Can EM Physicians work extra shifts for extra compensation?

[BostonEmergencyMed]

Okay, I know I'm just a naive pre-med -- but I was wondering if EM docs can take on extra shifts for extra pay.
I figure if investment bankers and corporate lawyers can work crazy hours, physicians can too.

I've heard that EM docs work three 12-hour shifts a week. What if I were to do five, and survive by drinking coffee and energy drinks? I would only do this for like a year or two to erase my loans and buy a car.

To ER docs: I've never done a single shift so I don't know how hard you guys have it. I don't mean to make it sound easy.

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[WilcoWorld]

It is every bit as possible as it is unrecommended.

 

[dotcb]

There are generally 2 pay models - salaried or hourly.

Under the hourly or shift-based model, pay depends on amount worked. If your goal is to maximize income, the hourly model is for you.

I work in a salaried (academic) model, which does not allow me to earn more by working more clinically. Our providers are required to work a certain number of clinical hours monthly, with buy-down based on grants, education, administrative responsibilities. If I work extra one month, it reduces my need to do shifts in subsequent months. Academic jobs generally do not allow moonlighting.

 

[Daiphon]

There are generally 2 pay models - salaried or hourly.

Under the hourly or shift-based model, pay depends on amount worked. If your goal is to maximize income, the hourly model is for you.

I work in a salaried (academic) model, which does not allow me to earn more by working more clinically. Our providers are required to work a certain number of clinical hours monthly, with buy-down based on grants, education, administrative responsibilities. If I work extra one month, it reduces my need to do shifts in subsequent months. Academic jobs generally do not allow moonlighting.

Mine allows external moonlighting as long as the chair knows about it (plus we own a few critical access contracts, which makes "approval" easy).

Also, we pay out extra shifts if so desired - can either bank the hours for future use as you allude, or take a check quarterly/annually.

I usually do annually, that way if I miss shifts due to holidays overlapping my block (13 week repeat, I know my entire year by July 1) I'm not in the hole... and July paycheck is mucho dinero.

 

[RustedFox]

Hey bud,

Its a good question you pose. Its a common question, too - so it has many answers on here.

In summary:

It's possible, yes. It's not recommended, no. Many of we attendings have worked with those that have tried. The vast majority of those that try... wind up harming themselves, someone else, or both. To quote one director on here: "several of my rookie docs are on probation for performance issues after trying to work too much, too fast."

Anecdotally; I really thought that I was going to try to "pay 'em all off... fast!" Life changes, rapidly and unpredictably. Now, I could not imagine even trying to do that.

That being said... I regularly work more than my contracted 120 hours/month for extra pay. There's a ceiling that everyone hits; a "sweet spot" so to speak.

Anything more than 150 a month, and I really start to get burned out.

 

[Janders]

Short version--> yes

TL;DR version-->
Lots of people work extra-shifts for extra money. That said, I wouldn't suggest going from 13x 12hr shifts a month to 21x 12hr shifts a month, like you suggested in your original post. Its a huge increase in hours, and you'll be working overnights, all hours of the day. You'll never had a day that truly feels OFF.

That said, if your basic contract is 12x12hr shifts each month, and you work 13 or 14 for extra money, that is completely reasonable.

Many people will have a core job where they get their benefits, full time position, and then moonlight 1-2/mo shifts elsewhere. It provides extra money, a change of pace, potentially keeps other skills sharp, allows 1099 income versus W-2 which can have tax benefits, and provides networking opportunities and an additional safety net if you suddenly lost your main job.

My current job is, basically, fee-for-service. So if I work extra shifts I bill more patients and I end up making more money. My last job was basically hourly, and my set salary demanded I work Xhr/mo. Anytime I went over, I could ask to be paid out at the hourly rate. I often picked up 1 or 2 extra shifts a month to help payoff loans / put away down-payment money my first year out. I did cherry pick shifts that fit my lifestyle/schedule. When I moved jobs, I stayed on at the old place working 1-2/mo for a couple years, getting paid as a 1099 independent contractor.

While an above poster mentions an academic job that doesn't allow moonlighting and doesn't reward extra shifts be aware this is NOT universal. The academic department affiliated with my job certainly pays out any extra shifts, and encourages community time / moonlighting to its core academic faculty.

 

[Angry Birds]

The better thing about EM is that you can do the opposite: work less shifts. Quality of life is way more important than money.

 

[link2swim06]

It's not the number of hours available in the week. It's the mental energy you have without going crazy or being a crappy doctor. This is the limiting factor.

 

[Birdstrike]

Okay, I know I'm just a naive pre-med -- but I was wondering if EM docs can take on extra shifts for extra pay.
I figure if investment bankers and corporate lawyers can work crazy hours, physicians can too.

I've heard that EM docs work three 12-hour shifts a week. What if I were to do five, and survive by drinking coffee and energy drinks? I would only do this for like a year or two to erase my loans and buy a car.

To ER docs: I've never done a single shift so I don't know how hard you guys have it. I don't mean to make it sound easy.

"Can emergency physicians works extra shifts for extra money?"

Yes. In fact, due to the emergency physician shortage in most locations nationwide and EDs being overwhelmed and pressured to see unlimited patients within 30 min whether they have emergencies or not, you most likely will be required to exactly that, whether you want to or not.

 

[BostonEmergencyMed]

Thank you so much guys.. I hope the demand for EM physicians doesn't die out by the time I'm an attending.

 

[Daiphon]

Thank you so much guys.. I hope the demand for EM physicians doesn't die out by the time I'm an attending.

It won't. Can't fix stupid, including the ACA.

We may just be getting paid less for our work. d=/

 

[Birdstrike]

Thank you so much guys.. I hope the demand for EM physicians doesn't die out by the time I'm an attending.

What you want is supply that's "just right." You don't want a shortage or a surplus.

Surplus = declining wages and trouble finding jobs and hours.

Shortage = overwhelmed EDs that are miserable to work in and pressure to work more than is desired with burnout ensuing.

It's all about balance and moderation. Either extreme has problems.

 

[emergentmd]

Taking out academics, the answer is

IS WATER WET?

I love the shortage. The shorter the better. I want it to be even shorter than it is now. Bigger shortage, bigger leverage we have. I am part of a group and signed up for 120 hr per mo and can't get more than 140 hr a month per contract. That 120 hr is only 12 days a month. That leaves me many days to pick up locums shifts paying me 3x my reg pay and still have a lot of days off with the family. If I were single I would do 5 locums a month pulling in more than my reg job. I have to preface this that my locums is only 1 he drive away so I don't spend a full day traveling. Flying would make this much more difficult.

The bigger shortage, the more leverage I have to negotiate rates. I was offered 900/hr to cover Christmas holiday week but had family commitment. I could have made 60 k working Christmas week.

IMO the shortage will continue as long as FSEDs keep opening up. This is the biggest single driver of shortage in the. south. 1 FSED equals taking 5-6 full one ED doc out of the job pool.

This is the golden age of EM in my opinion. Who knows what's gonna happen in 5 yrs. I hope to milk his cow and retire in 5 yrs.

 

[Birdstrike]

Taking out academics, the answer is

IS WATER WET?

I love the shortage. The shorter the better. I want it to be even shorter than it is now. Bigger shortage, bigger leverage we have. I am part of a group and signed up for 120 hr per mo and can't get more than 140 hr a month per contract. That 120 hr is only 12 days a month. That leaves me many days to pick up locums shifts paying me 3x my reg pay and still have a lot of days off with the family. If I were single I would do 5 locums a month pulling in more than my reg job. I have to preface this that my locums is only 1 he drive away so I don't spend a full day traveling. Flying would make this much more difficult.

The bigger shortage, the more leverage I have to negotiate rates. I was offered 900/hr to cover Christmas holiday week but had family commitment. I could have made 60 k working Christmas week.

IMO the shortage will continue as long as FSEDs keep opening up. This is the biggest single driver of shortage in the. south. 1 FSED equals taking 5-6 full one ED doc out of the job pool.

This is the golden age of EM in my opinion. Who knows what's gonna happen in 5 yrs. I hope to milk his cow and retire in 5 yrs.

You're in Texas, right?

 

[emergentmd]

You're in Texas, right?

I am in Texas. I can tell you that it is similar in our bordering states.

I don't think FSED have opened up in Cali or tight markets in the northeast, but if it ever happens, There will be a huge shortage of ED boarded docs. This goes for the rest of the country.

If FSEDs were not legal in Texas, we would not have nearly the same shortage. I am just guessing there are about 100 FSEDs in Texas. That would take 500 full time docs to staff. if this spreads across the country, there wont be any ED docs to staff the hospitals.

When getting comparable pay, why not chill for 12 hrs seeing 1-1.5 pts an hr with most being quick care vs seeing mostly complicated pts in the hospital seeing 2+/hr while dealing with admin and all of their metrics?

FREESTANDING here I come.

 

[deleted109597]

If FSEDs were not legal in Texas, we would not have nearly the same shortage. I am just guessing there are about 100 FSEDs in Texas. That would take 500 full time docs to staff. if this spreads across the country, there wont be any ED docs to staff the hospitals.

There are nearly 100 in Houston alone. There's probably more than 500 at this point. It's gotten ridiculous. Austin used to be closed to EPs, having to spend their time at the outlying facilities to build up time in the group until they could pull rank and work in Travis County. Now they're hiring new grads. It's simply bizarre.
For places without that kind of draw, it's become almost impossible to hire anyone, which has made salaries skyrocket. I'm not losing any sleep.

 

[SoCuteMD]

There are generally 2 pay models - salaried or hourly.

Under the hourly or shift-based model, pay depends on amount worked. If your goal is to maximize income, the hourly model is for you.

I work in a salaried (academic) model, which does not allow me to earn more by working more clinically. Our providers are required to work a certain number of clinical hours monthly, with buy-down based on grants, education, administrative responsibilities. If I work extra one month, it reduces my need to do shifts in subsequent months. Academic jobs generally do not allow moonlighting.

I've worked in two different academic systems and there have been opportunities for moonlighting at both places.

 

[Groove]

Where does one find these TX opportunities? Job sites? Cold calling? I just recently got my TX license and have been looking around the state. I'm interested in part time gigs and also FSED with possible full time early next year. I flew down to the SE part of the state not long ago to look at a job and FSED opportunity but wasn't too enamored with the possibilities.

 

[BruceWilly]

I was offered 900/hr to cover Christmas holiday week but had family commitment.

Holy.

 

[WilcoWorld]

There are nearly 100 in Houston alone. There's probably more than 500 at this point. It's gotten ridiculous. Austin used to be closed to EPs, having to spend their time at the outlying facilities to build up time in the group until they could pull rank and work in Travis County. Now they're hiring new grads. It's simply bizarre.
For places without that kind of draw, it's become almost impossible to hire anyone, which has made salaries skyrocket. I'm not losing any sleep.

Sounds like a bubble, and all bubbles burst eventually. What do you think will happen to all the new hires?

 

[emergentmd]

Sounds like a bubble, and all bubbles burst eventually. What do you think will happen to all the new hires?

This bubble is nothing like the home market bubble. If for some reason FSEDs are not viable, these docs will all have jobs in Hospital EDs. I know many hospitals that would hire 10 ED docs tomorrow if they could. That is how short they are. The schedules that comes out have 70% uncovered shifts. Texas could easily absorb 1000 Docs.

It might not be the best jobs or location, but there will be jobs. Nothing like the stock market where people lost 70% of their retirement.

Might as well enjoy the ride. Nothing is guaranteed tomorrow. I hope to enjoy this into early retirement.

 

[WilcoWorld]

This bubble is nothing like the home market bubble. If for some reason FSEDs are not viable, these docs will all have jobs in Hospital EDs. I know many hospitals that would hire 10 ED docs tomorrow if they could. That is how short they are. The schedules that comes out have 70% uncovered shifts. Texas could easily absorb 1000 Docs.

It might not be the best jobs or location, but there will be jobs. Nothing like the stock market where people lost 70% of their retirement.

Might as well enjoy the ride. Nothing is guaranteed tomorrow. I hope to enjoy this into early retirement.

So, the new hires will move?

 

[deleted480308]

So, the new hires will move?

If they like jobs, yes

 

[Docinthetrenches]

Yes, extra moonlighting is one of the best things about EM. In many places you can work extra there for a higher rate but usually you have to go somewhere they have a shortage (rural areas, etc) to make more money per hour.

 

[deleted109597]

So, the new hires will move?

Otherwise it's Occupy NY all over again. If you like where you live and can tolerate the pay, stay there. If you want to be paid more, move. Our job is one of the easiest to do this. People live in Hawaii and work in Alaska even.

 

[Lord Humongus]

Taking out academics, the answer is

IS WATER WET?

I love the shortage. The shorter the better. I want it to be even shorter than it is now. Bigger shortage, bigger leverage we have. I am part of a group and signed up for 120 hr per mo and can't get more than 140 hr a month per contract. That 120 hr is only 12 days a month. That leaves me many days to pick up locums shifts paying me 3x my reg pay and still have a lot of days off with the family. If I were single I would do 5 locums a month pulling in more than my reg job. I have to preface this that my locums is only 1 he drive away so I don't spend a full day traveling. Flying would make this much more difficult.

The bigger shortage, the more leverage I have to negotiate rates. I was offered 900/hr to cover Christmas holiday week but had family commitment. I could have made 60 k working Christmas week.

IMO the shortage will continue as long as FSEDs keep opening up. This is the biggest single driver of shortage in the. south. 1 FSED equals taking 5-6 full one ED doc out of the job pool.

This is the golden age of EM in my opinion. Who knows what's gonna happen in 5 yrs. I hope to milk his cow and retire in 5 yrs.

That 60k in one week is insane. The fact you decided to turn down 60k in one week because of family committments is also insane (in a good way lol). 900/hr to cover Christmas shows that currently EM docs have crazy leverage. Any other field of endeavor, if they want you to cover a holiday, it's going to be 99% stick and 1% carrot and go ahead and find yourself another job if you don't like it. Will this leverage exist in 7-8 years when today's premeds are attendings? Who knows. It's interesting to look at the data though.

In 2010 there were 35,000 EM docs according to the AAMC. Today there are probably close to 40k.
https://www.aamc.org/download/313228/data/2012physicianspecialtydatabook.pdf

Also, only a little over 30% of EM docs were 55 or older in 2010. I'd assume that number is basically unchanged today or maybe even slightly lower.This means retirement from the field is not going to play a very significant role in our calcultions.

There were 1821 EM residency spots in 2015, up from 1668 in 2012. Let's just assume over the next 8 years the average number of residency slots will be 2000. In that case, the total number of Emergency Physicians will have increased from 40,000 today to 56,000 in 8 years from now, an increase of 40%, assuming (an unreasonable) 0% retirement rate.


The population will have grown and become older/more sickly over this 8 year span, increasing demand for emergency room services. Some of this rise in demand will definitely be absorbed by increasing the utilization of midlevels in the ER. There is no way to plug real numbers here, but it doesn't seem that demand for Emergency Physician services will rise by a whopping 40% in 8 years to match the 40% increase in the number of emergency physicians. There will definitely still be a market and I highly doubt docs with geographic flexibility will struggle to find jobs, but $900/hr to cover Christmas reflects today's supply vs demand situation and probably won't be around when that supply inreases by 40%.

Disclaimer: I'm an idiot premed and this is all speculation backed by grade school level arithmetic. Needless to say, if I had any confidence in my ability to predict the future I wouldn't be typing this because I'd be homeless and without access to a computer, having lost everythign gambling on the stockmarket.