Big Beautiful Bill

[DocEspana]

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It would hurt the poors

you could pretty easily work that out easily and say that everyone making under $30/60k is tax free. And the tax slowly increases a percent at a time at a regular interval from 1% to 25% as you go from 30/60k to 100/200k, and then it just remains 25% from 100/200k onwards.

Basically the real tax rate is 25% across the board, but the truly poor are exempt and those under the "upper middle class" pay a graduated rate. The math probably works out pretty damn good. Right now someone making exactly $100k pays $14k in taxes. In the system I just created off the top of my head they pay $17.5k. And 24% is the current tax rate from 100-200k, so my system is essentially unchanged from that same range. And you'd think "oh but we will collect so much less from the rich who dont have that 32/35/37 tax rate" but thats nonsense since the rich dont pay ANYTHING close to that tax rate. I pay sub 20% taxes thanks to all the tax sheltering stuff that is just standard on the tax code and I'm not some brilliant tax wizard, though my CPA might be.

 

[Splenda88]

you could pretty easily work that out easily and say that everyone making under $30/60k is tax free. And the tax slowly increases a percent at a time at a regular interval from 1% to 25% as you go from 30/60k to 100/200k, and then it just remains 25% from 100/200k onwards.

Basically the real tax rate is 25% across the board, but the truly poor are exempt and those under the "upper middle class" pay a graduated rate. The math probably works out pretty damn good. Right now someone making exactly $100k pays $14k in taxes. In the system I just created off the top of my head they pay $17.5k. And 24% is the current tax rate from 100-200k, so my system is essentially unchanged from that same range. And you'd think "oh but we will collect so much less from the rich who dont have that 32/35/37 tax rate" but thats nonsense since the rich dont pay ANYTHING close to that tax rate. I pay sub 20% taxes thanks to all the tax sheltering stuff that is just standard on the tax code and I'm not some brilliant tax wizard, though my CPA might be.

Yeah. That might work. How did you pay sub 20%?

I paid 20% to the feds, 5% to the state, 2.3% social security and 1.86% medicare. That is 29% total.

I will fire my accountant.

 

[DocEspana]

Yeah. That might work. How did you pay sub 20%?

I paid 20% to the feds, 5% to the state, 2.3% social security and 1.86% medicare. That is 29% total.

I will fire my accountant.

0% state was a nice part of that for me. The rest? Idk man. We don't do anything shady, we just make sure literally every standard trick is done and that ever expense in my whole spending history is honestly assessed to see if it qualifies as business related.

 

[Porfirio]

Do you think I could pay myself overtime to save on taxes with this new bill? I am 1099 LLC-Scorp, and I make W2s. I definitely work more hours than the average EM physician.

 

[EctopicFetus]

Also just revert to the 44% top tax rate of Reagan
or the 50% top tax rate of Reagan
or the 70% top tax rate of Reagan.

He cut the top tax rate *a lot* of times.

And its not a panacea for everything and its not a perfect solution, but it is undoing a bad (or three bad) decisions of Reagan which lead to him starting with a 1 trillion debt and making it a 2 trillion debt in his first term and a 4 trillion debt by his second term and we have been off to the debt races ever since. He proved cutting taxes recklessly gets you elected and Bush (the greater) proved that increasing them gets you voted out. so now we are just left growing programs AND not finding any way to pay for them forever and ever, amen.

IMO it is “lazy” (not referring to you) to just say increase taxes. It’s equally lazy to say “cut entitlements”. Reality is we need both. I would love to see the parties come up with a plan. I would love a dem supported plan to raise taxes and cut spending, same for a republican only version and then see how they would cross whereas Dems do the taxes and Rs do the spending cuts and then flip it.

Personally, if I were king it wouldnt be that hard. But politics is tricky and old people vote and many of them are unlikely to worry much about the future.

Similarly to “just raise taxes” we should just cut entitlements. Remove the ACA etc.

 

[EctopicFetus]

Do you think I could pay myself overtime to save on taxes with this new bill? I am 1099 LLC-Scorp, and I make W2s. I definitely work more hours than the average EM physician.

I believe it is limited by pay and on top of that “working more” than an average EM doc isnt the definition. So doubtful.

 

[DocEspana]

Do you think I could pay myself overtime to save on taxes with this new bill? I am 1099 LLC-Scorp, and I make W2s. I definitely work more hours than the average EM physician.

I asked Chat GPT this exact question because it seemed like something could figure out. They say that there is no restrictions on who can claim overtime, but it does need to be specifically documented as overtime pay in the financial documents. This is something you can probably do with whoever is doing your payroll. The only thing I would say is even though I don't see any evidence that it would be a problem to do so.... I think the general advice I'm always given is that you don't know if something is going to piss off the IRS auditors until they actually go and start auditing and you find out what they deem as ethical or unethical.

It feels unethical. But I also know that a lot of things that feel unethical to me are apparently established acceptable things

 

[EctopicFetus]

you could pretty easily work that out easily and say that everyone making under $30/60k is tax free. And the tax slowly increases a percent at a time at a regular interval from 1% to 25% as you go from 30/60k to 100/200k, and then it just remains 25% from 100/200k onwards.

Basically the real tax rate is 25% across the board, but the truly poor are exempt and those under the "upper middle class" pay a graduated rate. The math probably works out pretty damn good. Right now someone making exactly $100k pays $14k in taxes. In the system I just created off the top of my head they pay $17.5k. And 24% is the current tax rate from 100-200k, so my system is essentially unchanged from that same range. And you'd think "oh but we will collect so much less from the rich who dont have that 32/35/37 tax rate" but thats nonsense since the rich dont pay ANYTHING close to that tax rate. I pay sub 20% taxes thanks to all the tax sheltering stuff that is just standard on the tax code and I'm not some brilliant tax wizard, though my CPA might be.

The concept of hurting the poor needs to keep up with the reality of who pays federal taxes. First the left wants to confuse things with social security and Medicare etc.

If you take social security for what it is, then it is really a retirement fund for people. It isnt a “tax” the way federal, state and local taxes are.

The bottom 50% of the country pays 3% of the federal income tax collected.

The top 1% pay 40% of all federal income tax.

Summary of the Latest Federal Income Tax Data, 2025 Update

New IRS data shows the US federal income tax system continues to be progressive as high-income taxpayers pay the highest average income tax rates. Average tax rates for all income groups remain lower after the Tax Cuts and Jobs Act (TCJA).

taxfoundation.org

This isnt to argue what is fair or not just to point out the reality. Any tax cut is going to benefit the “rich” since they pay a disproportionate amount of tax.

The avg tax paid by the top 1% is 26%. I would suggest we go to a flatter system and remove all the tax loopholes and credits etc.

I think the answer is also a VAT or something similar but as simple as possible. I would do that, make it so that i would have 0 taxes on some very high amount of income. Perhaps 75k. I would then have 1-3 steps from there with no deductions. Perhaps 15% from 75k-150k and 25% from 150k to 500k (or $1m) and then 35% on everything above a million. I would have a separate system for long term capital gains. Perhaps the cut off there would be no taxes on anything under 150k and then 20% between 150k and $1m and 35% on everything over $1m. I would need to think a little more to make the numbers make sense. I would also remove limits on retirement contributions.

We need a simpler cleaner system with less shenanigans. I have been around the physician money world for a bit. The real wealthy docs do DB plans, 401k/PSP (or similar), then heavy expenses as 1099s. I would eliminate most of that.

Reality is someone needs to pay taxes and it should be those who earn well.

 

[EctopicFetus]

I asked Chat GPT this exact question because it seemed like something could figure out. They say that there is no restrictions on who can claim overtime, but it does need to be specifically documented as overtime pay in the financial documents. This is something you can probably do with whoever is doing your payroll. The only thing I would say is even though I don't see any evidence that it would be a problem to do so.... I think the general advice I'm always given is that you don't know if something is going to piss off the IRS auditors until they actually go and start auditing and you find out what they deem as ethical or unethical.

It feels unethical. But I also know that a lot of things that feel unethical to me are apparently established acceptable things

Here's a breakdown of the rules and what you need to know:

• Deduction, Not Exclusion: This is a deduction from federal income tax, not an outright exclusion of tips from taxable income. This means workers still need to report their tips and then claim the deduction when filing their tax returns.
• Cap on Deduction: The maximum amount of reported tip income that can be deducted annually is $25,000.
• Income Limit: The deduction is only available to workers whose total annual income (including tips, wages, and bonuses) is $150,000 or less ($300,000 for joint filers). The benefit is phased out for those exceeding this income limit.
• Qualifying Occupations: The deduction is intended for individuals engaged in occupations where tipping was customarily and regularly received on or before December 31, 2024. The U.S. Treasury Secretary is required to publish a list of qualifying occupations within 90 days of the bill becoming law.
• Reporting Requirements: Tips must still be reported to the employer, typically on a W-2 form.
• No Change to Payroll Taxes: Social Security and Medicare (FICA) taxes on tips still apply. This provision only addresses federal income tax.
• Temporary Provision: The "no tax on tips" deduction is currently in effect for tax years 2025 through 2028. Congress could potentially alter or abolish it in the future.
• State and Local Taxes: The deduction does not apply to state or local income taxes on tips, which may still be collected.

The recent "Big Beautiful Bill"
includes provisions for a federal income tax deduction on overtime pay.
Here's a summary of the rules around this deduction:

• It's a deduction, not an exemption: Overtime wages will still be subject to withholding, but workers can deduct the federal income taxes paid on those wages when filing their returns, even if they don't itemize.
• Deduction limit: The deduction is capped at $12,500 per year ($25,000 for those filing jointly).
• Income phase-out: The deduction amount is reduced if your modified adjusted gross income exceeds $150,000 ($300,000 for a joint return).
• Applies only to FLSA-required overtime: This deduction is for overtime compensation required under the Fair Labor Standards Act (FLSA), specifically the amount exceeding the employee's regular rate. It does not apply to overtime premiums paid based on contracts or state law only.
• No double-dipping: You cannot claim both a tip deduction and an overtime deduction for the same qualified income.
• Requires SSN: The deduction is not allowed unless you include your Social Security Number (and spouse's if filing jointly) on your tax return.
• Temporary: The deduction is in effect for tax years 2025 through 2028.
• Retroactive: These rules apply retroactively starting January 1, 2025.

 

[DocEspana]

Here's a breakdown of the rules and what you need to know:

• Deduction, Not Exclusion: This is a deduction from federal income tax, not an outright exclusion of tips from taxable income. This means workers still need to report their tips and then claim the deduction when filing their tax returns.
• Cap on Deduction: The maximum amount of reported tip income that can be deducted annually is $25,000.
• Income Limit: The deduction is only available to workers whose total annual income (including tips, wages, and bonuses) is $150,000 or less ($300,000 for joint filers). The benefit is phased out for those exceeding this income limit.
• Qualifying Occupations: The deduction is intended for individuals engaged in occupations where tipping was customarily and regularly received on or before December 31, 2024. The U.S. Treasury Secretary is required to publish a list of qualifying occupations within 90 days of the bill becoming law.
• Reporting Requirements: Tips must still be reported to the employer, typically on a W-2 form.
• No Change to Payroll Taxes: Social Security and Medicare (FICA) taxes on tips still apply. This provision only addresses federal income tax.
• Temporary Provision: The "no tax on tips" deduction is currently in effect for tax years 2025 through 2028. Congress could potentially alter or abolish it in the future.
• State and Local Taxes: The deduction does not apply to state or local income taxes on tips, which may still be collected.

The recent "Big Beautiful Bill"
includes provisions for a federal income tax deduction on overtime pay.
Here's a summary of the rules around this deduction:

• It's a deduction, not an exemption: Overtime wages will still be subject to withholding, but workers can deduct the federal income taxes paid on those wages when filing their returns, even if they don't itemize.
• Deduction limit: The deduction is capped at $12,500 per year ($25,000 for those filing jointly).
• Income phase-out: The deduction amount is reduced if your modified adjusted gross income exceeds $150,000 ($300,000 for a joint return).
• Applies only to FLSA-required overtime: This deduction is for overtime compensation required under the Fair Labor Standards Act (FLSA), specifically the amount exceeding the employee's regular rate. It does not apply to overtime premiums paid based on contracts or state law only.
• No double-dipping: You cannot claim both a tip deduction and an overtime deduction for the same qualified income.
• Requires SSN: The deduction is not allowed unless you include your Social Security Number (and spouse's if filing jointly) on your tax return.
• Temporary: The deduction is in effect for tax years 2025 through 2028.
• Retroactive: These rules apply retroactively starting January 1, 2025.

I assume most of us aren't paying ourselves too much more than 150k. I do pay myself more than 150k, but again, not too much more. So we are in the phase out zone, but not tremendously deep into it. I don't know how much shielding 25k really does for me, but it's something.

But as my accountant would say, if it ends up catching the eyeballs of the IRS, the amount that I would pay in services for an audit would be so much more than any savings on this

 

[EctopicFetus]

I assume most of us aren't paying ourselves too much more than 150k. I do pay myself more than 150k, but again, not too much more. So we are in the phase out zone, but not tremendously deep into it. I don't know how much shielding 25k really does for me, but it's something.

But as my accountant would say, if it ends up catching the eyeballs of the IRS, the amount that I would pay in services for an audit would be so much more than any savings on this

I assume your income is more than that. I also am no expert but I doubt it would be FLSA approved since I assume people would do this thru their 1099. I dont know the specifics of the law but hard to imagine they would allow you to do this if you work for yourself or spouse.

 

[DocEspana]

I assume your income is more than that. I also am no expert but I doubt it would be FLSA approved since I assume people would do this thru their 1099. I dont know the specifics of the law but hard to imagine they would allow you to do this if you work for yourself or spouse.

My income as an "employee" of my company that is sort of also me? No. It's about $180k. Which is pretty much the baseline for everyone down here in South FL

 

[Porfirio]

Joint is $300k. Which if you add full retirement could be ~$400k. Add in expenses, I bet I could make $460k a year and qualify for this.

Also this might make a Cash Balance Plan even more attractive to me.

 

[calvnandhobbs68]

I assume most of us aren't paying ourselves too much more than 150k. I do pay myself more than 150k, but again, not too much more. So we are in the phase out zone, but not tremendously deep into it. I don't know how much shielding 25k really does for me, but it's something.

But as my accountant would say, if it ends up catching the eyeballs of the IRS, the amount that I would pay in services for an audit would be so much more than any savings on this

Yeah I mean professionals using their S corp to BS "overtime pay" seems like stuff that'll be low hanging fruit for an audit. You would also have to break out how much is being paid ABOVE your usual rate which is the part that's deducted. Someone with an S corp who suddenly started paying themselves 1.5 times hourly rate "overtime" to get the same W2 income as prior years I'd guess would almost definitely raise some eyebrows.

Tax provisions in the One Big Beautiful Bill Act

The bill extends portions of the Tax Cuts and Jobs Act, provides deductions to eliminate income taxes on certain tips and overtime pay, and addresses other tax priorities of the Trump administration.

www.journalofaccountancy.com

"The bill defines qualified overtime compensation as overtime compensation paid to an individual required under Section 7 of the Fair Labor Standards Act of 1938 that is in excess of the regular rate (as used in that section) at which the individual is employed."

 

[DocEspana]

Yeah I mean professionals using their S corp to BS "overtime pay" seems like stuff that'll be low hanging fruit for an audit. You would also have to break out how much is being paid ABOVE your usual rate which is the part that's deducted. Someone with an S corp who suddenly started paying themselves 1.5 times hourly rate "overtime" to get the same W2 income as prior years I'd guess would almost definitely raise some eyebrows.

Tax provisions in the One Big Beautiful Bill Act

The bill extends portions of the Tax Cuts and Jobs Act, provides deductions to eliminate income taxes on certain tips and overtime pay, and addresses other tax priorities of the Trump administration.

www.journalofaccountancy.com

"The bill defines qualified overtime compensation as overtime compensation paid to an individual required under Section 7 of the Fair Labor Standards Act of 1938 that is in excess of the regular rate (as used in that section) at which the individual is employed."

What's the deduction? $15k? Lot of doctors working EXACTLY 15k and not a dollar more in extra overtime hours this year

Edit: I don't know if I got the total deduction right. I worked under the assumption that I got it right at 15K, but maybe it's 25k. Regardless, I did the math for what that would actually be if you were paying yourself 180k through the S Corp. 7.5 extra hours a month.

Feels scummy, but also it's barely any extra hours being reported.

It's just.... Also .. actually scummy since it's all a tax trick to begin with. There arent actually 7.5 extra hours being worked.

 

[Porfirio]

What's the deduction? $15k? Lot of doctors working EXACTLY 15k and not a dollar more in extra overtime hours this year

Edit: I don't know if I got the total deduction right. I worked under the assumption that I got it right at 15K, but maybe it's 25k. Regardless, I did the math for what that would actually be if you were paying yourself 180k through the S Corp. 7.5 extra hours a month.

Feels scummy, but also it's barely any extra hours being reported.

It's just.... Also .. actually scummy since it's all a tax trick to begin with. There arent actually 7.5 extra hours being worked.

7.5 hrs is nothing

 

[CliveStaples]

Physicians are exempted from FLSA overtime requirements anyway, so this would never apply.

I imagine the most personal benefit the new bill will bring to physicians is via expanded SALT deductions.

 

[EctopicFetus]

Physicians are exempted from FLSA overtime requirements anyway, so this would never apply.

I imagine the most personal benefit the new bill will bring to physicians is via expanded SALT deductions.

And keeping taxes “low”.

 

[WhatJobDoIPick]

Is this it?

Is this the thing that will convince the throngs of medical students that are still applying for this trash tier field to stop?

Heads up: this legislation will likely gut EM compensation. Get ready to do state mandated charity care that you'll still be on the hook for if you make a mistake.

 

[JacobMcCandles]

Is this it?

Is this the thing that will convince the throngs of medical students that are still applying for this trash tier field to stop?

Heads up: this legislation will likely gut EM compensation. Get ready to do state mandated charity care that you'll still be on the hook for if you make a mistake.

Are you saying the Medicaid issue is what’s going to gut EM compensation? Because that’s way too strong of a word for that. This is definitely a downward pressure but I’ll be incredibly surprised if compensation is “gutted” because of this.

 

[EctopicFetus]

Are you saying the Medicaid issue is what’s going to gut EM compensation? Because that’s way too strong of a word for that. This is definitely a downward pressure but I’ll be incredibly surprised if compensation is “gutted” because of this.

Yeah. Medicare cuts have hit us since covid.. meanwhile EM pay is up.. food for thought.

 

[WhatJobDoIPick]

Yeah. Medicare cuts have hit us since covid.. meanwhile EM pay is up.. food for thought.

What's your inflation adjusted pay doing?

 

[JacobMcCandles]

What's your inflation adjusted pay doing?

It’s not gutted, I’ll tell you that.

 

[EctopicFetus]

What's your inflation adjusted pay doing?

Im in a private group and I cant say specifics but it is way way up.. Again has less to do with government but I think it is total nonsense some of the discussions we are having. Medicare has been literally cutting pay.. Meanwhile EM pay is overall up. It may not be keeping up with inflation but lets be real. Society isnt about to shed a tear for people making nearly 400k a year. Personally I think we are underpaid when I see what many other docs do and go through.. That being said I think lots of docs are also overpaid. Given our complete lack of flexibility in work environment society has us by the short and curlys. Given the lack of leverage we are doing well. 15 years ago normal pay in EM was 180/hr. I chose to enter this field when i thought annual pay was 180k.

So again, I cant say personally that I havent kept up with inflation but i think we are near capped in my group. the CPI-U is up ~25% from Jan 2019 until now.. my pay is up more than that in that same time frame.

 

[WhatJobDoIPick]

Im in a private group and I cant say specifics but it is way way up.. Again has less to do with government but I think it is total nonsense some of the discussions we are having. Medicare has been literally cutting pay.. Meanwhile EM pay is overall up. It may not be keeping up with inflation but lets be real. Society isnt about to shed a tear for people making nearly 400k a year. Personally I think we are underpaid when I see what many other docs do and go through.. That being said I think lots of docs are also overpaid. Given our complete lack of flexibility in work environment society has us by the short and curlys. Given the lack of leverage we are doing well. 15 years ago normal pay in EM was 180/hr. I chose to enter this field when i thought annual pay was 180k.

So again, I cant say personally that I havent kept up with inflation but i think we are near capped in my group. the CPI-U is up ~25% from Jan 2019 until now.. my pay is up more than that in that same time frame.

I mean 400k for the work we do is crap shrug

 

[WhatJobDoIPick]

It’s not gutted, I’ll tell you that.

Yeah? Keeping up with inflation?

 

[HemorrhagicShock]

I mean 400k for the work we do is crap shrug

And you're not getting this kind of pay in a desirable place to live unless you have some inroads to a highly exclusive fat-payor-mix group.

I'm always wary when I hear these high incomes in EM, because there's always some give.

In medicine, you have the following: Pay, location, job satisfaction - you're lucky if you get TWO

In EM, you're lucky if you get one.

 

[EctopicFetus]

Yeah? Keeping up with inflation?

We can play this. IN 2020 EM docs per doximity made 354K.

Doximity Study Finds Physician Compensation Slowed in 2020

Research shows physician wages have grown by only 1.5% amid COVID-19 pandemic; Gender pay gap among doctors persists at 28%

press.doximity.com

Has link to the report.

in 2024 it was 398k also per doximity,.

Doximity 2024 Physician Compensation Report

Explore the Doximity 2024 Physician Compensation Report for comprehensive insights into physician compensation trends in the U.S., including changes in specialty earnings, the impact of employment settings, metro area comparisons, and updates on the gender wage gap. Get detailed analyses and...

www.doximity.com

CPI was 21%

U.S. food prices rose by 23.6 percent from 2020 to 2024 | Economic Research Service

From 2020 to 2024, the all-food Consumer Price Index (CPI) rose 23.6 percent, a higher increase than the all-items CPI, which grew 21.2 percent over the same period. Transportation prices grew the fastest across categories, with an increase of 34.4 percent between 2020–24, while housing...

www.ers.usda.gov

If we grew at 21% we would be at 428k. We grew more like 12%.

A few thoughts. This is much better given what medicare has done and inflation has been quite high.

It also presumes we arent / werent overpaid in 2020.

So much depends on what we pick as a starting point.

2019–2020 Emergency Physician Compensation Report - ACEP Now

ACEP Now offers real-time clinical news, news from the American College of Emergency Physicians, and news on practice trends and health care reform for the emergency medicine physician. ACEP Now is an official publication of the American College of Emergency Physicians.

www.acepnow.com

In 2009–2010, the national average was $141 per hour. This year, the national average is $221 per hour, a 36 percent increase over 10 years.

From 2010 to 2020, the average annual inflation rate in the U.S. was approximately 1.73%. This means that, on average, prices increased by 1.73% each year between 2010 and 2020. The cumulative inflation over the entire decade, according to the Bureau of Labor Statistics consumer price index, was about 18.69%

So what we see is from 2010 to 2020 our pay increase was about 2x inflation. It is easy to ignore that but it explains why the last 5-6 years havent kept up.

 

[EctopicFetus]

Looking way back..

10 Statistics on Emergency Medicine Physicians' Salaries - Becker's Hospital Review | Healthcare News & Analysis

The average salaries of emergency medicine physicians fell in 2011 from 2010, but compensation still stayed above $230,000.

www.beckershospitalreview.com

The average salaries of emergency medicine physicians fell in 2011 from 2010, but compensation still stayed above $230,000, according to Medscape’s

Inflation is about 47% from 2010 til now. Using 237k (it was lower) and using 47% inflation pay would be 348k. Yes.. we are about 12% above that inflation number. The point is we can always pick arbitrary numbers. The further back you go the better we have it. Sure there are exceptions. My first group I had guys telling me how they were making 700k in the late 90s. Hospital was paying 100% of billed charges apparently. Im not old enough to verify but no idea why people would lie.

Im a glass half full guy. Its pretty hard to find 400k a year jobs especially ones where you can completely clock out when you leave. Executives make 400k but they are not "off" as much as most EM docs are "off".

 

[JacobMcCandles]

Yeah? Keeping up with inflation?

Actually probably pretty close. A lot of that has to do with a competent billing company and insurance contracts. I work hard but my income reflects that and I honestly can’t complain in the grand scheme.

 

[emergentmd]

We can play this. IN 2020 EM docs per doximity made 354K.

Doximity Study Finds Physician Compensation Slowed in 2020

Research shows physician wages have grown by only 1.5% amid COVID-19 pandemic; Gender pay gap among doctors persists at 28%

press.doximity.com

Has link to the report.

in 2024 it was 398k also per doximity,.

Doximity 2024 Physician Compensation Report

Explore the Doximity 2024 Physician Compensation Report for comprehensive insights into physician compensation trends in the U.S., including changes in specialty earnings, the impact of employment settings, metro area comparisons, and updates on the gender wage gap. Get detailed analyses and...

www.doximity.com

CPI was 21%

U.S. food prices rose by 23.6 percent from 2020 to 2024 | Economic Research Service

From 2020 to 2024, the all-food Consumer Price Index (CPI) rose 23.6 percent, a higher increase than the all-items CPI, which grew 21.2 percent over the same period. Transportation prices grew the fastest across categories, with an increase of 34.4 percent between 2020–24, while housing...

www.ers.usda.gov

If we grew at 21% we would be at 428k. We grew more like 12%.

A few thoughts. This is much better given what medicare has done and inflation has been quite high.

It also presumes we arent / werent overpaid in 2020.

So much depends on what we pick as a starting point.

2019–2020 Emergency Physician Compensation Report - ACEP Now

ACEP Now offers real-time clinical news, news from the American College of Emergency Physicians, and news on practice trends and health care reform for the emergency medicine physician. ACEP Now is an official publication of the American College of Emergency Physicians.

www.acepnow.com

In 2009–2010, the national average was $141 per hour. This year, the national average is $221 per hour, a 36 percent increase over 10 years.

From 2010 to 2020, the average annual inflation rate in the U.S. was approximately 1.73%. This means that, on average, prices increased by 1.73% each year between 2010 and 2020. The cumulative inflation over the entire decade, according to the Bureau of Labor Statistics consumer price index, was about 18.69%

So what we see is from 2010 to 2020 our pay increase was about 2x inflation. It is easy to ignore that but it explains why the last 5-6 years havent kept up.

Shhhhhhh..... facts are not allowed. Back to carrying your pitchforks.

 

[DocEspana]

Physicians are exempted from FLSA overtime requirements anyway, so this would never apply.

I imagine the most personal benefit the new bill will bring to physicians is via expanded SALT deductions.

while true, you are raining on my fun parade of doing hypothetical math

 

[DocEspana]

Is this it?

Is this the thing that will convince the throngs of medical students that are still applying for this trash tier field to stop?

Heads up: this legislation will likely gut EM compensation. Get ready to do state mandated charity care that you'll still be on the hook for if you make a mistake.

This legislation? Wont specifically deter anyone from EM. It will deter people from medicine as a whole. Turns out you need loans to afford the schooling.

 

[GatorCHOMPions]

Looking way back..

10 Statistics on Emergency Medicine Physicians' Salaries - Becker's Hospital Review | Healthcare News & Analysis

The average salaries of emergency medicine physicians fell in 2011 from 2010, but compensation still stayed above $230,000.

www.beckershospitalreview.com

The average salaries of emergency medicine physicians fell in 2011 from 2010, but compensation still stayed above $230,000, according to Medscape’s

Inflation is about 47% from 2010 til now. Using 237k (it was lower) and using 47% inflation pay would be 348k. Yes.. we are about 12% above that inflation number. The point is we can always pick arbitrary numbers. The further back you go the better we have it. Sure there are exceptions. My first group I had guys telling me how they were making 700k in the late 90s. Hospital was paying 100% of billed charges apparently. Im not old enough to verify but no idea why people would lie.

Im a glass half full guy. Its pretty hard to find 400k a year jobs especially ones where you can completely clock out when you leave. Executives make 400k but they are not "off" as much as most EM docs are "off".

What are the numbers from like 2015 to now? I think most of us complaining are those who saw the relative good pay (overpaid perhaps?) in training and have seen only a modest increase or flat as attendings. Locally it's pretty much the same hourly rate for full time in 2016-2017 as it is today.

 

[EctopicFetus]

What are the numbers from like 2015 to now? I think most of us complaining are those who saw the relative good pay (overpaid perhaps?) in training and have seen only a modest increase or flat as attendings. Locally it's pretty much the same hourly rate for full time in 2016-2017 as it is today.

Right. The timing all depends. I THINK i posted it elsewhere. But from 2019 or so until now inflation is like 21% and pay is up 12%. Not terrible but definitely not keeping up. It is also IMO not reasonable to not look before that and see that perhaps the market overcorrected and then corrected back to keep up with inflation. If you look at what medicare has done in that same time you can see that the CMGs (who make up the majority of jobs) have paid much better than what they are paid by medicare/medicaid.

 

[Splenda88]

Can we continue on that path? Top 10% own 70% of the country, or top 1% own 30%...

Wealth distribution U.S. 2024| Statista

In the first quarter of 2024, almost two-thirds percent of the total wealth in the United States was owned by the top 10 percent of earners.

www.statista.com

 

[Mount Asclepius]

Can we continue on that path? Top 10% own 70% of the country, or top 1% own 30%...

Wealth distribution U.S. 2024| Statista

In the first quarter of 2024, almost two-thirds percent of the total wealth in the United States was owned by the top 10 percent of earners.

www.statista.com

It’s a valid question. To better understand, I’d like to see data on how that compares to a longer period of history (i.e. past 2,000 years), and the relationship between general prosperity and societal advancement. Not asking you specifically, or really anyone, but people often don’t like the ‘feels’ without having any data or historical context to really analyze this question. The wealthy will likely always own a higher percentage than they proportionally make up. The question is what percentage is fair and perhaps best/reasonable for society.

 

[Splenda88]

It’s a valid question. To better understand, I’d like to see data on how that compares to a longer period of history (i.e. past 2,000 years), and the relationship between general prosperity and societal advancement. Not asking you specifically, or really anyone, but people often don’t like the ‘feels’ without having any data or historical context to really analyze this question. The wealthy will likely always own a higher percentage than they proportionally make up. The question is what percentage is fair and perhaps best/reasonable for society.

That is an interesting question. After looking at it closely, it seems like the proportion has not changed that much.

The question is why do we hear that everyday in the media? Is it because the bottom 60-70% is having a tough time to afford things due to rampant inflation?

The Fed - Distribution: Distribution of Household Wealth in the U.S. since 1989

The Federal Reserve Board of Governors in Washington DC.

www.federalreserve.gov

 

[EctopicFetus]

That is an interesting question. After looking at it closely, it seems like the proportion has not changed that much.

The question is why do we hear that everyday in the media? Is it because the bottom 60-70% is having a tough time to afford things due to rampant inflation?

The Fed - Distribution: Distribution of Household Wealth in the U.S. since 1989

The Federal Reserve Board of Governors in Washington DC.

www.federalreserve.gov

I was listening to the huberman podcast and they had the author of Dopamine nation on there. She made some very interesting observations. She concluded that in America no society has ever been richer. All of our basic needs can be met without ever leaving our homes. Even the “poor” in America live well above the mean of other places. by rule the rich have to have a disproportionate amount of wealth. I think (IMO) the real question/issue is upward mobility. I am sure I am not unique on this board as having come from a lower class/middle class family and done very well for myself. I think the concern is that that opportunity is fleeting for future generations. I cant remember the exact number but Dave Ramsey quotes something like 90% of millionaires are self made aka it is not generational wealth. That “hope” is important for our society. In other parts of the world you know you are stuck with no hope of jumping the socioeconomic ladder. Thats what made and makes America such an amazing place. You can be an immigrant with low to no educated parents and do very well.

 

[Franzd'Epinay]

It’s a valid question. To better understand, I’d like to see data on how that compares to a longer period of history (i.e. past 2,000 years), and the relationship between general prosperity and societal advancement. Not asking you specifically, or really anyone, but people often don’t like the ‘feels’ without having any data or historical context to really analyze this question. The wealthy will likely always own a higher percentage than they proportionally make up. The question is what percentage is fair and perhaps best/reasonable for society.

From a historical standpoint, the sizeable, prosperous American middle class that thrived post-WWII is definitely an aberration.

I don't know if this is what you're suggesting, but if we are indeed going back to a historical norm, it won't be due to unexplainable historical forces, but as a direct result of policy decisions taken over the past four decades.

 

[DocEspana]

From a historical standpoint, the sizeable, prosperous American middle class that thrived post-WWII is definitely an aberration.

I don't know if this is what you're suggesting, but if we are indeed going back to a historical norm, it won't be due to unexplainable historical forces, but as a direct result of policy decisions taken over the past four decades.

Ah yes. The regression back to the mean.... of serfdom.

 

[hoot504]

But what % of this country are mouth-breathing idiots? We all know it isn't a small number. Sociologically, hell even physiologically it makes sense that some small percent of the population would dominate a much larger chunk. For everyone that won the genetic intelligence quotient lottery... a lot didn't.

 

[EctopicFetus]

But what % of this country are mouth-breathing idiots? We all know it isn't a small number. Sociologically, hell even physiologically it makes sense that some small percent of the population would dominate a much larger chunk. For everyone that won the genetic intelligence quotient lottery... a lot didn't.

That plays a big role. That being said there are a lot of really dumb people who have a lot of money. Athletes come to mind. One of the wealthiest people I know started his own construction company. Stroke of luck. Now has a Bentley and lives in a very $$ house. Iq matters. So does luck and non iq genetics.