Hourly rate

[emergentmd]

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I make $375 hourly at one facility as a 1099. That rate was not advertised. I negotiated that directly with the group bypassing locums (I don't use locums). I see 3pph, and most are nursing home trainwrecks. The gig is not sustainable long-term, so I pick up just a few shifts a month to pad my wallet.

They probably get rid of me soon when they find someone who can do the job cheaper. I'd miss the pay but not the job.

This sounds like an old locums job I had but I saw about 2pph b/c the place was so dysfuncitonal. But no way would I do yours or my old locums gig for $375/hr. I started to pick up shifts at $500/hr and even then they could not get the shifts filled.

I doubt your site will ever get filled. Docs will leave from burnout, and go PRN too once they find the locums guy is making $100 more an hr. The only way to sustain a consistent staff is to set rates high where docs will be money whipped into staying.

 

[EctopicFetus]

That's 500/hr assuming he worked 12hrs every day for a month straight.
Does he do coke?

He doesn’t. Some jobs pay insanely. Not mine which is excellent.

 

[EctopicFetus]

This sounds like an old locums job I had but I saw about 2pph b/c the place was so dysfuncitonal. But no way would I do yours or my old locums gig for $375/hr. I started to pick up shifts at $500/hr and even then they could not get the shifts filled.

I doubt your site will ever get filled. Docs will leave from burnout, and go PRN too once they find the locums guy is making $100 more an hr. The only way to sustain a consistent staff is to set rates high where docs will be money whipped into staying.

Golden handcuffs

 

[emergentmd]

The really good really high paying jobs don’t advertise that they are good or high paying. They don’t need to.

I know a guy who made 180k in a month. He worked a lot. Sdg on the west coast. Been there forever. Sustainable (for him) and a busy job but 180k in a month.

Avg partner in that group makes $1m +/- 200k.

In the end the advertised jobs are $160-250/hr. Better jobs are out there but word of mouth only.

That's 500/hr assuming he worked 12hrs every day for a month straight.
Does he do coke?

Only way to make this in a month is to be a partner who preys on other EM docs. No matter how good your payer mix, I know b/c our FSER is 90% insured, you are only making $200 pp max from professional billing. Our 90% insured payer mix professional billing gets close to 200/hr but never over.

So if he is a non partner, keeps all of his professional collections @200/pp (doubt if non partner), sees 3pph, works 12 hr shifts x 30 dys that is right at 200K.

In an uber efficient/well insured ER, after billing/admin costs, I would say max is $150/pp x 3pph = $450/hr. Pay non partner 250/hr benefits included. Keep $200/hr on top of his work hours, will get you around 180k/mo if he is working close to 30x12 hrs.

Many of our partners in well run sites who work full time (140hrs) avg about 90K/mo

 

[Rekt]

Only way to make this in a month is to be a partner who preys on other EM docs. No matter how good your payer mix, I know b/c our FSER is 90% insured, you are only making $200 pp max from professional billing. Our 90% insured payer mix professional billing gets close to 200/hr but never over.

So if he is a non partner, keeps all of his professional collections @200/pp (doubt if non partner), sees 3pph, works 12 hr shifts x 30 dys that is right at 200K.

In an uber efficient/well insured ER, after billing/admin costs, I would say max is $150/pp x 3pph = $450/hr. Pay non partner 250/hr benefits included. Keep $200/hr on top of his work hours, will get you around 180k/mo if he is working close to 30x12 hrs.

Many of our partners in well run sites who work full time (140hrs) avg about 90K/mo

Wrong. You'd be surprised what some groups can contract with an insurance company for patients. I've seen >400$.

There's always going to be small pockets of insanely good jobs like the above. I personally know docs pulling >800k a year clinical only, but the opportunity has been missed for most. New grads will be sitting inline for those jobs. If ever.

Also no one is going to come post their low rates they took in this thread so they can get reamed. They already know they're getting a sour deal. Fetus is right. Plenty of places cutting pay from when I did my interview circuit last year. Numbers are decent right now but it's not going to be and it's going to nose dive very fast. I bet it'll look exactly like covid came around. All the sudden everything stops and docs and new grads left to scramble for scraps. Come back to this thread in 4-5 years. I'd love to be proved wrong but the math is there and it's not good.

 

[emergentmd]

Wrong. You'd be surprised what some groups can contract with an insurance company for patients. I've seen >400$

I am not saying this is not possible, but to avg >$400/hr for prof collections, you have to be in an area with mostly boutique insurance with buffing charts to level 4/5 and your SDG is a prime target for a CMG takeover. Word travels, CMGS will find you and make a deal with the hospital admin to "buy" you out.

 

[EctopicFetus]

Only way to make this in a month is to be a partner who preys on other EM docs. No matter how good your payer mix, I know b/c our FSER is 90% insured, you are only making $200 pp max from professional billing. Our 90% insured payer mix professional billing gets close to 200/hr but never over.

So if he is a non partner, keeps all of his professional collections @200/pp (doubt if non partner), sees 3pph, works 12 hr shifts x 30 dys that is right at 200K.

In an uber efficient/well insured ER, after billing/admin costs, I would say max is $150/pp x 3pph = $450/hr. Pay non partner 250/hr benefits included. Keep $200/hr on top of his work hours, will get you around 180k/mo if he is working close to 30x12 hrs.

Many of our partners in well run sites who work full time (140hrs) avg about 90K/mo

With all due respect the $200 pp is nonsense. My old group made 250. This group I’m referencing makes even more per patient.

 

[EctopicFetus]

Wrong. You'd be surprised what some groups can contract with an insurance company for patients. I've seen >400$.

There's always going to be small pockets of insanely good jobs like the above. I personally know docs pulling >800k a year clinical only, but the opportunity has been missed for most. New grads will be sitting inline for those jobs. If ever.

Also no one is going to come post their low rates they took in this thread so they can get reamed. They already know they're getting a sour deal. Fetus is right. Plenty of places cutting pay from when I did my interview circuit last year. Numbers are decent right now but it's not going to be and it's going to nose dive very fast. I bet it'll look exactly like covid came around. All the sudden everything stops and docs and new grads left to scramble for scraps. Come back to this thread in 4-5 years. I'd love to be proved wrong but the math is there and it's not good.

100%

 

[EctopicFetus]

I am not saying this is not possible, but to avg >$400/hr for prof collections, you have to be in an area with mostly boutique insurance with buffing charts to level 4/5 and your SDG is a prime target for a CMG takeover. Word travels, CMGS will find you and make a deal with the hospital admin to "buy" you out.

Disagree. First plenty of people were out of network and I’ll say my info is pre nsa.

You know why it’s so quiet is no one says a thing. If envision and them can contract for 400% of Medicare and more being out of network means even more dough. A great payer mix like that place has and solid contracting and 3 pph gets you to that pay.

Also that group fwiw (I know 3 docs in that group) takes 0 from their docs. Day 1 you get 100% of your collections.

I’ll be honest unsure about use of mlps. It’s either minimal or 0.

 

[emergentmd]

Disagree. First plenty of people were out of network and I’ll say my info is pre nsa.

You know why it’s so quiet is no one says a thing. If envision and them can contract for 400% of Medicare and more being out of network means even more dough. A great payer mix like that place has and solid contracting and 3 pph gets you to that pay.

Also that group fwiw (I know 3 docs in that group) takes 0 from their docs. Day 1 you get 100% of your collections.

I’ll be honest unsure about use of mlps. It’s either minimal or 0.

Wherever your friends work, truly a unicorn job that is hard for me to see it lasting very long. Either insurance will continue to cut pay, hospital will employ them if they are making $500/hr, or a CMG will come in.

 

[Kryptocoin]

This sounds like an old locums job I had but I saw about 2pph b/c the place was so dysfuncitonal. But no way would I do yours or my old locums gig for $375/hr. I started to pick up shifts at $500/hr and even then they could not get the shifts filled.

I doubt your site will ever get filled. Docs will leave from burnout, and go PRN too once they find the locums guy is making $100 more an hr. The only way to sustain a consistent staff is to set rates high where docs will be money whipped into staying.

Yeah, I try not to disclose how much I make to the FT docs because they'll quit on the spot if they know I make 2x as much. Maybe I'm part of the problem......

 

[GassYous]

Yeah, I try not to disclose how much I make to the FT docs because they'll quit on the spot if they know I make 2x as much. Maybe I'm part of the problem......

If they quit then the place will get even more desperate and you may be able to get 3x

 

[Mount Asclepius]

I suspect most posting are in the middle quartiles of compensation. Those at both the high and low ends are going to be reluctant to post specific numbers. However, overall this does give you a sense of where the majority of pay is at currently for independent contractor or employed positions. Just know that partnership pay and probably locums positions will exceed the average. The stability is most jeopardized of those collecting >$200/patient. I wouldn’t count that amount as the norm or expected.

 

[Angry Birds]

This thread will definitely lead to an uptick in EM applicants next year

This is why it should be banned or made hidden.

 

[emergentmd]

This is why it should be banned or made hidden.

Wont matter. IMGs will flock to EM and be happy making 200/hr seeing 3pph. The field would go downhill if it becomes a refuge for IMGS

 

[miacomet]

I mean, the way to get more than $150/patient is to have midlevels seeing a ton of the well-remunerated ortho/lac cases and pay them much less and put it in your own pocket. Plenty of groups do this.

 

[EctopicFetus]

Wherever your friends work, truly a unicorn job that is hard for me to see it lasting very long. Either insurance will continue to cut pay, hospital will employ them if they are making $500/hr, or a CMG will come in.

Been that was for 15+ years. I imagine a haircut is coming with the nsa but if you don’t take a subsidy the CMGs have little to offer. Their reputation is becoming more well known and that’s bad for them. It might. It’s not my job but I am happy for them. Make that bread.

 

[turkeyjerky]

I'm at 170/hr. Partnership tract sdg in the SW.

Here's my prior history:
1) initially 185/hr, then increased to 200/hr (w2 hospital employed, major metro)
2) 200/hr (w2, partnership tract sdg in rural midwest)
3) 255/hr (w2, nocturnist, hospital employee in SW. Daytime guys made 230/hr)

 

[emergentmd]

Been that was for 15+ years. I imagine a haircut is coming with the nsa but if you don’t take a subsidy the CMGs have little to offer. Their reputation is becoming more well known and that’s bad for them. It might. It’s not my job but I am happy for them. Make that bread.

10 yrs ago we were a highly functional SDG that took no subsidies either. All the specialists loved us and some went to bat for us. You know how that went.

Their subsidy is that they make alot of $$$ well over the national average that the CMG/hospital can monetize.

 

[Backpack234]

Some of these listed rates are ridiculous. For every one of these there are 10 CMG gigs in the area paying “market rate” of 100 something plus rvu where you make around 220/hr supervising midlevel patients with a total of 2.5pph including theirs.

The unicorn gigs I’ve known of tend to prey on the younger docs. Older docs from the heyday of EM making 800k/yr working 0 shifts at the rural site their group started staffing while the pre partner docs work all those shifts for 180/hr.

If any applicants are looking at this…unless you know someone or get really lucky, it’s very unlikely you’re getting one of these unicorn gigs. More likely you’re working for a CMG seeing more patients per hour for less pay.

 

[EctopicFetus]

Some of these listed rates are ridiculous. For every one of these there are 10 CMG gigs in the area paying “market rate” of 100 something plus rvu where you make around 220/hr supervising midlevel patients with a total of 2.5pph including theirs.

The unicorn gigs I’ve known of tend to prey on the younger docs. Older docs from the heyday of EM making 800k/yr working 0 shifts at the rural site their group started staffing while the pre partner docs work all those shifts for 180/hr.

If any applicants are looking at this…unless you know someone or get really lucky, it’s very unlikely you’re getting one of these unicorn gigs. More likely you’re working for a CMG seeing more patients per hour for less pay.

The heyday of em imo was the early 90s. My old group told me the hospital was paying them the billed charges. Period. Insurance didn’t matter nothing did. guys were making insane dough seeing few patients.
not sure anything 2010 or later is the heyday. Unsure what time frame you are referring to. Not a ton of docs including SDGs make 800k.
most recent SDG posts I saw on Fb have docs in the midwest making under 300/hr.
there are a handful of guys/gals making 600k+ many of those do it off the backs of MLPs or young docs. Few do it on their own.
being involved in hiring I think it’s been interesting seeing the difference between those who have worked for CMGs for a couple of years and want to get out and comparing that to the new grads who often come across incredibly entitled.
reminds me of the quote.



“If you expect the world to be fair with you because you are fair, you’re fooling yourself. That’s like expecting the lion not to eat you because you didn’t eat him.”

 

[EctopicFetus]

Some of these listed rates are ridiculous. For every one of these there are 10 CMG gigs in the area paying “market rate” of 100 something plus rvu where you make around 220/hr supervising midlevel patients with a total of 2.5pph including theirs.

The unicorn gigs I’ve known of tend to prey on the younger docs. Older docs from the heyday of EM making 800k/yr working 0 shifts at the rural site their group started staffing while the pre partner docs work all those shifts for 180/hr.

If any applicants are looking at this…unless you know someone or get really lucky, it’s very unlikely you’re getting one of these unicorn gigs. More likely you’re working for a CMG seeing more patients per hour for less pay.

Wondering which group you refer to up there. I know of 3 groups like this that you mention above. Are you speaking in general or have one in mind.

 

[Rekt]

The heyday of em imo was the early 90s. My old group told me the hospital was paying them the billed charges. Period. Insurance didn’t matter nothing did. guys were making insane dough seeing few patients.
not sure anything 2010 or later is the heyday. Unsure what time frame you are referring to. Not a ton of docs including SDGs make 800k.
most recent SDG posts I saw on Fb have docs in the midwest making under 300/hr.
there are a handful of guys/gals making 600k+ many of those do it off the backs of MLPs or young docs. Few do it on their own.
being involved in hiring I think it’s been interesting seeing the difference between those who have worked for CMGs for a couple of years and want to get out and comparing that to the new grads who often come across incredibly entitled.
reminds me of the quote.



“If you expect the world to be fair with you because you are fair, you’re fooling yourself. That’s like expecting the lion not to eat you because you didn’t eat him.”

Entitled or know their worth? You speak a lot of the latter on here, but doesn't apply to new grads? Maybe because they've watched their attendings whine while they have incredibly easy jobs and have had it made for years while many new grads get **** jobs. Add in all the mid level nonsense and I'd call it resentment.

And from what I've seen many former CMG docs are some of the worst clinicians I've ever seen. Lactate, cultures, gram of rocephin, head to toe CT on everything that walks through the door.

 

[JacobMcCandles]

It isn't unusual to average over $200 collected per patient visit but you need to be in a somewhat affluent area with good insurance and really minimize Medicare/Medicaid patients. As your patient volume goes up, the payment per visit almost always goes down. I can almost guarantee there isn't a true ED in the US getting well over $200 PPV and averaging 3pph.

As far as making over $1M in EM, it's possible but if all the partners are making that much then they either employ an entire army of midlevels or have a bunch of employed docs that they're paying $100/hr to. Or they see the Gross Receipts box on their K1 and say that's their income. That'd be like a farmer saying he makes $1M/year but in reality, he brought in $1M but after paying for equipment, fuel, labor, other expenses, etc., his personal pretax income was really $70k.

 

[coachB]

You can certainly average over $200 collected per patient visit but you need to be in a somewhat affluent area with good insurance and really minimize Medicare/Medicaid patients. As your patient volume goes up, the payment per visit almost always goes down. I can almost guarantee there isn't a true ED in the US getting well over $200 PPV and averaging 3pph.

As far as making over $1M in EM, it's possible but if all the partners are making that much then they either employ an entire army of midlevels or have a bunch of employed docs that they're paying $100/hr to. Or they see the Gross Receipts box on their K1 and say that's their income. That'd be like a farmer saying he makes $1M/year but in reality, he brought in $1M but after paying for equipment, fuel, labor, other expenses, etc., his personal pretax income was really $70k.

I have a feeling I may know the group Ectopic is referring to. In fact, I may know it well. It is a true ED. Level 1 trauma center in fact, Collections are way above $200/pt. As you said, affluent area with good insurance. Not everybody is making 7 figures but some who work hard and see 3+ pph are. Do the math, It doesn't take an insane amount of hours at that level of reimbursement. No army of midlevels (one to run an obs unit) or employed docs (one or two working a handful of shifts getting paid $300/h or more). The group has been solid for many years and I think the contract is very secure. Sure, this is exceptional, a unicorn, but the point is that these jobs are out there but you aren't going to find ads for them. Have to know the right people.

 

[JacobMcCandles]

I have a feeling I may know the group Ectopic is referring to. In fact, I may know it well. It is a true ED. Level 1 trauma center in fact, Collections are way above $200/pt. As you said, affluent area with good insurance. Not everybody is making 7 figures but some who work hard and see 3+ pph are. Do the math, It doesn't take an insane amount of hours at that level of reimbursement. No army of midlevels (one to run an obs unit) or employed docs (one or two working a handful of shifts getting paid $300/h or more). The group has been solid for many years and I think the contract is very secure. Sure, this is exceptional, a unicorn, but the point is that these jobs are out there but you aren't going to find ads for them. Have to know the right people.

Ectopic said the average is $1M (but he also gave a range of $400k which is huge). I have no doubt that some are making that but I wouldn't be surprised if a few claims get stretched juuuuuuuust a bit. I can 100% believe an average total comp of around $800k. I do have some doubts that the true average partner income is $1M. Being at a level 1 trauma center would be even more rare. As I said, you can work incredibly hard in the right situation and get to $1M but it's not sustainable to do that for very long or without it being done off the backs of others.

 

[thegenius]

That's 500/hr assuming he worked 12hrs every day for a month straight.
Does he do coke?

I suspect there is more to that story. I doubt it's the cold hard truth...that every cent he made was from seeing patients.

 

[Mbekweni]

I suspect there is more to that story. I doubt it's the cold hard truth...that every cent he made was from seeing patients.

There is one group like that near me but they have a pyramid scheme. New docs get $200/hr+, not too bad and a fair bit more for nights, but there is a lot more meat on the bone given excellent payer mix and high volumes. The rest goes to full partners with no clear path towards partner, not guaranteed to advance. I think there are only 8-9 full partners total with another 20+ docs lower on the food chain waiting for their call to the big leagues. Rumors abound but I am pretty sure those at the top are clearing 1M+ once profit sharing is included. Top SDG groups that I am aware of (and would recommend) in my general area of the state are in the $240-$330/hr range plus profit sharing (17-25% or so on top), so up to ~$300-$400/hr at full partner which has a few years sweat equity buy in but still making the base along the way. Lots of others in the $220-240 range so would be pretty hesitant to take something lower than that. All seem pretty functional though every site has its quirks and work is work.

 

[xaelia]

It's a bit challenging to figure out my precise rate for clinical hours, since it's salaried with a few other benefits, a 1.5x rate differential for evening and weekend hours, and also comes with 9-10 weeks of paid leave –
But it's about ~NZD$180-200/hr

Day locums are NZD$167/hr and evening/weekend locums are NZ$250/hr
Backup short cover ranges between NZD$200-$300 at the moment for winter rates

No night shifts for FACEMs at our hospital. It's work, but it's about 60% supervisory work and 40% cherry-picking mostly quick or low-maintenance patients.

1 NZD = 0.65 USD tho, oh well.

 

[EctopicFetus]

Entitled or know their worth? You speak a lot of the latter on here, but doesn't apply to new grads? Maybe because they've watched their attendings whine while they have incredibly easy jobs and have had it made for years while many new grads get **** jobs. Add in all the mid level nonsense and I'd call it resentment.

And from what I've seen many former CMG docs are some of the worst clinicians I've ever seen. Lactate, cultures, gram of rocephin, head to toe CT on everything that walks through the door.

Sounds like working at hca. To be a bit contrarian. The term know your worth. Explain. Reality is the market sets your worth. I would bet if in a few years em pay drops to 150/hr the jobs would be full. My point is made by looking at markets like Denver.

the issue with a medical degree is it’s value is limited outside of clinical medicine. For some people who know their worth they would quit. Most just talk a big game. Many of the new grads think things were simple before. My first gig out of residency I made 25% of what those partners were making. The job sucked ass and was totally abusive from a financial and scheduling perspective e. That being said once you made partner the job was sweet. There was no equality from day 1.

there are crappy CMG and SDG docs. That’s just the truth. Many of the CMG old timers play the game they are to,d to play. They shut their traps and take the beatings. In my opinion if you are a medical student and you go into em this year or after you deserve the crap tastic jobs that will be there. Us medical schools should have 0 applicants to em. Yep em will go in the toilet due to imgs fmgs and CMGs but if u go to med school in the us you have no excuse.

 

[EctopicFetus]

It isn't unusual to average over $200 collected per patient visit but you need to be in a somewhat affluent area with good insurance and really minimize Medicare/Medicaid patients. As your patient volume goes up, the payment per visit almost always goes down. I can almost guarantee there isn't a true ED in the US getting well over $200 PPV and averaging 3pph.

As far as making over $1M in EM, it's possible but if all the partners are making that much then they either employ an entire army of midlevels or have a bunch of employed docs that they're paying $100/hr to. Or they see the Gross Receipts box on their K1 and say that's their income. That'd be like a farmer saying he makes $1M/year but in reality, he brought in $1M but after paying for equipment, fuel, labor, other expenses, etc., his personal pretax income was really $70k.

Nope. These people know. High acuity shop. Obviously great payer mix. Real $1m. No k1

 

[EctopicFetus]

I have a feeling I may know the group Ectopic is referring to. In fact, I may know it well. It is a true ED. Level 1 trauma center in fact, Collections are way above $200/pt. As you said, affluent area with good insurance. Not everybody is making 7 figures but some who work hard and see 3+ pph are. Do the math, It doesn't take an insane amount of hours at that level of reimbursement. No army of midlevels (one to run an obs unit) or employed docs (one or two working a handful of shifts getting paid $300/h or more). The group has been solid for many years and I think the contract is very secure. Sure, this is exceptional, a unicorn, but the point is that these jobs are out there but you aren't going to find ads for them. Have to know the right people.

I know where you live and we may know the same group.

 

[EctopicFetus]

Ectopic said the average is $1M (but he also gave a range of $400k which is huge). I have no doubt that some are making that but I wouldn't be surprised if a few claims get stretched juuuuuuuust a bit. I can 100% believe an average total comp of around $800k. I do have some doubts that the true average partner income is $1M. Being at a level 1 trauma center would be even more rare. As I said, you can work incredibly hard in the right situation and get to $1M but it's not sustainable to do that for very long or without it being done off the backs of others.

It’s $1m+ before taxes. Understand people work a variable amount. In my job the hours range widely between docs. Some literally work 2x the other. (Comparing top to bottom in clinical hours).
there are groups and sites that collect $300+/pt and have for a long long time. Not my current job (sadly).
I’ll say too the math is if you collect $200 /pt and do 3 pph (which is super tough) that’s $600/hr before expenses.

 

[GatorCHOMPions]

For those who know the economics of EM, please confirm if the math below checks out.

Volume: 180 patients per day x 365 days = 65,700 patients

Staffing: 48 hours MD ($230/hour), 36 hours MLP ($100/hour). 4.03M in MD salary + 1.31M in MLP salary per year

Pro fees: ~$150 per patient x 65,700 = 9.86M per year

Overhead: 15% (taken from estimates given by others in the thread)

9.86M x 0.85 (15% overhead) = 8.38M - 4.03M (MD) - 1.31M (MLP) = 3.04M profit per year to partners, CMG, hospital, etc.

Am I missing something? If there are only a handful of partners making money off the backs off of their lemmings it is easy to see how one can still make a million dollars in EM. And easy to see why private equity has taken over.

 

[cyanide12345678]

For those who know the economics of EM, please confirm if the math below checks out.

Volume: 180 patients per day x 365 days = 65,700 patients

Staffing: 48 hours MD ($230/hour), 36 hours MLP ($100/hour). 4.03M in MD salary + 1.31M in MLP salary per year

Pro fees: ~$150 per patient x 65,700 = 9.86M per year

Overhead: 15% (taken from estimates given by others in the thread)

9.86M x 0.85 (15% overhead) = 8.38M - 4.03M (MD) - 1.31M (MLP) = 3.04M profit per year to partners, CMG, hospital, etc.

Am I missing something? If there are only a handful of partners making money off the backs off of their lemmings it is easy to see how one can still make a million dollars in EM. And easy to see why private equity has taken over.

Some groups get a stipend from the hospital as well on top of what is billed. Depends on how the contract is negotiated. In the grand scheme, the hospital may lose a little money on the ER, but make big $$$ from facility fees, CR scans, labs, and admissions.

 

[Janders]

For those who know the economics of EM, please confirm if the math below checks out.

Volume: 180 patients per day x 365 days = 65,700 patients

Staffing: 48 hours MD ($230/hour), 36 hours MLP ($100/hour). 4.03M in MD salary + 1.31M in MLP salary per year

Pro fees: ~$150 per patient x 65,700 = 9.86M per year

Overhead: 15% (taken from estimates given by others in the thread)

9.86M x 0.85 (15% overhead) = 8.38M - 4.03M (MD) - 1.31M (MLP) = 3.04M profit per year to partners, CMG, hospital, etc.

Am I missing something? If there are only a handful of partners making money off the backs off of their lemmings it is easy to see how one can still make a million dollars in EM. And easy to see why private equity has taken over.

Yes you are missing all of the MD/PA compensation which is NOT hourly take home salary— medical, dental, retirement, malpractice, disability, umbrella, Employer side taxes, SS, licensing, CME, credentialing.

So your MD might get paid $230 an hour, but the actual COST for that might be $270/hr, plus then the OTHER overhead (coding, billing, HR, accounting, scheduling, group admin).

For the PA making $100/hr the group is spending say $140/hr…

 

[GatorCHOMPions]

Yes you are missing all of the MD/PA compensation which is NOT hourly take home salary— medical, dental, retirement, malpractice, disability, umbrella, Employer side taxes, SS, licensing, CME, credentialing.

So your MD might get paid $230 an hour, but the actual COST for that might be $270/hr, plus then the OTHER overhead (coding, billing, HR, accounting, scheduling, group admin).

For the PA making $100/hr the group is spending say $140/hr…

Makes sense, but then overhead is not just 15% as others had stated before.

 

[Janders]

This is why you need open books to analyze anything. These numbers are made up but also within the realm of possibility.

Lets say in a quarter I worked 13 shifts a month for 3 months (9hr shifts, for a total of 350hr)—
Generated $175k in patient revenue via my professional fees. I get no stipend. The hospital doesn’t pay my group either. This total DOES Include revenue assigned from PA patients. My grand total of earnings for the group is roughly $500/hr!

And my salary is 400k/year… 100k/quarter. Am I getting a raw deal? I’m only getting paid like $285/hr, who’s stealing my money?!

Well what if I…
Spent $25k of that on coding/billing/HR/group admin expense
Spent $20k for my share of the PA expenses.

Now I have $130k left.

I spend $6k on malpractice insurance
I spend $10k on the mix of medical, dental, disability, and other fringe benefits oh and also the employer-side taxes
I “spend” $10k getting it as pre-salary retirement matching in a 403b and other accounts.

Now I have $104k left.

I get 100k as my salary, and $4k as a quarterly bonus. Oh and also I got $10k of pretax money in various retirement accounts as mentioned above.

So really I was pained $114k this quarter + benefits.

When means I’m REALLY getting about $325/hr of salary + bonus + retirement cash, plus the value of all those insurances and fringe benefits.

Any in this scenario, no one is really skimming a lot off the top… there isn’t 5-10% going straight to HCA or something.

You really need to see where any penny goes to get an idea of fairness. You also need to understand the total WORTH of a package, purely hourly rates mean nothing unless you are comparing 1099 jobs to each other. A job with 12% retirement matching built in is very different than one with 1% and 2 year vesting, or a 1099 gig with no included benefits.

 

[Janders]

Makes sense, but then overhead is not just 15% as others had stated before

There are TWO overheads.

One is perhaps a GROUP overhead, meaning what the entire group needs to do to have a practice.
You need coders, you need billers, you need a scheduler, you need a director and other admin to handle chores, you need a modicum of HR and accounting and bank accounts and a retirement plan set up. 15% for all of this is possible but also is perhaps cutting it cheap?

But there is also the overhead for YOU. Yes they might pay you $300k a year, but you also get $30k retirement matching, they pay a $25k malpractice insurance every year, oh you get $5k/year of CME, oh also you get family medical insurance and the employer cost is $25k/yr and also dental and also you get group disability thats $5k/year and the short term disability thats $1k/yr and your employer has payroll taxes and who is paying social security…. So unless your employer is paying you as just a 1099 with NO malpractice and no benefits, there is a lot of overhead (some of which is beneficial to YOU, like retirement matching) that makes yours $300k/yr cost $400k/yr…

 

[JacobMcCandles]

For those who know the economics of EM, please confirm if the math below checks out.

Volume: 180 patients per day x 365 days = 65,700 patients

Staffing: 48 hours MD ($230/hour), 36 hours MLP ($100/hour). 4.03M in MD salary + 1.31M in MLP salary per year

Pro fees: ~$150 per patient x 65,700 = 9.86M per year

Overhead: 15% (taken from estimates given by others in the thread)

9.86M x 0.85 (15% overhead) = 8.38M - 4.03M (MD) - 1.31M (MLP) = 3.04M profit per year to partners, CMG, hospital, etc.

Am I missing something? If there are only a handful of partners making money off the backs off of their lemmings it is easy to see how one can still make a million dollars in EM. And easy to see why private equity has taken over.

Benefits and other things typically add up faster than many docs realize. In this scenario, you'd probably need 12 docs and 10 midlevels.

Physician Retirement Contribution (max out employer contribution): $486k
Midlevel Retirement Contribution (safe harbor + small profit sharing): $125k
Health Insurance (family insurance is about $20k/year): $440k
HSA Contribution: $160k
Billing Expense: $685k
Malpractice: $175k
Payroll Taxes: $240k
Practice Manager/Accounting: $150k
CME: $100k
Other fringe benefits, legal, unemployment taxes, etc.: $200k

That's about $2.75M there. That leaves $250k leftover. If 10/12 of the docs are partners, then that's only an extra $25k per partner.

Obviously, these aren't exact numbers and represents a group with good benefits but will give you a general idea on your proposed ED.

 

[JacobMcCandles]

Some groups get a stipend from the hospital as well on top of what is billed. Depends on how the contract is negotiated. In the grand scheme, the hospital may lose a little money on the ER, but make big $$$ from facility fees, CR scans, labs, and admissions.

True, but the fictitious ED that Gator proposed wouldn't get a stipend unless there were some kind of rare extenuating circumstances.

 

[Backpack234]

Wondering which group you refer to up there. I know of 3 groups like this that you mention above. Are you speaking in general or have one in mind.

There’s one group I know of that has this type of partnership structure. You start as a candidate of some kind. Then a junior partner. Then a partner. The partners are usually in their 60s and do very well on the easier shifts.

Wasnt a place I worked at, though.

 

[GatorCHOMPions]

Thanks @JacobMcCandles and @Janders for the explanation above. I had a feeling it wasn’t as simple as $150 per patient minus 15% overhead. I think most of us are clueless about EM economics.

 

[EctopicFetus]

For those who know the economics of EM, please confirm if the math below checks out.

Volume: 180 patients per day x 365 days = 65,700 patients

Staffing: 48 hours MD ($230/hour), 36 hours MLP ($100/hour). 4.03M in MD salary + 1.31M in MLP salary per year

Pro fees: ~$150 per patient x 65,700 = 9.86M per year

Overhead: 15% (taken from estimates given by others in the thread)

9.86M x 0.85 (15% overhead) = 8.38M - 4.03M (MD) - 1.31M (MLP) = 3.04M profit per year to partners, CMG, hospital, etc.

Am I missing something? If there are only a handful of partners making money off the backs off of their lemmings it is easy to see how one can still make a million dollars in EM. And easy to see why private equity has taken over.

Reasonable estimates. Yes this is quite the profit. FWIW I have spoken to a ton of billing companies (total of well over 20M visits) and they all quote $130-135/pt on avergae in collections. The CMGs are closer to 165 For example USACS is at 165 and so is APP. I would bet hospitals it is even lower than the SDGs on the pro side.

 

[EctopicFetus]

Makes sense, but then overhead is not just 15% as others had stated before.

I would say the 15% includes all overhead but the % depends on your $/pt (CPV). 15% is on the hgher end but also depends on how you count your overhead. My group the overhead includes billing and coding and admin and it is under 7% combined for those 2. Med mal is covered individually and mine is about 3% of my annual collections.

Much depends on the size/ structure of the group. The 230 depends on what you include and for MLPs the $100 includes all benefits/retirement etc. I dont know of any MLPs in EM that make $100/hr plus benefits. Most of them make around $75/hr plus benefits (some more, some less). the $100 totally includes everything.

 

[EctopicFetus]

There are TWO overheads.

One is perhaps a GROUP overhead, meaning what the entire group needs to do to have a practice.
You need coders, you need billers, you need a scheduler, you need a director and other admin to handle chores, you need a modicum of HR and accounting and bank accounts and a retirement plan set up. 15% for all of this is possible but also is perhaps cutting it cheap?

But there is also the overhead for YOU. Yes they might pay you $300k a year, but you also get $30k retirement matching, they pay a $25k malpractice insurance every year, oh you get $5k/year of CME, oh also you get family medical insurance and the employer cost is $25k/yr and also dental and also you get group disability thats $5k/year and the short term disability thats $1k/yr and your employer has payroll taxes and who is paying social security…. So unless your employer is paying you as just a 1099 with NO malpractice and no benefits, there is a lot of overhead (some of which is beneficial to YOU, like retirement matching) that makes yours $300k/yr cost $400k/yr…

Agreed here. I consider any money that benefits me as not overhead. The only one when I may feel otherwise is med mal.

I also think it depends on how you view your MLPs. You can view them as a cost center (I get the RVUs and have to pay their salary) or as I view them as a profit center. I pay them with beenfits ($100/hr) and they generate $200/hr for me.

MLPs make up a big part of the story.

When looking at % overhead what goes into that bucket really matters. I dont consider money put in my retirement account to be overhead. I view that as income. I earned that money.

 

[EctopicFetus]

Thanks @JacobMcCandles and @Janders for the explanation above. I had a feeling it wasn’t as simple as $150 per patient minus 15% overhead. I think most of us are clueless about EM economics.

I will say i (again) it depends on what you consider. If you are the sole owner putting money in for docs retirement is an expense. If you have a flat partnership I view this as my money. My group also allows me to maximally control my money.

In the examples most use they exclude the revenue from MLPs. The ones above here do not.

15% overhead is excessive if you arent including paying MLPs and consider physician retirement/HSA as overhead.

 

[EctopicFetus]

The really good really high paying jobs don’t advertise that they are good or high paying. They don’t need to.

I know a guy who made 180k in a month. He worked a lot. Sdg on the west coast. Been there forever. Sustainable (for him) and a busy job but 180k in a month.

Avg partner in that group makes $1m +/- 200k.

In the end the advertised jobs are $160-250/hr. Better jobs are out there but word of mouth only.

ONe last thing to think about most of the jobs out there are 1099 jobs and not a ton are paying 230/hr at least around me. Some are.. most arent. Many have moved to an RVU based model (they win either way)

 

[emergentmd]

Here are real world numbers from 10 yrs ago when we were a SDG, open book for all partners so we all saw the real numbers. I would guess the numbers are alittle worse given insurance headwinds, but lets assume they are unchanged. I would say this is typical so not including all the niche areas with extraordinary insurance/stipend, etc.

Background - above avg payer mix. All MD group, No NP. Docs saw about 2pph. 70% of the group were partners, 2 yr partnership track with same pay rate/nights/weekends as Partners with only difference being about a typical 50K partner distribution yearly.

Partner pay was about $230/hr + 50K SEP contribution + 50K partner distribution + 25K in benefits (med mal/insurance/etc). Most docs worked 140hrs/mo. This put Partners right at $300/hr all in or about 280/hr assuming all were partners. So full time docs pulled in about 500K working 140hrs/mo, Non partners 450K.

Adding 1 APC 10 hr shift typically boosted MD pay about $10/hr if my memory was correct vs hiring an MD.

Before we became a democratic group, the few owners essentially took all of the distribution so they made about 2.1M for just being the owners.


The avg pay above of $300/hr was after billing expense 12% of collections ($35/hr) with very little other administrative costs/medmal so about $50/hr all in for non physician pay.

So we collected about $350/hr at 2pph so the $200/pp seems about right.

I stand by my statement that a decent above avg hospitals system with above avg payer mix will pull in about $200/pp.

So if you are seeing 3pph and making $300/hr, your owner/CMG/employer is making $300/hr.

 

[miacomet]

Here are real world numbers from 10 yrs ago when we were a SDG, open book for all partners so we all saw the real numbers. I would guess the numbers are alittle worse given insurance headwinds, but lets assume they are unchanged. I would say this is typical so not including all the niche areas with extraordinary insurance/stipend, etc.

Background - above avg payer mix. All MD group, No NP. Docs saw about 2pph. 70% of the group were partners, 2 yr partnership track with same pay rate/nights/weekends as Partners with only difference being about a typical 50K partner distribution yearly.

Partner pay was about $230/hr + 50K SEP contribution + 50K partner distribution + 25K in benefits (med mal/insurance/etc). Most docs worked 140hrs/mo. This put Partners right at $300/hr all in or about 280/hr assuming all were partners. So full time docs pulled in about 500K working 140hrs/mo, Non partners 450K.

Adding 1 APC 10 hr shift typically boosted MD pay about $10/hr if my memory was correct vs hiring an MD.

Before we became a democratic group, the few owners essentially took all of the distribution so they made about 2.1M for just being the owners.


The avg pay above of $300/hr was after billing expense 12% of collections ($35/hr) with very little other administrative costs/medmal so about $50/hr all in for non physician pay.

So we collected about $350/hr at 2pph so the $200/pp seems about right.

I stand by my statement that a decent above avg hospitals system with above avg payer mix will pull in about $200/pp.

So if you are seeing 3pph and making $300/hr, your owner/CMG/employer is making $300/hr.

I have to say, I really admire the career you have put together for yourself. Very impressive- SDG, FSED, real estate. You should give a seminar, it's so amazing.