Can we talk about getting paid for a minute

[CSRA]

I was talking to a Critical Care Doc in the ICU the other night, and we started talking about what field he would go into if he had another chance. I said what about EM, because obviously I'm partial, he said "you guys don't get paid enough." Long story short the fellow says he makes $600,000/yr. I'm blown away. I know I've heard numbers for EM quoted as $200,000 - $500,000/yr.

1. What's with the descrepancy?

2. If I wanted to increase my salary for a few years to pay off loans what methods can I use? Log more hours? Learn to bill for procedures? Whatever.

3.Why is Fee-for-service not more prevalent? What's the downside?

4. Where do you find info on what people REALLY make/pay without asking to divulge personal info? (Either everyone is FOS or we make WAY more than googled salary surverys would have you believe)

5. Do we really get paid poorly in comparison to other fields (money per hour of work)? I know everyone has heard the "Rich Radiology, or I'd be that way if I had an Ortho's pay as well." (obviously an opinion)

6. How does Ortho get so much stinking money? (don't have to answer)

7. How does a student who wants to do Derm write a legitamate personal letter for ERAS? "I once saw a rash and . . . wait no, not really, I saw that my avg work hours would be 39.3/week and I'd make bank . . . so"

-(ok just kidding anyone who is Derm or married to derm. I just don't understand - most likely b/c I'm not as smart as you are!)

thanks for the time,

K

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[southerndoc]

Your questions are good ones, but complicated.

1. Not all intensivists/pulmonologists make that much.

2. Yes, you can always work more, but there comes a point where it isn't worth sacrificing your free time for it. One of the biggest perks of emergency medicine is having ample off time. You can work 80 hrs/week (like the intensivist), and probably would make more money than him doing so... or you can work half as less, make half as less, and spend double the time golfing, skiing, traveling, rock climbing, or whatever it is you love.

3. There are many models of fee-for-service. There is strict fee-for-service where if the patient doesn't pay, you don't get paid (which if there is more than one doc working at a time, might lead to cherry picking charts to only see the insured patients and leaving the new doc to see the uninsured). There is a productivity model where you get paid regardless of patient's ability to pay (using a formula recalculated every year for the percentage of charges collected by the group). There is a mixed model where you are paid an hourly wage and RVU bonuses. I work for a productivity system and think it's great. Your pay system is dependent on the type of group you are with. Most independent groups/small groups will be FFS, productivity, or mixed (either hourly with RVU bonuses or hourly with quarterly bonuses based on profit). Most large corporations prefer to keep the money themselves, so they pay you hourly regardless of your productivity.

4. There is an annual salary survey conducted by Daniel Stern and Associates. Someone at your medical school probably has access to it. If not, you can purchase it.

5. I make enough to enjoy my lifestyle and save for retirement. That's all that matters. I'm not on a quest to make the most money possible. I just want to live comfortably, debt free (or debt controlled, such as low-interest student loans), and be able to save for retirement.

6. No idea, but a friend of mine recently uncovered something that netted a particular orthopod extra money. I won't go into details of it because of pending litigation and state medical sanctioning.

7. Everything has its perks. Somebody in the dermatology forum might say "how does one write an ERAS for emergency medicine? 'I once saw a drug seeker and...'"

Good luck in your studies.

 

[CSRA]

Your questions are good ones, but complicated.

1. Not all intensivists/pulmonologists make that much.

2. Yes, you can always work more, but there comes a point where it isn't worth sacrificing your free time for it. One of the biggest perks of emergency medicine is having ample off time. You can work 80 hrs/week (like the intensivist), and probably would make more money than him doing so... or you can work half as less, make half as less, and spend double the time golfing, skiing, traveling, rock climbing, or whatever it is you love.

3. There are many models of fee-for-service. There is strict fee-for-service where if the patient doesn't pay, you don't get paid (which if there is more than one doc working at a time, might lead to cherry picking charts to only see the insured patients and leaving the new doc to see the uninsured). There is a productivity model where you get paid regardless of patient's ability to pay (using a formula recalculated every year for the percentage of charges collected by the group). There is a mixed model where you are paid an hourly wage and RVU bonuses. I work for a productivity system and think it's great. Your pay system is dependent on the type of group you are with. Most independent groups/small groups will be FFS, productivity, or mixed (either hourly with RVU bonuses or hourly with quarterly bonuses based on profit). Most large corporations prefer to keep the money themselves, so they pay you hourly regardless of your productivity.

4. There is an annual salary survey conducted by Daniel Stern and Associates. Someone at your medical school probably has access to it. If not, you can purchase it.

5. I make enough to enjoy my lifestyle and save for retirement. That's all that matters. I'm not on a quest to make the most money possible. I just want to live comfortably, debt free (or debt controlled, such as low-interest student loans), and be able to save for retirement.

6. No idea, but a friend of mine recently uncovered something that netted a particular orthopod extra money. I won't go into details of it because of pending litigation and state medical sanctioning.

7. Everything has its perks. Somebody in the dermatology forum might say "how does one write an ERAS for emergency medicine? 'I once saw a drug seeker and...'"

Good luck in your studies.

Thanks for the legit answer and not taking a stab at me for sounding like a money-hungry slob.

#7 - Drug seekers make the job interesting.

 

[docB]

Thanks for the legit answer and not taking a stab at me for sounding like a money-hungry slob.

Caring about how the finances in your specialty work doesn't make you money hungry, caring about it to the exclusion of all else does. Not caring at all how the finances work makes you crazy.

 

[Jeff698]

Thanks for the legit answer and not taking a stab at me for sounding like a money-hungry slob.

#7 - Drug seekers make the job interesting.

No, not really.

After about the millionth "I'm allergic to everything but X and will sue your ass off if you don't give it to me", it gets old. It gets easier to handle (much more comfortable telling them to go away) but it still sucks a pretty good chunk of your soul each time. Picture the Dementors from Harry Potter.

Take care,
Jeff

BTW, wanting to know how you'll be able to pay off your mountain of student loans and plan for retirement isn't being a money-hungry slob.

 

[GeneralVeers]

No, not really.

After about the millionth "I'm allergic to everything but X and will sue your ass off if you don't give it to me", it gets old. It gets easier to handle (much more comfortable telling them to go away) but it still sucks a pretty good chunk of your soul each time. Picture the Dementors from Harry Potter.

I like the idea of the Dementors. That's the perfect way to describe them.

Although I think the hypochondriac, not sick, "multiple complaint" patients who get upset if you don't order every test on them are more annoying.

 

[southerndoc]

I like the idea of the Dementors. That's the perfect way to describe them.

Although I think the hypochondriac, not sick, "multiple complaint" patients who get upset if you don't order every test on them are more annoying.

Personally I like the patients with chronic complaints for the past three years who haven't gotten a diagnosis from their 24 specialists at five of the top 10 hospitals, 7 CT's, 3 MRI's, 4 lumbar punctures, a brain biopsy, Russell viper venom times, and serum squirrel titers, but they're presenting to the ED because they want answers and they have so much confidence that I'm going to be able to tell them definitively what's causing their symptoms. (I usually leave the room after my H&P by notifying them that I won't be able to diagnose their condition, but we'll see if we can get them more comfortable.)

 

[WilcoWorld]

Personally I like the patients with chronic complaints for the past three years who haven't gotten a diagnosis from their 24 specialists at five of the top 10 hospitals, 7 CT's, 3 MRI's, 4 lumbar punctures, a brain biopsy, Russell viper venom times, and serum squirrel titers, but they're presenting to the ED because they want answers and they have so much confidence that I'm going to be able to tell them definitively what's causing their symptoms. (I usually leave the room after my H&P by notifying them that I won't be able to diagnose their condition, but we'll see if we can get them more comfortable.)

Hmm, sounds like a viral syndrome...

 

[EM OR BUST]

600K? Did he/she mention how many hrs they worked? I think thats pretty high for a CCM doc.

 

[Apollyon]

(I usually leave the room after my H&P by notifying them that I won't be able to diagnose their condition, but we'll see if we can get them more comfortable.)

That's almost exactly what I say, especially on Friday or Saturday night.

 

[Greenbbs]

600K? Did he/she mention how many hrs they worked? I think thats pretty high for a CCM doc.

Our anesthesia/crit care guys at my hospital make that much, easy. They had some guarantee set up through the hospital that there would be x amount of compensation, minimum, regardless.

 

[tegs15]

Our anesthesia/crit care guys at my hospital make that much, easy. They had some guarantee set up through the hospital that there would be x amount of compensation, minimum, regardless.

Wonder if that contract will get renewed with ObamaCare?

 

[Greenbbs]

Wonder if that contract will get renewed with ObamaCare?

it probably will because they negotiated it as part of the anesthesia deal. The anesthesia provider group is the same group that supplies critical care to the ICU. I'm pretty sure that to continue the open heart program, they have to have the crit care guys there.

 

[NinerNiner999]

it probably will because they negotiated it as part of the anesthesia deal. The anesthesia provider group is the same group that supplies critical care to the ICU. I'm pretty sure that to continue the open heart program, they have to have the crit care guys there.

Remember this key point as you move along in your career - ANY contract lasts only as long as its termination clause - period - for any reason. A 50-year contract can end in three short weeks (or even shorter) if someone wants it to end.

 

[enfuegoEP]

#7 - Drug seekers make the job interesting.

I had the worst drug seeker in the history of all drug seekers last night. This character had no game. He was walking around the waiting room chatting people up, laughing, and drinking coffee (as read in the triage note) and once he got a bed he started howling in pain with one eye open to see if anyone was looking at him. After about 10 seconds I was annoyed with his theatrics and went to see him. He started off the conversation by telling me he couldn't get in to see his pain management doc because he didn't have any money and on his last MRI "It was strange..they couldn't find anything wrong." His sciatica was acting up "in both legs this time" and he may have appendicitis. The strait leg test was something strait out of monty python. I've seen better acting in mexican soap operas. He really brought the house down when he declared in the middle of my exam that he was allergic to "Just about everything except dilaudid." I was so blown away by his complete failure as a drug seeker I almost gave him a mercy percocet.

 

[willow18]

Wonder if that contract will get renewed with ObamaCare?

Umm, take a stroll through an ICU, it's nearly all Medicare patients; old people's care in this country went Marxist/Hitlerist/Stalinist/Europeist, whichever you prefer, about 40 years ago and the docs don't seem to have it too bad.

Having said that, it's clear as day that once you start on this slippery Stalinistic/Hitleristic slope, it gets slippery real fast. So I'm sure eventually LBJ's plan was to kill all the Jews, old people, homosexuals, etc. Obama was probably engineered during the Great Society to put this final phase of Medicare into action. In fact, if you take the initials of HITLER, it spells out, Health (care) Is The Lever (to) Eryan Race (downfall). Ha, refute that.

Okay, I have no idea what I just said, but I'm just asking questions. I'm a simple person; I dont know much; just asking questions.

Sorry, been watching too much of ((( GB ))) lately.

 

[WilcoWorld]

Umm, take a stroll through an ICU, it's nearly all Medicare patients; old people's care in this country went Marxist/Hitlerist/Stalinist/Europeist, whichever you prefer, about 40 years ago and the docs don't seem to have it too bad.

Having said that, it's clear as day that once you start on this slippery Stalinistic/Hitleristic slope, it gets slippery real fast. So I'm sure eventually LBJ's plan was to kill all the Jews, old people, homosexuals, etc. Obama was probably engineered during the Great Society to put this final phase of Medicare into action. In fact, if you take the initials of HITLER, it spells out, Health (care) Is The Lever (to) Eryan Race (downfall). Ha, refute that.

Okay, I have no idea what I just said, but I'm just asking questions. I'm a simple person; I dont know much; just asking questions.

Sorry, been watching too much of ((( GB ))) lately.

At the bottom of that slippery slope awaits a straw man who will turn the US into China through argument by (weak) analogy!

 

[ER-ER-Oh]

I make great money in the ED. But I work a lot of extra hours by taking just about every available shift that comes up for grabs. If somebody can please make me stop spending almost as much as I make I'll give them $10,000 after I catch up a little.

 

[deleted109597]

I can't believe you like money too. We should hang out.

 

[deleted87716]

...serum squirrel titers...

 

[coffeebythelake]

I can't believe you like money too. We should hang out.

 

[Chromatid]

6. How does Ortho get so much stinking money? (don't have to answer)

Procedures procedures procedures. Not to mention they work like crazy... your life is your job, but most of them love it, so getting called during a movie or christmas or kids graduation is pretty much the norm, granted you can work less, but I'll take the hip specialist guy that does so many of them he can preform them in his sleep, I think hospitals and groups will take that guy too as they speak in $$$.
Consulting on the side pays nicely, $450/hr plus dinner, at least in my neck of the woods, plus you get the benefit of knowing your tax dollars are helping society by paying for like 10 uninsured people to have access to healthcare so you can actually get paid next time you fix that formerly uninsured guy that busted his hand in a bar fight.