pay difference

[friction]

I was wondering why the pay for primary care is less compared with ER and neurology? Off course both ER and Neuro has some procedures, but most of those procedures are not frequently performed. Especially in the ER, the daily routine is primary care like FM. Even Neuro, mostly they do consultation and neurohospitalists jobs are similar to IM hospitalist job.

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[deleted6669]

I was wondering why the pay for primary care is less compared with ER and neurology? Off course both ER and Neuro has some procedures, but most of those procedures are not frequently performed. Especially in the ER, the daily routine is primary care like FM. Even Neuro, mostly they do consultation and neurohospitalists jobs are similar to IM hospitalist job.

Part of the reason for em at least is the hours. we provide care 24/7/365. that means nights/weekends/holidays which at many places pay a premium. also even the minor procedures in em pay very well. a 2 layer closure of a laceration pays more than 30 min of critical care time. I+D of an abscess pays almost 700 dollars. any abscess. even a paronychia. remove a fb from an eye or any other place you care to mention and that pays very well. also reducing fractures and dislocations. stuff like this we do every day.
FM docs who do a variety of in-office procedures like minor derm, treadmills, sigs, etc can do very well.

 

[Kal EI]

I was wondering why the pay for primary care is less compared with ER and neurology? Off course both ER and Neuro has some procedures, but most of those procedures are not frequently performed. Especially in the ER, the daily routine is primary care like FM. Even Neuro, mostly they do consultation and neurohospitalists jobs are similar to IM hospitalist job.

Emergency physician move a lot of patients and they work overnight often. These pay more because churning patients pays more and working when no one else wants to always pays more. Have you worked overnight yet? Where are you in training (highschool? premed?).

 

[MOHS_01]

Part of the reason for em at least is the hours. we provide care 24/7/365. that means nights/weekends/holidays which at many places pay a premium. also even the minor procedures in em pay very well. a 2 layer closure of a laceration pays more than 30 min of critical care time. I+D of an abscess pays almost 700 dollars. any abscess. even a paronychia. remove a fb from an eye or any other place you care to mention and that pays very well. also reducing fractures and dislocations. stuff like this we do every day.
FM docs who do a variety of in-office procedures like minor derm, treadmills, sigs, etc can do very well.

Whoa -- WTF?

 

[deleted6669]

Whoa -- WTF?

YUP, check the er codes for I+D abscess, simple. $675 last time I checked.
also Intermediate/layered suture repair <2.5 cm. big bucks.
doing anything in the er just costs more. walking in the door and going through triage with an 02 sat checked costs a few hundred bucks before a provider even sees you for the facility fee.
procedures pay. look at derm for example. what can you guys bill for obtaining a simple shave biopsy with preparation and interpretation?

 

[MOHS_01]

YUP, check the er codes for I+D abscess, simple. $675 last time I checked.
also Intermediate/layered suture repair <2.5 cm. big bucks.
doing anything in the er just costs more. walking in the door and going through triage with an 02 sat checked costs a few hundred bucks before a provider even sees you for the facility fee.
procedures pay. look at derm for example. what can you guys bill for obtaining a simple shave biopsy with preparation and interpretation?

Where are you getting your numbers at? Facility or non facility? I think you may be confusing charges with actual payments... or someone is getting ducked with a F in the ED. :shrug;

 

[MOHS_01]

YUP, check the er codes for I+D abscess, simple. $675 last time I checked.
also Intermediate/layered suture repair <2.5 cm. big bucks.
doing anything in the er just costs more. walking in the door and going through triage with an 02 sat checked costs a few hundred bucks before a provider even sees you for the facility fee.
procedures pay. look at derm for example. what can you guys bill for obtaining a simple shave biopsy with preparation and interpretation?

Wow - never mind, still getting used to this mobile app. Man, those ED payments are just WOW!

 

[MOHS_01]

YUP, check the er codes for I+D abscess, simple. $675 last time I checked.
also Intermediate/layered suture repair <2.5 cm. big bucks.
doing anything in the er just costs more. walking in the door and going through triage with an 02 sat checked costs a few hundred bucks before a provider even sees you for the facility fee.
procedures pay. look at derm for example. what can you guys bill for obtaining a simple shave biopsy with preparation and interpretation?

A biopsy would be $70, give or take, irrespective of the type of biopsy performed. New guidelines will place significant limits on the realistic ability to do shave biopsies (and be reimbursed -- now the pathologist will have to code for the anatomic level much in the way they have to identify whether subcutaneous fat is identified in excisions). Global pathology used to be on the order of $100, but I believe that has been whacked pretty hard and I'm not sure that number is good any more. In any event, the vast majority of derms do not bill for all three so maybe it's not quite as good as you have been led to believe. The derms make their money on volume -- not reimbursement per unit provided.

**** - these ED guys get >5x what we do in the office to I&D. As far as that goes, they're getting paid to lance a boil more than I get paid for a micrographic procedure or a skin flap...

Maybe I should just change my practice location to the ED and work out of a back room somewhere.... SMH

 

[primadonna22274]

Would appreciate hearing from real folks in the SE what typical FM pays these days. I'm applying to mostly IM but there are a couple solid full-spectrum FM programs in my state that I'm including (one of them 10 min from my house in SC--very tempting). My EM friends tell me I can only expect $120k in FM and I really don't believe that but truthfully I couldn't afford that after making $105-110k as a PA and incurring another $150k in debt for med school. My break-even (eventually) threshold is $180s.
Thanks

 

[MOHS_01]

Would appreciate hearing from real folks in the SE what typical FM pays these days. I'm applying to mostly IM but there are a couple solid full-spectrum FM programs in my state that I'm including (one of them 10 min from my house in SC--very tempting). My EM friends tell me I can only expect $120k in FM and I really don't believe that but truthfully I couldn't afford that after making $105-110k as a PA and incurring another $150k in debt for med school. My break-even (eventually) threshold is $180s.
Thanks

how much do you want to work

 

[primadonna22274]

I'm a workaholic truth be told. No kids. I plan to be a hospitalist and enjoy inpatient medicine. Healthy patients, the worried well, kinda bore me. Funny since I started my PA career in outpatient FM and enjoyed clinic for several years but now it just drags. I do enjoy RURAL medicine where you do EVERYTHING and would consider locums like Cabin Builder does. I enjoy complex medical patients and geriatrics especially. I know my application screams IM but with a husband, nice house and 2 dogs I am considering the practical side of not moving again for residency if possible.
Help please

 

[deleted87716]

Demand for Family Physicians Fuels Salary, Compensation Increases, Study Finds

http://www.aafp.org/news-now/practice-professional-issues/20130709mgmacompensation.html?sf14814495=1

Median first-year guaranteed compensation for family physicians who do not practice obstetrics jumped by $7,000 between 2011 and 2012, from $163,000 to $170,000. This increase was driven in large part by a greater demand for family physicians, according to a recent survey(www.mgma.com) released by MGMA (formerly, the Medical Group Management Association).

 

[teacherman84]

A FM resident I'm working with is getting hositalist offers around the southeast starting out in the 220k range for suburban areas (research triangle area in NC)..higher in more rural locations.

 

[primadonna22274]

A FM resident I'm working with is getting hositalist offers around the southeast starting out in the 220k range for suburban areas (research triangle area in NC)..higher in more rural locations.

Very reassuring, thanks!!

 

[Smokemont]

Would appreciate hearing from real folks in the SE what typical FM pays these days. I'm applying to mostly IM but there are a couple solid full-spectrum FM programs in my state that I'm including (one of them 10 min from my house in SC--very tempting). My EM friends tell me I can only expect $120k in FM and I really don't believe that but truthfully I couldn't afford that after making $105-110k as a PA and incurring another $150k in debt for med school. My break-even (eventually) threshold is $180s.
Thanks

I think you need to stop listening to your EM friends. Our FM advisors tell us they are seeing ~190 (obviously depends on many factors) here in the Midwest. Can't be THAT different in the SE.

 

[smq123]

Would appreciate hearing from real folks in the SE what typical FM pays these days. I'm applying to mostly IM but there are a couple solid full-spectrum FM programs in my state that I'm including (one of them 10 min from my house in SC--very tempting). My EM friends tell me I can only expect $120k in FM and I really don't believe that but truthfully I couldn't afford that after making $105-110k as a PA and incurring another $150k in debt for med school. My break-even (eventually) threshold is $180s.
Thanks

I work at an urban community health center (= very poor patient population, mostly self-pay or Medicaid) in Florida, and I make more than that. And that's doing only outpatient, no hospital, no admissions.

 

[primadonna22274]

I think you need to stop listening to your EM friends. Our FM advisors tell us they are seeing ~190 (obviously depends on many factors) here in the Midwest. Can't be THAT different in the SE.

That's kinda what I thought too thanks
I think some of my EM friends have been in EM so long they only know EM.

 

[deleted6669]

most of the fp folks I know in the PNW are making $180-220k/yr without call or hospital work. FP hospitalists make more.

 

[deleted87716]

The average outpatient primary care physician income in our group is well in excess of $200K (typically for a four-day workweek - the five-day/wk. folks are taking home $300K+). The hospitalists are taking home $400K+. Mid-Atlantic area, suburban.

 

[primadonna22274]

Y'all are helping ease my misplaced anxiety quite a bit...thank you! Certainly money isn't everything but I want to feel like this wasn't a huge financial mistake

 

[Kal EI]

The average outpatient primary care physician income in our group is well in excess of $200K (typically for a four-day workweek - the five-day/wk. folks are taking home $300K+). The hospitalists are taking home $400K+. Mid-Atlantic area, suburban.

Any websites or sources on stuff like this? FM hospitalists earning 300-400k?

 

[ferning]

YUP, check the er codes for I+D abscess, simple. $675 last time I checked.
also Intermediate/layered suture repair <2.5 cm. big bucks.
doing anything in the er just costs more. walking in the door and going through triage with an 02 sat checked costs a few hundred bucks before a provider even sees you for the facility fee.
procedures pay. look at derm for example. what can you guys bill for obtaining a simple shave biopsy with preparation and interpretation?

And that is why EM is totally unsustainable for our society in its current form that provides primary care. I realized when I looked back doing workflow and throughput issues that the CEOs do not want to provide a primary care office on site because why get paid $50 for an ingrown toenail with a podiatrist when you can charge $500. The corporate structure looks at EM labor and says "hey why am I paying this guy to sit there and wait for a real emergency when he can be working his ass off doing primary care for 10x the profit margin" doesnt matter that its a totally inappropriate way to take care of someones primary care needs as they never have the same provider each time they come in and chronic conditions are just managed enough to get them out the door for the next acute exacerbation. 350k is great and you could be paid the same for doing what you were actually trained for if you didnt allow your labor to be so manipulated to bankrupt the society of people you serve.

Cut out the 50% BS you see at many EDs and you will still need the same physician coverage at most places. Its the ancillary techs and nurses that wouldnt be needed as you still need a physician on site for real emergencies.

For all the money that it costs the local population, payors, as well as the hospital to provide this care, a primary office could be on site and even open 24hrs for PCP duties. They dont do it cause the profit margin isnt there plain and simple. I worked at one of the largest and most misused EDs in the US and I still remember the ED attending who has been practicing for 40 years bring up a more adequate PCP facility, the CEO just looked down and basically ignored the comment while changing the subject. Took me awhile to get how things work years later in med shool.

Fast track, mid track, whatever still doesnt address the consistency of care that is more effective for chronic conditions as well as preventative health. You know a patients background and baseline function and you can gleam their clinical situation more accurately as well as manage better which should be intuitive.

It will change no matter what cause our country is broke from idiotic situations such as this, for EM physicians it whether you will steer the direction for societal improvement or corporate. And more money is assured in the former believe it or not as you are still labor and cost to me minimized by CEOs

 

[sazerac]

Would appreciate hearing from real folks in the SE what typical FM pays these days. I'm applying to mostly IM but there are a couple solid full-spectrum FM programs in my state that I'm including (one of them 10 min from my house in SC--very tempting). My EM friends tell me I can only expect $120k in FM and I really don't believe that but truthfully I couldn't afford that after making $105-110k as a PA and incurring another $150k in debt for med school. My break-even (eventually) threshold is $180s.
Thanks

Lol I know a FM PGY2 in northern Louisiana who made over $225K last year, moonlighting a lot. I don't think he sleeps much. His goal is to break $300K in his final year of residency.

It is my distinct impression that the inland areas of the gulf coast states are where you can really make FM bank, if of course you are willing to put in the hours.

 

[Postictal Raiden]

Lol I know a FM PGY2 in northern Louisiana who made over $225K last year, moonlighting a lot. I don't think he sleeps much. His goal is to break $300K in his final year of residency.

It is my distinct impression that the inland areas of the gulf coast states is where you can really make FM bank, if of course you are willing to put in the hours.

Your friend is my hero!

 

[Kal EI]

NA, plenty of money in FM, it all comes down to quality of the contract and how much you want to work. I could easily pass 300K a year but I don't want to work year round.

Please explain your schedule. Like hours per week and weeks per year.

How many 300k plus jobs are there? What is the position?

 

[Kal EI]

most of the fp folks I know in the PNW are making $180-220k/yr without call or hospital work. FP hospitalists make more.

I looked this up. There are very few FM hospital jobs. Like less than 10% of hospitalizes.

 

[deleted6669]

I looked this up. There are very few FM hospital jobs. Like less than 10% of hospitalizes.

Depends...my local urban hospital group is run by an IM group but has hired several FP hospitalists who did rotations there as residents. on paper it is an IM shop but the reality is very different.
both of my rural jobs have FP hospitalists only.

 

[deleted87716]

I looked this up. There are very few FM hospital jobs. Like less than 10% of hospitalizes.

I'm not exactly sure what you're trying to say. Less than 10% of hospitalists are FM? Less than 10% of advertised hospitalist jobs are open to FM? What's your source?

 

[Kal EI]

Apparently you don't know my story. I don't have a permanent job. I work locums and set my own schedule. When I am on a job site I do clinic/urgent care/hospital/ER, and take as much call as possible. I get paid by the hour plus call pay plus call back pay plus holiday pay when I can get it. I work as many hours in the day as I can to maximize my time away from home.

For instance, I am at a job site now and I work (6) 12 hr shifts a week, with charting that ususally turns into 13 hrs. I generally work 6-8 weeks straight and go home for 1-2 weeks then go to the next site.

So I don't have job that has a set salary of 300K, they exist but are hard to find.

Sounds good.

 

[MedicineDoc]

I looked this up. There are very few FM hospital jobs. Like less than 10% of hospitalizes.

False. Im a more than full time FM locums who works exclusively hospitalist with never having done any outpatient outside residency. I think i am more than a little bit more knowlegeable than you on this subject. I did 29 twelve hour shifts in july and 22 in august with paid by the hour. Needless to say I am making bank as a FM locums hospitalist right now. There are plenty of FM hospitalist and hospitslist jobs especially FM with experience and the stats as to the number of FM hospitalist are almost certainly an underestimation as FM hospitalist are often incorrectly categorized as IM. Also the american board FM together with the American board of IM are offering focused practice in hospitalist medicine which most think may be the first step toward creating a new specialty with entry points through either FM or IM.

 

[Postictal Raiden]

I'm a more than full time FM locums exclusively hospitalist with never having done any outpatient outside residency. I did 29 twelve hour shifts in july and 22 in september with paid by the hour. Needless to say I am making bank as a FM locums hospitalist right now. There are plenty of FM hospitalist and the stats are probobably not correct as they are sometimes categorized incorrectly as IM. Also the american board FM together with the American board of IM are offering focused practice in hospitalist medicine which most think may be the first step toward creating a new specialty with entry points through either FM or IM.

Nice!

If you don't mind sharing, how much is the hourly pay for an FM locum hospitalist?

 

[MedicineDoc]

Nice!

If you don't mind sharing, how much is the hourly pay for an FM locum hospitalist?

Same as IM hospitalist. Same work same pay.

 

[Postictal Raiden]

Same as IM hospitalist. Same work same pay.

Thank you.

When I work locums hospitalist it varies from $80-$100/hr. But don't extrapolate from what I make to the others. It all depends on the contract, the location, the expectation, the call/no call etc., the locums company and their site agreement. But you get the idea.

This is completely different from a permanent hospitalist position that may be salary or may be volume based. Someone who is a permanent hospitalist will have to chime in.

Thanks Cabinbuilder.

Assuming 80/hr (your lowest range), 12hr/shift, 22 shift a month, and 10 months a year (to have 2 months off per year), one could make $211K/year. Wow that's great! The next 7 years of my life will be loooooooooong!

 

[MedicineDoc]

When I work locums hospitalist it varies from $80-$100/hr. But don't extrapolate from what I make to the others. It all depends on the contract, the location, the expectation, the call/no call etc., the locums company and their site agreement. But you get the idea.

This is completely different from a permanent hospitalist position that may be salary or may be volume based. Someone who is a permanent hospitalist will have to chime in.

Cabin builder if you don't know you really shouldnt just throw some numbers out there. I made more than that as a permanent hospitalist without being a 1099 independent contractor where you lose some of the benefits of an employed position including paying more on social security taxes. I would never sign a contract for the numbers you describe and have never seen a hospitalist locums contract that bad. They can look for themselves what the offers are for locums hospitalist. Anyway, The better strategy for someone fresh out of residency planning on becoming a hospitalist is probably to work a permanent hospitalist position for a yr or two and then transition to locums if thats what looks good.

 

[Postictal Raiden]

Cabin builder if you don't know you really shouldnt just throw some numbers out there. I made more than that as a permanent hospitalist without being a 1099 independent contractor where you lose some of the benefits of an employed position including paying more on social security taxes. I would never sign a contract for the numbers you describe and have never seen a hospitalist locums contract that bad. They can look for themselves what the offers are for locums hospitalist. Anyway, The better strategy for someone fresh out of residency planning on becoming a hospitalist is probably to work a permanent hospitalist position for a yr or two and then transition to locums if thats what looks good.

Why so?

I was thinking, for someone fresh out of residency with mountains of debt, locum positions may come in hand due to their higher-than-average pay. Then once the debt is gone, one could choose to work a permenant, stable job.

 

[MedicineDoc]

You can negotiate student loan assistance for a one or two yr contract. Your first job is to be good at what you do with a good track record.

 

[primadonna22274]

I make $60/hr as an EM PA and I definitely would not work as a physician with an independent license and ultimate responsibility for less than $130/hr which seems to be on the low end for my EM physician colleagues. I think hospitalist ranges are similar. $80/hr is unjustifiable for me considering another $150k in debt for med school.
It's funny, I graduate in June and still have residency to go and have been getting cold calls and emails from hospitalist recruiters for 6 mos.

 

[Kal EI]

I looked this up. There are very few FM hospital jobs. Like less than 10% of hospitalists.

False. Im a more than full time FM locums who works exclusively hospitalist with never having done any outpatient outside residency. I think i am more than a little bit more knowlegeable than you on this subject. I did 29 twelve hour shifts in july and 22 in august with paid by the hour. Needless to say I am making bank as a FM locums hospitalist right now. There are plenty of FM hospitalist and hospitslist jobs especially FM with experience and the stats as to the number of FM hospitalist are almost certainly an underestimation as FM hospitalist are often incorrectly categorized as IM. Also the american board FM together with the American board of IM are offering focused practice in hospitalist medicine which most think may be the first step toward creating a new specialty with entry points through either FM or IM.

According to the State of Hospital Medicine Survey by the Medical Group Management Association and the Society of Hospital Medicine, 89.60% of hospitalists specialize in general internal medicine, 5.5% in a pediatrics subspecialty, 3.7% in family practice and 1.2% in internal medicine pediatrics.

 

[MOHS_01]

I make $60/hr as an EM PA and I definitely would not work as a physician with an independent license and ultimate responsibility for less than $130/hr which seems to be on the low end for my EM physician colleagues. I think hospitalist ranges are similar. $80/hr is unjustifiable for me considering another $150k in debt for med school.
It's funny, I graduate in June and still have residency to go and have been getting cold calls and emails from hospitalist recruiters for 6 mos.

OB hospitalists (laborists) earn 90-120/hr, 1099 or employed. Yes, I believe that sucks. They line up around the block for the opportunity to shed office based practice, though, so who am I to argue.

 

[primadonna22274]

OB hospitalists (laborists) earn 90-120/hr, 1099 or employed. Yes, I believe that sucks. They line up around the block for the opportunity to shed office based practice, though, so who am I to argue.

Well I detest OB so no problem there LOL

 

[Kal EI]

OB hospitalists (laborists) earn 90-120/hr, 1099 or employed. Yes, I believe that sucks. They line up around the block for the opportunity to shed office based practice, though, so who am I to argue.

That is terrible, but it's probably so much feast or famine that it is justified.

 

[cabinbuilder]

I make $60/hr as an EM PA and I definitely would not work as a physician with an independent license and ultimate responsibility for less than $130/hr which seems to be on the low end for my EM physician colleagues. I think hospitalist ranges are similar. $80/hr is unjustifiable for me considering another $150k in debt for med school.
It's funny, I graduate in June and still have residency to go and have been getting cold calls and emails from hospitalist recruiters for 6 mos.

Locums jobs are by the hour, if you wait to get your $130/hr you will be sitting on the couch not working. This is completely different from a permanent position that includes insurance, etc. I stick with locums for the freedom of taking as much time off as I want when I want and I don't answer to anyone. I just don't like being controlled by some corporate entity. Just hasn't worked for me.

 

[MedicineDoc]

Not sure where the difference is coming from but i have had no trouble getting work for much higher numbers.

 

[primadonna22274]

My guess is the difference is regional. I am not even a physician yet and I see ads for hospitalists in the Carolinas advertising $150+/hr.

 

[cabinbuilder]

My guess is the difference is regional. I am not even a physician yet and I see ads for hospitalists in the Carolinas advertising $150+/hr.

Well, I don't work as a permanent hospitalist and I don't work just a 40 hour week. I generally work 60-70hrs a week and for a locums assignment they aren't going to pay more.

 

[MedicineDoc]

Well, I don't work as a permanent hospitalist and I don't work just a 40 hour week. I generally work 60-70hrs a week and for a locums assignment they aren't going to pay more.

Like I said. I worked 29 twelve hour shifts in July and get all the work I want and more.

 

[cabinbuilder]

Like I said. I worked 29 twelve hour shifts in July and get all the work I want and more.

Where there is a lot to be said for you guys who work in bigger hospitals who do critical care ICU with central lines, etc. That's not what I do or what I ever wanted to do. We all have our place in medicine and of course the pay scales will be different.