EM-Critical Care - my pay and how it has evolved over a decade +

[Trailmusings101]

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A cross post here from the critical care thread because I'm EM-CC.
This describes what pay used to be like, and you can see the writing on the wall as we are increasingly marginalized by ICC, USACS, Envision, Sound, etc.

My Pay as an Intensivist - Then, now and to the future

When I came out of fellowship in 2009, I had a number of places vying for my services. I was interested in doing strictly critical care as an intensivist with no other specialty involvement. I had several academic offers where salary was about $275-300k for essentially two weeks of service a...

forums.studentdoctor.net

 

[emergentmd]

All specialties will go down this path. If there is money to be made, there is some specialists that will sell their soul to a CMG/VG

 

[Brigade4Radiant]

Thanks it’s good to know that spending two years to do a critical care fellowship may not be worth it if it is owned by private equity.

Academics can also suck since you must play politics

 

[bravotwozero]

Academics can also suck since you must play politics

still Much more tolerable than dealing with a toxic c suite full of a holes and an unhelpful medical director

 

[EctopicFetus]

still Much more tolerable than dealing with a toxic c suite full of a holes and an unhelpful medical director

Let’s be real. Do you think in academics there isnt a toxic environment? Both where I trained and where i know people it isnt exactly hunky dory. Docs getting screwed especially now during covid. Docs being taken advantage of in the name of “helping out” meanwhile these systems record record profits. Thats the for profits, non profits and the academic centers.

heck most of the academic centers are branching out as quick as they can and gobbling up hospitals to fatten their bottom lines. Indiana, Vanderbilt, Wake Forest, Etc.

 

[thegenius]

still Much more tolerable than dealing with a toxic c suite full of a holes and an unhelpful medical director

academics have c suites too. c suites and admin have their grubby little fingers in community, academics, in your back yard, up your arse. You can't run away from them.

If you went to Neptune they would be right behind you.

 

[Brigade4Radiant]

still Much more tolerable than dealing with a toxic c suite full of a holes and an unhelpful medical director

It depends on how high you are on the academic ladder. Team health and Envison still run the department on a lot of academic ED's. Plus you need to be productive in your clinical time deal with other departments and typically in academia ED gets **** on. IN big name programs it means big players such as internal medicine and Surgery which can make admitting painful.

Case in point in a midwestern ED residency that was run by the surgery department. The ED was run by the surgery department. He found out how ED used to get paid. He cut their salaries since they often made more than gen surgeons.

During the pandemic academic salaries have lowered and often shifts have increased.

Also the university that has the academic center doesn't want to give you tenure. They will work to make it as hard as possible.

 

[TheComebacKid]

Sorry, I disagree with some of the sentiment here regarding academics. As an academic ED doc, I can tell you that my day to day job is way better than my colleagues who are employed by CMGs, and many of them have reached out to me to see if they can get hired on where I work. Sure they make more than I do, but the environment appeals to many.

There's no question that academic centers care about the bottom line too. But I am never harassed about metrics, how many PPH I see, what my door to doc time is etc. One of the hospitals we cover is an inner city county facility, literally all they care about is that we see patients and try to keep them from dying in the waiting room. The acuity is good, but whether there is 80 in the waiting room or 5 in the waiting room, I just do my work and see them when I can. The nurses are also fairly good and supporting staff is decent. It's a challenging place to work, for sure, but I'd choose it any day compared to working for TeamHealth.

During the pandemic our department did not lay off people. We did not pull contracts on people that were already hired. Though it's probably not as much as you could get in other settings, we still posted a profit during COVID and faculty were awarded a bonus, which amounted to something like 24K for the year. Not a ton, but it was something. I got hired on during the worst part of the pandemic when there were no jobs, and I still got my small hiring bonus and relocation bonus.

It's by no means easy to work in academics. Your days off are taken from you to do other endeavors such as research, teaching residents, going to other meetings/committees etc. You definitely get paid less. But there is much more job security. You are afforded a higher degree of medicolegal protections, especially if you are a part of a public university. You have pretty much all the consultants in house. Yes sometimes it's hard to admit patients to medicine or surgery but that's usually when a PGY-2 is doing the admission. If I get pushback, I call the attending directly its taken care of. If it continues to be a problem I discuss with my medical director or department chair and it gets escalated.

There are definitely politics. The standards for tenure are virtually impossible to meet for most. But if you have a niche that you enjoy, you can find a way to get clinical buy down for it, its a great way to work less clinical shifts. The clinical shifts are what kill you in EM, and academics offers a good way to do less of those. Your value as an academic EM physician is more in how successful you are outside the clinical space i.e. in research, education, and other typical academic pursuits. There all these old timer academic EM gods who could maybe see no more than 5 patients a shift, but they are untouchable because their name is on a textbook or first author on an influential paper.