Another Poll...

[DocM]

---

Members don't see this ad.

This question is for up and coming EP's, residents and attendings.

When you decided to do EM how did you reconcile the fact that newly graduated EP's are compensated about the same as EP's who have been the field for over 5 or 10 yrs. According to this web site...

http://www.allied-physicians.com/salary_surveys/physician-salaries.htm

a newly minted EP makes ~200K. Off course this varies with geography. And EP's in the field for some time seem to top out at around 300K. So from what I have read the salary range seems to be narrow in EM (correct me if I am wrong). Has this been a sticking point for those in EM. And if so , how have you resolved it. Are there other perks to EM that make the narrow salary range issue not relevant?

 

[stoic]

Emergency Medicine Physicians are (for the most part) shift workers. So the phenomenon you've described is part of the game.

There are some variations to straight shift work. Some groups will partner you after a set number of years and yet other have production bonuses for # of patients seen/procedures performed.

 

[roja]

Why would making 200/300K even be an issue?


I think that I found better use of my time when I was a fourth year and now as a resident than to worry about this kind of stuff. 🙂 Like when alias was starting and what to eat for dinner. 😉

 

[waterski232002]

Why would making 200/300K even be an issue?


I think that I found better use of my time when I was a fourth year and now as a resident than to worry about this kind of stuff. 🙂 Like when alias was starting and what to eat for dinner. 😉

Personally, I feel that lifestyle is more important than my salary after a certain point... For me--that point happens to be over $200,000!!! I guess EM works out great!

 

[Freeeedom!]

A HUGE portion of your equation is missing...

MOST groups cut down shifts as seniority increases!! Or increasing vacation time.
In other words you may only have minimal increase in salary, but your monthly hours decrease...often times significantly.

To add to this, in 5 years you may be working 4 less shifts monthly you may now likely take part in group bonuses, and you may also add shifts for an hourly salary. Doesn't sound too bad to me.

 

[DocM]

Very informative. Thank you all. Keep'm coming. You and my freinds here in the ED are starting to convince me.

 

[roja]

I hope salary isn't the only thing convincing you. It is definately a nice benefit to EM but if you hate working in the ED, then it doesn't matter HOW much money you make. I don't know that I have every met anyone who was in the middle aobut EM. People either seem to love it or hate it.

There are other fields that do shift work as well.

 

[EMApplicant]

To the OP:

Would you prefer EM docs started at 125k and worked their way up? 😕

 

[DocM]

I hope salary isn't the only thing convincing you. It is definately a nice benefit to EM but if you hate working in the ED, then it doesn't matter HOW much money you make. I don't know that I have every met anyone who was in the middle aobut EM. People either seem to love it or hate it.

There are other fields that do shift work as well.

Salary is not one of things I am considering. I saw the link to salaries and was curious. My real dilemma is if I want to be a generalist or specialist. Surgery or non-surgical. I liked both my EM and surgery rotations (esp. Neuro). The part I did not like about EM was the amount of primary care that is done. It seemed to me (perhaps this was only my experience) that many cases presenting to the EM were not emergencies. I saw cases ( ~one in four or five ) about aliments that I personally would have never come to the ED for. But I my experience could have been unusual. Perhaps I need to rotate elsewhere to learn more. Another dilemma of mine is that EM did not seem to have an academic focus. And many of the attendings and residents I worked under did not seem interested in basic/ clinical research. I like research, so I wonder if I ‘ll be able to find a niche in EM. Although I do hear (Saem.org) that things are changing and more residents are being encouraged to publish.

 

[Sessamoid]

Salary is not one of things I am considering. I saw the link to salaries and was curious. My real dilemma is if I want to be a generalist or specialist. Surgery or non-surgical. I liked both my EM and surgery rotations (esp. Neuro). The part I did not like about EM was the amount of primary care that is done. It seemed to me (perhaps this was only my experience) that many cases presenting to the EM were not emergencies. I saw cases ( ~one in four or five ) about aliments that I personally would have never come to the ED for. But I my experience could have been unusual. Perhaps I need to rotate elsewhere to learn more. Another dilemma of mine is that EM did not seem to have an academic focus. And many of the attendings and residents I worked under did not seem interested in basic/ clinical research. I like research, so I wonder if I ‘ll be able to find a niche in EM. Although I do hear (Saem.org) that things are changing and more residents are being encouraged to publish.

It sounds like you still have some fairly broad decisions to make regardless career choice.

EM is a fair amount of primary care no matter where you go, partly because most people cannot distinguish an emergency from a non-emergency and partly due to the increasing proportion of un-/underinsured people in our country. If that bothers you, then you can probably cross EM off your list.

Research positions are certainly available, and if you're actively interested in research I don't think it would be difficult to find a teaching position. As a general rule, EPs tend to be very practical people and on the whole less interested in research than the average physician pool.

 

[roja]

It sounds like you still have some fairly broad decisions to make regardless career choice.

EM is a fair amount of primary care no matter where you go, partly because most people cannot distinguish an emergency from a non-emergency and partly due to the increasing proportion of un-/underinsured people in our country. If that bothers you, then you can probably cross EM off your list.

Research positions are certainly available, and if you're actively interested in research I don't think it would be difficult to find a teaching position. As a general rule, EPs tend to be very practical people and on the whole less interested in research than the average physician pool.

OOOOOOOOOOOOOOOOh, I get to disagree with sessamoid. 😀


I don't think that EM is alot of primary care. There is definately alot of nonemergent stuff that you see. However, the approach to the patient is NEVER the primary care approach. In EM we go through a completely different thought process than a primary doctor will. When someone comes in with SOB and pleuritic chest pain, I immediately have to rule out a number of life threatening illnesses. A primary doctor has a different approach.

It is very dangerous in EM to approach the nonemergents as though they are primary care patients. This is how atypical PE's, MI's, etc get missed. However, what you realize is that after you have been in it a while, you start to internalize the process of elimination and rapidly come to a disposition for your nonemergents. But as in the above case, I would be foolish to imediatly jump to 'cold/pleurisy' without thinking about other serious things. And that's why its not primary care but instead having to deal with nonemergent patients.

The academic focus, like all fields, will depend on the type of residency you pick. There are going to be residencies that focus on research and places that dont. We have a ton of bench and clinical research here. And there are research fellowships (often involves getting a masters). Not to mention fellowships like tox which are very heavy into research.

And this is also very resident based. We have residents that hate research. I love it and am involved in 4 projects. I have already finished one, I am int he process of writing an IRB for one small study and one very large one. I have also written a chapter for a book adn have two more due soon.

All EM based.

 

[WilcoWorld]

The more of your posts I read, the more I like you Roja.

I can't imagine how miserable people who go into medcine looking for easy $$$ must end up. My condolences (but not my sympathy!) to them.

 

[Sessamoid]

OOOOOOOOOOOOOOOOh, I get to disagree with sessamoid. 😀

You're entitled to your opinion of course. 🙂 But not all private practice emergency medicine will be the same acuity that you see in tertiary care academic institutions. You still go through the same thought process, but at many hospitals, the overwhelming majority of the patients come in for pure crap. It can end up being a lot of primary care once you've ruled out all the bad stuff. If the patient population is dumb enough, the "ruling out the bad stuff" part can be done by the time you finish reading the triage note.

It's not the same as primary care, but in many communities you end up doing a lot of primary care in addition to EM.

 

[Febrifuge]

Aww, you're both right. People may try to use (and they may succeed in using) the ED as a primary "clinic." ...But the differences between an ED and a true clinic are legion, and on some level that must be apparent to even the most Gomertonin-toxic pt out there.

Just to name one thing, in most primary-care settings, continuity is viewed as a good thing. In our ED, if the computer says you've been to see us 10 times in the last year, you will likely be having "the talk" with the social worker. Whatever you need -- if you're not sick -- we'll help you find it. But we don't want to be it.

And I'm sorry, but no, the County no longer gives cab vouchers. Again, talk to the social worker.

 

[Sessamoid]

The above being said, I still get enough out of the interesting and gratifying cases to make up for the obviously non-urgent crap that walks in so often. I had one case last shift of a girl who came in c/o general weakness and a history of supposed "hypokalemia" (her words) of allegedly renal origin. I was all set to start her on IVF with supplemental K, but the exam just didn't make sense. Carpalpedal spasms and generally increased tonicity. Tap her face and sure enough, she has Chvostek's sign. So instead of the K, she got CaCl instead (we don't have gluconate in the ER for some reason) and I threw in MgSO4 for good measure. Turns out her calcium was normal (ionized takes forever at my hospital), but her Mag level was 0.6. A touch on the low side....

 

[docB]

The fact that you make the same starting out that you will in the future is not really good or bad, it's just part of the game. The only problem I've had with it (not so much a problem as an amusing conversation) was with my broker who just couldn't understand that my income had already topped out.

 

[DrQuinn]

But not all private practice emergency medicine will be the same acuity that you see in tertiary care academic institutions. You still go through the same thought process, but at many hospitals, the overwhelming majority of the patients come in for pure crap. It can end up being a lot of primary care once you've ruled out all the bad stuff. .

So do you see more or less "crap" now than you did in residency? and I'm talking about your job out in CA not in FL. I was hoping I'd see less homeless/disability seeking and more real stuff (even if real stuff is sprain ankles, fxs, etc).

Dont' get me wrong, we see a LOT of acuity at TGH, with tons of trauma and what-not, but there is a lot of interspersed "crap" that walks in locally.

Q

 

[Sessamoid]

So do you see more or less "crap" now than you did in residency? and I'm talking about your job out in CA not in FL. I was hoping I'd see less homeless/disability seeking and more real stuff (even if real stuff is sprain ankles, fxs, etc).

Dont' get me wrong, we see a LOT of acuity at TGH, with tons of trauma and what-not, but there is a lot of interspersed "crap" that walks in locally.

Q

Depends a lot of the area you work in. I feel like I've done my part for the good of society having worked in this craphole of a neighborhood I have been for the past year. But the acuity is pretty damned low. We're used largely as a primary care clinic by the loads of uninsured/Medi-Cal and stupid patients. I end up having to do a whole mess of expensive tests for what is likely a minor or chronic condition. We get some good cases, but for the most part it's boring ****e.

Tonight is my last shift there, and the hospital closes the day after. I'm moving to a rather higher acuity center so I probably won't be so ticked off and bitter next week.

 

[ERMudPhud]

So do you see more or less "crap" now than you did in residency? and I'm talking about your job out in CA not in FL. I was hoping I'd see less homeless/disability seeking and more real stuff (even if real stuff is sprain ankles, fxs, etc).

Dont' get me wrong, we see a LOT of acuity at TGH, with tons of trauma and what-not, but there is a lot of interspersed "crap" that walks in locally.

Q

Not Kidding! Last weekend two carloads of people come zooming simultaneously into the ambulance entrance at 5:00 AM like someone is dying. Mom, Dad, Kids, Grandpa, Grandma are all here so that Grandma can be seen. Grandma ends up having a whole bunch of complaints. Some of which are active right now (neck pain) and others that happened a few days or weeks ago ("bleeding somewhere down there"). One family member actually said, "she just needs a good check up" As docB likes to say," EM, saving the world from having to see their PCP"

 

[Sessamoid]

The ones that really tick me off are multiple people that check in together. My basic rule of thumb for those is that as the number of people that check in together increases, the probability of any of them being truly ill approaches zero. If there was somebody in that group who was really sick, the others would be too concerned about the sick person's condition to bother signing in.