How was EM 10 years ago compared to now?

[RustedFox]

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To better illustrate my "OK BOOMER" argument (and to think I was anti "OK BOOMER" sentiment not so long ago)...

"Hi, I'm a BOOMER. I spent a lot of time and energy building this practice and group into a stable and well-running machine. It has made me a lot of wealth. I'm nearing retirement. Should I...."

A.) Maintain the integrity of myself, my partners, and the group by passing the torch and keeping control of the practice with the physicians, OR...
B.) SCREW 'EM. Sell it to corporate d!ckweeds who can't "medicine" for a stack of cash that I can never spend. I got mine, suckers. GLMF'ers.

Most of the BOOMERS chose (B), laying waste to the EM landscape for future grads, perhaps never to be restored.

"All that money you made will never buy back your soul." - Bob Dylan, "Masters of War"

 

[EctopicFetus]

To better illustrate my "OK BOOMER" argument (and to think I was anti "OK BOOMER" sentiment not so long ago)...

"Hi, I'm a BOOMER. I spent a lot of time and energy building this practice and group into a stable and well-running machine. It has made me a lot of wealth. I'm nearing retirement. Should I...."

A.) Maintain the integrity of myself, my partners, and the group by passing the torch and keeping control of the practice with the physicians, OR...
B.) SCREW 'EM. Sell it to corporate d!ckweeds who can't "medicine" for a stack of cash that I can never spend. I got mine, suckers. GLMF'ers.

Most of the BOOMERS chose (B), laying waste to the EM landscape for future grads, perhaps never to be restored.

"All that money you made will never buy back your soul." - Bob Dylan, "Masters of War"

Ill play devils advocate with some pretend numbers. I’m genuinely curious. Keep in mind most SDGs have little to no real buy in anymore. The old days of big buy ins is gone, they are the ones who sold IMO.

Let’s say the avg EM job today pays $200/hr. The SDG in question makes $300/hr. How much should you pay to buy into said practice? Thats at least 150k/yr delta plus control and continued upside. What should you pay for that?

Compare to other medical practices and to non medical businesses.

 

[emergentmd]

You never stop competing in life. Small percentage trips over their feet and become successful. Most compete to become successful and many fail.

Being a doc alone is successful. There is nothing wrong with working 30 hrs/wk and making 250-300K/yr. Most would kill for that. You could easily retire in 10 yrs if you live a modest life.

Money isn't all what successful means. I could easily work for a CMG and retire at 55 comfortably. I choose to take a risk b/c its worth it to make your own decisions and get satisfaction from owning a business and creating 20 jobs.

 

[Birdstrike]

You never stop competing in life. Small percentage trips over their feet and become successful. Most compete to become successful and many fail.

Being a doc alone is successful. There is nothing wrong with working 30 hrs/wk and making 250-300K/yr. Most would kill for that. You could easily retire in 10 yrs if you live a modest life.

Money isn't all what successful means. I could easily work for a CMG and retire at 55 comfortably. I choose to take a risk b/c its worth it to make your own decisions and get satisfaction from owning a business and creating 20 jobs.

I agree. Becoming a doctor, doing it well, garnering more respect and making more money than 98% of Americans (and more than 99.9% of the world) is being pretty darn successful in its own right; if you're happy doing it. To achieve that amount of "success," or at least what 99% of the population would agree is success, but to be bitter about it while allowing your envy of someone else make you feel unsuccessful, means one either needs to redefine their definition of success, or change course to something that makes them happy.

That was me 10 years ago. I had more "success" than 99.9% of the population, but I wasn't happy. The load on me was very heavy. I was always envying someone else's "better," "easier position" or "lucky break" that wasn't available to me. I spent too much time feeling bitter and cynical about the fact that my "success" wasn't making me happy like I thought it would. So I took a chance, left my comfort zone for a while and made a big change. My attitude, happiness, family and life are much better for it.

That's my 2 cent experience and opinion for what it's worth.

 

[Siggy]

If all you need to do to make $700k a year is "work harder," then wouldn't the answer to decreasing reimbursements also to be "work harder" and not complain about it? After all, if it's all intrinsic, then it shouldn't matter what the external environment is.

...but all these "more elbow grease... MOAR" people are now complaining that they've run out of elbow grease to make the same amount of money that they've become accustomed to.

 

[GeneralVeers]

If all you need to do to make $700k a year is "work harder," then wouldn't the answer to decreasing reimbursements also to be "work harder" and not complain about it? After all, if it's all intrinsic, then it shouldn't matter what the external environment is.

...but all these "more elbow grease... MOAR" people are now complaining that they've run out of elbow grease to make the same amount of money that they've become accustomed to.

I do the opposite. I try to make more or the same while expending less effort and time. That was why locums was a reasonable proposition for a few years.

 

[Birdstrike]

If all you need to do to make $700k a year is "work harder,"

No, no, no, no. That's absolutely not what you need to do. At this level, we all work plenty hard enough. Who said, "all you need to do is 'work harder'"? That's the worst plan of all. Don't do that. The secret is to either "work smarter" and get more out of the same work effort (either better higher paying job, or passive income), or to find work that doesn't feel as much, or not at all, like work.

"Work harder" = Burnout, perpetual frustration, anxiety.

"Work Smarter" and "Find work that's not 'work'" = Success, happiness, contentment.

 

[RustedFox]

No, no, no, no. That's absolutely not what you need to do. At this level, we all work plenty hard enough. Who said, "all you need to do is 'work harder'"? That's the worst plan of all. Don't do that. The secret is to either "work smarter" and get more out of the same work effort (either better higher paying job, or passive income), or to find work that doesn't feel as much, or not at all, like work.

"Work harder" = Burnout, perpetual frustration, anxiety.

"Work Smarter" and "Find work that's not 'work'" = Success, happiness, contentment.

RustedAshtray nods in agreement.

 

[sloh]

No, no, no, no. That's absolutely not what you need to do. At this level, we all work plenty hard enough. Who said, "all you need to do is 'work harder'"? That's the worst plan of all. Don't do that. The secret is to either "work smarter" and get more out of the same work effort (either better higher paying job, or passive income), or to find work that doesn't feel as much, or not at all, like work.

"Work harder" = Burnout, perpetual frustration, anxiety.

"Work Smarter" and "Find work that's not 'work'" = Success, happiness, contentment.

Brilliantly slack. And do not be ashamed. Get that fu money!

 

[Vandalia]

Retired, as in, you left medicine for good?

You and I have been on this forum for a lot of years together. I wasn't aware you had recently retired. Congrats!

Yes, we have been. Thanks.

Retirement is a bit less discrete in EM. In primary care, you are working one day and then you aren't the next. In EM you can drag it out a bit, "Come on, you can do two for us. We will give you the ones you really like." Sometimes I felt that if my phones were tapped the tapes would sound like I was talking with a drug dealer.

But yes, I have stopped all clinical work. That was right before COVID hit, so it made the decision making there a little easier. I am still winding up a bit of work for the hospital related to credentialing, JACHO, etc.

Don't ask how old I am. I am old, but the guy who was neurology department chair when I was a medical student is apparently still chugging along as a clinical faculty member. I didn't keep working because I had six wives and ten million in debt. Financially I could have quit years ago. But I knew I - like almost every EM - would not be happy spending all day on the couch watching Judge Judy with my wife.

Here is the key, fundamental, piece of wisdom that you need to understand: You can have exactly the same job, in exactly the same place, but it is dramatically different if you know you have to show up to work, versus if you know - and they know - that you can say "screw you" and quit the next day. When you have complete freedom - and they know you have complete freedom - then EM can be kind of fun.

The funny thing was that I threatened to retire three of four times, along with a couple of old, similarly thinking guys in other specialties in protest to stupid medical administrator decisions. You could almost see the cogwheels turning in the CEO's eyes as he suddenly saw all his medical staff, credentialing, JACHO, etc. work vanish in front of his eyes. Then all of a sudden he was open to reason. But to pull all that off, you need to have people who make themselves indispensable, but at the same time, are more than happy to walk away.

The sooner you reach the point where you can walk away, the better everything becomes.

 

[Birdstrike]

...you need to [make yourself] indispensable, but at the same time...more than happy to walk away.

The sooner you reach the point where you can walk away, the better everything becomes.

This is gold. So few people do this. But it's gold. I should be everyone's goal. Congrats.

 

[Siggy]

I do the opposite. I try to make more or the same while expending less effort and time. That was why locums was a reasonable proposition for a few years.

No no... I agree... the best is to work less hours for more pay. However the entire discussion about opportunities and work place situation earlier devolved into, "you whippersnappers just don't wanna work! We built this, we deserve this, and you have the exact same opportunity that we did!"

For example, this post:

How was EM 10 years ago compared to now?

I'm trying to get a decent idea of what the last decade has been like for specialties I'm interested in and what implications that means the next decade will be like. I also posted a similar question on radiology. basically, has your work flow gone up for the same salary? Do you think new...

forums.studentdoctor.net

Forming a successful business, be it MSFT, starting a CMG, or owning a FSED is always going to be part luck (is this opportunity still available to be seized) and part hard work. The division is separate. Saying, "Naw, bro, you just have to work harder to make $700k a year owning a FSED" like that opportunity is still around either in terms of market saturation or legislative barriers is the functional equivalent of saying, "Sure, the hourly wages are less and there's less profit sharing potential, but sure, all you really gotta do to make the same bank as 10 years ago is just work harder! What are you, too lazy to work hard?"


...or is someone going to argue that anyone can form the next MSFT? I mean... exactly how big is the operating system moat now a days? I mean... someone had to start Envision, truly the opportunity to start a CMG still exists to the same extent... right?

 

[Apollyon]

I think you two need to carry this into a private message thread. 🙂

For clarity, this person said that, you suggested it, and I did - and s/he didn't. This person did post again after my PM, but did not comply with their own statement.

 

[Siggy]

For clarity, this person said that, you suggested it, and I did - and s/he didn't. This person did post again after my PM, but did not comply with their own statement.

For clarity sake, I'm not Kuratz and Kuratz hasn't posted in response to Apollyon in this thread since the suggestion to take it to PMs.

 

[Apollyon]

For clarity sake, I'm not Kuratz and Kuratz hasn't posted in response to Apollyon in this thread since the suggestion to take it to PMs.

I didn't say it was you. I "know" you from SDN, but, I really don't know anything about that person.

 

[Birdstrike]

_____ and the like just like to complain, protest, and hope that someone will make their life better.

Often the haters want those more successful to make their life better and if they won't, dragging them down is second best. Taking action to better themselves is uncomfortable, so they don't even allow themselves to consider it's possible. "Life isn't fair." "I'm not lucky like them." "The Golden Years are over." "Everything sucks now." "Those before us pillaged and left us with nothing." "The system is stacked against me."

Those are all essentially negative affirmations that people tell themselves to guarantee inaction and remove any chance of success, because that what's easiest. Excuses are easier than solutions.

 

[Birdstrike]

Repeat these words 10 times every morning and 10 times before you go to bed: "I will determine the cost of success, then I will pay it."

It sounds corny, but this actually works. It might take 1 day, 10 days, or 3,000 days, but once you start looking for open doors, you can open them the minute you see them, unlike when you don't even check to see if they're open.

 

[Apollyon]

Often the haters want those more successful to make their life better and if they won't, dragging them down is second best.

That's called the "crab pot mentality". In a crab pot, if one tries to climb out, the others will drag it back down. It's like calling people who succeed and leave the neighborhood sellouts.

 

[Birdstrike]

Maybe what worked for

That's called the "crab pot mentality". In a crab pot, if one tries to climb out, the others will drag it back down. It's like calling people who succeed and leave the neighborhood sellouts.

Exactly. Crabs in a bucket, as they said in the ‘hood.

 

[EctopicFetus]

No no... I agree... the best is to work less hours for more pay. However the entire discussion about opportunities and work place situation earlier devolved into, "you whippersnappers just don't wanna work! We built this, we deserve this, and you have the exact same opportunity that we did!"

For example, this post:

How was EM 10 years ago compared to now?

I'm trying to get a decent idea of what the last decade has been like for specialties I'm interested in and what implications that means the next decade will be like. I also posted a similar question on radiology. basically, has your work flow gone up for the same salary? Do you think new...

forums.studentdoctor.net

Forming a successful business, be it MSFT, starting a CMG, or owning a FSED is always going to be part luck (is this opportunity still available to be seized) and part hard work. The division is separate. Saying, "Naw, bro, you just have to work harder to make $700k a year owning a FSED" like that opportunity is still around either in terms of market saturation or legislative barriers is the functional equivalent of saying, "Sure, the hourly wages are less and there's less profit sharing potential, but sure, all you really gotta do to make the same bank as 10 years ago is just work harder! What are you, too lazy to work hard?"


...or is someone going to argue that anyone can form the next MSFT? I mean... exactly how big is the operating system moat now a days? I mean... someone had to start Envision, truly the opportunity to start a CMG still exists to the same extent... right?

You do realize app started in 2015. They have over 100 contracts. Or is 5 years ago too long?
You only need 1 contract and yOur life will improve.

 

[EctopicFetus]

So I decided to look.. APP has 160 contracts.. the company didn't exist in 2014.. Think about that.. I deplore their model but they are to some degree successful. They do this with FP docs as medical directors. These folks lord over the silly EM docs who sit on their hands and allow their careers to be controlled.

The number is from the "about APP" on their press release from a few months ago.. It is chock full of BS.. but the 160 comes from there.

Headquartered in Brentwood, Tennessee, American Physician Partners was founded in 2015 to provide a better alternative to hospitals for their clinical outsourcing needs. Since its inception, the company has grown to approximately 160 care sites and has become a recognized leader in the provision of exceptional emergency medicine and hospital medicine management services to hospitals and healthcare systems nationwide. APP has earned its 100 percent client retention rate by remaining true to its purpose of exceeding the expectations of its patients, providers and hospital partners. Learn more at Emergency Medicine Leaders with 100% Hospital Partner Retention Rate.

They don't have 100% client retention..

 

[Groove]

So I decided to look.. APP has 160 contracts.. the company didn't exist in 2014.. Think about that.. I deplore their model but they are to some degree successful. They do this with FP docs as medical directors. These folks lord over the silly EM docs who sit on their hands and allow their careers to be controlled.

The number is from the "about APP" on their press release from a few months ago.. It is chock full of BS.. but the 160 comes from there.

Headquartered in Brentwood, Tennessee, American Physician Partners was founded in 2015 to provide a better alternative to hospitals for their clinical outsourcing needs. Since its inception, the company has grown to approximately 160 care sites and has become a recognized leader in the provision of exceptional emergency medicine and hospital medicine management services to hospitals and healthcare systems nationwide. APP has earned its 100 percent client retention rate by remaining true to its purpose of exceeding the expectations of its patients, providers and hospital partners. Learn more at Emergency Medicine Leaders with 100% Hospital Partner Retention Rate.

They don't have 100% client retention..

Yeah, it's crazy how fast they have grown. I had never heard of them until a few years ago. That being said, don't forget NETEP. They were a well established SDG controlling 6 EDs if memory serves and had maintained that contract for a long time. APP sprang up and they folded like a deck of cards and next thing I know, the medical director is one of APP's regional directors.

 

[Groove]

While we're on the topic, does anybody know what APP is paying their docs in E or NE TN?

 

[RustedFox]

So I decided to look.. APP has 160 contracts.. the company didn't exist in 2014.. Think about that.. I deplore their model but they are to some degree successful. They do this with FP docs as medical directors. These folks lord over the silly EM docs who sit on their hands and allow their careers to be controlled.

The number is from the "about APP" on their press release from a few months ago.. It is chock full of BS.. but the 160 comes from there.

Headquartered in Brentwood, Tennessee, American Physician Partners was founded in 2015 to provide a better alternative to hospitals for their clinical outsourcing needs. Since its inception, the company has grown to approximately 160 care sites and has become a recognized leader in the provision of exceptional emergency medicine and hospital medicine management services to hospitals and healthcare systems nationwide. APP has earned its 100 percent client retention rate by remaining true to its purpose of exceeding the expectations of its patients, providers and hospital partners. Learn more at Emergency Medicine Leaders with 100% Hospital Partner Retention Rate.

They don't have 100% client retention..

Yeah, they took the well running, nice to work at shop that I was at and turned it into a dumpster fire.

The only reason they were able to land the contract is because hospital admin wanted the old CMG to go to 3m/5m limits.

TEAMHealth said no. APP said yes.

Thanks a LOT, admin. Way to eff up yet another thing.

 

[Birdstrike]

Forming a successful business, be it MSFT, starting a CMG, or owning a FSED is always going to be part luck (is this opportunity still available to be seized) and part hard work. The division is separate. Saying, "Naw, bro, you just have to work harder to make $700k a year owning a FSED"...

Looking back 10 years and doing what guys did back then to be successful now, misses the boat. You have to look forward ten years to find out what you need to do now, be successful then. There's not easy-to-follow cookbook for that. Nor was there 10 years ago for the people who are sitting pretty now. The whole point is, we can't tell you what that is. You need to use creative thinking to find out what that is before everyone else already has. I know what that was for me 10 years ago. But I can't tell you what that is for you now, and in 10 years. It's not about failing to do what some others did 10 years ago. It's about finding what will work for you now and ten years in the future. It's not necessarily a constant. It wasn't 10 years ago and won't be 10 years from now. You've got to figure that out in real-time for yourself. And what works for you isn't necessarily what works for someone else. But when you've arrived you'll know it.

10 years ago I saw the writing on the wall, retired from EM and did an Interventional Pain fellowship years before it was even an official subspecialty of EM, and I'm much happier now. No one laid that plan out for me, in risk-free, easy to follow cookbook form 10 years ago. I had to use creative thinking, an open mind, calculated risk and let go of learned helplessness and resentment of others' successes. What works for you may be different from what I and others have done, but it won't be easy and it won't be handed to you on a silver platter by someone who's already done it.

 

[EctopicFetus]

Yeah, it's crazy how fast they have grown. I had never heard of them until a few years ago. That being said, don't forget NETEP. They were a well established SDG controlling 6 EDs if memory serves and had maintained that contract for a long time. APP sprang up and they folded like a deck of cards and next thing I know, the medical director is one of APP's regional directors.

Well the hospital was growing and I think they were becoming less and less profitable. I also think there was a lot of risk on the table for them and they folded. New rates at baseline but perhaps shrinking. E TN is interesting because there are a ton of FP/IM docs working in the EDs so they are driving the rates down. I know some of the folks there are unhappy and leaving. they had a decent bit of turnover and are actively hiring at a bunch of those sites.

Im guessing they will wise up soon and open up an ED residency and then they can have EM trained docs and a glut to staff their places and pay rock bottom prices.

 

[EctopicFetus]

Looking back 10 years and doing what guys did back then to be successful now, misses the boat. You have to look forward ten years to find out what you need to do now, be successful then. There's not easy-to-follow cookbook for that. Nor was there 10 years ago for the people who are sitting pretty now. The whole point is, we can't tell you what that is. You need to use creative thinking to find out what that is before everyone else already has. I know what that was for me 10 years ago. But I can't tell you what that is for you now, and in 10 years. It's not about failing to do what some others did 10 years ago. It's about finding what will work for you now and ten years in the future. It's not necessarily a constant. It wasn't 10 years ago and won't be 10 years from now. You've got to figure that out in real-time for yourself. And what works for you isn't necessarily what works for someone else. But when you've arrived you'll know it.

10 years ago I saw the writing on the wall, retired from EM and did an Interventional Pain fellowship years before it was even an official subspecialty of EM, and I'm much happier now. No one laid that plan out for me, in risk-free, easy to follow cookbook form 10 years ago. I had to use creative thinking, an open mind, calculated risk and let go of learned helplessness and resentment of others' successes. What works for you may be different from what I and others have done, but it won't be easy and it won't be handed to you on a silver platter by someone who's already done it.

Hence why doing US or CCM right now isn't a homerun. I just listened to a podcast about an EM doc from Indiana who became a developer and runs $150m worth of real estate. He created that from nothing and learned all about it, leveraged the reality that he worked with a bunch of people who make 400k+ and have money to spare and took off from there.

Being successful isn't an easy to follow guide. If you want to use a cookbook method you can. Find a niche that is incredibly underserved and serve it.

In various places there is a need that isn't being met. Meet that need and you can profit. IV Clinics, ketamine clinics, telemedicine etc.

Guy I worked with started his own telemedicine service serving mainly (get this) McDonalds franchises. no BS. small relative cost to the franchisee but their biggest cost is employee retention and training. It is quite a perk when you have no insurance to be able to chat up a doctor. He has since expanded his services but he had to knock on 100 doors before a good one opened. He leveraged his contacts, met with state Medicaid etc. Similarly another EM doc I know did telemedicine and is serving the Medicaid population of his state, he also created a platform for specialists and PCPs to communicate with their patients.

My point is there are ways. Find them.. some are a little more cookbook like real estate. All you have to do is learn how it works, spend an ass ton of time researching properties and educating yourself. and then go for it. Truly an EM doc can own $5m in mortgaged cash flowing real estate in a decade. At that point you can work very little if at all. It takes, hustle, knowledge etc. All the traits you already showed you had when you got into med school and finished residency.

You may be tired, frustrated and angry. None of those feelings will help make you successful. I found my side gig. I have income coming in from 4 places not including real estate, dividends / interest income. It also doesn't include my wife who works and does pretty well. Diversify.

 

[Birdstrike]

Hence why doing US or CCM right now isn't a homerun. I just listened to a podcast about an EM doc from Indiana who became a developer and runs $150m worth of real estate. He created that from nothing and learned all about it, leveraged the reality that he worked with a bunch of people who make 400k+ and have money to spare and took off from there.

Being successful isn't an easy to follow guide. If you want to use a cookbook method you can. Find a niche that is incredibly underserved and serve it.

In various places there is a need that isn't being met. Meet that need and you can profit. IV Clinics, ketamine clinics, telemedicine etc.

Guy I worked with started his own telemedicine service serving mainly (get this) McDonalds franchises. no BS. small relative cost to the franchisee but their biggest cost is employee retention and training. It is quite a perk when you have no insurance to be able to chat up a doctor. He has since expanded his services but he had to knock on 100 doors before a good one opened. He leveraged his contacts, met with state Medicaid etc. Similarly another EM doc I know did telemedicine and is serving the Medicaid population of his state, he also created a platform for specialists and PCPs to communicate with their patients.

My point is there are ways. Find them.. some are a little more cookbook like real estate. All you have to do is learn how it works, spend an ass ton of time researching properties and educating yourself. and then go for it. Truly an EM doc can own $5m in mortgaged cash flowing real estate in a decade. At that point you can work very little if at all. It takes, hustle, knowledge etc. All the traits you already showed you had when you got into med school and finished residency.

You may be tired, frustrated and angry. None of those feelings will help make you successful. I found my side gig. I have income coming in from 4 places not including real estate, dividends / interest income. It also doesn't include my wife who works and does pretty well. Diversify.

Good post.

 

[bravotwozero]

Yeah, they took the well running, nice to work at shop that I was at and turned it into a dumpster fire.

That makes two of us. Every time our medical director wants to improve staffing, he gets hit with 'the patient volume doesn't meet APP national staffing guidelines for increasing staffing'...

bull crap.

 

[GeneralVeers]

Brilliantly slack. And do not be ashamed. Get that fu money!

That makes two of us. Every time our medical director wants to improve staffing, he gets hit with 'the patient volume doesn't meet APP national staffing guidelines for increasing staffing'...

bull crap.

Every physician/midlevel hour costs them in terms of UI and SS payments. Their goal is to minimize their costs as much as possible to make money for the suits running the company. They don't care about patient safety, or burnout.

 

[Apollyon]

Hence why doing US or CCM right now isn't a homerun. I just listened to a podcast about an EM doc from Indiana who became a developer and runs $150m worth of real estate. He created that from nothing and learned all about it, leveraged the reality that he worked with a bunch of people who make 400k+ and have money to spare and took off from there.

Being successful isn't an easy to follow guide. If you want to use a cookbook method you can. Find a niche that is incredibly underserved and serve it.

In various places there is a need that isn't being met. Meet that need and you can profit. IV Clinics, ketamine clinics, telemedicine etc.

Guy I worked with started his own telemedicine service serving mainly (get this) McDonalds franchises. no BS. small relative cost to the franchisee but their biggest cost is employee retention and training. It is quite a perk when you have no insurance to be able to chat up a doctor. He has since expanded his services but he had to knock on 100 doors before a good one opened. He leveraged his contacts, met with state Medicaid etc. Similarly another EM doc I know did telemedicine and is serving the Medicaid population of his state, he also created a platform for specialists and PCPs to communicate with their patients.

My point is there are ways. Find them.. some are a little more cookbook like real estate. All you have to do is learn how it works, spend an ass ton of time researching properties and educating yourself. and then go for it. Truly an EM doc can own $5m in mortgaged cash flowing real estate in a decade. At that point you can work very little if at all. It takes, hustle, knowledge etc. All the traits you already showed you had when you got into med school and finished residency.

You may be tired, frustrated and angry. None of those feelings will help make you successful. I found my side gig. I have income coming in from 4 places not including real estate, dividends / interest income. It also doesn't include my wife who works and does pretty well. Diversify.

As Hannibal said 2k years ago, "We will find a way, or we will make one".

 

[emergentmd]

Making Money for an EM doc doesn't have to do with medical stuff. We have high income. Take some of that and open up another business. Buy rental properties. Investment syndication.

So many ways to make money when you have alot of $$ to invest. Yes it takes times and effort.

If you want to sit in an ER making 200/hr, then don't complain that you don't have the same options your forefather.

The next EM generation will have less opportunites than the current ones. So either put your money to work, or complain that you don't make enough $$.

 

[EMhawkeye]

So what I'm hearing is "we raped and pillaged the specialty to line our pockets and screwed over the next generation. Tough. *Extends middle finger" from our forefathers who sold us out to cmg's, app's and the proliferation of residency programs.

 

[Porfirio]

So what I'm hearing is "we raped and pillaged the specialty to line our pockets and screwed over the next generation. Tough. *Extends middle finger" from our forefathers who sold us out to cmg's, app's and the proliferation of residency programs.

You forgot to mention that the only people who could even try to stop this is the same generation of EM docs that f*cked us over. But they stopped caring long ago.

ABEM
Executive Committee
Mary Nan S. Mallory, M.D., M.B.A., President
Marianne Gausche-Hill, M.D., President-Elect
Jill M. Baren, M.D., M.S., M.B.A., Immediate-Past-President
Samuel M. Keim, M.D., M.S., Secretary-Treasurer
Ramon W. Johnson, M.D., M.B.A., Member-at-Large
Lewis S. Nelson, M.D., Senior Member-at-Large

Directors
Felix K. Ankel, M.D.
J. David Barry, M.D.
Michael S. Beeson, M.D., M.B.A.
Yvette Calderon, M.D., M.S.
Wallace A. Carter, M.D.
Carl R. Chudnofsky, M.D.
Hala Durrah, M.T.A.
Diane L. Gorgas, M.D.
Deepi G. Goyal, M.D.
Leon L. Haley, Jr., M.D., M.H.S.A.
John L. Kendall, M.D.
James D. Thomas, M.D.
Suzanne R. White, M.D., M.B.A.

 

[EctopicFetus]

You forgot to mention that the only people who could even try to stop this is the same generation of EM docs that f*cked us over. But they stopped caring long ago.

ABEM
Executive Committee
Mary Nan S. Mallory, M.D., M.B.A., President
Marianne Gausche-Hill, M.D., President-Elect
Jill M. Baren, M.D., M.S., M.B.A., Immediate-Past-President
Samuel M. Keim, M.D., M.S., Secretary-Treasurer
Ramon W. Johnson, M.D., M.B.A., Member-at-Large
Lewis S. Nelson, M.D., Senior Member-at-Large

Directors
Felix K. Ankel, M.D.
J. David Barry, M.D.
Michael S. Beeson, M.D., M.B.A.
Yvette Calderon, M.D., M.S.
Wallace A. Carter, M.D.
Carl R. Chudnofsky, M.D.
Hala Durrah, M.T.A.
Diane L. Gorgas, M.D.
Deepi G. Goyal, M.D.
Leon L. Haley, Jr., M.D., M.H.S.A.
John L. Kendall, M.D.
James D. Thomas, M.D.
Suzanne R. White, M.D., M.B.A.

What do you want a em to do? ACEP and AAEM are a different story.

 

[Apollyon]

True story: Wally Carter is a Caribbean grad!

 

[EctopicFetus]

I love rap music. The good stuff not nonsense.. there is a famous quote that I love but here is a more eloquent version in the same vein.

There Are Three Types of People: Those Who Make Things Happen, Those Who Watch Things Happen, and Those Who Wonder What Happened


Be the first.. make things happen.. that's success. it takes guts, risk tolerance and time. The business I set up I probably put in 1000 hours in 6 months on top of my clinical work and family time. now it is much less hands on and does well for me. I love real estate but the continued input of time limits how successful I will/can be in it. Yes there are still ways and I don't disagree but not for me. Ill keep feeding the other sources and keep my eye out for homeruns in real estate which I think will be easier to find in a few months when the economy really bears the brunt of the pandemic.

 

[Birdstrike]

So what I'm hearing is "we raped and pillaged the specialty to line our pockets and screwed over the next generation. Tough. *Extends middle finger" from our forefathers who sold us out to cmg's, app's and the proliferation of residency programs.

Awesome plan for success!

 

[Birdstrike]

There Are Three Types of People:

1) Those Who Make Things Happen
2)Those Who Watch Things Happen, and
3)Those Who Wonder What Happened

Group 1: Those Who Make Thing Happen = 10% of people
Group 2: Those Who Watch Things Happen = 30% of people
Group 3: Those Who Wonder What Happened = 60% of people

This applies to the world and it applies to SDN EM. Your membership in a group might be permanent, but it doesn't have to be permanent. You might be able to change groups or you might not. But you can't do it without permission from yourself. Complaining will not move you any closer from groups 2 and 3, to group 1. But it can make you drift from group 1, to 2 or 3. Take this from a hard-core complainaholic in recovery.

 

[EMhawkeye]

Awesome plan for success!

Social darwinism much?

 

[EMhawkeye]

Part of a generation that destroyed the specialty and tell the next generation to just work harder at a lower rate. When we point out how one generation screwed us over, they point out to get a second job to make the same amount of money. Don’t piss on our neck and call it rain

 

[Birdstrike]

Part of a generation that destroyed the specialty and tell the next generation to just work harder at a lower rate. When we point out how one generation screwed us over, they point out to get a second job to make the same amount of money. Don’t piss on our neck and call it rain

@EMhawkeye I've been on this forum blowing the whistle on these issues for a decade, telling everyone they'd been lied to by the older EM generation that was destroying EM and was sending us into a buzz saw. You ignored people like me, moved forward without a contingency plan and now you've just discovered the old guard was screwing us all along? You're a little late to the game it seems and now you're trying to tell me stuff I was telling you all 10 years ago.

For the record, I don't disagree with anything you're saying about the "last generation" and its effect on EM and the next generation.. I'm in the same boat. I'm not at the beginning of my career or at the end; I'm somewhere in the middle. I've got too long a way to go to stop caring, but not long enough that I can waste any more time complaining about what others did in the past. I've done my fair share of complaining and being bitter but I decided that was going to win me nothing, but to give negativity free rent in my head.

I'm not telling you to "get a second job to make the same money." Others may be. What I think those starting out need to do is to look forward and find a path that makes them feel successful and happy. If looking backwards and being bitter about what previous generations did is therapeutic for you, fine. Do it as much as you need to. God knows I spent years in this stage. But once you're ready, start looking for ideas to get yourself along a path that makes you feel successful and happy. It won't be and cannot be the same path the Boomers took. It also won't be the same path the generation after you needs to take. It's individual for you. And I can't tell you what that is for you.

Just remember this: Whatever you do end up doing with your career, those 15-20 years behind you are going to say the same thing that you're saying about the outgoing generation, now. So, make it count!

 

[RustedFox]

@Birdstrike

Amigo; I read you loud and clear:

The Tao of medicine has changed. Accept it and build upon it rather than gnash your teeth and rend your white coats.

But none of that forgives the sins of the fathers. Instead of letting medicine be run by the suits, all it would have taken is a little introspection and self-restraint from the BOOMERS, and the timeline could have changed. Medicine could be run by the physicians today, leading to a lot more global good... rather than being fleeced by the parasitic MBAs.

Forgive us if we're not done flogging the BOOMERS yet for their poor decisions. After all, they take every opportunity to tell us that we're making poor decisions while working on expanding their waistlines and occluding their coronaries.

 

[Birdstrike]

@Birdstrike

Amigo; I read you loud and clear:

The Tao of medicine has changed. Accept it and build upon it rather than gnash your teeth and rend your white coats.

But none of that forgives the sins of the fathers. Instead of letting medicine be run by the suits, all it would have taken is a little introspection and self-restraint from the BOOMERS, and the timeline could have changed. Medicine could by the physicians today, leading to a lot more global good... rather than being fleeced by the parasitic MBAs.

Forgive us if we're not done flogging the BOOMERS yet for their poor decisions. After all, they take every opportunity to tell us that we're making poor decisions.

Flog the Bommers all you want. They deserve every bit. But anyone that went into this game in the past 10 years has been duly warned by the likes of me, and others (like yourself more recently). I've been blowing the whistle on their lies for more than a decade now and you're witness. The person that wrote the book on EM spent their golden years giving false testimony against fellow ER doctors in such shameful grifter-style ACEP had to put a stop to it by sanctioning him for it. The speciality doesn't even try to hide its grifter, eat-its-own nature. THEY PUT HIS NAME ON YOUR BOOK.

And they're still spewing lies like, "Burnout is the doctor's fault, not EMs fault," "EM is a lifestyle specialty," "CMGs are your friend," "Administration is our 'partner,'" "Packing the specialty with new grads isn't about lining businessmen's pockets with cash," and "Metrics and Press-Ganey are good."

Outraged? Yes, every bit is justified. Surprised? There are no excuses. Not if you listened to me for the past 10 years.

 

[emergentmd]

I started EM 20 yrs ago. Made about 350K. Years in between I maxed out at 500K working similar 30-35 hrs/wk. Currently I could find a job making 350K/yr.

I don't see where my income drastically changed much. Opportunities definitely less, job environment less but income same. I didn't take a 2nd job. I don't think any EM doc needs to but an EM doc is blessed with a high income and more importantly TIME. What you do with that time matters.

While making my 350-450K avg, I saved mid 6 figures. Bought 6 rentals, leveraged. 5 yrs later all properties doubled and getting daily calls to buy it cash for 2x what I paid. Currently have 2 STRs that are worth about $1M each grossing about $100K each.

Once I pay off all these properties, I will likely net $150K/yr and $4M worth of properties. Some months I do very little with my properties. Some months I spend 20 hrs working on my properties. I was never a handy man but I have learned thanks to YouTube university how to do almost anything not requiring High voltage, crawling into attic space, or major plumbing. Power Washing, Painting, Internet fixing, TV mounting, 3 D printing stuff, Installing fishing lights, Tree cutting, sheetrock repair, Septic Tank maintenance, Mailbox installation, Security camera installation then I'm your man.

Everyone chooses a path depending on their risk tolerance. I was willing to risk $300K cash and $700K loan to start with rentals. If I ever pay them off, likely will leverage it again and double my holdings thus more risks. Nothing wrong with sitting on cash or investing in the market. I have had more failures than success. Lost 6 figures on a start up. Lost $$$ of high risk stocks.

Moral of the story is EM docs have $$, time, and advantages that most don't have such as banks willing to hand you money. You have more advantages and time than 99% of people who run their own successful business, so no reason to complain that your fore fathers had it easier. No one is arguing this point.

 

[RustedFox]

Whoops, guys.
Dumb me.
I guess I got into medicine for all the wrong reasons... You know... A noble profession that gives back and pushes science forward, and the ability to do so without undue influence.

Seems all this time, I should have just been looking to parlay this profession into some other cash machine.... Just like those who ruined it did.

 

[EctopicFetus]

I started EM 20 yrs ago. Made about 350K. Years in between I maxed out at 500K working similar 30-35 hrs/wk. Currently I could find a job making 350K/yr.

I don't see where my income drastically changed much. Opportunities definitely less, job environment less but income same. I didn't take a 2nd job. I don't think any EM doc needs to but an EM doc is blessed with a high income and more importantly TIME. What you do with that time matters.

While making my 350-450K avg, I saved mid 6 figures. Bought 6 rentals, leveraged. 5 yrs later all properties doubled and getting daily calls to buy it cash for 2x what I paid. Currently have 2 STRs that are worth about $1M each grossing about $100K each.

Once I pay off all these properties, I will likely net $150K/yr and $4M worth of properties. Some months I do very little with my properties. Some months I spend 20 hrs working on my properties. I was never a handy man but I have learned thanks to YouTube university how to do almost anything not requiring High voltage, crawling into attic space, or major plumbing. Power Washing, Painting, Internet fixing, TV mounting, 3 D printing stuff, Installing fishing lights, Tree cutting, sheetrock repair, Septic Tank maintenance, Mailbox installation, Security camera installation then I'm your man.

Everyone chooses a path depending on their risk tolerance. I was willing to risk $300K cash and $700K loan to start with rentals. If I ever pay them off, likely will leverage it again and double my holdings thus more risks. Nothing wrong with sitting on cash or investing in the market. I have had more failures than success. Lost 6 figures on a start up. Lost $$$ of high risk stocks.

Moral of the story is EM docs have $$, time, and advantages that most don't have such as banks willing to hand you money. You have more advantages and time than 99% of people who run their own successful business, so no reason to complain that your fore fathers had it easier. No one is arguing this point.

Inflation? 350k 20 years ago? Want to talk about where the Dow and SP500 were then. What did education cost etc.

I finished residency about a decade ago.. I’m no boomer.. i saw the writing on the wall before I finished residency and had FI on my mind then. The reason was desire for control. I had 400k in debt, the homeless guy who came into my ED all the time had a much higher net worth than me. I learned about he business of medicine by watching the nonsense my academic university faculty dealt with and how they were getting royally screwed. I have been anti cmg from the start, i moved across the country to get away. As I said on other threads the future is grim. Some people dont want to hear that.. its fine. I will say this there are plenty of docs I know who have been out 20+ years who aren’t crushing it. Some are.. so we focus on them.. i try to learn from others but overall stick to my plan no matter what others think. It has worked so far. I got a tremendous amount of crap when i left my old gig. “Sellout” ”no loyalty” etc. Meanwhile they chose to divorce me professionally.

 

[emergentmd]

Inflation? 350k 20 years ago? Want to talk about where the Dow and SP500 were then. What did education cost etc.

I finished residency about a decade ago.. I’m no boomer.. i saw the writing on the wall before I finished residency and had FI on my mind then. The reason was desire for control. I had 400k in debt, the homeless guy who came into my ED all the time had a much higher net worth than me. I learned about he business of medicine by watching the nonsense my academic university faculty dealt with and how they were getting royally screwed. I have been anti cmg from the start, i moved across the country to get away. As I said on other threads the future is grim. Some people dont want to hear that.. its fine. I will say this there are plenty of docs I know who have been out 20+ years who aren’t crushing it. Some are.. so we focus on them.. i try to learn from others but overall stick to my plan no matter what others think. It has worked so far. I got a tremendous amount of crap when i left my old gig. “Sellout” ”no loyalty” etc. Meanwhile they chose to divorce me professionally.

You knew my point. 350K today is still 275K take home (atleast in texas). If you have 400K student loan debt. put 200K/yr into debt, live off 75K. 75K take home is ALOT of money. If not, then put 150K, live off 125K, and pay off th debt in 3 yrs.

After 3 yrs, life off 175K. Put 100K into a rental property, have the renters pay for your mortgage/carrying cost. Do this for 5 yrs, and then you will have 5 properties with all carrying costs paid for by your renters.

After 8 yrs, you can put 100K into more or decrease your risks by putting it into your properties. After about 7 yrs, you will have 5 paid off properties.

So after 15 yrs, putting most EM grads at about 45 yrs old will have 5 paid off properties likely netting about 20K each. That is an extra 100K you can continue to invest in properties or slow down and work 1/3 less.

Its not that difficult. There are risks.

 

[fahimaz7]

I believe Fort Collins, Boulder, Colorado Springs, Pueblo, Grand Junction and Montrose as well as a few other more rural locations all still have SDGs (some may be hospital employed positions). While a few of those locations have facilities that are staffed by TeamHealth or USACS, they also definitely have non-CMG options. Denver is the only market in Colorado that has a predominantly CMG presence. UC Health and Kaiser are options, but many Denver locations are staffed by USACS.

Many people like to use Colorado as an example of where pay has been decimated by a CMG, while this is true for Denver it isn't reflective of the entire state. There are good jobs with good pay in Colorado with the benefit of a great location and medicolegal climate. Sure, there may be a few dumpster fires, and even forest fires, but universally that isn't the case. I think the Colorado discussion might be comparable to how others have commented that NYC is not the same as NY.

Fort Collins has EPR. Longtime SDG. Team Health is also there
Pueblo is a hot mess. USACS is also there
Colorado Springs is USACS (Centura has them staffing all sites) or UCHealth
Grand Junction is SDG I believe
Montrose is tiny
Durango was transitioned to USACS
Summit County is USACS
Gunnison is hospital-employee now
BV is hospital-employee
Steamboat is UCHealth
Vail is SDG

USACS is paying $140/hr for new docs and they just let go of all their PRN coverage. UCHealth docs get paid a bit better, but not what they are worth. Most of the rural hospitals are have employee or 1099 models at ~ 190/hour as a 1099. Are you working in Colorado?

 

[Mushdoc]

You could work fifteen 8's a month at 140/hr or five 12s at 280/hour and make the same amount.