Decrease in EP salaries/pay?

[BoardingDoc]

I have always wanted to do Sports Medicine, so I'm glad to see this is a fellowship option for EM. Does anyone have any insight into how working SM along with EM would affect your salary? I imagine it'd be lower... but how do you get the ED you work with to allow you to cherry pick shifts to be suitable for picking up shifts at an 8-5 job elsewhere like 1-2 times a week?

Schedule-wise it's pretty easy. E.g. you work SM Tues and Wed. Your calendar is blocked off for Mon-Wed so you don't have an overnight or evening shift leading into your Tues. You then work the same mix of days/nights as everyone else Th - Su. This of course means that you'll work a disproportionate number of weekends. I suspect most groups would be willing to hire you seeing as you'd be decreasing the number of weekends that the other docs have to work and not messing with the day/night balance. That said, if you were looking to work the same mix of weekends as everyone else, or get a "less nights" deal AND mix in this recurring schedule requirement it's a different story. I doubt anyone would hire you in that scenario unless they were desperate for ED docs, in which case you're probably living somewhere rather remote which isn't going to do your SM gig any favors.

As to the salary question: trading an EM shift for a day of work in SM is likely going to drop your salary unless you develop a robust patient panel with good insurance. Also depends on what you're doing. If it's mostly exams and routine visits, you're certainly not going to be making much money. If you are spending Tues and Wed doing back to back injections, you'll probably come out ahead.

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[miacomet]

Lol, true.

And telehealth

 

[KeikoTanaka]

Schedule-wise it's pretty easy. E.g. you work SM Tues and Wed. Your calendar is blocked off for Mon-Wed so you don't have an overnight or evening shift leading into your Tues. You then work the same mix of days/nights as everyone else Th - Su. This of course means that you'll work a disproportionate number of weekends. I suspect most groups would be willing to hire you seeing as you'd be decreasing the number of weekends that the other docs have to work and not messing with the day/night balance. That said, if you were looking to work the same mix of weekends as everyone else, or get a "less nights" deal AND mix in this recurring schedule requirement it's a different story. I doubt anyone would hire you in that scenario unless they were desperate for ED docs, in which case you're probably living somewhere rather remote which isn't going to do your SM gig any favors.

So, would you be able to work just 1 or 2 shifts a week in an ER? Or is that too little to like receive benefits or what not but its doable

 

[BoardingDoc]

So, would you be able to work just 1 or 2 shifts a week in an ER? Or is that too little to like receive benefits or what not but its doable

2 shifts a week in the ED, even if you're doing 12 hour shifts will certainly not meet the minimum requirements for full time. The lowest I've seen full time listed at is 100 hr/month and many places are 110 or 120/mo. 2 shifts a week doing 12 hr shifts would only get you to 96 hrs.

Is it possible? Yes. In a non-competitive market. If you're looking at a job which has other candidates looking to work there, then no, it is unlikely that you would be hired with a request for 8 shifts/mo.

 

[KeikoTanaka]

2 shifts a week in the ED, even if you're doing 12 hour shifts will certainly not meet the minimum requirements for full time. The lowest I've seen full time listed at is 100 hr/month and many places are 110 or 120/mo. 2 shifts a week doing 12 hr shifts would only get you to 96 hrs.

Is it possible? Yes. In a non-competitive market. If you're looking at a job which has other candidates looking to work there, then no, it is unlikely that you would be hired with a request for 8 shifts/mo.

Okay, that's kinda a downer. I'm just thinking ahead and like obviously I would want to maintain my SM skills, and maybe when I'm much older do it full time... so I can't just do the fellowship and then ignore it for 12-15 years lol. I'm not sure how to go about doing both without killing myself in work

 

[BoardingDoc]

Okay, that's kinda a downer. I'm just thinking ahead and like obviously I would want to maintain my SM skills, and maybe when I'm much older do it full time... so I can't just do the fellowship and then ignore it for 12-15 years lol. I'm not sure how to go about doing both without killing myself in work

Your best bet would probably to get attached to an academic center somewhere. If you are working at a place that does an SM fellowship after you've completed one, you could ostensibly teach, work in your clinic and still only be required to work 6-10 shifts a month in the ED.

Alternatively, you could work your SM gig full/near full time and just do IC work at an ED for as many shifts a month as you want, with the knowledge that if they ever hire a FT doc, you're out a job.

 

[KeikoTanaka]

Your best bet would probably to get attached to an academic center somewhere. If you are working at a place that does an SM fellowship after you've completed one, you could ostensibly teach, work in your clinic and still only be required to work 6-10 shifts a month in the ED.

Alternatively, you could work your SM gig full/near full time and just do IC work at an ED for as many shifts a month as you want, with the knowledge that if they ever hire a FT doc, you're out a job.

IC work?

 

[BoardingDoc]

IC work?

Independent Contractor. We're getting a bit into the weeds at this point. Focus on doing well in med school so that you can match into whatever specialty you want. You have more than enough time to sort out these finer details later.

 

[hundreddaysoff]

So, would you be able to work just 1 or 2 shifts a week in an ER? Or is that too little to like receive benefits or what not but its doable

To get a bit more into the weeds... benefits are overrated. You could certainly pull 1--2 locums shifts/w in flyover country and make enough to get yourself good healthcare (premium is ~$400/mo for an individual or $1100/mo for a family w/ Physician Solutions right now, and any IC doctor can purchase that). You could even (tenuously) retire in 10y doing that, if you're OK w/ living on $50K as an attending, which is about what the average American family makes anyway.

Will this all last for 5--10y? No one knows, but then no one really knows anything. Hell, no one even knows if they'll still allow independent contractors in CA in a few years (recent court case Dynamex v Superior Court).

 

[miacomet]

But this is my point... the main exit strategy is still to live cheap and save up as quickly as you can, so that you don't have to run the rat race for the rest of your life. There is no large scale exit strategy for EM or any other field in general, as none of those other fields/jobs that you mentioned can accommodate large influx. These are already niche markets with established players.

Oh, I agree, and I think ten years out most people realize they should have done another field. EM as a career is a fraud.

 

[Birdstrike]

Pain, hyperbarics, wound care, addiction medicine, telehealth, occupational medicine, urgent care, admin, public health etc. Yes, they all pay less, but a better schedule and lower stress. I agree EM is not rife with great exit strategies and is a fraud of a field that you can't do long term, but if you can earn 400k a year (unlikely if you are in the Bronx!), save up a couple million over a decade, and then retire to a cush job where you earn 150-200k, life is sweet, no?

Disagree, BTW, that salaries have been flat. The last two to three years they've flattened, but NYC pays much more than it used to.

I make more in Pain, that I ever did in EM. Enough so, that it's paid for the one lost year of salary during fellowship and then some, plus a better schedule. (The last I looked at the MGMA survey, Pain salaries were higher than EM on average, also, with EM being $300-399K, vs Pain at $400-499K; if someone has the current MGMA, please correct me if wrong and post it). That, combined with an interventional focus plus a strong referral & patient screening strategy to keep the addicts and dealers from getting in, makes it more than worth doing the year fellowship.

 

[miacomet]

I make more in Pain, that I ever did in EM. Enough so, that it's paid for the one lost year of salary during fellowship and then some, plus a better schedule. (The last I looked at the MGMA survey, Pain salaries were higher than EM on average, also, with EM being $300-399K, vs Pain at $400-499K; if someone has the current MGMA, please correct me if wrong and post it). That, combined with an interventional focus plus a strong referral & patient screening strategy to keep the addicts and dealers from getting in, makes it more than worth doing the year fellowship.

Pain=impossible for EM docs these days....

 

[Birdstrike]

Pain=impossible for EM docs these days....

It was impossible when I applied, too. My strategy was to apply to every program in the country and see if I got lucky. I got lucky.

 

[miacomet]

With all due respect, while it's always been hard, it's harder, and with USMLE scores rising, it's really difficult (impossible) if you graduated a few years back. It's also a match now. The situation isn't the same as when you applied. Sure, some will get in, but it's not a particularly sure exit strategy.

 

[ski89]

With all due respect, while it's always been hard, it's harder, and with USMLE scores rising, it's really difficult (impossible) if you graduated a few years back. It's also a match now. The situation isn't the same as when you applied. Sure, some will get in, but it's not a particularly sure exit strategy.

This is the match data for pain fellowship the last few years. If anything it is getting slightly less competitive. Number of unfilled positions is up and number of unmatched applicants is down. Also, EM applicants these days are much more competitive than anesthesia applicants (from med school), its a cake walk to get into anesthesia these days. Now sure, I think you probably have to show real interest in pain medicine throughout your residency to have a good shot, which is harder coming from EM than it is from Anesthesia or PM&R. If you have real interest it's totally a viable option from what I can see.

 

[BoardingDoc]

Oh, I agree, and I think ten years out most people realize they should have done another field. EM as a career is a fraud.

What's with the 5 month delay in your reply to this comment?

 

[e30ftw]

I graduated residency four years ago and have experienced significant increase in compensation with a minimal increase in work-load.