Comparisons Based on Most Recent Salary Survey

[thumbz]

Do neurohospitalist jobs typically require calls +/- a mix of nights and days? I'm just curious. The former isn't a thing for IM hospitalists and the latter is a thing sometimes

At my shop yes to both, and remember that old people love to get their "new" neurologic symptoms evaluated in the late evening, which will always result in a stroke alert. Our neurohospitalists get kept super busy from 5pm through midnight or so it seems

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[Splenda88]

At my shop yes to both, and remember that old people love to get their "new" neurologic symptoms evaluated in the late evening, which will always result in a stroke alert. Our neurohospitalists get kept super busy from 5pm through midnight or so it seems

That sucks. It seems like most people that come to the ED with "stroke-like symptoms" are outside of window, so why should a neurologist be involved?

 

[thumbz]

That sucks. It seems like most people that come to the ED with "stroke-like symptoms" are outside of window, so why should a neurologist be involved?

Ahhhhh you haven't met my ER docs, several of whom are a unique brand of terrible. They literally will not ask when the symptoms started, and instead just call a stroke alert so that us and neuro do the workup. Then they bill their extra super duper complex critical care time RVU's and disappear.

 

[Splenda88]

Ahhhhh you haven't met my ER docs, several of whom are a unique brand of terrible. They literally will not ask when the symptoms started, and instead just call a stroke alert so that us and neuro do the workup. Then they bill their extra super duper complex critical care time RVU's and disappear.

Everyone is milking the cow; that's why I believe the system will not be sustainable in 10 yrs.

 

[mrbreakfast]

That sucks. It seems like most people that come to the ED with "stroke-like symptoms" are outside of window, so why should a neurologist be involved?

Ahh, my friend, but that would entail actually asking the patient what time their symptoms started! Can't do that without a neuro consult.

Strokes and seizures are scary, many physicians feel uncomfortable assessing a patient who cannot eloquently tell you their entire life's story, and very, very few physicians remember anything from med school neurology. There is no shortage of work for us.

 

[When the Moon Forgot]

I wonder how accurate Medscape's salary survey really is. As a family physician, my hourly wage falls in the "Golden God" bracket on some days and the "Printing Money" bracket on others.

 

[Splenda88]

I wonder how accurate Medscape's salary survey really is. As a family physician, my hourly wage falls in the "Golden God" bracket on some days and the "Printing Money" bracket on others.

They are not accurate. I urge people to not look at these surveys and talk to colleagues before signing on the dotted line.

Most doctors these days can print money if they are a little bit creative.

 

[scoopdaboop]

Everyone is milking the cow; that's why I believe the system will not be sustainable in 10 yrs.

sustainable prior decade...dont see why itll change.

 

[Splenda88]

sustainable prior decade...dont see why itll change.

I am hoping that is the case.

 

[operaman]

They are not accurate. I urge people to not look at these surveys and talk to colleagues before signing on the dotted line.

Most doctors these days can print money if they are a little bit creative.

Yup. And when we figure out a good system, we keep the details to ourselves so nobody else does it!

Just read through CPT archives and you’ll see how docs of yore optimized their cash flow until too many got onboard and then the powers that be cracked down.

 

[Candidate2017]

Love this. I feel like I'm food stamps level - between inflation and no raise since 2018 I wish I had a Corolla

(I'm IM)

Telemedicine is a popular option for many doctors these days, including those who can't afford a Corolla or a monthly bus pass, as well as doctors with expensive German cars that break down often.

 

[collegestud2013]

Thanks for working on this. Great information. Another wrinkle would be length of training. Most on the higher end require 6-7 years of residency. A shorter residency provides a head start that is quite significant when crunching the numbers.

This. The difference between most higher paid specialties and and the ones that only require 3 years of training (eg EM, IM, FM) is much smaller than what these surveys make them to be, once you account for training time. The difference also increases once you factor in lost gains from investment over those years for specialties with longer training time.

Also, it would be more accurate to compare post-tax income. Even an additional $200k per year you could make in a high-paying specialty vs a lower paying specialty comes out to only ~$110k additional pear year after taxes. This is problem with high-paying specialties that have long training time; your income is compressed at the end and this is not favorable from a tax standpoint.

Also, would not rely on Medscape as the prime source of physician salaries. Their sampling method is very susceptible to bias, and they are listed means/averages (which for most specialties will be higher than the median as outliers affect the mean much more than the median). MGMA seems to be the gold standard for physician compensation data (and even then it still has its share of limitations) and it also gives specialty median pay which is more accurate, as well as percentile pay for each specialty. It does come with a fee to use, but med students and residents looking at compensation data should use MGMA instead if they want a better representation.

 

[operaman]

This. The difference between most higher paid specialties and and the ones that only require 3 years of training (eg EM, IM, FM) is much smaller than what these surveys make them to be, once you account for training time. The difference also increases once you factor in lost gains from investment over those years for specialties with longer training time.

Also, it would be more accurate to compare post-tax income. Even an additional $200k per year you could make in a high-paying specialty vs a lower paying specialty comes out to only ~$110k additional pear year after taxes. This is problem with high-paying specialties that have long training time; your income is compressed at the end and this is not favorable from a tax standpoint.

Also, would not rely on Medscape as the prime source of physician salaries. Their sampling method is very susceptible to bias, and they are listed means/averages (which for most specialties will be higher than the median as outliers affect the mean much more than the median). MGMA seems to be the gold standard for physician compensation data (and even then it still has its share of limitations) and it also gives specialty median pay which is more accurate, as well as percentile pay for each specialty. It does come with a fee to use, but med students and residents looking at compensation data should use MGMA instead if they want a better representation.

This.

You keep a lot more of the first $350k than you do of the second $350k, and the ratio gets worse as the numbers get bigger. Add in state and local income tax and it gets even worse. High COL coastal states can have double digit state tax rates for top earners with a total tax rate approaching 50%.

It’s too hard to compare all the possible combinations, but anyone using these sort of data for a major decision would be wise to figure post tax dollars for their personal living situation. Obviously someone living in a no income tax state like Florida or Texas would have different number than someone in a similar field in California with ~10% tax on top of 35-37% federal.

 

[ChordaEpiphany]

This.

You keep a lot more of the first $350k than you do of the second $350k, and the ratio gets worse as the numbers get bigger. Add in state and local income tax and it gets even worse. High COL coastal states can have double digit state tax rates for top earners with a total tax rate approaching 50%.

It’s too hard to compare all the possible combinations, but anyone using these sort of data for a major decision would be wise to figure post tax dollars for their personal living situation. Obviously someone living in a no income tax state like Florida or Texas would have different number than someone in a similar field in California with ~10% tax on top of 35-37% federal.

Yes, but also consider the substantial tax breaks you get for being married, having dependents, and using tax shelters correctly. Even at very high incomes, most people aren't paying anywhere near 50% in the states. An individual making $500K with no retirement tax shelter actually makes $295K and gets taxed at nearly 41%. Meanwhile a married couple with 2 kids making $650K combined and contributing the max $45K/year to a 401K makes $430K and has an effective tax rate of ~34% in CA.

 

[operaman]

Yes, but also consider the substantial tax breaks you get for being married, having dependents, and using tax shelters correctly. Even at very high incomes, most people aren't paying anywhere near 50% in the states. An individual making $500K with no retirement tax shelter actually makes $295K and gets taxed at nearly 41%. Meanwhile a married couple with 2 kids making $650K combined and contributing the max $45K/year to a 401K makes $430K and has an effective tax rate of ~34% in CA.

good point. What I meant to convey was more that the interval increase is taxed pretty close to 50% even if that number lowers when you combine it with the income at lower brackets.

So when comparing a 350k salary to a $500k salary, that extra 150 difference is itself subject to a very high tax rate and thus the increase in take home pay is less than it would be going from 150 to 300.

 

[emergentmd]

I know most are down on EM right now but that 150ish an hour is no way accurate. I do not know of any EM docs making 150/hr and most are over 200/hr. I can't think of a job that paid 150/hr working at a hospital ER in the past 20 yrs.

 

[Prehealth1011]

Yeah I’m in IM but I know my EM bros well. None of their seniors are signing for <200 an hour where I am

 

[collegestud2013]

Yeah I’m in IM but I know my EM bros well. None of their seniors are signing for <200 an hour where I am

Pretty good considering all the doom and gloom in EM right now. $150/hr is close to national average for IM/FM hospitalist right now for day shifts, so even if EM drops to $150 average they would be making similar to hospitalist with similar amount of training. Some of the lower paying settings in EM like academics, VA, saturated cities, or places with low patient volume can definitely drop down to $150/hr for EM.

 

[thepoopologist]

Corollas aren't cheap these days

 

[DoctorMD1]

I know most are down on EM right now but that 150ish an hour is no way accurate. I do not know of any EM docs making 150/hr and most are over 200/hr. I can't think of a job that paid 150/hr working at a hospital ER in the past 20 yrs.

radiology rate of ~190/hr is not accurate either.

 

[odyssey2]

radiology rate of ~190/hr is not accurate either.

What figure range would be more accurate?

 

[emergentmd]

Yeah I’m in IM but I know my EM bros well. None of their seniors are signing for <200 an hour where I am

I am sure all the numbers are deflated. If I had to guess, assuming no benefits, the avg EM doc prob pulls in 225/hr.

 

[Mad Jack]

I am sure all the numbers are deflated. If I had to guess, assuming no benefits, the avg EM doc prob pulls in 225/hr.

All of them certainly are. Psych typically nets way more than what the surveys would have you believe per patient contact hour. Perhaps people are doing a lot of work on admin and charting, as the hour numbers include that, not just paid patient contact time. Perhaps physicians are highly overestimating their time worked and spent outside of compensated hours. Couldn't tell you, really. It does give you trends, however.

 

[Splenda88]

Pretty good considering all the doom and gloom in EM right now. $150/hr is close to national average for IM/FM hospitalist right now for day shifts, so even if EM drops to $150 average they would be making similar to hospitalist with similar amount of training. Some of the lower paying settings in EM like academics, VA, saturated cities, or places with low patient volume can definitely drop down to $150/hr for EM.

$150/hr is still not bad. EM docs job is a lot harder than IM (hospitalist) IMO based what I see at my shop.

I heard the typical FT EM job is 32 hrs/wk so I guess that balance things out.

 

[Splenda88]

All of them certainly are. Psych typically nets way more than what the surveys would have you believe per patient contact hour. Perhaps people are doing a lot of work on admin and charting, as the hour numbers include that, not just paid patient contact time. Perhaps physicians are highly overestimating their time worked and spent outside of compensated hours. Couldn't tell you, really. It does give you trends, however.

Probably correct. Hospital medicine 7 on/off is 84 hrs, but most hospitalist work less than that. I would estimate that I work ~72 hrs out of 84 hrs.

One can say physician salary is still good. Never in my wildest dream I thought I would make 400k+/yr as a hospitalist without killing myself.

 

[SurfingDoctor]

I did 7 years of training and make less with the same amount of training.

But then again… medicine doesn’t reward knowledge and money ain’t everything.

 

[Splenda88]

I did 7 years of training and make less with the same amount of training.

But then again… medicine doesn’t reward knowledge and money ain’t everything.

I am going to quote Kanye here: "Having money isn't everything, not having it is."

 

[SurfingDoctor]

I am going to quote Kanye here: "Having money isn't everything, not having it is."