EM hourly rate approaching that of the nursing staff at my hospital

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Make all NPs revert to RNs. All problems solved. Docs happy. Hospitals happy. PAs happy. Patients happy. United unhappy...me happy.

The free market will make that happen
 
Wth does unsustainable even mean? The whole healthcare system is unsustainable. There are record profits being made and government will keep throwing money at the problem


This one CEO who had to resign abruptly after saying stupid things got a $50mil golden parachute. That would pay for a lot of travel nurses, EM Docs, or neurosurgeons for that matter.


 
They're still licensed as RNs, so even if they haven't worked a day as a nurse they can still go through new nurse orientation like everyone else.

That’s pretty crazy. Think about all those people who did their education online. Logged “clinical hours” by going to an office for a few months. And all they need is an “orientation” and they’re all good?
 
That’s pretty crazy. Think about all those people who did their education online. Logged “clinical hours” by going to an office for a few months. And all they need is an “orientation” and they’re all good?
You are thinking about NP education. Nursing education AFAIK is still in-person only. And I believe most NPs do have nursing experience (maybe not the new NPs, but even then they went to nursing school).
 
That’s pretty crazy. Think about all those people who did their education online. Logged “clinical hours” by going to an office for a few months. And all they need is an “orientation” and they’re all good?

I mean how hard could it be to be a nurse? Just stand behind the physician and yell that what they're doing is not how you've seen it done in the icu or anywhere else and refuse to follow their orders.
 
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You are thinking about NP education. Nursing education AFAIK is still in-person only. And I believe most NPs do have nursing experience (maybe not the new NPs, but even then they went to nursing school).
I was always under the impression that the old school went nurse to NP but the new ones bypass that shib and go straight to DNP
 
Am I missing something? People keep saying 150/hour is a joke and low for an EM physician but calculating that to annual salary based on average hours worked for ER docs isn’t that around 400K which is above the average salary for emergency medicine doctors I thought? And, if nurses are making that much than why is the average salary for RN’s reported as so much lower than that?
 
Am I missing something? People keep saying 150/hour is a joke and low for an EM physician but calculating that to annual salary based on average hours worked for ER docs isn’t that around 400K which is above the average salary for emergency medicine doctors I thought? And, if nurses are making that much than why is the average salary for RN’s reported as so much lower than that?

$150/hr is $300k if you are working a 40/hr week. It is near impossible to sustain 40/hr week in EM for any sustained length of time.
 
Am I missing something? People keep saying 150/hour is a joke and low for an EM physician but calculating that to annual salary based on average hours worked for ER docs isn’t that around 400K which is above the average salary for emergency medicine doctors I thought? And, if nurses are making that much than why is the average salary for RN’s reported as so much lower than that?
Few, if any nurses, are currently getting those rates at a sustained frequency.

I’m confused by the rest of your post. Most employed ER docs probably average around 1750 hours per year. $150/hr for 1750 hours is $262,500 which is well, well below average.
 
$150/hr is $300k if you are working a 40/hr week. It is near impossible to sustain 40/hr week in EM for any sustained length of time.

40 hours a week in the ER?
Just shoot me. Don't prolong the torture.

@wheatbar : 120-130 a month is standard. You get close to that 140-150 range, and you get crispy, quickly.
 
Am I missing something? People keep saying 150/hour is a joke and low for an EM physician but calculating that to annual salary based on average hours worked for ER docs isn’t that around 400K which is above the average salary for emergency medicine doctors I thought? And, if nurses are making that much than why is the average salary for RN’s reported as so much lower than that?
$150 is a joke. Normal range should be 250+
 
I can only speak for Tx but I have not seen anything under 225 working at any reasonably busy ER. The job has just become more difficult for similar or less pay than in the past. I actually think that pay hasn't gone down at all, docs are just seeing more pts.

When we actually had a SDG, we overstaffed and everyone knew it. We had 6, 9 hr doc shifts and a 12 hr APC shift with volume about 120 which was really 7-8hrs b/c docs stopped seeing pts last 1-2 hrs. It was just understood, everyone knew it, place was typically double covered so the guy not going home just sucked it up til new guy came in. New guy would then suck it up for 1-2 hr and see most pts. I think our avg was 2pph and the place was so efficient that it felt much easier compared to some of the crappy locums I did where 2pph was like walking in molasses.

I just talked to an old partner and TH running the place. Volume is about 160 and the volume does not justify 6 shifts so now they are scheduled 5, 9 hr shift and I assume increased APC shift hours. Their pay has gone down from what we made as a SDG.

No wonder they are having docs leaving in droves. Sad.
 
40 hours a week in the ER?
Just shoot me. Don't prolong the torture.

@wheatbar : 120-130 a month is standard. You get close to that 140-150 range, and you get crispy, quickly.
I work 140-160+ but I'm crispy. I also work enough slower shifts that it helps. I'd probably be around 130 if they were all at the mother ship.
 
The job I recently resigned (hospital employed) we got a pay cut in summer 2020 (yes in the pandemic). I was at $260-280 per month which included productivity and metric bonus paid monthly. The pay cut took us down to an hourly rate of of about $200 - 190 day, 220 night with the bonus (no productivity, just metrics) moved to an end of fiscal year adding up to $235. They also cut CME allowances, at the same time reducing flexibility of using it, increased the minimum full time hours, and increased health care premium. Right after the new contract got forced down our throats we were told the hospital was in "Strong financial condition"

Nurses are getting treated pretty crappy too though.
 
The job I recently resigned (hospital employed) we got a pay cut in summer 2020 (yes in the pandemic). I was at $260-280 per month which included productivity and metric bonus paid monthly. The pay cut took us down to an hourly rate of of about $200 - 190 day, 220 night with the bonus (no productivity, just metrics) moved to an end of fiscal year adding up to $235. They also cut CME allowances, at the same time reducing flexibility of using it, increased the minimum full time hours, and increased health care premium. Right after the new contract got forced down our throats we were told the hospital was in "Strong financial condition"

Nurses are getting treated pretty crappy too though.
I would straight quit.
 
The job I recently resigned (hospital employed) we got a pay cut in summer 2020 (yes in the pandemic). I was at $260-280 per month which included productivity and metric bonus paid monthly. The pay cut took us down to an hourly rate of of about $200 - 190 day, 220 night with the bonus (no productivity, just metrics) moved to an end of fiscal year adding up to $235. They also cut CME allowances, at the same time reducing flexibility of using it, increased the minimum full time hours, and increased health care premium. Right after the new contract got forced down our throats we were told the hospital was in "Strong financial condition"

Nurses are getting treated pretty crappy too though.
Rusted nailed that one. Even with strong ties to the area, I would straight up quit if they cut my salary by ~30%.
 
Rusted nailed that one. Even with strong ties to the area, I would straight up quit if they cut my salary by ~30%.

It's really just "one more reason why EM sucks". I'm officially in the Birdstrike camp on that one. Emergentmd has valid points that "it's not as bad as other things, considering", but the fact that we are the bastard children of the health system is inarguable.
 
The SLOE kinda blocks IMGs/FMGs. I have pccm fellows from India and Pakistan who wanted to do EM but couldn’t
Not moving forward. 55+ spots pre SOAP under 50 post SOAP. programs arent gonna give up the CMS money and cheap labor.

Hard to imagine anyone with functional neurons thinking EM is a great place to go into. The 4th year medical students in the US got the message. I suspect next year with a handful of new programs opening again and the joke that EM has become we may have 1k open spots pre soap. We should have 1k open spots post SOAP which would be ideal.

This year only 52% of programs filled pre SOAP. Crazy number.
 
Not moving forward. 55+ spots pre SOAP under 50 post SOAP. programs arent gonna give up the CMS money and cheap labor.

Hard to imagine anyone with functional neurons thinking EM is a great place to go into. The 4th year medical students in the US got the message. I suspect next year with a handful of new programs opening again and the joke that EM has become we may have 1k open spots pre soap. We should have 1k open spots post SOAP which would be ideal.

This year only 52% of programs filled pre SOAP. Crazy number.

Have a look over at reddit.
 
Not moving forward. 55+ spots pre SOAP under 50 post SOAP. programs arent gonna give up the CMS money and cheap labor.

Hard to imagine anyone with functional neurons thinking EM is a great place to go into. The 4th year medical students in the US got the message. I suspect next year with a handful of new programs opening again and the joke that EM has become we may have 1k open spots pre soap. We should have 1k open spots post SOAP which would be ideal.

This year only 52% of programs filled pre SOAP. Crazy number.
I've been actively encouraging our outgoing medical school bound scribes to not pick EM and happy to give my email address if they have questions later. I tell them something like, "If I ever see you here again, I hope it's because I called you as a consulting specialist."
 
Not moving forward. 55+ spots pre SOAP under 50 post SOAP. programs arent gonna give up the CMS money and cheap labor.

Hard to imagine anyone with functional neurons thinking EM is a great place to go into. The 4th year medical students in the US got the message. I suspect next year with a handful of new programs opening again and the joke that EM has become we may have 1k open spots pre soap. We should have 1k open spots post SOAP which would be ideal.

This year only 52% of programs filled pre SOAP. Crazy number.

There’s going to be lots and lots of people applying for this. I think it’s implosion is also going to attract people. Lots of people are sick and tired of medicine by the end of med school and see the light at the end of the tunnel and they want the fastest/simplest/easiest way. A 3 year residency in primary care was always that. Now that EM is seemingly on par for competitiveness this itself opens the door for some students. I personally know of at least a couple that are considering EM because it’s becoming less competitive. They’re not as concerned about the reason behind this drop in EM for some reason. good luck convincing a 20 something year old that they’re not going to like something 10 years down the road.
 
There’s going to be lots and lots of people applying for this. I think it’s implosion is also going to attract people. Lots of people are sick and tired of medicine by the end of med school and see the light at the end of the tunnel and they want the fastest/simplest/easiest way. A 3 year residency in primary care was always that. Now that EM is seemingly on par for competitiveness this itself opens the door for some students. I personally know of at least a couple that are considering EM because it’s becoming less competitive. They’re not as concerned about the reason behind this drop in EM for some reason. good luck convincing a 20 something year old that they’re not going to like something 10 years down the road.
Just had a call this weekend with a former scribe. Talked for an hour. He was considering other highly competetive op[tions like derm but he thought they were boring which I cant deny. I pushed and pushed. I told him right now you can get jobs making 225-250/hr unless you are with USUCKS and that I felt EM pay was gonna trend to 180/hr (just my opinion) and he was unphased. I said you will likely make 300k/yr which is good money but you can have a better life/lifestyle with derm And make at least 2x that with no stress and no hospital political nonsense.

Seems like it fell on deaf ears. Sad cause he is a good dude. He is smart and works hard but the EM monster is about to demolish the careers and lives of plenty of these current med students. I agree it is hard for some mid 20s person to think about what life will be like in their mid to late 30s let alone after that.

I told him about the financial woes of the CMGs, noctors etc and the pressure On wages and overall quality of job but alas i dont think it mattered.

Sad times, I suspect we are in the 800-1000 SOAP spots this year and I hope i am right. I hope we have at least 200 spots post soap that are open. The implosion must occur from within. ACEP is asleep at the wheel. AAEM is focused on CMGs/PE and less on residencies. The ACGME Is a willing and useful idiot and ABEM just wants $$ so the chosen few can take working vacations on our dime.

End of times for EM being decent isnt too far away.
 
I think an EP should make a minimum of 4 times what an ER nurse makes just for the added responsibility of what we expose ourselves to (litigation, etc.).
Agreed, but it's supply and demand. Nurses can and will and do flee the ER the minute it gets tough. Same with midlevels. Doctors are stuck, with no exit strategy.
 
Agreed, but it's supply and demand. Nurses can and will and do flee the ER the minute it gets tough. Same with midlevels. Doctors are stuck, with no exit strategy.

EM boarded doctors. FM/IM have plenty of other options. EM docs are much more pigeon holed by design or by choice. I have personally thought for a long time that EM should have always been a 1-2 year fellowship after FM. This gives EM doctors a pressure valve out and has a lot of overlap in knowledge base in prevention and mitigation of diseases while also dealing with its acute emergent states. I know it’s not popular to say this because EM attracts very different types than the FM crowd but I still think this makes the most sense.
 
EM boarded doctors. FM/IM have plenty of other options. EM docs are much more pigeon holed by design or by choice. I have personally thought for a long time that EM should have always been a 1-2 year fellowship after FM. This gives EM doctors a pressure valve out and has a lot of overlap in knowledge base in prevention and mitigation of diseases while also dealing with its acute emergent states. I know it’s not popular to say this because EM attracts very different types than the FM crowd but I still think this makes the most sense.

I see a future in which EM docs will work 5-6 shifts a month in the ER, and then 10 "days" doing something else.
 
I see a future in which EM docs will work 5-6 shifts a month in the ER, and then 10 "days" doing something else.

I agree but that requires a society-wide reorientation for acceptance of EM into these “something else” areas you mention. And I think it will be awhile before that’s the case. Everyone sees the only way out of EM rn to be either UC, fellowship or retirement. Once a “something else” is open and clear to EM drs and the rest of the establishment that will serve everyone well by offering that option.
 
Someone else’s license? Don’t nurses have their own licenses from State Boards of Nursing?
They do, and to hear them tell it, they are always just on the brink of losing their license or putting it in Jeopardy!

I couldn't possibly… (fecal disimpaction, IV lidocaine, analgesic ketamine, intranasal Versed for anxiolysis), do that, I'd lose my license!
 
Will preface this with noting that physicians should be able to make a good living due to the sacrifices required to achieve independent practice, that I don't support the vast expansion of midlevel independence, etc. Please don't hurt me.

As a travel nurse, I will note that the huge, huge pay I've heard about is fairly limited. I've made in the 110 range for a while (Midwest, ICU) and the only people making significantly more are either getting some of the very limited contracts for hard to fill areas or they're getting an overtime hourly rate. The agencies also leave out a lot of fine print; with nontax stipends and such, your take home is a lot lower unless you have both a mortgage somewhere else and you're renting a room somewhere near the hospital for market rates (my 110 drops a bit when I factor in employer-side taxes). The huge pay contracts are usually of limited duration and the hospital has no issue terminating it after a week if they want, so stability is basically nonexistent. Some of them, like the Krucial contracts that pay out huge $$$, house you in dormitory-style accommodation where your bags are searched for alcohol, you can't enter anyone else's room, and you have a curfew to leave the hotel between shifts with someone signing you in and out so you spend the whole contract working or being a monk in a motel. Benefits and such are more limited than staff jobs as well. The hospital treats you as being at the bottom of the pile, so inappropriate assignments are common-- I haven't ever circulated the OR and the last time I had a laboring mother was 11 years ago for like maybe 5 hours of clinical but that hasn't stopped them trying to make me work either. I'm not going to bleat "losin' mah lyyuu-sens" but I have no urge to be named in a malpractice suit with more exposure than otherwise for working outside my usual areas of practice.

It's great money, I plan on doing it for the next year to build reserves to pay for pre-med, but it's got definite downsides and doesn't reach attending level pay except in certain low-stability contracts. I doubt it'll be around for more than 2022, acuity will drop as covid vaccination and stuff like Paxlovid become more common. I also expect states to start enacting laws at the direction of hospitals to cap our pay; there's already been House hearings on our pay so there might even be a federal response.
I appreciate this and I think some of the emergency medicine physician frustration is equivalent to nurses cherry picking the few highly compensated shifts that I have had. I have earned comfortably over $500 per hour, I would not do it again and it wasn't worth it. Additionally, those shifts are exceedingly rare and stupidly dangerous.
 
I appreciate this and I think some of the emergency medicine physician frustration is equivalent to nurses cherry picking the few highly compensated shifts that I have had. I have earned comfortably over $500 per hour, I would not do it again and it wasn't worth it. Additionally, those shifts are exceedingly rare and stupidly dangerous.
If they're paying $500/hr, they're squeezing $600/hr or more of work out of you. What seems like a bonanza is a relief to those sticking it to you.
 
If they're paying $500/hr, they're squeezing $600/hr or more of work out of you. What seems like a bonanza is a relief to those sticking it to you.
Not necessarily. There are likely some last minute shifts where you’ll make more than what you bring in for them but obviously this won’t happen consistently as that’s a poor business model.
 
Just had a call this weekend with a former scribe. Talked for an hour. He was considering other highly competetive op[tions like derm but he thought they were boring which I cant deny. I pushed and pushed. I told him right now you can get jobs making 225-250/hr unless you are with USUCKS and that I felt EM pay was gonna trend to 180/hr (just my opinion) and he was unphased. I said you will likely make 300k/yr which is good money but you can have a better life/lifestyle with derm And make at least 2x that with no stress and no hospital political nonsense.

Seems like it fell on deaf ears. Sad cause he is a good dude. He is smart and works hard but the EM monster is about to demolish the careers and lives of plenty of these current med students. I agree it is hard for some mid 20s person to think about what life will be like in their mid to late 30s let alone after that.

I told him about the financial woes of the CMGs, noctors etc and the pressure On wages and overall quality of job but alas i dont think it mattered.

Sad times, I suspect we are in the 800-1000 SOAP spots this year and I hope i am right. I hope we have at least 200 spots post soap that are open. The implosion must occur from within. ACEP is asleep at the wheel. AAEM is focused on CMGs/PE and less on residencies. The ACGME Is a willing and useful idiot and ABEM just wants $$ so the chosen few can take working vacations on our dime.

End of times for EM being decent isnt too far away.

You did your best

He will learn the hard way like us
 
If they're paying $500/hr, they're squeezing $600/hr or more of work out of you. What seems like a bonanza is a relief to those sticking it to you.
Not necessarily. There are likely some last minute shifts where you’ll make more than what you bring in for them but obviously this won’t happen consistently as that’s a poor business model.
These were last minute shifts. Essentially almost any hourly wage was better than not staffing the ER.

We are talking > 55 bed ER, ~100k visits a year, and floor codes SOLO COVERAGE overnight. Way to go Team Health!
 
These were last minute shifts. Essentially almost any hourly wage was better than not staffing the ER.

We are talking > 55 bed ER, ~100k visits a year, and floor codes SOLO COVERAGE overnight. Way to go Team Health!
Whaaaat!? A 100k hospital is generally 500+ beds.. but doesn’t have a hospitalist or residents to cover floor codes? Insanity
 
These were last minute shifts. Essentially almost any hourly wage was better than not staffing the ER.

We are talking > 55 bed ER, ~100k visits a year, and floor codes SOLO COVERAGE overnight. Way to go Team Health!
Assuming there were also several midlevels or residents in the ED for these shifts. 100k visit/yr hospital with 55 beds in the ER can not be run by a single doctor. To be clear, even with residents / PAs, this is still insanely unsafe as you'd probably see ~60 patients in an 8 hr overnight shift. And expected to respond to floor codes? I have to believe that there are key details missing here. I'm assuming we're missing something like: so there's another doc until 3a, then morning comes in at 7a so it's really 4 hrs solo, plus there are 3 residents and a PA...

Even in that scenario, I wouldn't do that job for anything but a prince's ransom. Actual solo coverage at that volume is physically impossible.
 
These were last minute shifts. Essentially almost any hourly wage was better than not staffing the ER.

We are talking > 55 bed ER, ~100k visits a year, and floor codes SOLO COVERAGE overnight. Way to go Team Health!
What the actual ****, that’s brutal. Good for you for not doing those anymore. EM docs as a whole just have to refuse to work in such unsafe conditions, otherwise it won’t get better.
 
These were last minute shifts. Essentially almost any hourly wage was better than not staffing the ER.

We are talking > 55 bed ER, ~100k visits a year, and floor codes SOLO COVERAGE overnight. Way to go Team Health!

I'm going to call BS on this. That's literally just not feasible.
 
I think an EP should make a minimum of 4 times what an ER nurse makes just for the added responsibility of what we expose ourselves to (litigation, etc.).
Only 4X... I know one ER nurse in my hospital who makes $27/hr. No EM docs here makes < $225/hr from what I was told. ED NP/PA here make $100/hr (1099).
 
SLOE? You think that those hundreds of people who scrambled/SOAPED into EM had SLOEs?
My friend matched (Not SOAPed) w/o SLOE. He failed step1/2 multiple times and has been out of med school 4+ yrs. He was a US student though.
 
My friend matched (Not SOAPed) w/o SLOE. He failed step1/2 multiple times and has been out of med school 4+ yrs. He was a US student though.

I think you mentioned him in the match thread. I would bet money on this person either not finishing residency or being forced out very quickly from any post-residency job. Call me naive but there's a very slim chance of going from this to clinically competent. The credentialing alone seems like it would be a nightmare at any halfway decent place.
 
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I think you mentioned him in the match thread. I would bet money on this person either not finishing residency or being forced out very quickly from any post-residency job. Call me naive but there's a very slim chance of going from this to clinically competent.
I hope that won't be case. He is a smart dude but has too much confidence in his ability. Hopefully his attitude has changed.
 
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