Washington salary

[AppleJuice]

does anyone know what the average hourly rate in the Seattle/Tacoma area is ?

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[The Buff]

Hard to say exactly as most (all?) of the community jobs around here are 100% RVU based, some are IC. That said, Id say you can comfortably get $175/hr, some places more.

 

[The White Coat Investor]

I'm not in Washington, but this stuff isn't rocket science.

Depends on the job. I wouldn't pay someone $175 an hour to come moonlight with my group because I can easily find someone to do it for less. I certainly don't pay my employees that much. But I also generally make significantly more than that. So it really depends on what kind of job you're talking about. If you want to do locums on Christmas day, you can probably beat that, and maybe get twice that. If you are a partner in a small group, you'll probably beat that. But if you're talking about an employee of a hospital, a CMG employee or a pre-partner position, you're probably not going to get $175 at any job you actually want long-term unless there is some reason people don't want to live or work there. Last I checked, Washington is a pretty nice place to live. Also, keep in mind that the more you get in benefits, the less you can take in salary. So if you're getting $175 an hour plus $50K a year in a retirement plan and free health insurance, well, that may be pretty good.

If you get to eat exactly what you kill, and the payor mix is good, and the volume is adequate, and you're a quick, efficient doc, then $175 seems pretty lame to me. Last I looked I was billing $7-800 a patient and collecting a quarter of that. So $175 an hour is about a patient an hour. That's a pretty slow pace.

Always remember that an employee is never paid what he is worth, otherwise there is no profit for the business owner. If you want to be paid 100% of what you're worth, you must own the business and accept the responsibility that entails. It also helps to know where the money is coming from. These salaries don't come out of thin air. Eventually, it all comes back to what is being billed and what is being collected. Emergency Medicine is a business, like anything else. If you want to make some dough, you've got to know the business. Being "100% clinical" is a good way to be taken advantage of.

 

[Birdstrike]

Always remember that an employee is never paid what he is worth, otherwise there is no profit for the business owner. If you want to be paid 100% of what you're worth, you must own the business and accept the responsibility that entails. It also helps to know where the money is coming from. These salaries don't come out of thin air. Eventually, it all comes back to what is being billed and what is being collected. Emergency Medicine is a business, like anything else. If you want to make some dough, you've got to know the business. Being "100% clinical" is a good way to be taken advantage of.

Yes, yes, and yes. I've been preaching this on here for years now. The entire trend of physicians across all specialities to submit themselves to being employees is a big mistake. Is it a wonder so many doctors feel like mere abused, and replaceable hourly help?

It's because many now are (albeit highly paid) abused, replaceable hourly help. Personally, I plan on staying as independent from hospital or mega-corp employee status as long as possible. All Medicine is a business, fortunately or unfortunately. Learn as much about it as you can, even if you're are employee status and no matter what specialty, or you're ----ed. Otherwise you'll be wandering around confused and disillusioned, "Why did/didn't administration do this? Why did Medicare do that? Why won't they staff this or staff that?" like a sheep to the slaughter. The answer to, "What's it all about?" is the same. Every. Single. Time.

Although your and my intentions my be centered around patient care and best medical practice, it's not about "EBM" for many of those running hospitals, insurance companies, government or your bosses. I can't say that they don't care at all about these things, but the prime motivators for them are not about "patient wellness," or "patient centeredness." It's not about "helping people," efficiency" or cost "savings." It's not about "science." To many if not most of them, the prime motivators are the same thing three things every time.


Money,

money, &

money.


As much as possible for them.

All these bulls--t buzzwords such as "ACOs," "cost savings," "patient satisfaction," and the like all share the same translation to many hospital administrators, insurance companies, politicians or your bosses. Translation = more money in their pockets. I'm not saying it's ever likely to change or that it even should change, but that's definitively the prime motivator for just about everything done behind the scenes in healthcare, as dictated by non-physicians primarily.

 

[RustedFox]

Yes, yes, and yes. I've been preaching this on here for years now. The entire trend of physicians across all specialities to submit themselves to being employees is a big mistake. Is it a wonder so many doctors feel like mere abused, and replaceable hourly help?

It's because many now are (albeit highly paid) abused, replaceable hourly help. Personally, I plan on staying as independent from hospital or mega-corp employee status as long as possible. All Medicine is a business, fortunately or unfortunately. Learn as much about it as you can, even if you're are employee status and no matter what specialty, or you're ----ed. Otherwise you'll be wandering around confused and disillusioned, "Why did/didn't administration do this? Why did Medicare do that? Why won't they staff this or staff that?" like a sheep to the slaughter. The answer to, "What's it all about?" is the same. Every. Single. Time.

Although your and my intentions my be centered around patient care and best medical practice, it's not about "EBM" for many of those running hospitals, insurance companies, government or your bosses. I can't say that they don't care at all about these things, but the prime motivators for them are not about "patient wellness," or "patient centeredness." It's not about "helping people," efficiency" or cost "savings." It's not about "science." To many if not most of them, the prime motivators are the same thing three things every time.


Money,

money, &

money.


As much as possible for them.

All these bulls--t buzzwords such as "ACOs," "cost savings," "patient satisfaction," and the like all share the same translation to many hospital administrators, insurance companies, politicians or your bosses. Translation = more money in their pockets. I'm not saying it's ever likely to change or that it even should change, but that's definitively the prime motivator for just about everything done behind the scenes in healthcare, as dictated by non-physicians primarily.

Yep. This. Again and again.

 

[fuegofrio17]

I can pay a base of $200/h (10 patients per 24h) with bonuses based upon volume in freestanding ERs in various locations in Texas.

 

[GeneralVeers]

Both White Coat and Birdstrike have explained why being someone elses's employee is bad. You work hard, probably collect $300-$400 per hour which goes right to your employer. If you're lucky you get paid out half of that figure.

Washington State will always be in the mid-lower end of pay because it's an attractive place to live and high salaries aren't necessary to recruit people. If an employer can get someone to move to his site, and pay $150/hour, why pay more to someone else?

 

[Old_Mil]

Keep in mind thst Washington is one of the worst states for.physicisns in the country, scoring poorly on the one thing on the ACEP report card that matters: malpractice. A plaintiff's attorneh bave five years.to bring a case in thst state which.may be the longest window.of.exposure.in the country.

 

[SkiingDocMD]

Keep in mind thst Washington is one of the worst states for.physicisns in the country, scoring poorly on the one thing on the ACEP report card that matters: malpractice. A plaintiff's attorneh bave five years.to bring a case in thst state which.may be the longest window.of.exposure.in the country.

Is tail insurance subsequently more expensive in Washington? Aren't most states 1 year?

 

[SkiingDocMD]

If you get to eat exactly what you kill, and the payor mix is good, and the volume is adequate, and you're a quick, efficient doc, then $175 seems pretty lame to me. Last I looked I was billing $7-800 a patient and collecting a quarter of that. So $175 an hour is about a patient an hour. That's a pretty slow pace.

Are you really billing $7-800 per patient? How, seems to me we're only billing somewhere in the $450 range.

 

[Birdstrike]

Are you really billing $7-800 per patient? How, seems to me we're only billing somewhere in the $450 range.

What you bill is almost irrelevant in that as long as your fees are higher than your highest insurance allowables, what you bill will not alter your collections.

In others words, you can bill $161, $500 or $5,000 for a lumbar puncture, but in 2015 medicare only pays $161 (actual number) for it, no matter what # you charge. Similarly, Blue Cross may pay, for example $261 (made that up, guessing) for an LP, but what your group or WCI's group charges is irrelevant.

It matters for self pay, because they're the only ones that actually are expected to pay what the actual charge sent out, is. But ironically, most self pays have no cash and often you won't collect any money from them, nor the amount any insurer would pay, let alone the inflated funny-money fee schedule amount.

He may have made those numbers up, or his group may have a higher fee schedule, but the fee schedule has little if any bearing on collections or income. Also, his group may have higher acuity also, which could amount to higher collections/charges for higher levels of service.

Collections have everything to do with payer mix (higher amounts payed ie "allowables" for different insurance companies) and how aggressive and skilled your billing and collection people are at actually chasing down the money, appealing denials, etc.

This is a full time job in and of itself. If you have crappy billers, coders and collectors, a tremendous amount of money can be lost routinely, and you'll never even know.

 

[The White Coat Investor]

Are you really billing $7-800 per patient? How, seems to me we're only billing somewhere in the $450 range.

As noted, what we bill is largely irrelevant to all but the 3% of self-pay patients that pay their bills. So if you're collecting 45% of what you bill and bill $450 on average, and we collect 25% of what we bill and bill $750 on average, well, that's pretty much the same thing.

However, it's possible you have crappier insurance contracts, billers/coders etc than I do too.

However, the bottom line is that I'm collecting something around $175-200 a patient after expenses. So if I see 1.5 patients an hour, that's $300 an hour before expenses. If I see 2.5 patients an hour, that's $500 an hour before expenses. Some patients might be a little less (UTI, vag bleed), other patients might be a lot more (procedure, level 5, critical care, US charge, EKG charge etc). But the point is that if you're an employee, this is all a black box. If you own the business, well, the better the business is run the more you make.

I just took a look at my Medicare data on the public website. Looks like my average level 5 pays $131, critical care $171, etc. But keep in mind most private insurance pays better than that, there is often an additional EKG/US/procedure charge, and we have a decent payor mix. So $175-200 a patient is probably about right. If you're not making anywhere near that, well, I suggest you figure out where the money is going. Clearly when you're working for some CMG for $140 an hour and seeing 2 patients per hour you're not getting paid anywhere near what you're worth.