How was EM 10 years ago compared to now?

[EctopicFetus]

You knew my point. 350K today is still 275K take home (atleast in texas). If you have 400K student loan debt. put 200K/yr into debt, live off 75K. 75K take home is ALOT of money. If not, then put 150K, live off 125K, and pay off th debt in 3 yrs.

After 3 yrs, life off 175K. Put 100K into a rental property, have the renters pay for your mortgage/carrying cost. Do this for 5 yrs, and then you will have 5 properties with all carrying costs paid for by your renters.

After 10-12 yrs, you can put 100K into more or decrease your risks by putting it into your properties. After about 10 yrs, you will have 5 paid off properties.

So after 15 yrs, putting most EM grads at about 45 yrs old will have 5 paid off properties likely netting about 20K each. That is an extra 100K you can continue to invest in properties or slow down and work 1/3 less.

Its not that difficult. There are risks.

My plan as well. I’ve had my luck. I get that things are tough now. As I said some people want it on a silver platter. Real estate is available to all docs.

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[turkeyjerky]

UC Health often contracts with SDGs. Centura facilities in Colorado are staffed by USACS.

You are correct that EPR is the SDG in Fort Collins also staffing several other locations at UC Health facilities. Another facility in Fort Collins is staffed by TeamHealth. A SDG staffs the largest hospital in Colorado Springs, which is a UC Health facility. Likewise, Pueblo’s biggest hospital is loosely affiliated with UC Heath, but independent, and staffed by a SDG. Pueblo is far from a hot mess. Durango is staffed by USACS. Many EPs live in Durango though and commute to Farmington, NM. I believe Grand Junction is staffed by a SDG with Gunnison and Montrose either SDG or hospital employed. Many of the other smaller locations are a smattering of different models.

I’d prefer not to say where I live/work for anonymity, but am in the Rocky Mountain region and very familiar with many jobs in Colorado. Compensation is much better in places than what you have listed. While true in some locations, that isn’t universally the case across Colorado. Just don’t work for USACS.

You know if anyone's hiring?

 

[GeneralVeers]

I half expected to see several late career physicians retire this year instead of continuing to work because of SARS-CoV-2. Interestingly enough, I haven't seen that happen at all. I believe financially these folks don't need to continue working, but have a hard time giving it up even if they are only part time. I've seen a back and forth mentality of thinking of retiring, but then changing their mind and continuing to plug away. Makes me think maybe there is something to this job after all. I do believe like others have said that the freedom of being able to walk away at any point you choose might affect your desire to keep clocking in

Same here. Several docs in their 50s to 60s who probably shouldn't be working due to the risk, and they keep at it.

I guess some people just love EM and can't stop. I'm out as soon as I have enough passive income and savings.

 

[fahimaz7]

UC Health often contracts with SDGs. Centura facilities in Colorado are staffed by USACS.

You are correct that EPR is the SDG in Fort Collins also staffing several other locations at UC Health facilities. Another facility in Fort Collins is staffed by TeamHealth. A SDG staffs the largest hospital in Colorado Springs, which is a UC Health facility. Likewise, Pueblo’s biggest hospital is loosely affiliated with UC Heath, but independent, and staffed by a SDG. Pueblo is far from a hot mess. Durango is staffed by USACS. Many EPs live in Durango though and commute to Farmington, NM. I believe Grand Junction is staffed by a SDG with Gunnison and Montrose either SDG or hospital employed. Many of the other smaller locations are a smattering of different models.

I’d prefer not to say where I live/work for anonymity, but am in the Rocky Mountain region and very familiar with many jobs in Colorado. Compensation is much better in places than what you have listed. While true in some locations, that isn’t universally the case across Colorado. Just don’t work for USACS.

I too work in Colorado and I'm in a true SDG. We have too many to count cold-call applicants looking for a change from the front range and some of the other USASC/TH staffed sites. There has been a big change in income for a lot of EP's in the state, with 30% or more drop in their reimbursement if USACS takes over the contract. A great example of this is the COS group, which lost their president and multiple other long-time members of the "merger" which was forced.

 

[bravotwozero]

How is being a hospital employee better than working for a cmg staffing company? Aside from more requirements for due process IF you're a W-2 employee?

 

[dadaddadaBATMAN]

How is being a hospital employee better than working for a cmg staffing company? Aside from more requirements for due process IF you're a W-2 employee?

Will try not to dox myself, but there’s a couple advantages from my standpoint.

1. My hourly rate beats my coresidents that signed with Cmgs by about 20%, and will increase by another 10% over a few years if I don’t end up in the bottom 10% of the arbitrary metrics

2. Depends on the hospital, but my benefits package is pretty good and is not taken into account with my hourly rate, whereas many of my coresidents are “independent contractors” and have to buy their own.

3. The patients per hour I’m expected to see is about 3/4 of the average of my cmg friends.

4. I am trying to please the same gods as my consultants, and when they piss off my boss they are also pissing off their boss.

5. I might be naive, but the particular hospital I work for seems to have less blood sucking leaches than most at the top. Although a lot of the Normal nonsense applies, I kind of feel like the people in charge are trying to do the right thing most the times. My evidence is in my humane working conditions, pph, pay, benefits, and other stuff.

6. Downside is dealing with more hospital bs, the same gods thing works both ways, and they want you to be on a half dozen party planning committees (sepsis, qa, patient experience or parking lot experience or turkey sammich experience), and probably 10-15% lower pay than sdgs would eventually give me.

 

[bravotwozero]

Yes but those savings are never passed on to EPs. If you were to do an apples to apples comparison of a hospital employee vs CMG job, hospital employee jobs have historically paid a lower wage to EPs.

 

[Apollyon]

Will try not to dox myself, but there’s a couple advantages from my standpoint.

1. My hourly rate beats my coresidents that signed with Cmgs by about 20%, and will increase by another 10% over a few years if I don’t end up in the bottom 10% of the arbitrary metrics

2. Depends on the hospital, but my benefits package is pretty good and is not taken into account with my hourly rate, whereas many of my coresidents are “independent contractors” and have to buy their own.

3. The patients per hour I’m expected to see is about 3/4 of the average of my cmg friends.

4. I am trying to please the same gods as my consultants, and when they piss off my boss they are also pissing off their boss.

5. I might be naive, but the particular hospital I work for seems to have less blood sucking leaches than most at the top. Although a lot of the Normal nonsense applies, I kind of feel like the people in charge are trying to do the right thing most the times. My evidence is in my humane working conditions, pph, pay, benefits, and other stuff.

6. Downside is dealing with more hospital bs, the same gods thing works both ways, and they want you to be on a half dozen party planning committees (sepsis, qa, patient experience or parking lot experience or turkey sammich experience), and probably 10-15% lower pay than sdgs would eventually give me.

There is nothing there to dox yourself.

 

[Porfirio]

W2 sucks, less vacation CME write offs, less home office write offs, and less of a choice in retirement stock options.

 

[EctopicFetus]

How is being a hospital employee better than working for a cmg staffing company? Aside from more requirements for due process IF you're a W-2 employee?

Usually better pay and better perks. Also usually a lot more due process and employee protections.

 

[EctopicFetus]

W2 sucks, less vacation CME write offs, less home office write offs, and less of a choice in retirement stock options.

One of my residents took a job as a hospital employee. Rate was the same as the local CMG but she got paid vacation, retirement matching etc. I do agree in general CMGs pay better but your risk is higher. Pay cuts are more likely etc. ANything short of being your own boss means there is a lot of BS. CMGs have a lot of BS too but it comes with more money at least.

 

[GeneralVeers]

I've worked both, and my hospital-employed job paid less than or equal to a CMG job. Those theoretical savings get passed on to the C-suite bonuses, not the docs.

 

[emergentmd]

All Docs from this thread should not get clouded by the CMG vs SDG vs hospital vs FSER debate. Unless you get into a unicorn position, the pay will likely be the same for the region. I will be the 1st to admit that it is a unicorn job that I have where I will easily out earn most NSG this year.

What you/I should get out from this thread, esp young docs is

1. You make alot of $$$, have disposable income. Use this gift and work to retire early. Your choice is to use the $$$ in a passive income producing manner so in 15-20 yrs, you can have a choice to pick what kind of work you want to do or even get out of the EM. I am at my 20 yr mark next year and I wish someone told me this when I started. I was late to the game, made many mistakes, but have learned from them. I am finally at the point where I believe in 3-5 yrs, I can stop working completely.

2. Weather/location is nice but NEVER, NEVER work for less than 175/hr unless you are sleeping all the time. I can not fathom why anyone would work in Denver for U-SUCKs for 150/hr. You are essentially giving up 125K/yr to live somewhere. There are alot of very nice places in the US making $200+/hr. Do you want to stay in Denver working past 65 yrs old or do you want to live somewhere else, save 100K/yr and build a passive income flow where you can move to Denver at 55 and do whatever you want? Unless you want to work in the hospital until you are 65, think hard about accepting 150/hr.

 

[EctopicFetus]

All Docs from this thread should not get clouded by the CMG vs SDG vs hospital vs FSER debate. Unless you get into a unicorn position, the pay will likely be the same for the region. I will be the 1st to admit that it is a unicorn job that I have where I will easily out earn most NSG this year.

What you/I should get out from this thread, esp young docs is

1. You make alot of $$$, have disposable income. Use this gift and work to retire early. Your choice is to use the $$$ in a passive income producing manner so in 15-20 yrs, you can have a choice to pick what kind of work you want to do or even get out of the EM. I am at my 20 yr mark next year and I wish someone told me this when I started. I was late to the game, made many mistakes, but have learned from them. I am finally at the point where I believe in 3-5 yrs, I can stop working completely.

2. Weather/location is nice but NEVER, NEVER work for less than 175/hr unless you are sleeping all the time. I can not fathom why anyone would work in Denver for U-SUCKs for 150/hr. You are essentially giving up 125K/yr to live somewhere. There are alot of very nice places in the US making $200+/hr. Do you want to stay in Denver working past 65 yrs old or do you want to live somewhere else, save 100K/yr and build a passive income flow where you can move to Denver at 55 and do whatever you want? Unless you want to work in the hospital until you are 65, think hard about accepting 150/hr.

The thing is SDG money is completely decoupled from CMG or employed positions. It could be more or it could be less but the "market rate" doesn't control SDG pay. Do you really have a unicorn job? Or is it that you have an investment that you do well on? Those arent the same at all. If your hourly pay at the FSED is $200/hr then its not a unicorn job. Now if your profit sharing gets you to $4-500/hr and you don't need to work clinically to make the money then yes.

 

[Arcan57]

EM is regional and mostly follow supply and demand. 10 yrs ago, there were markets that were saturated and paid nonsensical amounts yet stayed fully staffed. Graduates from programs in those markets eventually couldn't find reasonable jobs and so went further afield where there were fewer ED docs and where populations (and ED visits) were expanding rapidly. My former city would be a classic example. From 2011-2017 you could basically walk out of residency into your choice of jobs paying ~$300/hr with a reasonable(ish) practice environment. Every doc with more than 7 years experience had left for the FSED and the city was experiencing year after year of double digit growth in visits. The FSED bubble started collapsing, releasing those docs back into the workforce, and hundreds of EM docs came to the city as the growth started to stagnate. In 2020, new grads that stay in state are as likely to end up in the Valley as they are to find a good job in the city. Pay is shrinking as a stable workforce doesn't require hypercompetitive pay to stay staffed and a saturated market means they don't have to pay a premium to recruit geographically distant docs.

But honestly, minus the FSED part, this has been playing out in different areas of the country at different times over the 4+ decades of emergency medicine's existence. Denver was a completely closed market when I graduated, the pay in the larger cities in the Midwest and NE has been proportionally terrible for decades, and the South's paucity of ED programs to population is leveling out (rather violently in some places). There are going to be microeconomies where you can find really good jobs, but the walking out of residency into your dream job in your dream city at your dream salary is going to be less and less common. If you went into EM based on stories of docs that came out into microbubbles, you're probably going to be disappointed with your prospects in 2020. So adjust your dreams, or accept more risk in pursuit of them. Lots of docs in SE TX invested in FSEDs, the # that ended up like emergent is significantly smaller.

 

[bravotwozero]

I will add this about the FSEDs going belly up. In Houston, it was primarily two chains. One was First Choice, the other neighbors. Both of them went bust because of mismanagement/greed and trying too expand to fast. One of those chains actually tried to creat a full on hospital, which was a recipe for disaster. As for the smaller, independently owned ones, many of them managed to survive.

 

[emergentmd]

FSERs when managed correctly with physician buy in is a more stable model. You can cut costs down to the bones if needed and survive until it gets better. I rather work in a FSER making 150-175/hr with ownership than working at the TH/EMCARE/USACS that dominated the area for $225/hr. A 24 hr shift making $3600/shift seeing 10-15 pts typically getting 4-8 hrs sleep >>>> working a 10 hr shift making $2250 getting killed. The upside of FSER ownership is much greater along with the downside than working for CMGs which currently is pointing down.

6, 24 hr shifts = 260K vs 10, 10 hr shifts = 260K. That is your choice.

Most of the FSERs closed b/c the corporate types (First, Neighbors, or Hospital associated - see Five Star) b/c they had too much fat, poor doctor buy in, poor experience that could not weather decreased reimbursement. The more local groups are able to better survive and some are doing well. These closed shops are being bought out by local groups who knows how to do it better.