Future EM salary?

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funnybanana

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Just wanted to see what others were thinking. It's not secret EM docs are paid very well. And for "only" 3 years of training, I think it's one of the best paid in all of medicine. But what's the outlook for the next 5-10 years? Should we see EM salaries rise, or will we see a decline?
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funnybanana said:
Just wanted to see what others were thinking. It's not secret EM docs are paid very well. And for "only" 3 years of training, I think it's one of the best paid in all of medicine. But what's the outlook for the next 5-10 years? Should we see EM salaries rise, or will we see a decline?
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No one knows. Likely downward, but how rapidly depends on political and economic factors we can't really predict.
 
funnybanana said:
Just wanted to see what others were thinking. It's not secret EM docs are paid very well. And for "only" 3 years of training, I think it's one of the best paid in all of medicine. But what's the outlook for the next 5-10 years? Should we see EM salaries rise, or will we see a decline?
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On one hand as pressure mounts to pass some form of “Medicare for all” all physicians could see a drop in salaries.

On the other hand the population of the US is getting sicker and old, fast. This will increase demand, which could put upward pressure on salaries.

And the big unknown - proliferation of mid-levels who are much cheaper to train but provide inferior care. Will Americans tolerate that? Will they care? Do they even know that the person in the white coat with 15 letters after their name isn’t an MD?
 
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I believe the hourly rate will continue to decrease, unfortunately...
...Either via direct reduction as supply continues to increase or via salary stagnation with a reduction when considering inflation.

Looking at job postings over the past several years, hourly rates have not been increasing... $170-220 per hour seeing 2.3 PPH is being painted as a great deal. Read this forum 5 years ago... people were talking about how common $230-280 was to find.

Since the income in EM is so easy to scale, I doubt there will be major drops depicted in the salary surveys anytime soon as the average doc will just work more to maintain their income expectations.
 
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It will decline if docs are stupid enough to work for less than $200 an hour. As RF wisely notes, below a certain dollar amount it's just not worth it. Better to do nonclinical, urgent care, or nonmedical work.
 
miacomet said:
It will decline if docs are stupid enough to work for less than $200 an hour. As RF wisely notes, below a certain dollar amount it's just not worth it. Better to do nonclinical, urgent care, or nonmedical work.
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Exactly. Anyone who takes those $160/hr USACS jobs is an idiot regardless of their "benefits" or promises. We need to hold firm and only work jobs that will pay decently.
 
The problem is these low-ball jobs are the only jobs we're going to have. The last thing thing I want to do is work for a CMG for <200/hr, but i have a family and loans. When I graduate if nothing is left, there's nothing else I can do.

-Massive residency expansion flooding the market. We can only work in EDs for the mort part. What are they thinking? I already know of several more opening within the next 1-2 years.

-Medicare for all will eventually pass.

-Constant direct attacks under the guise of Surprise Billing.

-CMGs hiring as many midlevels as possible.

Etc.

The only way is downward.
 
Rekt said:
The problem is these low-ball jobs are the only jobs we're going to have. The last thing thing I want to do is work for a CMG for <200/hr, but i have a family and loans. When I graduate if nothing is left, there's nothing else I can do.

-Massive residency expansion flooding the market. We can only work in EDs for the mort part. What are they thinking? I already know of several more opening within the next 1-2 years.

-Medicare for all will eventually pass.

-Constant direct attacks under the guise of Surprise Billing.

-CMGs hiring as many midlevels as possible.

Etc.

The only way is downward.
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And...this is why EM is a mess.
Don't take out too many loans. Don't have family, of any kind, until you can afford it. Don't go into a field that is fast becoming saturated. Consider doing a fellowship. Think outside the box. You having loans and a family does not make EM worth it at $160 an hour. There are still better options after EM residency.
IF you truly think the only thing you can do is work in the ER, then the issue is you!
 
I like EM enough that I'll still do it at $160/hr at a low volume facility that sees 1 pph. Plenty of those around
 
GeneralVeers said:
Exactly. Anyone who takes those $160/hr USACS jobs is an idiot regardless of their "benefits" or promises. We need to hold firm and only work jobs that will pay decently.
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Yet, states like CO are full of "idiots" working for that kind of money. I honestly don't get it. Don't get me wrong, I like CO, but damn...not that much. We need an EM union to negotiate salaries. That would be a riot. Then again, a nationwide EM "strike" wouldn't be the best PR.
 
The residency proliferation is one of the biggest issues. Supply is going to keep going higher and more and more people will end up working for less. 4-5 years ago edphysician.com used to have 8-9 pages of job postings in Texas, today we're down to 4 pages of postings.

Medicare for all may not pass today, but it will sooner or later in a decade or so. That will be a huge hit. If you see the debates, elizabeth warren is such a better speaker than the others and is gaining a lot of traction. Her very very liberal plans scare me. Massive massive pay cuts and tax increases if those plans got introduced. It's scary, and i say that as someone who has voted Democrat last 3 elections.

Look at derm and urology, the number of residency spots is so tightly controlled. That's where we should be. EM has increased spots at 15-20 percent annually.

I wish i knew more 4-5 years ago when i decided. I probably would have given anesthesia a much stronger consideration. Or gone into urology or gunned for derm. I had the scores for derm -_- just never considered it and didn't get any research in the field.
 
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petegriffin said:
No prob. I moonlit at an IHS ER facility, 1 pph, last year for $130/hr. Chill gig, low acuity, great malpractice coverage.
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And this is why salaries will keep falling. Someone will always be willing to take a lower salary with increasing supply.

The only place where I'm willing to take 130/hr sees 3500 a year, so about 10/day roughly. I always sleep 6-8 hours there.

One of my side gigs with 1.1 patients per hour, pays 170/hr. I took that happily as a pgy3 moonlighting. Now i don't do a shift there without a $500 bonus per shift ($210/hr). When the cmg is desperate, they will pay. The ones amongst us that settle for less will bring down wages for everyone.
 
cyanide12345678 said:
The residency proliferation is one of the biggest issues. Supply is going to keep going higher and more and more people will end up working for less. 4-5 years ago edphysician.com used to have 8-9 pages of job postings in Texas, today we're down to 4 pages of postings.

Medicare for all may not pass today, but it will sooner or later in a decade or so. That will be a huge hit. If you see the debates, elizabeth warren is such a better speaker than the others and is gaining a lot of traction. Her very very liberal plans scare me. Massive massive pay cuts and tax increases if those plans got introduced. It's scary, and i say that as someone who has voted Democrat last 3 elections.

Look at derm and urology, the number of residency spots is so tightly controlled. That's where we should be. EM has increased spots at 15-20 percent annually.

I wish i knew more 4-5 years ago when i decided. I probably would have given anesthesia a much stronger consideration. Or gone into urology or gunned for derm. I had the scores for derm -_- just never considered it and didn't get any research in the field.
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The sky has been falling for like 6 years on this forum and wages have not decreased.

I agree there are concerns though, as discussed above.

Anesthesia? You're kidding right? They are at nuclear war with the CRNAs right now, and they're losing.

Derm is being taken over by private equity just like EM.

Urology consistently reports the one of the highest burnout rates. Their compensation has recently been slashed.

EM pays extremely well on an hourly basis. I agree that I am not extremely motivated to work in an ED for less than $200/hr. It's hard work.

Warren would be a disaster, but I don't think a Democrat is winning in 2020.

Work, save, don't spend on stupid things, pay off your loans, if you choose to marry then marry someone who makes a decent wage as well.
 
Groove said:
Yet, states like CO are full of "idiots" working for that kind of money. I honestly don't get it. Don't get me wrong, I like CO, but damn...not that much. We need an EM union to negotiate salaries. That would be a riot. Then again, a nationwide EM "strike" wouldn't be the best PR.
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For some reason, I think there is a law that prevents this. Maybe it's part of the Sherman or Clayton Act? Can't remember, but I remember it being discussed once at a conference.
 
southerndoc said:
For some reason, I think there is a law that prevents this. Maybe it's part of the Sherman or Clayton Act? Can't remember, but I remember it being discussed once at a conference.
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I don't think there is a law preventing it, my understanding is that it's been seen as an ethical issue for emergency physicians to strike given the risk to the community as a result.
 
Who doesn't hire new grads? Slower and inexperienced, sure. But young, energetic, and more easily molded/guided.
sylvanthus said:
The problem also is that democratic groups are not exactly jumping to hire new grads, so alot of new grads find they don't really have a choice.
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The Knife & Gun Club said:
proliferation of mid-levels who are much cheaper to train but provide inferior care. Will Americans tolerate that? Will they care? Do they even know that the person in the white coat with 15 letters after their name isn’t an MD?
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hospitals will care when they realize the midlevels are discharging/admitting patients much slower than the docs who know wtf they're doing. The mid-level threat is so blown up it's crazy. I can see why it might be more prevalent in primary care, but in the ER, where working fast is important, they can't keep up. Even in primary care, salaries have been going up, even states with NP full practice authority, the docs salaries have been steady and not decreasing. Plus, as far as I see it, the more docs residencies churn out, the better the lobby is against NP's. yes, it might be more competition among doctors for certain jobs, but if that is the price to pay to lobby against NP's then so be it.
 
sylvanthus said:
The problem also is that democratic groups are not exactly jumping to hire new grads, so alot of new grads find they don't really have a choice.
Click to expand...

Every hire we have made over the last 4 years has been a new grad. Our next hire will likely be a new grad as well when we do. I haven’t heard of that being an issue with the other small groups I know either.
 
I dont think you'll see an overall decrease in salaries, but more of a leveling out. Salaries for EM have continued to rise nationally despite the constant fear the sky was falling in the last decade. But we have seen some leveling off. Some states where pay was not great have raised, and some states where pay was high have been more stagnant. High paying sdg jobs are going away as hospitals contract with CMGs, but CMG pay and the salaries of those of us that are hospital employees have risen.

Overall, when I was looking at a hospital employee jobs a decade ago in my area, salaries were in the 220-250k range. They are now in the 320-350k range. There has been a considerable and steady increase.

Will you make 500k working for an sdg in 15 years? Probably not. But I also dont believe for a second that we’ll all be slaving away for salaries in the low 200s anytime either unless there is some fundamental life altering shift in the payer model at the hands of the govt that really screws physicians in all fields over.
 
GonnaBeADoc2222 said:
The sky has been falling for like 6 years on this forum and wages have not decreased...
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I agree with Cyanide in thinking that residency expansion is the biggest issue (Besides CMG/PE obviously). It's going to take a couple more years before we fully see the ramifications of expansion. The last cycle or before that, EM was the second largest expander of residencies by a long shot. Like 15% growth. It was more than internal medicine I believe even. Each of these places are pumping out a minimum of 6 grads, but I'd bet the average is at least 8-10. I'd also argue that EM is the youngest physician workforce.

2018-2019: 11 new EM programs
2017-2018: 8 new EM programs
2016-2017: 11 new EM programs
2015-2016: 4 new EM programs
etc.

ACGME - Accreditation Data System (ADS)

apps.acgme.org apps.acgme.org

These numbers do not include the programs that were converted from AOA to ACGME. So these are purely new programs. Not to mention how many docs I see posting in various places talking about how they have a residency coming soon like it's a good thing.
 
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petegriffin said:
No prob. I moonlit at an IHS ER facility, 1 pph, last year for $130/hr. Chill gig, low acuity, great malpractice coverage.
Click to expand...

Nurses are getting paid $150 an hour in SF. They can and will pay you more.
Ask for more.
I routinely get offers for low-volume IHS facilities for $180-$210 an hour.

If I'm getting paid less than $200 and certainly less than $150, nights/weekends/holidays won't be worth it to me, and I'm off to pasture in palliative, occ med, utilization review, UC, whatever. It's not worth the liability and the stress. FWIW, I see 1-1.5 pts an hour and get paid decently.

Government-run health systems in Canada and Australia pay EM docs as well, or better, than here. IHS and VA pay over $180 per hour if you ask. It's PE and residency expansion that are the real threats.

Docs, please know your value and realize you DO have other skills that are marketable, certainly for $150 an hour. I REALLY wish residencies didn't have their heads in the clouds. They just don't get it. I had some rotating residents from a top program recently, and they said their director pushed and they ALWAYS got the jobs they wanted. Unlikely. My job doesn't care who you are or who your director was, and we rarely hire new grads. PDs need to get a clue and learn how to really guide their residents.
 
Balance billing, Medicare for all, midlevel encroachment, EM residency expansion, CMGs taking over the majority of the market, public/political rhetoric about docs getting paid too much, insurance companies and their lobbying power, .....

Yeah. Looks like the baby boomers lucked out, made their money and left the new generation to clean up the mess. People have been saying the salaries have been stagnant or decreasing for the past couple of years and it looks like IMO the trend will continue unless we as physicians do something about it. A union would help, but also more docs running the day to day operations instead of online school MBAs. My generation has to be proactive to protect our field. We need more business and politically oriented docs unfortunately to combat these and other issues but at the end of the day many docs do not want to be the "bad guy" or want to deal with it.
I am down to be that bad guy. I bring up these issues with my medical school peers and the majority are oblivious to what is going on and feel like a physician should not be involved in the business or politcal aspect of healthcare yet their okay with these clowns who have no experience in a medical setting dictate every little aspect of our day to day job. Blows my mind.
 
miacomet said:
Nurses are getting paid $150 an hour in SF. They can and will pay you more.
Ask for more.
I routinely get offers for low-volume IHS facilities for $180-$210 an hour.

If I'm getting paid less than $200 and certainly less than $150, nights/weekends/holidays won't be worth it to me, and I'm off to pasture in palliative, occ med, utilization review, UC, whatever. It's not worth the liability and the stress. FWIW, I see 1-1.5 pts an hour and get paid decently.

Government-run health systems in Canada and Australia pay EM docs as well, or better, than here. IHS and VA pay over $180 per hour if you ask. It's PE and residency expansion that are the real threats.

Docs, please know your value and realize you DO have other skills that are marketable, certainly for $150 an hour. I REALLY wish residencies didn't have their heads in the clouds. They just don't get it. I had some rotating residents from a top program recently, and they said their director pushed and they ALWAYS got the jobs they wanted. Unlikely. My job doesn't care who you are or who your director was, and we rarely hire new grads. PDs need to get a clue and learn how to really guide their residents.
Click to expand...
You keep quoting these $150/hr RN salaries but I just don't believe it
 
Rekt said:
I agree with Cyanide in thinking that residency expansion is the biggest issue (Besides CMG/PE obviously). It's going to take a couple more years before we fully see the ramifications of expansion. The last cycle or before that, EM was the second largest expander of residencies by a long shot. Like 15% growth. It was more than internal medicine I believe even. Each of these places are pumping out a minimum of 6 grads, but I'd bet the average is at least 8-10. I'd also argue that EM is the youngest physician workforce.

2018-2019: 11 new EM programs
2017-2018: 8 new EM programs
2016-2017: 11 new EM programs
2015-2016: 4 new EM programs
etc.

ACGME - Accreditation Data System (ADS)

apps.acgme.org apps.acgme.org

These numbers do not include the programs that were converted from AOA to ACGME. So these are purely new programs. Not to mention how many docs I see posting in various places talking about how they have a residency coming soon like it's a good thing.
Click to expand...

I agree. Check out the post from the Rad Onc forums.

126230 said:
www.nrmp.org

Match Data

Core to the NRMP’s mission is the development and distribution of data reports and publications that inform national conversations about the transition to residency and advance understanding of the…
www.nrmp.org www.nrmp.org

Residency expansion over the years

Rad Onc:
1995: 137 total spots (combined PGY-1/2, excluding "R" positions for consistency)
2000: 96
2005: 137
2010: 157
2015: 193
2018: 193

Dermatology:
1995: 18 total spots (combined PGY 1 and 2 and excluding "R" positions). Most spots were probably in a different match system.
2000: 251
2005: 316
2010: 360
2015: 407
2018: 437

Diagnostic Radiology/Integrated Interventional Radiology Residency:
1995: 1028
2000: 841
2005: 1018
2010: 1090
2015: 1132
2018: 1202 (combo of PGY1 IR and DR spots and PGY 2 IR and DR spots)

Emergency Medicine:
1995: 913
2000: 1064
2005: 1332
2010: 1575
2015: 1821
2018: 2278
Click to expand...
 
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GonnaBeADoc2222 said:
You keep quoting these $150/hr RN salaries but I just don't believe it
Click to expand...

You don't have to, but it's true. Starting salary for RNs in the Bay Area is 120k a year. Someone posted a link to nursing salaries in NoCal, and more than a few were earning in the mid six figures as experienced bedside/OR nurses.

We have a lot to learn from how well RNs advocate for themselves.
 
qwerty89 said:
I agree. Check out the post from the Rad Onc forums.
Click to expand...

I was looking for the raw spot data but couldn't find it. Yikes. I believe the most recent spot number was very close to 2500 as well.
 
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cyanide12345678 said:
The residency proliferation is one of the biggest issues. Supply is going to keep going higher and more and more people will end up working for less. 4-5 years ago edphysician.com used to have 8-9 pages of job postings in Texas, today we're down to 4 pages of postings.

Medicare for all may not pass today, but it will sooner or later in a decade or so. That will be a huge hit. If you see the debates, elizabeth warren is such a better speaker than the others and is gaining a lot of traction. Her very very liberal plans scare me. Massive massive pay cuts and tax increases if those plans got introduced. It's scary, and i say that as someone who has voted Democrat last 3 elections.

Look at derm and urology, the number of residency spots is so tightly controlled. That's where we should be. EM has increased spots at 15-20 percent annually.

I wish i knew more 4-5 years ago when i decided. I probably would have given anesthesia a much stronger consideration. Or gone into urology or gunned for derm. I had the scores for derm -_- just never considered it and didn't get any research in the field.
Click to expand...

My hope is that even with proliferation of BCEM, it will push out the non EM boarded guys first (FM/IM), etc.. I mean, why wouldn't it? It seems like hospitals would much prefer to have bylaws dictating only BCEM docs in the ED to help standardize (and hopefully optimize) care. That means that more and more FM/IM guys would get pushed to the outskirts or to lesser paying jobs that BCEM docs traditionally wouldn't consider. Until now, I haven't really noticed much of a pay discrepancy among non-EM boarded docs with experience vs BCEM docs but perhaps with the market being flooded, it will produce a higher pay discrepancy in the future.

I'm in a 60K ED and out of 11 docs, 4 of them are non-EM. Traditionally it's been an even higher number. This is probably the most EM boarded docs we've had in awhile.
 
funnybanana said:
Just wanted to see what others were thinking. It's not secret EM docs are paid very well. And for "only" 3 years of training, I think it's one of the best paid in all of medicine. But what's the outlook for the next 5-10 years? Should we see EM salaries rise, or will we see a decline?
Click to expand...

Isn't this question asked weekly on this forum? There has to be 10 posts on this subject over the past 3 months.
 
Groove said:
Yet, states like CO are full of "idiots" working for that kind of money. I honestly don't get it. Don't get me wrong, I like CO, but damn...not that much. We need an EM union to negotiate salaries. That would be a riot. Then again, a nationwide EM "strike" wouldn't be the best PR.
Click to expand...

People generally want to live in large metro areas and their surrounding suburbs. They whine and moan when salaries go down but at the end of the day when people are faced with the decision to either move or stay and accept less money most people tend to stay.

Same thing with job opportunities. In radiology when the market really tanked some were willing to do second fellowships (guaranteed employment for a year and adding something to your skillset) rather than move and take an attending job for far more $$$.

That's why you can't look at rural ERs and say "Look they still cant find full time board certified ED docs. The market can't be that bad!" It can. People will stay in saturated metros and just work more.

Same thing goes on in pharmacy. Their job market sucks (they literally have a job market sub forum now) and yet people will still work part-time for 40-50 an hr hoping to get a local full time gig down the line instead of moving.
 
IME rural hospitals pay less and will staff with any warm body, despite the unpopularity of working in the middle of nowhere.
 
I agree we are opening up too many residencies, but what can we do about it? Is it ABEM or ACGME that is the gate keeper for blessing new programs? Do we have any influence over those organizations?
 
Groove said:
I'm in a 60K ED and out of 11 docs, 4 of them are non-EM. Traditionally it's been an even higher number. This is probably the most EM boarded docs we've had in awhile.
Click to expand...

Out of the 8-9 regular docs in our group, two are non EM-boarded.

One is like, 63 and is a good doc in general. I would let him take care of me or my wife.

The other is 40 and is FM boarded. He comes in two flavors: He sees more patients/hour than any of us (and is generally a good doc), but makes some realllly questionable decisions from time to time. He will also stick a needle in anything (I swear the SOB does LPs or trigger-point injections for fun on anyone who will consent), and we had to have a group talk with him about doing bedside elective paracentesis-es because anyone who wanted their belly "conveniently" tapped quickly learned to show up and ask for Dr. Pokey McPokersen.

We have one PRN night-ranger who is 82 years old. 82!
He's sharp as a tack, and looks better than my dad, who is 66.
 
On the flip side, in my town there are now 4 hospitals (and a few freestandings).
2 of those hospitals require ABEM. 2 don't. The town graduates 10 residents a year, and now they all leave town because there are no spots. The two non ABME requiring hospitals (HCA) don't fire anybody to hire the new EM grads. It's pretty terrible.
 
suckstobeme said:
I agree we are opening up too many residencies, but what can we do about it? Is it ABEM or ACGME that is the gate keeper for blessing new programs? Do we have any influence over those organizations?
Click to expand...

ACGME is somewhat of a gate keeper, but only in the aspect of accreditation. Whoever wants a residency they come in determine if the meet the requirements, but they do not care about if the graduates have jobs or anything like that. They don't determine actual need.

ABEM, I'm not sure. I've never heard of them having a role in it. As far as I know they just deal with the board certification aspect.

ACEP is too busy giving under the table hand jobs to CMGs, so they'll be the last to speak out against it.

AAEM recently made a statement about growing concern for too many residencies, but it didn't gain much traction.

It's really up to EM docs to stop wanting to open them. Unfortunately, "a passion for teaching" isn't the main driving factor for some of these places...
 
Backpack234 said:
Salaries will be fine. Most kids nowadays just want to be youtubers and twitch streamers anyway. Even docs and lawyers are jumping on this bandwagon now. It’ll even out
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If only the US wasn't 4.5% of the world's population. They're making just as many new medical schools in other places as they are here.
Supply will always be there. Just like the investment banking boom. Look at the archives of SDN to see all the doom and gloom that was being discussed then.
 
Future EM? said:
Pretty variable... the beauty of ER is that you work as much or as little as you want. From talking to attendings, it seems like most work 12-15 shifts a month, 8-12 hr shifts. Most get paid hourly, pay varies widely depending on location, group practice etc. Generally, the coasts pay less, midwest and south pay more. You can generally expect to make at least $100/hr, i've heard from $75-80 in some higher supplied areas to $150+ in places like Texas.

In terms of academic EM, this link may be helpful: http://saem.org/publicat/tabofcon.htm
Click to expand...

This is a quote from 2003 in EM archives (Adjusted for inflation, $100.00 in 2003 is equal to $138.88 in 2019, $150.00 in 2003 is equal to $208.32 in 2019.)

It seems like salaries have kept up with inflation and far surpassed it overtime.
 
petegriffin said:
I like EM enough that I'll still do it at $160/hr at a low volume facility that sees 1 pph. Plenty of those around
Click to expand...

The problem is that those facilities will only offer you $100-$120 an hour at that point.
 
Rekt said:
ACEP is too busy giving under the table hand jobs to CMGs, so they'll be the last to speak out against it.
Click to expand...

True. How many of you have allowed your ACEP memberships to lapse? Being really blunt, if you don't do that, you're part of the problem.

AAEM recently made a statement about growing concern for too many residencies, but it didn't gain much traction.
Click to expand...

That's on us. We choose who speaks for us.

Unfortunately, "a passion for teaching" isn't the main driving factor
Click to expand...

True.[/QUOTE]
 
I let ACEP lapse and give what it would have cost to the AAEM PAC.
Old_Mil said:
True. How many of you have allowed your ACEP memberships to lapse? Being really blunt, if you don't do that, you're part of the problem.



That's on us. We choose who speaks for us.



True.
Click to expand...
[/QUOTE]
 
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