EM Doctors//Opinions about EM

[ChicagoPreMedStudent]

In your opinion, why do people on SDN and other medical forums advise people so heavily against training in emergency medicine?
I’m really interested in it but almost every forum I read says it’s one of the worst fields.
Do you agree with this?

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[Ms Procrastinator]

In your opinion, why do people on SDN and other medical forums advise people so heavily against training in emergency medicine?
I’m really interested in it but almost every forum I read says it’s one of the worst fields.
Do you agree with this?

High burnout rate plus destroyed circadian rhythm etc. Some people say dealing with difficult patients is kinda like working in retail (crappy customers).

 

[Rogue42]

Because they are sometimes seen as the lowest doctors in the hospital system, they work shift work, their circadian rhythm gets thrown off, they more often than not deal with primary care patients instead of emergency patients, they often have to ask for more help than other physicians - as in they have to refer to cards, gi, surg, etc, and they have recently had so many people pursue the specialty that people are worried about the elevated salary being decreased dramatically due to over-supply.

However, it is a great specialty if you are okay with the above statements. Also, how true those things are? Eh, only real ER docs know, but I know that is the usual lines of crap they get.

 

[ChicagoPreMedStudent]

Because they are sometimes seen as the lowest doctors in the hospital system, they work shift work, their circadian rhythm gets thrown off, they more often than not deal with primary care patients instead of emergency patients, they often have to ask for more help than other physicians - as in they have to refer to cards, gi, surg, etc, and they have recently had so many people pursue the specialty that people are worried about the elevated salary being decreased dramatically due to over-supply.

However, it is a great specialty if you are okay with the above statements. Also, how true those things are? Eh, only real ER docs know, but I know that is the usual lines of crap they get.

I can't believe that they are lowering the salary when its already pretty avg/low to begin with when it comes to physician's salary (in hospitals) in general. That is such a shame. I am super interested, but I have student loans to pay off.

 

[Rogue42]

I can't believe that they are lowering the salary wen its already pretty avg/low to begin with when it comes to physician's salary (in hospitals) in general. That is such a shame. I am super interested, but I have student loans to pay off.

I did not say they were lowering the salary for sure. What I meant is that people believe the salary will begin to trend downward.

Also, EM physicians make on average like $350-400k depending on region which is actually really high for physicians in the hospital AND only going to residency for three years. Not to mention they work fewer hours than most, and can pick up more shifts.

If you are worried about money, this ~ currently ~ is not the specialty to be worried about it in.

 

[DNAJB6]

High burnout rate plus destroyed circadian rhythm etc. Some people say dealing with difficult patients is kinda like working in retail (crappy customers).

+1. Not speaking from experience, but I'm sure the trauma cases really bother you after a while. One is bad enough.

 

[Vivid_Quail]

I can't believe that they are lowering the salary wen its already pretty avg/low to begin with when it comes to physician's salary (in hospitals) in general. That is such a shame. I am super interested, but I have student loans to pay off.

You can be in the top 5% of medical student loan debt and be in the bottom 10% of physician salary and still pay off your loans without much of problem. Anyways...

wen its already pretty avg/low to begin with when it comes to physician's salary

It is actually the exact opposite.

One reason why a lot of EM doctors are complaining about their field is that they were ridiculously spoiled for over two decades. It was not uncommon for EM doctors to make high $200/hr and be able to find locums for $300-400/hr. To put that into perspective, an orthopedic surgeon who got a 255 step 1, did a 6 year surgical residency+fellowship, makes $700k a year, works 50 hours/week, and takes two weeks vacation, would make as much per hour as an ED doctor who did a 3 year residency that is very easy to match into. The level of hourly compensation EM was getting was never going to be sustainable, because...hospitals aren't stupid and realized that EM doctors are a replaceable commodity, which ties into my next point.

The real reason for the increased EM doom and gloom in 2020-2021 is not what people in this thread are saying, even though that has also been true for decades (difficult patients and circadian rhythm diruption leading to high burnout). The real reason is the flooding of the job market with more residencies. The number of EM residency positions has increased "27.5 percent over four years—from 1,786 spots in 2014 to 2,278 in 2018," and is still climbing! New programs get added every year! Combined this with a MASSIVE drop in ED visits due to Covid and hours have been slashed, part-time doctors have been fired, and PGY-3 (final year) EM residents have been unable to find jobs anywhere.

I could go on but yeah, EM is one of the fields where the doom and gloom is actually based in reality.

 

[DNAJB6]

One reason why a lot of EM doctors are complaining about their field is that they were ridiculously spoiled for over two decades. It was not uncommon for EM doctors to make high $200/hr and be able to find locums for $300-400/hr. To put that into perspective, an orthopedic surgeon who got a 255 step 1, did a 6 year surgical residency+fellowship, makes $700k a year, works 50 hours/week, and takes two weeks vacation, would make as much per hour as an ED doctor who did a 3 year residency that is very easy to match into.

Many EM residencies are 4 years in length. Not all orthopedists do fellowship and residency is 5 years. Not that much difference TBH.

 

[Vivid_Quail]

Many EM residencies are 4 years in length. Not all orthopedists do fellowship and residency is 5 years. Not that much difference TBH.

You are entirely missing the point.

Also, in EM there are 174 3-yr programs vs 65 4-yr programs...not to mention there is 0 benefit of doing a 4-year program, even if they were as common. >90% of ortho residents do a fellowship so comparing vast majority of EM grads to vast majority ortho grads it is 3 vs 6 years. But again, you are missing the point. Ortho, CT surgery, and neurosurgery were the only specialties that made more per hour than EM which is laughable. Those surgical specialties generate so many RVUs per hour, are much more competitive, bring their own patients to the hospital, are harder to start a residency for, etc.

 

[DNAJB6]

You are entirely missing the point.

Also, in EM there are 174 3-yr programs vs 65 4-yr programs...not to mention there is 0 benefit of doing a 4-year program, even if they were as common. >90% of ortho residents do a fellowship so comparing vast majority of EM grads to vast majority ortho grads it is 3 vs 6 years. But again, you are missing the point. Ortho, CT surgery, and neurosurgery were the only specialties that made more per hour than EM which is laughable. Those surgical specialties generate so many RVUs per hour, are much more competitive, bring their own patients to the hospital, are harder to start a residency for, etc.

Source? Every time I look up physician salary data, I see large ranges based on academic v. community, geography, etc. I have never seen EM listed at $300-$400 per hour on average. I'm sure there are outliers for every field.

 

[Angus Avagadro]

You are entirely missing the point.

Also, in EM there are 174 3-yr programs vs 65 4-yr programs...not to mention there is 0 benefit of doing a 4-year program, even if they were as common. >90% of ortho residents do a fellowship so comparing vast majority of EM grads to vast majority ortho grads it is 3 vs 6 years. But again, you are missing the point. Ortho, CT surgery, and neurosurgery were the only specialties that made more per hour than EM which is laughable. Those surgical specialties generate so many RVUs per hour, are much more competitive, bring their own patients to the hospital, are harder to start a residency for, etc.

2 other points to consider. One , EM docs frequently point out to their hospital employer just how much revenue they generate by ordering imaging studies, lab work and consults. This justifies their compensation packages. I have personally seen many cases where imaging is performed prior to being evaluated by the attending. Secondly, PAs and NPs are cheaper to utilize, therefore less demand for ER attendings as more APPs are hired. In our area, some ER patients are seen by the APP only. With increased number of residencies, increased use of APPs, and perpetual headwinds for any increase in reimbursement, it seems reasonable for compensation packages for ER docs to decrease. Anytime you get more of something, the price goes down.

 

[Vivid_Quail]

Source? Every time I look up physician salary data, I see large ranges based on academic v. community, geography, etc. I have never seen EM listed at $300-$400 per hour on average. I'm sure there are outliers for every field.

My calculations were based on $280 an hour, which was not at all uncommon 10 years ago in the South and Midwest (especially if you convert that to today's dollar value). You can Google ACEP salary report and see that the hourly rate for EM is still $250-$280 an hour in some states. But my point is that it used to be really high $/hour and is going down. $300-$400 an hour was for EM locums not full-time work but the fact that that was even possible is insane. I don't even know if neurosurgery or cardiothoracic surgery locums ever pay that much.

 

[Vivid_Quail]

2 other points to consider. One , EM docs frequently point out to their hospital employer just how much revenue they generate by ordering imaging studies, lab work and consults. This justifies their compensation packages. I have personally seen many cases where imaging is performed prior to being evaluated by the attending. Secondly, PAs and NPs are cheaper to utilize, therefore less demand for ER attendings as more APPs are hired. In our area, some ER patients are seen by the APP only. With increased number of residencies, increased use of APPs, and perpetual headwinds for any increase in reimbursement, it seems reasonable for compensation packages for ER docs to decrease. Anytime you get more of something, the price goes down.

Completely forgot to mention APP's, very important addition haha. Even though other fields have been overrun by mid-levels, like anesthesia, they either have had more time to adapt, again like anesthesia, or the results of mid-levels are particularly dubious...I'm thinking complex internal medicine patients, ICU, surgery, etc. I'm not saying EM is easy by any means but from an admin point of view, I think they view emergency medicine as more algorithmic than other specialties.

And I don't think you are arguing this, especially because you highlighted that it basically comes down to supply and demand, but for premeds it's important to understand that if hospital systems can create enough of an oversupply of physicians applying for a job (and this already happens in "desirable" cities completely organically), they don't have to listen to how much a physician actually bills. They can just keep lowering the salary that they offer until no one will take the job. And we have seen that physicians will be stupid enough and stubborn enough about living in cities like Denver, that they will accept being paid ridiculous rates like $95/hour to work in the ED. Doesn't matter to them that they could make 150% more in an area with just as many outdoor activities but with less craft beer.

Edit: One of the big benefits of countries that basically don't allow non-physicians to own practices and then for physicians that work in hospitals, they have strong unions. When physicians own a practice they are not going to undercut themselves in terms of salary when they bill a ton. I guess they can undercut non-partners who they employ, but again this is mainly only possible in desirable cities were physician supply outpaces demand. So some of the same market forces exist in these countries, but I think it is still better for physicians and patients. I am mainly talking about Germany since that is the country I am most familiar with by far.

 

[la flame]

Is it common for ED docs to work in the ICU? I don't know if it's because it's covid related and my hospital is desperate for night coverage, but I've already seen many MD/DO EM docs run the ICU at night where I'm at

 

[ChicagoPreMedStudent]

You are entirely missing the point.

Also, in EM there are 174 3-yr programs vs 65 4-yr programs...not to mention there is 0 benefit of doing a 4-year program, even if they were as common. >90% of ortho residents do a fellowship so comparing vast majority of EM grads to vast majority ortho grads it is 3 vs 6 years. But again, you are missing the point. Ortho, CT surgery, and neurosurgery were the only specialties that made more per hour than EM which is laughable. Those surgical specialties generate so many RVUs per hour, are much more competitive, bring their own patients to the hospital, are harder to start a residency for, etc.

I agree with this, but I saw a post saying that the salary accounts for:
a) The bad living/working conditions that EM docs deal with (as highlighted in your first post)
b) The sheer # of patients EM docs see/how much work/charting etc they do
ER docs see more patients then most other specialties in the hospital.

I don't really know why you think residency is so important. Yes its way more years where you are paid less (during those years) but thats not the most relevant thing when it comes to pay after residency. Theres lots of other factors.
Like I said, I agree with some of your points that you are making, but the sweeping generalizations and the tone in your original post makes it sound like you are discounting how truly hard ER doctors work. How much they sacrifice to do that work.

I can understand how you may think that Ortho may be harder (or the other specialties you listed) but without very strong ER docs, there would be a big cog in the hospital system in general. I.E: Doctors running more tests then necessary, asking for consults and wasting time, even death of several or many patients. Some ER docs in big cities will preform minor surgery on critical trauma cases that come into the ER, some set bones, do stitches, and comfort children all in the same day. They are the most multifaceted specialty (in my opinion) and deserve more credit then what you have given them.

 

[ChicagoPreMedStudent]

I did not say they were lowering the salary for sure. What I meant is that people believe the salary will begin to trend downward.

Also, EM physicians make on average like $350-400k depending on region which is actually really high for physicians in the hospital AND only going to residency for three years. Not to mention they work fewer hours than most, and can pick up more shifts.

If you are worried about money, this ~ currently ~ is not the specialty to be worried about it in.

So I may have way weird stats that I am looking at (I am in Chicago for reference) but I was told by an ER doc that they make 230k and other docs in other specialties have told me they believe ER docs are underpaid or paid less then average

 

[Rogue42]

So I may have way weird stats that I am looking at (I am in Chicago for reference) but I was told by an ER doc that they make 230k and other docs in other specialties have told me they believe ER docs are underpaid or paid less then average

If an EM physician, working in Chicago, is only grossing 230k while working a full-time (12+ shifts a month), then they are being GROSSLY underpaid, and need to find a new job. MGMA data shows that the average salary for the Midwest EM was $380,000 in 2018.

EDIY: I know for a fact EM docs in Nashville, TN are averaging 250+ an hour and newer docs are averaging 220+ an hour. Average of 144-ish hours a month x 12 months = $380-$432k a year before taxes.

 

[KLMD44]

I assume salaries will also trend down because of the PA's and NP's flooding emergency departments, although it still seems like a good gig if you like the work!

 

[ChicagoPreMedStudent]

If an EM physician, working in Chicago, is only grossing 230k while working a full-time (12+ shifts a month), then they are being GROSSLY underpaid, and need to find a new job. MGMA data shows that the average salary for the Midwest EM was $380,000 in 2018.

EDIY: I know for a fact EM docs in Nashville, TN are averaging 250+ an hour and newer docs are averaging 220+ an hour. Average of 144-ish hours a month x 12 months = $380-$432k a year before taxes.

Thanks. Again, like I said maybe I am getting bad info which is why I came here

 

[maybeDRmaybenot]

 

[crazyozone]

I completed an EM residency. Including conference hours was about 65 hours. But EM is a dead end job and will soon become the first specialty to continuously produce board certified physicians that can't find a job -- which is unthinkable. The American Academy of Emergency Physicians recently wrote this:

An Open Letter to the Specialty of Emergency Medicine | AAEM Resident and Student Association

The American Academy of Emergency Medicine Resident and Student Association (AAEM/RSA) is a non-profit professional association for emergency medicine residents and medical students.

www.aaemrsa.org

Basically strong wording against another group, the american college of emergency physicians which has let EM become so corporate that we are wholly controlled by CMGs. Even before covid19 hit, EM doctors were in a slow tumble in pay. Once coronavirus hit, hourly pay decreased all over the country. Many physicians have been let go, and most of the workforce has seen reduced hours. This trend will continue. Furthermore, a few CMGs own most of the jobs (staffing wise) and have been pushing higher metrics and worse working conditions in a specialty known for extreme burnout.

The CMG that I am hired through sent an email to my group of docs stating they expect a .5% rate of downgraded charts. They also have sent emails to the group about the need for increased patient satisfaction (and this is during coronavirus when everyone was dieing and families weren't allowed to be present for their loved ones' last moments). They also sent multiple emails stating they expect patients to be seen faster. So spend less time with patients while making them happier and making your notes better. They control the jobs so they control what we must do and what we get payed, and if we don't like it there is nowhere else to turn. You're lucky to even have a job. I have many friends experience the same thing at different jobs from the same or similar CMGs. I suggest you avoid the specialty at all costs

 

[Mkif586]

I completed an EM residency. Including conference hours was about 65 hours. But EM is a dead end job and will soon become the first specialty to continuously produce board certified physicians that can't find a job -- which is unthinkable. The American Academy of Emergency Physicians recently wrote this:

An Open Letter to the Specialty of Emergency Medicine | AAEM Resident and Student Association

The American Academy of Emergency Medicine Resident and Student Association (AAEM/RSA) is a non-profit professional association for emergency medicine residents and medical students.

www.aaemrsa.org

Basically strong wording against another group, the american college of emergency physicians which has let EM become so corporate that we are wholly controlled by CMGs. Even before covid19 hit, EM doctors were in a slow tumble in pay. Once coronavirus hit, hourly pay decreased all over the country. Many physicians have been let go, and most of the workforce has seen reduced hours. This trend will continue. Furthermore, a few CMGs own most of the jobs (staffing wise) and have been pushing higher metrics and worse working conditions in a specialty known for extreme burnout.

The CMG that I am hired through sent an email to my group of docs stating they expect a .5% rate of downgraded charts. They also have sent emails to the group about the need for increased patient satisfaction (and this is during coronavirus when everyone was dieing and families weren't allowed to be present for their loved ones' last moments). They also sent multiple emails stating they expect patients to be seen faster. So spend less time with patients while making them happier and making your notes better. They control the jobs so they control what we must do and what we get payed, and if we don't like it there is nowhere else to turn. You're lucky to even have a job. I have many friends experience the same thing at different jobs from the same or similar CMGs. I suggest you avoid the specialty at all costs

This is very disturbing. I wonder, are there other specialties that face similar problems???