Compensation Survey

[The White Coat Investor]

The Daniel Sterns Compensation Survey is out for this year.

Employee Compensation:
10th percentile $199K, 1300 hours, $110/hour
50th percentile $258K 1700 hours, $145/hour
90th percentile $365K, 2184 hours, $195/hour

Partner Compensation
10th percentile $220K, 1300 hours, $120/hour
50th percentile $316K, 1632 hours, $178/hour
90th percentile $469K, 2040 hours, $260/hour

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[EctopicFetus]

here is the link..

http://www.danielstern.com/2011participantcopy/2011_NationalSurvey2.pdf

There is some healthy money being made out there. What struck me were the avg hours worked, seemed really high and much more than people I know work (myself and a few others excluded). Now there is a disproportionate number of young doctors who fill it out I believe 17% of participants were 4 years and under.

 

[deleted109597]

And if you look at the huge number of grandfathered and non-EM boarded docs in it you realize how far we have to go.

Good news is that I'm apparently doing OK as far as hourly salary.

 

[EM_Rebuilder]

And if you look at the huge number of grandfathered and non-EM boarded docs in it you realize how far we have to go.

Good news is that I'm apparently doing OK as far as hourly salary.

God Bless Texas....

What I find distubring is the last survey of the document:

Consider leaving the practice of Emergency Medicine?
49% Yes, 50% No

 

[gutonc]

What I find distubring is the last survey of the document:

Consider leaving the practice of Emergency Medicine?
49% Yes, 50% No

Curious what those numbers are for other specialties.

I have a theory that EM will (soon?) experience a somewhat massive exodus of relatively young docs who bought into the "lifestyle" aspect of the specialty and now realize that the Kool-Aid has kind of a bitter aftertaste.

I went to a med school with a very well regarded EM residency (probably the best residency at that institution) and found that a lot of my classmates who didn't really know what they wanted to do when 4th year rolled around defaulted into EM because it was fun and exciting with relatively limited work hours (raw number-wise) and well paid, especially given the relatively short training time frame. I know at least 3 who have already bailed out of EM (after <5y of practice), one to law school, one opened an Urgent Care with his wife who is an FP and the other went back to do another residency in Derm (had the scores for it initially but got seduced by the siren song of the Trauma Bay). Very small 'n' to be sure but a curious phenomenon nonetheless.

OTOH, perhaps as EM continues to mature as a specialty more people will go into it with eyes wide open and appropriate expectations.

 

[docB]

It might be based on how people perceived that question. I wouldn't want to practice any other kind of medicine than EM but I would be interested in leaving clinical medicine altogether. So would my answer be yes or no?

 

[WilcoWorld]

Agree with docB that it's hard to answer no to a question worded that way - I "consider" a lot of things. In fact, for me it's a point of pride to "consider" all sides of an issue. If you don't, how secure can you really be in your choices?

 

[Jack is Back]

Curious what those numbers are for other specialties.

I have a theory that EM will (soon?) experience a somewhat massive exodus of relatively young docs who bought into the "lifestyle" aspect of the specialty and now realize that the Kool-Aid has kind of a bitter aftertaste.

I went to a med school with a very well regarded EM residency (probably the best residency at that institution) and found that a lot of my classmates who didn't really know what they wanted to do when 4th year rolled around defaulted into EM because it was fun and exciting with relatively limited work hours (raw number-wise) and well paid, especially given the relatively short training time frame. I know at least 3 who have already bailed out of EM (after <5y of practice), one to law school, one opened an Urgent Care with his wife who is an FP and the other went back to do another residency in Derm (had the scores for it initially but got seduced by the siren song of the Trauma Bay). Very small 'n' to be sure but a curious phenomenon nonetheless.

OTOH, perhaps as EM continues to mature as a specialty more people will go into it with eyes wide open and appropriate expectations.

A huge downside to the future of emergency medicine is the focus on turn times and customer satisfaction. I read an article on this, http://journals.lww.com/em-news/Fulltext/2011/02000/Is_This_the_Future_of_Emergency_Medicine_.1.aspx, which basically describes a small partnership group that was unable to renew their contract due to lackluster surveys and slightly slower patient turn times. The quote that really hit home was,

No longer is it enough to practice patient-safe, evidence-based, clinically solid emergency medicine. The measuring stick has evolved into one that has metrics based upon opinion, speed, perception, and time-frame.

This is somewhate of a scary reality and I think this could be one of the major causes of the percentages considering leaving.

 

[Arcan57]

A huge downside to the future of emergency medicine is the focus on turn times and customer satisfaction. I read an article on this, http://journals.lww.com/em-news/Fulltext/2011/02000/Is_This_the_Future_of_Emergency_Medicine_.1.aspx, which basically describes a small partnership group that was unable to renew their contract due to lackluster surveys and slightly slower patient turn times. The quote that really hit home was,



This is somewhate of a scary reality and I think this could be one of the major causes of the percentages considering leaving.

I think it would be a mistake to say that turn around time (TAT) and customer satisfaction (PG for the sake of argument) burdens fall solely on EM. We have issues because we are hospital based, but so does anaethesia. In the clinic world, TAT and PG problems can sink an entire practice. Of course many PCPs have far more invested in their practice than EP's. Look at the FP forum for discussion on how many patients/hr they have to see in order to keep their doors open in the face of declining payments. Moving the meat and keeping people happy are essential skills in almost every branch of medicine, and the strain of doing so is felt by a majority of physicians.

Where small groups get hurt in EM is not having the infrastructure to cozy up to administration and convince the hospital take responsibility for the problems their broken processes create. For example, a major determinant of TAT in most EDs is hold hours. In the ED, if we are practicing appropriate care, there is little we can do about holding for beds upstairs. However, if you don't have someone tracking and constantly making the link in the CEO/COO's mind between length of stay (LOS) and hold hours, all the sudden the hospital becomes convinced that a regime change is going to fix their LOS issues.

 

[Radonkulous]

Somewhat of a side question, but can someone answer why EM hourly salaries tend to be 30-50% higher than hospitalist ones? I figure it has more to do with the patient load than anything else, but hourly salaries of $300 is somewhat obscene.

 

[Apollyon]

Somewhat of a side question, but can someone answer why EM hourly salaries tend to be 30-50% higher than hospitalist ones? I figure it has more to do with the patient load than anything else, but hourly salaries of $300 is somewhat obscene.

"Obscene" is a poor choice of words, and, compared to the relatively less utility of attorneys (as theirs is much "make work" and not required), and their making $500 or $800/hr, it's not bad. And, if you find it "obscene", you have quite the option of not making so much. There are places willing to hire you for $85/hr.

Also, comparatively, we as physicians are not bleeding anyone dry with our bills. It's the hospitals screwing people's credit, not us. My last group and current group both bill, but write off what people don't pay.

As to your point, I agree it's volume. It's also inequity as to reimbursement for inpatients vs emergency patients (although I don't have hard numbers).

 

[Radonkulous]

I think you are assuming too much with my choice of words. My use of that word was just to highlight the inequity of medical reimbursements across specialties. A hospitalist billing $100-150/hr compared to a EP billing upwards of $300/hr seems like a very big difference. Not questioning if the guy deserves $300/hr, just the discrepancy and the reason for it. I agree $300/hr is chump change compared to lawyers who might bill as high as $1000/hr, but I wasn't talking about lawyers.

 

[Apollyon]

I think you are assuming too much with my choice of words. My use of that word was just to highlight the inequity of medical reimbursements across specialties. A hospitalist billing $100-150/hr compared to a EP billing upwards of $300/hr seems like a very big difference. Not questioning if the guy deserves $300/hr, just the discrepancy and the reason for it. I agree $300/hr is chump change compared to lawyers who might bill as high as $1000/hr, but I wasn't talking about lawyers.

It took you a second post to clarify that.

"Speak, that I may know thee." With your choice of words, my "assumption" is a conclusion, as it is through words that we communicate here, and that the word you used does not have an innocuous meaning, and some would take it as being insulting.

Also, I might guess that there is a number of hospitalists billing at $200/hr, and the survey shows the 50th percentile for EM to be $145/hr. As such, that does not seem - at all - outside socially acceptable boundaries.

 

[alreadylernd]

I think you are assuming too much with my choice of words. My use of that word was just to highlight the inequity of medical reimbursements across specialties. A hospitalist billing $100-150/hr compared to a EP billing upwards of $300/hr seems like a very big difference. Not questioning if the guy deserves $300/hr, just the discrepancy and the reason for it. I agree $300/hr is chump change compared to lawyers who might bill as high as $1000/hr, but I wasn't talking about lawyers.

Quick point, but physicians don't bill for time like lawyers do. We may get paid per hour, but billing is a function of RVUs which have little bearing on time. You will get reimbursed the same for an appy, whether it takes 10 minutes or 2 hours. A CXR read is billed at the same rate no matter how long the radiologist spends looking at it. For better or worse, physician billing is based on what is done, not how long it takes...

 

[EM_Rebuilder]

I think you are assuming too much with my choice of words. My use of that word was just to highlight the inequity of medical reimbursements across specialties. A hospitalist billing $100-150/hr compared to a EP billing upwards of $300/hr seems like a very big difference. Not questioning if the guy deserves $300/hr, just the discrepancy and the reason for it. I agree $300/hr is chump change compared to lawyers who might bill as high as $1000/hr, but I wasn't talking about lawyers.

Emergency Medicine physician that ROUTINELY makes 300/hr+ is VERY rare (I think we are talking <top 0.01%). I have made almost double that when a place literally has no doctor to work and the night shift starts in 30 minutes...on Christmas..etc. That becomes supply and demand.

I think someone already said it; look at the survery, just over 200/hr is the more typical HIGH end.. and to make that routinely, its usually at a high volume place where you are easily seeing 2+ patients per hour... its also a less than desirable area of the country.

I am not a hospitalist, and I do not ever wish to dis what anyone does, but the few hospitalists I have met seem to have a much lower stress/less busy job than the typical 200/hr Emergency Medicine doctor...

 

[NEATOMD]

I would venture a guess that the big difference between EM and hospitalist pay is closely tied to the amount of work done per shift. As eluded to by another post above, your group is billing for what you do during your time at work. We hardly get a chance to use the restroom or eat during shifts in my ED. Most of the hospitalists get at least some sleep at night and typically have down time during their days. I suspect that if you had an aggressive hospitalist group that minimalized physician coverage, read their own studies, and performed the majority of their own procedures they would have similar pay to EM (ie: 1 patient per hour) probably can't afford to pay the EM physicians anything more than those hospitalists are being paid.

 

[deleted109597]

My use of that word was just to highlight the inequity of medical reimbursements across specialties. A hospitalist billing $100-150/hr compared to a EP billing upwards of $300/hr seems like a very big difference.

As everyone else has mentioned, they're not doing the same work, so they get paid differently. Remember, almost everyone gets paid by the RVUs they generate (in the end). So to get paid more, you have to work more.

 

[Arcan57]

As everyone else has mentioned, they're not doing the same work, so they get paid differently. Remember, almost everyone gets paid by the RVUs they generate (in the end). So to get paid more, you have to work more.

The hospital I just left had an internist that took q3 unassigned call, probably carried 50+ pts on his census (while being very aggressive about LOS), and would admit 20+ patients while on call. He had 2 docs that answered the phone for him on some call nights, but did all the rounding himself. I believe he was making north of $500k.

 

[EctopicFetus]

The hospital I just left had an internist that took q3 unassigned call, probably carried 50+ pts on his census (while being very aggressive about LOS), and would admit 20+ patients while on call. He had 2 docs that answered the phone for him on some call nights, but did all the rounding himself. I believe he was making north of $500k.

Doesnt sound safe to me.

 

[gro2001]

Doesnt sound safe to me.

Not just medico-legally unsafe, but shotgun-to-head-i've-had-enough-of-this unsafe.

 

[Arcan57]

Not just medico-legally unsafe, but shotgun-to-head-i've-had-enough-of-this unsafe.

He was crabby about admitting surgical patients, but otherwise seemed quite happy. He even won the patient satisfaction award within the last 6 months. Totally agree about the safety aspect brought up by Ectopic.

 

[AmoryBlaine]

The hospital I just left had an internist that took q3 unassigned call, probably carried 50+ pts on his census (while being very aggressive about LOS), and would admit 20+ patients while on call. He had 2 docs that answered the phone for him on some call nights, but did all the rounding himself. I believe he was making north of $500k.

I have a few attendings who have made me realize how much of a game all of this is.

None are the smartest (though they aren't the dumbest either) but they realize that moving pts through the ED really is just a big game. You pop in, make nice, tell a few jokes, order lots of tests because this is what patients want. You don't spend alot of time scratching your head over weird cases, when in doubt test and admit. They also all practice for satisfaction scores, sometimes even asking patients directly "are you satisfied with your care? How can we improve your satisfaction. I'm glad you are satisfied."

It's sort of the far end of a spectrum, and one at which I'm not sure I'll practice but damned if it isn't effective. And none of those guys are burning out that's for sure.

 

[docB]

I have a few attendings who have made me realize how much of a game all of this is.

None are the smartest (though they aren't the dumbest either) but they realize that moving pts through the ED really is just a big game. You pop in, make nice, tell a few jokes, order lots of tests because this is what patients want. You don't spend alot of time scratching your head over weird cases, when in doubt test and admit. They also all practice for satisfaction scores, sometimes even asking patients directly "are you satisfied with your care? How can we improve your satisfaction. I'm glad you are satisfied."

It's sort of the far end of a spectrum, and one at which I'm not sure I'll practice but damned if it isn't effective. And none of those guys are burning out that's for sure.

That is the wave of the future. After a decade or so of the "customer satisfaction" game we will have turned EM in to a used car lot. As students and residents watch the unnatural selection occur where competence is a secondary issue and PG scores are THE metric they will have to decide if they want to play or go thus perpetuating the type.