Houston job market questions

[Le MD]

Hey everyone, so I'm a soon to be new EM attending, who is planning on relocating to Houston after residency. It seems as if Envision is in charge of most of the sites there. I have a few questions that I would like answered.

1. Other than envision, who are the other CMG's or groups that service the Houston area?
2. What is the average compensation? (Envision states that it is around $260 on average and based on RVU; another non-envision site is offering $250/hr fixed).
3. What is a reasonable # of pts to see/hr. (Some of these places are advertising 3-4 pts/hr, I dont see how that is feasible)
4. Anything else I should know about the Houston market?

Thanks!

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[HemeOncHopeful19]

4. Anything else I should know about the Houston market?

¿Cómo es tu español?

 

[WildEMDoc]

Memorial hermann is mostly employed docs I believe but not sure of the rate, very rarely hiring I think. Outside of the UT Health group that staffs the main hospital + LBJ

Baylor is at Ben Taub

Envision is at all HCA hospitals 250ish/hr 1099

IES staffs a fair amount in the area (CHI in north Houston, some similar hospitals in south houston) pay is about 175/hr W2, plus RVU

Methodist is TeamHealth ?I think? not sure on pay but I would bet similar to Envision.

 

[miacomet]

$250 an hour for 1099? Is Houston that great?
That's an absurdly low salary.

 

[Mr. Vandemar]

$250 an hour for 1099? Is Houston that great?
That's an absurdly low salary.

Not related at all to Texas, but I spoke with at least 3 different groups (CMG and not) in the Raleigh/Durham, NC area and the highest I was offered was $200 an hour as a 1099.

 

[RustedFox]

$250 an hour for 1099? Is Houston that great?
That's an absurdly low salary.

Bro, this is more the market rate anywhere but your formerly unicorn gig.

 

[valianteffort]

Hey everyone, so I'm a soon to be new EM attending, who is planning on relocating to Houston after residency. It seems as if Envision is in charge of most of the sites there. I have a few questions that I would like answered.

1. Other than envision, who are the other CMG's or groups that service the Houston area?
2. What is the average compensation? (Envision states that it is around $260 on average and based on RVU; another non-envision site is offering $250/hr fixed).
3. What is a reasonable # of pts to see/hr. (Some of these places are advertising 3-4 pts/hr, I dont see how that is feasible)
4. Anything else I should know about the Houston market?

Thanks!

Houston is similar to most job markets. Worked academically at Baylor in the medical center for 250 an hour for a while. They hired locums because no one wanted to work there. The employed docs W2 were making 180. Not a bad gig and you have residents most off the time. I thought the pay was fair for what I did. My only issue was none of the academic center's EMRs are linked up which made it really annoying and hard to figure out who came from where and why. Between Texas childrens, Texas womens, MD anderson, baylor and HCA patients would hospital hop to try and find good care. It slowed down the process. Would frequently admit from the waiting room/start heparin drips there/abx. Would avoid the medical center if you want to accomplish something rather than averaging 1.2 patients per hour which is a limitation of the 'too large for its own good' system there.

 

[Rekt]

$250 an hour for 1099? Is Houston that great?
That's an absurdly low salary.

Unfortunately that’s like >80th percentile nowadays

 

[GonnaBeADoc2222]

$250 an hour for 1099? Is Houston that great?
That's an absurdly low salary.

Not related at all to Texas, but I spoke with at least 3 different groups (CMG and not) in the Raleigh/Durham, NC area and the highest I was offered was $200 an hour as a 1099.

Unfortunately that’s like >80th percentile nowadays

I feel like the math isn't mathing somehow.

In the northeast, I am making $250/hr (including matching and bonuses in this figure) as a W2 plus absurdly cheap health insurance.

 

[Le MD]

Thanks for the info everyone. Any additional input is much appreciated

 

[miacomet]

Bro, this is more the market rate anywhere but your formerly unicorn gig.

Currently getting $300+, 1099 at a new gig in a fairly desirable location...Houston seems underpaid, maybe because there is no state income tax?

 

[cyanide12345678]

I feel like the math isn't mathing somehow.

In the northeast, I am making $250/hr (including matching and bonuses in this figure) as a W2 plus absurdly cheap health insurance.

The large cities in Texas are extremely saturated. It’s no longer a great job market by any means. It doesn’t surprise me if people are making 250/hr for 2.5-3 pph.

 

[miacomet]

The large cities in Texas are extremely saturated. It’s no longer a great job market by any means. It doesn’t surprise me if people are making 250/hr for 2.5-3 pph.

Yeah, I repeat my question- I though the main attraction of TX was the good money.

What's the attraction of Houston or Dallas over other higher-paid areas with better weather, more amenities now that the markets are saturated and pay is the same as a travel nurse?

 

[cyanide12345678]

Yeah, I repeat my question- I though the main attraction of TX was the good money.

What's the attraction of Houston or Dallas over other higher-paid areas with better weather, more amenities now that the markets are saturated and pay is the same as a travel nurse?

Have you lived in either? I’ve lived in both.

Depends on what someone values. Cost of living is extremely reasonable for very large cities with every amenity and entertainment option. Malpractice reform is still better than most other states. No income tax. Extremely ethically diverse. In fact Houston is now considered the most ethnically diverse city in the US - so whether you are from the subcontinent, Asia, Africa, you will find a large community of yours.

Some people genuinely prefer hot and humid over cold and snowy. Maybe that’s what they grew up in.

400k in Texas goes a lot further than 400k in San Francisco, San Diego, denver, Salt Lake City, Boston, nyc etc.

You like mountains. Sorry these cities don’t have mountains - but a lot of people don’t care about those.

 

[nVictus]

Texas use to have top tier pay with no state income tax. But... you exchanged that for humid weather and high property taxes. Now that the pay has dropped, it's less enticing to deal with Texas problems. Also, housing has absolutely skyrocketed, making previously held beliefs about cost of living less applicable.

Imo, if you can get something comparable in WA/TN, other no/low income tax states, I would probably do that and enjoy better weather/scenery.

 

[cyanide12345678]

Texas use to have top tier pay with no state income tax. But... you exchanged that for humid weather and high property taxes. Now that the pay has dropped, it's less enticing to deal with Texas problems. Also, housing has absolutely skyrocketed, making previously held beliefs about cost of living less applicable.

Imo, if you can get something comparable in WA/TN, other no/low income tax states, I would probably do that and enjoy better weather/scenery.

Yes. I personally picked midwest over Texas. I really really really wanted to go back to Texas. But the saturated job market in Texas especially during covid days was painful to watch. In fact, i talked with EVERY cmg in November - December of 2020 when i was job hunting. There were 3-4 positions actively hiring at that time. And those were not in the big cities. The big cities were full - i think el paso midland lubbock that had 3 open positions. Texas job market was one of the worst in covid.

TN is great, just not that great of malpractice reform. Having been sued once, i literally cared about being in the best ever malpractice states with a huge shortage of doctors. My state has 1 EM residency i believe, and by population it is not a small state. Hence jobs still everywhere - even in 2020 covid days.

But honestly, i think there are only a handful of states that i would pick over Texas. Texas isnt as great as before, but it’s not terrible by any means.

 

[HemeOncHopeful19]

Texas use to have top tier pay with no state income tax. But... you exchanged that for humid weather and high property taxes. Now that the pay has dropped, it's less enticing to deal with Texas problems. Also, housing has absolutely skyrocketed, making previously held beliefs about cost of living less applicable.

Imo, if you can get something comparable in WA/TN, other no/low income tax states, I would probably do that and enjoy better weather/scenery.

Doesn’t WA have zero malpractice caps and Naturopaths.

I have also read on other forums that WA has it’s own version of No Surprise Act that is even worse than the federal one and decimated EM groups but I don’t know how true that is.

I also agree in the big cities Texas is no longer “LCOL”

 

[miacomet]

Have you lived in either? I’ve lived in both.

Depends on what someone values. Cost of living is extremely reasonable for very large cities with every amenity and entertainment option. Malpractice reform is still better than most other states. No income tax. Extremely ethically diverse. In fact Houston is now considered the most ethnically diverse city in the US - so whether you are from the subcontinent, Asia, Africa, you will find a large community of yours.

Some people genuinely prefer hot and humid over cold and snowy. Maybe that’s what they grew up in.

400k in Texas goes a lot further than 400k in San Francisco, San Diego, denver, Salt Lake City, Boston, nyc etc.

You like mountains. Sorry these cities don’t have mountains - but a lot of people don’t care about those.

Doesn’t WA have zero malpractice caps and Naturopaths.

I have also read on other forums that WA has it’s own version of No Surprise Act that is even worse than the federal one and decimated EM groups but I don’t know how true that is.

I also agree in the big cities Texas is no longer “LCOL”

I admit my $$$ job is in a state with high income taxes, but I still come out ahead, esp with all the deductions I can take as a 1099, and with lower property, sales tax, real estate prices. Decent medmal environment, not as good as TX or CA, but not PA or NY or LA.

But EM is starting not to be worth it at any price.

 

[cyanide12345678]

Doesn’t WA have zero malpractice caps and Naturopaths.

I have also read on other forums that WA has it’s own version of No Surprise Act that is even worse than the federal one and decimated EM groups but I don’t know how true that is.

I also agree in the big cities Texas is no longer “LCOL”

The center of the big cities were always expensive. The area around Rice university in Houston for example. It was expensive as hell in 2009-2012 when i was there. But if you moved to suburbs - the cost of living always was and still is reasonable - sugarland, katy, plano, richardson, tomball etc. plenty of 4000-5000 sqft home, 400-550k on Zillow right now in katy and sugar land. That’s where literally all the Indian and Pakistani doctors live 😅

You just have to make sure to work in a suburb and not the center of the city otherwise you’ll be spending your life on i10 or i69.

 

[miacomet]

The center of the big cities were always expensive. The area around Rice university in Houston for example. It was expensive as hell in 2009-2012 when i was there. But if you moved to suburbs - the cost of living always was and still is reasonable - sugarland, katy, plano, richardson, tomball etc. plenty of 4000-5000 sqft home, 400-550k on Zillow right now in katy and sugar land. That’s where literally all the Indian and Pakistani doctors live 😅

You just have to make sure to work in a suburb and not the center of the city otherwise you’ll be spending your life on i10 or i69.

Plano and Sugarland have absolutely gorgeous and very reasonable homes, to be sure; is there stuff to do there without the aforementioned driving? Can you avoid HOAs?

 

[HemeOncHopeful19]

Plano and Sugarland have absolutely gorgeous and very reasonable homes, to be sure; is there stuff to do there without the aforementioned driving?

Space Cowboys! 😎

 

[cyanide12345678]

Plano and Sugarland have absolutely gorgeous and very reasonable homes, to be sure; is there stuff to do there without the aforementioned driving? Can you avoid HOAs?

Sugarland isnt that far away as long as you don’t drive in rush hour. It was a 30 ish minute commute for me to get to Rice back in the day.

It’s really not that far.

Plano is incredible. If i had moved back to dallas, i would have bought a home in plano or Allen.

Plano is like 25 mins from center of dallas. A 25 minute drive is really nothing in Texas.

These suburbs are massive cities in their own right. Plano alone has a 300k population - plenty to do there. It’s consistently ranked as one of the best cities to live in the USA. It’s no 8 on niche.com as the best city to buy a home in the US, and ranked 8th best school district in the entire country. This is the place to be if you have kids and are raising a family. No. 1 on their list is woodlands - suburb of houston (this is far though - like 60 mins from downtown).

 

[hoot504]

Houston is awesome. I moved away after residency and now I drool over the real estate there.

 

[miacomet]

Sugarland isnt that far away as long as you don’t drive in rush hour. It was a 30 ish minute commute for me to get to Rice back in the day.

It’s really not that far.

Plano is incredible. If i had moved back to dallas, i would have bought a home in plano or Allen.

Plano is like 25 mins from center of dallas. A 25 minute drive is really nothing in Texas.

These suburbs are massive cities in their own right. Plano alone has a 300k population - plenty to do there. It’s consistently ranked as one of the best cities to live in the USA. It’s no 8 on niche.com as the best city to buy a home in the US, and ranked 8th best school district in the entire country. This is the place to be if you have kids and are raising a family. No. 1 on their list is woodlands - suburb of houston (this is far though - like 60 mins from downtown).

How do kids get around before they can drive? 25 minutes, not bad at all. Looks beautiful, is it possible to avoid HOA fees?

 

[bravotwozero]

Correcting above info on Houston Methodist. We’re now an APP shop and pay is around $220/hr-$250/hr at the freestanding ERs (RVU so can go higher) to $340/hr for a high producer in one of our busy hospitals.

Wait, 220-250, that’s $180 base plus rvus right?

Haven’t worked at a Methodist FSED since 2021, was averaging $200/hr with rvus. OK for an FSED but these places were busy.

 

[Rekt]

Correct on rate and busy-ness. Rate increased in Jan to reflect volume.

Do you guys stuff all the new hires at the FSEDs like 99% of what most similar groups are doing?

 

[cyanide12345678]

Correct on rate and busy-ness. Rate increased in Jan to reflect volume.

How busy are these places?

 

[cyanide12345678]

It varies tremendously per site. Cinco Ranch, Woodlands probably 20/day average, Spring/Kirby/Pearland can be 60 on a bad day. They each have a mid level with you a portion of the day.

What are they paying for the 20/day site?

 

[miacomet]

I’m not in any sort of leadership position here, but the guys they just hired seem to be scheduled equitably just like everyone else.

Fwiw I’m usually at or near the top of the productivity scale, so take that into account with the above numbers.

Yikes, how is this worth it?
I guess the medmal climate helps, hopefully a lot

 

[Splenda88]

The center of the big cities were always expensive. The area around Rice university in Houston for example. It was expensive as hell in 2009-2012 when i was there. But if you moved to suburbs - the cost of living always was and still is reasonable - sugarland, katy, plano, richardson, tomball etc. plenty of 4000-5000 sqft home, 400-550k on Zillow right now in katy and sugar land. That’s where literally all the Indian and Pakistani doctors live 😅

You just have to make sure to work in a suburb and not the center of the city otherwise you’ll be spending your life on i10 or i69.

Are you taking about pre-covid market? 400-550k might get you 2400-3000 relatively new homes in these suburbs.

 

[Le MD]

Any additional insight into each of the hospital systems? Looks like the main hospital systems are the following:

1. Houston Methodist
2. Memorial Hermann
3. HCA Houston
4. Oak Bend


Let me know if im missing anyone. Would love to hear more about each