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

[JacobMcCandles]

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

But what about that girl making $200k 'slinging Vaseline'? If I'm reading between the lines, I think she probably has an OnlyFans account.

 

[Tiger26]

But what about that girl making $200k 'slinging Vaseline'? If I'm reading between the lines, I think she probably has an OnlyFans account.

When I told my dad that I "wanted to help people" as a reason for going to med school, he said "hookers help people--why do you want to be a doctor?"

It seems like some of the posters here could go that route and make way more ....

George Goulburn, 52, gave up corporate life to become a male escort. Now he services 'attractive' younger women

 

[voxveritatisetlucis]

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

Not investment banking, they’re making 350+. She’s like a financial analyst like treasury and accounting stuff. Jobs that paid 85k before COVID

 

[Fpg1245]

Just wait until foreign doctors without residency training agree to staff ERs for 50k per year

More States Cut Training Requirements for Some International Medical Graduates

Alternative pathways to licensing for IMGs spreads beyond Tennessee

www.medpagetoday.com

Honestly it sounds like a recipe for fraud and exploitation.

Even the dingus peds nephro - “bargain basement rates” said the quiet part of loud

I’m sure IMGs with advanced degrees would love to work at bargain basement rates and be exploited by greedy low tier academic institutions for years on end. Just like NP were supposed to serve rural communities and CRNAs were supposed to make anesthsia so much cheaper

 

[WhatJobDoIPick]

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.

Again, I don't care how I stack up against others with far less skills and expertise than I have.

High comp jobs are not as rare as you think. All my engineering friends make the same as I do with a bachelor's and no student debt. Again, no nights, weekends, holidays.

I'm happy in medicine so don't try to move the goal posts.

If you're a hospital employee, you can certainly unionize.

If you work for a true SDG as I do now you're already working for yourself and fighting the fight.

If you work for a CMG, then you've accepted your fate. There isn't anything wrong with that inherently.

But don't say phooey to the drastic change that's happened. The generation before worked in academics and had vacation homes. Now my friends are pulling extra shifts just to afford their primary homes. Again, I'm more than fine because of choices I've made.

 

[WhatJobDoIPick]

But what about that girl making $200k 'slinging Vaseline'? If I'm reading between the lines, I think she probably has an OnlyFans account.

Nope. Marketing. Bachelors degree. No only fans. Believe it or not other fields have caught up to and are surpassing medicine. It's not just Finance.

 

[wamcp]

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???

With a family / multiple young kids, 150K a year is not anywhere close to enough. Especially after taxes on that check

 

[voxveritatisetlucis]

Honestly it sounds like a recipe for fraud and exploitation.

Even the dingus peds nephro - “bargain basement rates” said the quiet part of loud

I’m sure IMGs with advanced degrees would love to work at bargain basement rates and be exploited by greedy low tier academic institutions for years on end. Just like NP were supposed to serve rural communities and CRNAs were supposed to make anesthsia so much cheaper

Ya not a single person has mentioned the recent massive Nepal USMLE cheating scandal in relation to these bills

 

[JacobMcCandles]

Again, I don't care how I stack up against others with far less skills and expertise than I have.

High comp jobs are not as rare as you think. All my engineering friends make the same as I do with a bachelor's and no student debt. Again, no nights, weekends, holidays.

I'm happy in medicine so don't try to move the goal posts.

If you're a hospital employee, you can certainly unionize.

If you work for a true SDG as I do now you're already working for yourself and fighting the fight.

If you work for a CMG, then you've accepted your fate. There isn't anything wrong with that inherently.

But don't say phooey to the drastic change that's happened. The generation before worked in academics and had vacation homes. Now my friends are pulling extra shifts just to afford their primary homes. Again, I'm more than fine because of choices I've made.

Skills are somewhat arbitrary in the discussion. You’re not necessarily paid strictly on skills. You’re also paid on the demand of those skills. There are lots of other trades/jobs that work nights, weekends, and holidays that have more “skills” than you. They don’t have more medical skills but they’re also better at their own jobs.

Your circle of friends is irrelevant when looking at the entire picture. I didn’t say high comp jobs are rare but it’s much more common (in fact, extremely more common) for a majority of people to make less than physicians. Your engineering friends are also outliers from pretty much any data set you look at for the engineering fields. They’re even more outliers if they’re not in management positions.

I’ll argue even an SDG isn’t fully self-employed. You’re self-employed from a tax standpoint. You have much more control over your own job than most but you’re likely still reliant on a single vendor (one hospital system). Any business owner would tell you that you’d be crazy to rely on a single client or contract but that’s just the market in EM. Unfortunately, when it comes down to it, the hospital has the power with respect to an SDG.

With respect to your friends working extra shifts to afford their mortgage, you’re friends are either buying too much house, spending too much, or live in a VHCOL place where pretty much everyone has to stretch. If they think they deserve a 6,000 square foot house, Rolls Royce, and vacation home just because they’re a physician then life is going to humble them.

You can’t continuously compare jobs over separate generations. Things change. Professional athletes didn’t use to make the kind of money, comparatively, they do now. Even specialties within medicine see big changes in compensation over the years.

 

[WhatJobDoIPick]

Skills are somewhat arbitrary in the discussion. You’re not necessarily paid strictly on skills. You’re also paid on the demand of those skills. There are lots of other trades/jobs that work nights, weekends, and holidays that have more “skills” than you. They don’t have more medical skills but they’re also better at their own jobs.

Your circle of friends is irrelevant when looking at the entire picture. I didn’t say high comp jobs are rare but it’s much more common (in fact, extremely more common) for a majority of people to make less than physicians. Your engineering friends are also outliers from pretty much any data set you look at for the engineering fields. They’re even more outliers if they’re not in management positions.

I’ll argue even an SDG isn’t fully self-employed. You’re self-employed from a tax standpoint. You have much more control over your own job than most but you’re likely still reliant on a single vendor (one hospital system). Any business owner would tell you that you’d be crazy to rely on a single client or contract but that’s just the market in EM. Unfortunately, when it comes down to it, the hospital has the power with respect to an SDG.

With respect to your friends working extra shifts to afford their mortgage, you’re friends are either buying too much house, spending too much, or live in a VHCOL place where pretty much everyone has to stretch. If they think they deserve a 6,000 square foot house, Rolls Royce, and vacation home just because they’re a physician then life is going to humble them.

You can’t continuously compare jobs over separate generations. Things change. Professional athletes didn’t use to make the kind of money, comparatively, they do now. Even specialties within medicine see big changes in compensation over the years.

The waiting room that's 30 deep at 8pm seems to suggest there's a demand for my skills.

Is there a same waiting for an electrician at the same time? Or anytime?

We as EM docs are limited by an arbitrarily distorted space. We cannot hang a shingle and open an FSED in most states because politicians were paid off to outlaw these. We cannot change jobs as briskly as someone in tech or finance because of unnecessarily arduous licensing (sometimes 3 months or more) and credentialing (6 months) processes. These barriers are placed by design to limit our mobility.

 

[voxveritatisetlucis]

How much revenue do physicians generate? I bet it’s much more than they are paying you

 

[JacobMcCandles]

The waiting room that's 30 deep at 8pm seems to suggest there's a demand for my skills.

Is there a same waiting for an electrician at the same time? Or anytime?

We as EM docs are limited by an arbitrarily distorted space. We cannot hang a shingle and open an FSED in most states because politicians were paid off to outlaw these. We cannot change jobs as briskly as someone in tech or finance because of unnecessarily arduous licensing (sometimes 3 months or more) and credentialing (6 months) processes. These barriers are placed by design to limit our mobility.

I don’t think I said that there isn’t a demand for your skills. The point is that different jobs have different skills and physicians aren’t necessarily special in that regard. You probably can’t plumb your entire house just like a plumber probably isn’t well versed on an appropriate chest pain workup. Have you tried to do any major home improvement project lately? You’re probably going to be waiting months until they can even start. That’s if they even bother to show up because many of the good ones are all booked up for the foreseeable future. If it’s a small enough job, you likely won’t even be able to get someone licensed and may have to rely on a handyman.

Have you tried to book an appointment with a neurologist lately? Ours are booked out for months yet we make more than they do. A particular perceived demand doesn’t always exactly correlate with compensation.

Also, patients don’t come to the ED to literally see you. They come to see a physician. They don’t really care if it’s you or one of your other partners. Just like when there’s a line at the Chick-fil-A drive thru. I’m not there to see a particular worker. I’m there for the service and product they provide. EM is still a service industry at its heart but many of the people who think they need your service actually don’t.

 

[JacobMcCandles]

How much revenue do physicians generate? I bet it’s much more than they are paying you

As a general rule, no business can continue to pay their employees more money than they generate in perpetuity because they’ll eventually go out of business unless you can continuously get PE money but that money eventually dries up. You can certainly arbitrage certain situations but eventually the money has to come from somewhere.

Rural hospitals are a good example. Many have to pay physicians more but that goes against their market dynamics because they’re more likely to have more uninsured and Medicaid patients than a typical suburban hospital. They then rely on government funding. When they don’t get that funding they’ll eventually close like we’ve seen many do.

 

[Apollyon]

Also, patients don’t come to the ED to literally see you. They come to see a physician. They don’t really care if it’s you or one of your other partners.

Actually, in some situations, they do. Or, what occurred much more frequently at my last job is, the incoming pts saw who the doctor was who was working, and turned around and left. Or happened more than once that a pt thanked me for being there, simply because I WASN'T "the walking lawsuit", or one of the other inadequates.

 

[deleted1140701]

Skills are somewhat arbitrary in the discussion. You’re not necessarily paid strictly on skills. You’re also paid on the demand of those skills. There are lots of other trades/jobs that work nights, weekends, and holidays that have more “skills” than you. They don’t have more medical skills but they’re also better at their own jobs.

Your circle of friends is irrelevant when looking at the entire picture. I didn’t say high comp jobs are rare but it’s much more common (in fact, extremely more common) for a majority of people to make less than physicians. Your engineering friends are also outliers from pretty much any data set you look at for the engineering fields. They’re even more outliers if they’re not in management positions.

I’ll argue even an SDG isn’t fully self-employed. You’re self-employed from a tax standpoint. You have much more control over your own job than most but you’re likely still reliant on a single vendor (one hospital system). Any business owner would tell you that you’d be crazy to rely on a single client or contract but that’s just the market in EM. Unfortunately, when it comes down to it, the hospital has the power with respect to an SDG.

With respect to your friends working extra shifts to afford their mortgage, you’re friends are either buying too much house, spending too much, or live in a VHCOL place where pretty much everyone has to stretch. If they think they deserve a 6,000 square foot house, Rolls Royce, and vacation home just because they’re a physician then life is going to humble them.

You can’t continuously compare jobs over separate generations. Things change. Professional athletes didn’t use to make the kind of money, comparatively, they do now. Even specialties within medicine see big changes in compensation over the years.

Right on. Comparison is really the thief of joy. I think people should really just stop reading these articles. I look at myself and I’ve got a nice house, non gold digging spouse, great health, and am financially well off. I work more than most ER docs but never feel drained because I do the bare minimum and always leave on time but have good enough metrics that no one complains. People are nice to me, I get to live in a great city, and don’t take antidepressants. I think that’s good enough.

N=2 but I have (now) distant friends in other fields. One is at Nvidia. Doesn’t seem all that happy despite probably doing well. Looks 40 despite being 32, still single and overweight. Has a cocaine problem last I heard. Another guy burned out of I-banking after graduation from an Ivy and now works some chill job for the city. Gets racially profiled all the time and also looks 10 years older than his age.

 

[xaelia]

We're not selling lies to folks with more money than sense, therefore there's a ceiling on most doctors potential earnings.

Most of our "clients" are not wealthy and wouldn't otherwise be able to afford the medical care they're receiving. Even if that care is worth "a lot" to them, they simply don't have much to give. Heck, the U.S. spends ~$8B annually on the hospitalisation costs from firearm injuries – think about the trauma systems needed to support that sort of emergency, surgical, and critical care – for folks without the means to pay for it. Same goes for elderly, nursing home, dementia care, disabled, etc.

Not a rant about whether those folks "deserve" medical care, but that healthcare – in other countries moreso than the U.S., but still in the U.S. to some extent – is more a fundamental public service, like buses and sewers, and the general public will only fund to the bare minimum possible. The principles of "supply and demand" don't completely apply to the health sector because there's a disconnect between "demand" and the willingness/ability to pay more – because blue collar, government payor, etc. (even before for-profit insurer cartels are factored in).

A long, roundabout way to say – no, general physician salaries will not keep up with the private sector.

 

[xaelia]

Or, what occurred much more frequently at my last job is, the incoming pts saw who the doctor was who was working, and turned around and left.

Ah, the dark pleasure of these patient encounters.

Same patient you've discharged earlier that day returns hoping for a different doctor – gets you again instead.

"Awww **** man"

 

[EctopicFetus]

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?

This is a lie. Compensation is not tied to reimbursement for most of EM. If you are in an SDG sure.. If you arent its supply / demand. If ACEP / AAEM had balls they would lobby congress to not pay for ED E/M codes nor facility fees if patient isnt seen by an EM trained doc.

They want to have FP docs / IM docs etc pay less for the inferior care. I know that wont be popular with a few subgroups of people who work in EDs.

If you believe it is tied to reimbursement please explain regional variance in pay. Why is Denver, Chicago, Charlotte so crappy and Mississippi (who has long been near the top) so high? For those who dont know CMS pays differently for practice expense some of which is geographic. Hence having an office on Park Ave is gonna cost more than having an office in rural Montana.

 

[JacobMcCandles]

This is a lie. Compensation is not tied to reimbursement for most of EM. If you are in an SDG sure.. If you arent its supply / demand. If ACEP / AAEM had balls they would lobby congress to not pay for ED E/M codes nor facility fees if patient isnt seen by an EM trained doc.

They want to have FP docs / IM docs etc pay less for the inferior care. I know that wont be popular with a few subgroups of people who work in EDs.

If you believe it is tied to reimbursement please explain regional variance in pay. Why is Denver, Chicago, Charlotte so crappy and Mississippi (who has long been near the top) so high? For those who dont know CMS pays differently for practice expense some of which is geographic. Hence having an office on Park Ave is gonna cost more than having an office in rural Montana.

We both know that non-SDG EM pay has many factors but reimbursement absolutely plays a part. You’re right that there is supply and demand aspect and of course a business such as a CMG is going to try to pay the least amount that they can. As I mentioned in another post, if a business continues to pay out more than it brings in without some kind of cash infusion whether that be PE or government or hospital subsidy, they’re not going to be a business for too incredibly long. A hospital system is probably in a better spot than a CMG for compensation since they’ll have more revenue lines and areas to subsidize from than the average CMG. A CMG isn’t going to staff a hospital unless they think the overall picture favors them financially. They may take on a money losing contract to gain another more financially viable contract but reimbursements will absolutely come into play.

 

[dozitgetchahi]

Again, I don't care how I stack up against others with far less skills and expertise than I have.

High comp jobs are not as rare as you think. All my engineering friends make the same as I do with a bachelor's and no student debt. Again, no nights, weekends, holidays.

I'm happy in medicine so don't try to move the goal posts.

If you're a hospital employee, you can certainly unionize.

If you work for a true SDG as I do now you're already working for yourself and fighting the fight.

If you work for a CMG, then you've accepted your fate. There isn't anything wrong with that inherently.

But don't say phooey to the drastic change that's happened. The generation before worked in academics and had vacation homes. Now my friends are pulling extra shifts just to afford their primary homes. Again, I'm more than fine because of choices I've made.

I have a lot of friends from college who are engineers. Many don’t even make $100k. There’s only a very narrow slice of the engineering population who makes bank, and those folks are mostly concentrated in Silicon Valley…where everyone else is an engineer who makes $300k, so the price of everything is astronomical.

Yes doctors get screwed in a lot of ways, and yes there’s a lot of debt in becoming a doctor that sucks…but it ain’t a half bad profession in other ways.

 

[dozitgetchahi]

We're not selling lies to folks with more money than sense, therefore there's a ceiling on most doctors potential earnings.

Most of our "clients" are not wealthy and wouldn't otherwise be able to afford the medical care they're receiving. Even if that care is worth "a lot" to them, they simply don't have much to give. Heck, the U.S. spends ~$8B annually on the hospitalisation costs from firearm injuries – think about the trauma systems needed to support that sort of emergency, surgical, and critical care – for folks without the means to pay for it. Same goes for elderly, nursing home, dementia care, disabled, etc.

Not a rant about whether those folks "deserve" medical care, but that healthcare – in other countries moreso than the U.S., but still in the U.S. to some extent – is more a fundamental public service, like buses and sewers, and the general public will only fund to the bare minimum possible. The principles of "supply and demand" don't completely apply to the health sector because there's a disconnect between "demand" and the willingness/ability to pay more – because blue collar, government payor, etc. (even before for-profit insurer cartels are factored in).

A long, roundabout way to say – no, general physician salaries will not keep up with the private sector.

The problem isn’t this so much as the fact that the US healthcare system has become laden with grifters (healthcare execs) and rent-seeking middlemen (Change Healthcare, looking at you) who all are biting and shoving for a slice of the healthcare pie.

Why is healthcare so expensive? Well, because the Assistant Vice Dean for Curriculum Development needs to eat too, and apparently the price of him eating is >$500k. At the local hospital across town, a review of their nonprofit filings indicates that none of their execs make less than $700k.

There is lots and lots of money in the system - it just all gets gobbled up by these types of people.

 

[EctopicFetus]

We both know that non-SDG EM pay has many factors but reimbursement absolutely plays a part. You’re right that there is supply and demand aspect and of course a business such as a CMG is going to try to pay the least amount that they can. As I mentioned in another post, if a business continues to pay out more than it brings in without some kind of cash infusion whether that be PE or government or hospital subsidy, they’re not going to be a business for too incredibly long. A hospital system is probably in a better spot than a CMG for compensation since they’ll have more revenue lines and areas to subsidize from than the average CMG. A CMG isn’t going to staff a hospital unless they think the overall picture favors them financially. They may take on a money losing contract to gain another more financially viable contract but reimbursements will absolutely come into play.

Disagree. Now if you include “reimbursements” to include things like subsidies sure. Net revenue has to exceed net expenses. But it doesnt matter where the revenue comes from. In some places the payer mix is atrocious. Docs get paid reasonably well because the job sucks and they can’t recruit people.

As an example, pay in Tucson is pretty decent. Jobs paying around $300/hr. Phoenix not so much. Few jobs over 220/hr. The payer mix in Tucson isnt better than it is in Phoenix, especially the sites i have intimate knowledge of.

Pay in EM is about to go down the toilet. Reimbursement isnt gonna drop nearly as fast. Keep in mind Envision went bankrupt yet they were bringing in more revenue than they paid in salaries. They died because of the debt and the payments on that. If they had gotten those contracts for free then they would be fine and still more actively screwing docs.

 

[EctopicFetus]

The problem isn’t this so much as the fact that the US healthcare system has become laden with grifters (healthcare execs) and rent-seeking middlemen (Change Healthcare, looking at you) who all are biting and shoving for a slice of the healthcare pie.

Why is healthcare so expensive? Well, because the Assistant Vice Dean for Curriculum Development needs to eat too, and apparently the price of him eating is >$500k. At the local hospital across town, a review of their nonprofit filings indicates that none of their execs make less than $700k.

There is lots and lots of money in the system - it just all gets gobbled up by these types of people.

Exactly, plenty of people who generate no revenue make a lot of money. There is a beginning of a change of tide in business as a whole. Much less management. I cant even tell you the number of people who i talk to and i realize they literally do close to nothing at the hospital. They go to meetings, listen, maybe talk but then do literally nothing.

This isnt unique to medicine. My bro in law works for a fortune 100 company. Been there 20+ years. First job out of college. He is smart, likable and gets stuff done. He makes good money, has stock options etc. No debt as he went to an inexpensive university.

He had made 5-6 Apps because he could do his job in 1-2 hours a day and when he was working from home had a bunch of time. He hit the gym, got in great shape, played video games and designed those apps. One of them brought in 5-8k a month in passive income until it dwindled some. He still brings in 3k a month doing nothing as the app is just plugging along and he has subscribers.

That doesnt exist for clinicians.

 

[GatorCHOMPions]

This isnt unique to medicine. My bro in law works for a fortune 100 company. Been there 20+ years. First job out of college. He is smart, likable and gets stuff done. He makes good money, has stock options etc. No debt as he went to an inexpensive university.

That doesnt exist for clinicians.

My bro in law has a similar setup. Just this past week my wife who's on maternity leave ran into him at the playground two days in a row in the middle of the day. He had "one or two calls to do and that was it". Granted he's not making doctor money, more like 100-150k, but graduated with minimal debt and is a glorified babysitter most of the time.

 

[JacobMcCandles]

Disagree. Now if you include “reimbursements” to include things like subsidies sure. Net revenue has to exceed net expenses. But it doesnt matter where the revenue comes from. In some places the payer mix is atrocious. Docs get paid reasonably well because the job sucks and they can’t recruit people.

As an example, pay in Tucson is pretty decent. Jobs paying around $300/hr. Phoenix not so much. Few jobs over 220/hr. The payer mix in Tucson isnt better than it is in Phoenix, especially the sites i have intimate knowledge of.

Pay in EM is about to go down the toilet. Reimbursement isnt gonna drop nearly as fast. Keep in mind Envision went bankrupt yet they were bringing in more revenue than they paid in salaries. They died because of the debt and the payments on that. If they had gotten those contracts for free then they would be fine and still more actively screwing docs.

Reimbursements are a significant majority of revenue. I’m not sure you can argue that revenue plays a factor but reimbursements don’t. As I said, we both know it’s multifactorial but to say reimbursements play no role is false.

 

[Torsion]

High comp jobs are not as rare as you think. All my engineering friends make the same as I do with a bachelor's and no student debt. Again, no nights, weekends, holidays.

Where did your engineering friends go to school and where do they work? I can assure you that the average engineer is not making the kind of money we do. Most of my non-physician friends are engineers (went to a big, land-grant state school with a robust engineering program). 10 years removed from their bachelors degrees, I'd say they are on average making somewhere between 100-200k with most probably 100-150k. Not a bad living, but not what we are making.

I understand the financial headwinds facing reimbursement and the E/M and believe that we deserve every penny we earn. Still, I earn much more than my early-thirties non-physician friends. I suppose if you live in the Bay Area or have "engineering" friends that are Ivy-League grads or obtained lucrative jobs through family connections, things may be different.

 

[TooMuchResearch]

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??

What happens after 65?

 

[WhatJobDoIPick]

Obviously they are the wrong type of engineers. All of my friends are making 300k+ in energy and tech. It's really not that difficult.

 

[WhatJobDoIPick]

I have a lot of friends from college who are engineers. Many don’t even make $100k. There’s only a very narrow slice of the engineering population who makes bank, and those folks are mostly concentrated in Silicon Valley…where everyone else is an engineer who makes $300k, so the price of everything is astronomical.

Yes doctors get screwed in a lot of ways, and yes there’s a lot of debt in becoming a doctor that sucks…but it ain’t a half bad profession in other ways.

Where did your engineering friends go to school and where do they work? I can assure you that the average engineer is not making the kind of money we do. Most of my non-physician friends are engineers (went to a big, land-grant state school with a robust engineering program). 10 years removed from their bachelors degrees, I'd say they are on average making somewhere between 100-200k with most probably 100-150k. Not a bad living, but not what we are making.

I understand the financial headwinds facing reimbursement and the E/M and believe that we deserve every penny we earn. Still, I earn much more than my early-thirties non-physician friends. I suppose if you live in the Bay Area or have "engineering" friends that are Ivy-League grads or obtained lucrative jobs through family connections, things may be different.

Nope, not bay area, and not family connections. Couple Ivy leagues, but others state schools.

 

[VA Hopeful Dr]

Obviously they are the wrong type of engineers. All of my friends are making 300k+ in energy and tech. It's really not that difficult.

I only know a handful of engineers and they are doing well, but they aren't pulling it what I am much less non-primary care doctors who outearn me by a fair bit.

I will say what I have to tell the pre-meds at least once a year: medicine is the safest way to make mid/upper six figures. Yes, other fields can (and often do) make more than we do but its not basically guaranteed like it is with us. A full time physician in the US shouldn't be making less than 250k and the vast majority do way better than that.

 

[mheat3]

Also, while cuts are happening across the board for physician services it seems facility fees reimbursements continue to increase or at least remain flat.

Wonder who helped write these laws? 😉

 

[JacobMcCandles]

Obviously they are the wrong type of engineers. All of my friends are making 300k+ in energy and tech. It's really not that difficult.

You and your friends are likely too young to understand the cyclical nature of the energy industry. It’s a boom or bust industry. Ask anyone over 50 in that industry how their job stability has faired over the years. I can’t speak to tech but I can speak somewhat towards energy and your friends making $300k are not the norm and it isn’t “really not that difficult”. However, oil & gas is probably the “easiest” way to make $100k for a young man without a high school degree. It’s hard, hard work but he could make some good money without a high school degree. But, he usually ends up in a bad spot once he buys his Ford Raptor, wake boat, and has $500 bar tabs every weekend when the oil patch goes bust again.

I can’t stress enough that what you think is the real world isn’t the actual real world for most Americans. Apparently, all of your friends and acquaintances make over $200k-$300k at a young age with just a bachelor’s degree. How come even the average compensations within the industries you mentioned for people with bachelor’s degrees is much, much less?

 

[Kuratz]

Lots of bull**** jobs out there for sure. Human nature to be jealous of both my brothers-in-law who clear $200k working remote NYC jobs with 2-3 hours of real work a day with none of the debt or opportunity cost of med school. I’m in rads but I imagine like EM is a total grind (albeit inherently much different). Nonstop work all shift, maybe 20 min to eat if you are willing to fall behind. High liability. It’s ****ing exhausting and I’m not even a real clinical dealing with patients, on feet all day etc. I just don’t see how this is sustainable from the standpoint of attracting skilled young people. Will be a slow brain-drain of talent going elsewhere. Old guys in their mid-late 60s who still practice lament the old days where they worked half as hard for twice as much money. That’s how they live in houses that are laughably out of reach for newly minted docs, drive expensive cars, might have a vacation home, and have other luxuries like country club memberships. For as hard as we collectively work that’s the type of financial success that should be afforded to physicians. Low stress bull**** job paying $100-$150k out of college >>> the grind of being a doc, even if we end up with a higher number in the bank eventually.

 

[carbonizedeyesockets]

LOL at the citing all these other "high-paying" jobs. NYPD cops making >200K are either high up on the chain of command or working a lot of overtime. They're not working 32hr/wk for 48 weeks/yr. Financial analysts average a lot less than 175K. Someone in marketing making 200K/yr is really good at their job and has likely gotten multiple promotions. And again, both of those folks are working more than 40hrs/week. My partner is an executive VP for an advertising firm and makes more than me. She works during the day and then will lay in bed at night for hours doing work. Shes constantly doing work on weekends. I never envy her job.

EM/medicine sucks a lot. There are other things I'd love to do, but I couldnt make half as much doing them. Lets be real, we all may be burnt to a crisp, but we do decently enough and work less than the average person. Its why we keep doing it. If it was so easy to jump ship and make good money in something else most of us would do it. But we don't because we know we may not be able to do it or don't want to invest the time necessary to do it. We post to a forum for med students and scream into the ether instead.

 

[HoosierdaddyO]

Just out of curiosity. If you could jump ship, what would you jump ship to? And that goes for everyone here. If money or time worked wasn’t an issue. What would you rather do for a career choice instead of being in the doc box??

LOL at the citing all these other "high-paying" jobs. NYPD cops making >200K are either high up on the chain of command or working a lot of overtime. They're not working 32hr/wk for 48 weeks/yr. Financial analysts average a lot less than 175K. Someone in marketing making 200K/yr is really good at their job and has likely gotten multiple promotions. And again, both of those folks are working more than 40hrs/week. My partner is an executive VP for an advertising firm and makes more than me. She works during the day and then will lay in bed at night for hours doing work. Shes constantly doing work on weekends. I never envy her job.

EM/medicine sucks a lot. There are other things I'd love to do, but I couldnt make half as much doing them. Let’s be real, we all may be burnt to a crisp, but we do decently enough and work less than the average person. It’s why we keep doing it. If it was so easy to jump ship and make good money in something else most of us would do it. But we don't because we know we may not be able to do it or don't want to invest the time necessary to do it. We post to a forum for med students and scream into the ether instead

 

[gruemd]

Just out of curiosity. If you could jump ship, what would you jump ship to? And that goes for everyone here. If money or time worked wasn’t an issue. What would you rather do for a career choice instead of being in the doc box??

Pyrotechnic engineer. Been the dream since I was a kid making my own gunpowder and fireworks. But the pay is not great haha, though you're getting paid to blow stuff up.

 

[JacobMcCandles]

Just out of curiosity. If you could jump ship, what would you jump ship to? And that goes for everyone here. If money or time worked wasn’t an issue. What would you rather do for a career choice instead of being in the doc box??

For all the faults of EM, it's still a tough job to beat on a larger scale. Many other high compensation jobs require much more time and also require a level of participation in company politics and other games that I have no desire to play. I'm not envious of the people who work a few hours a day and make $100k-$150k or who work from home and bring in $150k. I'd rather continue to work 30ish hours a week and make multiples of that. Financial freedom is priceless and gives you many more options. I can get to financial freedom much quicker than most.

 

[AlmostAnMD]

For all the faults of EM, it's still a tough job to beat on a larger scale. Many other high compensation jobs require much more time and also require a level of participation in company politics and other games that I have no desire to play. I'm not envious of the people who work a few hours a day and make $100k-$150k or who work from home and bring in $150k. I'd rather continue to work 30ish hours a week and make multiples of that. Financial freedom is priceless and gives you many more options. I can get to financial freedom much quicker than most.

I used to think this was true.

The problem is we become more and more of a commodity than an actual human being over time by being disconnected from all the "company politics." You become completely dispensable and disposable while another plug-n-play doctor takes your job when you're gone. Since we've done nothing to meaningfully regulate physicians in the ED that's why private equity F's us from one end and midlevel encroachment from the other.

PE definitely views us as cost-prohibitive and utilizes us the least as they can. When AI hits the market with healthcare--and believe me, one day it will--you'll have midlevels "supervising" AI computers that do the grunt work and ED docs will be shown the door.

The attitude of "clock in and clock out" will lead to, I'm very sure but cannot prove, one day us clocking out and not clocking in again.

For now I suppose your arrangement is beneficial. Myself, I'm getting out. The writing on the way at least in the local environment is so bad I just know it's not sustainable another 10-15 years. Impossible.

 

[carbonizedeyesockets]

Just out of curiosity. If you could jump ship, what would you jump ship to? And that goes for everyone here. If money or time worked wasn’t an issue. What would you rather do for a career choice instead of being in the doc box??

Live music photographer.

Or, I would totally go back to being a Paramedic. It was, at least where I worked, the most pure EM I’ve ever practiced.

 

[JacobMcCandles]

I used to think this was true.

The problem is we become more and more of a commodity than an actual human being over time by being disconnected from all the "company politics." You become completely dispensable and disposable while another plug-n-play doctor takes your job when you're gone. Since we've done nothing to meaningfully regulate physicians in the ED that's why private equity F's us from one end and midlevel encroachment from the other.

PE definitely views us as cost-prohibitive and utilizes us the least as they can. When AI hits the market with healthcare--and believe me, one day it will--you'll have midlevels "supervising" AI computers that do the grunt work and ED docs will be shown the door.

The attitude of "clock in and clock out" will lead to, I'm very sure but cannot prove, one day us clocking out and not clocking in again.

For now I suppose your arrangement is beneficial. Myself, I'm getting out. The writing on the way at least in the local environment is so bad I just know it's not sustainable another 10-15 years. Impossible.

This is true for many jobs and moreso for most other jobs outside of medicine. I don't worry about my job security with regards to AI as much as other industries probably should.

 

[HoosierdaddyO]

For all the faults of EM, it's still a tough job to beat on a larger scale. Many other high compensation jobs require much more time and also require a level of participation in company politics and other games that I have no desire to play. I'm not envious of the people who work a few hours a day and make $100k-$150k or who work from home and bring in $150k. I'd rather continue to work 30ish hours a week and make multiples of that. Financial freedom is priceless and gives you many more options. I can get to financial freedom much quicker than most.

Not tryna give you a hard time lol. But that wasn’t my question. It was a hypothetical of all else was equal. What other passion for a career would you choose. For me it would be a teacher or professor. It was just a question to make you think what other passions are out there 🙂

 

[JacobMcCandles]

Not tryna give you a hard time lol. But that wasn’t my question. It was a hypothetical of all else was equal. What other passion for a career would you choose. For me it would be a teacher or professor. It was just a question to make you think what other passions are out there 🙂

Something automotive racing related.

 

[BoardingDoc]

Just out of curiosity. If you could jump ship, what would you jump ship to? And that goes for everyone here. If money or time worked wasn’t an issue. What would you rather do for a career choice instead of being in the doc box??

Greco roman mythology professor.

 

[HoosierdaddyO]

I appreciate the responses. Sometimes I find myself sooooo caught up in the rat race of medicine that I very rarely sit down and think to myself what am I without medicine. What are my hobbies, interests. So I’ve been doing that this year with the framework that if I won the lotto and money wasn’t an issue but still wanted purpose and a career I was passionate about what would that be. And oddly enough it’s opened my eyes to fitness, to traveling and photography, to writing, to teaching at the local college etc. Just a little mental and spiritual exercise is all I was pushing here 🙂.

 

[trackrunner321]

Just out of curiosity. If you could jump ship, what would you jump ship to? And that goes for everyone here. If money or time worked wasn’t an issue. What would you rather do for a career choice instead of being in the doc box??

Track coach or travel blogger

 

[EctopicFetus]

Reimbursements are a significant majority of revenue. I’m not sure you can argue that revenue plays a factor but reimbursements don’t. As I said, we both know it’s multifactorial but to say reimbursements play no role is false.

Maybe as a floor. But the other side would be hospital, closure and no job. Let’s play this out.. 3 hospitals.. A,B,C all in the same city Let’s say it’s a big city with 30 hospitals… we will focus only on these 3. Some assumptions. NO MLPs, volumes all the same. Pay in the city is $200/hr after expenses and every job sees exactly 2pph and every shift is the same with the exact same acuity. So for the sake of discussion all 30 hospitals are the same in every way and the other 27 of them pay the docs 200/hr (100/pt) . All jobs are run by CMGs who compete for the docs. Again this is to make the example simple and not get overwhelmed by the real life differences we all know exist.

Hospital A is in the rich part of town they collect $300/pt So revenue is 600/hr, hospital B is 200/pt and c is $10/pt (all after expenses) for the sake of this discussion.

Hospital A wont pay more than 200/hr, instead the CMG will profit $400/hr. Hospital B docs will also earn the 200/hr but the profit will be 200/hr for the CMG. None of that profit is shared with the docs. Why would it be if they can fill the schedule? Now the complicated question.. What does hospital C do? They cant recruit docs at $20/hr. So the CMG would have to either get a subsidy to get to $200/hr, if the hospital cant afford this subsidy they either wont have an ED or they have to close. The excess revenue (profit) is simply not shared. Every CMG and hospital wants to pay as close to the least they have to pay to get it staffed with the docs they want. They want to pay not 1 penny more. Now we all know the data out there is imperfect and real jobs arent that simple to compare. That being said pay in Denver sucks and it’s not because the payer mix is so bad there.

 

[EctopicFetus]

One other thing for our younger colleagues. Medicine as a whole is very recession resistant. When unemployment pops and at some point it will. Medicine will remain fairly steady. I remember the housing crash and the economic collapse around it. I remember reading how these idiotic mortgage brokers (some story on CNN) was pulling in 200k a year as a 23 year old with minimal education because the volume of work was insane.

That person went broke which is not surprising and then no one wants to hire this person as they have no useful skill. Meanwhile in medicine our pay dipped some as the payer mix of my sdg worsened but nothing substantial. I had the same number of hours and nothing else changed for the worse. It is in these periods where smart docs stick with their investment/ savings plan and come out way ahead.

Even more recently during covid some of us who dont work for cmgs didnt have much of a change. Volumes dropped, Uncle Sam ponied up dough for us. We risked our lives. Much of society was spooked, stopped working and got their stimulus money. SDGs got paid and got the covid money and more and more. My group made more that year due to federal money that the year prior and our volumes cratered as did all of EM for a period of time. A pandemic is a little different but a true economic recession is coming. People will get canned. Maybe AI pushes us there.

I would advise any young doc to find alternative sources of income. I have a small business, rental properties and a wife who runs her own small business. This is the way. Many ways to get ahead $$ wise. REPS for a spouse is the super Mario magic mushroom. My wife has no interest in it.. but if i married a stay at home wife this is what i would do. Major life hack for anyone with significant w2 income as EM docs and other docs have.

 

[JacobMcCandles]

Maybe as a floor. But the other side would be hospital, closure and no job. Let’s play this out.. 3 hospitals.. A,B,C all in the same city Let’s say it’s a big city with 30 hospitals… we will focus only on these 3. Some assumptions. NO MLPs, volumes all the same. Pay in the city is $200/hr after expenses and every job sees exactly 2pph and every shift is the same with the exact same acuity. So for the sake of discussion all 30 hospitals are the same in every way and the other 27 of them pay the docs 200/hr (100/pt) . All jobs are run by CMGs who compete for the docs. Again this is to make the example simple and not get overwhelmed by the real life differences we all know exist.

Hospital A is in the rich part of town they collect $300/pt So revenue is 600/hr, hospital B is 200/pt and c is $10/pt (all after expenses) for the sake of this discussion.

Hospital A wont pay more than 200/hr, instead the CMG will profit $400/hr. Hospital B docs will also earn the 200/hr but the profit will be 200/hr for the CMG. None of that profit is shared with the docs. Why would it be if they can fill the schedule? Now the complicated question.. What does hospital C do? They cant recruit docs at $20/hr. So the CMG would have to either get a subsidy to get to $200/hr, if the hospital cant afford this subsidy they either wont have an ED or they have to close. The excess revenue (profit) is simply not shared. Every CMG and hospital wants to pay as close to the least they have to pay to get it staffed with the docs they want. They want to pay not 1 penny more. Now we all know the data out there is imperfect and real jobs arent that simple to compare. That being said pay in Denver sucks and it’s not because the payer mix is so bad there.

I guess I’m confused if your argument is that reimbursements don’t matter but then you give an example where they do matter because the ED/hospital will be closing because of it. Again, we both know lots of factors boil down to compensation but reimbursement is absolutely one of those factors.

 

[JacobMcCandles]

One other thing for our younger colleagues. Medicine as a whole is very recession resistant. When unemployment pops and at some point it will. Medicine will remain fairly steady. I remember the housing crash and the economic collapse around it. I remember reading how these idiotic mortgage brokers (some story on CNN) was pulling in 200k a year as a 23 year old with minimal education because the volume of work was insane.

That person went broke which is not surprising and then no one wants to hire this person as they have no useful skill. Meanwhile in medicine our pay dipped some as the payer mix of my sdg worsened but nothing substantial. I had the same number of hours and nothing else changed for the worse. It is in these periods where smart docs stick with their investment/ savings plan and come out way ahead.

Medicine is pretty recession resistant, but again, pay will likely creep lower because of the factors you mentioned, including reimbursement because the payor mixes get worse. Non-SDGs may try to keep pay the same but then the previous pressures we discussed about paying out more than you take in come into play. And I believe we’re both talking about real recessions and not COVID where the government just turns on the money printer. We still haven’t paid hard for that.

 

[Tiger26]

I would advise any young doc to find alternative sources of income. I have a small business, rental properties and a wife who runs her own small business. This is the way. Many ways to get ahead $$ wise. REPS for a spouse is the super Mario magic mushroom. My wife has no interest in it.. but if i married a stay at home wife this is what i would do. Major life hack for anyone with significant w2 income as EM docs and other docs have.

Completely agree--very sage advice. I make almost as much with my 3 other non-EM jobs (photography, short-term rentals, and Army National Guard) as I do in EM and they all provide some level of satisfaction in different ways.

To the person who asked about alternative careers, I think it deserves its own thread but I'd be a full time photographer. I could probably make my physician salary with it (you'd be surprised when you position it as a luxury brand) but I also like the security/stability of medicine along with other things like insurance, pension (i.e. multi-million payout or really nice annuity in our system), matching retirement contribution, CME account, etc.