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.
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.
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?
4. 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
5. 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.
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.
7. 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?
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!
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?
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
to consider when looking for a job are fellowships,
part-time work, and locum tenems.
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.
you have any questions about the job search, you can
call the Maryland ACEP chapter at 410-727-2237 or email
questions to firstname.lastname@example.org.