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Turkeysamich

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As an MS4 hoping to match to EM this year, this forum seems like the world is ending when it comes to the future of EM. I was curious if any recent grads/ new attendings ( or anyone who is willing) could post what their job hunt was like in regards to location, salary, benefits, ect. Im pretty committed at this point thanks to student loans, so I am hoping is not as bad as everyone makes it seem.
 
Turkeysamich said:
As an MS4 hoping to match to EM this year, this forum seems like the world is ending when it comes to the future of EM. I was curious if any recent grads/ new attendings ( or anyone who is willing) could post what their job hunt was like in regards to location, salary, benefits, ect. Im pretty committed at this point thanks to student loans, so I am hoping is not as bad as everyone makes it seem.
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No one can predict 4 years from now, but with the current trend of the amount of graduates spewing into the pool of applicants to fill jobs I would not expect more than 200/hr for less desirable areas and about going rates of 140-160 for desirable places, which some cities already are.
 
Outside of the cities it's not hard to find 200/hr and up in the Northeast.

Sent from my Pixel 3 using SDN mobile
 
I would agree with $200 per hour in less desirable location and $140-160 per hour in desirable location in 4 years.

If this happens, find W2 employment because 1099 will not be worth it.
 
Charlotte and Raleigh were paying W-2 starting salaries of roughly $150ish plus full benefits. That $150 number includes bonuses for starting docs and may go up to $200 down the road. Both markets are in very desirable cities and are relatively saturated due to EM programs cranking out new grads...and CLT has a big USACS and ApolloMD presence.
 
Most jobs in desirable cities are 140-180/hr nowadays but I’d expect 120-160/hr by the time you graduate residency.
 
I was making 225 an hour in philly. I also made 225 an hour in the boonies NY. It is very variable. Now I’m 250-300 depends on RVU component. Would not work for under 200 (also don’t have to I’m sub specialist and just like picking up shifts for extra money / fun)
 
i know a guy that just signed at an hca hospital for 275 hour plus 100k sign on

*fresh out of residency

also agree with the post below, there seems to be makings of salary bubble bursting (increased labor, unknown future legislation) but 90% of people just get on here to bitch/moan/complain so you've gotta take that into consideration.
 
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Turkeysamich said:
As an MS4 hoping to match to EM this year, this forum seems like the world is ending when it comes to the future of EM. I was curious if any recent grads/ new attendings ( or anyone who is willing) could post what their job hunt was like in regards to location, salary, benefits, ect. Im pretty committed at this point thanks to student loans, so I am hoping is not as bad as everyone makes it seem.
Click to expand...

Try to ignore the doom-and-gloom posts. I graduated residency in 2015, and on SDN, the world was ending then as well.

If you plan to make $150/hr you'll probably find it. If you plan to make $250/hr you're probably find that as well, though maybe not right away or as conveniently.
 
Where were you making 225 in Philly? My residents graduating now seeing about 180.
swamprat said:
I was making 225 an hour in philly. I also made 225 an hour in the boonies NY. It is very variable. Now I’m 250-300 depends on RVU component. Would not work for under 200 (also don’t have to I’m sub specialist and just like picking up shifts for extra money / fun)
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Sent from my Pixel 3 using SDN mobile
 
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I’m 45, live in a desirable SE city, high cost of living (not SF or NYC but housing is expensive etc). Made 20% less in 2019 from 2018 working a few more hours. Starting in a academics set me some back financially, originally I had fantasies about cutting back to 7-8 shifts a month in a few years. Now looking at picking up more sites to get everything paid off in the next few years and get close to financial independence.
 
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Austin: $180-200/hr
San Antonio: One group I know pays $180-225/hr but they are restructuring their payment model so this is in turmoil...
Friend signed close to the coast for $270/hr
Rural shops lowballing as hard as $85-140 per hour "but they're really slowwwww" and don't care if they get a washed-up FM doc or MLP instead of EM-boarded physician.
 
Are these flat salaraies or salaries plus RVU productivity. Big difference if the base is 180 but avg RVUs get you to 250
 
e30ftw said:
Try to ignore the doom-and-gloom posts. I graduated residency in 2015, and on SDN, the world was ending then as well.
Click to expand...

I’m skeptical about this. Just looking through posts in 2015-2017 in this forum and everyone was pretty bullish about EM. ACEP also never had an official statement about the job market like it does now.
 
I get the equivalent of 180 in Philly in an academic setting. The actual hourly rate is much lower, but I'm paid based on a 40 hour work week, which is not what I'm working clinically. The bad thing is that the pay is worse elsewhere in the city.
 
Partner in SDG in medium sized, MCOL midwest city. 300+/hour after bonus. Also able to max 401k to 56K or whatever fed limit is every year.

This is seeing on average about 1.5-1.8 pph, about 20% admit rate (but sometimes as high as 40-50%)

I am fortunate and happy to have my gig - at this point I'd never work for a CMG and if the opportunity to be part of an SDG disappeared I would get out of EM for good. I hope for the good of our specialty and physician compensation SDGs don't become obsolete.
 
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Forgive my ignorance but why is $200/hr considered poor pay? Seems like at 40h/wk that puts you over $400k. I get that EM is a stressful job but so is surgery, high volume clinic, critical care and lots of fields of medicine. That doesn't appear to be some ridiculously low pay, especially for a residency that has an equivalent length as FM/IM/Peds. Where am I wrong on this?
 
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Kuratz said:
Forgive my ignorance but why is $200/hr considered poor pay? Seems like at 40h/wk that puts you over $400k. I get that EM is a stressful job but so is surgery, high volume clinic, critical care and lots of fields of medicine. That doesn't appear to be some ridiculously low pay, especially for a residency that has an equivalent length as FM/IM/Peds. Where am I wrong on this?
Click to expand...
$200 is poor when you get accustomed to $300
 
Kuratz said:
Forgive my ignorance but why is $200/hr considered poor pay? Seems like at 40h/wk that puts you over $400k. I get that EM is a stressful job but so is surgery, high volume clinic, critical care and lots of fields of medicine. That doesn't appear to be some ridiculously low pay, especially for a residency that has an equivalent length as FM/IM/Peds. Where am I wrong on this?
Click to expand...


Well for starters your math is assuming 40/hr week x 50 weeks to get to 400k...so only 2 weeks of vacation all year.

ED hours are non-stop with constant interruptions, and requests to balance taking care of the critically ill while still running a patient (or worse, customer) focused convenience department.

Rotating hours including overnights and working roughly 50% of weekends and holidays.

40/hr week is unsustainable for most even at a good shop (let alone 40/hr x 50+ weeks per year).

30/hr week at 44-48 weeks per year is more realistic in my opinion.
 
Kuratz said:
Forgive my ignorance but why is $200/hr considered poor pay? Seems like at 40h/wk that puts you over $400k. I get that EM is a stressful job but so is surgery, high volume clinic, critical care and lots of fields of medicine. That doesn't appear to be some ridiculously low pay, especially for a residency that has an equivalent length as FM/IM/Peds. Where am I wrong on this?
Click to expand...

We don't work 40 hours a week. "Full time" is 120-130 hrs/month for most of us.
 
Kuratz said:
Forgive my ignorance but why is $200/hr considered poor pay? Seems like at 40h/wk that puts you over $400k. I get that EM is a stressful job but so is surgery, high volume clinic, critical care and lots of fields of medicine. That doesn't appear to be some ridiculously low pay, especially for a residency that has an equivalent length as FM/IM/Peds. Where am I wrong on this?
Click to expand...
i got 350k, then taxes on that in say south carolina comes to 218k
 
Kuratz said:
Forgive my ignorance but why is $200/hr considered poor pay? Seems like at 40h/wk that puts you over $400k. I get that EM is a stressful job but so is surgery, high volume clinic, critical care and lots of fields of medicine. That doesn't appear to be some ridiculously low pay, especially for a residency that has an equivalent length as FM/IM/Peds. Where am I wrong on this?
Click to expand...

As others have said - ER work is much more taxing on the body and soul. Put aside the rotating shifts, nights/weekends/holidays - essentially an unexpected schedule every month (sorry hun I don’t know my hours hold off on booking that vacation!) - the work is non stop, high risk with no downtime. Even in a busy clinic ( I work in one) there is downtime.

sb247 said:
$200 is poor when you get accustomed to $300
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Yeah I’d also add more importantly we are doing the same (actually more work) for less pay. It wouldn’t sit well with any1
 
You know what else didnt happen in 2015,. Team Health announcing an across the nation pay cut. Simply the macro economics is sobering. Look at the number of EM grads. Dont heed the warnings and you will be burnt. Do you not think USACS already paying stupid low rates, Envision and APP wont follow their leads? Ignore at your own peril. Ill say I remember 2015 well. Hell I was just talking with one of my former residents yesterday. When he graduated jobs and good pay were plentiful. Thats not the case anymore. a few years ago in Phoenix people were getting 350+ doing locums. thats dry like the desert.

yep 180-200 is gonna be there for a bit but how long til that drops? Look at Denver people getting under 150/hr.
 
Realistically, how long do people think itll take the jobs that currently pay 200 ish an hour to tank to 150? Im trying to come up with a 5 and 10 year plan and if I need to bust my ass a bit more picking up shifts so be it.
 
Obviously impossible to predict but I’d guess in 5-10 years they’ll be widespread reductions on that level for most of us.

sylvanthus said:
Realistically, how long do people think itll take the jobs that currently pay 200 ish an hour to tank to 150? Im trying to come up with a 5 and 10 year plan and if I need to bust my ass a bit more picking up shifts so be it.
Click to expand...
 
5 good years left. If Envision decreases like TH then, 3-5 good years left.

It will be interesting (likely sad) to see the flood out of TH and Envision docs to saturate the other companies and thereby decrease their pay.

Hopefully, I am wrong.
 
Porfirio said:
5 good years left. If Envision decreases like TH then, 3-5 good years left.

It will be interesting (likely sad) to see the flood out of TH and Envision docs to saturate the other companies and thereby decrease their pay.

Hopefully, I am wrong.
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Clearly it will happen. The docs who work for the CMGs are basically all free agents. There is no loyalty to Envision, TH, USACS, Apollo, APP etc. If there is a better job in the same city paying $10/hr more people will move there.

It would be hard to see envision not following suit. Now that the cities are full of docs and we are graduating 2400 residents a year (who owe 250k in debt and dont know any better)they will work for $180 if thats the market. Also, dont discount the people who "must" live in X city. that person will work for 170 if they can get their hours.. that will drive rates down. The new grad sees the 170/180/hr. it basic economics and it is working against EM docs.

I think in 2-3 years we will see rates drop by 10%. I also think that if the Alexander BB legistlation passes it will be a bigger drop initially and then 25+% cut over 5-7 years.

I think if they pass the NY arbitration style we should expect a 10% cut in any mildly desireable city. I think the residents will soon see that even getting "A" job in a city of their choice will become harder and harder and they can expect to drive 1 hour plus just to have a job.
 
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Find a w-2 job for the benefits, get PSLF (if it still exists), and work as an independent contractor on the side for tax benefits.
 
sylvanthus said:
Find a w-2 job for the benefits, get PSLF (if it still exists), and work as an independent contractor on the side for tax benefits.
Click to expand...

The W2 gigs in my state have this cute little tendency to force exclusivity clauses into your contract to prevent you from working elsewhere. Love it.

That's the primary reason I left my job. And...because there are no other places to work around here (or they pay less than the job I left), I'm going to have to do locums/firefighting to be able to make good money.
 
Because most of us see enough patients to earn $300+/hour minus expenses, which aren't $100/hour.
Kuratz said:
Forgive my ignorance but why is $200/hr considered poor pay? Seems like at 40h/wk that puts you over $400k. I get that EM is a stressful job but so is surgery, high volume clinic, critical care and lots of fields of medicine. That doesn't appear to be some ridiculously low pay, especially for a residency that has an equivalent length as FM/IM/Peds. Where am I wrong on this?
Click to expand...
 
EctopicFetus said:
Clearly it will happen. The docs who work for the CMGs are basically all free agents. There is no loyalty to Envision, TH, USACS, Apollo, APP etc. If there is a better job in the same city paying $10/hr more people will move there.

It would be hard to see envision not following suit. Now that the cities are full of docs and we are graduating 2400 residents a year (who owe 250k in debt and dont know any better)they will work for $180 if thats the market. Also, dont discount the people who "must" live in X city. that person will work for 170 if they can get their hours.. that will drive rates down. The new grad sees the 170/180/hr. it basic economics and it is working against EM docs.

I think in 2-3 years we will see rates drop by 10%. I also think that if the Alexander BB legistlation passes it will be a bigger drop initially and then 25+% cut over 5-7 years.

I think if they pass the NY arbitration style we should expect a 10% cut in any mildly desireable city. I think the residents will soon see that even getting "A" job in a city of their choice will become harder and harder and they can expect to drive 1 hour plus just to have a job.
Click to expand...

Not sure why you're grouping Apollo with the others. We are physician owned and not owned by a private equity firm.
 
southerndoc said:
Not sure why you're grouping Apollo with the others. We are physician owned and not owned by a private equity firm.
Click to expand...
It may be physician owned but it is not equitable. Their pay at some sites is atrocious. Are the books open? Etc.. its a step up from CMGs much like vituity might be. It’s far from ideal though.

Also, their pay at some sites is terrible.. oddly those are usually places where the payer mix is decent.. Mount Pleasant, SC and Charlotte are but 2 examples.
 
Listen, I may be an antiquated dinosaur but these mega groups running medicine are horrific. They lead to BS pay, no rights, and burnout.

Show me how much I bring in, show me how much I keep and how you spend the difference. After 1-2 years everyone should be equal. The leaders of the group should be voted on.

if your group doesnt work that way.. then I think your group is stealing. People want to confuse the issue with “what about academics?”. Yep it is different but I would argue you can and should have the same setup.

For me and I’m not a terribly black and white person but this issue is fairly (not fully) black and white to me.

EM is taking a beating. Make no mistake this is caused by the behavior of TH, Envision, and USACS. See what Lamar Alexander sent out as a response to the BB issue. He mentioned ”3” private equity groups in medicine. Surely it is those.

This issue pisses me off to no end. I dont know what apollo corporate is skimming off you, it might be 5% it might be 20%. You may have no idea. Surely regular joe who is working for 2 years at a site has no clue.
 
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The fundamental problem isn't the three groups themselves. They are a natural reaction to how groups win contracts at hospitals. Hospital admin doesn't care about physician loyalty, happiness or even patient outcomes. Groups are selected by admins on a one-sided basis with docs essentially getting no input into the selection (I know because I've been through this three times now). This of course leads to "smart" groups figuring out exactly what verbiage to use to get a contract. The ones that do it best get all the contracts and grow.

Unless we can somehow change the mindset of the decision-makers, this problem is only going to get worse.
 
If you're an admin, I demand as a part of your schedule that you get in the pit for one shift every two weeks to see what the "fray" is like.

Don't wanna do it?
Guess you're just not interested enough in operations.
You're fired.
 
This thread is depressing. Our hospital just got bought out and a new CMG is probably going to take over in a few months. If that happens, chances are our salary will decrease significantly. I’m considering moving back to my hometown to work with an SDG made up of a bunch of guys that I used to work with but I’m not sure there are any openings. If things don’t pan out, I‘ll probably approach them in a few months and see if there‘s an opening. They are making a killing, last I heard. It’s in a location about 1.5 hours from a major airport but it’s a great hospital system and hey...you can’t have everything. I just can’t consider taking a major pay cut until I’ve got more saved for retirement. These guys are making well over $300/hr.
 
Groove said:
This thread is depressing. Our hospital just got bought out and a new CMG is probably going to take over in a few months. If that happens, chances are our salary will decrease significantly. I’m considering moving back to my hometown to work with an SDG made up of a bunch of guys that I used to work with but I’m not sure there are any openings. If things don’t pan out, I‘ll probably approach them in a few months and see if there‘s an opening. They are making a killing, last I heard. It’s in a location about 1.5 hours from a major airport but it’s a great hospital system and hey...you can’t have everything. I just can’t consider taking a major pay cut until I’ve got more saved for retirement. These guys are making well over $300/hr.
Click to expand...

One thing you can do is try to get the actual collections numbers for your site. It's ammunition you can use in negotiations with the new group to justify your demands. Remember the new group needs most of the old docs to stay to keep the place fully staffed. If you band together and make reasonable demands, you will likely get some of them. Just be prepared to walk if they refuse to compromise.
 
VA Hopeful Dr said:
Especially as SC outside of Charleston has a very low COL
Click to expand...
Yeah... COL in most cities/suburbs in the south is not as outrageous as NY, LA, DC, Boston etc...

I understand becoming a doc is not easy, but if the lay public read these threads and see us complain for making only 18k/month, they would say that physicians are out of touch...

Even if one is paying 3k/month in student loan, you still have 15k left, and15k/month is enough money to make ends meet.

Of course we all would like to make zillion $$$ but we should not go over the top on things
 
Splenda88 said:
Yeah... COL in most cities/suburbs in the south is not as outrageous as NY, LA, DC, Boston etc...

I understand becoming a doc is not easy, but if the lay public read these threads and see us complain for making only 18k/month, they would say that physicians are out of touch...

Even if one is paying 3k/month in student loan, you still have 15k left, and15k/month is enough money to make ends meet.

Of course we all would like to make zillion $$$ but we should not go over the top on things
Click to expand...

18K per month
- 3K for student loan
- 6K for taxes
- 4k for retirement
- 2K for mortgage
- 1K for car and various expenses

Only leaves 2K at the end of the month. It's amazing how much loans/taxes can eat away into a decent salary.
 
Splenda88 said:
Yeah... COL in most cities/suburbs in the south is not as outrageous as NY, LA, DC, Boston etc...

I understand becoming a doc is not easy, but if the lay public read these threads and see us complain for making only 18k/month, they would say that physicians are out of touch...

Even if one is paying 3k/month in student loan, you still have 15k left, and15k/month is enough money to make ends meet.

Of course we all would like to make zillion $$$ but we should not go over the top on things
Click to expand...

Same job once paid at 27k. When taken in a pay cut of that size... it hurts regardless
 
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