Emergency Physician Compensation Decreased Most Among Specialties Over Past 5 Years (Inflation-Adjusted), per MGMA '24

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2024 MGMA Provider Compensation and Production Report shows that emergency medicine had the biggest 5-year decrease in compensation (inflation-adjusted) among specialties in the US.

MGMA data is based on "211,000 physicians and advanced practice providers (APPs)." Full report linked here.

2024 MGMA Provider Compensation and Productivity Report chart:

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We’re #1! We’re #1!… in burnout, pay decreases…what else?
 
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Perhaps we would fare better if people would contact their legislators more often. Unfortunately, as a specialty, we have too much "I'm off work, I'm checked out" mentality and don't advocate for ourselves enough.
 
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Perhaps we would fare better if people would contact their legislators more often. Unfortunately, as a specialty, we have too much "I'm off work, I'm checked out" mentality and don't advocate for ourselves enough.
But isn’t Acep our lord and savior? Did they forget to save us here?
 
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We’re #1! We’re #1!… in burnout, pay decreases…what else?

Residency expansion, unfilled spots (until imgs flooded our specialty), corporate medicine take over

Anything else?
 
I mean literally no one here should be surprised.

We've all been saying this is coming since the number of EM residencies increased by over 100 in the last 10 years.

I'm going to be leaving academics this summer because the job has become increasingly terrible in the last few months but ironically despite
this our EM admin with 500K salaries have been able to hire EM fellowship trained new grads to work for 250K salaries with horrible benefits.
 
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Not if we don't vote in the right people or push them away from corporate overlords.
ACEP swears they matter and help. Unless the news is bad then it’s not their fault. It’s the most pathetic organization in medicine and that’s saying a lot.
 
I mean literally no one here should be surprised.

We've all been saying this is coming since the number of EM residencies increased by over 100 in the last 10 years.

I'm going to be leaving academics this summer because the job has become increasingly terrible in the last few months but ironically despite
this our EM admin with 500K salaries have been able to hire EM fellowship trained new grads to work for 250K salaries with horrible benefits.
There is a degree of panache of being an academic. It’s hilarious the jobs people will take to “do academics”. The pay is so atrocious I don’t understand how an otherwise intelligent doc can take that job. It’s not all about the money but usually the pay sucks, the system. Sucks, the hours suck and you are always a pawn for the admin kings in academics.
 
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There is a degree of panache of being an academic. It’s hilarious the jobs people will take to “do academics”. The pay is so atrocious I don’t understand how an otherwise intelligent doc can take that job. It’s not all about the money but usually the pay sucks, the system. Sucks, the hours suck and you are always a pawn for the admin kings in academics.

The only reason to do academics is if your passion is to be a funded researcher and you love the grant cycle.
 
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I would say that much like there being a wide variety of jobs in the community medicine, there are a wide variety of jobs in academics. Some pay at higher percentiles, some do a better job compensating in time/money for educational work, some may be more research/grant oriented (though less so in EM than most other houses of medicine), some will have better leadership structures, etc.

I've done community medicine. I do academics now. I'm not taking what I perceive to be a haircut in terms of my time or compensation and I like the environment better. This board constantly espouses alternatives to community medicine for the people that loathe it. Academic medicine is just one of those alternative pathways EM trained physicians can consider.
 
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This has been palpable. When I was a med student, the EM salary seemed amazing. 7 years later it’s about the same as it was back then. But of course cost of living has skyrocketed and other “low paying” specialties have nearly caught up.
 
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Wow, psych workloads went down, but salaries still went up!
 
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This has been palpable. When I was a med student, the EM salary seemed amazing. 7 years later it’s about the same as it was back then. But of course cost of living has skyrocketed and other “low paying” specialties have nearly caught up.

The pay is trash. I've seen CMGs advertise for 1099 jobs paying less than I made in 2017.
 
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hypothetical question… how many of y’all if you could collect a 150,000 check a year without ever having to work a single day in the ER again or work in general. Curious how many would take that life???
 
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hypothetical question… how many of y’all if you could collect a 150,000 check a year without ever having to work a single day in the ER again or work in general. Curious how many would take that life???
Isn’t that roughly and essentially just $4M FIRE?

Most once they get to this point start to look towards the exit.

Your time just becomes more valuable than the money.
 
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Deep regret not doing psych. I should’ve gone with my gut and not my ego!

Was advised to do Psych by a med school mentor. Told I'd make a great psychiatrist. Now my sister who did way worse than me on the MCAT and USMLE makes more money than I do and doesn't work nights weekends or holidays.
 
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hypothetical question… how many of y’all if you could collect a 150,000 check a year without ever having to work a single day in the ER again or work in general. Curious how many would take that life???

Inflation is too damn high
 
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I guess to further clarify! If someone gave you a 150k a year check every January 1st till age 65 to walk away from medicine for life. Would you be able to stop practicing as a doctor? How would that affect your persona or place in this world or how you think and feel about yourself not practicing anymore??
 
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I guess to further clarify! If someone gave you a 150k a year check every January 1st till age 65 to walk away from medicine for life. Would you be able to stop practicing as a doctor? How would that affect your persona or place in this world or how you think and feel about yourself not practicing anymore??
I’m not sure how much I identify solely as a physician any more. It’s been a substantial part of my life and was more important to me during college, medical school, residency and immediately after. As time goes by though, it becomes a smaller part of my identity compared to family and everything else.

I also feel at times in EM like a glorified, white collar, hourly worker or someone in sales rather than a respected physician in the medical community, an owner or an entrepreneur even despite being a part of a private group.

Yes, I think I could give up medicine finding contentment and feel okay about my place in the world.
 
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I guess to further clarify! If someone gave you a 150k a year check every January 1st till age 65 to walk away from medicine for life. Would you be able to stop practicing as a doctor? How would that affect your persona or place in this world or how you think and feel about yourself not practicing anymore??

I wouldn’t. I could retire off of that and accumulated assets but I want a bigger nest egg and I suspect what I’d want to do would cost some money. Ask me again in 10 years and I may change my mind.

I couldn’t care less about feeling like a physician or not. Being a physician has never personally been my top persona or dictated my place in the world.
 
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I guess to further clarify! If someone gave you a 150k a year check every January 1st till age 65 to walk away from medicine for life. Would you be able to stop practicing as a doctor? How would that affect your persona or place in this world or how you think and feel about yourself not practicing anymore??

Yes.

It would be a nice kick in the pants/safety net to get out there and do something different.

It seems very reasonable to not want to go through life as the same person having the same experiences for an entire adult career. So many options!
 
hypothetical question… how many of y’all if you could collect a 150,000 check a year without ever having to work a single day in the ER again or work in general. Curious how many would take that life???

250-300k and I’ll take it.

I can’t swallow that big a pay cut in my wealth building stage of life yet.
 
Genuine question - there’s been declining reimbursements for most specialties, in fact, cms decreased the $/rvu payment for 2024 i think as well.

How are other specialties increasing salaries despite decreasing reimbursement? Their reimbursements are decreasing just like ours. Granted some specialties had reimbursement increased like family medicine, but what about specialties with declining reimbursements?
 
Genuine question - there’s been declining reimbursements for most specialties, in fact, cms decreased the $/rvu payment for 2024 i think as well.

How are other specialties increasing salaries despite decreasing reimbursement? Their reimbursements are decreasing just like ours. Granted some specialties had reimbursement increased like family medicine, but what about specialties with declining reimbursements?
Many of those specialties are many times hospital employed and/or have other avenues for ancillary income.
 
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Genuine question - there’s been declining reimbursements for most specialties, in fact, cms decreased the $/rvu payment for 2024 i think as well.

How are other specialties increasing salaries despite decreasing reimbursement? Their reimbursements are decreasing just like ours. Granted some specialties had reimbursement increased like family medicine, but what about specialties with declining reimbursements?
I can speak to pain med which can likely be extrapolated to all procedure based specialities. It's all about the facility fees. Don't quote me on exact numbers but hospitals get paid over $500 for Medicare (and more for commercial insurance) for an epidural which takes 5-10 minutes and limited supplies. Also, the downstream revenue I create for ordering MRIs in house is a big moneymaker. I don't collect any part of that specifically but it's baked into the $/RVU they pay me. They are making such a huge margin off our labor that there's always room to increase for cost of living.
 
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Also, while cuts are happening across the board for physician services it seems facility fees reimbursements continue to increase or at least remain flat.
 
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For all the doom and gloom, I'm still making $100k above what I expected to make in EM while in med school almost 15 years ago (even after adjusting for inflation). The reality is that I make more in a year than my parents made in a decade growing up.

Of course EM has a lot of annoyances, but it's still a pretty good job when when you strip away everything and start just thinking about it as a job. I became a multimillionaire at 38 and get more days off in a month than many people get in a year.
 
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Genuine question - there’s been declining reimbursements for most specialties, in fact, cms decreased the $/rvu payment for 2024 i think as well.

How are other specialties increasing salaries despite decreasing reimbursement? Their reimbursements are decreasing just like ours. Granted some specialties had reimbursement increased like family medicine, but what about specialties with declining reimbursements?

More volume. I’m 1099
 
Genuine question - there’s been declining reimbursements for most specialties, in fact, cms decreased the $/rvu payment for 2024 i think as well.

How are other specialties increasing salaries despite decreasing reimbursement? Their reimbursements are decreasing just like ours. Granted some specialties had reimbursement increased like family medicine, but what about specialties with declining reimbursements?
In primary care we do see the lower RVU value but larger quality incentives. Plus Medicare has invented a new code for chronic disease management. Its only 0.25 wRVUs but I bet 2/3rds of my patients qualify. So we're talking an extra 100ish wRVUs per month.
 
For all the doom and gloom, I'm still making $100k above what I expected to make in EM while in med school almost 15 years ago (even after adjusting for inflation). The reality is that I make more in a year than my parents made in a decade growing up.

Of course EM has a lot of annoyances, but it's still a pretty good job when when you strip away everything and start just thinking about it as a job. I became a multimillionaire at 38 and get more days off in a month than many people get in a year.

Yeah I mean, this is gaslighting. The discussion isn't whether or not we are making more than our parents and have time off, it's whether we are adequately compensated for the risk we take on and for working nights / weekends / holidays.

My answer to that is: "kinda".

Per hour, we're still at the top of compensation I think.

You gotta get creative.

My group bills for ED OBS. We bill for EKG reads where able. We strive for level 5 and 4 charts on all encounters. We aggressively bill critical care within reason.

Contrast this to my previous trash hospital employed job. My chair wouldn't know an RVU if it hit him in the ****.
 
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Yeah I mean, this is gaslighting. The discussion isn't whether or not we are making more than our parents and have time off, it's whether we are adequately compensated for the risk we take on and for working nights / weekends / holidays.

My answer to that is: "kinda".

Per hour, we're still at the top of compensation I think.

You gotta get creative.

My group bills for ED OBS. We bill for EKG reads where able. We strive for level 5 and 4 charts on all encounters. We aggressively bill critical care within reason.

Contrast this to my previous trash hospital employed job. My chair wouldn't know an RVU if it hit him in the ****.
It isn't gaslighting when it's somebody's own opinion. To counter your point and raise discussion, there are a lot of other jobs that work nights, weekends, and holidays and pay much, much less than EM. From a risk standpoint, what's the true risk that a lawsuit is going to go above your malpractice limits? About as close to zero as it gets. That is looking at risk from only a financial standpoint and doesn't take into account the emotional and mental toll of being sued which are very real effects.

People complain about CMGs but yet people still work for CMGs. People complain about nights, weekends, holidays, etc. but most still work jobs that require them. It's because people put themselves and their family over pretty much anything else. I'm not saying that's a bad thing but it's the reality of our current situation.
 
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It isn't gaslighting when it's somebody's own opinion. To counter your point and raise discussion, there are a lot of other jobs that work nights, weekends, and holidays and pay much, much less than EM. From a risk standpoint, what's the true risk that a lawsuit is going to go above your malpractice limits? About as close to zero as it gets. That is looking at risk from only a financial standpoint and doesn't take into account the emotional and mental toll of being sued which are very real effects.

People complain about CMGs but yet people still work for CMGs. People complain about nights, weekends, holidays, etc. but most still work jobs that require them. It's because people put themselves and their family over pretty much anything else. I'm not saying that's a bad thing but it's the reality of our current situation.

Comparing us to "everyone else" working nights weekends and holidays (mostly unskilled workers, except for like pilots and a couple others) is what keeps rates depressed.

It's not just the financial risk when malpractice is concerned. There's unnecessary professional risk of increased scrutiny from peer review, medical boards, credentialing committees, etc.
 
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Comparing us to "everyone else" working nights weekends and holidays (mostly unskilled workers, except for like pilots and a couple others) is what keeps rates depressed.

It's not just the financial risk when malpractice is concerned. There's unnecessary professional risk of increased scrutiny from peer review, medical boards, credentialing committees, etc.
Comparing us to other jobs isn’t what keeps rates depressed. Compensation is ultimately tied to reimbursement. Lobbyists and the government are what ultimately keep rates depressed along with all the new residencies.

What is your SDG doing to raise EM compensation?
 
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Comparing us to other jobs isn’t what keeps rates depressed. Compensation is ultimately tied to reimbursement. Lobbyists and the government are what ultimately keep rates depressed along with all the new residencies.

What is your SDG doing to raise EM compensation?

We have an active PAC and one of our members is a high ranking member of the state chapter of ACEP.
 
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Ah yes, ACEP. The devil we know.

I hope your PAC is well, well, well, well funded.

Lol what do you want us to do? Go talk to Biden??

Don't ask what we're doing then **** on it cause you're cynical.

What are YOU doing???
 
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Lol what do you want us to do? Go talk to Biden??

Don't ask what we're doing then **** on it cause you're cynical.

What are YOU doing???
I guess as long as you aren’t comparing yourselves to other workers then compensation won’t be depressed.

I’m glad you asked what I’m doing. I’m working my shifts, stacking money, and spending time with my family.
 
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Yeah I mean, this is gaslighting. The discussion isn't whether or not we are making more than our parents and have time off, it's whether we are adequately compensated for the risk we take on and for working nights / weekends / holidays.

My answer to that is: "kinda".

Per hour, we're still at the top of compensation I think.

You gotta get creative.

My group bills for ED OBS. We bill for EKG reads where able. We strive for level 5 and 4 charts on all encounters. We aggressively bill critical care within reason.

Contrast this to my previous trash hospital employed job. My chair wouldn't know an RVU if it hit him in the ****.
Definitely didn't mean to "gaslight" you (hasn't that become such a cliche term over the past few years among the easily offended, though?)

Frankly, I'd love to make more (who wouldn't), but we're getting paid what the market decides to pay us based on supply and demand. I think one of the biggest mistakes our specialty has made in the last 20 years was the overproliferation of EM residencies, which has increased the chances of seeing a board-certified emergency physician for the public but decreased our individual bargaining ability.

Yes, nights/weekends/holidays suck. If you don't like it, then just find a way to make yourself more valuable and do a different job.
 
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Definitely didn't mean to "gaslight" you (hasn't that become such a cliche term over the past few years among the easily offended, though?)

Frankly, I'd love to make more (who wouldn't), but we're getting paid what the market decides to pay us based on supply and demand. I think one of the biggest mistakes our specialty has made in the last 20 years was the overproliferation of EM residencies, which has increased the chances of seeing a board-certified emergency physician for the public but decreased our individual bargaining ability.

Yes, nights/weekends/holidays suck. If you don't like it, then just find a way to make yourself more valuable and do a different job.

"Sorry to offend; here's another offensive comment." 😂

If you're willing to accept less, that's why you get paid less 🤷‍♂️
 
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For all the doom and gloom, I'm still making $100k above what I expected to make in EM while in med school almost 15 years ago (even after adjusting for inflation). The reality is that I make more in a year than my parents made in a decade growing up.

Of course EM has a lot of annoyances, but it's still a pretty good job when when you strip away everything and start just thinking about it as a job. I became a multimillionaire at 38 and get more days off in a month than many people get in a year.
With all due respect, salaries in medicine have not kept up at all. My ex-girlfriend is 22 and works as a financial analyst for a mid company where she already makes 175k. This is not uncommon. In five years, she will make more than most physicians aside from the impossibly competitive specialties. All with no debt, no opportunity cost, free food at work (meanwhile residents at my med school get yelled at for taking saltines and ginger ale lmao)

If physician salaries kept up, pediatricians would be making 750k and ER physicians 1 million. Doctors used to be able to afford vacation homes, super cars etc. the new generation of doctors won’t be able to buy houses or pay their loans
 
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With all due respect, salaries in medicine have not kept up at all. My ex-girlfriend is 22 and works as a financial analyst for a mid company where she already makes 175k. This is not uncommon. In five years, she will make more than most physicians aside from the impossibly competitive specialties. All with no debt, no opportunity cost, free food at work (meanwhile residents at my med school get yelled at for taking saltines and ginger ale lmao)

If physician salaries kept up, pediatricians would be making 750k and ER physicians 1 million. Doctors used to be able to afford vacation homes, super cars etc. the new generation of doctors won’t be able to buy houses or pay their loans

Medicine compensation is trash and has not kept up at all. I know someone in "marketing" slinging Vaseline making like 200k 5 years out of a bachelors degree. Shell prob be VP of something or other soon and make more than me. No nights, no weekends, no holidays, no stressful decisions.

The struggle is real brosephs. The residents are graduating with 400k debt (lulz).

I do pretty good cause I paid off my loans and live modestly. ***** new attending I know has two Teslas including a Cyber Truck (double lulz).

But why are you complaining?! There's burger flippers who make less than you!!! You should be thankful!!!!!
 
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Medicine compensation is trash and has not kept up at all. I know someone in "marketing" slinging Vaseline making like 200k 5 years out of a bachelors degree. Shell prob be VP of something or other soon and make more than me. No nights, no weekends, no holidays, no stressful decisions.

The struggle is real brosephs. The residents are graduating with 400k debt (lulz).

I do pretty good cause I paid off my loans and live modestly. ***** new attending I know has two Teslas including a Cyber Truck (double lulz).

But why are you complaining?! There's burger flippers who make less than you!!! You should be thankful!!!!!
I think your entire world is a little bit skewed. Could compensation in medicine be better? Absolutely. Is there an easy solution to make it better? No, because there is too much out of our control. We can't control the insurance lobbies, we can't control reimbursement, SDGs are typically reliant on one hospital system, etc. The jobs you mention are the exception and not the rule. In general, many jobs that pay comparably to physicians typically come with more hours, stress (I get it, it isn't life or death situations, but I have non-medicine friends much more stressed at their jobs than me), job instability, and on and on. I guess you could counter with many tech jobs in the Bay Area but those aren't the norm.

Medicine is still a good job relatively speaking but you've got to be smart about it. Will you be the richest person on your block? Doubtful. Will you be able to live a financially comfortable life if you're not a financial idiot? Yes. Careers are all about tradeoffs. Many other professions will technically have higher compensation ceilings than you but you will almost universally have a higher compensation floor. The bottom line is that it's never too late to get into a different career if you're that unhappy with medicine. Sometimes you a little perspective will do you good. If you make $500k in medicine then you're looking at the 2% of people in the US who make more than you and are jealous while the other 98% of Americans are looking at you with the same jealousy.
 
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Absolutely. Is there an easy solution to make it better? No, because there is too much out of our control.
Actually pretty easy through unionizing. How do you think nurses and cops in NYC make 200k per year, probably more than the average pediatrician in NYC
 
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Actually pretty easy through unionizing. How do you think nurses and cops in NYC make 200k per year, probably more than the average pediatrician in NYC
Who are you going to unionize against? Insurance companies and the government? Do you think they're going to care? The government could just not give you a license or DEA. The insurance companies couldn't care less. Police can unionize against a city. Nurse can unionize against hospitals. It isn't so easy for physicians who aren't employed.
 
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With all due respect, salaries in medicine have not kept up at all. My ex-girlfriend is 22 and works as a financial analyst for a mid company where she already makes 175k. This is not uncommon. In five years, she will make more than most physicians aside from the impossibly competitive specialties. All with no debt, no opportunity cost, free food at work (meanwhile residents at my med school get yelled at for taking saltines and ginger ale lmao)

If physician salaries kept up, pediatricians would be making 750k and ER physicians 1 million. Doctors used to be able to afford vacation homes, super cars etc. the new generation of doctors won’t be able to buy houses or pay their loans

Shocking news from the world of finance that you can make more in banking than in medicine!
 
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