Compensation in EM

[Perfect Hair Day]

Aloha,

Medical student, switching gears from IM to pursue EM.

I understand that for the early part of an IM/specialist career (based out of a hospital) salary is hospital-guaranteed, then partially guaranteed and partially based on the physicians RVUs.

How does compensation work in EM? My understanding is that pay is good as a newly-minted EM doc fresh out of residency (>275k) but how does this work? It is not as if an EM doc is a specialist that patients specifically "seek out" their care like in OP clinic. Wondering how this works, if the high salary wanes, if salary becomes a "feast of famine". Not sure of the long-term stability of compensation and trying to get a better understanding.

Appreciate any and all inputs.

Thanks

ButteredLobster

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[Arcan57]

Aloha,

Medical student, switching gears from IM to pursue EM.

I understand that for the early part of an IM/specialist career (based out of a hospital) salary is hospital-guaranteed, then partially guaranteed and partially based on the physicians RVUs.

How does compensation work in EM? My understanding is that pay is good as a newly-minted EM doc fresh out of residency (>275k) but how does this work? It is not as if an EM doc is a specialist that patients specifically "seek out" their care like in OP clinic. Wondering how this works, if the high salary wanes, if salary becomes a "feast of famine". Not sure of the long-term stability of compensation and trying to get a better understanding.

Appreciate any and all inputs.

Thanks

ButteredLobster

Many compensation models.

In non-partnership tracks, compensation starts at or close to the region's ceiling and remains there. If it's RVU based then you may see a mild uptick in compensation 1-2 yrs out as you maximize your efficiency. Eventually you'll start picking up fewer shifts/month as you get tired and other pursuits crop up and you'll make less. If it's hourly then what you make coming out is going to be what you make long-term barring significant changes in supply/demand for EPs.

In partnership track, generally you'll make something significantly below the region's medium with the promise of being (usually) significantly above the medium once you make partner.

 

[The White Coat Investor]

Your income as an attending emergency physician is mostly flat. You'll come out of residency and depending on how hard you work (i.e. how many shifts, how crummy of a place you are willing to work, how hard you work on shift, how long of shifts, more night shifts), will make $250-600K. The only exceptions are academics (who start low and have occasional raises) and docs in partnerships, who start even lower than $250K and then have a big raise when they make partner, but are flat after that.

Because of that, if you grow all the way into your income without carving out enough to build wealth, there is the potential that you will never build any, especially with the rapidly growing average doctor debt burden. Grow into that income as slowly as you can and never grow all the way into it. As you come out of residency, you ought to have more than 50% of your gross pay going to savings and paying off loans and you can gradually, especially as you pay off the loans, crank that down to a savings rate of about 20%.

 

[Perfect Hair Day]

Your income as an attending emergency physician is mostly flat. You'll come out of residency and depending on how hard you work (i.e. how many shifts, how crummy of a place you are willing to work, how hard you work on shift, how long of shifts, more night shifts), will make $250-600K. The only exceptions are academics (who start low and have occasional raises) and docs in partnerships, who start even lower than $250K and then have a big raise when they make partner, but are flat after that.

Because of that, if you grow all the way into your income without carving out enough to build wealth, there is the potential that you will never build any, especially with the rapidly growing average doctor debt burden. Grow into that income as slowly as you can and never grow all the way into it. As you come out of residency, you ought to have more than 50% of your gross pay going to savings and paying off loans and you can gradually, especially as you pay off the loans, crank that down to a savings rate of about 20%.

What do you mean "grow all the way into your income" ?

 

[SpacemanSpifff]

What do you mean "grow all the way into your income" ?

Spending money like an attending from the get go.

 

[Perfect Hair Day]

Spending money like an attending from the get go.

Damn. Kind of already there (see username) lol.


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[Welker]

What about inflation? Does EP income get adjusted for inflation? Otherwise you essentially make less every year no?

 

[shoal007]

What about inflation? Does EP income get adjusted for inflation? Otherwise you essentially make less every year no?

No guarantee for inflation raise. This yr we got no raise as a group.



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[Vandalia]

What about inflation? Does EP income get adjusted for inflation? Otherwise you essentially make less every year no?

EM/Physician income has been pretty much the same for many years. Which means an annual DECREASE in pay when inflation is factored in.

As mentioned, in almost any other career, pay increases as you get older. In medicine, if anything, it probably decreases. The accountant or the engineer is slightly justified in putting off savings/paying off debt because it is almost certain that their income will steadily increase, and after the kids leave college and the mortgage is paid off they will have a high level of "disposable income" before they retire. (Many problems with that view, but it is at least slightly justified for them.) In EM at least, likely before all that you will be cutting shifts and making less.

The physician is a bit like the pro-athlete. Given a lot of money before they have the capacity to handle it. Now obviously physicians are in much better shape to handle that, but the same fundamental issue remains. Your first couple of years in practice is where you are likely going to have the most disposable income. Yeah, you might have some young kids, but very shortly there will be private schools, sports travel teams, gymnastics, etc., etc., that will suck out money for decades to come. But unlike your peers, your salary will not increase. More likely, it will decrease when inflation is factored in. You are probably allowed one indulgence when you get your first real paycheck. But keep it just one.

 

[bravotwozero]

I have never heard of pay increases to compensate for inflation - in any field. This is entirely a new concept for me.


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[BoardingDoc]

I have never heard of pay increases to compensate for inflation - in any field. This is entirely a new concept for me.


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Getting a 3-4% annual raise to keep pace with inflation is fairly common in many fields.

 

[deleted109597]

I have never heard of pay increases to compensate for inflation - in any field. This is entirely a new concept for me.


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OTOH, tell me any group that is paying what they paid their doctors 10 years ago. Either they were exceedingly high paid then, or they're well under water now.

 

[gutonc]

I have never heard of pay increases to compensate for inflation - in any field. This is entirely a new concept for me.


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A COL raise is not uncommon for salaried folks (in medicine and out). I get one.

 

[carbonizedeyesockets]

I have never heard of pay increases to compensate for inflation - in any field. This is entirely a new concept for me.


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It's commonplace. My old job had cost-of-living raises along with performance-based raises.

 

[backcountryrez]

It's commonplace. My old job had cost-of-living raises along with performance-based raises.

At least your old job did that. Mine disguises a COL raise as a performance-based raise.

 

[bravotwozero]

Does inflation correlate with an increase in revenue? If not, the employer is shelling out more money with essentially the same revenue - not sure why they'd want to do that...


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[deleted109597]

Does inflation correlate with an increase in revenue? If not, the employer is shelling out more money with essentially the same revenue - not sure why they'd want to do that...


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Typically the hospital and the group also raise prices with inflation. They don't exactly line up, but they go up a little. Each microeconomy is different. Don't kid yourself though. The reason wages in NY and Philadelphia are low aren't because of reimbursement, it's because of supply. CMS actually pays more for codes in NYC than they do in Texas, but docs earn less.

 

[sum dude]

EM salaries have outpaced inflation (up 5% just in 2016). In general, since ACA, we've definitely seen inflationary prices in medicine, far outpacing US inflation (which has been relatively low past few years, likely due to banks/big corporations sitting on cash flows). Since I left residency, over 28% increase in wages. We are seeing higher volumes, and like it or not, ACA did help our wages (in addition to favoring consolidation and administrative tasks)

median 2011: $250,000
Median 2016: $322,000

 

[discongruent]

We are seeing higher volumes, and like it or not, ACA did help our wages (in addition to favoring consolidation and administrative tasks)

Correct.

Which necessarily begs to ask the following question, what is the route this will take once ACA has been slaughtered by current administration with no reasonable replacement?

 

[Welker]

Correct.

Which necessarily begs to ask the following question, what is the route this will take once ACA has been slaughtered by current administration with no reasonable replacement?

I think the current administration is not good for EM...

 

[emergentmd]

EM salaries have outpaced inflation (up 5% just in 2016). In general, since ACA, we've definitely seen inflationary prices in medicine, far outpacing US inflation (which has been relatively low past few years, likely due to banks/big corporations sitting on cash flows). Since I left residency, over 28% increase in wages. We are seeing higher volumes, and like it or not, ACA did help our wages (in addition to favoring consolidation and administrative tasks)

median 2011: $250,000
Median 2016: $322,000

Rise in income is related to supply and demand leaning towards the doctor. It has nothing to do with the CMGs increasing wages for COLA.

Billing has generally been flat or gone down.

 

[sum dude]

Rise in income is related to supply and demand leaning towards the doctor. It has nothing to do with the CMGs increasing wages for COLA.

Billing has generally been flat or gone down.

Who said anything about COLA? It's obviously a result of the demand--patients have no where else to go, PMD's are too swamped to see them, and specialists are too quick to send patients to ED rather than be bothered. The ACA, which is very mixed-bag for doctors, has resulted in more insured patients (granted most on medicaid who pay $0.50 on the dollar, but that's better than the $0.05 most self-pays offer). Add to that an aging and sicker population, and we are seeing much more and higher acuity patients than in 2010. Where as billing might be flat, ED visits have increased pretty similar pattern to increase in pay.