Is the end of fellowship creeping up quickly? Are you looking for a new PEM job? I recently talked to Dr. Jeff Bullard-Berent—who has been practicing PEM since 1990 about tips for getting a job in PEM. Dr. Bullard-Berent has worked in academic and community settings, established PEM divisions and started several PEM programs. He’s the immediate past chair of the ACEP Section on Pediatric Emergency Medicine and is currently working at the University of New Mexico as Vice Chair of Emergency Medicine, Medical Director of Child Ready Virtual Pediatric Emergency Department, and Professor of Emergency Medicine and Pediatrics.
What’s the your take on the state of jobs in PEM at the moment? The great news is that PEM docs are in demand so you’ll be able to find a job. But know that it may not be THE job. For example, by going into PEM you’ve already made some choices about location that you may not have realized. You’re not likely to get a rural or small town job. It’s going to be urban. Most community PEM jobs are in population centers of at least 300,00. If you’re looking for a freestanding children’s hospital, most are found in communities near 1 million.
What advice do you give junior PEM faculty who are looking for jobs? The advice I was given long ago–that still rings true today–was to think about the Location (the city, proximity to family), the Job (your hours, colleagues, opportunities) and the Money ($$). Then pick two because that’s probably the best you’ll get.
That’s a little cynical but at the same time, it’s realistic. Say you want to live in a place like San Francisco. It’s great city, maybe the job is great, but it’s expensive and you won’t have as much money available even if the pay is a little higher. Or in another job, the pay and location are ideal but you’re the only junior member of your division and everyone is 10 years older than you and in different places in their careers and have little in common.
Speaking of the job itself, many PEM fellows and junior faculty have been exposed only to academic jobs. Since you’ve worked in a number of community settings, what’s your perspective on community PEM jobs. Community might be right for you if you want to develop complete confidence in your own clinical practice. Just as in academics, community practices vary considerably. But you’ll likely be practicing without residents and completely responsible for the clinical decision-making.
There’s an adage in the community ED that says “The later the hour, the smarter the ED doc.” This means that in the middle of the night, the PEM attending gets to make the call and perform the procedures because consultant attendings don’t have residents to buffer them, and suddenly they trust your judgement! This means you’ll have more of an opportunity to practice to the full extent of your training. You may drain PTAs, perform fracture reductions, and do your own splinting/ casting.
What are some of the limitations of working in a community pediatric ED? One thing is that being in a community setting means that you may have to transfer a patient even if you know what needs to happen. Your orthopedist on call may not be peds trained and may not be comfortable with a Type III supracondylar necessitating transfer. You may not have a PICU for intubated patients, or a PICU that is not prepared to care for congenital hearts.
In the community, your contract will likely include a productivity incentive, like an RVU/hour model. It’s a meritocracy but that means if you’re not seeing enough patients or things are slow, that hurts your bottom line. You are also unlikely to be credited for education or research.
Since you’re talking about the bottom line, what’s the money like in community jobs compared to academic jobs? In general, community jobs pay more. But like I said, it’s often productivity based. If you only see 10 patients on a shift in a community job, that’s probably not enough. In most community settings full time work is 12-16 shift per month, which isn’t so different from most academic jobs. University gigs pay less but you get some credit for non clinical work, and the retirement plans typically include matching, making the total packages not that much different.
In our next posts, Dr. Bullard-Berent will share his perspectives on academic jobs, interviewing, and the negotiations. The PEMNetwork blog also has a job board where employers post available jobs. Click on the “Find PEM Jobs” tab above.
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