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$$$...Help me, Rural ED Hourly Rate, what is appropriate? (ed boarded)

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thejangler2013

thejangler
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Hello Everyone

I am a 3rd EM resident in good standing who is applying to Rural Emergency Departments in the upper midwest. Time for a real job!. I am focusing on rural emergency departments on the lower side of volume range. Ex 9k-14k patients per year with mostly 12 and 24 hours shifts with small attached hospitals.

Most are critical access hospitals (not glamorous cities or towns). I have a few location/contract options with some being employed by the hospital and others by staffing agencies. The Ed's are typically staffed with a mix of EM and family physicians, although the trend seems to the places are trying to staff more towards ED physicians. Most ED directors here are EM boarded. I feel like I am getting low-balled in the 150-175$.hr range, people at my residency in another part of the country tell me not accept anything less than 200$/hr.

1. What is an acceptable hourly rate for a EM trained doc. (not including basic benefits like retirement etc,)

2. Do I "deserve" more because I am EM trained and not Family trained like the other docs at these places? (I feel like they are trying to pay me as a family med doc)

3. What would be acceptable for a sign-on bonus and loan repayment?
 

redsbear

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I think a lot depends on how hard you're going to have to work. 10-20 pt in 24 hours? The range you cite is probably appropriate. 15-25 in 12 hours? At least 200-250+ is probably more like it.

I would think you're not going to find a place with different pay scale in the same department for ABEM vs Family Med. That's a recipe for sore feelings. After all, how would you feel as the experienced FM doc sitting next to a fresh EM grad, but making 2/3 for the same work?
 
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thejangler2013

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I hear you there. Thanks for the post and the opinion. The thing is though I know the FM doc sitting next to me cant intubate (calls in a paramedic from another county for emergency airway to intubate) and last put in a central line maybe15 years ago. This is part of the reason why I want to work in places like this. Better for patients.
 
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redsbear

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I hear you there. Thanks for the post and the opinion. The thing is though I know the FM doc sitting next to me cant intubate (calls in a paramedic from another county for emergency airway to intubate) and last put in a central line maybe15 years ago. This is part of the reason why I want to work in places like this. Better for patients.

I see. The FM docs I work next to have much of my same skill set. Less the ultrasound and more esoteric procedures like PTA I&D, nerve blocks, etc... Though I have heard horror stories about the care delivered in some rural shops.

I applaud your desire to bring boarded EM care to rural communities. They deserve it!
 
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1. What is an acceptable hourly rate for a EM trained doc. (not including basic benefits like retirement etc,)
There's no such thing. There is only what is acceptable or not acceptable to you. Everyone's situation and priorities are different and every job is different too. Now, if you want to know what's common, the range you cite aren't atypical of a critical access hospital. A few years ago I looked into these kinds of jobs and interviewed at a few places. Almost took a job in rural Kentucky. Some rural (but not critical access) hospitals pay >200/hr. The job I almost took was $250/hr, single coverage, seeing 2.5 pts per hour. The critical access hospitals were all <$200/hr, many closer to $150/hr. These tended to be much lower volume though, around 1.5 pt/hr. So the rates you've been told are definitely not atypical. I am not sure if the folks you've been talking too actually know what they are talking about vis a vis how much rural medicine pays. There are a lot of myths out there perpetuated by people who have never seriously considered a really rural job.

2. Do I "deserve" more because I am EM trained and not Family trained like the other docs at these places? (I feel like they are trying to pay me as a family med doc)
That's the wrong question. The rate is what it is. Sometimes there is a little room for negotiation, but usually not much. The question should really be: can they afford an EM trained physician? Sounds like the answer may be no.

3. What would be acceptable for a sign-on bonus and loan repayment?
Not familiar with the loan repayment situation. I would focus less on the sign on bonus. More often than not it's primary purpose is to confuse a poor resident into taking a job they wouldn't otherwise take.

This is my suggestion on how to weigh the sign-on bonus:
1) Look at the duration that you need it to 'vest' (most of these type of bonuses will come with a clause saying you need to work a minimum of X amount of years at that place, otherwise you need to pay the bonus back).
2) Calculate how many hours you would work in that period of time.
3) Divide the bonus amount by the hours you will work.
4) Add that $/hr amount to the hourly rate you've been quoted.
5) Ask yourself if that changes your thinking about the job. It probably won't. A lot of time even very generous sounding bonuses will work out to <$20/hr.

As to how much you should ask I would say ask for 10% of your expected annual income from the job, which they will probably negotiate down. After they agree to that, ask for a moving bonus too (say around $5k).
 
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