How do EPs rank in the overall picture of earnings?

[Newyawk]

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Considering all factors like health insurance and even malpractice insurance, how do EPs fare? Do they still take home a significantly smaller package than the average PP doc (derm, surg subspec, etc) who doesnt get these benefits?

 

[Alvarez13]

I googled this: Medscape: Medscape Access

 

[Zebra Hunter]

As far as average earnings for all doctors, we are above average in pay. If you go by specialty, we are right in the middle, but most of the specialists above us are much fewer in number.

 

[GeneralVeers]

Also remember most of the specialists work many more hours than us. Typically we work between 30-50 hours per week. Most of the specialties are working 60-100.

 

[Pudortu]

Also remember most of the specialists work many more hours than us. Typically we work between 30-50 hours per week. Most of the specialties are working 60-100.

I once heard that on a per hour basis we make more than just about everyone except maybe the sub specialist surgeon

 

[namethatsmell]

I once heard that on a per hour basis we make more than just about everyone except maybe the sub specialist surgeon

And on a per-hour basis probably no other field works as hard as us. There ain't no free lunch.

 

[DO3]

I will work 12 days and about 105 hrs/month and will make at least $285k/yr, likely closer to $300k. Not many professions where you can do that.

 

[Newyawk]

I will work 12 days and about 105 hrs/month and will make at least $285k/yr, likely closer to $300k. Not many professions where you can do that.

It seems based just on sdn reports that location matters so much in EM. Is it the same in other fields or is it even more important in EM?

 

[emergentmd]

The Avg Primary care doc/Pediatrician I know work about 50 hrs/wk. 9-5 + 10 per week charting/admin stuff. If they made the avg of EM medicine, it is about $225/hr = $585K/yr

So EM docs working 50hr/wk, would make over 2x the PCP counterpart.

I know orthopedics surgeons who work about 60 hrs a week counting call/late cases. That would put them at $700k/yr

 

[Newyawk]

The Avg Primary care doc/Pediatrician I know work about 50 hrs/wk. 9-5 + 10 per week charting/admin stuff. If they made the avg of EM medicine, it is about $225/hr = $585K/yr

So EM docs working 50hr/wk, would make over 2x the PCP counterpart.

I know orthopedics surgeons who work about 60 hrs a week counting call/late cases. That would put them at $700k/yr

Some of them actually make that tho

 

[emergentmd]

Some of them actually make that tho

I know some do but I it is not average. If we took high end EM earners, working 60 hrs a week would put them close to 1 Mil. $325/hr= over 1 mil.

 

[Brigade4Radiant]

EM is the highest by that most medical students can realistically get also it is very flexible location wise. Friends from the Midwest easily found jobs in Denver and South Beach. Also the residency is short 3-4 years vs 5-7 that surgery subspecialty requires so that’s like 900k more that you have.

 

[emergentmd]

There is definitely opportunity costs. If as an EM doc you are making 300K coming out and a Gen surge made 400k coming out, it would take the Gen surg 6 yrs to catch up without accounting for time loss/opportunity loss/loan interests. Realistically that is a 9-10 yr cost.

 

[anbuitachi]

And on a per-hour basis probably no other field works as hard as us. There ain't no free lunch.

Lol Lets not look down on how hard other doctors work. The work is different that's all. Many doctors work hard. At least as a resident, id much rather do my EM rotation (21 12 hr shifts over the month) over again than surgery or medicine rotation. Time passed fast in all 3 b/c all 3 were really busy. But at least i had more time on EM to get more sleep in after work and recharge.

EM has one of the highest earning potentials because there are only so many hours in 1 day. You can work 24/7 in many fields and you will not break 1M or come close. I checked a few years back and like someone said, only the highest paid specialties like neurosurg/ortho spine can compare with EM in terms of $/hr.

 

[BoardingDoc]

Lol Lets not look down on how hard other doctors work. The work is different that's all.

You have completely missed namethatsmell's point. The sentiment isn't that EPs work harder than other doctors. The sentiment is that per hour working EP's are generally busier than other specialties. The raw amount of work per day might be higher in EM, or it may well be higher in surgery, or the ICU or wherever, but that wasn't the point.

 

[Mbekweni]

It seems based just on sdn reports that location matters so much in EM. Is it the same in other fields or is it even more important in EM?

I often see the sentiment that location matters a ton in EM. I think it matters a little bit, but there are far bigger differences to be had with small changes in geographic location (ie at a hospital, individual group) basis. There is some basic supply and demand that can jump an hourly rate up a little bit, especially if a hospital is providing an ER group a subsidy. However, there is still the basic fact that most insurance plans (particularly medicare) will reimburse similarly for each hospital no matter which location. The big difference in pay with my experience comes from payer mix, volume, and acuity, occasionally with a bump if you get all 3 plus critical access site designation so medicare and medicaid pay better. The metric I look at most closely when assessing how well a site pays is Collections/patient x patients/hr and how that relates to $/hr in overall compensation. Small variations in the neighborhood demographics that feed into individual hospitals can make a huge difference in hourly pay, much more so than West, East, Southern US etc. Unfortunately this is only true for private groups. For the big CMGs this doesn't always hold true since any extra profit your site generates can be shared across the whole corporation and used to subsidize poorly performing sites elsewhere, give money to shareholders/executives etc.

Finally, something I face acutely as a California EP is cost of living and taxes. Ultimately what matters most with regards to compensation is post tax, post basic expenses (ie food/housing/transportation) income. There are some insanely good sites in California but with a ~10% state tax rate and high housing prices I face about a 3-4k monthly post tax cost of living penalty between living in California compared to Texas/Alaska etc despite working at a pretty darn good site.

 

[Vandalia]

It also may be worthwhile to consider career earnings. EM is a relatively young specialty, so we don't have extremely good data on the length of a career. I am still at it, but I am an exception and I am also literally counting down the hours.

If you are so burned out that you are retiring at 55 that has to be taken into consideration in comparison with a few of the primary care docs I know who are happy plodding along into their 70's. Or a few faculty from my medical school days who are still going at it in their 80's. I made an NFL analogy in another thread, and I like it. While they are earning a ton of money, the smart ones also keep in mind that they have 5 years of earning to provide for a lifetime.

 

[Newyawk]

It also may be worthwhile to consider career earnings. EM is a relatively young specialty, so we don't have extremely good data on the length of a career. I am still at it, but I am an exception and I am also literally counting down the hours.

If you are so burned out that you are retiring at 55 that has to be taken into consideration in comparison with a few of the primary care docs I know who are happy plodding along into their 70's. Or a few faculty from my medical school days who are still going at it in their 80's. I made an NFL analogy in another thread, and I like it. While they are earning a ton of money, the smart ones also keep in mind that they have 5 years of earning to provide for a lifetime.

Yea thats tough too. How old are you if you dont mind?

 

[BAM!]

It also may be worthwhile to consider career earnings. EM is a relatively young specialty, so we don't have extremely good data on the length of a career. I am still at it, but I am an exception and I am also literally counting down the hours.

If you are so burned out that you are retiring at 55 that has to be taken into consideration in comparison with a few of the primary care docs I know who are happy plodding along into their 70's. Or a few faculty from my medical school days who are still going at it in their 80's. I made an NFL analogy in another thread, and I like it. While they are earning a ton of money, the smart ones also keep in mind that they have 5 years of earning to provide for a lifetime.

Not sure how anyone could keep a full time ER schedule into their 60s...

 

[EctopicFetus]

The beauty of EM is that you can really work minimally and easily transition your practice. You can also control your pace.

When i moonlit the place was super low volume and we had docs there who did 1 -24 a week. My current job we allow our docs to work as little as 2 shifts per week (and then they can take vacation and go down even further in hours.

 

[emergentmd]

Burnout is real if you work 140+ hrs at a dysfunctional/busy/administrative stranglehold of a hospital. There are alot of options where burnout is much less than most specialties.

FSER where I see 6-10 pts/24 hrs
Urgent Care where its cold and sniffles
low volume rural ERs.

I work 4-6 somewhat difficult shifts a month
The rest is Free Standings which is cake.

 

[southerndoc]

Burnout is real if you work 140+ hrs at a dysfunctional/busy/administrative stranglehold of a hospital. There are alot of options where burnout is much less than most specialties.

FSER where I see 6-10 pts/24 hrs
Urgent Care where its cold and sniffles
low volume rural ERs.

I work 4-6 somewhat difficult shifts a month
The rest is Free Standings which is cake.

It's all up to the individual. I've worked 17-19 10-hour shifts/month at a 150,000-volume Level II trauma and comprehensive stroke center with incredibly high acuity (28% admission rate) and have been doing so for more than 6 years. I definitely do not feel burnt out and don't have any regrets when I have to go into work.

I've known of people who have worked in low acuity/low volume places and have gotten burnt out in 2 years.

My shifts have been cut to 12/month due to the incoming residency starting tomorrow. I will probably go crazy from boredom having so many days off (although some will be filled preparing lectures and such).

 

[Vandalia]

I at a 150,000-volume Level II trauma and comprehensive stroke center with incredibly high acuity (28% admission rate) and have been doing so for more than 6 years.

It is certainly debatable, but I would argue that "burnout" does not come from high acuity patients, but rather from the patients who should have never been in the ED in the first place. If you are doing this job, you almost certainly believe Emergency Medicine is fun and could keep doing it for a very long time; it is being a glorified school nurse that is the problem.

 

[Hercules]

Not sure how anyone could keep a full time ER schedule into their 60s...

We had 1/4 of our group over 60 when I got here so it’s definitely doable. The bigger question though is why would you work full time into your 60s? With the amount we earn we should all be financially independent well before that. I have no intentions of working at that point, but it’s not because of burnout or my field of choice. Work is fun but there are a lot of other things out there.


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[GonnaBeADoc2222]

It is certainly debatable, but I would argue that "burnout" does not come from high acuity patients, but rather from the patients who should have never been in the ED in the first place. If you are doing this job, you almost certainly believe Emergency Medicine is fun and could keep doing it for a very long time; it is being a glorified school nurse that is the problem.

I can do high acuity all day long. I love it. The more the better. This is what I went into the field for and trained hard to do. It's awesome.

What ginds my gears is the 12 patients that check in at 130am for:

"Persistent cough x 2 months."
"Ran out of albuterol."
"Asymptomatic HTN"
"Saw PMD earlier for whatever problem, didn't like answer, comes to ED for 'second opinion' "
"Man cold. Didn't take OTC meds."

And when the nurse is bugging you about all the misbehaving patients with the above while you are trying to manage the critically ill one.

I think as a new grad though you should work in a place with a high volume and mix of very high and very low acuity...at least in the beginning.

 

[southerndoc]

I see my share of those chronic problem patients along with my share of drug seekers. I guess I just view it differently. I never ask "why are you here?" unless I'm confused about their presenting complaint. I'm a physician who likes to treat patients, so if their cough has been ongoing for 3 months, if they're vomiting is self-induced after a cocaine binge, or if their BP is 145/90 (and mine is higher than theirs listening to their story), I don't let it get to me. I'm here to help and feel it's an honor to do so.

 

[Brigade4Radiant]

I don't mind reasonable chronic patients. They are part of the reason why EM pays so well.

 

[Mbekweni]

I don't mind reasonable chronic patients. They are part of the reason why EM pays so well.

I used to get really annoyed by the worried well, low acuity patients. Now I see that as part of the job and most importantly part of what pays the bills. If we only saw "true emergencies" I would likely have a much lower volume and likely lower salary (although perhaps staffing could be adjusted so it would stay reasonable).

 

[Candidate2017]

Considering all factors like health insurance and even malpractice insurance, how do EPs fare? Do they still take home a significantly smaller package than the average PP doc (derm, surg subspec, etc) who doesnt get these benefits?

Have you rotated through EM?

Money is but one data point in choosing a specialty, and a poor factor. DIfferent specialties earn money in ways that can be vastly different. Employed hourly rate in EM vs ownership stake in surgical subspecialties (facility fees, ancillary products, billings from associates), for example. It's more important whether you can tolerate the BS that's unique to a specialty for 30 years in order to earn that money.

 

[Candidate2017]

Lol Lets not look down on how hard other doctors work. The work is different that's all. Many doctors work hard. At least as a resident, id much rather do my EM rotation (21 12 hr shifts over the month) over again than surgery or medicine rotation. Time passed fast in all 3 b/c all 3 were really busy. But at least i had more time on EM to get more sleep in after work and recharge.

It's the opposite for me. The circadian shifts, insomnia afterwards, inhaling food, no time to wipe my butt, getting constipated, constant monitoring of labs/imaging, calling consultants, gimme a sammich patients, annoying families constantly interrupting me in the fishbowl, terrible warm body traveling RNs. On most days in IM I could peace out after putting orders in and maybe answer a page or two. If it wasn't for attending rounds, I could be done by 9 am.

 

[anbuitachi]

It's the opposite for me. The circadian shifts, insomnia afterwards, inhaling food, no time to wipe my butt, getting constipated, constant monitoring of labs/imaging, calling consultants, gimme a sammich patients, annoying families constantly interrupting me in the fishbowl, terrible warm body traveling RNs. On most days in IM I could peace out after putting orders in and maybe answer a page or two. If it wasn't for attending rounds, I could be done by 9 am.

So you do EM and IM?

 

[emergentmd]

It's all up to the individual. I've worked 17-19 10-hour shifts/month at a 150,000-volume Level II trauma and comprehensive stroke center with incredibly high acuity (28% admission rate) and have been doing so for more than 6 years. I definitely do not feel burnt out and don't have any regrets when I have to go into work.

I've known of people who have worked in low acuity/low volume places and have gotten burnt out in 2 years.

My shifts have been cut to 12/month due to the incoming residency starting tomorrow. I will probably go crazy from boredom having so many days off (although some will be filled preparing lectures and such).

How difficult a place to work is not related to the acuity. Its pph + admin + ER logistics + support staff + nursing staff

I could work at a level 1 200K ER, see 2 pph with a well run/staffed ER without breaking a sweat. Better than a low acuity ER where I see 1.5pph and have to do everything from begging for labs, calling labs to check if they got it, call the Rad tech to do my studies, call the radiologist to see if they got he study, calling the specialist and start an argument after taking 2 hrs to call me back, transfer everything even concerning, calling every specialists in the hospital bc/ the hospitalist is too lazy to call them......

 

[RoyBasch]

I can do high acuity all day long. I love it. The more the better. This is what I went into the field for and trained hard to do. It's awesome.

What ginds my gears is the 12 patients that check in at 130am for:

"Persistent cough x 2 months."
"Ran out of albuterol."
"Asymptomatic HTN"
"Saw PMD earlier for whatever problem, didn't like answer, comes to ED for 'second opinion' "
"Man cold. Didn't take OTC meds."

And when the nurse is bugging you about all the misbehaving patients with the above while you are trying to manage the critically ill one.

I think as a new grad though you should work in a place with a high volume and mix of very high and very low acuity...at least in the beginning.

I agree, I trained and live for high acuity patients. They are literally the reason I get up in the morning to go to work. The low acuity patients don't really phase me because...well...they're easy. Those 5 patients you listed are all minimal documentation, minimal risk/liability, 0-2 tests and near immediate dc. If anything at this point in my life I like that they pad my metrics as far as PPH and LOS.

The patients that burn me out are the "medium acuity" patients that can be very frustrating to deal with:

-Middle age/medium comorbidity with vague chief complaint, invariably a poor historian with "generalized weakness" or "dizziness" that could be anything catastrophic from an aortic dissection or posterior circulation CVA but 99% of the time is nothing.
-chronic abdominal pain patient who 99% of the time is really just there for opiates but swears "it's completely different this time" and you cannot totally rule out an ectopic, ovarian torsion, appy, SBO, etc. without labs/pelvic/CTAP/US etc.
-vague constellation of neuro symptoms that don't obviously correlate with a focal lesion but are hard to totally rule out a serious neurologic process.

These patients then have some combination of ridiculous allergies (including 'anaphylaxis' to contrast of any kind), difficult IV access, cluster B personality traits, etc.

When 4-5 of these types of patients show up in an hour (typically between 0200-00600) now its kind of a buzz kill for my work satisfaction.