Starting Salary

My experience is the higher end of that plus benefits in the southern US.

remember to compare apples to apples...figure in the cost of benefits, insurance, malpractice, etc if it's not included in what you get. Independent contractors may make much more hourly may come out about the same when you figure in all of those other things.

my experience is contractors at a military hospital make low-mid of the range you've said, in the northeast the hourly pay is not as high as you are stating but neither are the hours, generally.

Also consider if partnership is an option. If it is, the starting salary is usually lower for the first few years, then goes up considerably. If partnership is not available, at least at the places that I have sent my CV to, it seems that the starting salary is higher, but that is the ceiling for the pay.

Usually, people start looking for jobs in the fall...November or so. The biggest reason for this is that it can take a long time for licensing and credentials. In order to start in July with no problems, many states will need several months or to work on this stuff....Florida, California, Texas are notoriously a pain for getting licenses through.

This is something to think about when you're moonlighting too. Plan ahead and be sure you are following directions to a T. It is always an advantage to send as much of the info as possible in at once in the same envelope to limit the possibility of misfiling etc.

chumbojumbo said:

To those who have recently got their first job out of residency, what is the current salary for BC EPs? I have read figures ranging from $135 - 180/hr. for anywhere between 1500-1900 hours/year which makes the annual salary range 200 - 350k/year. Does this sound correct? How do they compare to the offers you all have received/are receiving? BTW, These are for non-academic postions.

CJ

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I"m not sure there are a "ton" of places that are paying a starting salary of 350k, that seems to be a bit high, but otherwise those numbers are about correct.

BTW I think I would shoot myself if I had to work 1900 hours a year.

I agree, these numbers are a bit on the high side. Although it goes even higher (see below). It really greatly depends on how many hours you work and in which state/region. Also like mentioned already; partner status, as well as the difference between being an employee vs. independent contractor (differences in taxes and benefits) have to be taken into account.

There is an annual survey of EP compensation. About 1100 EPs from all 50 states and DC answered the 2007 survey (by Daniel Stern and Associates)

And these were the results:

Employees: $168,804 (base) to $180,450 (total: includes benefits and bonuses) = 10th% (percentile) in US
all the way to : $280,000 (base) to $335,940 (total)= 90th% (percentile)

Partners: $203,133 (total) =10th% to $412,500 (total) = 90th%

Independent Contractors: $188,500 (total) =10th% to $337,500 (total) = 90th%

Note: EPs reported # hours worked all across the board from less than 1200/yr to 2050/yr and more. (about 7% worked more than 1900/yr and 15.5% working less than 1300/yr)

Hourly compensation ranged between $95/hr =10th% and $160/hr = 90th% (this is not including possible benefits/bonuses).

In general compensation in the Northeast is much lower than in the South and Midwest.

The salary surveys always seem to low-ball, I wonder if alot of part-timers are being surveyed...

Talking to a resident the other day, he is taking a job at a BUSY level 1 trauma center is a very nice city (>1 mil). Democratic group, starting at 350. He definitely did say that this is not the easiest place in the world to work and that it's not for everyone.

AmoryBlaine said:

The salary surveys always seem to low-ball, I wonder if alot of part-timers are being surveyed...

Talking to a resident the other day, he is taking a job at a BUSY level 1 trauma center is a very nice city (>1 mil). Democratic group, starting at 350. He definitely did say that this is not the easiest place in the world to work and that it's not for everyone.

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I think those include both academic and private figures, so that might be where the discrepancy is. I may be mistaken, but I think there is close to a 100,000K difference, on average.

AmoryBlaine said:

The salary surveys always seem to low-ball, I wonder if alot of part-timers are being surveyed...

Talking to a resident the other day, he is taking a job at a BUSY level 1 trauma center is a very nice city (>1 mil). Democratic group, starting at 350. He definitely did say that this is not the easiest place in the world to work and that it's not for everyone.

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That is an excellent job. These opportunities are very rare. This is why:

Most Level Is in the country are academic. Plan on a starting salary of $150-180K plus benefits for a gross package of $200-220K for academics.

Level Is that ARE NOT academic (or at least are staffed by a private group and thus essentially "community" compensation packages) are few and far between. I know of only a handful in the entire country, as a matter of fact.

I'm not saying your friend is lying. I'm saying he/she has one of the 'gold star' appointments in my opinion. Good on 'em!

I'm all fee for service next year with 3+1 A-rated mailpractice and tail coverage provided. All other benefits are my responsibility.

This is not the system to work for if you need a lot of benefits. For me, it's the best system. Being single and young, all I need is health and disability insurance and retirement. As an independent contractor, I can toss in up to $45,000/year in a SEP-IRA, which is far more than the $15,500 annual limit in a 401(k)/403(b).

I won't say what my earnings potential will be because it's all dependent on the number of patients I see. I can tell you that I'm normally very quick seeing patients and documenting them, and the average salary for all docs is at the high end of the numbers you quote.

I will be working in a very busy (120,000 patients/year) ED with no residents or PA's, and the surgeons aren't in-house for the traumas (it's not a Level I trauma center, but is "equivalent" to a Level II -- I say that because it's not designated as such, but trauma patients are still brought there and even transferred there from other hospitals).

Are there many options of jobs with NO benefits and NO retirement setups? I would rather recieve every penny myself and I will manage those aspects of my life.

A good friend of mine who finished in 2004 made over $400k his first year out in Texas...

EM_Rebuilder said:

Are there many options of jobs with NO benefits and NO retirement setups? I would rather recieve every penny myself and I will manage those aspects of my life.

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Yes. Many IC (independent contractor) arrangements do exactly this. Many will provide malpractice +/- tail and leave everything else up to you.

Take care,
Jeff

We need to delete this thread and keep the topic on the downlow for the next couple of years.....

It's great to have a forum where soon to be EP's like myself can get this kind of information. I'm eternally grateful for the old school guy's and girls on here that answer our questions. I'm uncomfortable asking attendings these kind of questions. If it weren't for you all I'd be lost... Thank you

chumbojumbo said:

wow...i guess location is a big factor! I hoped for making around 250k starting, but it seems like I should be looking for more like 350k! Oh, and is there ample opportunity for overtime, and are you paid 1.5?

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I wouldn't jump the gun on the 350k. There are some places where you can get that for starting pay but there are not that many places. Looking for a job is down the road for me but I have learned in the last few months that tail coverage, malpractice, benefits including retirement, and health (especially with a family) are huge and should be considered much more than salary in certain circumstances.

There are a decent amount of FFS groups with great benefits and earning potential toward 400k, but be prepared to work your butt off if you want to be on that high end. Some people are not trained to see patients at that high pace because the volume wasn't there during residency and they will struggle in a FFS system. You'll also be the one doing all the procedures on the critically ill patients (because that's how you get paid) and will have to juggle that with the other 10-12 or so patients you will be carrying at any one time. Again, some people can do that well, others can't. I've made it a goal of mine to see as many patients as I can at one time now as an intern. Having 9 patients at once is the highest I've gotten so far, and it can be tough at times.

Also, many places have great retirement packages that will give you 20-40k a year into whatever retirement fund they like. You're yearly salary will be lower, but by the time you cash in on your retirement money and the interest that accrued, you'd end up with more money in the end.

There are some places that will pay 1.5 for certain shifts (holidays) and will let you pick up extra shifts at your regular pay rate, but I haven't heard of 1.5 pay for "overtime" but it might exist. Some places will pay a little higher if you exceed the number of yearly hours that is in your contract, but I doubt it's 1.5.

Overall, the earning potential in EM can be great but don't forget job satisfaction. Working less hours and getting paid a little less doesn't mean you will make less overall because you may have a longer career (academics for example). These are just some things to consider that haven't been mentioned yet in this thread...

TraumaCheers said:

That is an excellent job. These opportunities are very rare. This is why:

Most Level Is in the country are academic. Plan on a starting salary of $150-180K plus benefits for a gross package of $200-220K for academics.

Level Is that ARE NOT academic (or at least are staffed by a private group and thus essentially "community" compensation packages) are few and far between. I know of only a handful in the entire country, as a matter of fact.

I'm not saying your friend is lying. I'm saying he/she has one of the 'gold star' appointments in my opinion. Good on 'em!

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Yeah, I kind of got that impression. Not the sort of guy to lie though and keep in mind that the city we're talking about would make people on the coasts want to shoot themselves.

I think the most important thing to remember is that there is no free lunch in EM. If you're going to make 350k then they are going to work every penny of that out of you. There's a lot to be said about lifestyle and longevity. For what its worth I was looking at a hospital employee job in PA that paid 178k with a full benefit package. Definitely on the lower end.

Seaglass said:

I think the most important thing to remember is that there is no free lunch in EM. If you're going to make 350k then they are going to work every penny of that out of you. There's a lot to be said about lifestyle and longevity. For what its worth I was looking at a hospital employee job in PA that paid 178k with a full benefit package. Definitely on the lower end.

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I prefer to work hard when I'm there and make lots of money. I get bored easily. Working hard will let me make $300-350k/yr on average working only 14 shifts/month (fee for service).

Regarding SolidGold's post about juggling 10-12 patients at a time, keep in mind that this is often easier to do as an attending than as a resident. During residency, residents are often responsible for doing many things that are done by nurses in community hospitals. For instance, we are required to do our own ABG's, insert our own NG tubes, and even discharge our own patients. In the community setting, the nurses will often insert NG tubes (some FFS groups get paid for this and the attending may do it), and they almost always discharge the patients. You won't be making your own phone calls and spending 5 minutes on hold with an answering service trying to page a primary care physician (if you are required to do this as an attending, look elsewhere). You won't be wasting time setting up your own suture trays. The techs will do it for you.

So, juggling 10-12 and even 15 patients at a time is a lot easier than during residency.

chumbojumbo said:

Also, how long do you all plan on working. Are there any residency trained EPs out there who have been working for more than 15 years?

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I work with several residency trained EP's who've been at it for 30 years.

There are VERY good points in this thread. I'll use my job as an example. I'm on the low end of hourly rate for the southeast (SW Florida), but on a similar scale for my region. I joined a democratic group that owns several urgent care centers, a concierge private family practice, and staffs the two biggest hospitals in Naples. I am on the partnership track to owner equity in 2 years. My base hourly rate right now is $105, then increases over the next two years to a base of $126. This excludes my benefit package, which includes nearly $50k per year into a tax-deferred retirement fund, employee profit sharing bonus. I do not work nights. I have been on the same steady, regular schedule for the past four months (since I started) and am very well rested (except for the cold keeping me awake tonight). I see less than 2 patients per hour and have no pressure to crank through numbers. Ironically, I'm one of the top producers in my goup for this quarter and am making a bonus on top of my salary.

What does this mean? I get paid $15k per year less right now than the hospital up the street, but I don't work nights. I have every day off to relax, no lost days due to sleep catchup and waste. To me, this is well worth $15k per year.

In 18 months I will earn a base salary of $218,000 per year, get a bonus of $20k per year, my retirement and profit sharing $50k per year, plus my benefits for a total package of around $350k per year. In addition, I will be eligible for partership and profit sharing, which will give me 1/12th of the total revenue for the group (corporation) profits. This can range from $50k-150k per year per partner, and as the group expands its urgent care business and other opportunities (HD center, Medical offices for rent, etc) the profits will continue to increase, but the number of partners will stay the same.

I work 1840 hours per year for the first two years (but see less than 2 pph - not hard work), and this gets reduced to 1700 per year after 2 years.

For me, the true benefit is that I didn't go directly from residency salary to top-tier salary. I didn't buy a huge million-dollar home, and I'm VERY comfortable with my lifestyle on my $200k base salary right now. I'm also secure knowing this is the "worst case" scenario within this group. My mortgage payment stays the same, but my salary continually (and predictably) goes up.

Long post, but trust me - there is MUCH more than starting in a high-paying job. Look five years down the road and try to find the fit.

Thanks for the info Niner!

I think someone had asked earlier up.....and I know things constantly change and go up and down, but is there a general consensus on the "state" of Emergency Medicine in the next 4-5 years? Do you think EM will be a little isolated (for lack of a better term) from some of the current reimbursement cuts?

Excellent Post Niner. Thanks. When evaluating jobs a lot of people focus on hourly wage, benefits, and pt's per hour as a gauge to how hard they are working. Another important number they often don't tell you to look at is dollars per patient. This figure has really helped me compare apples to apples among different groups.
Currently I'm preparing to interview for some IC jobs on the west coast that are strictly RVU based. I'm coming out of a busy residency program and can move meat, but am worried about the transition to an entirely FFS structure. For those of you who went to a fee-for-service contract out of residency, how did you adjust? Did your employer offer you any education on billing, documentation, etc. to maximize your collections? Or did you just learn from your partners and fly by the seat of your pants? Would it be wise to negotiate a base hourly wage for at least the first year while the learning curve is high? Thanks everyone. Good thread

During my job search i was looking at IC jobs initially making 300-400k per year. After doing the math, i realized that i could earn more as an employee with good benefits than as an IC and paying my own way. Some groups offer ICs an initial hourly rate for the first few months until accounts recievable starts generating revenue. Other groups may offer an advance of your pay to get you started. While in the short term this can be helpful, be leary of this option because this is essentially a loan that can come off of your bottom line for years and, since it is a salary advance, you will pay taxes on it as well. Typically your startup costs as an IC are negotiable, but be sure to do all of the math.

So all of this talk of jobs has got me thinking. Now that we fourth years are wrapping up medical school and heading into residency I am curious about what we need to do during residency to make ourselves competative in the job market. I know that we need to work hard and become as competant as possible but how do future employers judge the job applicants? In med school they tell you to work hard, score high and get good evals. What do they tell you in residency? Also, does the residency you go to open doors for you besides the ones provided by previous grads? It seems the 'best fit' mantra has been repeated endlessly here on SDN which I love but is it really true? Is it worth ranking a 'name' program that you like but don't love over one that is lesser known but feels better?

JBlue said:

So all of this talk of jobs has got me thinking. Now that we fourth years are wrapping up medical school and heading into residency I am curious about what we need to do during residency to make ourselves competative in the job market. I know that we need to work hard and become as competant as possible but how do future employers judge the job applicants? In med school they tell you to work hard, score high and get good evals. What do they tell you in residency? Also, does the residency you go to open doors for you besides the ones provided by previous grads? It seems the 'best fit' mantra has been repeated endlessly here on SDN which I love but is it really true? Is it worth ranking a 'name' program that you like but don't love over one that is lesser known but feels better?

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So far in my experience, most groups are desperate for warm bodies to fill their contract obligations. As long as you're competent, don't have a criminal record, and are in good standing with your residency there's not much you need to do for a community job. The current job I'm considering is paying about 300K (plus benefits) for 140 hrs per month in a major city.

what veers said, along with "keep breathing".

Really, the most important thing you can do is read and learn everyday, show up with a good attitude, work hard, and take ownership of your patients and your actions. Aside from just being the right thing to do, this is relevant because it will impact how you are recommended.

I know at least one potential future employer did not ask for letters of recommendation, etc. and just called around to ask about me instead, in that people are more likely to tell what they really think of you on the phone rather than in writing.

Toohotinvegas33 said:

We need to delete this thread and keep the topic on the downlow for the next couple of years.....

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Oops, look at SDN's newest front page article.

Just got the complimentary copy of the "Career Planning Guide for Emergency Medicine" by Garmel from EMRA today. Looks like it covers everything you need to know about getting your first job from benefits to consider, types of contracts, and things to look for as far what the hospital has to offer.

As far as one of the posts above about covering 10-15 patients at once: It surely is harder to do it as a resident, but I suppose the comparison should be made between an attending in academics vs. the community. Since I am doing my first community EM month right now, I can say without a doubt it's a different beast and taking care of patients is much smoother. Patient care is the same, but dealing with community consultants and hospitalists takes some real getting used to.

And thanks niner for the hard numbers to give us a clear perspective.

Well simply put.. I cant speak to solidgold's opinion but I have dealt with consultants in the community and they tend to be easier than overworked residents. I guess it just depends. Most of them realize that this is where/how they make their money.


In regards to salary there are still places paying only $100/105 per hour to start with that going up rather quickly, there is a big difference in benefits and this needs to be closely looked at. Todd Taylor from ACEP came and they have a sheet to truly compare offers since benefits are often 1/3 or more of your totaly package and tend to be a little harder to balance across the board.

You are right, the community consultants make money off of the patients we call them about, it's just the butt kissing portion that you have to do for a select few specialists that gets tiresome (because they have some kind of bias against EM or something that is chronically up their a$$), at least at this particular hospital. The other community hospital we work at may be different... Overall, it's great dealing with community folks and I'm considering working in the community a bit more than I did before this month.

Im just curious as to what people are looking at for southern California in terms of pay...I am in the beginning of starting to look for jobs out there, and really don't have any idea of what I'm getting into....anyone out there currently looking or working in southern CA area want to lend some advice? THanks!

One possible reason for the big variation in salaries is that reimbursement varies considerably from one state to the next. This can be particularly important for EM, as it has a high Medicaid component.

Medicaid is mostly a state run program and rates vary a lot from state to state. Nevada medicaid pays $36 per unit, while California Medicaid pays $11 per unit. If 40% of your patients are Medicaid, that can add up fast.

Places like Texas have historically had good reimbursement. Areas like Philadelphia have really bad reimbursement. There was just an article in Medical Economics about Philly and how bad the pay there is. There biggest problem is that one HMO has about 85% of the business there and subsequently pays doctors peanuts.

Regarding So-Cal, I would be surprised if the pay was anything but average. Anesthesia jobs there pay about 10% to 20% below average. Other specialties I have checked into are similar. Many doctors want to live there and are willing to do it for less money. That is how California gets away with paying so poorly for Medicaid, they can still get people to take their piddly $11 per unit.

Just out of curiousity...in general I have not heard of EM jobs with loan repayment, anybody get offered anything like this?

Your question is dependant on the state, not the job. Often these are forgiveness programs with requirements (you work in an underserved area, provide primary care type of services). I have two friends (one in ny, on in tx) who are on these programs.


Regarding making oneself competitive: this depends on where you want to go. If you want to go to rural texas, keep breathing and graduate. If you want to go to austin, tx, you might need to do more than that. If you want nyc or san fran, you will need even more.

In general: work hard, be nice, do what you love.

i cant wait to earn a real paycheck.

Good info on here, I just hope it all still applies in 6 years when I'm done with residency. I'm just thinking of the career advice people were getting 20 years ago just before the HMOs came on the scene. Sigh.

Wow these numbers are amazing! I wonder why the EP's I work with always complain that Radiologists and Plastic Surgeons get paid too much

Perhaps because they get paid more? These numbers are also a little high for a partnership track. Many partnership tracks start you at the low end of this range or even a bit below.

Signing my contracts for my first job as an attending - I looked not at the highest paying job, but at the most potential and the one with least attrition and most content attendings.

My yearly income is good and I'm happy with my choice.

pinipig523 said:

Signing my contracts for my first job as an attending - I looked not at the highest paying job, but at the most potential and the one with least attrition and most content attendings.

My yearly income is good and I'm happy with my choice.

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This is what I did. 2 years of crap income. Then bonus checks and other perks and im now doing well and my income will continue to rise for a few more years.

Also, even though it is historically true I am not sure why a rads guy deserves more than I do. This is a med school presumption.

I think considering most of us are non stop for our 8-12 hour shifts with the stress of dealing with anything and anyone who comes in the door.

Any insights about GHEP in Houston ( Greater Houston Emergency Physicians) and how they are better than independent contracts like Emcare and private groups?

ii