Job Market/Compensation

[parkerMD]

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Could any of the attendings or senior residents give their opinion on the EM job market? Can you pretty much pick an area you want to live in and find a job there (specifically in Florida). What is compensation like in coastal areas of Florida? Is 250k with benefits (working 12-15 shifts a month) the average for a new grad? Are the jobs listed on edphysician.com considered good jobs? Thoughts on large national groups like ApolloMD are also appreciated. Thank you in advance for your feedback.

 

[Eric714]

I agree what is going to determine your job is what is more important to you. Is location or compensation more important to you? I've been an attending for almost a couple years now. And I've seen that the more desirable the area, the lower the compensation. I almost took a job on the big island of Hawaii, but with the cost of living and just coming out of residency with the thought of having to pay back loans... it just wasn't enough money.

Also, other factors include the pay structure (fee-for-service, hourly, salary, etc), benefits, employee or independent contractor, setting (community, rural, urban), hospital type (teritary, community, BFE, etc)

Just remember you're not going to get your dream job coming out of residency, most of us end up changing jobs within the first 2 years.

Good luck on your search... Eric

 

[Hercules]

Just remember you're not going to get your dream job coming out of residency, most of us end up changing jobs within the first 2 years.

I always felt like the stats on job changes within 2 years were more a reflection of poor planning on the part of graduating residents. We tend to take the first job and realize it's not what we really wanted because we never really sat down and figured out what was important before starting the process.

I've been out a year and I am at my dream job. Before I started interviewing I came up with my list of wants and dealbreakers, and this job met everything I was looking for. The location is exactly where I wanted. I'm in a true small democratic group of 8 docs with no pyramid scheme and open financial books (when the paycheck comes out we all receive a spreadsheet showing how much each MD received, what their productivity was, etc). I work with all residency trained EM docs at a community hospital seeing a reasonable number of patients per hour for very good pay with consultants that are easy to get along with and an extremely supportive hospital administration.

Just pointing out that if you do your homework and know what you want you'll have a much better chance of being happy with your decision. It also helps if you're interested in a location that is not as popular nationwide.

 

[The White Coat Investor]

It also helps if you're interested in a location that is not as popular nationwide.

That's the understatement of the year. EM is like real estate in that it is all about location, location, location.

I had a job search within the last year. I couldn't find a democratic group hiring in Denver, Portland, or Anchorage. I found two hiring in Salt Lake and one hiring in Flagstaff. Heaven forbid you want to live in Bend or Boulder.

Many of these groups in desirable locales don't hire anyone out of residency. Some don't hire anyone directly into a full-time position until you've worked there prn for a while and they know they like you. They certainly don't have to offer signing bonuses and other crap. One job I interviewed for interviewed 20 people for 4 spots. It was like residency tryouts all over again.

Sure, if you want to work in Kansas or West Texas you can pick your group, but for the rest of us, realize that if your location is highly desirable to EPs you're going to have to take what you can get.

All that said, I got a job with a great group in a desirable location. I wasn't an average applicant though. 4 years out with a lot of admin experience thanks to the military, great residency training, and most importantly, good contacts in the area where the job was.

To the OP: The really good jobs aren't advertised. And they don't necessarily pay $250K to a new grad for only 12-15 shifts. Don't be surprised if you make less than $200K while in a partnership track in a good job.

 

[southerndoc]

Although ApolloMD is large, it's not operated like a large corporation. Each hospital/health system is its own subsidiary and is run independently from ApolloMD.

 

[countthestars]

Whats the job market like in NYC? Are most of the jobs academic? I think the only hospitals in NYC (Manhattan) that do not have a residency program associated with the ED are Beekman hospital and Lenox Hill. I'm guessing it's pretty hard to get a nice paying community gig in nyc...

 

[DrQuinn]

Agree with what some of the other attendings said.

I did change my job after 2.5 years. I went into academics but I wasn't making the cash I wanted, the job wasn't very "fair" in regards to productivity (salaried, but you had to jockey and compete for raises), and DC was too expensive (I grew up there).

I got VERY lucky. I landed into a great high paying job, open book, democratic, in a fantastic EM environment (I can schedule anyone to see a specialist within 24 hours). I landed in this job VERY luckily.

I will reiterate what was said above, the good jobs simply aren't advertised. Period.

Q

 

[EM6771]

then how do you find one. Forgive my ignorance as I am just starting my EM residency this July, but is it simply networking? Can anyone recommend steps to take early in your career?

 

[doctorFred]

Whats the job market like in NYC? Are most of the jobs academic? I think the only hospitals in NYC (Manhattan) that do not have a residency program associated with the ED are Beekman hospital and Lenox Hill. I'm guessing it's pretty hard to get a nice paying community gig in nyc...

i believe (someone correct me if i'm wrong) that nyc attending salaries are among the lowest in the country (when factoring in the cost of living.) supply and demand.

 

[The White Coat Investor]

then how do you find one. Forgive my ignorance as I am just starting my EM residency this July, but is it simply networking? Can anyone recommend steps to take early in your career?

Have an impeccable academic and then clinical record, meet as many emergency docs as you can, and stay in touch with them.

Also, when visiting cities you want to live/work in, go to the ED and meet people. Keep bugging the medical director of your dream group, be willing to be prn/part-time until something opens up etc.

Or, be less picky and you can get a job that pays fine in a reasonable place to live. The less picky you are the easier it will be to find your "dream job."

 

[DrQuinn]

Have an impeccable academic and then clinical record, meet as many emergency docs as you can, and stay in touch with them.

Also, when visiting cities you want to live/work in, go to the ED and meet people. Keep bugging the medical director of your dream group, be willing to be prn/part-time until something opens up etc.

Or, be less picky and you can get a job that pays fine in a reasonable place to live. The less picky you are the easier it will be to find your "dream job."

ADMD gives good advice.

I stumbled by pure luck on my "dream job." I was going to accept a not nearly as open/democratic/lucrative job (with a five year buy-in, and no open books!), but figured "hey I should probably call the other ERs in the area." Left a message on the Med Director's voicemail, he sent that info to the Pres of the group, and the rest is history. Yes. A true "COLD CALL." But I am so unbelieivably happy in my group, its not even funny. I truly believe we have the best EM job in the country.

That's if you can stand Wisconsin winters. (Coming from FL for 7 years its honestly not that bad, as long as you have heated seats!)
Q

 

[GeneralVeers]

Yes. A true "COLD CALL." But I am so unbelieivably happy in my group, its not even funny. I truly believe we have the best EM job in the country.

Q

I did the same thing. Sent letters to 10 or so ER groups I'd like to work for in various regions, and found a pretty good un-advertised job right out of residency.

 

[deleted109597]

Veers, how did you find the groups that ran those departments? Job fairs?

 

[GeneralVeers]

Veers, how did you find the groups that ran those departments? Job fairs?

No. I started out by picking cities I'd want to live in (mainly CA, TX, NV and a few midwest) then more or less randomly picked hospitals to contact. It was easy enough to track down the director of EM for each hospital and address a letter specifically to them. Often those letters get directly referred to a recruiter for the group. Sending the letters resulted in three job interviews, and a great job in Vegas that was unadvertised. It's mostly a matter of luck, as to get an unadvertised job you have to send a letter at the time they are hiring. That's why I would recommend sending multiple letters to multiple places.

I think location is the most important factor overall, followed by work environment and then salary.

 

[Hawkeye Kid]

I was taught that each job has, more or less, three aspects: money, location, and the actual job/working conditions. It's fairly easy to get two of those three things but getting all three can be difficult. Like others have suggested, you really need to decide what's most important to you and what your deal-breakers are.

Oh, and I know several people in Quinn's group and he's not just blowing smoke--every single one of them raves about their job (almost like a nerd dating a cheerleader).

 

[Greenbbs]

I'm done with training in June, so I'll qualify this as just my experience.

When I looked for the job I ultimately took, I took into account several things.

First and foremost, I took into account longevity. I've got a family (a 10 month old, and a wife who's a pediatrician). Finding a job for me meant finding a job that I could grow roots in and be at for a long time. It's not easy when you have a two doctor family and one has an amazingly strong desire to be in a private office type practice. When I interviewed at the place I took my job at, I talked to new grads working there and the older docs. Most docs in the group have been there upwards of 10 years. The new guys working there say they'd do it all over again if they could. It's rare to find a job with that kind of longevity in a single place.

Secondly, I looked at the group structure. My residency is based in a hospital that is staffed by one of those won't-be-named mega companies, which I can't stand. Having a hospital owned group (like the group I joined) provided some additional stability because the whole ED isn't outsourced as independent contractors. I will be a hospital employee, which has it's perks. I get full benefits, and a pension, and other generous compensation.

Thirdly, the type of practice. My future employer is a large non-academic ED tertiary care center (with other residencies). The ED is its own separate entity within the structure of the hospital (it's not under medicine or surgery). By doing this, it ensures my department will always be at the forefront instead of under another branch of the hospital. No competing with anyone for funding. Vast resources. Happiness abounds. Appropriate staffing (a doc and PA per 10 beds- 45 bed adult side, plus peds, psych, etc.)

Lastly, salary. My compensation is going to be generous. I get benefits. Money's money. The other stuff was always more important to me than the cash.

Location was a moot point. We were going to end up by one of our families regardless, so I just started calling around until I found my home. And I can't wait.

 

[DrQuinn]

Oh, and I know several people in Quinn's group and he's not just blowing smoke--every single one of them raves about their job (almost like a nerd dating a cheerleader).

Funny. I am a pretty big nerd, and my wife was a cheerleader a few years ago. And I love my job. Shoot, I'm on SDN at 1140pm WHILE AT WORK.

 

[samnite]

Random question:

I know of a place (rural ED) that offers $200 per hr to do a 12 hr shift

Is this considered normal for rural EDs?

 

[WilcoWorld]

Funny. I am a pretty big nerd, and my wife was a cheerleader a few years ago. And I love my job. Shoot, I'm on SDN at 1140pm WHILE AT WORK.

I just noticed that you need to change the location on your info... then have a Spotted Cow for me.

 

[DrQuinn]

Random question:

I know of a place (rural ED) that offers $200 per hr to do a 12 hr shift

Is this considered normal for rural EDs?

Depends on hte location. In the midwest we have some rural hospitals (~10k visits/yr), that pay between $193-220 an hour. The reason the pay is so high is because they are critical access hospitals (i.e. the gov't needs to keep these hospitals open for local rural trauma, otherwise there would be no close hospital for 100 miles+). Pretty sweet gigs, a lot of decent pathology. Generally at night you can get 0-6 hours of sleep, too.
Q

 

[DrQuinn]

I just noticed that you need to change the location on your info... then have a Spotted Cow for me.

Done and soon to be done. And I got a case from Costco in my fridge in the basement!

 

[samnite]

Depends on hte location. In the midwest we have some rural hospitals (~10k visits/yr), that pay between $193-220 an hour. The reason the pay is so high is because they are critical access hospitals (i.e. the gov't needs to keep these hospitals open for local rural trauma, otherwise there would be no close hospital for 100 miles+). Pretty sweet gigs, a lot of decent pathology. Generally at night you can get 0-6 hours of sleep, too.
Q

Interesting. I don't think they pay for any benefits though so it seems like a lot but you end up having to pay for the stuff that lower paying jobs pay for if you want to make it a long term gig.

 

[deleted109597]

I'm talking to a place that pays $200 an hour and isn't rural. I'm looking into it more because everyone keeps saying "there's a reason they pay so much..."

Of course, not many people have problems with it, so who knows?

 

[corpsmanUP]

Texas is honestly an incredible place to work! I have pretty much created my own pseudo locums gig where I work for 4 different groups in the Houston area, none of which are fully democratic, but none of which are big names like EC and TH. I refuse to work for them at this point. The groups I work for pay RVU but I always negotiate for a base in case the RVU's are on the low side. In all honesty none of my groups ever pay as low as the base because we are pretty busy most of the time. The highest months are in the 225/hour range and the less busy months might be close to 200/hr. Taxes are killer as an independent contractor. None of the jobs I work at were advertised. I just spent this whole year networking and met many of the medical directors by accident. I am thinking I may settle in to one job at some point because they hard part about having several is that your pay times are all different, your schedule making is a nightmare, and you have to learn multiple different computer systems. The good part is that you only give them a few shifts and they always need more of you. It makes it easy to step up and work more when you are already credentialed. Credentialing at several places is in my opinion the most important thing you can do. You never know when you are going to need to change jobs and it can take 3-4 months at some places to get credentialed.

 

[deleted109597]

UP, while I agree with not working for TeamHealth (and sent their recruiter an email to the same effect), do you have a reason to dislike EmCare other than that they are big?
They offer 225 an hour some places too. Not a terrible gig it seems like. Plus, you can go to their other hospitals.
EC, TH, EMP, EPMG, MEP, etc all do pretty well. Yes, the holy grail is a democratic group where you earn everything, but for some reason there aren't many of those around.

 

[GeneralVeers]

Texas is honestly an incredible place to work! I have pretty much created my own pseudo locums gig where I work for 4 different groups in the Houston area, none of which are fully democratic, but none of which are big names like EC and TH. I refuse to work for them at this point. The groups I work for pay RVU but I always negotiate for a base in case the RVU's are on the low side.

I also work part-time in Texas. I have to ask people on this forum, why the hatred for EmCare and TeamHealth?

I work part-time for EmCare, and though I don't necessarily agree with their corporatist approach they have treated me well. Typically my airfare, hotel and rental car are covered as I work in an underserved area. The reimbursement on top of that is quite good as well, and there is one person at EmCare whom I work with for all my credentialing/licensure issues, and she's easy to get a hold of.

 

[GeneralVeers]

Yes, the holy grail is a democratic group where you earn everything, but for some reason there aren't many of those around.

Two of the jobs I looked at were with "Democratic groups". Both had pyramid-scheme partnership tracks, whereby they use you for 2 years then have the option of discarding you. The massive "buy-ins" were also a turnoff. Be very careful what you wish for.

 

[old_boy]

Two of the jobs I looked at were with "Democratic groups". Both had pyramid-scheme partnership tracks, whereby they use you for 2 years then have the option of discarding you.

Can you please define "use you"? $80/hr? $100/hr? Lots of nights/wkends?

The massive "buy-ins" were also a turnoff.

How big are we talking?

There's a thread going over on the anesthesia forum discussing national staffing companies in that field... it seems the tradeoff in that field is often similar: work for "the man" or potentially be screwed by co-workers in a field that sometimes eats its young.

 

[NinerNiner999]

Can you please define "use you"? $80/hr? $100/hr? Lots of nights/wkends?


How big are we talking?

I've been down this pathway. Try $105/hr, $180,000 buy in. These groups are becoming much more difficult to find, and with the coming medicare changes, will become less likely to last.

 

[deleted109597]

I also work part-time in Texas. I have to ask people on this forum, why the hatred for EmCare and TeamHealth?

Personally I think the national conglomerate model works for EM better than other fields (because we don't own the patients, etc).
However, my dislike of team health has nothing to do with their business model. It has everything to do with them sending out fliers to FM residencies for EM jobs.

 

[xaelia]

Texas big city academic @ $170/hr for time over your base 112 hrs/mo.

Could be worse.

Then again, Texas.

 

[bronx43]

I've been down this pathway. Try $105/hr, $180,000 buy in. These groups are becoming much more difficult to find, and with the coming medicare changes, will become less likely to last.

Wait, you're saying these abusive groups will be harder to find? How will Medicare changes decrease the number of these?

 

[NinerNiner999]

Wait, you're saying these abusive groups will be harder to find? How will Medicare changes decrease the number of these?

This may be long, so please stay with me...


There are many factors that will play into this. At first, private groups will see a boom once uninsured patients begin to pay because of the new law. Then the cuts will set in and essentially equalize emergency medicine reimbursement while other specialties lose revenue. This will drive private practices to close their doors to Medicare and medicaid, which will send more patients into the ER and increase each doctor's volume, leading to increasing malpractice costs with an overall lower reimbursement. Add in the flawed SGR formula that has already caused a 21% cut across the board this year and reimbursement will be even less.

Hospitals will likely be forced to bundle their admissions, which means that insurers will only pay one fixed fee per admission and diagnosis. This means that every specialist involved with a patient's care will be fighting over their portion of the fixed amount, likely leaving the scraps to the emergency doctor. This will begin to impact the more lucrative emergency medicine groups who have had stable contracts with their hospitals and enjoy a stipend. Likely, these stipends will no longer be included in hospital budgets as hospitals begin to lose income and revenue. In some cases, stipends can account for up to a third of an EM practice's annual budget.

Finally, as costs of practice continue to rise, including malpractice premiums, groups will face an ever-increasing battle to spend less each year. Groups with a high portion of medicare and Medicaid patients will be the first to fall, and will likely sell out to larger contract management groups such as those mentioned above to gain a stable salary and save on economy of scale.

The groups dependent on hospital stipends will also likely suffer the same fate, as their stipends become reduced and senior partners decide to sell out.

Finally, with the insurance regulations, increasing malpractice costs, and decreasing regulations, it will become nearly impossible for new private EM groups to start and remain viable corporations.

We may begin to see a large resurgence in the Hospital Employee model, which will likely effect many markets as well.

Sadly, the ability of the emergency medicine group to survive and profit, like most other physician groups, has taken a large blow. In my area alone, I do not know how many private practices will survive this summer.

Please also note that this is not a political commentary, just a reaslitic view of what is already happening. That being said, i don't think these changes are a matter of "if" but of "when". The best advice I can give to those of you looking for jobs is to get a good understanding of the payor mix where you interview, because I believe that will be a good marker of how stable your income will be for the next 5-7 years until the insurance regulations settle in.

 

[GeneralVeers]

Sadly, the ability of the emergency medicine group to survive and profit, like most other physician groups, has taken a large blow. In my area alone, I do not know how many private practices will survive this summer.

Please also note that this is not a political commentary, just a reaslitic view of what is already happening. That being said, i don't think these changes are a matter of "if" but of "when". The best advice I can give to those of you looking for jobs is to get a good understanding of the payor mix where you interview, because I believe that will be a good marker of how stable your income will be for the next 5-7 years until the insurance regulations settle in.

This is already happening to some degree at my group. We're currently seeing about 20% more volume per doctor than 5 years ago, yet revenue has decreased slightly. Essentially we've had to become more efficient and increase our volume and our RVUs per patient just to keep our salaries stable. A 21% cut in Medicare will result in a 10-15% cut in our overall salaries.

Last month I billed 11 RVU/hour!!! 5 to 10 years ago this would have been worth well over $250/hour.

 

[bronx43]

Wow, thanks for the response Niner. Response like these keep me coming back to this forum.

Can you clarify one thing? Why would the Hospital Employee Model flourish while private groups die down? Aren't hospitals subject to the same reimbursement cuts and budget problems as the private groups?

Also, the last thing you mentioned - insurance regulations. I haven't heard much on that. What are you referring to and how will that alleviate the problem that EM groups face?

 

[RustedFox]

Yes, do go on about this. Thanks, GV and Niner - you have my full attention.

 

[old_boy]

We're currently seeing about 20% more volume per doctor than 5 years ago, yet revenue has decreased slightly.

Is this because of worse payor mix? More uninsured? Cuts in certain procedural codes? My understanding was that CMS has been fairly good to EM over the years, so maybe some of the big insurers in your area are tightening up?

 

[TeamZissou]

Yes, do go on about this. Thanks, GV and Niner - you have my full attention.

+1

I'm listening and learning.

 

[RxnMan]

Niner - The flight of the private doctors you mentioned early on in your post makes me think that there will be a two-tier system in the future. One that services Medicare/Medicaid, and smaller but richer level that services insured or actual self-pay patients. I would guess that the academic centers would always be in the former level, but how would EM fit into the latter?

 

[NinerNiner999]

When it comes to running a business - which all medical practices are - there is a very tight margin to consider. As malpractice costs rise, employee benefits rise, and market forces continue to place healthcare providers at a financial disadvantage, groups will have a harder time keeping their current revenue without cutting staff or providers, which causes a downward spiral for revenue. Further, groups who place themselves in the financial position to reduce staff risk reducing hospital coverage, which in turn risks their contract renewal with the hospital. In the era of patient satisfaction scores and door-to-doctor times, fewer staff members means longer patient waits and less-satisfied patients. These are the two biggest metrics that hospitals measure closely in their departments, aside from medicare quality initiatives.

A group malpractice policy may cost 1.5 million dollars for a group of 15 EM physicians depending on location and risk. That's 1.5 million off of a group's bottom line. The hospital employee model allows these groups to save on this cost due to bulk discount or at times self-insurance/sovereign immunity. This policy can cost 1/2 to 1/3 of the private group rate, allowing those in the "group" to benefit from the saving in the form of profit. The same applies to dictation/records services, and insurance, which can also be paid by the hospital.

Medicare/Medicaid taxes paid to physicians will increase (as will other employee benefits such as health insurance, disability, etc), all of which also must be paid by the individual group, and subtracting from the group's bottom line. A larger corporation such as a hospital again allows groups to benefit from the economy of scale. This is also the reason that there are such a large number of independent contractors in EM. It is very expensive to pay for an employee - especially ones making the income we do.

In regards to the two-tier system - you are absolutely correct - and this is already happening (ergo concierge physicians and those who are already declining to take medicare/medicaid). The disparity between these patients and their private practice physicians will become more evident in those towns with an even mix of individual wealth (the haves) and those dependent on medicare/medicaid (the have nots). In the world of EM, however, these issues do not matter, in that the government already mandates us to see everyone who walks in our doors (EMTALA). This means that as more private doctors refuse to see medicare patients, the Emergency Physicians will become flooded with them at their doors. The only way I can see this not happening is if one of two things happen - 1) the government wipes out concierge medicine or places a similar requirement for all physicians to accept their insurance (become de facto government workers) or 2) the government adopts a policy limiting the use of emergency departments to true emergencies and penalizes accordingly. Clearly neither of these options will be good financially for emergency medicine providers, let alone private groups.

Nobody knows where compensation is going to go for Emergency Medicine, but clearly nobody wants to see a drop in their salary. Physicians will protect this aspect of their individual business at all costs. I believe we are seeing the beginning of a large market shift to HOW these salaries will be maintained in the form of larger corporations. Sadly, we as physicians may have already seen the peak of our salaries come and go. Clearly we will continue to work harder for less, and see more to stay the same.

Some more food for thought - Emergency Physicians are already "government workers" for all intents and purposes in that we held to the EMTALA law and mandated to see everyone whether they pay or not. This will not change, and I fear we may the first specialty to feel the immediate ramifications of cuts in insurance reimbursement. Those specialites with the ability to pick their patients (and create their own payor mix) will be able to hold this off for much longer.

 

[RxnMan]

...In regards to the two-tier system - you are absolutely correct - and this is already happening (ergo concierge physicians and those who are already declining to take medicare/medicaid)....In the world of EM, however, these issues do not matter, in that the government already mandates us to see everyone who walks in our doors (EMTALA)...1) the government wipes out concierge medicine or places a similar requirement for all physicians to accept their insurance (become de facto government workers) or 2) the government adopts a policy limiting the use of emergency departments to true emergencies and penalizes accordingly...

But IIRC, EMTALA only works for institutions that accept Medicare/Medicaid. If we truly went to a two-tiered system, where there were hospitals supported by the rich (the haves), they wouldn't bother with Medicaid/Medicare. That would mean EMTALA would not apply.

In parallel with this thought process, there are free-standing private EDs out there. While they happen to see and treat everyone who come through their doors, they only stabilize and transfer (there's no hospital + consultants to back them up). To my understanding, these make money even in today's environment by setting up shop in richer neighborhoods.

Of course, anything can be legislated, so EMPs may in fact be forced to abide by EMTALA-like controls no matter where they practice.

 

[iridesingltrack]

But IIRC, EMTALA only works for institutions that accept Medicare/Medicaid. If we truly went to a two-tiered system, where there were hospitals supported by the rich (the haves), they wouldn't bother with Medicaid/Medicare. That would mean EMTALA would not apply.

In parallel with this thought process, there are free-standing private EDs out there. While they happen to see and treat everyone who come through their doors, they only stabilize and transfer (there's no hospital + consultants to back them up). To my understanding, these make money even in today's environment by setting up shop in richer neighborhoods.

Of course, anything can be legislated, so EMPs may in fact be forced to abide by EMTALA-like controls no matter where they practice.

It is my understanding, via rumor only, that The Mayo Clinic has done this very thing...stop taking medicare/medicaid payments. Maybe some of the Mayo residents on here can refute or confirm this rumor. It is interesting to envision being free from EMTALA...

Also, in the past couple days alone I've seen 2 pts with severe chronic medical problems who've lost their PMD 2/2 PMD converting to boutique practice and 3 pts with medicaid who've been told that their PMD will not be seeing gov't insured pts anymore. This is gonna get painful for us in the ED...

 

[turtle md]

This will begin to impact the more lucrative emergency medicine groups who have had stable contracts with their hospitals and enjoy a stipend. Likely, these stipends will no longer be included in hospital budgets as hospitals begin to lose income and revenue.

This happened at one of the EDs across town. A democratic group was losing money 2nd not getting their stipends, so sold out. That left all the non-partners in an attempt to secure new positions. One of the big groups flew in and got the contract, and a few of the flounders popped over.

 

[GeneralVeers]

The Mayo Clinic in Phoenix stopped accepting Medicare patients last year. The entire Mayo system loses an estimated $200 million/year by treating Medicare patients.

The fix is simple. The Federal/State governments will likely mandate participation in government-run plans as a condition of licensure. It's easy enough to do through the DEA system, as they could deny your DEA registration for non-participation.

 

[bronx43]

The Mayo Clinic in Phoenix stopped accepting Medicare patients last year. The entire Mayo system loses an estimated $200 million/year by treating Medicare patients.

The fix is simple. The Federal/State governments will likely mandate participation in government-run plans as a condition of licensure. It's easy enough to do through the DEA system, as they could deny your DEA registration for non-participation.

This already happened in Massachusetts. Only time before this becomes a federal mandate.

 

[docB]

The Mayo Clinic in Phoenix stopped accepting Medicare patients last year. The entire Mayo system loses an estimated $200 million/year by treating Medicare patients.

The fix is simple. The Federal/State governments will likely mandate participation in government-run plans as a condition of licensure. It's easy enough to do through the DEA system, as they could deny your DEA registration for non-participation.

This already happened in Massachusetts. Only time before this becomes a federal mandate.

Frighteningly this would be a good thing for EM, or at least for EPs. While I find the concept of the government making licensure dependent on contracting with a particular insurer abhorrent it would help us get specialty coverage. It would also create a precedent that would likely lead to compulsory call participation. That would be great for us.

 

[bronx43]

Frighteningly this would be a good thing for EM, or at least for EPs. While I find the concept of the government making licensure dependent on contracting with a particular insurer abhorrent it would help us get specialty coverage. It would also create a precedent that would likely lead to compulsory call participation. That would be great for us.

Why would compulsory call be good?

 

[docB]

Why would compulsory call be good?

Right now I've got no urology and no ENT. They are in the community and some are even on staff but they won't take call because they would get stuck with uninsured patients. I would love to see them shoulder some of the EMTALA burden.

 

[GeneralVeers]

Right now I've got no urology and no ENT. They are in the community and some are even on staff but they won't take call because they would get stuck with uninsured patients. I would love to see them shoulder some of the EMTALA burden.

I don't think it would quite work out that way. While mandatory Medicare/Medicaid participation would prevent ENT and urology from turning away Medicare patients, EMTALA would not affect them as their duty would only be to stabilize and arrange appropriate transfer of an Emergency, unless you think a urologist is going to take care of a torsion in his/her office.

What you are suggesting is that they would have to take mandatory call, which isn't something forced on them by Medicare participation or EMTALA. It would remain a medical staffing issue for the hospital.

Here's an interesting and frightening article from Quebec in 2002:

http://www.cmaj.ca/cgi/content/full/167/6/681-a

Essentially they were forcing all physicians who had worked in any ER in the past 4 years (regardless of current specialty) to work shifts, or be fined.

 

[deleted109597]

That's the future I'm expecting.
Step 1. 2014 occurs, and physicians stop seeing medicaid/medicare rather than lose money
Step 2. In an effort to stop this, the government makes it a necessity to get licensed (they already tried in Tennessee to pass mandatory Tenncare acceptance or pay the state back $500K for your education)
Step 3. Physicians start retiring earlier
Step 4. profit?
Step 5. Government determines your hours, as we already have a "shortage"