EM Future

Panacea Financial Contract Review
This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
Members do not see this ad.
alpinism said:
Rosenberg is a quack who employs holistic nurses to perform energy healing on emergency patients.

www.jennifermargulis.net

I broke my leg, doc, so why is that lady playing the harp? — Jennifer Margulis

Dr. Mark Rosenberg believes holistic practices and a more human touch—both literally and figuratively—can improve Emergency Room care and patient outcomes.
www.jennifermargulis.net www.jennifermargulis.net
Click to expand...
The irony of that article is it totally nails why EDs are like they are:

"Many of us have had similar experiences: a high level of personalized care at a smaller community-oriented hospital but a much lower level of care at bigger hospitals where staff can barely keep up with the patients coming in."

You can't conjure patients out of thin air in rural facilities and you can't drop down below single coverage (although some CMGs try with the you have to cover the ED and round on inpatients model). You can deliberately short staff a busy department.
 
Apollyon said:
1989. So, the actual grandfathered in docs are, very likely, at, or close to, retirement, or dead.

Back in 2012 I worked in a ****ty rural hospital, with a guy who just missed the practice track in 89. He's FM. He was (and, I believe, still is) working 240 hours/month - 12 hour shifts, nights, Thursday through Monday nights. When I asked him why, he said, "don't make the mistakes I did", one of which was part of the axiom, "one or fewer spouses, and one or fewer houses".
Click to expand...
Remind me where you practice.
 
Old_Mil said:
The biggest issue with Family Medicine who haven't been fellowship trained working in the emergency department is the difference in mindset. That specialty has the mindset of "address the common diagnoses empirically first before moving on to testing". We have the mindset of "address the most life threatening diagnoses with testing before concluding it isn't."

This is how an FM *attending* during my FP rotation as an MS3 sent home a 50 something year old man with chest and epigastric pain with a "normal" ekg having GERD...who proceeded to die of a massive MI that night.
Click to expand...
No, we really don't; or at least we're not supposed to and most of the ones I know don't.
 
Apollyon said:
1989. So, the actual grandfathered in docs are, very likely, at, or close to, retirement, or dead.

Back in 2012 I worked in a ****ty rural hospital, with a guy who just missed the practice track in 89. He's FM. He was (and, I believe, still is) working 240 hours/month - 12 hour shifts, nights, Thursday through Monday nights. When I asked him why, he said, "don't make the mistakes I did", one of which was part of the axiom, "one or fewer spouses, and one or fewer houses".
Click to expand...

I know a guy who had an alcoholic wife he he talked about divorcing. But he never did. His reasoning was, “It would cost me too much.” She eventually drank herself to death, which is what he apparently had banked on. At the funeral he looked all cross-fitted up and had gone from round to super buff at 60. He took his new biceps and pecs, promptly quit EM, and I haven’t heard from him since.
 
Birdstrike said:
I know a guy who had an alcoholic wife he he talked about divorcing. But he never did. His reasoning was, “It would cost me too much.” She eventually drank herself to death, which is what he apparently had banked on. At the funeral he looked all cross-fitted up and had gone from round to super buff at 60. He took his new biceps and pecs, promptly quit EM, and I haven’t heard from him since.
Click to expand...
I'm not sure how I should feel about this, but I admire his pragmatism and moving forward with life! 🙂
 
EM docs should not be working til they are 60. The ones who do tend to have wives that spend way toooo much or have more than 1.

Once you remarry and have more kids, you are essentially resetting your work clock to day #1.

Don't do it. If you divorce, don't marry again if you want to retire before 60.
 
emergentmd said:
EM docs should not be working til they are 60. The ones who do tend to have wives that spend way toooo much or have more than 1.

Once you remarry and have more kids, you are essentially resetting your work clock to day #1.

Don't do it. If you divorce, don't marry again if you want to retire before 60.
Click to expand...
What did I say, right above you?

"One or fewer houses, and one or fewer spouses."
 
Apollyon said:
What did I say, right above you?

"One or fewer houses, and one or fewer spouses."
Click to expand...
I see too many docs divorce then marry someone young and have kids. Don't see the reason to not only reset the clock but obliterate any retirement.
 
emergentmd said:
I see too many docs divorce then marry someone young and have kids. Don't see the reason to not only reset the clock but obliterate any retirement.
Click to expand...
Probably a calculation of [delayed retirement] < [not wanting to die alone] + [companionship] + [the fulfillment of raising little money parasites]
 
Not to distract from this discussion of which things in life are better to rent and which are better to buy, apparently this isn't the first time this has happened. Just the first time in our memories. From the November 1947 issue of JAMA.
 

Attachments

  • physicianoversupply.jpg
    physicianoversupply.jpg
    51 KB · Views: 165
Old_Mil said:
Trying to get physicians to do anything together is only slightly harder than herding cats. Start with something simple like destroying ACEP by everyone cancelling their memberships this year.
Click to expand...
I’m on this train. I was a member For a while. Dropped membership. Rejoined due to work at the Ruc and reimbursement issues. Then realized those issues don’t help CMG or employed docs at all. So they can eat a big fat D and they can keep doing it without my dues.
 
Old_Mil said:
Trying to get physicians to do anything together is only slightly harder than herding cats. Start with something simple like destroying ACEP by everyone cancelling their memberships this year.
Click to expand...

Herding cats is definitely easier. I heard a doc the other day say they couldn't possibly provide a good recommendation for another doc moving to a different job because they felt this doc just wasn't up to their standard. I don't know about you but I have no idea how good the other docs I work with are at practicing medicine and patient care. It's not just that physicians cant do anything together, it's that as a profession we love to tear each other down.
 
There are many unhappy docs on this forum/thread and even the most fervent docs likely have done nothing other than canceling memberships. Good luck doing anything substantial as 99% of the docs would not do anything to risk their 300K+ Paychecks.
 
emergentmd said:
There are many unhappy docs on this forum/thread and even the most fervent docs likely have done nothing other than canceling memberships. Good luck doing anything substantial as 99% of the docs would not do anything to risk their 300K+ Paychecks.
Click to expand...
Yes. This is the why nothing has changed. They have too much to lose, in dollars, including the MD lifestyle. It’s hush money. But if salaries fall low enough, the damn will break. But that’s a big if. We shall see.

Beware of a man with nothing to lose.
 
Last edited:
Birdstrike said:
I know a guy who had an alcoholic wife he he talked about divorcing. But he never did. His reasoning was, “It would cost me too much.” She eventually drank herself to death, which is what he apparently had banked on. At the funeral he looked all cross-fitted up and had gone from round to super buff at 60. He took his new biceps and pecs, promptly quit EM, and I haven’t heard from him since.
Click to expand...
This is the darkest thing I have read in a while.
 
emergentmd said:
This is called going from depressed to living life again. amazing how marriage can suck the souls out of some people.

See this transformation all the time.
Click to expand...
Since government gets involved in marriage (strange if you think about it), then we should have mandatory pre-nups. The default is that you get to keep whatever assets you take into marriage, and everything subsequent is community property. People can change it from the default if they wish, but both parties would have to affirm.
 
emergentmd said:
I have property managers on all of my properties and spend maybe 1 hr a month responding to emails a month. Well worth the 6-8% LTR and 15% STR to avoid all of the headaches. This is about as passive as you can get. You can chose to be as passive or active as you like.
Click to expand...

What market are you in? Would you be willing (offline) to share more about costs, cash flow, etc. Thanks!
 
emergentmd said:
There are many unhappy docs on this forum/thread and even the most fervent docs likely have done nothing other than canceling memberships. Good luck doing anything substantial as 99% of the docs would not do anything to risk their 300K+ Paychecks.
Click to expand...
Does anyone seriously think docs would then do anything substantial if it drops to $200k jobs?
 
HeyDalaron said:
This is the darkest thing I have read i
Click to expand...

wamcp said:
Does anyone seriously think docs would then do anything substantial if it drops to $200k jobs?
Click to expand...
It'd be like that old Simpson's line where you just go in and do you job real half ass, the American way. Or for the socialists: they pretend to pay us, we pretend to work.
 
wamcp said:
Does anyone seriously think docs would then do anything substantial if it drops to $200k jobs?
Click to expand...
if all docs income was capped at 200K tomorrow, 99% of them would keep coming to work. What else are they going to do to make 200K a year? They all have their Mcmansion, boats, second wives, student loans, kids private schools, college to pay for.

They would just complain more and still do a good job b/c someone else will do it or they will just hire more APCs.

Oh wait, isn't this going to happen with medicare for all? If privates go away, and everyone is put on medicare rates then everyone's pay will plummet.
 
wamcp said:
Does anyone seriously think docs would then do anything substantial if it drops to $200k jobs?
Click to expand...
Like what? Protest? Threaten to walk out?

The biggest downside to the pursuit of medicine is that you pigeon hole yourself into one very specific career with a specific set of very focused skills and you give up years of your life to learn the craft. If you get an MBA you can work anywhere if you aren't happy with your gig. We can't pick up and practice a different specialty. The opportunity cost is high.

We were promised that "we would always have jobs" by the boomer generation when we signed up for this. Now the chickens have come home to roost, unfortunately.

Physicians will take whatever pay we are offered, even sub 200K and dare I say it, sub 150K salaries if it came down it. Because as pitiful as those salaries are, the alternative (being unemployed) is far worse.
 
TheComebacKid said:
Like what? Protest? Threaten to walk out?

The biggest downside to the pursuit of medicine is that you pigeon hole yourself into one very specific career with a specific set of very focused skills and you give up years of your life to learn the craft. If you get an MBA you can work anywhere if you aren't happy with your gig. We can't pick up and practice a different specialty. The opportunity cost is high.

We were promised that "we would always have jobs" by the boomer generation when we signed up for this. Now the chickens have come home to roost, unfortunately.

Physicians will take whatever pay we are offered, even sub 200K and dare I say it, sub 150K salaries if it came down it. Because as pitiful as those salaries are, the alternative (being unemployed) is far worse.
Click to expand...
Knowing this is what allows administrators to collude against EPs.
 
TheComebacKid said:
Physicians will take whatever pay we are offered, even sub 200K and dare I say it, sub 150K salaries if it came down it. Because as pitiful as those salaries are, the alternative (being unemployed) is far worse.
Click to expand...
Perhaps this generation. Going forward very few people are going to sign up for premed, medical school, and residency for a job that pays twice what a convenience store manager makes.
 
Birdstrike said:
Knowing this is what allows administrators to collude against EPs.
Click to expand...


This goes with all hospital based doctors. If admin came to rad and said we are capping you at 250k/yr where are they going to go? Anesthesiology - where are they going to work? Pathology- whose hiring them.

It’s coming for all.
 
emergentmd said:
This goes with all hospital based doctors. If admin came to rad and said we are capping you at 250k/yr where are they going to go? Anesthesiology - where are they going to work? Pathology- whose hiring them.

It’s coming for all.
Click to expand...
You are too cynical and practical.
 
If they pay me 200K per year I wouldn't do this job. Even a pay cut to 150/hr and I wouldn't do it, at least not seeing 2-2.5 pts/hr on my own while supervising midlevels at the same time.

We all need to work towards passive income of 10K per month. All of us should be able to live decent lifestyles on that amount of money, and can augment with other side income.

I expect Envision to drop the hammer very soon, and we will see what happens. Unfortunately most docs I work with are trapped, as they are either new grads with mountains of debt, or old-timers with multiple divorces and lots of kids.
 
GeneralVeers said:
If they pay me 200K per year I wouldn't do this job. Even a pay cut to 150/hr and I wouldn't do it, at least not seeing 2-2.5 pts/hr on my own while supervising midlevels at the same time.

We all need to work towards passive income of 10K per month. All of us should be able to live decent lifestyles on that amount of money, and can augment with other side income.

I expect Envision to drop the hammer very soon, and we will see what happens. Unfortunately most docs I work with are trapped, as they are either new grads with mountains of debt, or old-timers with multiple divorces and lots of kids.
Click to expand...
You may not but there will be 10x APCs and MDs who will do it for sub 150/hr. Bank on it.

When docs realize that they are not rare/important to the system and just a cog/widget, then they will have a better outlook and use their wealth/brains to say FU to the system. Most are not able.

I for one should be at 25k/mo passive income by years end and if they paid me less than $200/hr, I would just do some sleepy FSER/Telemed/UC

Everyone seems to be jumping into RAD as its the flavor of the decade. They are so vulnerable with telerad and easily replaceable.
 
GeneralVeers said:
If they pay me 200K per year I wouldn't do this job. Even a pay cut to 150/hr and I wouldn't do it, at least not seeing 2-2.5 pts/hr on my own while supervising midlevels at the same time.

We all need to work towards passive income of 10K per month. All of us should be able to live decent lifestyles on that amount of money, and can augment with other side income.

I expect Envision to drop the hammer very soon, and we will see what happens. Unfortunately most docs I work with are trapped, as they are either new grads with mountains of debt, or old-timers with multiple divorces and lots of kids.
Click to expand...
For some reasons, docs like big houses, expensive cars even if they have no time to enjoy them.

I know one hospitalist that bought an E-class and a Tesla in his second year of attending-hood.
 
GeneralVeers said:
If they pay me 200K per year I wouldn't do this job. Even a pay cut to 150/hr and I wouldn't do it, at least not seeing 2-2.5 pts/hr on my own while supervising midlevels at the same time.

We all need to work towards passive income of 10K per month. All of us should be able to live decent lifestyles on that amount of money, and can augment with other side income.

I expect Envision to drop the hammer very soon, and we will see what happens. Unfortunately most docs I work with are trapped, as they are either new grads with mountains of debt, or old-timers with multiple divorces and lots of kids.
Click to expand...
Do you already have FU money?
 
emergentmd said:
You may not but there will be 10x APCs and MDs who will do it for sub 150/hr. Bank on it.

When docs realize that they are not rare/important to the system and just a cog/widget, then they will have a better outlook and use their wealth/brains to say FU to the system. Most are not able.

I for one should be at 25k/mo passive income by years end and if they paid me less than $200/hr, I would just do some sleepy FSER/Telemed/UC

Everyone seems to be jumping into RAD as its the flavor of the decade. They are so vulnerable with telerad and easily replaceable.
Click to expand...
Rads is in a better position than clinicians. They haven’t drastically increased their training spots over the past decade and the system is going full on imaging buffet for everyone with or without a pulse that enters the door. Plus, midlevels love imaging since it gives them a way out of having to think critically about the nuances of medicine.
Headache? Let’s get aMRI.
Chest pain? Let’s get CTPE, stress test.
Joint pain? Let’s get X-rays.

If an imaging test exists for a particular part of the body and the patient has any symptom remotely close to said body part, they will order it.

and it’s not just the midlevels, docs are doing it too given the “customer is always right mentality.” Better to just click on a few icons on Epic than argue with the customer and get a bad eval score or complaint.

Who benefits? Admin, midlevels, and rads.
 
Last edited:
Cath Up said:
Do you already have FU money?
Click to expand...

Yes. House paid off and I could go indefinitely without working, provided I don't spend lavishly. I have had a 12 year career. I made sure to max out 401K every year of my career, and invest in real estate and other equities. I sold the real estate to pay off my house a few years ago.
 
bronx43 said:
Rads is in a better position than clinicians. They haven’t drastically increased their training spots over the past decade and the system is going full on imaging buffet for everyone with or without a pulse that enters the door. Plus, midlevels love imaging since it gives them a way out of having to think critically about the nuances of medicine.
Headache? Let’s get aMRI.
Chest pain? Let’s get CTPE, stress test.
Joint pain? Let’s get X-rays.

If an imaging test exists for a particular part of the body and the patient has any symptom remotely close to said body part, they will order it.

Who benefits? Admin, midlevels, and rads.
Click to expand...

This is what everyone said about EM 7-10 yrs ago when there was a shortage and rates were 250-350/hr. What happened? HCA/CMGs opened up training programs.

VC, hospitals, and soon CMGs will start to buy out/take over Rad groups. HCA will then open up a bunch of rad residencies and flood the market. You don't think this blueprint has not been created?

Carriers will start pooping on reimbursement for reads. Then what?

Bottom line is, unless you own something you are easily replaced. Unless you own something, someone is making decisions for you. Unless you own something, the owners will sacrifice you to make more $$$$.
 
Splenda88 said:
For some reasons, docs like big houses, expensive cars even if they have no time to enjoy them.

I know one hospitalist that bought an E-class and a Tesla in his second year of attending-hood.
Click to expand...
I know a vascular surgeon who drives a 10 yr old prius.

I'm planning to get a stick shift kia forte gt
 
GeneralVeers said:
Yes. House paid off and I could go indefinitely without working, provided I don't spend lavishly. I have had a 12 year career. I made sure to max out 401K every year of my career, and invest in real estate and other equities. I sold the real estate to pay off my house a few years ago.
Click to expand...
With a house paid off, 7k/month is plenty of $$$ to live adjusted for inflation. Good to know that there are docs out there doing it the right way...


What's your net worth after 12 yrs?
 
emergentmd said:
7K/mo is plenty if you are single without kids. With kids, 7k won't cut it. My FU money would be around 25K/mo so I don't have to touch retirement.
Click to expand...

Assuming both your kids go to private school? I'd make the same decision. If not, then you must live in a super high cost area for 25K to be necessary.

I'm looking at 10K income. If I can milk EM for another year I can get that up to 12K monthly. That's without touching retirement. Add in Telemedicine and I'd be around 25K without going in to the hospital. The problem with telemedicine is that it's not a stable job, and with all the competition could dry up at any point.
 
GeneralVeers said:
Assuming both your kids go to private school? I'd make the same decision. If not, then you must live in a super high cost area for 25K to be necessary.

I'm looking at 10K income. If I can milk EM for another year I can get that up to 12K monthly. That's without touching retirement. Add in Telemedicine and I'd be around 25K without going in to the hospital. The problem with telemedicine is that it's not a stable job, and with all the competition could dry up at any point.
Click to expand...
FU money for our family is not to be able to live a decent live. If so, we could do it tomorrow. FU money for me would be to have no lifestyle changes which would be about 200K after tax money.

3 kids private schools-30K-45K for next 8 yrs til college
I would say vacation and trips around 40K/yr
Donations/giving - 20K

There is 100K. 100K for living expenses sounds about right for us.

Now if we had to, we could make by on 100k/yr. Kids would go to public, vacations/donations down to 20k.
 
Splenda88 said:
With a house paid off, 7k/month is plenty of $$$ to live adjusted for inflation.
Click to expand...
I checked the marketplace to see what health insurance would cost to bridge to Medicare.

1,700 a month, 17,000 a year deductible.

For a Blue HMO.

It's pretty easy for the government to hide inflation.
 
emergentmd said:
VC, hospitals, and soon CMGs will start to buy out/take over Rad groups. HCA will then open up a bunch of rad residencies and flood the market. You don't think this blueprint has not been created?
Click to expand...
I’m a member of a 100+ radiology group and we are in the final stages of creating a radiology residency program. I can tell you that it’s not that easy to just create such a program. To get accreditation, you must have enough volume and subspecialty radiologists for residents to rotate through, ie, body, chest, MSK, neuro, mammo, IR, peds, nucs, etc. An HCA hospital with 2-3 radiologists on-site won’t cut it. Even smaller radiology residencies usually have around 20 radiologists in the department. That’s part of the reason why you haven’t seen an explosion of radiology residency spots over the last 10 years.
 
Old_Mil said:
I checked the marketplace to see what health insurance would cost to bridge to Medicare.

1,700 a month, 17,000 a year deductible.

For a Blue HMO.

It's pretty easy for the government to hide inflation.
Click to expand...
You get DPC and do what people w/o insurance do. Go to ED for extended care...
 
You must log in or register to reply here.

Similar threads

B
EM Alliance
Replies
1
Views
1K
RustedFox
RustedFox
E
Houston EM forum
Replies
3
Views
1K
HemeOncHopeful19
H
Boatswain2PA
Best EM podcasts?
2
Replies
64
Views
5K
Janders
J
D
EM at the VA, future career advice
Replies
23
Views
5K
GBR0321
GBR0321
G
EM Match 2025
2
Replies
90
Views
11K
RustedFox
RustedFox
Top