I m a family med doc working in ER and I make $270/hr and I m sure I could have maybe gotten a little more but I didnt have a ton of ER experience previously. What is considered good for ER docs? I thought they were mostly making 300-350+/hr?
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Leaving EM
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I m a family med doc working in ER and I make $270/hr and I m sure I could have maybe gotten a little more but I didnt have a ton of ER experience previously. What is considered good for ER docs? I thought they were mostly making 300-350+/hr?
On SDN, everyone is making $300/hr+ (just like of all our MCAT scores are 38+ and all Step 1s 270+. We also all see 2.5+ pph).
In real life it’s location dependent and nationally probably around $230/hr.
Depends but you’re going to wish you had actual EM training once your first crashing kid or multiple traumas come in at the same time.
Spoiler: I had actual EM training and when that happened I wished I could leave because that gets so tiresome after the nth catastrophe
then I did
lol
Yeah I had a real destroyer of a shift last week and am enjoying a sleepy Monday in the exact same critical access department hoping the other shoe decides not to drop.
I just started so we ll see. There are multiple other providers there at all times. They hired me knowing I m an FM doc with minimal EM experience and they would train me upto the traumas. They havent thrown me into the traumas yet.
Bittersteel
Full Member
So the actual ER docs are absorbing the liability from those cases. Got it.
Is this a troll post?
Bittersteel
Full Member
No, this is the state of EM. We allow people with no training to work in the ER.
Ha! Let me know what hospital this is so I can take my chances in a ditch.
Wild.
“Hey guys I’m EM trained but working as a general surgeon. Don’t worry, they haven’t thrown me into the chole’s yet, so we’re all good!”
And don’t give me that bs about being an under supply of ER docs so “some access to care is better than nothing.” There isn’t, and it’s not.
I thought this was a sleepy rural facility with solo coverage but if this has 24/7 physician double coverage then it’s likely got some pathology. Medicine is tough and I think we should have each other’s backs but somebody practicing EM without training in EM would probably be an example where I’d expert witness for the patient for a malpractice suit. Somebody practicing a specialty they’re not trained in is negligent in its own right.
The only way I can even think of why this is even a thing (non EM trained docs in EM settings), is that the oversupply of grads hasn't (yet) quite caught up to the amount of available positions. The ones that got grandfathered into EM should be mostly retiring by now.
Otherwise, I just don't get why a hospital/recruiter shouldn't be saying 'sorry, ABEM certified docs only'.
I love how a "Leaving EM" thread devolved into how to bend the rules to get into EM.
Come now - if any specialities were closer, it's EM and FM. "Under" is not "no".
I'm somewhat surprised you're in support of non-EM trained physicians practicing EM. There is certainly overlap between a lot of specialties but that doesn't mean I want to see a non-EM trained physician in the ED.
Not in support - I was just calling out the "black and white fallacy".
I think this is a pretty easy example of choosing black or white. You either support non-EM trained docs working in the ER or you don't.
You miss the point - the "black and white fallacy" is seeing a binary decision, when there are shades of grey. We are trained in "the rapid recognition of sickness and health", realizing that the huge majority of what we see is not sick. Primary care docs can see the primary care patients as well or better than we can, but we see the sick much better. To deny this is uninformed. However, I don't support non EM in the ED, as a matter of policy.
Bittersteel
Full Member
This is a clown statement.
Black and white thinking.
EM is acute generalists. FM is chronic generalists. The clown is you, if you don't see this.
Bittersteel
Full Member
That kind of unfair. Do you think most people that come to the ED require the expertise of EM doc?
It's all about the setting. If a sick patient comes into a PCP's office they call the ambulance and the patient goes away. When a sick patient comes into our ED, they're ours. Nobody is going to argue that there are people in the ED who aren't sick. Probably a majority of the patients we see are going to get better no matter what we do. We're there for the truly sick ones. To minimize your own specialty is sad. With that said, I don't support any non-EM trained physicians working in the ED.
I think someone coming to the ED deserves an EM trained physician there whether or not they need all those particular skills for that visit.
Bittersteel
Full Member
We have midlevels for those.
And I guarantee ours can move faster and have better EM chops than any FM doc.
And they all practice under OUR supervision.
We don't either, but I am likely about to start some casual work in a place so rural they didn't even have a credentialing form for emergency medicine. They told me I can just cross off family medicine, write in emergency medicine, and cross off any items I don't do as an emergency physician and they'll make it work. I'm not sure they've had an emergency physician work there in the past.
I think the management of overall patient flow including the critically ill through the very much well requires the expertise of an emergency physician though many individual patients do not.
Dude, I am minimizing nothing. As I said, when critical care is needed, that's why we're there. You are intentionally taking a lower resolution.
"Probably" a majority? More like "certainly".
It's the recognition that is the difference.
Bittersteel
Full Member
Im sure I can learn how to do uncomplicated choles and appys in a month. Hell PGY3 surgery residents do these cases almost independently.
We're either a speciality or we're not.
My group values expertise and board certification. It's clear that you do not.
Get over yourself. What if an HCA grad, who is ABEM, applied? Would you crap on them? What about AOBEM?
We are not an island unto ourselves. Here's an analogy for you: North Dakota and Montana border. They have a lot in common, but, also, an individual character. You are saying they are completely different, and that's just not true.
Does your group have mid-levels?
Don’t make it so black and white.
What kind of logic is that?
Imagine: “Most of the people that come to ortho clinic don’t even need surgery. That why we replaced our orthopedist with an FM doc. I mean cmon, you don’t think an FM doc can’t manage a sprained ankle?? The surgery part is such a small part of their job anyway.”
When your family member has a medical emergency, you’re okay with them seeing an FM doc because “most people they see in the ER aren’t that sick anyway”? Or is that just for everyone else, not for you?
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Lots of orthopedic clinics will have FPs in their offices for this exact reason, usually sports med trained. As a guy that refers to ortho every day I'd prefer that to their midlevels 99% of the time.
Similarly, I'd prefer an FP who has decent EM experience over an NP most of the time especially after hearing y'all complain about how little oversight you often have over the midlevels that work in the ED with you.
Obviously I'd prefer EM-trained 100% of the time but I'm not aware of many EDs doing that anymore.
Totally agree that I would hire an FM doc to fill an APP role in my ER. That’s not what we’re talking about and you know it. Id be willing to bet no FM doc in the history of medicine has taken a PA/NP role in the ER.
I’m not sure where this hubris comes from. I could do 95% of what an FM doc does, but I would never claim I could deliver good or appropriate primary care. For some reason, some FM docs think they can just phone in the last 5% of my job though under the “some care is better than no care.” It’s not. It’s harmful, and you don’t even realize why it’s harmful because of the knowledge gap.
I was responding to your post specifically not the overarching discussion. I'm on record many many times here saying FPs as a rule shouldn't be in the ED.
And I’m saying it’s a straw man. I don’t think anyone is arguing FM docs shouldn’t be able to work as PAs in the ER. But that’s not a thing that anyone wants, so it’s not worth even talking about.
I can debunk that last claim, I've personally seen it. It was a board cert'd FM doc that was required to present all acuity 2 and 3 cases to an attending. 4's and 5's he could dispo himself, wasn't allowed to touch 1s.
I spoke to him about it at one point out of curiousity, he liked the extra money and he felt it made him a stronger FP doc in clinic. Both are valid points.
As far as the broader topic of who gets to staff the ED:
Putting on my administrator hat and combining it with my personal opinion--
no one gives a ****. No one singular human. Not one person outside of the ED doc community truly cares. Unless whoever is staffing the ed has a stream of bodies or wildly, grossly inappropriately admits everyone they see it's just a non-issue to the hospital system at large.
The only place this will ever be discussed is here, a place populated by ED docs. EM is on such an isolated island seismic shifts, including the entire island sinking, won't be felt by anyone outside of the people who live on this island--half the reason I left it. We are truly an inconsequential specialty, but whether you choose to believe that is immaterial to the truth it represents.
The staffing of the ED will always go to the lowest bidder. An ABEM boarded group, a CMG, a ****ing psychiatrist, whatever the hospital has to deal with the least amount and costs the least is the winner. FM, NPs, and eventually AI working into it. Whoever is cheapest will always and forever be the winner, there are no moral victories in the finance world.
It's really, really sad. I can't tell you how many meetings I've sat in on at the system level of a massive, 50 hospital system and "who staffs the ED" hasn't come up even once. Only the dollars coming in/complaints/etc. And some rural sites are indeed staffed by what appear to be FM docs (same site has a cardiology NP as the "staff cardiologist" for non-interventional cases, entirely different can of worms).
It all goes back to EM not being a fellowship of IM or FP. EM is waaaaaaaaaaaaaaaaaaaaaaaaay too isolated, making it vulnerable to attack or abuse from virtually any angle.
My prediction of the (distant) future is large sites will have an EM doc supervising an army of NPs who work in tandem with AI. it's the cheapest route, therefore, the most likely.
EDIT: To be clear, I WANT to be wrong, I WANT ED docs to be VALUED, but I just don't think it will happen. When the dollar is god, the worshipper's identity is irrelevant
I don’t disagree with a single thing you’ve said. I mean hell, even other docs think they can do our jobs. The suits and the patients don’t stand a chance.
It’s just a shame we can’t have the same reciprocity. I wish I could shadow an anesthesiologist for a few shifts and then change my specialty. I know how to intubate and sedate a patient, right? Though even through burnout I’d still care about patients too much to do that.
Early in the EM career you want to preserve EM work for EM trained doctors only. Later, a switch flips and you're begging for anyone to work ED shifts other than you, training be damned.
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I mean, it's not, but if you want to say it is you're welcome to do so.
I think near 100% of people on this forum and in the community would support FM docs in mid-level roles in the ER. I’ve never heard of one that did, but apparently one poster above has.
I've never personally experienced FM in PA roles in the ED but have worked in multiple places with them in fast track and can see ESI 4-5 cases.
Bittersteel
Full Member
Not sure why you'd pay a physician to see URIs when you can employ midlevels for 25% of the cost but maybe that's the difference between a successful group and one thats not.
Bittersteel
Full Member
If you're not an owner, this is your mentality.
If you actually own your group you dont want these trash staffing your ED because complaints, quality issues, etc eventually force you to work these shifts anyway.
Eh, depends. The Houston VA employs non EM boarded docs to work those areas and they do get paid less than the full time VA docs. Somehow they end up hiring people
Owning shares in your group does not make a person immune to burnout.
It does not but owning the contract is a step in the right direction. There’s just an inherent difference in mentality and how you approach something if you have a vested interest or if you’re just clocking in and clocking out.
Bittersteel
Full Member
Low quality physicians means higher risk of lawsuits.
More suits means higher malpractice premiums which means lower partner distributions.
