Is EM Really Recession Proof?

[docB]

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I hear lots of people saying that EM is "recession proof." I would argue that this is not true. While it is unlikely that EPs will get laid off (except in a particular situation I will discuss later) we have seen and will continue to see a decline in our pay. When the public loses their jobs, insurance and disposable income they can't pay for their ER care. At the same time they will come to the ED more and more because their primaries won't see them for free. So we will be working harder for less.

In general EM groups will not be able to cut staffing because the volumes will stay the some or more likley increase. The only likely scenario that would see a group make staffing cuts would be if there were docs who are so hard up that they are willing to get killed and cope with these high volumes with no help. I think that the seeing more for less situation will be the norm.

 

[GeneralVeers]

Our group saw reimbursement decrease, and we've cut back on hours. No one has been fired (yet).

 

[docmartin252]

It has been my experience lately, working in an ER, that the volume has significantly increased, along with people who have lost jobs and are self pay. However, I have also noticed a rise in the number of people who are receiving government insurance such as Medicaid. Although the hospitals can only take so much of a hit financially due to patients that can not pay, hospitals can't afford to be understaffed and expect to stay open. What I hope this means is that there will be a happy medium where physicians can still be properly compensated, while the hospital can still afford to stay in business.

And as much as I know that people don't like to hear it, maybe going to a European system of Universal health insurance isn't such a bad idea. This system covers doctors and patients, even though this system can't be set up overnight.....just a thought.

Happy St. Paddy's Day

 

[GeneralVeers]

It has been my experience lately, working in an ER, that the volume has significantly increased, along with people who have lost jobs and are self pay. However, I have also noticed a rise in the number of people who are receiving government insurance such as Medicaid. Although the hospitals can only take so much of a hit financially due to patients that can not pay, hospitals can't afford to be understaffed and expect to stay open. What I hope this means is that there will be a happy medium where physicians can still be properly compensated, while the hospital can still afford to stay in business.

And as much as I know that people don't like to hear it, maybe going to a European system of Universal health insurance isn't such a bad idea. This system covers doctors and patients, even though this system can't be set up overnight.....just a thought.

Happy St. Paddy's Day

There is no happy medium. One only has to look at Los Angeles with a huge number of unfunded illegals and Medi-cal patients. They have essentially bankrupted most of the hospitals resulting in 10 ED closures in the last five years. The reimbursement from a Medi-Cal patient isn't even enough to pay for the electricity used to pump up their blood pressure cuff......

 

[Hayduke]

I hear lots of people saying that EM is "recession proof." I would argue that this is not true. While it is unlikely that EPs will get laid off (except in a particular situation I will discuss later) we have seen and will continue to see a decline in our pay. When the public loses their jobs, insurance and disposable income they can't pay for their ER care. At the same time they will come to the ED more and more because their primaries won't see them for free. So we will be working harder for less.

In general EM groups will not be able to cut staffing because the volumes will stay the some or more likley increase. The only likely scenario that would see a group make staffing cuts would be if there were docs who are so hard up that they are willing to get killed and cope with these high volumes with no help. I think that the seeing more for less situation will be the norm.

Recent fitting impression of EM -"you will always have a job, you will not necessarily get paid"


Watching the class above me elbow their way to jobs this year, it seems that the specialty will divide more and more along geographic/economic lines. We already see tiers of EDs. We train in the academic and county armpits that care for the indigent. Then, the majority of us seek the cherry slots where people have real insurance and get treated like the customers they have become.
As the number of customers shrinks, so will the number of decent paying jobs. Competition for the shrinking number of those slots will increase with an ever expanding supply of BE/BC EPs.
We have made ourselves the ever present PCPs to an entire country.
Now we will earn like primary docs.

 

[DogFaceMedic]

Clarity of terminology:
Medicine is recession proof relative to other industries. It is not immune to the impact of the economy on percentage reimbursment.
Medicine is not government proof.

 

[GeneralVeers]

Clarity of terminology:
Medicine is recession proof relative to other industries. It is not immune to the impact of the economy on percentage reimbursment.
Medicine is not government proof.

The nice thing though, if I don't like the government I can move anywhere in the world. Gold Coast of Australia looks nice today......

 

[EC3]

Recent fitting impression of EM -"you will always have a job, you will not necessarily get paid"


Watching the class above me elbow their way to jobs this year, it seems that the specialty will divide more and more along geographic/economic lines. We already see tiers of EDs. We train in the academic and county armpits that care for the indigent. Then, the majority of us seek the cherry slots where people have real insurance and get treated like the customers they have become.
As the number of customers shrinks, so will the number of decent paying jobs. Competition for the shrinking number of those slots will increase with an ever expanding supply of BE/BC EPs.
We have made ourselves the ever present PCPs to an entire country.
Now we will earn like primary docs.

I think for all specialties there are potentially drastic changes coming down the pike. At least EPs can work independent of institutions and without needed referrals. Having a very broad knowledge base also allows for greater diversity of jobs.

The healthcare industry as it currently stands is not sustainable. Americans have unrealistic expectations about healthcare. They want the absolute best care in the world, yet they don't want to take responsibility for their care and they don't want to pay for it themselves. Currently we allow patients to dictate care without regard to cost and we defray costs by having everyone else pay for it. The problem, as we're finally realizing is that you can't defray costs as disproportionately more people begin to use the services than pay for the services; this is no different to problems facing social security. Then consider the American legal climate and the end result of this story is clear as day. There is no system devisable that can be successfully run based on these givens.

Americans are going to have a reality check coming their way.

 

[docmartin252]

We have made ourselves the ever present PCPs to an entire country.
Now we will earn like primary docs.

The primary mission of the EP as I know it, but of course correct me if I'm wrong, is to treat the patient enough so that they may consult their PCP within a matter of days post being discharged. But what happens with the people that lose their jobs, and as a consequence, lose insurance? That's right, you become the PCP like it or not. That means you'll get the frequent fliers, or the person that comes back later the same day because their "abx are not working." So this does make EM recession proof, just not bullet proof to the doctor's paychecks as the current economy continues to falter. However, just as certain specialties change in how competitive they are every few years, the market will adjust at some point....just perhaps not in the near future.

 

[DogFaceMedic]

The nice thing though, if I don't like the government I can move anywhere in the world. Gold Coast of Australia looks nice today......

I'm on board, when do we sail?
Do pre-meds try to lecture Attendings along the Gold Coast?

 

[GeneralVeers]

I'm on board, when do we sail?
Do pre-meds try to lecture Attendings along the Gold Coast?

I sure hope so, how else would I get my entertainment?