Future salaries for EM physicians going down?

drox said:

I was talking with a radiologist who has been in the practice for a while and he was telling me that the salaries for EM physicians will go down in the future. For some reason, I didnt ask him why he thought so. Do you think there is any reason for it to go down?

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The expectation is that as saturation begins to hit the markets, that EPs will be paid less. Of course, this isn't supposed to happen for 20 years, and no one knows what healthcare will look like then, so I wouldn't worry about it now. Current healthcare reform will likely have a more profound impact on all physicians than anything about to impact EPs significantly in the near future.

why would this particular radiologist have any insight into EP salaries? i personally think salaries will go up. non-boarded EM doctors are going to be phazed out. there is plenty of room for EM doctors and no saturation in sight.

imho it is the law of supply and demand. i don't know anywhere else but at my school ER is the number one pick. everyone wants it, and i can see why. in the future, if there are plenty of er docs to go around they will not be able to demand more $. this is why radiology and dermatology neurosurgery hand surgery can command so much money....there just are fewer of them, less residency programs etc. also in the future there is a movement toward not allowing people to use the ER as primary-care-right-now. For example, the hospitals in my area are implimenting a program that if it is not an emergency you must pay $200 cash or credit card on arrival in the ER. The hospitals are sick of people who have no insurance skipping out on their bills. The debate becomes what is an emergency? I did a shift in the ER today I had 3 altered mental status elderly patients from NH's (one NPH, one coded after transfer to the floor and died (afib with RVR, right pleural effusion, left consolidation, 95 years old, only responsive to noxious stimuli on the left side of her body), and one pneumonia) two hypertensive urgencies, one severe constipation, one DKA and one infected lacerations. My guess is that asking for money for the non-emergencies will not affect the bottom line that much....as most of what i did today would be considered emergencies or the litigation would roll...but i am in florida litigation capital of the world. As for the future of ER docs income...no can tell for sure but I don't think it will be going up.

drox said:

I was talking with a radiologist who has been in the practice for a while and he was telling me that the salaries for EM physicians will go down in the future. For some reason, I didnt ask him why he thought so. Do you think there is any reason for it to go down?

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He should probably spend the same amount of time he's spending worrying about our jobs that he does about his. Some of his has already been shipped offshore.

amyl said:

imho it is the law of supply and demand. i don't know anywhere else but at my school ER is the number one pick. everyone wants it, and i can see why. in the future, if there are plenty of er docs to go around they will not be able to demand more $. this is why radiology and dermatology neurosurgery hand surgery can command so much money....there just are fewer of them, less residency programs etc. also in the future there is a movement toward not allowing people to use the ER as primary-care-right-now. For example, the hospitals in my area are implimenting a program that if it is not an emergency you must pay $200 cash or credit card on arrival in the ER. The hospitals are sick of people who have no insurance skipping out on their bills. The debate becomes what is an emergency? I did a shift in the ER today I had 3 altered mental status elderly patients from NH's (one NPH, one coded after transfer to the floor and died (afib with RVR, right pleural effusion, left consolidation, 95 years old, only responsive to noxious stimuli on the left side of her body), and one pneumonia) two hypertensive urgencies, one severe constipation, one DKA and one infected lacerations. My guess is that asking for money for the non-emergencies will not affect the bottom line that much....as most of what i did today would be considered emergencies or the litigation would roll...but i am in florida litigation capital of the world. As for the future of ER docs income...no can tell for sure but I don't think it will be going up.

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EM is FAR from the top pick at my school. We went around in a room of about 15 people last year (2nd year) and at least 8 said "EM" (it's not "ER" by the way, it's Emergency Medicine and it's Emergency Department) was their first choice. Weeks into third year, at least half of those people are looking elsewhere.

I just got a 5% raise in my salary.

Q

I agree with above. It's far from a popular choice at my school (probably averaging about 7 out of a class of 150 each year). I think this is due to -- and it's probably true at many schools -- not having a core clerkship in EM during the third year. Those interested have to seek it out.

SoCuteMD said:

He should probably spend the same amount of time he's spending worrying about our jobs that he does about his. Some of his has already been shipped offshore.



EM is FAR from the top pick at my school. We went around in a room of about 15 people last year (2nd year) and at least 8 said "EM" (it's not "ER" by the way, it's Emergency Medicine and it's Emergency Department) was their first choice. Weeks into third year, at least half of those people are looking elsewhere.

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Interesting discussion.

I can tell you there really *is* a solid reason to back the claim that EP salaries will go down -- the fact that the medicaid payments are being cut 9% in the budget this year. Every year we go through this merry-go-round of proposed cutbacks followed by a one-year holdover. It has been repeated every year for several years, but eventually the holdover won't occur. Note that with holdovers, you never see fee increases.

Once again, it represents the lack of collective will among physicians to protect their turf. Too many just think that physician salaries are "high enough already" or that a certain altruism should offset salary concerns. It doesn't help when the public can't differentiate the salary of a neurosurgeon or cardiac cath specialist vs. a community pediatrician. They all think we're rich. To say nothing of the staggering educational debt load and opportunity cost (8 years in school).

Also, it's funny, but I've come full circle: As a senior medical student and then resident, I was always militant about using the correct label: ED for emergency department (never ER!), EP for emergency physician, EM for emergency medicine....

Now I realize it doesn't matter one whit if it's called the "ER" or "ED". I've decided that to be so pedantic is to miss the forest for the trees.

Call it what you want. I'm still the primary care provider to the nation according to POTUS.

it's POTUS not podus you whit

bulgethetwine said:

Every year we go through this merry-go-round of proposed cutbacks followed by a one-year holdover.

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Well, of course we keep going through it. It benefits everyone to keep doing so (except, say, patients and physicians). Politicians get rewarded every year through institutional bribery to not create a permenent fix and our professional associations get another huge issue with which to raise money.

Sorry, call me cynical. If we'd have really wanted to solve this problem, we'd have done it by now.

bulgethetwine said:

Now I realize it doesn't matter one whit if it's called the "ER" or "ED".

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That's the great service Bob Dole did for emergency medicine. A speaker at a conference awhile back pointed out that, right after his Viagra ads came out, ER sounded a whole lot better than ED.

Take care,
Jeff

DrQuinn said:

I just got a 5% raise in my salary.

Q

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Sucker, I got like 400% this year.

amyl said:

one coded after transfer to the floor and died (afib with RVR, right pleural effusion, left consolidation, 95 years old, only responsive to noxious stimuli on the left side of her body)

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You sent that patient to the floor?!?! In Florida...yikes

WilcoWorld said:

You sent that patient to the floor?!?! In Florida...yikes

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I thought that too....I'm hoping the patient was a DNR and they just didn't want to use up an ICU bed for that reason. Let's hope anyway...
streetdoc

streetdoc said:

I thought that too....I'm hoping the patient was a DNR and they just didn't want to use up an ICU bed for that reason. Let's hope anyway...
streetdoc

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In the eyes of most reasonable people, it would be criminal to resuscitate that patient. Why postpone the inevitable?

bulgethetwine said:

Also, it's funny, but I've come full circle: As a senior medical student and then resident, I was always militant about using the correct label: ED for emergency department (never ER!), EP for emergency physician, EM for emergency medicine...

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I often refer to myself as an ER doc. It rolls off the tongue a lot easier than emergency physician, ED doc, EM doc, etc. Plus people know what you're talking about when you say ER doc.

I get most of my salary info from radiologists and those in other specialties. They KNOW.

bulgethetwine said:

Interesting discussion.

I can tell you there really *is* a solid reason to back the claim that EP salaries will go down -- the fact that the medicaid payments are being cut 9% in the budget this year. Every year we go through this merry-go-round of proposed cutbacks followed by a one-year holdover. It has been repeated every year for several years, but eventually the holdover won't occur. Note that with holdovers, you never see fee increases.

Once again, it represents the lack of collective will among physicians to protect their turf. Too many just think that physician salaries are "high enough already" or that a certain altruism should offset salary concerns. It doesn't help when the public can't differentiate the salary of a neurosurgeon or cardiac cath specialist vs. a community pediatrician. They all think we're rich. To say nothing of the staggering educational debt load and opportunity cost (8 years in school).

Also, it's funny, but I've come full circle: As a senior medical student and then resident, I was always militant about using the correct label: ED for emergency department (never ER!), EP for emergency physician, EM for emergency medicine....

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I agree. I predict that changes in CMS payments will have a much greater effect on EP opportunities than anything else.

bulgethetwine said:

Now I realize it doesn't matter one whit if it's called the "ER" or "ED". I've decided that to be so pedantic is to miss the forest for the trees.

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I too have given up on the ER vs. ED thing. I do, however, demand to be called an Emergentologist.

Dakota said:

Physician salary is determined not by supply and demand, it is determined by medicare reimbursements. Basically every insurance policy bases their reimbursement schedule off of medicare rates. The only physicians who escape this are those who have a lot of procedures not covered by insurance or those who go cash only.

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This is exactly true. EM staffing is done based on (what have I always said it all comes down to?) payor mix. If CMS reimbursement (I hate that word, it's a summary of all that's wrong in heathcare) goes down staffing, pay or more likely both will have to fall as well. That means fewer job prospects.

Look at it this way: In my group we try to staff for about 1 doc hour for every 2 patient visits or 2 patients per hour per doc. If CMS $ falls we've gotta decide if we want to keep our pay the same and staff less (work harder) or keep staffing and work loads the same but take a pay cut. Either way it's unlikely we'll decide to staff more hence no new openings beyond our attrition.

Now before the more excitable among you freak out I think opportunities in EM will continue about as they have. My reasoning is that the industry is predicting an increase in attrition as the boomers start to retire in droves and I don't think we'll get hit as hard by CMS as the dire predictions are now. CMS has historically warned of badness and then spared EM from the big cuts. They know who the safety net is right now. So I expect the variables to change but the net to stay stable.

docB said:

I too have given up on the ER vs. ED thing. I do, however, demand to be called an Emergentologist.

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Haha. Good point .

For some reason "ER doc" and "ER" don't really bother me. When people say they are "interested in going into ER" that is like nails on a chalkboard to me, though!

After the match, I've never heard anyone having issues with using 'ER'. Most residents I've talked to even refer to themselves as ER residents. All the other residents refer to us as 'ER residents.' I don't get what the big deal is. I think its only an issue when you are applying.

docB said:

I too have given up on the ER vs. ED thing. I do, however, demand to be called an Emergentologist.

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Silly rabbit, it's 'Emergetrician'. Sigh...

As far as the OP, that's why in 10 years I'm opening a 100% fee for service doc-in-the-box right smack in the richest section of town, with a Starbucks, Williams-Sonoma and day spa in the lobby; genuine Corinthian leather exam tables, as well as a 5 minute out-the-door 'double-your-money-back' guarantee. I also want a fountain in the lobby, too. So, now, who's coming with me?!? WHO'S COMING WITH ME?!? WHO'S-COMING-WITH-ME?!?

ditch doctor said:

Silly rabbit, it's 'Emergetrician'. Sigh...

As far as the OP, that's why in 10 years I'm opening a 100% fee for service doc-in-the-box right smack in the richest section of town, with a Starbucks, Williams-Sonoma and day spa in the lobby; genuine Corinthian leather exam tables, as well as a 5 minute out-the-door 'double-your-money-back' guarantee. I also want a fountain in the lobby, too. So, now, who's coming with me?!? WHO'S COMING WITH ME?!? WHO'S-COMING-WITH-ME?!?

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IN

ditch doctor said:

Silly rabbit, it's 'Emergetrician'. Sigh...

As far as the OP, that's why in 10 years I'm opening a 100% fee for service doc-in-the-box right smack in the richest section of town, with a Starbucks, Williams-Sonoma and day spa in the lobby; genuine Corinthian leather exam tables, as well as a 5 minute out-the-door 'double-your-money-back' guarantee. I also want a fountain in the lobby, too. So, now, who's coming with me?!? WHO'S COMING WITH ME?!? WHO'S-COMING-WITH-ME?!?

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Free coffee for doctors?

I'm in if you change that Starbucks to an Einstein's.

Couple of thoughts to add to the discussion:

1) Procedural specialties make more money not because they avoid Medicare reductions, but because they keep coming up with new CPT codes that have high rates. Rads, RadOnc, Derm are coming up with new procedures to replace the old ones that don't bill well anymore. It takes good lobbying, but these specialties seem to have politically savvy leaders.

2) One silver lining of healthcare reform is that EM might actually make $15 or $20 vs. $0 from the uninsured patients we treat today. It won't change the world, but may help offset some of those Medicare cuts.

ditch doctor said:

Silly rabbit, it's 'Emergetrician'. Sigh...

As far as the OP, that's why in 10 years I'm opening a 100% fee for service doc-in-the-box right smack in the richest section of town, with a Starbucks, Williams-Sonoma and day spa in the lobby; genuine Corinthian leather exam tables, as well as a 5 minute out-the-door 'double-your-money-back' guarantee. I also want a fountain in the lobby, too. So, now, who's coming with me?!? WHO'S COMING WITH ME?!? WHO'S-COMING-WITH-ME?!?

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Not me. I hate rich patients. One of my hospitals is in the swanky part of town and I want to gouge out my own eyes every time I'm there. It's just my personality. I do better in the ghetto.

docB said:

Not me. I hate rich patients. One of my hospitals is in the swanky part of town and I want to gouge out my own eyes every time I'm there. It's just my personality. I do better in the ghetto.

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Yes... I completely agree, which is why I will just kick them out. If I'm 100% fee for service, that means no medicaid which means no EMTALA, right? We will be the 'Soup Nazi' of Urgent Care. I'll just kick them out.

"YOU!! You have offended me!!! NO Bactrim for one year!!!"

SoCuteMD said:

EM is FAR from the top pick at my school. We went around in a room of about 15 people last year (2nd year) and at least 8 said "EM" (it's not "ER" by the way, it's Emergency Medicine and it's Emergency Department) was their first choice. Weeks into third year, at least half of those people are looking elsewhere.

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This news pleases me. I aspire to be an Emergentologist.




Salaries won't go down. Universal health care will fix everything. The politicians will see to it.

Wackie said:

"Just go to the ER" is not a national health policy.

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As of last week, now it is. I've always said that John Edwards, were he on fire, I would not whiz on him to put him out, and now the other side of the aisle chirps up with the President saying that everyone has health care - "just go to the emergency department". A bunch of idiots all around.

Hmph!

ditch doctor said:

Yes... I completely agree, which is why I will just kick them out. If I'm 100% fee for service, that means no medicaid which means no EMTALA, right? We will be the 'Soup Nazi' of Urgent Care. I'll just kick them out.

"YOU!! You have offended me!!! NO Bactrim for one year!!!"

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Now that sounds fun.

drox said:

I was talking with a radiologist who has been in the practice for a while ...

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Ask this radiologist how he feels about radiologists in India who don't piss and moan about doing night call who are doing more & more to alleviate some of his workload. My job isn't going to be outsourced overseas anytime soon. And when it becomes possible, I'm going to outsource myself to a beach somewhere. "To administer haldol press 1. To administer ativan press 2. To administer haldol and ativan press 3."

Emergency physicians are just as vulnerable as any specialty to the across-the-board reimbursement cuts that have been threatened, but the bean counters are starting to look to the procedural specialties to cut some of the fat out of the Medicare budget. High expense non evidence-based care like the MRI workups for non-athletes with three weeks of atraumatic knee pain, laminenctomy & fusion for back pain (without cord impingement) and stenting of non-acute coronary lesions are low hanging fruit ripe for the plucking by your health insurance adjuster.

A few things to consider!

1) EM (and medicine in general) is not at all about Supply and Demand. If my ED is bulging and 300 people are in my waiting room I cant bill more for an I & D than if there was only 1 patient in the whole ED.

2) The number of people going into EM is solely based on the number of spots (which are filled in a 95 to 99% range) funded by our government.

3) With the recent change in CPT codes ACEP news (I know this isnt like god saying it) they expect and "average" ED doc to make another 20K per yr. Of course this would be more than offset by a huge medicare/caid cut.

4) I really wouldnt worry what other specialties think about what will happen to our salaries. Frankly until I spoke with people in the field I had no idea how much people really made. I think part of this is because talking money in medicine is taboo and partially because payment schemes to attendings is complicated. Is the number reported salary? or salary plus bonuses? is it eay what you kill? etc.

As bartleby mentioned MRIs and other incredibly expensive unproven procedures will be cut before they cut how much they pay me to I&D some big pimple.

I have been keeping up with socioeconomic issues in medicine since i was in med school back in 1990. I firmly believe, that as the physician shortage worsens, all physicians are going to see their incomes go up. I doubt they are going to double, but I would not be surprised to seem them go up 10%.

It is all about supply and demand. Prior to my current job, I did locums for 2 years and the daily rate for anesthesia has gone from $1000/8hr day to $1200/8hr day in just a year and a half. Other specialties have seen similar increases.

Yes, Medicare is cutting rates, but physicians are finding ways to extract money from hospitals. They have all the money, not patients. You have to go where the money is. Reimbursement for the total joint replacement DRG, which is how hospitals get paid, has gone up about 60% in the past 10 years. Reimbursement for a total joint to the doctor has gone down about 55%. It is clear who has the better lobby.

EM is going to get subsidies just like the general surgeons, anesthesiologists, and orthopedists. They are all getting call stipends and fees for seeing no-pay patients. Basically, they have demanded the money from the hospitals and they are getting it. If your group isn't getting a piece of the pie, then get on the stick.

EM trained people are in high-demand. Like I said, I have been keeping up with this for over 15 years. Specialities that have gotten paid continue to get paid. EM is one of those. I think Radiology is going to continue to demand high salaries, but only for those people who are specialized. The days of making $600k reading chest films are probably over. But, the invasive stuff and complicated MRI imaging will still command high salaries.

I have been out of training for 6 years now, and my hourly income keeps going up. I have to demand it, but it does go up. Negotiation is the key to getting your slice of the American Dream. We physicians are valuable, demand what you are worth.

mdjobexchange said:

I have been keeping up with socioeconomic issues in medicine since i was in med school back in 1990. I firmly believe, that as the physician shortage worsens, all physicians are going to see their incomes go up. I doubt they are going to double, but I would not be surprised to seem them go up 10%.

It is all about supply and demand. Prior to my current job, I did locums for 2 years and the daily rate for anesthesia has gone from $1000/8hr day to $1200/8hr day in just a year and a half. Other specialties have seen similar increases.

Yes, Medicare is cutting rates, but physicians are finding ways to extract money from hospitals. They have all the money, not patients. You have to go where the money is. Reimbursement for the total joint replacement DRG, which is how hospitals get paid, has gone up about 60% in the past 10 years. Reimbursement for a total joint to the doctor has gone down about 55%. It is clear who has the better lobby.

EM is going to get subsidies just like the general surgeons, anesthesiologists, and orthopedists. They are all getting call stipends and fees for seeing no-pay patients. Basically, they have demanded the money from the hospitals and they are getting it. If your group isn't getting a piece of the pie, then get on the stick.

EM trained people are in high-demand. Like I said, I have been keeping up with this for over 15 years. Specialities that have gotten paid continue to get paid. EM is one of those. I think Radiology is going to continue to demand high salaries, but only for those people who are specialized. The days of making $600k reading chest films are probably over. But, the invasive stuff and complicated MRI imaging will still command high salaries.

I have been out of training for 6 years now, and my hourly income keeps going up. I have to demand it, but it does go up. Negotiation is the key to getting your slice of the American Dream. We physicians are valuable, demand what you are worth.

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This seems true from everything I have read/seen. I think sometimes as students we tend to only look at our immediate surroundings (usually urban, usually academic, usually with nearby residencies) and say "wow, there is a glut of EPs." ACEP and SAEM disagree with this though. I have actually heard knowledgable EPs say that they are worried about the "practice-track" opening up again for FP/IM because EPs become a scarce commodity.

One thing I think we often fail to incorporate into our thinking about supply/demand in EM is that it takes a lot of EPs to staff an ED. When 36 hours in considered a full week and when many clinicians want to work part-time you need a lot of people.

AmoryBlaine said:

This seems true from everything I have read/seen. I think sometimes as students we tend to only look at our immediate surroundings (usually urban, usually academic, usually with nearby residencies) and say "wow, there is a glut of EPs." ACEP and SAEM disagree with this though. I have actually heard knowledgable EPs say that they are worried about the "practice-track" opening up again for FP/IM because EPs become a scarce commodity.

One thing I think we often fail to incorporate into our thinking about supply/demand in EM is that it takes a lot of EPs to staff an ED. When 36 hours in considered a full week and when many clinicians want to work part-time you need a lot of people.

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They just opened a ton of new residencies. I dont think the EM shortage will last forever but it will last into the near future.

And I agree with AB, there are a decent number of people that want to work less and less in EM (at least people I know), its not that people want to quite but want to work fewer and fewer hours to enjoy time doing other things they like.

southerndoc said:

I often refer to myself as an ER doc. It rolls off the tongue a lot easier than emergency physician, ED doc, EM doc, etc. Plus people know what you're talking about when you say ER doc.

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What is so hard about emergency doc? That's what I use.