$200/hr salary

[friction]

How reliable are online job listings? I just looked an ER job listed on MDsearch and it says $200/hr. It is a 12 hr, 15 shift, permanent, hospital job. 12hr x 15 shift x 12 month = 432K. How common is to get an ER job with $200/hr?

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[deleted547339]

Four things:

1) before everyone else jumps on you - do a search. There's a lot of stuff on here, particularly in the FAQs.

2) totally possible. depends on the location. If you are willing to live somewhere awful, you can def make over $200/h. There's a reason that post is in the middle of nowhere Nebraska. If you want to live somewhere with a tight market (NYC, Boston, SF, Denver, etc), expect to make substantially less.

3) common advice is that advertised jobs aren't the best ones. places that have good jobs (read: happy EPs, low turnover rate, low BS, not seeing a ton of pts/hr) don't have openings often and don't have to advertise their jobs in the throw-aways/online or use recruiters.

4) 15 12 hours shifts ain't nothing.

 

[Lumberg]

We're hiring...substantially more $$, better location too. PM me if interested. FFS, democratic group, stable, AAEM philosophy.

 

[circulus vitios]

Four things:

1) before everyone else jumps on you - do a search. There's a lot of stuff on here, particularly in the FAQs.

2) totally possible. depends on the location. If you are willing to live somewhere awful, you can def make over $200/h. There's a reason that post is in the middle of nowhere Nebraska. If you want to live somewhere with a tight market (NYC, Boston, SF, Denver, etc), expect to make substantially less.

3) common advice is that advertised jobs aren't the best ones. places that have good jobs (read: happy EPs, low turnover rate, low BS, not seeing a ton of pts/hr) don't have openings often and don't have to advertise their jobs in the throw-aways/online or use recruiters.

4) 15 12 hours shifts ain't nothing.

Obviously it depends on which city and which hospital, but on average how much can one expect to make in a large city? $150/hour? $100/hour?

 

[Hamhock]

$200/hr is not that uncommon, I have found...and not necessarily in awful locations...not in SF or Denver, but in many places that folks on this board speak highly of.

However, I would echo one of the posters above: fifteen 12h shifts is quite a bit...not recommended for more than a year or so.

HH

 

[Cerberus]

4) 15 12 hours shifts ain't nothing.

totally disagree - If I was told I had to work 15 12s, I'd laugh and walk away.

 

[The Buff]

I think that is what he meant with the double negative. It isn't nothing, meaning it is something, ie it is a lot to work 15 12s. I wouldnt work that schedule either , thats what you work in residency not after (unless you are broke.)

 

[Rendar5]

15 shifts a month minimum is a lot for an attending
I've worked more before, but voluntarily, and never for more than a couple months at a time. But I personally wouldn't sign a contract for 15 minimum =p may just be me though. (hey, that's what negotiating a contract is for)

 

[Shodddy18]

totally disagree - If I was told I had to work 15 12s, I'd laugh and walk away.

I agree. I hate 12's. 15 12's is a lot. I work 14-15 8hour shifts and I am very happy.

 

[GeneralVeers]

$200 isn't that hard to get. States like Texas tend to pay a lot more than California or the NE. I know of one job in Houston that constantly advertises at $220. Not sure if it's a terrible job or not, but if they're paying that much and have to advertise, something is fishy.

FYI I got a job at $250/hour in a small city with 8-9 hour shifts and about 1.7 patients/hour. It's the best job I've ever had, but it wasn't advertised, and required some phone work to find.

 

[Birdstrike]

Don't ever forget The Inalterable 50% Law of Emergency Medicine:

Every 8 hr shift equals 12 hrs doing anything else (50% of 8hr = 4hr. Add 4hr to your 8 hour shift to know what time will recovery will be required and what mental, physical and emotional toll will be taken).

Any 12 hr shift in EM is like 16 hr doing anything else.

Any 14 shift month will actually feel like 21 shifts doing anything else.

Before signing up for the 15, 12-hr shifts per month (180 hr total), ask yourself if you would like working 15, 16 hour shifts every month (240 total). Do the math. Obey this law and you will stay medium; warm red center. Disobey, and you may come out well done; overcooked:

http://decollins1969.files.wordpress.com/2012/01/burnout.jpg

 

[southerndoc]

Obviously it depends on which city and which hospital, but on average how much can one expect to make in a large city? $150/hour? $100/hour?

Many jobs in Atlanta pay $230-280/hour.

So jobs in big cities paying a lot aren't that uncommon.

 

[Hercules]

To the OP, $200/hr is not hard to come by and 180 hrs (scheduled with potential to work longer shift to document) is too many hours.

To everyone else, I've often wondered why the more "desirable" locations pay less. Physician reimbursement actually isn't a supply and demand market. Blue cross blue shield and Medicare pay the same rates whether 1 doctor wants the job or 10,000 doctors want the job. The only way physician reimbursement is affected by supply and demand is if the contract holder is creating the supply and demand market. I know CMGs will do this but a SDG in a desirable location shouldn't make any less than a SDG in a less desirable location in the same state, assuming similar payor mixes.

 

[Arcan57]

To the OP, $200/hr is not hard to come by and 180 hrs (scheduled with potential to work longer shift to document) is too many hours.

To everyone else, I've often wondered why the more "desirable" locations pay less. Physician reimbursement actually isn't a supply and demand market. Blue cross blue shield and Medicare pay the same rates whether 1 doctor wants the job or 10,000 doctors want the job. The only way physician reimbursement is affected by supply and demand is if the contract holder is creating the supply and demand market. I know CMGs will do this but a SDG in a desirable location shouldn't make any less than a SDG in a less desirable location in the same state, assuming similar payor mixes.

Part of it is that less desirable areas are willing to subsidize pay in order to get coverage. Also, how common are open book democratic groups in non-academic hospitals in the destination cities? It may be that most of the jobs have a stream of profit being skimmed off by the doc that own the contract (or group of partners) or that the hospital is demanding a cut in order for the group to stay. Having not worked in a destination city, the last sentence is pure speculation.

 

[deleted547339]

totally disagree - If I was told I had to work 15 12s, I'd laugh and walk away.

Sorry, my redneck-ness came out.

I think that is what he meant with the double negative. It isn't nothing, meaning it is something, ie it is a lot to work 15 12s. I wouldnt work that schedule either , thats what you work in residency not after (unless you are broke.)

Yea, that's what I meant. I meant that I plan on working an attendings schedule, not resident's schedule after I graduate. 180 hours would be no bueno.

 

[iish]

I've heard of academic centers in very desirable locations paying 180-200/hr so I can't imagine that it's that hard to find in the community

 

[IdealGas]

For those complaining about hours,180 hrs may be a heavy work load for most, but I know a ER doc who consistently pulls 240+ hrs and I have been assured that these hours are significantly less than his previous gig (80 hrs/wk). Not trolling.

 

[deleted547339]

I've heard of academic centers in very desirable locations paying 180-200/hr so I can't imagine that it's that hard to find in the community

Whoa. I've been interested in academics since day 1, but always heard the pay is crap (relative to community). Even if it's heresay, mind PM'ing me said places paying that kind of cash for academics?

For those complaining about hours,180 hrs may be a heavy work load for most, but I know a ER doc who consistently pulls 240+ hrs and I have been assured that these hours are significantly less than his previous gig (80 hrs/wk). Not trolling.

Whoa. That's nuts. You're talking 5 12s a week.......if you do ANY nights, you'd basically be working or sleeping 24/7.

 

[Postictal Raiden]

How feasible is it for a fresh grad to work such a schedule (15 twelve-hour shifts) for 2-3 years in order to pay off their entire student debt? Would you recommend such a commitment to someone leaving residency with a 500K in loans and interests?

 

[IdealGas]

Whoa. That's nuts. You're talking 5 12s a week.......if you do ANY nights, you'd basically be working or sleeping 24/7.

He works 27-28 9 hour shifts per month, essentially all are the night solo coverage shifts. Pretty much has a monopoly on those shifts and this is an urban area as well.

 

[Birdstrike]

He works 27-28 9 hour shifts per month, essentially all are the night solo coverage shifts. Pretty much has a monopoly on those shifts and this is an urban area as well.

This follows a thought process along these lines:

Because someone out there does something very self-destructive and inadvisable, therefore I should, too.

If that works for you, great. "It's all you buddy." And you are trolling, simply because any poster that feels the need to claim not to be trolling, obviously is.

I don't recommend anyone to work 28 9-hour shifts per month, even if it's the easiest, slowest pace, least stressful career on the planet. Don't work 7 days per week. Period. (Yeah, I know, unless you're a resident. You have no choice, but it's not forever). It's not smart to choose for yourself long term. So, one guy out there does, and loves it. Who cares? There are people who cut themselves to make the bad thoughts go away, too. LOL

 

[Groove]

$200 isn't that hard to get. States like Texas tend to pay a lot more than California or the NE. I know of one job in Houston that constantly advertises at $220. Not sure if it's a terrible job or not, but if they're paying that much and have to advertise, something is fishy.

FYI I got a job at $250/hour in a small city with 8-9 hour shifts and about 1.7 patients/hour. It's the best job I've ever had, but it wasn't advertised, and required some phone work to find.

GV, CMG or Private Dem/Ind? 1.7pt/h.. lol, that's nuts. We make in that range in the South but sig more busy.

 

[fahimaz7]

Many jobs in Atlanta pay $230-280/hour.

So jobs in big cities paying a lot aren't that uncommon.

No kidding. Inside or outside the perimeter?

 

[circulus vitios]

Whoa. I've been interested in academics since day 1, but always heard the pay is crap (relative to community). Even if it's heresay, mind PM'ing me said places paying that kind of cash for academics?



Whoa. That's nuts. You're talking 5 12s a week.......if you do ANY nights, you'd basically be working or sleeping 24/7.

When you guys say "12 hour shifts," is it really 12 hours or do you have to come in an hour early to prepare and leave an hour late to finish up and close out?

 

[Perrotfish]

What's a normal hourly rate for Peds EM? Is there an equivalent of middle of nowhere Nebraska for Peds EM, or does the relationship with Children's hospitals pretty much me an that all of the jobs are in desirable locations?

 

[deleted109597]

What's a normal hourly rate for Peds EM? Is there an equivalent of middle of nowhere Nebraska for Peds EM, or does the relationship with Children's hospitals pretty much me an that all of the jobs are in desirable locations?

There are lots of children's hospitals that aren't in desirable locations.
NY, Cincinnati, Baltimore.

I kid.

There are children's hospitals in smaller communities, and places that aren't big names. They're harder to find, but they're there. The problem is that there aren't a ton of peds EM fellowship trained people out there, so many of those places are staffed by pediatricians. They look at EM boarded people with sideways glances.

 

[EM2BE]

Just of note - everyone on here is talking about $/hr, but not benefits. You may get paid well per hour, but not have any benefits. I know I am pretty much stuck working for less/hr to get benefits unless I find a spouse and I can be on their insurance policies.

 

[Perrotfish]

There are lots of children's hospitals that aren't in desirable locations.
NY, Cincinnati, Baltimore.

I kid.

There are children's hospitals in smaller communities, and places that aren't big names. They're harder to find, but they're there. The problem is that there aren't a ton of peds EM fellowship trained people out there, so many of those places are staffed by pediatricians. They look at EM boarded people with sideways glances.

I'm a Pediatrician looking at a Peds EM fellowship, actually. I'm just curious what the compensation is vs. some other specialties I'm looking at.

Also is there really any upside (other than providing better care) to being the Peds EM certified guy in the ED? Are they getting paid more than the guys who are only borded in EM or Peds?

 

[Birdstrike]

When you guys say "12 hour shifts," is it really 12 hours or do you have to come in an hour early to prepare and leave an hour late to finish up and close out?

You shouldn't have to come in early for shifts. Staying late can happen often depending on your group's system of shift change. If you're busy for 12 hours, it's hard to put on the brakes and get at at hour 12:01. For that reason, staying late for a 12 hr shift would not be unusual, depending on your system. If you pick up a simple patient at hour 11 and it turns out to be more complicated, you can get stuck. You can try to turn it over to the next guy coming on, but that can be fraught with its own issues and problems, ie, people not wanting to take patients over or handoff fumbles where things get forgotten or overlooked. Handoffs are a classic medical malpractice risk. The other option is to do very little your last 1 to 2 hours, but that can irritate co-workers. It can work, but what you are doing is essentially turning your 12 hr shift into an 11, without consent of your co-workers or director. There's an art to "getting out on time," and a very imperfect art, at that.

Bottom line, 12's often do become 13's. Add the commute home and a string of shifts in a row and it can be tough.

(See above "50% law")

 

[deleted109597]

I'm a Pediatrician looking at a Peds EM fellowship, actually. I'm just curious what the compensation is vs. some other specialties I'm looking at.

I know that. It's just that nobody else on here that I know of is Peds EM. The only Peds EM people I know make $150-170/hr at the community-esque peds ED.

Also is there really any upside (other than providing better care) to being the Peds EM certified guy in the ED? Are they getting paid more than the guys who are only borded in EM or Peds?

They get paid more than pediatricians. They may in certain places make more than EM working in the same ED.
I would argue that Peds EM isn't better care than EM based on the literature (and maybe worse), but it's certainly better than peds. They also are the only ones who can train new Peds EM fellows.

Peds EM is a fellowship that increases pediatrician pay, but it decreases EM pay.

 

[Kal EI]

I'm a Pediatrician looking at a Peds EM fellowship, actually. I'm just curious what the compensation is vs. some other specialties I'm looking at.

Also is there really any upside (other than providing better care) to being the Peds EM certified guy in the ED? Are they getting paid more than the guys who are only borded in EM or Peds?

Wow.

I remember reading a thread where you were bashing EM. Times have changed.

 

[Perrotfish]

Wow.

I remember reading a thread where you were bashing EM. Times have changed.

I'm not sure which thread you're recalling (I can think of a couple), but I think you should be able to discuss the strengths, weaknesses, a perceptions of a profession without it being considered bashing. Peds certainly criticizes our own training and patient care models often enough, and the ABP just completely revamped our residency requirements just this year in response to some of those criticisms.

That kind of conversation can be hard to have on the Internet, though, and of course you can't really do it with a live audience until you're out of training, so maybe its not worth it to say anything about anything. Anyway Peds EM has always been on of my top three choices for fellowship since I did my first rotation as an MS4.

 

[Kal EI]

I'm not sure which thread you're recalling (I can think of a couple), but I think you should be able to discuss the strengths, weaknesses, a perceptions of a profession without it being considered bashing. Peds certainly criticizes our own training and patient care models often enough, and the ABP just completely revamped our residency requirements just this year in response to some of those criticisms.

That kind of conversation can be hard to have on the Internet, though, and of course you can't really do it with a live audience until you're out of training, so maybe its not worth it to say anything about anything. Anyway Peds EM has always been on of my top three choices for fellowship since I did my first rotation as an MS4.

Fair enough. Maybe you were just really discussing the weaknesses the day I read it.

I did recall a comment along the lines of "carving out the easiest residency in all of medicine" which I remember thinking was funny.

Anyway, good luck.

 

[namethatsmell]

Fair enough. Maybe you were just really discussing the weaknesses the day I read it.

I did recall a comment along the lines of "carving out the easiest residency in all of medicine" which I remember thinking was funny.

Anyway, good luck.

On a related note, I got my first "your job in the ED is way harder than I ever understood" comment from a surgical consultant the other night. I generally don't look for external validation, but damn it was good to hear.

 

[Old_Mil]

Just of note - everyone on here is talking about $/hr, but not benefits. You may get paid well per hour, but not have any benefits. I know I am pretty much stuck working for less/hr to get benefits unless I find a spouse and I can be on their insurance policies.

This is a very important point, especially as 1. you get older and 2. Obamacare reduces the availability of and increases the price of private insurance plans. It may not seem like a big deal at age 28 with no kids, but at 48 with a wife and 2 or 3 kids you may be cutting a $2000 check every month for health insurance.

In my opinion, 120 hours a month is about right whether that is 15 x 8 or 10 x 12. I wouldnt recommend trying more than that.

Sent from my A110 using Tapatalk 2

 

[GeneralVeers]

When I was in the process of leaving my old job, I did a calculation of what the IC rate would be.

The job paid $160/hr plus some good benefits. When I factored in payroll taxes, 401K, health insurance, disability, life insurance, and CME money, the hourly came up to about $220/hr for IC rate. I did not include malpractice, as most hospitals/groups will provide this to the IC.

That made my job search easier, as I needed something paying an IC rate of $220 or more. Anything less, and I'd actually be losing money going to IC status.

Also, with most IC jobs the hospital/group will pay your travel. If you're a mile-hoarder like myself and like to go on long international vacations, this can be a great benefit, that most people overrate. By making 3 trips per month, I rack up about 13000 miles per month between two progams. That comes to 156,000 miles per year, which enough to go round-trip, first class internationally ever year for free. Not a bad deal at all.

 

[michaelrack]

Bottom line, 12's often do become 13's.

I realize there is probably some variability, but are EM docs typically paid a flat fee for shift, or are they paid for any extra time worked?

just curious.
thx

 

[Rendar5]

I realize there is probably some variability, but are EM docs typically paid a flat fee for shift, or are they paid for any extra time worked?

just curious.
thx

generally paid on one of two systems: flat fee per hour. or fee based on revenue units generated. a lot of places will do a combo of bonus pay based on revenue units and other metrics on top of a lower hourly fee..

 

[gutonc]

generally paid on one of two systems: flat fee per hour. or fee based on revenue units generated. a lot of places will do a combo of bonus pay based on revenue units and other metrics on top of a lower hourly fee..

I think the question was more, "if you're scheduled for 12 hours, but you wind up staying 14 to finish up paperwork and help out with a code, do you get paid for 14 hours?". To which I assume the answer is no.

 

[dotcb]

It varies.

academic - usually salary
private - pure RVU - work more, do more, get paid more
or
- hourly base + productivity (to incentivize night shifts, etc.) The hourly pay may include only your scheduled hours or may include your time past the clock.

Generally if you work more, you will get paid more. Use caution in pay per hour or patient per hour quotes. They aren't accurate if they don't account for time after your shift charting or cleaning up.

I realize there is probably some variability, but are EM docs typically paid a flat fee for shift, or are they paid for any extra time worked?

just curious.
thx

 

[doctorFred]

as has been mentioned, overall package is very important. particularly with big academic centers (aside from great health benefits) that may match into a 403b on top of a cash balance plan (which requires no contribution from you at all.)

finally, many large academic centers fall into the (slightly absurd) "not-for-profit" category, meaning if you're repaying med school loans under IBR, and continue to do so, the balance of your loans will potentially be forgiven in 10 years (and if you began repaying in residency, this comes out to 5-7 years of attendinghood, depending on whether you've done a fellowship.) if you've got 200-300k in student loans, and have been paying under IBR (which essentially doesn't touch the balance), spreading that debt forgiveness over 5-7 years is an extra 25-50k in effective income.

 

[a runner]

This would be great for someone with a huge amount of debt (ie. $500k+), but how many of these jobs at non-profit academic centers are actually employed directly by the academic center and not staffed indirectly through a third party for-profit physician group?

finally, many large academic centers fall into the (slightly absurd) "not-for-profit" category, meaning if you're repaying med school loans under IBR, and continue to do so, the balance of your loans will potentially be forgiven in 10 years (and if you began repaying in residency, this comes out to 5-7 years of attendinghood, depending on whether you've done a fellowship.) if you've got 200-300k in student loans, and have been paying under IBR (which essentially doesn't touch the balance), spreading that debt forgiveness over 5-7 years is an extra 25-50k in effective income.

 

[swamprat]

This would be great for someone with a huge amount of debt (ie. $500k+), but how many of these jobs at non-profit academic centers are actually employed directly by the academic center and not staffed indirectly through a third party for-profit physician group?

Yeah I'm curious about this as well.. also I wonder if IBR will be viable for the amount of time I would be in the program which won't even start for me until July. It would suck majorly to be making insignificant payments on my 250K debt which actually could have been used for entertainment or what have u in residency to find out u won't be grandfathered in and now ur debt is 450K or something absurd.

 

[Kal EI]

as has been mentioned, overall package is very important. particularly with big academic centers (aside from great health benefits) that may match into a 403b on top of a cash balance plan (which requires no contribution from you at all.)

finally, many large academic centers fall into the (slightly absurd) "not-for-profit" category, meaning if you're repaying med school loans under IBR, and continue to do so, the balance of your loans will potentially be forgiven in 10 years (and if you began repaying in residency, this comes out to 5-7 years of attendinghood, depending on whether you've done a fellowship.) if you've got 200-300k in student loans, and have been paying under IBR (which essentially doesn't touch the balance), spreading that debt forgiveness over 5-7 years is an extra 25-50k in effective income.

I still baffles me that people believe the American government is going to forgive hundreds of thousands in debt to physicians earning 300k. This is the same government trying to figure out how to stop paying residency salaries.

Good luck on that one.

 

[J ROD]

I dont think the IBR was made for physicians or other high income professionals. But, you cant separate them based on the way the law was written. I believe once people start taking advantage of this at a greater rate and the politicians see the amount of money being lost. They will change it rather quickly. It was proposed and accepted under a Rep admin and now the Dems are in there and less likely to get rid of it. But, I dont think this will be something that gets bipartisan support unless it is to get rid of in the future. Afterall, we all know physicians make too much money!

 

[J ROD]

Back to the 200/hr........are these numbers as independent contractors where you are responsible for insurance, retirement, etc.....or as an employee where you get this as your salary in addition to the other benefits that usaully come in a compensation package.

Because these per hr salaries seem rather high to me and very good if you are an employee with the other compensatory measures.

 

[Apollyon]

I realize there is probably some variability, but are EM docs typically paid a flat fee for shift, or are they paid for any extra time worked?

just curious.
thx

A contract management group with which I am acquainted put out a memo that 30 minutes before or after a shift was considered "de minimis" - for those of you not up on your Latin, that means "trivial", and they said that they wouldn't pay people for work done in that half hour before or after the shift. However, in 1938, there was a statute known as the "Fair Labor Standards Act" enacted, which says you have to be paid for working (which, although sounding logical, had to be put into words). We'll see how this shakes out.

 

[Groove]

Back to the 200/hr........are these numbers as independent contractors where you are responsible for insurance, retirement, etc.....or as an employee where you get this as your salary in addition to the other benefits that usaully come in a compensation package.

Because these per hr salaries seem rather high to me and very good if you are an employee with the other compensatory measures.

You can certainly find that with employee status that offers that amount. In general, IC jobs will pay more due to your already mentioned reasons. However, do your research on W2 vs 1099 within the context of EM. I think ACEP might even have a few links. I passed on a W2 job that was around 240/hr with bennies for a higher paying 1099/IC job. In actuality, I'm probably "making" less when all the variables are factored into the equation but I prefer 1099 status. Lots of tax advantages and I prefer self directed retirement investing and the increased options. Sure, it's a bit more of a pain with a PLLC and quarterly tax filings but again... I prefer it... for a variety of reasons.

 

[deleted109597]

A contract management group with which I am acquainted put out a memo that 30 minutes before or after a shift was considered "de minimis" - for those of you not up on your Latin, that means "trivial", and they said that they wouldn't pay people for work done in that half hour before or after the shift. However, in 1938, there was a statute known as the "Fair Labor Standards Act" enacted, which says you have to be paid for working (which, although sounding logical, had to be put into words). We'll see how this shakes out.

I always wonder what would happen if one started challenging the "status quo". I mean, sure, you could win at court, but I bet CMG would fire you before it got to that point. Someone independently wealthy would have to take them on.
Some places will pay you extra if you're doing something you can't stop, like a code, but they won't pay extra for you to do paperwork. Others pay you the entire time you're there, which is awkward, 3 hours after their shift when you ask people, "are you going to go home?"

 

[dotcb]

There are no guarantees is life. I think paying IBR as a resident is a very smart move if you know you want an academic career and can live cheaply enough as a resident to do so. In some high price cities COL might just be too high to pay loans as a resident.

The more training you do, the more sense it makes - Ex: Do neurosurgery with a fellowship - graduate and pay loans for 2-3 years - goodbye loans.

On the other hand, enjoying residency more, getting a private job, living modestly, and then aggressively paying off high interest debt is also a great way to go.

Yeah I'm curious about this as well.. also I wonder if IBR will be viable for the amount of time I would be in the program which won't even start for me until July. It would suck majorly to be making insignificant payments on my 250K debt which actually could have been used for entertainment or what have u in residency to find out u won't be grandfathered in and now ur debt is 450K or something absurd.