Income, benefits, compensation thread

[cyanide12345678]

I remember you during those early days, bro. I remember you.

Good on you for being smart.

Where were you guys to keep me from going astray 8 years ago when I decided on EM ?

Y'all failed me

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[WorkNoteEmergency]

I don’t mind feeling that way coming out of the gym after a workout. The ED, not so much…

Ha, last fall, when I was still working regular shifts, I did an organized 62 mile gravel bike ride with a lot of climbing. It was hard but not soul sucking and felt fine at the end. Next day I was kind of sore and washed out feeling and I thought “holy ****e, this is exactly how I feel day after a hard shift!”

Now that I am almost completely out of EM, I more clearly recognize those days of feeling like crap, wondering if I was sick or not, out of shape or not, was just sleep disruption and being drained from work.

 

[psychemdoc]

Admittedly I have not read every post in this thread but I did see some med student postings as well. I remember those days well and was also a bright eyed, naive med student looking into EM. I had worked in an ER for a few years prior to med school when I was in my early 20's and was convinced that was what I wanted to do. As I started getting older I was having second thoughts on that and ended up pursuing Psych. Soooooooooooooooooo glad I made that decision as now I'm in my late 30's and could not imagine working the schedule and dealing with what ya'll have to endure. I just separated from active duty so I haven't gotten to see the full fruits of my decision yet, just started my civ job less than 2 weeks ago. But so far, working 4 days per week, outpatient psych, good patient population, no nights, no weekends, no holidays, no call, 3 day weekends, lots of PTO, standard benefits. Hoping to make between 3-400K but have heard some working for this same group have cleared 5-600K so it's possible to make a bit more. For the med students out there, consider closely what has been said in this thread regarding EM. I respect you EM peeps as I know I couldn't do what you do.

I swear the Psych/EM residency track would do so well today but there is a lack of enterprising PDs out there. Too many people on here and on the Psych forums and irl that have a hard time between those two. I know that’s not a good reason but still I feel that if you create one I bet it will get sufficient interest that more would follow. Assuming it would be 5 years I definitely would have applied for it. If it was like 6+years I could see the math being harder for it.

 

[Mount Asclepius]

225 bench for 6 sets x 5 reps with no difficulty. Gonna attempt a 300 PB next week.

5 foot 6. 165 pounds.
I tell you what: if I get a 300 press, I will post video on here and wear my full face bike helmet and shades to hide my face and such to maintain anonymity.

Current PR is 285 and it went up.

Impressive. My bench PR was 315 back in college, but not at your weight. Looking forward to this epic video.

 

[RustedFox]

Impressive. My bench PR was 315 back in college, but not at your weight. Looking forward to this epic video.

*Challenge accepted meme*

 

[dchristismi]

Since we're totally off track, I won't feel bad posting that on a REALLY sweet day, I see 2-5 patients, talk with families, chart, do some paperwork, and am salaried.
On a bad day, I take someone off life support, cry with their family, see 12 patients, take call but don't get called after 10 pm, and am still salaried. Don't put this in the spreadsheet since I'm not EM anymore, but for comparison, Hospice, boarded, I have an inpatient unit so deal with very sick patients and families often in crisis, W2, 180K base for 0.8 FTE, full benefits, 403b match, PTO, 15K bonus which varies by year but that's what it was this year for me, plus 80% of my billings on weekends which will probably be another 40K at the rate I'm going.

I have a Peloton, but it's collecting dust since I seem to have developed something with my right hip, so I'm not really running or biking... but am going to apparently (hopefully? I'm not exactly sure what to hope for here) bike the last ~30 km of Paris-Roubaix with my dad in 3 weeks. I'm hoping that actually means we do the 2.5 km of the Arenberg trench and he decides that the cobbles are exactly as bad as they look on TV, we say we did "some" of it, put the bikes back in the car, drive some, bike the last bit to the Velodrome and take some photos here and there. I rode it a lot for years, but I'd sell it if anyone wants to buy it. Hip nags if I run even a little, but I can walk without any problems. So I just walk now... 2-3 miles every morning. Sometimes a lot more. Guess I'm getting old. (And my strategy for Paris-Roubaix, if we actually do bike it, is naproxen, tylenol, beer and complaining a lot. Seems solid.)

 

[EctopicFetus]

I think an important point is that the quality of job matters on the site itself, the hospital/system itself.

There are sdgs making bank that have a great setup. There are horrific jobs. This is true for em hospitalists, gas, ccm.

In em there are fewer good jobs. I define that as good pay, good group / leadership and a good system. Hca has 160-180 hospitals. All those jobs fall out. The va pays bad. Etc etc. I’m sure there are decent cmg jobs out there.

But the world is changing. The workforce issues are coming. People want to ignore them but pay will drop precipitously I suspect in competetive markets and slower in the others. thr speed or severity is questionable but it’s coming.

 

[end stage fibro]

Don’t become an anesthesiologist, hospitalist, intensivist, EM doc. Some of these may be doing well right now but the future is uncertain. All of these specialties share midlevel encroachment, predatory staffing groups, lack of control at work, and are viewed as an expense by hospital systems. What to do? Surgical subspecialties or procedural IM subspecialties. If you can’t get into those, do a non-procedural, outpatient focused IM subspecialty.

The love for hospitalist on this board stems from a handful of frequent posters. Maybe because they have great jobs or maybe they are new grads with rose colored glasses. For every 1 good job that someone is happy at, there are 4 bad ones. I know way too many unhappy hospitalists. You’re the absolute bottom of the totem pole in the hospital, some may tolerate the regular disrespect fine, but most don’t.

You’re not making a decision for the next 5 years, your decision is for the next 30+. I don’t have a crystal ball but the future of these 4 specialties looks pretty ****ty.

this is so true it bears repeating. doomsday scenario: i feel like each year, the job of a hospitalist gets slowly whittled down and will eventually become a triage NP job. you need to ahve a job where you make a ton of money for the hospital or control your own patients

also agree on the hospitalist salaries I see on here. I don't doubt them for a second but they always seem to be in BFE. i live in a big city and good luck getting more than 300k without grinding. I mean starting census 20 high acuity pt to start with, 3-4 admits, low RVU bonus, lack of extra shifts. i know a few hospitalists making 500k plus but damn they are working for it, 25+ shifts plus SNF and directorships.

 

[xaelia]

Employer: The Crown
ER setting: Small Urban
Region: Way way way south west
Hourly: ~NZD $137/hr (~$200 per clinical hour)
W2 or 1099 or k1: salaried
Patients per hour: ~0.5 cherry picking, supervise a zoo
Annual census: 120k
Cme: NZD $16k
Occasional Quarterly Bonus: No
Annual bonus: Stipend for optional participation in backup roster, stipend for taking overnight call, 10% recruitment/retention bonus
Benefits: Paid leave (6 weeks annual leave + 2 weeks public holidays + 2 weeks CME), 6% retirement contribution match, paid sick leave, paid parental leave, no night shifts

Definitely not here for the money (oh god the current exchange rate), but the QoL is great, and the work is mostly fun and rewarding.

 

[chillaxbro]

Someone tell me how good/****ty my pay is

Employer: City hospital
ER setting: Urban/academic
Region: large northeast city
Hourly: base salary / 52 weeks / 32 clinical hours a week = slightly more than $150/hr
OT rate = $190/hr
W2 or 1099: W2
Patients per hour: 1.5-2.2 but almost all seen by resident/PA first, just briefly confirm H+P with patient, review labs, imaging, EKGs, sign notes etc
Annual census: ~150k
CME: 40 paid hours, and $2k a year
Bonus: ~$50k a year
Benefits: good health insurance, all holidays paid, 5-6 weeks paid vacation per year, 10% of base salary free into 401k every year, sick days.

Can get OT rate if you work instead of using your holiday / vacation / CME hours

 

[Groove]

Damn, dude. I can't believe you guys work for that kind of pay up in the NE.

 

[chillaxbro]

🥲🥲🥲

 

[GonnaBeADoc2222]

Someone tell me how good/****ty my pay is

Employer: City hospital
ER setting: Urban/academic
Region: large northeast city
Hourly: base salary / 52 weeks / 32 clinical hours a week = slightly more than $150/hr
OT rate = $190/hr
W2 or 1099: W2
Patients per hour: 1.5-2.2 but almost all seen by resident/PA first, just briefly confirm H+P with patient, review labs, imaging, EKGs, sign notes etc
Annual census: ~150k
CME: 40 paid hours, and $2k a year
Bonus: ~$50k a year
Benefits: good health insurance, all holidays paid, 5-6 weeks paid vacation per year, 10% of base salary free into 401k every year, sick days.

Can get OT rate if you work instead of using your holiday / vacation / CME hours

I mean, after you factor in bonus, paid vacation and sick days, the rate approaches 200/hr which I would say is not terrible for academics in a large city.

However, my next question is, how many non clinical hours are required?

 

[TooMuchResearch]

But the math was correct? Sorry for the stupid questions.

EM keeps coming up on my list of specialties I am considering but everyone on this forum and even some of my mentors in the field have said to stay away from it.

My predicament is that I feel IM is going to deal with some of the same bullcrap going on in EM and there has been less acuity on my IM rotation. I enjoy thinking on my feet and the few cases of actual emergent cases that came into the ER during my 5 years as a scribe.

I guess a main concern I have is the salary tanking due to the scope creep etc.

Don't do EM. You're welcome.

 

[chillaxbro]

I mean, after you factor in bonus, paid vacation and sick days, the rate approaches 200/hr which I would say is not terrible for academics in a large city.

However, my next question is, how many non clinical hours are required?

Mostly I just do resident and med student evaluations if they submit requests to me.

They've otherwise been lax about lectures, going to conferences, procedure labs, research etc. So far it's all "volunteer" and I have done 0

 

[Mbekweni]

Current data according to Barb Katz. This is heavily skewed since she gets her data drom
CMG and public job postings and never hears about the best of the best jobs. But it’s a good place to start.

Interesting to see the percentage of CMG jobs. Seems to be the norm particularly in the Southeast. I’m in CA and they are around but not at all inevitable.

2023–2024 Emergency Physician Compensation Report - ACEP Now

ACEP Now offers real-time clinical news, news from the American College of Emergency Physicians, and news on practice trends and health care reform for the emergency medicine physician. ACEP Now is an official publication of the American College of Emergency Physicians.

www.acepnow.com

 

[sloh]

Mostly I just do resident and med student evaluations if they submit requests to me.

They've otherwise been lax about lectures, going to conferences, procedure labs, research etc. So far it's all "volunteer" and I have done 0

Where is your passion for academia!?!?!

 

[Splenda88]

Where is your passion for academia!?!?!

People in academia have ruined medicine...

 

[The Knife & Gun Club]

But the math was correct? Sorry for the stupid questions.

EM keeps coming up on my list of specialties I am considering but everyone on this forum and even some of my mentors in the field have said to stay away from it.

My predicament is that I feel IM is going to deal with some of the same bullcrap going on in EM and there has been less acuity on my IM rotation. I enjoy thinking on my feet and the few cases of actual emergent cases that came into the ER during my 5 years as a scribe.

I guess a main concern I have is the salary tanking due to the scope creep etc.

I’d think about what you actually consider the “bullcrap” of each specialty. If you mean medically - like MI rule outs, annoying patients, cyclical revolving door nursing home patients, etc then pretty much all the specialities become medically similar once you’re out. The orthopods, Hospitalist, EM docs, PCPs see a couple interesting things a month, and everything else becomes mundane and repetitive (as it should, because safe patient care is mundane).

The things that really grate on you over the years are nights, weekends, admin annoyances, prior authorization/insurance, call, etc. and these are the things that will vary drastically between fields. There’s no admin cutting the cardiac surgeons bonus because their patient satisfaction score is low. But they’re hard pressed to find a job that doesn’t come with some really significant call burden. You’ll have A similarly hard time to find an EM job without nights. Or a IM job that doesn’t deal with insurance issues. They all exist but are not common.

So maybe take a step back from the medicine and think about the practice environment you’re looking for. Doing nights in the prime of your life sucks, not to mention later in life. Look at any doc that does a lot of nights or call late in their career - the toll it takes can be visible.

 

[emergentmd]

There is not one field without issues. Its like a marriage. Find a wife where there is no deal breakers and you can handle the rest. Otherwise, you will always think about a divorce.

 

[usopen]

New attending here.. What do you guys think of my gig?

Employer: University hospital (There is minimal teaching for me as I am a nocturnist and no EM residents)
ER setting: Semi-rural
Region: 1-2 hrs from DC
Hourly: base salary ~$240/hr (1.0 FTE is 108hrs/month)
OT rate = ~$270/hr
W2 or 1099: W2
Patients per hour: Usually 1-2 pph. Has seen anywhere between 3-30 per night.
Annual census: ~40k
CME: ~$4k/yr
Bonus: Maybe? Not sure
Benefits: Good health insurance options (Only pay like $60 per month), 6% matching + double dipping on retirement accounts as I get paid by 2 separate entities, sovereign immunity.
Cons: Limited specialist back up in person, a lot get transferred out, cannot moonlight outside of the system

 

[NicksMD]

Employer: SDG
ER setting: Suburban
Region: Southeast/Mid-Atlantic
Hourly: $315-350 (100% RVU)
W2 or 1099 or k1: w2
Patients per hour: 2.5
Annual census: >100k
Cme: 5k
Benefits: health, life, vision, dental. 401k match 6%.

 

[RustedFox]

I have a terrible ER job.
Florida Man "L".

 

[EctopicFetus]

New attending here.. What do you guys think of my gig?

Employer: University hospital (There is minimal teaching for me as I am a nocturnist and no EM residents)
ER setting: Semi-rural
Region: 1-2 hrs from DC
Hourly: base salary ~$240/hr (1.0 FTE is 108hrs/month)
OT rate = ~$270/hr
W2 or 1099: W2
Patients per hour: Usually 1-2 pph. Has seen anywhere between 3-30 per night.
Annual census: ~40k
CME: ~$4k/yr
Bonus: Maybe? Not sure
Benefits: Good health insurance options (Only pay like $60 per month), 6% matching + double dipping on retirement accounts as I get paid by 2 separate entities, sovereign immunity.
Cons: Limited specialist back up in person, a lot get transferred out, cannot moonlight outside of the system

I think this is a pretty standard job. nothing amazing, nothing terrible. As long as you are happy with the location.

 

[JustUnder9000]

Employer: Hospital
ER setting: Critical Access
Region: PNW
Hourly: $310-340
W2 or 1099 or k1: 1099
Patients per hour: 2.5, 12 hour shift
Annual census: <30K
Cme: 0
Benefits: Malpractice

Does not qualify for PSLF which is a bummer, but seemed like a cool place to get good experience. The pay was the highest I've seen anywhere near here. Group seemed happy. Almost seemed too good to be true, even though it doesn't include benefits. Am I missing something big picture here?

 

[Splenda88]

Employer: Hospital
ER setting: Critical Access
Region: PNW
Hourly: $310-340
W2 or 1099 or k1: 1099
Patients per hour: 2.5, 12 hour shift
Annual census: <30K
Cme: 0
Benefits: Malpractice

Does not qualify for PSLF which is a bummer, but seemed like a cool place to get good experience. The pay was the highest I've seen anywhere near here. Group seemed happy. Almost seemed too good to be true, even though it doesn't include benefits. Am I missing something big picture here?

This is a remarkable salary.

I was told our hospital pays ED docs $275/hr and one of these ED docs work 20+ days/month (12-hr shift) and has been doing it for over 4 years now since he graduated from residency.

 

[Groove]

This is a remarkable salary.

I was told our hospital pays ED docs $275/hr and one of these ED docs work 20+ days/month (12-hr shift) and has been doing it for over 4 years now since he graduated from residency.

12 hour shifts at 2.5+ pph? Noway dude, lol. Your 240hr/mo ED doc example is on the fast track to burnout or an MI.

 

[xaelia]

12 hour shifts at 2.5+ pph? Noway dude, lol. Your 240hr/mo ED doc example is on the fast track to burnout or an MI.

2.5pph can be a breeze – if you're just treating ambulatory UTIs based on symptoms, doing chest pain rule-outs, your staff provides a lot of the facetime with patients, and inpatient dispos are smooth.

But ... that sounds a bit aspirational.

 

[Splenda88]

12 hour shifts at 2.5+ pph? Noway dude, lol. Your 240hr/mo ED doc example is on the fast track to burnout or an MI.

I am not sure if it is 2.5+ pph. I remember they say they see an average ~150 ppd. It appears they have 3 docs and 2 midlevels during the day and 2 docs and 1 midlevel at night.

 

[TooMuchResearch]

This is a remarkable salary.

I was told our hospital pays ED docs $275/hr and one of these ED docs work 20+ days/month (12-hr shift) and has been doing it for over 4 years now since he graduated from residency.

Yet a terrible job. You shouldn't see 2.5 ED pts per hour other than for brief periods of time and certainly not an average over 12 hours.

 

[GonnaBeADoc2222]

Is local PRN at 1.2 PPH for $225/hr a decent gig?

I'd say so.

I make 250/hr total comp for 1.4pph

 

[Groove]

I think I got linked to this from some ACEP message or email. Anyway, I wish someone had done this a long time ago. Lots of salaries posted already. Lots of W2, SDG Partners, SDG Partnership tracks, CMG 1099. C'mon all you Daddy Warbuck SDG Partners who are supposedly killing it. Make your contributions because I'm sure not seeing anything very exciting from the SDG pool.

Ivy Clinicians

Find your next emergency medicine job

www.ivyclinicians.io

 

[GonnaBeADoc2222]

Damn I didn't make it in before the SDG white knight

 

[Groove]

Income, benefits, compensation thread

Yeah but this list has almost 800 entries.

 

[RustedFox]

SWFL checking in. Generally 265-295 hourly (Base + RVU).
Benefits? What are benefits?

 

[cyanide12345678]

Yeah but this list has almost 800 entries.

800 ER docs or all specialties?

 

[Groove]

800 ER docs or all specialties?

It says EM salaries

 

[Mbekweni]

Self reported data likely significantly flawed and subject to bias in terms of true averages. MGMA actually looks at actual hospital payroll data so is likely highly accurate for employed physicians but I suspect less accurate for SDG or some combination of stipend and collections.

As always best to ask around in person to a variety of peers and check different sources to get a feel for “fair” or standard.

I think most people go 75% with geography or family preferences and then shop around for the 2-5 jobs in that general area and pick one if there are a few that are hiring and you are a good candidate. Alternatively hear through friend of a friend about a good job in a good city and make the jump. It’s easy enough to compare 3-5 jobs. Much harder to get a true assessment of national EM job market. Honestly I couldn’t care less what the CMG market in Florida vs Texas is looking like this year.

 

[Restart13]

for those in private groups what was and is currently your buyin? Has it gone up?

Mine was ~$160k in sweat equity (pretax) over 2.5 years or so. Currently modified/capped.

 

[BoardingDoc]

for those in private groups what was and is currently your buyin? Has it gone up?

Mine was ~$160k over 2.5 years or so. Currently modified/capped.

No buy in, but an egalitarian pay system. Entirely keep what you kill minus overhead from day one. No partner structure. Works out well.

 

[GonnaBeADoc2222]

No buy in, but an egalitarian pay system. Entirely keep what you kill minus overhead from day one. No partner structure. Works out well.

This is the way. I almost laughed out loud when I interviewed with the "democratic group" which has it's required organization partners still collecting off the top.

 

[Janders]

This is the way. I almost laughed out loud when I interviewed with the "democratic group" which has it's required organization partners still collecting off the top.

Yeah, I would be entirely on board with a 1 year “pre-partner” period where you get a (REASONABLE) hourly rate without the annual partner profit-share payout. A reasonable period to make sure you fit the group, covers your startup costs (which are real), etc. Yes the partners are skimming a little off the top, but they put the group together and keep it running and you are new.

What I don’t like are these reports of 3+ years of MARKEDLY lower pay rate (like 40% lower), with an additional cash buy in after 3years as this low pay rate sweat equity wasn’t enough, with super-partners who don’t work clinically and continue to skim off the top of the “partners”. Woof.

 

[chillaxbro]

Someone tell me how good/****ty my pay is

Employer: City hospital
ER setting: Urban/academic
Region: large northeast city
Hourly: base salary / 52 weeks / 32 clinical hours a week = slightly more than $150/hr
OT rate = $190/hr
W2 or 1099: W2
Patients per hour: 1.5-2.2 but almost all seen by resident/PA first, just briefly confirm H+P with patient, review labs, imaging, EKGs, sign notes etc
Annual census: ~150k
CME: 40 paid hours, and $2k a year
Bonus: ~$50k a year
Benefits: good health insurance, all holidays paid, 5-6 weeks paid vacation per year, 10% of base salary free into 401k every year, sick days.

Can get OT rate if you work instead of using your holiday / vacation / CME hours

For 2023 my total comp including benefits ended up being >$475k

 

[cyanide12345678]

Was doing a year end review to see how much more taxes to pay.

It’s been a great year. Here’s how it went:

Made 487k at my day job after a retention bonus, a quality bonus, a couple of extra shifts and a profit distribution bonus. + 20k employer contribution to 401k + 5K cme.

Made slightly above 200k on options

Wife made 245k which includes a retention bonus + 10k 401k employer contribution

Made 25k in rental income

Added slightly above 600k to net worth after all expenses etc.

 

[RustedFox]

Wow, I want to work where you guys work.
I don't get squat.

 

[cyanide12345678]

Wow, I want to work where you guys work.
I don't get squat.

The retention bonus was a one time deal for 3 years of 60k. And I worked about 1850 or so annual hours for that income. So an above average number of hours for an ER doc.

Otherwise on paper I make a humble 200/hr.

 

[Splenda88]

Was doing a year end review to see how much more taxes to pay.

It’s been a great year. Here’s how it went:

Made 487k at my day job after a retention bonus, a quality bonus, a couple of extra shifts and a profit distribution bonus. + 20k employer contribution to 401k + 5K cme.

Made slightly above 200k on options

Wife made 245k which includes a retention bonus + 10k 401k employer contribution

Made 25k in rental income

Added slightly above 600k to net worth after all expenses etc.

Remarkable!

What was the net worth at the end of 2022?

I might have to start tracking my net worth at the end of each year as well.

 

[RustedFox]

The retention bonus was a one time deal for 3 years of 60k. And I worked about 1850 or so annual hours for that income. So an above average number of hours for an ER doc.

Otherwise on paper I make a humble 200/hr.

Even still. I get a paycheck and nothing else. No benefits whatsoever.

 

[GonnaBeADoc2222]

The retention bonus was a one time deal for 3 years of 60k. And I worked about 1850 or so annual hours for that income. So an above average number of hours for an ER doc.

Otherwise on paper I make a humble 200/hr.

Wish I had the stamina to work that much. I can barely stomach 1400.

 

[cyanide12345678]

Remarkable!

What was the net worth at the end of 2022?

I might have to start tracking my net worth at the end of each year as well.

1,920,000.

But realizing i probably owe 70-80k in taxes by April 15th.

Edit: sorry misread it @Splenda88 .2023 end was 1920000

2022 was 1276000. See attached last 12 months.