EM is happier with salary than Derm

[Strider_91]

For the first time in many years derm ( 65%) is not the specialty which feels the most fairly compensated with their salary. It is EM (68%).


Interestingly, ortho made the most and were some of the least satisfied physicians with their income (48%).

Do you feel fairly compensated?

---

Members don't see this ad.

 

[emergentmd]

From a purely compensation standpoint, EM docs are well compensated.

Even at only 175/hr, your making close to 300K working 30 hrs a week. And that is in the WAY low end in most places.

 

[doctalaughs]

For the first time in many years derm ( 65%) is not the specialty which feels the most fairly compensated with their salary. It is EM (68%).


Interestingly, ortho made the most and were some of the least satisfied physicians with their income (48%).

Do you feel fairly compensated?

Its all about what you had before. Derm salaries have been stable or slight decline (last year) for the last 15 years but EM from what I understand has really increased over the last 15.

I'm a dermatologist and still feel I'm very fairly compensated but definitely need to see more patients per hour to keep income the same. That may be the other difference -as I understand EM has a fairly well established industry acceptance of number of patients-per-hour that is allowable/safe. Since derm is low-acuity there is really no limit- should I see 5 patients an hour? 6? 8? 10? It can be safely done but patients will hate you (cant talk to them if you have 6 minutes) and documentation on an EMR is troublesome with that volume. Now you could say, just see fewer patients and take less income. However thats not always the physician's choice (employee models) and a 10% decrease in patient volume may actually equal a 40% cut in income due to overhead.

Not complaining - just pointing out the change from prior may explain differences in happiness survey more than how fair compensation really is.


Sent from my iPhone using SDN mobile

 

[BAM!]

as I understand EM has a fairly well established industry acceptance of number of patients-per-hour that is allowable/safe

It saddens me to inform you that you understand wrong. EMTALA is blind to patients-per-hour. You could literally get 10 crashing patients all at once, and you are liable for all of them. This is regardless of whether you have an 8 bed ER, don't have enough nurses, are single coverage, your CT scanner is down. Patients are not scheduled like in outpatient clinics. You can't ramp up or down your patient load. It is what it is.

EM rates are not increasing. Sure they may be in select undesirable parts of the country where politics can keep it high. But all specialties are making less due to lower reimbursements and more administration and management inserting themselves and skimming from the top.

 

[Strider_91]

It saddens me to inform you that you understand wrong. EMTALA is blind to patients-per-hour. You could literally get 10 crashing patients all at once, and you are liable for all of them. This is regardless of whether you have an 8 bed ER, don't have enough nurses, are single coverage, your CT scanner is down. Patients are not scheduled like in outpatient clinics. You can't ramp up or down your patient load. It is what it is.

EM rates are not increasing. Sure they may be in select undesirable parts of the country where politics can keep it high. But all specialties are making less due to lower reimbursements and more administration and management inserting themselves and skimming from the top.

How do you explain that across almost every specialty there has been an increase since 2012 in physician compensation. This is for medscApe and mgma. A few specialties have gone done, but most went up (EM included).

I know reimbursement for procedures has gone down but it seems employed docs are still able to make a decent salary when they work for groups with significant negotiating power (obviously they aren't getting what they are worth because the business needs to make money) but they may still be making more than they could in their own practice.

 

[doctalaughs]

It saddens me to inform you that you understand wrong. EMTALA is blind to patients-per-hour. You could literally get 10 crashing patients all at once, and you are liable for all of them. This is regardless of whether you have an 8 bed ER, don't have enough nurses, are single coverage, your CT scanner is down. Patients are not scheduled like in outpatient clinics. You can't ramp up or down your patient load. It is what it is.

EM rates are not increasing. Sure they may be in select undesirable parts of the country where politics can keep it high. But all specialties are making less due to lower reimbursements and more administration and management inserting themselves and skimming from the top.

I guess my wording was poor. I meant to say the patients-per-hour average over a long period of time. I'm still aware the ED flow is unpredictable even if it's been more than 10 years since med school for me .

What I don't know about is the trend for patients-per-hour over the last 15 years and how overhead plays into the equation for an EM group.

I can tell you for sure that dermatology is sort of like radiology in that total reimbursement has gone up slowly (but not much if you adjust for inflation) but with that, number of patients/studies per hour has skyrocketed to a ridiculous level to maintain this income. In addition overhead has increased to pay for EMR and backstaff dealing with more red tape.


Sent from my iPhone using SDN mobile

 

[Groove]

I have absolutely no complaints with the EM salary in the SE. It is ridiculously high and makes it almost impossible for me to entertain the idea of moving elsewhere. I probably make more than most of our surgeons. The salary reports are very misleading and many of them are based on someone working almost part time.

 

[BoardingDoc]

I have absolutely no complaints with the EM salary in the SE. It is ridiculously high and makes it almost impossible for me to entertain the idea of moving elsewhere. I probably make more than most of our surgeons. The salary reports are very misleading and many of them are based on someone working almost part time.

Do you feel like the acep compensation report is fairly accurate? Keeping in mind that the hourly rates quoted there assume that you get (salary + 25k worth of benefits + whatever your productivity bonus is (if applicable)) / 1632 hours

 

[deleted109597]

Do you feel like the acep compensation report is fairly accurate? Keeping in mind that the hourly rates quoted there assume that you get (salary + 25k worth of benefits + whatever your productivity bonus is (if applicable)) / 1632 hours

I don't. I've never seen hourly rates advertised that correspond to what people get paid.
OTOH, I have heard 2 people tell me that in DC and Philadelphia they are paid exceedingly poorly. It's comical how low they're paid.

 

[WilcoWorld]

I guess my wording was poor. I meant to say the patients-per-hour average over a long period of time. I'm still aware the ED flow is unpredictable even if it's been more than 10 years since med school for me .

What I don't know about is the trend for patients-per-hour over the last 15 years and how overhead plays into the equation for an EM group.

I can tell you for sure that dermatology is sort of like radiology in that total reimbursement has gone up slowly (but not much if you adjust for inflation) but with that, number of patients/studies per hour has skyrocketed to a ridiculous level to maintain this income. In addition overhead has increased to pay for EMR and backstaff dealing with more red tape.


Sent from my iPhone using SDN mobile

Depends on pay structure. In "eat what you kill" structures, EM Docs are getting paid more when they work harder. In salaried structures, a lot of us are seeing higher volumes without seeing an increase in pay. Also, when EM Docs report a stable pts/hr, they may be referring to the patients that they personally see. This fails to account for the fact that, while they continue to see 2 pts/hr, they now supervise an addition 1-2 pts/hr seen by physician extenders (for which we are fully liable).

In conclusion, I think that the overall trend for all specialties in medicine is to work harder for the same pay.

 

[Groove]

Do you feel like the acep compensation report is fairly accurate? Keeping in mind that the hourly rates quoted there assume that you get (salary + 25k worth of benefits + whatever your productivity bonus is (if applicable)) / 1632 hours

Which report? Acepnow?

 

[hypnix]

Which report? Acepnow?

http://www.acepnow.com/article/emer...-lack-standardization-specialty/?singlepage=1

Looks like I make a lot less in my state. I interviewed at a lot of places last year. I guess partners really make huge bank and the CMGs take a lot off the top

 

[emergentmd]

If you just want to talk about numbers and ignore everything else (pos or neg) about a specialty, I would put EM pay again almost every other specialty and still Pick EM. The Economics makes EM a no brainer when it comes to the bottom line.

I know income are all over the place and many specialties make way more than what is stated in medscape, but lets just take medscape as a reasonable starting point. Lets assume 4 docs going to Peds (BOTTOM), EM, Gen Surg(SIMILAR), Ortho(TOP) with the exact salary stated by Medscape. Lets further assume all finished college at 21, med school at 25. Lets assume no delay in residency, no fellowhip, no debt/student loan, and everyone hits their avg right out of training. Fast Forward 3 yrs and all are 28yrs old.

1. Peds makes 202k x 10 yrs = 2.02Mil of income at age 38.
2. EM makes 339K x 10 yrs = 3.39 mil at age 38
3. Gen Surg makes 352K x 8 yrs = 2.82mil + 100k (2 extra yrs of residency) = 2.92 Mil at age 38. Gen Surg likely will never catch up to EM.
4. Ortho makes 489K x 8 yrs = 3.9mil +100K (2 extra yrs residency) = 4 mil at age 38. TOOK ortho 5 yrs after getting out of residency to catch EM. 600K adv after 10 yrs.

SO if you rank just on $$$$, Ortho would be ahead with EM, then Surg and Peds lagging way behind. But if you take into account that Ortho has a much bigger debt load after 5 yrs residency vs 3 yrs, then that 600K advantage shrinks. Add to the fact that EM right out of residency makes 339K while ortho will take years to get to their 489K., I would say that even at year 10, EM is still ahead. Also, the opportunity value of having earlier income with compound investing would put EM ahead of ortho well into their 40's.

Other than Ortho and Plastics, I would say every field making more than EM would take a whole career to catch up when you factor in longer residency, larger debt after residency, lost opportunity costs of making money earlier, delay in hitting the avg compensation., and the fact that most making more than EM requires a fellowship to hit the average.

And I do not even want to get into the personal cost of doing an extra 2 yrs of residency.

 

[deleted109597]

Emergency Physicians' 2016–2017 Compensation Report Shows Lack of Standardization for Specialty - ACEP Now

Looks like I make a lot less in my state. I interviewed at a lot of places last year. I guess partners really make huge bank and the CMGs take a lot off the top

It should upset you even more if you cross reference it with FairHealth or some other source and find out that CMS (and insurances tied to it) pay more for 99285 codes in NY than in Texas, but NY gets paid worse.

 

[Groove]

http://www.acepnow.com/article/emer...-lack-standardization-specialty/?singlepage=1

Looks like I make a lot less in my state. I interviewed at a lot of places last year. I guess partners really make huge bank and the CMGs take a lot off the top

Yes, I would say that report for the SE insofar as ranges and annual compensation is fairly accurate.

 

[brabbit2222]

Yes, I would say that report for the SE insofar as ranges and annual compensation is fairly accurate.

What do you think the ranges are in reality?

 

[HooliganSnail]

It saddens me to inform you that you understand wrong. EMTALA is blind to patients-per-hour. You could literally get 10 crashing patients all at once, and you are liable for all of them. This is regardless of whether you have an 8 bed ER, don't have enough nurses, are single coverage, your CT scanner is down. Patients are not scheduled like in outpatient clinics. You can't ramp up or down your patient load. It is what it is.

EM rates are not increasing. Sure they may be in select undesirable parts of the country where politics can keep it high. But all specialties are making less due to lower reimbursements and more administration and management inserting themselves and skimming from the top.

While flex situations are normal in EM, for the most part, the number of patients you see is relatively stable when averaged out. The industry standard is 2pph. This largely brings conflict between the ER group and the hospital. As a rule, the hospital always wants MORE coverage, and the EM group wants to get by with less coverage, so they make more money.

You are absolutely right about management (CMGs) skimming off the top, but everything is in perspective.