Class of 2021 job market insights

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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.

Well in truth I'm fortunate in that I am 10 years out residency now with no debt, I've saved/invested pretty aggressively, my wife has a good income (non medical) and we live well but not at all extravagant (don't care for luxury items, no 2nd home/cabin, planning for public school for kids, etc...). Also I've done well as a partner in an SDG for the past 5 years. All those aspects give me flexibility.

I don't know what I'd do but no chance in hell I'd work even a modestly busy EM job for <200/hr....i'd rather make 100/hr reviewing charts part time or something.

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Well in truth I'm fortunate in that I am 10 years out residency now with no debt, I've saved/invested pretty aggressively, my wife has a good income (non medical) and we live well but not at all extravagant (don't care for luxury items, no 2nd home/cabin, planning for public school for kids, etc...). Also I've done well as a partner in an SDG for the past 5 years. All those aspects give me flexibility.

I don't know what I'd do but no chance in hell I'd work even a modestly busy EM job for <200/hr....i'd rather make 100/hr reviewing charts part time or something.


Thanks. I was very interested in EM but with ~$200,00 in students loans at graduation and posts like this as well as similar concerns from a EM physician at my school about future salary decreases and saturation has made me reconsider choosing EM.
 
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Thanks. I was very interested in EM but with ~$200,00 in students loans at graduation and posts like this as well as similar concerns from a EM physician at my school about future salary decreases and saturation has made me reconsider choosing EM.

I wouldn't make life altering decisions based upon a 8-10 person echo chamber here on SDN. If you go to other forums on here you'll get the same doom and gloom. Anesthesia, for example, has been talked up on this thread. I did a rotation in anesthesia last year. I'd be bored out of my mind in that career. The docs I worked with didn't seem particularly happy, either. But then again, one of them complained ad nauseum about how he hated that deep sea fishing was his hobby because he had to spend money on fuel, and an expensive charter boat (that he owned), and have people help him crew. I don't know about you, but I can't imagine what an inconvenience it must be to have the ability to go gulfstream fishing whenever I want. The horror.

Perspective is key.
 
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I wouldn't make life altering decisions based upon a 8-10 person echo chamber here on SDN. If you go to other forums on here you'll get the same doom and gloom. Anesthesia, for example, has been talked up on this thread. I did a rotation in anesthesia last year. I'd be bored out of my mind in that career. The docs I worked with didn't seem particularly happy, either. But then again, one of them complained ad nauseum about how he hated that deep sea fishing was his hobby because he had to spend money on fuel, and an expensive charter boat (that he owned), and have people help him crew. I don't know about you, but I can't imagine what an inconvenience it must be to have the ability to go gulfstream fishing whenever I want. The horror.

Perspective is key.

Tell us more medical student.

Prospective residents should absolutely take market into account when choosing a specialty.
 
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Tell us more medical student.

Prospective residents should absolutely take market into account when choosing a specialty.

Yikes! I hope I didn't match into your program if that's the way you like to treat people. I'll be a medical student for about one more week. I think my original post in this thread made it clear that a prospective resident absolutely should take market into account. Even if you took out my postings, which you cleary discount as noncontributory, you would still see a plurality of perspectives on what the EM job market currently is and what it will be.

SDN frequently negative on the prospects of every specialty and has been since I began lurking on here almost ten years ago. At the time, it was common wisdom that the ACA was going to gut physician salaries. That is not what ended up happening. My point to the poster was to collect a variety of perspectives, including and perhaps more heavily weighted toward physicians and mentors in real life rather than anonymous internet voices. I think that's good advice for all things in life. Not really sure what struck a nerve with you.
 
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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.
Some academic sites are around this.
 
Yikes! I hope I didn't match into your program if that's the way you like to treat people. I'll be a medical student for about one more week. I think my original post in this thread made it clear that a prospective resident absolutely should take market into account. Even if you took out my postings, which you cleary discount as noncontributory, you would still see a plurality of perspectives on what the EM job market currently is and what it will be.

SDN frequently negative on the prospects of every specialty and has been since I began lurking on here almost ten years ago. At the time, it was common wisdom that the ACA was going to gut physician salaries. That is not what ended up happening. My point to the poster was to collect a variety of perspectives, including and perhaps more heavily weighted toward physicians and mentors in real life rather than anonymous internet voices. I think that's good advice for all things in life. Not really sure what struck a nerve with you.

You're going to need to thicken up if you're going EM if your feelings are hurt so easily.
 
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Tell us more medical student.

Prospective residents should absolutely take market into account when choosing a specialty.
Residents definitely should take that into account, the tricky part comes from trying to predict the future. Physicians have for as long as I can remember been very doom and gloom about what the job market was going to look like going forward and have been almost universally wrong.

That of course doesn't mean that things will always be good and never go in a bad direction, just that trying to pick a specialty based on what you think will happen in 10 years is almost never wise.
 
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Thanks. I was very interested in EM but with ~$200,00 in students loans at graduation and posts like this as well as similar concerns from a EM physician at my school about future salary decreases and saturation has made me reconsider choosing EM.

FTR I personally don't think reimbursements will drop to that level (at least in my locale) and I plan to stay in EM for another 10+ years....just was giving you my acceptable bottom rate for sake of discussion.
 
You're going to need to thicken up if you're going EM if your feelings are hurt so easily.

It seems to be your feelings that are the ones that are hurt. Keep piling on the graduating med student while you can if that makes you feel better.
 
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Thanks. I was very interested in EM but with ~$200,00 in students loans at graduation and posts like this as well as similar concerns from a EM physician at my school about future salary decreases and saturation has made me reconsider choosing EM.
I think you can work 1500 hours a year and make 300k. Im not sure that disappears but could require some hustle and grind and right now it doesnt. i know of a site seeing 1.3pph and paying almost $200/hr.

some at 1pph just below that. The question is how far do you have to drive to get there? City jobs across the US are fairly full. Same for the suburbs. Overall hospitals are closing and there is an ever increasing push to decrease ED volumes. The last 1-2 years have shown this to be true. There are fewer ED visits and we can expect more resources to keep people at home. All of us who work clinically have seen an increase in people who are afraid of coming to the ED. that harms our volume and no one knows when it will come back.

My real worry if i was a med student or resident is the mix of 1) more graduates 2) decreased need 3) CMG financial strain

Also reality is EM is fairly consolidated and in some markets is fully a monopoly (see Denver). Some people want to be optimistic but Denver should be a cautionary tale.

USACS has been trying to get into the SLC market because they know they can replicate the success of screwing EM docs like they did and do in Denver.
 
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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:

Perspective is key.
 
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As jobs get tighter I think that the CMG market hourly will tank. Independent SDG groups will still be able to fight the good fight for a while longer so long as patient volume returns and reimbursements aren't significantly changed. There is also room to play with staffing with a SDG to try and maintain income ie dropping midlevel coverage or double coverage times to keep productivity at a certain level. However these plum SDG jobs will become harder and harder to get. Knowing someone, or barring that coming from a highly regarded residency will likely be increasingly necessary. We may see something approaching big law where you need to go to a top 10 law school to get that coveted high paying corporate job or else you have a rougher road ahead and can very well end up making 80k a year and struggling with debt payments. Being a midlevel or wanting to live/work in a market dominated by CMGs is looking more and more bleak right now. I work for Vituity which is sort of a hybrid between big corporate behemoth and independent SDG and have been pleased by the COVID adjustments being made including a nice pivot towards supplemental income with telemedicine. Sure there have been pay cuts, but for any group so long as the profits flow directly to you once the volume returns and you have a direct voice in staffing your shop that's the most important part.
 
SDN when I was a premed: "Your 41 on the MCAT, 4.0 GPA, and three first author publications in NEJM where you present the cure for cancer will not be enough to get into medical school. "

SDN when I was looking for job: "Your 4 years of medical school, 4 years of residency, 1 year of fellowship means you will never find a decent paying job. Are you ready to work for pennies on the dollar?"

I'm starting to notice a trend here.

Meanwhile, every community EM physician I've talked to: "Yeah, hours are getting cut right now, but things are picking back up again, our medical director is planning to go back to full staffing in the next 2-4 weeks. Thankfully I have enough saved up and can weather the storm. It sucks temporarily, but I'm not losing sleep over it."

I'm not saying everything is rosy. EM is sure to have its share of problems. But so did anesthesia. So did radiology. When you look at any given specialty over the period of 20-30 years, there will be ups/downs, ebbs and flows. When you take a single snapshot in time, it's very easy to get a mischaracterization of how things truly are (whether good or bad).

Also, HemorrhagicShock: telling people to do fellowship, because, from what I gather your argument is, that it gives you some sort of "protection" is not great advice IMO. You should do fellowship because you enjoy something and want to build a niche. NO employer is saying, "look! they did a 1 year fellowship in ultrasound, lets pay them more." Fellowship is an overall poor financial investment. We will never see a day where someone who did Global Health, Wilderness Medicine, Ultrasound, EMS, etc will be more valued for their skills in those arenas than for their skills in seeing patients.

We get paid for the MD/DO after our names. We get paid for the nights, weekends, holidays. We get paid for taking care of the drug seekers, drunks, and the derelicts. In the academic world, maybe employers have more interest in you because of your fellowship training, but these "niches" by and large do not generate significant income for academic departments unless you are doing research and acquiring significant grant funding.
 
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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.

Desirability and modesty are subjective terms, but I think one can accomplish most of those things on less than a physician's income even if the bottom were to drop out for EM to the numbers you suggested earlier. Maybe not the Tesla, but in most small to midsize cities 150-200k with a family of 4 will still get you a decent house zoned in a good public school system. It would still offer what most would consider an upper middle class lifestyle. If someone had a working spouse who contributed half that, you'd once again be sitting in comfortable position. Don't get me wrong, it would be a real bummer if salaries plummeted like that and it would require some lifestyle adjusting for people earning or expecting to earn far more, but someone making 200k starting in their early 30s will still be leagues beyond the vast majority of their non-medical peers.

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.

Agreed. Was actually browsing that site the other day.

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.

I'm certainly concerned about it and that's why I'm following this thread. Unfortunately there is very little I can do about it personally at the moment. Following the money is generally considered a bad gamble (as echoed on this thread) and I chose emergency medicine because I genuinely enjoyed the work as a student. I've heard "doom and gloom" perspectives from people in the real world and have generally closely followed developments important to the field such as balance billing legislation and the mid-level independence movement. I understand the mechanisms by which a market contraction could occur and I hold no illusions about landing a 450k+ gig in a few years, but as I'm sure you understand the prospect of getting the rug absolutely pulled out from underneath us in catastrophic fashion does not leave me feeling very good. I think its natural to seek out alternative points of view in that circumstance.

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).

I'm interested to hear more about this, because EM salaries not keeping up with inflation over the past 10-15 years seems to go counter to the data I've seen as well as most of what people on SDN have mentioned anecdotally. I definitely understand the drag of documentation, metrics, changes to payment structure. It would still seem that there has been a general rise in salaries in excess of inflation over the past decade.

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?

I agree that anonymity offers an opportunity to speak freely and openly that might offer more honest insight. The other side of the coin is that it is also more difficult to evaluate somebody's sources of information, their life circumstances, and general affect. Just like you mentioned that the academic docs I've worked with might present a bias of the fulfilled, happy physician, the internet can often present the opposite way. I think SDN had me convinced I failed Step 1, Step 2, and CS. Turned out I didn't have much to be concerned about.
 
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Lots of good points and frankly I agree that the anonymity on this site allows honesty. I will say that those who dont think the ACA screwed EM docs had a bad spot to begin with. Let’s look at the consolidation that did occur in EM afterwards. Note that there was very little of this and it wasn’t terribly active. since the ACA hospitals consolidated and that instability led to EM docs selling practices etc. That led to lower pay.

SDGs are uncommon and hopefully there will be more on the horizon but I wonder how many people still have the skills to run a shop?

With respect to academics I dont know who you are talking to but most of them are making in the low 200s working 1400 hours a year or so.

I went into EM with the thought of making 200k. I have saved a lot and that has given me tremendous flexibility and freedom. I would advise as others said to find some side business(es) to make some money unless your spouse has a 6 figure income.

I listen to some of the older docs who were in successful practices and it was next level. Hospital would pay them some % of billed charges, guys making insane money back in the day. Surely the CMG thing seems better now than it was but I am unsure it outpaced inflation. Actually I know it hasn’t but CMG revenue and profit sure has. They just screwed themselves cause they got so greedy they went into insane debt And now its time to bleed.
 
Desirability and modesty are subjective terms, but I think one can accomplish most of those things on less than a physician's income even if the bottom were to drop out for EM to the numbers you suggested earlier. Maybe not the Tesla, but in most small to midsize cities 150-200k with a family of 4 will still get you a decent house zoned in a good public school system. It would still offer what most would consider an upper middle class lifestyle. If someone had a working spouse who contributed half that, you'd once again be sitting in comfortable position. Don't get me wrong, it would be a real bummer if salaries plummeted like that and it would require some lifestyle adjusting for people earning or expecting to earn far more, but someone making 200k starting in their early 30s will still be leagues beyond the vast majority of their non-medical peers.



Agreed. Was actually browsing that site the other day.



I'm certainly concerned about it and that's why I'm following this thread. Unfortunately there is very little I can do about it personally at the moment. Following the money is generally considered a bad gamble (as echoed on this thread) and I chose emergency medicine because I genuinely enjoyed the work as a student. I've heard "doom and gloom" perspectives from people in the real world and have generally closely followed developments important to the field such as balance billing legislation and the mid-level independence movement. I understand the mechanisms by which a market contraction could occur and I hold no illusions about landing a 450k+ gig in a few years, but as I'm sure you understand the prospect of getting the rug absolutely pulled out from underneath us in catastrophic fashion does not leave me feeling very good. I think its natural to seek out alternative points of view in that circumstance.



I'm interested to hear more about this, because EM salaries not keeping up with inflation over the past 10-15 years seems to go counter to the data I've seen as well as most of what people on SDN have mentioned anecdotally. I definitely understand the drag of documentation, metrics, changes to payment structure. It would still seem that there has been a general rise in salaries in excess of inflation over the past decade.



I agree that anonymity offers an opportunity to speak freely and openly that might offer more honest insight. The other side of the coin is that it is also more difficult to evaluate somebody's sources of information, their life circumstances, and general affect. Just like you mentioned that the academic docs I've worked with might present a bias of the fulfilled, happy physician, the internet can often present the opposite way. I think SDN had me convinced I failed Step 1, Step 2, and CS. Turned out I didn't have much to be concerned about.
The effort today is much higher than in the past. We are monkeys on our computers pecking away. Admin breathes down our necks to make sure we hit whatever idiotic metric they think is important this week. Some sites like HCA have nurses busting your balls and tattling on you.

many younger docs wont know the difference but it used to be easier and better. Now its tough. Some shifts are exhausting not because of the volume of patients but the difficulty in the system. Honestly, working for a CMG may be in my future in 5-10 years.. I hope not.. the huge drop in income will be real but its the incessant BS and dealing with idiots that will be the real drag.

The cut in pay has happened at many CMGs and frankly, it is unlikely to come back. They made the job harder by cutting scribes, pay, benefits, CME etc. Everyone did some part of that. Those benefits make work a little harder and makes every shift take a little more out of you. It is a cumulative effect.
 
Isn't Vituity a CMG as well? With a disingenuous "partnership" model? I've read pretty bad reviews of their operation on other threads here

It's not a CMG. It's the largest EM democratic group in the country. I think there are a few people on this board who are used to locums gigs and are upset that they make 20% less than a full partner with Vituity for the same work but I'm not sure what else would be upsetting about the group. That's what a partnership track is all about and any other SDG will have some permutation on that structure with some form of reduced pay giving you some sweat equity in the group. You make a bit less than market rate to start and if you end up sticking with it after 4 years with Vituity you can frequently make a bit above market rate for the better part of a career afterwards (plus with the larger group other perks like mobility if you loose a site contract etc). There is some administrative bloat (trying to get cut down and pretty successful in the past few years), and in a small site far away from Emeryville their headquarters it can be more isolating but I'm really pleased to be working with them. Covid changes and the struggles of TeamHealth and Envision seem to be leading to a lot of growth for Vituity over the past few months. I don't want to hijack the thread but feel free to PM if you want any other opinions or information.
 
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I agreed with everything you said until the middle-last part where you suggest that going to a well-regarded residency will save you. No it will not unless you're telling me that your big county or academic powerhouse program has a need/in-house job openings for all 20 residents from their PGY-4 class. Some residents will be working in the community however way you slice it. I don't give a darn if you trained at LAC or Cincinatti; you're not getting paid $250-300 an hour because of your highly regarded residency, because I have another HCA-trained ABEM certified doc willing to work for half as much who will take your job.

I didn't mean to imply that you would be paid more for your pedigree. Just that the good jobs are getting tougher and tougher to get with lots of qualified applicants so qualifications will matter more. I know several jobs in CA paying mid 200s per hour starting and mid 300s or more as full partner. That will be the pay structure if you get hired...but getting the job in the first place is the hard part. I suspect that coming from a good residency compared to CMG sweatshop will help, though from my experience hiring and on the job search it's still the personal recommendations that seem to matter most.
 
I didn't mean to imply that you would be paid more for your pedigree. Just that the good jobs are getting tougher and tougher to get with lots of qualified applicants so qualifications will matter more. I know several jobs in CA paying mid 200s per hour starting and mid 300s or more as full partner. That will be the pay structure if you get hired...but getting the job in the first place is the hard part. I suspect that coming from a good residency compared to CMG sweatshop will help, though from my experience hiring and on the job search it's still the personal recommendations that seem to matter most.

I've seen it frequently mentioned that the best jobs do not advertise and fill by word of mouth. I would think that well established residency programs with good reputations that have been around for 3-4 decades would offer significant advantages in this department based on networking and shear volume of alumni. At least on the interview trail this year it seemed like most graduating residents were happy with the jobs they had lined up.
 
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I've seen it frequently mentioned that the best jobs do not advertise and fill by word of mouth. I would think that well established residency programs with good reputations that have been around for 3-4 decades would offer significant advantages in this department based on networking and shear volume of alumni. At least on the interview trail this year it seemed like most graduating residents were happy with the jobs they had lined up.

People like to say this especially when deciding between programs but its not as big of an advantage as you'd expect these days. My program was one of the first programs that started in the 1970s and many of our alumni have gone on to start well known programs across the country. While it is true the chairman and program director can make phone calls and recommendations it only goes so far with jobs. As has been said before this advantage really only applies to academic jobs because most community jobs really couldn't care less where you did your residency. The fact of the matter is that they just want the cheapest and most efficient provider as possible and if tom from the old UF EM program is willing to work for 160/hr with 2PPH while mike from the new HCA EM program is willing to work for 140/hr with 2PPH they'll choose mike every time. Not only that but if david from unknown FM program is willing to work for 120/hr with 2PPH many places will choose him instead.
 
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It's not a CMG. It's the largest EM democratic group in the country. I think there are a few people on this board who are used to locums gigs and are upset that they make 20% less than a full partner with Vituity for the same work but I'm not sure what else would be upsetting about the group. That's what a partnership track is all about and any other SDG will have some permutation on that structure with some form of reduced pay giving you some sweat equity in the group. You make a bit less than market rate to start and if you end up sticking with it after 4 years with Vituity you can frequently make a bit above market rate for the better part of a career afterwards (plus with the larger group other perks like mobility if you loose a site contract etc). There is some administrative bloat (trying to get cut down and pretty successful in the past few years), and in a small site far away from Emeryville their headquarters it can be more isolating but I'm really pleased to be working with them. Covid changes and the struggles of TeamHealth and Envision seem to be leading to a lot of growth for Vituity over the past few months. I don't want to hijack the thread but feel free to PM if you want any other opinions or information.

Uh, it's a CMG. Just because the ownership is structured a certain way doesn't mean it's not a CMG.
 
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I want to interject something. I don't think medical students should make job market factors the primary concern when choosing a specialty. I think choosing a specialty you don't like because the job market is better would be a mistake and would lead to years of misery. People should choose their specialty based on what they want to do for a whole career. After that, job market considerations and personal choices should dictate where to live and work.
 
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Nobody cares in the community where you were trained. There's always the basic assumption that you can practice with a certain modicum of competency but that's it. If you're working for a CMG, you instantly become more valuable if you're willing to take less of a sign on, work for less $$/hr and are able to see more pph. You're a warm body to feed the machine. Academics is much more about networking and who you know..which is funny since most of these jobs are for much less $$$ than the community gigs.
 
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I know that CMGs fill the booths at ACEP for residents graduating. Are SDGs usually at these conferences? Or is it strictly word of mouth to get on?
 
I know that CMGs fill the booths at ACEP for residents graduating. Are SDGs usually at these conferences? Or is it strictly word of mouth to get on?

They’re there sometimes. I remember talking to an SDG from Pueblo, CO at ACEP one year way back. I don’t think they exist anymore.
 
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They’re there sometimes. I remember talking to an SDG from Pueblo, CO at ACEP one year way back. I don’t think they exist anymore.

Our SDG has never had a booth at ACEP. There’s just never been a need or interest from the group. As stated above, our last 5 or 6 hires have all been word of mouth or known entities.
 
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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.

Lots of options. I enjoy EM but if the pay became untenable then I would ring the bell and leave. The two easiest options upon leaving would be to:
—throw my time into opening up several more urgent cares and build that into my full time gig.
—go full time on adding to my multifamily rental portfolio
—pursue some blend of the two to create the income and lifestyle desired.

I’m sure there are other options, but that would be my knee jerk response to a pay rate of $130/hr.
 
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Our SDG has never had a booth at ACEP. There’s just never been a need or interest from the group. As stated above, our last 5 or 6 hires have all been word of mouth or known entities.
Same with the 2 SDGs I have been a part of. I also think the networking matters more related to who your attendings know than anything else. If you matched beneath the in n out residency which is the best residency hands down and all the graduates took crap CMG jobs no one is gonna care about you at the good jobs if they don’t know your faculty. Good gets more good and bad gets more bad. And in this case it has less to do with quality of program. I know of a really top notch em residency with a great training rep but all their docs take crappy jobs. No one at a good SDG will care cause they don’t know you or know people you know.
 
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Lots of options. I enjoy EM but if the pay became untenable then I would ring the bell and leave. The two easiest options upon leaving would be to:
—throw my time into opening up several more urgent cares and build that into my full time gig.
—go full time on adding to my multifamily rental portfolio
—pursue some blend of the two to create the income and lifestyle desired.

I’m sure there are other options, but that would be my knee jerk response to a pay rate of $130/hr.
Those of us who are about 10 years out who had good jobs and saw the writing on the wall diversified our income. That leads to choices.
 
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Uh, it's a CMG. Just because the ownership is structured a certain way doesn't mean it's not a CMG.

Yeah - there's no outside money or private equity in Vituity. So, no, it isn't. It is large (>2,000 partners + MLPs + support staff/admin) but there are no outside shareholders or investors. It's owned by the physician partners, and only physicians can become partners.

I get that the lines are blurred with the likes of USACS advertising "ownership", but that's not the same thing.
 
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Yeah - there's no outside money or private equity in Vituity. So, no, it isn't. It is large (>2,000 partners + MLPs + support staff/admin) but there are no outside shareholders or investors. It's owned by the physician partners, and only physicians can become partners.

I get that the lines are blurred with the likes of USACS advertising "ownership", but that's not the same thing.

Reread my statement. Ownership structure has nothing to do with it. Vituity manages a large number of contracts. By definition, a contract management group. The fact that the owners are physicians who also engage in clinical care does nothing to change that.
 
Just out of curiosity... do midlevels have a partnership track with groups like Vituity and other SDGs? Please, please, please say no.
 
Just out of curiosity... do midlevels have a partnership track with groups like Vituity and other SDGs? Please, please, please say no.

My SDG does not offer midlevels partnership nor am I aware of any other SDG that would offer a midlevel partnership track.
 
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My SDG does not offer midlevels partnership nor am I aware of any other SDG that would offer a midlevel partnership track.
Same. No MLP partners. They arent privy to our books etc. We still treat them better than most CMGs treat docs.
 
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How many of you are starting to see job offers for new grads at established programs get rescinded? There are quite a few now that I am aware of who have either had their start dates pushed back months or rescinded with a eye towards “maybe” hiring them on next year...

I never thought I would see this in Emergency Medicine. Grads are starting to freak out.

edit: not trying to freak anyone out. Just offering a direct observation and to foster discussion. Lot of theory being espoused (some of which I agree with) but less direct observation.
 
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I know of only a couple personally but there's also been a bunch of graduating residents posting on EMDocs who ended up losing their jobs.
 
I know of only a couple personally but there's also been a bunch of graduating residents posting on EMDocs who ended up losing their jobs.
It’s been fairly common. Volumes down, the stock market down. Hard for the old guys to hang it up if they werent conservative With their investments. They didn’t expect a 20% hit to their portfolio AND a cut in income right before they ease out.

In some shops the PT got their hours cut at some or all their places and are now looking to pick up shifts.

Throw in on top of that vacations have been cancelled or pushed back for most people. If you aren’t doing a vacation may as well work. Being at work isnt all that bad when your kids have been home nonstop for 3 months.

Put all that together and the newbies get pushed out.. I dont suspect things will be easy for the class of 2021. Volumes will likely stay down 10-20% (likely closer to 10% nationwide but will be regional) hence... less pay for folks and either cutting back coverage or people will want to work more to maintain income.
 
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If an ED doesn't make enough through patient volume and billing to pay over $200/hr, that's fine. The issue I have is with groups that clearly generate >$400/hr per doc and only pay $180. That's where the benefit of SDGs should come in, bringing that difference back to the docs in the group.

But then I talk to some SDGs and wonder where the heck that money actually went? Denver CMGs paying $140/hr are DEFINITELY earning way more than that. Even making $180/hr after partnership, there's still gotta be more. Where's all the money?
 
If an ED doesn't make enough through patient volume and billing to pay over $200/hr, that's fine. The issue I have is with groups that clearly generate >$400/hr per doc and only pay $180. That's where the benefit of SDGs should come in, bringing that difference back to the docs in the group.

But then I talk to some SDGs and wonder where the heck that money actually went? Denver CMGs paying $140/hr are DEFINITELY earning way more than that. Even making $180/hr after partnership, there's still gotta be more. Where's all the money?

Paying for the free drinks and unlimited shrimp at the USACS parties at ACEP. Certainly not enriching the pit docs who are touted as having "ownership".
 
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If an ED doesn't make enough through patient volume and billing to pay over $200/hr, that's fine. The issue I have is with groups that clearly generate >$400/hr per doc and only pay $180. That's where the benefit of SDGs should come in, bringing that difference back to the docs in the group.

But then I talk to some SDGs and wonder where the heck that money actually went? Denver CMGs paying $140/hr are DEFINITELY earning way more than that. Even making $180/hr after partnership, there's still gotta be more. Where's all the money?
I dont understand 2 points in this.

If an ED doesnt make enough to pay $200/hr thats fine? Why? It’s not fine unless its a low volume sleepy place.

If a group makes $400/hr but pays $180 thats not ok? Really? Why not? As a CMG and all the residents listen up closely. They dont pay you based on what you bring in revenue wise. They pay you the minimum amount needed to have you show up at work.

You bring up denver... tons of people want to live there and are willing to work for cheap. It’s like McDonald’s.. the guy who owns it might be making a huge profit but that doesnt mean he needs to pay his employees anymore. The issue with CMGs and why i hate them is just that. They dont bring anything of value to the table. They simply conned some idiot CEO to use them.

As far as CMGs the money goes to the private equity owners. KKR didn’t drop billions of dollars to help enrich pit docs, ya feel me?
 
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Some silver lining of everything going on recently is that while some of the big CMGs might be bleeding money these days, AAEM with some docs on Facebook EM Docs are starting to get organized and making competitive offers for contracts that will be run solely by ED docs.

The challenge of the future of EM is going to be getting Admin to side with the docs rather than corporate suits. EM remains competitive as its ever been, but long term, I think med students will start turning away knowing that it's saturated and pay will be going down to outpatient PCP levels.
 
I dont understand 2 points in this.

If an ED doesnt make enough to pay $200/hr thats fine? Why? It’s not fine unless its a low volume sleepy place.

If a group makes $400/hr but pays $180 thats not ok? Really? Why not? As a CMG and all the residents listen up closely. They dont pay you based on what you bring in revenue wise. They pay you the minimum amount needed to have you show up at work.

You bring up denver... tons of people want to live there and are willing to work for cheap. It’s like McDonald’s.. the guy who owns it might be making a huge profit but that doesnt mean he needs to pay his employees anymore. The issue with CMGs and why i hate them is just that. They dont bring anything of value to the table. They simply conned some idiot CEO to use them.

As far as CMGs the money goes to the private equity owners. KKR didn’t drop billions of dollars to help enrich pit docs, ya feel me?


whoops. I wrote “Denver cmgs pay 140/hr, even after partnership”. I absolutely meant SDGs. There’s no partnership in CMGs. My mistake.

the point I’m trying to make is if your shop is a profit sharing partnership, your partners should be making a split of the revenue minus costs. But for some reason even SDGs in areas with low paying CMGs (like Denver) aren’t paying partners that much.

I’m talking about the disconnect between market hourly rates set by CMGs and partnership rates that should be set by revenues, but aren’t.
 
whoops. I wrote “Denver cmgs pay 140/hr, even after partnership”. I absolutely meant SDGs. There’s no partnership in CMGs. My mistake.

the point I’m trying to make is if your shop is a profit sharing partnership, your partners should be making a split of the revenue minus costs. But for some reason even SDGs in areas with low paying CMGs (like Denver) aren’t paying partners that much.

I’m talking about the disconnect between market hourly rates set by CMGs and partnership rates that should be set by revenues, but aren’t.
I suspect you're simply incorrect about what partners are getting paid. What is likely happening is that partners are making 140/hr base + profit sharing.
 
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I think the general tone here is too doom and gloom, and frankly too self centered. The current problem of decreased volumes, cuts, and staffing is a result of a pandemic. Pretty much every specialty is suffering because of it. At my hospital, surgeons are taking a cut. Primary care is. Anesthesia is. Nurses are being sent home. Everyone is suffering. Fewer patients and less pay = less pay. Period EM isn't any worse off than other specialties here. Or at the very least, we're middle of the road in terms of negative impact. Yes, pay will soften just like it has for nearly everyone in the country. We're not immune. But lets not be so pessimistic as to thing these tough times will last forever.

Lets not have such short memories. At my shop, last winter was the busiest ever. Probably too busy. We added shifts. We at times didn't have enough docs last year. The population is increasing, and people are using the ED a lot. We will get volumes back, it will just be a slow climb there. I'm seeing volumes increase already. We're already adding back a few shifts. To those who think the volumes will never return...why? Whats the rationale to draw that conclusion based on the effects of a once in a lifetime situation were currently living in. I dont buy it. Just give it time. People still get sick. The emergency room is still the safety net and entry point of the healthcare system. Unless that changes, people will come.

We DO need to keep pressing our groups to make sure DOCS are staffing hospitals as volumes ramp back up. I've been vocal about this with administration. We have to make sure we demand to be paid what were worth. We have to work together and not sell ourselves out.

For perspective, I'm working outside of atlanta, making 220/hr down from 250/hr and working 10 shifts down from 15.

EM, and the whole economy and every specialty is going to feel this now. Dont be so down on EM. I truly think things will get better. There already are slowly improving from my limited vantage point.
 
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I’ll be sure to pass this on to my residents who have lost the jobs they were supposed to start in less than 2 months and are struggling to find any work. But to counter my doom and gloom, at least one of them was able to find full time hours at a rural ED for $90/hr


Please do. Let them know that many people are out of work completely. let them know that at my hospital today, medication specialists, techs, and front office workers were sent home. Let them know that the pain they feel is real, but that everyone is feeling it. Some are making 0/hour. And let them know this wont last always.
 
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Please do. Let them know that many people are out of work completely. let them know that at my hospital today, medication specialists, techs, and front office workers were sent home. Let them know that the pain they feel is real, but that everyone is feeling it. Some are making 0/hour. And let them know this wont last always.

Yeah and the people displaced from Target and Ross and the local bar have 200-300k in debt too right?

You're a tool
 
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I think the general tone here is too doom and gloom, and frankly too self centered. The current problem of decreased volumes, cuts, and staffing is a result of a pandemic. Pretty much every specialty is suffering because of it. At my hospital, surgeons are taking a cut. Primary care is. Anesthesia is. Nurses are being sent home. Everyone is suffering. Fewer patients and less pay = less pay. Period EM isn't any worse off than other specialties here. Or at the very least, we're middle of the road in terms of negative impact. Yes, pay will soften just like it has for nearly everyone in the country. We're not immune. But lets not be so pessimistic as to thing these tough times will last forever.

Lets not have such short memories. At my shop, last winter was the busiest ever. Probably too busy. We added shifts. We at times didn't have enough docs last year. The population is increasing, and people are using the ED a lot. We will get volumes back, it will just be a slow climb there. I'm seeing volumes increase already. We're already adding back a few shifts. To those who think the volumes will never return...why? Whats the rationale to draw that conclusion based on the effects of a once in a lifetime situation were currently living in. I dont buy it. Just give it time. People still get sick. The emergency room is still the safety net and entry point of the healthcare system. Unless that changes, people will come.

We DO need to keep pressing our groups to make sure DOCS are staffing hospitals as volumes ramp back up. I've been vocal about this with administration. We have to make sure we demand to be paid what were worth. We have to work together and not sell ourselves out.

For perspective, I'm working outside of atlanta, making 220/hr down from 250/hr and working 10 shifts down from 15.

EM, and the whole economy and every specialty is going to feel this now. Dont be so down on EM. I truly think things will get better. There already are slowly improving from my limited vantage point.
Overall, I agree with much of the sentiment in your post. The way economics works, and has worked for centuries, is that huge crashes rebound back over time. We've seen it in the markets even as recently as this past decade. You are correct, things will get better I suspect.

That being said, the current situation is god awful and extremely concerning if you are a graduating resident. You have paid your dues, invested in your education over decades, gotten beaten to a pulp in residency, for the promise that when you get out, you will be able to *hopefully* return the hundreds of thousands of dollars you owe back to the federal government. Maybe provide for your family. Maybe stash away some cash for a rainy day.

Graduating residents shouldn't be placed in the same category as "rich doctors". I feel like the general public often turns a blind eye to physician hardship because they view them as well off. They don't take into account the immense sacrifices, debt incurred, and delayed gratification that goes into being a physician. So you can't compare a physician to say, a medical tech or an RN, or pretty much any other occupation in America.

Your salary dropping to 220/hr is very different than what a new resident is going through where their contract has just been pulled and they don't have a job. While yes, it is the middle of a pandemic, it is also in many ways a commentary on how large groups and the health care system has really taken advantage of physicians.

Is that "self-centered" of me? Hardly.
 
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