ER Docs in Desirable Cities, What's Life Like?

[TheComebacKid]

I'm just curious about those folks living in the desirable cities for EM physicians... Thinking mostly of the Mountain West and Pacific Northwest regions.

Given the insanely tight job market for people trying to break into these areas, for those folks that have been there for awhile, is pay coming down? More metrics? More hoops to jump through just to keep your job? If you are a new doc who is lucky enough to even get an opportunity, the pay is atrocious, and you are likely selling your soul to USACS or some other horrid CMG.

But I would imagine the people already working in these markets for years are getting pressured, because there's probably 100 docs there ready and willing to take your job for less money. Or are there people who got in during the glory days, and have had smooth sailing and are untouchable? I would think supply/demand market forces would put a lot of pressure on the "lucky ones" who have been there awhile or got in early, but I don't really have a sense for how it works for those that have been there awhile.

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[thegenius]

Expensive

 

[EctopicFetus]

I'm just curious about those folks living in the desirable cities for EM physicians... Thinking mostly of the Mountain West and Pacific Northwest regions.

Given the insanely tight job market for people trying to break into these areas, for those folks that have been there for awhile, is pay coming down? More metrics? More hoops to jump through just to keep your job? If you are a new doc who is lucky enough to even get an opportunity, the pay is atrocious, and you are likely selling your soul to USACS or some other horrid CMG.

But I would imagine the people already working in these markets for years are getting pressured, because there's probably 100 docs there ready and willing to take your job for less money. Or are there people who got in during the glory days, and have had smooth sailing and are untouchable? I would think supply/demand market forces would put a lot of pressure on the "lucky ones" who have been there awhile or got in early, but I don't really have a sense for how it works for those that have been there awhile.

Private groups are immune to this. There aren’t many but there are some out there.

 

[Jabbed]

Echoing @EctopicFetus. New grad in a tight city but working with a private group. Normal sweat equity, but the job is great. Everyone that I talk to that's working at the CMGs in my neighborhood is desperately trying to get out.

 

[Tenk]

The PNW is a raging dumpster fire atm due to covid + a huge influx of people over the last several years combined with not enough hospital beds to begin with.

 

[TheComebacKid]

Private groups are immune to this. There aren’t many but there are some out there.

So there are still people in Denver pulling in 300/hr as part of a SDG?

 

[Rekt]

Echoing @EctopicFetus. New grad in a tight city but working with a private group. Normal sweat equity, but the job is great. Everyone that I talk to that's working at the CMGs in my neighborhood is desperately trying to get out.

Don't worry, they'll be out soon once the CMG spawns their own new grads from all these new residencies.

 

[slchino]

i cannot speak for all docs but you will likely have to trade more of your time/life in exchange for the privilege to live where most people vacation

From a financial perspective it makes no sense to live where I live but I do bc it makes my wife happy and it’s cheaper to keep her happy than get divorced and start all over😂

 

[namethatsmell]

 

[slchino]

💯

 

[The Knife & Gun Club]

What would you say your list of highly desirable locations would be?

 

[sylvanthus]

The PNW is a raging dumpster fire atm due to covid + a huge influx of people over the last several years combined with not enough hospital beds to begin with.

can confirm.

 

[Angry Birds]

I live in a very desirable area but commute an hour to work.

 

[TheComebacKid]

What would you say your list of highly desirable locations would be?

Denver, Salt Lake, Portland, Seattle, Bozeman, Jackson Hole...

 

[bravotwozero]

The PNW is a raging dumpster fire

This is both literally and figuratively accurate, given the forest fires up there…

Not so ‘desirable’ when you take that into consideration.

 

[DocEspana]

Southeastern desirable city dweller here.

Left a job where I was making $215ish/hr (metrics were strange) to get a job giving a flat $250. Covid hit and my old job basically dropped to $190ish an hour AND cut everyones hours by a small amount (made each shift 1 hour shorter and removed one of the five physician shifts completely). They havent gone back to old hours yet and the change from 215ish to 190ish was contractually mandated in a way where 'refusal to sign within 30 days will be considered your tacit resignation.'

my $250 job actually *increased* our hours and we all made a **** ton of money during the peak of covid. but during the lull we went back to usual staffing numbers and the company came by and said "hey we are gonna adjust some stuff" and now we make $240-242 per hour (lost $60 per hour on the flat rate but gained incentives worth about 50-52 per hour).

The big thing I can say is that *everywhere* else around me is absolutely overstaffed (in that they will not hire anyone) and running their physicians on bare minimum physician hours of coverage and at paycuts. So we are pretty lucky that we are the CMG's golden goose in florida - a foothold into a major system where the high functioning ED is considered the center piece of that hospitals attempt to rebrand itself. The CMG loves this and gives us a sweet deal because of it.

and yes i'm aware I just said a $10 haircut is a sweet deal. It is when you see how bad everyone else around us got reamed by covid changes in staffing/payment.

 

[WilcoWorld]

 

[HemorrhagicShock]

The PNW is a raging dumpster fire atm due to covid + a huge influx of people over the last several years combined with not enough hospital beds to begin with.

I work in the PNW in what I think most would consider close to a very desirable place to live, and yes this is my EXACT experience.

Pay has remained constant, but the amount of "work units" required per hour has substantially increased. It's particularly tough and burn-out-inducing. I've been wanting to leave for a while but loans, wife's family, young child are all preventing this.

 

[Apollyon]

Sure, ok, Academy Award and all that, but, how can you NOT appreciate some of the other lyrical stylings of the Three Six Mafia, including the inimitable "Azz and T***iez"? Now, that part of their ouevre, that's gold. Gold, Jerry, gold! In the pantheon of human expression, this one is right up there with the (I Am Not Making This Up) first song I ever downloaded - by that master, Sisqo - "The Thong Song".

 

[Mount Asclepius]

I'm familiar with a subset of your regions of interest, but not everywhere. I believe without a specific connection it is tough to land a quality SDG position with a reasonable partnership track in those cities mentioned. That isn't necessarily new. If you are willing to consider and open up your search to small-mid sized cities in those regions you might have better luck. SDGs are more insulated, but not entirely immune to pressures exerted by corporate medicine. SDGs are becoming more rare as a result of this. For those that remain, compensation can still be really good. Some hospitals value the groups of EPs they employ and don't want to bring in a national staffing group. Just because 100s of EPs are knocking on the doors doesn't threaten the position of those in a SDG if the hospital is satisfied with the quality the group provides.

 

[Mbekweni]

Yes. I know several excellent SDG practices in coastal California with paid rates around $225-275/hr and extra end of the year profit sharing bringing things to the $300/hr+ range. Typically hire one or two docs every 2-3 years via internal referral. I have a friend who works SDG in PNW and was a good gig but as others has mentioned is really hard to work in the last year or two, and they are leaving the area now.

 

[MechEDoc]

SDGs are more insulated, but not entirely immune to pressures exerted by corporate medicine. SDGs are becoming more rare as a result of this.

Very true. I looked at (and was offered a job) at a SDG that I really wanted to join in the PNW. There were hints that the group might not be there forever (despite doing a great job), but also strong indications that they would be there for a long time to come. The c-suite has decided to make all the docs employees and the group is on it's way out. It has no other contracts, no alternative income streams, no FSED, no UC, nothing. They're transient. The strength of CMGs is spreading their risk around a region or the country. I doubt that hospital or region will see another CMG, they're all gone or nearly gone.

Ugh.

 

[alpinism]

I can only speak for Colorado but on the front range its generally <200HR for >2PPH right now.

As a general rule of thumb for most places the closer you get to Denver the worse the compensation.

 

[emergentmd]

Southeastern desirable city dweller here.

Left a job where I was making $215ish/hr (metrics were strange) to get a job giving a flat $250. Covid hit and my old job basically dropped to $190ish an hour AND cut everyones hours by a small amount (made each shift 1 hour shorter and removed one of the five physician shifts completely). They havent gone back to old hours yet and the change from 215ish to 190ish was contractually mandated in a way where 'refusal to sign within 30 days will be considered your tacit resignation.'

my $250 job actually *increased* our hours and we all made a **** ton of money during the peak of covid. but during the lull we went back to usual staffing numbers and the company came by and said "hey we are gonna adjust some stuff" and now we make $240-242 per hour (lost $60 per hour on the flat rate but gained incentives worth about 50-52 per hour).

The big thing I can say is that *everywhere* else around me is absolutely overstaffed (in that they will not hire anyone) and running their physicians on bare minimum physician hours of coverage and at paycuts. So we are pretty lucky that we are the CMG's golden goose in florida - a foothold into a major system where the high functioning ED is considered the center piece of that hospitals attempt to rebrand itself. The CMG loves this and gives us a sweet deal because of it.

and yes i'm aware I just said a $10 haircut is a sweet deal. It is when you see how bad everyone else around us got reamed by covid changes in staffing/payment.

How things have changed in 5 years. When a good job "allows you" to make 250/hr then looks like CMGs has won.

 

[bravotwozero]

What do you mean ‘looks like’? They HAVE won. The job market has been cornered.

 

[DocEspana]

How things have changed in 5 years. When a good job "allows you" to make 250/hr then looks like CMGs has won.

I mean. Highly desirable city with good specialty support asking me to see 1.5pph. it has perks. I'm more concerned by the $190ish wanting >>2pph.

But the CMGs definitely won

 

[namethatsmell]

I can only speak for Colorado but on the front range its generally <200HR for >2PPH right now.

As a general rule of thumb for most places the closer you get to Denver the worse the compensation.

So I actually owe the EM market in Denver a lot of thanks.

Several years ago I considered moving there for my wife's family. Interviewed at an academic place, a few CMG places, and a doc-owned group (hard to tell if it was a true sdg). Most of them started the interview with something like "Denver is the bestest city in the galaxy and you're lucky to be getting this interview." I encounted the single most evil "EM physician leader" I've ever met who seemed nearly gleeful when describing how they replaced physician hours with midlevel hours -- "target" doc staffing was 2.8 pph. I think the highest offer was $170hr if I was willing to be a straight nocturnist and a nebulous path to "partnership." Most other jobs were like ~150/hr.

This was during the golden age where you could still get 400/hr for locums in several parts of the country. I was crushing it. And if I hadn't interviewed myself in Denver and gotten a first-hand look at that market, I never would have believed just how low EM rates could go and how bad working conditions could get...it became painfully obvious where EM headed. On the flight outta there I began to think about how I was going to diversify my skill-set outside of EM.

So thank you Denver and the terribly greedy corporations and boomer docs who sold out our profession there. You were an excellent canary in the coal mine and spurred me to change the trajectory of my career at a much younger age than I otherwise would have.

 

[MechEDoc]

On the flight outta there I began to think about how I was going to diversify my skill-set outside of EM.

So thank you Denver and the terribly greedy corporations and boomer docs who sold out our profession there. You were an excellent canary in the coal mine and spurred me to change the trajectory of my career at a much younger age than I otherwise would have.

What did you diversify yourself into?

 

[emergentmd]

"target" doc staffing was 2.8 pph. I think the highest offer was $170hr if I was willing to be a straight nocturnist and a nebulous path to "partnership." Most other jobs were like ~150/hr.

In all seriousness, Why would any EM boarded doc put themselves through this? See almost 3 sick demanding pts an hour, deal with admins/CMG protocols, keep high pt sats, deal with short staffed ERs, flipping between nights and days, weekends, holidays for a typical $150/hr?

If you have to live in Denver, why would you put up with this?

Better Options
#1 - Do telemedicine. You can find a full time gig and just see 6pph giving out scripts
#2 - Travel and do a sleepy FSERs and make $150/hr. Take a 8 day trip. Do 4 24s and 4 off which is close to full time AND you get 3 wks off a month. I know docs who do this.
#3 - Travel to kindda Crappy places (but doesn't seem too crappy compared to 2.8pph) and make $300/hr. I know of some. Take a 5 dy trip and do 5 12 hr shifts.

You could literally do 15, 12 hr tough shifts a month and make 325K/yr after the gov takes their 30% and State tax of 4.6%, you get to take home 200K for this torture?

 

[thegenius]

In all seriousness, Why would any EM boarded doc put themselves through this? See almost 3 sick demanding pts an hour, deal with admins/CMG protocols, keep high pt sats, deal with short staffed ERs, flipping between nights and days, weekends, holidays for a typical $150/hr?

Agree not for $150-200 / hr

Better to work somewhere seeing 3/hr and make 300/hr.....and then fly to Denver several times a year to ski or board or whatever.

Thankfully though the 3/hr they are not sick. Most people who come to the ER are not sick.

Whatever it's free market economics. It doesn't really bother me at all. I live in the Bay Area and it's crazy expensive here. I'm just glad I do well enough to seemingly afford it (although sometimes I question that too)

 

[namethatsmell]

What did you diversify yourself into?

3 different areas, but the one with the biggest opportunity cost was pain. One year fellowship was worth it but if I hadn't had this hellish sneak preview of the future of my beloved EM, along with some other experiences, I'm not sure I would have felt the pressure to take the leap to go back to training.

 

[namethatsmell]

In all seriousness, Why would any EM boarded doc put themselves through this? See almost 3 sick demanding pts an hour, deal with admins/CMG protocols, keep high pt sats, deal with short staffed ERs, flipping between nights and days, weekends, holidays for a typical $150/hr?

If you have to live in Denver, why would you put up with this?

Better Options
#1 - Do telemedicine. You can find a full time gig and not have to see 6pph giving out scripts
#2 - Travel and do a sleepy FSERs and make $150/hr. Take a 8 day trip. Do 4 24s and 4 off which is close to full time AND you get 3 wks off a month. I know docs who do this.
#3 - Travel to kindda Crappy places (but doesn't seem too crappy compared to 2.8pph) and make $300/hr. I know of some. Take a 5 dy trip and do 5 12 hr shifts.

You could literally do 15, 12 hr tough shifts a month and make 325K/yr after the gov takes their 30% and State tax of 4.6%, you get to take home 200K for this torture?

No idea.

The only guy I know who lives there and puts up with this is chained there due to his wife's family. Doesn't want to do locums because they have young kids. No way on earth I could do it, but to each their own.

The other folks I knew who lived there flew in/out to work in better markets or did locums on top of their FT job. But eventually they got tired of it and the needless expense of Denver and moved away.

 

[sloh]

3 different areas, but the one with the biggest opportunity cost was pain. One year fellowship was worth it but if I hadn't had this hellish sneak preview of the future of my beloved EM, along with some other experiences, I'm not sure I would have felt the pressure to take the leap to go back to training.

How long have you been out of fellowship and practicing pain for? What is income like?

 

[EMPertinent]

I live in Denver. I’m from Colorado. My family is here. My kids are here. I travel for work 10 days a month so that I can make a “normal” EM attending salary. However, as soon as my loans are paid off and I’ve met some other financial milestones, I’ll probably debase myself at some lame CMG-run shop in town, because I’m sick of being away from home, eating dinner alone in ****-hole chains, and sleeping in call rooms. There’s no great options for me other than trying to get out of clinical EM altogether.

 

[GeneralVeers]

I live in Denver. I’m from Colorado. My family is here. My kids are here. I travel for work 10 days a month so that I can make a “normal” EM attending salary. However, as soon as my loans are paid off and I’ve met some other financial milestones, I’ll probably debase myself at some lame CMG-run shop in town, because I’m sick of being away from home, eating dinner alone in ****-hole chains, and sleeping in call rooms. There’s no great options for me other than trying to get out of clinical EM altogether.

I did that for 5 years. If you can stick with it, and only take high-paying jobs, you can get to FIRE quickly. The end goal is to go part-time or not work at all in medicine. It's nice to have enough money to tell CMGs to shove their cr@ppy jobs.

 

[RustedFox]

I did that for 5 years. If you can stick with it, and only take high-paying jobs, you can get to FIRE quickly. The end goal is to go part-time or not work at all in medicine. It's nice to have enough money to tell CMGs to shove their cr@ppy jobs.

Welcome back, homey.

 

[Kuratz]

What’s this obsession with Denver? I lived there for 25 years and while it’s a fine city it has become California-lite. Expensive, ****ty traffic, poor physician opportunities and it’s genuinely 2 hours to the mountains. I was ecstatic to get out of there to a non-coastal “less desirable” place for residency. Unfortunately both my wife and I have family there so we will likely go back but in a vacuum I would not choose to move there. This country has plenty of other totally fine places to live. I don’t get it. The relative sacrifice to live there is huge.

 

[GeneralVeers]

Welcome back, homey.

Thanks! I had a nice vacation, feel refreshed, and ready again to do battle!

 

[skougess]

What’s this obsession with Denver? I lived there for 25 years and while it’s a fine city it has become California-lite. Expensive, ****ty traffic, poor physician opportunities and it’s genuinely 2 hours to the mountains. I was ecstatic to get out of there to a non-coastal “less desirable” place for residency. Unfortunately both my wife and I have family there so we will likely go back but in a vacuum I would not choose to move there. This country has plenty of other totally fine places to live. I don’t get it. The relative sacrifice to live there is huge.

It’s the same obsession with the other top 5 or so cities-that-are-marginally-better-than-other-cities in this country that people are willing to forego all reason to live in. You tell people you like living in South Carolina and they look at you like you’re okay with living in Mogadishu.

 

[Torsion]

It’s the same obsession with the other top 5 or so cities-that-are-marginally-better-than-other-cities in this country that people are willing to forego all reason to live in. You tell people you like living in South Carolina and they look at you like you’re okay with living in Mogadishu.

Good. Hopefully people will continue to have that attitude. It means more future job opportunities for us southerners and midwesterners. 20-30 years ago it was probably true that only the big "desirable" cities had great food, nightlife and other cultural amenities that young, educated people would enjoy. That is plainly no the case anymore and hasn't been for a while.

 

[namethatsmell]

How long have you been out of fellowship and practicing pain for? What is income like?

Broadly speaking, think EM pay on one end with the potential for surgical sub-specialist pay at the other.

 

[TheComebacKid]

What’s this obsession with Denver? I lived there for 25 years and while it’s a fine city it has become California-lite. Expensive, ****ty traffic, poor physician opportunities and it’s genuinely 2 hours to the mountains. I was ecstatic to get out of there to a non-coastal “less desirable” place for residency. Unfortunately both my wife and I have family there so we will likely go back but in a vacuum I would not choose to move there. This country has plenty of other totally fine places to live. I don’t get it. The relative sacrifice to live there is huge.

I find it to be a fairly attractive city with lots of sunny skies and decent weather. 2 hours to the mountains may sound like a lot, but for most of the country, 2 hours to that kind of outdoor environment is almost unheard of. For a city with that much to offer in terms of food, night life, the arts etc. to be so close to the mountains is pretty awesome.

Not worth the 120/hr that USACS will pay you to work there IMO, but for some people, especially in our specialty, quality of life outside of work is important.

I agree that you can still have a great quality of life in other, more affordable cities that pay better, but if the mountains are your thing, Denver/SLC are pretty unique places.

My biggest knock on Denver is I have absolutely no idea why the airport is literally in the middle of nowhere.

 

[EctopicFetus]

So there are still people in Denver pulling in 300/hr as part of a SDG?

Are there SDGs in Denver? Understand working for a CMG your salary is based on nothing more than supply demand. When you are in an SDG your pay is based on how hard you want to work, payer mix and group contracts.

 

[TheComebacKid]

Are there SDGs in Denver? Understand working for a CMG your salary is based on nothing more than supply demand. When you are in an SDG your pay is based on how hard you want to work, payer mix and group contracts.

I have no idea if there are any SDGs.

I was just wondering if there were people who got into the area during the glory days of EM, found some cush group (that will never hire ever again), and are sitting on top of the world enjoying the view watching all the peasants picking apart each other for a 120/hr USACS gig.

More than likely I figure nobody is immune from the CMG vultures.

I get the sense there are some SDGs in the country, albeit very few, that haven't hired in awhile, have protected their core group of people and maintained decent pay. There were a couple of groups I looked at last year that seemed like dream jobs, but literally had zero turnover because they were so good.

 

[turkeyjerky]

Are there SDGs in Denver? Understand working for a CMG your salary is based on nothing more than supply demand. When you are in an SDG your pay is based on how hard you want to work, payer mix and group contracts.

Carepoint claims to offer partnership, but I don't how democratic a group can be with several hundred docs staffing hospitals in multiple states (many of which are HCA). Could always ask White Coast Investor...

I think there are one or two actual SDGs in the metro area. One posted on FB a few weeks ago (although they got shat on for the poor partnership-tract pay)

 

[alpinism]

Brighton Community Physicians covers a small community hospital and freestanding about 20 min north of downtown.

They had an opening recently but were advertising something like 120/hr for new partnership track physicians.

 

[skougess]

Brighton Community Physicians covers a small community hospital and freestanding about 20 min north of downtown.

They had an opening recently but were advertising something like 120/hr for new partnership track physicians.

So basically if you want to practice emergency medicine in Denver there is zero point in going to medical school. Just become a PA.

 

[miacomet]

I find it to be a fairly attractive city with lots of sunny skies and decent weather. 2 hours to the mountains may sound like a lot, but for most of the country, 2 hours to that kind of outdoor environment is almost unheard of. For a city with that much to offer in terms of food, night life, the arts etc. to be so close to the mountains is pretty awesome.

Not worth the 120/hr that USACS will pay you to work there IMO, but for some people, especially in our specialty, quality of life outside of work is important.

I agree that you can still have a great quality of life in other, more affordable cities that pay better, but if the mountains are your thing, Denver/SLC are pretty unique places.

My biggest knock on Denver is I have absolutely no idea why the airport is literally in the middle of nowhere.

Denver is not near the mountains, particularly.
Salt Lake is, but your lungs will suffer year round now.
I think California is actually a better deal these days. Higher pay, can live on the smog-free coast, better unis, better schools, fresher food.

 

[Fox800]

Agreed. Just look at Texas. Once the shining star of EM and high wages. Now every single SDG has evaporated/folded, the boomers sold out for hay.

Dallas-Fort Worth, Austin, Houston, San Antonio, and El Paso are overrun with USACS, TEAMHealth, Envision, and Schumacher.

There are a few weird private (but NOT democratic) operations around, but they are not SDGs, at all.

The one decent sized hospital-based operation sucks, and they don't even staff all of their own hospitals. Some are contracted to outside groups (including CMGs)...bizarre.

What do you mean ‘looks like’? They HAVE won. The job market has been cornered.

 

[Fox800]

I did that for 5 years. If you can stick with it, and only take high-paying jobs, you can get to FIRE quickly. The end goal is to go part-time or not work at all in medicine. It's nice to have enough money to tell CMGs to shove their cr@ppy jobs.

The problem is the high-paying travel jobs have evaporated. The locums market is paying the same crap that full-time local positions pay: $180-250 per hour. The $300+/hr with paid travel gigs are gone.

Oh, and you don't get any retirement match or insurance, no benefits, and have to sleep in a hotel 1/3 the month. I did this last year and the pay was barely worth it, spending 14 days a month in an airport or hotel dealing with COVID in the Midwest was not. Some of these idiot firms don't even offer to pay travel any more, I had one recruiter even list that as a benefit (paying my own travel and deducing it as a business expense).