Is EM really that competitive?

[emergentmd]

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not what I'm saying at all, just saying there's gotta be some realistic drawbacks that aren't readily apparent because the hourly pay and lifestyle appear to be insane. something that appears too good to be true generally is

EM is not all rosy. No one is saying this. Its hard 35 hrs of work. But not as hard as many would make it out to be. Flipping shifts is prob the worse but if if I am only working 13 -14 dys a month its not that big a deal to me.

Also,, almost no one works 12 hr shifts at a difficult place after residency. Most do 8-10 per shift

 

[Ho0v-man]

If someone wouldn't mind indulging a premed who doesn't think he knows everything, I'd like to ask a question to anyone more knowledgeable than me about EM.

At the hospitals I've worked, it seems that BCBS patients have to be evaluated by a physician, even if they are a PA/NPs patient. If rules like this ever go away, what's to stop community ERs from just going to mid levels and diverting complex cases to bigger facilities? Most PAs and NPs can work up a chest pain or whatever else and if there's an in house hospitalist on call, that could probably circumvent any supervision rules regarding their practice.

I'm actually not too interested in EM (maybe just rural moonlighting one day), but it's always seemed that with the stroke of a pen the EM doc job market could face an overnight bottleneck.

Is there something I'm missing, here?


Sent from my iPhone using Tapatalk

 

[Cinematographer]

@tymont12 what i meant was with increasing midlevel encroachment coupled with what mad jack said, is that not reason to be concerned about its future? Those sound pretty significant!

You really do not know what you are talking about. Not to mention that you've asked about this on both here and the EM subforum (multiple times if I might add) and told how invalid these concerns were.

 

[asdf123g]

You really do not know what you are talking about. Not to mention that you've asked about this on both here and the EM subforum (multiple times if I might add) and told how invalid these concerns were.

I dont even recall. I'm sorry this has caused you distress.

 

[Mad Jack]

You really do not know what you are talking about. Not to mention that you've asked about this on both here and the EM subforum (multiple times if I might add) and told how invalid these concerns were.

Midlevels aren't much of an issue (No idea why he keeps bringing that up, I've addressed it at least a dozen times in the past), but the changes to reimbursement rules are potentially huge and possibly financially crippling for the future of the field. See the thread in the EM Santorum about reasonable rate rules being tossed out for a full explanation of why it's such a big deal. I don't care to remake the wheel on a cell phone.

 

[asdf123g]

Midlevels aren't much of an issue (No idea why he keeps bringing that up, I've addressed it at least a dozen times in the past), but the changes to reimbursement rules are potentially huge and possibly financially crippling for the future of the field. See the thread in the EM Santorum about reasonable rate rules being tossed out for a full explanation of why it's such a big deal. I don't care to remake the wheel on a cell phone.

some people are saying its going to be an issue. thats why!

 

[Mad Jack]

some people are saying its going to be an issue. thats why!

Those people are all ignorant premeds or medical students.

 

[Tenk]

 

[Wordead]

Those people are all ignorant premeds or medical students.

Disagree. It's going to be an issue; it already is at a couple of the hospitals we operate at. There is 1 attending and 4-5 PAs/NPs the attending "oversees" working in the ED.

It's annoying because the midlevels will call for even dumber crap than the ED normally does.

 

[emergentmd]

Disagree. It's going to be an issue; it already is at a couple of the hospitals we operate at. There is 1 attending and 4-5 PAs/NPs the attending "oversees" working in the ED.

It's annoying because the midlevels will call for even dumber crap than the ED normally does.

MLs are not a problem at this time. Could they go to a gas model of 4:1? I guess they could. Would the ED be functional with that? No. Could it ever happen? Sure. Would it happen quickly? No prob not for atleast 10 years.

Docs are just much faster than Midlevels esp with complicated pts. Even if you went to a 4ML:1Doc mode, a current 5 doctor day would need like 2 doc and 8 Midlevels to even function. Not to mention the ED would bog down.

But ML is penetrating all fields. I can't name of one not hiring a Midlevel.

 

[Mad Jack]

Disagree. It's going to be an issue; it already is at a couple of the hospitals we operate at. There is 1 attending and 4-5 PAs/NPs the attending "oversees" working in the ED.

It's annoying because the midlevels will call for even dumber crap than the ED normally does.

That's largely the exception rather than the rule. There may be anecdotal places here and there, but by and large, midlevels are far, far from taking over emergency medicine for a great number of reasons, from efficiency to liability. The only places I know if that largely utilize midlevels do it not by choice, but because they can't attract physicians.

 

[Wordead]

MLs are not a problem at this time. Could they go to a gas model of 4:1? I guess they could. Would the ED be functional with that? No. Could it ever happen? Sure. Would it happen quickly? No prob not for atleast 10 years.

Docs are just much faster than Midlevels esp with complicated pts. Even if you went to a 4ML:1Doc mode, a current 5 doctor day would need like 2 doc and 8 Midlevels to even function. Not to mention the ED would bog down.

But ML is penetrating all fields. I can't name of one not hiring a Midlevel.

I agree that it's not a problem at this time and nowhere near widespread and wont affect any of us for awhile to come, but thats not really the issue. You'll be retired by then but the current generation of med students wont be.

 

[racerwad]

not what I'm saying at all, just saying there's gotta be some realistic drawbacks that aren't readily apparent because the hourly pay and lifestyle appear to be insane. something that appears too good to be true generally is

Those of us in EM have been pretty clear about the very real drawbacks to EM. It is not the perfect field by any stretch (hint - such a field does not exist), but everything @emergentmd has said (more or less) are true. The compensation is good, the residency is short, and the scheduled hours are not too bad. This is definitely a crap sandwich job if you don't love the work, but that is true of virtually any field.

 

[Makati2008]

That's largely the exception rather than the rule. There may be anecdotal places here and there, but by and large, midlevels are far, far from taking over emergency medicine for a great number of reasons, from efficiency to liability. The only places I know if that largely utilize midlevels do it not by choice, but because they can't attract physicians.

I know of a few places personally that utilize them for cost cutting measures which makes me angry. I tried to moonlight at these places and was told no that it was covered by mlp.

 

[exsanguination]

I challenge everybody in this thread to look up emergentmd's posting history. I'd say a good half of them are about how he's (she's?) cleaning it up in texas, that he could walk outside and stumble over jobs paying 400/hr, and that he's negotiating directly with hospitals to make ridiculous rates. He's the only EP in the EM forum that makes these claims. Haven't seen one practicing attending there corroborate those kind of rates. In fact he routinely gets called out about how they sound too good to be true (hint: anything in medicine that seems that way IS ACTUALLY TO GOOD TO BE TRUE).

EVERYTHING else he says is totally true and legitimate about the specialty. But make no mistake - he is the 99.999% percentile when it comes to EM income without a doubt. What do you think EM docs are making in reasonable cities? I've seen rates in the $100/hr range.. disgusting! What are some of these desirable city jobs pushing you to see? 3 patients per hour or more and these aren't your ESI 4-5 patients (because those are being skimmed by the multiple PAs which you are REQUIRED to "supervise").

Any current MS4 who is hoping to go into EM can look forward to a salary of around 200k/year given current trends. It is inevitable in 4-5 years.

And to everybody really thinking seriously about EM, look into the balance billing legislation that JUST passed.

Here.. I'll even post the EM forum thread for you go to read: http://forums.studentdoctor.net/threads/well-this-is-nice.1172315/

I'll say it again, I really love EM. The day to day is awesome, I love the nitty gritty, and what's cool about the specialty is pretty much everything you read within the house of medicine is somewhat relevant to your knowledge as an ER doc. Additionally, it's actually a specialty that society still respects due to how we're portrayed in the media.

BUT - to practice in a medicolegally safe setting and be paid what I think we are worth (give the time, effort, debt, sweat, blood, tears, and lost youth), I'll have to go live in the sticks or some other fairly undesirable area to perhaps delay these foreseen pay decreases. And even then you're not making the kind of money emergentmd is talking about.

 

[Lord Humongus]

I actually hope EM becomes less competitive, spots dont fill, half the EM residencies close down. I just need another 5 yrs of EM shortage and I can retire in peace before 50.

The spots will fill, it's just that your residents and future colleagues will have degrees from East Calcutta Medical University and the Robert Mugabe School of Medicine.

 

[Siggy]

The big conundrum with every patient is not, "What's going on and how do we treat it?" but rather, "How can I get this patient out of the ED as quickly as possible (either to inpatient, obs, or home)?" I take no satisfaction or pleasure in nearly anything I do.

As a med student, I was gung ho for EM, but had some red flags that ultimately led me to match into a TRI out of med school. As a TRI intern (and now as an IM PGY1), I realized exactly what was posted above regarding, "Disposition (i.e. triage) is the most important thing" and sudden I couldn't have been happier not being in EM. As an IM resident, I still get rapid responses and codes. I'm still the one called overnight to the ICU to intubate, place lines, etc (the critical care aspect). If I go hospitalist, there are plenty of small hospitals were the hospitalist is the defacto intensivist (It's not the best situation for the patient, but if I want to scratch the CC itch without a fellowship), so there's the sick patient.

On the other hand, I get to diagnose and treat patients... not sort into admit/discharge.

 

[PL198]

As a med student, I was gung ho for EM, but had some red flags that ultimately led me to match into a TRI out of med school. As a TRI intern (and now as an IM PGY1), I realized exactly what was posted above regarding, "Disposition (i.e. triage) is the most important thing" and sudden I couldn't have been happier not being in EM. As an IM resident, I still get rapid responses and codes. I'm still the one called overnight to the ICU to intubate, place lines, etc (the critical care aspect). If I go hospitalist, there are plenty of small hospitals were the hospitalist is the defacto intensivist (It's not the best situation for the patient, but if I want to scratch the CC itch without a fellowship), so there's the sick patient.

On the other hand, I get to diagnose and treat patients... not sort into admit/discharge.

What is a TRI? why didn't you just go straight into IM

 

[Psai]

Traditional rotating internship. I'm under the impression that it's like a transitional year for do interns. My guess is that he applied to something else

 

[SLC]

Traditional rotating internship. I'm under the impression that it's like a transitional year for do interns. My guess is that he applied to something else

TRI is just that, traditional rotating internship, sort of like a 5th year of med school in that you bounce around doing month-long rotations in various fields, but as a resident, rather than as a student. Different from transitional year in that it's not focused on IM or surgery.

 

[charmiedermie]

TRI is just that, traditional rotating internship, sort of like a 5th year of med school in that you bounce around doing month-long rotations in various fields, but as a resident, rather than as a student. Different from transitional year in that it's not focused on IM or surgery.

A preliminary year is focused on 1 thing like IM or Surgery. A transitional year is not focused on a particular field. You transition from 1 field to another, gaining a broad experience. The downside is you can't really apply it as credit towards a categorical residency. So a transitional year = TRI.

 

[W19]

What's the point of doing a transitional year if one can't apply it as credit towards a categorical residency?

 

[Dral]

What's the point of doing a transitional year if one can't apply it as credit towards a categorical residency?

A. Buying time to figure out specialty.

B. Didn't match into specialty of choice before starting TRI

C. Applying for something like Derm during TRI, don't get it, get into other specialty like IM

 

[Siggy]

What's the point of doing a transitional year if one can't apply it as credit towards a categorical residency?

Depends on your situation.
1. For DOs, there's still 4 or 5 states that require either a DO internship year or DO residency for licensure. Alternatively, there's hoops you can jump through to make an ACGME residency count.
2. It offers more flexibility than a prelim medicine or prelim surgery, especially if you want to try to set up an early away elective.
3. I really liked the hospital that I did my TRI at (So. Cal. county hospital).
4. It's not prelim-surgery.

 

[Siggy]

What is a TRI? why didn't you just go straight into IM

I didn't know then what I knew now and wanted to give a second shot at matching EM.

 

[Siggy]

What's the point of doing a transitional year if one can't apply it as credit towards a categorical residency?

Even if you can apply credits, it doesn't mean the residency will let you. I actually can get up to 6 months credit. However, if you want to apply to a fellowship, then that's up to 6 months of not working (which will include loan repayment time) between graduating residency and starting fellowship. Additionally, losing a senior resident halfway through a year can wreck havoc on the schedule.

 

[IslandStyle808]

A preliminary year is focused on 1 thing like IM or Surgery. A transitional year is not focused on a particular field. You transition from 1 field to another, gaining a broad experience. The downside is you can't really apply it as credit towards a categorical residency. So a transitional year = TRI.

I thought you could? Are you referring to those that apply to a transitional year without applying to a categorical position?

 

[allantois]

Hate to break it to anyone, but not being able to receive emergency care when such care is available is absolutely unprecedented anywhere in the world. So if you want to be paid for every patient you see, then stop opposing universal healthcare. And if that reform is indeed carried out, then there's nothing ER physicians should worry about.

 

[Siggy]

Hate to break it to anyone, but not being able to receive emergency care when such care is available is absolutely unprecedented anywhere in the world. So if you want to be paid for every patient you see, then stop opposing universal healthcare. And if that reform is indeed carried out, then there's nothing ER physicians should worry about.

Ah, if it was only so easy. It's not just getting paid for every patient, it's getting paid appropriately for every patient.

 

[exsanguination]

Hate to break it to anyone, but not being able to receive emergency care when such care is available is absolutely unprecedented anywhere in the world. So if you want to be paid for every patient you see, then stop opposing universal healthcare. And if that reform is indeed carried out, then there's nothing ER physicians should worry about.

Pretty short-sighted there amigo

UHC, while philosophically I am totally for it, realistically (and now that I am not a pre-med or medical student, but actual resident w/ a few years in the trenches so I can say this with some legitimacy) it is a horrible idea.

Putting ONE PAYOR in charge of what doctors get paid is the FASTEST way to get ER physicians (and honestly ALL physicians) to start worrying. I take that back, outpatient cash-based services are, of course, removed from these arguments. But to the matter at hand, are you gonna let a non-physician econ-majored went-to-law-school-cuz-I-didn't-know-what-else-to-do politician tell you how much your sweat and knowledge is worth? Are you gonna let a panel of these cronies determine how much you'll make for a knee replacement? Will you let them reimburse you $10 for coordinating the entire preventative health strategy for a non-compliant patient in a 10 minute office visit? Oh and that office visit, if when the patient comes back with lab values that are unacceptable to government-determined metrics, will now only be reimbursed $9 because your patient didn't care to take his insulin as prescribed?

Man, doctors have LOST ALL CONTROL OF MEDICINE.

The only safe specialties are the SURGICAL SPECIALTIES

 

[the argus]

Hate to break it to anyone, but not being able to receive emergency care when such care is available is absolutely unprecedented anywhere in the world.

I hate to break it to you, but this is a completely ridiculous and false statement, and just shows that you haven't spent much time in many parts of the world.

 

[Psai]

Hate to break it to anyone, but not being able to receive emergency care when such care is available is absolutely unprecedented anywhere in the world. So if you want to be paid for every patient you see, then stop opposing universal healthcare. And if that reform is indeed carried out, then there's nothing ER physicians should worry about.

The blind following the blind.

 

[twospadz]

Ah, if it was only so easy. It's not just getting paid for every patient, it's getting paid appropriately for every patient.

What were your red flags that prevented you from matching EM?

 

[smokn]

What were your red flags that didn't allow you to match EM?

The edit button is your friend.

 

[scoKraz4]

Pretty short-sighted there amigo

UHC, while philosophically I am totally for it, realistically (and now that I am not a pre-med or medical student, but actual resident w/ a few years in the trenches so I can say this with some legitimacy) it is a horrible idea.

Putting ONE PAYOR in charge of what doctors get paid is the FASTEST way to get ER physicians (and honestly ALL physicians) to start worrying. I take that back, outpatient cash-based services are, of course, removed from these arguments. But to the matter at hand, are you gonna let a non-physician econ-majored went-to-law-school-cuz-I-didn't-know-what-else-to-do politician tell you how much your sweat and knowledge is worth? Are you gonna let a panel of these cronies determine how much you'll make for a knee replacement? Will you let them reimburse you $10 for coordinating the entire preventative health strategy for a non-compliant patient in a 10 minute office visit? Oh and that office visit, if when the patient comes back with lab values that are unacceptable to government-determined metrics, will now only be reimbursed $9 because your patient didn't care to take his insulin as prescribed?

Man, doctors have LOST ALL CONTROL OF MEDICINE.

The only safe specialties are the SURGICAL SPECIALTIES

Yeah this sounds pretty bad. Plus the government will continue to dish out an unlimited amount of money to students for going to school-->continuously rising tuition cost-->more debt with less ability to pay.

 

[PL198]

Yeah this sounds pretty bad. Plus the government will continue to dish out an unlimited amount of money to students for going to school-->continuously rising tuition cost-->more debt with less ability to pay.

leading to hungrier and hungrier new physicians gunning to take the spot of existing ones, creating an endless cycle of take less or gtfo

 

[Zebra Hunter]

I challenge everybody in this thread to look up emergentmd's posting history. I'd say a good half of them are about how he's (she's?) cleaning it up in texas, that he could walk outside and stumble over jobs paying 400/hr, and that he's negotiating directly with hospitals to make ridiculous rates. He's the only EP in the EM forum that makes these claims. Haven't seen one practicing attending there corroborate those kind of rates. In fact he routinely gets called out about how they sound too good to be true (hint: anything in medicine that seems that way IS ACTUALLY TO GOOD TO BE TRUE).

EVERYTHING else he says is totally true and legitimate about the specialty. But make no mistake - he is the 99.999% percentile when it comes to EM income without a doubt. What do you think EM docs are making in reasonable cities? I've seen rates in the $100/hr range.. disgusting! What are some of these desirable city jobs pushing you to see? 3 patients per hour or more and these aren't your ESI 4-5 patients (because those are being skimmed by the multiple PAs which you are REQUIRED to "supervise").

Any current MS4 who is hoping to go into EM can look forward to a salary of around 200k/year given current trends. It is inevitable in 4-5 years.

And to everybody really thinking seriously about EM, look into the balance billing legislation that JUST passed.

Here.. I'll even post the EM forum thread for you go to read: http://forums.studentdoctor.net/threads/well-this-is-nice.1172315/

I'll say it again, I really love EM. The day to day is awesome, I love the nitty gritty, and what's cool about the specialty is pretty much everything you read within the house of medicine is somewhat relevant to your knowledge as an ER doc. Additionally, it's actually a specialty that society still respects due to how we're portrayed in the media.

BUT - to practice in a medicolegally safe setting and be paid what I think we are worth (give the time, effort, debt, sweat, blood, tears, and lost youth), I'll have to go live in the sticks or some other fairly undesirable area to perhaps delay these foreseen pay decreases. And even then you're not making the kind of money emergentmd is talking about.

He really isn't the 99th percentile for EM physicians. Most of the 3rd years in my program have already signed for jobs making $250+/hr, and that's straight out of residency. Those cities include Austin, Houston, DFW, I know another moving to Vermont making $260/hr, another in North Carolina making $300. Heck I was offered a job in my home town after I graduate where I'd be making $350/hr. Sure, you aren't going to find these rates in California, the Northeast, Denver, or Chicago, but you are significantly mistaken if you think these jobs aren't present in other desirable cities rather than exclusively in "the sticks". But I like emergentmd's philosophy on the nonbelievers, you're right, these jobs don't exist, and all those considering EM should look elsewhere, and please, please don't come to Texas.

As for the competitiveness of EM. The average step 1 score has increased 8 points from 2011 to 2014 based on charting outcomes. By comparison, the average step score of all applicants in every specialty increased by 4 in the same time span. So yes, it is absolutely becoming more competitive, but no where near the level of derm or plastics, at least yet.

 

[W19]

He really isn't the 99th percentile for EM physicians. Most of the 3rd years in my program have already signed for jobs making $250+/hr, and that's straight out of residency. Those cities include Austin, Houston, DFW, I know another moving to Vermont making $260/hr, another in North Carolina making $300. Heck I was offered a job in my home town after I graduate where I'd be making $350/hr. Sure, you aren't going to find these rates in California, the Northeast, Denver, or Chicago, but you are significantly mistaken if you think these jobs aren't present in other desirable cities rather than exclusively in "the sticks". But I like emergentmd's philosophy on the nonbelievers, you're right, these jobs don't exist, and all those considering EM should look elsewhere, and please, please don't come to Texas.

As for the competitiveness of EM. The average step 1 score has increased 8 points from 2011 to 2014 based on charting outcomes. By comparison, the average step score of all applicants in every specialty increased by 4 in the same time span. So yes, it is absolutely becoming more competitive, but no where near the level of derm or plastics, at least yet.

WTF? I guess I should jump into the EM bandwagon... Can an average student match easily into EM?.... 225+ step1... 2nd-3rd quartile class rank...1-2 research paper(s) with no pubs...

 

[Zebra Hunter]

WTF? I guess I should jump into the EM bandwagon... Can an average student match easily into EM?.... 225+ step1... 2nd-3rd quartile class rank...1-2 research paper(s) with no pubs...

Fairly easily as long as you apply broadly and have no red flags.

 

[alpinism]

WTF? I guess I should jump into the EM bandwagon... Can an average student match easily into EM?.... 225+ step1... 2nd-3rd quartile class rank...1-2 research paper(s) with no pubs...

If you don't enjoy working in the ED all the money in the world won't make you happy.

 

[charmiedermie]

I thought you could? Are you referring to those that apply to a transitional year without applying to a categorical position?

A transitional year can be directly applied to an advanced specialty. For a categorical residency, it is up to your program how many months they will accept for credit towards their residency. Family Med tends to be pretty lax in applying it to their field, IM and General Surg probably much less likely to, maybe a few months here and there, I don't know.

 

[charmiedermie]

Hate to break it to anyone, but not being able to receive emergency care when such care is available is absolutely unprecedented anywhere in the world. So if you want to be paid for every patient you see, then stop opposing universal healthcare. And if that reform is indeed carried out, then there's nothing ER physicians should worry about.

How about all of dentistry accepting single payer universal healthcare first before lecturing ER docs? I'll wait. How much you are reimbursed matters and so the type of insurance matters.

 

[PhillyMed777]

How about all of dentistry accepting single payer universal healthcare first before lecturing ER docs? I'll wait. How much you are reimbursed matters and so the type of insurance matters.

under the poster's location, it says "moral high" HAHA

 

[TooMuchResearch]

EM is definitely becoming increasingly difficulty to match into. This difficulty will only increase as more and more people begin to realize it is the best specialty in medicine.

Independent wealth is the best specialty in medicine.

 

[allantois]

You may oppose universal healthcare on philosophical or practical grounds, but my point that people are not denied emergency care in civilized parts of the world stands valid.
I see that people are complaining of having to treat patients that won't pay for their services, well I have suggested a solution to that - universal healthcare coverage. Whether that would drop how much ER physicians make I don't know, but last time I checked physicians in Canada were doing well even though that is exactly the system that they have. But what's the alternative - denying people emergency care altogether?

 

[Makati2008]

You may oppose universal healthcare on philosophical or practical grounds, but my point that people are not denied emergency care in civilized parts of the world stands valid.
I see that people are complaining of having to treat patients that won't pay for their services, well I have suggested a solution to that - universal healthcare coverage. Whether that would drop how much ER physicians make I don't know, but last time I checked physicians in Canada were doing well even though that is exactly the system that they have. But what's the alternative - denying people emergency care altogether?

So how many folks are you willing to treat for basically free in your clinic. It's wrong to let people suffer in pain due to poor teeth...

 

[emergentmd]

He really isn't the 99th percentile for EM physicians. Most of the 3rd years in my program have already signed for jobs making $250+/hr, and that's straight out of residency. Those cities include Austin, Houston, DFW, I know another moving to Vermont making $260/hr, another in North Carolina making $300. Heck I was offered a job in my home town after I graduate where I'd be making $350/hr. Sure, you aren't going to find these rates in California, the Northeast, Denver, or Chicago, but you are significantly mistaken if you think these jobs aren't present in other desirable cities rather than exclusively in "the sticks". But I like emergentmd's philosophy on the nonbelievers, you're right, these jobs don't exist, and all those considering EM should look elsewhere, and please, please don't come to Texas.

As for the competitiveness of EM. The average step 1 score has increased 8 points from 2011 to 2014 based on charting outcomes. By comparison, the average step score of all applicants in every specialty increased by 4 in the same time span. So yes, it is absolutely becoming more competitive, but no where near the level of derm or plastics, at least yet.

I don't like to get into arguments about pay esp with people who have no clue about compensation. I am sure most who are in EM knows the pay out there. I have been in private groups and I know what we bill. Unless you are in a low reimbursement area, making less than 200/hr means someone is skimming 50-100/hr off from your work. Just the facts.

In my avg reimbursement private group, we were making 250/hr with full benefits in a very nice city. Add the benefits on top of that and I would be well over 300/hr.

I would never work for less than 200/hr IC and anyone who does is filling pockets of owners/CMGs. But even at 200/hr. 35hr/wk puts you at 360k/yr.

 

[emergentmd]

Pretty short-sighted there amigo

UHC, while philosophically I am totally for it, realistically (and now that I am not a pre-med or medical student, but actual resident w/ a few years in the trenches so I can say this with some legitimacy) it is a horrible idea.

Putting ONE PAYOR in charge of what doctors get paid is the FASTEST way to get ER physicians (and honestly ALL physicians) to start worrying. I take that back, outpatient cash-based services are, of course, removed from these arguments. But to the matter at hand, are you gonna let a non-physician econ-majored went-to-law-school-cuz-I-didn't-know-what-else-to-do politician tell you how much your sweat and knowledge is worth? Are you gonna let a panel of these cronies determine how much you'll make for a knee replacement? Will you let them reimburse you $10 for coordinating the entire preventative health strategy for a non-compliant patient in a 10 minute office visit? Oh and that office visit, if when the patient comes back with lab values that are unacceptable to government-determined metrics, will now only be reimbursed $9 because your patient didn't care to take his insulin as prescribed?

Man, doctors have LOST ALL CONTROL OF MEDICINE.

The only safe specialties are the SURGICAL SPECIALTIES

I have never

I challenge everybody in this thread to look up emergentmd's posting history. I'd say a good half of them are about how he's (she's?) cleaning it up in texas, that he could walk outside and stumble over jobs paying 400/hr, and that he's negotiating directly with hospitals to make ridiculous rates. He's the only EP in the EM forum that makes these claims. Haven't seen one practicing attending there corroborate those kind of rates. In fact he routinely gets called out about how they sound too good to be true (hint: anything in medicine that seems that way IS ACTUALLY TO GOOD TO BE TRUE).

EVERYTHING else he says is totally true and legitimate about the specialty. But make no mistake - he is the 99.999% percentile when it comes to EM income without a doubt. What do you think EM docs are making in reasonable cities? I've seen rates in the $100/hr range.. disgusting! What are some of these desirable city jobs pushing you to see? 3 patients per hour or more and these aren't your ESI 4-5 patients (because those are being skimmed by the multiple PAs which you are REQUIRED to "supervise").

Any current MS4 who is hoping to go into EM can look forward to a salary of around 200k/year given current trends. It is inevitable in 4-5 years.

And to everybody really thinking seriously about EM, look into the balance billing legislation that JUST passed.

Here.. I'll even post the EM forum thread for you go to read: http://forums.studentdoctor.net/threads/well-this-is-nice.1172315/

I'll say it again, I really love EM. The day to day is awesome, I love the nitty gritty, and what's cool about the specialty is pretty much everything you read within the house of medicine is somewhat relevant to your knowledge as an ER doc. Additionally, it's actually a specialty that society still respects due to how we're portrayed in the media.

BUT - to practice in a medicolegally safe setting and be paid what I think we are worth (give the time, effort, debt, sweat, blood, tears, and lost youth), I'll have to go live in the sticks or some other fairly undesirable area to perhaps delay these foreseen pay decreases. And even then you're not making the kind of money emergentmd is talking about.

I have never said you could stumble onto a 400/hr job but I can point you to 5 full time jobs right now paying 300+/hr. I have said that I could find locums work at 400-600/hr but it does require flexibility to work less desirable shifts.

And I am not the 99.99999% of salary. I know many EM docs making 500K+. I know a few who works their behind off making close to 1 mil. This year I made close to 500K with full benefits working right at 35hrs/wk working in one of the fastest growing city in the US. Thus a very desirable city.

But who knows how long this will last. I am quite sure it will last until I am ready to retire with the constant badgering by staffing agencies and headhunters.

 

[the argus]

You may oppose universal healthcare on philosophical or practical grounds, but my point that people are not denied emergency care in civilized parts of the world stands valid.

Except that wasn't your point. You said,

Hate to break it to anyone, but not being able to receive emergency care when such care is available is absolutely unprecedented anywhere in the world. So if you want to be paid for every patient you see, then stop opposing universal healthcare. And if that reform is indeed carried out, then there's nothing ER physicians should worry about.

"absolutely unprecedented anywhere in the world" is different than "in civilized parts of the world."

And don't make assumptions about people's views based on the fact that they call you out for making stupid comments, regardless of which side of the argument you are on. In most debates, it's possible to argue for either side without sounding like an idiot. You are failing miserably at this right now.

 

[racerwad]

You may oppose universal healthcare on philosophical or practical grounds, but my point that people are not denied emergency care in civilized parts of the world stands valid.
I see that people are complaining of having to treat patients that won't pay for their services, well I have suggested a solution to that - universal healthcare coverage. Whether that would drop how much ER physicians make I don't know, but last time I checked physicians in Canada were doing well even though that is exactly the system that they have. But what's the alternative - denying people emergency care altogether?

No one is denied emergency care in the US. It is against the law. As EPs, our contention isn't that we have to see certain pts, it is that we have to take on all of the liability without a equitable system for compensation for that risk.

Your suggestion for universal healthcare coverage won't make this situation better in this specific context because there is already a mandate for universal emergency care; the problem is that this mandate is not funded and new there is new legislation that may just make things worse, not better.