Emergency Medicine Pay Changes?

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NYYk9005

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Hey all, question for those shrewd EM doctor veterans,

I signed on with a CMG (I know, I know) fresh out of residency and they gave me a per hour rate and signing bonus.

Now I am board certified and three years experienced and looking to stay on, but the per hour rate stays the exact same and there is no bonus.

Is that normal? To have your total take home pay drop despite working the same amount after you become certified and more experienced compared to just out of residency? It makes sense to me, are there any other options?
 
Yeah, the option is to quit working for a CMG.
That’s funny. I lol’d but for some that’s not an option!

Most cmgs pay the same rate regardless of experience. The VA pays based on experience but the rates are already low compared to community so you will probably end up with a lower rate if you decide to work for the VA.

So, yes it’s typical for envision and sound. I saw Apollo offer a guaranteed rate for new attendings and then offer each doc a different rate based on what they do; nights etc
 
I agree it's not an option for a select few. Maybe a family member is Ill or you have to support them for another reason. Maybe a spouse is doing a residency in that area.

Aside from these, can't think of too many other reasons why someone "has" to stay in a certain area and be a CMG slave.

If you "have" to be someplace for a reason other than the above then no reason to keep complaining...the CMG certainly doesn't care.

OP you either walk or you stay. Small chance they increase your pay if you walk. Most likely they say see ya and bring in a fresh grad, locums, or firefighter.

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Fixed hourly wages without any productivity element is not highly common. I suspect you work at a relatively low volume shop or you oversee many midlevels. If either is the case the CMG doesn’t have much incentive to raise your pay over time, other than to keep you happy and retain you. Retention is a huge issue as recruiting and training to a system is very expensive. Hence why some CMGs do give “partner bonuses” (eg Vituitys five level bonus structure which functions as golden handcuffs.)
 
I mean, we for all intents and purposes have a flat pay structure (i.e. you don't get more money for being around for 5 years).

But we are productivity based with open books and low overhead. Not what you are describing.
 
Unless there is a line of docs out the door waiting to fill your spot, consider asking the CMG for a retention bonus. I had several colleagues in my CMG days who asked for and got them.

CMGs will usually play ball since you're technically not increasing your hourly rate so it's a less sensitive issue for them. They know the costs of losing a doc and recruiting another one. That's the range to negotiate in.
 
Fixed hourly wages without any productivity element is not highly common. I suspect you work at a relatively low volume shop or you oversee many midlevels. If either is the case the CMG doesn’t have much incentive to raise your pay over time, other than to keep you happy and retain you. Retention is a huge issue as recruiting and training to a system is very expensive. Hence why some CMGs do give “partner bonuses” (eg Vituitys five level bonus structure which functions as golden handcuffs.)

The other problem with fixed hourly wages is laziness.

My main gig is at an SDG. I'm partner-track and therefore making **** pay, but in the meantime I'm picking up at a CMG 1.5 hrs away that pays nearly twice as much as my SDG gig (a bit under my partner rate, or what it will be). At my SDG profit sharing incentivizes you to be productive. At this CMG everyone is paid $240/hr, which means docs are cherry picking charts, stop picking up patients 2.5 hrs prior to end of shift, are lazy, etc....the money is good but man it's a terrible environment
 
I wish I could stop picking up charts 2.5 hrs before my shift ends. That sounds amazing - where is this?
 
Pay structure will differ based on your work environment.

Most places will pay a flat rate regardless of experience. I make the same in my group as docs with 15+ years more experience. There's a bonus structure, but everyone still makes the same.

A friend of mine did start getting RVU bonuses after becoming board certified, but it doesn't go up any further.

Almost every CMG pays everyone the same, with the exception of some productivity differences. You might make $200/hr year one and $215 year two, but the difference isn't based on years of experience. Instead it's based on RVUs, billing, and patient numbers. In this model there is a theoretical cap where you can't physically bill any more.

Groups with partnership tracks typically pay significantly less during your pre-partner years. Say the partner rate is $200...you might make $150 as a "buy in". After the buy in period, you become partner and get that $200 rate. Depends on how long the buy in period is.

Other groups have multi-level partnerships. For example, the 5 docs who started the group are "partners" or owners with equity in the company and split the pie between themselves before it goes to the rest of the docs. I don't have real numbers, but say there's 50% net profit split between these 5 docs. After their cut, the remaining 15 junior "partner" docs split the other 50%. Of course any pre-partner docs don't get any profit share.

So, to answer your question OP: Yes. That's normal. Don't expect the rates to go up over time. In fact, if all this fear mongering about the new senate bill comes true, expect to get paid less. (scroll down the front page of sdn EM to read about that).

What can you do? If you want another sign on bonus, you can ask for a retention bonus. CMGs have an acquisition cost to hire a new doc, and it may be cheaper for them to pay you to stay. Or you can leave for another group and collect a different sign on bonus. Or you can join a SDG on a partnership track and make whatever their structure is. Or, you could get paid more through geographical arbitrage. Move to rural somewhere and make $400/hr if that exists.

But, you still won't necessarily make more over time. In fact, if you account for inflation, you'll make about 2-3% less year over year in real dollars.

This is a fairly simple explanation, though. I think there have been increases in average EM pay over the last decade, but I haven't seen anything built into current employment offers.

What I would do? Look into FI/RE. Be smart with your money, pay off your loans, and get to a point where your investments make enough money that your hourly pay loses some importance.
 
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