ER Physicians

[teapot16]

Hey, I was wondering if anyone can tell me what the lifestyle of ER doctors are (compensation, hours, competitiveness in terms of residency, etc..) and what fellowships are available. Thanks.

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[Firebird]

Hi! Welcome to SDN! Since you haven't been here long, let me make mention of something. Before you ask a generalized question, you might try a forum search for your topic. A search for "EM", "Emergency Medicine", etc. might yield some good results.

But I'll go ahead and tackle your question anyway.

I'm not even a med student, but I've been around SDN for a while, so I think I can answer your question decently well.

Lifestyle for EM is top notch...probably in the top five lifestyle specialties. This stems from the fact that your weekly hours working can be as low as 36, which is four less hours than a full-time job. But I suspect that is pretty low for an EM physician.

Also, you're never really on call. EM is 99% shift work, so you should be able to schedule yourself with some freedom...and again, no call.

An interesting note about EM schedules...sometimes ER docs will work every day for 12 hours for two weeks straight. Then they'll have two weeks where they don't work at all.

Compensation is fairly high, with a starting salary of around 75-90 dollars per hour (I think). And then if you moonlight, you can reach 125 per hour. Which, goes without saying, is very good.

With that said, it's only natural that EM residencies will be very competitive. Great lifestyle, high salary, excellent benefits (the hospital pays for your malpractice insurance), and you don't have to run an office. All in all, EM is probably also in the top five competitive specialties.

 

[godfather]

ER has some good and some very bad aspects to it and i'll list them.
Good
1 Starting pay is excellant about a 100 dollars/hr
2 get lots of days off, typically work about 18
days/month
3 lots of residencies and number of spots in each residency
4 Field has been glorified by the tv show
5 plenty of jobs
6 acute care
7 you deal with all patient types and in theory any type of medical emergency
8 don't deal with insurance bull****
9 your the first to treat and thus your also the first to diagnose
10 chics will dig you(thanks again to the tv show)
11 only a three year residency
12 don't really take work home with you
Bad
1 your pay peaks very early and er physicians rarly make mor than 120/hr(about 200,000 if you work humanly hours)
2 When your working your working hard and there are no breaks to catch a breather Ie there is always another patient to see.(easy to do in 20's and 30's hard to do in 50's)
3 shift work means scedule at times can be inflexible
4 although glorified by tv show in some physician circles viewed little more than triage nurses.(ie tv show is nothing like reality)
5 lots of spots but competition for those spots has increased tremendously over last 8 years.(mostly thanks to the tv show)
6 gets very redundant, sometimes it seems like everything falls into one of these 4 categories, headache, backache, stomachache, or cold
7 in ers in which surgery alternates or runs traumas the er guys get virtually no respect
8 if there's ever a group of people that can be replaced by pa's the er guys are the ones
9 hi hi hi burnout rate is well documented
10 at times you are dealing with the scum of the earth.(not to be cruel but i did my er rotation in a big city and there are some evil people there)
11 pay peaks at180- to 200k
12 not your own boss ie hospitol owns you, thus when times are tough in theory hospitol could get rid of you

 

[sig]

er..... some people say that they are just glorified triage nurses...and yes, some are, the ones who don't care and just want their days off.
the others though, the ones who like thier job, don't look at it like that, they look at it as fun.
the ups are that the scheduling is good, if you can handle shift work... usually 12 hr shifts, some overnight shifts, but it is compensated for with a plethera of days off.
the atmosphere, depends where you work, can be fun.. its fast paced, usually not bored. and usually no pager. when your done with your shift, your done. you go home.. no post call, etc...
scott

 

[tBw]

So this is probably just my ignorance godfather - but what do EM physicians do after they burn out if it is a common occurence? Practice as non-board certified family practioners? What are their options?

thanks

onwis

 

[Goofy]

Originally posted by Firebird:
•Hi! Welcome to SDN! Since you haven't been here long, let me make mention of something. Before you ask a generalized question, you might try a forum search for your topic. A search for "EM", "Emergency Medicine", etc. might yield some good results.

But I'll go ahead and tackle your question anyway.

I'm not even a med student, but I've been around SDN for a while, so I think I can answer your question decently well.

Lifestyle for EM is top notch...probably in the top five lifestyle specialties. This stems from the fact that your weekly hours working can be as low as 36, which is four less hours than a full-time job. But I suspect that is pretty low for an EM physician.

Also, you're never really on call. EM is 99% shift work, so you should be able to schedule yourself with some freedom...and again, no call.

An interesting note about EM schedules...sometimes ER docs will work every day for 12 hours for two weeks straight. Then they'll have two weeks where they don't work at all.

Compensation is fairly high, with a starting salary of around 75-90 dollars per hour (I think). And then if you moonlight, you can reach 125 per hour. Which, goes without saying, is very good.

With that said, it's only natural that EM residencies will be very competitive. Great lifestyle, high salary, excellent benefits (the hospital pays for your malpractice insurance), and you don't have to run an office. All in all, EM is probably also in the top five competitive specialties.•••

I have to say that the 'lifestyle' benefits frequently preached about ER are not necessarily what they seem. ER physicians work perhaps the most intensive shifts when they are on call. Even with a 3-4 day workweek, 8 hour shifts become 10 and 10 hour shifts become 12. When you are off, your body is so overtired that you need a day or two to recoup. With all of this jetlag recouperation, you end up with about one day of solid 'free time' during any given week.

Another significant barrier many complain about is burnout. Most ER physicians I know above the age of 40 are actively pursuing other fields of interest simply because they feel it is a young man's profession.

This leaves a significant problem. There are very few fellowship opportunities after ER further limiting what an ER physician can actually do. The best advice I have heard is to do a combined ER/Medicine residency. You get doubled boarded in medicine with just two extra years, a phenomenal deal in my opinion. This leaves you with a wealth of opportunity once you hit the inevitable burn out years.

Walk into a variety of emergency rooms to get a flavor of who is there. The attendings are mostly young, with the occasional older fellow who more or less looks out place there. The immediate payoff in ER is nice. High pay that unfortunately doesn't rise very much. It's fun for a couple of years, but once burnout hits, you might be looking for a career change.

I know several ER physicians in their late 30's to early 40's actively pursuing alternative fields of expertise. This includes business, pharmaceutical, EMS, as well as going back to do another residency several years later. If you don't mind having this as a very real and pressing possibility, than go for it. Just realize that the majority of ER attendings eventually do something other than ER full time.

It should be noted that medical students are finally realizing this. ER is a phenomenal field for those who take this into account. Unfotunately the compensation attracted a lot of applicants that did not take this into account. Applications to ER programs has slowed significantly last year following a several year frenzy. Applications this year are down further. It is still a popular field, but by no means 'very competitive.'

Good luck

 

[Voxel]

ER Fellowships as per the <a href="http://www.SAEM.org" target="_blank">www.SAEM.org</a> website:

Administration, Cardiovascular Emergencies, Clinical Forensic Medicine, Disaster Medicine, Disaster and Mass Gathering Medicine Research, EM/IM/Peds, EMS, Environmental Health, Faculty Development, Geriatric EM, Hyperbaric Medicine, International Emergency Medicine, Injury Control, Medical and Occupational Toxicology, Medical Educatio, Medical Informatics, Neurologic/Neurovascular, Other/Policy, Pediatric
Emergency Medicine, Research - Clinical Science, Sports Medicine, Toxicology, Pharmacology, Trauma/Critical Care, Ultrasound, Wilderness & EMS.

I think the main ones are in pediatrics and toxicology. You can check out how many spots/places are offered at each particular fellowship.

I agree with ER burnout. There are many ER board certified physicians who burnout in their late 40s after 10-15 years of practice. Depending on where you practice, your patient population and the variety of illnesses and trauma seen will greatly influence your work life.

What about the burnout rate for other specialties? Any other specialties that have a high burnout rate once you are board-certified?

 

[Goofy]

Originally posted by oldernotwiser:
•So this is probably just my ignorance godfather - but what do EM physicians do after they burn out if it is a common occurence? Practice as non-board certified family practioners? What are their options?

thanks

onwis•••


See my post just above this one. Many, in fact most, eventually go onto a career entirely divorced from clinical er medicine.

 

[Goofy]

Originally posted by Voxel:
•ER Fellowships as per the <a href="http://www.SAEM.org" target="_blank">www.SAEM.org</a> website:

Administration, Cardiovascular mergencies, Clinical Forensic Medicine, Disaster Medicine, Disaster and Mass Gathering Medicine Research, EM/IM/Peds, EMS, Environmental Health, Faculty Development, Geriatric EM, Hyperbaric Medicine, International Emergency Medicine, Injury Control, Medical and Occupational Toxicology, Medical Educatio, Medical Informatics, Neurologic/Neurovascular, Other/Policy, Pediatric
Emergency Medicine, Research - Clinical Science, Sports Medicine, Toxicology, Pharmacology, Trauma/Critical Care, Ultrasound, Wilderness & EMS.

I think the main ones are in pediatrics and toxicology. You can check out how many spots/places are offered at each particular fellowship.

I agree with ER burnout. There are many ER board certified physicians who burnout in their 40s after 10-15 years of practice. Depending on where you practice, your patient population and the variety of illnesses and trauma seen will greatly influence your work life.

What about the burnout rate for other specialties? Any other specialties that have a high burnout rate once you are board-certified?•••


I could easily come up with an exhaustive list for any field of medicine. Unfortunately your list says nothing about reality in fellowship opportunities for er physicians. As you say, the main one is toxicology, but many attendings will argue what doors this opens. ER medicine is largely viewed as a field with very limited fellowship opportunities.

 

[Goofy]

Originally posted by Voxel:
•ER Fellowships as per the <a href="http://www.SAEM.org" target="_blank">www.SAEM.org</a> website:


What about the burnout rate for other specialties? Any other specialties that have a high burnout rate once you are board-certified?•••


I believe burnout exists in all fields of medicine. This results from a variety of factors including compensation, workload, happiness. For whatever reason, ER phsyicians seem to complain about burnout far more often and vocally than others. At least in my experience.

I know a number of Er physicians who entered the field, attracted by the 'short' work week consisting of 3 12 hour shifts. They anticipated doing ER 'part time' using the remaining days to pursue other interests. What they are finding is that their 'other interests' include recuperating from a very demanding shift. Those that do pursue these 'other interests' seem to be giving up clinical ER medicine altogether.

A great meter to use when evaluating ER as a possibility is whether you can see yourself doing this 20 years from now. If not, perhaps it might be wise to look elsewhere. Alternatively, it might be a great fit if you don't mind shifting to a different career later on.

 

[Voxel]

One other thought. You can finish an ER residency in 3 years instead of the 4 years. There are 90 approved programs that allow one to do this. Check out <a href="http://www.saem.org" target="_blank">www.saem.org</a> under residency catalogue. The most sought after ER residencies are 4 years. These are things to ponder. Think about IM vs ER vs FP all can be done in 3 years. I agree that thinking about ER/IM 5 year programs should be a serious consideration for people.

 

[Whisker Barrel Cortex]

I agree with many of the above posts and wanted to add another reason why ER physicians may burn out. As on attending on my ER rotation told me, they practice in a "glass bowl." Since they make many critical decisions when a patient first comes to the hospital and then consult a specialist, any mistake they make is there for the world to see. Even if it wasn't really a mistake but ends up with a bad result, specialists can look back over the record and show how you missed something because hindsight is 20/20.

The best example of this happened on my ER rotation when a 66 y/o man came in with lower back pain of 1 weeks duration. I won't go into the whole clinical history, but he was very stable with good vitals and had a likely colonic obstruction on his abdominal series. He seemed very similar to the multitude of nonspecific back and abdominal pain cases that come to the ER daily. We admitted to GI and when the patient was transferred to the floor, he died of a ruptured AAA. As I looked back on all of the data after the fact, there were many little clues. However, seeing him in the ER, none of these pointed to a likely AAA. The surgeons and the GI docs considered this a missed diagnosis, even though they may have made the same assessment had they been in the ER when the patient came in.

The stress of ER is high due to this fact and probably contributes to the high burnout rate.

 

[droliver]

This must be the "jump on the pile" thread for ER snipers

A lot of negative aspects of ER have been highlighted here that are just not very clear to a lot of people when they're in med school. I think what a lot of people don't recognize is how hard it is to do ER shifts in busy ER's with a lot of potential liability present on every encounter. A lot of ER docs also work signifigantly more than 3-4 days a week to make more money. The burn out factor has previously been touched upon nicely here.

 

[Freeeedom!]

Honestly, I think most of you are terribly off base here...to the point that I doubt any of you have done an ED rotation. Godfather, you are a TOTAL goof. Pay peaks at 180-200K? Tell that to the resident I just spoke with starting at 230K. And regarding respect, when you get down to it, each and every specialty gets bad-mouthed, from IM to Ortho. PA's? Dude, I wouldn't let a PA tie my shoe, let alone treat abdominal pain in an emergent fashion. Ain't ever gonna happen dude. And guess what, there are more and more EM groups that work hospital ED's like any other practicing group does. Your comments alone testify to your complete lack of knowledge.

EM compensation ranges from geographic areas and to community vs academic institutions. Typically ranging from $110-130/hr. A typical monthly schedule for an attending is worked 15-20 days per month and anywhere from 8-12 hour shifts. (resident shifts vary from training program to program)
Unlike what someone else told you, this is purely shift work, when the resident/attending comes to relieve you, you run through your patient list and you leave...never to be on call.
With that being said, the relative "burn out" is far less frequent now vs 10 years ago when less EM physicians were trained. And I think it is can EASILY be said that EM docs are far less worked and far less burned out than ANY IM doc,OB-GYN doc or Surgeon around. These are many of the reasons why EM has grown by leaps and bounds in the past decade, and remains as one of the most competetive spots in medicine. One of the reasons I chose EM was that they were the most fun people I had worked around! I had every intention of entering Ortho Surgery, until I saw how absolutely miserable every surgical resident was. And while no resident sits and plays playstation all night, the EM residents just were more "fun" and far happier than any other resident except Psych or FP.
The <a href="http://www.saem.org" target="_blank">www.saem.org</a> website is great as well as the ACEP, EMRA, and AAEM sites for more information.

Good luck.

 

[Whisker Barrel Cortex]

I disagree that ER physicians "just check out and leave." This may be the case at some hospitals, but not all. I rotated at hospital in a city with a smaller ER which had only one attending on duty at a time and no residents. During my ED rotation there, many times the ER doc who was on duty from 7am-3pm was there well past that (up to 6 pm) doing dictations and finishing up loose ends so as not to leave these for the incoming doc. I'm sure there are many places where this is not the case (especially where there are residents).

 

[Firebird]

Originally posted by Freeeedom!:
•Honestly, I think most of you are terribly off base here...to the point that I doubt any of you have done an ED rotation. Godfather, you are a TOTAL goof. Pay peaks at 180-200K? Tell that to the resident I just spoke with starting at 230K. And regarding respect, when you get down to it, each and every specialty gets bad-mouthed, from IM to Ortho. PA's? Dude, I wouldn't let a PA tie my shoe, let alone treat abdominal pain in an emergent fashion. Ain't ever gonna happen dude. And guess what, there are more and more EM groups that work hospital ED's like any other practicing group does. Your comments alone testify to your complete lack of knowledge.
•••

Man, if you want to disagree with someone, fine. But at least show some respect for the other individual.

What is your hang up on PA's? They have far less training than MD's/DO's, but I believe they could handle "tying your shoes" or some of the other basic to intermediate medical procedures.

Besides, much of medical training is "on the job" as opposed to med school. That's why we have residencies.

 

[godfather]

freedom way off base, hardly. 230k to start maybe but where out in the boonies. In my post i said if you work humanly hours you'll peak at 200k. LOOK you can't have it every way. if you guys are bragging about what a great lifestyle er guys live than that life style comes at a cost. you make less money if you want your 12 days a month off and work 36 hours a week which is why this field is appealing in the first place right.
Now we all agree that er docs in the cities(NOT THE BOONIES) make from anywhere from 90 to 110$/hr. Let's use 100 as the pay(one because it's a nice even number two that's what er docs in large metropolisis make) then it means that in one 36 hour work week(three 12 hour shifts) you take home 3600 dollars which if you multiply by 48 weeks ( i use 48 weeks because most docs take 1 continous month off as a vacation month) then your yearly salary comes to 172k. Now if you work more than that, yeah you make more but than that defeats the whole lifestyle reasons for going into the field. And as far as your friend making 230k to start as an er doc, that's the biggest bull**** i have ever heard in my life(and that's even if he goes to the boonies). Pick up any er journal and go to the classified and you'll see that er jobs are pretty consistant(regardless of location) in starting of at 90 -100$/hr and peaking at 110-120$ an hour. As far as pa's being able to do many aspects of an ER docs job. it's quite possible. 95% of what er docs do is repetitive and redundant(ie same basic labs,xrays,and consults are oredered that any layman could do).you watch too much tv my friend, the true emergencies are always handled by the trauma surgery teams. medical emergencies in real life are usually handle by specialists who the er guys consult( now i know your going to give me this bull**** about how a good er guy doesn't need to consult anybody but in real life (not the tv show) a consultant who specializes in his field and sees that problem day in and day out is going to better serve a patient's interest than an er guy who may be very good but doesn't see that problem as much as the consultant, thus to best serve the patient and to cover your ass from liability you had better get a specialist's opinion and not try to be a superhero like they are on tv. The only real emergencies er docs take care of are metabolic disturbances (DKA) that any primary care doc could also handle. Everything else falls into 1 of 2 categories. One it isn't a true emergency(ie patient's life isn't really in jeopardy and is usually an overconcerned parent or patient or somebody without any insurance) or two is a surgical emergency for which an er doc is as good as a shrink. As already mentioned there is very little differance between FP's and ER except that FP choose to work more at the chronic end of the problem and er works at the acute end of the problem. Both are needed and serve a very important need but please don't believe what you watch on tv.(Which is one of the big reasons er is popular anyways, and if you don't believe me look at how easy it was to get into ER before the show versus after the show hit tv)

 

[godfather]

freedom way off base, hardly. 230k to start maybe but where out in the boonies. In my post i said if you work humanly hours you'll peak at 200k. LOOK you can't have it every way. if you guys are bragging about what a great lifestyle er guys live than that life style comes at a cost. you make less money if you want your 12 days a month off and work 36 hours a week which is why this field is appealing in the first place right.
Now we all agree that er docs in the cities(NOT THE BOONIES) make from anywhere from 90 to 110$/hr. Let's use 100 as the pay(one because it's a nice even number two that's what er docs in large metropolisis make) then it means that in one 36 hour work week(three 12 hour shifts) you take home 3600 dollars which if you multiply by 48 weeks ( i use 48 weeks because most docs take 1 continous month off as a vacation month) then your yearly salary comes to 172k. Now if you work more than that, yeah you make more but than that defeats the whole lifestyle reasons for going into the field. And as far as your friend making 230k to start as an er doc, that's the biggest bull**** i have ever heard in my life(and that's even if he goes to the boonies). Pick up any er journal and go to the classified and you'll see that er jobs are pretty consistant(regardless of location) in starting of at 90 -100$/hr and peaking at 110-120$ an hour. As far as pa's being able to do many aspects of an ER docs job. it's quite possible. 95% of what er docs do is repetitive and redundant(ie same basic labs,xrays,and consults are oredered that any layman could do).you watch too much tv my friend, the true emergencies are always handled by the trauma surgery teams. medical emergencies in real life are usually handle by specialists who the er guys consult( now i know your going to give me this bull**** about how a good er guy doesn't need to consult anybody but in real life (not the tv show) a consultant who specializes in his field and sees that problem day in and day out is going to better serve a patient's interest than an er guy who may be very good but doesn't see that problem as much as the consultant, thus to best serve the patient and to cover your ass from liability you had better get a specialist's opinion and not try to be a superhero like they are on tv. The only real emergencies er docs take care of are metabolic disturbances (DKA) that any primary care doc could also handle. Everything else falls into 1 of 2 categories. One it isn't a true emergency(ie patient's life isn't really in jeopardy and is usually an overconcerned parent or patient or somebody without any insurance) or two is a surgical emergency for which an er doc is as good as a shrink. As already mentioned there is very little differance between FP's and ER except that FP choose to work more at the chronic end of the problem and er works at the acute end of the problem. Both are needed and serve a very important need but please don't believe what you watch on tv.(Which is one of the big reasons er is popular anyways, and if you don't believe me look at how easy it was to get into ER before the show versus after the show hit tv)

 

[godfather]

freedom way off base, hardly. 230k to start maybe but where out in the boonies. In my post i said if you work humanly hours you'll peak at 200k. LOOK you can't have it every way. if you guys are bragging about what a great lifestyle er guys live than that life style comes at a cost. you make less money if you want your 12 days a month off and work 36 hours a week which is why this field is appealing in the first place right.
Now we all agree that er docs in the cities(NOT THE BOONIES) make from anywhere from 90 to 110$/hr. Let's use 100 as the pay(one because it's a nice even number two that's what er docs in large metropolisis make) then it means that in one 36 hour work week(three 12 hour shifts) you take home 3600 dollars which if you multiply by 48 weeks ( i use 48 weeks because most docs take 1 continous month off as a vacation month) then your yearly salary comes to 172k. Now if you work more than that, yeah you make more but than that defeats the whole lifestyle reasons for going into the field. And as far as your friend making 230k to start as an er doc, that's the biggest bull**** i have ever heard in my life(and that's even if he goes to the boonies). Pick up any er journal and go to the classified and you'll see that er jobs are pretty consistant(regardless of location) in starting of at 90 -100$/hr and peaking at 110-120$ an hour. As far as pa's being able to do many aspects of an ER docs job. it's quite possible. 95% of what er docs do is repetitive and redundant(ie same basic labs,xrays,and consults are oredered that any layman could do).you watch too much tv my friend, the true emergencies are always handled by the trauma surgery teams. medical emergencies in real life are usually handle by specialists who the er guys consult( now i know your going to give me this bull**** about how a good er guy doesn't need to consult anybody but in real life (not the tv show) a consultant who specializes in his field and sees that problem day in and day out is going to better serve a patient's interest than an er guy who may be very good but doesn't see that problem as much as the consultant, thus to best serve the patient and to cover your ass from liability you had better get a specialist's opinion and not try to be a superhero like they are on tv. The only real emergencies er docs take care of are metabolic disturbances (DKA) that any primary care doc could also handle. Everything else falls into 1 of 2 categories. One it isn't a true emergency(ie patient's life isn't really in jeopardy and is usually an overconcerned parent or patient or somebody without any insurance) or two is a surgical emergency for which an er doc is as good as a shrink. As already mentioned there is very little differance between FP's and ER except that FP choose to work more at the chronic end of the problem and er works at the acute end of the problem. Both are needed and serve a very important need but please don't believe what you watch on tv.(Which is one of the big reasons er is popular anyways, and if you don't believe me look at how easy it was to get into ER before the show versus after the show hit tv).

 

[godfather]

sorry guys when posting the key jammed on me and thus the 3 posts.

 

[A little elf]

I have to kind of stick up for FREEEDOM. I'm not exactly sure where all of you ER bashers are doing your training, or even if you've done any EM rotations, but as a MS4 who is going to be matching in EM shortly, some of the comments on this thread strike me as being funny. First of all...I also know residents who have been offered starting salaries of over 200,000 per year...and not in the "boonies". I have done rotations at major medical centers with great EM residencies, and I hardly think that FPs, PAs, or even surgeons could handle some of the conditions in the ED...I'm not sure where some of you have been watching EM being practiced (or if you even have been in an ED), but some of the comments in recent posts have been crazy. If you would have been at a medical center that wasn't stuck in 1970, you'd see how good EM docs/residents are, and how valuable they are. There's a reason why the best med students are now going into EM and not surgery...and it's not because of lifestyle. EM is a challenging, diverse field that is going to continue to gain in respect and popularity...and it's closed-minded people like some of the previous posters that are resistant to this because they are stuck in the past.

 

[Freeeedom!]

Godfather, did you ride the short bus to school? Really, were you the guy in class that was always in the back row eating glue??

It is SO obvious you haven't done an EM rotation, or if you did, it was at some rinky-dink place with 15,000 visits. I would bet you are either pre-med or a first year!
The resident making 230k is working in St.Louis you goon, and working 15, 12 hr shifts/month, one of the hospitals is St. Marys...that specific enough for you? Sound like the boonies? You know zero my friend.
Lets now look at the "journals". I have the Sept 2001 "Annals of Emergency Medicine" in my hand, and I will pick a page at random. As I have stated, pay is typically regional...and here we have on page 72A 73A, Detroit making 120/hr, Massachusetts 120/hr, Michigan 120/hr, Minnesota 125/hr, Nebraska 130/hr, New Mexico 200-260k/yr. Yeah, I would consider the "Annals" to be a good journal.
You see, a BC/BE EM doc always gets paid more than a IM guy just "working" the ED, that is the difference. My Peds/EM attending made 300k, and my attending in Las Vegas made 330k. How do I know, well, they told me...when you are friends and you enter the same field of medicine, you share info. Money certainly isn't that big of a deal, EVERY field of medicine makes enough (from FP to OB we ALL are important), but it is your other silly little claims that are absolute nonsense.
By the way, do you always compare things to TV? Before "ER" the malpractice rates for OB-GYN were lower, before "ER" surgeons made more money, before "ER" drug comapanies didn't advertise on TV, before "ER" there were far less BC EM docs, before "ER" Godfather was 12 years old...all of these things are true but have little to do with the TV show, it is called the passing of time. Look into it.

Regarding your "ER docs don't see true emergencies" comment...well, that is just *****ic. I am delighted you were able to spell DKA though.
Nice job.


Seriously, I am not trying to be mean to you, but you really should "look before you leap". You will make a good doctor some day I am sure, but you just need to experience a little more before you start saying such Sweeping Generalizations!
Good luck to you, though I won't be at Wayne State, I would love you invite you to where I match to do a EM rotation. Take it easy.

Merry Christmas

 

[Goofy]

Originally posted by Freeeedom!:
•Godfather, did you ride the short bus to school? Really, were you the guy in class that was always in the back row eating glue??

It is SO obvious you haven't done an EM rotation, or if you did, it was at some rinky-dink place with 15,000 visits. I would bet you are either pre-med or a first year!
The resident making 230k is working in St.Louis you goon, and working 15, 12 hr shifts/month, one of the hospitals is St. Marys...that specific enough for you? Sound like the boonies? You know zero my friend.
Lets now look at the "journals". I have the Sept 2001 "Annals of Emergency Medicine" in my hand, and I will pick a page at random. As I have stated, pay is typically regional...and here we have on page 72A 73A, Detroit making 120/hr, Massachusetts 120/hr, Michigan 120/hr, Minnesota 125/hr, Nebraska 130/hr, New Mexico 200-260k/yr. Yeah, I would consider the "Annals" to be a good journal.
You see, a BC/BE EM doc always gets paid more than a IM guy just "working" the ED, that is the difference. My Peds/EM attending made 300k, and my attending in Las Vegas made 330k. How do I know, well, they told me...when you are friends and you enter the same field of medicine, you share info. Money certainly isn't that big of a deal, EVERY field of medicine makes enough (from FP to OB we ALL are important), but it is your other silly little claims that are absolute nonsense.
By the way, do you always compare things to TV? Before "ER" the malpractice rates for OB-GYN were lower, before "ER" surgeons made more money, before "ER" drug comapanies didn't advertise on TV, before "ER" there were far less BC EM docs, before "ER" Godfather was 12 years old...all of these things are true but have little to do with the TV show, it is called the passing of time. Look into it.

Regarding your "ER docs don't see true emergencies" comment...well, that is just *****ic. I am delighted you were able to spell DKA though.
Nice job.


Seriously, I am not trying to be mean to you, but you really should "look before you leap". You will make a good doctor some day I am sure, but you just need to experience a little more before you start saying such Sweeping Generalizations!
Good luck to you, though I won't be at Wayne State, I would love you invite you to where I match to do a EM rotation. Take it easy.

Merry Christmas•••

While some of the responses may not have been as professional as what one might hope for, this counter is equally sophomoric.

It is fine to disagree. It is even fine to have heated exchange. But rhetoric, replete with name calling doesn't help anyone.

I disagree with much of what you have written, and will proceed to dissect it, respectfully so.

There are a few truths that need to be appreciated. ER phsyicians make very good money when they first start, better than many other specialties, especially when you consider training is usually 3 years. Another truth; ER physicians peak very close to their starting salaries. I'm not about to entertain a conversation about who makes what where, becasue obviously there is a wide range of salaries, many of which might violate the rule. But what I have stated is a general truth about ER compensation that most rational people accept. The starting salary is great, unfortunately it doesn't go much higher.

The idea that every physician 'makes enough' isn't entirely true. While physicians are well paid compared to the general population, they also spend an innoridante number of years training. Many of you will lose literally millions of dollars in opportunity cost. For those of you with some sort of business background you will understand what I mean. For the others, tuition is the smallest part of your debt although the most visible. You are also losing years and years of prime earning potential. Years that you are going into debt instead of making money. Years you cannot contribute to retirement and 401k. These lost years of early savings result in a phenomenal amount of money lost. Having said that, there are many many physicians, particularly in densely populated cities, having trouble making ends meet. Unfortunately this truth is usually pushed off while still in training. Most will do fine, but a growing and sizable physician base is looking outside of medicine to supplement income.

ER physcians certainly see true emergencies. The problem is that in most set ups, they represent a small percentage of cases. Many ER phsyicians complain that the overwhelming amount of time is spent with primary type patients who should have visited their GP instead of the ER. The other problem is that most places are set up so someone other than the ER attending runs the trauma. Some look at this as a benefit, but it limits the amount of 'true emergency' exposure and authority. ER physicians will typically run codes. But many complain that this offers little gratification as the overwhelming majority wont make it. ER does offer variety and high paced primary care that many find titillating. For those that do, more power to ya, you are very much appreciated. For others, a more specialized approach to medicine is the real jewel. That is the beauty of medicine, it has something to offer everyone.

Freeedom, your comments about salary are off the mark. Peds ER is notoriously a poor paid profession. If someone willingly gave you those numbers, I'm afraid you have been grossly misinformed. Peds ER is limited by the number of hospitals that offer this service. This requires oppressive restraints on you geographically. Additionally, the pay is miniscule. If you truly know an attending making that much, he is likely supplementing his income in another way. The peds ER attendings I know have looked into many other fields including accupuncture therapy to supplement. These guys simply don't make the money you claim, and undeservedly so.

Your comments about residents 'happiness' has some merit to it. The problem is that you are basing your entire life on how residents 'seem' over a very short and finite number of years. The problem is that you are not going to be a resident forever. The best meter is whether you love doing what you have chosen. This will give you the best chances of being happy over lifetime.

A similar scenario to consider is dermatology. EVERYONE going into the field loves it and is happy. At least in my experience. The problem is that many go into only for this reason. The result, dermatologists as a group are not a happy bunch. I know MANY who have left derm, even in middle of presitigious residencies because while it offered a great lifestyle, it didn't offer the professional gratification that said doctor had been looking for.

It cannot be 'easily said' that EM docs are far less worked. What your missing is that 3 twelve hour shifts really amount to 3 very exhaustive, non-stop, 14 hour shifts. In most hospitals, you don't have the authority to simply walk off the job once your 12 hours are up. You need to make sure you list of patients are taken care of and signed out. After these shifts, you are a beaten man. Younger residents seem to have more coping mechanisms to handle this, but the hours are much longer, and certainly more intense than you suggest.

I believe the burn-out rate has actually increased from ten years ago, as many have entered the specialty because of the short training and promise of a quick high salary. It is far more easier to burn out when entering a profession for the wrong reasons.

 

[Firebird]

Originally posted by Freeeedom!:
•Godfather, did you ride the short bus to school? Really, were you the guy in class that was always in the back row eating glue??

[middle part omitted]

Seriously, I am not trying to be mean to you, but you really should "look before you leap"... •••

???

 

[Freeeedom!]

It is called sarcasm...poking fun, without an intent to do harm.

 

[Arch Guillotti]

Godfathers claim that the only real emergencies ER docs take care of are metabolic in nature could not be further from the truth. Before medical school I worked in and around many ER's for close to ten years. I have seen thousands of patients in my time. As a paramedic I have had patients that I passed on to ER physicians (not specialists) that have had many life-threatening illnessess - not just DKA. Severe CHF'ers, status asthmaticus, hyperthermia &gt;105 degrees, status epilepticus, pulsating AAA's, tubed CVA's, massive gi hemorrhage, tricyclic overdoses, allergic rxns w/ severe airway compromise, many acute MI's, all kinds of crazy heart blocks. It is a laundry list that goes on and on and on. Every one was handled by ER docs - attendings and/or residents - of course they were passed on when they were admitted. While in my experience ER docs do not run the traumas so much as the surgeons, I have seen many an ER doc putting in central lines or intubating or even cracking a chest during a trauma. As well, I have been in on traumas where there were no surgeons present. I have also seen surgeons stand off to the side and observe while the ER docs stabilize the patient. I have had the experience of standing on the bay at several hospitals when GSW's (usually previous drive-bys) roll up without warning and I have helped to carry them in. The surgeons and anesthetists made it down about 15 minutes later. As a side point, in many rural hospitals the ER doc is all there is in the case of a major trauma until the patient can be shipped out by ground or by air.

As far as ER docs needing time to "recover" from their shifts - it doesn't take that long. Many nurses and other staff work their wheels off during the shift in a busy ED, not just the docs. Okay, so we all know that the docs make all the important decisions - but many people work physically just as hard and they work more days. I have worked 36 hour shifts a number of times with little or no rest. All it took for me was a long solid night of sleep to recover. The time to recovery, IMHO, is most closely related to health and age. I would take 3 brutal ED shifts a week over 9-5 office hours ANYTIME.

 

[Goofy]

Originally posted by Arch Guillotti:
•
As far as ER docs needing time to "recover" from their shifts - it doesn't take that long. Many nurses and other staff work their wheels off during the shift in a busy ED, not just the docs. Okay, so we all know that the docs make all the important decisions - but many people work physically just as hard and they work more days. I have worked 36 hour shifts a number of times with little or no rest. All it took for me was a long solid night of sleep to recover. The time to recovery, IMHO, is most closely related to health and age. I would take 3 brutal ED shifts a week over 9-5 office hours ANYTIME.•••


I think you are missing the point I was trying to make. The young medical student or resident largely consider the work manageable. The problem is that years from now, you will still be expected to perform on these grueling and intensive 12 hour shifts. As a resident it's even fun. As a profession, many consider it very taxing, especially as one grows old.

The fact that many others have phsyically demanding jobs is irrelevant in my opinion. There are also slaves somewhere in this world building a wall between countries for 20 hrs a day subsisting on bread and water. The fact that others may or may not suffer doesn't make my job any easier.

Further, comparing nurses, who often work part time, to the guy steering the ship, the guy who takes the blame if someone dies, the guy in charge of dozens of other personnel is a poor one. The demands of an ER physcian go well beyond the burdensome physical requirements.

 

[Freeeedom!]

Klebsiella, it would interesting to see where your experience comes from and for doubting my information...well, looks like I will have to show you up as well. Not only did I post "want-ads" from "Annals" but now you doubt what I stated about my attending. I will go through this piece by piece you won't get lost...ready...go

I have spent 2 months on Peds-EM, and yes you are limited regarding typical geography...just like ANY SUBSPECIALIST would be! Not too many Peds-ortho surgeons in the boonies are there? Ok.
This was also in St. Louis, my attending was roughly 52 years old and had done peds-EM for maybe 20 years, he currently works 18 shifts a month (I was there) each 12 hours, and makes over 300k. No, he doesn't wait tables, no he doesn't do anything else. The other Peds-EM doc that I worked with at the same institution made roughly the SAME AMOUNT and works 2 24 hour shifts----only friday to sunday. He lives in a different state and actually flies in to St. Louis on friday. You may email me if you want the Hospital, their names, and where they graduated from! I would be happy to supply you with any information you need, so you will just be quiet!

I mean really man, you just don't know what you are talking about! Too bad.

Ok, back to the other points. At the end of any shift, be it 8,9,10, or 12 hours you ALWAYS CHECK OUT. But that is one reason why the next shift guy will come in 15 minutes early...so the guy can leave. THis is how an ED works! I have worked in 6 ED's in 3 states (from ED's with 15k to 100K visits) and NO ONE WORKS 2 HOURS OVER THEIR SHIFT? Why would anyone do this?

As far as recovery...look at IM, they are working anywhere from 10-16 hour days with/without call...look at surgery, at LEAST 12 hour days, look at ALL surgical subspecialties! Look at OB-GYN, even psych can rack up some long days!

You would think someone with any clinical experience would know this. Any first year resident in EM loves doing the ED because there is NO CALL...dude that is where you rack up your hours. Get for real man. You get tired in every single profession. Wise up.

 

[Goofy]

Originally posted by Freeeedom!:
•Klebsiella, it would interesting to see where your experience comes from and for doubting my information...well, looks like I will have to show you up as well. Not only did I post "want-ads" from "Annals" but now you doubt what I stated about my attending. I will go through this piece by piece you won't get lost...ready...go

I have spent 2 months on Peds-EM, and yes you are limited regarding typical geography...just like ANY SUBSPECIALIST would be! Not too many Peds-ortho surgeons in the boonies are there? Ok.
This was also in St. Louis, my attending was roughly 52 years old and had done peds-EM for maybe 20 years, he currently works 18 shifts a month (I was there) each 12 hours, and makes over 300k. No, he doesn't wait tables, no he doesn't do anything else. The other Peds-EM doc that I worked with at the same institution made roughly the SAME AMOUNT and works 2 24 hour shifts----only friday to sunday. He lives in a different state and actually flies in to St. Louis on friday. You may email me if you want the Hospital, their names, and where they graduated from! I would be happy to supply you with any information you need, so you will just be quiet!

I mean really man, you just don't know what you are talking about! Too bad.

Ok, back to the other points. At the end of any shift, be it 8,9,10, or 12 hours you ALWAYS CHECK OUT. But that is one reason why the next shift guy will come in 15 minutes early...so the guy can leave. THis is how an ED works! I have worked in 6 ED's in 3 states (from ED's with 15k to 100K visits) and NO ONE WORKS 2 HOURS OVER THEIR SHIFT? Why would anyone do this?

As far as recovery...look at IM, they are working anywhere from 10-16 hour days with/without call...look at surgery, at LEAST 12 hour days, look at ALL surgical subspecialties! Look at OB-GYN, even psych can rack up some long days!

You would think someone with any clinical experience would know this. Any first year resident in EM loves doing the ED because there is NO CALL...dude that is where you rack up your hours. Get for real man. You get tired in every single profession. Wise up.•••


Your arguments are as hollow as your comments are offensive. I have seen you attack various members of the forum in a most undignified way. I offered you a cogent, well thought out reply. I would hope you would do the same. At the very least, your posts should reflect some element of respect for your peers, even if they disagree with you.

I will not entertain discussion with you any longer.

 

[godfather]

Freedom i'm actually getting ready to graduate from med school and beleive me i'm hardly trying to insult people over salaries and job descriptions. if i had it my way everybody in the world would make alot of money and be extremely happy. As far as where did i do my er rotation, i did it in downtown detroit, believe me the er here is one of the busiest in the country. the info i gave is first hand account from residents being involved in numerous trauma calls and er attendings themselves. Having given my background i would be really curious to know at what level of training your at (ie premed, 3rd year, etc) because in general 4th year med students have the best info about residencies salaries etc. Now correct me if i'm wrong but er docs get paid per hour so if your friend is making 230 to start than he's putting hours that commisurate with that 230k salary. i don't know you know your friends better than i do but i know a couple of people out here that just started and are starting at 90$ an hour. How much they make is up to them in how many hours they want to work, but believe me if they want to work 3 12 hour shifts a week they're not going to make 200k a year. Those jobs you listed at 120$ an hour i'm also familar with but they're not to start they're usually for somebody with experience. I'm not doubting that there aren't er docs around the country making 300k a year, but guess what they're were working for that salary to the tune of 300k divided by 120$/hr in terms of number of hours worked. Believe me when you do the math this comes out to more than the mythological 36 hour per week job your talking about. As far as emergencies, the true trauma cases were virtually always taken care by the surgery team at the hospitol i did my rotation. Even at a busy place like in detroit 99.5 percent of the problems the er handled could hardly be labeled as true emergencies. The .5 that are are usually taken care of by the trauma surgery team. ER docs are very sharp and if thats what your going into i wish you the best, but part of the purpose of these forums is to disseminate information about various careers to help other people out especially the junior med students. the intent never is to demean.

 

[MUN2005]

There you go teapot16, does that answer your question? Haha.

 

[MUN2005]

On a serious level though, I was wondering if anyone know how these things generally run in Canadian hospitals? As far as I know, in most hospitals, the senior EM resident runs all traumas but with a trauma surgeon either in the department or on call. Anybody?

 

[Arch Guillotti]

Klebsiella wrote,

"I have to say that the 'lifestyle' benefits frequently preached about ER are not necessarily what they seem. ER physicians work perhaps the most intensive shifts when they are on call. Even with a 3-4 day workweek, 8 hour shifts become 10 and 10 hour shifts become 12. When you are off, your body is so overtired that you need a day or two to recoup. With all of this jetlag recouperation, you end up with about one day of solid 'free time' during any given week."

----

My point is that while you may need a day or two to recoup, many people do not. Also, the comparison to nurses was to make a point, which you did not understand. After years of schooling and medical training, decision making becomes routine - even if they are truly "life and death". Just because a doc makes a bunch of decisions during a shift doesn't mean s/he will be exhausted for the next 2 days. Geez. Sure there are stressful times, but we all know that 95% of ED is routine UTI's, gonorrhea, H/A's, gomers, winos, etc. Plus in many ED's the docs rotate through to non acute areas where they see a bunch of ear infections and lacerations all day long.

Yes I know that ED docs work their asses off - most of the time. However, there are down times (the dead middle of the night when things slow down, certain holidays, etc.). I have also spent lots of time just chatting away with residents and/or attendings. So most of the time they are pretty busy - occasionally they don't do jack and sometimes they work at warp speed for an entire shift.

Arch

 

[ENTer sandman]

Hi. I'm new to posting messages but I read the threads often. I'm getting tired of listening to all of you making generalizations about every field. It doesn't matter if its IM, EM, surgery etc. It seems like everyone knows everything about every field or know someone who does. Teapot asked a group of simple questions. If you know the answer (not if you think you know) please respond based on first hand clinical experience. This does not mean that your experience is the definition of the field nor should you make such generalizations. Simply describe your own personal experience; if you aren't receiving a paycheck and don't see the paychecks of the attendings, you don't know what they earn. If you haven't worked as an attending for years, you don't know the percentage of what cases you see etc. You also don't know how people feel after they work. To make statements about this is ridiculous. Most of you are medical students and maybe do a 2-4 week ER rotation. This is not enough time to know everything about a field. Instead, talk about what you experienced. If enough people do this, I think teapot will get a better idea of what the med student er experience is like.

 

[sig]

burnout.. yes it occurs..and when it does... you can continue doing what you like, ER type stuff, but more laid back atmosphere.
you can work at an urgent care clinic or in a FP office, you ARE a board certified physician. you can work in a clinic or a fp place, doing the same thing, but at a slower pace.
i am slightly biased since i'm applying for em, if i don't get a residency spot, then i'll probably be pretty jaded..but until then. its a great deal, time off, lifestyle, intensity and you get to do every profession, rolled into one.

 

[sig]

er2b.... where are you going to match.? anyplace on the east coast?

 

[teapot16]

can we all get along, for real thanks for all the info

 

[Freeeedom!]

I am certainly not trying to hurt feelings here...I guess I play too rough for the prim and proper P.C. folks around here.

Regarding Godfather and Klebsiella, my assumption is that you haven't done an EM rotation that is why you really don't know much about the profession. Too bad, it is the most flexible, fun, and best learning environment I have been in. Regarding the wages...well we are going in circles, because you don't believe me, and there isn't alot I can do about that(other than I was just at an interview where RESIDENTS were moonlighting for $90/hr, and yes being offered over 200k in the midwest)...but like everyone, I don't enjoy being called a liar. Perhaps that is why I snapped back a bit harder than before.
Klebsiella, I am a 4th year matching in EM and other than that I have little to say to either of you two except, good luck in your training and perhaps we will meet someday.
Anyone is welcome to email me to clarify any information.

Good luck

 

[Hannibal Gabriel]

So far as wages do, I know that every graduate from the University of Kentucky's EM residency program this year signed right out of the box for $225-350.

I think if $225,000 per year was my peak, I could probably live with that. Might have to cut back on my lobster dinners, maybe three or four nights a week instead of seven, and chop a few rooms off my mansion, but I'd survive. I'd hate to meet the greedy bastards who couldn't live on $200K per year.

 

[midwest girl]

I just have to write to agree with Freeeedom
regarding salaries. I am a senior medical student from the midwest, and I have spoken with many graduating residents who have taken salary offers in the range of $215- $235K to start (and this is working about 18 9-hour shifts a month). Actually, the guy that is taking the job for $235K is only working 16 9-hour shifts a month. None of these jobs are in small cities (boonies). Most are in places like St. Louis, the Twin Cities, Indianapolis, and Louisville.

Most people around here MOONLIGHT for approx. $100/hr.

 

[rdennisjr]

I can't believe I actually agree with Freeedom on something but I'm afraid he is right in this case - the ER Residents I know tend to moonlight in the midwest (KC) for around 90-110 an hour, and the attendings I know who have finished their residencies in the last couple of years have started anywhere from 225-300k in larger cities - ie, Omaha)

 

[jjbiv]

Where are the higher paying jobs located and how many hours are these guys working? There's quite a spread between the low and high starting salary number. Are you better off in a city with competition or out a ways in the only hospital for miles? Thanks!

BTW -- I'm just curious...not even a med student...yet!

joe

 

[sig]

jjbiv.... the more higher paying er spots are where they need docs... like the middle of no where, midwest, etc..
in a big city, there are sometimes 4 hospitals serving a 20 mile radius... and there are plenty of doctors around, especially if they graduate from a residency program in the city.
you want excitement and a little lower pay,.. go to a city, you are in it for the lifestyle and money the move out west..

 

[sig]

jjbiv.... the more higher paying er spots are where they need docs... like the middle of no where, midwest, etc..
in a big city, there are sometimes 4 hospitals serving a 20 mile radius... and there are plenty of doctors around, especially if they graduate from a residency program in the city.
you want excitement and a little lower pay,.. go to a city, you are in it for the lifestyle and money the move out west..

 

[Freeeedom!]

One must admit there are many things that drive salary and need in particular areas.
The highest wages with the lowest cost of living is typically in the Great Lakes and Mid West regions. Mid sized cities in these areas see a HUGE amount of paitients in their respective ED's therefore increasing the need for docs in the ED.
With the continued push by AAEM and ACEP, all ED's love to grab and to keep board certified EM docs.
I think it can be universally agreed that the lowest wages can be found in academic settings...yet these are positions that many EM docs love (the proposition to teach is one that I would love as well).
The highest wages are where there is greatest need and adequate budgets to fill the need. Private EM groups typically pay the best, but benefits may differ.

 

[Voxel]

All this arguing over salary and how much people work. Let's do the math.

We can make some calculations based upon the going rate of pay to see what it takes to earn 300K as an ER physician. We can take $100/hr as the low end for starting hourly rate.

300K/yr / ($100/hr) = 3000 hrs/yr. 3000hrs/yr / 12 hour shifts = 250 - 12hr shifts/yr.

250/ 365days/yr = 0.6849 shifts/day. 0.6849 12hrshifts/day * 30 days/month (typical days per month) = 20.5 12 hr shifts per month. That leaves you with about 10 days off a month. About 1-2 days more days off per month than someone who works 12hrs/day M-F (this is more like 60hrs/wk not the mythical 36hrs/wk). So it's 300K and you get 1-2 days more off per month. Not a bad deal. Yes, it is stressful, physically and mentally demanding. But long hours and hard work are found in most fields that pay $300K/yr.

To make 300K at $120/hr you will need to work about 17.1 12hr shifts/per month (30 days). This means you get 13 days off per month and 4-5 more days off than M-F 12hrs/day person. If scheduled back to back that could mean 1 week on and 1 week off. That one week on would be tough though and may be tough to schedule. Anyway, you get the point. The number of days on and off, depend on how much you want to make and how much you are paid per hour.

Note these numbers do not take into account paid benefits.

Cheers.

 

[droliver]

Voxel,

don't you have to factor several other factors into your math? Depending upon their employment situation, an ER physician may have to contribute for Malpractice coverage which I assume is very expensive for the potential liability they carry. I think some ER physician groups also have financial stakes in the the efficiency/profitability of the ER they work in & can have some fluctuation of their income depending upon their collection %.

The point of this being that I don't think you can multiply (shifts) x (hr. rate) to come up with the salary. Intuitively I think you would have to work more shifts to meet those $$$$ unless you're in a free-agent strict salary arrangement with your expenses withheld up front.

 

[droliver]

Are there any recent ER grads who can answer this ? more definatively?

 

[Voxel]

Yes, I specifically did not include benefits such as vacation time, paid malpractice insurance, 401K/403B, etc. I was looking at this from the standpoint of being an employee (ER physician) of the hospital with paid benefits.

 

[DrQuinn]

This is a question for Klebiella pneumoniae or anyone else who would know...

Where did you get the information that the # of applicants to EM residencies has decreased in the past year? Was it from the NRMP? I can't say that I've compared the #s from previous years. It would be good news indeed if the # of applicants has dropped, as I will be applying next year as a DO student into an MD program...