Adjusting for inflation that would be ~$130/hr. There’s no way I would even consider doing EM for $130/hr. There’s too many easier ways to make that kind of money. Even urgent care is going to pay close to or better than that without having to do the nights and holidays.
Agreed. My absolute floor I think would be 200/hr and I wouldn't be willing to see more than 1.5pph at that rate. If rates in my area ever get that low it probably means either my SDG folded or volumes never bounced back.
Perfect! There are plenty of new grads and upcoming grads that would take those positions in a heart beat:
1550 hrs x $130/hr = about $200k/year
With $400k in loans (quickly accruing interest), desire to start a family, buy a house and other delayed life goals, there will be ample competition still for those spots. Much like what happened with Nephrology and corporate dialysis, I theorize we will start to see way more foreign graduates in EM within the decade. Those new graduates and CMG overlords are waiting for all of you who "wouldn't step foot in an ER for less than 200/hr" to vote with your feet!
What would be the alternative for you (or other EM physicians) if the pay went lower? Just quit? Fellowship? Administration? I'm just curious how EM physicians could have any other choice than to work for the lower pay unless they had enough savings to retire especially with a mortgage/family expenses.
The simple answer is that if one is going to choose EM then at no point should a prospective medical student have any desire for an upper middle class life. Is it possible? Definitely yes. Is it likely? Probably not. Do not anticipate buying a Tesla Model S. Do not anticipate the ability to live in the nicest neighborhood with the best schools. Do not anticipate the ability to live in a desirable city. Do not anticipate the ability to buy more than a modest house. Do not anticipate being able to keep a job in a single location for more than a few years based on how contracts work. Be open to the idea of going back to fellowship or doing a fellowship directly from residency. Be always mobile.
Strongly consider diversifying income streams that you can achieve with an MD/DO (insurance chart review, expert witness work, etc.)
I've found this website to be helpful with day dreaming (no financial interests, but fully support the FIRE movement/passive income strategies):
The List of Physician Side Hustles | Passive Income M.D.
Yikes! I hope I didn't match into your program if that's the way you like to treat people.
Torsion, I do not think anybody is "piling" on the graduating medical student. In fact congratulations on being about to finish, it's a big milestone and a huge achievement. I'm happy you chose our specialty as (ideally) your life's work, there's nothing in medicine as fun as resuscitating a dying patient, but we are trying to warn you that increasingly it will be an obstacle in achieving other goals you may have in life. I'm sorry but beyond other physicians and maybe your mom and dad...
nobody cares about your skill, value or respects you for your achievement beyond what the market dictates.
We are suggesting that you (as a representative of many medical students as a whole) are
not taking the EM market as seriously as you should. Even from my perspective I know how you feel because I felt similar as a medical student. The problem is that I didn't have the industry insight to truly make an informed decision. I didn't listen to some of those "doom and gloom" attendings as well as I should have.
Let me give you an example of this based on your own words:
"At the time, it was common wisdom that the ACA was going to gut physician salaries. That is not what ended up happening. "
Superficially this is true, but do you know why?
It continued the trend of heavily entrenching our insurance-as-healthcare system, allowing them to really put the squeeze on documentation requirements, metrics to meet (along with CMS and other governing bodies), and other "value-based" BS that forced physicians and their administrative staff to become even more creative with reimbursement. It forced us to see more volume to keep up the same pay (which by the way has not kept up with inflation). So in effect it did put huge pressures on reimbursement if we were to continue seeing patients as we were, but physicians (being smart and creative) found ways to stay solvent, though at HUGE mental health and overwork costs (see the arguments for EMR as related to moral injury/burnout etc).
My entire point with this example is to demonstrate that there are very specific reasons things are reaching a boiling point in regards to EM day-to-day practice and you only get to see it superficially given your position. You only see the top level "oh it's been fine, don't worry" side of the coin.
And because I'm furloughed in regards to some of my hours, and wife is handling the kid, I'll do you a solid and breakdown another line:
"Perhaps more heavily weighted toward physicians and mentors in real life rather than anonymous internet voices."
This is your availability bias with what you've been exposed to as a medical student. When you rotate at big county trauma centers, tertiary referral centers with every specialty/toy under the sun, and even that high acuity high volume community shop, you miss out on perspective from nearly 80% of all EM physicians. The majority of us do not practice in those settings. Those jobs aren't easy to get, and those physicians are relatively protected for a variety of reasons, and also do quite a bit more than their clinical work (admin, research, teaching, sub-specialty directorships) to their respective organizations. They tend to have been in the field for at least 10-15 years (the golden ages), and many are even grizzled 20+ year veterans that have carved out nice niches only possible in yesteryear.
How many rotations did you do at a TeamHealth/USACS/CMG suburban community shop? How many rotations did you do in a Kaiser ED? How many rotations did you do in a for-profit urgent care? How many rotations did you do in a very rural critical access hospital with 24 hour shifts and no ICU doc?
Did you consider that the physicians that willingly expose themselves/volunteer time to medical students likely have a optimistic disposition in regards to the specialty? Did you consider that the veil of anonymity allows some physicians to give you a perspective that's not subject to organizational scrutiny (look at how many ER doctors have been fired for speaking up during the COVID19 pandemic). Did you also consider how easy it is to fire a frontline physician that's not a revenue-generating specialist/proceduralist?
You said it yourself: