Is it true that hospitals quickly give the boot to older EMs?

[medstudent87]

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The primary-care physician I was shadowing for a couple weeks told me not to go into emergency medicine because hospitals will get rid of you by not renewing your contract once you get older, since the younger guys will work for a lot less. Is this true? I was interested in EM, but now I'm having second thoughts.

 

[Kris1]

Oh geesh... can we just have one day pass by on this forum where we aren't hearing some tale of a primary care doc trying to dissuade the impressionable young medical student?

The answer to your question is that if you are so easily dissuaded by something that one doctor told you when he or she has no idea of the reality then EM is not the career for you.

 

[Kris1]

How is that even remotely applicable to only EM? Couldn't that just as easily be the case for any career in medicine?

 

[medstudent87]

How is that even remotely applicable to only EM? Couldn't that just as easily be the case for any career in medicine?

well don't EMs always have to work for a hospital instead of having the option of opening a private practice? Its never good to work for a boss...

 

[TBS12]

well don't EMs always have to work for a hospital instead of having the option of opening a private practice? Its never good to work for a boss...

umm... please do some more research on the employment of emergency physicians before making a claim like that.

 

[medstudent87]

umm... please do some more research on the employment of emergency physicians before making a claim like that.

care to enlighten me?

 

[Hercules]

well don't EMs always have to work for a hospital instead of having the option of opening a private practice? Its never good to work for a boss...

I'll second the recommendation for a search, but offer you the ray that I am an EM physician not employed by the hospital as are several others on here. I am a partner in a small democratic group. The hospital does not pay me a dime. As a side note, even though I am a partner and own my practice, you always have a boss (government and insurance companies have power over all of us).

 

[Kubed]

You get your palm flower crystal at intern orientation

 

[deleted65604]

Only a tiny fraction of ER docs are hospital employees. Most are members of either a corporation (s-corp) consisting of a few docs. Many others are employed by large corporation over-lords like EMCARE, who take a certain portion of the profit in exchange for billing and recruiting for the ER.

Family Practice docs, hour for hour, make less than us, unless they are doing a lot of OB, and admitting patients to the hospital. This makes for a very busy life and in this situation, they may make as much or more than us, but putting in many more hours.

I'm not sure that your scenario plays out on a consistent basis in real life, but in the rare occasion that it does, is that REALLY such a bad thing? A hospital tries to change your contract so that they get more of the profits from the ER, the previously well-reimbursed docs say, "Screw that! We are out of here!" and move on to more well-paying pastures. That speaks to the versatility and mobility and financial security of being an ER doc. If you don't want to, you don't have to put up with that kind of crap.

 

[The White Coat Investor]

Oh, and one last thing, older emergency docs don't really make any more than younger ones. It is a very flat pay curve. Most groups you make less for 1-3 years as you are a group employee, then you become a partner and get a significant pay bump, but your pay may not even keep up with inflation after that.

 

[cach]

Unfortunately EM is a hospital based specialty like Pathology, Radiology, Anesthesia, hospitalists, and a few others that work at the pleasure of the hospital administration. While the OP may not have clearly articulated the issue. He does point out a major weakness of hospital based specialties. Hospitals exits to enrich and entertain hospital administrators anything else is a distant second. Hospital administrators have the power to determine who works at their hospital or even worse for hospital based specialties force us to work for a management company if we want to work at their hospital. Many hospital administrators find dealing with individual providers to much work so they give the contract to management companies. Then if they have a problem with a provider they have to simply call the management company and the offending provider is no longer working in their facility. If there is a group or an individual with privileges, the hospital administrator needs to actually document a problem with the provider and present the problem to the group or the medical staff. This is easily accomplished but it represents to much work for the lazy administrators, who would prefer to make a single phone call to can a provider.

Thus the IP is right that hospital based specialty are employed at the discretion of the hospital administrators and can easily be fired for little or no reason. Secondly the hospital administrators can take your groups contract from you and give it to a management company and force to to take a 30% to 40% paycut if you want to stay at that facility.

 

[Kris1]

Thus the IP is right that hospital based specialty are employed at the desecration of the hospital administrators and can easily be fired for little or no reason. Secondly the hospital administrators can take your groups contract from you and give it to a management company and force to to take a 30% to 40% paycut if you want to stay at that facility.

It's not nearly as easy as you make it sound and it requires not extending a contract, so it's not as if one day you have a job and one day you don't. Not to mention that your post has nothing to do with the OP's question about being let loose for being too old. Unless you're suggesting that a hospital will not sign another contract for a group because one employee is too old and his/her salary expectations are too much.

 

[cach]

It's not nearly as easy as you make it sound and it requires not extending a contract, so it's not as if one day you have a job and one day you don't. Not to mention that your post has nothing to do with the OP's question about being let loose for being too old.

The OP mentioned a number of issues related to emergency medicine's relationship with hospitals including;


age discrimination
right to work
hospital contract renewal
emergency physician pay
salary versus experience
right to own your own practice


I never said that you would get fired in a single day, but every hospital contact I have seen with a hospital based group allows the hospital the right to terminate the contact without cause in 60 to 90 days. I worked at a place where the providers were told at noon, the contact was ending at 1700. When I left at 1700, I was told I might be called sometime in the early evening if they still had the hospital contact.


Working in the ED is like working in a fish bowl, even if you never miss a diagnosis, never forget to order the best test, never order to many tests or never have a bad patient outcome, your job and reputation is vulnerable. ED interacts with many of the hospital's specialties most of who would prefer not to get called in the middle of the night. A week after every patient goes home they get a Press Ganey patient survey so they can whine about you not giving them Demerol or Percoset for their headache. This mean with out much effort the hospital administrator can compile all the ammunition they need to fire you when ever they feel the need.

 

[deleted109597]

Yep. And every day you hear stories of people getting fired from EDs. Wait, no. Most hospitals realize that they need the stability of the ED, as more than half of the admissions come from the ED. Which means more than half of the hospital's money. While it is easy for any contract to be released, the same is true for every speciality that works in the hospital. That means, cards, surgery, hospitalist medicine, peds, everything. Yet it doesn't happen daily like you're implying.

 

[Jlaw]

Why are you shadowing a pcp as a medical student?

 

[Cmaj7th]

Why are you shadowing a pcp as a medical student?

I'm going to go out on a limb and guess the OP wanted to see what their practice was like.

 

[NinerNiner999]

Yep. And every day you hear stories of people getting fired from EDs. Wait, no. Most hospitals realize that they need the stability of the ED, as more than half of the admissions come from the ED. Which means more than half of the hospital's money. While it is easy for any contract to be released, the same is true for every speciality that works in the hospital. That means, cards, surgery, hospitalist medicine, peds, everything. Yet it doesn't happen daily like you're implying.

Not to nitpick the Ninja - who is usually quite on point...

While it is true that the ED accounts for a large percentage of admissions at most hospitals, the revenue it generates is highly variable based on payor mix and subspeciality coverage. In my shop, there are days that the cardiac cath lab alone generates more revenue in 8 hours than the entire day of patients seen in the ED. As a corporation, hospitals will always trend towards favoring and maximizing their highest and leanest earning specialties while attempting to "squeeze" their most resource-intensive departments to maximize their profits.

From a resource/benefit perspective, the ED as a whole is a loser for everyone but the physicians. Once patients leave the ED and get admitted, the specialist consultations and procedures reap benefits for the hospital. Indirectly yes, in some places, the ED can be responsible for over 50% of the hospital billing. As a free-standing facility, and depending on patient diagnosis, it is often a thorn in the administration's side.

As you consider the field of EM, think carefully about the population where you may practice (old/young, wealthy/poor, employed/unemployed, etc). Also look at the hospital and their specialty backup and volume. Hospitals that have a high volume of paying cardiac patients, orthopedic patients, and neurosurgical patients will often have a politically weak ED. It is in these instances where the administration may focus on the "loss" of the department and make changes.

However, as the new healthcare policy kicks in, ED's across the country will likely see a sharp rise in their percentage of paying patients, and this may cause many hospitals to reorganize their economic priorities...

 

[Arcan57]

From a resource/benefit perspective, the ED as a whole is a loser for everyone but the physicians. Once patients leave the ED and get admitted, the specialist consultations and procedures reap benefits for the hospital. Indirectly yes, in some places, the ED can be responsible for over 50% of the hospital billing. As a free-standing facility, and depending on patient diagnosis, it is often a thorn in the administration's side.

That's also a somewhat blanket statement. I know there are places where the ED loses money hand over fist. However, I've never worked in an ED where the ED was a direct money loser. With a decent payor mix, there is no reason an ED should lose money.

 

[NinerNiner999]

That's also a somewhat blanket statement. I know there are places where the ED loses money hand over fist. However, I've never worked in an ED where the ED was a direct money loser. With a decent payor mix, there is no reason an ED should lose money.

Agreed - but only with a decent payor mix and a large proportion of self-pay patients who make good.