Is there an equivalency in EM where an EP can become a partner, or earn more by having a "senior" position?

[Doctor_Strange]

For instance, I know of a cardiology practice where once junior partners become senior partners they earn more. Likely also incur more responsibilites. In the EM world, what would be the equivalent outside of I guess SDGs (if that even)? I only bring this up because my current limited understanding or assumption is that young or old, EPs will be paid the same for the same shift, there is no preference to older docs, and maybe there is a bias against them (my own supposition) since they cannot work as much or many shifts as the more younger attendings.

Looking for any insight on this topic as I am very ignorant on this despite me wanting to pursue EM as a M3.

Thanks in advance

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[EctopicFetus]

Another way to ask this is "are there EM practices that treat people differently". Yes. If you own the contract you can do what you want. Things in EM are equal in the good groups because it is designed that way. There are plenty of opportunities where certain people have better shifts, higher pay etc.

 

[B-Bone]

coming from another specialty, one thing I’ve never really understood about EM is where the money comes from/goes to and how it relates to the specialty-wide focus on hourly rate. Obviously, money comes into some entity from insurers/patients and goes out to the ED docs. Someone somewhere (SDG, CMG, hospital, etc) is assuming some risk by paying a guaranteed hourly rate to the EP, and likely someone is profiting (or losing) and someone is making/losing money because of that.

In private practice in other specialties, income is determined simply by revenue minus costs. For example, in my private anesthesia practice we pay all the bills each month and the partners split all the profit. We have no minimum, maximum, hourly rate, etc. Revenue changes from month to month, depending how busy we are. As such, my paycheck changes dramatically from month to month. My December paycheck might be 10x my January paycheck (lot more expenses in January, lot more revenue in december). If we paid people per hour, there’s a chance we’d lose money in a given month, and there’s a chance we’d make money on them in a given month. From an employee’s perspective, an hourly rate means there’s a chance they’re making money on the employer (who is in turn losing money on the employee) and there’s a chance the employer is making a profit off of their work.

Given that businesses don’t tend to continue to run at a loss (at least not private medical practices), if you are guaranteed an hourly rate, someone is likely making money off of you. Otherwise why would your employer stay in business?

I mention all this in regards to the OP as a prompt to think about where the money comes from/goes to. If you pay “senior” people more, where does the money come from? In the end it’s a zero sum game. Profit = revenue minus expenses. If you pay somebody more, it comes out of somebody’s profits (or adds to somebody’s losses).

 

[Doctor_Strange]

coming from another specialty, one thing I’ve never really understood about EM is where the money comes from/goes to and how it relates to the specialty-wide focus on hourly rate. Obviously, money comes into some entity from insurers/patients and goes out to the ED docs. Someone somewhere (SDG, CMG, hospital, etc) is assuming some risk by paying a guaranteed hourly rate to the EP, and likely someone is profiting (or losing) and someone is making/losing money because of that.

In private practice in other specialties, income is determined simply by revenue minus costs. For example, in my private anesthesia practice we pay all the bills each month and the partners split all the profit. We have no minimum, maximum, hourly rate, etc. Revenue changes from month to month, depending how busy we are. As such, my paycheck changes dramatically from month to month. My December paycheck might be 10x my January paycheck (lot more expenses in January, lot more revenue in december). If we paid people per hour, there’s a chance we’d lose money in a given month, and there’s a chance we’d make money on them in a given month. From an employee’s perspective, an hourly rate means there’s a chance they’re making money on the employer (who is in turn losing money on the employee) and there’s a chance the employer is making a profit off of their work.

Given that businesses don’t tend to continue to run at a loss (at least not private medical practices), if you are guaranteed an hourly rate, someone is likely making money off of you. Otherwise why would your employer stay in business?

I mention all this in regards to the OP as a prompt to think about where the money comes from/goes to. If you pay “senior” people more, where does the money come from? In the end it’s a zero sum game. Profit = revenue minus expenses. If you pay somebody more, it comes out of somebody’s profits (or adds to somebody’s losses).

Great insight -- thank you! Lots to consider for me moving forward...

 

[EctopicFetus]

coming from another specialty, one thing I’ve never really understood about EM is where the money comes from/goes to and how it relates to the specialty-wide focus on hourly rate. Obviously, money comes into some entity from insurers/patients and goes out to the ED docs. Someone somewhere (SDG, CMG, hospital, etc) is assuming some risk by paying a guaranteed hourly rate to the EP, and likely someone is profiting (or losing) and someone is making/losing money because of that.

In private practice in other specialties, income is determined simply by revenue minus costs. For example, in my private anesthesia practice we pay all the bills each month and the partners split all the profit. We have no minimum, maximum, hourly rate, etc. Revenue changes from month to month, depending how busy we are. As such, my paycheck changes dramatically from month to month. My December paycheck might be 10x my January paycheck (lot more expenses in January, lot more revenue in december). If we paid people per hour, there’s a chance we’d lose money in a given month, and there’s a chance we’d make money on them in a given month. From an employee’s perspective, an hourly rate means there’s a chance they’re making money on the employer (who is in turn losing money on the employee) and there’s a chance the employer is making a profit off of their work.

Given that businesses don’t tend to continue to run at a loss (at least not private medical practices), if you are guaranteed an hourly rate, someone is likely making money off of you. Otherwise why would your employer stay in business?

I mention all this in regards to the OP as a prompt to think about where the money comes from/goes to. If you pay “senior” people more, where does the money come from? In the end it’s a zero sum game. Profit = revenue minus expenses. If you pay somebody more, it comes out of somebody’s profits (or adds to somebody’s losses).

The issue is in EM lots of groups slice and dice it differently. The SDG assumes no risk as an entity. The partners assume the risk but if you have all partners does it matter? SDGs do not have to pay on a guaranteed hourly. Many CMGs have a component of RVUs (same with SDGs). Less risk to no risk.

As a partner in an SDG my income is also revenue minus costs (as it is for all our partners). Usually if there is an hourly guarantee it is low. In EM they are usually getting 30+% in profit (see filings when the CMGs were public). Keep in mind that they may lose money in a single shift but not in a month. If they do they will bail on the contract. Unlike your private practice they dont care. It is nothing but a businessfor them. Just a P/L statement. NO commitment to their hospital/client and for sure no commitment to their docs. Thats the crappiest part as an employee. they dont care 1 bit about you.

In the end all entities make money (SDG, CMG, hospital employed). Its more how it is divvied up and who keeps the excess and how that excess pays out.

 

[AdmiralChz]

Also coming from another specialty where it is nearly universally true that “tiered” private practices that aren’t equal are horrible places to work and milk new hires for years if not a decade or more while the old dudes skim the top. For us nearly all of these groups sold out long ago to private equity (senior partners often got a multiplier more than junior!) as those folks approached retirement. You don’t want this setup, find a democratic group where the incentive is to make more you need to work more (e.g. pick up extra shifts)

 

[Fox800]

Tiered partnership models, by and large, are horrible. They take advantage of junior partners for the benefit of the fat cats at the top. Hard pass.

 

[Doctor_Strange]

Also coming from another specialty where it is nearly universally true that “tiered” private practices that aren’t equal are horrible places to work and milk new hires for years if not a decade or more while the old dudes skim the top. For us nearly all of these groups sold out long ago to private equity (senior partners often got a multiplier more than junior!) as those folks approached retirement. You don’t want this setup, find a democratic group where the incentive is to make more you need to work more (e.g. pick up extra shifts)

Well, I'm glad I asked this q then! I suppose I thought that the older one gets the less shifts a doc would pick up conceivably and thus their income would begin to decline so finding some way to counteract that would be ideal but I see now that would be inevitably at the expense of younger docs in a given group.

 

[Dr Mantis Toboggan]

to quote Marky Mark in The Other Guys: you can’t have a conscience in the pimp game.

Well, I'm glad I asked this q then! I suppose I thought that the older one gets the less shifts a doc would pick up conceivably and thus their income would begin to decline so finding some way to counteract that would be ideal but I see now that would be inevitably at the expense of younger docs in a given group.

 

[TooMuchResearch]

Our partners are paid a more modest hourly rate and then a very large RVU based bonus once everyone else (HR/admin staff, billing/coding company, etc) are paid. This isn't paid monthly, though.

coming from another specialty, one thing I’ve never really understood about EM is where the money comes from/goes to and how it relates to the specialty-wide focus on hourly rate. Obviously, money comes into some entity from insurers/patients and goes out to the ED docs. Someone somewhere (SDG, CMG, hospital, etc) is assuming some risk by paying a guaranteed hourly rate to the EP, and likely someone is profiting (or losing) and someone is making/losing money because of that.

In private practice in other specialties, income is determined simply by revenue minus costs. For example, in my private anesthesia practice we pay all the bills each month and the partners split all the profit. We have no minimum, maximum, hourly rate, etc. Revenue changes from month to month, depending how busy we are. As such, my paycheck changes dramatically from month to month. My December paycheck might be 10x my January paycheck (lot more expenses in January, lot more revenue in december). If we paid people per hour, there’s a chance we’d lose money in a given month, and there’s a chance we’d make money on them in a given month. From an employee’s perspective, an hourly rate means there’s a chance they’re making money on the employer (who is in turn losing money on the employee) and there’s a chance the employer is making a profit off of their work.

Given that businesses don’t tend to continue to run at a loss (at least not private medical practices), if you are guaranteed an hourly rate, someone is likely making money off of you. Otherwise why would your employer stay in business?

I mention all this in regards to the OP as a prompt to think about where the money comes from/goes to. If you pay “senior” people more, where does the money come from? In the end it’s a zero sum game. Profit = revenue minus expenses. If you pay somebody more, it comes out of somebody’s profits (or adds to somebody’s losses).