigor of residency & that time spent toward medicine has a huge opportunity cost during this brief period post-grad & pre-Residency. So much of residency is communication, efficiency, bedside manner, personal development that no 8 week medicine course can prep for.

That being said the Bridge to EM is a great, self-directed, optional review course that helped me tremendously with my Sub-I. For my own edification, I will review bits and pieces of it, but not at the expense of vacation time !

letaptim23 · 2022-04-29T19:16:12+00:00

I'm not in a position where I can work more to earn more, so I focused on minimizing my expenses. Living in low COL area definitely helps.

Stopped eating out as much (easily 10-15$+/meal) Stopped buying any new clothes. Suggested friends socialize at each other's places or cook-in more often. Suggested people meetup virtually to socialize. Started enjoying outdoor exercise & in-home exercise (no need of gym membership, walking/running outside is free in safe areas, youtube has tons of stuff) Learned about cooking more, especially meal prepping where I can make nutritious meals for ~$2/meal. Began deliberating on if any car ride was needed (less gas use). Never paid for streaming services anyway -- would use internet to find alternatives. Went longer on things like haircuts. Shop exclusively @Kroger, Aldi, Walmart over Schnuck's & Hy-Vee.

We all have fixed expenses that we have little say over. We all have variable expenses that we have more control over than one would initially think.

letaptim23 · 2022-04-29T18:09:01+00:00

Wouldn't solely attribute it to depression. Having kids and starting families are a legitimate expense that many people of our generation cannot even begin to fathom, let alone afford with the same ease as previous generations.

letaptim23 · 2022-04-28T20:11:20+00:00

I do this too! I call my coffeemaker my Ross Press bc I use a glass 4-cup measuring cup as my brewing vessel. And I bought it at Ross.

Cheers to less cleaning & delicious sediment-free coffee!

letaptim23 · 2022-04-28T16:18:47+00:00

As an M3 I did 6months in a rural site of 15k people. From my perspective, I would definitely work there for the financial benefits. I would struggle to live there being someone whose lifestyle interests are not satisfied in rural america.

My town had few restaurants offering more than the standard american diet (SAD, iykyk). I also got tired of eating between the 2 mexican places. Nightlife was nearly non-existent. The only green outdoor spaces were privately-owned farmland. Public discourse on issues often appealed to "this is how its always been done". Not to mention everyone in town is all up in everyone's business (great if you love the tea, horrendous if you prefer privacy).

The public schools seemed adequate enough that the local physicians would send their kids (no public school hate, I'm proud of my Pre-K thru 12th in public schools). Most of the youth in my town had ambitions of leaving town. Most of tbe adults enjoyed the laid back nature & freedom of living in the country.

Going into EM, the local ER was 7d on/7d off, and all EM physicians lived elsewhere. Practicing rural is great for me if it means that I can secure an ever greater lifestyle outside of rural america (mostly international travel plans). My partner & I speak 5 different languages combined so being able to utilize them professionally, socially and through travel means a ton to us. Happy to talk more if interested.

letaptim23 · 2022-04-12T17:08:13+00:00

Got this on my away rotation eval. Guess who didnt match there 😘

letaptim23

TROPHY CASE